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What to pediatric PTs screen for?
- early identification (developmental delays, postural abnormalities)
- early intervention (birth to 3)
- referral to other team members of the team
What to ped. PTs evaluate?
- gross and fine motor development
- muscle strength and tone
- joint motion
- reflec development
- oral motor function
- breathing patterns
- equipment needs
- environmental adapations
What types of direct treatment provisions do ped. PTs do?
- developmental therapy
- adaptive equipment fabrication and design
- training in use of assistive devices, braces, and artificial limbs
- self help skill development
- postural drainage/breathing exers
- pool therapy
- feeding program
- mobility training
- burn/ulcer care
Who may a ped. PT provide consult teaching to?
(postioning, lifting and handling techniques, equipment selection, environmental adaptation, programming and placement)
- school personnel
- other therapy providers
- health care deliverers
- community organizations
- advocacy groups
Who do ped. PTs treat?
- perinatal high risk factors
- congential/genetic abnormalities
- neurologic impairments
- orthopedic conditions
- minimal cerebral dysfunction
- cardio-pulmonary disorders
- metabolic and endocrine disorders
- neuromuscular disorders
- sensory impairments
When would a ped. PT be consulted?
- high risk factors- prematurity, low birth weight, failure to thrive
- delay in motor reflex development
- asymmetry in use of body
- lack of mvmt or maintenance of a fixed posture (pts that arent very active)
- excessive/involuntary mvmt
- inability or reluctance to assume, maintain, or move within a posture
- "clumsy" child syndrome
- excessive or limited joint mobilty
- chronic lung congestion
- abnormal walking patterns
- postural abnormalities
- untapped potential for mobility within an environment
- need for equipment purchase, repair, adaptation or fabrication to prevent deformity or increase function
What type of settings could a ped. PT work?
- school systems
- ped. rehab centers
- acute hospitals
- home health/community based programs
- private offices
What is developmental sequence?
- normal maturation of the CNS
- individuals progressive ability to maintain more difficult postures
What is the sequence of motor control progress?
- cephalocaudal (face>head>neck>upper and lower trunk)
- proximal to distal (within an extremity, UE before LE)
- reflex dominance to reflex integration and volitional control)
- gross to fine motor skills (large m. groups then small)
- developmental milestones (large BOS>small BOS, low COG> high COG)
What is the order of the 5 motor control progressions for infants?
physiological flexion-> antigravity extension-> lateral flexion-> rotation-> diagonal control
What are the 4 stages of motor control?
- controlled mobility
What occurs during the mobility control stage?
- nonvolitional, reflex based, random mvmt
- ability to initate mvmt through functional range
- reflexive in nature, not sustained or well coordinated
- can be facilitated with: guided mvmt, icing, quick stretch, traction
What occurs during the stability control stage?
- able to maintain a position despite the influence of gravity
- maintains position or posture through a co-contraction (muscle stability) and tonic holding (postural stability) around a joint
- unsupported sitting with midline control, head control in prone pivot, prone on elbows, quadraped, squat
can be facilitated with approximation, alternating isometrics, and rhythmic stabilization
What occurs during the controlled mobility stage?
- 4 points of contact
- fixation of distal segments while proximal segments move
- ability to move within a weightbearing position or rotate around a long axis-dynamic stability
- activities in prone on elbows, rolling, reaching, transitional mvmts, or weight shifting in quadraped (rocking)
can be facilitated with weightshifting
What occurs during the skill control stage?
- most mature stage
- sequences of coordinated mvmts superimposed on stability
- ability to consistently perform functional tasks and manipulate the environment with normal postural reflex mechanisms and balance reactions
- highly coordinated, communications, manipulation, locomotion
- ADLs, community ambulation, crawling
can be facilitated with resisted motion to increase proprioceptive feedback
Who developed NDT (neurodevelopmental treatment)?
karl and berta
What is NDT?
- neurodevelopmental treatment
- common intervention for hemiplegic pts
- believed that abnormal postural reflex activity and muscle tone is caused by loss of CNS at the brainstem and spinal cord levels
- dysfunction leads to slowing of motor development and inhibition of righting and equilibrium reactions and automatic mvmts
purpose of PT is to inhibit abnormal postural reflexes and to facilitate normal patterns, such as head and trunk control, balance reactions, and UE support
- facilitation- elicits voluntary muscle contraction
- inhibition- decrease excessive tone or mvmt
- *head injury
What are the key points of control for NDT?
- handling (shld, pelvis, hand, foot) to influence posture, alignment, control
- *by manually controlling the pelvis, you can improve trunk posturing to perform a functional activity such as walking with an improved gait or increased ROM in the arm to reach for objects
- placing- pt musch hold placement against gravity
What method is based on sherrington and the reflec stimulus model?
What is ROOD?
- believed all motor output was result of both past and present sensory input
- goal of apporach is to obtain homeostasis in motor output and activate muscles and perform tasks independently of a stimulus
- once response is obtained, stimulus should be withdrawn
- facilitation- approximation and compression, icing, light touch, quick stretch, resistance, tapping, traction
- inhibition- deep pressure, prolonged stretch, warmth, prolonged cold, carotid reflex
What is the ayers method?
based on sensory integration and the impact of sensory processing on learning, emotions, and behavior
What is physiological flexion?
