Week 1- Postural Control Flashcards
What is the age range for infancy?
It is birth to 1 year
What are the parts of infancy?
Neonatal and infant are part of infancy
What is the age range for neonatal?
It is birth to 2 weeks of age
What is the age range for infant?
It is 3 weeks to 12 months of age
What is the age range for toddlerhood?
It is 13 months to 2 years (includes 2 yrs, 11 months)
What are the parts of early childhood?
Preschool and elementary school are part of early childhood
What is the age range for preschool?
It is 3 yrs to 5 yrs
What is the age range for elementary school?
It is 5 yrs to 10 yrs (includes 10 yrs, 11 months)
What is the age range for adolescence?
It is 11 yrs to 18 yrs
What is the age range for young adulthood?
It is 18+ yrs
True or False: Pediatric PT’s are often involved in the care of children through early adulthood
True
What is the age range for adulthood?
It is 22-40 yrs
What is the age range for middle age?
It is 40-65 yrs
What is the age range for late adulthood?
It is 65+ yrs
What does Advanced Maternal Age (AMA) describe?
It describes a pregnancy where the mother is older than 35
Who developed the eight stages of development?
Erik Erikson developed the eight stages of development
What does the eight stages of development theorize?
There is a specific psychological struggle that takes place through the eight stages of a person’s life. These struggles contribute to one’s personality throughout their development.
What is postural control?
It involves controlling the body’s position in space for the dual purposes of stability and orientation
What is postural orientation?
It is the ability to maintain an appropriate relationship between the body segments and between the body and the environment for a task
What is postural stability?
It is the ability to control the center of mass in relationship to the base of support
What is center of mass (COM)?
It is the point that is at the center of the total body mass
Where is the center of mass (COM)?
It is anterior to S-2 in the upright position
What is the center of mass (COM) controlled by?
It is controlled by the postural system
What is center of gravity?
It is the vertical projection of the center of mass (COM)
What is the center of gravity dependent on?
It is dependent on the weight and distribution of weight within the body
What is the center of pressure (COP)?
It is the center of the distribution of the total force applied to the supporting surface
Why does the center of pressure (COP) move continuously around the COM?
It keeps the COM within the support base
What is the base of support (BOS)?
It is the area of the body that is in contact with the support surface
What is quiet stance?
It is the small amount of spontaneous postural sway as the body moves continuously within its BOS
Where does the vertical line of gravity fall in the midline between?
It falls in the midline between:
-mastoid process
-anterior to shoulder joints
-hip joints
-anterior to knee joints
-anterior to ankle joints
What are the the tones for body alignment in quiet stance?
They are muscle tone and postural tone
What is muscle tone?
It is the force to which a muscle resists being lengthened (stiffness)
What happens when we stand upright?
Activity increases in antigravity postural muscles to counteract the force of gravity
What is critical to postural tone?
Sensory inputs from multiple systems
True or False: Postural control, stability, and orientation requirements will not vary with the task and environment
False
What are the three types of postural control?
-Steady state control
-Reactive control
-Proactive or anticipatory control
What is steady-state control?
It is the ability to control the COM relative to the BOS in fairly predictable and nonchanging conditions (ex: sitting, standing quietly)
What is reactive control?
It occurs in response to outside forces, such as perturbations, displacing the COG or moving the BOS (ex: being bumped in a crowd)
What is proactive or anticipatory control?
It occurs in anticipation of internally generated, destabilizing forces, such as the intent to move (ex: stepping onto a curb)
Which postural control provides a supportive framework for skilled movements?
Proactive/anticipatory control
True or False: Most functional tasks require all three aspects of balance control at some point or another
True
What does reactive balance rely on?
It relies on feedback mechanisms
How does reactive balance rely on feedback mechanisms?
Postural control that occurs in response to sensory feedback from an external perturbation
What does proactive/anticipatory balance rely on?
It relies on feedforward mechanisms
How does proactive/anticipatory balance rely on feedforward mechanisms?
Anticipatory postural adjustments that are made in anticipation of a voluntary movement that is
potentially destabilizing in order to maintain stability during the movement
What kind of perturbation is the ankle strategy?
This postural strategy has a smaller, slower perturbation
What kind of perturbation is the hip strategy?
This postural strategy has a larger, faster perturbation
What kind of perturbation is the stepping strategy?
This postural strategy has the largest, fastest perturbation
What strategy is more frequent with aging?
The stepping postural strategy is more frequent with age
What kind of perturbation is the reach strategy?
This postural strategy is elicited by a similar perturbation as the stepping strategy
What are the primary curvatures?
Thoracic and sacral are these curvatures
What are the secondary curvatures?
Cervical and lumbar are these curvatures
What does anterior protective extension look like?
Arms extend forward to prevent falling
What does lateral protective extension look like?
Arms extend to the side to prevent from falling
What does posterior protective extension look like?
The child extends head and arms forward to recover balance
What does upper extremity parachute look like?
The child, in prone horizontal suspension, is moved towards the surface head first. There is symmetrical arm extension and abduction
How old does a child show anterior and lateral protective extensions?
These reflexes appear around 6-9 months
How old does a child show the upper extremity parachute reflex?
This reflex emerges around 6-7 months
How old does a child show the posterior protective extension?
This reflex emerges around 9 months
When can children independently sit?
7-9 months
What systems is balance composed of?
Vision, vestibular, and proprioception are three systems that compose balance
When is adult-like postural control fully developed?
7 yrs
These reflexes are at the newborn to 2 months mark
Primary standing/positive support and automatic walking
What is primary standing/positive walking?
