Typical Paediatric Motor Development & Reflexes Flashcards
1
Q
What is the sculptor of the baby brain?
A
Experiences: more experiences = more myelin is layed down in brain
2
Q
When does the organization of the sensory and motor cortices occur? What does this imply for premature babies?
A
- organize during late fetal period.
- Premature Babies: born during the late fetal period => integration of sensory and motor cortices is affected bc no longer in the safe environment and affected by gravity => at risk for developmental delay
BUT can modify environment to ensure proper integration bc brain = plasticity
3
Q
Describe the brain’s function postnatally in general
A
Function & identity of brain areas remain malleable to input from environment (experiences)
4
Q
When is the optimal period for early intervention in peds
A
first 2 years of their life (most dramatic and rapid period of myelination of brain)
5
Q
What is the baby blueprint composed of?
A
genes & environmental input
6
Q
What is myelination
A
addition of myelin to neuron’s axons
7
Q
When and where does myelination begin
A
- prenatal
- in caudal brain stem and progresses rostrally to forebrain
8
Q
What weeks are the 3 trimesters?
A
1st trimester = wk 1-13
2nd trimester = wk 13-26
3rd trimester = 26-40
9
Q
Describe the general (neuronal) development of the brain during each trimester
A
Trimester 1
- Neuron develop
- Neuron multiply
- Neuron migrate
Trimester 2 - Neuron multiply -Neuron migrate - Neuron branch & form synapses (brain remains smooth, no sulci/gyri)
Trimester 3 - neuron branch and form synapses - pruning (apopstosis) & synapses reorganization - myelination (all of these continue postnatally)
10
Q
Why is folic acid recommended to take during 1st trimester
A
ensures closure of neural tube that will become SC (if not spina bifida)
11
Q
What occurs if baby is born prior to 26 weeks
A
prior to 3rd trimester
=> pruning, myelination, and synapse reorganization occur outside womb
=> can lead to deficit like CP, deafness, blindness…
12
Q
Describe the general order of development of body parts
A
- NS (3 wks)
- heart
- limbs
- eyes
- teeth
- ear
- genitalia
13
Q
What are the risk factors/predictors of development delay (6)
A
- gestational age (prematurity)
- apgar scores
- birth weight
- head circumferences
- genetics
- epigenetics
14
Q
How do you calculate adjusted age for prematurity
A
weeks born early until 2yo
15
Q
What is the critical period/window of development
A
period of time something develop => sooner the better
16
Q
Critical Period: Binocular vision
A
0-5yo
17
Q
Critical Period: auditory/visual cortex (seeing/hearing)
A
0-5yo
18
Q
Critical Period: Receptive Language & speech production (Broca)
A
Prenatal (-1 mo) to 5yo
19
Q
Critical Period: Higher cognition (prefrontal cortex)
A
prenatal (-3 mo) to 15 yo
20
Q
Critical Period: Emotional control
A
0.5-5yo
21
Q
Critical Period: Habitual ways of responding
A
few months old to 5yo
22
Q
Critical Period: Peer social skills
A
3-7yo
23
Q
Critical Period: Language
A
0.5-7yo
24
Q
Critical Period: Symbols (cognition)
A
1 & few months - 5yo
25
Critical Period: Relative Quantity (cognition)
4-7yo
26
What is the developmental theory?
Dynamic system between neuromaturation (reflexive to volitional) & environment & systems (motor, sensory, cognition, motivation)
27
What is state regulation?
Adults need to encourage babies to self-regulate => support infant in being stable/organized/competent
28
What are the 4 examples of state regulations that adults should support in infants?
1. sucking reflex (want to bring their hand into their mouth bc it soothes them)
2. self soothing
4. quiet alert (want them quiet and watching you vs screaming and crying)
5. functions: feeding & bonding
29
In babies, what does sensorimotor control/experience entail/include? (6)
1. proprioception
2. vestibular
3. tactile
4. postural control via antigravity control
5. balance (protective reactions when seated)
6. self regulation
30
when does sensorimotor development occur?
in utero
31
what is antigravity control?
antigravity control contributes to postural control => ex: able to keep head upright when baby in prone
32
What are protective reactions? what life skill do they contribute to?
Protective reactions contribute to overal balance wheren forward protective reaction (when baby seated, they automatically reach forward with arms) develop[s first then lateral then posterior
33
describe the overall development of postural control/stability.
overall: reflexive to volitional
1. antigravity control develops to allow for stability in midline alignment
=> antigravity movement in prone THEN supine
2. Then combination of mobility and stability => first weight-bearing then weight-shifting
34
DM Postural control: newborn
fetal position (arms and knees flexed, in prone, chin tucked in)
35
DM Postural control: 1 mo
in prone: chin raised (arms and legs remain flexed, chest still prone)
36
DM Postural control: 2mo
in prone: chin and chest up (arms and legs remain somewhat flexed)
37
DM Postural control: 4 mo
sits when supported
38
DM Postural control: 7 mo
sits unsupported/alone
39
DM Postural control: 9 mo
stands holding onto furniture
40
DM Postural control: 10 mo
crawls
41
DM Postural control: 11 mo
walks if led & stands alone
42
DM Postural control: 12 mo
walks alone (with falls) and creeps well
43
Name in order the developmental positions.
