W2 PPT- Peds- Typical and Atypical Postnatal Development PDF

2/29/2024 Through the Lifecycle (PTA 1011) Power Point #2 Typical & Atypical Development Babycenter.com 1 1  2/29/2024 Review: Na...

2/29/2024 Through the Lifecycle (PTA 1011) Power Point #2 Typical & Atypical Development Babycenter.com 1 1  2/29/2024 Review: Name these reflexes Memorangapp.com HelloMrdoctor.com Quizlet.com 2  2/29/2024 Name these Reflexes Moro Reflex ATNR Journalsrcni.com Natural health and learning centre ©Stanbridge University 2024 3 3  2/29/2024 Chapter 3 Motor Control and Motor Learning ©Stanbridge University 2024 4 4  2/29/2024 After reading and studying these chapters and the materials presented, the student will be able to: Identify stages of development postnatal) and motor milestones Understand the development of motor control Recognize postural reactions and their Learning impact on development Understand the characteristics of Objectives typical and atypical development and recognize red flags Recognize the effects of poverty on development 5  2/29/2024 Described by the relationship of mobility and stability of body postures and by the acquisition of automatic postural responses Development Develops in this order: of Motor Mobility- Stability- Controlled Control Mobility- Skill With acquisition of each new posture comes the development of control within that posture- for example weight bearing in prone precedes rolling from prone to supine (refer to figure 3-6 on following slide and in Martin/Kessler Ch. 3, pg. 37) 6  2/29/2024 Stage 1- Mobility -Random movements for first 3 months, often reflexed based; in supine Stage 2- Stability -Ability to maintain a steady position in a weight-bearing, anti-gravity posture; divided into tonic holding and co- contraction Stage 3- Controlled Mobility -mobility superimposed on previously developed postural stability by weight shifting w/in a posture; proximal mobility combined with distal stability Stage 4- Skill - Most mature type of movement and is usually mastered after controlled mobility; reciprocal creeping and walking 7 ©Stanbridge University 2024 7  2/29/2024 With newborns- sensory stimulus produces a reflexive motor Role of response As voluntary movement emerges Sensation sensation provides feedback accuracy for hand placement during in Motor reaching and later for creeping Sensation from weight-bearing Control reinforces maintenance of developmental postures such as prone on elbows and quadruped 8  2/29/2024 Sensation provides the necessary feedback for the body Sensory information is crucial to the mover when interacting with objects and maneuvering within the environment 9  2/29/2024 Development of Postural Control Develops in a Postural control is The infant learns to cephalocaudal demonstrated by the attain and maintain direction ability to maintain the an upright posture alignment of the through automatic (head to toe) body postural responses ©Stanbridge University 2024 10 10  2/29/2024 What are they? Autonomic movements and adjustments in response to, or in anticipation of, changes of position in relation to the center Righting of gravity There are three: Protective Postural Reactions and Responses Equilibrium 11  2/29/2024 They allow an individual to maintain an erect posture against gravity while Postural adjusting to movement “Develop as the infant matures and Reactions reflexive behaviors are integrated and provide the basis for postural stability and upon where more mature movement is built.” (Alexander et al, 1993) Responses It involves both stability and movement Various factors influence it such as vision and muscle tone 12  2/29/2024 Function of Righting Reactions Responsible for Maintaining head and orienting the head in First postural reactions body alignment through space, keeping the eyes to develop changing positions and mouth horizontal to the ground Gravity or change in Normal alignment is Involve head and trunk head or body position maintained in the movements to maintain provide cues (vision upright vertical position or regain alignment or cues- optical righting, when the body is tilted orientation gravity cues for or rotated labyrinthine) Martin/Kessler pg. 38-39 13  2/29/2024 Righting reactions occur Head righting reactions when weight is shifted are the initial ones to within a base of support- develop and assist the the amount of displacement infant in developing head determines the degree of control the response Have maximum influence Righting reactions are no on movement and posture longer present if child is between 10-12 months old able to