Peds Unit 1: Child development and family centered continuum of care

what is motor control

the organization and regulation of the systems responsible for movement such as the brain, spinal cord, and muscles

what is motor learning

the process of acquiring or refining motor skills through practice and experience occurring over hours, days, or weeks

what is motor development

the age related process if change in motor behavior over a longer time scale such as months, years, or decades

what is the neuromaturational theory

states that motor development follows a predictable sequence driven by the maturation of the CNS

what is the dynamic systems theory

states that multiple systems all interact to influence motor behavior highlighted by varied ability, adaptability, and non linear development as natural and necessary

what do the ecological and perception action theories emphasize

the child's interaction with their environment

what are the general trends seen in motor development (5)

cephalocaudal control

gross motor before fine motor

proximal to distal control

reflexive and spontaneous movements to controlled voluntary movement

foundational infantile or primitive reflexes lead to postural reaction

what are the three key stages in developing the ability to move against gravity

physiological flexion

anti gravity extension

anti gravity flexion

what is physiological flexion

the dominant posture at birth due to the curled up position in the wound

what is seen in physiological flexion

hips, knees, elbows, and shoulders are all flexed

what does physiological flexion provide

passive stability and the starting point for movement development

what is anti gravity extension

the babies first active motor effort against gravity when the baby lifts their head up when laying on their stomach

when does anti gravity extension occur

around the 1-2 month range

what does anti-gravity extension do

strengthens the back, neck, trunk, and spine extensors

lays the groundwork for future skills like sitting, rolling, crawling

when is anti-gravity flexion seen

around 4-6 months

what is seen in anti-gravity flexion

the infant brings their hands to their knees or feet to their mouth when on their back

what does anti-gravity flexion provide

activates the abdominal muscles to help develop midline orientation, symmetry, and control for transitions and upright mobility

what standardized assessments can be used to assess development more objectively (3)

alberta infant motor scales

test of infant motor development

development assessment of young children

what is the most influential external factor to development

nutrition and body composition

what activities tend to promote better motor performance

tasks that are meaningful and engaging

what does vision do for development

it helps with spatial awareness and balance

what do the vestibular and somatosensory systems provide for development

they provide feedback for postural control in righting reactions

what is one of the strongest predictors of development

parental involvement and support

according to the updated developmental screening when is a milestone included

if at least 75% of the children are expected to achieve it by a given age

what is seen in normal physiological flexion

hips at 30 degrees

knees 20 degrees

ankles dorsiflexed

rounded kyphotic posture

when does motor skill development start

long before birth as they practice essential movements like touching their face or explore the uterine wall

what are examples of early motor skills (3)

changing positions

reaching

mobility

what is the earliest indicator of postural development

head control

what leads head movement

eye movement

when does midline head position in supporting sitting and prone occur

by 2-3 months

how is a newborns posture describes

asymmetrical as their head is turned to the side seeming to look at an outstretched arm

what replaces the initial asymmetrical posture in newborns

relative symmetry around 4 months

what is the initial sitting development stage

prop sitting

what is seen in sitting around 6-7 months

infants can independently sit and reach for toys showing improved trunk and pelvic control

what are the stages of sitting progressing (3)

prop sitting (4-5 months)

unsupported sitting with poor balance (5-6 months)

independent sitting and reaching (6-7 months)

when is crawling and emerging mobility seen

7-10 months

what are the stages of crawling and emerging mobility (4)

combat crawl or belly scoot (7 months)

hands and knees crawling (8-9 months)

pivoting and transitions to sitting

pulling to stand at furniture

when does standing progression and pre walking occur

9-12 months

why are infants relatively weak around 9-12 months

they have high body fat percentages making them weak compared to their weight

what can influence an infants supported standing posture as their legs grow

hip flexion contractures and bowlegged stance

what is the speed of leg growth compared to trunk development in infants

legs grow quickly and the trunk develops slower

what can contribute to increased hip flexor and extensor strnegth

early movements like kicking and prone play

when do infants typically start walking

12-15 months

what is seen in gait in infants

wide based with shot steps and flat foot contact

still extended posture for stability

what happens after 1-3 months of walking in infants (4)

gait patterns rapidly refine

co-contractions decrease

reciprocal movements emerge

muscle synergy complex increases

what is the limiting factor in early gait

strength especially extensor strength

what occurs in the legs in month 19-24

the bow legged or varus alignment of the knees resolve and the limb appears straight in standing

