Developmental psychology

Physical Therapy Assistant
(PTA) Program
Developmental Psychology
Instructor: Dr. George Boghozian, B.Sc., D.C.

Dr. George Boghozian, B.Sc., D.C.
Education:
1980-1985: Iranian Medical College
B.Sc. In Medical Laboratory Science
1998-2000: York University
Kinesiology and Health Science
2000-2003: Cleveland Chiropractic College
Doctor of Chiropractic (D.C.)

Dr. George Boghozian, B.Sc., D.C.
Teaching Experience:
1985-1989: Bushehr Midwifery School
Medical Laboratory
Nutrition
Clinical Genetics
2001-2003: Cleveland Chiropractic College
Clinical Laboratory Diagnosis
2005-2006: Canadian Memorial Chiropractic
College
Systems Pathology

Prepared by:
Dr. George Boghozian
Developmental Psychology

Introduction to Functional
Development
Definition:
Development refers to the process of change in
the individual’s level of functioning
These changes may be either quantitative or
qualitative
It is a product of growth, maturation, and
experience
To interact effectively with other individuals we
need to be aware of what they can and cannot do
physically, cognitively, and socially

Development
If we understand what constitutes the normal
range of development, we can better
understand and guide individuals who may
be developing abnormally
We can use our understanding of
development to improve health and
performance
Our understanding of development makes a
contribution to a more comprehensive body
of knowledge that in turn enables us to
better understand ourselves

Development
Domains of function:
Functional activities with similar outcomes can be
grouped together into categories or domains
The three domains of function include:
Biophysical, psychological, and socio-cultural
No one domain stands alone
All three are interrelated and interdependent in
meeting everyday challenges

Development
Biophysical:
Includes the motor skills needed to perform activities of
daily living
Examples: dressing, ambulating, and maintaining
hygiene
Psychological:
Is influenced by intellectual activities
Motivation, concentration, problem solving, and
judgment are all factors that contribute to psychological
function, as well as affective function, which allows a
person to cope with everyday stresses

Development
This domain also influences how we perceive
our ability to function
Factors such as anxiety, depression, emotional
well-being, and self-esteem influence affective
function
Socio-cultural:
Relates to our ability to interact with other
people and to successfully complete social roles
and obligations
Cultural norms or expectations help define
social function

Development
Functional abilities and health status:
Health is a state of complete physical, mental, and
social well-being, not merely the absence of
disease and infirmity
Health influences our ability-without the necessary
functional abilities, it is difficult to achieve the
state of complete physical, mental, and social
well-being
Therefore, functional ability can be disrupted as a
result of poor health

Development
Functional independence & disability:
The two models used in analyzing health status from
functional independence to disability:
Saad Nagi
ICIDH
These models provide basic categories for classifying a
client’s functional outcome status
The Nagi model supports the identification of limitations in
functional tasks appropriate and important for the specific
individual
It is important to keep in mind that developmental issues,
social expectations, family attitudes, and adaptability of the
environment are all issues that help determine whether
limitations are present

Development
The ICIDH model has been revised and is more
similar to the Nagi model:
Impairment: any limitation or abnormality in
anatomical, physiological, or psychological
processes
Disability: refers to a deficiency in the
performance of daily activities
Handicap: is related to an individual’s inability
to perform expected social roles, leading to a
diminished quality of life
Functional limitation: deficits occurring because
of impairment and affecting the ability to
perform usual activities

Development
Lifespan issues:
Across the lifespan, the physical capacity of
the individual changes and helps to define
functional capacity
Development occurs not only as a result of
physical changes within the body but also
because of environmental influences
Examples: interaction with family,
community, social, and cultural contexts

Development
Through these examples, our development
is shaped and functional roles or tasks are
defined
Therefore, development and function are
related throughout the lifespan
Examples:
Growth spurt and flexibility
Workplace productivity and family

Development
Growth, maturation, adaptation, learning:
Growth:
Observable changes in quantity
It represents an increase in body size
Maturation:
The qualitative functional changes that occur with
age
It is a fixed order of progression
The time intervals may vary but the sequence of
appearance of characteristics generally does not

Development
Adaptation:
The body’s accommodation to the immediate
environment
Learning:
The permanent change in performance that
results from practice or past experiences
Cephalo-caudal development:
Growth that proceeds from head to feet

Development
Factors affecting the quality of physical
function:
Flexibility:
Refers to the capacity to bend
Two types of flexibility can be assessed
Static: refers to the ROM available at a joint
Dynamic: describes the resistance offered to active
movement of the joint
Balance:
Is related to a state of equilibrium and is
achieved when we can maintain our COG

Development
Coordination:
Implies that various muscles are working
together to produce movement
Power:
Refers to the rate at which work is done
Endurance:
Is related to the ability to continue to perform
work over an extended period

Development
Social learning:
What you learn from a child comes from
observing others
Learning and modeling
Behavior is shaped by direct reinforcement
Motivation:
Based on a need hierarchy
In which each life stage is seen from the
perspective of fulfilling a certain need
Survival, safety, love, esteem, self-actualization

Development
Lifespan stages:
Infancy:
Trust vs. mistrust
Self-trust, attachment
Late infancy:
Autonomy vs. shame or doubt
Independence, self control
Childhood (preschool):
Initiative vs. guilt
Initiates own activity
School age:
Industry vs. inferiority
Works on projects for recognition

Development
Adolescence:
Identity vs. role confusion
Sense of self: physically, socially, sexually
Early adulthood:
Intimacy vs. isolation
Relationship with significant other
Middle adulthood:
Generativity vs. stagnation
Guiding the next generation
Late adulthood:
Ego integrity vs. despair
Sense of wholeness, vitality, and wisdom

