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173 Cards in this Set

  • Front
  • Back
Human development is:
-pattern of lifelong change
-multidimensional
-contextual and biological
-plastic(broad range of individual differences)
-studied by many disciplines
Core Concepts and themes of human development
-children are active participants
-self-regulation is cornerstone
-human relationships are important
-timing of early experiences matters
Theories of Motor Control (4)
-reflex, hierarchical, neural maturation
-behavior
-learning
-dynamic systems
Theories of Motor Development
Neural maturationist
Cognitive theories
Dynamic Systems
Systems Theory
Neural-Maturationist Theory
-development is innate, predetermined
-development controlled by maturation of CNS
-primitive reflexes, righting and equilibrium reflexes
-neurofacilitation
-assessment w/ norm-referenced tools
What are the 2 Cognitive theories of Motor Skill Development
Behavioral and Piagetian
Behavioral Theory
-Skinner 1972
-environment is motivator and shaper of motor and cognitive development
-response to stimulus with reinforcer
Piagetian Theory
Piaget 1952
-combination of maturation of cognitive and neural structures and the environment
-stages of development-cognitive development (used to promote mvmt)
Motor Program theories
central pattern generators
Dynamical Systems Theory
-development is not a series of discrete stages, but a series of states of stability/instability
-wells and valleys, stable vs non-stable
-work during nonstable periods
Intervention in dynamic systems theory
-based on
1. evolution of constraints
2. meaningful environmental support
3. manipulation of control parameters
Systems Theory
-interaction between individual, task and environment
-task oriented, functional/goal directed
-compensation strategies in brain
Individual (systems theory)
-cognition
-perception
-action
Task (systems theory)
-functional grouping
-discrete vs continuous
-stability vs mobility
-manipulation with task
-mvmt variability (open vs closed task)
Environment (systems theory)
-regulatory
-nonregulatory
Movement principles
-flexion/extension
-antiGravity
-elongation/activation
-Symmetry/Asymmetry
-Cephalocaudal
-Proximodistal
-Stability/Mobility
-Unrefined to refined
-Action plans
Movement processes
sensitive periods
spiraling patterns of development
Sensitive periods
-Is there a time when babies can learn to make a movement?
-What times during the lifespan are most helpful to work with child?
Spiraling patterns of development
Times of strength and weakness
Systems are changing
When do you want to work on what?
Def Postural Control
ability to hold posture in changing conditions. different from functional mvmt in that it is not goal directed
2 aspects of postural control
Postural orientation and postural stability
Postural orientation
orientation of body & environment for a task
Postural stability
maintaining COM within BOS
Postural control is interaction between......
Task, Individual, and Environment
Theories of developing postural control
reflex/hierarchical theory
motor programming (learning) theory
systems theory
What are the stereotypical responses to sensory stimuli associated with emergence of postural control?
Additudinal reflex
Righting reflex
Balance/protective reflex
-appear early in development-no agreement of their role or period of disappearance
Additudinal reflex
head orients itself to space (upright). Body changes with the head (ATNR, STNR, etc)
Righting Reflex
righting head in orientation to horizon. (optical, tilt)
Balance (protective) Reflex
control of COG, putting arms out to protect, lean to opposite side of tilt
Development of postural control theories
-reflex-hierarchical model consistent with systems model in explaining postural development
-emergence of postural control characterized by rules--
sensory inputs->motor actions-mapping
-many systems contribute to the development of postural control but they develop at different rates
-not all systems contributing to the development of postural control develop at the same rate
systems contributing to postural control
-internal representation
-adaptive mechanisms
-anticipatory mechanism
-sensory strategies
-individual sensory systems
-neuromuscular synergies
-musculoskeletal components
Which sensory system develops first?
