Main Milestones Of Childs Psycho-motor DevelopmentNeurologic Assessment.Signs Of Deviations Of Psycho-motor Development.

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

General guidelines for neurological assesment of the newbornGeneral 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

General appearance of a newborn

General hypotonus (rag-doll baby)

Muscle Hypertonus

Neuromuscular 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

Muscular hypotonus of the back muscles

The heel-to-ear manoeuvre

Potential signs of distress/major abnormalitiesHypotoniaHypertonia 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

Opisthotonus

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 infancythe 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, Dolls eye reflex, rooting, extrusion, lip or trunk reflex, and Babkins reflex2. The reflexes of spinal automatism.Reflex of defence, grasp, Moro reflex, startle, placing, dance (stepping), crawling (Bauers) reflex, Kernigs reflex, Babinskis reflex, trunk incurvation (Galant) reflex, Perez reflex3. Myelocephalic reflexes.Asymmetric tonic neck reflex and Symmetric neck-righting reflex

Rooting reflex

Babkins reflex

Defence reflex

Grasp

Moros reflex

Placing and Dance reflexes

Crawling (Bauers) reflex

Babinskis reflex

Trunk incurvation (Galant) reflex

Peress reflex

Asymmetric tonic neck reflex

Steps of neurological assesment in infants and elder childrenMental statusMotor functioning:gross motor fine motortest muscle strength, tone, and developmenttest cerebellar functioning Sensory functioningReflexes (deep tendon)Cranial nerves

Tests for cerebellar function:Finger-to-nose test: with the childs 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 sign Have child touch tip of each finger with thumb in rapid succession

Sensory functioningTest vision and hearingSensory 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

Reflexes (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 cchilds 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.

Psycho-motor development of childrenGross 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 Landaus reflex

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

At 8 -10 months: Sitting and standing

At 9-11 months: Crawling

First steps

At 16 monthsPostural control and co-ordinate hand and finger movementsNote 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 - 0-1 monthII stage - 1 - 3 monthsIII stage - 3-6 monthsIV stage - 6-9 monthsV stage - 9-12 monthsVI stage - 1 - 3 years

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