Theories affecting development
Introduction:
Theories provide the framework for ideas and are
the basis for their implementation
Theories are defined as a summary of known facts
and assumptions that serves to organize
information in a meaningful way
Theories are not designed to answer all questions
related to development
Yet each makes some contribution to our
knowledge base

Lifespan theories of development:
Biophysical development:
Most of the theories focus on one age group
Lockman and Thelen (1993) introduced the term
developmental bio-dynamics to explain the organization of
motor behavior based on interaction between perception
and action
According to developmental bio-dynamics, motor behavior
emerges from that interaction rather than from nervous
system maturation, as previously theorized
The human organism is an open organism because it
interacts with internal and external environment
Dynamic systems theory emphasizes on biological dynamics
with some environmental context

Schroots and Yates (1999) applied dynamic
system theory to development and aging
because they saw development and
senescence as having similar features
These common features change over time
These changes require energy and cause the
production of new structures or functions
Differences between development and
senescence are the degree and rate of change
The rate of change is faster in early
development and slower during senescence

Psychological development:
Erikson (1968) transformed Freud’s psychoanalytical
theory into a psychosocial view of human development
His view combined biological needs with cultural
expectations
Producing the most broadly applicable theory of human
psychological development for present day society
By replacing Freud’s sexual focus with traits of social
interaction
His stages incorporate more than one domain of function
and are identified as necessary for individual’s growth
At each stage a conflict must be resolved to advance in
the developmental process

Erikson’s developmental stages:
Stage 1: infant
Infants first conflict is whether to trust or mistrust the
people within the world
This trust is gained through physical and care giving
If the care giving forms positive attachments that are
mutually reinforcing then trust will be gained
If this does not occur then a negative attachment will
occur
Leading to mistrust of others, the environment, and
even the self

Stage 2: late infancy (toddler)
The toddler expresses newfound independence both
socially and motor
They must be allowed to do as much as possible to
prevent feelings of doubt about their new developing
abilities
Stage 3: childhood (preschool; between 3-5 years)
Self regulation develops as the child learns the
boundaries of appropriate social behavior
Examples of self regulation are: toilet training, learning
to share, or learning to take turns
The parents teach what is acceptable and what is not
The parents should encourage the child’s confidence
without fear of negative result or the burden of guilt

Stage 4: school age
Deals with the conflict between industry and inferiority
The initiative developed in the previous stage is applied
to learning how to work hard on a project and to enjoy
the satisfaction of a job well done
A positive self image grows out of achievment
Without success the child will learn to be helpless
Which in turn, will lead to a negative self image
The initial self image formed between 2 and 3 years of
age is expanded during the middle childhood in the
struggle with success or failure in school
Becomes more aware to the expectations of others
To gain the approval of a favorite teacher (authority
figure)

Stage 5: adolescence
Most trying psychological dilemma: identity vs. role
confusion
The identity is a blend of what they learned in childhood
and what they will become in adulthood
Identity formation is affected by social and sexual
experiences, cognitive abilities, and self knowledge
Self knowledge is gained from the five senses as well as
knowledge of body functions
Emotionally, self knowledge includes self esteem and self
image
Emotional development at this time: achievement of
emotional independence from parents and other adults
Social development: the adolescent is expected to
develop appropriate behavior toward their own and
opposite sex

Sexual identity is established along with moral ideology
to guide socially responsible behavior
The successful end result is a stable view of the self, a
life philosophy, and a career path
The pursuit of a career path allows the adolescent to
move away from their previous egocentrism
Role confusion describes the failure to form an identity
during adolescence
Role confusion may result if adequate support systems
are not available
This leaves the adolescent confused about their role in
society and makes it difficult to formulate a philosophy of
life, forge a career, or to start a family

Stage 6: early adulthood
Once an identity has been established, the young adult
must deal with the conflict of intimacy very isolation
Forming intimate relationships involves sharing the
values, hopes, goals, and fears found during the search
for identity
Schuster (1980) states that a person learns to share love
in many different forms:
Parental love, Spousal love, Child love, Friend love, and
spiritual love
Negative result from losing the battle for intimacy is to
become self absorbed and unable to relate openly with
other people

Stage 7: middle adulthood
Generativity is an unconscious desire to guide
and assist the next generation
Generally through parenting, but also through
occupation (teaching)
Stagnation is the alternative to generativity
It is the “Is that all there is?” attitude toward
life

Stage 8: late adulthood
The conflict between integrity and dispair
Integrity as a sense of wholeness of self related
to life already lived and life yet not experienced
There is a sense of vitality, expectation, and
wisdom that comes from the life cycle being
reflected back upon
If the older adult does not achieve ego integrity
because inner resources from successful
handling of previous psychosocial dilemmas
have not been built up, despair replaces vitality
The task of how we led our life, the choices we
made, and the paths not taken is not easy

Socio-cultural learning:
Social learning:
Bandura’s (1986) social learning theory explains
observational learning
The essential process in Bandura’s cognitive social theory
is that of modeling
Modeling is described as a type of cognitive patterning
based on experience
Experience paired with memory equals learning
This pairing is possible, because of the interaction among
behavior, cognition, and the environment
Each influences the other

Motivation:
Maslow (1954) theory of motivation is based on a
hierarchy in which each life stage is seen from the
perspective of fulfilling a certain need
We all have an innate drive to survive, grow, and find
the meaning of life
The sequence of needs progresses from the physiological
needs related to survival and safety to needs for love,
self esteem, and ultimately, self actualization
Self actualization occurs when we have become all it is
possible for us to be
It cannot be achieved unless all other needs have been
met