vision
-kids with visual delays will need extra help early with postural control
-infants lift head due to visual stimuli
Organizing 'Model'
-development of sensory systems
-changes in musculoskeletal system
-dev synergies (trunk strategy issues in CP)
-sensory strategies for organizing multiple inputs
-importance of mapping of perception (preparing for mvmt) to action
-dev of anticipatory mechanisms
-continuous development
Stages of motor development in the first year
1. prone-on-elbows
2. rolling
3. rolling supine to prone
4. independent sitting
5. hands and knees
6. creeping on hands and knees
7. pull to stand
8. stand indep
9. walk indep
postural control first 3 mos
-control head in all positions
-turn head in prone or supported sitting
-load-bearing surfaces shift caudally
-control of pelvis and LE in supine
Development of head control in first 3 mos
-spontaneous (need vision to start)
-sensory contributions
(visual orientation and tracking)
-motor coordination
(response to perturbations)
(coordinated response to neck mm)
Attitudinal reflexes
result from changes in head position
-ATNR (birth-3 mos)
-STNR (4mos and up)
-TLR (birth-6 mos)
Postural control 3-6 mos
-arm and upper trunk control
-start on elbows, then ext elbows
-increase ability to control in reach while sitting
-initial trunk control
(sitting, manip objects,. free arm mvmt in prone, pivoting)
Development of independent sitting
6-9 mos
-related to head control (coordinate)
-stronger response to backward sway than forward
-sensory contributions-vision, somatosensory(objects to mouth), vestibular
Postural control 6-9 mos
mastery of control of lower trunk and pelvis in upright position
-crawling
-creeping
-pull to stand
-supine to all 4s
-rotational abilities within axis of trunk
postural reflexes at 6-9 mos
-automatic response to loss of balance
-righting reflexes
-protective reactions
-equilibrium reactions
Postural control at 9-12 months
Control of lower extremities
-independent standing
-reciprocal hip and knee flexion
-lowering from standing
-independent walking
Stages of independent stance
-pre pull to stand- no coordinated mm response (2-6 mos)
-early pull to stand- use of ankle mm and mm synergies (7-9 m)
-pull to stand- add thigh mm, distal to proximal sequence
-late pull to stand and indep stand- trunk mm consistently active, complete synergy (9-11 m)
-motor coordination-strength not a major determinant of stance post control
-sensory contributions- visual before somatosensory, adaptive capability
Ankle synergy
contralateral contraction
distal -> proximal
typical postural control stance
LE synergies- distal to proximal!
Surveillance vs Screening
surveillance is subjective, screening is objective. Screening is done at set points in time. Screening uses validated instruments
Issues with surveillance
-cannot rely solely on clinical judgement
-development is dynamic and hard to measure
What is the purpose of screening?
-identify children who MAY HAVE developmental delays or disabilities
-guide decisions about referrals
-connect families to resources
What are the benefits of screening?
Assists in sorting children into 3 categories
What are the 3 categories screening sorts children into?
Needs Additional Evaluation
-did not pass screen
Needs close monitoring/surveillance
-passed but has risk factors
Needs ongoing monitoring in context of well-child care, surveillance
-passed screen with no risk factors
3 steps to the screening process
-select a population
-select a tool(ages and stages)
-map the process (SoonerStart)
Ages and Stages
-completed by parent/caregiver given approx every 2 mos
-color-coded questionnaire and developmental items
-5 domains
-section for parental concerns
-if below cutoff, referral for further developmental testing
What are the 5 domains in Ages and Stages
-communication
-gross motor
-fine motor
-problem solving
-personal-societal
Ages and Stages (ASQ) scoring
assign a value of 10 to yes, 5 to sometimes, 0 to never
gray=may be a concern
Standards for screening tests
reliability-test over and over
validity-measures what it says
sensitivity- snout
specificity- spin
positive predictive value
the proportion of people who test positive and actually have the diagnosis
negative predictive value
proportion of people who test negative who do not have the diagnosis
Screening pitfalls
-relying on internal methods
-using a measure too time consuming for setting
Screening limitations
-use of informal checklists of developmental skills
-informally eliciting parents concerns (parents not always sure if they are worried)
-accuracy of clinical judgment
Rules for sharing results of screening
-timely manner
-explain tool is just a snapshot and results can be affected by: shyness, tiredness
-description of results
-provide anticipatory guidance
What should you do when you suspect a delay after screening?
