Provides all systems with oxygen and nutrients

Removes byproducts of metabolism

Must be able to adapt to stresses (ie. exercise)

Size of your fist

Between ribs 2-5

Midsternum and slightly left

Tilted with the apex is anterior and to the left; base is posterior and to the right.

Syncitium - multinucleated, interconnected ball of cells. When one fiber is stimulated, every other cell will depolarize instantly.

Similar to skeletal muscle's Sliding Filament Theory, but not exactly.

How does the heart beat?

(5 terms with definitions)

Automaticity - ability to initiate its own electrical impulse

Excitability - ability to respond to electrical stimulus

Conductivity - ability to transmit electrical impulse from cell to cell within the heart

Contractibility - ability to stretch as a single unit and recoil

Rhythmicity - ability to repeat the cycle in syncrony with regularity

Right Pulmonary Pump

Left Systemic Pump

Left and Right Atria - thin walled, sac-like structures; conduits; receive and store blood; latin for "corridor"; 70% of blood just passes through, 30% pushed through via "atrial kick".

Left and Right Ventricles - thick walled, muscular; left is thicker than right due to the "systemic pumping" system.

Pericardium

Epicardium

Myocardium

Endocardium

tough, protective layer

attaches to sternum and diaphragm

secretes serous fluid so heart may move within sac without friction

3 layers: fibrous, parietal, visceral (epicardium)

pericardial cavity/space - potential space

simple squamous cells

lines inner surface of heart, valves, chordae tendinae, papillary muscles

Right Atria

Tricuspid Valve

Right Ventricle

Semi-Lunar Valve

Pulmonary Arteries

Lungs

Pulmonary Veins

Left Atria

Bicuspid (Mitral) Valve

Left Ventricle

Aortic Valve

Aorta

Tunica Externa (Adventitia)

External Elastic Lamina

Tunica Media

Internal Elastic Lamina

Tunica Intima

Lumen

aka Tunica Adventitia

collagenous connective tissue coat with longitudinal organization that provides support structure

high pressure tubes whose walls are lined with smooth muscle.

even at rest there is resting muscle tone; otherwise BP would be so low we would faint.

located in arteries and arterioles

NO GAS EXCHANGE HERE

conducts and directs blood flow;

stores and stretches blood so phasic flow from the heart is continuous and smooth in body and brain

Deoxy blood from Right Ventricle to Lungs

exchange vessels

walls are one-layer of cells thick

allows nutrient, waste, and gas exchange

.008 mm is the furthest distance of any cell from a capillary

constricts and dilates to control blood flow into capillaries

smooth muscle

*Our capillaries are usually closed off until we need them

capacitance vessels = storage

returns deoxy blood to heart

one-way valves

external compression (muscle contraction) pushes blood through

Vena Cavae and Pulmonary vein included

Aortic -  Left Ventricle to Aorta

Tricuspid - right atria to right ventricle

Bicuspid (Mitral) - left atria to left ventricle

Pulmonary Semi-Lunar - right ventricle to pulmonary artery

Blood at Rest

Blood after Eating

~50% in the gut, 20% in muscles, 14% in brain, 6% in skin, 4% in heart

~70% in the gut = cardiac patients should NOT exercise after eating!!!

They supply blood to the heart itself

originate at the coronary sinus behind the cusps of aortic valve where Aorta meets Left Ventricle

Courses are highly variable!

Overlap of blood supply

Most of blood is supplied during diastole (relaxation)

supplies whole right side of the heart, inferior wall of left ventricle, and SA node (and AV node in 50% of the population)

Major Branch = Right Marginal Branch

supplies left side of heart

~Left Ant. Desc. - branch off LMA; supplies anterior wall of left ventricle (and AV node in 50% of population)

~Left Circumflex Branch - branch off LMA; supplies lateral and posterior wall of left ventricle and atrium

*Left Diagonal Branch - 1st branch

*Left Obtuse Marginal Branch - major branch

Specialized electrical tissue that is capable of initiating and conducting electrical impulses

Natural pacemaker - 60-90 bpm WITH parasympathetic control (without = 100 bpm)

