Development

Question 1

what are the basic tenants of Maturational Theory?

Answer 1

1. development occurs in a cephalocaudal direction
2. development occurs in a proximal-distal direction
3. development of one motor skill leads to the development of another
4. motor milestones are invariant in their sequence
5. motor skills develop from gross to fine
6. motor skills progresses from reflexive to voluntary
7. total response before localized response
8. cephalic control before caudal control

Question 2

what is the dynamic systems theory?

Answer 2

holistic approach to understanding human motor development

assumes that the individual functions as a complex, dynamic system comprising many subsystems and that there is an innate organization that occurs between complex particles that is directed by no one system

Question 3

Kinesiology Concepts NDT

Answer 3

1. Physiologic flexion
2. Antigravity extension
3. Antigravity flexion
4. Lateral flexion
5. Rotation
6. Asymmetry
7. Symmetry
8. Controlled asymmetry

Question 4

Kinesiology concepts NDT → rotation-dissociation

Answer 4

• rotation requires balanced control of flexion and extension and dissociation between body segments
• dissociation is the breaking up of the mass pattern, it is the ability to separate movement in one body part from associated movement in another
• examples
  
  • eyes-head
  • head-trunk
  • hand-elbow

Question 5

what is gestation?

Answer 5

a period of time during which an embryo develops in the mother’s womb

• most radical change in human existence
• a single cell grows into a complex and functional human being within 37-42 weeks
• divided into 3 periods

Question 6

what are the 3 periods of gestation?

Answer 6

1. First trimester → weeks 1-12
   
   • all major body systems are established
2. Second trimester → weeks 13-26
   
   • body proportions grow to newborn proportions
3. Third trimester → weeks 27-40
   
   • body weight triples and body length doubles
   • body fat accumulates which aids in body temp regulation
   • at 36 weeks, lungs are developed

Question 7

describe early prenatal movement

Answer 7

• fetal movement is seen around 7-8 weeks gestation
• at 9 weeks, some jerky, startle type movement
• there are both gross and fine movements, random and coordinated patterns
• fetal movements may have the purpose of preventing stasis and adhesions and preparing the fetus for birth

Question 8

T/F: fetal movements may have diagnostic or predictive value

Answer 8

TRUE

the quality of fetal movement provides an indicator of the chronic neurological condition of the fetus

Question 9

list some atypical development characteristics

Answer 9

1. abnormal tone
2. exaggerated, prolonged reflex behavior
3. absense of normal reflexes
4. flexion and extension are not balanced
5. persistence of asymmetry
6. Lack of:
   
   • variability, variety, and frequency of spontaneous movement
   • adaptability
   • antigravity control
   • dissociation, rotation
   • controlled weight shifts
   • elongation on WBing side w/lateral flexion on WBing side
7. poor proximal stability w/decreased ability to move against gravity
8. prolonged fixing or limiting DOF due to poor underlying control
9. abnormal postural alignment
10. poor coordination and control of movement

Question 10

what is considered a premature birth?

Answer 10

less than 38 weeks

Question 11

describe the physiologic characteristics of a newborn

Answer 11

1. head proportionally larger with short LEs
2. kyphotic, horizontal ribs
3. ROM differences:
   
   • excessive DF
   • 30º flexion contractures at hips and knees
4. Physiological flexion

Question 12

newborn positions

Answer 12

1. supine
2. prone
3. supported sit

Question 13

newborn characteristics in supine

Answer 13

1. head rotated
2. rooting reflex
3. neonatal neck righting

Question 14

newborn characteristics in supported sit

Answer 14

1. fleeting attempts to lift head
2. back rounded but pelvis perpendicular

Question 15

newborn characteristics in prone

Answer 15

1. weight bearing through upper trunk, shoulders, head
2. lifts head to clear airway

Question 16

Newborn UE positioning

Answer 16

1. hands open as arms abduct
2. hand movement related to arm movement
3. strong grasp but hand loosely flexed at rest
4. resting posture - slight shoulder adduction, elbow flexion, elbow pronation

