Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
92 Cards in this Set
- Front
- Back
|
Primitive standing reflex Automatic stepping response No ATNR (generally) Semicircular canals developing, getting used to gravity Physiological Flexion! |
0-1 Month old |
|
|
Supine – flexed, head midline, begin to elongate Sitting – needs suppor, start to lift head Prone – flexed posture, deep pressure on zygomatic arch stimulates suck/swallow reflex, belly can move, which helps breathing and eating, access to hands, can see 7-12 inches with no depth perception |
0-1 Month old |
|
|
2 Months (asymmetry)
Reflexes Prone – Supine – Sensory: Play – Hand skills – Manipulation: |
2 Months (asymmetry) Disorganized and hypotonic – look like they've regressed more head lag and decreased grasp reflex ATNR – increased neck ROM Prone – wgt bearing on ulnar borders of forearm – premature tripod, get head out of “bucket of clavicles” Supine – start to get feet down Sensory: tactile stim emphasized (rooting, suck and swallow reflex is strong... dissipates by 4-5 months), begins to combine auditory and visual, recognizes parents voices, bottle, microwave Play – dependent for play, mostly asleep, prefers sensory input in supportive situations, prefers Mom Hand skills – no voluntary grasp, just reflex. Manipulation: hand to mouth |
|
|
___ Months (_____) Prone: tripod with more thoracic extension, deep pressure on upper abs helps with development, chin tuck, deep pressure into elbows Supine: more play at chest level, supported stand- collapsing at knees occurs, cry is more developed Vision fully developed, Color not depth ect Head – developing head righting Sitting – not much extension, requires support to sit |
3 Months (symmetry) Prone: tripod with more thoracic extension, deep pressure on upper abs helps with development, chin tuck, deep pressure into elbows Supine: more play at chest level, supported stand- collapsing at knees occurs, cry is more developed Vision fully developed, Color not depth ect Head – developing head righting Sitting – not much extension, requires support to sit |
|
|
___ Months (_____) If they miss active symmetry, less balanced (like scooter who always has R leg in front of him) Antigravity Legs – wide BOS Arms symmetrical – no hand dominance Supine – ribs expanding, can lift legs and hold longer, arms extend up, more wrist control Prone: deep pressure to lower abs, pubis, and thighs, lateral weight shifts, forearms – pronation to supination, extension into L region, prone on elbows (shoulders from IR to ER, deep pressure to back of hand |
4 Months (active symmetry) If they miss active symmetry, less balanced (like scooter who always has R leg in front of him) Antigravity Legs – wide BOS Arms symmetrical – no hand dominance Supine – ribs expanding, can lift legs and hold longer, arms extend up, more wrist control Prone: deep pressure to lower abs, pubis, and thighs, lateral weight shifts, forearms – pronation to supination, extension into L region, prone on elbows (shoulders from IR to ER, deep pressure to back of hand |
|
|
Prone on elbows – __-__ months milestone |
Prone on elbows – 3-4 months milestone |
|
|
Fine motor at 3-4 months Reach: Grasp: Manipulation: Release: |
Fine motor: Reach: near body at 3 mo, away from body by 4 mo, hands to midline bilateral approach Grasp: tenodesis (if wrist flexes, toy drops) Manipulation: active fingering of toys at midline, start isolated finger extension on skinny toy Release: involuntary, get distracted and leg go |
|
|
Sensory/Play: __-__ mo Proprioceptive input – active WB and WS through trunk and Ues auditory localization accommodates to loud noises tolerates more variety in sensory Big visual gains – eye convergence Very social – likes interaction, more awake time Enjoys toys that move or make sound |
Sensory/Play: 3-4 mo Proprioceptive input – active WB and WS through trunk and Ues auditory localization accommodates to loud noises tolerates more variety in sensory Big visual gains – eye convergence Very social – likes interaction, more awake time Enjoys toys that move or make sound |
|
|
low or no head lag on pull to sit More extension in T & C spine in sitting, less support needed Prone on elbows – _-_ months milestone Reflexive hand grasp reduced: prone leads to integration (attenuation of reflex) Standing – at _ months will stand for seconds then begin to collapse at knees |