Located on posterior aspect of the right atria where superior vena cava enters

right atrium depolarized directly

impulse taken by internodal pathways to left atrium

internodal pathways also take impulse to AV node

2nd highest order of rhythmicity

Set at 40-60 bpm

Located on right side of the heart, in atrioventricular septum, posteriorly

Point of Delay = allows the left side to catch up with right side, so both ventricles contract simultaneously

1. Bundle of His - AV node to septum to ventricles; splits in Bundle Branches

2. Bundle Branches - R: direct continuation of Bundle of Hise; L: perpendicular to Bundle of His, courses down the left side of IV septum, common site of impulse blockage

3. Purkinje Fibers - complex network of conducting fibers, pierce and supply entire myocardium, fastest conducting tissues in the body (rapid depol of ventricles), able to initiate impulses at 15-40 bpm

"fight or flight"

via thoracolumbar sympathetic system

increases HR

increases contractility

generalized peripheral vasoconstriction (mainly arterioles)

"rest and digest"

via Vagus Nerve

decreases HR

decreases contractility

blood is directed to digestive viscera

Norepinepherine - constricts arterioles

Epinepherine - coronary artery vasodilation

catecholamine - "stress hormone", increases HR

Systole

Diastole

contraction; ejection

relaxation; filling

atria contract and empty

70% ejects due to pressure changes

30% ejects due to atrial contraction "atrial kick"

ventricular contraction

initially isovolumetric (builds pressure but no change in volume and no ejection of blood), this generates pressure necessary to serve as the catalyst for rapid ejection of ventricular blood

ventricular relaxation and filling

left ventricular end diastolic volume (LVEDV or EDV) = the volume of blood left in the left ventricle after its been pumped out (always some left to maintain shape and structure)

The amount of blood pumped by the heart in one minute

CO = HR x SV

changes are chronotropic (changes in HR) or inotropic (changes in SV)

Changes must occur to keep perfusion good

Preload

Afterload

amount of tension on ventricle wall before it contracts; related to return volume; affects SV by increasing left ventricular end diastolic volume.

resistance to ejection during ventricular systole; affected by aortic valve opening and PVD

relationship between length and tension of myocardium; the greater the stretch the stronger the contraction

unlike skeletal muscle, the whole heart is involved (not individual muscle fibers); length = volume;

the greater the volume returned to the ventricle during diastole yields a greater ejection volume.

Percentage of ventricular volume ejected with each heartbeat; a measure of function of the pump (only an estimate).

Can recover after MI.

Normal = 60-70%

Mild Dysfunction = 40-60%

Moderate Dysfunction = 30-40%

Severe Dysfunction = <30%

average pressure in the entire system during a single cardiac cycle.

MAP = CO x TPR (total peripheral resistance)

resistance that must be overcome to allow flow to periphery.

normal = 93.3 mmHg

needed = >60 mmHg to perfuse all organs

activated through a group of mechanoreceptors sensitive to changes in pressure

increased pressure activates mechanoreceptors and results in the inhibition of the vasomotor center of the medulla that increases vagal stimulation = vasodilation, decreases HR, decreases contractility

activated through a group of mechanoreceptors sensitive to stretch

increases in volume in the right atrium = increases pressure on atrial wall; this activates the vasomotor center of medulla = increases HR and contractility

located on the carotid and aortic bodies

have primary effect on the increased rate and depth of ventiliation in response to CO2 levels

changes in CO2 may result in sinus arrhythmia

I. disease present, but no limits nor symptoms

II. slight limitations and symptoms

III. marked limitations

IV. symptoms at rest

1. Vascular

2. Muscular (pump) and Pericardial

3. Electrical (Rhythm and Conduction)

4. Valvular

5. Congential

6. Traumatic

aka Coronary Artery Disease/Atherosclerotic Heart Disease

progressive disease characterized by irregularly distributed lipid deposits in the intimal layer of medium and large coronary arteries.

