Kinesiology and Sensorimotor Functioning

1. Kinesiology and SensorimotorFunctioning Chapter 5, Vol. 1

2. Terminology • Flexion – bending a joint • Extension – straightening of joint • Dorsiflexion – bend at ankle, point toe upward • Plantar flexion – bend at ankle, point toe down • Abduction – sideward motion of arm/thigh away from middle • Adduction - sidward motion of arm/thigh toward midline

3. Why should you know these terms? • Understnaidng of these basic terms, allows the O&M specialist to analyze the performance of mobility and other motor skills • Allows for exchange of information efficiently among health care professionals such at PT’s and OTs.

4. Principles of Sensorimotor Development • Cephalocaudal – the development of motor skills in infants proceed from head to toe. • Proximo – distal – Infants first gain motor control of motions at joints closest to the trunk then those furthest away • Gross to fine – and general to specific – Motor skill development begins with large, general motions. Small, refined motions develop later.

5. Sensorimotor Development of Children • Critical state of motor development occurs when the infant spends time in the prone (stomach – lying) position • This is critical for head control, weight bearing on forearms, and sensory information that stimulates proprioceptive functioning

6. Sensorimotor Development of Children with Visual Impairments • Remember, infants with visual impairments don’t get the “reward” of lifting their head • These children often fail to fully develop muscle strength and control of the head, neck and trunk which can cause issues later with posture. • Generally children with visual impairments achieve motor skills that require independent movemetn much later than sighted children (Adelson & Fraiberg, 1974)

7. In addition… • Infants who are blind do not reach for objects until later than their sighted peers • Often do not begin walking until aorund 18 months of age • Lower activity in belly crawling, and crawling on all fours • Lack the postural stability in their trunk and back and shouldter girdle and have difficulty getting into and out of all crawling positions

8. Sensory Awareness • ALL CHILDREN use sensory information to learn about : • Their bodies • Their enviornment • To develop spatial and enviornmental concepts

9. 7 Types of Sensory Input to Brain • Visual • Tactile • Vestibular • Proprioceptive • Audtiory • Olfactory • Gustatory

10. Visual System • “Vision, together with the vestibular and proprioceptive systems, provides the feedback mechanism by which children develop, self-monitor, refine and integrate sensorimotor skills into daily functioning.” • Imitative Learning • Integrating other sensory systems –vision helps integrate tactile, proprioceptive and vestibular functions in the early years.

11. Tactile System • Six types of sensory information provided by touch: • Deep touch (awareness of touch) • Light touch (textures) • Vibration • Pain • Temperature • Two-point touch (identification of the number of points of contact an object has with the skin at any time)

12. Proprioceptive System • Sensors located in the muscles, tendons and joints o the body and provide an awareness of STATIC body position at any given moment and the relationship of the body parts to one another. • Begins to develop in infancy and occurs through a combination of movement experiences and visual feedback.

13. Proprioception and Visual Impairment • The lack of visual incentive to play (initially with hands and feet) results in missed opportunities for propriocetpive input and development of trunk strength because of lack of leg movements. • Proprioceptive sensory ability plays a major in body awareness including laterality, direcitonality and spatial awareness • Also is connected to musle tone and balance.

14. Haptic Awareness • Combination of proprioception and tactile awareness. • The person’s ability to determine the properties (texture, size, shape and temperature) of an object by handling it.

15. Vestibular System • Located in the inner ear • Registers • Speed • Force • Direciton of movement • Effect of gravity on the body • Head position

16. Vestibular System • Fully functional at birth • First sensory system to mature • Children learn to use this sytem through motor activities • Vision plays a role in how the vestibular system develops and how input is used.

17. Vestibular System and Children with Visual Impairment • If the child is unable to use vestibular inputs efficiently the child may have difficulty: • maintaining their head upright • developing good balance and equilibrium • Developing mature gross motor skills requiring coordination of both sides of the body

18. Muscle Tone • Motoric “readiness for movement” • Related to proprioception • Low muscle tone is a recognized problem for children with congenital visual impariment (Boehme, 1990) • Children with poor muscle tone lack stable postural foundation • Domino effect

19. Stability and Mobility • Stability – body’s ability to maintain static posture • Mobility – the body’s ability to perform unrestircted motions • Both impacted by low muscle tone

20. Coordination • Neurological system’s co-ordering of activity to organize movement. • Begins in infancy with primative reflexes • Reflexes and reactions are the building blocks of coordination

21. Reflexes • Reflexes are stereotypical responses to specific stimuli (rooting reflex) • Provide tactile, proprioceptive and kinesthetic stimulation as children interact with their environment (ATNR) • Reflexes integrate

22. Reactions • Reactions are automatic movements that occur in response to changes in the body’s position relative to gravity. (falling) • Neurological responses that remain throughout life. • Contribute to 3 types of motor functioning: • Righting reactions • Protective and support reactions • Equilibrium

23. Posture • Fundamental concepts that underly the development of good posture: • Body Planes • Frontal plane (divides front from back) • Transverse planes (divides top from bottom) • Sagital plane (divides left from right) Body segments are alighed with respect to one another in the three planes

24. Posture (cont) • Center of Gravity • Every body segment has a center of gravity • Optimal body posure segments are aligned on on top of the other • The BODY’s center of gravity is the intersection of the three body planes at the (upper sacral region of the) pelvis

25. Balance • Static • Used to maintain a static posture such as sitting or standing • Proprioception is in use • Dynamic • Used during movement • Vestibular system is engaged

26. Balance and Children with Visual Impairments • Bouchard (2000) reports inadequate balance reactions in the majority of school children with low vision • Gipsman(1981) found dynamic balance was impaired in children who had a range of congenital visual impairments • Rosen (1989) found that limited balance correlated with the presence of immature gait characteristics such as out-toeing and short stride

27. Gait • Gait is the normal manner of walking • Gait pattern is one’s collection of specific gait characteristics • 2 phases of gait • Stance • Swing

28. Gait and Children with Visual Impairments • Spatial gait pattern may not fully develop, but plateaus at an immature level that is characteristic of a sighted toddler (Rosen 1986) • Reasons for the immature gait pattern include: • Loss of sensory data needed to time steps • Impoverished balance • Difficiency of protective reactions

29. Gait and Children with Visual Impairments (cont) • Motoric influences • Hypertonia • Limited proprioceptive awareness • Poor integration of primitive reflexes • Poor integration of mature reactions • Poor trunk rotation necessary to keep trunk facing forwarde while rotating the pelvis

30. Implicatons? • It is ALL connected • Early intervention is ESSENTIAL! • Make sure to assess all of these areas