NORMAL DEVELOPMENT

PART 1.

HEAD CONTROL

CONSIDERATION

POSTURAL CONTROL POSTURAL ORIENTATION

INTERNAL REPRESENTATION BODY CONCEPT(Awareness, Schema ,

Image ) SENSORY CHANNEL MUSCULOSKELETAL COMPONENT NEUROMUSCULAR COMPONENT CENTRAL PATTERN GENERATOR

HEAD CONTROL

PELVISHIP

kNEE

ANKLEMOVEMENT

SHOULDERSCAPULAR

ELBOWHAND

PROXIMAL(ALIGNMENT)

STATOKINETIC REACTION

STABILITY/ MOBILITY = WORKS TOGETHER WHILE DOING

SOMETHING. ( PURPOSEFUL MOVEMENT) = WE CALL IT POSTURAL CONTROL. = BASIS OF MOVEMENT = RR. ER, SR

CENTRAL PATTERN GENERATOR

POSURAL ALIGNMENT MOVEMENT ACIVATION FROM THE MUSCLES PROGRAMED MOVEMENT INFORMATION

Central Pattern Generators. Spinal circuits act as central pattern

generators. The existence of pacemaker cells within

neural tissue demonstrate the ability for circuits to be active without sensory input.

The overall stepping pattern consists of a rhythmic alteration in the contractions of flexor and extensor muscles.

The pattern of the pattern generator is written into the CNS map i.e. it is genetic.

Central Pattern Generators. EACH LIMB HAS IT’S OWN

PATTERN GENERATOR EACH OF WHICH CAN ACT INDEPENDENTLY OF THE OTHER GENERATOR.

THE LIMBS ARE TIMED SPATIALLLY AND TEMPORALLY BY CEREBELLAR CONTROL.

MIDBRAIN LOCOMOTOR AREA

3 DIFFERENT ZONAL AREAS IN BASE OF THE FOREBRAIN HAVE BEEN IDENTIFIED, EACH CAPABLE OF INITIATING WALKING FOR DIFFERENT REASONS.

1. LATERAL HYOTHALAMUS2. ZONAL INCERTA3. PERIVENTRICULAR ZONE

ASSESSMENT

MUSCLE Length Direction Strength Synergist ROM

SKELETAL DIRECTION LENGTH SIZE MOBILITY

HEAD CONTROL

Most important part of the body - Appearance (expression) - Function of vision, breathing, eating,

speech, auditory - Mirror of postural control Neck space, Chin tuck, Hyperextended neck

- Initiation of all kind of activity

HEAD CONTROL

Base of support Trunk control(proximal

stability) Rib cage, Scapular, Pelvis

Neck elongation Shape of head

HEAD CONTROL(III)

Vestibulocollic reflex

Vestibulospinal reflex

Vestibuloocular reflex

Optokinetic reflex

Tongue Maseters

DEVELOPMENT OF HEAD CONTROL

Starting from rolling to side to side Rolling means - Neck space (Elongation) - Dissociation from the shoulder & Arms, Trunk, lower part of the

body - Dissociation each part of the body

RIB CAGE SCAPULAR SHOULDER ARM, HAND

HEAD CONTROL

PROXIMALABDOMEN,TRUNK,

PELVIS

HIP KNEE ANKLE

RIB CAGE SCAPULAR SHOULDER ARM, HAND

HEAD CONTROL

PROXIMALABDOMEN,TRUNK,

PELVIS

HIP KNEE ANKLE

ARM MOVEMENT

ARM MOVEMENT

HEAD VISION & AUDITORY RIB CAGE , UPPER BACK

MUSCLES SCAPULAR ABDOMINAL , BACK MUSCLES PELVIS & LOWER EXTREMITY

PATHOLOGIC ARM MOVEMENT

Moves in together Hyperextended Neck and Back Muscle

Adducted scapular as a PUMP LACK OF PROXIMAL STABILITY

HEAVY ARM FIXATION OF SCAPULAR COMPENSATORY HEAD FIXATION UPWARD GAZE POOR STABILITY FROM PROXIMAL & LEGS

PATHOLOGIC ARM MOVEMENT

PATTERN WITH LESS MOVEMENT CHANGING DIRCTION AND MUSCLE PROPERTIES

RETRACED OR PROTRACTED SHOULDER PRONATED ELBOW FLEXED WRIST AND FINGERS

TRUNK

BACK MUSCLE GROUP

- STEREOTYPED DIRECTION

- CHANGING DIRECTION

a) LESS MOVEMENT b) TOO SHORT c) ASYMMETRY

RIB CAGE

ASYMMETRY

POOR MOBILITY

HIGHER POSITION

LOWER STABILITY

PELVIS

LEGS

HEAD CONTROL

TRUNK CONTROL

* LENGTH THROUGH PROXIMAL STABILITY W.T SHIFTING ELONGATION

* RIB CAGE CONTROL * FOUNDATION OF MOVEMENTS

PATHOLOGIC TRUNK MOVEMENT

MOVES TOGETHER HIGHER RIB CAGE ASYMMTRY RIB CAGE PULLED BACK AND FIXATED SCAPULAR IMMOBILIZES RID CAGE POOR STABILITY FROM PROXIMAL & LEGS PELVIS INSTABILITY