Question 17

Newborn LE positioning

Answer 17

1. vigorous, rhythmical reciprocal kicking
2. automatic standing and stepping
3. biomechanical aspects:
   
   • medial femoral torsion
   • femoral anteversion
   • femoral bowing
   • femoral coxz
   • valga
   • shallow acetabulum
   • genu varum
   • tibia varum
   • tibial torsion
   • calcaneal varus
   • forefoot varus
   • occassional metatarsal adductus

Question 18

newborn vision

Answer 18

1. easiest to fixate on a moving object Laterally and Vertically
2. prefer strong constrasts
3. best at 8-9 inches away

Question 19

describe the physiologic characteristics of 1-2 month year old

Answer 19

1. decrease in physiologic flexion
2. relative hypotonia and asymmetry
3. beginning of active postural control
4. increased alertness and visual awareness
   
   • more purposeful head movement

Question 20

1-2 month positions

Answer 20

1. prone
2. supine
3. supported sit
4. supported stand

Question 21

1-2 month characteristics in prone

Answer 21

1. better head lift → momentarily to 45º
2. elbows behind shoulders
3. increased head/neck extensors muscles with less WS forward on the face and shoulders
4. decreased hip flexion

Question 22

1-2 month characteristics in supine

Answer 22

1. increased cervical rotation with movement of extremities away from the body
2. ATNR may appear
3. head rarely in midline

Question 23

1-2 months characteristics in supported sit

Answer 23

1. begin to see scapular adduction to assit with head lift
2. during pull to sit
   
   • head lags but may see grasp reflex
   • traction response with elbow flexion

Question 24

1-2 months characteristics in supported standing

Answer 24

1. Atasia abasia
   
   • motor incoordination for standing and walking

Question 25

1-2 month UE positioning

Answer 25

1. swiping in supine 2. grasp reflex decreased 3. may voluntarily retain object placed in hand for brief period 4. bilateral scapular retraction and spinal extension provide synergistic stability for head lifting

Question 26

1-2 month LE characteristics

Answer 26

1. kicking may be bilateral and symmetrical, feet come together

Question 27

describe the physiologic characteristics of a 3 month year old

Answer 27

1. alert and aware 2. interacts visually with caregivers 3. symmetry and midline orientation beginning 4. marked increased in bilateral symmetrical activity and antigravity flexor control

Question 28

3 month positions

Answer 28

1. prone 2. supine 3. supported to sit 4. pull to sit 5. standing 6. ability to track 180º w/head extended and eye hand regard

Question 29

3 month characteristics in prone

Answer 29

1. sustains prone on elbows with head elevated 45-90º in midline 2. rotated head while elevated subtle weight shifts 3. increased caudal weight shift → lumbar extensors help stabilize thorax

Question 30

3 month characteristics in supine

Answer 30

1. symmetry and midline become dominant 2. chin tuck → bilateral control of capital and cervical flexor muscles * capital flexion elongates capital and cervical extensors 3. foot to foot play * increased active knee extension accompanied by hip extension and adduction, but also decreased hip ER

Question 31

3 month characteristics in supported sit and pull to sit

Answer 31

1. supported sit → sustained head lift 2. pull to sit → head rights midway

Question 32

3 month characteristics in standing

Answer 32

1. Atasia abasia usually gone 2. able to sustain head lift 3. scapular adduction 4. toe curling 5. plantar grasp reflex 6. WBing on medial side of foot

Question 33

describe the physiologic characteristics of a 4 month year old

Answer 33

1. beginning of controlled purposeful movements and alternating, coordinated movements 2. easily alternate between flexion and extension in supine and prone 3. visual tracking w/o head turning 4. development of downward visual gaze

