Peds Exam 2

direction of development

cephalocaudal (starting at head, lifting up against gravity)

proximal to distal

posture definition

alignment of body’s parts in relation to each other and the environment

posture control definition

ability to control one’s center of mass (COM) over the base of support (BOS)

rooting reflex: stimulus - response

light touch on side of face - opens mouth and turns head in direction of touch

rooting reflex: age

28 weeks GA-3 months

rooting reflex: lack of integration

interferes with exploration of objects and head control

sucking/swallowing reflex: stimulus - response

light touch to oral cavity - closes mouth, sucks and swallows

sucking/swallowing reflex: age

28 weeks GA-3 months

sucking/swallowing reflex: lack of integration

interferes with coordination of sucking/swallowing/breathing

palmar grasp reflex: stimulus - response

pressure on ulnar side of palm - fingers flex

palmar grasp reflex: age

30 weeks GA-4-6 months

palmar grasp reflex: lack of integration

interferes with release of objects

asymmetric tonic neck reflex (ATNR): stimulus - response

head turns to one side - arm/leg on face side extend and on skull side flex

asymmetric tonic neck reflex (ATNR): age

one month-4-6 months

asymmetric tonic neck reflex (ATNR): lack of integration

interferes with reaching, grasping, bilateral hand use and rolling

righting balance reaction definition

realignment of the body during rotation, flexion, extension = keeps head in upright position while body moves around. ability to keep body and head in upright position. starting to sit up and balance

protective balance reaction definition

reactions to external disturbances in forward, lateral, and backward space. catching yourself when you fall

protective responses automatic reaction: how to observe

in sitting, gently push child off balance to the front, side, back - observe them for arm extension to prevent falling

protective responses automatic reaction: age response emerges

front: 6-7 months

side: 7-10 months

back: 9-12 months

head righting automatic reaction: how to observe

in sitting, move child from side to side/front and back to observe child moving head in the opposite direction to maintain head alignment with the body

head righting automatic reaction: age response emerges

3-4 months

neck on body righting automatic reaction: how to observe

in supine, rotate child’s head to one side, not if body rotation and the child rolling to prone occurs as a unit or segmentally

neck on body righting automatic reaction: age response emerges

segmental rolling emerges at 4-5 months

equilibrium automatic reactions: how to observe

tilt supporting surface to one side and the other - when tilted to the left notice lateral flexion on the right, when tilted right notice lateral flexion on the left, all with head righting

equilibrium automatic reactions: age response emerges

sitting: 7-10 months

quadruped: 9-12 months

standing: 12-20 months

muscle tone definition

internal state of muscle fiber tension within individual muscles. state of continuous, mild contraction which is affected by gravity and emotional state

normal tone definition

high enough to resist the effects of gravity in posture and movement, but low enough to allow for freedom of movement

hypotonic muscle tone definition

decreased muscle tone, too much flexibility, decreased strength (like down syndrome)

hypertonic muscle tone definition

increased muscle tone, lack of flexibility (like cerebral palsy)

tactile sensory system

recognition of the properties of surfaces and objects via touch

proprioception sensory system

position and movement of body/joints

vestibular sensory system

provides information about head position, balance, and position in space

vision sensory system

guides a lot of balance, how does that impact all other systems?

reactive postural adjustments (RPA)

ability to react to unexpected external postural challenges

ex: someone bumped into you and you don’t fall over, have to react quickly

anticipatory postural adjustments (APA)

ability to adjust to expected postural changes related to the production of voluntary movement; combining postural control reactions with voluntary movement

ex: body can plan change in movement, like getting on an escalator

praxis

plan, organize, and carry out sequence of unfamiliar actions

ideation in praxis

though, planning and idea, ability to visualize activity

motor planning in praxis

making a plan for the action

execution in praxis

actually doing the action

4 phases of infant motor development

infantile: birth-3 months

preparation: 4-6 months

modification: 7-9 months

refinement: 10-12 months

infantile phase (birth-3 months)

reflexive action dominates movement - flexed posture initially, almost all movements are reflexive, not much intentional movement

