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Motor (and Sensory) Development

Motor (and Sensory) Development. Why is it important? This is my new favorite article: https://www.ewi-ssl.pitt.edu/psychology/admin/faculty-publications/201008311333100.Iverson_2010.pdf http://www.people.com/people/archive/article/0,,20353593,00.html

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Motor (and Sensory) Development

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  1. Motor (and Sensory) Development • Why is it important? • This is my new favorite article: • https://www.ewi-ssl.pitt.edu/psychology/admin/faculty-publications/201008311333100.Iverson_2010.pdf • http://www.people.com/people/archive/article/0,,20353593,00.html • http://www.autismspeaks.org/science/science_news/kennedy_krieger_early_signs.php

  2. Review • “Development results from interrelated processes of maturation, physical growth, and learning and may be observed in genetic and environmental adaptation”- Cech & Martin (2002), p. 51. • Maturation= genetics/biophysical • Adaptation= body’s response to the environment • The progression from reflex dominance to increasingly advanced motor skills

  3. Motor Development Concepts • Sequential: across cultures, despite individual differences • Directional concepts: • Cephalocaudal • Proximaldistal • Mobility & Stability: the relationship between these is=postural control • Sensory Input: first movements or reflexes are initiated by sensation and continues with voluntary control.

  4. Sensory Input • Vision • Somatosensory: • Tactile: • Proprioception: interpreting stimuli originating in muscles, joints and other internal tissues that give info. about position of body part in relation to another • Vestibular: interpreting stimuli from the inner ear receptors regarding head position and movement

  5. Reflexes • Predictive movements in response to a stimuli • The integration of reflexive reactions follows a sequence that correlates with the acquisition of motor skills • Present in the neonatal and become integrated in time; persistence beyond the time of anticipated decline may signal brain abnormalities • Almost all reflexes should be integrated by 9-12 months Motor Development

  6. Asymmetric Tonic Neck Reflex http://www.babyzone.com/baby/nurturing/photos_physical_development_milestones/3 Motor Development

  7. Emergence of Postural Reactions • Righting • Protective • Equilibrium • See Table 9-2 • Nature versus Nurture

  8. Postural Reactions • Automatic responses to sensory input that act to keep the body parts in alignment, maintain equilibrium and prevent injury. • Are of primary importance with static and dynamic balance. • Appear between 2-18 months, with few exceptions, persist throughout life. • 3 categories: righting, protective, and equilibrium Motor Development

  9. Righting Reactions: adjustments of the head and trunk • Automatic postural responses elicited by sensory input that signal that the head or trunk is not in midline. • Think of examples… Motor Development

  10. Protective Reactions: extension of the limbs when balance is challanged • To prevent or break a fall. • Elicited by vestibular input that signals a change in head position. • These reactions are often delayed or absent in persons with severe disabilities. • How would this impact occupational performance??? Motor Development

  11. Protective Reaction Motor Development

  12. Equilibrium Reactions: total body responses • To prevent falls • Elicited by vestibular input from any position. • Appear between 5-18 months of age and persist for life. • 5 key positions for testing: • Prone, supine, sitting, all fours, and standing (tilt board) Motor Development

  13. Equilibrium Reaction Motor Development

  14. Motor development • Variations exists in all areas of development • ”Abnormal motor development cannot be recognized and correctly interpreted without a solid knowledge of normal motor development” (Piper & Darrah, 1994, p.2) • Use normal motor development as a reference point to understand abnormal motor development and establish treatment techniques Motor Development

  15. Problems Associated with Retention of Primitive Reflexes Conditions: • CP • TBI • Genetic Syndromes • ….What are these related to? • NEUROLOGICAL INTEGRITY • http://aut.sagepub.com/content/early/2011/05/19/1362361311402230.abstract Motor Development

  16. Characteristics of Immature Movement PatternsNeurological Problems • Inconsistency • Perseveration • Mirroring • Asymmetry • Loss of dynamic balance • Falling after performance • Extraneous movements • Inability to maintain rhythm or pattern • Inability to control force • Inappropriate motor planning Motor Development

  17. A delay in motor development occurs if: • Primitive reflexes do NOT appear in the first year of life. • Primitive reflexes appear, but do NOT DISAPPEAR by the end of the first year. • Equilibrium reactions do not appear by the end of the first year. • Equilibrium reactions do not persist throughout life. • http://pathways.org/awareness/healthcare-professionals/early-motor-surveillance/ Motor Development

  18. Muscle Tone • The degree of normal tension in a specific muscle or muscle group • The resistance of passive stretch • Constant state of reflex contraction • For body posture Motor Development

  19. Disorders of Muscle Tone • Hypotonus • Too little tension • Characterized by unusual postures and increased joint ROM • Hypertonus • Increase muscle tone • Too stiff to perform movements properly • Spasticity and rigidity significantly limit ROM • Athetosis • Exhibit both hyper and hypo tonus Motor Development

  20. Recognizing Early Motor Delays • At Four and Six Months of Age Today, 1 in 40 children in the U.S. has an early motor delay. 1 • Celebrating over 25 years of assuring the best for all babies’ development • 1Statistics compiled by the Pathways Awareness Medical Round Table from a variety of sources, including the March of Dimes, Pediatrics Annual Summary of Vital Statistics, and the Centers for Disease Control and Prevention

  21. Early Motor Delays Early Motor DelaysTummy TimeSurveillance Recognizing Early Motor Delays 4-month comparison 6-month comparisonReferrals Early Intervention Thank You Survey “Early motor delays” is used to describe a variety of conditions from low muscle tone to cerebral palsy. Early motor delays can later affect a child’s ability to learn basic skills such as grasping, crawling, standing, walking, and talking.  