assume standing and may continue to be from supine without using present until the age of 5 trunk rotation Righting Reactions 14  2/29/2024 Righting Reactions: Head righting develops first then trunk righting Neck on Body Righting (NOB)- immature and Postural mature Reactions Optical Righting/Labyrinthine and and neck righting Trunk Righting- Body on Responses Body Righting (BOB)- immature and mature Landau Seated trunk and head righting 15  2/29/2024 Head / Neck Righting Reactions Neck on Body Righting (NOB)- immature Slideshare.net Stimulus: Child in supine, rotate head to one side Response: Child rolls to same side head Head is turned (log roll) passively turned- Significance: Infant uses it to transition infant log between supine, side lying and eventually rolls to prone same side Onset: 34 weeks gestation Integration: 4-6 months ©Stanbridge University 2024 16 16  2/29/2024 Head / Neck Righting Reactions Neck on Body (NOB)- mature Stimulus: head turn to one Babycenter.com side Response: Child rolls to Segmental roll, same side with a segmental roll infant able to Significance: allows for more dissociate upper mature rolling and later gait and lower body- rotation lower body Onset: 4-6 months Integration: 5 years old ©Stanbridge University 2024 17 17  2/29/2024 18 Optical Righting/Labyrinthine Righting Stimulus: tilt child anterior, posterior, then laterally to both sides (can hold child in Youtube.com upright vertical position or perform seated on therapy ball or lap) Response: head orients to vertical position (moves opposite the body); eyes and face remain vertical or horizontal to the horizon Significance: allows head to be upright to the horizon; earliest form of body orientation Onset: birth -2months Integration: persists through life *To isolate labyrinthine- cover eyes/blindfold Quizlet.com 18  2/29/2024 Example of head Head Righting righting in prone- The infant is also able to shift weight onto one extended arm and to reach forward with the other hand to grasp an object. The reaching movement is counterbalanced by a lateral weight shift of the trunk that produces lateral head and trunk bending away from the side of the weight shift This lateral bending in response to a weight shift is called a righting reaction, (6 months old). Martin/Kessler 2016 FIGURE 4-32 Lateral righting reaction. 19 ©Stanbridge University 2024 19  2/29/2024 Trunk Righting Reactions Body on Body righting (BOB)- immature Stimulus: Child in supine, gently grasp one LE and cross it over the contralateral LE with the hip in flexion Response: log rolling over to same side Significance: assists infant in rolling between supine and prone Onset: 34 weeks gestation Integration: 4-6 months Body on Body righting (BOB)- mature Reflexes Flashcards- cram.com Stimulus: Same as above Response: Child rolls segmentally Significance: facilitates spinal rotation; important for quadruped, sitting and standing positions Onset: 4-6 months Integration: 5 years old ©Stanbridge University 2024 20 20  2/29/2024 Trunk Righting Reactions Landau (total body righting against gravity) Stimulus: hold child in horizontal suspension under the tummy and observe Response: the head, hips, UEs and spine should extend, “superman” appearance. If head is flexed, lower extremity and upper extremity should flex as well. Significance: can indicate abnormal muscle tone; breaks up total flexion pattern seen at birth; helps infant develop co-contraction of the proximal joints and coordination of movement between flexion and extension Onset: 3-4 months Integration: 12-24 months Without integration: can cause movements to be stiff in the lower body with challenges in hopping and jumping Image from You Tube- Pediatric neuro exam 21 21  2/29/2024 FIGURE 4-33 A, Eliciting a Landau reflex. B, Spontaneous Landau reflex. Martin/Kessler 2016 This extended posture is called the Landau reflex and represents total body righting against gravity. It is mature when the infant can demonstrate hip extension when held away from the support surface, supported only under the tummy. The infant appears to be flying ©Stanbridge University 2024 22 22  2/29/2024 Reaction Age at Onset Age at Integration Head Righting- Neck 34 weeks gestation 4-6 months (immature- NOB) Labyrinthine Birth-2 months persists Optical Birth-2 months persists Head Righting- Neck 4-6 months 5 years (mature- NOB ) Trunk Righting- body 34 weeks gestation 4-6 months (immature- BOB) Trunk Righting-body 4-6 months 5 years (mature- BOB) Landau 3-4 months 1-2 years Righting Reactions 23  2/29/2024 Function of Protective Reactions