L6: Atypical Motor Dev. Flashcards
1
Q
Physio Flexion
Leads to soft tissue tightness where?
A
- Hip flexion
- ABDuction
- ER
- knee flexion
- ankle DF
2
Q
Dev. of LE control
Gravity pulls them into ?
A
Frogged leg pos.
3
Q
More on gravity
Frogged leg position
A
- Lumbar EXT + Hip Flex== anterior pelvic tilt (incd ABD and ER)
- APT active 3-4mos
4
Q
APT active when
A
3-4mos
5
Q
Developing LE control
Crucial time developing pelvic mobility how?
A
Floor and tummy time leading up to hands to knees ~4mos
6
Q
Floor + tummy time leads up to hands to knees when?
A
~4mos
7
Q
Dev. of LE control:
Knees/hands to feet
VERY IMPORTANT!
WHAT PLANE?
A
Hands to feet== sagittal plane
8
Q
2 main components to Knees/Hands to feet
A
Posterior pelvic tilt*
Elongation of HS’s*
9
Q
More on Knees/Hands to feet
A
- PPT
- Abd. flexion, LE flexion, ADDuction, ER
- Pelvic mvmt accompanied by LE mvmts→ control around ea jt.
- Elongation of HS’s
- Int. obliques
- body awareness and exploration
10
Q
Components of Development of LE Control:
4:
A
- Physio flexion
- Gravity= frogged leg pos.
- Pelvic mobility (floor+tummy time) leads to hands to knees
- Knees/Hands to feet
11
Q
BIG component to TYPICAL development of LE control
A
Lateral wt. shift (frontal plane)
12
Q
TYPICAL Dev. of LE control
Lat. wt shift develops after…..
A
Sagittal plane control (APT and PPT)
13
Q
TYPICAL Dev. of LE control
Lateral wt shift
Elongates WB side→ facilitates what?
A
Elongation of WB side→ facilitates lateral righting of trunk and lateral hiking of pelvis
14
Q
TYPICAL Dev. of LE control
LE mvmts + ability to what?
A
LE dissociated mvmts and ability to reach
15
Q
TYPICAL Dev. of LE control
Active knee flexion and EXT in prone→ explain cascade of events
A
Active knee flex/ext in prone→ elongates quads→ activates glute max→ pelvic stab. for UE use
16
Q
Maintenance of frog-legged position represents what ?
A
Atypical Development of LE
17
Q
Atypical Dev of LEs
Maintenance of frog-legged position
Results from this:
A
- Absence of antigravity flexion; Decd postural stab. (no synergistic stab.)
- Unable to post. tilt pelvis to elongate lumbar extensors
- NO hands to feet, unable to lift legs***
- Absence of antigravity hip flex+ADD→ lack of hip ABD elongation
- Lack of pelvic control
18
Q
Maintenance of Frog legged position
What happens→ Supine?
A
Legs and anterior pelvic tilt block from moving and achieving any other position.
Stuck and not able to roll/trunk rotate
19
Q
Maintenance of Frog legged position
What happens→ Prone?
A
More lateral flexion/army crawling bc NO rotation available for crawling
20
Q
Atypical development: LEs
Missing components aka
A
Compensations/”fixing” elsewhere
Prolonged compensations become pathological if never modified
21
Q
Red Flags
Birth→3mos
A
- Easy startle response
- Incd stiffness
- Poor head control
- Reliance on head/neck hyperEXT
22
Q
Red Flags
4-8mos
A
- HypOtonia
- Mass patterns of mvmt
- Asymmetry
- Limtd variety of mvmt patterns or lack of mvmt
23
Q
Red Flags
9-12mos
A
- HypOtonicity
- HypERtonicity
- Poor protective responses
24
Q
Neurological deficits
2:
A
- Excessive EXT mm activty
- Inad. development of postural tone
25
Neuro Deficits
## Footnote
**Excessive EXT mm activity**
**Explain**
Antgravity flexion does NOT develop/is NOT strong enough to balance EXTs
26
Neuro Deficits
## Footnote
**Inadequate dev. of _postural tone_**
* Lack of stability for mvmt/mobility
* Infant learns to **“fix”** in order to gain stability
* **“fixing” becomes stronger and “blocks” normal postural dev.**
27
What does **“Fixing”** limit?
