Pediatrics: Extra Info & Main Points from Lec 1&2

postural control

critical part of development

- reflex-hierarchical

- cognitive

- motor learning

- dynamic systems

(4) developmental theories

CNS maturation

reflex-hierarchical theory primary driver

learning processes & external influence of scaffolding

cognitive theory primary driver

predetermined motor programs

motor learning theory primary driver

none

dynamic systems primary driver

- describes that development follows cephalocaudal sequence

- driven by CNS maturation

- appearance & disappearance of integration of primitive reflexes reflect increasing maturity of cortical structures & emergence of higher & more complex motor skills

characteristics of reflex-hierarchical theory (3)

reflexes

involuntary stereotyped movement responses to a specific stimuli

28 weeks gestation

when do reflexes begin

1st birthday

when are reflexes integrated

- inhibited by maturing CNS

- integrated into new movements

why reflexes may not completely disappear (2)

- head turn to side

- flexion of skull side extremities

- extension of face side extremities

ATNR characteristics (2)

- head flexion --> UE flexion --> LE extension

- head extension --> UE extension --> LE flexion

- arms follow the head

STNR characteristics (3)

optical righting reaction

orients head in space using visual input

righting reaction of head & trunk

used by humans to return or "right" the body to the upright position via adjusting body parts relative to the vertical axis

birth to 2 months

head righting onset

persists throughout life

head righting integration

tilt infant anteriorly, posteriorly, & laterally from 45° vertical so head can drop forward, backward, & sidways

stimulus for head righting reaction

head orients to vertical position & is steady

response for head righting reaction

4 months

head righting progression from prone (2)

4-6 months

head righting progression from sideways

7 months

head righting progression from supine

emergence supports the development of postural control & stability

significance of head righting reaction

equilibrium reactions

allow the whole body to adapt to slow changes in shifts of COM within the BOS to adjust for a change to remain upright

rotational component

requires co-contraction of the trunk flexors & extensors, including head & body righting

balance & protective reactions

rotational component is critical for

staggering reactions

response to instability in the lateral direction (aka sideways stepping)

balance & to prevent falling

postural reactions are necessary for ___ & to ___, especially in sitting & standing

tilting reaction

produced in response to a shift of COM caused by the moving surface that is considered an equilibrium reaction

protective reaction

responsible for protecting the body from harm after the COM has been displaced beyond the BOS (parachute reactions)

6-7 months

UE forwards protective reaction development in sitting

7-8 months

UE sideways protective reaction development in sitting

9 months

UE backwards protective reaction development in sitting

- no primary driver

- movement produced from interaction of multiple sub-systems w/in the person, task, & environment

- all sub-systems self-organize & interact in a specific way to produce most efficient movement solution for each specific task

- development is non-linear

- variability

- any driving influence has the potential to change over time

characteristics of dynamic system theory (6)

body schema

internal representation of the body's spatial properties, including length of limbs & limb segments, their arrangement, configuration in space, & the shape of the body surface

due to lack of organized motor activity

what does Prechtl et al believe about the lack of head control in newborns

1 month old

direction specific postural responses in neck muscles that underly reactive balance control in infants, neck flexors, can begin to emerge

vision

important in calibration of vestibular & proprioceptive system to help develop internal models of posture & calibrate somatosensory input for head posture control

vestibular

input that is important in emergence of gross motor skills

- no control

- attempts to initiate upright sitting

- partial control with large range of body sway

- functional control with minimal sway

(4) stages of mastering postural trunk sway for independent sitting

reaching

Improved trunk control is associated with improved ____ abilities

- trunk sways forward

- reach is jerky & takes longer

Rachwani et al.--> trunk support effect on reaching at 4-months-old WITHOUT pelvic support (2)

- less trunk sway

- reach is smoother and faster

Rachwani et al.--> trunk support effect on reaching at 4-months-old WITH pelvic support (2)

3-months

EMG analysis shows some anticipatory trunk activity at ____ old that increases with age

reactive balance control

Does reactive balance or anticipatory balance control emerge first?

visual input

Are infants dependent on visual or somatosensory input first?