low or no head lag on pull to sit More extension in T & C spine in sitting, less support needed Prone on elbows – 3-4 months milestone Reflexive hand grasp reduced: prone leads to integration (attenuation of reflex) Standing – at 3 months will stand for seconds then begin to collapse at knees |
|
|
_ Months (__) Sitting: prop sitting (hand support) Can weight shift if arms propped on legs ATNR (integrating) can move in and out Increase in reactions – Landau, STNR, Body on body, Body on head and equilibrium reactions in supine Wide BOS Deep pressure to heels of hands hold breath to stabilize Standing: bouncing at knees, more extensor control |
5 Months (big changes) Sitting: prop sitting (hand support) Can weight shift if arms propped on legs ATNR (integrating) can move in and out Increase in reactions – Landau, STNR, Body on body, Body on head and equilibrium reactions in supine Wide BOS Deep pressure to heels of hands hold breath to stabilize Standing: bouncing at knees, more extensor control |
|
|
Age for milestone of Sitting: prop sitting (hand support) |
5 months |
|
|
_ Months Protective responses: after solid trunk, 1st forward, 2nd sideways, 3rd backward, initially slow Side lying: Enjoy play on side Segmental rolling initiated glutes increase in strength Supine Feet to mouth Full ROM at hip Prone deep pressure to hands and thighs Vision – full binocular vision Sitting: Independently! |
6 Months Protective responses: after solid trunk, 1st forward, 2nd sideways, 3rd backward, initially slow Side lying: Enjoy play on side Segmental rolling initiated glutes increase in strength Supine Feet to mouth Full ROM at hip Prone deep pressure to hands and thighs Vision – full binocular vision Sitting: Independently! |
|
|
5-6 Months: Motor Motor: ____ weight shift extended arm wt bearing – helps develop arches Reach Grasp Manipulation Release |
5-6 Months: Motor Motor: lateral weight shift extended arm wt bearing – helps develop arches Reach direct and accurate, gaining unilateral reach and supination, mid-range control – less overshooting Grasp Palmar grasp Thumb adducted Mp hyperextension and abduction Manipulation combine grasp and arm movements in play thumb flex and ext on grasped toys Release still involuntary transfers hand to hand via mouth |
|
|
5-6 months: Sensory Body awareness – pressure – Visual skills ____ driven reach plays alone about __ min Prefers – ___ toys, ___ toys Understands cues of ____ or ___ voice |
Sensory Body awareness – peek a boo purposeful attempts to get objects Un-graded pressure – often crushes cracker Visual skills mature – binocular vision, head dissociated form eyes, convergence, tracking smoothly, small object recognition, looks before mouthing Cognitively driven reach plays alone about 15 min Banging, shaking, and mouthing Prefers – 1 hand toys, cause and effect toys Understands cues of angry or happy voice |
|
|
_ Months More lateral sitting Can move to sit from side lying Belly crawl May rock on all fours – will fall BOS support getting more narrow |
7 Months More lateral sitting Can move to sit from side lying Belly crawl May rock on all fours – will fall BOS support getting more narrow |
|
|
_ Months Starting to rock on all fours Crawl – ipsilateral rotation in spine and vaulting over arm from all 4s pull to stand – using trunk and uppers to power themselves up, then scoop legs under more vestibular awareness |
8 Months Starting to rock on all fours Crawl – ipsilateral rotation in spine and vaulting over arm from all 4s pull to stand – using trunk and uppers to power themselves up, then scoop legs under more vestibular awareness |
|
|
___ Months Crawling – all 4's primary mobility Sitting – variety of postures – can reach out of BOS and regain/return Pull to stand – will move through ½ kneel to stand very quickly Cruise – may be attempting to WS and step (wide BOS) Climbing (beginning) Standing – wide BOS, plop from standing (lack eccentric control or lock their legs), toe clawing to gain stability |
9 Months Crawling – all 4's primary mobility Sitting – variety of postures – can reach out of BOS and regain/return Pull to stand – will move through ½ kneel to stand very quickly Cruise – may be attempting to WS and step (wide BOS) Climbing (beginning) Standing – wide BOS, plop from standing (lack eccentric control or lock their legs), toe clawing to gain stability |
|
|
Parachute reaction: around _ months
|
Parachute reaction: around 6 months
|
|
|
Sideways protective response: _-_ months Backward protective response:
|
Sideways protective response: 7-8 months Backward protective response – last to appear
|
|
|
Crawling: __ months
|
Crawling: 10 months
|
|
|
Pull to stand: _-_ months Standing: __ months Independent standing: __ months
|
Pull to stand: 9-10 months Standing: 11 months Independent standing: 12 months
|
|
|
Walking: __ months Plantar grasp occurs until _____ |
Walking: 12 months Plantar grasp occurs until walking well |
|
|
_-_ months: Fine motor Motor: transitions, rotation, and stable uppers for WB and WS Hand control: Reach – unilateral and out of midline, combined with weight shift, accommodates to task, supination active Grasp: _ months: raking grasp of pellet _ mo: scissoring grasp of pellet palm and thumb activity increased play interest promotes grasp and manipulation Manipulation: holds 2 toys at the same time, self-feeding, alternate hand use Release: drops everything, first true release |
7-9 months: Fine motor Motor: transitions, rotation, and stable uppers for WB and WS Hand control: Reach – unilateral and out of midline, combined with weight shift, accommodates to task, supination active Grasp: 7 months: raking grasp of pellet 9 mo: scissoring grasp of pellet palm and thumb activity increased play interest promotes grasp and manipulation Manipulation: holds 2 toys at the same time, self-feeding, alternate hand use Release: drops everything, first true release |
|
|
_-_ months: Sensory/Play Sensory: play schemes involve exploration in sensory and motor experiences – watching and moving constantly Increasing amount and detail of motor programs Judgement of height, distances, and weight Proprioception and tactile discrimination Visual detail Play: loves novelty, differences *More independent from mom in play Loves to explore, move, curious |
7-9 months: Sensory/Play Sensory: play schemes involve exploration in sensory and motor experiences – watching and moving constantly Increasing amount and detail of motor programs Judgement of height, distances, and weight Proprioception and tactile discrimination Visual detail Play: loves novelty, differences *More independent from mom in play Loves to explore, move, curious |
|
|
__ months: Can stand up from ½ kneel Walking with 2 hands held Climbing Cruising – holding 1 hand while looking in the direction headed Increased hand usage and control
|
10 months: Can stand up from ½ kneel Walking with 2 hands held Climbing Cruising – holding 1 hand while looking in the direction headed Increased hand usage and control
|
|
|
__ Months: Upright child May stand alone (accidentally) able to WS over stance leg with hand held Can lower ½ to floor, then plop Walks next to furniture Perceives self as upright child |
11 Months: Upright child May stand alone (accidentally) able to WS over stance leg with hand held Can lower ½ to floor, then plop Walks next to furniture Perceives self as upright child |
|
|
__ Months: Stand independently Takes steps independent Has bias towards extension Moves quickly – balance issues No rotation with indep ambulation Fine motor and speech may decrease with new interest in walking |
12 Months: Stand independently Takes steps independent Has bias towards extension Moves quickly – balance issues No rotation with indep ambulation Fine motor and speech may decrease with new interest in walking |
|
|
__-__ months: Sensory and Play Sensory: Negotiating obstacles Climbing Tactile proprioception exploration with hands Pre-shaping hands to fit situations Increase visual perception Enjoys rough housing Play: Interest and activity critical to developing hand skills Prefers household toys Entertains self Refinement occurring |
10-12 months: Sensory and Play Sensory: Negotiating obstacles Climbing Tactile proprioception exploration with hands Pre-shaping hands to fit situations Increase visual perception Enjoys rough housing Play: Interest and activity critical to developing hand skills Prefers household toys Entertains self Refinement occurring |
|
|
Transitional movement ability is at its peak at age __ |
Transitional movement ability is at its peak at age 16 |
|
|
When was the Individuals with Disabilities Educational Act enacted? What were it's 7 key concepts? |
1991 - (IDEA) PT for kids 3-5 All involved kids under 5 get services zero reject Provide education in the least restrictive environment Right to due process Individualized education plan (IEP) involve parents Right to related services - PT, OT, etc.
