Skill Acquisition - Reach, Grasp, Manipulation Flashcards
process of learning to reach is one of
discovery
initial movement patterns for reaching are often
very unpredictable (flapping, uncontrolled bursts of movement) –> before becoming task specific
adult-like pattern of reaching does not evolved before ____ and may not be refined until ____
- 2 y/o
- 8-12 y/o
what are the two phases of reaching
Transport phase and grasp phase
occurs in the beginning of reach - brings hand toward target; visually trigged; controlled by proximal shoulder mm; present at birth
transport phase of reaching
last part of reach; directed by distal mm; position of arm is visually guided and defined
grasp phase
during grasp phase of reaching, the position of the arm is visually guided and defined but this does not develop until when and when does skill development peak
- develop after 4th mo
- peaks around 7 mo
at what age can we make movements without visual feedback
4-6 y/o
neural pathways controlling gross arm movements and those controlling fine movements of the hand and fingers develop
at different rates
_____ controlled by the brainstem develops earlier than _____ control mediated by the cortex
arm control
hand-finger control
anticipatory control of grip and lift forces begins to develop around when and matures around
- 1-4 y/o
- 11 y/o
at what age can children begin to show pre-reaching behaviors
1 week old
describe the first reaching attempts in infancy
- both hands
- symmetrical
- meeting at midline to reach
at what age is an infant able to flex fingers as elbow and arm extend and head-arm movements become strongly coupled so that reaching is very segment-bound (non-fluid and accidental)
2 mo
when does head and trunk control develop –> essential for further development of reaching
2-4 months
the ability to what helps drive controlled reaching
locate objects, fix and shift gaze
_____ develops before smooth pursuit –> occurs in neonate
saccadic movements
the ability to disengage attention and examine new objects will occur at what age
about 4 mo
smooth pursuit is poorly developed when and begins to improve by
- develops 1 mo
- improves quickly by 6 weeks
eye-head coordination begins to develop when and is dependent on object size
2-5 mo
when does the coupling of head-arm movements allow for successful visually guided reaching
4 months
beyond 4 months, reaching becomes refined with what occurring
path straightening
arm trajectory moves from what to what as the child ages
rounded to linear (also seen in adults with neurological pathology)
describe how a child reaches in sitting
- uses 1 hand to reach for toy
- other hand used to support balance
when does mature reaching in sitting emerge
around 10 months
when does anticipatory control develop in sitting and describe
around 10 months - able to activate trunk mm BEFORE initiating reach
what is the initial type of grasp
palmar grasp reflex/reflexive palmar grasp
- involuntary
can voluntarily grasp and release appropriately sized objects but with poor control
4 months
at 4 mo, kids use what grasp to rake small objects into hand
ulnar palmar grasp – do NOT use thumb
(medial to lateral development principle)
can transfer objects from hand to hand, hold a bottle with 2 hands (bimanual)
4-5 months
type of grasp used up to 6 months but may be inconsistent
hand babbling
age of voluntary palmar grasp
6 months
age of radial palmar grasp
7 months
age of inconsistent controlled release
7-9 months
describe voluntary palmar grasp
do not use thumb, only use other 4 fingers
describe radial palmar grasp
thumb adduction
age at which radial distal grasp develops
9 months
beginning use of opposition of thumb
radial distal grasp
age inferior pincer grasp develops
9-12 months
able to pick up small items using lateral index finger and thumb (pinch)
inferior pincer grasp
age superior pincer grasp develops
12 months
thumb and index finger are tip to tip
superior pincer grasp
age 3-jaw chuck grasp
12 months
distal pads of thumb with index and middle fingers; difficulty orienting spoon for feeding
three jaw chuck grasp
age controlled release a small container without support develops
12 months
age controlled release of a small pellet into a bottle develops
15 months
around what age do kids begin to understand how to use objects such as spoon to hand and hand to mouth
~ 1 yr
at what age do kids understand that certain objects go together (stacking blocks, items into a box)
13-21 months
when does palmar supinated grasp develop
13-18 months
imitation of scribbling with a large crayon with fisted hand, flexed and slightly supinated wrist
palmar supinated grasp
when does digital pronate grasp develop
24-36 months
can hold pencil or crayon with all fingers and straight pronated wrist
distal pronate grasp
when does the development of tripod grasp of pencil develop (draws squares, triangles, begins writing, tying shoes)
4-6 years old
all grasping patterns mature when
2nd year of life
reaction times become ____ as children mature
faster (important for bouncing, catching, throwing activities
______ depends on accuracy and distance requirements of the task
Movement time (Fitts’ law)
reaction times develop most sharply by what age with continued but slower development until
8-9 y/o
16-17 y/o
what is power grip and what are the different types
using the palm and palmar surfaces of the fingers with the reinforcement of the thumb
what is precision grip and what are the different types
- between terminal pads of the fingers and the thumb; requires independent movement of individual fingers
- pad to pad, tip to tip, key, 3-jaw chuck
decreased reaching, grasp, and manipulation associated with aging can be improved how and how long can it be transferrable to other UE tasks
- improved with training
- 1 month
learning without consciously knowing (riding a bike)
implicit learning
active or intentional learning (declarative knowledge - facts or figures is explicit learning) focused task with specific goal
