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What is cephalocaudal principle?
develop occurring from top down, head to tail.
Head develops first then to end of spine
fundamental principles governing pre & post natal
What is proximodistal principle?
development from near to far (center outwards).
Ex. Core strengthening first. Head and trunk come before arms.
fundamental principles governing pre & post natal
What are six general principles of motor development?
1. cephalocaudal principle
2. proximodistal principle
3. Unrefined movements moving towards refined movements
4. Stability to controlled mobility:
5. Spiraling manner
6. Sensitive periods
What is Stability to controlled mobility?
a baby sits by themselves (stable) & then they try to reach something and not fall over (controlled mobility)
What is Spiraling manner?
periods of equilibrium (everything is constant) and disequilibrium (a lot of change and growth)
What is Sensitive periods?
while developing give them more environmental stimulation. Make the baby try to do something, engage them in these skills.
Touch: specific localization
= 12-16 months. Pay attention to and look at areas where they have been touched. May not recognize themselves in the mirror
Infants: Smell & Taste (2)
1. prefer sweet. Have full smell at birth. They can identify mom by smell
Infants: Vision (5)
1. least developed at birth because the retina is still incomplete.
2. Optic nerve is not yet fully functioning at birth.
3. 20/600 to 20/1200 vision at birth. 20/20 vision is at 6 months.
4. First month seeing in black & white, because cones are developed.
5. Red is first color to identify, then green (complimentary color to red). If boys are not attracted to the colors then maybe color blind. 3month start to see blue, end of 3rd month then sees yellow.
Infants: Pattern perception
= infants love patterns, attracted to B&W patterns (ex. Newspaper). They like: Light dark transitions, contours, they focus on where the division is (where is changes), complex pattern (checkerboard), moving objects (mobiles)
Motor development: 1 month (6)
1. ↓ flexion
2. tracks a moving object (hold close, can't see)
3. head usually to side (weak neck muscles)
4. hand fisting indwelling thumb most of the time
5. reciprocal & symmetrical kicking
6. alert, brightening expression
Motor development: 4 months (4)
1. rolls from back to side, stomach to side (1/2 roll)
2. sits with support
3. no head lag in pull to sit (head goes along w/trunk)
4. laughs out loud
Motor development: 7 months (6)
1. can maintain 4-point (hands & knees)
2. pivots on belly
3. assumes sitting from 4-point
4. trunk rotation in sitting
5. recognized tone of voice
6. may show fear of strangers
Prehension development: Grasp of raisin (4)
1. whole hand contact (28 weeks)
2. scissors grasp (36 weeks)
3. index finger approach (40 weeks)
4. Neat pincer grasp (52 weeks)
What are four survival reflexes?
1. breathing reflex
2. eye-blink reflex
3. pupillary reflex
4. swallowing reflex
what is babinski reflex?
1. fanning and then curling toes when bottom of foot is stroked. (foot goes in & leg goes up and out)
2. if seen in adult then BIG problem
what is puberty? (3)
- a period of rapid physical growth & sexual maturation.
- the sequence of physical changes is universal, but the timing varies (typically lasting 3-5 years)
- age of onset ranges between 8-15 years
What is menarche?
- the term for a girl's first period.
- it signals that ovulation has begun (although it is often irregular for a few years)
What is spermarche?
the term for a boy's first ejaculation, which signals sperm production has begun
1. puberty begins with a signal from the hypothalamus to the pituitary gland to the adrenal glands (HPA axis) and gonads
2. Gonad release testosterone & estradiol
3. influence MOOD & THOUGHT
1. genital development
3. voice changes
4. important in sex drive in both men & women
What does the hypothalamus regulate? (6)
6. aggressive behavior
What are primary sex characteristics?
the parts of the body directly involved in reproduction
Ex. testicles, ovaries
what are secondary sex characteristics?
- not necessary for reproduction
- Ex. odor, acne, breast development, hair, voice changes
Early maturing girls are a higher risk of four things?
2. early sexual activity
3. eating disorders
4. early substance abuse
Early maturing boys are a higher risk of three things?
