Presentation on theme: "Main Milestones Of Child’s Psycho-motor Development Neurologic Assessment. Signs Of Deviations Of Psycho-motor Development."— Presentation transcript:
Main Milestones Of Child’s Psycho-motor Development Neurologic Assessment. Signs Of Deviations Of Psycho-motor Development.
The categories of adaptive behaviors: (1) gross motor,(1) gross motor, (2) fine motor,(2) fine motor, (3) language, and(3) language, and (4) personal-social behavior.(4) personal-social behavior.
General guidelines for neurological assesment of the newborn 1.General appearance: Posture – flexion of head and extremities, which rest on chest and abdomen. Frank breech is assesed as common variation – extended legs, abducted and fully rotated thighs, flattened occiput, extended neck
of a newborn General appearance of a newborn
General hypotonus (‘rag-doll’ baby)
2.Neuromuscular system: Extremities usually maintain some degree of flexion Extension of an extremity followed by previous position of flexion Head lag while sitting, but momentary ability to hold head erect Able to turn head from side to side when prone Able to hold head in horisontal line with back when held prone Movements – the envoluntary reflex responce Quivering or momentary tremors are assesed as minor abnormalities
Muscular hypotonus of the back muscles
The ‘heel-to-ear’ manoeuvre
Potential signs of distress/major abnormalities Hypotonia Hypertonia – jittery, arms and hands tightly flexed, legs stiffly extended Asymmetric posturing (except tonic neck reflex) Opisthotonic posturing – arched back Signs of paralysis Tremors,twiches, and myoclonic jerks Marked head lag in all positions
3.Assesment of reflexes: the unconditioned reflexes that persist throughout life (swallowing reflex, papillary reflex, sneeze reflex, blinking or corneal reflex, glabellar reflex, yawn reflex, cough reflex, gag reflex, and tendon reflexes) the transitional reflexes or reflexes of neonate and infancy, which disappear during infancy the righting reflexes that are absent in a newborn and appear during infancy
Reflexes of neonate and infancy: 1. The reflexes of oral automatism. –Sucking reflex, Doll’s eye reflex, rooting, extrusion, lip or trunk reflex, and Babkin’s reflex 2. The reflexes of spinal automatism. –Reflex of defence, grasp, Moro reflex, startle, placing, dance (stepping), crawling (Bauer’s) reflex, Kernig’s reflex, Babinski’s reflex, trunk incurvation (Galant) reflex, Perez reflex 3. Myelocephalic reflexes. –Asymmetric tonic neck reflex and Symmetric neck-righting reflex
Placing and Dance reflexes
Crawling (Bauer’s) reflex
Trunk incurvation (Galant) reflex
Asymmetric tonic neck reflex
Steps of neurological assesment in infants and elder children 1.Mental status 2.Motor functioning: gross motorgross motor fine motorfine motor test muscle strength, tone, and development test cerebellar functioning 3.Sensory functioning 4.Reflexes (deep tendon) 5.Cranial nerves
Tests for cerebellar function: Finger-to-nose test: with the child’s arm extended, have touch nose with the index finger Heel-to-shin test: with child standing, have run the heel of one foot down the shin of the other leg Romberg test: have child stand erect with feet together and eyes closed. Falling or leaning to one side is abnormal and is called the Romberg sign Have child touch tip of each finger with thumb in rapid successionHave child touch tip of each finger with thumb in rapid succession
Sensory functioning Test vision and hearing Sensory intactness: touch skin lightly with a pin and have child point to stimulated area while keeping eyes closed Sensory discrimination: –Touch skin with pin and cotton; have child describe it as sharp or dull –Touch skin with cold and warm object (such as metal and rubber heads of reflex hammer); have child differentiate between tenperatures –Using two pins, touch skin simultaneously with both or one pin; have child discriminate when one or two pins are used
Reflexes (deep tendon) Biceps, triceps, brachioradialis, knee jerk or patellar reflex, achilles, ankle clonus Tendon reflexes are assesed in grades from 0 to 4. Grade 2 (++) is normal. Grade 0 is absent. Kernig sign: flex cchild’s leg at hip and knee while supine; note pain or resistance Brudzinski sign: with the child supine, flex the head; note pain and involuntary flexion of hip and knees These special reflexes are elicited when meningeal irritation is suspected. Positive signs require immediate referral.These special reflexes are elicited when meningeal irritation is suspected. Positive signs require immediate referral.
Psycho-motor development of children Gross motor behavior includes developmental maturation in posture, head balance, sitting, creeping, standing, and walking.
Head and neck control in prone position at 6-8 weeks.
Upper Landau’s reflex
Sitting with support (at 5 mo) and without (8 mo)
At months: Sitting and standing
At 9-11 months: Crawling
At 16 months Postural control and co-ordinate hand and finger movements Note the knock knees and broad base stance
At 3-4 years: Fully controlled posture
The stages of the psychomotor development of the child I stage month II stage months III stage months IV stage months V stage months VI stage years