- exploratory

- performatory

(2) postural sway strategies that infants use control sway when learning to stand & walk

exploratory postural sway

investigate & explore sensorimotor workspace for posture control

performatory postural sway

uses sensory information to control posture

5 years old

age of children where their steady state balance is similar to that of adults

7-10 years old

age of children where their reactive postural control is like those in adults

anticipatory activity present but highly inconsistent

Forssberg & Nashner on anticipatory postural control progression in standing in response to resistance applied when pulling a drawer at 10-11 months

anticipatory activity present consistently

Forssberg & Nashner on anticipatory postural control progression in standing in response to resistance applied when pulling a drawer at 13 months

able to adapt postural control to deal with the added resistance while pulling drawer

Forssberg & Nashner on anticipatory postural control progression in standing in response to resistance applied when pulling a drawer at 15 months

4-6 years old

by what age should children have matured anticipatory postural adjustments preceding arm movements while standing

- learning through individual movement exploration through variability & errors

- tons of repetition

- intensive practice through trial & error

(3) key features of motor learning in children

- rapid changes in body structure & function

- decreased information processing capabilities

- feedback schedules

- long time to learn with lots of practice

- practice schedules

(5) key differences of motor learning between children & adults

prenatal development

process in which a baby develops from a single cell after conception into an embryo & later a fetus

38-42 weeks

full-term human gestation

from conception to implantation: 0-2 weeks

duration of germinal stage

3-8 weeks after conception

duration of embryonic stage

9 weeks GA till birth

duration of fetal stage

14-16 weeks in utero

when spontaneous activity or movement motor skills start developing

- locomotion rhythms seen in embryonic movements

- forelimbs movement precede hindlimbs in cephalocaudal direction

- intralimb then interlimb coordination

- proximodistal 1st detectable movements

prenatal steady state gait development

9 weeks GA

isolated leg & arm movements develop prenatally by

16 weeks GA

alternating movements of LE-like walking movements after birth develop prenatally by

red flag

lack of or limited variability in a child's motor skill's repertoire is a definite

- head to side

- unable to keep midline

neonate head control in supine (2)

lifts & clears partially

neonate head control in prone

- head in 80-90° extension

- head in midline

- propping on forearms

4-month old head control in prone (3)

- flexed head falls forward, backward, & sideways

- hold for 1-2 seconds (not sustained)

- able to lift head to midline from flexion or extension

- unsteady head movement

neonate head control in supported sitting (4)

- head in midline with frontal plane

- eye gaze 30° below horizontal plane

- head turn unsteady

- oscillations seen when attempting to maintain head upright

2-month-old head control in supported sitting (4)

- stable head control

- stable head turn lead by visual pursuit

- brief oscillations & loss of control

3-4-month-old head control in supported sitting (3)

head lags but attempts to right when pulled up to vertical

neonate to 3-month-old head control in pull-to-sit

keeps head in line with the body

4-5 month old head control in pull-to-sit

- random & writhing at 90° plane

- positional & reflexive hand-on-hand contact in side-lying

neonate reaching with arms (2)

- grasp reflex

- hands open as arms abduct

neonate fine motor skills (2)

consistent head in midline

3-month-old head control progression in supine

- more interested in faces

- present at birth

0-3 month old eye gaze

more interested in toys

3-6 months old eye gaze

6 weeks old

when does an infant begin having a smooth visual pursuit

14 weeks old

when does an infant have an adult-like visual pursuit

decrease in visual skills in response to effort required while acquiring a new motor skill

what does dynamic systems theory say about infants during early development of head control & eye gaze

4 months old

when should an infant be able to hold their head up 45° in prone by

binocular vision

allow infant to identify depth cues

4-5 months

when should a child develop binocular vision by

LE flexion & extension; primarily in a flexed posture

Phase 1 of McGraw's prone progression

spinal extension begins as well as development of head control

Phase 2 of McGraw's prone progression

- cephalocaudal progression of spinal extension to T-spine area

- prop on extended arms lifting chest off surface

Phase 3 of McGraw's prone progression (2)

propulsion movements start in arms & legs

Phase 4&5 of McGraw's prone progression

begin to assume quadruped & plantigade

Phase 6 of McGraw's prone progression

disorganized attempts at progression

Phase 7 of McGraw's prone progression

organized propulsion in the creeping position emerges

Phase 8&9 of McGraw's prone progression

SL to supine

rolling 1-2 months

- supine to SL

- log roll

- no rotation

rolling 3 months (3)

- prone to supine

- emerging segmental

- dissociation

rolling 5 months (3)

supine to prone

rolling 6-8 months

- prop sitting

- 4-5 months old

- experiments limits of head & trunk with tripod stability

sitting development stage 1 from Campbell (3)

- ability to sit without use of arms for 1-2 minutes

- 5-6 months

- cannot maintain posture while engaged visually with surroundings or using

sitting development stage 2 from Campbell (3)

- sits indefinitely without falling

- 6-7 months

- not yet able to get out of sitting with control

sitting development stage 3 from Campbell (3)