HDV 1-3 -- neonatal development

Pharyngeal (limbic) reflex

"gag"

fidgety movements

-- Circular movements, small amplitude, moderate speed -- Starts in legs -- *Symmetrical but not bound*

General Movement Assessment

-- Designed by Prechtl and the GM trust -- They defined what normal and abnormal general movements (spontaneous movements) are for the young infant (premature-5 months) -- *98% sensitivity and 94% specificity predicting CP* -- *Interscorer reliability 89-93%*

writhing movements

-- Low to moderate amplitude and speed -- Elegant, fluent, complexity, variable, *asymmetrical* -- *Has beginning and end* note: Resembles Tai Chi or dance like

Postural Reflexes/Reactions: -- Appear after ____ months of age, some earlier -- They integrate during the ____-____ year, although some remain throughout lifespan

-- appear after 2 mo -- integrate in first to early second yr

pt is in fidgety period; when mom coos at baby, his movement becomes more rapid and erratic; is this abnormal?

-- no, they are normal, but *still need to see fidgety between these bursts* -- in this case the fast movements are called pleasure bursts

Sucking/rooting/tongue retrusion (limbic reflex)

-- reflexive repertoire for finding, impelling, and expelling objects/food from the mouth -- inhibit the gag reflex

in Pull to Sit, head lag is expected until ___-___ months

4-5 mo

baby is in deep sleep; what behavioral state are they in: A. 1 B. 2 C. 3 D. 4 E. 5 F. 6

A -- state 1

*** which of the following is NOT true of Neonatal Motor Behavior: A. Reflexive patterns dominate newborns motor behavior B. Higher cortical centers are not yet active C. Prone baby stays more in flexed position D. Supine baby stays in more extended position

B -- *Higher cortical centers ARE active

you test the rooting reflex and baby demo full head turn toward stimulated side and opening of the mouth; they have scored a: A. 0 B. 1 C. 2 D. 3 E. A

C -- 2

*** Dargassies considers what to be the most critical for CNS maturation: A. nystagmus B. crossed extension C. flexor withdrawal D. ATNR

C -- flexor withdrawal

which of the following is NOT part of the LE protective extension/reaction: A. knee extension B. hip ABD C. hip ER D. ankle PF

D -- *ankle DF

baby is alert with a bright look but is limited in motor interaction; what behavioral state are they in: A. 1 B. 2 C. 3 D. 4 E. 5 F. 6

D -- state 4

when do the following close: Ductus Arteriosus -- Foramen Ovale --

Ductus Arteriosus -- closes within first few hours (failure to close called Patent Ductus Arteriosus (PDA)) Foramen Ovale -- closes within first two weeks (failure of closure called Patent Foramen Ovale (PFO))

which of the following is NOT true of Reflexes/Attractor Well: A. Reflexive movements occur quickly after onset of stimuli B. They involve single muscle or specific group of muscles (not whole body) C. They cannot be extinguished at any one time D. Persistence may indicate neurological problems E. Integration is when the reflex is erased from memory

E -- false; integration = reflex is no longer dominant; it is NOT erased from memory

baby is crying; what behavioral state are they in: A. 1 B. 2 C. 3 D. 4 E. 5 F. 6

F -- state 6

Protective Responses

Help infant to learn protection from falls as well as learning early WB through extremities

Righting Reactions

Helps learn to keep head oriented to body in correlation with gravity

After about six months of life the Tonic Labyrinthine Reflex transitions into the...

Labyrinthine Righting Reaction note: think of the Labyrinthine Righting Reaction as the fight against gravity

what is the first rotary righting reaction

Neonatal Neck Righting note: immature version of body righting on body; mature body righting on body happens segmentally, hips then lower legs

optic head righting labyrinthine righting

Optic head righting -- more of head and trunk will move to try and align with gravity Labyrinthine righting -- same test but with eyes closed

bw PDA and PFO, which of the two is more of a concern with premature infants what if both don't close?

PDA is the most important in premature babies life threatening issue, will require surgery (called "persistent fetal circulation")

Equilibrium Reactions

Reactions occur due to relation to body orientation in space

integration

Reflexive pattern is no longer highly predictable or preferred pattern

Staggering stim, response, onset

Stimulus -- COG displaced Response -- Take a few steps Onset -- 15-18 months

LE protective extension/reaction stim and response

Stimulus -- Movement downward Response -- Extend knee, abduct and externally rotate hip, dorsiflex foot

Tonic Labyrinthine Reflex stim, response, onset, integration

The TLR is the opposite of STNR -- when a baby looks up TLR causes the baby to straighten it's legs and arms -- when the head goes down the limbs fold in

Laryngeal (limbic) reflex

cough in response to irritation of the larynx

eye blink (limbic reflex)

defensive, stimulated by looming, corneal contact

what is a neonate

first 4 wks of life

what is the earliest equilibrium response

head righting

Labyrinthine Righting Reaction

in TLR ext in supine → in LRR can flex in sup in TLR flex in prone → in LRR can ext in prone

acoustic stampedes reflex (limbic reflex)

muscle attached to the stampedes muscle contracts to protect the middle ear from excessive noise

Do the righting, equilibrium and protective reflexes disappear completely?

no, some stay for a lifetime

Nystagmus stim, response, onset, integration

norm = ≤4 beats abnorm = A or ≥5 beats

plantar grasp stim, response, onset, integration

note: Integration depends on how much weight bearing child has done

Glabellar stim, response, onset, integration

note: norm = newborn will blink with first 4 or 5 taps to bridge of nose when eyes are open

If child is not walking by 13-15 months, what reflex should we check

plantar grasp

Abnormal Moro could be sign of...

shoulder dislocation, fractured clavicle, Erb's and Klumpke's Palsy

UE protective extension/reactions: sideways -- forward -- backward --

sideways -- 5-7 mo forward -- 6-7 mo backward -- 9-10 mo

head righting stim, response, onset, integration

stim -- hold and tilt baby response -- baby right head to keep it vertical onset -- birth-1 mo integration -- 2-3 mo note: at 2-3 mo transitions into optic head righting and labyrinthine righting

Neonatal Neck Righting stim, response, onset, integration

stim -- turn the head response -- whole body log rolls onset -- birth integration -- not listed

what is the current theory about Spontaneous movements or General Movements (GMs)

that they are building blocks, similar to some voluntary movements

*** why does ankle clonus integrate so late (7-10 mo)

they haven't started walking yet

if a child is 1 month old what GM are you looking for

writhing

***** writhing period -- transition phase -- fidgety period --

writhing period -- 36 PMA - 8 wks transition phase -- 9-15 wks fidgety period -- 16-22 wks

Can parents limit the integration of reflexes?

yes ex: keep in crib or car seat all day, limits interaction c environment

Will an infant have writhing while sleeping?

yes until 6 mo of stage