Week 5- Reach, Grasp, and Manipulation/ Developmental Assessment/MSK Development Flashcards
1
Q
PART 1: REACH, GRASP, AND MANIPULATION
A
PART 1: REACH, GRASP, AND MANIPULATION
2
Q
What are the 4 key components of UE control?
A
- ) Locating the object (visual regard or perhaps auditory regard)
- ) Transportation of arm in space (reaching and the necessary postural control to support reaching)
- ) Grasp and release
- ) In-hand manipulation
3
Q
What is the difference between feedback and feedforward control?
A
- Feedback – input from sensory systems is compared to a reference signal (the movement that was intended) – the difference is used to update the output of the system.
- Feedforward – or anticipatory control – relies on previous experience to predict the consequences of sensory information that is received.
4
Q
Locating a Target:
- Normally ________ is used to locate object and guide UE movements – requires coordination of eyes (central visual field) and head (peripheral visual field)
- Kinematic studies – eyes reach object before head movement occurs but EMG studies – neck muscles are activated first.
- Reaching to objects in the far visual field will also involve _______ movements.
- Hand movements are more accurate if _____ movements are involved.
A
- vision
- trunk
- eye
5
Q
Kinematics of Reach and Grasp:
- The control of arm movements depends on the _______ of the task.
- During pointing – all segments of the arm are controlled as a unit.
- During reach and grasp – the hand is controlled ____________ of the other arm units.
- Velocity profiles and movement durations vary dependent on _______.
A
- goal
- independently
- task
6
Q
Grasping:
- Patterns vary depending on________, ______, and _______ of object.
- ________ vs. ________ (eye liner versus hammering).
- Posture of thumb and fingers will vary.
A
- location, size, and shape
- power vs precision
7
Q
- ______ grasp – handle of a suitcase
- _________ grasp – softball
- _________ grasp - bottle
A
- Hook
- Spherical
- Cylindrical
8
Q
- ________ Grip – the finger and thumb pads are directed toward the palm to transmit a force to the object.
- ________ Grip – the forces are directed between the thumb and fingers – allows movement of the object relative to the hand and within the hand.
A
- Power
- Precision
9
Q
What are the requirements for successful grasp? (2)
A
- The hand must be adapted to the shape, size, and use of the object.
- The finger movements must be timed appropriately in relation to transport so that they close on the object just at the appropriate moment.
10
Q
Shaping of the hand for grasp occurs during the ___________ phase of the reach and is affected by:
- ) the ________ properties of the object such as size, shape, and texture.
- ) the ________ properties such as orientation, distance from the body, and location with respect to the body.
A
Transition Phase
- intrinsic
- extrinsic
11
Q
What are the 4 phases of Grasp and Lift tasks?
A
- ) Contact between fingers and object.
- ) Grip force and load force (load on fingers) increase.
- ) Load force overcomes weight of object – movement starts.
- ) End of task – decrease in grip and load force shortly after object makes contact with table.
12
Q
Grasp and Lift Tasks:
- This scheme allows great flexibility in lifting objects of different weights.
- Duration of loading depends on objects ________.
- Grip and load force ratios have to be above a certain level otherwise _________ will occur.
- Previous experience and afferent information assist in determining these ratios.
- If there is a mismatch – receptors in finger pads are activated – pacinian corpuscles.
- Role of cerebellum – predictive control of grip forces.
- ________ lesion – poor predictive control of grip forces.
- ________ lesions – normal timing of predictive grip forces but reduced response amplitudes.
A
- weight
- slipping
- cerebellar
- cortical
13
Q
- Although reach and grasp are controlled by different systems, the timing of each is _________.
- In a patient with dysfunction, do we train them seperately or together?
A
- coupled
- both separately and together
14
Q
- What do we develop at 4-5m of age?
- What do we develop at 9-13m of age?
- At what age do higher cognitive aspects begin?
A
- more accurate reaching and grasp components
- pincer grasp
- 12m
15
Q
Eye Head Coordination:
- Control of saccadic eye movements develops _______ smooth pursuit.
- Initial tracking is performed with ________ eye movements.
- Limited ______ ________ present in the infant.
- Quickly improves around __ weeks of age.
- __ months – eyes stay on object most of time.
