NORMAL AND ABNORMAL DEVELOPMENTAL PATTERNS IN A CHILD AND THE NEED FOR THERAPY

WHAT IS DEVELOPMENTAL PATTERNS

Developmental patterns and milestones are certain skills, like babbling, crawling, and reading, that we expect to see a child learn to do as he or she grows into an adult childhood age group has unique developmental milestones. And there are specific age ranges of when we expect certain milestone to appear.

WHAT IS THE NORMAL DEVELOPMENTAL PATTERNS A CHILD SHOULD FOLLOW.

A child is developing normally when he or she does or behaves in the way he or she should behave at that particular age. Normal developmental patterns implies that the child is growing and developing normally exhibiting the normal skills and behaviors at each particular age that he/she is supposed to. Each age of a child comes with an age appropriate patterns of skills and behaviours.

Below is a summary of what to expect in a child at every developing age.

AT 6WEEKS(1month)
 This week marks one of the crucial developments stages in your baby which you might just miss. Your little one begins to gain some control over head movements, though not completely. If you hold your baby upright supporting the abdomen and back, she will be able to hold her head straight, albeit briefly.

AT 2 MONTHS

Physical and motor-skill markers:

Closing of soft spot at the back of the head (posterior fontanelle )
Several newborn reflexes , such as the stepping reflex (baby appears to dance or step when placed upright on solid surface) and grasp reflex (grasping a finger), disappear

When on stomach, able to lift head almost 45 degrees

Less flexing of the arms and legs while lying on the stomach

AT 4 MONTHS
Be able to sit straight if propped up
Raise head 90 degrees when placed on stomach
Be able to roll from front to back
Hold and play with object
Play with a rattle when it's placed in their hands, but won't be able to pick it up if dropped
Be able to grasp a rattle with both hands
Be able to place objects in the mouth

AT 6 MONTHS
Able to hold almost all weight when supported in a standing position
Able to transfer objects from one hand to the other
Able to lift chest and head while on stomach, holding the weight on hands (often occurs by 4 months)
Able to pick up a dropped object
Able to roll from back to stomach (by 7 months)
Able to sit in a high chair with a straight back
Able to sit on the floor with lower back support
Beginning of teething

AT 9 MONTHS
Puts hands forward when the head is pointed to the ground (parachute reflex) to protect self from falling
Is able to crawl
Sits for long periods
Pulls self to standing position
Reaches for objects while sitting
Bangs objects together
Can grasp objects between the tip of the thumb and index finger
Feeds self with fingers

AT 12 MONTHS
Have a head circumference equal to that of their chest
Have 1 to 8 teeth
Stand without holding on to anything
Walk alone or when holding one hand
Sit down without help
Bang 2 blocks together
Turn through the pages of a book by flipping many pages at a time
Pick up a small object using the tip of their thumb and index finger

AT 18 MONTHS(1 YEAR 6 MONTHS)
Is able to control the muscles used to urinate and have bowel movements, but may not be ready to use the toilet
Runs stiffly and falls often
Is able to get onto small chairs without help
Walks up stairs while holding on with one hand
Can build a tower of 2 to 4 blocks
Can use a spoon and cup with help to feed self
Imitates scribbling
Can turn 2 or 3 pages of a book at a time

AT 2 YEARS(24 MONTHS)
Can build a tower of 6 to 7 cubes.
Can kick a ball without losing balance.
Can pick up objects while standing, without losing balance. (This often occurs by 15 months. It is a cause for concern if not seen by 2 years.)
Can run with better coordination . (May still have a wide stance.)
May be ready for toilet training.
Should have the first 16 teeth, but the actual number of teeth can vary widely.
At 24 months, will reach about half final adult height

WHAT ARE ABNORMAL DEVELOPMENTAL PATTERNS IN CHILDREN

When your child is unable to show and exhibit the normal skills and behaviours of each particular age ,there is a problem... When there is a delay in achieving this skills and behaviours then the child is having delayed developmental milestone.