Extension of extremities in the same direction of an external force to promote stability and safeguard balance in higher postures such as sitting (e.g. out-stretching of arm(s) when body is pushed forward or sideways) Typically rapid diagonal or horizontal displacement forces elicit the response By extending one or both extremities they prepare for a fall or to catch themselves from falling over Second postural reactions to develop; they emerge in an effort to safeguard balance in higher postures such as sitting 24 24  2/29/2024 Response: Infants LEs Stimulus: hold infant in extend and abduct and vertical upright then Downward LEs: quickly lower to feet dorsiflex in preparation for weight- supporting surface bearing Integration: persists Onset: 4 months Martin/Kessler Ch. 3 through life Protective Reactions 25  2/29/2024 Protective Reactions Parachute (forward extension downward) : Flickr.com Stimulus: hold infant in vertical upright then quickly plunge the infant downward toward the surface with head leading Response: Infants UEs extend with hands open, fingers extended in order to protect their head/face and break the fall Onset: 6-7 months Integration: persists through life Neuro exam, Youtube.com ©Stanbridge University 2024 26 26  2/29/2024 Protective Reactions Sideways or Lateral UE Extension: Stimulus: Infant sitting in long sitting or ring Neuro exam, Youtube.com sitting, apply a force to the shoulder girdle to displace center of gravity laterally Response: the arms should abduct and extend to the side toward the fall or loss of balance with open palms then weight bear on the surface to prevent a fall Onset: 7-8 months Integration: Persists through life 27 Flickr.com 27  2/29/2024 Protective Reactions Backward or Rear UE Extension: Stimulus: Infant sitting in long or ring sit, Flickr.com apply a force to the anterior shoulder girdle or trunk to displace center of gravity backwards Response: Infant extends one or both UEs backward to catch themselves from falling (may extend arm back in a more diagonal position depending on direction of force) Onset: 9- 10 months Integration: Persists through life FIGURE 4-39 Lateral upper extremity protective reaction in response to loss of sitting balance. ©Stanbridge University 2024 28 28  2/29/2024 Reaction Age at Onset Age at Integration Downward lower 4 months persists extremity Forward upper 6-7 months persists extremity Sideways upper 7-8 months persists extremity Backward upper 9 months persists extremity Stepping lower 15-17 months persists extremity Protective Extension Reactions 29 ©Stanbridge University 2024 29  2/29/2024 Equilibrium Reactions Develops in all postures beginning in prone Returning body position to vertical after being displaced They are the most advanced postural reactions and last to develop Allow body as a whole to adapt to small changes in the relationship with the COG with the BOS Incorporates the already learned righting reactions and adds extremity responses and lateral movements of the head and/or trunk to regain equilibrium Martin/Kessler 2016, Ch. 3 ©Stanbridge University 2024 30 30  2/29/2024 Equilibrium Reactions First seen in prone position around 6 months old as infant moves against gravity The infant is always working on more than one postural level at a time For example: an 8-month-old infant is perfecting supine equilibrium reactions while learning to control weight shifts in sitting (freeing one hand, then two) Sitting equilibrium reactions mature Adamila.com when the infant is creeping on all fours 31 ©Stanbridge University 2024 31  2/29/2024 Reaction Age at Onset Age at Integration Equilibrium- prone 6 months persists Supine 7-8 months persists sitting 7-8 months persists quadruped 9-12 months persists standing 12- 24 months persists Equilibrium Reactions 32 ©Stanbridge University 2024 32  2/29/2024 1) The Landau Response is a righting reaction, and helps the infant to do what? a) Helps infant move between flexion and extension Development b) Helps infant to find food Learning source Assessment c) Helps infant to hold bottle in midline d) Helps infant to creep on all fours 33  2/29/2024 2) Neck on body (NOB) describes what type of postural reaction? Development a) Equilibrium reactions Learning b) Protective extension Assessment c) Primitive reflex d) Righting reactions 34  2/29/2024 Development of Performance Skills Motor Skills Process Skills Communication/Interaction Skills ©Stanbridge University 2024 35 35  2/29/2024 Development takes place in more than one dimension, not just in Development motor development of Many different