2. breaking the law
3. stress and depression from relationships = once all other boys catch up they are no longer the "it" boy
Late maturation (2)
1. may be difficult for boys in a school in which athletics is valued
2. girls may feel anxiety about when puberty will hit
Bigger and stronger: what is a growth spurt?
growth spurt is a sudden & rapid period of physical growth during puberty
Other physical changes (2)
1. lymphoid system (tonsils, adenoids) decrease in size. this makes teens less susceptible to asthma & colds
2. skin gets oilier, sweatier, more acne-prone
Body rhythms (2)
1. teenagers prefer to stay up late & sleep in
2. teens get too little sleep for their growing bodies -> risk of mood disorders & driving problems
Anorexia: binge-eating/purging type - 3 charactertistics
1. frequent episodes of binge eating & purging
2. marked by severe weight reduction
3. alternate btw period of rigid control & impulsive behavior
Four diagnostic features of anorexia nervosa
1. refusal to maintain weight beyond minimal normal weight. a weight at least 15% below normal
2. strong fear of putting on weight, or becoming fat despite being very thin
3. distorted body image, perceived as fat though others think they are thin
4. absence of 3 or more periods
Seven medical complications of anorexia
1. weight loss of 35% of total, may develop anemia
2. dermatological = dry, cracking skin, yellowish & lanugo
3. cardiovascular = irregularities, hypotension, dizziness upon standing, blackout
4. gastro = constipation, abdominal pain, obstruction of bowels
6. muscle weakness, abnormal bone growth
Four warning signs of anorexia
1. secret dieting
2. dissatisfaction after losing weight
3. setting new lower goals
4. excessive exercising
What are five characteristics of bulimia?
1. obsession w/weight loss & body shape
2. don't become abnormally thin
3. overwhelmed with feelings of shame, self-contempt & depression over eating habits
4. low self-esteem
5. history of wide weight fluctuations, dieting & frequent exercise
Four diagnostic features of bulimia
1. recurrent episode of binge eating = eating unusual high quantity of food in 1-2 hours and feel sense of loss of control of the food intake during this episode
2. regular behavior to prevent weight gain = vomiting, laxatives, diuretics, enemas, fasting, excessive exercise
3. minimum 2 binges episodes per week & inappropriate behavior over at least 3 months
4. concern about the shape & weight of ones body
Nine medical complication of bulimia
1. no period
2. potassium deficiency = muscle weakness/cramping, cardiac irregularities, sudden death
3. irritation of skin around the mouth
4. tooth decay
6. blockage of salivary glands
7. damage taste receptors (especially on tongue)
8. abdominal pain & hiatal hernia
what are six causes of obesity?
1. decreased activity
2. poor eating habits
4. faulty metabolism
5. genetically abnormally large fat cells
6. problem with hypothalamus = don't know when you are full
nine physical complications of obesity
1. heart disease
2. organ failure
3. sleep apnea
4. bone fractures
5. pressure ulcers
6. back problems (lower)
7. joint problems (hips, knees)
9. type 2 DM
four psychological complications of obesity
2. OCD with food
four clinical approaches to obesity
1. nutritional counseling
2. exercise program
3. identify behaviors that reinforce food consumption
4. family support & counseling
Late Adulthood: Musculoskeletal changes (7)
1. loss of muscle strength: peak is age 30. In non-exercising adults by time you are 65 you can lose 20-45% of your strength. Exercise = walking, swimming
2. lose skeletal muscle mass
3. change in muscular endurance: more likely to fatigue out
4. change in cartilage: decrease in water content, wearing away of cartilage → stiffness (hips & knees)
5. lose some height in the disk in the back
6. loss of bone mass & density: peak is age 40. Women can lose 25% of bone mass by the time they are 70
7. flattening effect of the spine
Late Adulthood: Senile postural changes (5)
1. forward head placement: can impact feeding, sleeping
2. kyphosis of the thoracic spine (hunch over/top of the back)
3. flattening out the lumbar spine
4. knee and/or hip flexion contracture: get people up and moving
5. Clinical implications:
a. movements slower
b. decreased trunk rotation
c. head rotation limited
d. balance is off (cane, walker)
Late Adulthood: sensory deprivation
= loss of sense: doesn't go out, loss of ____________(55:00), senility, strain on social interactions (may not want to go out), run the risk of injury.