The baby, in supportive standing, first accepts weight on legs for 20-30 sec, then collapses
What is automatic walking?
The baby steps reciprocally when inclined forward
These reflexes are at the newborn to six months mark
Asymmetric tonic neck reflex (ATNR) and tonic labyrinthine reflex (TLR)
What is ATNR?
In supine, head rotation elicits chin side arm/leg extension and skull side arm/leg flexion
What is TLR?
Neck extends: increased extensor tone and extension of all limbs
Neck flexes: increased flexor tone and flexion of all limbs
Developmental changes of prenatal (25-27 weeks)
-Somersaults
-Axial rotations
-Flexing
-Kicking
-Stretching
-Punching
Developmental changes of newborn (at birth)
-Proportionately large head, relatively shorter legs than trunk and arms, C-curve throughout spine
-Flexion is the predominate posture in all limbs
What are some developmental changes in infancy during the first 3 months?
-Flexed posture dominates (head tipped forward in supported seating)
-Limb symmetry at first, progressing to asymmetry
-Increased extension of spine
-Midline orientation (ex: holding a toy at midline)
When does limb symmetry progress to asymmetry?
Begins at 2 months
When does a baby begin to lift their head in prone?
By 2 months
When does a baby show midline orientation?
By 3 months
What are some developmental changes in infancy during 4-6 months?
-On elbows on on hands posture
-Spinal extension includes lumbar region
-Head held upright
-Begins hand knees position from prone
-Becomes more independent in sitting, once positioned
-Begins to take weight on legs again in supported stance
When does a baby become more independent in sitting once positioned?
By 6 months
What are some developmental changes in infancy during 7-9 months?
-continues rolling and achieves quadrupled position
-belly crawling to creeping
-independent, though wobbly, achievement of sitting posture
-sitting becomes the preferred position for the 8 month old
-improve body-weight shifting skills
-transitions between postures are readily practiced
How old is a baby when sitting becomes the preferred position?
8 months
What are some developmental changes in infancy during 10-12 months?
-vertical postures now preferred by child
-lumbar lordosis and protruding abdomen
-pulls to standing at first, then begins to stand up without pulling
-walking: early steps with wide base of support, arms in “high guard”
How old is a baby when exaggerated lordosis and protruding abdomen begin to disappear?
2-6 years old
Around 2-6 years old, the % of body fat steadily decreases from ____% at age one year to about _____ at age five years
-22%
-12.5%-15%
Increased ___________ and decreased ___________ five the child appearance of being more lean and muscular at 2-6 years old.
-muscle tone
-body fat
What are some developmental changes in middle childhood around 7-12 years?
-Improved transitional movements and improved symmetry
-By age 10, adult skills are being refined and mastered
-Standing postural patterns emerge (ectomorphs and mesomorphs)
This body type is described as:
-passive stance, slouched posture
-small bone structure
-thin (hard to gain weight)
-lean muscle mass and flat chest
Ectomorph
This body type is described as:
-active, more military posture
-strong, athletic, hard body with defined muscles
-gain muscle easily and gain fat more easily than ectomorphs
Mesomorph
Adult skills are being refined at mastered at this age.
10 years old
Static balance (stance control in childhood)
-more difficult for children
-higher center of mass (T12)
-faster sway rate (reaches adult levels from 9-16 years)
Describe the postural responses to perturbations at ages 2-3 years old.
Well organized by amplitudes and latencies are longer than adults
Describe the postural responses to perturbations at ages 4-6 years old.
Responses become slower and more variable
Describe the postural responses to perturbations at ages 7-10 years old.
Essentially like those of an adult
Describe the sensory adaptation for 4-6 years old
Larger sway, very little reliance on vestibular system and more on somatosensory system
Describe the anticipatory control for 12-15 months old
-Able to activate postural muscles prior to arm movements
-Adult like postural control not fully developed until age 7
When does the ideal posture develop?
Adolescence
What characterizes the ideal posture?
-Less abdominal protrusion
-Less knee hyperextension
-Head and shoulders well aligned
When are transitional movements most symmetrical?
Adolescence
At what age does a child have peak control of transitional movements?
15 years old
SLIDE 33
Postural changes in older adulthood
-widened base of support
-slightly flexed knees and hips
-trunk forward lean, or protuberant abdomen
-reduced lumbar lordosis –> increased thoracic kyphosis (decreased strength of spinal extensor muscles, impaired balance, slower walking and stair climbing, shorter functional reach)
-loss of spinal flexibility and decreased ROM
In older adulthood, patients revert to more _____ postures
asymmetric
In older adulthood, the time during transitional movements _______ between positions
increase
What are contributing factors to impaired transitional movements?
-decreased balance, strength, flexibility, and confidence
-decreased activity
What systems make up balance?
Vision, vestibular, proprioception
What types of musculoskeletal changes occur in older adulthood?
-decreased strength, endurance, and muscle mass
-decreased number of type I and type II muscle fibers
-decreased number of motor units
-muscles fatigue more rapidly
-decreased spine and ankle joint ROM, as well as postural shift back onto heels
What are some balance and postural changes in older adulthood?
-increased sway in quiet stance
-reduced functional stability limits
-increased use of hip movements as opposed to ankle movements to regain balance
-altered anticipatory posture abilities due to delayed muscle onset times
-altered response strategy due to muscle weakness, reduced ankle-joint sensation, and joint stiffness
What are some cognitive changes in older adulthood?
Decreased attentional capacity, especially during multitasking
_____________ tends to increase with age and risk of injury is a major concern.
Falling
______________ is better than treatment of injury.
Prevention
True or false: Power training my be more effective than strength training in older adults with muscle weakness
True