when does heel strike start to occur in gait

by 24 months

what occurs in gait as the leg grows

more narrow BOS to enhance gait efficiency

what leads to smoother more controlled gait

co-contraction decreases

what can children do by age 2 (3)

walk backward

run

ascend stairs step to without support

when is a more adult like gait pattern seen

around age 3 with the emergence of SL stance

what leads to decreased head and trunk sway during walking

the knees adopt a valgus or inward alignment and improved trunk control

what is seen in stairs at age 3-4

able to walk stairs with alternating feet

what is seen in balance at age 3-4

balance is improved but perturbation response is still immature

what activities are seen by age 3 (3)

hump with 2 feet together

able to rise on toes and stay

throws perpendicular to target

what is seen by age 4 (2)

walk up and down stairs without support

tandem walk on line

what can children do by age 7 (4)

skip and gallop

SLS for 10 seconds

hop 8-10x on one foot

mature throwing pattern

when do primitive reflexes emerge

by the end of the second trimester and are integrated during the first year of life

what can signal abnormal NM development with primitive reflexes

any deviation in their presence, strength, or timing

why do primitive reflexes fade

due to the growing complexity of movement and increasing ability to select motor strategies

what do primitive reflexes reflect

activity of the brainstem in the SC

what is the rooting reflex

when you stroke a newborns cheek near the mouth they will turn their head towards the stimulus

what is the purpose of the rooting reflex

it helps the baby locate the food source like a bottle or breast as a survival reflex

what is the suck-swallow reflex

when a finger or nipple is placed in the infants mouth there is lip closure followed by a strong rhythmical sucks and swallow

what is the Moro reflex

when the infants head in drops backwards their arms extend/abduct, then flex/adduct accompanied by crying, shaking, or tremors

what is the traction reflex

when the infants foreams are grasped and pulled to sit there is complete flexion of both UE including a grasp

what is the palmar grasp reaction

the baby curls around a finger or object

what is the asymmetrical tonic neck reflex (fending position)

when the infant turns their head there is extension of the extremities on the face side with flexion of extremities on the skull side

what is the symmetrical tonic neck reflex

when the infants head is extended there is UE extension and LE flexion

when the infants head is flexed there is UE flexion and LE extension

what is the landau reflex

there is complete ext of the head, trunk, and extremities with the infant in prone horizontal suspension

what is the overall progression of postural and motor control

mobility

stability

controlled mobility

skill

what is mobility

the ability to initiate movement

what is stability in children

when they learn to hold postures using co-contraction of the muscles around joints

what is controlled mobility

allowing movement within a stable posture like wt shifts or reaching in prone

what is skill

the ability to interact with objects in the environment in a goal directed way while maintaining posture

how is mobility observed in newborns

spontaneous limb and head movements

what is the first phase of stability

structural stability where tight issues provide passive support

what is second phase of stability

postural stability where the body uses a wide BOS

what is the third stage of stability

internal stability which is marked by writing in equilibrium reactions which is an active process

what is controlled mobility a critical transition point before achieving complex movement skills

for achieving complex movement skills

when do postural reactions start

around 2-3 months

what are righting reactions

orienting the head in space to keep head upright in midline

what are protective reactions

extension of extremities to prevent fall forward, sideways, backward

what are equilibrium reactions

orienting the whole body to midline and upright position against gravity

when is acute care used for peds

when the child is admitted due to a medical issue like surgery, trauma, and illness

when is inpatient rehab used for peds

for pts very similar to those for adults that can tolerate at least 3 hrs of therapy between OT, PT, and SLP daily

how long do ped pts stay in inpt rehab

often between 1-3 weeks staying overnight at the rehab unit

what is the day hospital setting

the child pt gets dropped off and picked up each day for rehab similar to inpatient rehab unit

what setting is beneficial for peds

in their natural environment like their home

what is school based therapy

schools that are funded by the government that provide PT services to children to improve their learning or participation in school

what is intensive therapy with chronic conditions

3-11 x/wk

what is intensive therapy for pts in acute care

> 6 visits/wk

what is frequent therapy for pts in acute care

5x/wk

what is regular therapy for pts in acute care

3-4 x/wk

what is occasional therapy for pts in acute care

1-2x/wk

what is consult therapy for pts in acute care

1-2 visits total

who initiates consultive/monitoring therapy

parent

what does pediatric gait look like at 12 months (5)

bowlegged

wide BOS

short steps

flat foot contact

high guard arms

what does gait look like at 18 months (3)

varus alignment is resolving

emerging heel strike

narrow BOS