- __ months – predictive abilities.
- Head movements in smooth pursuits – present in 1 month olds and increases with age through at least 5.
A
- before
- saccadic
- smooth pursuit
- 6w
- 3m
- 5m
16
Q
Eye Hand Coordination:
- At __ months – head-arm movements become coupled very strongly and then become uncoupled to allow more flexibility.
- At __ months – beginning postural stability – stable base for moving.
A
- 2m
- 4m
17
Q
Motor Components of Reach and Grasp:
- __-__ months –extension of arm – opening of hand – difficulty to grasp object.
- __ months – reaching becomes more refined – approach path straightens, number of segments of the reach decreases.
- __ months – visually guided reaching.
- Reaction time reducing with age up to 16-17 years.
A
- 0-2m
- 4m
- 5m
18
Q
Changes in Adults:
- ____-______ changes such as slowing of onset latencies for postural response or decreased movement speed.
- Coordination factors related to changes in movement or muscle activation patterns.
- Changes in the use of ________ and _________ control of both postural and mobility skills.
A
- time-related
- feedback and feedforward
19
Q
Reaching Changes with Age:
-Discrete reaching slows __-__% in velocity – depending on task.
Hypothesized to be due to changes in information processing.
Changes in reaching coordination with more time spend in the deceleration phase.
More complex tasks – more age related changes.
A
30-90%
20
Q
Grasping Changes with Age:
- Decrease in manual ________.
- Time required to manipulate small objects increased __-__% by age 70.
- Older adults use larger grasp forces and take longer to adapt the force.
- Most age-related decrements in reaching performance can be improved with training. Training effects remain high for at least a month after training has ended and also transfer to other reaching tasks.
A
- dexterity
- 20-45%
21
Q
PART 2: DEVELOPMENTAL ASSESSMENT
A
PART 2: DEVELOPMENTAL ASSESSMENT
22
Q
What are the purposes of developmental testing? (4)
A
- Diagnosis/Prognosis
- Eligibility for various programs
- Evaluation of outcomes
- Treatment planning
23
Q
What are the basic methods of the assessment? (4)
A
- Interview
- History
- Clinical Observation
- Assessment Tools
24
Q
- What is age equivalent score?
- What is percentile score?
- What is raw score?
A
- Age equivalent score: mean chronologic age represented by a certain test score.
- Percentile score: indicates the number of children of the same age or grade level who would be expected to score lower that the child tested.
- Raw score: total number of items that are passed or correct on a particular test.
25
- ______ = lowest score
| - ______ = highest score
- Basal
| - Ceiling
26
- What is interobserver reliability?
| - What is test-retest relaibility?
- Interobserver = The reliability of 2 people performing a test and getting the same thing.
- Test-retest = Closeness of the agreement between the results of successive measurements.
27
- _________________________ gives an estimate of the margin of error associated with a particular test score.
- _________ scores are expressed as deviations or variations from the mean score for a group – expressed in units of standard deviation.
- Standard Error of Measurement
| - Standard Scores
28
What are the 5 types of validity?
- Content
- Construct
- Face
- Concurrent
- Predictive
29
- ___________ validity means the test measures appropriate content.
- __________ validity means the test measures the skills/abilities that should be measured.
- _______ validity is simply whether the test appears (at face value) to measure what it claims to.
- _________ validity is a type of evidence that can be gathered to defend the use of a test for predicting other outcomes.
- _________ validity is one approach of criterion validity that predicts individual performance on some measure scores administered at a later date.
- Content
- Construct
- Face
- Concurrent
- Predictive
30
What are the criteria for evaluating a standardized test? (9)
1. ) Purpose
2. ) Age Range
3. ) Areas Tested
4. ) Time Required
5. ) Administration
6. ) Appropriateness
7. ) Cost
8. ) Reliability
9. ) Validity
31
What is the difference between norm-referenced and criterion-referenced test?
- Norm-referenced test is a comparison between a specific child and an "average" child.
- Criterion-referenced test is a comparison to specific criteria rather than comparison to a "normal" group.
32
When are norm-referenced tests most appropriate?
Most appropriate when the purpose is to determine whether an infant has a motor delay or to determine eligibility for early intervention.
33
When are criterion-references tests most appropriate?