#1 killer of Americans

Framington Heart Study - whole town observed, not treated; found those with risk factors had more CVD

Non-Modifable 

Risk Factors of Vascular CVD

a. gender (males>females, but post-MI mortality females >males); estrogen has positive effect, pear body types are good.

b. family history + = MI, sudden death of primary male relative <55, female <65; no specific gene isolated

c. age

a. Smoking (4x more likely, even light smokers are 3x ischemic deaths as non-smokers); PPD x years = Pack year history (PYH); quitting immediately reduces risks; promotes thrombus formation; contains carbon monoxide (increased cardiac workload, decrease O2 available) and nicotine (increases catecholamines, HR, BP, and vasocostriction, platelet aggregation)

b. Hypertension - normal <120/80; borderline 120/80; high 140/90; preventable and treatable; damages arteries, roughens intima.

c. obesity - increased LDLs

d. increased waist-to-hip ratio - navel/widest point around hips/butt; normal = 0.7 females, 0.9 males (80% of Am. women are >0.9)

e. hypercholesteremia - some is good to convert sunlight into vitamin D; problem later in life; transports lipid molecules; HDL carry lipids away from cells to liver; LDL delivers lipids to cells and deposits in arterial endothelium; desired cholesterol <200 mg/dl; borderline = 200-239; high >240 mg/dl; LDL <130, HDL>40-50

f. elevated triglycerides - glycerol + 3 fatty acids; increased by eating fat and carb's; desired <150, borderline = 150-199, high = 200-499, very high <500; precedes diabetes

g. diabetes mellitus - type I: pancreas doesn't produce insulin; type II: insulin resistance due to receptor deficits; insulin production good; 90% is II; associated with obesity;  decreased HDL, increased platelet adhesion

h. sedentary lifestyle - exercise increases HDL, and decreases BP, resting HR, catecholamines

i. Psychosocial - Type A/Stress (increases catecholamine)

j. Caffeine - not risk factor, but can cause dysrythmias

k. ETOH - not risk factor, but causes cardiomyopathies

1. Injury to tunica intima making it permeable to circulating lipoproteins; atheromas form.

2. lipoproteins invade smooth muscle cells, forming a fatty streak (made of foam cells); lipids composed of LDL, triglcerides, and phospholipids.

3. fibrous plaque forms impeding blood flow.

4. complicated lesion appears, marked by calcification or rupture of the plaque

5. flapping, thrombus can occur in the lumen. symptoms appear at 70% occlusion

inflammatory response triggers proliferation of endothelial cells and smooth muscle cells, and increased platelet adhesion and aggregation.

spasms of arterial wall smooth muscle can temporarily cause ischemia.

length of tube

fluid viscosity

diameter

- cutting diameter in half decreases flow by 16x

reverses CVD via lifestyle modifications

1 hershey kiss = 25 calories

3500 calories in a pound of fat

disorder of one or more of the four valves.

Categories = stenosis (narrowing), regurgitation (backflow). prolapse (floppy)

Congenital Problems (CVD)

General Thorax Information

~mobility

~function

~ribs

~sternal angle

~relatively good mobility

~support structure for maintaining and varying the volume of thoracic cavity and lung volume

~True ribs 1-7, false ribs 8-12; ribs slow downward and forward

~between manubrium and sternum, at the level of rib 2 anteriorly, T4 posteriorly, and tracheal bifurcation.

lower ribs elevate laterally and superiorly (bucket handle)

upper ribs elevate anteriorly and superiorly (pump handle)

"potential space" between visceral and parietal pleura ( actually stuck together)

maintain negative pressure here is vital for lung expansion

neumothorax = air in pleural cavity, lung collapses

diaphragm

external intercostals

accessory - SCM, scalenes, pec major/minor, trapezius, serratus posterior and anterior

other - upper airway musculature

innervated C3-C5 via phrenic nerves

crural fibers draw central tendon downward, costal fibers work to elevate the ribs superolaterally

altered L-T relationship = reduced force of contraction and susceptibility to fatigue

ie, spinal cord injury

no superolateral contraction therefore an abdominal binder is needed to mimic abdominal cavity support

L-T relationship effected by hyperinflation of the lungs, postures, and spinal deformities.

