Typical Development: 18 Months - 6 Years Flashcards

1
Q

In order to develop gross motor skills, what does a child need to be able to do?

A
  • Balance with significantly reduced stability limits
  • Maintain anti-gravity strength
  • Steadily increase coordination between muscle groups
  • Utilise intact sensory systems & cognition
  • Anticipatory postural control improves instead of reactive
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2
Q

Which develops first, anti-gravity strength or independent stance?

A

Anti-gravity strength develops well before independent stance

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3
Q

Why is static balance more difficult for 2-6 year olds than adults?

A

Due to relatively high centre of mass (T12 vs L5)

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4
Q

How does experience influence the probability of effective postural responses occurring?

A
  • Due to stronger connections between sensory & motor pathways
  • Visual & somatosensory input remain essential for postural control throughout development
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5
Q

What drives development?

A
  • Experience i.e. exposure to activities & practice (not maturation of the neural system alone)
  • More efficient movement achieved with feed forward & feedback loops
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6
Q

What is age-related gait development due to?

A
  • Increasing extensor muscle strength to support the body’s weight on a single limb BOS
  • Development of dynamic balance with decreasing co-contractions for stability
  • Improved postural control (anticipatory and integrative postural adjustments)
  • Biomechanical changes
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7
Q

What are the characteristics of gait at ages 9-15 months?

A
  • Wide BOS with abducted hips
  • Slight hip/knee flexion & hip ER
  • Lateral stability greater then AP
  • Loses balance if head moves outside BOS
  • Arms in high guard position
  • Short stride
  • Increased cadence
  • Full foot initial contact
  • Relative foot drop in swing phase
  • Significant co-contraction
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8
Q

What does early walking resemble & what is it thought to be related to?

A
  • Treadmill training (response to the momentum to keep balance)
  • Thought to be related to stepping & kicking patterns in the newborn
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9
Q

What is an example of significant co-contraction during gait for 9-15 month year olds?

A

Tib ant & gastrocs co-contract during swing, quads & hamstrings co-contract during stance for stability

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10
Q

What are the characteristics of gait at ages 18-24 months?

A
  • BOS decreases, now in line with pelvis
  • COM descends
  • Hip extension strength increases with mild hip extension during end of stance phase
  • SLS becomes more stable
  • Consistent heel strike with knee extension develops by 24months
  • Increased velocity associated with increased stride length
  • Decreased co-contraction due to improved control and stability
  • Arms no longer in high guard
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11
Q

What is increased stride length correlated with?

A

Age, leg length and height

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12
Q

What are the characteristics of gait at ages 3-4 years?

A
  • COM continues to descend
  • Heel strike present with knee flexion in early stance
  • Walking velocity normalised for height is now equivalent to adult
  • Cadence decreases
  • Reciprocal arm swing developing (firmly established by 4 years)
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13
Q

What are the characteristics of gait at ages 6-7 years?

A
  • Gait generally fully matured
  • COM still slightly higher (L3) than adult
  • Cadence continues to decrease
  • Balance & postural control show improvement
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14
Q

Why is there a period of disequilibrium between balance & postural control seen between 4-6 years?

A

Due to disproportionate growth compared to body dimensions

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15
Q

What are the main gross (fundamental) motor skills?

A
  • Running, jumping, hopping, leaping
  • Galloping, skipping, sliding
  • Ball skills (catching, throwing, kicking, striking)
  • Refer to checklists
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16
Q

What does postural control require?

A

Interaction of neural sensory (visual, vestibular, proprioceptive & tactile), motor & musculoskeletal systems

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17
Q

How does postural control change with development?

A
  • More reactive in early stages

- Becomes more anticipatory (adaptive) with development

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18
Q

What does anticipatory postural control act to minimise?

A

Potential disturbance that may arise from initiating & completing a movement

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19
Q

What are the postural control reactions?

A
  • Head righting (
    vertical & horizontal +/- visual input)
  • Protective/parachute reactions (anterior, lateral, lower limbs)
  • Equilibrium (sitting & standing)
  • Placing, supporting, weight shift
20
Q

What are the standardised assessments used for development between 18 months & 6 years?

A
  • PDMS 2 (Peabody Developmental Motor Scales 2)
  • BOT 2 (Bruininks-Oseretsky Test of Motor Proficiency)
  • MABC-2 (Movement Assessment Battery for Children 2)
21
Q

What does the Peabody Developmental Motor Scales 2 (PDMS2) assess?

A
  • Gross & fine motor skills from 1 month-6 years
  • Valid & reliable
  • Discriminates motor problems from normal motor variability (identifies areas of strength & weakness)
  • Sensitive to change over 6 month period for children with delay & CP
  • Does not include quality of movement
22
Q

What does the Bruininks-Oseretsky Test of Motor Proficiency (BOT2) assess?

A
  • Gross & fine motor skills for ages 4.5-14.5 years
  • Designed for normal & disabled populations
  • Valid for assessing motor performance over time
  • Distinguishes between typically developing children & those with learning difficulties
23
Q

What areas does the BOT2 test?

