Child Development.pdf

Child Development Environmental factors on ICF model Lack of transportation Lack of support in school/work system Personal factors on ICF model Having to be transported Age sex motivation lifestyle...

Child Development Environmental factors on ICF model Lack of transportation Lack of support in school/work system Personal factors on ICF model Having to be transported Age sex motivation lifestyle 1  Brain Development First synapse and neurons form around 7 weeks after conception, allows for movement within the womb Pruning occurs throughout life Sensory pathways Occur before birth 2 Brain Development- Neuro Review! Begins the first few weeks of conception and at birth is structurally the same as an adult brain Neural plate-> neural tube Divided into Parts of brain: Forebrain (cerebral hemispheres, limbic system) Midbrain Hindbrain (cerebellum and brainstem) Spinal cord Myelin increases the speed with which nerve impulses occur Most pathways are laid down through the first 5 years of life, but some pathways continue into later years Frontal cortex 3  Cerebrum Occipital Lobe- visual field information If damaged, visual deficits Parietal Lobe- integrates sensory input If damaged, you’ll see spatial neglect, apraxia, etc Temporal Lobe- auditory & language processing, If damaged: remembering how to complete a task, social norms object recognition, memory, social understanding Frontal Lobe- executive function, impulse control, If damaged: expressive aphasia, disinhibition, higher level skills motor planning, cognitive function Frontal lob: Disinhibition (social filter), motor planning (how do I complete a jumping jack, how to build a tower) 4  Limbic System Thalamus -“Relay Hypothalamus Hippocampus Amygdala Station” Sends sensory Controls Critical for Emotional and motor Sleep/Wake memory regulation and information to cycles formation attachment the brain Key brain site Controls spatial Strong Relays all for central reasoning communication sensory control of the between Pre- information autonomic frontal cortex except for smell nervous system PFC and amygdala is correlated, so may see underdeveloped in children with ADHD, autism, children in general hippocampus and spatial reasoning shape sorters for children is how they learn this Hypothalamus Controls fight or flight system 5 Cerebellum Functions: 6  Cerebellum Cont. Undergoes DRAMATIC increase in growth from 28 weeks to 40 weeks gestation About 10% of the brains volume but contains about 50% of the brain's neurons Creates neural circuits for implicit learning Social skills, gestures 95% of people with autism have smaller cerebellum (when researched in post-mortum study) *think about how this affects premature infants and how they are developing implicit learning: Non-episodic learning of complex skills/information without awareness of what has been learned "learning without realizing it” Learning without thinking about it EX: riding a bike, jump rope Born early (24 weeks). They will need More feedback More verbal cues 7  Brain Stem Connects cerebrum to spinal cord and cerebellum Responsible for many vital functions: Breathing, heart rate, BP Sleep House many cranial nerves Contains many motor and sensory tracts Controls reflexes Remember 10 of the 12 cranial nerves are housed here Motor tracts: corticospinal & Corticobulbar Sensory: DCML, corticospinothalamic 8  Corpus Callosum Occurs between 16-20th weeks of GA Millions of fibers connecting the two hemispheres Integrates motor, sensory, cognition across hemispheres CROSSING MIDLINE Size increases up until mid-twenties, more rapid growth early on Changes between typically developing and children with neurodevelopmental disorders We see alterations with neurodevelopmental disorders Agenesis of the corpus callosum Helping them form connections and crossing midline 9 What Affects Brain Development Experiences Genetics Environment Prenatal Factors 10  Prematurity Brain underdeveloped (corpus callsoum, smaller cerebellum) Poor muscle tone, typically lower NICU environments Poor sensory processing Sensitive to light, noise, touch Sensory systems: they are used to the warmth, comfort of mother’s womb, they can push against abdomen and get resistance, supported in fluid to turn and flip Tone Controlled in the cerebellum NICU Loud environment Feeling the total effects of gravity 11  Sensory System Pyramid Tactile, vestibular, proprioception Regulate the body Issues you see in children with sensory processing disorder 12  Plasticity Brain’s ability to change structure and function As the brain matures, it is less capable to reorganize and adapt to new or unexpected changes Easier to learn when younger than “re- hardwire” in later years Cognitive, emotional, and social capacities are inextricable intertwined throughout the life First 18 months Lots of develop happening in these few months 13  How Stress affects brain development Exposure to prenatal stress adversely affects structure of amygdala in infant Affects learning and behavior The more adverse childhood experience, dramatically affects health over lifetime Asthma, ADHD, risk of harmful behaviors Homes with constant stress – children have increased cortisol levels, brain changes, effects immunity Stress also leads to