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