Positioning of neck and upper extremities can either facilitate or inhibit ventilation

"others" can be compromised in those with neurologic dysfunction or sleep apnea

1. diaphragm

2. lower chest expansion (bucket)

3. upper chest expansion (pump)

abdominals

internal intercostals

~should be passive

3 lobes on the right, 2 on left (lingular on left upper lobe)

airways have progressive reduction in size, cartilaginous support, muscular support.

trachea > bronchi > bronchioles > resp. bronchioles > alveoli

T2 posteriorly = upper/lower lobe division

Rib 10 posteriorly = bottom of the lungs posteriorly

Rib 8 on the mid-axillary line = bottom of lungs laterally

Ribs 4 & 6 anteriorly = lingula seperation

R and L main bronchi > seconday and tertiary bronchi > bronchioles > resp. bronchioles > acinus (multiple alveoli)

Alveoli = grape (1 cell layer)

Acinus = group of grapes

Parenchyma = grapeskin

Interstitum = stems on the bunch (network of connective tissue that anchors ancinus and supports other airways)

Voluntary Control of Breathing

Involuntary Control of Breathing

cerebral hemispheres, motor and pre-motor cortex

brain stem, pneumotaxic center (pons, dorsal/ventral resp. neuron groups in medulla)

~dorsal = inspiration

~ventral = expirtation

central chemoreceptors - sensitive to pH changes caused by changes in pCO2 that stimulate increased rate and depth of respiration --> CO2 can't cross BBB well, so no rapid pH change, thus not primary stimulus for changing breathing.

peripheral chemoreceptors - (carotid bodies) sensitive mostly to pCO2, but also pH and pO2.

mechanoreceptors - from muscles to either stimulate or inhibit inspiration

refers to distensibility/resistance to inflation.

can be influenced by age, autoimmune disorders, musculoskeletal disorders, hyperinflation and loss of elasticity due to COPD

Also effected by surface tension (resists expansion), surfactant is produced to decrease surface tension

Elasticity and Compliance in:

COPD

Pulmonary Fibrosis

increased compliance, decreased elasticity

decreased compliance and elasticity

aka airflow

movement of air in and out of the lungs

goal - increase alveolar pO2 and decrease pCO2

distal airway resistance is smaller than larger airways (due to greater overall volume distally)

interstitum allows for transmission of tensile force during inspiration = airway diameter changes with each breath

aka blood flow

pulmonary arterioles vasoconstriction in response to decreased pO2 (<65-70 mmHg) and does NOT have neural regulation (opp. of peripheral vasculature).

low pressure system with a low hydrostatic pressure

1. right ventricular function - fails due to increased pressure

2. patency/compliance of pulmonary arteries and veins

3. left ventricular functions - backs up into pulmonary system

ventilation is maximized in the dept. portion of the lung and allow a greater change in volume relative to resting volume.

perfusion is maximized in the dept. portion of the lung due to the effect of gravity.

it is the matching of greatest change in alveolar volume and greatest perfusion that optimizes gas exchange.

it is optimized by sending oxygenated blood where it's needed in position dept. positions

shunt - more perfusion relative to ventilation; increased blood to alveolus that is not exchanging air

dead space - more ventilation relative to perfusion; ex: blood clot blocking alveoli perfusion.

occurs at resp. membrane (2 layers total - 1 alveolar 1 capillary)

site of gas exchange for O2 and CO2

effected by: changes to resp. membrane (scarring, edema)

changes to V/Q mathcing (dead space, shunt)

surface area changes (decreased in COPD)

when O2 is needed by the tissues, Hgb releases it more easily ("right shift"), caused by decreased pH, elevated DPG, and increased temp or CO2 levels.

total oxyge content of blood = Hgb saturation + Hgb concentration + dissolved O2 in plasma

CO2 is dissolved readily in plasma, not so much for O2

H2O + CO2 --> H2CO3 --> H+ + HCO3

More acidic blood = more H+, increased CO2; if lungs cannot expell CO2 resp. acidosis ensues; hypoventilation accum. CO2 and H+