Ecology:
Bronfenbrenner’s (1979) ecological systems
approach is the application of the biological
concept of studying organisms
In their natural habitat
Bronfenbrenner’s model describes systems
each named for its relationship to the child

Theories of child development:
Maturation
Dynamic systems
Psychological development:
perception
Piaget’s four stages:
Sensorimotor stage
Preoperational stage
Concrete operational stage
Formal operational stage

Maturation:
The motor development correlates all movement
acquisition with the onset of changes in the nervous
system relative to the onset of integration of reflexes,
hierarchy of control, and timetable of myelination
Gesell and McGraw are the primary contributors to this
theory
They attribute developmental changes to genetics and
tend to ignore the role of experience
Gesell and associates (1974) studied motor development
as a means to understand mental development, and in
the process became known as the “father of
developmental testing”

Gesell defined stages of motor development
that he thought governed behavior during each
age period
McGraw (1963) described in detail movement
sequences in infants
She was also interested in the relationship
between structure and function in generating
developmental change
She related movement acquisition to biological
maturation

Dynamic systems:
Thelen and colleagues (1993-1994) applied a
dynamic systems theory of motor control to
early motor development
While studying reflexive lower extremity
movements in infants, Thelen discovered a
biomechanical explanation for the
developmental changes in motor behavior
previously attributed to reflex integration
Thelen proposed that perceptual development
and motor development are tied together

Psychological development: Intelligence
Piaget’s theory
Piaget (1952), a well known developmental psychologist,
identified four stages of cognitive development in
children
Each stage is characterized by different ways of
interacting with environment
His theory explains how humans acquire and process
information and learn about the world
Piaget believed that individual’s ultimate goal was to
master the environment

He identified two basic functions of all
organisms that make this mastery possible
The individual’s ability to organize, which he called
assimilation
The ability to adapt, which he called accommodation
These two processes allow individuals to learn
about and adapt to the environment around
them
Assimilation is the interpretations of external
objects and events in terms of one’s preferred
way of thinking about them

Accommodation is a form of adaptation that involves
noticing and taking in the environment
He introduced the concept of a cognitive system that
develops in parallel with other body systems
He used the model of assimilation and accommodation to
describe cognition as another form of ontogenetic
adaptation
Ontogenetic adaptation refers to the structural,
physiological, or behavioral characteristics unique to an
organism
Four stages of Piaget’s theory:
Sensorimotor, preoperational, concrete operational,
formal operational

Sensorimotor stage:
The first two years of life
Infants uses sensory information or assimilation
to cue movement and uses movements or
accommodation to explore the environment
Infants interact with the environment and by
repeated interactions they undergo
developmental changes and cognitive growth
A developmental therapist is concerned with
the impact of maturation and experience on the
motor develop

Preoperational stage:
In this stage the child is trying to master verbal
expressions
Using symbols, words, or objects to present things that
are not present
Example, all forms of transportation is labeled “ride” or
all four legged animals are “dog” or “cat”
Behavior at this stage is self centered, and reasoning is
always in relation to the self
Toward the end of this stage, most children begin to
have some understanding of time
Which eventually allows them to learn how to wait

Concrete operational stage:
During this period, children develop the ability to classify
objects according to their characteristics
They can solve concrete problems (those in which the
objects are physically present), examples: “which string
is longer?” or “which cup is bigger?”
Piaget’s most famous conservation experiment is the one
in which he performed to demonstrate a child’s ability to
transform objects from one set of circumstances to
another while preserving the idea that the object were
unchanged
For example, two cups hold equal amounts of water

One cup (B) is poured into several other containers (A)
and the child is asked whether the amount of water
poured from cup B is the same as what is in A. If the
child says yes then he demonstrates conservation
Formal operational stage:
Highest level of development
Occurs in early adolescence
They are able to deal with hypothetical as well as real
situations
May not apply this to all aspects of life
They may selectively use this ability only in certain
situations

Psychological development: Perception
Information processing:
Information processing theories are all predicted on the
belief that thinking is information processing
Mind is described like a computer
Environmental affordance:
The environment affords a child the opportunity for
interaction, and in that interaction the object and the
child are somehow changed
Perception is the means by which the child comes in
contact with the world and adapts to it
The ecological view of perceptual development does not
repuire the child to construct action with objects as did
objects as did Piaget’s model

Socio-cultural development:
Behaviorist:
Most famous is B.F. Skinner (1938)
Father of stimulus-response (S-R) psychology
Performed experiments with rats and mazes to show that
certain behaviors can be conditioned
He applied the principles of operant conditioning to the
development of human behavior
He believed that the environment was the most
influential factor in determining behavioral outcomes
Skinner was able to condition a fear response in a child
According to behaviorists, all behavior is learned by
observational imitation and can be conditioned or shaped
through reinforcement

Social learning:
Sears and colleagues (1965) attempted to explain the
early behavior of the child according to observable social
interaction
Sears used Skinner’s S-R cycle
Sears’ theory became known as social learning theory
and is predicted on identifying the common reinforce
used to produce social behavior
The theory states that behavioral development is learned
with the parents as the first teachers, extended family
next, and then social group

Theories of aging:
Theories believe aging occurs because of
biological or physical changes in the human body
Aging can be defined as the sum of all changes
that normally occur in an organism with the
passage of time
Again also can be described as a process that
transforms healthy adults into frail ones