Limits DOF
28
First step
of **skill acquisition**
Fixing
29
Fixing is first step of **skill acquisition**
## Footnote
**explain**
* First step of skill acquisition so SHOULD resolve as baby gains incd control
30
When **Fixing** does NOT resolve===
Inc stiffness, tone, altered sensory feedback
\***fixing in one area == compensations in another**
31
Compensations
* **Functional compensations achieve baby's goal**
* diff. to change UNLESS you help them dev. a better way to achieve same goal
* Sensory feedback altered w/ compensations
* **Motor dev. dependent on feedback**
32
altered w/ compensations
Sensory feedback
\***Motor dev. dependent on feedback**
33
“Blocks” to Normal Development
3:
1. Neck Block
2. Shoulder Block
3. Pelvic Block
34
“Blocks”
## Footnote
**Neck Block**
**2 types**
1. HyperEXT
2. Head/Neck Asymmetry
35
“Blocks”
## Footnote
**Neck Block→ HyperEXT**
**Cause?**
* **Neck flex does not dev. to balance EXT**
* **No midline**
* no chin tuck
* Use head/neck hyperEXT to lift head
* incd strength of hyperEXT
36
“Blocks”
## Footnote
**Neck Block→ HyperEXT**
**What baby does?**
* Lack of norm head control
* elevates shoulders to stab. head
* exaggerates hyperEXT
* tongue/oral mm's used to “fix”
37
“Blocks”
## Footnote
**Neck Block → HyperEXT**
**Results:**
* Decd scap mobility→ blocks UE use
* open mouth posture→ protraction of jaw
* Decd head righting→ decd ability to lateral wt shit→ decd abd strength→ decd rib cage mob/stab.
* over elongation capital flexors
* impaired suck for feeding
* impaired coord. of respiration for phonation/sounds
* impaired visual convergence and down. gaze
38
“Blocks”
## Footnote
**Neck Block → Head/Neck Asymmetry**
**Cause?**
* Does develop symmetrical B/L head and neck flexors
* decd midline
* dominated by ATNR\*\*\*
39
“Blocks”
## Footnote
**Neck Block → Head/Neck Asymmetry**
**What baby does?**
Uses 1 UE for reaching
Uses lateral or uncoord'd ocular mvmts
40
“Blocks”
## Footnote
**Neck Block → Head/Neck Asymmetry**
**Results?**
* Dec visual convergence→ poor visual perception
* Dec BUE use
* Decd body awareness
* Deformities
41
“Blocks”
## Footnote
**Shoulder Block**
**Cause?**
* Dec scap stability
* Lacks forearm WB
* Decd T/S EXT = limits L/S EXT
* Lack dissociation humerus and scap
* Lack shoulder girdle control
42
“Blocks”
## Footnote
**Shoulder Block**
**What baby does?**
* Primitive prone EXT
* Fixing of humerus w/ EXT, ADD, IR
43
“Blocks”
## Footnote
**Shoulder Block**
**Results:**
* Dec reach, grasp, manip.
* Poor UE WB in prone→ limites creep/crawl
* Decd protective EXT/balance rxns and wt shifting onto UE for transitions
* shortened pecs
* reinforced neck hyper EXT & lack of SH flex.
44
Pelvic Blocks
2 types
APT/hip block
PPT/hip block
45
“Blocks”
## Footnote
**Anterior Pelvic Hip block think….**
Maintaining **Frog legged position!!!**
46
“Blocks”
## Footnote
**Ant. Pelvic Tilt (maint. frog legged pos.)/hip block**
**Causes:**
* APT never balanced w/ PPT due to lack of antigravity flex/Decd postural stab.
* shortened L/S exts
* tight hip ABD's
* Norm. lower pelvic control NOT dev'd
47
“Blocks”
## Footnote
**Ant. Pelvic Tilt/hip block**
**What baby does?**
* Maint. or fix w/ frog legged pos. to control or prevent wt shift
* Use hip flexion for stability
48
“Blocks”
## Footnote
**Ant. Pelvic Tilt/hip block**
**Gen. consequences:**
* APT and L/S EXT becomes stronger/tighter
* Abnorm wt shifts (shortening of WB side)
* Rely on sag. plane for transitional mvmts
* Poor dev. of hip EXTs
* Poor dissociation of LE
49
“Blocks”
## Footnote
**Ant. Pelvic Tilt/hip block**
**Results: Supine**
* Hip ADDs elongated (bc frog legged pos maint.)
* ABDs+TFL tight
* L/S EXtd
* poor control lumbar flex
* poor dev abdoms
* possible hip disloc.