Late Adulthood: Vision Pathology (9)
1. presbyopia = can't focus on objects, blurring of images, because lens loses elasticity (need reading glasses)
2. light/dark adaptation
3. increased sensitivity to bright light and glare
4. loss of color discrimination: cones start to weaken. Especially blues & greens
5. decreased in pupillary reflex
8. Senile macular degeneration
9. Diabetic retinopathy
Late Adulthood: cataracts
clouding of the lens due to changes in proteins around the lens. It will cause loss of vision. Lose central vision first, then peripheral. Problem with glare, it is a general darkening of vision
Late Adulthood: glaucoma
increase in intraocular pressure in the eye. If high pressure continues causes problems with optic nerve. Lose peripheral vision first (seeing thru tunnel). Can lead to blindness
Late Adulthood: Senile macular degeneration
decreased blood supply to the retina. Lose central vision first, then peripheral, then blindness
Late Adulthood: Diabetic retinopathy
- damage to retinal capillaries.
- Abnormal growth of blood vessels. (kind of like weeds in a garden).
- Late stage diabetes.
- Retinal scarring, retinal detachment.
- Loss of central vision.
- Blindness is rare, they have peripheral vision.
Late Adulthood: Hearing (5)
1. changes can occur as early as your 40's. men lose hearing at twice the rate of women and earlier than women.
2. Wax build up in external canal
3. Middle ear have minimal changes
4. Tympanic membrane (eardrum): tearing (hearing aids may not work)
5. Inner ear: atrophy of the cochlea → affects your balance, sound sensitivity, problems understanding speech. Older adults more prone to inner infections: nausea, balance, don't drive.
Late Adulthood: Somatic sensory system (touch) (6)
1. decrease touch sense
2. proprioceptive losses = loss of receptors in your joints → Kinesthetic sense (being able to tell where you are in space)
3. cutaneous skin changes = pain receptors & ability to tell hot and cold decreases with age
4. taste decreases → poor diet, poor nutrition. Compensate with too much sugar and too much salt
5. smell decreases → safety concern (smoke detectors, gas leaks)
6. Taste & smell decreases losses causes: smoking, dentures, allergies, ______1:29
Late Adulthood: Integumentary system (6)
1. dermis starts to thin, loses elastin → wrinkling, thinning of the skin
2. easily bruising (senile purpura)
3. yellowing, dark spots
4. hair thins & grays
5. nails grow slower and become more brittle. Many can't reach toe nails to cut them (call podiatry)
6. decreased sweat production because decreased sweat glands. Can't regulate temperature so they are cold, wear lots of clothes in hot weather → dehydration
Late Adulthood: gastrointestinal changes (7)
1. decreased salivary glands = hard to taste foods
2. poor swallow reflex
3. acid reflux (heartburn)
4. hiatal hernia
6. constipation = use warm prune juice
7. intestinal movement slows down
Late Adulthood: renal/urogenital (4)
1. prostate enlargement → uti → bladder infection (Flomax for enlarged prostate)
2. UTI can kill an older person
3. Women: problem with bladder → weakness, incontinence, decrease capacity to hold urine, frequency
4. Urinary incontinence =10million adults & 50% of nursing home residents. 1/3 of people living at home. Pelvic floor weakness if you had a lot of kids.
Late Adulthood: Osteoporosis (7)
= reduction of bone mass & failure of bone to form.
1. Affects 20 million & 80% are women
2. 1/3 of all orthopedic problems are related to osteoporosis.
3. Common affected areas: Vertebral column/back, femoral neck (problems & fractures), humorous, distal radial & ulnar (wrist fractures)
4. Causes: hormonal deficiencies (estrogen), nutritional deficiencies (Ca), drinking large amounts of caffeine, alcohol (impairs absorption of Ca), decreased physical activity
5. Medication causes bone loss: chemotherapy, thyroid medications, seizure medications, corticoid steroids (erodes the joints).
6. Diseases that cause bone loss: diabetes, liver disease, certain cancers, hyperthyroidism
Late Adulthood: Fractures (6)
1. older individual more prone due to co-morbidity (more than 1 disease process)
3. psychotropic medications
4. Hip fracture = the one to be most concerned with. Mobilize right away. Rate of fracture doubled after 90. One third of all women over 90 will have hip fractures. 50% will not return back to normal life style. Issues of dependency arise.