PELVIS

BACK MUSCLE GROUP

- STEREOTYPED DIRECTION

- CHANGING DIRECTION

a) LESS MOVEMENT b) TOO SHORT c) ASYMMETRY

RIB CAGE

ASYMMETRY

POOR MOBILITY

HIGHER POSITION

LOWER STABILITY

PELVIS

LEGS

FEET

HEAD CONTROL

PELVIC CONTROL

SIZE OF PELVIS MOBILITY OF PELVIS ( DISSOCIATION)

- POSTERIOR . ANTERIOR TILTING PROXIMAL STABILITY ANGLE OF HIP JOINT LENGTH AND STRENGTH OF MUSCLES DIRECTION OF LEG MOVEMENT

PATHOLOGIC PELVIC MOVEMENT

MOVES TOGETHER LACK OF PROXIMAL STABILITY TYPICAL PATTERN SMALL RANGE OF MOVEMENT POOR DISSOCIATION

INFLUENCE TO LEG MOVEMENT

LEG & FEET

BACK MUSCLE GROUP

- STEREOTYPED DIRECTION

- CHANGING DIRECTION

a) LESS MOVEMENTb) TOO SHORTc) ASYMMETRY

RIB CAGE

ASYMMETRY

POOR MOBILITY

HIGHER POSITION

PELVIS

HEAD CONTROL

LEG AND FEET CONTROL

LEG & Feet MOVEMENT SIZE OF PELVIS PROXIMAL STABILITY ANGLE OF HIP JOINT LENGTH AND STRENGTH OF

THE MUSCLULATURES DIRECTION OF LEG MOVEMENT

PATHOLOGIC LEG AND FEET MOVEMENT

1. LACK OF PROXIMAL STABILITY2. TYPICAL PATTERN3. SMALL RANGE OF MOVEMENT4. POOR DISSOCIATION5. CAN’T EXTEND THE LEGS – CHANGED DIRECTION6. ANKLE INSTABILITY7. SMALL FEET ( MAINLY MEDIAL PART)8. POOR MUSCULATURE ACTIVITY

SITTING

ALIGNMENT + B.O.S WEIGHT BEARING ON BONES,

MUSCLE, LIGAMENTS, SKINS TRUNK MOVES AGAINST PELVIS PELVIS SHOULD BE STABILIZED-

MOVES LATERALLY POSURAL CONTROL

SITTING

PROXIMAL QUADRICEPS & HAMSTRING, GLUTEUS GROUP STABILIZE

PELVIS ANKLE GUIDES PELVIS MOVEMENT AND STABILIZE PELVIS ANKLE IS THE SIGNAL OF PICTURE OF THE PELVIS

PATHOLOGIC LEG AND FEET MOVEMENT

1. LACK OF PROXIMAL STABILITY2. TYPICAL PATTERN3. SMALL RANGE OF MOVEMENT4. POOR DISSOCIATION5. CAN’T EXTEND THE LEGS – CHANGED DIRECTION6. ANKLE INSTABILITY7. SMALL FEET ( MAINLY MEDIAL PART)8. POOR MUSCULATURE ACTIVITY

PATHOLOGIC SITTING

STRUCTUAL PROBLEMS SMALL, IMMOBILIZATION, ASYMMETRY

DIRECTION OF THE JOINT AND MUSCLES

POOR PERCEPTUAL MOTOR EXPERIENCES

STANDING UP

NORMAL 1) Tibillis anterior2) Rhomboides3) Trapezius4) Quadriceps

ABNORMAL

1) Rhomboideus2) Trapezius3) Tibialis anterior4) Quadriceps

STANDING

ALIGNMENT COG tends to move forward because

of instability on trunk and pelvis.

- Especially, poor structure of abdominal muscles and stereotyped direction of the back muscles .

WALKING

Spinal CordThe spinal cord is necessary but not sufficient for the expression of even the most rudementary of stepping behaviour (Bronstein, Brandt and Woollacott 1996)

Central Pattern generatorsNeuronal networks in the spinal cord capable of producing rhythmical movements such as walking. (Mackay-Lyons 2002) Produce stereotyped locomotor patternsEach limb has its own pattern generator ( Leonard 1998)

Descending tractsProvide modulation to the spinal circuitry during locomotion

Timing

Somatosensory System– input comes from afferent receptors in muscles tendons skin.– Gives us information on orientation of body parts, movement of body parts,

muscle tension, orientation of support surfaces and body with reference to support surface.

Visual Systemvisual clues help in alignment, step frequency and even step length. Gives

us movement relative to environment.

CerebellumTiming cannot be considered without considering the cerebellum

Co-ordination

Cerebellum receives a huge amount of information during locomotion.

If information is unexpected the olive is able to modify walking via the reticulospinal, vestibulospinal and rubrospinal tracts.

The cerebellum does not initiate walking but is more involved in the modulation of CPGs where necessary.

In order to learn to cope with a variety of of complex environments there is a need to be exposed to different situations to enable the cerebellum to develop strategies.

It is also thought that the cerebellum can alter step cycle according to visual information received.

The overall function of the cerebellum is improved inter and inter limb co-ordination

Motivation

Limbic System

Involved in core emotions / motivations (eg fight or flight reactions)