Pediatrics Exam 1: Lecture 3

- primary standing reaction (neonatal positive supporting reaction & reflex)

- automatic stepping reflex

- partial WB in LE

- narrow BOS, poor head & trunk control

newborn supported standing progression (4)

- stepping reflex fades & can exhibit temporary LE disorganized period

- astasia

- abasia

2 month old supported standing progression (3)

little to no WB when placed on feet

what is astasia

automatic stepping not elicited

what is abasia

- emerging volitional partial WB on LE

- moderate hip ABD, flexion, & ER

- knee flexion

- pronated feet

5 month old supported standing progression (4)

- emerging volitional full WB on LE

- posture more pronounced

- may stand & walk with UE supported

7 month old supported standing progression (3)

- emerging to pull up in crib with mostly arm strength

- holding to rail & begins to explore standing abilities --> bounce

- need UE to hold self up --> letting go = drop to sitting

7-8 month old supported standing progression (3)

10 months

when should a child be able to pull to stand with their arms

10 months

when should a child be able to cruise

12 months

when should a child be able to perform a pull to stand from half kneel

symmetry

in any transitional phase of development, it is important to have

- rolling to prone

- moving to all fours

- pull to stand on external object

- progress to 1/2 kneel pull up

earlier development of supine to stand (4)

- rolling to prone

- moving to all fours

- up to plantargrade

- up to stand

later development of supine to stand (4)

- supported stepping UE with trunk supported

- cruising & stepping along side an object or furniture while holding onto it

- unsupported stepping & walking 10-15 months of age

standing progression (3)

- motor coordination within locomotor pattern generator

- functional, visual, vestibular, & somatosensory systems

- motivation to move forward

- sufficient strength to balance & use to propel body forward

infants who are about to take their first steps have already developed (4)

when postural control system can effectively control the COM to avoid a fall

what is the developmental tipping point for infants to take first steps?

cadence

number of steps taken per minute

stride

the activity that occurs between the time one foot touches the floor & the time the same foot touches the same floor again

step

one 1/2 of a stride

step length

linear distance between point of foot contact (heel strike) of one extremity to the point of heel strike of the opposite extremity

- stepping reflex

- astasia

- volitional WB

- assisted locomotion

- arms in high guard position

- arms down to the side

- trunk & head become more erect

(7) phases to erect locomotion

- arms in high guard position

- arms down to the side

- trunk & head become more erect

- Last 3 phases

which phases are the (4) phases of erect independent walking

stepping reflex

what is phase 1 to erect locomotion

astasia

what is phase 2 to erect locomotion

volitional WB

what is phase 3 to erect locomotion

assisted locomotion

what is phase 4 to erect locomotion

arms in high guard postition

what is phase 5 to erect locomotion

arms down to the side

what is phase 6 to erect locomotion

trunk & head become more erect

what is phase 7 to erect locomotion

- difficulty maintaining upright posture

- leans trunk forward to propel body forward

- unpreductable loss of balance

- arms in high guard

- increased step frequency & cadence

immature gait pattern features in initial stage (5)

- flexion

- abduction

- ER

- femoral anteversion

- 40-50° antetorsion

9-15 month old structural alignment of the hips during gait (5)

genu varum

9-15 month old structural alignment of the knees during gait

- pronated

- everted

9-15 month old structural alignment of the ankles during gait (4)

- COM moves downward

- supported gait with wide BOS

- ER hips with emerging unsupported gait

- better frontal plane control --> Medial-lateral

- less sagittal stability

9-15 month old features of gait (5)

due to long bone growth

why does COM start to move downward when 9-15 months old during gait

- decreased abduction causing decreased BOS

- less hip flexion with increased extension to 4°

- persistent antetorsion with greater hip extension

- genu varum resolving to neutral

- ankles everted

18-24 months structural alignment features of gait (5)

- moves downward

- due to rapid LE growth from 1-2 years of age

18-24 months COM feature of gait (2)

- heel strike is emerging

- decreasing BOS

- more A/P movement

- emergence of PF moment

18-24 months gait pattern features (4)

