Neuro Peds - 01 - Normal Growth and Development Flashcards
(87 cards)
1
Q
what is Integration?
A
Integration is the mechanism by which less mature responses are incorporated into voluntary movement.
2
Q
list the pre-natal reflexes developed at the following milestones: 7 weeks 10 1/2 weeks 14 weeks 22 weeks 29-30 weeks Birth
A
7 weeks - w/d head if stimulus at lips (pull away)
10 1/2 weeks - swallow
14 weeks - moves body if stimulus to head
22 weeks - pout
29-30 weeks - thumb suck
Birth - bladder
3
Q
Newborns have what two types of movement?
A
reflexive
spontaneous
4
Q
what is development?
A
the process of change in motor behavior that is related to the age of the individual
5
Q
what influences development?
A
nutrition
stimulation
genetics
environment/socialization
6
Q
name the important Primitive Reflexes
A
Flexor Withdrawal Crossed Extensor Galant Placing Stepping Plantar Palmar Grasp Moro Rooting Traction ATNR STNR TLR Landau Positive Support Suck-swallow
7
Q
describe the Role of Righting Reactions
A
responsible for
- orienting the head in space and keeping the eyes and mouth horizontal
- returning to midline
- seeing the world straight
8
Q
list the order of Head Righting Reactions
A
Neck (immature) - 34 wks gest
Labyrinthine - 0-2 mos
Optical - 0-2 mos
Neck (mature) 4-6 mos
9
Q
list the order of Trunk Righting Reactions
A
Body (immature) - 34 wks gest
Body (mature) - 4-6 mos
Landau - 3-4 mos
10
Q
list the order Protective Reactions
A
Downward LE - 4 months Forward UE - 6 months Sideways UE - 7 months Backward UE - 9 months Stepping LE - 15 months
11
Q
describe role of Protective Reactions in normal development
A
movements that occur in response to rapid displacement
12
Q
list order of Equilibrium Reactions
A
Prone (6 months) Supine (7-8 months) Sitting (7-8 months) Quadruped (9-12 months) Standing (12-24 months)
13
Q
what is role of Equilibrium Reactions?
A
allow the body to adapt to slow changes in relationship between COM and BOS
14
Q
what is the Order of development of the Reactions?
A
Righting
Support
Protective
Equilibrium
15
Q
describe the 4 phases of early walking
A
1st: wide stance and high arm guard
2nd: feet come more under pelvis and mid-arm guard
3rd: feet closer in and low arm guard
4th: heel to toe gait and no arm guard
16
Q
describe the Flexor Withdrawal Reflex
A
position: supine
test: noxious stimulus to sole of one foot
response: withdrawal of stimulated LE from stimulus
17
Q
what is the normal duration for the Flexor Withdrawal Reflex?
A
birth to 2 months
18
Q
what is the function of the Flexor Withdrawal reflex?
A
protection
pain/injury avoidance
19
Q
what is the problem if Flexor Withdrawal is persistent?
A
if Flexor Withdrawal is stronger than Positive Support, standing is not possible
20
Q
describe the Crossed Extension Reflex
A
position: supine
test: hold one LE at the knee in extension; noxious stimulus to sole of the foot
response: flexion, adduction and then extension of contralateral LE
21
Q
what is the normal duration of the Crossed Extensor Reflex?
A
birth to 2 months
22
Q
what is the function of the Crossed Extensor Reflex?
A
Helps maintain balance, pushes body away from painful stimulus and stiffens contralateral leg to support entire weight of the body
23
Q
what is the problem if the Crossed Extensor Reflex persists?
A
- Difficulty flexing both legs at once (bridging)
- If obligatory, the reflex will dominate posture and inhibit reciprocal kicking and walking
24
Q
describe the Positive Support Reflex
A
position: supported in vertical
test: allow firm contact of child’s feet with floor or table
response: bilateral LEs extend with contraction of flexors and extensors into weight bearing
25
what is the normal duration of the Positive Support Reflex?
birth to 2 months
26
what is the function of the Positive Support Reflex?
it is prerequisite for stepping reflex
27
what is the problem if Positive Support Reflex persists?
difficulty bridging
28
describe the Plantar reflex
position: supine
test: stroke lateral aspect of the sole of the child's foot from the heel towards the toes.
response: toe extension
29
what is the normal duration of the Plantar reflex?
birth to 9 months
30
what is the function of the Plantar reflex?
Prepare for Positive Support reflex
31
what is the problem if the Plantar reflex persists?
a sign of under developed neural something?