theorists and psychologists have theories on the Performance development of intelligence, Skills cognition, personality, movement and perception (e.g., Piaget, Maslow, Erikson) 36  2/29/2024 Involved in moving and interacting with the environment Performance Posture, mobility, Skills- Fine coordination, strength, and Gross effort, and energy Motor Skills Example – stabilizing the body and manipulating objects 37  2/29/2024 Performance Skills- Processing and Cognition skills used in knowledge, Example – maintaining temporal attention to a task, gathering completing daily the right tools and materials tasks organization, for a task, and responding to organizing space problems by accommodating and objects, the methods used adaptation 38 38  2/29/2024 Developed a theory on intelligence in 1952 based on the behavioral responses of his children He believed that in the first 2 years of life the infant learns to understand the world by associating sensory experiences with physical actions Piaget He called these associations “schemas” The infant develops schemas for looking, eating and reaching, etc… 39  2/29/2024 Life Span Period Stage Characteristics Infancy Sensorimotor Pairing of sensory and motor (0-2) reflexes lead to purposeful activity Preschool Preoperational Unidimensional awareness of (ages 2-7) environment; begins use of symbols and increased use of language School age Concrete Operational Solves problems with real (ages 7-11) objects; classification, conservation; logical thought Pubescence Formal Operational Solves abstract problems; induction and deduction ©Stanbridge University 2024 40 40  2/29/2024 Life Span Period Stage Characteristics Self-trust, attachment; Infancy Trust vs. Mistrust infant must form a loving- trusting relationship Erikson’s Eight Stages of Late Infancy Autonomy vs. Shame or doubt Independence, self- control; motivated toward Development functional movement Initiative vs. guilt Initiation of own activity; Childhood (preschool) motivated by social challenges Describes stages that a person goes through to Industry vs. Inferiority Working on projects for School Age recognition; peer establish personality comparisons These stages are linked to ages in the person’s Identity vs. role Sense of self, physically, life, with each stage Adolescence confusion socially, and sexually representing a struggle between two opposing Intimacy vs. Isolation Relationship with traits Early Adulthood significant other and deeper friendships Erikson’s theory is an excellent example of a Generativity vs. Guiding the next life span approach to Middle Adulthood Stagnation generation; motivated development toward development of satisfaction in chosen Martin/Kessler Ch. 4 occupation Ego Integrity vs. Sense of wholeness, Late Adulthood despair vitality, wisdom and fulfillment from life 41  2/29/2024 Language and Skills needed to Psychosocial interact with Development other people Performance Skills- Communication and Interaction Examples: skills gesturing, Information affect, relating in exchange, and a manner that relations establishes rapport ©Stanbridge University 2024 42 42  2/29/2024 First 3 months - Characterized by lung expansion, increased efficiency of blood flow, developing CNS to control body’s regulation of sleep, digestion, and temperature By 4 months sleep patterns begin to be regulated – may sleep through the night Infancy Development Physical growth in first 6 months- more rapid than any other time except during gestation By 6 months – get first tooth, a lower incisor – saliva production increases 43  2/29/2024 Infancy- Vision Development Newborn infants see best at 8”- 10” Usually the distance between the caregiver's face and theirs Newborns are nearsighted Goodtherapy.com 44  2/29/2024 By 1 month – shows preference for patterns By 3 months- can By 12 months- visual and contrast and distinguish a real face acuity is about 20/100 distinguishes between from a picture of a face to 20/50 dark and light colors Infancy – Vision Development 45  2/29/2024 https://www.youtube.com/watch?v=cCFzqcje838 Infancy Vision Development ©Stanbridge University 2024 46 46  2/29/2024 According to the AOA- Eye-hand coordination American Optometric starts developing as the Depth perception and Association: Vision (acuity, Eye and vision focusing and moving eyes problems can affect infant starts tracking color vision typically accurately and together) and moving objects with their developed by 5 months normal development eyes and then reaches for how the brain uses visual old information are learned skills them (3 