Neuromuscular: Pediatrics & Development Flashcards by Craig Satterley

STNR

Stimulus: Head position, flexion or extension
Response: 
  Flexion - Arms flex, legs extend
  Extension - Arms extend, legs flex
Normal Age: 6-8 months

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ATNR

Stimulus: Head position, turn to one side
Response: Extremities face side extend, scalp side flex, spine convexity face side
Normal Age: Birth - 6 months

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Tonic Labyrinthine Reflex (TLR)

Stimulus: Head position
Response: Supine extremities extend, prone extremities flex
Normal Age: Birth - 6 months

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Galant Reflex

Stimulus: Touch skin along spine shoulder to hip
Response: Sidebend to side of stimulus
Normal Age: 30 Weeks gestation - 2 months

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Palmar Grasp Reflex

Stimulus: Pressure ulnar side of palm
Response: Flexion of fingers
Normal Age: Birth - 4 months

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Plantar Grasp Reflex

Stimulus: Pressure to base of toes
Response: Toe flexion
Normal Age: 28 Weeks gestation - 9 months

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Rooting Reflex

Stimulus: Touch cheek
Response: Turn head same side with mouth open
Normal Age: 28 Weeks gestation - 3 months

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Moro Reflex

Stimulus: Head drops suddenly into extension a few inches
Response: Arms abduct with fingers open, then adduct; cry
Normal Age: 28 Weeks gestation - 5 months

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Startle Reflex

Stimulus: Loud sudden noise
Response: Similar to Moro but elbows remain flexed, hands closed
Normal Age: 28 Weeks gestation - 5 months

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Positive Support Reflex

Stimulus: Weight on balls of feet when upright
Response: Legs stiffen into extension
Normal Age: 35 Weeks gestation - 2 months

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Walking (Stepping) Reflex

Stimulus: Supported upright position, soles on firm surface
Response: Reciprocal flexion/extension of legs
Normal Age: 38 Weeks gestation - 2 months

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Newborn - 1 Month

PRONE: Physiological flexion, Lifts head briefly, Head to side
SUPINE: Physiological flexion, Rolls partly to side
SITTING: Head lag in pull to sit
STANDING: Reflex standing and walking
GENERAL: Objects in direct line of sight, Follow to midline, Fists, Jerky arms, Purposeful or random

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2 - 3 Months

PRONE: Lift head 90 degrees briefly, Chest up with some weight in forearms, Roll to supine
SUPINE: Strong ATNR, Reciprocal leg kick, Prefer head to side
SITTING: Head bobbing upright, Variable head lag in pull to sit, Full support to sit
STANDING: Poor weight bearing, Hips flexed behind shoulders
GENERAL: See farther, Hands opening, Eyes follow 180 degrees, Grasp reflexive, Palmar grasp

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4 - 5 Months

PRONE: Weight on extended arms, Pivot to reach toys
SUPINE: Rolls to side
SITTING: Head steady if supported, Turns head, Sits alone briefly
STANDING: All weight in legs if supported
GENERAL: Grasps and releases toys, Ulnar-palmar grasp

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6 - 7 Months

PRONE: Rolls to prone, Holds weight on one hand to reach for toy
SUPINE: Lifts head
SITTING: Lifts head and helps pull to sitting, I move to sitting, I sitting
MOBILITY: May crawl backward
GENERAL: Approach object with one arm in neutral, Radial-palmar grasp, “Rakes” small objects, Release object to other hand

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8 - 9 Months

PRONE: Moves to hands-knees
SUPINE: Does not tolerate supine
SITTING: Moves to prone, Sits long period without hand support, Pivot in sitting
STANDING: Stands and pulls to stand at furniture, Lowers to sitting if supported
MOBILITY: Crawl forward, Cruising
GENERAL: A supination, Radial-digital grasp, Inferior pincer grasp, A wrist ext, Point/poke with index finger, Out of container

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10 - 11 Months

STANDING: Without support briefly, Pull to stand with half-kneel, Pick object up from floor if supported
MOBILITY: Walk with 1-2 hand hold, Creep on hands and feet (bear walk)
GENERAL: Fine pincer grasp, Into container, Grasp crayon adaptively

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12 - 15 Months

MOBILITY: Walk unsupported, Fast, Backwards, and Sideways, Bend over to look between legs, Creeps/hitches upstairs, Throw ball in sitting
GENERAL: Use crayons, Build tower with 2 cubes, Turn over small container for contents

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16 - 24 Months

Squat in play
Walk up/downstairs with one hand held, both feet on step
Propel ride-on toys
Kick ball
Throw ball forward
Pick toy from floor without falling
Fold paper
String beads
Stack 6 cubes
Imitate vertical/horizontal strokes with crayon on paper
Hold crayon with thumb and fingers

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2 Years

Ride tricycle
Walk backward
Walk on tiptoe
Run on toes
Walk downstairs alternating feet
Catch large ball
Hop on one foot
Turn knob
Open/close jar
Button large buttons
Child-size scissors with help
12-15 Piece puzzles
Fold paper or clothes

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Cephalic To Caudal

Head and UE control first. General skill acquisition from head to toe.

