Lifespan Development - Exam 1 (Weeks 1 and 2)

How do we measure health status?

NOT mearly the absence of disease, we measure the wellbeing of:

• Physical

• Mental

• Social

We measure through signs, symptoms and functional status

What are the three componetns of function?

• Purpose

• Participation

• Level of health and well being

Disability vs Handicap

• Disability: Individuals diminished functional capacity

• Handicap: frame of reference defined by society. Happens when individuals are percieved to not be able to perform the tasks expecteed by society

T/F: The loss of functional ability always results in disabilty or handicap

FALSE

Components of the ICF model

• Body structure’s function

• Activities

• Participation

• Enviornmental factors

• Personal factors

ADLs vs Insturmental ADLs

• ADLs: “Basic” (grooming, dressing, toileting, eating, hygene)

• IADLs: skills management (cooking, shipping, working)

Age ranges of development

• Prenatal: Before birth (embryonic and fetal)

• Infancy: Birth - 1 year

• Childhood: 6 to 10-12 years

• Adolescence: 12 to 18 years

• Adulthood: 19 to 64 years

• Older Adulthood: 65 years and older

Explain senesence

Progressive physiological decline that results in increasing vulnerability to stress → progessing likelihood of death

T/F: Senescence is a single, linear process that is not related to the development of function

FALSE. Senescence is composed of multiple nonlinear processes that affect the development of function over time.

What are the three domanis that determine functional status?

1. Biological

2. Psychological

3. Sociocultural

These are also the stages of maturation

According to the APTA, what body systems contribute to our movement?

• Endocrine

• MSK

• Neuro

• CV

• Intergumentary

• Pulmonary

Is every oldder adult less active than before?

NO, variability is high

What body systems contribute to balance?

• Vestibular

• Vision

• Propioception/vsomatosensory

“Ears, eyes, and feet” OR

• Nervous

• MSK

• Sensory

What contributes to imbalance in older adults?

• Reflex activity

• Vestibular dysfunction

• posture changes

• deconditioning from disuse

• Medications/ploypharmacy

• dehydration

Define coordination

When muscles work together to produce smooth and efficient movement. They work in the correct sequence and with the right timing

Define power

Strength and speed combined. Ability to generate strength quickly (rate at which work is done)

Gestational Age

Age from the first day of the last menstrual period

What is adjusted age?

Only done if baby was born prematurely. Eg. 32 week preemie is turning 52 weeks

1. Substract the age the infant was born at from 40 (40-32= 8 weeks early)

2. Substract those weeks from the current age (52-8= 44)

3. Now you have the adjusted developmental age (44 weeks)

We STOP this after 2 years!

Stepping Reflex

Stimulus: hold infant in vertical suspension, touch feet to support surface, and lean slightly forward.

Response: reciprocal flexion/extension of legs or stepping (often weak but present).

Purpose: diagnostic for CNS involvement; when integrated, allows for voluntary LE movement development.

If persists: it never achieves voluntary stepping with control.

(38 weeks of gestation; to 2 months)

Body-righting reflex

Aligns body after head turns, supports rolling and other coordinated movements

Crawling

Baby placed on stomach + pressure applied to soles of their feet = attempt to push against the surface

(crawling motion – gone after few weeks PP)

Parachute

Stimulus: Hold the infant in the air in the prone position, then suddenly lower the infant headfirst toward the table (simulating a fall)

Response: The infant extends the upper extremities as if to break the fall (arrow).

Purpose: confirming of protective extension

Abnormal response appears with a startle response to testing indicating a hyperresponsive state. CNS involvement with hyper and hypo-responsiveness.

You may also examine for protective extension backwards by perturbating a child in sitting

(fully developed by 10^th month - should be through adulthood).

Swimming

When in water → moves arms in swimming motion + hold breath

(gone by 6 mos)

Tonic Labyrinthine Reflex

Stimulus:

• For infants, suspend their body in the prone supporting them at their abdomen/trunk.

