CHILDHOOD DEVELOPMENT: dev of sensorimotor integration/ reflexes/ development continuum in self-feeding / feeding /developmental evaluation

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SENSORIMOTOR INTEGRATION: prenatal

-responds tactile stim
-reflex developmt occurring
-innate tactile, proprio, vestib rxns occurring

SENSORIMOTOR INTEGRATION: neonatal

-auditory system starts orienting to sounds/voices
-tactile, propio,vesitb CRITICAL for body scheme dev
-vestib (tho fully dev at birth) refines/impacts arousal and organization
-visual syst dev as orients to faces/items of high contrast 10 " fr face

SENSORIMOTOR INTEGRATION: 1st 6 mo

-vestib, proprio, visual syst integrate n lay foundation for postural control, which facilitates steady vis field
-tactile, proprio syst refine, laying foundation for dev of sensorimotor skills
-vis, tactile integrate as child reach/grasps obj, laying foundation for eye-hand coord

SENSORIMOTOR INTEGRATION: 6-12 mo

-vestib, vis, somatosens responses increase in quality and quantity as infant is more mobile
-tactile, proprio perceptions refine, allowing for dev of fine motor/motor planning skills; also lead to midline skills/cross midline
-aud, tactile, proprio perceptions heightened, allowing for dev of sounds for communication
-tact, proprio, gustatory, olfactory integration, allowing for primitive sefl feeding

SENSORIMOTOR INTEGRATION: 13-24 mo

-tactile perception b/c precise; allows discrimination and localization to refine fine motor skills
-integration of all systems promoting complexity of motor planning as child expands mvmt patterns
-symbolic gesturing/vocalization promotes ideation, indicating ability to conceptualize
-motor planning contributes to sefl concept as child masters environment

SENSORIMOTOR INTEGRATION: 2-3 yrs

-period of refinement as vestib, proprio, vis further dev, leading to improved balance/postural control
-tactile discrim/localization dev=improved fine motor
-motor planning/praxis ideation progress

SENSORIMOTOR INTEGRATION: 3-7 yrs

-driven to challengesensorimotor competencies thru roughouse play, plyaground, games, sports, art, school tasks, hhold chores, etc

REFLEXES: rooting

onset: 28 wks
integration age: 3 mo
stimulus:stroke corner of mouth, upp/low lip
response:mvmt of tongue, mouth and/or head
towards stimulus
relevance: allows searching for/locate feed source

REFLEXES: suck-swallow

onset: 28 wks
integration age: 2-5 mo
stimulus: place index fing in infant mouth w/head in
midline
response: strong, rhymical sucking
relevance: allows ingestion of nourishment

REFLEXES:traction

onset: 28 wks
integration age: 2-5 mo
stimulus:grasp infant f.arms and pull to sit
response:complete flexion of upper extrmeties
relevance:enhances momentary reflexive grasp

REFLEXES: moro

onset: 28 wks
integration age: 4-6 mo
stimulus:rapidly drop infants head back
response:1st phase-arm ext/abd, hand opening; 2nd
phase- arm flex/add
relevance:faciliatates ability to depart gotm dominant
flexor posture; protective response

REFLEXES: plantar grasp

onset: 28 wks
integration age: 9 mo
stimulus:apply pressure w/thumb on infants ball of
the foot
response:toe flexion
relevance:increases tactile input to sole of foot

REFLEXES: galant

onset: 32 wks
integration age: 2 mo
stimulus:hold infant in prone suspension, gently
scratch or tap alongside spine w/finger, from
shoulder to butt
response:lateral trunk flexion and wrinkling of skin on
stimulated side
relevance:facilitates lateral trunk mvmts necess for
trunk stabilization

REFLEXES: asymetric tonic neck

onset: 37 wks
integration age: 4-6 mo
stimulus:fully rotate infants head and hold 5 sec
response:ext of extremities on face side, flexion of
extremities on skull side
relevance:promotes visual hand regard

REFLEXES:palmar grasp

onset: 37 wks
integration age: 4-6 mo
stimulus:place examiners finger in infant's palm
response:finger flexion; reflexive grasp
relevance:increases tactile input on palm side of hand