|
|
|
4 Most Common diagnoses in peds |
1. Cerebral palsy 2. Developmentally delayed 3. Mental retardation 4. high risk infants |
|
|
Red Flags: when sensory integration might be a problem Infants and toddlers:
|
Red Flags: when sensory integration might be a problem Infants and toddlers: Problems eating or sleeping Refuses to go to anyone but me Irritable when being dressed, uncomfortable in clothes Rarely plays with toys Refuses cuddling, arches away when held Cannot calm self Floppy or stiff body, motor delays |
|
|
Red Flags: when sensory integration might be a problem Pre-schoolers: |
Pre-schoolers: Over-sensitive to touch, noises, smells, other people Difficulty making friends Difficulty dressing, eating, sleeping, and/or toilet training Clumsy, poor motor skills, weak In constant motion, in everyone's face and space Frequent or long temper tantrums |
|
|
Red Flags: when sensory integration might be a problem Grade schoolers: |
Grade schoolers: Over-sensitive to touch, noises, smells, other people Easily distracted, fidgety, craves movement, aggressive Easily overwhelmed Difficulty with handwriting or motor activities Difficulty making friends Unaware of pain and/or other people
|
|
|
Red Flags: when sensory integration might be a problem Adolescents and Adults: |
Adolescents and Adults: Over-sensitive to touch, noise, smells, and other people Poor self-esteem; afraid of failing at new tasks Lethargic and slow Always on the go; impulsive; distractible Leaves tasks uncompleted Clumsy, slow, poor motor skills or handwriting Difficulty staying focused (incl. at work and in meetings) |
|
|
A Heterogenous condition that includes a variety of subtypes. Individuals with ____ have impaired responses to the processing of and/or organization of sensory information that affects participation in functional daily life routines and activities |
Sensory Processing Disorder (Miller 2007) |
|
|
3 primary diagnostic groups of Sensory Processing Disorders (SPD) |
Sensory Modulation Disorder: sensory over-responsive, under-responsive, seeking/craving
Sensory-based Motor Disorder: Dyspraxia - problems in planning and sequencing
Sensory Discrimination Disorder: Difficulty interpreting the specific characteristics of sensory stimuli (intensity, duration, temporal, spatial elements) - vestibular, proprioceptive, and 5 senses |
|
|
Treatment for Sensory Processing Disorders: (basic premiss) |
The child engages in meaningful activities while the therapist subtly controls the sensory influences upon muscles, joints, skin and the vestibular system This encourages the production of natural adaptive responses A sensory program can and should be adapted to the home |
|
|
Identifying symptoms of arousal level issues: increased: decreased: |
increased: tactile defensibility, increased verbalizations, tendencies to focus on irrelevant aspects of the task (some increased arousal might be age appropriate) Decreased: Tendency to stay in one place Need repeated suggestions to engage in an activity |
|
|
Signs/symptoms of sensory over-responsivity (SOR) |
Touch hypersensitivity (does it tickle or hurt?) preference to touch rather than be touched overreaction to minor bumps and falls discomfort with face washing, hair and teeth brushing Sensitivity to textures of clothing or food avoidance of play with sand, finger paint, walking barefoot Preference for solitary play Avoidance to being cuddled and hugged resistance to barefoot or shoes
|
|
|
Signs/symptoms of sensory under-responsivity
|
(response is too little, or needs extremely strong stim to become aware of the stimulus) Touch hyposensitivity: decreased awareness and responsivity touch, pain, or temperature that would normally elicit behavioral response does nothing - under react to bumps and bruises, can't distinguish what objects they are touching outside of visual field |
|
|
Calming treatment techniques |
Slow bouncing Rocking / Swinging Deep compressions/touch Proprioceptive treatment Hugs (deep) Slow brushing Weighted blanket/ vest Wraps (ace, burrito, sandwich) Resistance / resistance training Sunshine / out doors Calm music Water |
|
|
Arousing treatment techniques |
Fast bouncing, rolling Fast swinging / rocking Light touch Spinning Fast brushing Running Vestibular input Traction activities Vibration Water
|
|
|
Principle 1: Start with self-application of sensory stimuli. Principle 2: Gradually introduce new sensations. Principle 3: Build trust and use predictability. Principle 4: Anxiety and intensity of responses can be mediated through motivation, attention and cognition. Principle 5: Engage the parasympathetic NS to counter balance the sympathetic NS. Principle 6: Structure environment and tasks to minimize over reaction