CAUSES OF DELAY IN A CHILDS DEVELOPMENTAL PATTERNS
A genetic defect, such as Down syndrome
Fetal alcohol syndrome , caused by a mother drinking alcohol during pregnancy
Fragile X syndrome , an inherited type of cognitive impairment
Severe medical problems developing soon after birth, often associated with prematurity
Ataxia, a defect that impairs muscle coordination
Cerebral palsy, a condition caused by brain damage before birth
Cognitive delays
Myopathy, a disease of the muscles
Problems with vision
Spina bifida , a genetic condition causing partial or total paralysis of the lower part of the body

WHAT TO DO IF YOU OBSERVE A DELAY IN DEVELOPMENT PATTERN OF YOUR CHILD

Visit a therapist ..a physiotherapist and an occupational therapist to help your child learn the skills appropriate for their ages....




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KNEE REPLACEMENT AND YOUR THERAPY SESSIONS

                 

           

                                                               

WHAT IS A KNEE REPLACEMENT

Knee replacement is a kind of arthroplasty. Arthroplasty literally means "the surgical repair of a joint," and it involves the surgical reconstruction and replacement of degenerated joints, using artificial body parts, or prosthetics.
When the articular cartilage of the knee becomes damaged or worn, it becomes painful and the knee is hard to move. Instead of sliding over each other, the bones rub and crush together.
With a prosthesis, the patient will feel less pain, and the knee will move properly. 


There are three common reasons for knee replacement

Osteoarthritis : this type of arthritis is age related, caused by the normal wear and tear of the knee joint. It mostly affects patients aged over 50 years, but younger people may have it.
Osteoarthritis is caused by inflammation , breakdown, and the gradual and eventual loss of cartilage in the joints. Over time, the cartilage wears down and the bones rub together. To compensate, the bones often grow thicker, but this results in more friction and more pain.

Rheumatoid arthritis : also called inflammatory arthritis, the membrane around the knee joint to become thick and inflamed. Chronic inflammation damages the cartilage, causing soreness and stiffness.


Post-traumatic arthritis : this type of arthritis is due to a severe knee injury. When the bones around the knee break or the ligaments tear, this will affect the knee cartilage.



AFTER KNEE REPLACEMENT WHAT FOLLOWS

Every person who undergoes knee replacement must consult with a therapist to provide therapy exercises to strengthen the muscles around the new knee.
Therapy begins from the first day after the knee replacement to the next three months. This Is because it takes 12weeks I.e 3 months for knee replacement rehabilitation.
   
WHY DO YOU NEED A THERAPIST AFTER YOUR KNEE REPLACEMENT

Therapist provide pain MAnagements, exercise program , muscle stimulation, proper lying and sitting positions, energy conservation techniques etc. A regular exercise program is a key part of recovery from your operation. When you build up strength in the muscles around your new joint, it will help you get back to your normal activities 

METHODS OF ACHIEVING THERAPY GOALS

ELECTRICAL MUSCLE STIMULATION
Electrical stimulation is a therapy that passes an electrical current to an affected area. Nerve conduction within the region is altered, which can in turn alter muscle contractility. Blood flow to these tissues is also increased with electrical stimulation. Patients often experience less pain after electrical stimulation. 

   

Ice and Heat Application. Ice and heat are useful in warming up and cooling off muscles. In addition, these methods can stimulate blood flow and decrease swelling, important parts of the healing process. The key to proper treatment is knowing when to ice and heat an injury.

Ultrasound. Ultrasound uses high frequency sound waves to stimulate the deep tissues within the body, which leads to warming and increased blood flow to these tissues

Stretches for Muscles and Joints. Stretching is vital in maintaining good range of motion for joints and flexibility of muscles. If the individual has stiff joints or tight muscles, normal activities, such as climbing stairs or reaching overhead, can be severely affected. With proper stretching, these functions can be preserved.  After an injury or surgery, scar tissue forms and soft tissue contracts, so stretching is especially important.

Exercises to Strengthen the Body. Strengthening exercises help the patient improve the function of the muscles surrounding the replacement. The goal is to improve strength and increase the range of motion of the replaced joint over time. Recently, therapists have placed more emphasis on core strengthening, because the body’s core is its foundation. Strengthening muscles in the back and pelvis increases stability and improves balance, which goes hand-in-hand with a successful recovery from knee or hip replacement.



