M1 LOs PDF

1. Consider PTs role in health and wellness Help provide development of human skills, health, and wellness throughout their lifespans. - Maximize potential - Having direction and purpose - Meet challenges of environment - Look beyond needs of self to needs of so...

1. Consider PTs role in health and wellness Help provide development of human skills, health, and wellness throughout their lifespans. - Maximize potential - Having direction and purpose - Meet challenges of environment - Look beyond needs of self to needs of society - Doing everything with joy 2. Explain 4 processes of development - Growth: Changes in physical dimensions (height, weight, head circumference) o Head: 2x o Trunk: 3x o Arms: 4x o Legs: 5x - Maturation: Changes toward adult form and function - Adaptation: Changes from accommodation to the environment (positive or negative) - Learning: Relatively permanent change in behavior resulting from practice 3. Understand 2 theories of aging and discuss factors that influence movement (Senescence) - Genetic Theories o Internal causes, specific to organism o Genetically determined o Gradual failure of body systems at specific point in time - Non-Genetic Theories o External causes o Interaction with environment (like pollutants), pathologies, or catastrophes lead to rapid decline - Factors that Influence Movement o Individual/Child (physical characteristics, body systems, temperament) o Environment (family, cultural practices, safety, equipment etc.)  4. Identify common reflexes and reactions and understand why we study them We are studying them because they are part of developmental sequence, indicator of neurological status, and indicator of asymmetry. a) PRIMITIVE REFLEXES (Adapted from: Barnes MR, Crutchfield CA, Heriza CB. The Neurophysiological Basis of Patient Treatment)- i) Sucking (1) Onset: 28 weeks gestation (2) Integration: 2-5 months (3) Position: supine with head in midline (4) Stimulus: place finger or nipple into infant’s mouth (5) Response: rhythmical sucking movements ii) Rooting (1) Onset: 28 weeks gestation (2) Integration: 3 months (3) Position: supine with head in midline (4) Stimulus: stroke perioral skin at corner of mouth, moving laterally toward the cheek, upper lip and lower lip, in turn (5) Response: Directed head turning toward stimulated side iii) Galant’s response (trunk incurvation) (1) Onset: 28-32 weeks gestation (2) Integration: 2 months (may persist) (3) Position: prone in neutral alignment (4) Gently stimulate along a paravertebral line about 3 cm from midline and from shoulder to buttocks: one side at a time (5) Response: lateral flexion on stimulated side iv) Moro (1) Onset: 28 weeks gestation (2) Integration: 4-6 months (3) Position: supine with head in midline (4) Stimulus: support infant’s head and shoulders with hands; allow head to drop back 20-30 degrees with respect to trunk, stretching neck muscles (5) Response: abduction of upper extremities with extension of elbows, wrists and fingers, followed by subsequent adduction of arms at shoulders and flexion at elbows v) Palmar (1) Onset: birth to 2 months (2) Integration: 4-6 months with purposeful reach/grasp (3) Position: supine with head in midline and hands free (4) Stimulus: place index finger of examiner into hand of infant from ulnar side; gently press against palmar surface (5) Response: infant’s fingers will flex around examiner’s index finger  vi) Plantar grasp (1) Onset: 28 weeks gestation (2) Integration: 9 months (3) Position: supine with head in midline, legs relaxed (4) Stimulus: firm pressure against plantar surface on infant’s foot over metatarsal heads (5) Response: Plantar flexion of all toes vii) Neonatal positive supporting (LE) (1) Onset: 35 weeks gestation (2) Integration: 1-2 months (3) Position: support infant in vertical position with examiner’s hands under the arms and around the chest (4) Stimulus: allow feet to make firm contact with tabletop or other flat surface (5) Response: simultaneous contraction of flexors and extensors so as to bear weight on lower extremities. (a) Child may only support minimal amount of body weight (b) Characterized by partial flexion of hips and knees Spontaneous walking/stepping (6) Onset: around birth (7) Integration: 2 months (8) Position: Support infant in vertical position with examiner’s hands under arms and around chest (9) Stimulus: support child upright, feet touching table surface. Incline child forward and gently move child forward to accompany any stepping (10) Response: child will make alternating, rhythmical and coordinated stepping movements b) ATTITUDINAL REFLEXES: stimulus is head and neck position (subcategory of primitive reflexes, never obligatory in typically developing children) i) Asymmetrical Tonic Neck Reflex (ATNR) (1) Onset: birth to 2 months (2) Integration: 4-6 months (3) Position: place child supine with head in midline; can test or observe in other positions (sitting, quadruped, standing) (4) Stimulus (a) Have child actively turn head by following an object from side to side (b) Passively turn child’s head slowly to one side and hold in extreme position with jaw over shoulder (5) Response: arm and leg on face side extend, arm and leg on skull side flex (fencer’s position) LOOK