Definitions
What is Postural Control?
The ability to control one's body in space for the purpose of stability and orientation
Babies are typically able to pull to stand by this month
9- 10 mo
Ankle strategy involves shifting weight at the ankle/foot to maintain balance due to this intensity perturbations
Minimal
Turning head toward side that cheek is brushed on
Begins in utero and lasts until 3 - 4 mo
Your patient is a 68 y/o with a history of falls. Upon exam you notice she resorts straight to stepping strategy when experiencing moderate perturbations. What are some interventions you might use to train hip strategy?
Tandem stance, compliant surfaces, mild to moderate perturbation
Postural Stability
Balance- The ability to keep CoM within LoS
Creeping begins during these months
8- 10 mo
Hip strategy involves shifting weight at the hip to maintain balance, usually due to this intensity perturbations
Moderate
What is the Moro Reflex and when is its timeframe?
Startle reflex tested by flexing the babies head and then allowing it to drop- arms and feet so fling up into extension
Utero - 3 mo
You were asked by your friend to evaluate her 3 week old son. You notice that he turns his head toward her when his cheek is brushed by her shirt and that he has a generally flexed posture in supine, as well as splayed toes when you touch his feet. Are any of these findings a point for concern.
No, rooting, babinski, and a flexed posture in supine is normal for this age
Tone
The amount of tension in a muscle at any given time
Independent sitting typically occurs when?
6-8 mo
When would someone likely use stepping strategy?
After both ankle and hip strategy has failed, as a last resort to catch oneself to maintain balance
What is the Babinski Reflex and when is its time frame?
Splaying of the toes when the bottom of the foot is brushed
Birth- 9/10 mo
You are examining a patient with Down's Syndrome, do you expect their postural control to be on time, early, or delayed?
Delayed, Down's Syndrome causes hypotonia, which decreases the child's ability to develop postural control in the same time line
Static Balance
The ability to control CoM when the body is not moving
Being able to prop up on forearms and roll towards a side occurs when?
3 mo
Babies develop protective reaches during the first 9 mo of life, after these reaches have been developed they begin working this that lasts into adulthood
Trunk Equilibrium
What is the sucking reflex and when is its time frame?
Sucking when an object is placed in the baby's mouth
Utero to 3 mo
Your patient is a 3 y/o with myelomeningocele around L3-L4, what would you expect for postural control below to affected area?
Poor, if they have any control at all
Define Dynamic Balance and each type
The ability to control CoM when there is movement, divided into Anticipatory and Reactionary. Anticipatory: expected changes in the postural control due to anticipated internal or external perturbation. Reactionary: unexpected changes in postural control due to unanticipated external perturbations or an inappropriate response to an anticipatory perturbation
Independent standing typically occurs at 12 mo, but for at 12 mo chronological age and 9 mo corrected age, are they expected to be independent standing?
No, but pulling to stand and creeping are both expected to begin around this time.
What is a strategy for postural control that PTs use when transferring patients?
Suspensory/ Lowering
What is ATNR and what is its time frame?
When head is turn, limbs on the side that the face is toward go into extension while the opposite side goes into flexion
Birth- 3/4 mo
Your patient is a 9 mo baby. You were brought in to exam his reflexes. Upon testing plantar grasp you notice that it is still intact. The baby also exhibits babinski reflex as well as ATNR. Is this a normal exam?
No, while babinski and plantar grasp can last this long, ATNR should've disappeared around 3-4 mo