• For older children: position prone and ask the child to fully extend (airplane position) or position supine and ask the child to curl up like a ball flexing head onto chest.

Response: Infants: in prone suspended position

• Head in extension: the body and extremities tend to be dominated by extensor tone

• Head in flexion: dominated by flexor tone. 

For older children: persistent influence will result in difficulty sustaining a fully flexed position in supine or fully extended position in prone.

Purpose: basis for postural control of head and trunk

Abnormally: abnormal muscle tone will further develop, imbalance, motion sensitivity, and spatial orientation abnormalities.

(birth - 6 months)

Landau (more voluntary TLR)

Stimulus: prone laying or prone suspension

Response: cervical extension begins developing in first month of life and progresses to full extension of head and all limbs (superman) by month 4

Purpose: development of head and trunk control; development of normal spinal curves (fully developed within 4-6 months when as Tonic Labyrinth Reflex integrates)

If abnormally persists: indicates extensor tone in CP and will be named by limb involved. Mobility impaired.

(4 weeks to 12-24 months (becomes voluntary) (fully developed once TLR integrates)

Head-righting

Similar to the Labyrinthine reflex, it keeps head aligned when tilted or moved. Helps balance and coordination

(appears by 2-3 mos)

Pull-up

When infant is sitting + hold their hands up and pull to standing = flexion of their arms “pull up” on their own

(appears by 3-4 mos integrates by 6)

Palmar/plantar grasp

Pressure on ulnar side of palm → fingers curl around stimulus.

Purpose: automatic grabbing and eventual development of purposeful grasping; if absent or weak can diagnostic for CNS or peripheral nerve involvement

If abnormally persists: difficulty with fine motor skills; poor manual dexterity; messy handwriting

(birth to 5-6 mos)

Sucking/Rooting

Stimulus:

Rooting - stroke face starting at the corner of the mouth and moving outward. Sucking - finger is placed in the mouth (yours or baby’s)

Response:

Rooting - head turns toward stimulus, and mouth opens; may be stronger in breastfed infants

Sucking – baby begins rhythmically sucking.

Purpose: survival for feeding purposes. Sucking is also a self-calming activity for the baby. Dry-sucking can help them gain ability to perform suck/swallow/breathing coordination for functional feeding.

If abnormally persists: head will remain turned toward stimulus and midline is difficult to establish over time.  Will have difficulty with achieving feeding goals (fussy eating; drooling; excessive thumb sucking). May develop speech and articulation problems.

(28 weeks gestation; 3-4 months)

Moro and startle

Stimulus:

Moro: Hold in semi-reclined or supine and suddenly drop the head into extension (just a couple of inches). 

Startle reflex: similar to moro but the stimulus is a loud, sudden noise.

Response:

Moro: abduction of arms with fingers open.  A full Moro response may also include UE movement ending with quickly by adducting of the arms at the end.

Startle reflex: same as Moro.

Purpose: Primitive fight or flight. Assess ANS and CNS

Bilateral absence: CNS depression by narcotics or anesthesia; Brain anoxia; Very Premature baby
Asymmetric response: Erb’s palsy; fracture clavicle or humerus.

If it persists: hypersensitivity to quick movements and noise; sensory overload, hyperreactivity. During mobility, can cause loss of balance, falls.

 

(28 weeks gestation; 5-6 months)

ATNR

Stimulus:

For infants, turn head in supine. 

For older children, on hands and knees actively have child turn head to the side.

Response:

For infants, increased extensor tone in extremities on the face side; increased flexor tone in extremities on the skull side.  Spine is curved with convexity toward the face side. 

For older children, arm on skull side will collapse into flexion while in the stimulus position of quadruped.

If it persists : poor eye/hand coordination, difficulty crossing midline, difficulty rolling.

