2. NORMAL DEVELOPMENT PART 1. HEAD CONTROL

3. CONSIDERATION POSTURAL CONTROL POSTURAL ORIENTATION INTERNAL REPRESENTATION BODY CONCEPT(Awareness, Schema, Image ) SENSORY CHANNEL MUSCULOSKELETAL COMPONENT NEUROMUSCULAR COMPONENT CENTRAL PATTERN GENERATOR

4. HEAD CONTROL PELVIS HIP kNEE ANKLE MOVEMENT SHOULDER SCAPULAR ELBOW HAND PROXIMAL (ALIGNMENT)

5. STATOKINETIC REACTION STABILITY/ MOBILITY = WORKS TOGETHER WHILE DOING SOMETHING. ( PURPOSEFUL MOVEMENT) = WE CALL IT POSTURAL CONTROL. = BASIS OF MOVEMENT = RR. ER, SR

6. CENTRAL PATTERN GENERATOR POSURAL ALIGNMENT MOVEMENT ACIVATION FROM THE MUSCLES PROGRAMED MOVEMENT INFORMATION

7. Central Pattern Generators. Spinal circuits act as central pattern generato rs. The existence of pacemaker cells within neur al tissue demonstrate the ability for circuits to be active without sensory input. The overall stepping pattern consists of a rhyt hmic alteration in the contractions of flexor a nd extensor muscles. The pattern of the pattern generator is written into the CNS map i.e. it is genetic.

8. 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 AND TEMPORALLY BY CEREBELLAR CONTROL.

9. MIDBRAIN LOCOMOTOR AREA 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

10. ASSESSMENT MUSCLE Length Direction Strength Synergist ROM SKELETAL DIRECTION LENGTH SIZE MOBILITY

11. 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

12. HEAD CONTROL Base of support Trunk control(proximal stability) Rib cage, Scapular, Pelvis Neck elongation Shape of head

13. HEAD CONTROL(III) Vestibulocollic reflex Vestibulospinal reflex Vestibuloocular reflex Optokinetic reflex Tongue Maseters

14. 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

15. RIB CAGE SCAPULAR SHOULDER ARM, HAND HEAD CONTROL PROXIMAL ABDOMEN,TRUNK, PELVIS HIP KNEE ANKLE

16. RIB CAGE SCAPULAR SHOULDER ARM, HAND HEAD CONTROL PROXIMAL ABDOMEN,TRUNK, PELVIS HIP KNEE ANKLE ARM MOVEMENT

17. HEAD VISION & AUDITORY RIB CAGE, UPPER BACK MUSCLES SCAPULAR ABDOMINAL, BACK MUSCLES PELVIS & LOWER EXTREMITY

18. 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

19. PATHOLOGIC ARM MOVEMENT PATTERN WITH LESS MOVEMENT CHANGING DIRCTION AND MUSCLE PROPERTIES RETRACED OR PROTRACTED SHOULDER PRONATED ELBOW FLEXED WRIST AND FINGERS

20. 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

21. TRUNK CONTROL * LENGTH THROUGH PROXIMAL STABILITY W.T SHIFTING ELONGATION * RIB CAGE CONTROL * FOUNDATION OF MOVEMENTS

22. 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

23. 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

24. 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

25. PATHOLOGIC PELVIC MOVEMENT MOVES TOGETHER LACK OF PROXIMAL STABILITY TYPICAL PATTERN SMALL RANGE OF MOVEMENT POOR DISSOCIATION INFLUENCE TO LEG MOVEMENT

27. 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

28. PATHOLOGIC LEG AND FEET MOVEMENT 1. LACK OF PROXIMAL STABILITY 2. TYPICAL PATTERN 3. SMALL RANGE OF MOVEMENT 4. POOR DISSOCIATION 5. CAN’T EXTEND THE LEGS – CHANGED DIRECTION 6. ANKLE INSTABILITY 7. SMALL FEET ( MAINLY MEDIAL PART) 8. POOR MUSCULATURE ACTIVITY

31. SITTING ALIGNMENT + B.O.S WEIGHT BEARING ON BONES, MUSCLE, LIGAMENTS, SKINS TRUNK MOVES AGAINST PELVIS PELVIS SHOULD BE STABILIZED- MOVES LATERALLY POSURAL CONTROL

32. SITTING PROXIMAL QUADRICEPS & HAMSTRING, GLUTEUS GROUP STABILIZE PELVIS ANKLE GUIDES PELVIS MOVEMENT AND STABILIZE PELVIS ANKLE IS THE SIGNAL OF PICTURE OF THE PELVIS

33. PATHOLOGIC LEG AND FEET MOVEMENT 1. LACK OF PROXIMAL STABILITY 2. TYPICAL PATTERN 3. SMALL RANGE OF MOVEMENT 4. POOR DISSOCIATION 5. CAN’T EXTEND THE LEGS – CHANGED DIRECTION 6. ANKLE INSTABILITY 7. SMALL FEET ( MAINLY MEDIAL PART) 8. POOR MUSCULATURE ACTIVITY

34. PATHOLOGIC SITTING STRUCTUAL PROBLEMS SMALL, IMMOBILIZATION, ASYMMETRY DIRECTION OF THE JOINT AND MUSCLES POOR PERCEPTUAL MOTOR EXPERIENCES

35. STANDING UP NORMAL 1) Tibillis anterior 2) Rhomboides 3) Trapezius 4) Quadriceps ABNORMAL 1) Rhomboideus 2) Trapezius 3) Tibialis anterior 4) Quadriceps

36. 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.

37. 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

38. 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

39. 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.

40. 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

41. Motivation Limbic System Involved in core emotions / motivations (eg fight or flight reactions )