birth-3 yrs
-refer to early intervention (SoonerStart) for further eval and eligibility
Above 3
-refer to local school district for eval and eligibility
FirSTEp
-designed to identify young children (2yr9m-6y2m) who MAY HAVE mild to severe school related problems
-companion to Miller Assessment for Preschoolers (MAP)
-screen for development in 5 domain areas (Cognition, communication, motor, social-emotional, adaptive functioning)
Calculating Age
Year Mo Day (test)
-Year Mo Day (birth date)
-------------------------------------
age of child
Adjusting for prematurity
Calculated Age of child
Year Mo Day
-Prematurity
---------------------
Adjusted age
(divide weeks into mos and days
4 weeks=1 mo, 7 days= 1 week)
What are the 3 purposes for tests or measures?
1. to discriminate between individuals along a continuum of health, illness or disability
2. predict outcome or prognosis
3. evaluate a within-person change over time
Three broad categories of applications of health measures
-discrimination
-prediction
-evaluation
Discriminative index
used to distinguish between individuals or groups on an underlying dimension when no external criterion or gold standard is available for validating these measures
Predictive index
used to classify individuals into a set of predefined measurement categories when a gold standard is available, either concurrently or prospectively
Evaluative index
used to measure the magnitude of longitudinal change in an individual or group on the dimension of interest
Steps in constructing an index to measure quality of life
-selection of item pool
-item scaling
-item reduction
-determination of reliability
-determination of validity
-determination of responsiveness
Selection of the item pool
bring together a set of items which might plausibly be included in the final instrument
Item scaling
options available for patients in answering each question; that is, the scale associated with each item
Item reduction and internal consistency
investigator may initially choose items from the total item pool for the first version of the questionnaire based on item frequency and importance but the content of the definitive instrument must depend on item performance in the setting in which the index will ultimately find its use
Reliability
reliability of a single application of a measurement instrument can be defined as the ratio of the variance attributable to true differences among subjects to the total variance
Criterion validity
refers to the extent to which a measuring instrument produces the same results as a gold standard, or criterion measure
Construct validity
the extent to which a particular measure relates to other measures in a manner which is consistent with theoretically derived hypotheses concerning the concepts being measured
Responsiveness
-demonstration of reliability and validity is sufficient for concluding that an instrument is useful for descriptive or predictive purposes, we must also have info about an instrument's responsiveness before we can confidently use it in a clinical trial
-concerns the power of the index to detect a difference when one is present-that is, sample size required to observe a small, medium, or large change or effect size in the population
What are the 2 main types of cognitive theories of motor skill development?