Biophysical theories:
Divided into genetic and non-genetic
investigation
Genetic: based upon the premise that aging is
programmed in the cell nucleus
Programmed cell death:
Aging is determined by biological clock that turns
on death genes or causes certain hormones to
be secreted
Programmed cell death, called apoptosis, is
apparent during early development when
unwanted or unused cells are destroyed

Non-genetic: based on environmental factors,
genetically controlled but influenced by
environment
Assumes aging changes occur because of
outside of the cell nucleus and involve some
maladaptive response to cell, tissue, or system
damage
These events eventually reach a level not
compatible with life
Cross linkage:
Cross linking agents attaches itself to two large
molecules as a result of a chemical reaction
As we age the linkage cannot occur resulting in
death

Free radical:
Free radicals damage cells resulting in loss of
division
Free radicals increase with age and production of
antioxidants decreases
Immune:
Bone marrow and thymus are affected by the aging
process
As the thymus gets smaller and bone marrow less
efficient the immune system becomes weaker
Moderate exercise and endurance training increase
immune function
Neuro-endocrine:
Negative effects of stress and hormonal imbalances
As we age our internal environmental loses its
balance (homeostasis)

Psychological theories:
There are two dimensions of intelligence:
Fluid intelligence: refers to learning reflective of
induction, deduction, and abstract thinking
Crystallized intelligence: is related to knowledge of
life experiences and education or cultural knowledge
Cognitive processing:
Assesses differences in attention, reaction time, and
working memory
A decrease in these areas leads to impairment in
cognitive functioning

Selective optimization:
Explains why some individuals compensate for age-
related declines
Successful aging is viewed as optimizing gains while
minimizing loses
Disengagement:
Aging adults turn inward as a means of withdrawal
from family and society
Disengagement is neither normal nor natural

Activity:
Staying actively involved with friends, family and
society is necessary for successful aging
Activity allows for adaptation, which is a constant
part of life
Those who adapt and remain active are most
successful in aging
Continuity:
Replaced the debate between activity and
disengagement
Here, the individual seeks continuity by linking things
in the past with changes in the future
Using prior knowledge for to benefit future change

Motor Development, Motor Control,
&
Motor Learning
Motor Development:
Definition:
Includes the change in motor behavior over the
life span
Includes the sequential, continuous, age-
related process of change
It is determined by the merging of our genetic
blueprint for movement and our experiences
The mover and the environment are both
changed in the process

&
Motor Learning
Motor development concepts:
1: Developmental sequence
Movement skill development is sequential
What will happen depends on what happened before
Each movement learned will be used again to achieve
something else
2: Directional concepts
Cephalo-caudal: development progresses from the foot
to the head
Proximal-Distal: development occurs from proximal to
distal. Includes the midline of the neck and trunk, as well
as the parts of the extremities

&
Motor Learning
3: Mobility and stability
Mobility: moving
Stability: holding a posture
Mobility is present before stability
Once a stable posture is established,
movement control within the posture develops
4: Sensation:
The first movements experienced by the
newborn are reflexively cued by sensation
It is present before vision

&
Motor Learning
Motor control and motor learning:
Motor control:
It is the physiological process whereby motor
development occurs
Motor learning allows motor development to
occur systematically
Results in a permanent change in motor
behavior due to experience

&
Motor Learning
Comparing development, control &
learning:
Time frames
Control: millisecond. Learning: hours, days, weeks.
Development: months, years, decades
Maturation system:
The development of motor control begins with the
control of self-movements and procedes to the
control of movements in relationship to changing
conditions
The relationship between the task, the individual,
and the environment, must all be considered when
thinking about motor development, motor control,
and motor learning

&
Motor Learning
Reflexes and feedback:
Reflexes
Phasic: reflexes mediated in the spinal cord, because
they are typically of short duration
Tonic: reflexes mediated at the brain stem level, because
of their long duration
Feedback
Feedback is a very crucial feature of motor control
Feedback is defined as sensory or perceptual information
received as a result of movement
Feedback is important for two reasons:
Feedback provides a means to understand the process
of self-control
Feedback also provides the fundamental process for
learning new motor skills

&
Motor Learning
Functional implications:
Definition:
The functional implications are that movement abilities
over time, or across the life span
Each individual develops functional movement in a
similar sequence, but the rate achievement shows
variation
Infancy:
Reflexes
Gross motor
Fine motor

&
Motor Learning
Childhood:
2-year-old
Up and down stairs one step at a time
Jump off a step with a 2-foot take-off
Stand on one foot for 1 to 3 seconds
Kick a large ball
Throw a small ball
3 to 6 years of age
Hopping
Galloping
Skipping
Running
Jumping
Throwing

&
Motor Learning
Catching
Striking
Pedaling a tricycle
Climbing a jungle gym or ladder
Sharp turns while running
Balance on toes and heels in standing
Standing with one foot in front of the other or on
one foot
Alters steps when going up and down stairs
6 to 10 years of age
A child masters the adult forms of running, throwing,
and catching

&
Motor Learning
Sherrington’s reflex model:
Sherrington proposed his “reflex model”
wherein a sequence of reflexes formed the
building blocks of complex motor behavior
Unfortunately, this theory did not explain
movement that occurs without sensory
stimulus, nor did it explain how actions
were modified depending on the context in
which they occur

&
Motor Learning
Random versus blocked practice:
Random practice
Refers to the practice of different tasks or task variations
in a varying sequence on successive trials rather the
practice of multiple repetitions of any one task
Blocked practice
A blocked practice schedule assumes that multiple trials
are completed on one task or task variation before
moving onto a different one

