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Year 2: MLC II > Test 2 > Flashcards

Test 2 Flashcards

1
Q

2 functional components of reach and grasp

A

transportation
- uses proximal muscles
- hand shapes to match object
- under visual control

grasp phase
- distal muscles
-early on, tactile sense to learn how to grasp
- later, grasp anticipated using visual system too

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2
Q

what affects grasp shape

A

intrinsic properties - object size, shape, etc

extrinsic properties - object orientation, distance from body, location

change in grip size due to finger movement; thumb stays in place

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3
Q

what to look for in grasp at 6 months

A

should be moving smoothly

should be able to use muscle groups separately (i.e. extend arm while flexing fingers)

look out for stiffness, speed, smoothness of reach

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4
Q

3 components of upper limb control

A

reaching

object manipualtion- separating fingers out/using independently to move/control object

anticipatory grasp- eyes and hand + arm/ integration of sensory info/ know necessary tension/force needed to grasp

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5
Q

what do you see in the first 2 months vs after 2 months with upper limb control

A

in the first 2 months of life = when arm is extended, hand does too

after 2 months = arm can extend and fingers can flex; allows for voluntary palmar grasp

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6
Q

what may indicate a problem with grip/upper limb control and possible intervention

A

holding arm stiff

not disassociating grip and arm movement

interventions = rolling, WBing, putting weight through hand

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7
Q

MSK components that are needed for grasp

A

joint ROM

spine flexibility

muscle properties

proper biomechanical relationships

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8
Q

Motor aspects needed for proper grasp

A

appropriate muscle tone

muscle strength

coordination

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9
Q

what combined joint motions are required for successful reach and grasp

A

scapular RT
movement of humeral head
forearm supination
shoulder/elbow flexion
extension of wrist beyond neutral
mobility of hand to allow grab and release

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10
Q

feedforward vs feedback

A

feedback
- early on
- allows for motor correction DURING mvmt
- improvement through pressure, touch, etc
- allows kid to become more skilled using sensory system

feedforward
- later in skill acquisition
- plans movement beforehand

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11
Q

sensory systems involved in grasp

A

visual
- hand eye coordination

auditory
- i.e. have kid use racketball that they can hear when it hits

somatosensory
- knowing where arm is in space
- makes posture/reach more efficient

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12
Q

how does vision help in reach in grasp/how is this info processed in brain

A

sensory stimulus coded in retina that turns into motor output for controlling reach and grasp

parietal lobe interprets visual space and sends info back to eye muscles

visual feedback given back in regard to final accuracy of reach and grasp

MOST IMPORTANT FOR REFINED MOVEMENTS

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13
Q

When is somatosensory info most important and how does it help with movement/grip force

A

important for fine regulation; not needed for initiation/execution so long as mvmt is simple

receptors active at extremes of joint motion; not middle

cutaneous afferent info essential for grip forces

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14
Q

role of premotor/primary motor areas in grasp

A

parietal lobe encodes goals for reach and grasp, intended hand formation, and object orientation

all parietal info sent to premotor and primary motor cortex

premotor = planning
primary = execution

intraparietal neurons code for grasping actions (i.e. precision vs power grip)

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15
Q

how/when does postural control begin to be associated with reach

A

postural control is critical for reach

initially = use 1 hand to support self and 1 to reach

6-8 months = start using postural control for anticipatory reach

by 10 months = controlled/smooth reach

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16
Q

things to consider if reach is delayed

A

is it postural? do they do better if PT supports body?

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17
Q

goal/purpose of early hand use

A

goal = bring hand/object to mouth initially

hands interaction with target is driver of perceptual development; NOT just reach alone

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18
Q

grasp timeline

A

1-5 months = spontaneous/early grasp behaviors

2-4 months = fisting decreases; pre-precision/precision grasp emerge

4 months = increase in self directed grasping/self exploration

6-8 months = anticipatory reach/grasp/posture/using thumb
** concerning if not grasping and letting loose by 6 months

10 months = pincer grasp using thumb
**if no pincer by 12 months, concerning

9-10 months = can slowly release object; not just drop it

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19
Q

4 grasping patterns used in 1st 5 months

A

fisted grasp = fisted/grasping clothes

pre-precision (thumb to side of middle or index finger) = bringing thumb in

precision grip of objects = by 10-12 months

self directed grasp of own body or clothing = exploration of objects/body

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20
Q

describe development and timeline of grasp/release

A

initially = palmer grasp reflex; grasp parent finger

4 months = voluntary hold with involuntary release

4-5 months = fingers flex and thumb adducts

6 months = grasping smaller objects/hold bottle
**should be holding at midline

7-12 months = rapid changes in grasp

12 months = precise release of grasp

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21
Q

stages of object manipulaiton + timeline

A

rotation (angular displacement) by 2 months

translation of grasped objects by 3 months

vibration (shaking) of held objects by 4 months

bilateral hold/2 handed hold by 4.5 months

hand to hand transfer by 4.5 to 6 months

coordinated action; object in one hand manipulated by the other by 5-6.5 months

coordinated action with 2 objects such as striking 2 blocks together by 6-8.5 months

