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128 Cards in this Set
- Front
- Back
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Motor Learning
2 Types of Practice |
Mental and Physical Practice
Combined mental and physical practice works the best |
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Motor Learning
Mental Practice |
Thinking about the movement.
Visualize how you would do the movement. The act of visualizing in your head seeing yourself going through a movement or skill. Used in sports a lot, as well as stroke patients (not as fatiguing as physical practice) Works well for beginners as others who might need to refine a skill 3-5 Min practice shown to be affective and improves performance as well as motor learning for those learning gross skills |
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Motor Learning
Mental Practice (see actual notes for references) |
Increases concentration
Improve error correction in execution increase speed of moverment improve balance improve accuracy and efficiency increase isometric strength increase endurance |
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Motor Learning
Physical Practice |
Types of Tasks
Continuous [no specific start or end (use of a computer mouse, driving and using a steering wheel, arbitrary beginning and end)] Discrete [have a specific start or end (turning on a light switch)] Serial [combination of continuous and discrete (diving a manual car)] Open Closed Complex Simple |
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Motor Learning
Physical Practice |
Therapist needs to address
Repetitions Sequencing Scheduling Fatigue Variability Guidance Feedback Environment |
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Motor Learning
Physical Practice Repetitions |
People will learn best, when using repetitions, if whatever we are doing more closely matches the skill we want to do
(Gets back to the exercise issue) |
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Motor Learning
Physical Practice Sequencing |
Less complex vs More complex
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Motor Learning
Physical Practice Sequencing |
Blocked
Good for early learning or refining complex skills (AAA, BBB, CCC) |
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Motor Learning
Physical Practice Sequencing |
Serial
Generalizable Predictable and repeating order Involves multiple tasks Patient can take this task and transfer it to doing a similar task away from us at another time (ABC, ABC, ABC) |
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Motor Learning
Physical Practice Sequencing |
Random
None repeating and can't be predicted. Long term motor learning is ensued Patients performance decreases for awhile, however, motor learning improves Takes more repetitions, good with generalizability (CAB, BCA, ABC) |
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Motor Learning
Physical Practice Sequencing |
Part vs Whole
Part= good if task is complex (break up task into parts to practice) Whole= More for a direct skill or if patient has cognitive capabilities |
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Motor Learning
Physical Practice Scheduling |
Distributed vs Masses
Distributed (rest time> or = to practice time)= good for patients who have poor endurance or concentration. Good for performance improvement [Dyspraxia-> motor planning deficit "clumsy" mild, "stroke" severe"] Massed (practice time is > than rest time)= good for athletes, young people, or people who are highly coordinated, have good endurance, or highly motivated Better for motor learning Long term retention of task |
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Motor Learning
Physical Practice Fatigue |
You want to fatigue your patient
Look at fatigue in terms of a balance or a trade off People won't learn if they don't have some form of fatigue with motor learning Without some evidence of fatigue you are not going to practice enough to learn and retain skills DO NOT WANT EXTREME FATIGUE |
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Motor Learning
Physical Practice Variability |
Enhances generalizability and adaptation (Patient takes responsibility and problem solving. Able to think through and figure out the best way to do something)
To improve ability change the speed, distance, direction or time of the task (Big in sports) Too much variation and you will get confused, no motor learning or performance Too little variation there will be an improvement in performance but not in motor learning |
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Motor Learning
Physical Practice Guidance |
Can be given by instructor or mechanical piece of equipment
Can be verbal, physical or a combination Improves performance but not learning. Trail and error is moire effective for retention and transfer of a task (water skiing to snow skiing- different environment, different task, basically same skill) Continuous guidance hinders learning Guidance should be delayed for children b/c they have longer response times for task performance |
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Motor Learning
Physical Practice Feedback |
Therapists tend to talk and give too much feedback
Can be provided verbally or nonverbally Can be provided while the task is being performed (concurrent) or at the end of the task (terminal) Two types of feedback 1) Intrinsic- sensory cues occurring as a natural result of movement (proprioceptors) 2) Extrinsic- (augmented or enhanced) sensory cues proved by another person or the environment |
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Motor Learning
Physical Practice Feedback |
Extrinsic or Augmented Feedback
Knowledge of Results (KR): magnitude, direction, duration and forcefulness of a movement END RESULT Knowledge of Performance (KP): Quality of movement. Few variables- positions, velocities, and time. (kinematics of movement) |
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Motor Learning
Physical Practice Feedback |
Frequency of Feedback
Frequent: improves performance but slows retention (good for a group) Varied: slows initial acquisition of a skill but improves retention (one on one) All depends on the person and complexity of a task |
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Motor Learning
Physical Practice Feedback |
Feedback Schedules
Summed: given after a set number of trials (ie every 3rd wrong) good for simple tasks or first learning complex tasks Faded: given at teh first of every trial and then less frequently (more feedback at first, give less as they improve) Bandwidth: given only when the performance is outside a given error range (safety is usually the error range or quality of movement) facilitates motor learning Delayed: Given after a time delay, promotes better motor learning (if too soon it reduces motor learning or skill, reduces accuracy more so in children) |
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Motor Learning
Physical Practice Environment |
Closed: structured, quiet, visually dull. Better for people with cognitive problems, bad attention span or difficulty focusing
Open: non-structured, distractions, noisy. More real world. Eventually want people to get here |
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Motor Development
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Changes over time as we age.