&
Motor Learning
Proactive & reactive control:
Proactive control:
Refers to the use of previous sensory information for
planning before movement execution
Example: safely crossing the street with handful of
books and a cup of coffee without spilling or dropping
anything
The individual steers himself around oncoming traffic,
avoids a path-hole in the road, and slowed his walking
speed so as not to spill the coffee
Reactive control:
Refers to the use of sensory information to adjust and
adapt movement responses after an unexpected event
Example: tripping on an unexpected obstacle while
walking

&
Motor Learning
Fitts’ three stages of motor skill
learning:
Cognitive phase:
Learner must understand the goal of the task
to be performed and recognize the regulatory
features of the environment to which the
movement must conform
Example: in walking across a room, the surface
of the floor and location of the people within
the room are considered regulatory features

&
Motor Learning
Associative phase:
Learner has presumably picked the best strategy to use
for a specific task and has begun to refine it
The focus is on how to do the movement
Example: in learning to brake appropriately for a stop
sign, the driver might start applying the brakes several
car length in front of the stop sign to allow enough time
to stop
Autonomous phase:
The skill becomes more autonomic because the learner
does not need to focus all of his attention on the motor
skill
Example: a baseball player demonstrates the ability to
hit the ball using different types of bats

&
Motor Learning
Implicit and explicit learning:
Implicit learning:
Refers to the learning of complex information in an
incidental manner, without awareness of what has been
learned
Example: the boy is able to throw the basketball while
his attention is diverted toward the yelling crowd during
a game, but he still accurately gets the ball in the net
Explicit learning:
Has traditionally been linked with conscious recall of
information or declarative memory
Example: a boy throwing a basketball into net must
learn about the size and texture of the ball and how he
can manipulate it with his hands

Evaluation of Function
&
Structural and/or Functional Changes
Evaluation of function:
When evaluating someone’s functioning the
following should be considered:
Basic activities of daily living (BADL)
Dressing,washing, eating, and ambulating
Instrumental activities of daily living (IADL)
Shopping, cleaning, transportation usage
Selecting standardized functional
assessments
Focus: it is important to choose a standardized
functional assessment that best meets the
needs of each individual client

&
Design: it is important to choose the best type
of assessment for the client:
Interview assessment: completed by a trained
interviewer; client is asked a set of standardized
questions and the answers are recorded in a
standardized format
Self-administered assessment: usually presented
as questionnaires with clearly written instructions;
the questions are structured so as not to bias the
answers

&
Performance based assessment: evaluator
observes the client’s performance in functional
tasks
Rating performance: functional assessment
vary in how they rate an individual’s
performance:
Some use checklists, while others use visual analog
scales or summative rating systems
The quality of performance of a skill may also be
rated

&
Measurement issues for standardized
instruments:
Reliability: refers to the ability of the test instrument to
report findings in a consistent and repeatable fashion
Validity: implies that the assessment is achieving its
intended function and truly measures what it is supposed to
measure
Responsiveness: responsiveness to change refers to a test’s
ability to measure an aspect of performance that is
anticipated to change as a result of therapy
Precision: refers to the ability to detect appropriate levels of
change

&
Adult functional assessment instruments:
Katz index of activities of daily living
Used to assess BADL of institutionalized individuals
Ambulation or mobility was not measured therefore,
limiting its usefulness
Functional status index
Derived from Katz index for use with individuals with
arthritis
BADL and IADL are assessed
Includes the degree of independence and the degree of
pain experienced

&
Barthel Index
Developed to measure improvement in clients
with chronic disabilities who were participating
in rehabilitation
BADL are assessed
They are rated on how to perform them
And to the degree of assistance needed

&
Structural and/or functional changes:
Skeletal system:
Constant compression leads to thinning of cartilage
Excessive compression contributes to degeneration of
the cartilage
Water content of cartilage decreases in the adult
Years of microtrauma, isolated instances of severe joint
trauma, and aging of the cartilage result in the
breakdown of articular cartilage
Which contributes to the development of osteoarthritis
IVDs become flattened and less resilient with age
Bone mass declines with age leading to osteoporosis

&
Stress fracture: usually related to overuse and
stress on the system beyond the ability of self
repair
It can lead to scoliosis and kyphoscoliosis
Chondromalacia of the patella, results from
stress on the knee cap
It is the rotational or angular misalignment of
the patella

&
Muscular system
As we age, the amount of connective tissue
increases
As we age, muscle fibers are lost and are
replaced by fat and collagen
In the older adult, the three phases of isotonic
cure are prolonged
Loss of strength is associated with a loss of
function
Power diminishes with age

&
Motor unit remodeling is when a muscle fiber
loses its motor neurons resulting in a decline in
the functional motor units
The ability of the muscle to generate force is
reduced with age
Force control is lessened in the older adult
because of the greater number of low treshold
motor units compared with the number found
in younger adults

&
Cardiovascular system:
Number of myocytes in the heart decreases, but
the size increases with aging
Heart valves become thickened and calcified
Vessels become more rigid, thicker, and more
dilated
Structural changes of the left ventricular wall
reduce the ability of the ventricle to fill and
contract
Blood pressure increases through adulthood and
older adulthood

&
Increased amount of elastic tissue, fat, and collagen
contribute to increased stiffness and decreased compliance
of ventricles
Increased demand on the heart to pump blood through a
less compliant vascular system
Increased fat is found within the epicardium
Changes in heart vessels and conduction system
Calcification within the aortic and mitral valves impairs their
ability to close completely
Leading to increased chance of a heart murmur
Vessels become thicker, more rigid, and more dilated leading
to arteriosclerosis
Aerobic exercise can minimize the age related changes