REFLEXES:tonic labrinthine supine

onset: > 37 wks
integration age: 6 mo
stimulus:place infant in supine
response:increased extensor tone
relevance:facilitates total body extensor tone

REFLEXES:tonic labrinthine prone

onset: > 37 wks
integration age:6 mo
stimulus:place infant in prone
response:increased flexor tone
relevance:facilitates total body flexor tone

REFLEXES: labrinthine/optical (head) righting

onset: birth-2mo
integration age:persists
stimulus:hold infant suspended vertically and tilt slowly (ab 45 degrees) to side, forw or backwd
response:upright positioning of head
relevance:orients head in space; maintains face
vertical

REFLEXES:landau

onset: 3-4 mo
integration age: 12-24 mo
stimulus:hold infant in horizontal prone position
response:complete ext of head, trunk, extremities
relevance:breaks up flexor dominance; facilitates
prone extension

REFLEXES:symmetric tonic neck

onset: 4-6 mo
integration age: 8-12 mo
stimulus:place infant in the crawling position and
extend the head
response:flexion of hips and knees
relevance:breaks up total extensor posture; facilitates
static quadraped position

REFLEXES:neck righting

onset: 4-6 mo
integration age: 5 yrs
stimulus: place in supine, fully turn head to one side
response:log rolling of entire body to maint align
w/head
relevance:maint head/body alignmt; init rolling (1st
ambulation effort)

REFLEXES:body righting

onset: 4-6 mo
integration age:5 yr
stimulus:place in supine, flex 1 hip and knee to chest
and hold briefly
response:segmental rolling of upp trunk to maint
alignmt
relevance: facilitate trunk/spinal rotation

REFLEXES:downward parachute (protective ext downward)

onset: 4 mo
integration age: persists
stimulus:rapidly lower infant toward supporting
surface while suspended vertically
response:ext of BLE
relevance:allows accurate placement of BLE in
anticipation of a surface

REFLEXES:forward parachute (protective ext forward)

onset: 6-9 mo
integration age: persists
stimulus:suddenly tip infant forward toward
supporting surface while suspended vertically
response: sudden ext of BUE, hand opening, neck ext
relevance:allows accurate placement of BUE in
anticipation of supporting surface to prevent
fall

REFLEXES:sideward parachute (protective ext sideward)

onset: 7 mo
integration age:persists
stimulus:quickly but firmly tip infant off balance to
side while in sitting
response:arm ext/abd to side
relevance:protects body to prevent fall; supports body
for unilateral use of opposite arm

REFLEXES:backward parachute (protective ext backward)

onset: 9-10 mo
integration age: persists
stimulus:quickly but firmly tip infant off balance
backward
response:backward arm ext or arm ext to 1 side
relevance:protects body to prevent fall; unilaterally
facilitates spinal rotation

REFLEXES:prone tilting

onset: 5 mo
integration age: persists
stimulus:after positioning infant in prone, slowly raise
1 side of supporting surface
response:curving of spine towards raised side
(opposite to the pull of gravity); abd/ext of
arms and legs
relevance:maintain equilibrium w/out arm supp; facilitate postural adjustments in all positions

REFLEXES:supine tilting and sitting tilting

onset: 7-8 mo
integration age: persists
stimulus:after positioning infant in supine or sitting,
slowly raise 1 side of supporting surface
response:curving of spine towards raised side
(opposite to the pull of gravity); abd/ext of
arms and legs
relevance:maintain equilibrium w/out arm supp; facilitate postural adjustments in all positions

REFLEXES:quadraped tilting

onset: 9-12 mo
integration age:persists
stimulus:after positioning infant on all fours, slowly
raise 1 side of supporting surface
response:curving of spine towards raised side
(opposite to the pull of gravity); abd/ext of
arms and legs
relevance:maintain equilibrium w/out arm supp; facilitate postural adjustments in all positions

