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Management of the pediatric patient > Week 1 > Flashcards

Week 1 Flashcards

1
Q

Knowledge of ____ is the foundation for the practice of physical therapy

A

Knowledge of normal body development is the foundation for the practice of physical therapy

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2
Q

What are the three primary theories of motor development?

A
  • Neural-maturationist
  • Cognitive
  • Dynamical systems
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3
Q

How do human develop, according to the neural-maturationist theory of motor development?

A

Development is genetically pre-determined and neurologically driven.

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4
Q

What does the neural-maturationist theory of motor development assume?

A

It assumes that primitive reflexes are the building blocks of development and as the CNS matures, voluntary movements and functional behaviors appear

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5
Q

____ development theory system assumes a very hierarchical system of nervous system maturation

A

Neural-maturationist development theory system assumes a very hierarchical system of nervous system maturation

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6
Q

What does the neural-maturationist developmental theory attribute normal development to?

A

Increasing corticolization of the CNS

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7
Q

According to the neural-maturationist developmental theory, development is ___ and in a _____ order

A

According to the neural-maturationist developmental theory, development is linear and in a very predictable order

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8
Q

True or False. And why?

The neural-maturationist developmental theory favors more of the nature side of the nature vs nurture debate

A

True. It doesn’t recognize the importance of other body systems, the environment or the task

The neural-maturationist developmental theory favors more of the nature side of the nature vs nurture debate

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9
Q

Pediatric PT was built on the ____ developmental theory

A

Pediatric PT was built on the *neural-maturationist * developmental theory

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10
Q

Therapist that focus on the neural-maturationist developmental theory focuses on ____

A

Therapist that focus on the neural-maturationist developmental theory focuses on *the emphasis on the examination of reflex development and motor milestones

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11
Q

What is the treatment in the neural-maturationist developmental theory organized on?

A

Inhibiting primary reflexes and facilitating writing equilibrium reactions. It was very important that each child progress through each stage of motor development, hitting every motor milestone

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12
Q

According to the cognitive theory of motor development, ___ is the site of developmental control, and ____ drives development

A

According to the cognitive theory of motor development, the environment is the site of developmental control and experience drives development

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13
Q

Cognitive theory of development recognizes that early movements are based on ____, but assumes that voluntary movements are learned as a result of the child _____

A

Cognitive theory of development recognizes that early movements are based on primitive reflexes, but assumes that voluntary movements are learned as a result of the child interacting with the environment

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14
Q

Cognitive theory of development assumes that motor behavior is learned through ___

A

Cognitive theory of development assumes that motor behavior is learned through trial and error and conditioning

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15
Q

True or False

The cognitive developmental theory favors more of the nature side of the nature vs nurture debate

A

False

The cognitive developmental theory DOES NOT favor more of the nature side of the nature vs nurture debate

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16
Q

Although the cognitive theory of development doesn’t really have a significant impact on the practice of pediatric PT, what have they contributed?

A

They brought attention to the influence of cognition, the environment, and the task itself on motor development

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17
Q

___ is the most contemporary theory of motor development and is the most widely accepted today

A

The dynamical systems is the most contemporary theory of motor development and is the most widely accepted today

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18
Q

What does the dynamical systems theory of motor development assume?

A

Development of a motor pattern depends on a combination of mechanical neurologic, cognitive and perceptual factors in addition to environmental factors.

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19
Q

According to the dynamical systems theory of motor development, ____ is equal to other structures and processes that influence development, including the environment

A

According to the dynamical systems theory of motor development, neural maturation is equal to other structures and processes that influence development, including the environment

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20
Q

According to the dynamical systems theory of motor development, movements are self organizing, which means that individual sub-systems come together behaving collectively in an ordered way. What are the sub-systems that merge together to do this?

A
  • Pattern generation of the coordinative structure leading to reciprocal LE activity
  • Development of reciprocal activity of flexor and extensor muscles
  • Strength of extensor muscles
  • Changes in body size/composition
  • Antigravity control of upright posture of head & trunk
  • Appropriate decoupling of the tight synchronization characteristic of early reciprocal LE movements
  • Visual flow sensitivity required to maintain posture while moving through the environment
  • Ability to recognize the requirements of the task and be motivated to move toward a goal
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21
Q

What are the systems that are major themes of the dynamical systems theory?

A
  • Sensorimotor
  • Mechanical
  • Cognitive
  • Task
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22
Q

What are the things that the PT needs to do when applying the dynamical systems theory to pediatric practice?

A

• Search for constraints in the subsystems that limit motor
behavior. EX: decreased strength, ROM or spasticity
• Create and environment that supports or compensates for
weaker or less mature components of the systems
• Practice tasks in a meaningful and functional context
• Promote exploration of a variety of movement patterns that may be appropriate for the task
• Search for control parameters that may be manipulated by
intervention

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23
Q

What are the principles of motor development?

A
  • Developmental direction
  • Neural maturation
  • Sensitive periods
  • “Stages” of development
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24
Q

In what direction does motor development occur?

