IDEA (Individuals with Disabilities Education Act Parts*
Part C - Early Intervention
Provides services for children under 3 years of age
Provides for family directed services
Part B- Early Childhood Special Education
Provides services for children 3 years old through 21 years of age & provides:
- Free, appropriate, public education in the least restrictive environment
Family Centered Care - S M A R T
S – Support
Families with information, education, understanding , and resources
M – Measure
The effectiveness of programs through qualitative and quantitative outcome measures
A- Ask
The right questions. Determine the individual needs of the patient and family. This will decrease the tendency to make biasing generalizations
R – Respect
That individual differences between the child, family and therapist do occur and that they may be different from our own.
T – Train
Early on in the health care profession, and recognize that the training is lifelong and ongoing
6 Stages of Adjustment for Disability
1) Shock
2) Denial
3) Depression
4) Anger
5) Acknowledgement
6) Adjustment
Types of Teams
Multidisciplinary Team
Discipline specific roles are well defined
Professionals work independently but recognize and value contributions of other disciplines
Little or no interaction or ongoing communication
occurs among professionals
Treatment occurs in isolation for remediation of
weaknesses
Fragmentation of reporting occurs
Overlap and gaps in services may occur and child may not be visualized as a whole
Interdisciplinary Team
Discipline specific roles are well defined (role
definitions are relaxed)
Emphasis on teamwork
Therapy services may occur in isolation; however,
team discusses at regular intervals during team
meetings
Individuals from different disciplines work together cooperatively to:
- Plan
- Implement
- And evaluate services
Transdisciplinary Team
Decreases the number of professionals that families must encounter on a regular basis while meeting the needs of the child
Professionals committed to teaching, learning, and working with others across traditional disciplinary
boundaries
Role release
Transference of information and skills specific to one discipline to other team members of different disciplines
Team members work together to conduct assessments, program plan, develop goals and implement treatment plans
Dynamic Systems Theory
explains how complex, self-organizing systems—ranging from motor development to ecological interactions—change over time through interconnected, nonlinear components rather than linear, predetermined steps. It focuses on how new behavioral patterns (attractors) emerge from the interaction of multiple subsystems (e.g., infant walking, motor skills in autism) and adapt to environmental influences.
3 important elements of motor control
Motor Control Strategies
Motor program – a set of pre- structured muscle commands that end up producing coordinated movement / learned task / carried out without influence of peripheral feedback
Motor plan - overall strategy for movement
Feedback – afferent information sent by sensory receptors to control centers with constant updates that allow for corrections shaping the ongoing movement & allows motor responses to be adapted to the demands of the environment
Motor-skill acquisition – behavior is organized to achieve a goal directed task with active problem solving needed for the development of the motor program, plan, and learning & is adaptive to the specific demands of the environment
CNS recovery - reorganization is dependent on experience - practice is required to regain lost skills, & ability to retain & generalize re-learned skill to other similar tasks or to apply in other environmental contexts
Feed-forward - prepares the system in anticipation of responses required for movement and adjusts the system for incoming sensory feedback for future movements
Anticipatory (feed-forward) postural adjustments used by children with cerebral palsy and typically developing children to counteract self-generated motions that disturb balance.
Neonatal Prematurity: Prematurity
Birth at less than 37 weeks
Fetus considered viable at 22 to 23 weeks of gestation
Principles of Motor Development: Directional Concepts
Cephalic to Caudal (Head to Tail)
Proximal to Distal
Gross to Fine
Undifferentiated to Specific
Physiologic Flexion
Full term babies are born in physiologic flexion due to confinement & position in the womb
Hip, knee & ankle flexion contractures
Antigravity Extension
Voluntary, active movement against gravity first seen at the neck then the trunk
In prone, begins with lifting of the head
In prone, extensors strengthen & flexion contractures decrease
Antigravity Flexion
Develops in supine first
Foot-play, head lifting
Progression from supine to sit
Lateral Flexion & Rotation
Lateral flexion activity leads to crawling
Rotation leads to rolling
Reflexes/Automatic Movements
Reflexes
Basic unit of movement in the
hierarchical theory of motor control
Involve the combination of a sensory
stimulus & a motor response
Primitive Reflexes
Typically present at birth
Normal for young infants
Usually integrated in the first 9
months of life
Abnormal Reflexes
Persistent, abnormal, or
asymmetrical usually indicate early
brain damage and will affect future
normal development
Occur in response to a stimuli & often involuntarily
Significance:
- Initial appearance demonstrates functioning subcortical primitive centers
- These early reflexes eventually
diminish reflecting maturation of the
nervous system with increased
control of the cortex
Include:
Permanent Reflexes
Primitive (Neonatal) Reflexes
Postural Reflexes
Primitive Reflexes
Are succeeded by the postural reflexes (inhibited by the frontal lobes) which enable the maturing child to interact effectively with his environment (Goddard, 1996)
If present beyond 6 to 12 months of life, they are termed aberrant & may result in immature patterns of behavior
Despite the acquisition of later skills, may cause immature systems to remain
Primitive Reflexes:
Rooting
Suck / Swallow
Moro
Startle
Palmer Grasp
Plantar Grasp
Positive Support
Stepping
Asymmetrical Tonic Neck Reflex (ATNR)
Symmetrical Tonic Neck Reflex (STNR)
Tonic labyrinth Reflex (TLR)
Galant Reflex
Postural Reaction vs Postural Reflex
While often used
interchangeably, “postural reaction” and
“postural reflex” are technically not
exactly the same, with “postural reaction”
sometimes considered a broader term
encompassing the complex motor
response to a balance disturbance, while
“postural reflex” refers specifically to the
automatic, involuntary muscle activation
triggered by sensory information to
maintain posture; essentially, a postural
reaction is the full response involving
multiple reflexes and muscle actions to
maintain balance.