Life long process (ie stair climbing vs age) Normal motor development is dependent upon normal motor control |
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Motor Development
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Abnormal motor development can occur:
Prenatal At birth Postnatal |
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Reflex Development
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Begin to develop in utero
Develop movement patterns as a result of sensory stimulus movement patterns/reflexes will parallel motor development as we are born grow, mature, and age |
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Reflex Development
Terms/Def |
Gestational age (GA): age from conception to birth (sometimes people guess this)
Menstrual Age (MA): calculated from th first day of the mother's last menstrual cycle. Is +/- 2 weeks of GA Chronological age (ChA): age since birth |
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Reflex Development
Terms/Def |
Full Term is 40 weeks (+/- 2 weeks) (don't know if it is full gestational or menstrual)
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Reflex Development
Terms/Def |
Corrected age (used to determine motor skills up to ChA 2yrs) is ChA minus # weeks preterm (based on 40 weeks)
If child is born between 38-42 weeks, you don't correct the age Pre-terms need a chance to catch up in motor skills After 2yrs they stay at the ChA ie- ChA is 36 weeks what is the corrected age? 40-36=4 4 weeks preterm 36-4=32 Child is 32 weeks old corrected age |
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Reflex Development
Terms/Def |
Reflexes:
Stereotyped (looks the same in everyone), obligatory (involuntary, no control), automatic (occurs without thought or process) movement responses to specific stimuli |
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Reflex Development
Terms/Def |
Primitive Reflexes
Appear during gestation or at birth and most become integrated at 4-6 months of age |
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Reflex Development
Terms/Def |
Postural Reactions
Appear during infancy or childhood and persist throughout life Need these for balance and stability |
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Reflex Development
Terms/Def |
Integration
Occurs when a relfex comes under the control of the higher centers of the brain or when the reflex is modified to the point that it is no longer recognizable **Reflexes do NOT disappear and primitive reflexes can become reactivated under stress or when there is damage to the nervous system |
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Reflex Development
Classification of reflexes |
Classified by when they appear and are integrated
According to their function or the way they are elicited [prehensile reflexes (hands) oral reflexes (mouth)] According to the level of the nervous system that controls them -mediated at the spinal cord reflexes are primitive (occur without a lot of input from teh brain -Brainstem reflex (change of head or body in space) -Midbrain (righting reflexes) -Semicircle canals in inner ear (automatic reflexes for equilibrium) -Cerebral cortex (Changes in COG) |
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Flexor Withdraw
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Onset = 28 weeks GA
Integration 1-2 months With head in midline and legs in extension, touch or rub the plantar surface of the foot. The infant should flex the hip and knee up on the same side of the stimulated foot, withdrawing reflex, protective in nature. If response is only seen on one side it may indicate damage to one side of the brain (opposite of stimulated side) or a peripheral nerve injury. (they can't move if they don't feel the stimulus) Failure to obtain or persistence of the response may indicate a problem with the central nervous system. Persistence interferes with walking (functional outcome) |
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Crossed Extension
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Onset - 28 Weeks GA
Integration- 1-2 months With infant supine, in midline, and legs in extension, scratch the bottom of the foot (holding leg in extension). Observe the other leg. Infant should flex opposite hip and knee while adducting. Then extend. "Scissoring gait or pattern" Test both legs. Asymmetry may indicate damage to one side of the brain or peripheral nerve injury. Failure to obtain or persistance may indicate a problem with the CNS. Persistence interferes with walking |
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Plantar Grasp
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Onset- 28 weeks GA
Integration- 1-2 months With infant supine and head in midline, touch the ball of the foot. Infant is going to flex toes around finger. Asymmetry may indicate damage to one side of the brain or a peripheral nerve injury Failure to obtain or persistence may indicate a problem with the CNS Persistence interferes with walking |
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Moro
TEST THIS LAST |
Onset- 28 weeks GA
Integration- 5-6 months With infant supine, head should be in midline and flexed. Arms should be placed on the infants chest. Let the head drop back 20-30 degrees very suddenly. The infant's arms should abd, ER. Elbows flex. Then they will come back in midline. Asymmetry can indicate a damage to one side of the brain, a peripheral nerve damage (same side of the arm that does not move), an arm fracture, or Erb's Palsy (brachial plexus {collection of nerve roots that come off the top of the spinal cord and goes down the arm} injury, could be overstretched, ie-from birth. Usually comes back depending on the damage) **Not the same as a startle reflex** (Moro = proprioceptor; startled=auditory) |