REFLEXES:standing tilting

onset: 12-21 mo
integration age:persists
stimulus:after positioning infant in standing, slowly
raise 1 side of supporting surface
response:curving of spine towards raised side
(opposite to the pull of gravity); abd/ext of
arms and legs
relevance:maintain equilibrium w/out arm supp; facilitate postural adjustments in all positions

REFLEXES: age of onset (28 wks)

rooting
suck-swallow
traction
moro
plantar grasp

REFLEXES: age of onset (32 wks)

galant

REFLEXES: age of onset (3-4 mo)

landau

REFLEXES: age of onset (4-6 mo)

symetrical tonic neck (STNR) -must be able to lift
head in order to do this
neck on body (NOB)
body on body (BOB)

REFLEXES: age of onset (>37 wks)

37 wk: ATNR
37 wk: palmar
>37 wk: supine tonic labyrinthine
>37 wk: prone tonic labyrinthine

REFLEXES: all C5 tilting reflexes

prone tilting-5 mo
supine tilting - 7-8 mo
quadraped tilting - 9-12 mo
standing tilting - 12-21 mo

REFLEXES: all parachutes/protective extention

downward-4 mo
forward-6-9 mo
sideward-7 mo
backward-9-10 mo

REFLEXES: age of onset (birth-2mo)

labyrinthine/optical head righting
baby is learning to keep head up!

REFLEXES: age of integration (2 mo)

galant

REFLEXES: age of integration (2-5 mo)

traction
suck-swallow

REFLEXES: age of integration (3 mo)

rooting

REFLEXES: age of integration (4-6 mo)

palmar grasp
ATNR
moro

REFLEXES: age of integration (6 mo)

tonic labyrinthine, prone and supine

REFLEXES: age of integration (8-12 mo)

STNR (facilitates static quadraped)

REFLEXES: age of integration (9 mo)

plantar grasp

REFLEXES: age of integration (12-24 mo)

landau

REFLEXES: age of integration (5 yr)

NOB
BOB

REFLEXES: age of integration (persists)

labyrinthine/optical head righting
dn, fwd, side, bkwd parachute/protective
prone, supine, sitting, quadraped, standing tilting

why are reflexes important?

used to screen for delays
det extent of CNS dysfunction
implications for CP, CVA, TBI, etc

what is a reflex?

predictable motor response elicited by tactile, propio, vestibular stimulation
primitive reflexes present at/just after birth and integrate thru the 1st yr - persistance/reemergence of these reflexes are indicative of CNS problem

DEVELOPMT CONTINUUM IN SELF FEEDING (5-7 mo)

eating/feeding performance: take cereal/pureed baby food from spoon

sensorimotor:good head stability; emerging sitting; reach for and grasp toys; explore/tolerate various text; put object in mouth

cognition:attend to effect produced by actions such as hitting/shaking

psychosocial:plays w/caregiver during meal; engage in interactive routine

DEVELOPMT CONTINUUM IN SELF FEEDING (6-8 mo)

eating/feeding performance: attempts to hold bottle but may not retrieve if falls; needs to b maintained for safety

sensorimotor:good head stability; emerging sitting; reach for and grasp toys; explore/tolerate various textures; put object in mouth (same as 5-7 mo)

cognition:object permanence emerging; anticipates food/bottle

psychosocial: easily distracted by stimuli in environmt

DEVELOPMT CONTINUUM IN SELF FEEDING (6-9 mo)

eating/feeding performance:holds/tries to eat cracker but sucks on it more than bites it; consumes soft foods tht dissolve in mouth; grab at spoon but bangs or sucks it

sensorimotor:good sitting stability emerges; able to use hands to manipulate smaller parts of rattle; guided reach; palmar grasp applied to hand-to-mouth actions w/objects

cognition:use familiar actions initially w/haphazard variations, seeks novelty and anxious to explore objects

psychosocial: recognizes strangers; emerging sense of self

DEVELOPMT CONTINUUM IN SELF FEEDING (9-13 mo)

eating/feeding performance:finger feeds self portion of meal of soft table food and objects if fed by adult

sensorimotor:various grasps on obj of diff sized; able to isolate radial fingers on smaller objects

