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Pediatrics: Motor Control, Postural Control, and Theories
Terms in this set (59)
What systems interact to achieve postural control?
Sensory, motor, and musculoskeletal system
What are the three inputs of the sensory system?
Visual, somatosensory (proprioception), and vestibular
Which of the three sensory inputs is the most powerful in regulating posture in a developing child?
Vision (used for anticipatory postural strategies and feedback correction)
What is the function of somatosensory input?
Takes input related to body position to trigger appropriate postural activity for the task; Tactile and pressure input may also play a role
What is the function of vestibular input?
Relates to head position and control; Dynamic co-contraction to stabilize the body; Midline awareness to stabilize the body in midline
T/F: Somatosensory and vestibular input often work together to gain postural control.
T; Head and trunk move together during functional tasks
How does the sensory system differ in children with Down Syndrome and general cognitive delays?
Over reliance on the visual system beyond when children usually shift to somatosensory or vestibular input
How does the sensory system differ in children with developmental coordination disorders?
Difficulty processing proprioceptive, tackle, and vestibular inputs
What is the progress in children learning to balance in sitting or standing?
Period of instability to period of constraining DOF to period of releasing DOF
When do children begin to select a postural strategy for reactive postural control?
By 13-14 months (e.g. stepping, squatting, or reaching)
T/F: Limit the amount of movements children explore to develop postural control.
F; Exploring different movements helps acquire a motor repertoire for solving more challenging tasks later
Describe the reactive postural control in children with Down Syndrome and CP.
-Down Syndrome = Delayed response and not quick enough to regain balance
-CP = Delayed muscle response and disordered muscle activations during sitting perturbations (all-or-none)
How is anticipatory postural control improved?
Experience in movement
Describe the anticipatory postural control in children with disabilities.
-Impaired feed-forward strategies
-Difficulty choosing appropriate anticipatory strategies
-Easily lose balance
What are biomechanical variables that should be considered in a growing child?
COM is higher on the body during the first year of life and COP along the AP axis of the foot is more posterior at younger ages (<6)
Which developmental theory is defined by the integration of primitive reflexes?
Which developmental theory involves concepts of Piaget and Pavlov?
Cognitive/learning (Piaget focuses on thinking developing in stages of increasing complexity and Pavlov focuses on classical and operant conditioning)
Movement emerges from an interaction of the child's internal system, task, and environment in which developmental theory?
Which developmental theory is commonly used today?
Dynamic systems as approaches are organized around goal directed and functional tasks
What are considerations when utilizing development theories to structure intervention?
-Child and family goals should be determined first
-Sequence of motor skills can vary
-Motor milestones develop in overlapping sequences
T/F: It is more important to focus on the sequence of development than what a child needs to be functional.
F; Functional needs should be determined based on the age of the child and extent of disability
In what direction do motor skills typically develop in?
Cephalocaudal and proximodistal
T/F: In regards to motor development, body parts cannot develop at the same time.
What milestones need to be met to develop mature motor skills?
Postural control, strength, and perception
What is the difference between unstable and stable movement patterns?
Unstable movement patterns are present when a child learns a new skill and are effortful and exaggerated; Stable movement patterns are effortless and smooth and a child has chosen an efficient strategy
T/F: Regression of motor skills is abnormal.
F; Regression of motor skills is normal and transient as a newer and less stable movement pattern is emerging and superseding the more stable pattern
When is the "sensitive period" of development in which the brain is neuroplastic?
Birth to 3 years
T/F: The order of critical periods of plasticity from earliest to latest is sensory, motor/language, and higher cognition.
How do "sensitive periods" of development affect intensity and timing of interventions?
Greater intensity and frequency during "sensitive periods" can be beneficial for motor control and learning
T/F: Children with disabilities may struggle with self-driven, self-initiated motivation to move.
T; Children with disabilities may present with low cognition, lack of motivation to explore, and limited patterns of movement available
Which theory of neuronal group selection results in a primary repertoire of infant behavior and eventually pruning?
"If you don't use it, you lose it"
Which theory of neuronal group selection results in experience dependent neural maturation?
"Neurons that fire together, wire together"; Synaptic connections are selectively strengthened based on individual sensory, motor, and social experiences
Which theory of neuronal group selection explains the uniqueness in neural structure and function among children?