months) Infancy – Vision Development 47  2/29/2024 Slideplayer.com Adult Vision vs Newborn Vision 48 ©Stanbridge University 2024 48  2/29/2024 Slideplayer.com Adult Vision vs 6 Month Infant 49 ©Stanbridge University 2024 49  2/29/2024 Infancy – Auditory (hearing) Development Well developed at birth Respond strongly to mother’s voice Studies show that infant hears mother’s voice in utero At 2 months respond to sound with random body movements At 3 months move eyes to source of sound At 6 months localize direction of sound to left and right sides and will turn their head toward the sound ©Stanbridge University 2024 50 50  2/29/2024 ONE OF THE MOST TASTE SMELL TOUCH, IMPORTANT STIMULI AT BIRTH – ABLE TO 0 – 3 MONTHS ARE TEMPERATURE, PAIN, BETWEEN BIRTH AND 3 TASTE SWEET, SOUR, ABLE TO AND PRESSURE MONTHS IS SKIN AND BITTER DIFFERENTIATE CONTACT AND VERY SENSITIVE TO WARMTH! HOLDING BETWEEN PLEASANT AND NOXIOUS ODORS THESE DURING FIRST 3 AND SWADDLING MONTHS Infancy – Other Sensory Skill Development 51  2/29/2024 Head Control – 4 months Segmental rolling supine to prone – 6- 8 months Infancy Sits alone steadily without help- 6- 8 months Development - Motor Four-point Creeps – 9-10 months Milestones Standing alone – 10-11 months Walking – 12 months 52  2/29/2024 Infancy- Fine Motor Development Grasp is initially reflexive Hands tend to be fisted in newborns Pediatrics.aappublication Reflexive grasp is replaced by voluntary grasp by 6 months Grasping rattle (palmar grasp) – 2-3 months Developing ability to release objects at 4-5 months Raking with fingers with forearm pronated at 5-6 months (i.e., cereal, raisins) ©Stanbridge University 2024 Connectability.ca 53 53  2/29/2024 Figures 416, 4-17, and 4-18- Martin/Kessler Infancy- Fine Motor Radial palmar grasp- thumb Development adduction begins Grasp on cube – Radial digital grasp- – Radial Palmar grasp – 7 months beginning opposition (Fig 4-16) – Radial digital grasp – 8-9 months (Fig 4-17) Grasp on pellet – Fine Inferior pincer – Fine Inferior pincer grasp – 9-12 grasp- isolated index pointing months (Figure 4-18) ©Stanbridge University 2024 54 54  2/29/2024 Infancy- Fine Motor Development Grasp on pellet continued– Superior pincer grasp Three jaw chuck grasp Superior pincer grasp (tip to tip) Fig. 4-19, Martin/Kessler Fig 4-20, Martin/Kessler – 12 months (Fig. 4-19) Three jaw chuck grasp- 12 months (Fig. 4-20) Wrist extended with ulnar studyhippo.com deviation; maturing release Grasp on marker – Palmar-Supinate – 1 to 1 ½ years Palmer supinate grasp 55  2/29/2024 Psychologenie.com Infancy – Cognition and Processing Skills Piaget’s Sensorimotor Period- birth to about age 2 According to Piaget, the Sensorimotor stage of development is the first stage that a child will pass through. This stage begins at birth and continues until the age of two. The infant gains information about the world by tasting, banging and grasping, etc… By the end of this stage, the child begins to understand cause and effect and object permanence – Object permanence is the realization that objects continue to exist outside their direct visual field ©Stanbridge University 2024 56 parents.com 56  2/29/2024 Biomechanical Considerations in Motor Development Full-term babies are born with predominant flexor tone called, “physiological flexion” Slideshare.net – The limbs and trunk naturally assume a flexed position – If you try to straighten or uncoil any extremity, it will return to its original position easily – Influence of gravity, infant’s body weight, and some of the early primitive reflexes help the infant to extend out of flexion – Essential for the development of normal posture and movement Figure 4-7, Martin/Kessler ©Stanbridge University 2024 57 57  2/29/2024 In supine position- In Prone position- no active control in midline, avoids overstimulation, provides uncoordinated movements, stable base and more symmetry random kicking helps move for infant newborn out of flexion Flexion pushes weight towards Infant able to stretch out and head and shoulders elongate (extend trunk and legs) Physiological flexion 58  2/29/2024 Biomechanical Considerations in Motor Development Antigravity Extension- easiest to achieve early on due to extensor muscles in a lengthened position from prone physiological flexion position – i.e., Lifting up the head off surface in prone Babies have a c-shaped spine at birth- – Exposure to head lifting in prone develops the secondary cervical curve Fig. 4-10, Martin/Kessler – Lack of prone or tummy time diminishes the infant’s ability to extend their head up and turn their head ©Stanbridge University 2024 59 59  2/29/2024 Biomechanical Considerations in Motor Development Antigravity Flexion- exhibited from the Tomt.skillsforaction.com supine position – Develops after antigravity extension – Ability to pick up head off surface using neck flexors in supine- no head lag – Ability to lift limbs off the surface, i.e., Fig. 4-25 Martin/Kessler hands coming to midline, kicking LEs ©Stanbridge University 2024 60 60  2/29/2024 Importance of Tummy Time During Early Development Physiological flexion in prone and prone positioning assists with development: – Newborn and early infancy- Developmentalgym.com Facilitates head turning and head control Rooting reflex and cheek pressure for sucking and chewing- increases oral- motor control Hand to mouth Healthxchange.sg ©Stanbridge University 2024 61 61  2/29/2024 Importance of Tummy Time During Early Development Physiological flexion in prone and prone positioning assists with development: (cont.) – Middle infancy- UE strengthening and shoulder girdle stability: – Pushing up in prone 5 months – provides sensory awareness, allows infant to view both hands, and increases shoulder girdle and neck strength – Pushing up in prone- puts weight on ulnar side of palm first, facilitating palmar grasp Fig. 4-30, Martin/Kessler – By six months weight shifts in prone- put weight on radial side of palm – preparing to assume quadruped ©Stanbridge University 2024 62 62  2/29/2024 Atypical Development Chapter 1, pgs. 12-15 ©Stanbridge University 2024 63 63  2/29/2024 Common Characteristics of Delayed or Atypical Motor Development Muscle Lack of variety of Abnormal weakness and Asymmetry movements or muscle tone joint instability positions Develop atypical Imbalance Retained or non- Poor prone movement between flexion integrated tolerance patterns and extension reflexes 64 64  2/29/2024 Excessive frog leg position (low Warning Signs and muscle tone) Red Flags for Atypical Development Cortical fisting Presence of strong ATNR (asymmetrical tonic neck reflex) after 5 months old Rolling – if it persists past 4 months (rolls around to get everywhere but does not develop past rrnursingschool.biz that) Poor postural and/or head control after 5 months Head lag after 5 months Avoidance or inability to weight bear on upper extremities in prone by 5 months old Excessive Frog Leg Position (Flexion, Abduction and Extension of Lower Extremities) Pediatrics.aapublication. Persistent cortical thumb position in fist (a sign of CNS or neurological dysfunction) – Should be resolved by 7 months Severe head lag (low muscle tone) ©Stanbridge University 2024 65 65  2/29/2024 Atypical Development- Tone Tone- is the normal tension found in muscles and can be described as a slight resistance felt when a joint is moving in its total range of motion https://www.youtube.com/watch?v=YNnwf_XbRac Atypical tone becomes an issue when it affects the child’s ability to move and be independent. 66 66  2/29/2024 Atypical Tone- Types Fluctuating Rigidity Hypertonia Tone Hypotonia Flaccidity ©Stanbridge University 2024 67 67  2/29/2024 Hypertonia- increased tone or spasticity – Seen in individuals with upper motor neuron disease – Resistance to movement increases in response to rapid movement of the joint or limb, as if it were Types of “catching” – Clonus Abnormal – Can be reduced through handling, orthotics and medications Fluctuating tone- athetoid, writhing and Tone uncontrolled movements – Tone fluctuates between hypertonia and near- normal tone – Damage near the basal ganglia (extrapyramidal) 68  2/29/2024 Rigidity- significant resistance to movement caused from dystonia as seen in Parkinson’s disease or anoxic events – Dystonia- a movement disorder in which a Types of person’s muscles contract uncontrollably – Rigidity differs from spasticity because it is Abnormal present throughout the entire range of motion – Described as “lead-pipe” or “cogwheel” rigidity Tone Lead-pipe- extreme tone that does not break; stiffness and inflexibility that remains uniform throughout PROM Cogwheel- intermittent breaks in increased tone; jerky movements 69  2/29/2024 Hypotonia- decreased tone, “floppiness” – lack of resistance to moving Flaccidity- marked hypotonia Types of – Both hypotonia and flaccidity can be Abnormal associated to lower motor neuron involvement and present in disorders Tone such as polio, spinal cord injury and brachial plexus injuries, also some genetic disorders such as Down syndrome 70  2/29/2024 Table 1-3 Modified Ashworth Scale Grade Description 0 No increase in muscle tone 1 Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the ROM when the affected part(s) is moved in flexion or extension Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout 1+ the remainder (less than half) of the ROM 2 More marked increase in muscle tone through most of the ROM, but affected parts move easily 3 Considerable increase in muscle tone; passive movement difficult 4 Affected part(s) rigid in flexion or extension ©Stanbridge University 2024 71 71  2/29/2024 Atypical tone may interfere with the therapy session It needs to be addressed as part of the therapy session either by controlling it, reducing it, or using it Techniques used to reduce hypertonicity or Tone spasticity – Positioning/handling Reducing – PROM/stretching Techniques – Slow, rhythmical movements – Modalities (i.e., electrotherapy) – Joint compression, weight bearing Always starting at proximal joints provides a better chance for success 72  2/29/2024 Tone Reducing Techniques Intervention 5-9, Slow, rhythmic rotation of the trunk in side-lying to decrease muscle tone and to improve respiration. Some children are unable to attempt any change in position without this preparation. (Martin/Kessler) ©Stanbridge University 2024 73 73  2/29/2024 UE’s Tone Reducing Techniques Fig 5-8 Handshake grasp LE’s The child’s extremity is slowly and rhythmically externally rotated as the arm is abducted away from the body and elevated. The abduction Intervention 5-10, Alternating Intervention 5-12, Lower trunk rotation and elevation of the arm allow for pressure with manual contact and pelvic rocking to aid in abducting some trunk lengthening, which can on the pelvis can be used to the lower extremities in the presence be helpful prior to rolling or shifting decrease muscle tone and to of increased adductor muscle tone. weight in sitting or standing.. facilitate pelvic and lower (Martin/Kessler) Various hand grasps can be used extremity motion. when moving the upper extremity. (Martin/Kessler) A handshake grasp is commonly used, as is grasping the thumb and thenar eminence, ©Stanbridge University 2024 74 (Martin/Kessler) 74  2/29/2024 Tone Reducing Techniques Intervention 5-13, When generalized increased tone exists, as in a child with quadriplegic cerebral palsy, slow rocking while the child is prone over a ball may sufficiently reduce tone to allow initiation of movement transitions, such as rolling to the side or head lifting in prone Intervention 5-13 , A, B. Slow rocking on a ball can promote a reduction in muscle tone. C. Head lifting. (Martin/Kessler) ©Stanbridge University 2024 75 75  2/29/2024 A child born blind or with visual impairments will affect typical development – Acquisition of gross motor skills will be delayed With hearing impairments, an infant may appear to develop typically to a certain age – Until it becomes apparent, they have cognitive and Other language delays – Frequent ear infections can result in developmental Developmental delay due to the vestibular apparatus affecting balance and equilibrium function and development Issues Children with peripheral nerve damage or born with a missing limb may also experience delays in development – They learn to adapt to their environment by using prosthetics, orthotics, and with therapy and catch up to their age-appropriate skills usually by ages 3-5 years 76  2/29/2024 Poverty- significantly affects health and child development ❖ In US, a child is more likely to acquire asthma, Other diabetes, high lead levels, malnutrition dehydration, or depression. Developmental ❖ More babies are born with deformities, and Issues- other congenital diseases in low-income areas. Poverty ❖ Limits the family's access to adequate healthcare ❖ Prenatal care is inadequate or non-existent, resulting in more premature and low birth weight infants. 77  2/29/2024 1) Abnormal muscle tone can affect typical development. Which term below is Best described as significant resistance to movement caused from dystonia? Learning a) Athetoid b) Flaccidity Assessment c) Hypotonia d) Rigidity 78  2/29/2024 2) What position dominates a full-term newborn? a) Hands open and hips fully extended and internally rotated b) One side in flexion, other side in Learning extension Assessment c) Physiological flexion in supine or prone d) Supine with all limbs extended fully 79  2/29/2024 3) Tummy time and prone physiological flexion facilitate early infant development in several ways including which of the following? Learning a) Anti-gravity flexion Assessment b) Helps move newborn out of flexion c) Oral motor control and head control d) Walking 80