Presentation on theme: "Main Milestones Of Child’s Psycho-motor Development"— Presentation transcript:
1Main Milestones Of Child’s Psycho-motor Development Neurologic Assessment.Signs Of DeviationsOf Psycho-motor Development.
2The categories of adaptive behaviors: (1) gross motor,(2) fine motor,(3) language, and(4) personal-social behavior.
3General guidelines for neurological assesment of the newborn 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
7Neuromuscular system: Extremities usually maintain some degree of flexionExtension of an extremity followed by previous position of flexionHead lag while sitting, but momentary ability to hold head erectAble to turn head from side to side when proneAble to hold head in horisontal line with back when held proneMovements – the envoluntary reflex responceQuivering or momentary tremors are assesed as minor abnormalities
10Potential signs of distress/major abnormalities HypotoniaHypertonia – jittery, arms and hands tightly flexed, legs stiffly extendedAsymmetric posturing (except tonic neck reflex)Opisthotonic posturing – arched backSigns of paralysisTremors,twiches, and myoclonic jerksMarked head lag in all positions
12Assesment 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 infancythe righting reflexes that are absent in a newborn and appear during infancy
13Reflexes 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 reflex2. 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 reflex3. Myelocephalic reflexes.Asymmetric tonic neck reflex and Symmetric neck-righting reflex
25Steps of neurological assesment in infants and elder children Mental statusMotor functioning:gross motorfine motortest muscle strength, tone, and developmenttest cerebellar functioningSensory functioningReflexes (deep tendon)Cranial nerves
26Tests for cerebellar function: Finger-to-nose test: with the child’s arm extended, have touch nose with the index fingerHeel-to-shin test: with child standing, have run the heel of one foot down the shin of the other legRomberg test: have child stand erect with feet together and eyes closed. Falling or leaning to one side is abnormal and is called the Romberg signHave child touch tip of each finger with thumb in rapid succession
27Sensory functioning Test vision and hearing Sensory intactness: touch skin lightly with a pin and have child point to stimulated area while keeping eyes closedSensory discrimination:Touch skin with pin and cotton; have child describe it as sharp or dullTouch skin with cold and warm object (such as metal and rubber heads of reflex hammer); have child differentiate between tenperaturesUsing two pins, touch skin simultaneously with both or one pin; have child discriminate when one or two pins are used
28Reflexes (deep tendon) Biceps, triceps, brachioradialis, knee jerk or patellar reflex, achilles, ankle clonusTendon 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 resistanceBrudzinski sign: with the child supine, flex the head; note pain and involuntary flexion of hip and kneesThese special reflexes are elicited when meningeal irritation is suspected. Positive signs require immediate referral.
29Psycho-motor development of children Gross motor behavior includes developmental maturation in posture, head balance, sitting, creeping, standing, and walking.
30Head and neck control in prone position at 6-8 weeks.