Week 5- Reach, Grasp, and Manipulation/ Developmental Assessment/MSK Development Flashcards
PART 1: REACH, GRASP, AND MANIPULATION
PART 1: REACH, GRASP, AND MANIPULATION
What are the 4 key components of UE control?
- ) Locating the object (visual regard or perhaps auditory regard)
- ) Transportation of arm in space (reaching and the necessary postural control to support reaching)
- ) Grasp and release
- ) In-hand manipulation
What is the difference between feedback and feedforward control?
- Feedback – input from sensory systems is compared to a reference signal (the movement that was intended) – the difference is used to update the output of the system.
- Feedforward – or anticipatory control – relies on previous experience to predict the consequences of sensory information that is received.
Locating a Target:
- Normally ________ is used to locate object and guide UE movements – requires coordination of eyes (central visual field) and head (peripheral visual field)
- Kinematic studies – eyes reach object before head movement occurs but EMG studies – neck muscles are activated first.
- Reaching to objects in the far visual field will also involve _______ movements.
- Hand movements are more accurate if _____ movements are involved.
- vision
- trunk
- eye
Kinematics of Reach and Grasp:
- The control of arm movements depends on the _______ of the task.
- During pointing – all segments of the arm are controlled as a unit.
- During reach and grasp – the hand is controlled ____________ of the other arm units.
- Velocity profiles and movement durations vary dependent on _______.
- goal
- independently
- task
Grasping:
- Patterns vary depending on________, ______, and _______ of object.
- ________ vs. ________ (eye liner versus hammering).
- Posture of thumb and fingers will vary.
- location, size, and shape
- power vs precision
- ______ grasp – handle of a suitcase
- _________ grasp – softball
- _________ grasp - bottle
- Hook
- Spherical
- Cylindrical
- ________ Grip – the finger and thumb pads are directed toward the palm to transmit a force to the object.
- ________ Grip – the forces are directed between the thumb and fingers – allows movement of the object relative to the hand and within the hand.
- Power
- Precision
What are the requirements for successful grasp? (2)
- The hand must be adapted to the shape, size, and use of the object.
- The finger movements must be timed appropriately in relation to transport so that they close on the object just at the appropriate moment.
Shaping of the hand for grasp occurs during the ___________ phase of the reach and is affected by:
- ) the ________ properties of the object such as size, shape, and texture.
- ) the ________ properties such as orientation, distance from the body, and location with respect to the body.
Transition Phase
- intrinsic
- extrinsic
What are the 4 phases of Grasp and Lift tasks?
- ) Contact between fingers and object.
- ) Grip force and load force (load on fingers) increase.
- ) Load force overcomes weight of object – movement starts.
- ) End of task – decrease in grip and load force shortly after object makes contact with table.
Grasp and Lift Tasks:
- This scheme allows great flexibility in lifting objects of different weights.
- Duration of loading depends on objects ________.
- Grip and load force ratios have to be above a certain level otherwise _________ will occur.
- Previous experience and afferent information assist in determining these ratios.
- If there is a mismatch – receptors in finger pads are activated – pacinian corpuscles.
- Role of cerebellum – predictive control of grip forces.
- ________ lesion – poor predictive control of grip forces.
- ________ lesions – normal timing of predictive grip forces but reduced response amplitudes.
- weight
- slipping
- cerebellar
- cortical
- Although reach and grasp are controlled by different systems, the timing of each is _________.
- In a patient with dysfunction, do we train them seperately or together?
- coupled
- both separately and together
- What do we develop at 4-5m of age?
- What do we develop at 9-13m of age?
- At what age do higher cognitive aspects begin?
- more accurate reaching and grasp components
- pincer grasp
- 12m
Eye Head Coordination:
- Control of saccadic eye movements develops _______ smooth pursuit.
- Initial tracking is performed with ________ eye movements.
- Limited ______ ________ present in the infant.
- Quickly improves around __ weeks of age.
- __ months – eyes stay on object most of time.
- __ months – predictive abilities.
- Head movements in smooth pursuits – present in 1 month olds and increases with age through at least 5.
