MOTOR CONTROL LECTURE 14: DEVELOPMENT OF POSTURAL CONTROL (EXAM III)

Postural control & development is not ____

Linear

____ _____ & _____ is the simultaneous development of postural, locomotor & manipulative systems

Postural control & development

The postural, locomotor & manipulative systems are challenging and supporting each other during _____

Development

Postural control & development is crucial to the ____ & _____ of skill in postural, locomotor & manipulative systems

Emergence & refinement

Postural control is a critical part of ____ ____

Motor development

Delayed, immature or abnormal development of postural systems will limit the development of other ____ ____

Functional behaviors

Children with low tone will lift their head to the side due to a lack of neck ____ strength against gravity

Extensor

_____ is a term of direction

Cephalocaudal

Cephalocaudal is a term for ____ & ____ development

Motor & postural

We develop control starting with the ____

Head

Order of control:

1. Head

2. Trunk

3. Pelvis

Your child should develop ____ control before learning how to walk

Head

Every functional activity requires ___ ____

Postural control

___ ___ are predictable sequences of motor behaviors

Motor milestones

___-___ months:

- sitting

4-7

___-___ months:

- crawling with the belly on the floor (crawling)

- crawling with the belly off the floor (creeping)

8-10

___-___ months:

- pull to stand

9-10

____-____ months:

- independent stance

12-13

____/_____ ____ states the emergence of posture and movement control is dependent on appearance and subsequent integration of reflexes

Reflex/hierarchical theory

Appearance and disappearance of reflexes reflect increasing maturity of ____ ____

Cortical structures

The reflex/hierarchical theory explains the development of ____ ___

Postural control

The appearance of _____ followed by the inhibition and integration of ____ leads to the child having functional postural and voluntary motor responses

Reflexes; reflexes

_______ are involuntary stereotypical movement responses to a specific stimuli

Reflexes

Reflexes influence of movements of the fetus and infant begin at ____ weeks gestation and most are integrated by their ____ birthday

28; first

Infant reflexes may not completely disappear:

- they may be inhibited by maturing _____

- they may be integrated into new ______

CNS; movements

Reflexes are a tool to assess ___

Children

Knowing about ______ is important to HCP because they are a reflection of what is happening in the CNS

Reflexes

_____ can alert us that something might be going wrong in development

Reflexes

Tonic attitudinal reflexes produce persisting changes in body posture that results from a change in ____ ____

Head position

______:

- turning the head to the side will cause flexion on the skull side and extension on the face side

ATNR

_____:

- head flexion causes flexion of the UE and extension of the LE while head extension will cause extension of the UE and flexion of LE

STNR

_____ is also called the fencing reflex

ATNR

______:

- this reflex appears at birth and should decrease its influence by 4-6 months

ATNR

_____:

- if it persists it will interfere with head control (neck righting)

- it can interfere with the child rolling over

- if your head is affecting your arms, it can interfere with hand use or bringing hands together

- if it is not integrated it can include inability to get hands to midline, scoliosis, subluxation or dislocation of hip on skull side, inability to grasp and regard an object at the same time, inability to balance well enough to walk unaided

ATNR

Integration of ____ reflex must happen for a child to creep

STNR

If the ____ reflex is not integrated, then the patient cannot move reciprocally

STNR

_____ _____:

- enable normal standing

- maintain stability while moving

Righting reactions

Righting reactions of the ____ & ____:

- used to return to "right" the body to the upright position via adjusting body parts relative to the vertical axis

Head & trunk

Labyrinthine (head) righting/optical righting ____ is birth to 2 months

Onset

Labyrinthine (head) righting/optical righting ____ is persistent throughout life

Integration

Antigravity neck _____:

- 4 months (it is a red flag of a child cannot do this by 4 months)

Extension

Antigravity lateral neck ____:

- between 4-6 months

Flexion

Antigravity neck ____:

- 7 months

Flexion

Emergence of labyrinthine (head) righting/optical righting will support development of postural ___ & ____

Control & stability

____ ____ allow the whole body to adapt to slow changes in shifts of COM

Equilibrium reactions

A ____ reaction is produced in response to a shift of COM caused by the moving surface (it is generally considered an equilibrium reaction)

Tilting

____ ____ are necessary for balance and to prevent falling, especially in sitting & standing

Postural reactions

____ ____ is a response to instability in the lateral direction (sideways stepping)

Staggering reactions

_____ emerges in association with sequentially organized series of equilibrium reactions

Balance

A ____ component is critical for equilibrium reactions & requires co-contraction of the trunk flexors/extensors