(birth; 5-6 months)

Symmetrical tonic neck relfex (STNR)

Stimulus: position the child in prone; active or passive neck extension

Response:

• neck extension: increased, extensor tone is observed in the UEs and increased flexor tone in the lower extremities. 

• neck flexion: flexor tone in UEs and extensor tone in LEs.

Purpose: preparatory for creeping on hands and knees

If it persists: may not achieve creeping; poor sitting posture, poor sitting balance, causing concentration difficulties as the child ages.

(birth; 6-8 months)

Postural reflexes list

1. Stepping (38 weeks gestation → 2 months)

2. Body righting

3. Crawling (birth → few weeks PP)

4. Parachute (6-7 months to 9 months → adulthood)

5. Swimming (birth → 6 months)

6. Laberynthine (birth → 6 months)

7. Head-righting (2-3 months →?)

8. Pull-up (3-4 months to 6 months → ?)

Primitive reflexes list

1. Palmar/plantar grasp (birth →5-6 months)

2. babinksi (birth → 9-24 months)

3. Sucking and Rooting (28 weeks gestation → 3-4 months)

4. Moro and startle (28 weeks gestation → 5-6 months)

5. ATNR (birth → 5-6 months)

6. Symmetrical tonic neck reflex (birth → 6-8 months)

Which reflexes have an onset during gestation?

• Rooting and sucking (28 weeks)

• Moro + startle (28 wks)

• Galant (30 wks)

• Stepping Reflex (38 wks)

What is stereotypical movement, and when is it normal to see it?

Nearly no degrees of freedom - they move in a programmed way over and over. Rhythmical, patterned, seemingly centrally controlled movements, but still without full motor control.

Normal in infants, but they should integrate and become normal movements → If they persist, they are “obligated” to stereotypical movements.

Abnormal reflex activity in infants

When reflexes don’t integrate when they should.

A primitive reflex would be abnormal when it is absent or diminished during the period it should be active or lasts beyond the normal age limit for its disappearance

When does someone acquire a skill? (aka motor learning)

When motor activity becomes better organized, more effective and efficient as a result of practice.

How can early motor skills be enhanced?

1. Task training → Use of goal-oriented tasks.

2. Feedback →

   Internal feedback (based on how it was experienced and if it was as the child intended)

   External feedback (knowledge of performance and results offered by another person, teaching them)

3. Practice of high intensity and duration

4. Culture and family interest play a role

Describe the Dynamic Systems Theory (DST)

Indicates an emerging movement pattern arising from the interaction of system(s) elements.

• task

• environment

• organism

It is a system with layers building on themselves (muscular, skeletal, nervous, endocrine) that are self-organized and interactive. (we learn from our environment)

Describe the Neuronal Group Selection Theory (NGST)

Motor skills result from the interaction of developing body dynamics and the function of the brain. The brain and its CNS related regions change based on how the body is used.  Neural pruning and efficiencies develop over time as skills become more refined.

What is neural pruning?

• We get rid of the redundant motor units when they are not used

• With time, used motor commands need fewer motor units (↑efficient, NOT losing variety)

How are the DST and the NGST similar?

• Motor development is a nonlinear process which is affected by both child and environmental factors.

• The natural environment influences success (safe place to play, the presence of toys, housing, etc.)

• Integration of multiple systems (not just motor) are used to perform a functional task.

• The brain is not in isolation and is not a “computer”.

• Neuroplasticity is a lifespan constant feature.

