peds exam 1

child
task
environment

what are the 3 parts of the dynamic systems theory that influence motor movement?

ecological theory

developmental theory:

How we plan movements is based on our understanding of our world

-how our environment impacts our development

-everyones experiences are different

perception action

actions cause us to perceive the environment; what we perceive encourages further action

how child plans movement is based on what information they are getting.

Ex. Take child to trampoline park and get sensory experience of vestibular they want to keep seeking this input because they like it

what is perception action?

child + task + environment

based on the dynamic systems theory movement emerges based on ______+______+_______

constraint

limiting factor for developing a skill

false (they do NOT)

T/F: motor skills develop on a smooth predictable timetable

ready and overlapping

movement emerges when all 3 systems (child, environment, and task) are all ______ and _______ at the same point

•Genetics
•Cognition & Behavior
•Sensory & Musculoskeletal Systems

what are some factors from the CHILD that can impact development?

prenatal
perinatal
postnatal

what are 3 different environments discussed in terms of child development?

•Biomechanical requirements
•Meaningfulness
•Motor strategies

what are some task characteristics that impact child development?

generalization

transferring skills from clinic to home

variability
errors

practice should have ______ and _______

true

T/F: children are not little adults

more

children need (less/more) frequent feedback than adults

immediate feedback (because they have shorter attention spans)

what type of feedback should we give children/do they need?

-generalization
-practice should have variability and errors
-children are not little adults
-task oriented training

what are some Motor learning principles in pediatrics?

sensitive periods

-Time when brain is especially responsive to experience
- Presence/absence of an experience can cause irreversible change
- Peaks and valleys; not well-defined amount of time

irreversible

Presence/absence of an experience during sensitive periods can cause ________ change

windows of opportunity

sensitive periods can be thought of as ______ of _______ for neuroplasticity

because when we are younger the brain is more open to neuroplasticity/highly sensitive periods

why is early intervention so important?

experience

sensitive periods is a time when the brain is especially responsive to ______

-Service delivery model
-Collaboration of family and service providers
-Caregivers are the "expert" on their child

what are some attributes of family centered care?

family structure (human and material resources)
-family function and dynamics
-culture
-family stress and adaptation
-service and therapist factors

what things influence family centered care?

60
2

fitness and exercise recommendations:

School-aged children = ______+ minutes of activity/day

- Limit screen time to < _____ hours/day

true

T/F: As a healthcare provider, you are a mandated reporter if you have concerns related to child abuse or neglect

-Explanation doesn't fit the injury as to pattern, timing, or developmental ability of child
-Explanation keeps changing
-Child is consistently blamed as cause of repeated injuries
-Significant injuries attributed to a young sibling
-Delay in seeking medical care
-History of multiple ED visits
-Frequent change of primary care provider

what are some examples of injury redflags?

rooting
suck-swallow
moro
galant
palmar grasp
plantar grasp
ATNR
STNR
flexor withdraw
neonatal positive support
neonatal neck righting
tonic labyrinthine

what are 12 primitive reflexes?

rooting

which reflex?

Stimulus: Touch around mouth of hungry infant

Response: Turning head and lips towards stimulus

suck-swallow

which reflex?

Stimulus: Touch to lips and inside of mouth

Response: Rhythmic excursions of jaw with tongue up and down then swallow

moro

which reflex?

Stimulus: Head drop backwards

Response: Abduction and extension of arms, splaying fingers, may be followed by arm flexion and adduction

abduction and extension
splaying
flexion and adduction

with the moro reflex the response is:

______ and _____ of arms
______ of fingers

and may be followed by arm ____ and _____

galant

which reflex?

Stimulus: Stroke paravertebral skin in prone

Response: Lateral flexion of spine to stimulated side

stimulated

galant reflex response is: lateral flexion of the spine to ______ side

palmar grasp

which reflex?

Stimulus: Pressure to palm of hand

Response: Finger flexion

plantar grasp

which reflex?

Stimulus: Pressure to just distal of metatarsal heads or supported standing on feet

Response: Toe flexion

ATNR

which reflex?

Stimulus: Cervical rotation

Response: Facial shoulder abducts with elbow extension; occipital shoulder abducts with elbow flexion

abducts
extension
abducts
flexion

ATNR:

Stimulus: Cervical rotation

Response: Facial shoulder ______ with elbow _______

occipital shoulder _______ with elbow_______

STNR

which reflex?

