Week 1 L 6-10 Flashcards
List some factors that can influence development.
Genetics
nutrition
environmental factors
What are the 5 main prinicples of development?
Continous process
requires maturation of the nervous system
sequence same but rate varies
cephaloaudal direction
generalised mass activity changing to more specific controlled movements
List the 4 areas of development.
Gross motor
Fine motor and vision
Language and hearing
Social behaviour and play
Give some examples of primitive reflexes.
Sucking and rooting
Palmar and plantar graap
Asymmetric tonic neck reflex (ATNR)
Describe the ATNR and why is it used?
One arm beside head and other strecthed out.
To stop baby rolling off unstable surface
When does the ATNR disappear and why?
3-4 months
need to lose this to develop voluntary movement
Define developmental delay.
Failure to attain appropriate developmental milestones for child’s corrected chronological age.
What are the red flags of development?
Asymmetry of movement Not reaching for objects by 6 months Unable to sit unsupported by 12 months Unable to walk by 18 months No speech by 18 months concerns re vision or hearing Loss of skills (regression)
Define Global developmental delay.
Significant delay in 2+ of:
gross/ fine motor, speech/ language
cognition, social/ personal, ADL
What is a globa developmental delay called in shool age children?
Learning disability
Give an example of a global developmental delay condition.
Down’s syndrome
Give examples of a developmental delay that is specifically a motor delay.
Duchenne Musculaar Dystrophy
Cerebral Palsy
Treacher- Collins syndrome is an example of what?
A specific sensory deficit and associated delay
Give an example of a specific sensory deficit and associated delay.
Oculocutaneous albinism
ASD is an example of what?
Developmental deviation
Developmental regression is seen in what syndrome?
Rett’s syndrome
What % of the UK child population has is on the autistic spectrum?
1%
What % of the UK child population have a specific learning disability?
5-10%
What causes Down’s syndrome?
Trisomy 21
Give some causes of Down’s syndrome.
prematurity hypoxia intrauterine infection kernicterus many cases no specific cause is found
What is the triad of disorders of ASD?
Communication
Social interaction
Flexibility of thought
What else can affect someone on the autistic spectrum?
Restictive/ repetitive behaviours
sensory difficulties
What investigations may be carried out if you were concerned a child had a developmental delay?
Chromosomes, FRAX, Oligoarray CGH
Neonatal PKU
Thyroid studies
CK
When does human brain development start?
The 3rd post-conception week
What intrauterine environmental factors may influence brain development?
Maternal health and disease
alcohol exposire
placental function and foetal nutrition
Give some extrauterine factors which may influence brain development.
Nutrition and environmental toxins
Emotional and social factors (neglect and lack of stimulation)
How long is the embryonic period?
Conception to week 9
What appears during the embryonic period?
Primitive streak and primitive node
What does gastrulation result in?
The development of a 3 layered embryo: ectoderm, mesoderm and endoderm
Before gastrulation occurs, the embryo is made of 2 layers, What are these called?
epiblast and hypoblast
What does the ectoderm go on to create?
skin, hair, nails and neura tissue
The mesoderm goes on to create what?
Muscle bone cartilagea nd vascualr system
What does the endoderm create?
gut and respiratory system
When does the neural tube form?
day 27
The anterior/ rostral end of the neural tube forms what? and what does the posterior/ caudal end form?
Anterior - motor cortex
Posterior - visual cortex
When does the foetal development occur?
week 9 - term (week 40/42)
Do the neuronal progenitor cells in the VZ divide asymmetrically first?
No symmetrically then asymmetrically
What process occur during neuronal migration to create the 6 layered brain cortex?
Some translocations
radial glial guides
tangeital migration and signalling pathways
Briefly describe myelination.
Oligodendrocyte progenitor cells develop processes which wrap around axon giving a myelin sheath whihc allows faster conduction of APs
When does the majority of myelination occur?
first 2 years but is ongoing into twenties
What happens when the posterior neural tube fails to close?
Spina bifida
Where is 2/3rds of the CSF produced?
By the choroid plexus located in he lateral, 3rd and 4th vetricles
Where else produces CSF?
Result of interstitial fluid movement
secreted by the lining of the subarachnoid space
What is the total CSF volume of an adult and neonate?
Adult 150mls
neonate 10-60mls
What are the functions of CSF?
Cushions the brain
maintains ICP at a constant level
transports metabolic waste products, antibodies and chemical away from the brain
Name the foramens the CSF flows through to get to the subarachnoid space?
Foramens of Magendi and Luschka
How is the CSF absorbed from the subarachnoid space?
Through the arachnoid villi into the venous drainage system of the brain
What coour should the CSF be?
Clear colourless and the same viscosity of water
If blood is in the CSF, what colours may it be?
Yellow, ink or straw coloured
If the CSF is turbid and cloudy what might this indicate?
Inflammatory cells, presence of micro-organisms or raised protein
What chemicals are most commonly measured in CSF and what would an increase in them indicate?
Protein - inflammation or infection
Glucose - raised blood glucose
What detremines intracranial pressure?
The brain and CSF volume
What does the brain require to get enough oxygena nd glucose delivered and how is this calculated?
Normal cerebral perfusion pressure (CPP)
CPP= MABP - ICP
What will cause the CPP to fall?
MAP drops or ICP rises
What can cause increased ICP?
Intracranial mass lesion/ tumour
excessive intracranial fluid or blood
faulty CSF circulation
What is the most important sign in a hydrocephalus?
Enlarging head circumference
What later signs may present in a hydrocephalus?
Setting sun sign
prominent scalp veins
splaying of the sutures
enlarged fontanelles
How may a hydrocephalus present in an adult?
Slowing mental capacity headaches blurred vision drowsiness difficulty walking secondary to spasticity
What is the treatment for a hydrocephalus?
Ventriculoperitoneal shunt
What are the indications for a lumbar puncture?
Suspected CNS ifection
Suspected subarachnoid haemorrhage
Therapeautic reduction of CSF pressure
Sampling of CSF for any other reason
What are the contraindications to lumbar pucture?
local skin infection raised ICP susected spinal cord mass or intracranial mass lesion uncontrolled bleeding diathesis spinal cord deformities lack of patient cooperation
