Pediatrics

This is an example of what reflex…

Asymmetrical Tonic Neck Reflex (ATNR)

This is an example of what reflex…

Symmetrical Tonic Neck Reflex (STNR)

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Tonic Labyrinthine Reflex (TLR)

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Galant Reflex

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Rooting Reflex

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Positive Support Reflex

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Palmar Grasp Reflex

This is an example of what reflex…

Plantar Grasp Reflex

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Moro Reflex

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Startle Reflex

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Walking (Stepping) Reflex

Stimulus & Response:

Asymmetrical tonic reflex (ATNR)

• Stimulus:

  • turn head to one side

• Response:

  • same side arm/leg extend

Stimulus & Response:

Symmetrical tonic reflex (STNR)

• Stimulus:

  • extend head/neck or flex head/neck

• Response:

  • arms extend, legs flexed or legs extend

Stimulus & Response:

Doll-eye

• Stimulus:

  • flex head

• Response:

  • eyes looked up

Stimulus & Response:

Palmar grasping

• Stimulus:

  • touch palm with object

• Response:

  • hand closes

Stimulus & Response:

Moro

• Stimulus:

  • shake head by tapping pillow

• Response:

  • arms/legs extend, fingers spread, then arms/legs flex

Stimulus & Response:

Sucking

• Stimulus:

  • touch face above or below lips

• Response:

  • sucking

Stimulus & Response:

Babinski

• Stimulus:

  • stroke sole of foot

• Response:

  • toes extend

Stimulus & Response:

Searching, rooting

• Stimulus:

  • touch cheek

• Response:

  • head turns to stimulus

Stimulus & Response:

Palmar-mandibular (Babkin)

• Stimulus:

  • apply pressure to both palms

• Response:

  • mouth open, eyes close, head flexes

Stimulus & Response:

Plantar grasping

• Stimulus:

  • stroke ball of foot

• Response:

  • toes contract

Stimulus & Response:

Startle

• Stimulus:

  • tap abdomen or startle infant

• Response:

  • arms/legs flex

Reflex Timeframe:

ATNR

newborn - 4 months

Reflex Timeframe:

STNR

6 - 7 months

Reflex Timeframe:

Doll-eye

newborn - 2 weeks

Reflex Timeframe:

Palmar grasping

newborn - 4 months

Reflex Timeframe:

Moro

newborn - 3 months

Reflex Timeframe:

Sucking

newborn - 3 months

Reflex Timeframe:

Babinski

newborn - 4 months

Reflex Timeframe:

Searching, rooting

newborn - 1 year

Reflex Timeframe:

Palmar-mandibular (Babkin)

1 - 3 months

Reflex Timeframe:

Plantar grasping

newborn - 12 months

Reflex Timeframe:

startle

7 - 12 months

Age: Newborn - 1 month

• Prone: lifts head briefly, heads to side, body flexion

• Supine: body flexion, partially rolls to side

• Sitting: head lag when pulling to sit

• Reflex standing/walking

Age: 2 - 3 months

• Prone: lifts head to 90 degrees, chest up with some weight on forearms, rolls to supine

• Supine: ATNR, reciprocal leg kick

• Sitting: head upright but unstable, requires full support otherwise

Age: 4 - 5 months

• Prone: WB on extended UEs, pivot

• Supine: rolls supine to side

• Sitting: head stable, turns head, brief solo sitting

• Standing: full WB in LEs in supported standing

Age: 6 - 7 months

• Prone: rolls supine to prone, WB on one UE to reach with other UE

• Supine: lifts head

• Sitting: independent

• Mobility: crawling backwards

Age: 8 - 9 months

• Prone: can achieve quadruped

• Supine: does not tolerate

• Standing: stands with help from furniture, lowers to sitting

• Mobility: crawls forward, cruises along furniture

Age: 10 - 11 months

• Standing: brief unsupported standing, ½ kneeling to stand

• mobility: walks with hand assistance, bear crawl

Age: 12- 15 months

• walks without support

• creeps upstairs

• throws ball in sitting

Age: 16 - 24 months

• walks up/down stairs

• plays in squatting

• kick, throw ball

• tide-on toys

Age: 2 years

• rides tricycle

• runs on toes

• walks downstairs with reciprocal pattern

• catches large ball

• hops on one foot

SS:

Arthtogryposis Multiplex Congenita

• cylinder-like extremities with minimal definition

• joint contractures

• dislocation of joints muscle atrophy

PT Tx and Tx:

Arthtogryposis Multiplex Congenita

PT:

• stretching

• positioning

• splinting

• adaptive equipment

• strengthening

Tx:

• possible surgical intervention

SS:

Autism Spectrum Disorder

• speech problems (non-purposeful, absence of speech)

• diminished facial expressions

• poor understanding of non-verbal cues

• poor social interactions

• lack of empathy

• repetitive self-stimulating behaviors

• routines/rituals

• many have exceptional talents with music, art, and academics

PT Tx and Tx:

Autism Spectrum Disorder

PT Tx:

• decrease non purposeful movements

• sensory integration

Tx:

• multidisciplinary

• improve social communication

• decrease non-purposeful vocalizations

S&S:

Cerebral Palsy

• varies from mild/undetectable to severe loss of motor control and intellectual disability

• abnormal muscle tone

• impaired mobility

• abnormal reflexes present

• impaired modulation of movement

Pt Tx and Tx:

Cerebral Palsy

PT Tx:

• stretching

• strengthening

• motor learning

• developmental milestones

• positioning

• WB activities

• mobility

Tx:

• possible surgical intervention for orthopedic management and spasticity reduction

• pharmacological intervention

SS:

Down Syndrome

• intellectual disability

• hypotonia

• joint hypermobility

  • atlantoaxial instability

• flattened nasal bridge

• narrow eyelids

• small mouth

• feeding impairments

• flat feet

• scoliosis

• congenital heart disease

• vision and hearing loss

PT Tx and Tx:

Down Syndrome

PT Tx:

• avoid compensatory patterns

• tone management

• increase strength, minimize laxity

• maximize respiratory function

Tx:

• pharmacological intervention

• achieve max potential is overall goal

• learning strategies

SS:

Duchenne Muscular Dystrophy

• progressive weakness

• low interest in running

• falling

• toe walking

• excessive lordosis

• pseudohypertrophy of muscle groups

PT Tx and Tx:

Duchenne Muscular Dystrophy

PT Tx:

• developmental milestones

• maintaining strength

• encourage mobiltiy

• adapt to loss of function

• promote family involvement in home program

Tx:

• maintaining function as long as possible

• pharmacological intervention

• respiratory care

• emotional support

SS:

Prader Willi Syndrome

• small hands, feet and sex organs

• hypotonia

• almond-shaped eyes

• obesity

• constant desire for food

• coordination impairments

• intellectual disability

PT Tx and Tx:

Prader Willi Syndrome

PT Tx:

• postural control

• fitness

• exercise

• gross motor skill

Tx:

human growth hormone (HGH)

SS:

Spina Bifida

• motor loss below lesion

• sensory deficits

• hydropcephalus

• clubfoot

• scoliosis

• arnold-chiari type II malformation

• osteoporosis

• tethered cord syndrome

• bowel and bladder dysfunction

• learning disabilities

• latex allergy

PT Tx and Tx:

Spina Bifida

PT Tx:

• positioning

• ROM

• handling

• developmental milestones

• skin care

• strengthening

• balance

• mobility

• equipment management

Tx:

• surgical closure of neural tube defect

• medical management of bowel and bladder dysfunction

SS:

Spinal Muscular Atrophy (SMA)

• progressive muscle weakness

• muscle atrophy

• diminished (or absent) DTRs

• end-stage respiratory compromise

• sensation intact

• cognition intact

PT Tx and Tx:

Spinal Muscular Atrophy (SMA)

PT Tx:

• positioning

• visual/vestibular stimulation

• mobility training

• assistive devices

• adaptive equipment

• strengthening

SS:

Congenital Hip Dysplasia

• asymmetrical hip abduction

• tightness and and shortening of femur on affected side

PT Tx and Tx:

Congenital Hip Dysplasia

PT Tx:

• stretching

• strengthening

• caregiver education

Tx:

• open reduction

• hip spica cast

• harness

• bracing

• splinting

• traction

SS:

Congenital Torticollis

• lateral cervical flexion (to same side)

• cervical rotation (to opposite side)

• facial asymmetries

PT Tx and Tx:

Congenital Torticollis

PT Tx:

• stretching

• AROM

• positioning

• caregiver involvement

SS:

Legg-Calve-Perthes

• pain

• decreased ROM

• positive trendelenburg sign

• antalgic gait

PT Tx and Tx:

Legg-Calve-Perthes

PT Tx:

• stretching

• splinting

• aquatic therapy

• traction

• crutch training

Tx:

• pain management

• maintain femoral head

• improve ROM

• possible surgical intervention

• orthotic devices

SS:

Osteogenesis Imperfecta

• pathological fxs

• osteoporosis

• hypermobility

• weakness

• scoliosis

• impaired respiratory function

• bowing on long bones

PT Tx and Tx:

Osteogenesis Imperfecta

PT Tx:

• AROM

• positioning

• functional mobility

• fx management

• use of orthotics/wheelchairs

SS:

Scoliosis

• asymmetry of shoulders

• possible rib hump

• pain due to pressure/abnormal forces on other tissues

PT Tx and Tx:

Scoliosis

PT Tx:

• muscle strengthening

• flexibility exercises

• shoe lifts

• bracing

• spinal orthosis for curves between 25 - 40 …

SS:

Cystic Fibrosis

• salty tasting skin

• persistent productive cough

• frequent lung infections

• wheezing

• SOB

• poor growth/weight gain

• frequent greasty, bulky stools

PT Tx and Tx;

Cystic Fibrosis

PT Tx:

• airway clearance

• breathing

• assisted cough

• ventilatory muscle training

Tx:

• medications (antibiotics, nutritional supplements, bronchodilators, etc)

• lung transplants

SS:

Delayed Milestones/Prematurity

• birth less than 37 weeks gestation considered premature

• 22 - 23 weeks is age of viability

PT Tx and Tx:

Delayed Milestones/Prematurity

PT Tx:

• treat deficits so they catch up to peers

• meet milestones

Tx:

• respiratory function

• feeding tube if needed

SS:

Hydrocephalus

• enlarged head or bulging fontanelles

• headache

• vision changes

• seizures

• alteration in appetite, vomiting

• incontinence

PT Tx and Tx:

hydrocephalus

PT Tx:

• treats deficits

• be aware of signs and symptoms of shunt malfunction

Tx:

• medical intervention to alleviate excessive fluid

• shunt placement