&
Pulmonary system:
Respiratory muscles become less efficient with age
Thorax becomes stiffer which increases the work
of breathing
Thickening of the mucus layer resists air flow and
diminished the recoil of the lungs
Abdominal muscles become weaker and less able
to stabilize the diaphragm
Thoracic height increases

&
Nervous system:
Nerve conduction velocity of peripheral nerves decreases
Brain weight and thickness of the cortex decline
Neuronal atrophy, cell death, and ventricular enlargement
Loss of enzymes involved in neurotransmitter synthesis and
loss of receptor sites for certain transmitters
Decreased awareness of touch and vibration
Decrease in complex cognitive skills involving memory
Alzheimer disease is a progressive degenerative dementia
that is the fourth leading cause of death in adults
Characterized by a slow decline in memory, cognition, and
functional abilities

&
Sensory changes:
Structural changes in skin such as loss of dermal
thickness and loss of collagen and elastin fibers
Skin receptors responsible for the perception of
pressure and light touch decline in number
Deep pain perception diminishes
Loss of vibratory sensation
Decline in joint position sense (proprioception)
Vestibular system undergoes degeneration which
may cause dizziness and vertigo
Possible cause is a decrease in hair cells

&
Visual acuity declines with age
Cataract is common in older people, which is a
decrease in the transparency of the lens
Color discrimination becomes more difficult
Pupil size declines with the age allowing less light
into the eye
Decline in the hearing acuity is due to loss of
sensory cells in the inner ear
Loss of taste bud function
Loss of smell is greater than that of taste

Vital Functions
Definition:
Those functions necessary for survival
In humans, vital functions are:
Breathing
Sleeping
Eating
Eliminating
They can be broken down into six processes:
Ventilation-respiration
Sleep-wakefulness
Ingestion
Digestion
Absorption
Excretion

Vital Functions
Processes and functions are cyclical
The purpose of cyclic nature of our bodies
is:
To make it easier to adapt to different
environments
To provide us with a clue to their control
And a way to explain behaviour

Vital Functions
Endocrine changes across the lifespan:
Prenatal
The first endocrine gland to form in utero is the thyroid,
at 24 days
Essential for normal maturation of the nervous system
Infancy through adolescence
Human Growth Hormone (HGH) is the main impetus for
postnatal growth
Secretion of HGH controls the rate of growth and
development
Thyroid and parathyroid hormones are important to the
growth of bones, teeth, and the brain
Puberty: axillary and pubic hair, menarche, and
testosterone, etc.

Vital Functions
Adulthood
Hormones are associated with our normal physiological
response to stress
Secretion of cortisol and most other hormones
Older adulthood
As the body ages, it is less resilient to environmental
stress
It becomes more difficult to maintain the status quo or
homeostasis
Menopause
Andropause

Vital Functions
Homeostatic control mechanisms by the
endocrine system
Reflexes:
The integrating centre stimulates an effector
(typically muscle or gland)
Which in turn produces a response that corrects the
error
Therefore reestablishing homeostasis
Local responses:
These occur within the tissues
Circadian rhythms:
These rhythms are driven by hormones

Vital Functions
Concerns about vital function:
Prenatal:
Intauterine growth restrictions
Cretinism
Newborn:
Apnea
Failure to thrive
Sudden infant death syndrome
GERD
Childhood:
Obesity
Enuresis

Vital Functions
Adolescence:
Obesity
Anorexia
Bulemia
Adulthood:
Obesity
Sleep apnea
Older adulthood:
Urinary incontinence
Constipation
Fecal incontinence
Dehydration

Posture and Balance
Definition:
Posture
The attitude or position of the body
Being in a prone position and in a sitting
position are both posture
Has three functions:
Must maintain alignment of the body’s segments in
any position
Must anticipate change to allow our engagement in
voluntary, goal-directed movements
Must react to unexpected deviation and disturbances
in balance

Posture and Balance
Balance
Control of posture is balance
The goal of postural control systems is to attain
a stable vertical posture of the head and trunk
against the force of gravity
When postural control is attained
A base is provided for adequate reaching,
sitting, standing, and walking

Posture and Balance
Postural Balance
The unconscious level of functioning of basic reflexes
That enables one:
To maintain upright posture
Hold head erect
Sit and stand
Static balance
Able to keep desired body posture
When the body is relatively stationary (stand on one
foot)
Dynamic balance
The ability of the body to maintain and control posture
While in motion

Posture and Balance
Components of a postural control system:
Posture is a complex interaction of biological,
mechanical, and movement components
The components involved in postural control
include:
Limits of stability
Sensory organization
Eye-head stabilization
The musculoskeletal system
Motor coordination
Predictive central set
Environmental adaptation

Posture and Balance
Neural basis for postural control and
balance:
Traditional hierarchical model
Attributes certain reflexes to specific levels of
the nervous system
Reflexes and reactions help to restore stability
before the activation of voluntary systems

Posture and Balance
Automatic postural adjustments
Righting
Maintenance or restoration of the proper alignment
Of the head or trunk in space
Equilibrium
These reactions are more sophisticated than righting
reactions
Involve a total body response to slow shift
Of the centre of gravity
Outside the base of support

Posture and Balance
Systems model
Postural adjustment precede most functional movements
Posture is adjusted before the performance of an overt
action or movement
Anticipatory responses depend on proactive control
Depend on age, musculoskeletal maturity, and cognitive
abilities
Anticipatory control develops along with reactive postural
control
Postural control can be changed through learning and
experience
Most basic premise of a systems perspective is with
practice and repetition
Learning requires that all perceptual systems contribute
useful information from many different senses