1. supine
2. prone
3. rolling: prone to supine THEN supine to prone
4. sitting
5. crawling THEN kneeling
6. standing
7. walking
44
DM Postural control/locomotion: 15 MO
walks alone & creeps upstairs
45
DM Postural control/locomotion: 18 mo
runs
46
DM Postural control/locomotion: 2 yo
walks up and downstairs
| jumps
47
DM Postural control/locomotion: 3 yo
alternate feet going upstairs
48
DM Postural control/locomotion: 4 yo
alternate feets when going down stairs
| hops on 1 foot
49
Describe the principles of sensorimoto development
goes from gross/generalized movement to fine/dissociated/dissociated movements
=> we develop cephalo caudal (head to feet) so shoulders have to develop first to provide stability so that grasp can be performed more distally
50
Why is tummy time important? How often should the baby be performing tummy time?
allows to work on antigravity control in prone position
- can encourage baby by going to their level and providing smile and toy
- 1h/day (progressively) @ 3mo
- 80 min/day @ 4mo
(make sure to not have baby sleeping on tummy bc increased risk of choking & asphyxiation)
51
What antigravity activity should be encouraged in supine?
bringing and encouraging baby to bring hands to feet in supine
52
What are the 2 equilibrium reactions?
1. center of gravity & base of support
| 2. rotational component (ex: being able to turn head whilst seated)
53
DM Fine motor - grasp: 1-1.5 yo
cylindrical grasp (like a fist) => more ulnar movement
54
DM Fine motor - grasp: 2-3 yo
digital grasp: whold with fingers with pen on palmar side but not holding it with palm
55
DM Fine motor - grasp: 3.5-4 yo
modified tripod grasp
56
DM Fine motor - grasp: 4.5-7
tripod grasp (normal grasp)
57
What would you explain to parents to encourage them to do tummy time with their baby?
works on antigravity control (upright head in midline looking at parent or at toy), on proximal stability (needed for fine mortor), weight shiftiing, socialization, sensory development
58
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Rooting (searching) reflex
primitive reflex
start: 28 wk gest
integrated: 3 mo
- Stroke cheek and cheek will turn torwards that side
- role: breast feeding
59
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Suck (swallow) reflex
primitive reflex
start: 28 wk gest
integrated: 2-5 mo
- put finger in their mouth and they will suck
- role: to eat
60
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Traction reflex
primitive reflex
start: 28 wk gest
integrated: 5 mo
- when position bby in seated position, they reflex flex their UE and perform grasp
- role: prepares for voluntary grasp
61
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Moro reflex
primitive reflex
start: 28 wk gest
integrated: 6 mo
- create falling sensation (dropping bbys head) or loud noise => bby will first extend and abduct arm then rapidly flex and adduct arm (throws and head flings limb)
- role: create instinct to cling to mother
62
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Plantar grasp
primitive reflex
start: 28 wk
integrated: 9 mo
apply pressure to sole of foot => babys toe will curl over finger
- role: prepare for standing position & prevents hypersensitivity and gravitational insecurity
63
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Galant reflex
primitive reflex
start: 32 wk
integrated: 2 mo
- create stimulus on one side of spine => will flex that side
- role: prepares for crawling/walking by facilitating trunk stabilization
64
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Palmar grasp
primitive reflex
start: 37 wk gest
integrated: 4-6 mo
- touch palm of hand & hand will grasp
- role: increases tactile input at palm (needs to be integrated to allow for grasp, fine motor)
65
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
asymmetric tonic neck reflex (ATNR)
primitive reflex
start: 37 wk gest
integrated: 6 mo
- in supine, rotate head by 90 => arm facing face will extend and arm facing skull will flex
- role: head eye coordination (if not: poor reading comprehension bc cant cross midline, handwriting, hand eye coordination, bringing arms to midline to bring things to mouth, reaching for object at front), rolling
66
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
tonic labyrinthine relfex (TNR)
primitive relfex
start: 37 wk gest
integrated: 6mo
- in prone: flexor tone; in supine: extensor tone
- role: if not integrated, will have difficulty extending/lifting head in prone bc flexor tone, and diff sitting up from supine bc extensor tone, poor m coordination
67
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Symmetric tonic neck reflex (STNR)
primitive reflex
start: 4-6 mo
integrated: 8-12 mo
- crawling and flex head: arms flex and legs extend (butt in air)
- crawling and extend head: arms extend and legs flex
- role: if not integrated: difficulty siting from supine (bc need to flex head first to sit up but that would cause leg to extent), poor m tone, poor posture (bc if arm bend then legs extend and vis vs => causing slouching forward)