|
|
|
|
Principle 1: Use stimulating sensations Principle 2: Engage in activities that enhance tactile, proprioception and vestibular stimulation. Principle 3: Find sensory activities that are motivating. Principle 4: Use facial expressions and affect to entice child to participate. Principle 5: Address body awareness and postural components if under respective in proprioception and vestibular senses |
Principles of Supports for Sensory Modulation Disorder: Sensory UNDER-responsive |
|
|
Principle 1: Create organized movement experiences that have a goal and purpose. Principle 2: Environment changes can increase attention. Principle 3: Use sensory and self-regulation programs that use “heavy work”. Principle 4: Combine movement with proprioceptive, get head out of upright position. Principle 5: Use start and stop activities Principle 6: Use Sensory backpacks |
Supports for Sensory Modulation Disorder: Sensory Craving |
|
|
Principle 1: Strengthen core muscles of trunk. Principle 2: Work on co-activation of stabilizing muscles. Principle 3: Use weight bearing, weight shifting and rotation. Principle 4: Work on shoulder, forearm and wrist stability. Principle 5: Make sure sitting posture is stable to maximize arm and hand function. Principle 6: Address strength and endurance. Principle 7: Work on static and dynamic balance. |
Supports for Sensory-based Motor Disorder: Postural Disorder |
|
|
Principle 1: Sensory feedback enhances motor performance. Principle 2: Use activities the require timing and spatial organization. Principle 3: Choose activities that require sequencing of body movements Principle 4: Practice Ideation (all the time) Principle 5: Help child develop body maps and spatial maps. Principle 6: Use words to reinforce sequence of tasks Principle 7: Have child conceptualize and plan their daily routines |
Supports for Sensory-based Motor Disorder: Dyspraxia |
|
|
Principle 1: Use fun activities that address properties of the object. Principle 2: Encourage the child to use visualization and verbalize what they can’t see. Principle 3: Improve quantitative percepts by playing games that measure ht, wt, etc. Principle 4: Use activities that require attending to specific sounds. Principle 5: Use games that relate to specific location of the body and body movement through space Principle 6: Use games that occlude vision |
Supports for Sensory Discrimination Disorder: One or more sense |
|
|
Associated impairments from low tone |
respiratory system sensory deprivation cardiovascular compromise pre-existing/acquired cognitive limitations oral motor problems skeletal deformities/ROM skin (irritation, from lack of motion) |
|
|
Hypertonia |
may include increased resistance to passive stretch, contracture, spasticity or clonus
neuromotor control: extreme reciprocal inhibition - antagonist too relaxed co-contraction or non-functional co-activation limited and dysfunctional synergy selection overuse of the "tonic" reflexes or "coordinative structures" Postural tone: inability to "set tone for the task at hand" lack of timing and sequencing weakness and ROM |
|
|
Associated impairments from hypertonia |
skeletal deformities/ROM respiration cardiovascular visual oral motor developmental delays somatosensory dysfunction hearing deficits seizures skin perceptual/learning disabilities |
|
|
Levels of Newborn Intensive Care |
Level I : Basic Care Newborns who require minimal observation or care Care to infants 35-37 wks GA, stabilize <35 for transfer Located in small community hospitals Level II: Specialty Care Intravenous medications, tube feedings, oxygen Level IIA; moderately ill infants >32 weeks Level IIB: Provides mechanical ventilation for short periods of time Level III: Subspecialty Care IIIA: Care for infants >28 wks, performs minor surgical procedures IIIB: Care for infants < 28 wks, advanced respiratory support (i.e. high frequency ventilation), advanced imaging and pediatric surgical specialists and access to subspecialists IIIC: (IV) Extracorporeal membrane oxygenation (ECMO) and complex cardiac surgery with cardiopulmonary bypass IV: highest level of care. All of level III with location in big cities and large teams of specialist
|
|
|
Factors that place baby at High Risk for Morbidity/Mortality and Developmental Delay |