- before
- saccadic
- smooth pursuit
- 6w
- 3m
- 5m
Eye Hand Coordination:
- At __ months – head-arm movements become coupled very strongly and then become uncoupled to allow more flexibility.
- At __ months – beginning postural stability – stable base for moving.
- 2m
- 4m
Motor Components of Reach and Grasp:
- __-__ months –extension of arm – opening of hand – difficulty to grasp object.
- __ months – reaching becomes more refined – approach path straightens, number of segments of the reach decreases.
- __ months – visually guided reaching.
- Reaction time reducing with age up to 16-17 years.
- 0-2m
- 4m
- 5m
Changes in Adults:
- ____-______ changes such as slowing of onset latencies for postural response or decreased movement speed.
- Coordination factors related to changes in movement or muscle activation patterns.
- Changes in the use of ________ and _________ control of both postural and mobility skills.
- time-related
- feedback and feedforward
Reaching Changes with Age:
-Discrete reaching slows __-__% in velocity – depending on task.
Hypothesized to be due to changes in information processing.
Changes in reaching coordination with more time spend in the deceleration phase.
More complex tasks – more age related changes.
30-90%
Grasping Changes with Age:
- Decrease in manual ________.
- Time required to manipulate small objects increased __-__% by age 70.
- Older adults use larger grasp forces and take longer to adapt the force.
- Most age-related decrements in reaching performance can be improved with training. Training effects remain high for at least a month after training has ended and also transfer to other reaching tasks.
- dexterity
- 20-45%
PART 2: DEVELOPMENTAL ASSESSMENT
PART 2: DEVELOPMENTAL ASSESSMENT
What are the purposes of developmental testing? (4)
- Diagnosis/Prognosis
- Eligibility for various programs
- Evaluation of outcomes
- Treatment planning
What are the basic methods of the assessment? (4)
- Interview
- History
- Clinical Observation
- Assessment Tools
- What is age equivalent score?
- What is percentile score?
- What is raw score?
- Age equivalent score: mean chronologic age represented by a certain test score.
- Percentile score: indicates the number of children of the same age or grade level who would be expected to score lower that the child tested.
- Raw score: total number of items that are passed or correct on a particular test.
- ______ = lowest score
- ______ = highest score
- Basal
- Ceiling
- What is interobserver reliability?
- What is test-retest relaibility?
- Interobserver = The reliability of 2 people performing a test and getting the same thing.
- Test-retest = Closeness of the agreement between the results of successive measurements.
- _________________________ gives an estimate of the margin of error associated with a particular test score.
- _________ scores are expressed as deviations or variations from the mean score for a group – expressed in units of standard deviation.
- Standard Error of Measurement
- Standard Scores
What are the 5 types of validity?
- Content
- Construct
- Face
- Concurrent
- Predictive
- ___________ validity means the test measures appropriate content.
- __________ validity means the test measures the skills/abilities that should be measured.
- _______ validity is simply whether the test appears (at face value) to measure what it claims to.
- _________ validity is a type of evidence that can be gathered to defend the use of a test for predicting other outcomes.
- _________ validity is one approach of criterion validity that predicts individual performance on some measure scores administered at a later date.
- Content
- Construct
- Face
- Concurrent
- Predictive
What are the criteria for evaluating a standardized test? (9)
- ) Purpose
- ) Age Range
- ) Areas Tested
- ) Time Required
- ) Administration
- ) Appropriateness
- ) Cost
- ) Reliability
- ) Validity
What is the difference between norm-referenced and criterion-referenced test?
- Norm-referenced test is a comparison between a specific child and an “average” child.
- Criterion-referenced test is a comparison to specific criteria rather than comparison to a “normal” group.
When are norm-referenced tests most appropriate?
Most appropriate when the purpose is to determine whether an infant has a motor delay or to determine eligibility for early intervention.
When are criterion-references tests most appropriate?
Are most appropriate for evaluation of the effects of physical therapy and treatment planning.
For many infants, is a norm- or criterion-referenced test recommended?
For many infants, the use of both a norm-referenced and criterion referenced assessment is recommended.