- posture, position, or muscle tone of a typical newborn
- flexed at the hips, knees, ankles, and elbows
What occurs during neonate motor development (2-4 weeks)?
- unable o lift head against gravity
- tend to nose swipe
- moro-startle reflex
- rooting-suck, swallow
What is hypotonia?
- floppiness stage
- decreased head and trunk control secondary to decreased asymmetry
What is ATNR?
- asymmetric tonic neck reflex
- fencing position
- arms and legs are extended on the face side, arms and legs are flexed on the skull side
What is astasia/abasia?
- in standing
- poor foot orientation, may weight bear for a moment when placed in standing then collapse
What occurs during the 2nd month of motor development?
What month is the age of symmetry (midline control)?
What occurs during the 4th month of motor control?
- age of symmetry
- infant can lift their head past 90 ext
- no lead lag
- gain abdominal and paraspinal strength resulting in the emergence of lateral flexion (trunk righting), and head righting
- midline orientation of head/body is present in supine and begins to bring hands/feet together. may result in rolling
- may have body on body reaction
What occurs during the 5th month of motor development?
- body on head reaction- where body goes, head follows
- antigravity neck flexion- can lift head off a surface in supine and maintain
- begin to note dissociation of head and limbs- alter between swimming and weight shifts on extended arms in prone
- ROLLS PRONE TO SUPINE (less challenging)
What is dissociation?
limbs doing opposite things (flex/ext)
What is the 6th month of motor development called?
landau and equilibrium/righting reactions present: protective responses forward
What is the landau reaction?
- total body righting against gravity
- max head and trunk ext in prone along with ext and abd of limbs away from the body
- indicates antigravity hip ext is present and is critical in preparing a child to stand upright and crawl
- can transfer objects hand to hand
What is righting reaction?
lateral bending in response to a weightshift
What is equilibrium reaction?
allows the body as a whole to adapt to slow changes between the base of suport and COG
What is protective response?
- extremity mvmts that occur when the body is rapidly displaced by horizontal or diagonal forces
- when one or both of the extremities are ext the individual attempts to catch himself or prepare for a fall
What occurs at the 6th month of motor development?
- landau reaction
- righting reaction
- equilibrium reaction
- protective responses
- ROLLS SUPINE TO PRONE- more difficult
- full voluntary palmar grasp- fingers flex to palm
What occurs at the seventh month of motor devlopment?
- may push to quadraped and rock back n forth
- radial palmar grasp- thumbs begin to adduct
What occurs at the 8th month of motor development?
- independent sitting
- equilibrium reaction (external rotation of WBing side, lateral flexion of WBing side, elongation of nonWBing side, and ext of UE on WBing side
- stand with a wide BOS and fall to get down
What occurs at 9 months of motor development?
- true reciprocal creeping (crawling)
- cruising begins - sides steps around furniture with hip hiking, wide abduction, and 2 hand support with the body facing the surface
- inferior pincer grasp-thumb to index finger
What occurs during the 10th month of motor development?
mature cruising- holds on with one hand, hip hikes, and begins to rotate in order to face forward away from surface
What occurs at the 11th month of motor development?
- early standing posture-stands alone
- high guard, arms in the air, scapular adduction and elevation, trunk extension, wide BOS with hip abduction
What age is considered normal for walking?
What occurs at 12 months of motor development?
- normal for walking
- superior pincer grasp-thumb to finger tip
What occurs at the 15th month of motor development?
rises to stand from the middle of the floor with no hand use (can emerge later between 16-18 months), usually via squatting or 1/2 kneel
What occurs between 16-18 months of motor development?
- goes up and down stairs
- walk sideways and backwards
What is the purpose of the sidelying position?
- promote lateral head a trunk control
- mroe flexion dissociation
- hands to midline
- respiratory mvmts
- decrease head and low back hyperextension
- assists in inhibiting abnormal mvmt patterns
- visual-motor coordination
When positioning in sidelying, what should you be sure to do?
- get lengthening of WBing side
- get chin tucked
- place object to be visually attended to below the level of the chin
- free the UE on the WBing side
- can use bolster or towel rolls, etc
What is the purpose of the supine position?
- midline head orientation
- chin tuck
- hands to midline
- midline trunk orientation and tummy work
- neutral LE position
- hands to knees/feet
- encourages hand-eye coordination
When placing in the supine position, what should you be sure of?
- stabilize head in midline with back of neck elongated so chin is tucked
- bring shld girdle forward
- elevate legs under knees to prevent frogging or scissoring
- can use towel rolls, pillows, tunbleforms
What is the purpose of prone positioning?
- promote body ext with chin tuck
- midline trunk orientation
- propping on forearms to facilitate WBing in UEs
- increase head control against gravity
- visual exploration and visual-motor coordination
- hands to midline
- maintain hip ext ROM
While positioning in prone, what should you be sure to do?
- prevent hyperextension of head/neck and upper and low back
- prevent excessive shld elevation
- keep elbows even with or infront of shlds
- prevent LEs from frogging or scissoring
- can use wedges, abductors for LEs, towel roll or half wedge under chest