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Gross To Fine

Large muscle movement acquisition progressing to small

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Mass To Specific

Acquire simple movements progressing towards complex

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Proximal To Distal

Trunk control (midline stability) progressing to distal control (extremities)

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Recovery: Stage 1

No volitional movement initiated

Recovery: Stage 2

Basic limb synergies appear | Spasticity begins

Recovery: Stage 3

Synergies are voluntary | Spasticity increases

Recovery: Stage 4

Movement patterns dictated by more than synergies | Spasticity decreases

Recovery: Stage 5

Independence from limb synergies | Further spasticity decrease

Recovery: Stage 6

Isolated joint movement performed with coordination

Recovery: Stage 7

Normal motor function restored

Raimiste's Phenomenon

Involved LE abduct/adduct with uninvolved LE resistance in same direction

Souque's Phenomenon

Raise UE > 100 degrees with elbow extension = extension and abduction of fingers

NDT Intervention Constructs

1. Inhibit abnormal patterns with facilitation of normal patterns 2. Avoid abnormal reflexes or associated reactions 3. Manual contact and handling through key points of control for (+ and -) 4. Emphasize use of rotation 5. Orientation to midline by moving in and out of midline with dynamic activity

Knowledge Of Results

Terminal feedback of movement outcome in relation to movement's goals

Knowledge Of Performance

Feedback of actual movement pattern used to achieve movement goal

Massed Practice

Practice Time > Rest Time

Distributed Practice

Rest Time = or > Practice Time

Constant Practice

Practice of given task under uniform condition

Variable Practice

Practice of given task under differing conditions

Random Practice

Varying practice of different tasks

Blocked Practice

Consistent practice of a single task

Three Stage Model Of Motor Learning

1. Cognitive Stage: High concentration of processing info, begin problem solving Controlled environment, participation a must Many errors, repetition, listen/observe/process feedback 2. Associative Stage: Begin distinguishing correct vs incorrect performance, linking feedback to movement goal Progress to less controlled environment, avoid excessive feedback Less errors, less concentration/cognition, a lot of practice 3. Autonomous Stage: Improves efficiency without great need of cognitive control Variable environment Automatic regardless of distraction, mainly error-free, mostly internal feedback

PNF: Agonistic Reversals (AR)

Controlled mobility, skill 1. Isotonic concentric against resistance 2. Alternating concentric and eccentric contractions Slow and sequential

PNF: Alternating Isometrics (AI)

Stability One side of joint to the opposite without rest Endurance/strengthening

PNF: Contract-Relax (CR)

Mobility Increase ROM Maximal contraction of antagonist 8-10 sec

PNF: Hold-Relax (HR)

Mobility Isometric contraction of all muscle groups at end of ROM Increase ROM, used in patients with pain

PNF: Hold-Relax Active Movement (HRAM)

Mobility Improve initiation if 1/5 or less MMT 1. Isometric contraction after passively shortened 2. After relaxed, move to lengthened position with quick stretch 3. Actively return to shortened position with isotonic contraction

PNF: Joint Distraction

Mobility Slow manual traction often with mobs Add quick stretch to initiate movement

PNF: Normal Timing (NT)

``` Skill Improve coordination Distal to proximal sequence Proximal components restricted until distal components activate and initiate movement Repetition ```

PNF: Repeated Contractions (RC)

Mobility Initiate movement and sustain contrition throughout range at weak point Quick stretch followed by isometric or isotonic contractions

PNF: Resisted Progression (RP)

Skill Coordination of proximal components during gait Resistance to pelvis, hips, or extremity Enhance coordination, strength, or endurance

PNF: Rhythmic Initiation (RI)

Mobility Initiating movement in hypertonia Passive - Active Assistive - Slightly Resistive Let me move you - Help me move you - Move against the resistance Slow and rhythmical to reduce hypertonia and use full range

PNF: Rhythmical Rotation (RR)

Mobility Passively rotate extremity around longitudinal axis Relaxation will increase ROM, decree hypertonia

PNF: Rhythmic Stabilization (RS)

Mobility, stability Increase ROM, coordinate isometrics Isometric contraction of all muscles around joint against progressive resistance Stability: Progression from AI

PNF: Slow Reversal (SR)

Stability, controlled mobility, skill Slow resisted concentric contractions of agonists and antagonists around joint Rest between reversals Improve control and posture

PNF: Slow Reversal Hold (SRH)

Stability, controlled mobility, skill | SR with added isometric at the end of each movement to gain stability

PNF: Timing For Emphasis (TE)

Skill Strengthen weak component of motor pattern Isotonic and isometric contractions produce overflow to weak muscles

APGAR

``` Administered 1, 5, 10 min after birth 5 Items scored 0-2 HR Respiration Reflex irritability Muscle tone Color Good = 7+ ```

Stages Of Development

``` 0-1 Armadillo baby 2-3 Ninja baby 4-5 Sexy baby 6-7 Sit-seven baby 8-9 Cool baby 10-11 Boom baby 12-15 Cocky baby 16-24 Cardio kid 2 3-4 5-8 9-12 13+ ```

Neuromuscular: Pediatrics & Development Flashcards

(60 cards)