motor (and sensory) development
Post on 11-Feb-2016
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Why is it important?
This is my new favorite article: https://www.ewi-ssl.pitt.edu/psychology/ad
min/faculty-publications/201008311333100.Iverson_2010.pdf
http://www.people.com/people/archive/article/0,,20353593,00.html
http://www.autismspeaks.org/science/science_news/kennedy_krieger_early_signs.php
“Development results from interrelated processes of maturation, physical growth, and learning and may be observed in genetic and environmental adaptation”- Cech & Martin (2002), p. 51.◦ Maturation= genetics/biophysical◦ Adaptation= body’s response to the environment
◦The progression from reflex dominance to increasingly
advanced motor skills
1) Sequential: across cultures, despite individual differences
2) Directional concepts:a) Cephalocaudalb) Proximaldistal
3) Mobility & Stability: the relationship between these is=postural control
4) Sensory Input: first movements or reflexes are initiated by sensation and continues with voluntary control.
Vision Somatosensory:
◦ Tactile:◦ Proprioception: interpreting stimuli originating
in muscles, joints and other internal tissues that give info. about position of body part in relation to another
Vestibular: interpreting stimuli from the inner ear receptors regarding head position and movement
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Reflexes• Predictive movements in response to a
stimuli• The integration of reflexive reactions
follows a sequence that correlates with the acquisition of motor skills
•Present in the neonatal and become integrated in time; persistence beyond the time of anticipated decline may signal brain
abnormalities•Almost all reflexes should be integrated
by 9-12 months
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Asymmetric Tonic Neck Reflex
http://www.babyzone.com/baby/nurturing/photos_physical_development_milestones/3
Righting Protective Equilibrium See Table 9-2
Nature versus Nurture
Automatic responses to sensory input that act to keep the body parts in alignment, maintain equilibrium and prevent injury.
Are of primary importance with static and dynamic balance.
Appear between 2-18 months, with few exceptions, persist throughout life.
3 categories: righting, protective, and equilibrium
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Automatic postural responses elicited by sensory input that signal that the head or trunk is not in midline.
Think of examples…
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To prevent or break a fall. Elicited by vestibular input that signals a
change in head position. These reactions are often delayed or absent
in persons with severe disabilities. How would this impact occupational
performance???
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Protective Reaction
To prevent falls Elicited by vestibular input from any
position. Appear between 5-18 months of age and
persist for life. 5 key positions for testing:
◦ Prone, supine, sitting, all fours, and standing (tilt board)
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Equilibrium Reaction
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• Variations exists in all areas of development
• ”Abnormal motor development cannot be recognized and
correctly interpreted without a solid knowledge of normal motor
development” (Piper & Darrah, 1994, p.2)
• Use normal motor development as a reference point to
understand abnormal motor development and establish
treatment techniques
Motor development
04/22/23Motor Development 17
Conditions: CP TBI Genetic Syndromes ….What are these related to? NEUROLOGICAL INTEGRITY
http://aut.sagepub.com/content/early/2011/05/19/1362361311402230.abstract
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Inconsistency Perseveration Mirroring Asymmetry Loss of dynamic balance Falling after performance Extraneous movements Inability to maintain rhythm or pattern Inability to control force Inappropriate motor planning
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Primitive reflexes do NOT appear in the first year of life.
Primitive reflexes appear, but do NOT DISAPPEAR by the end of the first year.
Equilibrium reactions do not appear by the end of the first year.
Equilibrium reactions do not persist throughout life.
http://pathways.org/awareness/healthcare-professionals/early-motor-surveillance/
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The degree of normal tension in a specific muscle or muscle group
The resistance of passive stretch Constant state of reflex contraction For body posture
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Hypotonus◦ Too little tension◦ Characterized by unusual postures and increased
joint ROM Hypertonus
◦ Increase muscle tone◦ Too stiff to perform movements properly◦ Spasticity and rigidity significantly limit ROM
Athetosis◦ Exhibit both hyper and hypo tonus
1 Statistics compiled by the Pathways Awareness Medical Round Table from a variety of sources, including the March of Dimes, Pediatrics Annual Summary of Vital Statistics, and the Centers for Disease Control and Prevention
Celebrating over 25 years of assuring the best for all babies’ development
Recognizing Early Motor Delays At Four and Six Months of Age
“Early motor delays” is used to describe a variety of conditions from low muscle tone to cerebral palsy.
Early motor delays can later affect a child’s ability to learn basic skills such as grasping, crawling, standing, walking, and talking.
