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Critical Development Period
-4 months
Midline development of the hands
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Critical Development Period
-5 Months
no head lag in in pull to sit or supported sit (pull to sit from supine)
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Critical Development Period
-Six months
Rolling, integration, of most primitive reflexes
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Normal Phases of Motor Development
Infantile Phase (Cognitive)
Birth to 3 months
- -Flexed position w/ head up in prone 45 (1 month)
- -Beginning head control in prone w/ forarm support (3 months)
- -Visual and auditory tracking all directions (2-3 months)
- -Pelvis flat on floor (2-3 months)
- -Pulls to sit w/ beginning head control (2-3 months)
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Normal Phases of Motor Development
Preparation Phase (Associative)
4-6 Months
- -Mobility, rolling (B) w/ weight shift through arms and legs (6 months)
- -Sustained head control w/ hands to midline (4 months)
- -Sits w/ support of arms or support at trunk (6 months)
- -Feet to mouth when supine (5 months)
- -Head control in prone w/ exteneded arm support (5 months)
- -Pulls to sit w/ head control (5 months)
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Normal Phases of Motor Development
Modification Phase (Associative)
7 to 9 Months
- -Transitional movements in ann dout of positions (9 months)
- -Sits independently w/o arm support (7-8 months)
- -Pulls to stand and cruises w/ aid (8-9 months)
- -Quadruped crawl forward independently (9 months)
- -Most primitive reflexes integrated (9 months)
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Normal Phases of Motor Development
Refinement Phase (Refinement)
10 to 12 Months
- -Refinement and coordination of all skills (12 months)
- -Increased speed and accuracy of all skills (12 months)
- -Independent cruise and ambulation (12-15 months)
- -Reciprocal four point crawl (12 months)
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Normal Phases of Motor Development
Continued Refinement
- -13 to 15 months = independent walking
- -18 months = running and jumping
- -24 months = independent use of stairs, walks w/ narrow base of support
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PT Eval process shold include info in the following 11 areas:
- 1. History/observation
- 2. Tone/strength
- 3. AROM and PROM
- 4. Alignment
- 5. Reflexes
- 6. Quality of movement
- 7. Automic Reactions
- 8. Functional skills
- 9. Adaptive Equipment
- 10. Communication skills
- 11. Cognitive Abilities
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History/Observation
- -Look for soft signs or red flags regarding the diagnosed problem or other problems
- -Question the pt/family on activity level, pain level, etc.
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Tone/Strength
- -What is the overall strength level scale 0-5
- -What is the strength level of the involved body part on the same scale
- -What is the overall tone like (hypertonic, hypotonic, fluctuating)
- -Does the strength or tone problem affect function
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AROM and PROM
- -What is the passive/active ROM
- -Is it w/i functional limits or WNL
- -Does it affect function
- -If restricted, what restricts the motion (pain, tissue, bone, etc.?)
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Alignment
- -Is the body aligned or held to one side, or rotated to one side
- -Are the extremities symmetrical
- -Is the head positioned in midline
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Reflexes
- -Is there any evidence of primitive, patological or obligatory reflex patterns
- -Do they interfere w/ function
- -Are they age appropriate or not
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Quality of Movement
- -How well can the pt. move in and out of different positions
- -How are their motor planning skills can they transition smoothly
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Automic Reactions
- -How well can the pt. catch themselves when their balance is challenged in all directions and positions
- -Are the reactions present on both sides
- -Are any reactions delayed
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Functional Skills
- -What is the chronological age vs. the adjusted age vs. the developmental age
- -What ADL's can the pt. perform or cannot perform
- -What are the pt's overall functional skills
- -How does this affect their abilities to function
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Adaptive Equipment
- -What type of equipment does the pt. need to improve function
- -Will the equipment help w/ mobility, stability, alignment, communication
- -Assess the use of equpment and the need for revisions
- -Ensure the equipment fits and is appropriate for the pt.
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Coummunication skills
- -Can th ept. comprehend what you are telling them
- -Can the pt express themselves and be understood
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Cognitive Abilities
- -Can the pt. comprehend what you are asking and respons in a normal, socially acceptable manner
- -This is the most important function for a pt. to have to enable a positive rehab outcome
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