Chronic CO2 retention/acidosis, kidneys retain bicarb. to normalize pH; this eliminates sensitivity if central chemoreceptors drive to ventilate

Normal Tidal Volumes

Normal Dead Space

300-800 mL

120-170 mL

residual volume

expiratory reserve volume

tidal volume

inspiratory reserve volume

vital capacity

inspiratory capacity

functional residual capacity

total lung capacity

cannot be expired

volume you can exhale after normal breathe in

normal breathe volume (norm=500mL)

volume you take in after tidal volume

absolute volume you can move (norm=3.7-4L;IRV+TV+ERV)

IRV + TV

volume in lungs after passive expiration (ERV+RV)

IRV + TV + ERV + RV

____ is a byproduct of oxidative/aerobic metabolism.

____ + O2 -->____ + H2O

CO2

CHO

CO2

When workload increases, energy production shifts toward ________ metabolism.

This requires ______ ventilation to _____ _____ _____ to buffer the excess ______ production.

Thus, the onset of __________ metabolism has a significant ventilatory requirement.

anaerobic

increased, clear more CO2, H+

anaerobic

Individuals with lung disease have a severely impaired _________ capacity from _________ and subsequent ________________.

The onset of ______ metabolism occurs earlier and at ________ workloads, and they are _____ to meet ventilitory demand.

aerobic, inactivity, deconditioning

anaerobic, lower, unable

COPD

char. by limited airflow, particularly with expiration.

airflow limitation is not fully reversible

chronic, obstructive

sputum producing cough for 3 months a year over 2 consecutive years

char. by ciliary dysfunc., hypertrophy and increased density of secretory cells, resp. bronchiolar inflammation/narrowing, excessive mucous production

"Blue Bloater" = stocky, fatigued, obese, hypoxemic resulting in cyanosis

chronic, obstructive

char. by bronch./alveolar edema, decreased elasticity, airway enlargement/destruction, large bullae formation (trapped air)

two types- centrilobular, panlobular

"Pink Puffer" = thin with barrel chest (due to hyperinflation), good saturation, works hard to expire due to loss of elasticity

chronic hypoxemia results in:

1) polycythemia (excess RBC production, increases viscosity)

2) hypoxic pulmonary artery vasoconstriction leading to pulmonary arterial hypertension = right heart failure due to pulmonary disease (cor pulmonale)

Centrilobular Emphysema

Panlobular Emphysema

more proximal to the alveoli, more assoc. with smoking and chronic bronchitis. Smoking cessation slows the rate of loss of FEV1.

involves mostly the alveoli and is assoc. with alpha-1 anti-trypsin deficiency; alpha-1 inhibits protease which destroys distal airway tissue; accelerated in those who smoke; typically 20-30's; lung transplants!

reversible obstructive

char. by bronchiolar smooth muscle contraction, mucosal inflammation, overproduction of mucous, reversible when inflammatory response if treated/inhibited.

types- allergic/extrinsic, non-allergic (irritants like smoke), exercise-induced (dry cool air and mouth breathing)

untreated can lead to airway remodeling and irreversible limitations

status asthmaticus-fatal

obstructive

char. by sig. sputum production, colonization of bacteria/fungus, increased susceptibility of mucous plugging.

acute inflammatory injury char. by diffuse destruction of the conducting (cart.) bronchioles

assoc. with lung transplant rejection and infection in children/infants

may lead to bronchiectasis

obstructive

char. by edematous/ulcerated mucosa, dilation and fibrosis of bronchi and bronchioles, non-ciliated epilithium present, sputum prod., colonization of bacteria/fungus, increased susceptibility of infection

end result - impaired mucociliary transport, pooling of secretions, and risk of repeated infection

Assoc. with infection (pertussis, measles)

obstructive

char. by sig. sputum prod., colonization of bacteria/fungus, increased susceptibility to mucous plugging

autosomal recessive genetic disorder effecting exocrine glands due to chloride ion channel

creates abnormally viscous mucous, impaired mucociliary transport, infection...

