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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 SHOULDER SCAPULAR ELBOW HAND PROXIMAL (ALIGNMENT) PELVIS HIP kNEE ANKLE MOVEMENT 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 gener ators. The existence of pacemaker cells within ne ural tissue demonstrate the ability for circui ts to be active without sensory input. The overall stepping pattern consists of a r hythmic alteration in the contractions of fl exor and extensor muscles. The pattern of the pattern generator is writt en 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 OTHE R GENERATOR. THE LIMBS ARE TIMED SPATIALLLY A ND TEMPORALLY BY CEREBELLAR C ONTROL. MIDBRAIN LOCOMOTOR AREA 1. 2. 3. 3 DIFFERENT ZONAL AREAS IN BASE OF THE FOREBRAIN HAVE BEEN IDENTIFIED, EACH CAPABLE OF INITIATING WALKING FOR DIFFERENT REASONS. LATERAL HYOTHALAMUS ZONAL INCERTA 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 HEAD CONTROL PROXIMAL ABDOMEN,TRUNK, PELVIS HIP KNEE ANKLE RIB CAGE SCAPULAR SHOULDER ARM, HAND HEAD CONTROL ARM MOVEMENT RIB CAGE SCAPULAR SHOULDER ARM, HAND PROXIMAL ABDOMEN,TRUNK, PELVIS HIP KNEE ANKLE 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 HEAD CONTROL RIB CAGE ASYMMETRY BACK MUSCLE GROUP - STEREOTYPED DIRECTION - CHANGING DIRECTION a) LESS MOVEMENT b) TOO SHORT c) ASYMMETRY POOR MOBILITY HIGHER POSITION LOWER STABILITY PELVIS LEGS 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 HEAD CONTROL RIB CAGE ASYMMETRY BACK MUSCLE GROUP - STEREOTYPED DIRECTION - CHANGING DIRECTION a) LESS MOVEMENT b) TOO SHORT c) ASYMMETRY POOR MOBILITY HIGHER POSITION LOWER STABILITY PELVIS LEGS FEET 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 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. 2. 3. 4. 5. 6. 7. 8. LACK OF PROXIMAL STABILITY TYPICAL PATTERN SMALL RANGE OF MOVEMENT POOR DISSOCIATION CAN’T EXTEND THE LEGS – CHANGED DIRECTION ANKLE INSTABILITY SMALL FEET ( MAINLY MEDIAL PART) POOR MUSCULATURE ACTIVITY SITTING ALIGNMENT + B.O.S WEIGHT BEARING ON BONES, MUSCLE, LIGAMENTS, SKINS TRUNK MOVES AGAINST PELVIS PELVIS SHOULD BE STABILIZEDMOVES 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. 2. 3. 4. 5. 6. 7. 8. LACK OF PROXIMAL STABILITY TYPICAL PATTERN SMALL RANGE OF MOVEMENT POOR DISSOCIATION CAN’T EXTEND THE LEGS – CHANGED DIRECTION ANKLE INSTABILITY SMALL FEET ( MAINLY MEDIAL PART) POOR MUSCULATURE ACTIVITY PATHOLOGIC SITTING STRUCTUAL PROBLEMS SMALL, IMMOBILIZATION, ASYMMETRY DIRECTION OF THE JOINT AND MUSCLES POOR PERCEPTUAL MOTOR EXPERIENCES STANDING UP NORMAL Tibillis anterior 2) Rhomboides 3) Trapezius 4) Quadriceps 1) ABNORMAL Rhomboideus 2) Trapezius 3) Tibialis anterior 4) Quadriceps 1) 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 Cord The 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 generators Neuronal networks in the spinal cord capable of producing rhythmical movements such as walking. (Mackay-Lyons 2002) Produce stereotyped locomotor patterns Each limb has its own pattern generator ( Leonard 1998) Descending tracts Provide 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 System visual clues help in alignment, step frequency and even step length. Gives us movement relative to environment. Cerebellum Timing 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)