Premature birth Poor prenatal care Maternal age (<18 or >35) Multiple births (twins, triplets, etc) History of multiple losses Exposure to toxins- chemical or air borne (Smoking, drugs, alcohol) Daily Stress (physical/mental) History of bleeding in the first or second trimester High or low amounts of amniotic fluid Diabetes Blood clotting problems Undesirable vitals (mother or baby) Poor APGAR scores |
|
|
Risk Factors for Developmental Delays |
Low Birthweight below 1500 grams (3 pounds) Gestational age under 32 weeks Genetic Disorders Physical Malformations Cleft palate, SB Cub feet Chronic illness Low or high tone Lethargy Inconsolable Avoidance defensiveness Neurological insult before, during or after birth Hypoxia hydrocephalus, IVH (grade III,IV), meconium aspiration Traumatic birth injuries BPI, clavicle Fx Maternal substance abuse history (cessation) Feeding difficulties |
|
|
What does apgar stand for? purpose? |
A scoring system to evaluate the physical condition of newborn infants after delivery; developed by Virginia Apgar in 1953 A = appearance, P = pulse, G = grimace, A = activity, R = respiration Taken at first and fifth minute of life (and every 5 minutes until score >6)
|
|
|
Scoring of APGAR |
Appearance - skin color Pulse - heart rate Grimace - reflex irritability Activity - muscle tone Respiration
Score of 0: A: blue color P: no hr G: no response to stimulation A: none
Score of 1: A: blue at extremities P: <100 G: grimace/feeble cry when stimulated A: some flexion R: weak or irregular
Score of 2: A: no blue cyanosis P: >100 G: sneeze/cough/pulls away when stimulated A: active movement R: strong
<3 critically low; 4-6 low; >7 normal |
|
|
Interpreting the APGAR |
A score in the range of 3 to 4 indicates the need for bag and mask ventilation Scores of 5 to 6 require blow-by oxygen A score of 7 to 10 is considered typical for term newborns, and the infant does not require resuscitation |
|
|
Normal and low birthweights |
Average neonatal birthweight > 2500 grams (~5.5 lbs) Low birthweight (LBW) < 2500 grams Moderately low birthweight: 1,500-2,500 grams Very low birthweight: < 1,500 grams (~3lb 5 oz) Extremely low birthweight: < 1,000 grams (~2 lbs 3 oz)
454 grams in a pound
AGA = appropriate for gestational age AGA refers to an infant whose weight at birth falls within the 10th and 90th percentiles for his or her age SMA = small for gestational age LGA = large for gestational age
|
|
|
Common lung/cardiac problems in premature infants |
Respiratory Distress Syndrome Incomplete lung development Decreased surfactant Leads to BPD Bronchiopulmonary Dysplasia Chronic lung disease Reaction to O2 and ventilation necessary to sustain life “wet lung” rapid breathing and poor growth Life long susceptibility to respiratory complications Asthma, Allergies, etc.
Patent Ductus Arteriosus “Open” between the blood vessels connecting the pulmonary artery and the aorta Requires medication or surgery to close if it does not on its own |
|
|
4 levels of neonatal intensive care |
Level I Newborns who require minimal observation or care Located in small community hospitals Level II Intravenous medications, tube feedings, oxygen Neonatologists and neonatal nurses Contained in regional or community hospitals Level III Provides highly specialized services Provides complex medical interventions, advanced diagnostic testing, surgery, and respiratory support Neonatal intensive care unit Level IV Level III nursery Provides extracorporeal membrane oxygenation (ECMO) therapy |
|
|
Automatic signs of stress in an infant |
Color changes Flushing, cyanosis, pallor (modeling) Red, pale, blue Changes in vital signs HR, respiratory rate, blood pressure, O2 sats Visceral responses Vomiting, gagging, hiccups, yawning and sneezing
|
|
|
Motor signs of stress in an infant |
Generalized Hypotonia Frantic flailing movements Finger splaying Hyperextension of extremities Also look for: Diffuse sleep states Twitching and grimacing Glassy eyed appearance (tuning out) Gaze aversion Locked gaze Panicked look Irritability Difficult to console
|
|
|
Focus of therapy in the NICU |
Foster parental attachment and comfort Identify high risk behavior Assess and promote normal develop neurobehavioral organization Prevent physical deformity Provide education staff and families Develop home therapy programs parents or caretakers Make referrals to appropriate follow-up agencies |
|
|
Positioning in preterm infants |
Avoid postures of extension that lead to discomfort and an imbalance of flexion and extension Promote neutral head and neck position Slight chin tuck, scapular protraction to promote upper extremity flexion, and hands midline Use blanket rolls or commercially available devices |
|
|
What body position poses the most challenges to a preterm infant? |