What are standardized screening tests intended to do?
differentiate between those persons who are normal and healthy in a particular respect from those who are not.
Standardized Screening:
- To identify the risk for dysfunction in specific __________ of children.
- To detect the risk for dysfunction in an _________ child.
- To formulate a register or monitoring system for children identified at risk.
- Usually done at regular intervals (i.e., yearly).
- categories
- individual
Standardized Evaluation:
- To help team determine a _________.
- To identify _________ development.
- To obtain ___________ information on child’s performance or status.
- To determine eligibility for service.
- Usually ______-referenced and/or formal.
- Usually done once or infrequently.
- diagnosis
- atypical
- baseline
- norm-referenced
Standardized Assessment:
- To plan an __________ program.
- To delineate strengths, weaknesses, and needs across domains and environments.
- Often are __________-referenced and/or informal.
- Done on an on-going basis (i.e., within treatment).
- intervention
- criterion-referenced
- Standardized Evaluation = _____-referenced
- Standardized Assessment = ______-referenced
- Standardized Evaluation = norm-referenced
- Standardized Assessment = criterion-referenced
Is the Alberta Infant Motor Scale (AIMS) a standardized assessment, evaluation, or screen?
screen
What is the bottom line for standardized tests?
Norm-referenced assessments enable the physical therapist to document the infants’ level of development and to monitor general progress; while the criterion-referenced assessment serves as a measure of direct effects of physical therapy.
How do we choose an appropriate standardized test? (8)
- Purpose of test
- Type of test
- Age Range
- Domains tested
- Psychometric characteristics
- Administration
- Time required
- Price
What are some screening tests used?
- Harris Infant Neuromotor Test (HINT)
- Miller First Step Screening Test for Evaluating Preschoolers
- Milani-Comparetti Motor Development Screening Test
- Denver II (DDST)
Harris Infant Neuromotor Test:
- Age range?
- Purpose?
- 3-12m
- Purpose is to identify developmental delay.
Miller First Step Screening Test for Evaluating Preschoolers:
- Age range?
- Purpose?
- 2y9m to 6y2m
- Assesses cognitive, communicative, physical, social-emotional, and adaptive function.
Milani-Comparetti Motor Development Screening Test:
- Age range?
- Purpose?
- 0-2 years
- Evaluates motor development on the basis of a correlation between the functional motor achievement of the child and the underlying reflex structure.
Denver II (DDST):
- Age range?
- Purpose?
-0-6y
-Screens 4 areas of development
(Personal-social, Fine motor, Language, Gross motor)
What are some tests of motor function?
- Movement Assessment of Infants
- Test of Infant Motor Performance
- Peabody Developmental Motor Scales-2 (PDMS-2)
- Alberta Infant Motor Scale (AIMS)
- Bruininks-Oseretsky Test of Motor Proficiency (BOT)
Movement Assessment of Infants:
- Evaluates muscle tone, primitive reflexes, automatic reactions, and volitional movements in the _________ of life.
- _________-referenced
- 65 items
- Requires extensive handling of the infant
- ___ minutes for testing and scoring
- first year
- criterion-referenced
- 90 minutes
Test of Infant Motor Performance:
- Purpose: capture the components of _________ and _________ control of movement that are important for function in early infancy.
- 32 weeks gestational age – 3.5 months after full term delivery
- ________-referenced
- 27 observed items, 25 elicited items
- postural and selective
- criterion-referenced
Peabody Developmental Motor Scales-2 (PDMS-2):
- Purpose?
- Age Range: Birth-__ months
- Areas Tested: _____ and _____ motor
- ______-referenced
- Time Required: __-__ minutes
- Approx. Price: $______
- Determine level of motor skill acquisition, detect small changes in motor development in children w/ known delays or disabilities and assist in programming for children with disabilities.
- 71 months
- gross and fine motor
- norm-referenced
- 45-60 minutes
- $400
Alberta Infant Motor Scale (AIMS): -Purpose? -Age Range: Birth-\_\_ months -Type: \_\_\_\_\_\_\_ or \_\_\_\_\_\_\_\_\_\_\_ -Areas Tested: 58 \_\_\_\_\_\_ motor skills divided amongst 4 positions (prone, supine, sitting, and standing) -\_\_\_\_\_\_\_-referenced Time required: \_\_-\_\_ minutes. Approx Price: $\_\_\_\_\_\_
- Identify infants and toddlers with gross motor delay and to evaluate gross motor skill maturation over time.