lifespan is shortened (25 for females, 30 for males) with death usually due to respiratory failure

restrictive

inflammation/scarring in distal airway lung parenchyma and interstitum; capillary walls are fibrosed; reduced diffusion and hypoxemia

end-stage will have honeycomb appearance on CT

idiopathic-due to aberrant non-inflamm autoimmune, fibroproliferative response

secondary- occurs secondary to occupation/environment exposures, autoimmune disease, or ARDS; responds to corticosteroids

Occ. Exposure - miners, welders, asbestos

Autoimmune disease - RA, SLE, scleroderma

Acute Resp. Distress Sx - (ARDS) secondary to inflammation due to ventilator, pneumonia, etc.

SIRS - precursor to ARDS

Musculoskeletal - rib fx, kyphosis, ankylosing spondylitis

Neuromuscular - hemidiaphragm paralysis, MS, CVA, PD, SCI

mechanism of increased pressure includes both vasoconstriction and endothelial cellular proliferation

higher pulm. pressure and subsequent increased pulmonary vascular resistance create a deadspace whereby there is a relatively poor perfusion relative to ventilation, resulting in reduced gas exchange as well as left vent. filling, and reduced CO.

DVT's can be assymptomatic

PE can be symptomatic

risk factors of DVT - venous stasis, hypercoagulation, intimal injury

Symptoms of PE - dyspnea, anxiety, pleuritic chest pain, hemoptysis, signs of right heart failure

jugular venous distension

ascites (fluid in abdomen)

lower extremity edema

pleural effusion

air in the pleural cavity due to:

iatrogenic

spontaneous - primary (unknown cause), secondary (rupture of bullae)

traumatic - causes mediastenal shift, increases thoracic pressure, decreases venous return, decreases CO.

hemothorax-blood in pleural cavity

fluid (transudate/exudate) in the pleural space due to heart, liver, or renal failure, bacterial pneumonia, PE, malnutrition.

due to increased hydrostatic pressure of pleural capillaries or if pleara are involved in inflammatory process allows drainage of exudate into pleural space.

results from a failure of numerous mechanisms to prevent various viral, bacterial, or fungal organism from causing infections involving parenchyma

bacterial - cause exudate,edema, consolidation of airspace

viral-exudates, edema, increased risk of bacterial infection

risk factors - atelectasis (airway closure), smoking, age, aspiration

inhaled as a small, dry droplet which is airborne due to cough or sneeze

incubates 2-12 weeks, forms granuloma and encapsulated

skin test + @ 2-8 weeks, long-term course of isoniazid

80-90% are smoke related, with genetic predisposition

small cell cancers are from smoking, have high metastatic rate, inoperable due to location

Metastices are to brain, bone, liver, pancreas, adrenal gland, kidney.

Metastices from colon, rectum, breast, kidney, thyroid, skin, prostate, pancreas

periods of apnea during REM sleep caused by mech. upper airway obstruction due to loss of muscle tone.

risk factors - obesity, adenoid/tonsilar enlargement, hypertrophy of uvula, nasal obstruction

higher assoc. with COPD, CAD, CHF, HTN

impaired peripheral VO2 assoc. with decreased muscle mass, capillary density, ox. enzyme concentration, and type 1 muscle fibers.

results in early onset lactic acidosis at markedly low workloads

COPD only

reduced elastic recoil contributes to decreased ability to move air and alot of work required to expire

as residual volume increase, minute ventilation decreases

muscle length-tension altered

those with restrictive lung volumes, dynamic hyperinflation and/or neuromuscular weakness

inability to meet ventilatory demand and high ventilatory muscle demand may result in ventilatory muscle fatigue and increase in dyspnea

abilities to find meaning in confusion, solve new problems, recognize new patterns, visualize, quantitative reasoning

declines with age

rarely affected by brain injury

abilities to develop long term memory, vocabulary, language, reading comprehension

preserved with age

susceptible to brain injury

Prenatal: germinal, embryonic, fetal

Infancy: birth to 2 years

Childhood: 2 years to onset of puberty

Adolescence: 10 years for girls, 12 years for boys; prepubescence (2 years before puberty), pubescence (4 years of hormones), postpubescence (2 years until adulthood)