deformation of objects by 7-8.5 months

instrumental sequential actions by 7.5 to 9.5 months

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22
Q

how does anticipatory control of hand with grasping develop in the first year

A

hand prepares to grasp based on object characteristics

sensory info guides motor actions

by 5 months = orient had to object

5-8 months = develop vision to anticipate contact with object and orient hand

9-13 months = anticipate size of object by dustance between thumb/index finger

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23
Q

characteristics of later stages of motor learning

A

adapt movement pattern acquired in initial stages to specific demands of any situation

become consistent in performing skill

movements more efficient/reduced energy cost; “economy of effort”

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24
Q

implicit vs explicit learning

A

implicit (non-declarative)
- procedural
-associative learning (classic/operant conditioning)
-nonassociative (habituation/sensitization)

explicit (declarative)
- facts
- events

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25
Q

who best benefits from mental practice

A

more beneficial in adults

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26
Q

crawling infants practice approximately how much

A

crawling infants practice maintaining balance approximately 5+ hours/day which equates to 300 crawling steps

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27
Q

emerging toddlers practice approximately how much

A

emerging toddlers undergo 14000 steps, 46 football fields, and 100 falls/day with hundreds of thousands of trials spread out over weeks or months

28
Q

practice considerations

A

generalization of motor skills

presenting instructions (verbal vs demonstration)

presenting feedback during instruction

practice structure

29
Q

rehab focus with kids with CP

A

infants with CP dont retain infantile coordination strategies through impairments

but, they can improve with sufficient practive over course of development

30
Q

major attributes of typical walking

A

stability and stance

foot clearance

foot positioning

step length

energy conservation

adequate strength, ROM, sensation, force production, bone structure

31
Q

examples of impairments that can affect stability and stance

A

spasticity

low mm tone

affects ability to WB

32
Q

examples of impairments that can affect foot clearance

A

low mm tone can affect

not able to work against gravity

33
Q

examples of impairments that can affect foot positioning for initial contact

A

i.e. toe walkers

34
Q

examples of impairments that can affect step length

A

toddlers already have short step length

some kids maintain this type of walking through development due to poor balance or postural control

35
Q

examples of impairments that can affect energy conservation

A

spasticity and other disorders can lead to overworked mm in legs

finding AD compatible for fluid gait pattern and decreased energy expenditure is essential

36
Q

examples of impairments that can affect adequate strength, ROM, sensation, force production, bone structure

A

i.e. kids with spina bifida, dwarfism, club foot have trouble with these factors

37
Q

characteristics of initial walking (6 months after learning to walk)

A

LOB unpredictable

rigid/halting stepping

short step length (22cm)

high hand guard/outstretched UE

flat foot contact

wide BOS

toes turned out/ER

brief SLS (32% gait)

knee flexion in stance

17 falls/hour

38
Q

characteristics of immature walking (approximately 2 years of age)

A

occasional loss of balance

gradual smoothing of walk pattern

increased step length

reciprocal arm swing

heel strike

BOS w/i lateral dimensions of trunk

minimal toe out/ER

vertical lift

longer single limb stance (34%)

greater knee flexion after foot strike then ext before toe off

seldom falls

39
Q

characteristics of mature walking (7 years of age)

A

rarely looses balance without perturbation

relaxed/elongated gait

increased step length (48cm)

reciprocal arm swing

heel strike

narrow BOS

minimal vertical lift

38% gait cycle single limb stance

40
Q

prerequisites for walking; birth to 9 months

A

weak/less mm

CNS development for posture control

pushing/crawling to develop mm needed for gait

good prone ext

pill up to stand mostly with arms but controlling affects of gravity

COM over BOS

41
Q

characteristics of gait 9-15 months

A

walking with large BOS

controlled fall

leaning forward

normal genu varus

flat feet

mm are stretched with walking and will develop normal ER of the leg overtime with more use

COM lowers down

DS kids, less mm tone, harder to develop

how are visual/vestibular functions? convergence? do they follow your finger?

no arm swing but still in high guard at 15-16 months could mean developmental delays