A

Cephalocaudal “head to toe”. EX: A new born baby learns to move their heads 1st, then it works its way down

Proximodistal “inside out”. Have to gain control of the core muscles before the extremities can be used

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25
Q

The direction of motor development is often dictated by ____, especially ___ but is also influenced by anthropometric characteristics

A

The direction of motor development is often dictated by muscle strength, especially extensor strength but is also influenced by anthropometric characteristics

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26
Q

What are some of the factors that can affect the rate at which development occurs?

A
  • Amount of body fat
  • Stature
  • Relative size of the head to the body
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27
Q

___ is one of the most difficult component of learning how to walk

A

Gaining control of the relatively large head in reference to the BOS is one of the most difficult component of learning how to walk

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28
Q

Edelman’s theory of neuronal group selection describes neuronal 2 sets of neuronal networks. What are they?

A
  1. Neuronal networks formed based on a genetic code. ie: nature
  2. Neuronal networks formed based on experiences ie: nurture
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29
Q

According to neural maturation, what does an individual do when faced with a motor task?

A

The individual selects the combination of neuronal groups that allows for the production of the movement that is specific to the environmental demand and uniqueness to the individual.

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30
Q

What does experience dependent and experience- expectant maturation describe?

A

The development of an early species’ specific primary repertoire of synaptic connections with a secondary repertoire developing based on experiences.

31
Q

It is thought that ____ may be the result of experience dependent maturation

A

It is thought that sensitive periods may be the result of experience dependent maturation

32
Q

Wha is a sensitive period in development?

A

After the overproduction of synapses, but before we lose the ones we don’t use

33
Q

According to practitioners, when are interventions more beneficial to educate on?

A

During the sensitive period

34
Q

According to the study done by McGraw, what approach to development was most effective?

A

Nature

35
Q

Thelen developed the dynamical systems of theory after finding what out through her research?

A

Movement comes from a complex interaction between the brain, the body and the environment

36
Q

What are primitive reflexes?

A

Involuntary movements that are present in a newborn. They originate in the lower portions of the CNS

37
Q

What happens to primitive reflexes as a newborn gets older and when?

A

Primitive reflexes start to go away or integrate. Starts to happen at 6 months, and should be gone by a year

38
Q

What happens when the primitive reflexes of a newborn don’t do what they are supposed to as the child get older?

A

There may be concern that the higher centers of the CNS are not developing properly. Because as they develop, they gain the ability to voluntarily move

39
Q

What are the primitive/spinal reflexes found in the body?

A
  • Flexor withdrawal
  • Crossed extension
  • Traction
  • Moro
  • Startle
  • Grasp
40
Q

How is the primitive/spinal reflex: flexor withdrawal stimulated and in what position is it tested?

A

Noxious stimulus (pinprick) to sole of foot. Tested in supine or sitting position.

41
Q

How is the primitive/spinal reflex: crossed extension stimulated and in what position is it tested?

A

Noxious stimulus to ball of foot of LE fixed in extension; tested in supine position.

42
Q

How is the primitive/spinal reflex: traction stimulated and in what position is it tested?

A

Grasp forearm and pull up from supine into sitting position.

43
Q

How is the primitive/spinal reflex: moro stimulated and in what position is it tested?

A

Sudden change in position of head in relation to trunk; drop patient backward from sitting position.

44
Q

How is the primitive/spinal reflex: startle stimulated and in what position is it tested?

A

Sudden loud or harsh noise.

45
Q

How is the primitive/spinal reflex: grasp stimulated and in what position is it tested?

A

Maintained pressure to palm of hand (palmar grasp) or to ball of foot under toes (plantar grasp).

46
Q

What is the normal response of the primitive/spinal reflex: flexor withdrawal, when is its onset and when does it usually get integrated?

A
  • Toes extend, foot dorsiflexes, entire LE flexes uncontrollably.
  • Onset: 28 weeks of gestation. - Integrated: 1–2 months.
47
Q

What is the normal response of the primitive/spinal reflex: crossed extension, when is its onset and when does it usually get integrated?

A
  • Opposite LE flexes, then adducts and extends.

- Onset: 28 weeks of gestation. - Integrated: 1–2 months.

48
Q

What is the normal response of the primitive/spinal reflex: traction, when is its onset and when does it usually get integrated?

A
  • Grasp and total flexion of the UE.

- Onset: 28 weeks of gestation. - Integrated: 2–5 months.

49
Q

What is the normal response of the primitive/spinal reflex: moro, when is its onset and when does it usually get integrated?

A
  • Extension, abduction of UEs, hand opening, and crying followed by flexion, adduction of arms across chest.
  • Onset: 28 weeks of gestation. - Integrated: 5–6 months.
50
Q

What is the normal response of the primitive/spinal reflex: startle, when is its onset and when does it usually get integrated?

A
  • Sudden extension or abduction of UEs, crying.
  • Onset: birth.
  • Integrated: persists.
51
Q

What is the normal response of the primitive/spinal reflex: grasp, when is its onset and when does it usually get integrated?

