NURYANI SIDARTA

OVERVIEW

CONSIDERATION FOR
GROWTH AND DEVELOPMENT ARE
ESSENTIAL COMPONENTS IN THE
DIAGNOSTIC ARMAMENTARIUM OF
PEDIATRIC PHYSIATRISTS
 OVERVIEW

DEVIATION FROM NORMAL

ARE USED TO PROJECT
SHORT-TERM AND LONG-TERM
PROGNOSES,
ON WHICH BOTH
FUNCTIONAL AND PREVENTIVE
INTERVENTIONS ARE BASED
GROWTH AND DEVELOPMENT
 GROWTH

IS AN INCREASE IN PHYSICAL SIZE

AND DIMENSIONS RELATIVE TO
MATURITY
DEVELOPMENT

IS THE ACQUISITION AND

REFINEMENT OF ADVANCING SKILLS
THE NEUROPHYSIOLOGIC BASIS FOR
ACHIEVING NEW DEVELOPMENTAL
MILESTONES IS AN ASCENDING
PROCESS OF CENTRAL NERVOUS
SYSTEM MATURATION
DEVELOPMENTAL
ASSSESSMENT
IS A COMPARISON OF THE CHILDS
BEHAVIOR RELATIVE TO AGE-
SPECIFIC NORMATIVE DATA
THE EVALUATION SHOULD INCLUDE
OBSERVED BEHAVIORS AND THOSE
REPORTED AT HOME OR OTHER
FAMILIAR SETTINGS.
DEVELOPMENTAL ASSESSMENT

DEVELOPMENTAL EVALUATION IS
COMPLEMENTARY TO A STANDARD
NEUROLOGIC EVALUATION,
WHICH INTENDS TO IDENTIFY AND
LOCALIZE SIGNS OF SPECIFIC CNS
LESIONS
DEVELOPMENTAL ASSESSMENT

GROSS MOTOR BEHAVIOR

FINE MOTOR BEHAVIOR
LANGUAGE BEHAVIOR
PERSONAL SOCIAL BEHAVIOR
PEDIATRIC ASSESSMENT
INSTRUMENTS
DENVER DEVELOPMENTAL
SCREENING TEST
BAYLEY SCALES OF INFANT
DEVELOPMENT
PEABODY MOTOR SCALES
GROSS MOTOR FUNCTION
MEASURES (GMFM)
DENVER DEVELOPMENTAL SCREENING
TEST
DOMAIN : GROSS MOTOR, FINE
MOTOR, ADL, ADAPTIVE BEHAVIOR,
LANGUAGE COMMUNICATION
APPLICATION : DEVELOPMENTAL
DELAY
AGE RANGE : 1MO 6 YEARS
BAYLEY SCALES OF INFANT
DEVELOPMENT
DOMAIN : GROSS MOTOR, FINE
MOTOR, ADL, ADAPTIVE BEHAVIOR,
LANGUAGE COMMUNICATION AND
REFLEX DEVELOPMENT
DIAGNOSIS : DEVELOPMENTAL
DELAY
AGE RANGE : 2-30 MONTHS
PEABODY MOTOR SCALES

DOMAIN : GROSS MOTOR, FINE

MOTOR AND ADAPTIVE BEHAVIOR
APPLICATION : MOTOR DELAY
AGE RANGE : 0-83 MONTHS
MILESTONES IN CHILD
DEVELOPMENT
NEWBORN
4 MONTHS
7 MONTHS
10 MONTHS
14 MONTHS
18 MONTHS
2 YEARS
3 YEARS
4 -7 YEARS
NEWBORN

GM : FLEXOR TONE PREDOMINATES

FM : HANDS FISTED
PERSONAL/SOCIAL : HABITUATION
AND SOME CONTROL OF STATE
SPEECH AND LANGUAGE : CRY
COGNITIVE : REFLEX STAGE
EMOTIONAL : BASIC TRUST VS BASIC
MISTRUST
4 MONTHS

GM : HEAD MIDLINE
FM : HANDS MOSTLY OPEN, MIDLINE
HAND PLAY
PERSONAL SOCIAL : RECOGNIZE
BOTTLE
SPEECH AND LANGUAGE : TURNS OF
VOICE AND BELL CONSISTENLY
COGNITIVE : CIRCULAR REACTION
EMOTIONAL : LAP BABY, DEVELOPING
A SENSE OF BASIC TRUST
7 MONTHS