Question 34

4 month positions

Answer 34

1. prone 2. supine 3. sidelying

Question 35

4 month characteristics in prone

Answer 35

1. head extended at 90º 2. pivot prone 3. prone on extended UE 4. Landau 5. increased lordosis 6. able to flex head w/o collapsing 7. increased activity of adductors, erector spinae and horizontal obliques * ribs less horizontal 8. weight on forearms, pecs more active and begin to balance extension

Question 36

4 month characteristics in supine

Answer 36

1. increased hip extension and adduction 2. alternates between pelvic anterior and posterior tilting * important development of trunk synergistic activity for LE movements 3. hands to knees and other body parts 4. begin to see ankle PF, INV/EV

Question 37

4 month UE characteristics

Answer 37

1. reach in supine with forearm pronation, wrist extension 2. primitive ulnar grasp and squeezing pattern 3. can bring hands together but not yet transfer 4. cannot release with control 5. shakes and bangs, mouth objects

Question 38

what is significant about a 4 month year old shaking and banging objects with arms and putting things in their mouth?

Answer 38

important for perceptual awareness of shapes and sizes and textures and in decreasing tongue and mouth sensitivity

Question 39

4 month characteristics in sidelying

Answer 39

1. baby may roll from supine with hands on knees * initiated with head rotation and symmetrical flexion 2. sidelying is important in rib cage shaping 3. provides new visual and vestibular orientation 4. angulation of rib cage important for respiration, phonation, trunk and rib cage mobility

Question 40

describe the physiologic characteristics of a 5 month year old

Answer 40

1. voluntary asymmetrical, dissociated, and reciprocal movements 2. balance of flexion and extension with emergence of lateral flexion 3. increased spinal mobility * basis for body RR * equilibrium reactions * diagonal movements

Question 41

5 month characteristics in prone

Answer 41

1. lateral weight shift in POE * frees face side hand for reach, LEs 2. may push up on hands 3. rolls to supine

Question 42

5 month characteristics in supine

Answer 42

1. feet to mouth 2. flexes head if hand held 3. rolls to side

Question 43

5 month characteristics in supported sitting and sidelying

Answer 43

1. supported sitting * ring sits * props on hands 2. sidelying * first symmetrical then asymmetrical * momentary lateral flexion of head

Question 44

5 month UE characteristics

Answer 44

1. palmar grasp 2. occasionally manipulates and transfers 3. brings toy to mouth rather than mouth to toy 4. grabs, mouths, bangs, shakes toys

Question 45

describe the physiologic characteristics of a 6 month year old

Answer 45

1. more active, uses less positional stability 2. good head control in flexion, extension, lateral flexion 3. LEs gain extensor control 4. beginning to respond to diagonal WS with rotation 5. independent sitting

Question 46

6 month characteristics in supine

Answer 46

1. lifts head * activity of capital and cervical flexors with synergistic activity of abdominals to stabilize the thorax 2. legs extend with PTS 3. rolls to prone 4. lots of playing w/feet in air

Question 47

6 month characteristics in prone

Answer 47

1. mature landau but extension balanced with flexion * head-neck extension balanced with flexion * chin tucked with elongation of extensors 2. prone on extended arms, pivoting 3. pushing backwards, may assume quadruped

Question 48

6 month characteristics during rolling from supine to prone

Answer 48

1. initated with flexion 2. transitions to extension in sidelying

Question 49

6 month characteristics in sitting

Answer 49

1. positional stability of legs 2. protective extension forwards

Question 50

6 month characteristics with head rotation

Answer 50

WS occurs to the same side as head turns may cause the baby to fall

Question 51

6 month characteristics during standing

Answer 51

1. sufficient hip and trunk control to indpendently hold on to the support of a person * may bounce * legs abducted

Question 52

6 month characteristics of UEs

Answer 52

1. increased abdominal control provides synergistic stabilization to the thorax during humeral movements * SA provides stabilization for the scapula 2. rotator cuff, deltoid and pec major dynamically stabilize the humerus for reaching 3. can stop humerus movement midstream * more precise reaching * cross midline * isolate elbow movements 4. forearm still pronated, some supination in combo with shoulder ER 5. palmar and radial palmar grasp