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Galant
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Onset- 32 Weeks GA
Integration- 2 months With infant PRONE gently stroke the shoulder to buttocks on one side of the spine (para-vertebral muscles) Infant should have a later flexion of the trunk to the side of the stimulus. Absence below the level of the lesion may indicate a spinal cord injury Persistence can lead to scoliosis Persistence prevents symmetrical stabilization of the trunk in midline |
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Neonatal Neck Righting
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Onset-34 Weeks GA
Integration- 4 months (when mature neck righting begins) With infant supine and in midline, Turn and rotate the head to one side and hold there. Repeat on opposite side. The infant's body will follow and turn with the head (log rolling- lost rotation of the trunk, everything rolls at once) Needed for rolling from supine to sidelying. Persistence prevents the development of segmented rolling |
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Neonatal Body Righting
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Onset- 34 weeks GA
Integration- 4 months (when mature body righting begins) With infant in supine and head in midline, take the outside leg, flex and adduct over the opposite leg. Wait for the top part of the body to follow in the same position. Repeat on opposite side. Is needed for the development of segmental rolling and other skills required for trunk rotation |
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Neonatal Positive Support
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Onset- 35 weeks GA
Integration- 1-2 Months Suspend Infant vertically while holding the infants chest. Slowly lower the infant down to a firm surface. The infant should try and bear a little weight. Should show a little bit of extension of the hip (the younger the less of this) should also show a little bit of plantar flexion (up on toes). Test both sides. Asymmetry may indicate damage to one side of the brain or peripheral nerve injury. Failure to obtain or persistence may indicate a problem with the CNS Persistence interferes with walking May be absent in Infants with muscle weakness or low muscle tone (Hypotonic) |
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Proprioceptive Placing of the Lower Extremities
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Onset- 35 weeks GA
Integration 2 months Hold the infant in vertical around the chest facing a stool. Feet are not touching the surface. At the edge of the surface brush the dorsum of the foot. The infant should flex leg and then extend it and place the stimulated foot on the surface Asymmetry may indicate damage to one side of the brain or a peripheral nerve injury Failure to obtain or persistence may indicate a problem with the CNS Persistence interferes with walking Absence may indicate a spinal cord injury |
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Spontaneous Stepping
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Onset- 37 weeks GA
Integration- 2 months Hold infant in vertical with hands around the chest. Place infant on a firm surface and slightly tilt forward. Infant will take little steps. If infant is preterm the steps will be more choppy then the smooth and rhythmical steps of a full term. Asymmetry may indicate damage to one side of the brain or peripheral nerve injury Failure to obtain or persistence may indicate a problem with the CNS Persistence interferes with walking May be absent in infants that have muscle weakness or low muscle tone. Absence may indicate a spinal cord injury |
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Reflex and Postural Reactions
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Tools to guide development. A child needs to learn how to deal with gravity once they are born
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Reflex Development
Reflexes and Reactions |
Give us a general path of direction for development
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Reflex Development
Gross Motor Reflexes and Reactions 1)Primitive |
Primitive (orientation)
-alert and orientation -give us a template for movement |
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Reflex Development
Gross Motor Reflexes and reactions 2)Righting reactions |
Righting Reactions
-Allow orientation to body parts, head in space, neck to body, body to body (ie, hula hoop) |
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Reflex Development
Gross Motor Reflexes and reactions 3)Equilibrium Reactions |
Equilibrium Reactions
-Allow orientation to the outside world |
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Reflex Development
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Together the reflexes and reactions give a protective, mobile, but stable stance (position or movement) against gravity
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Normal Reflex Development
Traditionally |
Considered to be the foundation for infant movements.
Reflexes were tested individually to determine maturational level of nervous system (spinal cord, brain stem, midbrain, cortical) |
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Normal Reflex Development
Newer Views |
One of many variable will affect motor development
Through observation and analysis of movement to identify presence of reflexes, you can still test to confirm what you see |
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Normal Reflex Development
Observation Method |
Learn to identify individual reflexes.