Posture and Balance
Assessment of posture and balance:
There are many ways in which to assess balance
One way is using the clinical test of sensory
integration on balance (CTSIB)
The other is sensory organization test (SOT)
They are both essentially the same
In both tests the examiner measures how long a
client can stand in six different sensory conditions

Posture and Balance
These conditions are:
Normal
Eyes closed
With a dome over the head
Standing normal on foam
Standing on foam eyes closed
Standing on foam with a dome over the head
Postural stress test is used to quantify the effect of
push on someone by using a defined force to
displace them
Functional reach is a quick measure of balance in
standing. The subject stands with an arm
outstretched and reaches forward as possible
without losing balance

Posture and Balance
Posture and balance across the lifespan:
Infancy and childhood
Postural control develops in a cephalo-caudal and
proximal-distal sequence in infants
Head control is achieved before trunk control, pelvic
control before foot control, and shoulder control before
finger control
Postural control is essential to developing skilled actions
such as locomotion and manipulation
When infants begin to stand and walk, their feet are flat
They begin to exhibit a longitudinal arch only as the fat
pad in the foot diminishes

Posture and Balance
18 month old child will stand with bowed legs
The legs straighten out by six years of age
Balance on two feet increases as independent
locomotion is achieved
Older adults
The ability to maintain an erect aligned posture
decreases with advanced aged
Decreased movement can accentuate age
related postural changes
The disks lose water

Posture and Balance
The strength of the muscles decline with age
Which will contribute to a decline in the ability of the
older adult to maintain postural alignment
Postural changes include forward head, kyphosis of the
thoracic spine, loss of lumbar lordosis, loss of hip and
knee flexion, and loss of ankle mobility
The older adult who sits most of the day may be at
greater risk for a flattened lumbar area
A loss of flexibility and diminished postural response lead
to less organized motor patters
These changes shift the centre of gravity forward and
create an instability during standing and walking

Locomotion
Definition:
The process of moving from one place to another
The essential elements of locomotion include
progression, stability, and adaptation
We must have strength and control necessary to
progress toward a location, sufficient dynamic
balance to maintain our posture and to overcome
the force of gravity or other external forces
We must have the ability to adapt the locomotor
pattern to meet our needs and demands of the
environment
Different forms of locomotion that can be used to
get from point A to point B

Locomotion
Clinical research on locomotion:
Variety of motor patterns: rolling, crawling, creeping, walking,
running, galloping, hopping, and skipping
Independent locomotion progresses from rolling to crawling to
creeping to walking
The first upright pattern of locomotion
It follows by running, galloping, hopping, and skipping
Kinematics refers to the relationship between the segments
that produce the motion: displacements, velocities, and
accelerations
Kinetics refers to the moving bodies and the forces
Internal forces are referred to as stressed
External forces are referred to as loada

Locomotion
Locomotion patterns across the lifespan:
Rolling is the earliest pattern used for locomotion
It is defined as moving from supine to prone or
vice versa
The earliest spontaneous axial rotation is seen in
the fetus at about 10 weeks of gestation
One part of the body initiates the movement, and
the other parts of the body follow, which is called
segmental rotation
The significance of these movements is so that the
fetus doesn’t get adhesions or stasis

Locomotion
Phases of rolling:
Phase A: newborn
The newborn infant is predominantly in a posture of
flexion and is unable to produce the movements that
would create the activity of rolling
Infants first begin to roll spontaneously
Phase B: spinal extension
Rolling form side lying posture to supine position
This is seen at about 1-2 months of age
Rolling from side position to prone is seen at about 4-5
months of age
The body moves as a unit and is called “log rolling”

Locomotion
Phase C: automatic rolling
Most often initiated by the upper extremities
Followed by the trunk and lower extremities
Or initiated by the lower and then followed by the upper
body
This is performed with more segmentation and more
deliberation
Phase D: deliberation
Rolling from supine to prone is seen at 6-8 months of
age
Adult rolling patterns were related to flexibility and
muscle strength of the individual

Locomotion
Crawling and creeping:
Crawling is defined as prone progression in which
the belly remains on the supporting surface as the
arms and legs move in reciprocal pattern to propel
the body forward or backward
Creeping is defined as a prone progression in
which the abdomen is lifted off the supporting
surface while the arms and legs move reciprocally
to propel the body forward or backwards
The prone progression of crawling to creeping is a
nine phase sequence:

Locomotion
Phase A: newborn
Is the general posture of the infant, which is flexion
The weight is forward on the head, making head lifting
in prone position difficult for newborns
Phase B: spinal extension
The centre of mass has moved inferiorly, and the
extensor muscles actively promote head lifting in prone
position
Phase C: advanced spinal extension
Spinal extension is even more evident, and the infant can
maintain the head and trunk in an elevated position for
some time
Phase D: incipient propulsion in superior region
The infant attempts to move the superior region of the
body, but the inferior region remains unorganized

Locomotion
Phase E: incipient propulsion in the inferior region
The inferior region becomes organized but the two
regions remain mostly unsynchronized, and the infant
cannot move the body as a unit
Phase F: assumption of creeping posture
Represents more coordination between the regions of
the body, but the infant does not make deliberate
attempts to progress
Often in this phase the infant lifts the abdomen from the
surface but loses balance and falls
In this phase the infant spends time rocking back and
forth on hands and knees without progression

Locomotion
Phase G: deliberate but unorganized progression
The infant may raise one arm forward and then the
other, but the legs move as a unit
The infant moves by using the arms to pull them
Phase H: organized progression
The abdomen is up off the floor with contralateral
movemnts of the extremities propelling the infant
forward
The movement pattern is somewhat uncoordinated
Phase I: integrated progression
The progression is smooth and integrated

