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Paediatric Interventions > Typical Development: 18 months to 6 years > Flashcards

Typical Development: 18 months to 6 years Flashcards

1
Q

To develop gross motor skills, but does a child need to be able to do?

A
  • Balance with significantly reduced stability limits (less support, narrower BOS)
  • Maintain anti-gravity strength
  • Steadily increase coordination between muscle groups
  • Utilise intact sensory systems and cognition
  • Anticipatory postural control
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2
Q

What developments change gait with age?

A
  • Increasing extensor muscle strength to support the body’s weight on a single limb BOS
  • Development of dynamic balance with decreasing co-contractions for stability
  • Improved postural control in the form of anticipatory and integrative postural adjustments
  • Biomechanical changes
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3
Q

What are the characteristics of gait in a 9-15 month old?

A
  • Wide base of support with abducted hips
  • Slight hip and knee flexion
  • COM closer to head and upper trunk
  • Lateral stability is greater than AP
  • Loses balance if head moves outside BOS
  • Arms in high guard position to lock trunk extension
  • Response to the momentum to keep balance
  • Short stride, increased cadence
  • Full foot contact
  • Relative foot drop in swing phase
  • Significant co-contraction
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4
Q

What are the characteristics of gait in 18-24 month olds?

A
  • Decreasing BOS (in line with pelvis)
  • COM descends
  • Hip extension strengthening increases with mild hip extension during end of stance phase
  • Single leg stance become stable
  • Consistent heel strike in conjunction with knee extension
  • Increased velocity, increased stride length
  • Decreased co-contraction
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5
Q

What are the gait characteristics associated with 3-5 year olds?

A
  • Descending COM
  • Heel strike present with knee flexion in early stance
  • Velocity normalised
  • Decreasing cadence
  • Reciprocal arm swing
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6
Q

What are the gait characteristics associated with 6-7 year olds?

A
  • COM slightly higher than an adult (L3 vs sacrum)
  • Decreasing cadence
  • Period of disequilibrium due to disproportionate growth
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7
Q

What are the gross motor skills?

A
  • Running, jumping, hopping, leaping
  • Galloping, skipping, sliding
  • Ball skills: catching, throwing, kicking, striking
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8
Q

What systems are involved in postural control?

A

Interaction of neural sensory (visual, vestibular, proprioceptive, tactile), motor and musculoskeletal systems

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9
Q

What is the role of anticipatory postural control?

A

Acts to minimise the potential disturbance that may arise from initiating and completing a movement.

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10
Q

What are protective/parachute reactions?

A

Drop of limbs to protect when ‘dropped’ quickly

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11
Q

When do forward, lateral and backward fall protection reactions develop?

A

Forward fall protection: 6 months

  • Lateral: 8 months
  • Backwards: 10 months
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12
Q

What are the standardised assessments used to assess motor skills in children?

A
  • Peabody Developmental Motor Scales 2 (PDMS 2)
  • Bruininks-Oseretsky Test of Motor Proficiency (BOT 2)
  • Movement Assessment Battery for Children 2 (MABC-2)
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13
Q

What does the Peabody Developmental Motor Scales assess and what age group is it used for?

A

Gross and fine motor skills from 1 to 72 months of age

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14
Q

What does the Bruininks-Oseretsky Test of Motor Proficiency assess and what age and population is it used for?

A
  • Assesses gross and fine motor skills in children aged 4.5 to 14.5 years of age
  • Designed for use with typical and atypical (disabled) populations
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15
Q

What specific areas does the Bruininks-Oseretsky Test of Motor Proficiency?

A
  • Running speed and agility
  • Balance
  • Bilateral coordination
  • Strength
  • Upper limb coordination
  • Response speed
  • Visual motor control
  • Upper limb speed and dexterity
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16
Q

What does the Movement Assessment Battery for Children assess and what age group and population is it appropriate for?

A

Assesses fine and motor skills in children 3-16 years of age with suspected motor delays

17
Q

What are the three test components of the Movement Assessment Battery for Children 2?

A
  • Manual dexterity
  • Aiming and catching
  • Balance
18
Q

From where is lower limb alignment measured?

A

Measured through the centre of the head of femur, and centre of the ankle.

19
Q

How does normal lower limb alignment chance with development?

A

Newborn: varus
2 years: valgus
4-5 years: straight with mild out-toeing gait

20
Q

What are the common lower limb alignment issues?

A
  • Genu varum
  • Genu valgum
  • In toeing: metatarsus adductus, internal tibial torsion, femoral neck anteversion
  • Ankle over-pronation
21
Q

At what age is genu varum most prominent?

A

6 months of age

22
Q

What can cause excessive genu varum?

A

Ricketts disease (Vitamin D deficiency)

23
Q

How is genu varum assessed?

A
  • Photograph the child in standing to monitor progression
  • Medial aspects of the ankles are approximated firmly and the distance between the medial condyles is measured (≤ 8cm is within normal limits)
  • Determine whether symmetrical
  • Determine whether same/better/worse since first identified (typically improves within 6 months of walking)
24
Q

At what age does normal physiological genu valgum occur?

A

3-5 years and again at 12-14 years of age

25
Q

How is genu valgum assessed?

A
  • Photograph the child in standing to monitor progression
  • Medial condyles of knees are approximated firmly and the distance between the apices of the medial malleoli are measured (≤ 8cm is within normal limits)
  • Determine whether symmetrical
  • Determine whether same/better/worse since first identified
26
Q

What can cause an intoeing gait?

A
  • Metatarsus adductus (newborn)
  • Internal tibial torsion (1-3 years)
  • Medial femoral torsion (3-10 years)
27
Q

How is metatarsus adductus diagnosed?

A

Diagnosed with the Pirani method which involves assessing curvature of the lateral border of the foot, the presence of medial crease at the midfoot and palpation of the lateral head of the talus

28
Q

What are the common treatments for metatarsus adductus?

A
  • Shoes recommendations
  • Stimulation of side of foot to encourage AROM
  • Serial casting (Pirani score of 1.5-3)
29
Q

What are the internal tibial torsion norms for infants, 2.5 year olds and adults?

A

Infants: -15 to 0 degrees
2.5 years: 0 degrees
Adult: +5 to +5 degrees

30
Q

How is internal tibial torsion diagnosed?

A

Thigh/foot angle compared to norms

31
Q

How is femoral neck anteversion diagnosed?

A
  • Hypermobility

- Internal and external hip rotation ratio (IR 80-90, ER 0-10 degrees)

32
Q

How does overpronation present?

A
  • Midfoot in close proximity to the ground (navicular drop when standing)
  • Everted calcaneum
33
Q

What does idiopathic toe walking involve?

A

Consistent toe walking with lack of heel strike

34
Q

What are the treatment options for idiopathic toe walking?

A
  • Passive calf stretches +/- hamstrings
  • Eccentric calf exercises
  • Orthotic correction
  • Serial casting
  • Gait retraining

Paediatric Interventions (23 decks)

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