PEDS 1

head to tail

– trunk before extremities

– simple to complex tasks ( gross motor to fine motor)

functional behavior appears as the nervous system matures, with more complex behaviors being based on the activity of progressively higher levels of the nervous system. This theory depends on the hierarchic maturation of neural control structures. In other words, your development becomes more mature as you get more cortical control.

experience shapes behavior. Progressions in development depend on opportunities and circumstances inherent in the individual's makeup and in his or her past and present physical and social environments. You learn your activities as you are exposed to them and refine with repetition.

emphasizes process rather than product. The environment is as important as the organism

developmental theories continue to be ever changing. Most developmental therapists take from all the theories and believe that CNS maturation as well as environment form and mold normal development

evolves from a complex set of neurologic and mechanical processes that govern posture and movement, the initiation, execution and control of movement.

movements learned through interaction and exploration of the environment; i.e. sit to stand contains >1 motor plan

uses sensory information about movement to guide and shape its development. It is a set of commands that when initiated results in the production of a coordinated movement sequence; arm bending.

combine several motor programs into an action strategy where subprograms are smaller subroutines of coordinated muscle action; multiple motor programs such as throwing a ball

stores the programs and subprograms and allows for repeat performance; a pitcher throwing a ball the same every time.

Reflex patterns that predominates our movement early in life; they are genetically predetermined movement responses to a stimuli. Primitive reflexes are essential in normal development. Responses to and integration of these reflexes prepares the child for progressive development. Primitive reflexes normally integrate at an early age, but can be apparent in some adults under special circumstances. (stress, fatigue, CNS damage)

predominance of primitive spinal and brainstem reflexes with motor development of a prone or supine creature.

predominance of midbrain development, with righting reactions and motor development of a child who can right self, turn over, assume crawling and sitting.

cortical levels of development revealing equilibrium reactions with motor development of a child who can stand and walk

organize sensory information and elaborates the overall motor plan.

shapes and defines the specific motor programs and initiates the commands

executes the commands and translates into final muscle actions.

This hierarchy is flexible and proceeds through numerous feedback loops. It is believed that the levels of the CNS are used depending on the difficulty of the task; ie may use all levels for harder skills like picking up a bug or only lowest levels like reflex testing.

primary function is
inhibition
+ protective
extension
Trunkal equilibrum

Righting reactions
Body on body
Neck on body

+ATNR
+STNR
+TLS
+TLP

Crossed extension
Flexor withdrawl
+Babinski
+Moro
+Startle

stimulation at corner of the mouth, mouth and tongue and head will turn toward stimulus. Precursor to head control.

If persists: can interfere with suck.

28 weeks gestation to 3 months

. place finger at lips, lip closure with rhythmic suck and swallow. Child needs this for sensory input and nourishment.

If persists:interferes with normal tongue movements which will later cause speech problems.

28 weeks gestation to 2-5 months

drop head back slightly while holding the baby in sitting, arms will extend and abduct, then flex and adduct. Allows breakup of flexion.

If persists:problems with head control and sitting

28 weeks gestation to 5-6 months

pull up on baby’s forearms, baby will pull back in flexion

If persists: delays reach and grasp.

28 weeks gestations to 2-5 months

hold one LE in extension, apply a noxious stimulus to ball of the foot. The contralateral leg will flex, then adduct and extend

If persists: child will exhibit decreased reciprocal LE movement endangering independent gt.

28 weeks gestation to 1-2 months

noxious stimulus to sole of the foot, total flexion of the LE.

If persists: delay in ability to stand.

28 weeks gestation to 1-2 months

. press thumb into ball of the foot, the toes will grasp around it

If persists: toe clawing (inability to stand flat), decreased balance, decreased gt ability.

28 weeks gestation to 9 months

child in prone, stroke along paravertebral line from the 12th rib to the iliac crest; incurving of trunk towards the stimulated side.

If persists: may cause delay of symmetrical trunk stability and difficulty with sitting, standing and walking.

32 weeks gestation to 2 months

contact stimulation into baby’s palm from ulnar side. Baby will grab onto stimulus.

If persists: difficulty in reaching for and grasping objects, once grasped, will have difficulty releasing and weight bearing on an open hand

Birth to 4-6 months

reaction to a sudden noise (loud and harsh) will produce extension and abduction of arms and a cry.

Should persists: but if hyperactive will affect balance.

Birth to persists

Brush dorsum of the baby’s hand against edge of the table, stretch reflex will cause baby to extend and "place" hand on table usually fisted

If persists: brushing dorsum of hand will cause automatic wrist extension, affecting grasp

Birth to 2 months

Stimulate bottom of foot with a fingernail or handle of reflex hammer on the lateral border from the heel to the ball of the foot then go across the ball of the foot in one motion. A positive response will result in fanning of the toes with dorsiflexion of the great toe.