Question 53

6 month characteristics of LEs

Answer 53

1. Hips more adducted with less ER 2. LEs prone to lateral WS with dissociation 3. In prone * WB side extends, adducts, IR to neutral * nonWB side flexes and rotates backward (opposite response in sitting) 4. Importance of hip IR and elongation of hip abductors for WS

Question 54

describe the physiologic characteristics of a 7 month year old

Answer 54

1. variety of movement 2. more incentive, desire, and capability to move into environment 3. **transitions from quad to sit** * requires marked mobility at hip joints as femurs move under pelvis, and dynamic trunk-pelvic stability 4. assumption of quad from prone 5. lordosis in quad with hips abducted 6. may assume bear standing

Question 55

7 month characteristics in sitting

Answer 55

1. Sitting → assumed from quad * able to rotate trunk * legs abducted and ER * trunk straight, may see slight lordosis * arms free for play * protective extension sideways

Question 56

7 month characteristics during pull to stand

Answer 56

1. at first sing a symmetrical pattern and then half kneeling

Question 57

describe the physiologic characteristics of an 8 month old

Answer 57

1. preferred position for play 2. creeping for mobility 3. may begin climbing on furniture, stairs 4. increased interest in small objects 5. play in kneeling * rely on UE for stability * hips and knees flexed * ankles DF

Question 58

8 month characteristics in sitting

Answer 58

1. trunk and pelvic-femoral muscles provide sufficient stability to play with different LE positions 2. progress to long sit, half sit, side sit

Question 59

8 month characteristics in quadruped

Answer 59

1. beginning of equilibrium 2. crawing reciprocal extremity movements require counter rotation, diagonal control * combo of lateral WS, LE dissociation, diagonal trunk control

Question 60

8 month characteristics during climbing

Answer 60

1. indication of problem solving * how to manipulate body on unfamiliar, uneven, unsteady surfaces

Question 61

8 month characteristics in standing

Answer 61

1. still need the UEs to stabilize the posture * LEs abducted * may release one hand and reach out in space * rotation of trunk over stable pelvis and extended LEs 2. may lower to floor from standing * how low they get before falling is an indicator of eccentric quad control

Question 62

8 month characteristics for cruising and walking

Answer 62

1. cruising sideways, body facing forward 2. walk with hand-held * steppage gait (hips flexed, abducted, ER during swing) * leads by leaning trunk forward, does not yet use active lower trunk, * LE WS * hip in line w/body in standing due to lordosis, hip extension still incomplete

Question 63

describe the physiologic characteristics of a 9 month old

Answer 63

1. variety, versatility 2. good trunk control 3. strong desire to stand and walk 4. more refined cruising - hip abducts with less hip flexion and more knee extension 5. increased control of hip abd/add 6. closer alignment of LE with trunk during single limb WB 7. independent kneeling w/more active hip extension 8. LEs more active during pull to stand 9. cruising * semi turn towards direction moving

Question 64

10 month olds are \_\_\_\_\_\_\_\_\_\_\_

Answer 64

busy, active, exploring

Question 65

8 month UE characteristics

Answer 65

1. container play * in/out, practicing release 2. 3-jaw chuck, pincer 3. mimics gestures 4. reaching across midline

Question 66

8 month cruising and walking characteristics

Answer 66

1. triplanar motion of hips, may cross open spaces 2. cruises around corners * perceptual challenges * motor planning 3. cruises around different height, texture, and firmness of objects 4. supported walking * scapula adducted * trunk extended * anterior pelvic tilt

Question 67

8 month standing characteristics

Answer 67

1. increased ankle movement in standing * more activity of gastroc * PF and INV calcaneus 2. toe standing

Question 68

11 month characteristics

Answer 68

1. stands alone when absorbed in a task 2. walks with one hand held 3. assumes standing (quad-semi half kneel-squat-stand) 4. squatting → weight posterior with minimal ankle DF 5. hip extensors, abdominals, quads, and ankle DF work in synergy 6. rise to stand * symmetrical extension at hips and knees while ankles stabilize 7. may see regression in postural control with attempts at independent walking 8. UE * more control of release, neat pincer

Question 69

12 month characteristics

Answer 69

1. basic motor skills present 2. independent standing * wide BOS * may begin to use hands more 3. increased LE dissociation, greater skill in planning, organizing and executing climbing activities 4. most walk independently

Question 70

Motor signs of motor disorders can be generally classified in what 2 categories?