  22. Tummy Time • Early Motor DelaysTummy TimeSurveillance • Recognizing Early Motor Delays 4-month comparison • 6-month comparisonReferrals • Early Intervention • Thank You • Survey Supervised time while awake that babies spend on their stomachs Tummy Time is critical for building muscle strength in the core,back, neck, andshoulders; strength children need to meet their developmental milestones.

  23. Surveillance – More Than Screening • Early Motor DelaysTummy TimeSurveillance • Recognizing Early Motor Delays 4-month comparison • 6-month comparisonReferrals • Early Intervention • Thank You • Survey • Dworkin defined developmental surveillance: “a flexible, continuous process whereby knowledgeable professionals perform skilled observations of children during the provision of health care. The components of developmental surveillance include eliciting and attending to parental concerns, obtaining a relevant developmental history, making accurate and informative observations of children, and sharing opinions and concerns with other relevant professionals.”2 Observe in more than one position Observe the quality of the movement

  24. Recognizing Early Motor Delays • At the 2, 4 and 6 month Well Visit Early Motor DelaysTummy TimeSurveillance Recognizing Early Motor Delays 4-month comparison 6-month comparisonReferrals Early Intervention Thank You Survey Typical • Eight positions to observe movement Good vertical alignment from head to feet Atypical Supine Sidelying Prone Pull to Sit 5. Sitting 6. Horizontal Suspension 7. Protective Response 8. Standing No independent head lifting

  25. Recognizing Early Motor Delays At the 4 Month Well Visit Early Motor DelaysTummy TimeSurveillance Recognizing Early Motor Delays 4-month comparison 6-month comparisonReferrals Early Intervention Thank You Survey • Click on image to play video Handout #9

  26. Recognizing Early Motor Delays At the 6 Month Well Visit Early Motor DelaysTummy TimeSurveillance Recognizing Early Motor Delays 4-month comparison 6-month comparisonReferrals Early Intervention Thank You Survey • Click on image to play video Handout #10

  27. http://pathways.org/awareness/parents/developmental-milestones/atypical-and-typical-infant-development#.UUNpRxc3txVhttp://pathways.org/awareness/parents/developmental-milestones/atypical-and-typical-infant-development#.UUNpRxc3txV

  28. http://pathways.org/awareness/parents/developmental-milestones/atypical-and-typical-infant-development#.UUNpRxc3txVhttp://pathways.org/awareness/parents/developmental-milestones/atypical-and-typical-infant-development#.UUNpRxc3txV • http://pathways.org/images/random_pdfs/Hot-Topics-2-months.pdf • http://pathways.org/images/random_pdfs/Hot-Topics-4-months.pdf • http://pathways.org/images/random_pdfs/Hot-Topics-6-months.pdf • 2 month old • 4 month old • 6 month old

  29. Referrals Early Motor DelaysTummy TimeSurveillance Recognizing Early Motor Delays 4-month comparison 6-month comparisonReferrals Early Intervention Thank You Survey • If you assess a child and observe a potential early motor delay • Next step: • Refer your patient for an evaluation or a screening by a specialist • Handout #11

  30. Early Intervention… What is it? Early Motor DelaysTummy TimeSurveillance Recognizing Early Motor Delays 4-month comparison 6-month comparisonReferrals Early Intervention Thank You Survey • Pediatric • Physical • Therapy Pediatric Occupational Therapy Pediatric Speech/Language Therapy • Pediatric therapy provided early improves the abilities of a child

  31. Early Motor DelaysTummy TimeSurveillance Recognizing Early Motor Delays 4-month comparison 6-month comparisonReferrals Early Intervention Thank You Survey Thank you for taking the time to learn about Pathways.organd recognizing early motor delays. We hope that this overview of four and six month motor development has provided you with the skills and tools to: Understand the importance of surveillance Identify early motor delays at the 4 and 6 month visits using structured observation Refer children for further screening as soon as possible

  32. Recommended Organizations • Early Motor DelaysTummy TimeSurveillance • Recognizing Early Motor Delays 4-month comparison • 6-month comparisonReferrals • Early Intervention • Thank You • Survey • American Occupational Therapy Association (AOTA): www.AOTA.org • American Physical Therapy Association (APTA): www.APTA.org • Neuro-Development Treatment Association (NDTA): www.NDTA.org • State-by-State Early Intervention: • www.pathways.org/awareness/parents/parent-resources/your-states-child-early-intervention-offices • Pediatric Neurologist: www.childneurologysociety.org • Developmental and Behavioral Pediatricians: www.sdbp.org/find_a_clinician.cfm • Easter Seals: www.easterseals.com • Pathways: www.pathways.org • Handout #12

  33. Also consider… • Sensory Processing Disorder • Sensory Modulation Disorder (SMD) • Sensory Based Motor Disorder (SBMD) • Sensory Discrimination Disorder (SDD) • Visual • Auditory • Sensory Over- Responsivity • Sensory Under-Responsivity • Sensory Seeking/ Craving • Dyspraxia • Postural Disorders • Tactile • Taste/Smell • Position/Movement • (Miller, Anzalone, Lane, Cermak, Osten, 2007)

  34. Resources to hit this home… • http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3109213/ • http://www.aota.org/Educate/Research/CATsandCAPs/SI.aspx

  35. http://www.autismspeaks.org/blog/2012/09/25/top-8-autism-therapies-%E2%80%93-reported-parentshttp://www.autismspeaks.org/blog/2012/09/25/top-8-autism-therapies-%E2%80%93-reported-parents Q & A

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