Supine positioning allows maximal observation and access to the infant by caregivers Supine poses the most challenges for the infant Forces of gravity pull the baby into neck extension, trunk extension, scapular retraction, anterior pelvic tilt, external hip rotation, and abduction Does not promote calming and self-regulation |
|
|
Side-lying positioning in preterm infants |
Demonstrates decreased stress behaviors than supine positioning Symmetry and midline orientation of trunk and extremities, which promotes hands to mouth The diaphragm is placed in a gravity-eliminated plane, which lessens the work of breathing Reflux is decreased in left side-lying, and gastric emptying is increased in right side-lying |
|
|
When does the heart begin to develop and what's the process like? |
Development starts at day 15 of gestation! 2 paralel tubes. First organ system to become functional in a human embryo |
|
|
Fetal circulation - foramen ovale and ductus arteriosus |
Foramen Ovale - whole in the heart between the atria. Oxygenated blood comes from the placenta from the mother - through unbilical vein into right atria, blood doesn't necessarily need to go to the R ventricle, so it's shunted into L atria (some goes into pulmonary system to provide oxygen), When blood leaves L ventricle, it goes through Aorta (just like it does in humans... adults). Ductus arteriosis allows mixing of oxygenated and deoxygenated blood to provide more nourishment for pulmonary system (hole between aorta and pulmonary artery) |
|
|
What happens to the heart at birth, or close after? |
Cessation of umbilicus blood flow leads to decreased right atrium and increased left atrium pressure. Foramen ovale closes. Increase in oxygen levels leads to closure of ductus arteriosus
Circulation starts working in series Increased systemic vascular resistance leads to hypertrophy of left ventricle |
|
|
Changes to the heart as a baby grows |
Changes to increase in body size and configuration Increase in stroke volume (Stroke volume doesn't change in utero (not very contractile)) Increase in cardiac output - slight decrease in cardiac index Hypertrophy of myocardial cells - No new cells, but they can get bigger. |
|
|
Changes in vital signs with age |
Blood Pressure: Neonate: 75/50 Childhood: 105/60 Adolescence: 118/60
Heart Rate: Neonate: 140 Childhood: 95 Adolescence: 82
Respiratory rate Neonate: 30-40 Childhood: 20-25 Adolescence: 16-20 |
|
|
Development of the lungs |
At 4 wks, start seeing development of airways. Takes until about 40 weeks |
|
|
What happens in lungs at birth or shortly after? |
Asphyxia -> respiratory centers in brainstem are stimulated Fluid in lungs replaced with air and expand Pulmonary arterioles dilate -> pulmonary vascular resistance decreases. Rise in pulmonary blood flow, placental oxygenation to neonatal perfusion
Brainstem says, "hey, I'm about to die" and it starts breathing |
|
|
When do the lungs mature? |
Full lung maturation doesn't occur until late teens! |
|
|
CP considerations in the preterm infant Capillary bed development Surfactant production and elastic properties of lungs Delayed ductus arteriosus closure High-oxidative fibers: ~10-20% of diaphragm Lack of fatty insulation |
Capillary bed development: 26 weeks. Increasd pulmonary vascular resistance; R-L shunting Surfactant production and elastic properties of lungs: 35 weeks. Decreased lung compliance Delayed ductus arteriosus closure. L-R shunting High-oxidative fibers: ~10-20% of diaphragm. Diaphragm fatigue; respiratory failure Lack of fatty insulation. hypothermia nd increased O2 consumption
Notes: Capillary beds can't develop until the rest of the body develops so they know where they're going sufactant - decreases friction in lungs, comes in pretty late Increased oxygen consumption to stay warm - if supply exceeds demand, death will eventually occur. Babies can go into cardiac arrest because of that. |
|
|
Definition and Prevalence of congenital heart disease (CHD) |
A gross structural abnormality of the heart or interthoracic great vessels that is actually or potentially of functional significance ~0.8% of all live births with moderate - severe in 0.6% Disturbance during embryologic development Most are compatible with fetal circulation |
|
|
Patent Ductus Arteriosus |
That communication doesn't close... mix of blood. |
|
|
Tetralogy of Fallot |
* A large ventricular septal defect (VSD)
* Pulmonary (PULL-mun-ary) valve stenosis * Right ventricular hypertrophy (hi-PER-tro-fe) * An overriding aorta
septal defect and stenosis (in picture?)