42
Q

characteristics of gait 18-24 months

A

better bone structure

alternating walking pattern

longer step/extension

no crouch posture

normal toe out is forming, mm are forming

wider base

genu varus still normal, but not excessive

work on control = better alignment

more posture control

no more fwd lean

decreased ABD ROM in hip

step over, up, and down; avoid obstacles

falling is still normal

43
Q

characteristics of gait 3-3.5 years

A

more valgus

toe walkers - look at ROM, alignment, mm flexibility, vestibular, neurological issues

44
Q

characteristics of gait 6-7 years

A

consistent to what you see in an adult

some are flat footed

45
Q

kinematics vs kinetics

A

kinetics = force and motion only; how forces affect motion; i.e. GRF

kinematics = motion only; how objects move through space; gait observation; subjective

46
Q

describe energy expenditure in relation to gait

A

kids compensate for abnormal gait (i.e. low mm tone/spina bifida)/not using mm efficiently - causes increased energy expenditure

look at gait for compensation/deviations but also how hard is it to complete task

47
Q

examples of primary impairments you may see in gait and how they might present

A

primary impairments = low m tone, spasticity, CP, alignment (club foot), etc

presentation
- inhibited/exaggerated arm swing
- arms crossinf midline
- improper foot placement
- exaggerated fwd lean
- arms flopping at sides or held out for balance
- twisting of trunk
- poor rhythmic action
- landed foot flat
- flipping foot or lower leg in/out
-crouching due to increased tone, decreased strength, etc

48
Q

secondary compensations you may see in gait

A

mm get tighter so kids often need tendon lengthening (gastroc, soleus, etc)

may need MD for botox, contractures, deformities, degeneration

49
Q

ICF impairment examples

A

strength
ROM
spasticity

50
Q

ICF activity

A

what are they restricted from doing?

can they socialize? play at school?

51
Q

ICF environmental factors

A

family support

is there follow up at home?

is it neglectful?

52
Q

ICF other health conditions

A

psychological?

behavior problems?

53
Q

how to guide decision making based of ICF in peds

A

can PT change the impairment?

do you need to refer?

54
Q

describe the contemporaary model for management of children with disabilities evidence based practice

A

no longer a medical model (i.e. MD decides and PT comes in after)

determines what kids need (i.e. cant get around school like other kids)

top down approach

evidence based practice

55
Q

things to look at in pediatric assessment (Hx, tests/measures/systems review)

A

if working in schools- contact parents too

medications?

tests? scans?

if breach, check for hip displacement

have they been healthy since birth?

56
Q

describe top down approach

A

compensatory

focus on maximizing skills and getting kids doing what they want/should be

identify strengths/obstacles

figure out strategies to bypass

form intervention based on these things q

57
Q

describe the bottom up approach

A

restorative

looking at aquiring skills/restoring function to allow pt to do what they want to normally

intervention based on specific demand rather than specific goal or task pt struggles with

i.e. focuses on restoring strength rather than ways to navigate hallways

58
Q

describe diagnosis as it relates to PT

A

we dont make MD dx

talk to doc/family

tell them what you see or if you think they need to refer

PT looks at how they function and makes dx based on these things; more focus on the IMPACT

i.e. toe walker vs autism or weakness on L side vs spastic CP

detailed analysis of physical function

59
Q

describe prognosis as it relates to PT

A

predict what pts optimal level is

want realistic outcomes

often hard to do, especially with kids

60
Q

hierarchy of competence in learning motor skills in peds

A

acquisition of learning a new activity

fluency
- developing proficiency of a skill
- how do they do it? use their hands? assistance?
- how proficient are they?

maintenance of performing activity over time
- can they do it consistently?

generalization
- multiple environments?
- with different people/equipment?

61
Q

factors to consider when developing a PT POC

A

talk with school/family

what are the deficits

what activities are they struggling with

what is realistic to the pt

62
Q

define goals vs objectives vs outcomes

A

goal = intended outcome in general terms (i.e. ascend stairs)

objective = specific terms (i.e. achieve 60 degrees hip flexion and 5/5 MMT)

outcome = result (i.e. pt can navigate home safely)

63
Q

elements of good EBP

A

consultation
- consult family
- how are they progressing?
- any other problems?

judgement
- how to apply EBP guidelines
- some kids may not tolerate some things

creativity
- not a cookie cutter approach
- kids are so different
- look at what is out there in terms of evidence and get creative

64
Q

what are clinical/critical/care pathways

A

structured plans of care that translate guidelines and/or evidence into localized infrastructure and processes

65
Q

reasons to discontinue care

A

objective measures

parents decide that is what they want

pt doesnt want to participate

episodic care?
- pt comes in for a little while
- takes break from PT
- comes back as new problems develop
- often for people with chronic disabilities

pt wont progress toward objective goals any longer

improvement required by insurance is not met

Year 2: MLC II (2 decks)

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