pearls pediatry 2

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0catch 1257897119-0 visited=11%2F10%2F2009; visited=11%2F10%2F2009; visited=11%2F10%2F2009; visited=11%2F10%2F2009; visited=11%2F10%2F2009; visited=11%2F10%2F2009><table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=110 BGCOLOR="#666699" TEXT="#080000" bgproperties="fixed" background="04a00840erlcjm.gif"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>pediatryPART I</B></FONT><B>     |     </B><A HREF="index.htm" TARGET="_top" TITLE="pediatryPART I"><U><B>home</B></U></A></div> <div> <A HREF="id31.htm" TARGET="_top" TITLE="PEDIATRIC PEARLS FOR THE USMLE"><U>PEDIATRIC PEARLS FOR THE USMLE</U></A>   |   <B>pearls pediatry 2</B>   |   <A HREF="id18.htm" TARGET="_top" TITLE="general"><U>general</U></A>   |   <A HREF="id34.htm" TARGET="_top" TITLE="appendiceal colic"><U>appendiceal colic</U></A>   |   <A HREF="id35.htm" TARGET="_top" TITLE="ATOPIC DERMATITIS"><U>ATOPIC DERMATITIS</U></A>   |   <A HREF="id19.htm" TARGET="_top" 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BGCOLOR="#CCCCFF" TEXT="#080000" background="04411c00egdysm.gif"> <bR> <div> <B><IMG SRC="0fb938a0.gif" border=0 width="147" height="138" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <A HREF="id31.htm" TARGET="_top" TITLE="PEDIATRIC PEARLS FOR THE USMLE"><U><B>PEDIATRIC PEARLS FOR THE USMLE</B></U></A></div> <div> <B>pearls pediatry 2</B></div> <div> <A HREF="id18.htm" TARGET="_top" TITLE="general"><U><B>general</B></U></A></div> <div> <A HREF="id34.htm" TARGET="_top" TITLE="appendiceal colic"><U><B>appendiceal colic</B></U></A></div> <div> <A HREF="id35.htm" TARGET="_top" TITLE="ATOPIC DERMATITIS"><U><B>ATOPIC DERMATITIS</B></U></A></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="Stuttering"><U><B>Stuttering</B></U></A></div> <div> <A HREF="id20.htm" TARGET="_top" TITLE="enuresis"><U><B>enuresis</B></U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="Conduct Disorder in Children and Adolesc"><U><B>Conduct Disorder in Children and Adolescents </B></U></A></div> <div> <A HREF="id22.htm" TARGET="_top" TITLE="Specific Growth Curve Deviations "><U><B>Specific Growth Curve Deviations </B></U></A></div> <div> <A HREF="id23.htm" TARGET="_top" TITLE="Common Medical and Surgical Problems"><U><B>Common Medical and Surgical Problems</B></U></A></div> <div> <A HREF="id24.htm" TARGET="_top" TITLE="Chronic Abdominal Pain in Childhood: Dia"><U><B>Chronic Abdominal Pain in Childhood: Diagnosis and Management </B></U></A></div> <div> <A HREF="id25.htm" TARGET="_top" TITLE="child devlpt"><U><B>child devlpt</B></U></A></div> <div> <A HREF="id26.htm" TARGET="_top" TITLE="ACETAMINOPHEN OVERDOSE"><U><B>ACETAMINOPHEN OVERDOSE</B></U></A></div> <div> <A HREF="id27.htm" TARGET="_top" TITLE="SHAKEN BABY SYNDROME"><U><B>SHAKEN BABY SYNDROME</B></U></A></div> <div> <A HREF="id28.htm" TARGET="_top" TITLE="NEONATAL JAUNDICE (HYPERBILIRUBINEMIA)"><U><B>NEONATAL JAUNDICE (HYPERBILIRUBINEMIA)</B></U></A></div> <div> <A HREF="id29.htm" TARGET="_top" TITLE="Hyaline Membrane Disease (Respiratory Di"><U><B>Hyaline Membrane Disease (Respiratory Distress Syndrome) (HMD) (RDS</B></U></A></div> <div> <A HREF="id30.htm" TARGET="_top" TITLE="infectious disease"><U><B>infectious disease</B></U></A></div> <div> <A HREF="id32.htm" TARGET="_top" TITLE="HEMORRHAGIC DISEASE IN A NEW BORN"><U><B>HEMORRHAGIC DISEASE IN A NEW BORN</B></U></A></div> <div> <A HREF="id33.htm" TARGET="_top" TITLE="OPTIC NERVE GLIOMA"><U><B>OPTIC NERVE GLIOMA</B></U></A></div> <div> <A HREF="id36.htm" TARGET="_top" TITLE="New Born Assessment "><U><B>New Born Assessment </B></U></A></div> <div> <A HREF="id38.htm" TARGET="_top" TITLE="laryngomalacia"><U><B>laryngomalacia</B></U></A></div> <div> <A HREF="id39.htm" TARGET="_top" TITLE="CRANIOSYNOSTOSIS "><U><B>CRANIOSYNOSTOSIS </B></U></A></div> <div> <A HREF="id40.htm" TARGET="_top" TITLE="DANDYWALKER MALFORMATION "><U><B>DANDY-WALKER MALFORMATION </B></U></A></div> <div> <A HREF="id41.htm" TARGET="_top" TITLE="DEJERINESOTTAS DISEASE "><U><B>DEJERINE-SOTTAS DISEASE </B></U></A></div> <div> <A HREF="id42.htm" TARGET="_top" TITLE="DOWN SYNDROME "><U><B>DOWN SYNDROME </B></U></A></div> <div> <A HREF="id43.htm" TARGET="_top" TITLE="Respiratory Syncytial Virus (RSV)"><U><B>Respiratory Syncytial Virus (RSV)</B></U></A></div> <div> <A HREF="id44.htm" TARGET="_top" TITLE="FABRY DISEASE "><U><B>FABRY DISEASE </B></U></A></div> <div> <A HREF="id45.htm" TARGET="_top" TITLE="PRADERWILLI SYNDROME "><U><B>PRADER-WILLI SYNDROME </B></U></A></div> <div> <A HREF="id37.htm" TARGET="_top" TITLE="new born fun"><U><B>new born fun</B></U></A></div> <div> <A HREF="id46.htm" TARGET="_top" TITLE="RETT SYNDROME "><U><B>RETT SYNDROME </B></U></A></div> <div> <A HREF="id47.htm" TARGET="_top" TITLE="Alexander Disease"><U><B>Alexander Disease</B></U></A></div> <div> <A HREF="id49.htm" TARGET="_top" TITLE="leukemia"><U><B>leukemia</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U><B>Contact Me</B></U></A></div> </td> <td valign="top" height=370 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> pearls pediatry 2</div> <div> There are several different types of white blood cells:</div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">granulocytes</B>: fight bacteria by surrounding them and "eating" them. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">monocytes</B>: fight germs, but aren't as specific as granulocytes. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">B-lymphocytes</B>: these cells attach antibodies on germs (or anything they don't think belongs) with antibodies, which in turn signal other WBCs to get the tagged germ. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">T-lymphocytes</B>: these cells signal orders to other WBCs to come to a germ, and they make those other WBCS stay at the battle sight. </div> <bR> <bR> <div> RBCs, platelets, and WBCs are all made in the bone marrow. In fact, they all derive from one cell type, called a stem cell, which then differentiates into one of the three types.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">ALL, CLL, AML, and CML stand for which type of white blood cell is growing out of control. Thus:</div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">lymphocytic</B>: uncontrolled growth of B- or T-lymphocytes </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">myelogenous</B> (granulocytic): uncontrolled growth of granulocytes </div> <bR> <div> If these leukemias progress quickly, they are further denoted <B>acute</B> (as in ALL and AML). If they progress slowly, they are called <B>chronic</B> (as in CLL and CML). Acute leukemias are most prevalent in children and are therefore often called "childhood leukemias". In summary,</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">ALL: acute lymphocytic leukemia </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">CLL: chronic lymphocytic leukemia </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">AML: acute myelogenic leukemia </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">CML: chronic myelogenic leukemia </div> <bR> <div> =====================================================================================================================</div> <div> <IMG SRC="104030d0.jpg" border=0 width="515" height="269" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <B>=======================================================================================================================</B></div> <div> <IMG SRC="10390fa0.jpg" border=0 width="400" height="250" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <bR> <bR> <div> A pediatrician is examining a young infant and notes that the infant symmetrically abducts and extends his extremities after a loud noise and then begins to cry. This reflex is known as which of the following</div> <div> <B>Moro reflex</B></div> <div> <B><IMG SRC="0f6c8780.jpg" border=0 width="200" height="120" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0fd0ef70.gif" border=0 width="526" height="247" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <div> Chronology - emerges around 8-9 weeks in utero and is inhibited at about 16 weeks of neonate life. It is transformed into the adult startle or Strauss <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT>, and should not be present in children beyond the age of one year at the very, very latest</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The Moro reflex is initiated by loud noise or sudden motion.