Early Motor Delays
Early Motor DelaysTummy TimeSurveillance
Recognizing Early Motor Delays
4-month comparison 6-month comparison
ReferralsEarly Intervention
Thank YouSurvey
Tummy Time
Supervised time while awake that babies spend on
their stomachs
Early Motor DelaysTummy TimeSurveillance
Recognizing Early Motor Delays
4-month comparison 6-month comparison
ReferralsEarly Intervention
Thank YouSurvey
Tummy Time is critical for building muscle strength in the core, back, neck, and
shoulders; strength children need to meet their
developmental milestones.
“a flexible, continuous process whereby knowledgeable professionals perform skilled observations of children during the provision of health care. The components of developmental surveillance include eliciting and attending to parental concerns, obtaining a relevant developmental history, making accurate and informative observations of children, and sharing opinions and concerns with other relevant professionals.”2
Early Motor DelaysTummy TimeSurveillance
Recognizing Early Motor Delays
4-month comparison 6-month comparison
ReferralsEarly Intervention
Thank YouSurvey
Dworkin defined developmental surveillance:
Observe in more than one positionObserve the quality of the movement
Recognizing Early Motor Delays
At the 2, 4 and 6 month Well Visit
1. Supine2. Sidelying3. Prone4. Pull to Sit5. Sitting6. Horizontal
Suspension7. Protective Response8. Standing
Atypical
Good vertical alignment from head to feet
No independent head lifting
Typical Eight positions to observe movement
Early Motor DelaysTummy TimeSurveillance
Recognizing Early Motor Delays
4-month comparison 6-month comparison
ReferralsEarly Intervention
Thank YouSurvey
Early Motor DelaysTummy TimeSurveillance
Recognizing Early Motor Delays
4-month comparison 6-month comparison
ReferralsEarly Intervention
Thank YouSurvey
Click on image to play video Handout #9
Early Motor DelaysTummy TimeSurveillance
Recognizing Early Motor Delays
4-month comparison 6-month comparison
ReferralsEarly Intervention
Thank YouSurvey
Click on image to play video Handout #10
http://pathways.org/awareness/parents/developmental-milestones/atypical-and-
typical-infant-development#.UUNpRxc3txV
http://pathways.org/images/random_pdfs/Hot-Topics-2-months.pdf
http://pathways.org/images/random_pdfs/Hot-Topics-4-months.pdf
http://pathways.org/images/random_pdfs/Hot-Topics-6-months.pdf
2 month old
4 month old
6 month old
Referrals If you assess a child and observe a
potential early motor delayEarly Motor DelaysTummy TimeSurveillance
Recognizing Early Motor Delays
4-month comparison 6-month comparison
ReferralsEarly Intervention
Thank YouSurvey
Next step: Refer your patient for an evaluation or
a screening by a specialist
Handout #11
Pediatric Occupational Therapy
Early Intervention… What is it?
Pediatric
PhysicalTherapy
PediatricSpeech/Language
Therapy
Pediatric therapy provided early improves the abilities of a child
Early Motor DelaysTummy TimeSurveillance
Recognizing Early Motor Delays
4-month comparison 6-month comparison
ReferralsEarly Intervention
Thank YouSurvey
Thank you for taking the time to learn about Pathways.org and recognizing early
motor delays. We hope that this overview of four and six month motor development has
provided you with the skills and tools to:
•Understand the importance of surveillance •Identify early motor delays at the 4 and 6 month
visits using structured observation•Refer children for further screening as soon as
possible
Early Motor DelaysTummy TimeSurveillance
Recognizing Early Motor Delays
4-month comparison 6-month comparison
ReferralsEarly Intervention
Thank YouSurvey
American Occupational Therapy Association (AOTA): www.AOTA.org
American Physical Therapy Association (APTA): www.APTA.org
Neuro-Development Treatment Association (NDTA): www.NDTA.org
State-by-State Early Intervention:
www.pathways.org/awareness/parents/parent-resources/your-states-child-early-
intervention-offices
Pediatric Neurologist: www.childneurologysociety.org
Developmental and Behavioral Pediatricians:
www.sdbp.org/find_a_clinician.cfm
Easter Seals: www.easterseals.com
Pathways: www.pathways.org
Early Motor DelaysTummy TimeSurveillance
Recognizing Early Motor Delays
4-month comparison 6-month comparison
ReferralsEarly Intervention
Thank YouSurvey
Handout #12
Recommended Organizations
Sensory Processing Disorder
Sensory Modulation Disorder (SMD)
Sensory Over- Responsivity
Sensory Under-
Responsivity
Sensory Seeking/ Craving
Sensory Based Motor Disorder (SBMD)
Dyspraxia Postural Disorders
Auditory
TactileTaste/Smell
Visual
Sensory Discrimination Disorder (SDD)
Position/Movement
(Miller, Anzalone, Lane, Cermak, Osten, 2007)
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109213/
http://www.aota.org/Educate/Research/CATsandCAPs/SI.aspx
Q & A
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