Adulthood: young, middle, young-old, middle-old, old-old

influenced by maturation and experience

unique to each individual

influenced by environment (65%) and heredity (35%)

growth

maturation

adaptation

learning

changes in physical dimensions; rapid during infancy and adolescence

produces physical changes that cause the organs and body systems to reach their adult form and function; influenced by environment

accomodation to the immediate environment; + example is antibodies to chicken pox; - example is delayed motor development of understimulated infants

relatively permanent change in behavior resulting from practice and may be considered an adaptation

assumption

implies that later development is dependent on what came before (Eriksons' theory that successful resolution of something is required to move on to the next)

assumption

can be thought of as quantitatively; postulates that there are qualitative changes that occur throughout development; at each new level of development a new skill can be observed

rapid progression to a skill followed by mastery of that skill followed by rapid progression to the next skill

hypthesizes that internal or external flucuations of nonequilibrium systems can pass a critical point and create order out of disorder through a process of self-organization

the child learns to adapt movements to the demans of the task and environment

ex, ability to fight gravity in order to walk

Thelen proposed that motor and perceptual dev. were related

1. Infancy - Trust vs Mistrust

2. Late Infancy - Autonomy vs Shame/Doubt

3. Childhood-preschool - Initiative vs Guilt

4. School age - Industry vs Interiority

5. Adolescence - Indentity vs Role Confusion

6. Early Adulthood - Intimacy vs Isolation

7. Middle Adulthood - Generativity vs Stagnation

8. Late Adulthood - Ego Integrity vs. Despair

explains observational learning

modeling is essential and a type of cognitive patterning

Maslow's Hierarchy of Needs (love --> self-esteem --> self-actualization

last stage can't be achieved without the one before

Bronfenbrenner

application of biological concept of studying organisms in their natural habitat

ex. family, community, culture all interact

linked to cognition

information processing and environmental affordance

B.F. Skinner, father of stimulus-response psychology

environment was the most influential factor in determining behavioral outcomes

no life-span view

believe all behavior is learned by observation and imitation and can be shaped by reinforcement

Gessell

correlate all movement acquisitions with the onset of changes in the nervous system (myelination) relative to the onset and integration of reflexes/reactions, hierarchy of control, and myelination.

Sensorimotor (Infancy)

Preoperational (Preschool)

Concrete Operational (School age)

Formal Operational (Pubescence)

Hayflick Limit Theory

Programmed cell death Theory

number of cell replications possible in life span was thought to be 50

apoptosis; telomere shortening decreases replication

if cross linking attaches 1 DNA = repairable

if cross linking attaches 2 DNA = inrepairable

with aging, 2 DNA linking is more common and over time impede cell function

collagen, elastin, DNA might be responsible for signs of aging (ie. tanning)

decrease in speed of processing operations leads to impairment in cognition

fluid and crystal intelligence

Disengagement Theory

Activity Theory

Continuity Theory

not normal; aging adults turn inwards as a means of withdrawal from family and society

engagement with people and environment leads to successful aging

most acceptable; utilizing life skills to tackle new challenges

MD:

Developmental Concepts

1. development is sequential

2. development is directional (cephalo-caudal, proximal-distal)

3. Mobility and stability contribute to postural control; mobility present before stability; positional stability uses joints and ligaments for stability more than muscles (ex. W-sitting); dynamic stability uses muscles (ex. quadruped).

4. Sensation --> reflex first, voluntary action later

MD:

Perceptual-Cognitive Theory

"sensory integration"--> perception and cognition

sensory integration problems - tactile defensiveness (hating being touched, even by clothes); gravitational insecurity (lacking the ability to interpret gravity)

Assimilation

Accommodation

individual's ability to organize; interpretation of external objects and event in terms of one's preferred way of thinking about them

ability to adapt; form of adaptation that involves noticing and taking into account the real properties and relationships of objects and events in environment

MD:

Fitt's Law

speed-accuracy trade-off

the faster the response, the less accurate

the greater the difficulty, the greater the movement time

child < adult > older adults

Thelen

movement emerges from interaction of multiple body systems; includes affordances provided by the nervous system.

