Pediatric Physical Therapy - Development PDF

Pediatric Physical Therapy Topic: 3 Development Prof. Dr. Mohamed A. Eid Professor of Pediatric Physical Therapy Cairo University Aqaba University for Technology 1 Lecture Outline Classification of Motor...

Pediatric Physical Therapy Topic: 3 Development Prof. Dr. Mohamed A. Eid Professor of Pediatric Physical Therapy Cairo University Aqaba University for Technology 1 Lecture Outline Classification of Motor Development Prerequisites of Gross Motor Skills Head Control Rolling Sitting & Creeping Standing & Walking Fine Motor Development 2 Child Growth and Development ▪ Definition of related terms: Growth: It is a quantitative change in behavior. e.g. an increase in physical dimensions such as height and weight. Development: It is a qualitative change in behavior. Normally, growth and development proceed together, and problems arise when there is discrepancies. 3 Child Development ▪ Satisfactory development requires: 1) A well – formed and normally functioning nervous system. 2) An environment which provides appropriate and adequate nutrition at all stages. 3) Opportunities to learn and to act. 4) Both challenges and rewards. 4 Child Development  Definition:  Change in the child that occurs over time. Changes follow an orderly pattern that moves toward greater complexity and enhances survival.  Periods of development:  Prenatal period: from conception to birth  Infancy and toddlerhood: birth to 2 years  Early childhood: 2-6 years old  Late childhood: 6-12 years old  Adolescence: 12-19 years old Child Development Child development includes: Motor development. Language development. Vision development. Hearing development. MOTOR DEVELOPMENT 7  Definition: The change in motor behavior across the lifespan” “The sequential, continuous age-related process whereby an individual progresses from simple, unorganized, and unskilled movement to the achievement of highly organized, complex motor skills and finally to the adjustment of skills that accompanies aging” Changes in motor behavior which reflect the interaction of the maturing organism and its environment” 8  Gross movement Motor Movement controlled by the development large muscles or muscle groups (e.g. legs). is classified into: Fine movement Movement controlled by the small muscles or muscle groups (e.g. hands). 9 Gross Motor Development in Infants A typical infant tends to follow a known developmental progression that starts at birth. As the infant grows and his central nervous system matures, the gross motor skills develop in a head to foot progression. 10 Prerequisites for any gross motor milestone: 1- Maturation of CNS. 2- Intact musculoskeletal system. 3- Intact vestibular system. 4- Intact vision. 5- Intact proprioception. 6- Maturation of previous milestone. 11 Gross motor skills: 1- Head control. 2- Trunk control. 3- Rolling. 4- Sitting. 5-Crawling , creeping. 6- Standing. 7- Walking. 8- Running , jumping. 12  Head Control Head control is the first movement that a baby achieves. It is necessary to attain other movement skills such as sitting, crawling, and walking. Head control requires strength and coordination of the muscles which flex (bend) and extend (straighten) the neck. Infants are born with a flexion pattern throughout their neck and bodies. The infants will develop extension by repeatedly attempting to lift their head and turn it from side to side. A baby will develop head control in three major positions; prone (on tummy), supine (on back), and in sitting. 13 Head control As the infant learns to raise, turn and maintain his head in the upright position. A baby is generally motivated to turn his head in attempt to see an object, or to locate a nearby sound. A newborn can distinguish colors, focus on a human face, and follow the movement of the face across his visual field. When a child has a visual and hearing impairment, there are other ways to encourage head control and exploration. 14 Prerequisites for 1) Intact vestibular system. the development 2) Intact eyes and optical of head control pathway. include: 3) Intact proprioceptors of neck region. 4) Intact neck structures including joints, capsules, ligaments and muscles. 15 Head Control At 4 weeks, the Head lag is noted in infant’s head position the pull to sitting is dominated by the position. tonic neck reflexes. 16  Head Control ▪ Head control go through 3 stages as follows: 1) From prone 1 – 2 months. 2) From supine 3 – 5 months. 3) From side lying 5 – 7 months. 17 Head Control Newborn Age 6 months 18 19 20 21 22 Rolling The ability to roll smoothly from back to stomach, or stomach to back requires some degree of head control, and a rotation movement that occurs along the trunk of the body, between the hips and the shoulders. Rolling is the first movement that allows a baby to change his position, and usually develops between four and five months of age from prone to supine, about 6 months from supine to prone. 