- Screen or evaluation
- gross motor skills
- norm-referenced
- 20-30 minutes
- $100
Bruininks-Oseretsky Test of Motor Proficiency (BOT):
- Assesses ______ and _____ motor functioning.
- Age Range: __-__ years
- ____-referenced
- gross and fine motor
- 4-14 years
- norm-referenced
What are some comprehensive developmental scales?
- Hawaii Early Learning Profile (HELP)
- Bayley II
Hawaii Early Learning Profile (HELP):
- Purpose?
- Age Range: __-__ years
- What areas are tested?
- ________-referenced
- Time required: __-__ minutes
- Determine the level of motor skill acquisitions, detect small changes in motor development in children with known delays or disabilities and assist in programming for children w/ disabilities.
- 0-6 years
- gross motor, fine motor, cognitive, social, self help, language
- 20-30 minutes
Bayley II:
- ______-referenced
- Three parts including _____, _____, and ______ scale.
- norm-referenced
- mental, motor, and behavior scale
Early Intervention Developmental Profile (EIDP):
- 6 scales?
- Age Range: birth-__ months
- ________-referenced
- perceptual fine motor, gross motor, cognition, language, social or emotional, self care
- 36 months
- criterion-referenced
PART 3: MUSCULOSKELETAL DEVELOPMENT
PART 3: MUSCULOSKELETAL DEVELOPMENT
“The effects of forces on the musculoskeletal system during the entire life span.”
Developmental Biomechanics
General Principles of Growth:
- Biological tissue is created, shaped, and remodeled through __________ or _________ forces.
- Type, direction and magnitude of force influence body size.
- As does genetics, nutrition, drugs, hormones.
internal or external
Effects of Loading on Tissue Type:
- The _______ and __________ of loading influences the type of tissue or articulation being formed.
- Forces are important in determining the type of tissue formation.
- ____________ – intermittent loading
- ___________ – continuous loading
- type and duration
- Chondrogenesis
- Osteogenesis
Bone Formation:
- Bone, cartilage, and muscle are all developed from the ___________.
- Bone formation occurs through either __________ or ___________ ossification.
- All bones, except the clavicle, mandible, and skull, are formed by ____________ ossification.
- mesoderm
- endochondral or intramembranous ossification
- endochondral
Bone Formation:
- Primary ossification centers are typically located in the center of the ___________ or body of bone. By birth, diaphysis are almost ossified.
- _________, or distal ends of bone, remain cartilaginous at birth.
- diaphysis
- epiphysis
Premies have _____ calcified bones, calcification of fetal bone increases as the fetus gains weight.
less
Bone Formation:
- Secondary ossification centers appear in early childhood in the __________.
- Timing of ossification varies with each bone, most ossified by 20 years.
- After birth, long bones grow in length at the epiphyseal plate.
epiphysis
Bone Formation:
- Bone also increases in size through ________ growth which is the accumulation of new bone in the bone surface, thus increasing bone density and thickness.
- What are the most rapid periods of bone growth?
- appositional growth
- prenatal, 7 years old, adolescence
Joint Formation:
- Begins with the formation of the cartilaginous models.
- Basic structures formed during __-__ weeks of gestation.
- Final shape develops throughout early childhood.
6-8 weeks
Bone and Mechanical Forces:
-Early on, the role of mechanical forces is ________. As fetus grows and space becomes confined, mechanical influences become more important.
-Uterine crowding can result in ______ foot and abnormal facies.
Decreased joint movement can result in _______, _________ bones.
- minimal
- club foot
- fragile, misshapen
Modeling:
- After initial development, bone shape can be changed through a process called modeling, which involves bone _________ and _________.
- What is Wolff’s Law?
- formation and resorption
- Bones develop a particular internal trabecular structure in response to the mechanical forces that are place on them.