Time frames: MD (month-years), MC (millisec), and ML (hour-days-weeks)

Maturation of Systems: MC improves as neural connections increase in number and mature, feedback loops refined, and neuronal group selection occurs. MD increases as the toddler learns (ML) more complex ways to ascend and descend stairs.

top-down

cortex->mid-brain->brain-stem-> spinal cord->DTR->prim.reflex

MC:

Open-Loop model

Closed-Loop model

Motor Program

Brooks model

without feedback; driven by central command or sensory information from periphery without benefit of feedback

with feedback; visual info. assiting in planning the completion of the movement or next movement

memory structure that provides instruction for control of action

Hierarcichal, motor programs, limbic system involvement, and closed loop feedback

MC:

Adams closed loop theory

Schmidt's Schema theory

feedback loops are essential and include intrinsic feedback from the body and extrinsic feedback called knowledge of results (criticized because no explanation of controlled fast movements)

an abstract memory that represents a rule, or generalization, about skilled actions or motor programs

MC:

Dynamic Systems Theory

and Assumptions

predominant model

1. neuronal group selection and plasticity

2. self-organizing systems play a role in activities

3. skill processes develop asynchronously, and non-linearly.

4. shifts from one behavioral mode to another are discontinuous.

MC:

hierarchichal

motor program

systems

chaining reflexes together creates complex motor behavior; brain cortex controller

movement patterns are hard-wired; Adam's closed loop; Schmidt's open loop

MC distributed throughout; solutions are unique to the task; motor pathways are soft-wired; maybe neuronal groups with motor plan

Degrees of Freedom: key task of CNS is to minimize energy expenditure by reducing DOF; DOF may increase after skill is mastered

Optimization: nervous system seeks increased efficiency in movement to accomplish goal within the task demands

Utilization of Sensory Info.: proactive control (anticipatory, feedforward) and reactive (after an unexpected stimulus)

MC and ML:

Neuronal Plasticity

Cognitive phase: discovery of what to do; finding best movement strategy

Associative Phase: mastery of how to do it; refinement and decreased variability

Autonomous Phase: generalization and adapting to new circumstances; decreased mental effort

conscious focus on movements to achieve goal; similar to Fitt's cognitive/associative phases

learning without focused awareness of the movement, similar to Fitt's assoc/auton. phases

1. Discrete - clear beginning/end; flip switch, sit-to-stand

2. Serial - have parts; getting dressed

3. Continuous - arbitrary begin/end; walk, swim

4. Closed task - environmental features remain constant, stationary

5. Open task - environment varies, people move, unpredictable

Levels:

1. Acquisition- initial performance while practicing task

2. Retention- performance following a time delay without practice

3. Transfer- performance of related, yet different tasks

Measurements:

1. Consistency- repeatability of performance; measures errors and successes

2. Flexibility- transferability; measures height/position

3. Efficiency- cardiovascular energy cost and degree of musculoskeletal coordination; meausres HR, BP, RR, time

structuring practice (amount/scheduling)

structuring the environment

performer reinforcement (feedback)

massed practice

distributed practice

shaping practice

random practice

blocked practice

practice>rest

rest>practice

practicing components with increasing complexity

task variation in sequence; better for adults

multiple trials of 1 task; better for children

whole practice

part practice

task specific practice

task is practiced as a whole, begin to end

components are practiced as parts to a whole

actually practicing the functional task or clearly related task

modeling

mental practice

therapist/peer shows the performer what to do

cognitive rehearsal and visualization of an action in absence of overt movement

intrinsic feedback

extrinsic feedback

concurrent feedback

how did it feel and look (proprioception, kinesthesia)

from the therapist/coach/teacher

info. given during task; may be helpful initially, but should be used selectively

knowledge of results (KR) - more frequent

knowledge of performance (KP)

intermittent feedback  --> less than 100% of the time

faded feedback --> freq. decreases over time

summary feedback - a summ. of "x" trials after "x" trials