Week 8 Flashcards
Features of early movements
- Stepping reflex
- Rolling
- Commando crawling
- Crawling
- Bear walking
- Supported walking
- Cruising
- Walking 2 hands held
- Walking 1 hand held
- Supported walking
- Early independent walking
Gait from birth to 9 months
Early indicators of walking from birth:
- Leg movements in utero
- Primary stepping (stepping reflex can be maintained up to independent walking)
- Early stepping
- Supine kicking
- relationship between supine kicking and upright stepping
- Disproportionate contribution of fat content to overall increases in body mass first 8 months
- With increasing age and mobility, fat content drops and muscle mass increases
- Emergence of locomotor skills may have be influenced by size of child - bigger infants slower to achieve upright milestones
- Developing extensor muscle moment influences ability to move against gravity
- Body structure affects ability to stand upright - flexion at hips, some ER
- Supported walking: Hip abd, ER, flexion, tibial torsion and everted talocrural joint
- Increased hip and knee extension = ability to pull to stand
- Cruising builds strength of hip abductors
- By 8 months visual, proprioceptive and vestibular systems work to bring the COM back to a stable position - postural corrections
Age related characteristics of gait seen throughout childhood
- Stability in stance
- Sufficienct foot clearance in swing
- Prepositioning of foot for initial contact
- adequate step length
- energy conservation
Gait from 9 to 15 months
- Period of independent locomotion
- Rate limiting constraints to upright locomotion (sufficient extensor muscle strength, dynamic balance, anticipatory postural adjustments)
- Gait characterised by wide BOS, hip abdduction, flexion and external rotation
- Mild internal tibial torsion, genu varum and heel eversion
- COM at lower thoracic level - head still proprtionately large
- Prolonged stance phase and delayed swing phase typically present (will resolve usually at 2)
Gait from 18 to 24 months
- Varus angulation of tibiofemoral angle has resolved
- Hip flexion decreased to approx 5 degrres
- Hip abd decreased - normal BOS and increased anterior-posterior movement over weightbearing foot
- Heel remains everted
- Knee flexion wave emerging in initial stance phase as heel strike develops
- Improved efficiency of gait
- Rapid lower limb growth - decreased COM and cadence
- Consistent heel strike by 24 months
- Prolonged stance phase but decreased single leg stance - decreased duration phases of quads, hams and tib ant
Gait from 3-4 years
- Stabilisation of gait from 3-4 years
- Joint angles mature into adult pattern but joint torque and propulsion immature
-Tibiofemoral angle shows maximum valgus alignment - Femoral anteversion decreasing but still higher than adult values
- COM has decreased but sitll higher than adult
- Heel eversion still apparent but decreasing
Gait at 3-6 years
- Heel strike consistently present in conjunction with knee flexion wave in early stance - little difference in swing phase knee flexion from 1-7 years
- Adult percentage spent in single limb support by 4 years
- Increase pelvic-span/ankle spread ration indicates narrowing of BOS - remains constant from this point
- Postural adjustments continue to be refined - perturbation responses however still immature - vertical acceleration of COM at foot contact demonstrates deficiency in stance leg muscles to control balance
Gait at 7 years+
- By 7 years kinematic, joint torque and propulsion patterns similar to adult pattern
- Tibiofemoral angle and heel position neutral
- COM still slightly higher than adult at approx. L3
- From 7 years to puberty: increases in strength, coordination, speed in motor skills, reflected in improved efficiency of gait
- Energy expenditure - O2 consumption higher pre-puberty
Features of reach, grasp and manipulation
Upper limb function involves two main features:
- control of hand towards a target (reach)
- Object manipulation and release
Internal factors
- Age
- Experience
- Postural control
External factors
- Body position
- Degree of support
- Seating configuration
- Object properties
Development of eye-head-hand coordination
- To reach for target, infant must be able to locate it in space
- Eye movement alone or eye and head movement in combination
- Requires visual, vestibular, proprioceptive information
- Moving eye to target - saccadic eye movement
- Stabilising eye on target - smooth pursuit movement
- Saccadic develops before smooth pursuit - present in newborn
- Limited smooth pursuit in newborn - improves rapidly after 6 weeks
Development of reaching
- Requires control of the hand towards a target
- Important components to transport the arm and hand: shoulder abd and flex, elbow ext, forearm mid pronation/supination, wrist ext and radial dev
Reaching strategies from 1-7 years
- Very minimal change in strategies from 9months to 7 years
- 7 years seen as transitional period leading to adult reaching strategy
- Main differences seen in visual perception, kinaesthetic and proprioceptive input
- 1-5 years, ballistic strategies, 7 years constant monitoring of reaching, 9-11 years reduced attention required
- Seem to coincide with sensorimotor and musculoskeletal development
Development of grasp - object manipulation and release
- First few months grasp controlled by tactile and proprioceptive sensors
- <2 months hand opens with extension of arm - difficulty to grasp (coupling)
- 6-7 weeks short period of limited reaching - hand fisted and lasts for approx. 1-2 weeks
- Followed by open hand in conjunction with visual fixation on object - intentional grasping and manipulation
- New development phase at approx. 4 months - improved smoothness, improved amplitude of trajectory
Features of reach, grasp and manipulation throughout childhood
Predictable features in first 12mths largely as a result of child rearing practices:
- rotation of held objects (by 2mth)
- translation of grasped object (by 3mth)
- vibration/shaking of objects (by 4mth)
- bilateral hold of 2 objects (by 4 ½ mth)
- 2-handed hold of single object (by 4 ½ mth)
- hand-to-hand transfer of object (4 ½-6mth)
- coordinated action single object (5-6 ½ mth)