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> It involves abduction of the extremities and extension of the elbows and knees, followed by flexion.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> The Moro reflex appears at birth and disappears at approximately 4 months of age.</div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> If the reflex is asymmetric, this suggests extremity fracture or peripheral nerve injury. </B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Also known as the <B>startle </B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B>reflex[</B></FONT>; startle reflex; embrace reflex]</div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">,</B> this is the characteristic <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> of newborns.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> When the baby is startled (classically one allows the baby's head to fall back a bit), he throws his arms wide, spreading the fingers, then grabs instinctively with the arms and fingers (for his mother, of course). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> should be brisk and above all symmetrical.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> One of the functions of <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>swaddling</U></FONT>, in my mind, is to suppress this <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT>, which often upsets the little tyke.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> An <B>asymmetric startle </B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B>reflex</B></FONT><B>,</B> in which one arm does not act symmetrically with its companion, implies a paralysis or weakness on one side of the body, most commonly <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Erb's palsy</U></FONT>. </div> <bR> <div> <TABLE BORDER="2" CELLPADDING="2" CELLSPACING="1" WIDTH="858" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" BGCOLOR=#000066 > <tR> <tD VALIGN=TOP HEIGHT= 2118 WIDTH="846"><div> <B><U>Role & description </U></B></div> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">- the </B><B>Moro</B><B> is a clasp </B><B>reflex</B><B>.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> It is a panic alarm </B><B>reflex</B><B> which helps the baby to hang on and cry in alarm. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">At birth the cortex is not wired up - we are a brain stem functioning, </B><B>reflex</B><B>ive, floppy mass.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Built into the brain stem is the </B><B>Moro</B><B> </B><B>reflex</B><B> to protect the new born child. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">As the baby cannot use the cortex to interpret the threat, the result is a panic response. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Once the adult startle </B><B>reflex</B><B> has been developed, the individual will use the senses (eyes and ears) to locate the source of any perceived threat and will make an intellectual, cortical decision - </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">should I be frightened or not? If the source cannot be located, a child may become worried and cry, but should not scream. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The startle </B><B>reflex</B><B> is a rapid intake of breath, blink, shoulders up and then locate the source</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">. Agorophobia panic victims, for example, still retain the </B><B>Moro</B><B> </B><B>reflex</B><B>. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Activation - can be activated by at least three things:</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> a sudden noise (auditory </B><B>Moro</B><B>),</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> movement/alteration of head position (vestibular </B><B>Moro</B><B>) </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">or change of light (visual </B><B>Moro</B><B>). </B></div> <bR> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Reaction - the arms go out, and as the response becomes stronger, the arms come back in again.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> It is the clasping or bringing back of the arms which is the </B><B>Moro</B><B> </B><B>reflex</B><B>.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> So there is a rapid intake of breath, out arms, legs to a lesser degree, freeze for a second, then back come arms and legs and then the baby screams the place down! </B></div> <bR> <bR> <div> <B>Consequences - </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">If a person grows up with this </B><B>reflex</B><B> but manages to control it, it can affect the entire personality. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">They may need to ask question after question and are not happy about change unless they have instigated it.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> If they are going somewhere they want to know who will be there, what will happen and what they will have to do. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">They may be uptight and egocentric, not because they want to be, but because they need to be in control as much as possible. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">They also find it difficult to make relationships as they need to control the other person. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Quite often the </B><B>Moro</B><B> driven child, in addition to being immature, very sensitive, over reactive, and who often loses cortical control, has pupils which tend to remain enlarged under minimum stress.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Obviously, if you are very anxious or very frightened,</B><FONT SIZE="3" COLOR="#33FFFF" FACE="Arial" ><B> your pupils will be more dilated than normal because of the fight/flight mechanism</B></FONT><B>, but you will still have some pupillary reaction to strong light.</B></div> <div> <FONT SIZE="3" COLOR="#FFFF00" FACE="Arial" ><B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> </B></FONT><B>However, with many of the children with a strong </B><B>Moro</B><B>, the pupils remain dilated and they are hypersensitive to light. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">They do not know when to stop and do not learn from experience.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> The </B><B>Moro</B><B> affects the personality tremendously, and so has a very catastrophic effect it it remains present. </B></div> <div> <B>Adrenaline and cortisol are two of the body's main defences against infections and allergies.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> If they are in use very frequently, as in the </B><B>Moro</B><B> driven individual, they are distracted from their primary role and the body may lack enough of them to provide immunity and a balanced reaction to potential allergens. This may be the child who catches every cold or other infection, and who over reacts to some types of medication. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The child might also be sensitive to certain foods or food additives, and this can affect behaviour and concentration.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> They will also tend to burn up blood sugar quicker than other children, which will make swings in mood and performance more pronounced. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The </B><B>Moro</B><B> child, being oversensitive in one or more sensory channels, is often operating at a high level of awareness.