Are most appropriate for evaluation of the effects of physical therapy and treatment planning.
34
For many infants, is a norm- or criterion-referenced test recommended?
For many infants, the use of both a norm-referenced and criterion referenced assessment is recommended.
35
What are standardized screening tests intended to do?
differentiate between those persons who are normal and healthy in a particular respect from those who are not.
36
Standardized Screening:
- To identify the risk for dysfunction in specific __________ of children.
- To detect the risk for dysfunction in an _________ child.
- To formulate a register or monitoring system for children identified at risk.
- Usually done at regular intervals (i.e., yearly).
- categories
| - individual
37
Standardized Evaluation:
- To help team determine a _________.
- To identify _________ development.
- To obtain ___________ information on child’s performance or status.
- To determine eligibility for service.
- Usually ______-referenced and/or formal.
- Usually done once or infrequently.
- diagnosis
- atypical
- baseline
- norm-referenced
38
Standardized Assessment:
- To plan an __________ program.
- To delineate strengths, weaknesses, and needs across domains and environments.
- Often are __________-referenced and/or informal.
- Done on an on-going basis (i.e., within treatment).
- intervention
| - criterion-referenced
39
- Standardized Evaluation = _____-referenced
| - Standardized Assessment = ______-referenced
- Standardized Evaluation = norm-referenced
| - Standardized Assessment = criterion-referenced
40
Is the Alberta Infant Motor Scale (AIMS) a standardized assessment, evaluation, or screen?
screen
41
What is the bottom line for standardized tests?
Norm-referenced assessments enable the physical therapist to document the infants' level of development and to monitor general progress; while the criterion-referenced assessment serves as a measure of direct effects of physical therapy.
42
How do we choose an appropriate standardized test? (8)
- Purpose of test
- Type of test
- Age Range
- Domains tested
- Psychometric characteristics
- Administration
- Time required
- Price
43
What are some screening tests used?
- Harris Infant Neuromotor Test (HINT)
- Miller First Step Screening Test for Evaluating Preschoolers
- Milani-Comparetti Motor Development Screening Test
- Denver II (DDST)
44
Harris Infant Neuromotor Test:
- Age range?
- Purpose?
- 3-12m
| - Purpose is to identify developmental delay.
45
Miller First Step Screening Test for Evaluating Preschoolers:
- Age range?
- Purpose?
- 2y9m to 6y2m
| - Assesses cognitive, communicative, physical, social-emotional, and adaptive function.
46
Milani-Comparetti Motor Development Screening Test:
- Age range?
- Purpose?
- 0-2 years
- Evaluates motor development on the basis of a correlation between the functional motor achievement of the child and the underlying reflex structure.
47
Denver II (DDST):
- Age range?
- Purpose?
-0-6y
-Screens 4 areas of development
(Personal-social, Fine motor, Language, Gross motor)
48
What are some tests of motor function?
- Movement Assessment of Infants
- Test of Infant Motor Performance
- Peabody Developmental Motor Scales-2 (PDMS-2)
- Alberta Infant Motor Scale (AIMS)
- Bruininks-Oseretsky Test of Motor Proficiency (BOT)
49
Movement Assessment of Infants:
- Evaluates muscle tone, primitive reflexes, automatic reactions, and volitional movements in the _________ of life.
- _________-referenced
- 65 items
- Requires extensive handling of the infant
- ___ minutes for testing and scoring
- first year
- criterion-referenced
- 90 minutes
50
Test of Infant Motor Performance:
- Purpose: capture the components of _________ and _________ control of movement that are important for function in early infancy.
- 32 weeks gestational age – 3.5 months after full term delivery
- ________-referenced
- 27 observed items, 25 elicited items
- postural and selective
| - criterion-referenced
51
Peabody Developmental Motor Scales-2 (PDMS-2):
- Purpose?
- Age Range: Birth-__ months
- Areas Tested: _____ and _____ motor
- ______-referenced
- Time Required: __-__ minutes
- Approx. Price: $______
- Determine level of motor skill acquisition, detect small changes in motor development in children w/ known delays or disabilities and assist in programming for children with disabilities.
- 71 months
- gross and fine motor
- norm-referenced
- 45-60 minutes
- $400
52
```
Alberta Infant Motor Scale (AIMS):
-Purpose?
