Three levels of motor control in the central nervous system can be distinguished in human development. In neonates, general movements and primitive reflexes are controlled at the spinal and brainstem levels. Analysis of these in newborns allows for early screening and recognition of abnormal development risk. From birth to one year, motor control emerges at the subcortical level, enabling basic trunk stabilization and postural control. Cortical motor control develops last, allowing for isolated and refined movement. Assessment of motor skills, reflexes, and posture at different developmental levels can aid in diagnosing and treating motor system dysfunction.
Spinal Functioning and the Vestibular System_Kauffman_InserviceJere Hess
The document discusses the relationship between back pain and the vestibular system. It provides information on spine anatomy and how poor posture can lead to back pain. It notes that back pain is a leading cause of disability. The vestibular system controls balance, spatial orientation, and upright posture. Two studies are summarized that show older adults with neck pain have poorer balance and rely more on the vestibular system for stability compared to controls without neck pain. The document suggests strengthening the vestibular system may help correct mechanical issues that lead to poor posture and back pain.
Jose Austine- Orthopaedic evaluation of cerebral palsyJose Austine
This document provides an overview of cerebral palsy (CP), including its history, definition, classification, etiology, assessment, and orthopedic evaluation. CP is caused by non-progressive brain lesions early in development that result in abnormal muscle tone and movement. It is important to correctly classify a patient's CP based on their motor function and movement disorder. A thorough orthopedic evaluation includes assessing medical history, physical exam of muscle tone and strength, contractures, deformities, and gait. Gait analysis through observation and in a lab helps document the patient's movement and plan for surgical interventions. The goal of evaluation and classification is to guide appropriate treatment and management of CP.
The document defines cerebral palsy and describes its causes, types, and treatments. Cerebral palsy is a neurodevelopmental condition caused by brain lesions early in development. It affects movement, posture, and motor skills. There are several types defined by the parts of the body affected and patterns of muscle overactivity. Treatments aim to reduce spasticity, strengthen muscles, improve mobility, and may include medication/surgery. Gait analysis is used to evaluate patterns and plan the most effective treatments.
This document discusses common orthopedic procedures and postoperative rehabilitation for patients with cerebral palsy. It describes the types of cerebral palsy and focuses on spastic quadriplegia, diplegia, and hemiplegia. For patients with spastic quadriplegia, it outlines procedures for the spine, hips, knees, and feet to address issues like scoliosis, subluxation, dislocation, and contractures. Rehabilitation goals are to improve seating, positioning, comfort, and upper extremity function. The document also details gait analysis and common procedures for spastic diplegia/hemiplegia, and the stages of postoperative physical therapy focusing on range of motion, strengthening, and regaining
This document provides information on cerebral palsy (CP), including its definition, classification, causes, symptoms, and treatment approaches. CP is a non-progressive brain injury early in life that results in impaired motor function. It is classified based on the type of movement abnormality (e.g. spastic, athetoid) and the parts of the body affected (e.g. hemiplegia, diplegia). Common causes include prenatal infections, complications during birth like hypoxia, and postnatal infections. Treatment involves physical therapy, bracing, medication to reduce spasticity, botulinum toxin injections, and surgery to correct musculoskeletal deformities. The goals are to improve motor function, prevent
The term ‘cerebral palsy’ includes a group of disorders that result from permanent non-progressive brain damage during early development and are characterized by abnormalities of movement and posture.
This document discusses spastic diplegic cerebral palsy (SDCP), a type of cerebral palsy that affects muscle tone and movement. SDCP is characterized by stiff muscles in the legs and lower body. It accounts for around 77% of all cerebral palsy cases. The causes of SDCP can include periventricular leukomalacia, cerebral dysgenesis, intracranial hemorrhage, and asphyxia. Symptoms include difficulty walking with legs bent inward and stiff feet. Treatment focuses on physical, occupational, and recreational therapy to improve mobility and prevent complications from progression.
This document discusses the physiotherapy management of cerebral palsy. The goals of rehabilitation are to improve mobility and function, prevent deformity, educate parents, and promote social integration. Therapy programs address issues specific to infants, toddlers, preschoolers and adolescents. Methods include stretching, strengthening, positioning, electrical stimulation, cryotherapy, hydrotherapy, neurofacilitation techniques like Vojta and Bobath methods, horseback riding, bracing, and mobility aids like standers, walkers, canes and crutches. The document provides details on various therapy methods and how they address issues for children with cerebral palsy.
Spinal Functioning and the Vestibular System_Kauffman_InserviceJere Hess
The document discusses the relationship between back pain and the vestibular system. It provides information on spine anatomy and how poor posture can lead to back pain. It notes that back pain is a leading cause of disability. The vestibular system controls balance, spatial orientation, and upright posture. Two studies are summarized that show older adults with neck pain have poorer balance and rely more on the vestibular system for stability compared to controls without neck pain. The document suggests strengthening the vestibular system may help correct mechanical issues that lead to poor posture and back pain.
Jose Austine- Orthopaedic evaluation of cerebral palsyJose Austine
This document provides an overview of cerebral palsy (CP), including its history, definition, classification, etiology, assessment, and orthopedic evaluation. CP is caused by non-progressive brain lesions early in development that result in abnormal muscle tone and movement. It is important to correctly classify a patient's CP based on their motor function and movement disorder. A thorough orthopedic evaluation includes assessing medical history, physical exam of muscle tone and strength, contractures, deformities, and gait. Gait analysis through observation and in a lab helps document the patient's movement and plan for surgical interventions. The goal of evaluation and classification is to guide appropriate treatment and management of CP.
The document defines cerebral palsy and describes its causes, types, and treatments. Cerebral palsy is a neurodevelopmental condition caused by brain lesions early in development. It affects movement, posture, and motor skills. There are several types defined by the parts of the body affected and patterns of muscle overactivity. Treatments aim to reduce spasticity, strengthen muscles, improve mobility, and may include medication/surgery. Gait analysis is used to evaluate patterns and plan the most effective treatments.
This document discusses common orthopedic procedures and postoperative rehabilitation for patients with cerebral palsy. It describes the types of cerebral palsy and focuses on spastic quadriplegia, diplegia, and hemiplegia. For patients with spastic quadriplegia, it outlines procedures for the spine, hips, knees, and feet to address issues like scoliosis, subluxation, dislocation, and contractures. Rehabilitation goals are to improve seating, positioning, comfort, and upper extremity function. The document also details gait analysis and common procedures for spastic diplegia/hemiplegia, and the stages of postoperative physical therapy focusing on range of motion, strengthening, and regaining
This document provides information on cerebral palsy (CP), including its definition, classification, causes, symptoms, and treatment approaches. CP is a non-progressive brain injury early in life that results in impaired motor function. It is classified based on the type of movement abnormality (e.g. spastic, athetoid) and the parts of the body affected (e.g. hemiplegia, diplegia). Common causes include prenatal infections, complications during birth like hypoxia, and postnatal infections. Treatment involves physical therapy, bracing, medication to reduce spasticity, botulinum toxin injections, and surgery to correct musculoskeletal deformities. The goals are to improve motor function, prevent
The term ‘cerebral palsy’ includes a group of disorders that result from permanent non-progressive brain damage during early development and are characterized by abnormalities of movement and posture.
This document discusses spastic diplegic cerebral palsy (SDCP), a type of cerebral palsy that affects muscle tone and movement. SDCP is characterized by stiff muscles in the legs and lower body. It accounts for around 77% of all cerebral palsy cases. The causes of SDCP can include periventricular leukomalacia, cerebral dysgenesis, intracranial hemorrhage, and asphyxia. Symptoms include difficulty walking with legs bent inward and stiff feet. Treatment focuses on physical, occupational, and recreational therapy to improve mobility and prevent complications from progression.
This document discusses the physiotherapy management of cerebral palsy. The goals of rehabilitation are to improve mobility and function, prevent deformity, educate parents, and promote social integration. Therapy programs address issues specific to infants, toddlers, preschoolers and adolescents. Methods include stretching, strengthening, positioning, electrical stimulation, cryotherapy, hydrotherapy, neurofacilitation techniques like Vojta and Bobath methods, horseback riding, bracing, and mobility aids like standers, walkers, canes and crutches. The document provides details on various therapy methods and how they address issues for children with cerebral palsy.