</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000ffff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Imagine, then, the effect on such a child of simply being in a classroom - bright fluorescent lights, much movement and activity, often a great deal of noise and high temperatures - such a child can easily experience sensory overload. Add to this the fact that many of these children are stimulus bound (unable to ignore irrelevant stimuli within their visual field) and have a poor concentration span. </B></div> <bR> <div> <B>LONG TERM EFFECTS OF A RETAINED </B><B>MORO</B><B> </B><B>REFLEX</B><B> </B></div> <div> <B>1. Vestibular problems such as travel sickness or impaired coordination and balance, particularly seen during ball games. </B></div> <div> <B>2. Physical timidity. </B></div> <div> <B>3. Oculomotor and visual-perceptual problems - stimulus bound (inability to ignore irrelevant stimuli within the visual field, so that the eyes are drawn to the outline of a shape at the expense of being unable to perceive internal aspects of the shape or object). </B></div> <div> <B>4. Poor pupillary reaction to light, photosensitivity, dificulty with black print on white paper. The individual tires easily under fluorescent lights. </B></div> <div> <B>5. Possible auditory confusion resulting from hypersensitivity to certain specific sounds. The individual may have poor auditory discrimination skills and have difficulty shutting out background noise. </B></div> <div> <B>6. Allergies and lowered immunity - asthma, eczema or a history of frequent ear, nose and throat infections. </B></div> <div> <B>7. Adverse reaction to drugs. </B></div> <div> <B>8. Poor stamina. </B></div> <div> <B>9. Dislike of change or surprise - poor adaptability. </B></div> <div> <B>10. Poorly developed CO2 </B><B>reflex</B><B>. </B></div> <div> <B>11. Reactive hypoglycaemia. </B></div> <bR> <div> <B>POSSIBLE SECONDARY PSYCHOLOGICAL SYMPTOMS </B></div> <div> <B>1. Free floating anxiety - "Angst" (continuous anxiety, seemingly unrelated to reality). </B></div> <div> <B>2. Excessive reaction to stimuli: </B></div> <div> <B>a. Mood swings - labile emotions. </B></div> <div> <B>b. Tense muscle tone - body armouring. </B></div> <div> <B>c. Difficulty accepting criticism, as this individual finds it so difficult to change. </B></div> <div> <B>3. Cycle of hyperactivity followed by excessive fatigue. </B></div> <div> <B>4. Difficulty making decisions. </B></div> <div> <B>5. Weak ego, low self esteem: </B></div> <div> <B>a. insecurity/dependency. </B></div> <div> <B>b. Need to control or manipulate events</B></div> <bR> <div> <B><IMG SRC="0fc0ecc0.gif" border=0 width="526" height="460" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> </tD> </tR> </TABLE></div> <bR> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The asymmetric tonic neck reflex (ATNR)  appears at approximately <B>2 weeks of age and disappears at approximately 6 months of age. </B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">There is flexion of the arm and leg on the occipital side and extension on the chin side, creating a "fencer position.''</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> The parachute reflex  appears at about<B> 8 to 9 months of age and persists voluntarily. </B>The child is placed in the examiner's hands and is permitted to free-fall in ventral suspension. The child extends his extremities symmetrically to distribute his weight for landing.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The grasping reflex  appears at birth and disappears at about <B>3 months of age</B>. This is when the infant reflexively grasps at an object placed in his palm.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The protective equilibrium reflex  appears at 4 to 6 months of age and persists voluntarily. The child is pushed laterally by the examiner and flexes his trunk toward the force to regain equilibrium while he extends one arm to protect against falling.</div> <bR> <div> reflex<FONT SIZE="3" COLOR="#000000" FACE="Arial" >es that persist into adulthood are: </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">blinking (corneal) <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> (blinks before eyes are touched or when sudden bright light appears) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">sneeze <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> (sneezes when nasal passages irritated) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">gag <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> (gags when throat or back of mouth stimulated) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">yawn <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> (yawns when needs additional oxygen) </div> <div> <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U><IMG BORDER="0" SRC="Symb075c00b700f0ff000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">cough</U></FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> (coughs when airway stimulated) </div> <div> Infantile <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT>es (normal in infants, abnormal in all others): </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Moro<FONT SIZE="3" COLOR="#000000" FACE="Arial" > response </FONT></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">tonic neck <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">grasp <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">rooting <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">sucking <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> (sucks when area around mouth stimulated) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">startle <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> (pulling arms and legs inward after loud noise) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">step <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> (stepping motions when sole of foot touches hard surface) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">crawl <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> (crawling motions when placed on abdomen) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">parachute <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> <IMG SRC="1000e190.gif" border=0 width="526" height="537" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">parachute reflex</div> <bR> <bR> <bR> <div> <B>The Palmar </B><FONT SIZE="4" COLOR="#800000" FACE="arial" ><B>Reflex</B></FONT><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <B><IMG SRC="0f796710.jpg" border=0 width="150" height="113" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1010e4a0.gif" border=0 width="526" height="330" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f00000ff00.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Chronology - emerges at around 11 weeks in utero and is inhibited or suppressed at about 2-4 months after birth. </B></div> <bR> <bR> <div> <B><U>Role & description -</U></B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> another of the group of 'clasp' <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT>es,</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> the Palmar allows the baby to practice grasping and the letting go of objects. </div> <div> <B><U>Activation -</U></B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> activated by stimulation in the palm of the hand. </div> <div> <B><U>Reaction - </U></B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">if you place your finger into the palm of the baby's hand, the thumb will come over and lock your finger, then the baby's other fingers will lock in the thumb and your finger very tightly. If you do this in both hands at the same time, the baby cannot let go. It is therefore possible to hang a baby from a washing line, but please do not try to do this!!! (there is a similar <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> present in the feet, called the Plantar <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT>). </div> <bR> <div> <B><U>Consequences -</U></B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> the Palmar <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> should not be present beyond the first year of life, but if it remains present in children of school age, writing problems will develop.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> As soon as a pen or pencil is put into the child's hand, the fingers automatically tighten, and get tighter and tighter. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The pressure increases on the paper and they start to lose control of the hand. It is no use telling them not to grip it so tightly! Writer's cramp is a likely result, and difficulty will be experienced in catching a ball.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> They may also not find it easy to juxtapose the fingers and thumb for rapid alternate movement, and if they cannot do this (dysdiadochokinesia), it shows that there is an immaturity of the cerebellum, and poor speech/language is a likely consequence. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The cerebellum does not cross over, and so if you cannot do the movement on the right side, it shows that there is a problem in the right side of the cerebellum. I recall a boy in my class at school who, when writing, always made chewing movements - as though he was chewing food with his mouth open. It was a source of much hilarity for the rest of us (and ridicule for him) when the teacher pointed out that we write with our hands not our mouth! In <B>the early months of life the Palmar </B><FONT SIZE="3" COLOR="#800000" FACE="Arial" ><B>Reflex</B></FONT><B> can be activated by sucking movements. </B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The hands and the mouth are linked together in what is called the Babkin response. </B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The hands and the mouth are the baby's main tools for exploration and for expression, and residual <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT>es in these areas can affect speech and articulation and fine muscle control. </div> <bR> <div> LONG TERM EFFECTS OF A RETAINED PALMAR <FONT SIZE="3" COLOR="#800000" FACE="Arial" >REFLEX</FONT> </div> <div> 1. Poor manual dexterity - the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> will prevent independent thumb and finger movements. </div> <div> 2. Lack of "pincer" grip, which will affect pencil grip when writing. </div> <div> 3. Speech difficulties - continuing relationship between hand and mouth movement via the Babkin response will prevent the development of independent </div> <div> muscle control at the front of the mouth, which will then affect articulation. (The Babkin response is demonstrated well in kittens where the action of sucking causes kneading of the paws in time to sucking movements). </div> <div> 4. Palm of the hand may remain hypersensitive to tactile stimulation. </div> <div> 5. Child may make movements with the mouth when trying to write or draw. </div> <bR> <bR> <div> <B>The Asymmetrical Tonic Neck </B><FONT SIZE="4" COLOR="#800000" FACE="arial" ><B>Reflex</B></FONT><B> (ATNR)</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <bR> <div> <B><IMG SRC="0f8af6e0.jpg" border=0 width="175" height="110" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <B><IMG SRC="0fe0e020.gif" border=0 width="526" height="258" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0ff0e440.gif" border=0 width="526" height="324" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <B>Chronology - emerges at around 18 weeks in utero and is inhibited or suppressed between 6-8 months after birth, while awake. It persists up to three and a half years while asleep. </B></div> <bR> <bR> <div> <B><U>Role & description -</U></B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> the ATNR fulfils many purposes. It has been suggested that one of its primary functions is to assist in the birth process -</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> the rotation of the head allows the shoulders to move, and therefore the baby moves in a spiral down the birth canal.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> The ATNR may also help survival. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">When a baby is placed prone, it should not go into the "frog" position. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The head should go to one side, with extension of the jaw arm and leg.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> This allows free passage of air.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> The ATNR is the first training ground for eye-hand coordination.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> When a baby is born it can only focus its eyes at about eight inches</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">. Outside of that the baby can see movement and shadow, but it cannot focus. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Through the ATNR, the baby slowly extends the vision from near point fixation to distance, and therefore this is vital for eye-hand coordination training. </div> <bR> <bR> <div> <B><U>Activation </U></B>- </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">head rotation to either side. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Reaction - the jaw arm would slowly extend, the jaw hand and fingers would also slowly extend. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The jaw leg would extend, but not as much as the arm. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The occipital (the back of the head) arm and leg would bend. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This is the "kick" the mother feels, and it should get stronger and stronger as birth approaches. </div> <bR> <bR> <div> Consequences -</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> If the ATNR remains strongly present it might affect vision. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The hand does not want to cross the midline, and as the eyes are locked in to the hands, they do not want to cross the midline either. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This may mean that, <B>when reading for example, when the eyes get to the midline, they "jump" and the child may lose his/her place.</B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> <B>In crawling, the child is unable to reach and then bend the elbow to drag itself along (it is physiologically impossible to creep, commando style)</B>.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> In creeping, the arms need to remain straight, but the ATNR causes a bending of the occipital arm.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> In grasping, when the baby looks at the object, the fingers will want to straighten out. In the older child, it is as though there is an invisible force which causes the arm and hand to straighten whenever the head is turned to one side. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The child may have to exert a great deal of conscious control when writing - something that should be automatic.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> In addition to the fatigue caused by the effort of fighting the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT>, the child's comprehension can suffer due to the cortex being involved in movement. This can, in turn, affect concentration. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Judging distance will also be difficult. If present in the legs, walking will be affected, and the child will tend to walk with a stiff leg gait. </div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">When at school, catching a ball (bringing the hands together at the midline) will be affected. </B></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">When the head turns right, the left knee will bend and therefore disturb balance.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Writing and copying problems will also be seen.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Gross and fine muscle coordination and eye tracking will also be affected.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Many children who are articulate and bright just cannot seem to express themselves well in written work.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> It is as though the mind can think and the mouth can speak, but when a motor task is added (writing, for example) the child seems unable to demonstrate the intelligence that we know is there. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">It is clear, therefore, that the ATNR can have a very severe effect. </div> <bR> <div> SYMPTOMS SUGGESTIVE OF A RESIDUAL OR RETAINED ASYMMETRICAL TONIC NECK <FONT SIZE="3" COLOR="#800000" FACE="Arial" >REFLEX</FONT> </div> <div> 1. Balance may be affected as a result of head movements to either side. </div> <div> 2. Homolateral (one sided), instead of normal cross pattern movements - e.g. when walking, marching, skipping, etc. </div> <div> 3. Difficulty crossing the midline. </div> <div> 4. Poor ocular pursuit movements, especially at the midline. </div> <div> 5. Mixed laterality (the individual may use left foot, right hand, left ear, or may use left and right hand interchangeably for the same task). </div> <div> 6. Poor handwriting and poor expression of ideas on paper. </div> <div> 7. Visual-perceptual difficulties, particularly in symmetrical representation of figures. </div> <bR> <div> <B>The Tonic Labyrinthine </B><FONT SIZE="4" COLOR="#800000" FACE="arial" ><B>Reflex</B></FONT><B> (TLR)</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="202" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 624 WIDTH="198"><div> <IMG SRC="10207000.gif" border=0 width="263" height="512" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="0f9c8660.jpg" border=0 width="200" height="102" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </tD> </tR> </TABLE></div> <div> <B>Chronology - emerges around 3 - 4 months in utero (in flexion, or forwards) and at birth (in extension, or backwards - as in the picture) and is inhibited or suppressed between 3 -4 months after birth (in flexion) and 3 - 4 months to 3 and a half years (in extension). </B></div> <bR> <bR> <div> <B><U>Role & description -</U></B></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> This <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> is the baby's way of responding to gravity, hence it is otherwise known as "the baby balance <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT>".</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> In extension, the TLR helps the baby to straighten out from the flexus habitus position, and it therefore plays a role in the development of muscle tone, a process which also helps to train balance and proprioception (the awareness of the position of the body or limbs). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The TLR in extension is present at birth, and gets stronger over the next ten days. It has been suggested that when the baby breaks out of flexus habitus, the head has to go back to get into the birth canal. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">With an elective caesarean section, the head has not gone into the TLR in extension position.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> If there is an emergency caesarean, and the head has engaged, the TLR in extension has been activated. </div> <bR> <bR> <div> <B><U>Activation -</U></B></div> <div>  </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">head movement above and below the level of the spine. </div> <bR> <div> <B><U>Reaction - </U></B></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">TLR in flexion: if we had a new born baby lying on its back, and its head was gently lifted up above the level of the back, as you lifted the head up the knees would come up and the baby would go into a foetal form (flexus habitus - seen in utero). TLR in extension: if we have a baby lying on its back and you slowly lowered the baby's head below the level of the back, you get the exact opposite from flexion. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">As the head goes back, so the legs and the feet stretch out, and the arms and hands stretch out into a near crucifixion position. </div> <bR> <bR> <div> <B><U>Consequences -</U></B> </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">There can be a devastating effect on many functions if the TLR remains present - eyes, balance and proprioception to name but a few. Head movement can affect muscle tone ('floppy' child - low or weak muscle tone), and this can cause a distortion in the centre of balance. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The brain will lack a secure reference point from which to judge space, depth, distance and speed, and this, in addition to causing problems with directions such as left, right, up, down, etc, can lead to difficulty with spatial tasks. </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The ability to track smoothly and evenly with the eyes only comes as the TLR in extension is inhibited, and the continued presence of the TLR prevents the proper emergence of the Head Righting <FONT SIZE="3" COLOR="#800000" FACE="Arial" >Reflex</FONT>es. </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">As the eyes and ears operate on the same circuit of the brain (even sharing cranial nerves), poor visual information will affect balance, and poor balance will affect vision. </div> <bR> <div> SYMPTOMS SUGGESTIVE OF A STRONGLY RESIDUAL TONIC LABYRINTHINE <FONT SIZE="3" COLOR="#800000" FACE="Arial" >REFLEX</FONT> FORWARDS </div> <div> 1. Poor posture - stoop. </div> <div> 2. Hypotonus - weak muscle tone. </div> <div> 3. Vestibular related problems: </div> <div> a. poor sense of balance. </div> <div> b. propensity to get car sick. </div> <div> 4. Dislike of sporting activities, physical education classes, running, etc. </div> <div> 5. Oculomotor dysfunctions: </div> <div> a. Visual-perceptual difficulties. </div> <div> b. Spatial problems. </div> <div> 6. Poor sequencing skills. </div> <div> 7. Poor sense of time. </div> <div> SYMPTOMS OF A STRONGLY RESIDUAL TONIC LABYRINTHINE <FONT SIZE="3" COLOR="#800000" FACE="Arial" >REFLEX</FONT> BACKWARDS </div> <div> 1. Poor posture - tendency to walk on toes. </div> <div> 2. Poor balance and coordination. </div> <div> 3. Hypertonus - stiff, jerky movements because the extensor muscles exert greater influence than the flexor muscles. </div> <div> 4. Vestibular related problems: </div> <div> a. Poor sense of balance. </div> <div> b. Tendency to motion sickness. </div> <div> 5. Oculomotor dysfunction: </div> <div> a. Visual-perceptual difficulties. </div> <div> b. Spatial perception problems. </div> <div> 6. Poor sequencing skills. </div> <div> 7. Poor organisation skills. </div> <bR> <bR> <bR> <div> <B>The Symmetrical Tonic neck </B><FONT SIZE="4" COLOR="#800000" FACE="arial" ><B>Reflex</B></FONT><B> (STNR)</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="144" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 156 ><NOBR><div> <IMG SRC="0fa8f960.jpg" border=0 width="143" height="150" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> </tR> </TABLE></div> <div> <B>Chronology - emerges around 9 - 11 months after birth and is inhibited or suppressed at about one year. </B></div> <bR> <bR> <div> <B><U>Role & description </U></B>-</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> it has a very short, significant life. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This is virtually the cat <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT>. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">After the baby, ideally in development, has <B>crawled on its stomach, around 9 - 11 months</B> the developing brain releases the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> to allow the baby to begin to defy gravity. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The sole task of the STNR is to get the child to begin to defy gravity. </div> <bR> <bR> <div> <B><U>Activation -</U></B></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> from a 'kneeling' position, either movement of the baby's head upwards or downwards. </div> <bR> <div> <B><U>Reaction - </U></B></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">every time the baby looks up the bottom goes back onto the ankles, and every time the baby looks down the elbows bend and the head virtually hits the floor. </div> <bR> <bR> <div> <B><U>Consequences </U></B></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">- if it remains it impedes, in some way, creeping on hands and knees. It is impossible to crawl if the STNR persists, and the child will be a "bottom hopper".</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> If you test just for the STNR alone, it may be a good indication of neurological dysfunction. In around 75% of LD children there is a retained STNR.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> When writing, the elbows bend and the head goes nearer and nearer to the writing surface. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">It also makes them messy eaters. When they are using a spoon and they put their head down, they do not have control over the hand and head movement, and therefore spill as much food as they put in their mouth. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">These children tend to compensate by lifting the spoon up and putting their head down. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The STNR has been associated with reading, writing and concentration problems. It will also affect copying and spelling and has a definite, noticeable effect on posture and movement.