UP! ii) Symmetrical Tonic Neck Reflex (STNR) (1) Onset: 4-6 months (2) Integration: 8-12 months (3) Position: place child in ventral position supported by trunk, over examiner’s knee or place in quadruped position  (4) Stimulus: examiner passively flexes then extends the child’s head and neck (5) Response (a) Head and neck flexion produces flexion of the upper extremities, extension of the lower extremities (b) Head and neck extension produces extension of the upper extremities, flexion of the lower extremities Automatic Postural Reactions 1. Automatic Postural reactions a) Provide foundation for posture, balance, locomotion, and prehension b) Reactions appear during infancy and remain throughout life c) Occur in response to changes in body’s orientation and pattern of weight distribution in BOS 2. Three categories: a) Protective: extremities move out to catch person, usually due to fast or large movement of center of gravity (COG) b) Head and Trunk Righting a. Produce alignment of the body with the environment or alignment in space b. Keep the head and trunk aligned with each other (e.g. optical righting, labyrinthine righting, Landau) c. Uses three systems i. Visual ii. Vestibular iii. Somatosensory (proprioceptive or tactile) c) Equilibrium a. Equilibrium reactions: response to a slow shift of the COG b. Orderly sequence: Prone, supine, sitting, quadruped, standing c. Lags behind attainment of movement in the next higher developmental posture d. Includes lateral righting and rotation 3 Most often seen in children with neurological conditions: Neonatal positive support, Asymmetrical Tonic Neck Reflex (ATNR), Symmetrical Tonic Neck Reflex (STNR) Primitive and Attitudinal Reflexes: Integrated in the first year Automatic Postural Reactions (Protective, Righting, Equilibrium): Integrated first year + 5. List hallmark motor development skills and the age at which they develop CDC List - 2 Months o Can hold head up while on tummy o Makes smoother movements with arms and legs (fidgety movements 2-3 mo.) - 3 Months – 1B Motor Develop. Video o Dominated by physiological flexion o Able to clear airway in prone o Rhythmic kicking o Head lag o Lift head -45 degree in prone o Initial Asymmetry o Symmetry begins, more antigravity flexion control - 4 Months o Holds head steady w/out support o Pushes down on legs with feet are on hard surfaces o (possibly) roll over from tummy to back o Brings hands to mouth o When laying on stomach, pushes up with elbows o Can hold a toy and shake it - 6 Months o Rolls over in both directions (front to back and back to front) o Begins to sit w/out support o When standing, supports weight on legs and might bounce o Rocks back and forth, sometimes brawling backward before moving forward - 9 Months o Stands, holding on o Can get into sitting position o Sits w/out support o Pulls to stand  o Crawls (more modern approaches don’t include this as much) - 1 Year o Sits w/out help o Pulls to stand, walks holding furniture (cruising) o May take a few steps w/out holding on o May stand alone - 18 Months o Walks alone o May walk up steps and run o Pulls toys while walking o Can help undress themselves o Drinks from cup o Eats with spoon - 2 Years o Stands on tiptoe o Kicks a ball o Begins to run o Climbs onto and down from furniture w/out help o Walks up and down stairs holding on o Throws ball overhand o Makes or copies straight lines or circles - 3 Years o Climbs well o Runs easily o Pedals tricycle o Walks up and down stairs, one foot on each step - 4 Years o Hops and stands on one foot up to 2 seconds o Catches a bounces ball most of the time o Pours, cuts w/ supervision, and mashes own food - 5 Years o Stands on one foot for 10 secs or longer o Hops; maybe skip o Can do somersault o Uses a fork and spoon, sometimes table knife o Can use the toilet on own o Swings and climbs  6. Understand how to score the AIMS and calculate chronological and adjusted age Next week. 7. Observe and kinesthetically describe the developmental progression through the first year of life - Developmental Surveillance - Developmental Screening - Developmental/ Diagnostic Evaluation - Development is sequential (rate varies, not sequence) - Directional (Cephalo-caudally and proximal-distally) - Mobility and stability interplay Dynamic Systems Theory: The demands of the task and the environment in which a movement occurs causes an adaptation of an original movement. (Motor behavior is a result of interaction between perception and action not just NS maturation) Motor Development Concepts - Development is sequential (rate varies, not sequence) - Directional (Cephalo-caudally and proximal-distally) - Mobility and stability interplay - Sensation influences movement - Gross-motor à Fine-motor - Reflexive movement à skilled/controlled movement - Flex/extension à lateral flexion à rotation/counter-rotation - Always look for variability!!!! Postural Control - 3 systems o Visual o Vestibular o Somatosensory - Anticipatory planning occurs before a movement, reactive is response to the moment. Visual System - Plays a dominant role in postural control early in development (up through 3 years) - Studies show use of vision for postural control as early at 32-34 weeks gestation - 13-17 mo, infants