beginning head control - head lags behind when pulling to sitting, starting to see them hold their head up a little bit

gradual extension of the body - 3 months = more balance of flexion and extension

preparation phase (4-6 months)

beginning mobility

sustained head control in all positions

increased neck and back extension: prone on forearms, extended arms

weight bearing and weight shifting through arms and legs

beginning to reach and grasp

grasping, finding , and playing with feet = good for abdominal and core strength

rolling in preparation phase (4-6 months)

first purposeful movement in space

combines flexion and extension (trunk, hips, shoulder)

develops rotation within body axis

balance: side lying and in rotary movements

START stomach to back THEN back to stomach later

supported sitting in preparation phase (4-6 months)

can bear weight over legs in supported standing

modification phase (7-9 months)

transitional movements for changing positions characterize this phase = looking at transitional movements from place to place

assume and maintain: can explore movement from variety of postures due to increased postural control (independent sitting, creeping/crawling, hands and knees, kneeling, squatting, supported standing)

sitting

first independent vertical posture

dependent on

* extension established in prone
* flexion established in supine
* rotation from rolling
* differentiation of upper and lower trunk

sequential establishment of balance

* arms provide support
* midline stability: moving away from and back to midline
* trunk rotation
* nice position for midline = symmetry and rotation

crawling

bilateral crawl = symmetrical propulsion (commando crawl)

* stomach ON surface/ground
* extremities push and pull

creeping

mature creep = reciprocal pattern

* stomach OFF floor
* trunk rotation with weight shift
* opposite arm and leg move forward
* important for bilateral coordination

refinement phase (10-12 months)

increase balance, strength, and postural control during locomotion

reach with precision and accuracy

advanced levels of: coordination, speed, and timing

skill acquisition: 1/2 kneel, cruising, climbing, knee walking, walking

standing

UE strength for pulling to stand

combines flexion and extension

balance:

* early = wide BOS, arms in high guard
* with rotation = base narrows, movement between/around items
* weight shift = side to side, up and down

walking

requires balance between flexors/extensors of trunk and hips

cruises (lateral movements)

independent steps: overly flexed, loses balance forward

early pattern: wide base, lateral weight shifts, toe griping and executive arm posture

with increased postural control: arms flexed and shoulders retracted progresses to arms begin to extend and abduct

as rotation is integrated, arms lower and base narrows

equilibrium reactions established

hand skills and childhood occupations

play, ADLs, and education

components of hand skills

reach = movement of arm in correct area to play

grasp = getting an object in hand

carry = maintaining grasp on object to transport

release = let go of item

in-hand manipulation = move things within muscles of your hand

bilateral hand use = use 2 hands together in coordinated manner

tool use = something in hand to complete another task

reach definition

movement and stabilization of the arm and hand for the purpose of contacting an object with the hand

shoulders moving in correct direction

development of reach

* visual regard of objects and activation of the arms = visually attend first
* swiping and batting = no good gradation or control
* midline orientation of hands develop = hands move towards midline, play with/suck on hands
* hands move further away from body = playing out to the side
* symmetrical bilateral reaching = both hands reaching together
* unilateral reaching = 1 hand reaching
* hands open more than necessary = very extended hand to pick up something
* trunk extension and rotation
* arm placement and finger extension accuracy improve = most mature

grasp definition

attainment of an object with the hand

development of grasp patterns

no voluntary hand use, just reflexive movement

palmar grasp, not much finger movement

crude raking = item there and grasp with whole hand and rake it in a surface, starting to eat

radial digital grasp

use of thumb to attain tiny object

refinement use of thumb and finger pad control for tiny and small objects

sequential development of grasp

ulnar grasp, palmar grasp, radial grasp (starts ulnar and moves radial)

palmar contact, finger surface contact, finger pad contact

use of long finger flexors, use of intrinsic muscles with extrinsic muscles

most immature = inside the palm

most mature = finger pad to thumb

development of grasp patterns

more precision of fingers, more inhibition of ulnar fingers, slight wrist extension and forearm supination