"Neurons that fire together, wire together"
What are the implications of a child who has a large and variable repertoire of movement patterns?
Variable pathways that will lead to improved adaptability to respond to changes in task demands or to novel tasks
How is the theory of neuronal group selection applied to children with developmental impairments?
Children with developmental impairments often have stereotypical, invariable movement patterns that lead to poorly differentiated neural maps and they will likely struggle with adaptability to respond to changes in task demands or to novel tasks
What is perceptual-cognitive development?
Process of taking in, organizing, and interpreting information about objects, one's own movements, and one's surroundings
T/F: Age drives perceptual-cognitive development.
F; Experience drives perceptual-cognitive development
What might a child do when gaining information about an object?
-Looks at it, mouth it, and take it out again
-Pat, push, mount, and squeeze play doh
-Explore pegboard holes with fingers then look for other things to fit the holes
What might a child do when gaining information about his/her movement?
-Walk slowly and carefully when carrying an open cup of milk
-Handle fragile things carefully
What might a child do when gaining information about his/her environment?
-Stop crawling when the edge is reached
-Walk slow on rocks and fast on pavement
-Sit on his/her bottom and slide down a steep hill than walk down it
What is a limiting factor to developing perceptual-cognitive skills?
Motor development because a child should be able to explore his/her surroundings
What are considerations for effective treatment planning?
-Facilitate self-initiated exploration by finding what motivates the child
-Promote cognitive/intellectual development
-Facilitate problem solving scenarios
-Recognize "sensitive periods"
What are the four variables important to acquisition of gross motor skills?
Sensorimotor, mechanical, cognitive, and task
What is perceptual motor integration ?
CNS ability to process sensory input and form an organized motor response; Good perceptual motor integration incorporates visual sense, proprioceptive sense, spatial sense, and vestibular sense
What mechanical variables affect motor control?
-Child's total body mass
-Distribution of child's mass (e.g. large head or large abdominal girth)
-Viscoelastic properties of the child's musculoskeletal
What cognitive variables affect motor control?
-Level of alertness
What task variables affect motor control?
-Complexity of the task
-Requirements of the task
-Meaningfulness of the task to the child
What action should be taken when a child is struggling with a certain task?
Figure out which variable that affects motor control the child is struggling with and modify the variable
What is the difference between adults and children with disabilities?
Children are rarely trying to regain function and learning needs to occur in the context of development
What is the difference between the initial and later stages of motor learning according to Gentiles?
Initial stage has a motor pattern that receives a reasonable amount of success, but the pattern is unrefined and inefficient; whereas the later stage has a motor pattern that is adaptable, successful, and energy efficient
What are strategies to facilitate motor learning?
-Generalize to home setting
-Demonstrate the task/activity
-Verbally describe the task/activity
-Practice variability in the task/activity and environment
-Give the child feedback on their performance (i.e. fading technique)
What are strategies to implement when a task is too hard for a child?
-Breakdown the task
-Give the child more support
-Give the child a mechanical advantage
-Reduce the speed the task is performed to allow more attention to the movement pattern
T/F: Integrating a play activity to a task will enhance motor learning.
T; Goal should be for the child to enjoy the activity to increase repetition and to increase motor learning
What are characteristics of children that need little to no reinforcement?
Cooperative, high level cognition and language, old age, no pain, easy task, and well rested and fed
What are characteristics of children that need a lot of reinforcement?
Highly distracted, low level cognition, very young age, significant pain, difficult task, sick, tired, and hungry
What are strategies commonly used to manage behaviors and motivation during PT sessions?
-Positive reinforcement = Add or incorporate things that will encourage behavior, cooperation, and effort from the child (e.g. give specific praise, earn stickers, earn free play)
-Negative reinforcement = Take away something to bring about the desired behavior (e.g. ignore acting out behavior, have the parents step out, treat in a private room, redirect/distract the child)
T/F: Strategies used to deal with tantrums during therapy are used for children with and without intellectual disabilities.
What are "negative" strategies that should be avoided during therapy?
-Repeating "no," "stop," and "don't" commands
-Raising voice or losing temper when a child acts out
-Commenting to other staff about negative behaviors
-Do not ignore dangerous behavior
What are strategies that can be used to address severe behavioral issues?
-Refer to OT
-Apply team based approach
-If in the school district, involve therapeutic support staff (TSS) or establish behavior plans as part of IEP
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