Understand their significance. Train your eyes to observe movement and posture to be able to determine which reflexes and postural reactions are there and which ones are missing, or partly there You will see things blending and get multiple reactions |
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Reflexes and Postural Reactions
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Organized as:
Primitive reflexes, Developmental Reactions, Righting Reactions, Placing and Protective reactions, Equilibrium Reactions |
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Primitive Reactions
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Flexor withdrawal, Crossed extension, plantar grasp, Galant Response, Neonatal Neck Righting, Neonatal Body Righting, Proprioceptive placing (LE), Neonatal positive supporting, Spontaneous Stepping, Proprioceptive placing (UE) Tonic labyrinthine, Asymmetrical Tonic Neck, Symmetrical Tonic Neck
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Proprioceptive Placing (UE)
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Onset- Birth
Integration- 2 months Support the infant in vertical with hands on chest. Move the infant so that the dorsum of one hand lightly presses against the edge of a surface. The arm should flex and the hand is then dropped to the surface. The arm then extends with wrist extended and fingers extended and abducted. In newborn, the fingers may remain flexed. This is replaced by visual placing at a later age, preparation to later being able to place hand and UE for support in sitting and quadruped At any age: if too much pressure is applied to the hand you may get a withdraw response. Asymmetry may indicate insult to one side of the brain, muscle weakness or peripheral nerve injury |
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Tonic Labyrinthine Reflex (TLR)
PRONE |
Onset-Birth
Integration-6 months Place baby in prone. (head position in relation to gravity) 1) extend head and note the amount of resistance-pressure of flexor tone. 2) grasp infants hand and lift arms upward noting the degree of resistance to movement 3) lift infant (4months+) under the arms and note whether elbows remained flexed. Look at Posture and tone Increased flexor tone TLR prone flexion TLR prone extension Many believe this reflex is always abnormal. Child can neither lie flat nor raise the head, extend the spine or support the weight on the elbows Persistence of TLR will interfere with the development of activities which require graded co activation of flexor and extensor musculature Difficulties in rolling over Difficulties in sitting-presence may result in contractures and kyphosis |
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TLR (extra notes)
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Baby is born in Physiological flexion.
Tradition TLR is where the body is in relationship to gravity. Typically if in supine you have more extensor tone. If in prone you have more flexor tone. Sometimes you see reflexes of just what the neck is doing in space and the rest of the body will follow what happens to the head and neck. if you have a TLR prone, sometimes the neck flexors are so strong that when you extend the neck the body will follow which will overcome what the traditional TLR looks like |
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TLR
SUPINE |
Onset- Birth
Integration- supine While infant is in supine note the overal muscle tone when child is at rest. Place hand behind the head and begin to bring the infant to sitting position, note amount of resistance, extensor tone. Increased extensor tone may be noted in the neck and trunk when child is pulled to a sitting position if the head remains in extension Increased extensor tone TL supine extension TL supine flexion Many believe this reflex is always abnormal Helps decrease physiological flexion to create balance between flexors and extensors In supine, Child cannot eras head or bring hands in midline Difficulties in rolling over and other activities that require graded co activation of flexor and extensor muscles Difficulties in sitting-presence may result in contractures and kyphosis |
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Asymmetrical Tonic Neck Reflex
(ATNR) |
Onset- Birth
integration- 4-6 months Have infant in supine with head in midline (can also test in sitting, quadruped or standing, depending on the child's age. May be seen during heel walking, standing on one foot, walking on a balance board) Triggered through neck rotation. Have the child follow an object from one side to the other or PASSIVELY turn the dead slowly to one side and hold in this extreme position with jaw over the shoulder. The arm and leg on the jaw side extend. Arm and leg on the skull side flex. (younger will have more response in the arms) In full term infants, UE will show more than LE Persistence will interfere with appearance of mature neck righting Persistence will interfere with attainment of symmetry of posture (scoliosis) Must be integrated for child to roll over Problems noted with an obligatory ATNR include: inability to get hands to midline, scoliosis, sublaxtion or dislocation of hop on skull side, inability to grasp and regard and object at the same time, inability to balance well enough to walk unaided **comes out under stress |
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Symmetrical Tonic Neck Reflex
(STNR) |
Onset- 4-6 moths
Integration- 8-12 months Suspend the infant in a ventral position or place the infant over the examiner's knees. Passively first extend and then flex the child's head. With the head extended, the extensor tone will predominate in the UE's and flexor tone will predominate in the LE's With the head flexed, flexor tone will predominate in the UE's and extensor tone will predominated in the LE's Promotes quadruped by breaking up the extensor pattern which is strong at 6 months of age. Integration of this reflex coincides with creeping Hinders good sitting posture Difficulty walking Difficulty in getting to floor from standing If STNR is present child will "creep" like a rabbit (bunny hopping) |
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Developmental Reactions
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Moro, Associated Movement, Landau, Amphibian
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Associated Movement/Reactions
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Onset-Birth-3months
Integration- Never but less common after 8-9 years Either in supine of sitting Children UNDER 4 yrs old, have them squeeze a rubber toy for 15 seconds in one hand Children OVER 4 years have them do a sequential finger to thumb opposition or do rapid alternating forearm rotation Contralateral extremity mimics activity being performed by other extremity; with increasing age there is decrease in associated movements; by 8-9 years, these movements should be inhibited upon demand. An increase in muscle tone of a tonic quality is an indication of brain damage, in both children and adults. **Reaction you cannot override (not normal) **Movement you can override (normal) |
