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555-2
Gross & Fine Motor
| Term | Definition |
|---|---|
| neuromaturational theory | Development depends on CNS maturation Primitive to controlled Cephalo-caudal Proximal to distal Constant rate of development |
| neuromaturational model reasons for movement dysfunction | Lack of inhibition from higher centers Abnormal tone Abnormal postural reactions Abnormal patterns of movement |
| clinical applications for neuromaturational model | Head control Proximal to distal work Stability before mobility Hierarchy of typical skills- always going for the next level Assumption that motor skill transfers to other contexts |
| focus of intervention with neuromaturational model | Waiting for CNS to develop Child Impairment Assumption that fixing impairment will fix function Quality of movement as opposed to function |
| types of intervention with neuromaturational model | Neurodevelopmental treatment (NDT, Bobath) Rood Brunstrom Doman Delacato |
| dynamic systems theory | Spontaneous self organization of motor behavior from contributions of child, environment, and task Non-linear Movement for functional goal Period of transition |
| constraints and dynamic systems model | Movement dysfunction is caused by constraints of child, task, environment Child- cognitive Task- tools of task Environment- climate |
| clinical applications of dynamic systems model | Work in functional context Different motor solutions for diff contexts CNS is important but not the only factor for motor skills |
| focus of intervention for dynamic systems model | Child, task, environment Functional goal Identification & remediation of constraints Doesn't explicitly guide us if movement is compensatory or typical |
| types of intervention with dynamic systems model | Activity based Functional therapy Task oriented Context Ecological task analysis |
| neuronal group selection theory (NGST) | Similar to dynamic systems regarding transition, environmental influence, non-linear, importance of practice But emphasizes genetic influence & epigenetic mapping Motor skill variations are set by genome |
| primary vs. secondary variability | Baby can't select strategy that fits situation best vs. Baby selects most adaptive strategy through trial & error & sensory processing. Positive effect on neural development. |
| clinical applications with NGST | Baby needs opportunity to trial and error a variety of situations Hands on facilitation interferes with activity and motor learning Focus on function, not quality |
| intervention with NGST | Coping w/ & caring for infants w/ special needs Therapist as coach Hands off Provide opportunities for variation Acceptance of infant's mvmnt choices |
| primitive reflexes | Stimulus response mvmnt Born w/ primitive reflexes As CNS develops, cortex assumes control of mvmnt If reflex retained beyond normal age of integration or obligatory, we have pathology |
| palmar grasp (integration, stimulus, response) | Integrates at 4-7mo Stimulus: pressure on palm Response: flexion of fingers (grasp) |
| rooting (integration, stimulus, response) | Integrates at 3mo Stimulus: touch cheek or around mouth Response: turn head and lips to stimulus Functional purpose is feeding |
| asymmetrical tonic neck reflex (integration, stimulus, response) | Integrates at 4-5 mo Stimulus: turning of head Response: facial arm extends and occipital arm flexes & abducts |
| tonic labyrinthine reflex (integration, stimulus, response) | Integrates at 4 mo Stimulus: neck extension/ flexion Response: neck ext- ext of arms & legs; neck flex- flex arms & legs |
| symmetrical tonic neck reflex (emerge, integration, stimulus, response) | Emerges at 4-6 mo Integrates at 8-12 mo Stimulus: neck ext/ flex Response: neck ext- arms extend & hips flex; neck flex- arms flex & hips extend |
| roles of primitive reflexes | Get in proper position for birth (primary stepping & placing) Participate in birth process (+ve support) Practice mvmnts needed for survival (rooting, sucking swallowing) Early marker for normal development |
| current approach with reflexes | Primitive reflexes are reactions rather than reflexes May serve functional purpose for those with motor impairments May be controlled by more than just CNS maturation |
