Human Growth and Development

Samantha Jensen10/13/2014

CU Denver Anschutz Medical Campus Physical Therapy

Human Growth and Development Portfolio

This portfolio is being developed to be used as a study aide for the Human Growth and Development course. The information within has been derived from power points, documents and lecture discussions as well as from the pages of the Functional Movement

Development text.

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HG&D Portfolio: Part 1

Reflexes and Reactions

DefinitionsReflexes: automatic movements in response to sensation, or a sensory stimulus

1. Primitive reflexes: appear prenatally or at birth, are integrated at approximately 4-6 months of age (exceptions: plantar grasp and STNR)

2. Attitudinal reflexes: stimulus is head/neck position (e.g. ATNR, STNR, TLR)a. Subcategory of primitive reflexes, never obligatory in typically developing children

Reflex Integration: when the reflex is no longer obligatory or the most common response to the stimulus Primitive Reflex

Neonatal Positive SupportingOnset Integration Position Stimulus Response

35 weeks gestation 1-2 months Support infant in vertical position with examiner’s hands under the arms and around the chest

Allow feet to make firm contact with tabletop or other flat surface

Simultaneous contraction of flexors and extensors so as to bear weight on lower extremities Child may only

support minimal amount of body weight

Characterized by partial flexion of hips and knees

Attitudinal Reflexes

Asymmetrical tonic Neck Reflex (ATNR)Onset Integration Position Stimulus Response

Birth to 2 months 4-6 months Place child supine with head in midline; can test or observe in other positions (sitting, quadruped, standing)

1. Have child actively turn head by following an object from side to side

2. Passively turn child’s head slowly to one side and hold in extreme position with jaw over shoulder

Arm and leg on face side extend, arm and leg on skull side flex (fencer’s position)

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Symmetrical Tonic Neck Reflex (STNR)Onset Integration Position Stimulus Response

4-6 months 8-12 months Place child in ventral position supported by trunk over examiner’s knee or place in quadruped position

Examiner passively flexes then extends the child’s head and neck

1. Head and neck flexion produces flexion of the upper extremities and extension of the lower extremities

2. Head and neck extension produces extension of the upper extremities and flexion of the lower extremities.

Tonic Labyrinthine Reflex Prone (TLR)Onset Integration Position Stimulus Response

Birth ~6 months Prone Prone positioning Flexor tone dominates, child has difficulty extending to lift head, neck or trunk; cannot support weight on arms

Tonic Labyrinthine Reflex Supine (TLR)Onset Integration Position Stimulus Response

Birth ~6 months Supine Supine positioning Extensor tone dominates, child will not flex in pull to sit

Postural ReactionsAutomatic postural reactions provide the foundation for posture, balance, locomotion and prehension. These reactions appear during infancy and remain throughout the lifespan. They occur in response to changes in the body’s orientation and pattern of weight distribution in the base of support.

Category Stimulus Response NotesProtective Fast or large movement of

center of gravityExtremities move out into extension to catch person

Head and trunk righting Change position of body in space

Produce alignment of the body with the environment or alignment in space. Keep the head and trunk aligned with each other.

Uses three systems: Visual Vestibular Somatosensory

(proprioceptive or tactile)Equilibrium Slow shift of the center of

gravity.Find balance in response to shift in center of gravity

Orderly sequence:Prone supine sitting quadruped standing

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Lags behind attainment of movement in the next higher developmental posture.

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Illustrations of attitudinal reflexes are shown to the left with a timeline of when these reflexes can be observed.

Below are pictures of babies demonstrating these reflexes.

An illustration to the left depicts the protective extension postural reaction occurring in multiple different positions.

Illustrations of the equilibrium reactions are depicted to the left.

Below, pictures demonstrate examples of head and trunk righting reactions. These include neonatal neck on body (NNOB), neonatal body on body (NBOB), optical righting and landau. Not pictured is labyrinthine righting.

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Developmental Gross Motor Milestones

Month Prone Supine Sitting Standing1

(Physical flexion)

Lifts head and turn head to side.

Hips flexed, head to the side.Arms flexed with hands by face.

Back rounded, head forward.

Positive support. Partial flexion in hips and knees

2

(Maximum asymmetry)

Head at 45°.Prone musculature elongated.

Head to side. Presence of ATNR. Arms out further. Less tightness at hip and knee flexion.

Head lag in pull to sit.Rounded.

Decreased weight bearing and possible onset on astasia.