5. T8-L3 = common fractures. Compression fracture just coming off chair if osteoporosis is really bad.
6. Stress fractures = pelvis & feet
Late Adulthood: Degenerative arthritis (3)
1. affects joints → hips, knees, fingers, spine
2. 16 million Americans
3. Osteoarthritis = pain and stiffness, worse in early morning, worse when overuse. More prone to muscle spasms, loss of range of motion, mobility issues, muscle weakness secondary to less use Ex. Knee gets really big
Late Adulthood: Parkinson's disease (6)
1. 1.5 million, 50,000 new cases each year
2. 59-62 years when first see symptoms
3. chronic, progressive disease of the nervous system
4. lack of dopamine. Losing dopamine in the substantia nigra (midbrain). Neurons not producing dopamine.
5. Medications = L-DOPA to help remaining neurons produce dopamine & to retain long enough to remain in synaptic cleft.
6. Develop: rigidity in movement, resting tremor, postural reflexes becomes weakened, problems initiating movements, freezing episodes, flexed forward posturing, shuffling gait, lose arm swing, problems with speech, eating problems (usually end up with feeding tube)
Late Adulthood: decubitus ulcers (pressure ulcers) (2)
1. Risk factors: immobility, sensory impairments, cognitive deficits, decreased circulation, poor nutritional status, incontinence
2. Common over bony areas: sacral area, heels, shoulders, knees (two knees pressing together), elbows, back of the head
Late Adulthood: Immobility-disability (3)
1. limitations increase with age
2. after age 65 23% of people have problems with ADLs (food, dressing, bathroom, bathing)\
3. 27% people difficulties with managing things around the house (cleaning, laundry, etc.)
Late Adulthood: Falls-instability (3)
1. increased caution & fear of falling → reduced motivation to move/activity
2. lose confidence if they have fallen before
3. watch for increased risk of more falls
Late Adulthood: Medications (2)
1. 10-15 medications on average
2. problems: not taking medications properly (poor interaction, drug overdose), watch when they are taking medications (BP, drowsy), drug toxicity
Late Adulthood: Nutrition (8)
1. many under-nourished = can't get to the grocery store
2. poverty = fixed incomes, what to spend their money on? food or medications.
3. Some lose interest in food
4. Improperly fitting dentures
5. Taste & smell decrease
6. Eating by yourself so they don't eat (especially when spouse dies)
7. Lack of mobility
8. Arthritis is so bad because they can't cut.
what is cognitive development?
Developing the activity of knowing & the processes through which knowledge is acquired and problems are solved.
what are Piagets four stages?
I. Sensorimotor stage
II. Preoperational stage
III. Concrete operational
IV. Formal operational
What is Sensorimotor stage?
= 0-2 years.
- Infants experience the world thru their senses and their motor movement. Ex. Taste, smell, sight.
- They get object permanence = they recognize that an object still exists even when out of sight.
- Infantile amnesia = don't have concrete memories for the first two years of life.
What is Preoperational stage?
2-7 years. It is defined by 3 things kids cannot do =
1. Cannot think backwards
2. Cannot split their attention, they have centered thought. (Ex. Won't stop to pee)
3. They cannot do conservation tasks (ex. Different sizes of glasses of water & they go for the one that looks bigger. One dollar coin vs. four quarters).
They do imaginary or pretend play.
What is Concrete operational?
= 7-11 years. They can think backward, they have decentered thought/they can split their attention, they can do conservation tasks. They begin to understand math concepts. They begin to understand the difference between fantasy & reality.
What is Formal operational?
= 12 year →adulthood. Mature adult thinking, which is primarily based in frontal lobe (decision making is done in the frontal lobe). You can think hypothetically, abstract concepts, inductive (specific facts to general conclusions or theories. Ex. Darwin or Einstein) and deductive (from general ideas to specific facts) reasoning, understand concepts of past, present & future, understand what is in the realm of possible and what is impossible and that the realm can change.
What is post formal thought? (2)
= (Shaie) defined by two characteristics (things younger people cannot do.
