1. Main Milestones Of Child’s Psycho-motor Development
Neurologic Assessment.
Signs Of Deviations
Of Psycho-motor Development.

2. The categories of adaptive behaviors:
(1) gross motor,
(2) fine motor,
(3) language, and
(4) personal-social behavior.

3. General 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

4. General appearance of a newborn

5. General hypotonus (‘rag-doll’ baby)

6. Muscle Hypertonus

7. 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

8. Muscular hypotonus of the back muscles

9. The ‘heel-to-ear’ manoeuvre

10. 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

11. Opisthotonus

12. 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

13. 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

14. Rooting reflex

15. Babkin’s reflex

16. Defence reflex

17. Grasp

18. Moro’s reflex

19. Placing and Dance reflexes

20. Crawling (Bauer’s) reflex

21. Babinski’s reflex

22. Trunk incurvation (Galant) reflex

23. Peres’s reflex

24. Asymmetric tonic neck reflex

25. Steps of neurological assesment in infants and elder children
Mental status
Motor functioning:
gross motor
fine motor
test muscle strength, tone, and development
test cerebellar functioning
Sensory functioning
Reflexes (deep tendon)
Cranial nerves

26. 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 succession

27. 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

28. 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.

29. Psycho-motor development of children
Gross motor behavior includes developmental maturation in posture, head balance, sitting, creeping, standing, and walking.

30. Head and neck control in prone position at 6-8 weeks.

31. Upper Landau’s reflex

32. Sitting with support (at 5 mo) and without (8 mo)

33. At 8 -10 months: Sitting and standing

34. At 9-11 months: Crawling

35. First steps

36. At 16 months
Postural control and co-ordinate hand and finger movements
Note the knock knees and broad base stance

37. At 3-4 years: Fully controlled posture

38. 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

41. Thank You for Attention