-Age Range: Birth-__ months
-Type: _______ or ___________
-Areas Tested: 58 ______ motor skills divided amongst 4 positions (prone, supine, sitting, and standing)
-_______-referenced
Time required: __-__ minutes.
Approx Price: $______
```
- Identify infants and toddlers with gross motor delay and to evaluate gross motor skill maturation over time.
- Screen or evaluation
- gross motor skills
- norm-referenced
- 20-30 minutes
- $100
53
Bruininks-Oseretsky Test of Motor Proficiency (BOT):
- Assesses ______ and _____ motor functioning.
- Age Range: __-__ years
- ____-referenced
- gross and fine motor
- 4-14 years
- norm-referenced
54
What are some comprehensive developmental scales?
- Hawaii Early Learning Profile (HELP)
| - Bayley II
55
Hawaii Early Learning Profile (HELP):
- Purpose?
- Age Range: __-__ years
- What areas are tested?
- ________-referenced
- Time required: __-__ minutes
- Determine the level of motor skill acquisitions, detect small changes in motor development in children with known delays or disabilities and assist in programming for children w/ disabilities.
- 0-6 years
- gross motor, fine motor, cognitive, social, self help, language
- 20-30 minutes
56
Bayley II:
- ______-referenced
- Three parts including _____, _____, and ______ scale.
- norm-referenced
| - mental, motor, and behavior scale
57
Early Intervention Developmental Profile (EIDP):
- 6 scales?
- Age Range: birth-__ months
- ________-referenced
- perceptual fine motor, gross motor, cognition, language, social or emotional, self care
- 36 months
- criterion-referenced
58
PART 3: MUSCULOSKELETAL DEVELOPMENT
PART 3: MUSCULOSKELETAL DEVELOPMENT
59
"The effects of forces on the musculoskeletal system during the entire life span."
Developmental Biomechanics
60
General Principles of Growth:
- Biological tissue is created, shaped, and remodeled through __________ or _________ forces.
- Type, direction and magnitude of force influence body size.
- As does genetics, nutrition, drugs, hormones.
internal or external
61
Effects of Loading on Tissue Type:
- The _______ and __________ of loading influences the type of tissue or articulation being formed.
- Forces are important in determining the type of tissue formation.
- ____________ – intermittent loading
- ___________ – continuous loading
- type and duration
- Chondrogenesis
- Osteogenesis
62
Bone Formation:
- Bone, cartilage, and muscle are all developed from the ___________.
- Bone formation occurs through either __________ or ___________ ossification.
- All bones, except the clavicle, mandible, and skull, are formed by ____________ ossification.
- mesoderm
- endochondral or intramembranous ossification
- endochondral
63
Bone Formation:
- Primary ossification centers are typically located in the center of the ___________ or body of bone. By birth, diaphysis are almost ossified.
- _________, or distal ends of bone, remain cartilaginous at birth.
- diaphysis
| - epiphysis
64
Premies have _____ calcified bones, calcification of fetal bone increases as the fetus gains weight.
less
65
Bone Formation:
- Secondary ossification centers appear in early childhood in the __________.
- Timing of ossification varies with each bone, most ossified by 20 years.
- After birth, long bones grow in length at the epiphyseal plate.
epiphysis
66
Bone Formation:
- Bone also increases in size through ________ growth which is the accumulation of new bone in the bone surface, thus increasing bone density and thickness.
- What are the most rapid periods of bone growth?
- appositional growth
| - prenatal, 7 years old, adolescence
67
Joint Formation:
- Begins with the formation of the cartilaginous models.
- Basic structures formed during __-__ weeks of gestation.
- Final shape develops throughout early childhood.
6-8 weeks
68
Bone and Mechanical Forces:
-Early on, the role of mechanical forces is ________. As fetus grows and space becomes confined, mechanical influences become more important.
-Uterine crowding can result in ______ foot and abnormal facies.
Decreased joint movement can result in _______, _________ bones.
- minimal
- club foot
- fragile, misshapen
69
Modeling:
- After initial development, bone shape can be changed through a process called modeling, which involves bone _________ and _________.
- What is Wolff's Law?