32
describe the Moro reflex
position: supine
test: quickly tip child backwards to allow a 30 degree head drop
repsonse: child should startle by quickly extending, abducting shoulders, extending and abducting fingers, crying. in 2-3 seconds, shoulders flex and adduct to bring UE back to chest
33
what is the normal duration of the Moro reflex?
birth to 6 months
34
what is the function of the Moro reflex?
alarm reflex
| help child cling to mother
35
what is the problem if Moro Reflex persists?
over-sensitivity to sensory stimuli
36
describe the Asymmetrical Tonic Neck Reflex
postion: supine
test: turn child's head slowly to one side and hold gently
repsonse: arm and leg extend on face side, arm and leg flex on skull side
37
what is the normal duration of the Asymmetrical Tonic Neck Reflex?
birth to 6 months
38
what is the function of the Asymmetrical Tonic Neck Reflex?
Connection between touch and vision helps to establish distance perception and hand-eye coordination. In the early months, ATNR locks vision on to anything which catches attention.
39
what is the problem if Asymmetrical Tonic Neck Reflex persists?
cannot roll
cannot bring extended arm to mouth
hip dislocation on flexed side
affect trunk and predispose to scoliosis
40
describe the Symmetrical Tonic Neck Reflex
position: supine over examiner's knees or quadruped
test: passive or active neck extension and flexion
response: neck extension produces UE extension and LE flexion, neck flexion causes UE flexion and LE extension
41
what is the normal duration of the Symmetrical Tonic Neck Reflex?
4 to 12 months
42
what is the function of the Symmetrical Tonic Neck Reflex?
is a stepping stone to crawling on hands and knees (creeping)
43
what is the problem if Symmetrical Tonic Neck Reflex persists?
prevents reciprocal creeping, allowing child only to bunny hop
when obligatory, arms and legs imitate or contradict the head movement
44
describe the Tonic Labyrinthine Reflex
position: supine, prone
test: passively attempt to lift child's head from surface
response: supine - extensor tone dominates in body; prone - flexor tone dominates in body
* Landau Reflex (vertical suspension)
45
what is the normal duration of the Tonic Labyrinthine Reflex?
birth to 6 months
46
what is the function of the Tonic Labyrinthine Reflex?
to produce change in muscle tone and posture
increase extensor tone
increase flexor tone
47
what is the problem if the Tonic Labyrinthine Reflex persists?
can impair infant's ability to develop antigravity motion
cannot flex against gravity in supine
cannot extend against gravity in prone
48
what is the role of Righting Reactions in normal motor development?
righting reactions are the first in the sequence of development of postural reactions
- For balance
- Orienting head and eyes in space
- To get back to midline
- To see the world straight
49
what is the progression of the Righting Reactions?
1st - Head righting
- Optical: visual clues (birth----to persist)
- Labyrinthine: gravity clues (birth----to persist)
2nd - Trunk righting
- Neck on body: head turn causes body to turn
- Body on body: upper or lower trunk turn causes body to turn
50
what are the Support Reactions?
Kind of like progression to like the Positive Supporting Reflex.
But without stimulus.
51
What are Protective Reactions?
| What is their role?
Extremity movements in response to rapid movement
To safeguard balance in higher postures, such as sitting.
52
what is the order of onset of Protective Reactions?
```
Downward LE 4 months
Forward UE 6 months
Sideways UE 7 months
Backward UE 9 months
Stepping LE 15 months
```
53
what is the purpose of the Equilibrium Reactions?
- Allow the body to adapt to slow changes in relationship between COM and BOS
- Incorporate righting reactions
- Try to keep COM inside BOS
54
what is the order of onset of the Equilibrium Reactions?
```
Prone (6 months) (5)
Supine (7-8 months) (8)
Sitting (7-8 months) (8)
Quadruped (9-12 months) (12)
Standing (12-24 months) (15)
```
55
gross and fine motor milestones:
| birth to 3 months
gross:
- prone - all flexy, by 3 mos some extend, weight-bearing arms
- supine - head not midline
- pull to sit - head lag
- rolling - only a reflex
fine:
- palmar grasp reflex
56
gross and fine motor milestones:
| 4 months
gross:
- prone - lift head to 90 degree
- supine - midline orientation, head and hands
- pull to sit - keep head in line
- rolling - still reflex
fine:
__
57
gross and fine motor milestones:
| 5 months
gross:
- prone - swimming, prop elbows, small weight shifts
- supine - neck flexion, leg pedaling, bottom lifting
- pull to sit - chin tuck, counter balance with legs
- rolling - still accidental
- sitting - propped, fall over
fine:
- raking
- transfer object from one hand to other
58
gross and fine motor milestones:
| 6 months
gross:
- prone - pivot, lots of swimming
- supine - eh
- pull to sit - right up to stand
- sitting - pillows for low back, one hand play/one hand support
- rolling - voluntary
```
fine:
- reaching
- grasping
- letting go
(voluntary palmar grasp)
```
59
gross and fine motor milestones:
| 7 months
gross:
- prone - prop straight arms
- supine - mostly avoided
- quadruped - maybe
- sitting - ring sit, half long
fine:
- radial palmar grasp
60
gross and fine motor milestones:
| 8 months
gross:
- prone - crawling, quadruped rocking
- sitting - trunk twist
- more transitions
fine:
__
61
gross and fine motor milestones:
| 9 months
gross:
- prone - creeping, quad rocking, quad reaching
- sitting - side, transition to prone or quad
- kneeling - pull to half
- standing - against surface, upright, weight-shifting, dissociated arm/leg
- cruising
fine:
- radial digital grasp
- inferior pincer grasp
62
gross and fine motor milestones:
| 12 months
gross:
- walking - wide-stance/high-guard, narrower-stance/mid-guard, more narrow-stance/low-guard, heel-toe/no-guard
fine:
superior pincer grasp
three-jaw chuck
63
what is motor control?