underdeveloped neural connections Stress can affect inutero development AND post-natal development Think about what’s happening when you’re stressed->Constant fight or flight state, which leads to increased cortisol levels, weakened immune system 14  Experience Interaction: children constantly reach out for interaction through babbling, facial expressions, gestures Adults then react to these interactions helping the brain to form positive attachments Think about what this means for children of neglect Neglect They won’t know any positive interaction and won’t have any positive attachments 15  Tone Amount of resting tension or resistance to movement in a muscle Assists in maintaining posture Usually does not change from birth* Normalizes by 12-15 months Flexor tone typically develops around 30-32 weeks in legs and 36 weeks in UE-> why we see preemies with arms out Disorders of muscle tone are caused by dysfunction in the brain, spinal cord, muscle spindles, or neural circuits of these structures Tones helps us hold our bodies upright and the change in tone allows us to move, helps to control movement *Exceptions to change from birth: CP and premies If a baby is born before the 30-32 weeks they will be laying like the picture 16  Tone Classifications 1. Hypotonia 2. Hypertonia Decreased ability Abnormal increase Diminished resting Typically increased to generate muscle in resistance to an tone resting tone force external force Low tone: “gravity is difficult”, much more effort needed to move Hypertonia Sometimes parents mistake high tone as strength!! But it is not the same thing 17 Hypotonia Common causes: Pre-term Birth, prenatal drug exposure, neurological disorders, genetics Decreased gross motor skills, especially sitting, crawling, walking 18 Primitive Reflexes See separate powerpoint 19  Postural Reflexes Begin to develop after birth Triggered by effects of gravity Allow subconscious control of posture, balance and coordination Skill is automatic Don’t have to think about it Take up to 3 1/2 years to be fully developed Divided into two categories: righting reactions and equilibrium reactions Will be activated based on degree of disturbance Head misaligned – righting Body Misaligned – equilibrium After birth unlike primitive reflexes Midbrain higher level than brain stem/ primitive reflexes à appearance signifies the nervous system is maturing Automatic skills to free up space for high level cognitive skills With age, may decay 20  Righting Reactions Develop at or right after birth in response to gravity Most distinguishable at 10-12 months Movements of HEAD on trunk Allows us to orient our head in upright posture against gravity Controlled at midbrain, automatic Relationship of body segments and gravity Allow us to orient to our environment and our own body Important for rolling 21  Equilibrium Reactions Appears around 6 months Begins as transitions emerge Controlled by higher brain centers, like Cerebellum Automatic Maintain balance in response to alterations in the body’s COG or BOS May include protective responses Body also starting transitional movements 22  Age Expected Skill Head Control Newborn No control, full head lag expected (with pull to sit) 1 Month Can lift head momentarily Measure of strength for infants in prone Begins to develop within the first 2 Month Maintain head in midline in couple weeks of life supported sitting with gaze downward Incorporates eye control 3 Months Prone prop on elbows, slight head lag expected with pull to sit with demo of chin tuck 6 Months Full head control, prone prop on extended elbows, no head lag, anticipates pull to sit Reliant ability to maintain prone Needed in order to have right reactions 23 Motor development 24  Motor development is NOT straight linear What we THINK ACTUAL development Sometimes you have moments of plateau or slight return to previous ways of moving sitting posture with walking crawling when walking 2 handed reaching Looking for stability 25 Think about it 26  Physiolgic Flexion Supported sitting Newborn- Prone 2 months Kicking in supine Systematic: Eye movement & tracking Supported sitting Have to help sit them up Holding everything up Prone Laying on belly Tracking Toys (black and white) Faces 27  Newborn-2 months Supported Sitting External support utilizing neck musculature more against gravity (max1-2 seconds) Prone Hands to mouth Minimal and brief cervical extension Kicking in supine Systematic: Eye movement, prefers tracking faces or high contrast objects Ability to move the eyes directly relates to motor movements and cognitive function Above picture 6 weeks Kicking in supine Very little Ability to move the eyes Relates to cognitive ability and motor development 28  Prone on elbows emerges 3-4 Reciprocal kicking Minimal head lag with chin tuck months Systematic: Emergence of depth perception Hands to mouth Hands to mouth encourages tactile sensations and body awareness 29  3-4 months Interventions Prone on elbows emerges Legs and pelvis provide stable base to lift head and trunk into extension Tracking side to side-midline! See next slide Minimal head lag, Chin tuck Assists with midline positioning Chin tucks with small lifts on wedge Use toy (hold chin tuck and lift shoulders) Reciprocal Kicking: Have fun socks