This document provides an overview of spasticity in cerebral palsy from a physiotherapist's perspective. It defines cerebral palsy and spasticity, describes the pathophysiology and clinical evaluation of spasticity, and outlines various management techniques including movement and handling, soft tissue lengthening, electrical stimulation, thermal treatments, advanced techniques like vestibular stimulation and hippotherapy. The goal of management is to reduce spasticity and its consequences through a stepped care approach beginning with more conservative methods.
The document provides information on cerebral palsy, including:
- It was first described in 1862 and the term originated with Freud.
- It is a non-progressive disorder of motor development caused by disturbances in the developing brain.
- Symptoms can include developmental delays, abnormal muscle tone and movement patterns, unusual posture, and early hand preference.
- It is classified based on affected limbs (diplegia, hemiplegia, quadriplegia) and physiological characteristics (spastic, dyskinetic, ataxic, hypotonic).
- Assessments evaluate multiple body systems and functions like posture, mobility, sensation, and fine motor skills.
A brief introduction to the topic cerebral palsy, prepared by Dr Yash Oza, PG resident in MS Orthopaedics
Etiology, Classification, assessment, diagnosis, treatment
This document discusses various health issues that can result from birth trauma to the cervical spine and cranium, including headaches, vestibular problems, auditory troubles, visual disturbances, pharyngolaryngela disorders, vasomoter and secretion dysfunction and psychic disturbances. It notes that care to realign the neck through chiropractic adjustments can achieve excellent results for many of these dysfunctions. The document then discusses various causes of spinal trauma in infants and children, including the birth process, falls while learning to walk, playfully tossing babies in the air, automobile accidents, and whiplash-like injuries. It notes that spinal cord trauma is more likely than vertebral damage in infants due to the structure of the
This document discusses the management of pediatric spinal deformities such as early onset scoliosis, late onset scoliosis, congenital scoliosis, and neuromuscular scoliosis. It begins by classifying the different types of pediatric spinal deformities and then goes into further detail about the evaluation, treatment options including bracing, growing rod constructs, and fusion, as well as surgical techniques and outcomes for each condition. In particular, it focuses on the importance of allowing spinal growth and lung development in young children with spinal deformities through the use of growing rod constructs.
This document provides information on assessing a 4-year-old male child with cerebral palsy. It defines cerebral palsy as a group of disorders affecting movement and posture due to brain lesions or anomalies. The child's history notes his mother fell during pregnancy and he was born via C-section blue and did not cry. Physical exam findings include inability to walk, sit, or hold objects independently. The assessment examines developmental milestones, motor skills, reflexes, and provides differential diagnoses for the child's condition.
Scoliosis 101 describes the condition of scoliosis, how it is evaluated, traditional treatment recommendations,andt he most recent developments in non-invasive
rehabilitation based treatment. For more information visit http://www.treatingscoliosis.com or call
This document provides guidelines for investigating and managing cerebral palsy. It discusses various radiological investigations including MRI and CT scans to evaluate brain damage and identify risks. It also discusses potential helpful laboratory tests to rule out other causes, though there are no definitive lab tests for cerebral palsy. Treatment involves a multidisciplinary approach including physicians, therapists, and other specialists. Management seeks to improve functions, prevent deformities through stretching and positioning, and may include oral medications, intrathecal baclofen, botulinum toxin injections, orthopedic surgery, or selective dorsal rhizotomy. The overall goal is maximum physical, social and vocational independence through rehabilitation.
Cerebral palsy (CP) is a neurological condition caused by brain injury before development is complete, affecting motor control and muscle tone. Exercise rehabilitation programs aim to improve motor skills, reduce symptoms like spasticity, and enhance independence. Programs are individualized and include stretching, strengthening, balance activities, and tasks practicing daily living skills. Regular exercise can maintain function and quality of life for those with CP.
This document provides an overview of congenital muscular torticollis (CMT). CMT is caused by shortening of the sternocleidomastoid muscle at birth and results in an inclined neck. It affects 0.3-2.0% of live births. Diagnosis is based on history and examination. Treatment involves gentle stretching exercises before age 12 months. Surgery to lengthen the muscle may be considered for older children if conservative treatment fails. Surgical techniques aim to release the tight sternocleidomastoid muscle while avoiding injury to nearby nerves and vessels. Post-operative immobilization and exercises are used to prevent recontracture. Early treatment generally results in over 90% success rate.
This document provides information on cerebral palsy (CP), including its definition, classification, etiology, management, and common lower limb deformities seen in CP patients. Some key points:
- CP is a non-progressive disorder of the brain resulting in impaired motor function and posture. It occurs due to an insult to the developing brain, most commonly during prenatal, perinatal, or postnatal periods.
- Common classifications of CP include spastic, athetoid, ataxic, and mixed types based on the predominant motor symptoms. Lower limb deformities often seen include hip flexion contractures, knee flexion contractures, and foot equinus.
- Management involves controlling spasticity
The document discusses treatments for cerebral palsy that aim to promote independence and a healthy lifestyle. Physical therapy focuses on improving physical abilities like range of motion, muscle tone, and gait through exercises and assistive devices. Exercises include stretching, strengthening, and gait training. Aqua therapy is also used given its benefits of reduced injury risk and improved function for those with limited mobility. Orthoses and devices help with tasks of daily living and mobility issues through customized braces, walkers, wheelchairs, and adapted equipment. The overall goal is maximizing independence and quality of life.
The posterior
spinal fusion is then
performed with bone
graft placed between
the transverse
processes. An
instrument assistant is
used to maintain
correction during the
procedure.
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
Final Construct: The final
construct shows the
anterior and posterior
instrumentation
connected together with
the spinal fusion
performed between the
transverse processes.
This provides a rigid
three column construct to
correct and stabilize the
spinal deformity.
Dr. Clayton Stitzel, 1
Holistic concept in treatment of Cerebral Palsy jitendra jain
it is very difficult to manage cerebral palsy because we cant repair brain damage but we can give good quality of independent life by combination good rehabilitation tool which include advance therapeutic technique, botulinum toxin early age child and SEMLOSSS surgical concept in others. Our aim of management is to take these person to their highest capability and decrease their physical limitation as much as possible. This ppt have brief review about latest concept in mx of cerebral aplsy
This document discusses brachial plexus palsy, specifically Erb's palsy. It defines the brachial plexus and describes different types of brachial plexus injuries based on the nerves involved. Risk factors for brachial plexus palsy include large birthweight, shoulder dystocia during delivery, and maternal factors like age and gestational diabetes. The document outlines methods for diagnosing and managing brachial plexus palsy through conservative physical therapy or potential surgical interventions like nerve grafts or tendon transfers. Prevention focuses on identifying at-risk deliveries and properly managing shoulder dystocia using techniques like the McRoberts maneuver.
Bone age assessment is performed to evaluate growth in pediatric patients and diagnose endocrine disorders. It relies on visual evaluation of hand and wrist skeletal development compared to standard references. Key applications include diagnosing growth disorders and predicting final adult height. Skeletal development is divided into stages from infancy to post-puberty based on characteristics like appearance of ossification centers and epiphyseal fusion. Bone age is assessed by comparing a patient's hand and wrist radiograph to standardized images for their age and sex.
CP-Care curriculum, training course and assessment mechanism (ECVET based)
Website: http://cpcare.eu/en/
This project (CP-CARE - 2016-1-TR01-KA202-035094) has been funded with support from the European Commission. This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.
Cerebral Palsy Orthopedic Manifestations and TreamtnesShayDaji2
Cerebral palsy (CP) is a group of disorders caused by non-progressive brain damage early in development. It is characterized by abnormal movement and posture. The main types are spastic, dyskinetic, ataxic and mixed. CP is diagnosed based on symptoms, medical history and examination. Management includes therapies to improve mobility, surgical correction of deformities, medications to reduce spasticity, orthotics and assistive devices. The goals are maximizing function and independence.
This document provides an overview of spasticity in cerebral palsy from a physiotherapist's perspective. It defines cerebral palsy and spasticity, describes the pathophysiology and clinical evaluation of spasticity, and outlines various management techniques including movement and handling, soft tissue lengthening, electrical stimulation, thermal treatments, advanced techniques like vestibular stimulation and hippotherapy. The goal of management is to reduce spasticity and its consequences through a stepped care approach beginning with more conservative methods.
The document provides information on cerebral palsy, including:
- It was first described in 1862 and the term originated with Freud.
- It is a non-progressive disorder of motor development caused by disturbances in the developing brain.
- Symptoms can include developmental delays, abnormal muscle tone and movement patterns, unusual posture, and early hand preference.