- consistent heel strike

- COM changes slow as LE growth stabilizes

- genu valgus

- walking velocity has normalized

3-3.5 years old & the features of gait (4)

- Joint torque & propulsion similar to adults except ankle values are less

- COM is at L3

- fully mature gait pattern

- dimensionless time & distance parameters are constant

- postural control is improving

- intermuscular coordination rather than power limits movement speed kids < 10 y/o

6-7 years old & the features of gait (6)

sacral level

what is adult COM level during gait

10-12 years old

when does postural control reach full maturity

7

control of COM displacement during gait is a gradual process through age ___

4 years of age

development of steady-state gait for amplitude of VERTICAL & LATERAL COM displacement greater before

7 years of age

development of steady-state gait for amplitude of FORWARD COM displacement greater before

stability

being able to control COM is a good indicator of ___

- rhythmic stepping pattern --> progression

- control of balance

- ability to modify gait

requirements for successful locomotion in controlling COM (3)

adaptation

ability to modify gait is

- changes associated with increased stability during gait & increased ability to compensate for perturbations to gait

- integration of compensatory postural responses into gait cycle

reactive strategies for adaptation of gait (2)

- locomotion

- balance recovery

ability to step independently is fundamental skill for both (2)

does not

ability to take independent steps in walking (does/does not) automatically translate into ability to use a step for balance recovery

2.5

y/o for immature gait pattern

>/= 3

y/o for mature gait pattern

1-7

step length increases linearly to leg length at ____ y/o

1-4

step length increases linearly to age ___ y/o

decreases

cadence ____ throughout childhood

1-2 y/o

cadence decreases most rapidly at what ages

7

gait velocity increases up to ___ y/o

4-7 y/o

gait velocity rate of change decreases at ages

3.5 y/o

data demonstrates that preferred stride length & cadence increase & decrease respectively up to age of ____ then remain constant into adulthood

vision

___ guides locomotion

- layout of environment

- to body's orientation with respect to environment

how does vision guide locomotion (2)

cautious walking strategy

changes in gait in absence of vision result from more

- development of gvotolith function & structure

- control of HAT

- environment & surfaces that afford safe locomotion--> body contact & support

other sensory systems (3)

- more careful when engaged in attentionally demanding secondary task

- do not have attentional resources to maintain gait while performing a manual task

characteristics of the cognitive system in infant walkers (2)

cognitive tasks over gain in dual-task conditions

children under the age of 7 will prioritize ___

running

exaggerated form of walking

running will have a brief flight phase

how to distinguish running from fast walking

2

children start to run by age

gallop

by 4 years of age, 43% of children can

hop

by 4 years of age, 33% of children can

skip

by 4 years of age, 14% of children can

balance development

developmental milestones such as walk, run, gallop, hip, & skip are better indicators of _____ than chronological age

step hop

what is skipping also known as

increasingly harder or more difficult

as motor pattern skills progress, they will become ____ ____

- pattern of interlimb coordination

- limbs are 50% out of phase with one another

- easiest motor pattern to produce

define walking (3)

- like walking; pattern of interlimb coordination

- appears after walking

- requires more strength & balance than walking

define running (3)

- motor pattern

- asymmetrical gait with unusual timing

- each limb generates force in their own unique way

- may require more balance than running

define galloping (4)

- requires being able to balance all body weight on one leg/foot

- need extra force to lift body off the ground after landing

- need more strength due to narrower BOS since all body weight is handled by one limb during repetitive action of taking off & landing

define hopping (3)

- requires additional coordination abilities

- created by combining 2 different motor patterns into one

- stepping + hopping = skipping

define skipping or step-hop (3)

- stepping

- hopping

what (2) motor patterns make skipping

gets modified to a partial roll & sit-up pattern

development of supine to stand at 2-3 years of age

symmetrical sit-up pattern emerges that is adult-like

development of supine to stand at 4-5 years of age

- depends of opportunity

- first in quadruped

- ascending before descending

developmental progression of stairs (2)

ascending

What occurs first, ascending or descending stairs?