with bells Tickling feet Beads Turning head side to side leads to improved visual tracking Prone on elbows Hand on back to help them raise the trunk and head 30  Tummy Time Tummy time: 8 weeks: 15 minutes/day 4 months: 80 minutes/day Pictures On the ground Boppy/towel roll Wedge Mother’s chest Across lap Ball 31  Neck Extension required to roll, sit, Importance Shoulder girdle stability of Tummy Visual development Time Midline development Integration of reflexes Helpful for walking Visual development Allows them to scan the environment Midline development Bring the visual field to the center Helps with tracking and crossing midline 32  Weight Shifts Important because it allows babies to: Reach toys Precursor to movement (rolling, army crawling) Head righting Neck and shoulder strength Ball is a great resource!! Softer, decreases affects of gravity, easier If they are not showing any activation of movement Put hand on their shoulders and help them weight shift Working on a ball is helpful Make it easier for you to hold them Gravity helps them shift 33  Midline Interventions Sidelying! Holding a rattle at midline Lay next to the child Use mirrors or interesting toys Ease of finding hands Develops sensory input *Assess symmetry and movement to the position Helps integration of reflexes Lay down with them They love tracking faces 34  Prop sitting emerges Reaching 5 Rolling prone to supine months Starting pivoting in prone Systemic Babbling emerges Bangs toys together Forward flexed trunk with use of arms on legs to support self Typically widened BOS Quick head movements may cause balance disruption Rolling prone to supine: Improved strength of shoulders Head leads the roll Reaching towards objects Laying prone or in sitting 35  5 month Interventions: Propping and Reaching Prop sitting Place preferred toy in front ( push toys are great for this!) Encourage reaching with one hand up towards toys How to: provide surface to rest hands and can provide tactile support at shoulders Reaching Screen vision How to: have toys within reach and slowly move out of reach Try different positions: sidelying, supine, prone, etc Prop sitting Our hands on their shoulders This is a great way to assess vision 36 5 month Interventions: Rolling and Pivoting Rolling: Pre-req: should stability, neck extension, neck rotation How to: Have child follow a preferred toy in a circle Head leads the roll! Pivot in prone Pre-req: visual stimulation, all same as rolling, weight shifts How to: Place toy slightly out of reach and back at angle 37  Moving towards independent sitting Rolling all directions 6 Reaching across midline months Pull to sit without head lag Systemic Holding objects longer in hands Begins to recognize strangers/family Smiling consistently and laughs Full head control!!! Falling less but it is decreased 38  6 month Interventions: Sitting Frequent LOB Increase in trunk control and full head control Seated with pillows around hips Trial balance with lifting arm sequence Brief moments of arms lifting then Reaching with one arm, then reaching with both* * Remember right reactions Tips and tricks: Midline: have toy in hand, make contact and drag across body 39  6 month Interventions: Rolling Rolling supine to prone: Pre-reqs: Ability to lift legs Reach across midline Head righting (weight shifts) Neck rotation How to: address the above impairments; assist with hip flexion and bring over to side, assist with trunk, or just one Tips and tricks: Beads to lift legs with hands if this is difficult 40  Crawling Transitions 7 Systematic Considerations months Responds to facial expressions More babbling, ”shouting” for attention Holding own bottle “Peek a boo” 41  Army Crawl vs Quadruped crawling Army Crawl: Quad Crawl: ~6.5 months ~8-9 months Army crawling is the beginning of exploration! 42  7-9 Month Interventions Quad crawling: Pre-reqs: Maintain 4 point Glut strength Reaching in 4 point Rocking Transition in/out of 4 point How to: start in quad, give support as necessary and have toy out in front If not crawling yet Help them get on knees and see how they do with reaching Can work on these 43  Importance of crawling Neck extension, shoulder strength, Hip strengthening Bilateral Coordination Reflex Integration Hand positioning trunk extension----> POSTURE! STNR, ATNR, Dissociation Palmer Motor planning CDC has taken it off the developmental milestones list- what does this mean for families understanding of importance? Hand positioning: crawling allows for weight bearing through the palms, wrists, and joints up through shoulder, etc. This creates the arch in your hand needed to hold a pencil 44  7-9 month Transitions & Interventions Supine sitting Sidelying Prone to 4 point Tips: practice on wedge, weight shifts on ball Quad to sitting Side sitting Any types of postural preferences will be noted here How to: Encourage side sitting How to: have toy angled @ side and then place in position Tip: if going to the left, gently push right hip forward from behind Have to have that crossing to do this 45  7-9 month: More Transitions & Interventions Pull to stand pull to kneeling Deep squat to stand To kneeling Through side sitting Through quad How to: play in kneeling, playing in quad, Weight shift, lift leg Remember the role