Week 1: Atypical Development Flashcards
Risk Factors for Delivery
- facing foward (because shoulder can get stuck on pubic rim)
- face down, brow down, breech (can cause hip dislocation)
- depressed fetal heart rate from prolonged labor
- birth trauma (having to suction baby out??, forceps delivery)
ideal presentation of baby for delivery
facing backwards towards pelvis and down
delivery red flags for the mother
- diabetes, hyperthuroidism, hbp, infection, std
- T.O.R.C.H. (infections)
- poor nutrition
-placenta previa (placenta covers cervix) or abruption (placenta separates from wall or uturus) - rapid or prolonged delivery
- teratogen (ETOH, Drugs, opiods, radiation
- Neonatal Abstinence Syndrome NAS
red flags for neonates during delivery
- prematurity <37 wks
- LBW, VLBW, ELBW (extremely low birth weight <2lbs)
- HIE: hypoxic ischemic encephalopathy
- IVH: intraventricular hemorrhage
- PVL: periventricular leukomalacia
Clinical clue: motor domain
- popliteal angle
<90 degrees after 6mo
Clinical clue: motor domain
- what does hypotonia look like in newborn
- slipping through the axilla
- scarf sign
- head lag after 4mo
- landau not happening
Clinical clue: motor domain
- fisted hands >2mo
- cortical thumb
clue of nervous system
opistotonus & treatment
concerning if you lift the babys arm in supine and there is a lot of resistance
put baby in sidelying and then hands can go to midline and knees can come to chest
my baby does not want to sit- i pull her to sit, and she just stands up
CLINICAL CLUE: too much extensor tone to allow for sitting posture
refuse prone or little tummy time
CLINICAL CLUE of GI issues (should be 3 times/day at most)
toe walking all around
clinical clue of autism, low muscle tone
when should a baby favor one side/hand
not until kindergarten/late preschool
think of interuterine stroke
w sitting: clinical clue
cause low muscle tone; puts hamstring on slack
CLINICAL CLUE: bunny hopping after 10 mo
indicator for lack of disassociation of R leg from L leg (reciprocal inhibition)
Atypical Development age 1-3 mo
- excessive extension,
- tight fisting
- opisthotonus,
- synchronous movements, cramped,
- visual tracking not emerging
Atypical development age 4-6 mo
- obligatory reflexes, asymmetrical reflexes, handedness
- slipping through axilla
- no tummy tolerance
- arches in sitting
- no grasp, cortical thumb
- no smile or cooing
- no head ctrl
Atypical development age 7-9 mo
- lacks bright affeect
- enjoys supine
- presence of ANY reflexes
- no mobility
- poor sitting quality
- no protective reactions
- no parachute
- no babbling
- does not turn to name called
- no interest in social games
Atypical development age 10-12 mo
- delays in 0-8 mo skills
- no words (mama, moo)
- no pointing
- not trying to get attention
Atypical development age 14 mo
no interest in other children
- no imitating
- no use of push toys
- no 2 word phrases - no pointing
go to pathways.org to see quiz / exam pics
dont put 5 until you do this
summary and sequence of events for low tone
-> baby cannot stabilize
—> learns to hold segments artificially
——> fixing (stabilizing) prevents further mvmt of that segment
———> blocks normal process of stability w mobility
four blocks of __ development?
neck block
shoulder/scapular block
pelvic hip block (ant tilt)
pelvic hip block (post tilt)
Neck Block
hyperextension &/or ATNR
- low muscle tone
- slipping through axilla
- active chin tuck serves to elongate paraspinals
shoulder scapular block
- poor scapulo-humeral rhythm
- poor disassociation
- shoulder elevation
- weight stays on chest
Neck Block Intervations
- impart rotation in trunk to soften and activate shoulder girdle and begin increasing core strength and stability
- excessive arch = hold to tolerate flexion
- too much extension= work rotation obliques w/o touching extensors for feedback
shoulder scapular block intervention
- increase disassociation of shoulder from scapula
- lay supine w arms over foam roll or towel
–> have baby reach for toys in this position
ant pelvic tilt block
HYPOTONICITY
- no anti gravity hip flexion/adduction
- decreased trunk control
- lateral weight shift blocked, normal reactions decreased
ant pelvic tilt block compensation
frog leg persists –> wide BOS in all positions
ant pelvic tilt block intervention
get them out of sitting and get them to activate core, shoulder girdle
posterior pelvic tilt block
- hammies tight preventing full hip flexion/knee extension
- post pelvic tilt
- sacral wit
- w sitting = BAD
- rounded lumbar spine
- increased knee flexion
- difficulty w independent standing (narrow adducted BOS)
Post pelvic tilt block intervention
- sitting upright w/o influence of spastic hammies kicking in
- strength rotation around joint into ER
- sitting on bosu ball to strengthen core and glutes