GM : MAINTAIN SITTING, ROLLS TO PRONE

FM : TRANSFER CUBE FROM HAND TO HAND,
BANG OBJECTS
PERSONAL SOCIAL : DIFFERENTIATES
BETWEEN FAMILIAR PERSON AND STRANGER
SPEECH : USE SINGLE WORDS AND DOUBLE
CONSONANT-VOWEL CONSONANT
EMOTIONAL : BEGAN TO DIFFERENTIATE
BETWEEN MOTHER AND SELF
10 MONTHS

GM : CREEPS ON ALL FOURS, PIVOT IN

SITTING
FM : PINCER GRASP, BANGS TWO CUBES
HELD IN HAND
PS : PLAY PEEK A BOO, FINGER FEEDS
SPEECH : SHOUTS FOR ATTENTION, WAVES
BYE-BYE
COGNITIVE : CAN RETRIEVE AN OBJECT
HIDDEN FROM VIEW
EMOTIONAL : PRACTICING PHASE OF
SEPARATION-INDIVIDUATION, PRACTICES
INITIATIONG SEPARATIONS
18 MONTHS

GM : ARMS AT LOW GUARD, WALKS

BACKWARD
FM : EMERGING HAND DOMINANCE,
HOLD CRAYON BUT END IN PALM
PS : IMITIATES HOUSEWORK
SPEECH : POINTS TO NAMED BODY
PART
COGNITIVE : SOLVING PROBLEM BY
MENTAL COMBINATION
2 YEARS

GM : BEGINS RUNNING, WALKS UP

AND DOWN STAIRS ALONE
FM : BUILDS EIGHT CUBE T OWER
PS : PULLS ON GARMENT
SPEECH : TWOWORD PHRASES ARE
COMMON
COGNITIVE : PREOPERATIONAL
PERIOD ( 2-7 YEARS)
3 YEARS

GM : RUNS WELL, PEDALS TRICYCLE

FM : COPIES CIRCLE
PERSONAL/SOCIAL : TOILET TRAINED DAY
AND NIGHT
SPEECH : THREE WORD SENTENCES ARE
USUAL
COGNITIVE : CHILD IS CAPABLE OF
DEFERRED IMITATION SYMBOLIC PLAY
EMOTIONAL : STAGE OF IMITATIVE VS
GUILT
4 YEARS

GM : WALKS DOWN STAIRS

ALTERNATING FEET, PLANTAR
ARCHES DEVELOPING
FM : HANDLES A PENCIL BY FINGER
AND WRIST ACTION, COPIES A
CROSS, CUTS BY SCISSORS
PERSONAL SOCIAL : SHARING AND
INTERACTING, DRESSES AND UN-
DRESSES BY SUPERVISION
5 YEARS

GM : SKIPS, TIPTOES, BALANCES 10

SECONDS ON EACH FOOT
FM : HAND DOMINANCE EXPECTED,
DRAWS MAN HEAD, BODY AND
EXTREMITIES
PERSONAL : CREATIVE PLAY
SPEECH : FLUENT SPEECH
6 YEARS

GM : RIDES BICYCLE, ROLLER SKATES

FM : PRINTS ALPHABET, LETTER
REVERSALS
PERSONAL : TEACHER IN AN
IMPORTANT AUTHORITY TO CHILD,
USE FORK APPROPRIATELY
SPEECH : SHOWS MASTERY OF
GRAMMAR
7 YEARS

GM : CONTINUING REFINEMENT OF
SKILLS
PS : EAT WITH FORK AND KNIFE,
COMBS HAIR
COGNITIVE : CHILD IS CAPABLE OF
LOGICAL THINKING
 REFLEX DEVELOPMENT

IN NEONATES AND YOUNG INFANTS,

MOTOR BEHAVIOR IS INFLUENCED BY
PRIMITIVE REFLEXES AS A RESULT OF
THE IMMATURE CNS
THE REFLEXES GENERATE
PREDICTABLE AND STEREOTYPIC
MOVEMENT AND POSTURES
 REFLEX DEVELOPMENT

