Please enable JavaScript.
Coggle requires JavaScript to display documents.
Abnormal Motor Development - Coggle Diagram
Abnormal Motor Development
Intro
head control, rolling, sitting, standing, walking, balance, hand use asymm, invol movements
usually presents between 3mo-2yrs
hand dominance not acquired until 1-2 y/o
assym during 1st yr of life always abnormal (may suggest underlying hemiplegia)
late walking = >18mo
Causes
Central motor deficit e.g. CP
congenital myopathy/primary muscle disease
SC lesions e.g. spina bifida
global developmental delay
CP
abnormality of movement + posture
non-progressive
sometimes looks as though it's deteriorating
often a/w cognitive, communication, perception, sensation, behaviour, seizure, MSK issues
most common cause of motor impairment in children
affects 2 per 1000 live births
term used for brain injuries occurring up to 2y/o - after this use acquired brain injury
Causes
80% antenatal (maldevelopment of brain)
10% HIE
10% postnatal
esp premies (IVH + PVL)
meningitis/encephalitis
head trauma
hypoglyc
hydrocephalus
hyperbilirubinaemia
clinical presentation
abnormal posture + tone
slowing of head growth
feeding difficulties (oromotor incoordination, slow, gagging, vomiting)
abnormal gait
asymm hand function before 12mo
primitive reflexes may persist
this is how dx is made
Types
spastic
90%
UMN lesion (pyramidal or corticospinal)
limb tone persistently increased
brisk deep tendon reflexes + extensor plantar response
tone is velocity dependent - fast muscle is stretched the greater the resistance it will have
Dynamic catch = hallmark of spasticity
tone may suddenly yield under pressure in a clasp knife fashion
3 subtypes
Hemiplegia
unilat
arm>leg
face spared
presents @ 4-12mo
fisting, flexed + pronated arm
tiptoe walk
neonatal stroke
Quadriplegia
all 4 limbs
opisothonus (extensor posturing), poor head control, poor central tone
a/w seizures, microcephaly, moderate/severe ID
HIE
Diplegia
all 4 limbs but legs>arms
PTB, periventricular brain damage
dyskinetic (choreoathetoid)
invol, uncontrolled, stereotyped, more evident with active movement/stress
primitive motor reflexes predominate
types
chorea (irregular, sudden, brief, nonrepetitive)
athetosis (slow writing distal movements e.g. fanning of fingers)
dystonia (simultaneous contraction of agonist + antagonist muscles, twisting appearance)
intellect unimpaired
floppiness
extrapyramidal damage - basal ganglia
HIE, kernicterus
6%
ataxic (hypotonic)
4%
most genetic
can be due to acquired cerebellar injury
A mixed pattern may occur
prognosis difficult to determine in infancy - becomes clearer
MDT tx
Motor development age limits
3mo: hold head up, pushes up on arms
6mo: sits with support
9mo: sits without support
13mo: pulls to stand
18mo: independent standing/walking