Typical Development of skeletal system and locomotion Flashcards
1
Q
Growth and development of the skeletal system and location is generally?
A
- each stage of growth and development is affected by the preceding types of development
- predictable sequence
- each child is an individual
2
Q
What are some prenatal factors that can impact growth
A
- nutritional deficiencies (protein and calcium are important)
- diabetic mother can impact the size and make them larger
- exposure to radiation
- smoking can produce smaller babies
- mal-positions in utero
- mom needs exercise to give baby proprioception and bones get stronger
3
Q
Baby position during pregnancy:
-1. breech
- 2. incomplete breech
- 3. frank breech
A
- complete breech is the babies head is not down and both legs are flexed
- one leg is extended
- both legs are extended
- if a baby stays in the position too long that can get hip dysplasia which can increase risk of hip dislocation
4
Q
What are some postnatal factors that impact growth
A
- socio-economic status of the family
- child’s nutrition: infant weight affect step cycle, postural, and can cause bone deformities
- Exposure to gross motor experiences can impact bone growth (they need to be stressed) and motor development
- medications can impact bone growth - sometimes can be supplemented to help
5
Q
Muscular system: development of fibers
A
- type 1 fiber is matured at 21 weeks gestation
- type 2 fibers matured at 31 weeks gestational
- need to be perfected through development and strengthen
6
Q
Growth of muscle
A
- prenatally results from an increase in number of fibers (hyperplasia)
- postnatally for increases in size of individual fibers (hypertrophy)
7
Q
What is muscle growth impacted by
A
- nutrition: lean beef, chicken, fish, pork, beans, nuts, low-fat dairy
- exercise: fun activities, cycling, running, swimming, sport
- Good sleeping Habits: repair muscle = 10 hours of sleep for children
- strength training: light resistance and controlled movements
8
Q
Early Skeletal system
A
- head and trunk large in proportion to extremities with COM at Xiploid process
- spine lacks secondary curves
- growing bone is less dense and more porous than adult, more sensitive to compressive and tensile forces
9
Q
LE alignment: newborns
A
- femoral angle of inclination is 175 valgus?
- acetabulum shallow and more vertical
- 5-10º of internal tibial torsion
- tibiofemoral angle 16ºvarus
- 22º calcaneal varus
10
Q
Hip
1. torsion
2. antetorsion
3. Version
A
- normal development of rotation on a long bone
- antetorsion: head and neck of femur is rotated forward ; forward twist of femoral shaft
- version: position of the head of the femur in the acetabulum (ante version is an anterior position)
11
Q
Skeletal development: Wollf’s Law
A
- after bone develops initially it can be changed by bone function adaptation
- Mechanical forces –> bone, osteocyte and osteoblast activity –> bone structure growth
12
Q
Bone development
A
- Bones should not be as heavy as possible but rather stable as necessary
- important to create conditions that stimulate bones to become more stable
13
Q
Overview of skeletal development and bone mineral density
A
- period of increase in bone mineral density: 1-4year old, puberty
- high impact sports (gymnastics, volleyball, karate) or odd-impact sports (soccer, basketball, racquet sports) are associated with higher bone mineral density
14
Q
11-12 months skeletal development
A
- lumbar lordosis develops
- weight bearing deepens acetabulum, muscular attachments pull and reshape bone
- Wolff’s law
- cole’s law
15
Q
Tibiofemoral angle
1. 0-18 months
2. 13-30 months
3. 3-4 years
4. 8-10 years
A
- physiological varus
- at 18 months the angle is neutral
- tibiofemroal angle shows valgus alignment
- more in alignment and loss of most of the valgus alignment
16
Q
Where does more of the increase in lengthen and heigh come from at the ages of 18 months to adolescence
A
- primarily in the legs
17
Q
by 6 where is the COG
A
- 3rd vertebrae (L3)
18
Q
6 years +: skeletal system
A
- matures
- tibiofemoral angle back to neutral from vagus seen at 3
- heel position is now neutral
- COG is 3rd vertebra
19
Q
6 years +: how the body grows
A
- legs continue to account for most of height and increases until adolescence
- from adolescence to adulthood growth in trunk accounts for 60% of height increase