cognition:increased organization/seq of schemes to do desired activity

psychosocial:prefers to act on objects rather than b passive observer

DEVELOPMT CONTINUUM IN SELF FEEDING (12-14 mo)

eating/feeding performance:dips spoon in food; bring spoonful of food to mouth but spills by inverting spoon b4 mouth

sensorimotor: begin to place and release objects; uses pronated grasp on objects

cognition:recognizes tht objects have function and uses tools appropriately; relates objects together, shifting attn among them

psychosocial:interest in watching family routines

DEVELOPMT CONTINUUM IN SELF FEEDING (15-18 mo)

eating/feeding performance:scoops food w/spoon and bring to mouth

sensorimotor: shoulder/wrist stability 4 precise mvmt

cognition: experiments to learn rules of how obj work; actively solves problems by creating new action solutions

psychosocial:internalizes standards imposed by others for how to play w/objects

DEVELOPMT CONTINUUM IN SELF FEEDING (24-30mo)

eating/feeding performance:demonstrates interest in using fork; may stab at food like canned fruit; proficient at spoon use and eats cereal w/milk or rice w/gravy w/utencil

sensorimotor: tolerates various textures in mouth; adjusts mvmts to be efficient

cognition: expresses wants verbally; demo imitation of short sequence of occupation (i.e put food on plate and eat it)

psychosocial: increasing desire to copy peers; looks to c if they appreciate success in occupation; interested in hhold rtn

oral motor develpoment 35 weeks of gestation and after

jaw and tongue mvmts strong

oral motor development 40 weeks

rooting, gag/cough reflex up to 4 mo

oral motor development 4-5 mo

munching: phasic bite and release of soft cookie

oral motor development 6 mo

strong up/dn tongue mvmts

oral motor development 7-8 mo

mastication of soft/mashed food w/diag jaw mvmt

oral motor development 9 mo

lateral tongue mvmt for effective mastication of sof/mashed food, able to drink fr cup, jaw not firm

oral motor development 12 mo

jaw firm, rotary chew=good bite on hard cookie

oral motor development 24 mo

able to chew most meats and raw veggies

what is involved in a feeding evaluation?

1) parent interview
2) medical history
3) observe feeding (posture cntrl, oral sensitivity, motor cntrl of jaw, coord, endurance)
4) reccommend videofluoroscopy if high risk for aspiration

what is the OT intervention for oral motor control?

1) positioning (neutral head/pelvis, trunk stability)
2) hand positioning of caregiver (index under lip, middle under jaw, thumb mandible)
3) facilitate lip closure (upward press index under lip)
4) facilitate jaw closure (upwd press middle under jaw)
5) hand positioning of index and middle assist in tongue thrust (press spoon dn on tongue)
6) facilitate swallow by lip closure and press spoon on tongue
7) facilitate chew by place food bet gum/teeth
8) work out of abnormal patterns
9) find appropriate textured food

how do you work the child out of abnormal eating patterns?

1) if tonic bite: press on tongue
2) avoid choke: prevent tongue retraction
3) if tongue thrust: facilitate lip closure
4) lower sensitivity

how do you decrease tactile sensitivity in a child's mouth?

pressure, suck/chew on cloth, rub gums/palate/tongue, oral toys, NUK brush, vary text of food

what is included on an OT developmental evaluation?

1) info ab pregnancy/birth (apgar score, # of wks premature, adjusted age, # of days, weeks in incubator, intubated, vent, nasogastric tube)
2) med history
3) dev milestones
4) parent interview

what is involved in the apgar score?

heart rate, respiration, reflex irritibility, mm tone, color at 1/5/10 min after birth; measured on a scale of 0,1,2

whats involved in the assessment of a newborn, infant, child?

1) neuro status (consciousness, reflex, mm tone)
2) musculoskel (extremity/spine deformity, ROM, posture at rest/active)
3) developmental assess

what are the 2 assessments used on infants?

assessment of premature infant's behavior (APIB) and neurological assessment of preterm and full term newborn infants (NAPFI)

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