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Landau
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Onset- 3-4 months
Integration- 12-24 months Support the infant horizontally in the air in prone with hand under the lower part of the thorax. Position in space. Head extend, the back will arch with slight concavity upward and leg will extend at the hips in se |
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Asymmetrical Tonic Neck Reflex
(ATNR) |
Onset- Birth
integration- 4-6 months Have infant in supine with head in midline (can also test in sitting, quadruped or standing, depending on the child's age. May be seen during heel walking, standing on one foot, walking on a balance board) Triggered through neck rotation. Have the child follow an object from one side to the other or PASSIVELY turn the dead slowly to one side and hold in this extreme position with jaw over the shoulder. The arm and leg on the jaw side extend. Arm and leg on the skull side flex. (younger will have more response in the arms) In full term infants, UE will show more than LE Persistence will interfere with appearance of mature neck righting Persistence will interfere with attainment of symmetry of posture (scoliosis) Must be integrated for child to roll over Problems noted with an obligatory ATNR include: inability to get hands to midline, scoliosis, sublaxtion or dislocation of hop on skull side, inability to grasp and regard and object at the same time, inability to balance well enough to walk unaided **comes out under stress |
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Symmetrical Tonic Neck Reflex
(STNR) |
Onset- 4-6 moths
Integration- 8-12 months Suspend the infant in a ventral position or place the infant over the examiner's knees. Passively first extend and then flex the child's head. With the head extended, the extensor tone will predominate in the UE's and flexor tone will predominate in the LE's With the head flexed, flexor tone will predominate in the UE's and extensor tone will predominated in the LE's Promotes quadruped by breaking up the extensor pattern which is strong at 6 months of age. Integration of this reflex coincides with creeping Hinders good sitting posture Difficulty walking Difficulty in getting to floor from standing If STNR is present child will "creep" like a rabbit (bunny hopping) |
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Developmental Reactions
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Moro, Associated Movement, Landau, Amphibian
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Associated Movement/Reactions
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Onset-Birth-3months
Integration- Never but less common after 8-9 years Either in supine of sitting Children UNDER 4 yrs old, have them squeeze a rubber toy for 15 seconds in one hand Children OVER 4 years have them do a sequential finger to thumb opposition or do rapid alternating forearm rotation Contralateral extremity mimics activity being performed by other extremity; with increasing age there is decrease in associated movements; by 8-9 years, these movements should be inhibited upon demand. An increase in muscle tone of a tonic quality is an indication of brain damage, in both children and adults. **Reaction you cannot override (not normal) **Movement you can override (normal) |
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Landau
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Onset- 3-4 months
Integration- 12-24 months Support the infant horizontally in the air in prone with hand under the lower part of the thorax. Position in space. Head extend, the back will arch with slight concavity upward and leg will extend at the hips in sequence Not an isolated reaction; produced by labyrinthine righting, body and neck righting Helps break up predominant flexor patter seen at birth and in this way promotes extension development Absence may be due to motor weakness Poor quality response seen in children with hypotonia |
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Amphibian Reaction
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Onset- 6 months
Integration- persists throughout life Prone with head in midline, arms flexed near head and legs extended Examiner lifts up pelvis POSITIVE REACTION- Automatic flexion of the arm hip and knee on the same side NEGATIVE REACTION- Fails to flex arm, hip and knee Asymmetry of response indicates insult to one side of the brain Negative reaction after 6 months of age may be indication of delayed reflex maturation |
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Righting Reactions
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Labyrinthine Head, Mature Neck Righting Mature Body Righting
**Without head righting you cannot get other righting reactions. **If child has visual problems (blind) they will have a problem with righting reactions because they cannot see the visual stimulus |
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Labyrinthine (head) Righting/Optical Righting
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Onset- Birth to 2 months
Integration- persist throughout life Hold the infant vertically with hands on chest, suspended in space. Tilt the body anteriorly, posteriorly, and laterally from the vertical 45 degrees or more so that the head drops forward backward and sideways Head orients to vertical position (mouth horizontal) and is steady and maintained in proper orientation to environment Progression: -Head tilted from prone and steady (3 months)(Ext from gravity) -Head tilted from sideways and steady (between 3-6 months)(lat from gravity) -Head tilted from supine and steady (6months)(flex from gravity) Needed for head control as child moves in space, body can turn freely around head (rolling) Allows child to lift head from prone and supine Starting point for chain reflexes in space (Landau) Emergency will support development of postural control and stability Poor head control could be from hypotonia, insult to the CNS, to possible blindness Asymmetry could be torticolis (shortening of the neck muscles on the one side) |
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Mature Neck Righting
(NOB-mature neck righting acting on the body) |
Onset- 4-6 months
Integrations- 5 years when the child gets to standing position without rotation Infant in supine and in midline. Flex teh child's head and turn slowly to one side. Hold in extreme position with jaw over shoulder an observe. Repeat on opposite side (or just observe child at play) Child will roll in direction of head turn, rotation of shoulders, trunk, and then pelvis to side or prone SEGMENTED ROLLING Needed for mature roll from supine to prone and prone to supine and for rotation in gait Indicates rotation around body axis developed in child Asymmetry may indicate insult to one side of the brain or muscle weakness Persistence of log rolling strategy warrents a closer look as it may indicate CNS dysfunction. Inability to dissociate shoulders from pelvis or muscle tightness (Down syndrome does a lot of log rolling, low tone in trunk) |