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> <B>It is very closely tied in with the TLR and, in addition to affecting swimming, it is usually noted in the so called "clumsy child". </B></div> <bR> <bR> <div> SYMPTOMS SUGGESTIVE OF A STRONGLY RESIDUAL SYMMETRICAL TONIC NECK <FONT SIZE="3" COLOR="#800000" FACE="Arial" >REFLEX</FONT> </div> <div> 1. Poor posture. </div> <div> 2. Tendency to "slump" when sitting, particularly at a desk or table. </div> <div> 3. Simian (ape like) walk. </div> <div> 4. "W" leg position when sitting on the floor. </div> <div> 5. Poor eye hand coordination: </div> <div> a. Messy eater. </div> <div> b. "Clumsy child" syndrome. </div> <div> 6. Difficulties with readjustment of binocular vision (cannot change focus easily from blackboard to desk). </div> <div> 7. Slowness at copying tasks. </div> <div> 8. Poor swimming skills. </div> <bR> <bR> <bR> <div> <B>The Segmental Rolling </B><FONT SIZE="4" COLOR="#800000" FACE="arial" ><B>Reflex</B></FONT><B> (SRR)</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="202" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="198"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="198" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> <B>Chronology - emerges around 6 - 10 months after birth and remains present throughout life. </B></div> <bR> <div> <B><U>Role & description - </U></B></div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The Segmental Rolling <FONT SIZE="3" COLOR="#800000" FACE="Arial" >Reflex</FONT>es (also known as "neck on body reactions") allow the baby to roll over. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">For example, when lying on the tummy, the baby first begins to learn to hold the head up - then the upper torso is raised - and eventually the ability to roll over and up into a sitting position follows, in accordance with the "cephalo-caudal" developmental law (from head to toe). </div> <bR> <div> <B><U>Activation -</U></B> </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">in either prone or supine, raise either the shoulder or the knee and move it across the midline towards the other side of the body. </div> <bR> <div> <B><U>Reaction -</U></B> </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">when raising the shoulder the knee on the same side should begin to bend. When raising the knee, the shoulder and arm should begin to roll also. If you bend the knee up and you push the knee slowly across the midline, the arm/body should follow through. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This allows you to roll over. </div> <bR> <div> <B><U>Consequences </U></B>- </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">many children with coordination problems and dyspraxia do not have this. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">It is the ability to use one part of the body without other parts of the body on the same side locking in. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">So the SRR gives us that smooth, good, erect coordination of the body and facilitates fluidity of movement. </div> <bR> <div> SYMPTOMS SUGGESTIVE OF AN ABSENCE OF THE AMPHIBIAN AND SEGMENTAL ROLLING <FONT SIZE="3" COLOR="#800000" FACE="Arial" >REFLEX</FONT>ES </div> <div> 1. Lack of cross pattern crawling and creeping. </div> <div> 2. Hypertonus (high muscle tone) affecting gross muscle coordination. </div> <div> 3. Difficulty effecting positional changes. </div> <div> 4. Lack of fluidity of movement.</div> <bR> <bR> <div> <B><U>=====================================================================================================================</U></B></div> <div> Erik Erikson's 8 Stages of Psychosocial Development</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="930" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 39 WIDTH="167"><div> <B>Stage</B></div> </tD> <tD VALIGN=TOP WIDTH="104"><div> <B>Ages</B></div> </tD> <tD VALIGN=CENTER WIDTH="113"><div> <B>Basic</B></div> <div> <B>Conflict</B></div> </tD> <tD VALIGN=CENTER WIDTH="162"><div> <B>Important </B></div> <div> <B>Event</B></div> </tD> <tD VALIGN=TOP WIDTH="354"><div> <B>Summary</B></div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 57 WIDTH="167"><div> <B><U>. Oral-Sensory </U></B></div> </tD> <tD VALIGN=TOP WIDTH="104"><div> Birth to 12 to 18 months</div> </tD> <tD VALIGN=TOP WIDTH="113"><div> Trust vs. Mistrust </div> </tD> <tD VALIGN=TOP WIDTH="162"><div> Feeding</div> </tD> <tD VALIGN=TOP WIDTH="354"><div> The infant must form a first loving, trusting relationship with the caregiver, or develop a sense of mistrust.</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 96 WIDTH="167"><div> <B><U>Muscular-Anal</U></B></div> </tD> <tD VALIGN=TOP WIDTH="104"><div> 18 months</div> <div> to 3 years</div> </tD> <tD VALIGN=TOP><NOBR><div> Autonomy vs.</div> <div> Shame/Doubt</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="162"><div> Toilet </div> <div> training</div> </tD> <tD VALIGN=CENTER WIDTH="354"><div> The child's energies are directed toward the development of physical skills, including walking, grasping, and rectal sphincter control. The child learns control but may develop shame and doubt if not handled well.</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 57 WIDTH="167"><div> <B><U>Locomotor</U></B></div> </tD> <tD VALIGN=TOP><NOBR><div> 3 to 6 years</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="113"><div> Initiative vs.</div> <div> Guilt </div> </tD> <tD VALIGN=TOP WIDTH="162"><div> Independence</div> </tD> <tD VALIGN=CENTER WIDTH="354"><div> The child continues to become more assertive and to take more initiative, but may be too forceful, leading to guilt feelings.</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 57 WIDTH="167"><div> <B><U>Latency</U></B></div> </tD> <tD VALIGN=TOP><NOBR><div> 6 to 12 years</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="113"><div> Industry vs. Inferiority</div> </tD> <tD VALIGN=TOP WIDTH="162"><div> School</div> </tD> <tD VALIGN=CENTER WIDTH="354"><div> The child must deal with demands to learn new skills or risk a sense of inferiority, failure and incompetence.</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 38 WIDTH="167"><div> <B><U>Adolescence</U></B></div> </tD> <tD VALIGN=TOP><NOBR><div> 12 to 18 years</div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> Identity vs. </div> <div> Role Confusion</div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> Peer relationships</div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="354"><div> The teenager must achieve a sense of identity in occupation, sex roles, politics, and religion.</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 38 ><NOBR><div> <B><U>Young Adulthood</U></B></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> 19 to 40 years</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="113"><div> Intimacy vs.</div> <div> Isolation</div> </tD> <tD VALIGN=TOP><NOBR><div> Love relationships</div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="354"><div> The young adult must develop intimate relationships or suffer feelings of isolation.</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 38 ><NOBR><div> <B><U>Middle Adulthood</U></B></div> </NOBR></tD> <tD VALIGN=TOP><NOBR><div> 40 to 65 years </div> </NOBR></tD> <tD VALIGN=TOP WIDTH="113"><div> Generativity vs. Stagnation</div> </tD> <tD VALIGN=TOP WIDTH="162"><div> Parenting</div> </tD> <tD VALIGN=CENTER WIDTH="354"><div> Each adult must find some way to satisfy and support the next generation.</div> </tD> </tR> <tR> <tD VALIGN=TOP HEIGHT= 57 WIDTH="167"><div> <B><U>Maturity</U></B></div> </tD> <tD VALIGN=TOP><NOBR><div> 65 to death</div> </NOBR></tD> <tD VALIGN=TOP WIDTH="113"><div> Ego Integrity vs. Despair</div> </tD> <tD VALIGN=TOP WIDTH="162"><div> Reflection on and acceptance of one's life</div> </tD> <tD VALIGN=CENTER WIDTH="354"><div> The culmination is a sense of oneself as one is and of feeling fulfilled.