- It is classified based on affected limbs (diplegia, hemiplegia, quadriplegia) and physiological characteristics (spastic, dyskinetic, ataxic, hypotonic).
- Assessments evaluate multiple body systems and functions like posture, mobility, sensation, and fine motor skills.
A brief introduction to the topic cerebral palsy, prepared by Dr Yash Oza, PG resident in MS Orthopaedics
Etiology, Classification, assessment, diagnosis, treatment
This document discusses various health issues that can result from birth trauma to the cervical spine and cranium, including headaches, vestibular problems, auditory troubles, visual disturbances, pharyngolaryngela disorders, vasomoter and secretion dysfunction and psychic disturbances. It notes that care to realign the neck through chiropractic adjustments can achieve excellent results for many of these dysfunctions. The document then discusses various causes of spinal trauma in infants and children, including the birth process, falls while learning to walk, playfully tossing babies in the air, automobile accidents, and whiplash-like injuries. It notes that spinal cord trauma is more likely than vertebral damage in infants due to the structure of the
This document discusses the management of pediatric spinal deformities such as early onset scoliosis, late onset scoliosis, congenital scoliosis, and neuromuscular scoliosis. It begins by classifying the different types of pediatric spinal deformities and then goes into further detail about the evaluation, treatment options including bracing, growing rod constructs, and fusion, as well as surgical techniques and outcomes for each condition. In particular, it focuses on the importance of allowing spinal growth and lung development in young children with spinal deformities through the use of growing rod constructs.
This document provides information on assessing a 4-year-old male child with cerebral palsy. It defines cerebral palsy as a group of disorders affecting movement and posture due to brain lesions or anomalies. The child's history notes his mother fell during pregnancy and he was born via C-section blue and did not cry. Physical exam findings include inability to walk, sit, or hold objects independently. The assessment examines developmental milestones, motor skills, reflexes, and provides differential diagnoses for the child's condition.
Scoliosis 101 describes the condition of scoliosis, how it is evaluated, traditional treatment recommendations,andt he most recent developments in non-invasive
rehabilitation based treatment. For more information visit http://www.treatingscoliosis.com or call
This document provides guidelines for investigating and managing cerebral palsy. It discusses various radiological investigations including MRI and CT scans to evaluate brain damage and identify risks. It also discusses potential helpful laboratory tests to rule out other causes, though there are no definitive lab tests for cerebral palsy. Treatment involves a multidisciplinary approach including physicians, therapists, and other specialists. Management seeks to improve functions, prevent deformities through stretching and positioning, and may include oral medications, intrathecal baclofen, botulinum toxin injections, orthopedic surgery, or selective dorsal rhizotomy. The overall goal is maximum physical, social and vocational independence through rehabilitation.
Cerebral palsy (CP) is a neurological condition caused by brain injury before development is complete, affecting motor control and muscle tone. Exercise rehabilitation programs aim to improve motor skills, reduce symptoms like spasticity, and enhance independence. Programs are individualized and include stretching, strengthening, balance activities, and tasks practicing daily living skills. Regular exercise can maintain function and quality of life for those with CP.
This document provides an overview of congenital muscular torticollis (CMT). CMT is caused by shortening of the sternocleidomastoid muscle at birth and results in an inclined neck. It affects 0.3-2.0% of live births. Diagnosis is based on history and examination. Treatment involves gentle stretching exercises before age 12 months. Surgery to lengthen the muscle may be considered for older children if conservative treatment fails. Surgical techniques aim to release the tight sternocleidomastoid muscle while avoiding injury to nearby nerves and vessels. Post-operative immobilization and exercises are used to prevent recontracture. Early treatment generally results in over 90% success rate.
This document provides information on cerebral palsy (CP), including its definition, classification, etiology, management, and common lower limb deformities seen in CP patients. Some key points:
- CP is a non-progressive disorder of the brain resulting in impaired motor function and posture. It occurs due to an insult to the developing brain, most commonly during prenatal, perinatal, or postnatal periods.
- Common classifications of CP include spastic, athetoid, ataxic, and mixed types based on the predominant motor symptoms. Lower limb deformities often seen include hip flexion contractures, knee flexion contractures, and foot equinus.
- Management involves controlling spasticity
The document discusses treatments for cerebral palsy that aim to promote independence and a healthy lifestyle. Physical therapy focuses on improving physical abilities like range of motion, muscle tone, and gait through exercises and assistive devices. Exercises include stretching, strengthening, and gait training. Aqua therapy is also used given its benefits of reduced injury risk and improved function for those with limited mobility. Orthoses and devices help with tasks of daily living and mobility issues through customized braces, walkers, wheelchairs, and adapted equipment. The overall goal is maximizing independence and quality of life.
The posterior
spinal fusion is then
performed with bone
graft placed between
the transverse
processes. An
instrument assistant is
used to maintain
correction during the
procedure.
Dr. Clayton Stitzel, 1-866-627-3009,
drstitzel@clear-institute.org,
http://www.treatingscoliosis.com/
Final Construct: The final
construct shows the
anterior and posterior
instrumentation
connected together with
the spinal fusion
performed between the
transverse processes.
This provides a rigid
three column construct to
correct and stabilize the
spinal deformity.
Dr. Clayton Stitzel, 1
Holistic concept in treatment of Cerebral Palsy jitendra jain
it is very difficult to manage cerebral palsy because we cant repair brain damage but we can give good quality of independent life by combination good rehabilitation tool which include advance therapeutic technique, botulinum toxin early age child and SEMLOSSS surgical concept in others. Our aim of management is to take these person to their highest capability and decrease their physical limitation as much as possible. This ppt have brief review about latest concept in mx of cerebral aplsy
This document discusses brachial plexus palsy, specifically Erb's palsy. It defines the brachial plexus and describes different types of brachial plexus injuries based on the nerves involved. Risk factors for brachial plexus palsy include large birthweight, shoulder dystocia during delivery, and maternal factors like age and gestational diabetes. The document outlines methods for diagnosing and managing brachial plexus palsy through conservative physical therapy or potential surgical interventions like nerve grafts or tendon transfers. Prevention focuses on identifying at-risk deliveries and properly managing shoulder dystocia using techniques like the McRoberts maneuver.
Bone age assessment is performed to evaluate growth in pediatric patients and diagnose endocrine disorders. It relies on visual evaluation of hand and wrist skeletal development compared to standard references. Key applications include diagnosing growth disorders and predicting final adult height. Skeletal development is divided into stages from infancy to post-puberty based on characteristics like appearance of ossification centers and epiphyseal fusion. Bone age is assessed by comparing a patient's hand and wrist radiograph to standardized images for their age and sex.
CP-Care curriculum, training course and assessment mechanism (ECVET based)
Website: http://cpcare.eu/en/
This project (CP-CARE - 2016-1-TR01-KA202-035094) has been funded with support from the European Commission. This communication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein.
Cerebral Palsy Orthopedic Manifestations and TreamtnesShayDaji2
Cerebral palsy (CP) is a group of disorders caused by non-progressive brain damage early in development. It is characterized by abnormal movement and posture. The main types are spastic, dyskinetic, ataxic and mixed. CP is diagnosed based on symptoms, medical history and examination. Management includes therapies to improve mobility, surgical correction of deformities, medications to reduce spasticity, orthotics and assistive devices. The goals are maximizing function and independence.
SCOLIOSIS - Presentation on SCOLIOSIS .docZaherRahat1
Scoliosis is where the spine twists and curves to the side.
It can affect people of any age, from babies to adults, but most often starts in children aged 10 to 15. Scoliosis can improve with treatment, but it is not usually a sign of anything serious and treatment is not always needed if it's mild.
This document discusses various classification systems used for cerebral palsy (CP). It outlines definitions for different types of motor impairments seen in CP including spasticity, dystonia, hypertonia, and hyperkinetic movements. It also discusses classifications of limb distribution and negative motor signs. The goal of developing standardized classification systems is to improve communication between clinicians and researchers to better understand treatment outcomes.
This document provides information on cerebral palsy, including what it is, its types and causes. Cerebral palsy is a permanent movement disorder caused by damage to the developing brain, often before or during birth. It affects muscle tone, movement and motor skills. There are several types classified by the parts of the body affected and the brain areas damaged. Causes include genetic abnormalities, prenatal infections, complications during birth, traumatic brain injuries and infections after birth up to age 1. Signs and symptoms vary depending on the type and severity but may include muscle stiffness, poor coordination, delays in meeting motor milestones and abnormal reflexes. Diagnosis is based on observing developmental delays and obtaining a medical history.