explicit learning
percent of reduction in velocity due to aging
30-90%
what does time related changing in UE function depend on in aging
age, complexity of task
slowing of UE reaction times most often occurs due to what - time it takes to make decision about next part in the movement sequence slows down
slowing of central processing
coordination related changes with aging
- decreased hand steadiness with reaching
- little change in accuracy
- need more time to monitor responses to initial movement and to process other simultaneously occurring tasks
grasping changes related to age
- decreased manual dexterity
- diminished tactile sensation (unaware of how strongly they are holding objects)
- takes older adults longer to adapt to final grasp force to changes in objects weight, slippery vs non-slippery (decreased reduction in skin-to-object friction properties)
what neurological conditions affect UE Function
- stroke/TBI: U/L plegia, paresis, dyscoordination
- MS, PD, cerebellar disease: motor ataxia, resting/intention tremor, bimanual coordination dysfunction
- SC injury: quadriplegia
- Brachial plexus injury: klumpke’s/Erbs palsy, traction injuries
what MSK conditional can affect UE function
- RA/OA
- tendinous injuries, Dupuytrens contracture, DeQuervains tenosynovitis
- repetitive motion injuries: RTC, carpal tunnel
- adhesive capsulitis
effects neurological injury can have on reaching, grasping and manipulation
- difficulty locating target and maintaining gaze prior to reaching –> occulomotor, vestibular, and cerebellar injuries
- impaired coordination, timing, trajectory of movements
- delayed movement times
- sensory impairments
- loss of hemispherically governed patterns of movement
what is the test OT’s use to assess UE function
Wolf Motor Function Test
task-oriented approach to examination of a pt with UE dysfunction
- subjective interview focusing on impact of UE functional loss on social role
- impact on self-care, work, leisure activities
- current sx
- what is family or cultural values impact task performance
- pt primary concerns
examination begins with what
observation
what are some examples of functional scales that can be used to objectively measure impact of impairments
- barthel, FIM: measures low level UE skills - basic ADL
- Assessment of motor and processing skills: measures higher level UE skills - IADLs (phone, shopping, preparing meals, housework)
- Motor Activity Log: developed to determine amount and quality of hemiparetic UE activity following stroke
- Pediatric Scales: weefim, school functional assessment, manual abilities classification scheme (CP)
- Jebsen-Taylor hand function test: stimulates hand functions associated with everyday ADLs
what are other elements that can be assessed during UE examination
- handwriting
- eye-head or eye-head-hand coordination
- reach and grasp
- manipulate and release objects
- fine motor/dexterity activities
- in-hand manipulation
- B/L coordination
what to look at during handwriting analysis
- wrist stabilization
- ability to secure paper
- legibility
- writing speed
- implement mangament
what to look at when assessing reach and grasp
- have pt point/reach for objects of both involved and uninvolved side (randomize objects shape, size, textures, reaching distance)
- may see increased trajectory movement time and inefficient hand trajectory
- not problems with grip formation (closure, unstable grasp, orientation of hand to the object)
- observe trunk for postural stability (trunk rot in opposite direction to glenohumeral abduction and scapular retraction to keep hand moving in a straight path)
what to assess with eye-head coordination
- saccades and smooth pursuits in near and far central and peripheral vision fields (intact, diminished, absent)
- test in sitting, standing and walking
hold 2 objects 12 inches apart and 3 feet away from pt and have pt look back and forth between the 2
saccades
H and J patterns
smooth pursuits
assessing reach and grasp
if pt has difficulty with anticipatory control you will see:
- repeated knocking over of objects
- contact of objects with web spaces instead of finger tips
- denting or crushing lightweight objects after first grasping
- difficulty raising heavy but liftable objects off table
once an object is grasped it can either be
- manipulated
- stabilized
is the movement of an object in space or in reference to another object
manipulation
requires sustained isometric mm force to prevent object slippage
stabilizataion
_____ of grip force is impaired in individuals with neurological injury
modulation
pediatric outcomes measures of UE assessment
- BOT 2: fine manual coordination and manual coordination subscale
- Peabody: objective manipulation, fine motor and visual motor integration subscale
outcome measure to assess UE function in adults post stroke/TBI
- Fugl-Meyer UE Gross motor and fine motor coordination scales
- Wolf motor function test (OT)
- rivermead motor assessment
fine motor and dexterity tests
- perdue peg board
- minnesota rate of manipulation test
- box and block test
- peabody fine motor scale (up to 7 y/o)
what can you use to assess B/L Coordination
fold towels, toss a back back and forth between two hands, hold a cup in one hand and pour from a pitcher with the other
move a coin from fingers to palm of hand and back
translation in-hand manipulation
adjust your pencil from between your fingers to the palm of your hand and back
shift in-hand manipulation
turn a fork so that you can put it in your mouth after picking up food
rotation in-hand manipulation
difficulty with multiple tasks, cannot do it involuntary, cannot tell you what they want to do
ideational apraxia
cannot perform task for someone telling them to do something; pt can do it subconsciously; can tell you what they want to do but cannot do it
ideomotor apraxia
apraxia
difficulty with motor planning
how to assess strength using dynanomometer
- elbow 90 flex, FA/wrist between sup/pro
- mean of 3 trials