who can walk experience excess sway in response to looming visual stimulus - Vision may not be fully adult like until 2-3 years Vestibular and Somatosensory Systems - Can isolate via blindfolding - In sitting, at 4-5 mo, infants responded to moving platform using the directionally appropriate muscle activation patterns - Muscle response patterns of 15 mo olds to postural perturbations show similar latencies to 7–10-year-olds. Postural Control of 4–6-year-olds - Big changes in body form - Transition period in development of posture control with balance being highly variable o NS uses visual-vestibular inputs to fine tune ankle-joint proprioception in preparation for its increased importance in posture control - Vestibular is the last system in postural control to mature Postural Control of 7-10-year-olds  - By 7-10, similar to responses of adults in vision, vestibular, and somatosensory studies - Reach period of stability - Balance not completely mature until 15-16 years Automatic Posture Adjustments - Occur in response to changes in body’s orientation to gravity and in the pattern of weight distribution within the BOS - Help maintain or regain balance and make safe to move independently - 3 types o Protective Earliest, quick displacement, lowering or falling to a surface o Reactive Peak at 10-12 mo, stimulus may be vestibular, proprioceptive, or visual. Response is restoration of proper alignment of head and trunk space. o Equilibrium Most sophisticated, total body response to a slow shift in the center of gravity outside the BOS, include rotation when mature. Standing Balance Response - Strategy use depending on degree of perturbation o Ankle strategy: Low o Hip strategy: Medium o Stepping strategy: High - Order of development o Ankle strategy: starts around 10 mo o Stepping strategy starts around 12-15 mo o Hip strategy: starts around 3 years Systems of Development Vision - Birth – 4 months o Born farsighted (can’t accommodate) Focal distance 7-10 in from face (20/800 acuity) o Eyes start to work together, and vision rapidly improves o Eye-hand coordination beings to develop as infants start tracking (interest moves from other’s face à own hand à object) o By 2 months they should be able to track 180 degrees o Visual interest 1 month: faces to objects 2 months: unilateral hand regard 3 months: strong visual inspection of hands at midline 4 months: reach for objects and will hit and shake objects o Born color bling: at 4 months can see full color - 6 months o Adult accommodation o Acuity improved to 20/40, allowing them to see further away o Eye movement in all directions - 5-8 months o 5 months: depth perception and good color vision develops; vision directs grasp and manipulation 3D! o Crawling facilitates development of eye-foot-body coordination and further development of depth perception (around 9 months) - 9-12 month o Using eyes and hands together; anticipates future position of objects in motion o Judge distances fairly well and throw things with precision - 1-2 Years o Well-developed eye-hand coordination and depth perception by 2 o 20/20 acuity by year 1 and adult binocular vision by 2 o Recognize familiar things Cognition (process of knowing) Fine Motor/ Prehension Self-Help and Oral Motor - Self-Help: Skills that allow for one to care for themselves - Oral motor development: function of lips, tongue, jaw, teeth, and palates. o Important for speech, swallowing, consuming various foods o Begins prior to birth and cont. beyond 3 yrs. o By 4, most children safely consume solids and liquids without choking - Head position with bottle feeding is important in ability and development o Chin tuck is good - Independence with sitting o Feet on floor o Elbows right height of table o Back supported Speech and Language Development - Expressive lang: ability to communicate with others using language - Receptive lang: the ability to listen and understand language o Typically, higher in younger children Social and emotional Play Bringing it all together - How old child is based on milestones o Appropriate gross motor activity that could be good. - 4-6 months based on the infant’s ability to roll over and reach for what seems to be the caregiver. - One gross motor activity o Crinkle/brightly colored things to bring the baby from side to side o Allow them to grab it In class notes - Term: 38-42 weeks (40 for age adjustment) - Premi: 37 or less - 40-32 = 8 wks premature o 33-8 weeks = 25 wk adjusted age (they are 1 week old) - Delayed: Performing in appropriate manner, but slower pace - Atypical: Abnormal muscle tone, or something along those lines, where the child is not hitting milestones - PATTERNS OF GROWTH AND DEVELOPMENT o Sensory and motor process o Based on a natural progression to ascend further up against gravity o Expect to see rapid repeated movement in infants o Cephalocaudal (head to tail) o Proximally to distally o General to specific o 1st: Sagittal o 2nd plane: Frontal o Final: transverse o Elongation precedes activation (extension control first) o Control is indicated by balance around a joint o All movement involves a weight shift Primitive weight shift = lateral flexion toward the weight bearing side Mature weight shift = elongation on the weight bearing side