A
  • Running speed & agility
  • Balance
  • Bilateral coordination
  • Strength
  • Upper limb coordination
  • Response speed
  • Visual-motor control
  • Upper limb speed & dexterity
24
Q

What does the Movement Assessment Battery for Children 2 (ABC2) assess?

A
  • Fine & gross motor skills for 3-16 year olds with suspected motor delays
  • Child needs sufficient cognition & attention to participate
  • Valid, high inter-rate reliability, insufficient evidence for test-retest
  • More valid & reliable for typically developing children
25
Q

What areas does the ABC2 test?

A
  • Manual dexterity
  • Aiming & catching
  • Balance
26
Q

What are some of the common lower limb concerns?

A
  • Genu varum (bow legs)
  • Genu valgum (knock knees)
  • In-toeing: Metatarsus adductus, internal tibial torsion, femoral neck anteversion
  • Ankle over-pronation/flat feet
27
Q

When is genu varum (bow legs) typical during development?

A
  • Up to 2 years
  • Most prominent around 6 months
  • Often occurs with internal tibial torsion
28
Q

What can genu varum also be caused by?

A

Ricketts disease (vitamin D deficiency)

29
Q

What is the common treatment for genu varum?

A
  • Spontaneous correction expected
  • No evidence to suggest exercises or orthotics will improve gene varum
  • Refer for medical intervention if outside normal limits
30
Q

When is genu varum (bow legs) typical during development?

A
  • Normal physiological valgum between 3-5 years & 12-14 years
  • Due to femoral anteversion
31
Q

What is the common treatment for genu valgum?

A
  • Consider rotational components e.g. internal tibial torsion
  • Discourage W sit, encourage X-leg sit
  • As for genu varum
32
Q

What is intoeing?

A
  • Presents as pigeon-toed posture or W sitting
  • Stems from feet, knees or hips
  • Need to check joint ROM & torsion/angulation components in bones
33
Q

What is the prevalence of intoeing?

A
  • Feet (metatarsus adductus): Newborn
  • Knees (internal tibial torsion): 1-3 years
  • Hips (medial femoral torsion): 3-10 years
34
Q

How is metatarsus adductus intoeing diagnosed?

A
  • Pirani method of scoring (lateral curvature, medial crease, lateral head of talus)
  • Ankle ROM within normal limits
35
Q

What is the common treatment for metatarsus adductus intoeing?

A
  • Shoe recommendation
  • E-stim to side of foot
  • Serial casting
  • Spontaneous correction expected
  • Correction slow/incomplete in 10% of children
36
Q

How is internal tibial torsion diagnosed?

A

Thigh/foot angle norms:

  • Infants: -15˚-0˚
  • 2.5yrs: 0˚
  • Adult: 5-15˚
37
Q

What is the common treatment for internal tibial torsion?

A
  • Spontaneous correction expected
  • No evidence to suggest exercises or orthotics help improve it
  • Discourage W sitting, consider sleeping position
  • Refer for medical intervention
38
Q

How is femoral neck anteversion diagnosed?

A
  • Hypermobility
  • Hip IR/ER ratio:
    IR 80-90˚, ER 0-10˚, can the child sit cross-legged
  • Strength assessment
39
Q

What is the common treatment for femoral neck anteversion?

A

As for internal tibial torsion

40
Q

What is the presentation of ankle over pronation & pes planus (flat feet)?

A
  • Midfoot in close proximity to ground (Navicular drop when standing)
  • Everted calcaneum
41
Q

How is ankle over pronation & pes planus (flat feet) diagnosed?

A
  • Assess child in sitting with feet unsupported or standing on tip toes (arch should be evident)
  • Assess whether feet are flexible & able to be corrected
  • Assess calcaneal angle
  • Query whether feet are painful
  • Assess symmetry
42
Q

What is the common treatment for ankle over pronation & pes planus (flat feet)?

A
  • In shoe orthotic if outside normal limits

- Treat gross motor skills if delay is present

43
Q

What is the presentation of idiopathic toe walking?

A
  • Consistent toe walking with lack of heel strike
  • Short/tight calf muscles that shorten with growth
  • Hamstrings may also be tight
  • When standing with feet flat: Hips/knees flex, forefoot pronates & calcaneus everts
  • Shoe wear: Heels not worn, decreased proprioceptive & biomechanical input to heels
44
Q

How is idiopathic toe walking diagnosed?

A
  • By elimination (CP, DMD, hypotonia, hypermobility etc)
  • Neuro exam is normal
  • Musculoskeletal/sensory contributions
  • May be a family history
  • Gross motor skill acquisition is within normal limits (although typically have poor static balance)
  • Short stride length during running
45
Q

What is the common treatment for idiopathic toe walking?

A
  • Passive calf/hamstring stretches
  • Eccentric calf exercises
  • Orthotic correction as indicated
  • Serial casting
  • Gait re-training
  • Botulinum neurotoxin type A injections (rarely)
  • Surgery (questionnable)
  • Often reoccurs during periods of rapid growth
46
Q

What are the typical parameters for lower limb alignment?

A
  • Newborn: Moderate genu varum
  • 8 months: Minimal genu varum
  • 1 year 7 months: Legs straight
  • 2 years 6 months: Physiological genu valgum
  • 4-6 years: Legs straight with normal toeing out