of toys! 46  Standing Cruising Squatting 10-12 Climbing Assisted walking months Push toy holding hands Systematic Imitates new gestures Waves bye-bye Understands up to 10 words, including name Puzzles with knobs Stacking blocks 47  Standing and Squatting Interventions Starting out standing with a ledge Turning and letting go Standing with flat surface Requires more balance Putting them with their back is against the wall Causes forward weight shift Need this for walking 48  Cruising and Assisted Walking Cruising: Pre-req: Standing Weight shifts Toy placement for motivation Assisted walking: How to: hold onto push toy, scarf, hands while taking a few steps forward Pre-reqs are the areas you intervene, think about righting reactions for walking Push toys Watch out on wood floor 49  Independent walking and maturation of gait Creeps up stairs 12-18 Squat to play or for transitions months Systematic: Claps Points to ask for help Feeds self with spoon If not walking by 15 months suggest therapy 50  12-18 months: Walking & Stairs Independent walking Characteristics of new walker-> Frequent LOB & lots of practice on different surfaces Tips & Tricks: Keep parent/ toy close and slowly move away, start with back against the couch and encourage movement forward Creeps up stairs Being kneeling at stairs, assist with extremities as needed Walking Wide BOS Not good heel to toe contact 51  Walk backwards, fast walk, run Propels ride on toy Walks up steps with hand held 18-24 months Systemic: fling ball, beginning to kick ball screw lids on/off, stringing large beads Helps with dressing 52 18-24 months interventions: Fast Walking Practice walking/running on variety surfaces Progress to holding various objects Walk Backwards Pulling toy Practice ball skills 53 2-3 years Brief SLS Jumping with bilateral push off emerges Rides tricycle Ascends stairs reciprocally and descends step to Catches ball with arms extended Systemic: 2 step directions Imaginative play Copies simple shapes (by 3yrs) 54  2-3 year old interventions Stairs Visual, verbal, tactile cues Brief SLS Start with prop and then progress to lifting up briefly Jumps Brief SLS: Bubbles, kicking, knocking over tower Jumps: think about the quality gallop vs both leg jump 55  Hopping Galloping Catch ball with hands only (by 4 yrs) 3-4 years Small bicycle Systematic: Dressing self Joins other children to play 56  3-4 years Interventions: Hopping & Skipping Hopping Pre-req: Brief SLS Hip stability Galloping Walking on a line? Coordination? Bike: start with train 57  Climbing Skipping* 5 years+ Jump rope Jumping jacks 58  5+ year old skill Interventions Strengthening Coordination Motor planning Remember visual, verbal, demonstration cues or feedback 59  Development of gestures 9 months: give, shake head 10 months: reach, raise arms to be picked up 11 months: hold up objects, wave 12 months: open hand point, tap 13 months: clap, blow kisses 14 months: index finger point, "shhhh" 15 months: head nod 16 months: other symbolic gestures like high fives Predictor of language ability and academic success ** Handout on BB** 60  Incorporate Family Have family help with holding toys Siblings, parents, grandparents, etc Discuss strategies for setting up ”purposeful play” Make obstacles courses at home Working on crawling/standing?-> place toys slightly out of reach Know their routine Make sure to check with the family in what they can handle 61 Resourses https://harvardcenter.wpenginepowered.com/wp-content/uploads/2007/03/InBrief-The-Science-of-Early-Childhood-Development2.pdf National Research Council (US) and Institute of Medicine (US) Committee on Integrating the Science of Early Childhood Development; Shonkoff JP, Phillips DA, editors. From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington (DC): National Academies Press (US); 2000. 8, The Developing Brain. Available from: https://www.ncbi.nlm.nih.gov/books/NBK225562/ University of Edinburgh. "Stress in pregnancy may influence baby brain development." ScienceDaily. ScienceDaily, 24 November 2020.. Volpe JJ. Cerebellum of the premature infant: rapidly developing, vulnerable, clinically important. J Child Neurol. 2009 Sep;24(9):1085-104. doi: 10.1177/0883073809338067. PMID: 19745085; PMCID: PMC2799249. Tanaka-Arakawa MM, Matsui M, Tanaka C, Uematsu A, Uda S, Miura K, Sakai T, Noguchi K. Developmental changes in the corpus callosum from infancy to early adulthood: a structural magnetic resonance imaging study. PLoS One. 2015 Mar 19;10(3):e0118760. doi: 10.1371/journal.pone.0118760. Erratum in: PLoS One. 2015 Jul 13;10(7):e0133090. doi: 10.1371/journal.pone.0133090. PMID: 25790124; PMCID: PMC4366394. Noelia S. De León Reyes, Lorena Bragg-Gonzalo, Marta Nieto; Development and plasticity of the corpus callosum. Development 15 September 2020; 147 (18): dev189738. doi: https://doi.org/10.1242/dev.189738 Basinger H, Hogg JP. Neuroanatomy, Brainstem. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544297/ Ganguly J, Kulshreshtha D, Almotiri M, Jog M. Muscle Tone Physiology and Abnormalities. Toxins (Basel). 2021 Apr 16;13(4):282. doi: 10.3390/toxins13040282. PMID: 33923397; PMCID: PMC8071570. Seger CA. Implicit learning. Psychol Bull. 1994 Mar;115(2):163-96. doi: 10.1037/0033-2909.115.2.163. PMID: 8165269. 62