UNDERSTANDING CEREBRAL PALSY BY MINED ACADEMYMINED ACADEMY
This document provides information about cerebral palsy, including what it is, its types, causes, and signs and symptoms. Cerebral palsy is a permanent movement disorder caused by damage to the developing brain, resulting in impaired muscle coordination and abnormal movements. There are several types of cerebral palsy defined by the parts of the body affected and the areas of the brain damaged. Common causes include infections, genetic factors, complications during pregnancy/childbirth, and brain injuries during infancy. Early signs in infants may include difficulty feeding, irritability, delayed development, stiffening of the body, and impaired motor skills.
Cerebral palsy (CP) is a group of disorders that cause limitations in movement and posture due to non-progressive disturbances that occurred in the developing fetal or infant brain. It is diagnosed based on a motor impairment, static brain lesion, and injury occurring before age 2. Common causes include prematurity, infection, stroke, and birth asphyxia. CP is classified based on affected limbs and type of movement abnormality such as spastic, dyskinetic, or ataxic. Evaluation involves history, exam assessing tone and reflexes, and neuroimaging to identify brain lesions and timing of injury.
This study examined the active self-correction of spinal curvatures in 249 children (136 females, 113 males aged 10-14 years) in response to the command "straighten your back". Spinal angles were measured in standing and sitting positions both spontaneously and after the command. In standing, the command significantly increased sacral slope and decreased lumbar lordosis, thoracic kyphosis, and lower and upper thoracic kyphosis. In sitting, the command significantly changed sacral slope and lumbar lordosis from kyphotic to lordotic and significantly reduced thoracic kyphosis and flattened lower thoracic kyphosis. There were some gender differences in self-correction of lumbar lordosis and upper thoracic kyphosis
Traumatic and a traumatic spinal cord injury (1).pptxHebaSaad42
Spinal cord injuries in children can occur from accidents, abuse, or during birth and present unique challenges. Physical therapists must evaluate multiple body systems impacted by the injury over the child's lifetime. Examinations consider medical history, development, and assess areas like mobility, sensation, muscle tone, respiratory function and independence in daily activities. Therapists establish diagnoses and prognoses to set appropriate treatment goals and anticipate a child's optimal recovery based on factors like level of paralysis and initial recovery rate.
Cerebral palsy is a group of neurological disorders caused by non-progressive brain damage early in development. It is characterized by abnormal muscle tone, posture and movement. The document discusses the anatomy of the areas of the brain involved in motor control. It outlines the different types of cerebral palsy including spastic, dyskinetic, hypotonic and mixed. The etiology, signs, classification and multidisciplinary management approach are summarized. Community-based rehabilitation is emphasized as a way to promote independence and inclusion of people with cerebral palsy.
This presentation is adapted from the B.Ed course HUMAN DEVELOPMENT AND LEARNING (Code 8610) by TEACHER EDUCATION DEPARTMENT, FACULTY OF EDUCATION, ALLAMA IQBAL OPEN UNIVERSITY
This document provides an overview of the content for a physical education manual and workbook. It includes sections on motor learning and development, anatomy and physiology, and outdoor education and games for the first semester. The second semester covers adapted physical education, organization and administration, and child protection. Key topics in motor learning and development include motor skills, phases of motor development, and closed and open skills. Anatomy and physiology outlines anatomical terminology, the skeletal system including bone types and the vertebral column, and synovial joints. It also provides an overview of the muscular system and main skeletal muscles and their actions.
Falls and Preventive Measure of Fall in ElderlyKhalid Ghaznavi
The document discusses balance and falls in elderly patients. It notes that falls are a major cause of mortality, morbidity, fractures, and loss of independence in elderly individuals. The causes of falls are often multi-factorial, involving both intrinsic patient factors like aging, poor balance, and chronic conditions as well as extrinsic environmental hazards. A thorough evaluation of elderly fall risk involves assessing the patient's medical history, performing physical exams of systems like vision and sensation that affect balance, and testing the patient's balance, gait, and fall response strategies.
This document discusses posture and postural alignment. It defines posture and recognizes the importance of maintaining proper spinal curves and alignment with gravity. The document outlines the objectives of understanding posture, identifies the types of posture, and discusses the factors that can affect posture like age, pregnancy, muscle imbalances, and occupations. It also differentiates the muscles of the spine and explores methods of assessing posture, including X-rays, 3D motion analysis, raster stereography, and physical measurements.
SYBPO - Orthotics.This presentation consists of all the pathological reasons affecting the lower extremity causing various deformities. it consists of Cerebral Palsy, polio, CDH etc.
Cereberal palsy dr hussein abass 2019 pptHosin Abass
Cerebral palsy is caused by non-progressive disturbances in the developing fetal or infant brain that affect movement and posture. The document discusses the normal process of brain development and the critical periods of growth. The majority (80%) of causes are prenatal, such as maternal infections, drugs/alcohol exposure, genetic malformations, or complications during birth like prematurity, oxygen deprivation, or infections. While cerebral palsy was once considered static, some features like movement disorders and orthopedic complications can change over time.
5Physical Development
Novastock/Photolibrary/Getty Images
Learning Objectives
After completing this module, you should be able to:
ሁ Describe changes in body and brain structure from birth through adolescence.
ሁ Detail the process of nerve function and how neurons transmit signals.
ሁ Provide behavioral examples that demonstrate how the brain is organized.
ሁ Outline major milestones in motor development.
ሁ Clarify important issues related to toilet training.
ሁ Identify warning signs of various physical disabilities that may first appear in early childhood.
ሁ Describe physical changes that take place during puberty, including historical and cultural trends,
and the differential impact on males and females.
Section 5.1General Patterns of Growth
Prologue
Among infants and young children, tremendous changes occur in every domain of develop-
ment. However, none are more apparent than the physical changes. When new parents talk
about their baby’s growth, the first thing that usually comes to mind is height, weight, and
motor activity. Imaging devices now allow us to track coinciding changes in brain tissue. We
can conclusively differentiate between a male brain and a female brain—even at birth. Though
we are far from making predictions about physical development based on brain scans, we can
predict some effects of deprivation. For instance, malnutrition can have far-reaching conse-
quences, extending into physical, cognitive, and even psychosocial domains.
Quite unlike other animal species, human infants are virtually helpless at birth. Babies can
eat only if a nipple is provided; they cannot move objects out of the way or closer; and for the
most part they cannot manipulate the physical structure of the environment. Initially they
do not even have the muscle strength needed to hold up their heads. It is only with adult
assistance that infants can survive and eventually optimize growth. Technology and scien-
tific advancement have allowed us to better understand how we transition from completely
dependent beings into adolescents who are perfectly capable of walking away from their par-
ents. This module focuses on those physical developments.
5.1 General Patterns of Growth
Though parents do not often notice, the heads of infants are disproportionately large com-
pared to the rest of their bodies. On their way to adult proportions, the torso and limbs grow
faster than the head. This pattern of growth is an example of directionality, one of the gen-
eral principles of human growth. In this case, the direction is
cephalocaudal, literally meaning “head to tail.” At birth not
only is the head more developed physically than the rest of
the body, but also vision and hearing precede growth of the
limbs. That is, babies begin to focus their eyes on what they
hear well before they begin walking or perform coordinated
hand movements.
Physical growth also occurs in a proximodistal pattern—
from the inside out. In the prenat ...
pediatric electrodiagnostic for cerebral palsy,
A diagnosis of CP is often made based on MRI, delay of motor milestones and the presence of gait abnormalities in young children
Although the initial brain injury is non-progressive, the musculoskeletal impairments and functional limitations associated with CP are progressive
Three main classes of CP include spastic, dyskinetic and ataxic
This presentation provides an overview of cerebral palsy in children. It defines cerebral palsy as a permanent disorder of movement and posture caused by a non-progressive brain injury early in development. The main types of cerebral palsy are spastic, athetoid, ataxic, and hypotonic. Risk factors include preterm birth and infections during pregnancy. Treatment is multidisciplinary and includes therapies to improve motor skills and function.
Receptor Discordance in Breast Carcinoma During the Course of Life
Definition:
Receptor discordance refers to changes in the status of hormone receptors (estrogen receptor ERα, progesterone receptor PgR, and HER2) in breast cancer tumors over time or between primary and metastatic sites.
Causes:
Tumor Evolution:
Genetic and epigenetic changes during tumor progression can lead to alterations in receptor status.
Treatment Effects:
Therapies, especially endocrine and targeted therapies, can selectively pressure tumor cells, causing shifts in receptor expression.