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Mature Body Righting
(BOB Mature body righting acting on the body) |
Onset- 4-6 Months
Integration- Inhibited by child, 4-5 years Place child in supine, head in midline and flex one leg and rotate it across the pelvis to the opposite side and maintain it. Child will turn to prone segmentally, first the trunk, then the pectoral girdle and tehn head Modifies the neonatal neck righting Important in the acquisition of sitting, quadruped and standing Is integrated when teh infant is able to transistion from supine without rolling and moving to quadruped position Asymmetry may indicate insult to one side of the brain, primary muscle weakness or peripheral nerve injury supine->prone->quadruped |
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Continuum of Balance Responses
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When COM is displaced head then trunk righting. Then UE. Then head trunk limbs toward uphill. Then protective extension toward the support surface to widen BOS
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Balance
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To maintain balance is to:
-Keep COM within BOS -Compensate effectively when disturbed Balance skills make up postural reflex mechanism |
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Balance Skills
4 sub groups |
4 subgroups:
righting reactions, tilting reactions, equilibrium reactions, and protective reactions Each responsible for a specific aspect of balance They function in a predictable continuum |
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Righting Reactions
(AKA Labyrinthine Righting Reaction) |
Hold head in space in all planes (keep head vertical)
Mouth kept horizontal in relationship to the floor |
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Tilting and Equilibrium Reactions
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Secure body in space when balance is challenged
Responses are triggered by a slightly different stimuli. Tilting- COM is disturbed by movement of support surface Equilibrium-- Support surface is stationary. COM is displaced by a force applied to the body (pushed or trying to catch a ball) |
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Tilting Reaction
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Immediate head righting. If body senses HR is not enough then tilting reaction will happen.
Head righting-> spine curves->extreme respond OBJECTIVE Bring Body mass to center of BOS |
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Protective Reaction
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Responsible for regaining balance after COM has been pushed beyond the borders of BOS
HR and T/Er were elicited but not enough to regain control Child will immediately protect from fall by sticking hand/s &/or foot/feet |
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Placing and Protective Reactions
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visual placing (UE's), visual placing (LE's) Protective Extension (downward), Protective Extension (sideways), Protective Extension (backwards)
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Visual Placing (UE)
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Onset- 3-4 Months
Integration- persists through life Hold child vertically under the arms and around the chest Advance child toward supporting surface such as a table top The child will lift both arms and extend and then place them on the supporting surface with fingers abducted and extended (need proprioceptive placement first) Requires visual response Asymmetry may indicate insult to one side of the brain, primary muscle weakness, or peripheral nerve injury Failure to obtain may indicate a general depression of the CNS or sensorimotor dysfunction **Precursor for protective response, if you go fast and get a + response then it is protective extensions-forward |
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Visual Placing (LE)
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Onset- 3-4 months
Integration- persists through life Hold child vertically hands on chest Advance the child slowly-feet first- toward a supporting surface. Child will immediately orient and place both feel on top of surface. Child will coordinate your movement with the task Asymmetry indicates insult to one side of the brain, primary muscle weakness, or peripheral nerve injury Requires visual response Needed for independent walking Precursor for protective extension downward |
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Protective Extension Downward
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Onset- 4months
Persists through life Support child in vertical position hands on chest Plunge thee child toward the supporting surface Child will most noticeably exhibit knee extension. Also will see hip abduction and ER with dorsiflexion of the ankles Needed for upright standing, walking and braking a fall Asymmetry may indicate insult to one side of the brain, muscle weakness. or peripheral nerve injury If child responds with hip adduction and IR, we could suspect presence of pathological condition (cross extension/neonatal positive support) |
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Protective Extension of the Arms Forward
(AKA parachute reaction) |
Onset- 6-7 months
Persists throughout life Support child vertically with hands on chest Plunge child downward toward a supportive surface head first Arms will extend and slightly abduct, and fingers extend and spread as if to break a fall Needed for quadruped Needed for prop sitting (sitting with arm support) Asymmetry indicates insult to one side of the brain Absence indicates general sensory depression of the CNS or sensorimotor dysfunction |
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Protective Extension of the Arms Sideways
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onset 7 months
persists throughout life Symmetrical sitting with legs preferably straight Push child on one shoulder with enough force to cause loss of balance Abduction of opposite arm, with extension of elbow wrist and fingers before contact is made. Weight taken on open palm and figers Needed for Independent sitting Asymmetry indicates insult to one side of the brain Failure to obtain or late persistence indicated general depression of the CNS or sensorimotor dysfunction |
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Protective Extension of the Arms Backwards
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Onset 8-10 months
Persists through life Symmetrical sitting with legs straight Push the child backward with enough force so as to offset balance Child extends arms backward. Full reaction is backward extension of both arms. Frequently an element trunk rotation comes in and reaction is seen in one arm only (head in flexion) Needed for independent sitting balance and trunk rotation Asymmetry can indicate insult to one side of the brain, peripheral nerve injury, or primary muscle weakness **Tries to bring COM forward |