</div> </tD> </tR> </TABLE></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="511" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="280"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="280" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="216"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="216" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> Oral-Sensory</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="471" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 56 WIDTH="461"><div> Age: Infancy -- Birth to 1 year</div> <div> Conflict: Trust vs. Mistrust</div> <div> Important Event: Feeding</div> </tD> </tR> </TABLE></div> <div> Description:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The important event in this stage is feeding. According to Erikson, the infant will develop a sense of trust only if the parent or caregiver is responsive and consistent with the basic needs being meet. The need for care and food must be met with comforting regularity. The infant must first form a trusting relationship with the parent or caregiver, otherwise a sense of mistrust will develop.</div> <div> Elements for a positive outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The infant's need for care, familiarity, comfort and nourishment are met. Parental consistency and responsiveness is essential for the sense of trust to develop.</div> <div> Elements for a negative outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Babies who are not securely attached to their mothers are less cooperative and more aggressive in their interactions with their mothers. As they grow older, they become less competent and sympathetic with peers. They also explore their environment with less enthusiasm and persistence.</div> <div> Examples:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Babies will begin to understand that objects and people exist even when they cannot see them. This is where trust becomes important. </div> <bR> <DIV ALIGN="LEFT"></DIV> <div> Muscular-Anal</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="531" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 56 WIDTH="521"><div> Age: Toddler period -- 1 to 2 years</div> <div> Conflict: Autonomy vs. Doubt</div> <div> Important Event: Toilet Training</div> </tD> </tR> </TABLE></div> <div> Description:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">According to Erikson, self control and self confidence begin to develop at this stage. Children can do more on their own. Toilet training is the most important event at this stage. They also begin to feed and dress themselves. This is how the toddler strives for autonomy. It is essential for parents not to be overprotective at this stage. A parent's level of protectiveness will influence the child's ability to achieve autonomy. If a parent is not reinforcing, the child will feel shameful and will learn to doubt his or her abilities. "Erikson believes that children who experience too much doubt at this stage will lack confidence in their powers later in life""<FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>(Woolfolk, 1987). </U></FONT></div> <div> Elements for a positive outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The child must take more responsibility for his or her own feeding, toileting, and dressing. Parents must be reassuring yet avoid overprotection. </div> <div> Elements for a negative outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">If parents do not maintain a reassuring, confident attitude and do not reinforce the child's efforts to master basic motor and cognitive skills, children may begin to feel shame; they may learn to doubt their abilities to manage the world on their own terms. Children who experience too much doubt at this stage will lack confidence in their own powers throughout life. </div> <div> Examples:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In this stage children begin to assume important responsibilities for self-care like feeding, toileting, and dressing. </div> <bR> <DIV ALIGN="LEFT"></DIV> <div> Locomotor</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="546" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 56 WIDTH="536"><div> Age: Early Childhood -- 2 to 6 years</div> <div> Conflict: Initiative vs. Guilt</div> <div> Important Event: Independence </div> </tD> </tR> </TABLE></div> <div> Description:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The most important event at this stage is independence. The child continues to be assertive and to take the initiative. Playing and hero worshipping are an important form of initiative for children. Children in this stage are eager for responsibility. It is essential for adults to confirm that the child's initiative is accepted no matter how small it may be. If the child is not given a chance to be responsible and do things on their own, a sense of guilt may develop. The child will come to believe that what they want to do is always wrong. </div> <div> Elements for a positive outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In order for a positive outcome in this stage, the child must learn to accept without guilt, that there are certain things not allowed. Children must be guilt free when using imagination. They must be reassured that it is okay to play certain adult roles. </div> <div> Elements for a negative outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">If children are not allowed to do things on their own, a sense of guilt may develop and they may come to believe that what they want to do is always wrong. </div> <div> Examples:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">A four year old passing tools to a parent who is fixing a bicycle. Children at this stage will worship heroes. Pretend games are also common.</div> <bR> <DIV ALIGN="LEFT"></DIV> <div> : Latency</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="632" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 56 WIDTH="622"><div> Age: Elementary and Middle School Years -- 6 to 12 years </div> <div> Conflict: Industry vs. Inferiority </div> <div> Important Event: School </div> </tD> </tR> </TABLE></div> <div> Description:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">"In this stage children are learning to see the relationship between perseverance and the pleasure of a job completed" ~ANDERSMD/ERIK/refers.HTML" \l "Woolfolk,"<FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>(Woolfolk, 1987). </U></FONT>The important event at this stage is attendance at school. As a student, the children have a need to be productive and do work on their own. They are both physically and mentally ready for it. Interaction with peers at school also plays an imperative role of child development in this stage. The child for the first time has a wide variety of events to deal with, including academics, group activities, and friends. Difficulty with any of these leads to a sense of inferiority. </div> <div> Elements for a positive outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">It is essential for the child at this stage to discover pleasure in being productive and the need to succeed. The child's relationship with peers in school and the neighborhood become increasingly important. </div> <div> Elements for a negative outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Difficulty with the child's ability to move between the world at home and the world of peers can lead to feeling of inferiority. </div> <div> Examples:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In this stage children want to do productive work on their own. Students are able to water class plants, collect and distribute materials for teacher, and keep records of forms for teacher</div> <bR> <bR> <DIV ALIGN="LEFT"></DIV> <div> Adolescence</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="561" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 56 WIDTH="551"><div> Age: Adolescence --12 to 18 years</div> <div> Conflict: Identity vs. Role Confusion</div> <div> Important Event: Peer relationships</div> </tD> </tR> </TABLE></div> <div> Description:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">At this stage, adolescents are in search of an identity that will lead them to adulthood. Adolescents make a strong effort to answer the question "Who am I?" Erikson notes the healthy resolution of earlier conflicts can now serve as a foundation for the search for an identity. If the child overcomes earlier conflicts they are prepared to search for identity. Did they develop the basic sense of trust? Do they have a strong sense of industry to believe in themselves? </div> <div> Elements for a positive outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The adolescent must make a conscious search for identity. This is built on the outcome and resolution to conflict