                                  Calf resistance exercise

                            Leg raising and stretching exercise with resistance

                                          Leg extension exercise using ball

                                                        Bridge exercise

                                                Toe flexion and extension exercise

                                             
                                                              Heel slides exercise with resistance

                                                     Static stretches exercise 

                                         Hamstrings and calf muscles stretching exercise



Teaching patients proper lying and sitting at home. The therapist teaches patient proper sitting positions that will reduce the swelling on the knee. E.g Lie down with your surgical leg placed in a pillow and elevated at or above the level of your heart for at least 20 minutes. You may place two to three pillows length beneath your surgical leg if you have a wide swelling.
While you are resting and elevating the leg, place ice packs around your knee for 15 to 20 minute time. Place a clean, dry towel or pillowcase between  your skin and the cold pack.

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EFFECT OF FOLIC ACID ON CHILD'S BRAIN DEVELOPMENT.

 WHAT IS FOLIC ACID.

Folic acid is one of the B vitamins  used as a supplement. by women during pregnancy to prevent brain damage and neural tube defects (NTD) in the baby. Low levels in early pregnancy are believed to be the cause of more than half of babies born with neuratube defects.It may be taken by mouth or by injection. 
   

FOODS THAT CONTAIN FOLIC ACID

Folate naturally occurs in a wide variety of foods, including vegetables (particularly dark green leaf vegetables ), fruits such as oranges, banana, papaya, grape fruit juices, okra, beans, nuts, soybeans , chickpeas , dairy products, poultry and meat, eggs, seafood, grains, and some beers. Avocado , corn, carrots  beetroot ,spinach , liver, yeast, asparagus , kale , 
  

IMPORTANCE OF FOLIC ACID IN PREGNANCY.

1.  Folic acid helps prevent neural tube defects (NTDs). Neural tube defects are serious birth defects of the spinal cord (such as spina bifida) and the brain (such as anencephaly). The neural tube is the part of the embryo from which your baby's spine and brain develop.

2.  Prevention of anaemia and  Folic acid help in  production of red blood cell

 It is particularly important for women who are pregnant to consume enough folic acid. This helps prevent the fetus from developing major congenital deformities of the brain or spine, including neural tube defects, such as spina bifida and anencephaly.

Women planning to get pregnant should take folic acid supplements for a full year before conception to reduce the risk of thesemcvelopment.


HOW MUCH FOLIC ACID SHOULD A PERSON TAKE.

The recommended dose for all women of childbearing age is 400 mcg of folate each day. If you take a multivitamin every day, check to see if it has the recommended amount. If for some reason you don't want to take a multivitamin, you can take folic acid supplements .

Here's how much folic acid is recommended each day in terms of pregnancy:

While you're trying to conceive: 400 mcg
For the first three months of pregnancy: 400 mcg
For months four to nine of pregnancy: 600 mcg
While breast feeding:     500 mcg

FOLIC ACID DEFICIENCY SYMPTOMS

Without enough folic acid in your body, your baby's neural tube may not close correctly and she could develop health problems called neural tube defects. These include:

1.   Spina bifida : incomplete development of the spinal cord or the vertebrae of the child

2.  Anencephaly : incomplete development of major parts of the brain of the child.

Unfortunately, there are few tell-tale signs that a fetus is lacking the folic acid needed for normal fetal development. Often the deficiency is recognized after it is too late. However, there are common signs of an neural tube defects caused by a folic acid deficiency. The signs and symptoms include:

1.   An opening in the baby's back exposing the spine and spinal cord
2.  Paralysis below the point of the defect
3. Lack of bladder control and bowel function
4. Accumulation of fluid in the brain
5. Partially formed brain and spinal cord

                         Spinal bifida defect(protruding of the spinal nerve through an opening on the spine of the child)


                                                           


 Anencephaly ( incomplete development of major parts of the brain of the child.)

WHAT TO DO TO PREVENT FOLIC ACID DEFICIENCY.

It is extremely important for women to take folic acid vitamins and supplements before planning pregnancies and during pregnancy in order to prevent folic acid disorders from occurring.

Caring for a Child With a Folic Acid Deficiency Disorder

Was your child born with spina bifida? the most common folic acid disorder? The level of disability your child will experience depends upon where on the spine the defect occurred. Some children will learn to walk with assistance, others will need a wheelchair, and sadly, some of them are stillborn or do not live long following the delivery. 

Your child will need to go through surgery and afterwards series of therapy sessions to manage the disability and teach the child through the learning phase.

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