increased control of intrinsic muscles of hand

disc, spherical, cylindrical grasps

overall grasp patterns for variety of objects well developed

carry definition

movement of the arm in space for the purpose of transporting a hand held object from one place to another

release definition

intentional letting go of an object in the hand at a specific time and place

ability to release something

lots of baby toys promote release pattern

development of voluntary release

* inhibition of grasp reflex
* pulls out of other hand
* transfers freely, releasing hand fully opened
* releases objects without stabilization of other hand
* excessive finger extension

in hand manipulation definition

adjusting of an object within the hand after grasp, using intrinsic muscles of the hand to move to the position they want

in hand manipulation skills consistent by what age

4 = pre-k/kingergarten

finger to palm in hand manipulation skill: age

12-15 months

finger to palm in hand manipulation skill: definition

lots of time puff food gets gross because they can’t move it out of their fingers yet

palm to finger in hand manipulation skill: age

2-2.5 years

shift in hand manipulation skill: age

3-3.5 years

shift in hand manipulation skill: definition

linear movement on the radial side

rotation in hand manipulation skill

N/A

simple in hand manipulation skill: age

2-2.5 years

simple in hand manipulation skill: definition

fingers act around thumb, 90 degrees or less

complex in hand manipulation skill: age

2\.5-3 years

complex in hand manipulation skill: definition

fingers move independently of thumb greater than 90 degrees

bilateral hand use definition

effective use of two hands together to accomplish an activity

begins with hands doing the same activity = catching a ball

evolves to hands completing different tasks = one hand becomes more skilled and the other is the helper hand, catch ball with one hand and throw with the other hand

tool use definition

using an item to complete an occupation

general problems affecting hand skill

* inadequate isolation of movements = no good separation of hand muscles to complete fine motor activities
* poorly graded movements = opening hands wide to pick up things, squish things
* poor timing of movements (slow movements)
* poor bilateral integration
* limitation in trunk movement and control (proximal to distal)
* compensatory pattens of movement (in order to complete tasks)

evaluation of hand skills: watch them do tasks

occupational performance, skilled observation, activity analysis, AROM/PROM, strength, tactile and proprioceptive functioning, muscle tone, sensation, reflexes

evaluation of hand skills: non-standardized

reach and release, grasp patterns, dexterity, in-hand manipulation, bilateral hand use, hand preference, tool usage, postural control, sensory factors

evaluation of hand skills: standardized

* peabody developmental motor scale (PDMS2) = birth-5 years
* bruininks-oseretsky test of motor proficiency (BOT-2) = 4-21 years
* quality of UE skills test (QUEST) = 8 months-8 years movement patterns and hand function in children with cerebral palsy (differences in UE tone, don’t give PDMS or BOT)

palmar grasp age

6 months

radial palmar grasp age

7 months

raking grasp age

7 months

inferior pincer grasp age

9 months

pincer grasp age

10-12 months

superior, neat, fine, tip pincer grasp age

12-15 months

radial digital grasp age

8-9 months

3 jaw chuck grasp age

10-12 months

disk grasp age

18 months-3 years

spherical grasp age

18 months-3 years

cylindrical grasp age

18 months-3 years

children with high prevalence of vision disorders

autism, cerebral palsy, down syndrome, intellectual disability, spina bifida, low birth weight, sensory integrative dysfunction, learning disabilities

one component model of vision

only assesses visual integrity (acuity, refraction, eye health)

optician

make and fit glasses

ophthalmologist

MD, specialization in disease and surgery of the eye; focused on the structure of the eye

optometrist

trained to evaluate how we use vision in everyday life related to occupations

developmental optometrists

specialty with diagnosis and tx of vision problems that interfere with reading, learning, sports, and everyday life. would likely follow the three component model of vision

three component model of vision

1) visual integrity = the ability to see clearly at all distances

2) visual efficiency = clearly, efficiently, gather input from the environment

3) visual information-processing skills = visual cognitive skills

visual acuity

resolving power of the eye (20/20)