Neuro III lecture

What are neonates?

Newborn babies (within the first 10 days of life)

Born at the typical time (At 40 weeks)

Neonates experience many ________ extremity movements

Random

What 4 joints of a neonate are in physiological flexion?

Elbows, hips, knees, and ankles

When do newborns move the most?

During wake hours

What position is the spine of a neonate in?

Thoraco-lumbar kyphosis

What type of objects can neonates detect and briefly track? How is their vision initially?

High contrast (black/white)

Vision is blurry until about 3 months

What are the main interests of a neonate?

Eating, cuddling, caregiver attention

In what position are the LE of a neonate in supine?

Hip flexion, abduction, external rotation

They prefer the frog position

How is the flexibility of a neonate in the hip flexors and hamstrings in supine?

Limited flexibility

How many degrees of DF does a neonate typically have?

Increased ROM of 60 degrees

Does a neonate have medial or lateral femoral torsion?

Medial

Does a neonate have femoral anteversion or retroversion?

Anteversion

Does a neonate have femoral bowing or knock knees?

Bowing

Does a neonate have femoral coxa valga or vara?

Valga (A deformity of the hip where the angle formed between the head and neck of the femur and its shaft is increased, usually above 135 degrees)

Does a neonate have a deep or shallow acetabulum?

Shallow

The LEs of a neonate include:

Genu _______

Tibia ________

Tibial _______

Calceneal __________

Forefoot _________

Metatarsus _________

Varum (bow leggs)

Varum (inward curviture of the tibia)

Torsion

Varus

Varus

Adductus

What position are the shoulders, elbows, and forearms in, in a neonate who is in supine?

Shoulder adduction and EROT

Elbow flexion

Forearm pronation

*Clenched fists

Why/how do neonates have hand to mouth play?

They have flexed elbows and rotated heads

How does rolling happen in a neonate?

Rolling happens due to neonatal neck righting reaction and rooting reflex

Are assymetrical positions ok in a neonate?

Yes

How does a neonate track a toy?

Briefly from side to midline

From how far away can a neonate see/track an object?

8-9 inches

What is the sitting position of a neonate?

Head lag with no UE, abdominal, or LE activity

Normally the infant will respond with increased awareness and express this through facial expressions

Strong grasp reflex promotes strong grasp/grip

Supported sitting promotes brief moments of attempts to lift head/neck but quickly falls forward

What is the first goal of UE movement?

Reaching

One of the first motor skills infants perform

What are the social behaviors and language patterns of a 1 month old?

Visual preferences for humans

Moves in response to a voice

Vocalizes to caregivers and voice

2 months exhibit __________ movements

Disorganized

Do 2 month olds experience more or less physiological flexion?

Less

When is the greatest period of asymmetry exhibited?

2 months

How can 2 month olds track objects in supine?

Side to midline and back to side

2 month olds have a ________ degree of head rotation

Greater

What is a 2 month olds head rotation directed by?

Visual attention

NOT A CHIN TUCK

What may greater degrees of head rotation in a 2 month old stimulate?

Neck proprioceptors which elicit ATNR

When is ATNR most evident?

2 months

What happens to the UEs in a 2 month old?

They are in more abduction and ER

What happens to the LE at rest in a 2 month old?

Flexion, abduction, ER

What happens to the LE actively in a 2 month old?

Variety of LE movements

How does a 2 month old lift its head in prone?

Briefly to 45 degrees with asymmetrical extension

What can a 2 month old begin to do with its arms in prone?

Push up

Elbows remain posterior to the shoulder

2 month olds have __________ cervical and upper thoracic extension

Increased

What has happened to hip abduction and ER in a 2 month old?

It has decreased

What flexibility limitations decrease in a 2 month old?

Hip flexion and hamstring

What happens during sitting and standing at 2 months?

Insufficient head and neck flexor control with head lag

Back is flexed with head lifting

Increased awareness due to labyrinthine and optical righting reactions from the stimulus of head lifting

Lower extremity EROT

More control in standing

How many degrees can a 3 month old lift their head in prone and with how much bobbing?

45-90 degrees in midline with no bobbing

How many degrees can a 3 month old track in prone?

180

Consistently following object or face

What does head shifting cause in a 3 month old?

Lateral weight shifting

The labyrinthing and optical righting reactions ___________ at 3 months

Increase

3 month olds exhibit _________ spinal extension in prone

Increased

When do you see forearm WB (propping) in an infant?

At 3 months

The humerus will be abducted aligned with the shoulders or in front

What is the difference in pushing up between a 2 month old and 3 month old in prone?

At 2 months the arms are posterior to the shoulder while at 3 months they are in line or anterior to the shoulders

When do you see a scratching movement of the fingers in an infant?

3 months

At 3 months are the LE symmetrical or assymetrical in prone?

Symmetrical

Where does extension increase in a 3 month old in prone?

Hips and knees

Is EROT increasing or decreasing in a 3 month old in prone?

Decreasing

At what month do ankles begin to fluctuate between DF and PF in prone?

3 months

What happens to sitting at 3 months?

