HGD Quiz #4

Physical therapist aim to

promote overall health and wellness

Physical Activity for Infants (birth to 12 months)

tummy time while awake —> helps bring ribs down

30+ minutes throughout the day

Physical Activity for Toddlers (12 to 36 months)

neighborhood walks or free play outside

3+ hours throughout the day

Physical Activity for Preschoolers (3 to 5 years)

tumbling, throwing, and catching

3+ hours a day, including 1 hour of moderate to vigorous activity

Changes in vital signs with age

respiratory rate decreases —→ babies take more breaths

heart rate decreases

blood pressure increases

O2 saturations remain normal above 90-92%

body temperature remains the same

Pediatric Max HR

207- (0.7 * age)

Adult Max HR

220 - age

cardiac output

CO of adults = CO of children

hemoglobin

found in lower concentrations in a child’s blood circulations

VO2max

increases throughout childhood

1 liter/minute at 5 years old

3-4 liter/minute at onset of puberty

Sleep for infants (4-12 m.o.)

12 to 16 hours (including naps)

Sleep for toddlers (1-2 y.o.)

11 to 14 hours (including naps)

Sleep for preschoolers (3-5 y.o.)

10 to 13 hours (including naps)

Sleep for Gradeschoolers (6 -12 y.o.)

9 to 12 hours

Sleep for Teens (12-18 y.o.)

8 to 10 hours

Limited Sleep

increase in hypertension

increase in obesity

decrease in:

• emotional regulation

• reactivity

• language

• memory

• executive functions

Sleep Distrubances after Injury

sports injury, TBI/concussion, Burns/PICU

limited sleep = slows healing & increases the likelihood of re injury

PTs talk to caregivers —→ sleep hygiene and pain management

Body Max Index (BMI)

used to screen for excess body adiposity

• for children over 2 years old

Overweight

BMI at or above 85th percentile

Obese

BMI at or above the 95th percentile

Severe Obesity

Class 2: 120 to 140% of 95th percentile

Class 3: >140% of 95th percentile

Structural and Contextual Factors that impede and influence health and treatment

access to care

weight bias and stigma

obesogenic environments (food, deserts)

adverse child experiences

racism

health inequities

Domains of Development

sensory-motor (gross and fine motor)

cognition

speech (receptive and expressive)

social-emotional

self-help/adaptive

6 theories

Neural-Maturationist Theory

Behaviorism

Work of Myrtle McGraw — the transition

Action-Perception Theory (Gibson)

Dynamic Systems (Thelen)

Embodied Cognition (from both Gibson and Thelen)

The Neural-Maturationist Theory

motor development seen as caused by maturation-dependent changes of genetically predetermined patters in the nervous system

• environment: not significant; body: not significant

• theories rose in parallel to those of B.F. Skinner

every child develops skills in the same order

Top Down Development (NMT)

motor control results from increased cerebral cortex control over lower reflexes

• focus on reflexed (stimulus response) consistent with behaviorism

development as very orderly and controlled

Behaviorism

all children are trainable

• behavior broken down into stimulus, response, and refinforcement

Pediatric physical therapy’s founding theory

NMT

• caregivers were not involved

• reflex testing

PTs controlled the way children explored their environment = using hands to control muscle tone

children were denied adaptive equipment to explore their environment

Normalization (NMT)

of muscle tone, reflexed, and movement patterns

basis of ableism

motor differences needed to be cured rather than accepted

peak of medical model

Motor Cognitive/Perceptual Development

perceptions of the world allow the infant to develop as the child experiences the environment

it facilitates exploration in the case of affordances and inhibits it in the case of contraints

The environment provides ______ and _______ to the developing infant

affordances & constraints

Action Perception

the visual cliff ——> perception impacts action/exploration

• cognitive development cannot be separated from motor development

Fear of heights was innate in humans

infants in the first few weeks of crawling crossed the visual cliff

• infants do not transfer skills from earlier postures to later postures

Dynamic Systems Theory

no one system is the driving factor for developmental change

• environment is considered

• developmental change in non linear, varing sequence

Multicausality

no influence on development has greater weight than another, many influences come together to generate behavior

Newborn Stepping Reflex

changes within the infant (growth, weight gain) and environment (gravity) contribute to the reflexing being masked

Object Permanence

an object left in a spot is still present even if it’s hidden

A Not B Error

more about motor development than cognitive development

Embodied Cognition

the mind is entirely dependent on the brain within a physical body

learning is dependent upon bodily experiences

Key Cognitive Concepts and Motor Development

object permanence

means end

joint attention

object affordances

• all rely on head control, reaching/grasping, sitting, independent mobility

Means End

the execution of an intentional sequence of actions performed on a '“means” object to achieve a goal related to an “end” object

Joint Attention

child is able to attend to an object in mutual interest with another person

• child pick an object up, shows it, or points to it

Object and Body Affordances

first seen when an infant discovers they can use something for other than its known, intended purpose

1) Motor based cognitive learning

integrates means end, object permanence, object affordances, and joint attention

Evidence Based of Contemporary Pediatric PT (5 things)

2)child initiated movement, as opposed to facilitated movement

rather than therapist guided intervention, focus on (3)

parent guided intervention

child guided intervention

coach parents in sensitivity and mutually enjoyable interventions (4)

the “just right” level of intervention requires sensitivity

parents facilitate what they enjoy

*** a stressed child is not a learning child ***

to maximize early neuroplasticity, begin intervention early (5)

discourage “wait and see”

Explicit Memories

under our control to retrieve

Few explicit memories remain after early childhood

particularly for pre-verbal children

amnesia of childhood

Implicit Memories

not under our active control to retrieve

Information is there for use when we need it

motor learning is eventually stored as an implicit memory (riding a bike)

many implicit memories remain without conscious awareness

will only return to explicit or cognitive motor control if task requires

Memories related to trauma are also stored in implicit memory in pre-verbal children and in adults who experience trauma

sensations and movements may trigger traumatic responses

Postural Control

utilizes cooperative interaction of 3 sensory systems

• visual

• vestibular

• somatosensory system (touch and proprioception)

Postural variability is part of development

1) variability in posture is needed for motor skill acquisition

2) variable and adaptive postural control allows for environmental exploration through movement opportunities

3) limited complexity in postural control may be an early sign of developmental differences

Variability

ability to move in several different ways to achieve similar outcomes

adaptability

able to manaage the unique environmental constraints and affordances

complexity

ability to move in several planes with different speeds and accelrations/decelerations

enhancing the complexity of postural control

may lead to improvements in motor function

Birth to 6 weeks

first reaches are visually triggered, but not visually guided

7-11 weeks

visual exploration may be preferential to touch exploration as visual skills mature

12 weeks

frequency of reaching increases, when reaching is visually guided

12-14 weeks

infants focus on touching objects

15-18 weeks

infants grasp moving objects

19 weeks

reaching is characterized by a variable trajectory for the same target until 19 months

as posture improves

the reaching trajectory decreases in variability and is more direct