-Behavioral Theory (Skinner)
-Piagetian theory
Behavioral Theory
-Skinner
-importance of contingent learning w/ reinforcement from environment being motivator
-ENVIRONMENT is site of developmental control
-Pavlov- operant conditioning
-interventions should be individually tailored to behavior
Piagetian Theory
-emphasizes interaction b/t maturation of cognitive-neural structures and environmental opportunity to promote action
-person has self-regulating system for assimilation/accommodation
-4 stages
4 stages of Piagetian theory
Sensorimotor> 18-24 mos
development of language> 2-6 yrs
concrete operations
formal operations> 11yrs+
Dynamic Systems Theory
-emphasizes process rather than product
-neural maturation equals other processes and integrates
-structures become progressively integrated with self-organized properties of the system
-developmental change not a series of discrete stages but is a series of stages of stability, instability, and phase shifts
-focuses attn of therapist on 5 aspects of therapeutic process of facilitating functional activity
McGraw- exercise inc coordination but not development
5 aspects of therapeutic process of facilitating functional activity
1. search for constraints in subsystems that limit motor behavior
2. environments that compensate for weak subsystems promote participation
3. setting up a therapeutic environment that supports practice
4. activities to promote exploration of a variety of mvmt patterns for a task
5. search for control parameters
Consistent principles of motor development
-cephalocaudal
-proximodistal
-neural maturation
-spiraling-not continuous
-self-regulating- construction of developmental process
Processes involved in advanced stages of development of functional reach include:
1. visual fixation to localize the object
2. foveal analysis for perceptual identification of an object
3. manual capture
4. object manipulation
Reaching
1-2 mos> fisted hand, successfully reach and grasp with hand supported
4-5 mos> visual control w/ open hand
13-20 wks> consistent use of reach with grasp
Paillard- 4 features that characterize evolution of a primate nervous system
1. extension of precentral cortex developed principally for fine sensory-guided steering and control of the hand
2. enlargement of the lateral cerebellum
3. specialization of parietal association cortex
4. development of frontal association areas
Neuronal group selection theory-3 basic tennets
dynamic loops
1. how the anatomy of the brain is produced during development
2. experience strengthens certain patterns of responses
3. maps of the brain give rise to individual behavioral fxn through reentry
Selectionist model
when overtly similar mvmts are studied in a group of individuals, each person performs mvmt with unique combination of synergistic mm activation patterns
What are Sensitive periods in development based on?
-experience-expectant and experience-dependent maturation of neural systems
-experience dependent plasticity of NS can intake new synapses
-effects of experiences during sensitive periods differ from other times
Sensitive periods in development
2-4 mos> vary activity to reach a goal
7-8 mos> several actions relate in single functional unit
12-13 mos> coordinate actions to perform a function
18-21 mos> memory of an object can activate an action
Functional head control
-birth>ability to right the head from full flex or ext
-shifts of gaze preceded by rapid bursts of body mvmt
-smooth visual pursuit present at 6 wks, adult like at 14 wks
-sustain head in midline at 2 mos
Upright trunk control
-initial ability to maintain sitting indep on propped arms when placed is achieved once infant can:
1. ext head and trunk in prone position
2. control pelvis, LEs while using arms or moving head in supine
-usually sit alone around 6 mos
Lower trunk control in upright position
9 mos-crawling
supine to 4 pt and sitting, sitting to prone
What are the 2 features of object manipulation?
1. control of hand as terminal device for reach and grasp
2. object manipulation and release
What are the 4 grasping patterns in the first 5 mos?
1. fisted grasp
2. precision grasp
3. precision grip of objects
4. self-directed
Object manipulation by age
2 mos> rotation of held objects
3 mos> translation of objects (bring to mouth)
4 mos> shaking objects
4.5 mos> bilateral hold of 2 objects
4.5-6 mos> hand to hand transfer
5-6.5 mos> holding object and using other hand to manipulate it
6-8.5 mos> coordinated action, striking 2 blocks together
7-8.5 mos> deformation of objects(rip, bend, squeeze)
7.5-9.5 mos> instrumental sequencial action
Functional motor activities in preschoolers
2yrs- kick a ball
2.5yrs- tiptoe, jump w/ both feet, throw and catch, stand on one foot
3yrs- alternate feet to ascend stairs
3.5yrs- less coordinated
4yrs- skate, bicycle, wild, self confident
5yrs- dodge, skip, long jump, more conforming, household tasks