A
  • Maintained flexion of fingers or toes.
  • Onset: palmar, birth; plantar, 28 weeks of gestation.
  • Integrated: palmer, 4–6 months; plantar, 9 months.
52
Q

What are the tonic/brainstem reflexes found in the body?

A
  • Asymmetrical tonic neck (ATNR)
  • Symmetrical tonic neck (STNR)
  • Symmetrical tonic labyrinthine (TLR or STLR)
  • Positive supporting
  • Associated reactions
53
Q

How is the tonic/brainstem reflex: Asymmetrical tonic neck (ATNR) stimulated and in what position?

A

Rotation of the head to one side

54
Q

How is the tonic/brainstem reflex: Symmetrical tonic neck (STNR) stimulated and in what position?

A

Flexion or extension of the head

55
Q

How is the tonic/brainstem reflex: Symmetrical tonic labyrinthine (TLR or STLR) stimulated and in what position?

A

Prone or supine position

56
Q

How is the tonic/brainstem reflex: Positive supporting stimulated and in what position?

A

Contact to the ball of the foot in upright standing position

57
Q

How is the tonic/brainstem reflex: Associated reactions stimulated and in what position?

A

Resisted voluntary movement in any part of the body.

58
Q

What is the normal response of the tonic/brainstem reflex: Asymmetrical tonic neck (ATNR), when is its onset and when does it usually get integrated?

A
  • Flexion of skull limbs, extension of the jaw limbs, “bow and arrow” or “fencing” posture.
  • Onset: birth.
  • Integrated: 4–6 months.
59
Q

What is the normal response of the tonic/brainstem reflex: Symmetrical tonic neck (STNR), when is its onset and when does it usually get integrated?

A
  • With head flexion: flexion of UEs, extension of LEs; with head extension: extension of UEs, flexion of LEs.
  • Onset: 4–6 months.
  • Integrated: 8–12 months
60
Q

What is the normal response of the tonic/brainstem reflex: Symmetrical tonic labyrinthine (TLR or STLR), when is its onset and when does it usually get integrated?

A
  • With prone position: increased flexor tone/flexion of all limbs; with supine: increased extensor tone/extension of all limbs.
  • Onset: birth.
  • Integrated: 6 months.
61
Q

What is the normal response of the tonic/brainstem reflex: Positive supporting, when is its onset and when does it usually get integrated?

A
  • Rigid extension (co-contraction) of the LEs.
  • Onset: birth.
  • Integrated: 6 months.
62
Q

What is the normal response of the tonic/brainstem reflex: Associated reactions, when is its onset and when does it usually get integrated?

A
  • Involuntary movement in a resting extremity.
  • Onset: birth–3 months.
  • Integrated: 8–9 years.
63
Q

What does the lack of integration of the tonic/brainstem reflex: Asymmetrical tonic neck (ATNR) lead to?

A

It can get in the way of the development of good eye hand coordination, reaching and grasping

64
Q

What happens if the plantar grasp reflex persist past when it is supposed to?

A

The baby might have difficulty learning to stand and walk

65
Q

What is physiological flexion?

A

The fetal position that a newborn baby is in as a result of the position they were in the in womb

66
Q

What characterizes the movements that occur during the newborn age?

A

Movements are primarily reflexive, even when it is standing

67
Q

At what age is the baby supposed to be able to hold their head up?

A

3 months. In the time leading up to this, tummy time is very important

68
Q

What movements is a 3 month old baby supposed to be able to do?

A
  • Hold head up
  • Hold head in midline position when in supine
  • Put hands together, in mouth or look at their hands while in supine
  • Head control, in a supported seating or standing position
69
Q

True or False

A 3 month old baby is able to maintain independent sitting or standing position for approximately 3-4 seconds

A

FALSE

A 3 month old baby is NOT able to maintain independent sitting or standing position for any amount of time

70
Q

What movements is a 6 month old baby supposed to be able to do?

A
  • Learning to sit up for a few seconds before falling over
  • Gained trunk control to be able to hold up head, upper trunk and lower trunk in a sitting position, but is still pretty unsteady
  • Extend/push up on arms, lift chest off support surface and may bring knees under them to get to a hands and knees position in prone
  • Abdominal strength to curl the trunk, grab feet and put them in the mouth in supine
  • Able to roll from supine to prone
  • Can stand with hands held, but is probably not attempting to take any steps
71
Q

What movements is a 9 month old baby supposed to be able to do?

A
  • Achieved some sort of independent mobility: rolling, creeping or crawling
  • Move in and out of a sitting position
  • Pulls self to standing on a stable surface
  • Can take steps with hands held, can cruise by stepping from side to side by holding a stable surface
  • Possible stand independently for a few seconds or attempt to take a few steps independently
72
Q

What does it mean when a child is creeping?

A

Up on hand and knees with a reciprocal hand and knees pattern

73
Q

What movements is a 12 month old baby supposed to be able to do?

A
  • Gained control of knees, lower legs and ankles
  • Creeping and crawling may be primary means of mobility, but is beginning to stand independently and have takes 1st steps
  • Some babies might be crawling up and down stairs, attempt to squat w/out falling, possibly be able to run and climb

Management of the pediatric patient (8 decks)

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