1. Kinesiology and Sensorimotor Functioning 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