Locomotion
Erect walking:
Is the act of moving on foot
Ambulation is another term used for walking
Gait, refers to the manner in which a person
walks
A complete gait cycle is one complete stride of
one limb
Stride length is the time or distance from heel
strike of one foot to heel strike of the same foot
Step length is the distance from hell strike of foot
to heel strike of the other foot
Cadence is the frequency of steps per minute

Locomotion
Velocity of gait is the speed of which the body
moves through space
Walking is a complex task, where we must use all
parts of the body in a coordinated manner
Walking is defined in a two phase pattern of
movement
The stance phase, which is approximately 60% of
a complete gait cycle
The swing phase, which is approximately 40% of
a complete gait cycle

Locomotion
Body systems impact on walking control:
The nervous system plays a key role in the control
of walking
Early stepping movements are controlled by
pattern generators in the spinal cord or brain stem
This is seen in reflexive kicking in the infant
Sensory information assists in the adaptation of
the gait pattern to the environment in which it is
occurring
Visual information is an important stimulus for
locomotion

Locomotion
The somato-sensory system contributes to
the control of walking
Information from the muscle spindles and
joint receptors contribute to the rhythm of
walking
The Golgi tendon organ influences timing
of the transition from stance to swing
phase of the gait cycle

Locomotion
Locomotion developmental stages:
Infant and toddlers
Independent ambulation is attained by 11.5 months
The initial gait pattern is characterized by a wide base of
support; arms held in high guard position, short swing
phase, lack of heel strike or push off, the infants will
learn forward to propel themselves
The more mature gait pattern is seen by age 3-4 years
of age
There are seven phases for development of erect
locomotion:

Locomotion
Phase A: the newborn or reflex stepping
Phase B: inhibition or the static phase
Phase C: transition; the infant may stand in one position
and stamp the feet but here is no progression forward
Phase D: deliberate stepping; the infant attempts to step
when held upright
Phase E: independent stepping; the infant takes steps
independently. At about 12-13 months of age, the
infants learn to walk alone
Phase F: heel toe progression
Phase G: intergration or maturity of erect locomotion

Locomotion
Children
A child demonstrates a mature gait pattern between 3-4
years of age
Consistent heel strike and knee flexion are seen
A mature muscle activation pattern is exhibited
Adults
Performs walking easily
Centre of mass is the sacral level, improving stability of
gait
The adult easily changes pace, starts and stops, and
changes directions

Locomotion
Older adults
Many of the body systems that support the gait change
with age
Psychosocial factors such as ageism can also contribute
to changes in gait pattern
Meaning stereotypical concepts of aging will influence an
older individual’s self perception
Diseases will affect gait patterns
More incidences of falling occur with age
Slower walking velocity, loner step phase, shorter swing
time
Gait velocity declines per decade

Locomotion
The locomotion patterns:
Most of the research focuses on the head and
neck, the trunk, and the extremities
And how these components relate to each other
as a particular pattern evolves:
Running
Is defined as the pattern of movement that has a stance
phase and a swing phase
But more importantly, a flight phase
Flight phase is a period of non support (both feet are off
the ground)
To run we must produce sufficient force to project the
body into the air for the flight phase

Locomotion
Galloping
Is defined as the first asymmetric gait mode in the young
child
Walking is on the leading leg followed by a running step
on the rear leg
Galloping can be seen 20 months after a toddler begins
to walk
Hopping
One footed hopping is an asymetric pattern of
locomotion
The swing leg is inactive in the earliest form of the one
leg hop
At 4 years of age the swing leg begins to move in the
hop
Initially the arms are inactive

Locomotion
Skipping
Is defined as an alternating gait, a step, then a
hop on the other leg
Children can skip around age 4

Prehension
Definition:
Is the ability to use our hands and upper limbs
effectively
Primary components of prehension are:
Visual regard
Reach
Grasp
Manipulation
Release
Regard is visual attention held on an object
Reach or transport incorporates directing arm
position and preshaping the hands to match the
location, size, and shape of the object

Prehension
Grasp involves the act of closing and stabilizing
the hand on an object
Manipulation incorporates movement of an object
while it is being held
Release is the manner in which an object leaves
the hand
The corporative effort of both hands is termed
bimanual coordination
Prehension reflects the relationship between goal
directed movements and the environmental
constraints
Prehension uses proactive and reactive postural
control

Prehension
Visual regard:
Visual regard and perception prompt us to reach
for and grasp objects
These functions depend on the strength of our
attention, visual acuity, and ocular control
Visual perception is the ability to use visual
information to recognize, recall, discriminate, and
understand what we see
As children gain experience through play,
perceptual construct are developed
Depth perception allows us to localize objects in
space and to estimate size and distance

Prehension
Figure ground refers to the ability to visually focus
on specific details in the foreground by selectively
screening out the competing background
Visuo-construction is related to the spatial
planning process involved in building up and
breaking down two and three dimensional objects
Visual motor control or eye-hand coordination is
the ability of an individual to use visual
information for precise guidance of movement

Prehension
Grasp:
There are two types of grip: power and precision
Power grips are defined as forcible activities of the
fingers and thumb that act against the palm to
transmit a force to an object
Precision grip and pinch activities are forces directed
between the thumb and fingers, not against palm
Sustained hold of power and precision grips require
isometric contractions
Precision handling requires changes in position of
the handheld object, either in space or about its
own axes, as well as exact control of finger and
thumb position

Developmental psychology

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