Answer 70

1. Positive signs 2. Negative signs

Question 71

what are positive signs of motor disorders?

Answer 71

signs that lead to increased frequency or magnitude of muscle activity, movement, or movement patterns examples * hypertonia * chorea * tics * tremor

Question 72

what are negative signs of motor disorders

Answer 72

insufficient muscle activity or insufficient control of muscle activity examples * weakness * impaired selective motor control * ataxia * apraxia

Question 73

are negative or positive signs easier to detect in clinic?

Answer 73

* negative motor signs may be even more significant contributors to disability than positive signs * positive and negative motor signs are often simultaneously present and may be linked rather than indpendent features of a motor disorder

Question 74

describe the negative sign: weakness

Answer 74

* insufficient muscle activation, inability to generate normal voluntary force in a muscle or normal voluntary torque about a joint * assessed during attempts to generate force in a single joint at one point in time * can occur in the presence of hypertonia, hyperkinetic disorders, or other involuntary movements

Question 75

how can weakness be masked?

Answer 75

1. by the fact that a muscle with spasticity, dystonia, or rigidity may resist passive movement by the examiner 2. by the apperance of significant active but involuntary joint extension torque resulting from dystonia

Question 76

describe the negative sign: reduced selective motor control

Answer 76

1. defined as the impaired ability to isolate the activation of muscles in a selected pattern in response to demands of voluntary postures or movements * the expected pattern is not achieved either due to excessive activation of muscles that would be expected to be relaxed or inability to activate muscles that would be expected to be active

Question 77

give some examples of reduced selective motor control

Answer 77

1. activation of knee and hip flexors muscles when a child attempts to dorsiflex the ankle * these patterns are sometimes referred to as "obligate synergies" 2. reduced selective motor control may manifest as abnormal postures or unusual movement patterns * the child may have to adduct the shoulder in order to generate sufficient elbow extension force

Question 78

describe the negative sign: ataxia

Answer 78

1. defined as inability to generate a normal or expected voluntary movement trajectory that cannot be attributed to weakness or involuntary muscle activity about the affected joints * trajectory is a series of positions or joint angles over time * in some cases, may lead to decreased accuracy

Question 79

specific deficits that may be seen as components of ataxia include:

Answer 79

1. dysmetria (inaccurate motion to a target) 2. dyssnergia (decomposition of multijoint movements) 3. dysdiadochokinesia (lack of rhythmicity)

Question 80

what is apraxia?

Answer 80

impaired ability to accomplish previously learned and performed complex motor actions that is not explained by ataxia, reduced selective motor control, weakness, or involuntary motor activity

Question 81

what is developmental dyspraxia

Answer 81

failure to have ever acquired the ability to perform age-appropriate complex motor actions that is not explained by the presence of inadequate demonstration or practice, ataxia, reduced selective motor control, weakness or involuntary motor activity

Question 82

what are complex motor actions?

Answer 82

refer to actions that may have multiple components and are associated with goal-oriented task performance, tool use, or gestures

Question 83

what are other negative signs in childhood?

Answer 83

1. deficits in sensory function including tactile, kinesthetic, or proprioceptive sensation 2. sensory information and attention are needed to correct for errors during movement and to determine errors in the outcome 3. deficits in higher-order sensory function may impair the ability to determine spatial relationships between objects therefore can interfere with tool use, bimanual coordination or task planning

Question 84

what are signs that may assist in an early diagnosis of neuromotor dysfunction?