- coordinated action 2 objects (6-8 ½ mth)
- deformation of objects (7-8 ½ mth)
- sequential actions (7 ½ - 9 ½ mth)
Types of grasp
- Ulnar = 3 months
- Gross pincer = 4-8 months
- Palmar = 6 months
- Radial = 8 months
- Raking = 6-7 months
- Fine pincer = 8-12 months
- Index finger pointing = 1 year
- Opposition = 12-18 months
- Immature tripod = 2 years
- Static tripod = 3-4 years
- Dynamic tripod = 4-6 yeats
Why take base-line meausre
- Baseline of motor behaviour
- Change in performance
- Plan for and evaluate intervention
- Evaluate outcomes of known events - diagnosis, prognosis
- Screening
- Funding
Measuring capacity in motor skills across childhood
- Age
- Gender
- Growth and development
- Experience and practice (opportunity and variability)
DCD
Developmental coordination disorder
Motor coordination markedly below expected levels for the child chronological age and intelligence, which significantly interferes with academic achievement or activities of daily living, is not due to a general medical condition and does not meet the criteria for a pervasive developmental disorder
ICF for neurological conditions
Impairments:
- Weakness
- Spasticity
- Coordination
- Balance
- Paralysis
- Sensation
- Muscle stiffness
- Contracture
- CR fitness
Activity limitations
- Crawling
- PTS
- Walking
- Running
- STS
- stairs
Participation restrictions
- Community
- Preschool
- School
- Sports and recreation
Environmental factors
- Home
- Community
Personal factors
- Gender
- Age
- Personal intrinsic factors (cognition, motivation)
UMN lesion impairments/symptoms/signs
Muscle tone
- Is the force with which a muscle resists being lengthened and is dependent on the intrinsic stiffness (elasticity) of the muscle
- No neural component as the stretch reflex also resist lengthening of the muscle
Hypertonia:
- An increased resistance to passive movement and is due principally to muscle morphology and mechanical factors
Spasticity
- Is a velocity dependent increase in resistance to passive stretch of a muscle
Hypotonia:
- Is a decreased resistance to passive movement and is the result of weakness preventing voluntary activity
Primary positive and negative impairments in UMN lesions
Primary -ve
- Weakness (dynamometry, functional tests)
- Loss of dexterity (9-hole peg test, LEMOCOT, spiral test)
- Paralysis (MMT)
- Decreased sensation (sensory tests)
- Balance (modified BBS, paediatric balance scale, reach tests)
Primary +ve
- Abnormal postures
- Increased reflexes
- Spasticity (Tardieu scale)
- Hypertonia
- Muscle stiffness (muscle length and ROM tests)
- Contracture (muscle length and ROM tests)
Outcome measures for UMN lesion activity and participation restrictions
Activity
* Cardiorespiratory fitness – modified shuttle, step tests
* Walking capacity – 6-MWT, 10 metre WT
* Timed Up and Down Stairs
* Timed Up and Go
* Standing jump tests
Participation
* Canadian Occupational Performance Measure (COPM)
* Activities Scale for Kids (ASK)
* Participation and Environment Measure for Children and Youth (PEM-CY)
* Child and Adolescent Scale of Environment (CASE)
* Child and Adolescent Scale of Participation (CASP)
* Children’s Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC)
* Young Children’s Participation and Environment Measure (YCPEM)
Goal attainment scale (GAS)
- Assesses progress on individual goals in a specified time period.
- Goals are drawn from individualised education programs or individualised family service plans
- Aim of GAS to identity three IEP, IFSP goals that have the highest priority for the child and establish a 5-point scale to measure their progress
-SMART - -2 = much less than expected outcome
- -1 = less than expected outcome
- 0 = expected outcome after intervention
- +1 = greater than expected outcome
- +2 = much greater than expected outcome
Has good inter-rater reliable and good responsiveness to change
Participation based outcome measures
- Canadian Occupational Performance Measure (COPM)
- Activities Scale for kids (ASK)
- Participation and Environment Measure for Children and Youth (PEM-CY)
- Child and Adolescent Scale of Participation (CASP)
- +/- Child and Adolescent Scale of Environment (CASE)
- Children’s Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC)
- Young Children’s Participation and Environment Measure (YCPEM)
Canadian occupational performance measure (COPM)
- Outcome measure to assess outcomes of goals that are meaningful
- what activities do they want to improve?
- Focus on everyday activities
- Rates performance and satisfaction with performance
- Proxy-report for children under eight-years-old and those with communication difficulties or intellectual disability
Activities scale for kids (ASK)
- Self report questionnaire for children and youth
- 2 versions: Capability (‘can do’) and Performance (‘did do’)
- Ages 5-15 years
- Personal care, dressing, locomotion, play, standing, transfers, ‘other skills’
Participation and environment measure for children and youth (PEM-CY)
- Evaluates participation at home, school and community (e.g. indoor play and games, classroom activities, field trips, sporting groups etc)
- How often
- How involved
- Desire for change
- Each section asks about participation AND environmental factors
- Ages 5-17 years
- Duration: 30 minutes
Child and adolescent scale of participation (CASP)
- Measures the extent to which children participate in home, school and community activities
- Rate items as full participation, somewhat limited, very limited or unable (or N/A)
- Regardless of assistive devices or equipment
- Proxy report or youth report
- Duration: 10 minutes
Child and adolescent scale of environment (CASE)
- Measures impact (not frequency) of physical, social and attitudinal environmental factors
- Examines issues related to service quality and/or availability
- Duration: 5 minutes
Children’s assessment of participation and enjoyment (CAPE) and the preferences for activities of children (PAC)
- Age 6-21
- CAPE measures day to day participation and enjoyment of activities outside of school classes
- PAC takes into account the child’s preferences for those activities
- Assesses diversity, intensity and enjoyment and context (with whom, where?)
- CAPE 30-45 minutes PAC 15-20 minutes