DURING THE FIRST 6-8 MONTHS OF

LIFE AS CNS MATURATION
PROGRESSES, THERE REFLEXES
BECOME GRADUALLY SUPPRESSED
CONCURRENTLY, MORE
SOPHISTICATED POSTURAL RESPONSES
EMERGE BETWEEN 2 AND 14 MO OF
AGE THAT ARE USED AND
INCORPORATED INTO VOLITIONAL
MOTOR BEHAVIOR
 PRIMITIVE REFLEX
DEVELOPMENT
MORO
STARTLE
ROOTING
POSITIVE SUPPORTING
ASYMMETRIC TONIC NECK REFLEX
SYMMETRIC TONIC NECK REFLEX
PALMAR GRASP
PLANTAR GRASP
 PHYSIOLOGIC POSTURAL
REFLEX
HEAD RIGHTING
HEAD AND BODY RIGHTING
PROTECTIVE EXTENSION OR
PARACHUTE REACTION
EQUILIBRIUM REACTIONS
 THE DEVELOPMENT
PROGRESSIONS

PRONE PROGRESSION
SUPINE PROGRESSION
ROLLING PROGRESSION
SITTING PROGRESSION
ERECT STANDING PROGRESSION
PRONE PROGRESSION

PRONE LYING
PRONE ON ELBOWS
PRONE ON EXTENDED ARMS
PIVOT PRONE
QUARUPED
SUPINE PROGRESSION

SUPINE LYING AND PULL TO SITTING

HANDS TO KNEES AND FEET, FEET
TO MOUTH
 ROLLING PROGRESSION

NON SEGMENTAL ROLLING

SEGMENTAL ROLLING
ROLLING PRONE TO SUPINE
 SITTING PROGRESSION

SUPPORTED SITTING
PROPED SITTING
RING SITTING
INDEPENDEND SITTING
 ERECT STANDING
PROGRESSION
SUPPORTED STANDING
INDEPENDENT STANDING
CRUISING
ADVANCED MOTOR SKILLS

WALK STRAIGHT LINE : 3 YR

WALKS CIRCULAR LINE : 4 YR
BALANCES ON ONE FOOT FOR 3-5 sec : 5
YR
WALKS BACKWARD : 18 MO
JUMP : 2 YR
HOP : 3 YR
SKIPS : 6 YR
KICK BALL : 2-3 YR
THROW BALL : 2-3 YR
 MOTOR DEVELOPMENT
GOALS
TO CONTROL THE BODY AGAINST
GRAVITY
TO CONTROL THE ABILITY TO
MAINTAIN THE BODYS CENTER OF
MASS WITHIN THE BASE OF SUPPORT
TO PERFORM THE ISOLATED
MOVEMENT
ANTI-GRAVITY MOVEMENTS

HEAD

TRUNK

LOWER
EXTREMITY
 FINE MOTOR MILESTONES

NEWBORN
HAND FISTED
GRASP REFLEX
4 MONTHS
HAND MOSTLY OPEN
MIDLINE HAND PLAY
CRUDE PALMAR GRASP
 7 MONTHS
TRANSFERS CUBE FROM HAND TO
HAND
BANG OBJECTS
10 MONTHS
PINCER GRASP
BANGS TWO CUBES HELD IN
HANDS
 FINE MOTOR MILESTONES

14 MONTHS
HOLDS CRAYON FULL LENGTH IN PALM
CASTS OBJECTS
18 MONTHS
EMERGING HAND DOMINANCE
CRUDE RELEASE
2 YEARS
HAND DOMINANCE IS USUAL
DRAW WITH ARM AND WRIST ACTION
FINE MOTOR SKILLS

HAND GRASP REFLEX : BIRTH 4 TO 5

MO
SWIPES WITH WHOLE HAND : 2-3 MO
TRANSFER OBJECT ONE HAND TO OTHER
: 6 MO
PINCER GRASP : 10-11 MO
HOLD CRAYON : 11 MO
SCRIBBLES ON PAPER : 18 MO
BUILT TOWER ON THREE CUBES : 21 MO
UNSCREW JAR LID : 24 MO
BUILD TOWER ON 8 CUBES : 30 MO
 SPEECH DEVELOPMENT

Children develop production of various

speech sounds at different rates. Some
children appear to produce all sounds
correctly as they produce their first
words.
Some children will produce sounds that
seem distorted.
Other children may substitute one
sound for another as they learn to
speak (e.g. f/s as in "fwimming" for
"swimming").
All of these ways of learning to make
speech are appropriate.
 The learning process of
speech
Reflexive sound activity (stimulus)

Hearing (response)