6yrs- practice balance, dancing, climbing
3 perspectives in motor control development
1. maturational
2. learning
3. dynamic based
Hypothesis
attempt to predict a relationship between observations and environmental conditions
Maturational based theory
-behavior due to motivational changes in nervous system
-motor behavior is composite coordination of simple reflexes
Laws
define highly predictable relationships between variables
models
idealized constructs that incorporate the few most powerful variables in explaining relationships between events
Learning-based theories
-what attributes of the environment shape behavior
-motor programs are learned sets of instructions
-motor programs, CPGs
What are the 2 dynamic based theories
Dynamic System Theory
Dynamic Selection
Dynamic Systems Theory
Thelen
-most recent
-how does a child move from one state to another
-multiple variables establish context for movement and relationship. constant flux
-developmental stages viewed as ATTRACTOR STATES
-transitions in behavior are flips between attractor states
Dynamic Selection
Sporns & Edelman
-how the brain's circuitry can readily change to accommodate
-relationship between evolving movements and brain circuits
-recognizing the value of a mvmt experience will increase probability of repetition
3 key hypotheses to dynamic selection
1. genetically endowed with basic movement
2. genetically endowed with sensory system capable of detecting movements
3. can select movements having adaptive value
Central Pattern Generators
current hypothesis of motor control
-account for basic neural organization and function required to execute coordinated mvmt synergies
Equilibrium Point Hypothesis (Mass Spring Hypothesis)
-nervous system strives to control joint position in space
-every position is a unique combination of agonistic/antagonistic mm
Threshold Control Theory
motor control is a combination of mm activation thresholds with a steady state emerging from interaction b/t person and environment
Impulse Variability Model
NS controls mvmt by planning phasing, duration of mm contraction
Neural Network Models
-no simple relationship exists amongst nerve cells to explain movement
-mvmt is a phenomenon of their complex interactions
Sensorimotor variables
-physiologic mechanisms or processes that reside within NS
-CPGs play key role
-mechanical- motor skills affected by internal forces
-Cognitive- reasoning, memory, and judgement. Predictive posture> feed forward
Task requirements
-distinct motor control variables
-any variable that contributes to or alters movement
(biomechanical requirements, meaningfulness, predictability, etc)
Postural Control
achieved via cooperative interaction of neural sensory (3) and motor systems, & cooperating ms systems to meet goals
What is the most powerful sensory system is regulating posture?
vision
Down Syndrome and vision
Kids with DS and cognitive delays overrely on visual system after most switch to the other 2
CP and vision
Kids with Ataxic Cerebral Palsy have difficulty triggering motor responses when sensory info is conflicting
At what age can kids activate anticipatory postural mm
age 1
1st principles of neonatal care
1900s
-body temp
-infection control
-minimal handling
-special nursing care
how to minimize visual impairment in NICU
protect REM sleep, dark periods, limit noise, limit stimuli
how many ELBW babies have neurological disability?
about half
New Ballard Score (NBS)
determines gestational age
-neuromuscular, physical, external genitalia
Respiratory Distress Syndrome in NICU
-cause of most deaths/illness
-pulmonary immaturity
-low production of surfactant
3 Theoretical frameworks for the NICU
-enablement model
-family centered care
-infant neurobehavioral functioning
Recommendations for eval/exam in NICU
-protect infant's fragile neurobehavioral system
-repeat observations over time
-partner w/ parents, members of tx team
-observe, interpret, communicate behaviors
ICF
-Internal Classification of Functioning, Disability, and Health
-paradigm shift from classification of dysfunction/disease to a model of health
What are the components of the ICF?
-Health condition (disorder or disease)
-Participation
-Personal Factors
-Environmental factors
-Body functions and structures(impairment)
*circle around Activity
Participation vs Activity
Participation is purposeful and meaningful
Biomedical paradigm
focus is to uncover cause of illness and FIX the underlying disorder
Social (Ecological) Paradigm
-considers factors outside of the body
-determinants of health come from a wide range of environmental factors that interact with person variables
Def Disability
-umbrella term for impairments, activity limitations, or participation restrictions
-outcome of a relationship between the person and environment
ex: I would be disabled in a French speaking country
What are environmental barriers?