Answer 84

1. altered muscle tone 2. discrepancies between proximal and distal muscle tone 3. delayed milestones 4. prolonged fixation at a given stage

Question 85

what are soft signs of neuromotor dysfunction?

Answer 85

refers to a group of functional neurological findings which are general and not focal, often subtle, and may relate to faulty integration in abnormal development they may give clues to underlying poor organization and possible CNS deficit

Question 86

list some behavioral soft signs

Answer 86

1. sucking, swallowing and feeding abnormalities 2. colic 3. persistent irritability 4. demanding behavior 5. continuous gross movement and activity 6. markedly limited attention span 7. delayed speech with poor or repetitive expression 8. withdrawn and isolated behavior 9. irregular sleep habits 10. repetitive movements

Question 87

early differential diagnosis features of CP

Answer 87

1. History * soft signs → often positive colic: irritable, sleep problems * milestones → delayed 2. Physical exam → delayed growth 3. Neuro Exam * tone → increased/decreased * reflex behavior → persistent primitive, delayed postural

Question 88

early differential diagnosis features of Intellectual Deficit

Answer 88

1. History * soft signs → generally negative "easy baby" * milestones → delayed 2. Physical exam 3. Neuro exam * tone → hypotonia * reflex behavior → normal disapperance of primative, delayed postural

Question 89

early differential diagnosis features of ADHD

Answer 89

1. History * Soft signs → possible genetic active, demanding, colic, sleep problems * milestones → advanced motor, delayed speech 2. Physical exam 3. Neuro Exam * tone → normal * reflex behavior → normal disappearance of primitive reflexes, early apperance of postural

Question 90

how many hospital perinatal care levels are there?

Answer 90

4 levels

Question 91

describe the 4 levels of hospital perinatal care

Answer 91

* Level I → well-baby nursery * Level II → special-care nursery * babies born less than 32 weeks and weighing less than 1500g * mechanical ventilation for brief period * Level III → NICU * sustained life support * full range of medical specialities * advanced imaging * Level IV → regional NICU * surgery for complex conditions

Question 92

children born at less than 37 weeks gestational age and with VLBW are \_\_\_\_\_\_\_\_

Answer 92

30% more likely to develop CP, ID, RDS, BPD, ROP, HI

Question 93

list characteristics of a premature baby

Answer 93

1. hypotonia 2. decreased ratio of type I to type II * this results in muscular fatigue → particularly respiratory muscles 3. incomplete ossification of bones, ligamentous laxity * results in greater effects of positioning and gravity 4. more reactive to sensory stimuli

Question 94

evolution of sensory responses

Answer 94

touch movement smell and taste hearing sight

Question 95

describe the vestibular system in babies

Answer 95

1. mature in the full-term newborn 2. modifications with development due to synapses and dendrites 3. think of the vestibular stimuli provided in the womb as compared to the NICU 4. vestibular stimulation is known to enhance behavioral states

Question 96

describe the olfactory and gustatory development in newborns

Answer 96

1. olfactory development begins at 5 weeks gestation 2. the ability to smell begins at 28 weeks 3. taste buds begin to mature at approximately 13 weeks 4. the fetus experiences a variety of taste and smells in utero

Question 97

describe the auditory system in newborns

Answer 97

1. by 24 weeks' gestation, cochlea and peripheral sensory end organs are developed but the pathways continue to mature 2. the premie is exposed to NICU noise that may cause cochlear damage, sleep disturbances, and disturbed growth and development * the NICU has updated this

Question 98

describe the visual system in newborn

Answer 98

1. vision is the least mature at term birth 2. from 24 weeks to term, the retina and visual cortex undergo extensive maturation and differentiation 3. by 34 weeks, pupillary reflex present, may see brief eye opening and fixation on a high contrast from under low illumination 4. by 36 weeks, saccadic visual following horizontally and vertically 5. at term, vision is 20/400