in earlier stages. </div> <div> Elements for a negative outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">If the adolescent can not make deliberate decisions and choices, especially about vocation, sexual orientation, and life in general, role confusion becomes a threat. </div> <div> Examples:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Adolescents attempt to establish their own identities and see themselves as separate from their parents. </div> <bR> <DIV ALIGN="LEFT"></DIV> <div> Young Adulthood </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="575" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 56 WIDTH="565"><div> Age: Young Adulthood -- 19 to 40 years</div> <div> Conflict: Intimacy vs. Isolation</div> <div> Important Event: Love relationships</div> </tD> </tR> </TABLE></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Description:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In this stage, the most important events are love relationships. Intimacy refers to one's ability to relate to another human being on a deep, personal level. An individual who has not developed a sense of identity usually will fear a committed relationship and may retreat into isolation. It is important to mention that having a sexual relationship does not indicate intimacy. People can be sexually intimate without being committed and open with another. True intimacy requires personal commitment. However, mutual satisfaction will increase the closeness of people in a true intimate relationship. </div> <div> Elements for a positive outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The young adult must develop intimate relationships with others. Not resolving this conflict leaves the young adult feeling isolated. The young adult must be willing to be open and committed to another individual. </div> <div> Elements for a negative outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">An individual may retreat into isolation if a sense of identity is not developed and will fear a committed relationship. </div> <div> Examples:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Giving and sharing with an individual without asking what will be received in return. </div> <bR> <DIV ALIGN="LEFT"></DIV> <div> Middle Adulthood </div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="605" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 56 WIDTH="595"><div> Age: Middle adulthood -- 40 to 65 years </div> <div> Conflict: Generativity vs. Stagnation</div> <div> Important Event: Parenting</div> </tD> </tR> </TABLE></div> <div> Description:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In this stage generativity refers to the adult's ability to care for another person. The most important event in this stage is parenting. Does the adult have the ability to care and guide the next generation? Generativity has a broader meaning then just having children. Each adult must have some way to satisfy and support the next generation. According to Erikson, "A person does best at this time to put aside thoughts of death and balance its certainty with the only happiness that is lasting: to increase, by whatever is yours to give, the good will and higher order in your sector of the world" "<FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>(Erikson, 1974).</U></FONT></div> <div> Elements for a positive outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">To have and nurture children and/or become involved with future generations.</div> <div> Elements for a negative outcome:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">An individual must deal with issues they are concerned with or it can lead to stagnation in later life. </div> <div> Examples:</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">In this stage an adult will be concerned with issues such as: the future of the environment, what kind of world will we leave the next generation, equality for all people, etc.</div> <bR> <DIV ALIGN="LEFT"></DIV> <div> Maturity</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="605" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 75 WIDTH="595"><div> Age: Late Adulthood -- 65 years to death</div> <div> Conflict: Integrity vs. Despair</div> <div> Important Event: Reflection on </div> <div> and acceptance of one's life</div> </tD> </tR> </TABLE></div> <div> Description:</div> <div> The most important event at this stage is coming to accept one's whole life and reflecting on that life in a positive manner. According to Erikson, achieving a sense of integrity means fully accepting oneself and coming to terms with the death. Accepting responsibility for your life and being able to undo the past and achieve satisfaction with self is essential. The inability to do this results in a feeling of despair. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Elements for a positive outcome:</div> <div> The adult feels a sense of fulfillment about life and accepts death as an unavoidable reality. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Elements for a negative outcome:</div> <div> Individuals who are unable to obtain a feeling of fulfillment and completeness will despair and fear death. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Examples:</div> <div> An aged person may find it necessary to reflect and analyze what they have accumulated throughout life and decide what offspring will receive from them upon death. </div> <div> <B><U>=====================================================================================================================</U></B></div> <DIV ALIGN="LEFT"></DIV> <div> Piaget's Stages of Cognitive Development</div> <div> <TABLE BORDER="2" CELLPADDING="1" CELLSPACING="1" WIDTH="638" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 39 ><NOBR><div> <B>Approximate</B></div> <div> <B>Age </B></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="135"><div> <B>Stage</B></div> </tD> <tD VALIGN=CENTER WIDTH="375"><div> <B>Major Developments</B></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 56 WIDTH="108"><div> Birth to 2</div> <div> years</div> </tD> <tD VALIGN=CENTER WIDTH="135"><div> Sensorimotor</div> </tD> <tD VALIGN=CENTER><NOBR><div> Infants use sensory and motor capabilities</div> <div> to explore and gain understanding of</div> <div> their environments. </div> </NOBR></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 56 WIDTH="108"><div> 2 to 7</div> <div> years</div> </tD> <tD VALIGN=CENTER><NOBR><div> Preoperational </div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="375"><div> Children begin to use symbols.</div> <div> They respond to objects and events</div> <div> according to how they appear to be. </div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 38 WIDTH="108"><div> 7 to 11</div> <div> years</div> </tD> <tD VALIGN=CENTER WIDTH="135"><div> Concrete</div> <div> operations</div> </tD> <tD VALIGN=CENTER WIDTH="375"><div> Children begin to think logically. </div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 38 ><NOBR><div> 11 years and</div> <div> beyond</div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="135"><div> Formal</div> <div> operations</div> </tD> <tD VALIGN=CENTER WIDTH="375"><div> They begin to think about thinking.</div> <div> Thought is systematic and abstract.</div> </tD> </tR> </TABLE></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">A child will develop through each of these stages until he or she can reason logically. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The learner is advanced through three mechanisms. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Assimilation - fitting a new experience into an existing mental structure (schema) </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Accommodation - revising an existing schema because of a new experience </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Equilibrium - seeking cognitive stability through assimilation and accommodation </div> <bR> <bR> <div> ====================================================================================================================</div> <bR> <div> The <FONT SIZE="3" COLOR="#800000" FACE="Arial" >Moro</FONT> <FONT SIZE="3" COLOR="#800000" FACE="Arial" >reflex</FONT> may be abnormally present in <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Tay-Sachs disease</U></FONT>.</div> <bR> <bR> <bR> </td> </tr></table></body>