2. Relavistic thinking
What is metacognition?
= thinking about ones own thinking. Thinking about thinking. Analyze your own thoughts.
What is relavistic thinking?
= understanding that knowledge depends on the subjective perspective of the knower (the knowledge you acquire) = through your experience and observation adds to your knowledge base. (Ex. Ankle fracture throws a pulmonary embolism)
Immature characteristics of adolescent: Idealism & criticalness
= teens have an ideal vision of the world & when it falls short of expectations they hold their parents responsible. Find fault with their parents.
Immature characteristics of adolescent: Argumentativeness
= ***not necessarily bad. Stems from the development of their reasoning skills.
Immature characteristics of adolescent: Apparent hypocrisy
= sometimes don't recognize the difference between expressing an ideal or a desire and then making the sacrifices necessary to live up to it.
Immature characteristics of adolescent: Self-consciousness
= they assume that whatever they are thinking everyone is thinking the same thing. It is called the imaginary audience. (Ex. Everyone is looking at the zit on their nose)
Immature characteristics of adolescent: Specialness and invulnerability
= Personal fable → their belief that they are special, their experience is unique, and they are not subject to the rules that govern the rest the world.
Who is Lev Vygotsky?
= cognitive growth occurs in a sociocultural context. In order for a child to grow they have to have social interactions. Occurs differently from society to society. ***What are the mental tools & cultural values that are passed on. In order to pass these on you need to have someone with experience (parents, teachers, religious leaders). These people develop the internal cognitive dialogue of the individual.
What is Social speech?
= the beginning of development. It is speech with others that guides the child's behavior & knowledge base. (ex. Verbally directly how to put a puzzle together)
What is Private speech?
= speech to oneself that guides ones thoughts and behavior. (ex. Do puzzle by themselves and the think how to do it)
What is Zone of proximal development?
= range of tasks that are difficult for an individual to master alone but can be mastered with guidance & assistance from adults or skilled peers. Ex. How to study.
Contemporary concepts: Scaffolding
= change the level of support over the course of the teaching session
Contemporary concepts: Cooperative learning
= small groups working together to get something done. The group gets the reward
What is Delirium?
- temporary confusion and a loss of mental function. - You can reverse delirium. If it stays around for a long period of time it can lead to dementia.
- Acute onset often happens at night, worst at night, easily distractible, periods of agitation and hallucinations, talking but doesn't make sense (disorganized speech), sleep wake cycles are messed up.
Four causes of delirium?
1. Drug toxicity
2. Post anesthesia = memory loss, confusion
3. Oxygen deprivation to the brain
4. Environmental changes = not in their home environment
What are six cause of dementia?
1. Some drugs → sedatives, anti-anxiety medications, anti-depressants, BP meds, anti-convulsants
2. Nutrition disorders =Korsakoff's syndrome is seen in chronic alcoholics. They do not eat because they feel full from the alcohol. For healthy brains you need thymine and alcoholics don't get the thymine. Anterograde amnesia is what they will get = remember their past but no memory for new information.
3. Metabolic disorders
4. Chronic hypoglycemic
5. Kidney or liver failure
6. Certain cancers
When does sun downing occur?
Sun downing happens with dementia = later afternoon, hard to refocus them.
****What three things kills young people (physical development)?
1. Accidental injuries leading death (car accidents, drowning)
What is the orthogenetic principle?
development starts globally & undifferentiated & moves towards increasing differentiation.
ex. start as a cell and end up as an organ
what is primary circular reactions?
- repetition of interesting acts centered on own body
ex. sucking thumb, kicking legs
what is secondary circular reactions?
- repetition of interesting acts on objects
ex. shake rattle
what is coordination of secondary schemes?
- combination of actions to solve simple problems
ex. bat aside a barrier to get at an object
what is tertiary circular reactions?
- experimentation to find new ways to solve problems or produce interesting outcomes
ex. explore bathwater in different ways
what is assimilation?
interpret new experiences in terms of existing schemes or cognitive structures
ex. see an animal that looks like a dog so it must be
what is accommodation?
modifying existing schemes to better fit a new experience
- "it's not a cat, so mom must be right, its a skunk"
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