* Tight HS's
* dec body awareness
* poor dev. obliques
50
Blocks
## Footnote
**Ant. Pelvic Tilt/hip block**
**Results: Prone**
* Overuse frog legged pos== no lateral wt shifts
* Inc APT
* Incd LS ext
* **T12/L1 hypERmobility→ abnorm dissociation bw ribs & pelvis**
* No hip Ext= no pelvic stab for UE use
* No LE dissociation= no knee flex=tight quads
51
**Ant. Pelvic Tilt/hip block**
**Results: Quadruped (attained by symm. flexion of both LEs pulling up under trunk)**
* Hip flexors + APT stabilize w/ UE
* **No wt shift so _Bunny hop_ for mobility**
* Disuse of postural mm== overwork lg mvmt mm's
52
**Ant. Pelvic Tilt/hip block**
**Results: Quadruped→Kneeling**
* T12/L1 hypERmobilty → APT and hip flexion which **inhibits abdoms\*\*\***
* rib cage moves over pelvis→ stretches obliques
* excessive front. plane mvmt== ineff. wt shift
* diff getting to ½ kneel bc unable to lat. wt shift
53
**Ant. Pelvic Tilt/hip block**
**Results: Sitting**
* unable to keep COM over BOS w/out pelvic/hip control
* **W-Sitting\*\*\*\* → stabilizes/locks out pelvis and hip and COM\*\***
* **PROBLEM!:**
* hip flex dominance
* rib cage over pelvis
* obliques stretched
* knee flex contractures
* knee hypERmobility
* incd sag. plane mvmt
* dec front/transv plane mvmt
54
**Ant. Pelvic Tilt/hip block**
**Results: Standing**
**Typical 6mos**
Standing w/ support (sagittal)
55
**Ant. Pelvic Tilt/hip block**
**Results: Standing**
**Typical 7-8mos**
Cruising (frontal)
56
**Ant. Pelvic Tilt/hip block**
**Results: Standing**
**Typical 7-10mos**
Rotation (Transverse)
57
**Ant. Pelvic Tilt/hip block**
**Results: Standing**
**Typical Dev**
* Stand w/ support **6mos→ sagittal**
* Cruising **7-8mos→ frontal**
* Rotation **7-10mos→ transverse**
58
**Ant. Pelvic Tilt/hip block**
**Results: Standing**
**Atypical Dev**
* Wide BOS
* COM over BOS
* Poor or absent wht shift
* **LE ER**
* **Wt on medial side of feet**
* curl toes for stab.
59
**Ant. Pelvic Tilt/hip block**
**Results: Ambulation**
* **Leans whole trunk over WB side to wt shift**
* → **Crouched gait=** contractures/deforms of hips, knees, ankles
* Maints. APT to stab. spine/pelvis over COM
* wide BOS w/ toe out
* flex/ADD of knees to lower COG
* ankle pronated + eversion
60
Anterior pelvic tilt **consequences:**
* Contractures/deforms of **hips, knees, ankles**
* Hip flexors tight or contracture of HS's
* Develop quickly w/ extensive repetition of compensations in WB
61
Posterior Pelvic Tilt/Hip Block
## Footnote
**Prone**
* **Strong LS Ext w/ strong hip ext/ADD**
* EXT mm tight and antigrav flexors weak→ hip mobility limtd
62
Posterior Pelvic Tilt/Hip Block
## Footnote
**Sitting**
* Shortened mm's result in limtd mobility
* → **Sacral sitting**
* **abnorm flexion compensation→ W-sitting**
* Dec lateral wt shift== dec LE dissociation
63
Posterior Pelvic Tilt/Hip Block
**Standing**
* ADD'd legs
* narrow BOS
* PF
* lack postural control for wt shift/LE dissociation
* req's support to stand
64
Posterior Pelvic Tilt/Hip Block
## Footnote
**Ambulation**
* Diff + prob need AD
* Lack of wt shift== “falling” foot to foot
* Adduction== scissoring gait
* Contractures/deforms:
* **Limtd ABD ROM**
* **tendency to PF**
* **Tip Toe walk (DF really tight)**
65
Define “Midline”
Hands to knees and feet→ **HUGE milestone for typ. _frontal/transverse_ dev.\*\*\***
66
Fixing occurs when?
W/out **flexor/extensor balance, FIXING occurs to achieve functional goals**
**IF they persist→** they **BLOCK** typical progression!
67
Atypical development depends on variety of factors:
* Extent of CNS damage
* Cog status/lvl motivation
* Compensations also depend on therapeutic intervents child has received \*\*\*
68
RED FLAGS\*\*\*
## Footnote
**BIG ONE**
* **Regression of skills**
* occasionally typ dev children start crawling hands and knees but realize this takes more work than belly crawling; MAY revert back to that for a few days **but should NOT see regression for more than that\*\*\***
69
RED FLAGS\*\*\*
## Footnote
**Eye contact**
**Toe Walking**
* **Averting eye contact** w/ parents and **Toe walking emergence**
* Never toe walked before, now they are 2 and are toe walking== **Big Red Flag for neuro issues**