Heterogeneity:
Inherent heterogeneity within the tumor can result in subpopulations of cells with different receptor statuses.
Impact on Treatment:
Therapeutic Resistance:
Loss of ERα or PgR can lead to resistance to endocrine therapies.
HER2 discordance affects the efficacy of HER2-targeted treatments.
Treatment Adjustment:
Regular reassessment of receptor status may be necessary to adjust treatment strategies appropriately.
Clinical Implications:
Prognosis:
Receptor discordance is often associated with a poorer prognosis.
Biopsies:
Obtaining biopsies from metastatic sites is crucial for accurate receptor status assessment and effective treatment planning.
Monitoring:
Continuous monitoring of receptor status throughout the disease course can guide personalized therapy adjustments.
Understanding and managing receptor discordance is essential for optimizing treatment outcomes and improving the prognosis for breast cancer patients.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Applications of NMR in Protein Structure Prediction.pptxAnagha R Anil
This presentation explores the pivotal role of Nuclear Magnetic Resonance (NMR) spectroscopy in predicting protein structures. It delves into the methodologies, advancements, and applications of NMR in determining the three-dimensional configurations of proteins, which is crucial for understanding their function and interactions.
Can Traditional Chinese Medicine Treat Blocked Fallopian Tubes.pptxFFragrant
There are many traditional Chinese medicine therapies to treat blocked fallopian tubes. And herbal medicine Fuyan Pill is one of the more effective choices.
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
Microbiology & Parasitology Exercises Parts of the Microscope
Control motor
1. DEVELOPMENTAL PHYSIOLOGY
Developmental kinesiology: Three levels of motor
control in the assessment and treatment of the motor
system
Alena Kobesova, MD, PhD*, Pavel Kolar, PedDr, PhD
Department of Rehabilitation and Sports Medicine, Second Medical Faculty, University Hospital Motol, Charles University,
Prague, Czech Republic
Received 7 August 2012; received in revised form 11 March 2013; accepted 4 April 2013
KEYWORDS
Developmental
kinesiology;
Sensorimotor control;
Primitive reflexes;
General movements;
Postural stabilization;
Developmental
dyspraxia;
Dynamic
neuromuscular
stabilization
Summary Three levels of sensorimotor control within the central nervous system (CNS) can
be distinguished. During the neonatal stage, general movements and primitive reflexes are
controlled at the spinal and brain stem levels. Analysis of the newborn’s spontaneous general
movements and the assessment of primitive reflexes is crucial in the screening and early recog-
nition of a risk for abnormal development. Following the newborn period, the subcortical level
of the CNS motor control emerges and matures mainly during the first year of life. This allows
for basic trunk stabilization, a prerequisite for any phasic movement and for the locomotor
function of the extremities. At the subcortical level, orofacial muscles and afferent informa-
tion are automatically integrated within posturalelocomotor patterns. Finally, the cortical
(the highest) level of motor control increasingly becomes activated. Cortical control is impor-
tant for the individual qualities and characteristics of movement. It also allows for isolated
segmental movement and relaxation. A child with impaired cortical motor control may be diag-
nosed with developmental dyspraxia or developmental coordination disorder. Human ontoge-
netic models, i.e., developmental motor patterns, can be used in both the diagnosis and
treatment of locomotor system dysfunction.
ª 2013 Elsevier Ltd. All rights reserved.
* Corresponding author. Department of Rehabilitation and Sports Medicine, University Hospital Motol, V Uvalu 84, 150 06 Prague 5, Czech
Republic. Tel.: þ420 22443 9264; fax: þ420 22443 9220.
E-mail address: alenamudr@me.com (A. Kobesova).
+ MODEL
Please cite this article in press as: Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and
treatment of the motor system, Journal of Bodywork & Movement Therapies (2013), http://dx.doi.org/10.1016/j.jbmt.2013.04.002
1360-8592/$ - see front matter ª 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.jbmt.2013.04.002
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/jbmt
Journal of Bodywork & Movement Therapies (2013) xx, 1e11
2. The neonate
The neonate is functionally and anatomically immature
(Fig. 1). Organized at the spinal and brainstem levels of the
CNS control, primitive general movements (GMs) display
characteristic quality and intensity, involving the entire
body (Einspieler and Prechtl, 2005). The GMs (Prechtl,
1997; Hadders-Algra, 2004) are not triggered by any
obvious external stimuli (Adde et al., 2007) and do not
serve any specific purpose, such as grasping, reaching or
support. For example, a newborn cannot grasp purpose-
fully; grasping reflex is an automatic, involuntary response
to proprioceptive and tactile palm stimulation and does not
serve a purposeful grasp. The absence of antagonistic co-
activation, which is typical for early postural behavior,
does not allow for segmental stability. Therefore, postural
adjustment is quite different from the later development
when motor functions such as reaching or walking occur
(Hadders-Algra, 2005). Purposeful reaching also requires
coordinated activity of the head, eyes and hand which, in
turn, depends on trunk support. Such coordination is not
available in the neonatal stage and appears only at 4
months of age (Bertenthal and Von Hofsten, 1998). A
newborn’s ability to hold a segment in a static position
against gravity is very limited (Bertenthal and Von Hofsten,
1998; Orth, 2005). The body follows head rotation and an
asymmetrical posture occurs (Orth, 2005). According to
Prechtl, newborns are able to balance their head for a few
seconds in a sitting position (Prechtl, 1997). Although
ocular-motor coordination starts from the first month of life
(Bloch and Carchon, 1992), constant visual fixation and
tracking are quite limited in a newborn. This ability appears
at 1 month of age and rapidly increases over the next few
months of life. The contribution of head movements to vi-
sual tracking also appears at 1 month of age (Bertenthal
and Von Hofsten, 1998). Orofacial muscle activity,
including the tongue, becomes organized within general
movements. Healthy newborn can coordinate sucking,
swallowing and breathing which allows for a normal sucking
pattern (Palmer et al., 1993).
Assessment of neonatal motor behavior can serve as a
very early pediatric screening tool (Adde et al., 2007;
Burger and Louw, 2009). The normal physiology of newborn
GMs consists of a series of gross movements of variable
speed and amplitude that involve all parts of the body
(Hadders-Algra, 2004). For example, a newborn typically
keeps its fists closed with the thumb inside the palm
(Fig. 1). However, as a general movement of the arm oc-
curs, it also involves the hand, leading to hand opening and
the thumb moving outside the fist (Fig. 2). Under normal
physiological conditions, the fist is not a fixed postural
pattern (Hadders-Algra, 2004; Orth, 2005; Vojta, 2008). In
the neonatal period, the GMs are writhing, “elegant”,
rather slow with specific amplitude and involve not only the
extremities, but also the trunk and orofacial muscle sys-
tems. For example, under pathological conditions in infants
who later develop cerebral palsy (CP), not only that their
posture is different (Fig. 1C), but also their global move-
ment patterns demonstrate different quality, which is best
described as “cramped-synchronized” rather than
“elegant”. They involve mainly the proximal segments and
muscles, with different intensity, speed and amplitude
(Prechtl et al., 1997; Adde et al., 2007). Abnormal GMs are
insufficiently variable and lack complexity and fluency
(Hadders-Algra, 2004). Posturally, the physiologically
normal neonate may prefer head rotation towards one side,
which is known as “predilection” (Fig. 1A) (Orth, 2005;
Vojta, 2008). However, the head rotation is not fixed and,
even during the newborn stage, every healthy newborn
should be able to rotate the head across midline.
Primitive & postural reflexes
During the neonatal stage, primitive reflexes organized at
the spinal and brain stem levels can be elicited. Utilizing
adequate proprioceptive and exteroceptive (non nocicep-
tive) stimulation, certain reflexes, such as the crossed
extensor reflex, suprapubic reflex, step reflex, supporting
reflex and other reflexes (Fig. 3), can be observed. The
assessment of spontaneous complex motor behavior, prim-
itive reflexes and seven postural tests as outlined by Vojta
can be used to examine the infant‘s developmental age.
They can be used to determine whether the development is
physiologically normal or whether there is a risk for an
abnormal development (Zafeiriou, 2004; Orth, 2005; Vojta,
2008). An experienced clinician may even predict the
Figure 1 Neonate. A: A typical supine posture with the head rotated toward one side (called predilection), the hand closed in fist
with thumb inside the palm, cranial chest position, no postural activity in abdominal muscles. B: A typical prone posture: the chest
is the weight bearing area, the arm is in adduction, fist with thumb inside the palm, scapular elevation, anterior pelvic tilt, the
baby cannot hold the head steadily above the mat as a result of a lack of equilibrium and a lack of supporting arm function. C: Baby
with cerebral palsy e a pathological posture with opisthotonus; both the posture and quality of movements are different in
comparison with those found in an optimally developing baby.
