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Speech assessment Once the child has developed the ability to talk, spontaneous speech should be observed. Infants initially coo, then babble, and then say single words, some of which may be intelligible. If there are other abnormalities of articulation and no structural explanation. Dysarthia, or slurring of speech, generally is due to cerebellar or extrapyramidal disorders. Cerebellar speech is typically a telegraphic or scanning type of speech, whereas extrapyramidal disorders produce a monotonous slow speech with poor breath control. The assessment of function of the newborn infant or young child occurs within the context of the expected age-appropriate motor abilities. By age six years, the motor performance of normal children should include most of the repertoire of a mature nervous system, but not necessarily the skill and facility. Posture the clinician should inspect posture with infants in a supine and sitting position and with older children also in the standing position. The normal posture of the preterm infant is one of extension, whereas that of a full-term infant is one of flexion of the extremities. In younger children who are beginning to sit, there is some slumping forward, which improves with maturation. In older children there is the tendency for a lordotic posture during standing, which also improves with maturity. There should be no asymmetry, and the sitting and standing posture should be erect. When older children are asked to hold the arms horizontally outstretched in front of the body with the hands supinated, they should hold the arms steadily and symmetrically. Pronation and downward drifting of one of the limbs indicate motor impairment on that side (pronator drift). In the newborn the "frog-leg" posture in which the legs are externally rotated and abducted at the hips with flexion at the knees is frequently seen in profound weakness such as with anterior horn cell disease. Slumping of the child in a sitting position can indicate motor dysfunction at several areas of the nervous system. Head posturing can be associated with a variety of local or neuropathological processes, or both. Excessive lumbar lordosis may indicate weakness 14 of the muscles of the girdle or spine. The decerebrate posture with opisthotonus and extensor posturing of the limbs and the decorticate posture in which there is flexion of the upper limbs are fairly well known.

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Because the arms are motions of the butterfy create the feeling of the moving together, the catch starts wider than in the whole body surging forward. The hands come closer together as the the hips so that the upper body and arms can do arm stroke progresses (Fig. For this reason, the full explanation of body motion is described during Evolution of thE buttErfly the simultaneous overarm recovery out of the water and frst form of the dolphin kick were developed at the University of Iowa during the 1930s. University of Iowa swimmer Jack Sieg swam 100 yards using these initial forms of what is now known as the butterfy in 1:00. However, the butterfy breaststroke, as it was called, was declared a violation of competitive rules. In the 1950s, the butterfy stroke with the dolphin kick was fnally legalized and has been a mainstay of competitive swimming ever since. To do that, the elbow and hand must move wider than the shoulder, with the hands making a circular path (Fig. The wide catch helps lift the body and prepare the upper body for the breath and the next stroke. The catch ends with the elbows to the side of the shoulders and slightly in front of the body. At this point, the hands are directly below the elbows with the fngers pointing down. The catch starts with the arms extended in In the mid-pull, continue pressing backward front of the shoulders (Fig. The hands move begin to bend so that the palms and forearms from the wide position at the end of the catch start facing the feet. The elbows must remain to a point at the waist that is just inside the high and fngertips pointing down and slightly width of the body (Fig. Achieve this 108 Swimming and Water Safety by facing the palms and forearms directly backward. The arms extend toward the feet throughout the mid-pull and the hands come closer to the body as a result. As in the front crawl, the arms accelerate throughout the arm stroke so that the arms are moving the fastest at the end of the stroke. Unlike the front crawl, there is no body roll to help and the arms do not bend as much. To make the recovery easier, accelerate hard through the finish of the stroke and then lower the head as the arms recover. Then swing the arms wide to the sides with little or no bend in the elbows, making sure to lead this motion with the hands (Fig. The hands enter the water with the thumbs facing down and the elbows remaining slightly fexed in front of or slightly outside of the shoulders. After the entry, extend the elbows to prepare for the next arm stroke and pitch the hands down and slightly outward for the catch.

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Tai Chi Tai chi is an ancient Chinese form of exercise that involves slow, gentle movements, each fowing into the next. Tai chi incorporates posure, mental focus and deep breathing as the body is in consant motion. Fitness centers, senior centers and community recreation centers might ofer tai chi classes. It is important to speak with the tai chi insructor to learn if the class will be benefcial for you. You can learn more about tai chi and other therapies discussed in this chapter from the National Center for Complementary and Alternative Medicine at the National Insitutes of Health: Pilates the Pilates method focuses on developing srong core muscles to help build srength and teach body awareness, good posure and graceful movement. Classes are often ofered at ftness centers, senior centers and community recreation centers. It is important to frs speak with the Pilates insructor to learn which exercises are bes for you. Dance/ movement therapiss work with individuals and groups in a variety of settings. Boxing Non-contact boxing, when performed safely and in the proper setting, can be a fun and benefcial type of exercise. Working with a trainer is a good way to continue with your exercise routine once you are no longer receiving physical or occupational therapy. Encourage your therapis to review and explain your program to your trainer to ensure a smooth transition. Studies show that music can reduce sress, improve breathing and voice quality and promote self-expression. However, the right combination of exercises and new ways of moving can improve balance, limit or prevent falls and put confdence back into your sride. They can walk and talk and carry bags, purses and plates of food without difculty. Turning becomes challenging, often leading to a freezing episode and sometimes a fall.

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The clinician can also assess tone in most limbs by observing the motion of the unsupported part of the limb when it is shaken in a flapping motion. The posture of the newborn preterm (age 28-30 week gestation) is one of extension and as the gestational age of the newborn increases to full term (40 weeks gestation) there is a progressively increasing flexion posture. The limb tone is decreased in the preterm progressing to increased flexion tone in the full term newborn. Tone in the newborn is also assessed by range of movement tests such as the scarf maneuver in which the extent to which the arm can be gently pulled across the chest to the opposite side is determined. The degree of extension of the leg (popliteal angle) dorsiflexion of the foot and other maneuvers are also used to assess tone (and gestational age) in newborn infants. Muscle tone in the newborn can also be judged by assessing the degree and speed of limb recoil from an extended position after it is released. Shaking of the arm or leg by the clinician while he or she observes the amplitude of movement of the more distal hand or foot (flappability) is particularly useful in the newborn and young infant. The flexed tone and posture of the newborn gradually decreases until normal mature tone is seen by about the age of 6 months. In addition to 15 appendicular tone, the clinician can assess axial tone in the infant by supporting the trunk in ventral suspension and observing the position of the infant draped over the suspending hand. The examiner also observes the head and trunk posture and movement when the infant is held in an upright sitting position. These maneuvers and the traction response assess active tone (power) as well as passive tone. The clinician elicits the traction response by grasping the hands and pulling the supine infant to a sitting position while observing normal head support (or head lag) and normal reflex contraction of the biceps. In the very hypotonic (or weak) infant, care must be taken to avoid injury by excessive movement of limbs or head during these tests. It should also be remembered that tone can be markedly influenced by drugs, stress, excitement or systemic illness. Hypertonia is abnormally increased tone which usually is a sign of central nervous system abnormality. In children this condition is frequently spastic hypertonia, and this is characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone). If the limb is passively moved slowly the resistance is less, but if it is moved more rapidly there is correspondingly increased resistance (tone) until a sudden lessening occurs (clasp-knife response). Spasticity is due to an upper motor neuron abnormality, but it does not equate precisely with cortical spinal tract disturbance, as is often assumed. Rigidity is muscle hypertonia and stiffness appreciated as a persistent resistance to passive movement throughout the range of movement.