the ability to maintain posture and perform movement
64
how does motor control normally develop?
mobility
stability
controlled mobility
skill
65
identify the three phases of motor learning
cognitive - understand what to do
associative - learn how to do (practice)
autonomous - get really good and don't have to think about it
66
gross motor milestones 16-18 months
- stairs
- walk sideways/backwards
- floor to stand
- jumping
- squat
67
gross motor milestones 18 months gait
- Reciprocal arm swing
- “running-like” walk - no flight phase
- Momentary SLS - just a tiny movement, getting ready for stairs
- Decrease in falls
68
gross motor milestones 2 yo
- Gait
- Stairs
- Jumping - flight phase
- SLS = 1-3s - can do stairs, kick a ball, step over obstacle
- Kick a ball
- Throw a ball
- Stepping over obstacles
- True running - stopping and turning are hard, no agility
69
gross motor milestones 3 yo
- Gait - more typical, heel strike, pelvic rotation developing, longer step length
- Pedaling a tricycle -
- Climbing
- Agility emerges
- Tandem stance
- SLS = 3s
- Stairs - reciprocally up and down (unless really tiny)
- Jumping - over obstacle, with lead foot
70
gross motor milestones 4 yo
- SLS = 4-6s
- Hop 4-6x
- Hopping forward - swing air leg
- Galloping
- Catch a small ball
- Throw ball
71
gross motor milestones 5 yo
- SLS = 8-10 seconds
- Walk forward on balance beam
- Hop 8-10x
- skipping (diff than gallop)
- 2-3ft standing broad jump
- Skip
- Kick a rolling ball
- Catch a ball
72
gross motor milestones 6 yo
- SLS = 10s + with eyes opened/closed
- Throw/catch small ball
- Walk on balance beam
- Ride bike
- Skate
- Striking
73
What is the progression of rising from supine to standing?
```
1 - supine
2 - rolling
3 - four-point position (quadruped)
4 - plantigrade (bent at hips, hands on floor)
5 - squat
6 - semi-squat
7 - stand
```
74
before PT with children with low tone:
ramp them up
75
before PT children with high tone:
calm them down
76
how to ramp up a low tone muscle:
vestibular - swinging, rocking, spinning
touch - brush
sound - music
vision - bright lights
77
how to calm down high tone muscle:
touch - big hug, wrap up in mat, deep pressure, body sock
| approximation - press down and rock (as in quadruped)
78
why is the Use of Sensory Input important?
to wake up muscles in Low Tone kids
| to calm down muscles in High Tone kids
79
What are the details on using Touch to ramp up low tone?
- child should do himself if possible
- firm pressure (so as not to tickle)
- proximal->distal : start at arms/legs, move centrally as needed, face last (if at all)
- do in a closed environment
- only for a few minutes
80
what are the details on using Touch to calm down high tone?
- use deep pressure - as in bear hug or body sock or wrap in a mat
81
what are details on using Approximation to calm down high tone:
weighting and un-weighting of joints in weight bearing positions
- quadruped rocking
- bounce on therapy ball
82
what are the details for using Vision to ramp up low tone?
- ask all the pertinent seizure questions
| - note that babies will only see contrast
83
what is a detail for using Hearing/Sound to ramp up or calm down?
- use the right tone of voice to avoid a certain reflex
| fainting goats
84
what are the Developmental Principles?
- cephalocaudal
- proximodistal
- reflexive to voluntary
- general to specific
85
what are three theories of motor development?
Neural-Maturational - all on the nervous system
Cognitive - how individual perceives and interacts with environment
Dynamic Systems - everything has a role in development
86
When is Early Intervention?
0-3 months
87
What is the importance of family and environment when treating?
- family centered care - involve parents/siblings/caregivers to also "treat"
- do in natural environment (better than clinic)