2 A. Kobesova, P. Kolar
+ MODEL
Please cite this article in press as: Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and
treatment of the motor system, Journal of Bodywork & Movement Therapies (2013), http://dx.doi.org/10.1016/j.jbmt.2013.04.002
3. severity of impairments and the type of CP likely to develop
in a particular infant. These quick, noninvasive and inex-
pensive assessments should be performed during the
neonatal stage. This would allow for the initiation of an
early treatment where necessary, before any pathological
stereotypes become fixed leading to a subsequent
morphological damage. Primitive reflexes organized on
spinal and brain stem levels do not “disappear” after the
neonatal stage. These motor patterns are simply inhibited
by higher levels of control as the CNS matures. They
become integrated within more complex patterns
controlled at the subcortical and cortical levels. Under
pathological conditions, such as brain injury or stroke, the
primitive reflexes or its components become disinhibited
and reappear, sometimes being described by a neurologist
as positive pyramidal signs.
Musculoskeletal development
Functional neonatal immaturity goes hand in hand with
anatomic immaturity. Spinal curves are not yet defined
(Abitbol, 1987; Lord et al., 1995; Kasai et al., 1996), the
chest is barrel shaped (the anteroposterior diameter is
longer than the width; unlike in the adulthood), the tibial
plateau is oblique, the arch of the foot is not yet formed
(Forriol Campos et al., 1990; Volpon, 1994), etc. Anatomic
maturation continues after birth and, besides other factors
(i.e. genetic, hormonal, metabolic, and immunological), it
depends on the CNS control of muscle function. Muscles
pulling on the epiphyseal plates greatly influence structural
formation. Therefore, it is critical that the muscles acting
on the epiphyseal plates function in balance. Correct CNS
control ensures proportional activation between the ad-
ductors and abductors, external and internal rotators,
flexors and extensors and allows for an ideal skeletal for-
mation. In a child with CP, both an abnormal motor and
sensory function and the occurrence of anatomical de-
formities resulting from an abnormal CNS control can be
observed (Volpon, 1994; DeLuca, 1996; Koman et al., 2004;
Davids, 2010). To a certain extent, this may be positively
influenced by initiating an early and targeted treatment
Figure 3 Primitive reflexes: A e crossed extensor reflex, B e suprapubic reflex, C e step reflex, D e supporting reflex.
Figure 2 Within general movements, the thumb moves
outside the palm.
Developmental kinesiology 3
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Please cite this article in press as: Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and
treatment of the motor system, Journal of Bodywork & Movement Therapies (2013), http://dx.doi.org/10.1016/j.jbmt.2013.04.002
4. (Morrell et al., 2002; Ha¨gglund et al., 2005; Picciolini et al.,
2009).
The evaluation of spontaneous motor behavior, primitive
reflexes and postural reactions as a functional clinical
assessment can also serve as an important clinical tool to
re-evaluate the infant and to assess the effect of the
implemented therapy. It serves as a feedback to both the
clinician and the parent, but may also allow for comparison
of different types of treatment strategies (Vojta, 1972a,
1972b; Morrell et al., 2002). The concepts of Bobath and
Vojta (Bobath, 1980; Bobath and Bobath, 1984; Vojta, 2008;
Vojta and Schweizer, 2009) are the two most common
therapeutic approaches utilized in newborns and toddlers
with abnormal development.
The infant
When the neonatal developmental period is completed (the
first 28 days after birth), the posturalelocomotor function
related to maturation of the subcortical CNS (second) level
of motor control begins. Prior to movement of an extrem-
ity, the head or the neck, the core needs to brace within
the gravitational field (Hodges, 2004). To stabilize the neck
and the upper thoracic spine, balanced synergy between
the neck flexors and spinal extensors is required (Kapandji,
1992). A feed-forward activation of both the neck flexors
and extensors is a necessary mechanism for stability of limb
movements as well as for the visual and vestibular systems;
therefore ensuring stabilization and protection of the cer-
vical spine (Falla et al., 2004). To stabilize the lower
thoracic and lumbar spine, a complex synergy between the
diaphragm, pelvic floor, abdominal wall and spinal exten-
sors is essential. Harmonious concentric activity of the
diaphragm and the pelvic floor is followed by eccentric
activity of all sections of the abdominal wall. This muscle
synergy increases intra-abdominal pressure, thereby stabi-
lizing the low back from the front. Under ideal conditions,
this activity is in balance with the spinal extensors (Fig. 4)
(Cholewicki et al., 1999; Hodges and Gandevia, 2000;
Essendrop et al., 2002; Hodges et al., 2005, 2007; Kolar
et al., 2009).
This stabilizing muscle synergy develops during the first
4.5 months of life. After the neonatal period, the infant
begins to lift their legs in supine (Fig. 5A) and lift their head
when prone (Fig. 5B). For postural activity to occur, bal-
ance among all the stabilizers is necessary and depends on
optimal utilization of the supporting segments. A 3-month
old infant can lift their legs and weightbear on the upper
sections of the gluteal muscles while maintaining an upright
spine (Adde et al., 2007; Vojta, 2008). The chest and pelvis
are in a neutral position, the axis of the chest and pelvis are
in a parallel alignment, thus allowing for a balanced
postural function.
In a newborn, the diaphragm fulfills mainly its respira-
tory function (Murphy and Woodrum, 1998). It starts to act
as an important stabilizer (Kolar et al., 2009; Vojta and
Schweizer, 2009) after the neonatal period. While prone,
the baby utilizes the medial epicondyles of the elbows and
the pubic symphysis as support zones (Fig. 5B). The same
stabilizing muscle synergy occurs in supine (Fig. 5A) and
allows the baby to lift the legs with the spine perfectly
upright (Hermsen-van Wanrooy, 2006; Vojta and Schweizer,
2009). Since the upper thoracic segments functionally
belong to the cervical spine, as the infant lifts their head,
the movement is initiated in T3/4/5 segments at the origin
of the neck extensors: semispinalis cervicis and capitis,
splenius cervicis and capitis. The extensors work in balance
with the deep neck flexors (Kapandji, 1992). It is important
for the activity of all the stabilizers to be proportional. If
one link (a muscle or just a certain section of a muscle) is
weak, it must be counterbalanced by another muscle,
Figure 4 Schematic illustration of muscles stabilizing the
shoulder and pelvic girdle and the spine. Under a physiological
condition, the stabilizers: in red e the diaphragm, the pelvic
floor, all the sections of the abdominal wall and the spinal
extensors e automatically activate prior to purposeful move-
ment (e.g. hip flexion provided by the muscles in blue: the
iliopsoas, rectus femoris, sartorius) to establish a stable base
(“Feed forward mechanism”). In healthy subjects, the stabi-
lizing function of the trunk (in red) muscles prevents mala-
lignment of the lumbar segments during hip flexion. Well
balanced activity between the deep neck flexors and the spinal
extensors is necessary for stabilization in the cervical and
upper thoracic regions. (For interpretation of the references to
colour in this figure legend, the reader is referred to the web
version of this article.)
4 A. Kobesova, P. Kolar
+ MODEL
Please cite this article in press as: Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and
treatment of the motor system, Journal of Bodywork & Movement Therapies (2013), http://dx.doi.org/10.1016/j.jbmt.2013.04.002
5. leading to an imbalance in the global stabilization chain
(Lewit, 2010). Unless restored early by therapy, it may
remain for the rest of life and become a primary etiological
factor in the development of chronic pain in the locomotor
system (Kolar et al., 2010, 2011).
Emotional motivation is also an important component in
postural development. The infant starts to lift their head
and legs to adjust the entire posture to be able to look
around, later to grasp and, eventually, to start moving.
Proper interaction with the environment influences the
infant’s complex behavioral repertoire (Bell et al., 2008).
Differentiation of extremity movement
After basic stabilization of the core in the sagittal plane is
completed, the locomotor function of extremities occurs
(Hermsen-van Wanrooy, 2006; Vojta and Schweizer, 2009).
At 4.5 months, the infant starts to reach across the midline
when supine. Motivation, once again, triggers trunk rota-
tion at the age of 5 months when the infant can turn to a
sidelying position (Fig. 6) and complete rolling from supine
to prone at 6 months of age.