Rotational

____ _____ are responsible for protecting the body from harm after the COM has been displaced beyond the BOS (parachute reactions)

Protective reactions

UE protective reactions development progression:

- 6-7 months: _____ (in sitting)

- 7-8 months: _____ (in sitting)

- 9 months: _______ (in sitting)

Forwards; side; backward

_____/____ _____:

- views balance control as reactive

- tendency towards considering the role of CNS maturation as more important

Reflex/hierarchical theory

_____ _____:

- stresses importance of proactive, reactive, and adaptive aspects of the system

- does not emphasize the role of one system over the others

Systems theory

_____ & the _____ is a challenge for an infant when developing postural control

Gravity; environment

Development of cognitive resources & strategies is critical to controlling posture under ____ ____ conditions

Multi task

Development of _____ strategies for organizing multiple inputs in the control of:

- steady state postural control

- reactive postural control

- anticipatory postural control

Sensory

Development of _____ sensory systems includes:

- somatosensory

- visual

- vestibular

Individual

Development of ____ ____ strategies are important for the control of:

- steady state balance

- reactive balance

- anticipatory balance

Motor coordination

Changes in the ____ system is one of the key challenges in development of motor control

MSK

Development of ___ ____ happens through a complex interaction between neural & MSK systems and the environment

Postural control

Children are learning " ____ ____ ___"

On the go

____ ____ is an internal representation of the body spatial properties, including length of limbs and limbs segments, their arrangement, their configuration in space, and the shape of the body surface

Body schema

____ ____ postural control is not present at birth

Steady state

_____ balance control of the head can begin to emerge as young as 1 month of age

Reactive

___ ___ of infants occur often & vary in intensity and velocity showing coordination and fluidity

General movements

____ ____ ___ is a measure of spontaneous movements patterns in infants that is a reliable and valid prognostic tool to identify neurodevelopmental disabilities early

General movement assessment

It is a red flag if a child does not make eye contact/does not watch or follow objects with their eyes by ___ months old

3

_____ is important in calibration of vestibular and proprioceptive systems which helps in developing internal models of posture

Vision

_____ inputs are important in emergence of gross motor skills

Vestibular

_____ is critical in calibrating somatosensory inputs for control of head posture

Vision

Independent sitting occurs at ___-___ months of age

6-8

____ ____ emerges when the infant acquires the ability to control spontaneous sway sufficiently to remain upright

Independent sitting

Stages mastering ____ ____:

- no control

- attempts to initiate upright sitting

- partial control with large range of body sway

- functional control with minimal sway

Trunk control

Children limit ____ ___ ____ as they learn new skills

Degrees of freedom

If you do not have good trunk control/postural control, then you will have difficulty ____

Reaching

_____ reactions develop before equilibrium reactions

Protective

_____ balance control emerges before anticipatory control

Reactive

Newly sitting infant rely heavily on ____ input when controlling sway

Visual

To ____ independently, infants must learn to:

- balance with reduced stability limits compared to sitting

- control additional degrees of freedom

- recalibrate sensorimotor representations for postural control to include LE segments for balance to create an improved internal model for postural control of independent balance

Sitting

A patient with impaired postural control will need _____ attention to motor tasks

Increased

____ ____ is the ability to adapt sensory information about position and movement of the body in space to changing task and environment conditions

Postural control

Development of multi sensory reweighting is present at ___ years of age and contributes to a more stable & flexible control of upright stance

4

By __-___ years of age, postural response is basically like those in adults

7-10

Compensatory postural responses of young children (15 months old) are more ____ & ____ than those of adults

Variable & slower

_____ ____ have both postural and voluntary components

Skilled movements

Postural component establishes stabilizing framework that supports ____ & ____ component (the skilled action will deteriorate if the supporting postural framework is absent of impaired)

Secondary & primary

By ___ years of age children show more control and adaptability in balance abilities during quiet stance is similar to that of adults

5

___ ___ ___ is ability to support weight against force of gravity in standing position occurs before emergence of independent stance (thus not likely a major constraint to the emergence of postural control in infants)

Role of strength

_____ postural sway uses sensory information to control posture

Performatory

____ postural sway investigates and explores sensorimotor workspace for postural control (sensory information that will help calibrate sensor motor relationships needed for postural control)

Exploratory

The ____ system elicits organized postural responses in standing infants at an earlier age than the somatosensory system

Visual

Strategies to control _____ when learning how to stand/walk:

- exploratory postural sway

- performatory postural sway

Sway