68
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Landau (superman)
primitive
start: 3-4 mo
integrated: 12-24 mo
- hold bby horizontally in air prone => extension of nexk, limb, trunk
- role: break flexor tone, posture
69
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Neck righting
start: 4-6 mo
int: 5 yo
- supine and turn head fully to one side: baby will roll in that direction (log roll ie less mature rolling) to maintain head trunk alignment
- role: head trunk alignment & positioning of head
70
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Body righting
start: 4-6 mo
int: 5 yo
- supine & flex hip/knee torwards chest => baby does segmented roll (mature so body parts roll in fragments)
- role: trunk rotation
71
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
optical head righting
start: birth - 2 mo
int: lifetime
- suspend vertically and slowly tilt them off center (side to side, backwards) => bby maintain upright px by turning head using vision
- role: orient head in space when body taken out of position
72
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Labyrinthine righting
start: birth-2mo
int: lifetime
Suspend baby vertically and slowly tilt them off center (side to side, backwards) w blindfolds => will maintain upright px of head via vestibular system
- to orient head in space
73
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Downward parachute (protective reaction)
start: birth - 2mo
lifetime
Lower baby toward surface whilst suspended vertically => will extend LE
- protection against fall w accurate placement of feet
74
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Forward parachute (protective reaction)
start: 6-9 mo
lifetime
Tip baby forward whilst vertically suspended => extension of neck, UE with hands open
- protection against falls
75
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Sideward parachute (protective reaction)
start: 7 mo
lifetime
Tip baby to side whilst sitting => arm extend/abduct to side
- protection against falls, for sitting
76
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Backward parachute protective reaction)
start: 9-10 mo
lifetime
Tip baby backward => arm extend to side spinal rotation
- for walking
77
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Prone tilting (equilibrium rxn)
start: 5 mo
lifetime
Prone, tilt baby and raise 1 side of surface => baby spine curve and limbs extend/abduct
- for balance & postural adjustment & to maintain equilibrium w/o arm support
78
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Supine tilting (equilibrium rxn)
start: 7-8 mo
lifetime
Supine/sitting, tilt board, raise 1 side of surface => baby spine curve and limbs extend/abduct
- for balance & postural adjustment & to maintain equilibrium w/o arm support
79
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Quadrucep tilting (equilibrium rx)
start 9- 12 mo
lifetime
On all 4s, til board, raise 1 side => baby spine curve and limbs extend/abduct
- for balance & postural adjustment & to maintain equilibrium w/o arm support
80
Reflexes: starts at, integrated at, description (how to perform reflex & its role)
Standing tilting (equilibrium rxn)
start 12-21 mo
lifetime
Position baby standing on board and tilt and raise one side => baby spine curve and limbs extend/abduct
- for balance & postural adjustment & to maintain equilibrium w/o arm support
81
what does integration mean
the reflex now becomes voluntary
82
what activity should parents do with their children to practice antigravity movement (apart from tummy time)
gently bring their feet to their eyesight so that they reach for it or putting toy in middle or putting their hand or feet in their mouth
83
What activity should parents do to practice rolling
gently touch and rock baby on bottom or thigh and roll them halfway, supporting their trunk
OR
place them on tummy and weight of head causes baby to roll on back to see more
84
Name all reflexes that begin at 28 wk gest and when they are integrated (5)
1. rooting (3 mo)
2. suck (2-5 mo)
3. traction (5 mo)
4. moro (6 mo)
5. plantar (9mo)
85
name all reflexes that start at 32 wk and when they are integrated
galant (2 mo)
86
name all reflexes that begin at 37 wk gest and when they are integrated (3)
1. palmar (4-6 mo)
2. ATNR (6 mo)
3. TLR (6 mo)
87
Name the 4 righting reactions in order
1. neck righting: 4-6 mo to 5 yo
2. body righting: 4-6 mo to 5 yo
3. optical head righting: birth-2mo to lifetime
4. labyrinthine righting: birth-2mo to lifetime
88
name the protective reactions in order
all lifetime
1. downward: birth-2mo
2. forward 6-9 mo
3. sideward 7 mo
4. backward 9-10 mo
89
name the equilibrium rxn in order
```
all lifetime
1. prone tilting: 5 mo
2. supine tilting: 7-8 mo
3/ quadrcupet: 9-12 mo
4. stnading: 12-21 mo
```
90
name the tonic reactions in order
1. atnr: 37 wk gest to 6 mo
2. TLr 37 wk to 6 mo
3. STNR: 4-6 mo to 8-12 mo