The ipsilateral pattern of extremity locomotor function
develops from the supine position. The ipsilateral (bottom
when sidelying: Fig. 6) extremities serve as support. These
are activated in a closed kinetic chain, the direction of
muscle pull is distal and the proximal segments (e.g. the
acetabulum at the hip and/or the glenoid cavity at the
shoulder) move against the fixed head of the femur and the
humerus. Reciprocal, or the stepping forward and grasping/
reaching function, occurs in the opposite (top) extremities.
They are activated in an open kinetic chain, where the
direction of muscle pull is proximal, the distal part of the
segment moves against the fixed proximal part, i.e. the
humeral and femoral head move against a fixed glenoid
cavity or the acetabulum, respectively.
In the prone position, the contralateral pattern of lo-
comotor function develops (Fig. 7). If the left arm serves as
a support, the infant simultaneously weightbears on the
right knee, with the right arm reaching and the left leg
stepping forward. The kinetic chain principles are the same
as described for the ipsilateral pattern. Stepping forward
and supporting functions are reciprocal; they are the same
movements, only in opposite directions.
Both supporting and stepping forward extremity func-
tions fully depend on trunk stabilization (Hodges, 2004).
Therefore, during development, stabilization must initially
occur in the spine, chest and pelvis and only then it is
Figure 5 A 3-month old baby, supine and prone: a model of optimal trunk sagittal stabilization.
Figure 6 6 month old baby, side lying position e ipsilateral
pattern of locomotion extremity function based on optimal
core stabilization: bottom extremities serve for support, top
extremities are stepping forward/reaching.
Figure 7 Contralateral posturalelocomotion pattern: right
leg, left arm: supporting; left leg, right arm: stepping forward
(reaching).
Developmental kinesiology 5
+ MODEL
Please cite this article in press as: Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and
treatment of the motor system, Journal of Bodywork & Movement Therapies (2013), http://dx.doi.org/10.1016/j.jbmt.2013.04.002
6. followed by a phasic extremity function. The same is true
for a spontaneous motor behavior for the rest of life.
Joint centration and stabilization
Prior to any movement, the core needs to brace (Hodges,
2004; McGill et al., 2009; Borghuis et al., 2008). Naturally,
conscious focus is on the phasic part of any movement, while
the stabilizing function is subconscious and automatic.
Therefore, stability is often compromised and not easily re-
trained. It is suggested that corrective stabilization training
should be a primary step in any rehabilitation program
(Akuthota et al., 2008; Kobesova et al., 2012; Frank et al.,
2013). Balance or strengthening exercises prescribed to a
patient with poor stabilization will have limited effect or
they may even promote pathological patterns of movement
and exacerbate the patient’s pain (Akuthota et al., 2008;
Kola´r and Kobesova´, 2010; Kolar et al., 2011).
Assuming that core stability and basic extremity loco-
motor function are mainly under the subcortical CNS con-
trol, if CNS control is adequate, and muscles are activated
in balance, then each posture and each spontaneous
movement automatically bring all the joints into a func-
tionally centrated position. The functionally centrated
(neutral or functionally optimal) joint is not a static posi-
tion but a dynamic neuromuscular strategy that leads to the
most optimal joint position which then facilitates the most
effective mechanical advantage throughout the entire
range of motion. The joint contact area between the joint
head and the cavity is affected by ligament strain (Novotny
et al., 2000), and it is assumed that the centrated joint has
the greatest interosseous contact, which allows for optimal
load transfer across the joint and throughout the kinetic
chain. This implies maximum loading, minimum tension in
the joint capsule and the ligaments, and the protection of
all joint structures during loading.
It should be noted that posturalelocomotor function
also involves orofacial muscles and is greatly influenced by
all afferent stimuli. The CNS constantly processes all
tactile, proprioceptive, visual, vestibular and acoustic
stimuli. This can be demonstrated by visual integration
(Fisk and Goodale, 1985; Gribble et al., 2002; Henriques
et al., 2003). During development, the physiologically
normal infant is curious and desires to explore the envi-
ronment. To be able to observe their surroundings, the
infant adopts the most suitable posture, activates support
function in order to stabilize the entire body within gravity
and then looks around. Thus, the baby lifts the legs in su-
pine or lifts the head in prone while the eyes lead during
the stepping forward function. At the age of 5e6 months,
the infant turns the eyes towards an object of interest,
which triggers arm reaching followed by rolling. This syn-
ergy remains for the rest of life. A tennis player turns his
eyes in the direction of the ball as he prepares to hit it
while his tongue moves in the same direction (Fig. 8). Here,
the movement of the eyes and the tongue facilitates a
posturalelocomotor pattern, which promotes and en-
hances sport performance.
The scenario of a grasping reflex versus an active grasp
serves as another example. If the newborn’s palm is
touched, the baby automatically grasps (Orth, 2005; Vojta,
2008). This is a reflex organized at the spinal and brain stem
level. Since the stereognosis has yet not matured in the
palm of a newborn, the infant does not feel the hand
contact. The grasp is automatic, involuntary and does not
serve as an active grip. Later, between the 3rd and 4th
month of life, stereognosis in the palm develops and, at the
same time, the infant starts to grasp actively and pur-
posefully. Sensory perception is a prerequisite for motor
function (Metcalfe et al., 2005). These principles can be
effectively utilized in rehabilitation treatment to achieve
optimum stabilization and movement performance.
Various rehabilitation approaches can be used to assess
and restore an ideal muscle synergy to stabilize the core.
Dynamic Neuromuscular Stabilization (DNS) concept (Kola´r
and Kobesova´, 2010; Frank et al., 2013) may serve such a
purpose. DNS assessment is based on comparing the pa-
tient’s stabilization pattern with the stabilization patterns
typical for physiological development. A healthy infant
automatically utilizes ideal muscular synergy to stabilize
their spine, pelvis and chest in various positions. DNS is
based on the developmental positions and describes a set
of functional tests to assess the quality of patient’s sta-
bilization and to recognize a key link in dysfunction. The
treatment is based on developmental positions (see
Fig. 9). The goal is to achieve optimal muscle coordination
by placing the patient into various developmental posi-
tions while bringing the supporting joints and segments
into a functionally centrated position. At first, the patient
is manually and verbally guided to recognize the differ-
ence between the poor and the optimal stabilizing ste-
reotype. Then, the patient is instructed to maintain the
optimal pattern in different positions and later also during
a movement. Since the stereotype of stabilization is
closely related to a respiratory pattern (Kolar et al., 2009,
2010, 2011), the DNS assessment always includes the
evaluation of a breathing pattern. The training also ad-
dresses simultaneous stabilizing and respiratory functions.
The ultimate goal of DNS is to teach the patient the
integration of an optimal pattern of breathing and stabi-
lization within the activities of daily living and sport
performance.
Figure 8 A tennis player e integration of eyes, tongue and
orofacial muscles within the posturalelocomotor pattern.
+ MODEL
Please cite this article in press as: Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and
treatment of the motor system, Journal of Bodywork Movement Therapies (2013), http://dx.doi.org/10.1016/j.jbmt.2013.04.002
6 A. Kobesova, P. Kolar
7. Figure 9 Examples of exercise in developmental positions. Through verbal and manual guidance the patient is instructed to
achieve the same quality of posturalelocomotion function. A: An oblique sitting position corresponding with developmental
posture at 8 months of age. B: A crawling position corresponding with developmental posture at 10 months of age. C: A “high
kneeling” position corresponding with developmental posture at 10e11 months of age. D: A squat position corresponding with
developmental posture at 12 months of age.
+ MODEL
Please cite this article in press as: Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and
treatment of the motor system, Journal of Bodywork Movement Therapies (2013), http://dx.doi.org/10.1016/j.jbmt.2013.04.002
8. Cortical function
The cortical level of motor integration presents the highest
level of CNS control. It incorporates gnostic function, such
as multisensory integration, allowing for body image, self-
location and first-person perspective (Ionta et al., 2011)
The better the body perception, the better the quality of
phasic movement, the better the ability to perform isolated
movement in only one segment and the better the ability to
relax.