-physical
-social
-cultural
-institutional
Measuring Participation
-person's preferences and interests
-doing
-where and with whom
-how much enjoyment
-how much satisfaction
Environment of Intervention
-how aspects of the environment contribute to optimal or non optimal developmental outcomes
-how families/environment mediate change
-types of intervention programs that influence families and children directly
Transactional Theory
-child development
-interaction between child, family, and environment
-all have the power to change the nature of the interaction and outcome of development
Developmental Niche
-physical and social settings of a child's life
-culturally regulated customs and practices of child care and childrearing
-psychology of the care takers
4 areas of shared decision making in intervention
-common ground
-collaboration
-participatory guidance
-anticipatory guidance
Steps for involvement in learning opportunities
1. identify child's interests
2. identify family and community activities related to a child's interests and age
3. involve the child in the activities to promote competence
Assessing children's learning opportunities and participation
-activity settings
-child and family interests
-child and family assets
-functional and meaningful interactions
-current opportunities
-current participation
-possibilities
**examples in notes
Consequences of postural instability
-loss of functional independence
-falls
-severity of disability
Postural Instability
-inability to counteract the destabilizing force using direction-specific postural adjustments
Underlying factors of postural instability
1.Motor Components
-postural synergies not programmed
2.Sensory Components
-inability of sensory pathways to elicit activity in the synergies
3.Cognitive Problems
4.Other
Experimental paradigms of postural instability
1. destabilizing using movable support surface
-quick reaction
-compensatory control(feedback)
2. destabilizing force produced by voluntary movements
-anticipated
-anticipatory control (feed forward)
Problems in motor components of postural control
-motor coordination
-musculoskeletal contributions
-loss of aniticipatory postural control
3 Causes of motor incoordination
problems with
1. sequencing
2. timely activation of postural responses
3. adapting postural activity to environmental demands and changing task
*these are the WHY of the problem. Pick which ones of these as a starting point
Sequencing Problems
-reversal in mm recruitment order
-delayed recruitment pattern
-delayed activation of responses(timing)
-amplitude of mm response
ex: reversing order of contraction in ankle strategy
Examples of sequencing problems
crouch gait-hamstring before gastroc
scissor gait
toe walkers-tib ant before gastroc
seating-spastic diplegia-neck before hip
Co-activation
rigid, contracting everything at the same time
-primary problem in Parkinson's
-normal in healthy young children
-antagonist mm contract at same time
-limit flexibility
**this is a coping strategy to postural instability. Not a problem in and of itself
Motor Incoordination
-problems modifying postural control
-postural adaptation
Problems modifying postural control
Postural adjustment of environmental conditions
-appropriate size of muscles response
-combination of feed forward and feedback mechanisms
-inability to adapt amplitude of mm response to perturbations of increasing distance and velocity-recruitment problems
Postural Adaptation Issues
1. Lack of direction-specific adjustment
2. typical adjustment in children with CP (sitting)
-top-down recruitment of postural muscles
-excessive antagonistic co-activation
-incomplete modulation of amplitude to task contraints
Musculoskeletal contributions to posture
-alignment
-joint movement constraints
-changes in mm structure
-changes in mm force
Sensory disorders in postural control
-sensory organization- ability to adapt to sensory inputs, prevent development of accurate internal models of postural control
-loss of one sense- proprioception, vision, or vestibular
-loss of sensory redundancy
-sensory organization and selection problems
Impaired Cognitive function and postural control
-duals or multi-task (Parkinson's and TBI)
-motor incoordination in individuals with Alzheimer's disease
-sensory disorganization with restricted vision in individuals with Alzheimer's disease
General concepts of postural control
-muscle strength
-coordinated postural responses
-muscle response synergy
-onset of latency of mm response
-mapping-individual vs multiple senses
What percentage of infants less than 25 weeks are likely to have CP?