If persists: delay in ability to stand and gait

newborns should show a positive babinski for the first few days of life, then it should become negative.

hold the baby vertically, lower to the surface and incline and move forward. The baby will automatically "walk" with good coordination and rhythm

37 weeks to 2 months

these are "static" postural reflexes and responses that effect a change in the distribution of muscle tone throughout the body, either in response to a change in position in space, or a change in head position to the body.

Hold the baby vertically and lower to a surface. LE will extend and take weight through the feet. Allows weight bearing, seen prior to mature positive support

Persists: interferes with independent standing or total weight bearing. Neonatal positive support is followed by a period of baby not taking any weight through their LE's (sitting in the air) before mature positive support comes in

35 weeks gestation to 1-2 month

. turn the baby’s head to one side then the other. "bow and arrow "or fencing response: flexion on the skull side and extension on the jaw side of the upper and lower extremities.

Persists: will not develop symmetry, which will interfere with fine and gross motor development. Could also cause contractures and scoliosis as well as other orthopedic problems

Birth to 4-6 months, peaks at 1-2 months

Can be tested on the mat or in ventral suspension
Head extends- UE ext & LE flex
Head flexes- UE flex & LE ext (puppy under the fence)
Appears as ATNR integrates

Persists: will cause difficulty in walking and getting to the floor from standing; also prone propping and 4 point.
May use STNR for locomotion: bunny hop

4-6 months gestation to 8-12 months

when placed prone with the head in midline the baby will increase in flexor tone. When placed supine with head in midline, the baby will increase in extensor tone.

If persists: prevents motor difficulty in rolling and sitting.

Birth to 6 month

difficult or resisted voluntary movement of one body part will result in the same movement in the contralateral limb.

Persists as below: May be evident after integration under extreme stress.

Birth to 3 months for 8-9 years

with Pt in prone , head in midline, lift pelvis on one side. Results in automatic flexion of the hip and knee on the same side.

Should persist: if doesn’t begin, problems with crawling and gait

6 months to persists

tested in prone suspension, looks at the amount of spinal and hip extension

If Persists: Could indicate high extensor tone

Begins at 3-4 months until 12-24 months

these are righting reactions that interact with each other and work to establish normal head and body relationships to each other

. tested in prone or supine, roll the body to the side and the head will right itself vertically

Persists: If absent the baby will have difficulty with transitional movements.

Birth to 2 months to 5 years

baby in supine, turn head to the right or the left, the body will follow in a log roll at first then later as a segmental roll.

Persists: If absent the baby will have difficulty with transitional movements.

4-6 months to 5 years

baby in supine, roll shoulders or pelvis into sidelying; the rest of the body will follow, first as a log roll then later segmentally.

Persists: If absent the baby will have difficulty with transitional movements.

4-6 months to 5 years

these are righting reactions that interact with each other and work to establish normal head and body relationships in space

hold child vertically or in ventral suspension. Tilt child and head will right itself to the vertical position with the mouth horizontal. For a pure test the child should be blindfolded.

Should persist: If not, unable to keep head in normal upright position in space or bring it into the normal, upright position

Begins- birth to 2 months to persists

same as labyrinthine except no blindfold

Should persist: If not, unable to keep head in normal upright position in space or bring it into the normal, upright position.

Begins- birth to 2 months to persists

prepares baby for weight bearing when moved toward an object.

Should persist: If absent, unable to place the extremity accurately for activities

UE: 3-4 months
LE: 3-5 months

displace the center of gravity outside the base of support. Arms or legs will extend and abduct to support and protect the body from falling.

Should persist: If absent, pt will not be able to have protective response

UE: forward - 6-7 months to persists

UE: sideward - 7 months to persists

UE: backward - 9-10 months to persists

same as neonatal but Pt will take all their weight with flat feet.

Should persist: If absent, pt will not be able to stand / walk.

6-9 months to persists

hold child in horizontal prone and lower to the surface, will take weight through elbows or hands depending on developmental stage.

Should persist: If absent, pt will not be able to have protective response

hand 4-6 months to persists

Displace the center of gravity by tilting or moving the support surface. The trunk will curve toward the upward side along with extension and abduction of the extremities on that side; protective extension on the downward side

Should persist: If absent, will interfere with unlevel sufaces

prone - 6 months
supine - 7-8 months
sitting - 7-8 months
quadruped - 9-12 months
standing - 12-21 months

apply a displacing force to the body altering the center of gravity in its relation to the base of support. The trunk will curve toward the external force with extension and abduction of the extremities on the side to which the force was applied

Should persist: If absent, will interfere with unlevel sufaces

prone - 6 months
supine - 7-8 months
sitting - 7-8 months
quadruped - 9-12 months
standing - 12-21 months

utilized to maintain balance during gt when moved off base of support.

Should persist: If absent, will interfere with unlevel sufaces

15-18 months to persists