Postural Reactions
Postural
Reactions:
Righting &
Equilibrium
Reactions
Emerge as primitive reflexes
Emerge to help the infant or child
cope with demands of a gravity-
based environment
Provide the basis for the control of
automatic balance, posture and
voluntary movement
Are complex postural responses that
continue to be present throughout
adulthood
Righting Reactions
Thought to be mediated at midbrain level in
response to signaling from several different
sensory receptors including:
- Proprioceptors, cutaneous receptors, eyes and
labyrinth of the ears
Realigns the head or trunk with each other or
with an outside stimulus
Landau Reflex ***(almost always on boards)
Not a primitive reflex because it is not present
at birth (age of onset3-4 months) and it is not a true postural reflex because it should not persist beyond the age of 12-24 months
When the baby is held in prone suspension,
supported under the tummy, the head, spine
and legs will extend
Pediatric Gait
3 yrs. of age is when a child’s gait pattern
begins to resemble that of an adult. Initially there is a wide-based stance with rapid cadence and short steps.
Toddlers have a broad-based gait for support,
and appear to be high-stepped and flat-footed, with arms outstretched for balance. Legs are externally rotated, with a degree of bowing.
Heel strike develops at around 15-18 months
with reciprocal arm swing.
After the age of 2, running and change of direction occur.
School-aged children, demonstrate a step
length increase and step frequency slows.
Adult gait and posture occur around the age of
7- 8 years.
Gross Motor Milestones (for Boards)
Measured by months within the first 2 years & are significant:
* 2 months - head steady in sitting
* 6-7 months – supported sitting (ex. siting with arms behind or at sides supporting oneself)
* 8-9 months – sits without support
* 8-9 months - cruising (ex. using the couch to move around)
* 12-15 months - walking
* 24 months – runs & changes direction
Refer to Developmental Milestones Handout
Milestones forFlexibility / Posture / Alignment
Spine:
0-12 months
* Changes from the physiologic flexed & rounded posture with the emergence of cervical and lumbar curves (lordosis)
- Development of head control in prone leads to development of cervical lordosis
- Development of head control in sitting & standing contributes to lumbar lordosis
* Provides increased stability of the back and neck
1-6 years
* Curves continue to increase
* 1-2 years – standing and walking
Milestones for Pediatric Gait
Walking
* Walks without support (12-15 months)
Early Walking (12-18 Months):
* LE’s: Toddlers walk with a wide stance for stability. They often land flat-footed, rather than heel-toe. May have a “high-stepping” gait as they lift their feet higher to clear the ground
* UE’s: Arms are held up (high guard position) for balance. Arm swing is minimal or absent.
Developing Gait (18 Months - 3 Years):
* Narrowing base: The base of support gradually narrows as balance improves.
* Heel strike: Heel-to-toe gait starts to develop
* Reciprocal arm swing: Arm swing becomes more coordinated with opposite arm and leg movements.
* Increased step length: Step length increases as leg strength and coordination improve.
* Improved balance: Balance becomes more refined, allowing for running and changes in direction (2 years
Mature Gait (3 Years and Beyond):
Adult-like gait:
* .By around 3 years old, gait pattern becomes more similar to adults, with heel-toe contact, reciprocal arm swing, and a narrower base of support.
Gait maturation:
* .Gait continues to refine and mature, with increased velocity, step length, and coordination, reaching near-adult patterns by 7- 8 years old