Modeling:
- ____________ loading, parallel to the direction of growth, results in either compression or tension,
- If applied intermittently with appropriate force (weight bearing or muscle pull) it will stimulate _______.
- Intermittent compression appears to stimulate _____ growth than tension.
- Longitudinal
- growth
- more
Modeling:
- Constant or excessive static loading causes bone material to _________.
- _________-_______ Principle of bone growth regulation: growth plates produce increased growth in response to tension and decreased growth in response to excessive compression. (unequal forces due to malalignment = more malalignment)
- decrease
- Hueter-Volkmann
Modeling:
- What would stapling the epiphyseal plate do?
- _____ growth is commonly used with leg length discrepancies in children.
- The ______ technique for limb lengthening.
- Produce constant compressive slowing down one side.
- Slow growth
- Ilizarod
Modeling:
- Shear forces which run parallel to the epiphyseal plate can lead to ________ _______ changes, it occurs with normal muscle pull.
- This could result in genu ______/________, scoliosis.
- Asymetrical growth can also occur secondary to a fracture
- HOWEVER, ________ drift (Bone is able to straighten some degree of malalignment)
- torsion twisting
- varum/valgum
- flexure drift
Flexure Drift:
- Strain on a curved bone wall applied by repeated loading tends to move the bone surface in the direction of the concavity to straighten the bone.
- Bone is resorbed from the ________ side and laid down on the ________ side.
- Seen in the femur as the child loses the initial genu _______ posture.
- convex, concave
- varum
- Newborns generally have genu ______.
- At 1-2 years the legs _________.
- At 2-4 years, they generally have genu ______.
- varum
- straighten
- valgum
Alignment:
- Neonatal ___________ or “physiological limitations in motion”
- Hip, knee, and elbow _______ (hip 30 degrees)
- Spine ________
- Hips _________ and _________
- contractures
- flexion
- kyphotic
- shallow and unstable
Alignment:
- Hip – excessive _________ (69-76 degrees) decreases to a mean of 60 by 2 years of age.
- Extreme abduction appears to decrease along with the development of ________ postures.
- More _________ rotation – this relationship changes during the first two years.
- Decreased lateral rotation related to increased hip ________.
- abduction
- upright
- lateral
- extension
Alignment:
-Coxa _______ – increased angle of inclination or neck-shaft angle (135-145).
Angle decreases to adult values (125) by adolescence due to compression and tension forces that occur with weight bearing and muscle pull.
valga
Alignment:
- Torsion – normal amount of rotation present in a long bone (Femoral torsion)
- _________ occurs when the head and neck of the femur are rotated forward in the sagittal plane relative to the axis through the femoral condyles
- _________ occurs when the head and neck of the femur are rotated backwards.
- Antetorsion
- Retrotorsion
Alignment:
- Knee flexion contracture of __-__ degrees
- Apparent physiological bowing – tibia appears outwardly bowed in the frontal plane ( the entire tibia is rotated slightly forward – this places the lateral head of the gastroc in a more forward position.
-20-30 degrees
Alignment:
- The forward position of the tibia is due to the contracture of the medial knee structures due to intrauterine positioning.
- Tibiofemoral angle – ______ in the newborn.
- May be as high as 15 degrees but decreases to 5 during first year.
- __-__ yrs it shifts to genu valgum. (10-15 degree)
- varus
- 3-4 years
Alignment When to Treat:
- Bleck and McDade – If varus position of the knees is not decreasing by 18 months to 2 years – need to investigate particularly if beyond 25 degrees
- Genu valgum – If it does not reduce to __-__degrees.
-5-7 degrees
Alignment
- Tibial torsion
- Neonate – sight external torsion (5 degrees)
- Increases to ___ degrees by age 14 and 23-25 degrees by skeletal maturity.
-18
Alignment Ankle and Foot:
- Newborn – very flexible – but may have a _________ limitation.
- Talus and calcaneus are inclined medially – forefoot slightly inverted in nonweightbearing.
- Foot should have straight lateral border
- If the lateral border is a “C” – metatarsus adductus
plantarflexor