LEs are positioned into EROT and abduction

Back is more extended in sitting

Baby's weight is on the ischial tuberosities

Less support during sitting - if the baby feels unstable they will use bilateral scapular adduction or high guard position to maintain balance

Trunk control is building so if the baby is left unsupported for too long, the baby will fall forward

What are the social behaviors and language patterns of a 3 month old?

Listens to voices

Smiles purposely in response to caregivers face or voice

Coos

Cries to get attention - crying decreases with adult contact as they vocalize to express displeasure

What relationship do you expect between the hands and feet of a 4 month old in supine?

Hands to flexed knees

How is a 4 month old kicking its legs?

Symetrically or reciprocally

When will you see foot on foot play in supine?

4 months

When will an infant begin to use active hip adduction with hip flexion?

4 months

When is the period of symmetry and midline orientation of the head and hands?

4 months

When do you see an active chin tuck, flexion, and midline placement of the head/neck?

4 months

What kind of rolling does a 4 month old do?

Rolling supine to side lying is seen - flexed posture - initiated be head rotation or by an asymmetrical position of LE which causes a lateral weight shift

How does a downward gaze begin in a 4 month old?

Head flexion

What kind of reaching do you see in a 4 month old? What position are the forearms and wrists in?

Bilateral reaching towards toys with forearm pronation and wrist extension

Shows increased hand eye coordination

How does the trunk move in a 4 month old?

As one unit

When will you see an active anterior and posterior pelvic tilt in the sagittal plane?

4 months

What happens when an infant begins sidelying?

Rib cage shaping, head shaping, new visual orientation, vestibular orientation, proprioceptive feedback

What happens to sitting at 4 months?

Can sit unsupported for several seconds

Stabilizes trunk posture by leaning forward from hips

Baby enjoys supported sitting

Capital extensors are more active than flexors

Slightly propped arms and LEs are ERO, abducted and flexed

At what month does propped sitting begin?

5 months

How long can a 5 month old maintain propped sitting and how do they maintain balance?

8 seconds

Maintains balance by propping UEs

What are the main milestones at 5 months?

Full body extension positions

Now using "new" arm-extended position

Keeps practicing forearm WB positions, now refining WS

Now they can reach out with one hand without collapsing on WB forearm

Reaches hands to feet

Feet to mouth

LE: more selective control

LEs no longer mirror UEs (More dissociated and reciprocal movements)

When is a roll initiated with a chink tuck, spinal flexion, and reaching across the chest?

5 months

What are the social behaviors and language patterns of a 5 month old?

Laughs

Excited about food

Laughs at self in the mirror

Turns head towards a voice

Vocalizes

Laughs and babbles

When does contralateral hands to feet playing begin to occur?

6 months

At what month would you see a baby maintain and recover balance with legs lifted in supine?

6 months

At what month would you expect to see the pelvis off the surface showing good abdominal strength?

6 months

At what age do you see a baby roll from supine to prone and prone to supine?

6 months

At what age do you see a baby control weight shifting with abdominals and their non WB leg?

6 months

At what age do you see a baby who has mastered antigravity movements in supine and prone?

6 months

How old would a baby be who can sit unsupported with spinal alignment and the pelvis perpendicular to the floor for 60 seconds?

6 months

Will probably be in a ring sit for a wide BOS for proximal stability

UE are free

Controls sagital WS

At what month would a baby rarely stay in supine?

7 months

Should a baby stay in supine at 7 months?

No, it is a red flag if they stay in supine

At what month would you see a baby disassociating its LEs and playing in high sidelying?

7 months

When does quadruped start?

6-7

7 months but may have started at 6

When does rocking anterior to posterior start?

7 months

Initially done with large movements that lead to falling

Later there are more fine controlled movements with less falls

Lumbar lordosis is present initially and with practice is reduces

What are the quadruped transitions?

Prone to quad or sitting to quad

What 3 things does quadruped transitions require?

Ability to disassociate LEs

Increased ability to control WS

Increased trunk and proximal hip/GH strength

When do you see a baby transition from quadruped postures into bear crawling?

7 months

When do you see pulling to stand or standing at furniture?

7 months

Uses UE (relies heavily) to pull up on furniture or people from quadruped or kneel sit and stiffly extend knees

What happens to the foot when standing at furniture? How does the baby return to the floor?

Feet pronation with toe curling

By falling

What are the social behaviors and language patterns of a 7 month old?

Enjoys mirror, lively response to familiar people, babbles, vocalizes four different syllables, has two syllable combinations, responds to their name

What happens with crawling at 8 months?

Most efficient means for movement

Crawling on hands and knees which is critical at this age

What happens with standing on furniture and cruising at 8 months?

Uses wide BOS, UE still required for postural stability

Cruising is done around furniture while UE are keys for postural stability

What object manipulation occurs at 4.5 months?

Should be able to hold two objects, one in each hand

What object manipulation occurs at 5 months?

Two handed hold of a single object

What object manipulation occurs at 4.5-6 months?

Hand to hand transfer of objects

What object manipulation occurs at 6-8 months?

Bangs objects together

At what month would you see independent and functional sitting?

9 months

Due to good trunk/pelvis control at 9 months what can you expect to see a variety of?

LE postures