23  Rolling An infant with visual and auditory impairments can be encouraged to roll by providing him with an appropriate stimulus i.e brightly colored objects for children with auditory problem, musical toys for children with visual impairments. If a baby is physically unable to roll, you can help him roll so he can experience this pattern of movement. A child who is visually impaired generally prefers being on his back and will often learn to roll from his stomach to his back to avoid being on his stomach. 24  Rolling An infant with abnormal muscle tone may have difficulty with this movement. Spasticity can cause stiffness through the trunk, interfering with a coordinated rolling movement. A baby who is weak or floppy may not be able to begin the movement, as rolling requires enough strength to move against gravity. 25 26 Prerequisites for the (1) Development of head control development (even partially). of Rolling include: (2) Development of neck righting reaction. (3) Development of the ability to support on forearms and hands. 27  The infant is able to roll first Sequences of from supine to his side. the development of Rolling Then, from prone to his side include: then to supine. Lastly, from supine to prone. 28 Sequences of the Turning Start reflexively from supine development to side lying by 1 – 4 months. of Rolling include: From prone to supine 4–5 months. From supine to prone 5 – 6 up to 7 months. 29 30 Sitting The ability to maintain a sitting position requires a baby to have developed equilibrium reactions and protective responses in the forward, backward, and side to side directions. If a baby has difficulty with maintaining balance, his equilibrium reactions can often be improved by playing with him in the sitting position and challenging his balance in all directions. If a baby has muscle tightness in his legs, or weakness in his neck or trunk muscles, sitting will be more difficult for him/her. 31 Sitting Initially, a baby sits by propping forward with both hands in front of him. As his balance and upright posture improve, he maintains the sitting position by placing a hand to one side or the other as needed to keep himself sitting upright. Eventually the baby can hold himself in a good sitting position without the use of his hands for balance. 32 Sitting Prerequisites The ability to raise the for the trunk against gravity. development The ability to support on of sitting the upper limb. include: Pivoting (trunk rotation). 33 Sequences of the development of Sitting include: At 4 – 5 months, the neonate can sit with support. At 7 months, he can sit with back support by a chair or pillow, or arms propped forward. At 8 – 9 months, sitting occur without support. 34 Sequences of the development of Sitting include: 4) At 10 months, the child can sit erect and unsupported for several minutes and progress from a sitting to prone position. 5) At 12 months, the child can sit, rotate and pivot without losing balance and attain a creeping position from sitting. 35 Sitting Up Age 2 months Age 8 months 36 Creeping Creeping refers to four-point mobility with only hands and knees on the floor. This reciprocal limb motion demonstrates integration of many of the primitive reflexes before engagement in the more complex voluntary process of ambulation. With creeping and crawling, there is an increase in trunk flexibility and rotation 37 Creeping ▪ Prerequisites for the development of Creeping include: 1) The ability to raise the trunk against gravity. 2) The ability to support body weight on upper limbs and knees. 3) The ability to do reciprocal movements of hands and legs. Age range: 6 – 8 months. 38 Creeping 39 Standing The ability to stand is influenced by the emergence of postural stability. Once an infant develops strength, coordination, and balance to move about freely on the floor, he will begin to pull up to stand and discover ways to explore things that were previously out of his reach. As a baby pulls to his feet and stands, he gains further strength and control in his trunk and leg muscles. 40  Standing Sequences for the development of Standing : Pull to stand 10 – 10.5 months. Standing holding on 11 – 12 months. Stand without assistance 13 – 15 months. 41  Walking Prerequisites for normal walking: Maturation of C.N.S Adequate R.O.M Adequate motor control Good muscle strength Intact sensation Appropriate bone structure and composition. 42  Walking ▪ Sequences of the development of Walking : 1) First step: at 12 months, the child can walk with help. 2) Independent walking at 15 – 18 months: the child is able to move throughout with the help of a relatively immature balance system. (high guard position of upper extremities and wide based gait). 43  Walking ▪ Sequences of the development of Walking : 3) Walking up and down stairs 2 years. 4) Jumping and standing on one foot 2.5 years. 5) Running 3 years. 6) Walk on one line 4 years (tandum gait). 44 Ambulation Nine to 12-months 13-month-old Fine Motor Development ▪ Fine motor development includes: 1) Arm and hand movements involved in: A- Reaching. B- Grasping. C- Manipulating objects. 2) Co-ordination of hand movements and vision. (Development of prehension) 46 Fine Motor Development 6-month-old 12-month-old 48