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Equilibrium Reactions
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Tilting: Prone, supine, sitting, quadruped, standing, staggering
Same concept and reactions. Higher you go the more demands on the body |
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Tilting Reaction Prone
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Onset - 6 months
Persists through life Place child prone on a tilt board Slowly tilt board laterally to the right or left and wait for a response the repeat to the other side Child will curve against the displacement of the center of gravity, concavity of the spine upward towards the tilt the upper arm and leg may abduct Modifies righting reflexes Necessary part of balance mechanisms for sitting and supporting prone on hands Labyrinthine righting must be intact for tilting to be present Asymmetry may indicate insult to one side or brain or muscle weakness |
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Tilting Reaction Supine
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Onset- 7-8 months
Persists through life Place child supine on tilt board Slowly rock tilt board left of right and repeat on opposite side. Child will curve against the displacement of COG, concavity of the spine upward toward the tilt, the upper arm and leg may abduct Reactions in supine and sitting are needed for sitting without support Indicates righting reactions have been modified Asymmetry may indicate insult to one side of the brain, muscle weakness |
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Tilting Reaction Sitting
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Onset 7-8 months
Persists though life Sitting on tilt board facing (1) lengthwise; (2) crosswise Slowly tilt the board left and right then antero-posteriorly In lateral tilt- body remains upright and is flexed away from the downhill side; neck is flexed laterally and the head is slightly rotates, with the face toward the upper side. The arm and leg on the up hill die are abducted while those on the downhill side are adducted with the arm also extended In anterior tilt the limbs are retracted and the trunk moves backward In posterior tilt the limbs are advanced and the trunk moves forward Modify righting reaction Asymmetry indicates insult to one side of the brain Absence or general depression of the CNS or sensorimotor dysfunction |
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Tilting Reaction Quadruped
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9-12 months
Persists through life All fours place lengthwise and then cross wise on tilt board Tilt board slowly laterally to the right and left and then antero-posteriorly To the lateral tilt; the body flexes against the tilt with the concavity of the spine upward. The head is slightly rotated so that the face turns towards the uphill side. The arm and leg on the uphill side flexes and the arm and leg on the downhill side extend and abduct To anterior tilt; arms extend and leg flex, head is extended and trunk moves backwards To posterior tilt; shoulders and hips extends, elbows and head ten to flex and trunk moves forward Asymmetry indicates insult to one side of the brain. Absence indicates general depression of CNS or sensorimotor dysfunction |
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Titling Reaction Standing
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12-21 Months
Persists throughout life Upright positioning facing lengthwise and then crosswise on tilt board Slowly tilt board laterally to left and to right then antero-posteriorly To lateral tilt; the body is flexed away from the downhill side with concavity of the spine upward. Uphill leg is flexed and uphill arm is abducted. Downhill leg is extended and strongly braced To anterior tilt; the spine extends, displacing the body backward, legs extend, arms extend and are retracted To posterior tilt; the spine flexes displacing the body forward, legs extend, arms are flexed at the shoulders and extended at the elbows Labyrinthine must be intact for tilting to be present needed for child to stand and walk independently Asymmetry may indicate insult to one side of the brain or primary muscle weakness |
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Staggering Reactions
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15-18 Months
Persists through life Child is standing on a non-mobile surface Push child in all directions, forward backwards, sideways Correction movements of flexion extension, adduction and abduction of the limbs to restore COG Forward: Child takes one+ step to correct Backward: Child takes 1+ step to correct Sidewards: Child will either side step or cross one foot over the other depending on how hard they were pushed Protects the upright posture when the body is displaces by a horizontal force Needed for safe independent ambulation Asymmetry may indicate insult to one side of the brain, peripheral never injury or muscle weakness |
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Postural Fixation
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Onset- Occurs at about the same time as expected for tilting reactions in the various positions
Persists though out life Placed child in all previous tilting positions Encourage child to engage in voluntary activities or you will have to move them Curving of the vertebral column toward teh external force with abduction and extension of the extremities on the side to which the force was applied. In Standing, plantar flexion of the ankle should be noted when the child's weight is shifted anteriorly; dorsiflexion when the weight is shifted posteriorly; inversions when the weight is shifted laterally; and eversion when the weight is shifted medially Present necessary for normal balance and equilibrium Compensatory Action of teh ankles and feet well developed by two years when heel strike becomes part of normal amulation |
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Week 1
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-fertilization
-46 chromosomes -sex is determined -zygote begins to divide -formation of a morula |
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End of week 1
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-formation of a blastocyte
-implantation begins -Endoderm and Ectoderm form |
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Week 2
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-Implantation is complete
-Mesoderm forms -Placental circulation established |
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Week 3
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Neural plate arises from teh ectoderm
-Neural groove and folds are formed from the neural plate |
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Week 3-4
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-somites form
-GI tract develops |
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Week 4
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-Neural folds begin to fuse to form the neural tube with neuropores