Motor milestones: 1 Month

• supine

• physiological FLX

• Sitting → head lag

• Prone → COG towards face but can turn head

• Primitive reflexes: Standing, stepping, moro, babinski, ATNR, FLX posture, rooting, sucking, grasp

Motor milestones: 2 Months

• Supine

• physiological FLX (↓↓)

• Prone → Flatter hips and COG towards legs + head lift for 45s

• Standing

• Prone suspension= UE EXT

Motor milestones: 3 Months

• Supine midline orientation

• Sitting → PARTIAL head lag

• Prone → lifts head 90 degs and puts more weight thorugh arms

• Standing: Stepping reflex is integrated

Motor milestones: 4 Months

• Supine symmetry

• Sitting → MINIMAL head lag

• Prone → Landeau emerges

• Prone suspension → parachute emerges

Motor milestones: 5 Months

• Supine strong abdominals

• Sitting → NO head lag

• Prone → achieves POEE

• Standing → WB through own strength (not reflex)

• SL → dissociation of legs with elongation on WB side

Motor milestones: 6 Months

• Supine → rolls supine to prone

• Sitting → chin tuck

• Prone → strong Landau, prefers to play in prone

• SL: lateral neck flexion

• Prone suspension: protective response with 1 arm

Motor milestones: 7 Months

• Supine: Prefers prone play time

• Pivots in prone

• Sitting → Extension forward and side directions (moves from sitting to prone)

• Standing: begins to pull

• Quadraped: Prone to quad + weight shifts

• Fine motor: transfers objects and throws them

Motor milestones: 8 Months

• Sitting → independent sitting w/ secondary curves/ begins to side sit / prone to siting

• Good sitting balance in all directions

• SL → segmental rolling

• Standing: Pulls to stand

• Quadraped → creeps on hands and knees

Motor milestones: 9 Months

• Sitting: variety

• Standing→ pulls to stand using half kneeled transition

• Quadraped: frequent

• Kneeling: able to short kneel

Motor milestones: 10 Months

• Sitting → protective extension backward

• Standing: can cruise with one arm

Motor milestones: 11 Months

• Standing→ alone with HIGH guard

Motor milestones: 12 Months

• Standing: rises from quad w/o furniture

• Walking → may walk alone (wide BOS, HIGH guard, feet out, no heel strike, no arm swing)

T/F: Development occurs cephalocaudal + distal to proximal + head control precedes trunk control

FALSE, it is Development occurs cephalocaudal + proximal to distal + head control precedes trunk control

Fractionization

SINGLE isolated movement - often seen distally (finger FLX?)

Dissociation

Body segments move equal and opposite to each other (walking, rolling over)

What are the three phases of motor learning (in order and what happens in each phase)?

1. Cognitive (easiest; earliest, guiding)

2. Associative (need verbal cues; child feels motion)

3. Autonomous (more indep and automatic)

Describe the development of walking at 12 months and beyond up to 5 years + relate progressions

Walking age is 12-18 months

• 16-18 months: Walking is now easy, and can carry an object. Can creep (even stairs)

  • By 18 mos, we can expect reciprocal arm swing and heel strike

• 24 months: Heel strike in gait (NOT IN PUSH OFF), goes up/down 1 stair at a time, kicks large ball; throws small one, only one foot leaves the ground when they jump

  • MAY do 2 feet

• 3 years: Running, hopping, galloping, kicking, skipping (stability emerges)

  • Higher reciprocal skills, can walk on tip toes

• 4-5 years: Hops consecutively on one foot / SLS for 10s / Smooth overhand ball throw(if the ball fits hand)

At what age does the vestibular system mature?

8-10 years

Adolesence: Girls

• Puberty: 2 years earlier than boys

• Strength: Static strength increases, but not as much as boys

• Motor performance: Increases until 14 → Tasks are highly variable (interaction of strength and growth spurt)

Adolesence: Boys

• Puberty: Positively affects motor performance due to increased strength

• Strength: Early maturation = ↑↑↑ strength

• Motor performance: Peaks at 14 but stops at 18 → peak at 17-18

What is the main factor allowing older persons to still be skilled and motorically competitive? Basically, are they still trainable?

Yes. The main factor is that they remain active.

Define motor control

Ability to maintain and change posture and movement. It is the result of a complex set of neuro- and mechanical processes.

Define motor learning

The process by which motor skills and abilities are learned.

What are the three components that allow movement to emerge?