- skeletal maturity reached when epiphyseal closure is complete, about age 25 (can cause issues if damaged)
- from age 7 and up standing balance reactions are adult-like
20
Q
Girls vs boys skeletal system growth differences
A
Girls:
- growth spurt 12-13 years old
- increase bone width until14
- increase bone length until 16
Boys
- growth spurt at 14-16
- bone width until 16
- bone length until adulthood
can change with nutrition
21
Q
NIH (BONE DENSITY) for bone growth and devlopment
A
- bone mass peaks by their late twenties
- at that point, bones have reached their max strength and density
- up to 90% of peak bone mass is acquired by age 18 for girls and 20 in boys
22
Q
What other systems are important for musculoskeletal development
A
- sensory and nervous system
23
Q
Sensory system development beyond 5
A
- vestibular system matures by age 10-14
- depth perception full developed by 12 yr/o
- going to jump off surfaces = depth perception plays a big role, the ones who have this development are going to jump off and then develop MSK system
24
Q
Nervous system develops 5+ years
A
- brain undergoes growth spurts around ages 6-8, 10-12, and 18 years of age
25
Development of locomotion (order)
- rolling
- pivot prone: going incircles in prone position
- belly crawling
- hands and knees crawling
- cruising
- walking
26
Gait: 11-12 months
- equilibrium system still developing
- different recruitment patterns during gait with frequent co-activation of quads, hamstrings, gastric, anterior tib
- gastric/ant. tib during swin
- quads and hamstrings during stance
- may by due to decreased strength of muscles in antigravity position
- gets them to understand which muscles get most efficient movement
27
Gait: 18-24 months
- efficiency of gait is improving
- EMGs show decreased Co-contraction in antagonsitic muscle groups due to increased muscle control
- uses more hip flexion than adults (less robotic)
- consistent heel strike is present at 24 months and push off in stance occurs
28
Locomotion/neuromuscular system: from 12 months to 6 years
- children use Bottom up approach
- EMG studies of standing shows muscular recruitment for standing balance strategies similar to those of adults by 11-12 months
- control head movement
- stabilize hips, shoulders, head
- hips are a little more stiff
29
6 years and older Neuromuscular system
- by 7 years old there is top down organization
- children have standing balance strategies similar to adults
- head position with gravity by equilibrium control (no head lag)
30
What is the gait characterisitc regression hypothesis
- as we age we revert back to gait that an infant uses
- shorter duration of limb stance
- greater duration of double limb support
- wide BOS
- co activation of agonists and antagonists muscles during gait
31
Plagiocephaly
- head is misshapened
- not only head abnormality there is but the most common
- pressure that is applied over the skul consistently can mold the head into it
- children will have poor vision with this
32
Development of dysplasia of the hip
- breech position is probably the most important single risk factor
- keeping the legs in a naturally flexed and abducted position without restricting hip motion lessens the risk of DDH
-
33
Barlow maneuver
- the hip is first flexed and abducted then gradually adducted with pressure in posterior direction
- dislocation of femoral head over posterior acetabulum indicates unstable hip
34
Ortolani test:
- the hip is dislocated in a position of flexion and adduction
- apply flexion, abduction and slight traction
35
Treat for DDH
- depends on the age of the patient and the reducibility of the hip
- birth to 6months the main treatment is an abducted brace like Pavlik harness
- if this fails, closed reduction and spica casting is done
- after the age of 18 months treatment usually consists of open reduction and hip reconstruction surgery
36
Club foot
- can be unilateral or bilateral
- treated with splits of orthotics
- foot is in inverted position
37
Calcaneaovalgus
- foot in dorsiflexed position
38
Congenital talipes equinovarus
- the most common congenital anomaly
- incidence of one to two per 1000 live births
- calcaneovalgus occurs most frequently followed by equinovarus deformity
- 99% of cases, calcaneovalgus response to conservative treatment which involves passive manipulation by the mother and casting can be done