Stimulus: Neck flexion or extension

Response: neck flexion = elbow flexion with hip extension; neck extension = elbow extension with hip flexion

flexion
extension

extension
flexion

(the elbow does the same as the neck and the hip does the opposite)

with STNR reflex:

neck flexion= elbow ______ with hip _______

neck extension= elbow ______ with hip _____

flexor withdraw

which reflex?

Stimulus: Noxious stimulus to sole of foot

Response: Flexion withdrawal of leg

neonatal positive support

which reflex?
Stimulus: Balls of feet in contact with firm surface

Response: Legs extend to support weight

legs extend to support weight

what is the response in the neonatal positive support reflex?

neonatal neck righting

which reflex?

Stimulus: Cervical rotation in supine

Response: Shoulders and trunk will rotate the same direction as cervical rotation

tonic labyrinthine

which reflex?

Stimulus: Cervical flexion or extension in prone or supine

Response: Cervical flexion = extremity flexion; cervical extension = extremity extension

same

in neonatal neck righting reflex the shoulders and trunk will rotate in the _____ direction as cervical rotation

flexion

extension

in tonic labyrinthine reflex:

cervical flexion= extremity _______

cervical extension= extremity _______

labyrinthine head righting
optical head righting

what are 2 righting reactions?

vestibular

the labyrinthine head righting reaction is based on ______ feedback

visual

the optical head righting reflex is based on _______ feedback

labyrinthine head righting

which reflex?

Stimulus: Tilting body forwards, backwards, or sideways

Response: Adjusting cervical position to compensate to keep eyes facing forward and level with ears (ex. Tilt forward = neck extends; tilt right = left cervical lateral flexion
**based on vestibular

age

righting reactions develop with ______

extends

left cervical lateral flexion

(all an attempt to keep the eyes facing forward and level with the ears)

with the labyrinthine and optical head righting reflexes:

if tilt head forward the neck ________

if tilt head to the right what movement do we get?

forward

level

the labyrinthine and optical head righting reflexes goal is to keep the eyes facing _______ and ______ with the ears

optical head righting

which reflex?

Stimulus: Tilting body forwards, backwards, or sideways

Response: Adjusting cervical position to compensate to keep eyes facing forward and level with ears (ex. Tilt forward = neck extends; tilt right = left cervical lateral flexion)
**based on visual feedback

stronger/develops more

landau reaction develops as a child gets _______

3 months

landau reaction onset is about _______ _____ old

landau reaction

which reflex?

•Onset: ~3 months old
•Stimulus: supported horizontally in prone in the air

Response: neck extension with arching back, partial extension of the hips

extension
arching
extension

what is response of landau reaction of supporting child in prone?

neck ______ with ______ back and partial ______ of hips

equilibrium reaction

•Observed when COM shifts outside of BOS
•Response to external stimulus or in anticipation
•Torso elongates weight bearing side
•UE and LE abduct on NWB side

elongates
abduct

in equilibirum reaction:

torso ______ on the weight bearing side

UE and LE ______ on the NWB side

protective reaction

reaction:

when unable to maintain balance

-•Stepping, placing a hand down, or grabbing for support

learns motor skills essential for every day life

equilibrium and protective reactions develop as child does what?

protective extension in sitting

what reflex/reaction develops as sitting balance improves?

protective extension in sitting

•Ability to maintain balance with perturbations by extending UE to catch themselves
•Forward
•Lateral
Posterior

range

typical development is a ______

cephalic --> caudal
proximal --> distal
specific (dissociation)

direction of development=

(cephalic/caudal)---> (cephalic/caudal)

(distal/proximal) ---> (distal/proximal)

Undifferentiated --> ________

head (remember we develop cephalic --> caudal - gain head control first and then we gain hip control later when we begin standing)

do we gain (head/hip) control first when developing?

antigravity extension
antigravity flexion

(from fetal position--> tummy time--> chewing on feet)

•Physiological flexion ---> _______ _______ ----> _______ ______

mobility
stability
controlled mobility
skill

what are the 4 phases of motor control in the order they develop?

symmetry
controlled asymmetry

asymmetry --> _______ ---> _______ _______

true

T/F: language is very often correlated with motor development

4

5-6

when we start seeing dissociation:

•Scapulo-humeral ~______ months

•Shoulder-pelvic and legs ~____-___ months

greater degrees of freedom
increased control of movement later on

what does the development of specific/dissociated movements from undifferentiated movements allow for?