• Task

• Individual

• Enviornment

Explain the role of sensory input, does sensory drive motor?

YES! All sensory input from the environment (eyes, ears, feet, hearing, etc.)

What types of sensory feedback are we reliant upon?

Feedback detects errors and allows us to learn new motor skills

• Intrinsic feedback: from ANY sensory source inside or outside the body

• Enhanced feedback: Facilitatory, inhibitory, guiding (applied by therapist)

Motor program theory and motor imagery (basic premise)

• Motor programs are set of muscle commands specified at the time of action production (NO sensory input required)

• Distributed across different systems, as representing movement mentally (AKA motor imagery) = motor planning

• Motor control ↑ childhood to early adulthood → ↓late adulthood

Central pattern generators

• CPGs produce coordinated movement without thinking about it (walking), and sensory feedback adjusts the timing and reinforces proper muscle activation

Systems theory

Preferred way to describe the relationship between the brain and SC that control posture and movement

Degrees of freedom and task oriented approach

• There is redundancy in the CNS, which means that it has to reduce DoF (aka the number of independent movement elements use) to increase efficiency

• An example of this is co-contraction or closing kinetic chains to find stability and limit DoF

Dynamic systems theory

The development of control over movment is based on the interactions with the:

• Enviornment

• Task

• Person

Closed loop feedabck

• Sensory information is used as feedback during the movement.

• Feedback is transmitted by sensory system → CNS, guiding the next action

  • Providing self-control of movement. A loop is formed where errors can be corrected with practice and repetition to improve performance

Open loop feedback

• Movement is cued either by a central structure (a motor program) or by sensory information from the periphery.

• Errors are detected after the fact

Types of feedback as we learn a skilll

Used when we are learning a skill (we move slowly while mastering it). Then, as we learn the task, it can be done quickly without thinking (open loop)

“closed loop → Combination → open loop”

Massed vs Distributed practice

• Distributed (Easier): More time in rest (fatigue)

• Massed: More time in practice (CIMT example)

Random vs Blocked practice

• Blocked/mixed (easier): Same task is repeated over time (good in early cognitive stages/impairment)

• Random: variety of tasks practice in random order (MOST learning but difficult)

Constant vs variable practice

• Constant (easier): One variation of the skill several times in a row (e.g., practicing STS)

• Variable: Several variations of the skills (e.g., adding different surfaces)

Whole vs part practice

• Part (easier): task broken up into discrete compartments (weight shifting)

• Whole: Complete action/skill is performed (climbing stairs)

Open TASKS

• Done in a changing environment (driving)

• Needs constant adjustment and processing, difficult with a person with cognitive deficits or a novice

We get feedback after we do something but also we are doing tasks that require adapting to change [“open to it as time goes on”].

Closed TASKS

• Skills done in a parameter that stays the same (walking on a steady floor)

• Fewer motor challenges that do not need constant adjustment, good place to start!

We get feedback during the time we are doing something, but also we do not need to adapt due to few motor challenges [“not so open to change – still learning DURING and can’t tolerate change”].

Concurrent feedback

Knowledge of performance: Happens DURING the task

intermittent feedback

Knowledge of results: Happens AFTER a task is completed / Terminal feedback

Key deficits in motor learning in older adults

• Deficits in processing and encoding sensorimotor information

• Decline in the ability to learn motor skills (struggle to sequence tasks)

• Struggle to learn new technology, but they still benefit from practice

• Deficits in learning more complex skills with bimanual coordination, even if they have preserved or enhanced augmented feedback.

• We can’t recognize who will respond, so we will train them all

• Salience: it has to be important and meaningful to them, or they won’t do it (this applies at all ages)

Neuroplasticity

The adult brain can still change. It is not limited to the developing brain; responds to external and internal demands → modulates neurogenesis throughout life.

• Neuroplastic development: Ecological + activity-dependent

permanent changes in the CNS indicate ____________

Neuroplastic change