1 in 4
Criteria for selection of standardized tests
-primary complaints and family goals
-purpose (prevention=screening tool, diagnostic=diagnosing tool)
-Age
-current functional (cognitive & behavior) status
-theoretical frameworks
-psychometric properties of the tool
-current evidence on the tool
-therapist knowledge and experience
Psychometric properties
How well do items on a test define a construct of interest?
Does the item set reflect a useful range of performance?
How consistent are test scores?
How well does the score on the test measure a construct of interest?
How well does the score on the test meausre the performance of interest?
What is the clinical significance of test scores?
What are the consequences of making specific decisions based on the score?
TIMP
Test of Infant Motor Performance
-used to identify infants with motor delay before 4 mos corrected age
-used in special care nurseries and early intervention or diagnostic follow-up settings
-descriminative, predictive, evaluative
-plan intervention programs
-document change
Conceptual basis of the TIMP
-human infant is a self-organizing being
-multiple systems interact to create actions
-self-organization occurs in a task context shaping the mvmts used to accomplish a purposeful task
-self-organization links action with perception through movement
-TIMP tasks pose as problems for the infant to solve
Age Range for the TIMP
32-34 weeks gestational age to 16 weeks post term
TIMP Constructs
Postural Control
-control of position in space for stability and orientation
-stability is ability to maintain COM within BOS
-orientation is alignment of body segments
Selective Control
Items on the TIMP
Observed items
-used to rate spontaneous movement
(selective control, midline alignment, quality of movement)
Elicited items
-assess infants' motor responses to placement in various positions and to visual or auditory stimulation
TIMP Deviations in kids with CP
3 weeks- unable to hold head in midline for even a couple seconds; lack of anti-gravity arm movements during face covering
9 weeks- failure to inhibit neck righting, poor AP head control
12 weeks- poor prone head control, anti-gravity activity supine and sidelying, reaching and fingering objects, and failure to adopt synergies using extension in supine and prone
Summary of Research on TIMP
-rater and re-test reliability
-sensitive to age-related change and medical complications
-ecological relevance and predictive validity
-appears to form a linear, hierarchical scale assessing postural and selective control of movement
Germinal Matrix Hemorrhages
26-28 weeks
-germinal matrix, still full of tiny blood vessels, very susceptible to hemorrhage
-small hemorrhage is contained within the germinal layer
cortical hemorrhages
32-34 weeks
-changes in blood pressure now tend to result in multiple small hemorrhages in the cortical surface areas, resulting in diffuse damage
Intercerebellar hemorrhages
hemorrhages caused by external compression
(occipital molding from band of o2 mask, post head pressure, endotracheal tube)
Tactile Kinesthetic Stimulation vs Waterbed flotation
TKS (stroking, PROM, etc) was not beneficial. Waterbed flotation caused dec in resp pauses, better weight gain, better tone, less irritability
Parameters to be Considered in assessing infant function:
1. infant's current, newly emerging developmental agenda
2. infant's current level of subsystem balance
3. threshold of disorganization indicated by behaviors of defense and avoidance
4. degree of relative modulation and regulation of the various subsystems
5. degree of differentiation and effectiveness in rebalancing the subsystems in the accomplishment of the task
6. degree of environmental structuring, support, and facilitative aid necessary to bring about optimal implementation of the new task
7. degree of environmental structuring, support, and facilitative aid necessary to bring about organization at a smooth, well integrated and ideally more differentiated new level of functioning
Description of the Assessment of Preterm Infant's Behavior (APIB)
-appropriate for preterm infants, at-risk infants, and healthy full term infants
-provides an integrated subsystem profile of the infant, identifying his current level of smooth, well balanced functioning in the face of varying developmental demands
-administered at any time infant's behavior allows
3 subsystems (tasks already handled with ease, tasks which stress infant, tasks not yet appropriate)
-helps establish developmentally appropriate goals for infant
-behaviors grouped into autonomic/visceral signals, motoric signals, state-regulated signals