| key points with reflexes | Reflexes influenced by state of child Responses are variable within & across infants Reflex ax is small part of neuro ax- need to see posture, self initiated movement |
| head righting reactions | Optical righting- visual cues for head positions Labyrinthine righting- using equilibrium Body on head righting- sensory cues on the body |
| equilibrium reactions | Body attempting to maintain midline position & stay withing base of support Elongation of trunk of weight bearing side, rotating trunk, extremity mvmnt Prone (4mo)- Supine (6mo)- Sit(6-8mo)-Stand(10-12mo) |
| protective reactions of the arms | If CoG moved outside base of support, baby reaches out with arms In response to quick, unexpected movement Fwd(6mo) - Side(8mo) - Bwd(10mo) |
| components of Alberta Infant Motor Scale | 1. Sequence of appearance of mvmnt skills 2. Weight bearing/ shift 3. Core stability 4. Dissociation of mvmnt 5. Variability of mvmnt choices |
| sequence | Physiological flex- flex in trunk, extremities, 2wks Active ext- move against gravity, head up, ext arms, 3-4mo Active flex- supine 1st, using tummy muscles Rot- control ext & flex, roll/sit/stand/side-lying, start as unit then segments |
| weight bearing | 1st on upper body, then shifts down the body Give diff activities to see shifts in weight Baby can control- good equilibrium & weight shift Look for distribution, elongation on trunk, correcting unexpected weight shift |
| to have core stability, we need strength in | Trunk ext Trunk flex Trunk rotation Contributes to mature movement skills |
| when observing core stability, look for | Primary extension control Abdominal control Rotation in movement |
| dissociation of movement | Breaking up total patterns of mvmnt into finer, more selective patterns Parts of body move independently of other parts |
| variability of movement choices | Lots of choices Hallmark of typical gross motor development As babies get older, they have more movements |
| immature vs. mature movement patterns | Wide base, stable positions with little movements vs. Narrow base, mobility, trunk rotation, variety of movements |
| development in prone | Arms go flex to ext Legs flex to ext, to add Weight moves back Mobility emerges Variability of movement emerges |
| development in sitting | Wide to narrow base Arm support to no arm support Abdominal inactive to active (ext spine) Rotation Variety of leg positions while sitting |
| motor skill windows 1. head in midline 2. hands in midline 3. rolls prone to supine 4. established head control 5. sits alone 6. stand with support 7. hands to knees 8. hands to feet 9. ext arm support in prone | 1. 2mo 2. 4 mo 3. 3-5 mo 4. 4-5 mo 5. 5-9 mo 6. 5-8 mo 7. 3-5 mo 8. 4-6 mo 9. 6 mo |
| fine vs. gross motor control | Coordination of smaller movements for grasping, manipulating, and releasing objects vs. Coordination of larger body parts for running, jumping, throwing |
| OT role in motor development | Early detection Proper ax of specific motor skills & challenges Create tx plans to optimize performance & prevent severity of deformities Educate, coach, & support families |
| influences on fine motor skills | How we interact & explore environment Needs interaction btwn manual/ hand skills, posture, cognition, visual perception Visual-motor integration |
| categories of fine motor skills | Reach Grasp Carry Release In hand manipulation Bilateral hand use |
| reach vs. grasp | Movement of arm & hand to an object for purpose to contact object vs. Attainment of an object with the hand |
| development of reach 0-2 months vs. 3-4 months | Eyes observe & see objects, starting to swipe w/ shoulder movement & extended arms. vs. Midline orientation & recognition of 2 hands, wants to look at hands out in front. Babies are aware of their hands. |
| development of reach 1. 4-5 months 2. 6-8 months 3. 10-12+ months | 1. Symmetrical reach on back or supported sitting, may grab with overexaggerated fingers 2. Unilateral reach, dissociation of 2 sides, accurate grasp 3. Mature reach w/ more motor control & trunk stability, increased accuracy, precision & timing |
| prehension | First seen at 4 months Coordination of motor & visual Pattern made while hand moves to target Motivated movements create better learning |
| grasp determined by | Where items is grasped from Object properties What item will be used for How effective grasp is |