is

(at birth don't have co-contraction control to keep head/body in midline - normal for them to want to look one direction)

asymmetry (is/is not) normal at birth

weight shift

what is necessary for all transitions?

vestibular stimulation

weight shifts provide infant with controlled ______ ______

physiologic flexion

(if try to extend extremities and let go they will immediately curl back up-
Can extend/rotate neck but not able to hold It there)

neonates (0-10 days old) are in what position in supine and prone?

forward on face
extend
opposite
neck flexors
midline

neonates:

-physiologic flexion in both supine and prone
-Shifted ______ on _____ in prone
-Able to ______ neck and rotate head to ______ side
-no antigravity control of ______ _____
-briefly maintains head in _____

1-2 months

which age?

•Decreasing flexor tone
•Smooth visual pursuit present by 6 weeks, adult-like by 14 weeks
•Beginning to sustain head in midline, more often rotated
•Increasing socialization

flexor

at 1-2 months we see:

decreasing ______ tone

6
14

smooth pursuit is present by _____ weeks and adult-like by _____ weeks

midline
rotated

at 1-2 months beginning to sustain head in ______, more often ______

increasing

at 1-2 months we see (decreasing/increasing) socialization

3 months

which age?

•Prone: beginning to bear weight on forearms
•Supine: increasing midline orientation
•Head in midline with chin tuck
•Hands and eyes increasing time in midline
•LEs in frog-legged position
•Pull to sit: continued head lag with shoulder elevation

bear weight on forearms

at 3 months:

prone beginning to _____ ______ on _____

midline orienation

at 3 months:

supine we see increasing ______ _____

midline
chin tuck
hands
eyes
frog-legged (HF, ABD, ER)

at 3 months we see increasing midline orientation in supine including:

head in _____ with _____ ______
_____ and ______ increasing time in midline
LE's in _______ position

head lag

elevation

3 month pull to sit we see:

continued _____ _____ with shoulder ______

extend/flex

midline
flexion

stable
rotate

head control:

birth= fully _____/_____ neck when supported upright

2 months: ______ in frontal plane, oriented in slight ______

3 months: _____, able to _____ to follow vision

birth

2 months

3 months

match the age with the description of head control :

•_____: fully extend/flex neck when supported upright

•_______ midline in frontal plane, oriented in slight flexion
•Oscillations if in neutral flexion/extension
•Unable to rotate head unsupported

•_______: stable, able to rotate to follow vision
•Occasional oscillations or loss of control

3 months

the following are RED FLAGS for what age?

•Strong asymmetries
•Increased hypotonia (Excessive hip ABD and ER and just hanging out there
•Less kicking, waving of arms)
•Supine:
•Unable to achieve midline head posture
•Unable to bring hands to body
•Prone:
•Strong dislike of position
•Unable to adduct shoulders underneath for prone on forearms

asymmetries
hypotonia
midline head
hands to body
dislike
adduct (for prone on forearms)

3 month red flags:

strong _______

increased ______

supine:
unable to achieve _____ _____posture
unable to bring _____ to _____

prone:
strong ____ of position
unable to _____ shoulders underneath

4-5 months

what age?

•Strong symmetry balancing flexors and extensors
•Prone:
•Accidental rolls from prone to sidelying
•Shoulder adduction with chin tuck, begins reaching
•Beginning pelvic tilts
•Prone on hands
•Supine:
•Hands to knees and feet
•Core, hip flexors
•Rolls to sidelying
•May begin prop sitting
•No head lag in pull to sit

3-4

5

prone:
accidental rolls from prone to sidelying happen around _____-____ months

prone on hands begins about ______ months

rolls
adduction
tucks
reaching
pelvic tilts
hands

4-5 months in prone:

accidental _____
shoulder ____ with chin _____
begins ______
beginning _____ ____
prone on ______

knees
feet
sidelying
prop sitting
no

4-5 months in supine:

hands to ______ and ______
rolls to ______
may begin ______ ____
(yes/no) head lag in pull to sit

6 months

what age?

•Prone on extended arms
•Reaching in prone on forearms
•Rolls supine <> prone
•Sitting; may or may not use hands
•Accepts weight through legs, may bounce
•As you hold them at their trunk

6-7 months

what age do we begin to see rolls from supine <> prone?

6 months

what age do we expect to see sitting (may or may not use hands)?