Right ventricular hypertrophy |
|
|
Transposition of the great arteries |
Arteries switch spots
In TGA, blood returning from the body bypasses the lungs and is pumped back out to the body. This occurs because the main connections are reversed. The pulmonary artery, which normally carries oxygen-poor blood from the right side of the heart to the lungs, now arises from the left side and carries oxygen-rich blood returning from the lungs back to the lungs. |
|
|
Who gets CHD? |
Sometimes kids are born with no neuromuscular diseases but have congenital heart diseases. But, often goes along with one of these things
Down syndrome, Turner's, Marfan, Williams, Fetal alcohol, osteogenesis imperfecta, Friedreigch's ataxia |
|
|
Other cardiac conditions in children |
Kids can have things adults get (besides athlerosclerosis, it's fair game)
1. myocarditis 2. Cardiomyopathies 3. infective endocarditis 4. rheumatic fever 5. pericarditis 6. arrhythmias |
|
|
Pulmonary diagnoses in neonates and children |
Neonates: 1. Respiratory distress syndrome 2. Bronchopulmonary dysplasia 3. meconium asphyxiation syndrome 4. Apnea 5. congenital diaphragmatic hernia 6. esophageal atresia
Some due to birth process - 3, 4 (trauma during birth, premature birth) Can't do much about apnea as PTs.
Children: 2. Cystic fibrosis 3. primary ciliary diskinesia
1. bronchoconstriction as a result of spasm from environmental irritants (immune mediated response - T4?)
|
|
|
Which neuromuscular and motor conditions can result in CP dysfunction or may have PMH remarkable for CP complications? |
Cerebral palsy Down Syndrome Muscular dystrophy Spinal muscle atrophy Spina bifida Kyphoscoliosis Obesity
Neuromuscular conditions can have comorbid cardiopulmonary conditions |
|
|
Functional relationship of trunk control and respiration |
Focus on biomechanical component. |
|
|
Postural and respiratory consequences of weak abdominal obliques |
Lumbar lordosis, lower rib flaring, dec trunk rotation and ability to wt shift
Ineffective cough, high chest with horizontal ribs, diaphragm for trunk control |
|
|
Postural and respiratory consequences of tight pectoralis minor |
forward shoulders, scapula lat and ant, upper thoracic flexion
anterior upper chest can't fully expand |
|
|
Postural and respiratory consequences of weak serratus anterior |
scapular winging
dec structure of post chest wall, and stability of rib cage |
|
|
Postural and respiratory consequences of dec active upper thoracic expansion |
kyphosis, passive overelongation of scapular retractors
approximation of upper ribs, dec upper chest mobility and oxygenation of upper lobe |
|
|
Postural and respiratory consequences of dec ribcage stability |
Serratus anterior elevates the ribs, dec structural support for respiratory muscles |
|
|
What is the single most common cause of death in neonates? |
Respiratory distress syndrome Pathology = decreased amount of surfactant Alveolar collapse with diffuse atelectasis ventilation/perfusion mismatch 2nd increased pulmonary artery pressures decreased lung compliance
s/s: increased RR retractions nasal flaring, grunting cyanosis increased work of breathing |
|
|
Bronchopulmonary dysplasia (BPD) |
acute and chronic lung changes due to mechanical ventilation in preterm infants
Inflammatory response to extra stuff that's entering pulmonary system (airway, tube, more oxygen... all that is abnormal)
incidence increases with decreasing gestational age and birth weight (from 6-40% up to 90-100%)
increase in airway resistance and restriciton of airflow, leading to bronchial hyperresponsiveness, increased breathing effort Decrease in lung compliance increased residual volume and decrease in functional residual capacity hypoxemia hypercapnia in more severe cases Interruption in lung development
|