| sequential development of typical grasp | Proximal to distal Ulnar to palmar to radial Palmar contact to finger surface contact to finger pad contact Pronated to supinated Wrist flex to ext Small item raking to pinch |
| development of grasp 1. 0-3 months 2. 3-5 months 3. 5-6 months | 1. Reflexive, no active, items passively held 2. Reduced reflex, active emerges, ulnar- palmer grasp 3. Less change noted, progress to palmar grasp, baby feeds self |
| passive vs. active grasp | Item put in hand, its able to continue holding item. Can be used to an advantage. vs. Voluntarily able to wrap hand around object. |
| impact of gross motor development on fine motor | ~6 months Weight bearing through arms develops proximal UE muscles Flexors & open web space stretched due to opened on floor |
| development of grasp 6-9 months vs. 9-12 months | Thumb included, participate in self care, grasp large object from radial-palmar to radial digital. Pinch w/ small object, raking vs. Refinement of thumb & finger, more webspace open, pincer & tripod grasps mainly for pinch. More power in grasp |
| types of mature grasps | Power- spherical, cylindrical, disc Hook Lateral pinch Tip to tip or pincer Tripod pinch |
| Pencil grasps 1. palmer supinate 2. digital pronate 3. immature static tripod 4. developing tripod | 1. 12-18mo, lots of shoulder & elbow 2. 2-3yr, still in palm, little wrist movement 3. 3-4yr, shoulder & wrist mvmnt, minimal finger movement 4. 4+ years, similar to typical grip |
| correcting pencil grasps | Take note If there is problems with legibility, pressure, orientation, fatigue then you can correct Find out why it occurs |
| carry vs. release | Transporting handheld object from one place to another vs. Intentionally letting go of handheld item at specific time & place |
| development of release 1. 0-3 months 2. 4-6 months 3. 6-9 months | 1. No voluntary release, may drop or be pulled out 2. Volitionally hold & transfer objects btwn hands, clumsy 3. Refined release with goal to bring items to mouth, poor target accuracy |
| development of release 1. 9 months 2. 12 months 3. ~3-4 years | 1. Voluntary release with arm extended, better target accuracy 2. Stable wrist but still excessive finger extension, visuospatially engaging in other play 3. Refined & controlled finger mvmnt, Increased perception, cognition, sensory skills. |
| requirements for in hand movements | Increased supination Wrist stability Isolated finger movements Opposition Dissociated ulnar & radial Control of transverse hand arch |
| types of in-hand manipulation patterns | Finger to palm Palm to finger Shift- move btwn fingers Simple & complex rotation In hand manipulation w/ stabilization- part of hand is stable while moving |
| development of bilateral hand skills 1. 3-9 months 2. 9-10 months 3. 10-18 months | 1. Hands work symmetrically 2. Both hands hold items and bang together 3. One hand grasping object while the other manipulates |
| development of bilateral hand skills 1. 17-18 months 2. 18 months- 3 years 3. 3-4 years | 1. Hands used simultaneously, each for different functions 2. Learning simultaneous hand manipulation; depends on continued cognitive, perceptual, motor development 3. Hand preference confirmed |
| purpose of milestone charts | Understand developmental sequence & progression helps us be more effective Helps us better understand delays & where to target intervention Helps understand next step, regardless of any age |
| informal motor ax | Observation during specific tasks Interactions with caregivers Interviews & reports Virtual visit Pre session questionnaire |
| remedial vs. adaptive tx | For really young & plastic brains vs. Better for degenerative populations |
| delayed motor approaches | Environmental enrichment Developmental care Motor training Early childhood education |
| non-degenerative motor approaches | Task specific & high intensity training Environmental enrichment AT & adaptive equipment |
| degenerative motor approaches | AT & adaptive technology Pain and deformity management Gene therapies |
| key treatment concepts | Active, patient initiated Task specific practice is optimal High intensity has best outcomes Just right challenge Embed into daily routines Discuss AT early |
Created by:
craftycats_
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