-neural crest forms -Main divisions of the CNS are established -Heart begins to beat -Arm and leg buds are visible |
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Week 4-5
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-Heat begins to beat
-Eyes and ears form |
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Week 6
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-Further division of the CNS
-Feet and Hands are visible with digits (but webbed) -Lungs form -Peripheral nerves grow into limb bud |
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Week 7
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All essential organs form
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Week 8
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Structurally complete
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Week 9
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Development becomes functional rather than structural
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Week 9-12
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-Genitals are well differentiated
-Tooth buds appear -Cerebellum develops -RBC are produced by the liver -Growth of all existing structures |
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Week 13-16
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-skin is almost transparent
-lanugo develops on the head -meconium is made in the intestines -muscles and bones develop; bones are still soft -sucking motions are made with the mouth |
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Week 17-19
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-Can hear
-Mother can feel movement -spinal cord myelination begins |
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Week 20
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-Eyebrows and lashes form
-nails form |
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Week 21-23
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-Fetal heartbeat can be heard with a stethoscope
-Bone marrow makes blood cells -fat is stored -Lower respiratory system develops but still no surfactant |
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Week 24
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-All eye parts present
-Foot and handprints form |
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Week 25-28
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-rapid brain development
-eyelids open and close -Gas exchange is weak but possible |
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Week 29-32
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-Body fat is deposited rapidly
-Rhythmic breathing movements -Begins to store calcium and iron |
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Week 34
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-Surfactant is produced
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Week 35
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-Brain myelination begins and continues until one year chronological age
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Week 36
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Lanugo begins to disappear
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Week 37-40
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Small breast buds appear on both sexes
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Week 40
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Full term and adequate surfactant to sustain life
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Risk Factors
Before birth |
Genetics
Maternal Factors Paternal Factors Conditions in Utero |
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Risk Factors; before birth; genetics
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Hereditary diseases
Hundreds of thousands |
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Risk Factors; before birth; maternal factors
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-Age and health (older and younger have more problems)
-Down syndrome (3 genes on teh 21st chromosome) -Klinefelter's syndrome (XXY) -Higher Rate of Still born, perinatal mortality and prematurity (teenage mothers lack nutrition) Higher iincidence of cleft palate -Higher incidence of CHD |
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Risk Factors; before birth; maternal factors; Maternal nutrition and Ingested substances
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-Lack of proper nutrition can result in low birth weight, higher incidence of infant mortality and fetal brain damage
-smoking can result in low birth weight higher still born rate -excessive use of alcohol can result in fetal alcohol syndrome, heart disease, mental retardation, hypoglycemia, and craniofacial anomalies |
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Risk Factors; before birth; maternal factors; Prescribed medications and illegal drugs
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-salicylates-asprin-cause fetal hemmoraging
-antibiotics-streptomycin-hearding deficits to deafness -antibiotics-tetracycline- enamal deficits -Thalidomide- congenital limb deformities -muscle relaxants- nervous system problems -Heroin, coccain, etc- seizures, low birth weight, respiratory distress |
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Risk Factors; before birth; paternal factors
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-Age:
-achondroplasia -congenital deafness -CNS anomalies -fewer live born males -autism(?) -schizophrenia/bipolar disorder -Environmental substance exposure (heart problems) -Effects of poverty -Passing along genetic material: alcoholism; turrets |
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Risk Factors; before birth; conditions in utero
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Position:
-torticollis -facial palsy dislocated hip Too much amniotic fluid: -anencephaly -bulbarpalsy -menigocele copina bifida -cleft palate Too Little amniotic fluid -Torticollis -Renal and pulmonary disorders -congenital anomalies of the feet and ankles |
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Risk factors at birth
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-Prolonged labor
-c-section -blood incompatibility -abnormal presentation (breech) -meconium aspitation -placental/umbilical cord abnormalities -birth trauma |
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Risk factors after birth
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-genetics
-poor or inadequate nutrition -endocrine disorders -gender -diseases and infection -trauma and accidents |
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Motor Control
Motor Learning Motor Development |
-Motor control is composed up of motor development and motor learning.
-Every functional activity you do has to do with these three -They are differentiated by how fast it occurs |
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Motor Control
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Involves the interaction of:
-Individual (person who wants or is going to move) -Environment (surrounds present gives stimulus to move) -Task (goal to complete) |