- formation and resorption
| - Bones develop a particular internal trabecular structure in response to the mechanical forces that are place on them.
70
Modeling:
- ____________ loading, parallel to the direction of growth, results in either compression or tension,
- If applied intermittently with appropriate force (weight bearing or muscle pull) it will stimulate _______.
- Intermittent compression appears to stimulate _____ growth than tension.
- Longitudinal
- growth
- more
71
Modeling:
- Constant or excessive static loading causes bone material to _________.
- _________-_______ Principle of bone growth regulation: growth plates produce increased growth in response to tension and decreased growth in response to excessive compression. (unequal forces due to malalignment = more malalignment)
- decrease
| - Hueter-Volkmann
72
Modeling:
- What would stapling the epiphyseal plate do?
- _____ growth is commonly used with leg length discrepancies in children.
- The ______ technique for limb lengthening.
- Produce constant compressive slowing down one side.
- Slow growth
- Ilizarod
73
Modeling:
- Shear forces which run parallel to the epiphyseal plate can lead to ________ _______ changes, it occurs with normal muscle pull.
- This could result in genu ______/________, scoliosis.
- Asymetrical growth can also occur secondary to a fracture
- HOWEVER, ________ drift (Bone is able to straighten some degree of malalignment)
- torsion twisting
- varum/valgum
- flexure drift
74
Flexure Drift:
- Strain on a curved bone wall applied by repeated loading tends to move the bone surface in the direction of the concavity to straighten the bone.
- Bone is resorbed from the ________ side and laid down on the ________ side.
- Seen in the femur as the child loses the initial genu _______ posture.
- convex, concave
| - varum
75
- Newborns generally have genu ______.
- At 1-2 years the legs _________.
- At 2-4 years, they generally have genu ______.
- varum
- straighten
- valgum
76
Alignment:
- Neonatal ___________ or “physiological limitations in motion”
- Hip, knee, and elbow _______ (hip 30 degrees)
- Spine ________
- Hips _________ and _________
- contractures
- flexion
- kyphotic
- shallow and unstable
77
Alignment:
- Hip – excessive _________ (69-76 degrees) decreases to a mean of 60 by 2 years of age.
- Extreme abduction appears to decrease along with the development of ________ postures.
- More _________ rotation – this relationship changes during the first two years.
- Decreased lateral rotation related to increased hip ________.
- abduction
- upright
- lateral
- extension
78
Alignment:
-Coxa _______ – increased angle of inclination or neck-shaft angle (135-145).
Angle decreases to adult values (125) by adolescence due to compression and tension forces that occur with weight bearing and muscle pull.
valga
79
Alignment:
- Torsion – normal amount of rotation present in a long bone (Femoral torsion)
- _________ occurs when the head and neck of the femur are rotated forward in the sagittal plane relative to the axis through the femoral condyles
- _________ occurs when the head and neck of the femur are rotated backwards.
- Antetorsion
| - Retrotorsion
80
Alignment:
- Knee flexion contracture of __-__ degrees
- Apparent physiological bowing – tibia appears outwardly bowed in the frontal plane ( the entire tibia is rotated slightly forward – this places the lateral head of the gastroc in a more forward position.
-20-30 degrees
81
Alignment:
- The forward position of the tibia is due to the contracture of the medial knee structures due to intrauterine positioning.
- Tibiofemoral angle – ______ in the newborn.
- May be as high as 15 degrees but decreases to 5 during first year.
- __-__ yrs it shifts to genu valgum. (10-15 degree)
- varus
| - 3-4 years
82
Alignment When to Treat:
- Bleck and McDade – If varus position of the knees is not decreasing by 18 months to 2 years – need to investigate particularly if beyond 25 degrees
- Genu valgum – If it does not reduce to __-__degrees.
-5-7 degrees
83
Alignment
- Tibial torsion
- Neonate – sight external torsion (5 degrees)
- Increases to ___ degrees by age 14 and 23-25 degrees by skeletal maturity.
-18
84
Alignment Ankle and Foot:
- Newborn – very flexible – but may have a _________ limitation.
- Talus and calcaneus are inclined medially – forefoot slightly inverted in nonweightbearing.
- Foot should have straight lateral border
- If the lateral border is a “C” – metatarsus adductus
plantarflexor