Even with the eyes closed, it should be possible to
“read” one’s own body (Mon-Williams et al., 1999). We
know if we are sitting or standing, if our elbow is flexed or
extended, if we wear short or long sleeves, if our posture is
static or dynamic, etc. With our eyes closed, we should be
able to demonstrate our body proportions. For example, we
should be able to quite precisely draw the size of the foot,
demonstrate the width of the pelvis (Fig. 10), or the size of
the mouth. Body perception, primarily proprioception, al-
lows differentiation of an object’s weight, position and
motion. We can “read” a joint position (Mon-Williams
et al., 1999) and repeatedly perform the same move-
ment. These principles are critical in both sport perfor-
mance and rehabilitation. The better the body image the
more precise and efficient the movement is. Clumsiness
and poor coordination may be related to abnormal propri-
oceptive control (Adib et al., 2005).
Visual perception is also essential for purposeful move-
ment (Mon-Williams et al., 1999). It allows for estimation of
distance and speed as well as facilitation of an adequate
and coordinated motor response within our surroundings.
For example, the earlier a tennis player sees an
approaching ball, the quicker the estimate of the angle,
direction, and speed of the ball. Continuing the tennis
example, an individual’s quality of visual perception would
be a key aspect to success (Moreno et al., 2005; Ghasemi
et al., 2011). Visual perception and integration at a
cortical level enables us to mimic body positions, move-
ments, or gestures of another personda critical aspect in
sport and rehabilitation.
Vestibular perception is important not only for postural
balance (Angelaki and Cullen, 2008), but also for vertical
line perception. The perception of visual vertical is altered
in individuals with idiopathic scoliosis (Cakrt et al., 2011)
and may play a role in the development of scoliosis.
Whether an individual with idiopathic scoliosis perceives
vertical line differently because of the scoliosis, or if the
scoliosis is in fact a consequence of abnormal vertical line
perception, is a topic open to discussion.
Even skin perception influences our motion (Edin and
Johansson, 1995). Skin input contributes to both dynamic
position and velocity sense (Cordo et al., 2001). Very often,
the perceptiveness at the segment is restored after
manipulation or mobilization, which in turn allows for a
longer lasting effect of the manual technique applied.
Altered multi-sensory CNS integration may result in poor
motor planning, poor motor re-education (Polatajko and
Cantin, 2005), or a difficulty performing the simplest task.
Such individuals cannot adjust their muscle strength to the
actual demand, and usually activate too many unnecessary
muscles for stabilization, making the movements ineffi-
cient. They demonstrate poor diadochokinesis as well as
poor fluency and speed adjustment. A person with altered
sensory integration can barely perform selective move-
ments in only one joint, and usually have great difficulty
relaxing postural muscles.
Research shows that insufficient uni- or multi-sensory
integration at the cortical level may lead to painful syn-
dromes within the locomotor system (Flor et al., 1997;
Imamura et al., 2009). Injuries, degenerative joint disor-
ders, enthesopathies, orthopedic problems resulting from
chronic overload and repetitive stress injuries are typical
consequences. These disorders are usually considered to be
primary diagnoses rather than a consequence of an altered
sensorimotor integration and CNS control which is more
likely to be the real etiology. The therapy then only targets
“the diagnosis” rather than the primary etiology. Conse-
quently, the chosen therapy usually ends up being unsuc-
cessful in the long run.
In patients with poor integration of afferent informa-
tion (i.e. where poor body image is a key problem), it is
advised to integrate body perception training within the
rehabilitation program. The patient may be taught to
focus on a particular body part with compromised sensory
perception. First, with the eyes closed, the patient may
be instructed to realize the initial position in a segment,
then to slowly move the segment while focusing on
Figure 10 The body perception test: using the hands, the
person demonstrates the width of their pelvis.
8 A. Kobesova, P. Kolar
+ MODEL
Please cite this article in press as: Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and
treatment of the motor system, Journal of Bodywork Movement Therapies (2013), http://dx.doi.org/10.1016/j.jbmt.2013.04.002
9. movement in this segment only. The rest of the body
should be relaxed. The patient is instructed to train iso-
lated movement in one particular segment while fully
realizing the course of the movement, its direction and
range. Any pathological synkinesis or any substitutive
patterns need to be avoided. The patient should also learn
how to isolate a movement in one segment only and how
to switch between muscle activation and relaxation. The
patient learns how to “read their own body” without vi-
sual control (see Fig. 11). Feldenkrais concepts can also
be utilized to train cortical control of movement accuracy
and body image (Feldenkrais, 1999).
Developmental dyspraxia or developmental
coordination disorder
In childhood, insufficient uni- or multi-sensory integration is
usually diagnosed as developmental dyspraxia or develop-
mental coordination disorder (DCD) (Polatajko and Cantin,
2005; Gibbs et al., 2007; Kirby and Sugden, 2007). The
Movement Assessment Battery for Children (MABC)
(Henderson et al., 2007) and BruininkseOseretsky Test of
Motor Proficiency (BOTMP) (Wilson et al., 1995) can be used
to diagnose developmental dyspraxia. Children with DCD
who are involved in sports often complain of nonspecific
symptoms such as exhaustion, acute headache, vertigo and
nausea, especially during increased athletic activity (Gibbs
et al., 2007; Henderson et al., 2007). Such complaints are
usually considered vertebrogenic or psychosomatic. The
symptoms of DCD are to a certain extent resistant to con-
ventional treatment. An appropriate therapy should be
introduced as soon as the diagnosis is established (Hung and
Pang, 2010). Sport activities should be integrated within
the treatment strategy and team sports are especially
recommended. The therapeutic procedures should become
a routine part of activities of daily living (ADL) (Schott
et al., 2007; Poulsen et al., 2008).
Cerebellar function
The cerebellum is involved in all three levels of integration
and matures simultaneously with other parts of the brain.
This plays an important role in muscle tone regulation,
postural and balance maintenance. It helps to regulate the
movement’s accuracy, including very precise movements,
such as playing musical instruments (Beaton and Marie¨n,
2010). The cerebellum coordinates movements in time
and space and plays an important role in cognition (Beaton
and Marie¨n, 2010) and speech (De Smet et al., 2007). It
develops during ontogenesis. At 3 months of age, the
functional activity in the cerebellum increases substantially
(Chugani, 1998; Hadders-Algra, 2005) and its maturation
continues along with the rest of the brain until adulthood.
According to Hadders-Algra, the nervous system obtains its
adult configuration at approximately 30 years of age. Based
on the available research (Grossberg and Paine, 2000;
Katanoda et al., 2001), we assume that it is especially the
maturation of the cerebellar cortex and frontal and parietal
cortices that allows for hand motor dexterity that is suffi-
cient for writing at the age of 6, the age that, in most
countries, correlates with the beginning of school educa-
tion which is the age at which hand movement accuracy
allows for writing. Also, at that age, language and cognitive
functions are sufficiently developed. All three aspects play
a critical role in school education as well as in
rehabilitation.
Conclusion
General neurophysiological principles are presented, which
may be utilized in both the functional diagnosis and the
treatment of locomotor system dysfunctions, as well as in
many other cases involving neurologic and/or orthopaedic
diagnoses. Motor stereotypes are seen to be organized at
different levels of the CNS which may be potentially useful
in both clinical assessment and treatment. A set of dynamic
movement tests may be used to identify important
dysfunctional features in a compromised postural-locomo-
tor pattern. Postural exercises based on ideal ontogenetic
patterns may be used to achieve optimal postural function
and phasic movements. It is suggested that these methods
should not be conceived as comprising a treatment tech-
nique, but rather an educational approach based on
neurophysiology of individuals with chronic musculoskeletal
pain.
Acknowledgements
We would like to thank Ida Nørgaard, DC MSc for invaluable
help in preparing this manuscript. This study was supported
by Rehabilitation Prague School, by the foundation
Figure 11 An example of body image training in the area of pelvis: The patient is instructed to imagine sitting on a clock and to
slowly move the pelvis around the clock (the range of movement is rather small) while fully focusing on the precise selective pelvic
movement and maintaining proper course stability as well as avoiding any pathological synkinesis (e.g. lumbar spine extension and
flexion within pelvic rotation).
Developmental kinesiology 9
+ MODEL
Please cite this article in press as: Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and
treatment of the motor system, Journal of Bodywork Movement Therapies (2013), http://dx.doi.org/10.1016/j.jbmt.2013.04.002
10. Movement without Help, Prague, Czech Republic, and by
the Grant PRVOUK 38.
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Developmental kinesiology 11
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Please cite this article in press as: Kobesova, A., Kolar, P., Developmental kinesiology: Three levels of motor control in the assessment and
treatment of the motor system, Journal of Bodywork Movement Therapies (2013), http://dx.doi.org/10.1016/j.jbmt.2013.04.002