3

(Symmetry/ anti-gravity flexion)

Increased head shoulder control 45°-90°.Increased spinal extension, lower pelvis.Prop up on forearms.Head rotation.

Head and hands to midline.

Head to midline. Initial head lag.

Astasia or minimum support

4

(Increased symmetry)

Increased extension, bilateral adduction of scapula. First part of Landau reflex.Elbow support. May roll with lateral weight shift.

Head in midline with chin tucked. Hands to knees. Spine flattens.

Minimal head lag.Sits with support. More extended upper spine.

Weight in supported standing. Standing with 2 hands held. Static standing with extension.

5

(Increased flexion/extension

control)

Extended arms. Reaching in prone. Rolling. Increased lordosis.

Increased abduction control. Hands to feet. Rolling side to side. Pivoting.

Begins prop sit, which leads to lower hip extension. Arms up in high guard to increase balance. No head lag.

Full weight on legs with hand s or trunk held. May release extension and may flex at knees.

6

(6-12 months big in change in

thoracic development)

Increased extension through hips. Side play with lateral head righting. Pivoting. May push hips and knees.

Independent rolling. Foot to mouth. May demonstrate protective extension. Buttocks off floor.

Begin to sit independently. Easy to fall with weight shift.

Smaller base of support. May begin bouncing.

7 All fours rocking. Belly crawling. May fall with four-point reaching.

Sit with rotation. Begin transitioning from four-point to sit.

May pull to stand (UE pattern used).

8 Four point creeping prone transitioning to sit.

Supine to sit. Lots of UE and LE movement. Long-sitting which stretches the hamstrings.

Refined four-point transitioning to sit.

May try to cruise. Tall kneeling. Stand holding on. Begin half kneel to stand.

9 Refined four-point. Increased pelvic and femoral dissociation

Pull to stand to half kneel. Rotation with

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(fractionation). W-sitting.

cruising. Hold with one hand. Legs work more. Stepping with support. Increased hip flexion. Heel-toe play.

10

(Transitions)

Creep up steps (can’t go down)

Protected extension to back. Very functional.

Climb. Half-kneel play. Mobility between pelvis, thorax, and femurs.

11 Bench sitting. Chair sitting.

Stand with one hand. Cruise between 2 surfaces. More climbing to getting down.

12 Push toys- may let go. Independent stand. Independent steps. Squat to stand with minimal support. High guard.

18 Creeps up and down stairs.

Transition to standing from sitting on floor.

Pull or carry toy while walking. Walking sideways or backwards. Develop a run-like walk. Momentary 1-foot balance. Beginning arm swing and heel strike.

24(2 years)

Up and down stair one foot at a time with rail support. Jump off a step (2 foot takeoff). Stand on one foot 1-3 seconds. Kick a large ball. Begin to run. Begin to jump (alternating feet).

36(3 years- highest activity level at

any age in human lifespan)

Pedaling a tricycle. Climbing a jungle gym. Start, stop and turn while running. Tandem and one foot standing for at least 3 seconds. Up stairs, alternating feet.

48(4 years)

Hop on one foot 4-6 times (girls appear to have better balance in childhood). Rhythmic galloping. Up and down stairs alternating feet.

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Bounces and catches ball under control. Kicks 10-inch ball toward target. Runs 10 feet and stops well.

60(5 years)

Bikes usually without training wheels.

Stand on either foot 8-10 seconds. Walk forward on balance beam. Hop 8-10 times on one foot. 2-3 foot standing broad jump. Skip on alternating feet. Kick a rolling ball. Roller skates.

72(6 years)

Stand on one foot for longer than 10 seconds eyes open or closed. Walk on a balance beam in all directions. Running. Jumping, Throwing. Catching. Can incorporate game playing skills.

84(7 years)

Jumping jacks. Standing long jump of about 42 inches.

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Vital Signs

Age Mean Heart Rate Mean Respiratory Rate Mean Blood Pressure1 year 120 beats/min 20-40 breaths/min 90/56 mm Hg2 years 110 beats/min 25-32 breaths/min 91/56 mm Hg6 years 100 beats/ min 21-26 breaths/min 96/57 mm Hg

10 years 90 beats/min 20-26 breaths/min 102/62 mm Hg16 years 80 beats/min (girls)

75 beats/min (boys)16-20 breaths/min 117/67 mm Hg

Adult 74-76 beats/min 10-20 breaths/min 120/80 mm HgOlder Adult 74-76 beats/min *Data unavailable 150/85 mm Hg

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Human Growth and Development

Health & Medicine

Transcript of Human Growth and Development