Repetitive sound production

Pleasure of production
The learning process of
speech
External sound stimulus

Imitative response

Satisfaction of imitation

Continued repetition
 Factors influencing
language development in
the child
Physiological condition & motor
ability
Intelligence
Economic status
Sex
Home influences
Bilingualism
 SPEECH AND LANGUAGE
MILESTONES
Age Speech & Language development
Birth Sounds
Differentiating cries - baby uses a
0-3 months
different cry for different situations
4-6 months Vocal play - gurgling, babbling
Speech like babbling including the use
7-12 months of consonants and vowels. First
words - "mama", "doggie"
Use of two word questions - "No
1-2 years
doggie?", "Where ball?"
Two/three word utterances. Use of
2-3 years
attributes - "Big", "Furry"
Combination of four or more words in
3-4 years
sentence form
Use of long and detailed sentences. Use
4-5 years
of "adult-like" grammar
SEQUENCES OF SOUND
ACQUISITION
Age (Year) Sounds
2 m,n,h,p,n

2.4 f,j,k,d

2.8 w,b,t

3 g,s

3.4 r,l

3.8 (shy),t (chin)

4 Z (measure)

4+ Dz (jar),v,z
 COGNITIVE DEVELOPMENT
STAGE
REFERS TO INCREASING ABILITY OF THE
CHILD TO :
1. INTERPRET SENSORY EVENTS
2.REGISTER AND RETRIEVE INFORMATION
FROM MEMORY
3. MANIPULATE SCHEMATA, IMAGES,
SYMBOLS AND CONCEPT IN
THINKING,
REASONING, PROBLEM SOLVING
Figure 1. The Inspiration web above illustrates Piaget's four cognitive development stages;
sensorimotor (birth-2 years), preoperational (2 - 7 years), concrete operational (7 - 11 years),
and formal operational (adolescence - adulthood). By Tiffany Davis, Meghann Hummel, and
Kay Sauers (2006)
SENSORI MOTOR STAGE

A STAGE THAT SPANS TRANSITION

FROM IMMATURE REFLEX AND
SENSORIMOTOR RESPONSES TO
PURPOSEFUL ACTIVITY BY THE
FORMATION OF INCREASINGLY
COMPLEX SENSORY AND MOTOR
ABILITIES
ALLOW INFANTS TO ORGANIZE AND
EXERCISE SOME CONTROL OVER THEIR
ENVIRONMENT
PREOPERATIONAL STAGE

START WHEN THE CHILD LEARN

LANGUAGE
DEVELOP THE TOOLS FOR
REPRESENTATIVE SCHEMES
SYMBOLICALLY THROUGH LANGUAGE,
IMITATION, IMAGERY, SYMBOLIC PLAY
AND DRAWING.
THEY ACQUIRE CAPACITY TO DEAL
WITH OBJECTS AND EVENT NOT
PRESENT IN THE IMMEDIATE SITUATION
CONCRETE OPERATIONAL
THOUGHT
TI ME WHEN CHILDREN ENTER
FORMAL EDUCATION
THEY DEVELOP LOGICAL THINKING
AND CAN MANIPULATE GROUPS OF
CATEGORIES, CLASSIFICATION
SYSTEMS AND HIERARCHIES
FORMAL OPERATIONAL
THOUGHT
CHARACTERIZED BY THE ABILITY TO
CONCEPTUALIZE ABOUT MANY
SIMULATENEOUS INTERACTING
VARIABLES, TO USE ABSTRACT
REASONING, AND TO DEVELOP
HYPOTHETICAL THEORIES
 CONCLUSION

NORMAL MOTOR DEVELOPMENT IN

HUMANS USUALLY OCCURS
ACCORDING TO A PARTICULAR
SEQUENCE AND TIMING.
THE SEQUENCE AND TIMING ARE
IMPORTANT TO THE CLINICIAN AND
CAN BE USED AS QUIDES IN THE
PHYSICAL THERAPY EVALUATION AND
TREATMENT OF CHILDREN AND ADULTS
 CONCLUSION

A THOROUGH UNDERSTANDING OF
NORMAL MOTOR DEVELOPMENT IS
PARTICULARLY GERMANE TO THE STUDY
OF ABNORMAL NEUROMOTOR
DEVELOPMENT IN CHILDREN
ALTHOUGH ALL HUMAN SHARE A
COMMON ANATOMY, PHYSIOLOGY AND
DEVELOPMENTAL SEQUENCE, ONE MUST
KEEP IN MIND THAT MANY INTRINSIC AND
EXTRINSIC FACTORS, INCLUDING
PATHOLOGY AND CULTURE AFFECT THE
SEQUENCE AND TIMING OF MOTOR
DEVELOPMENT IN AN INDIVIDUAL.
 CONCLUSION

KNOWLEDGE OF NORMAL GROWTH

PATTERNS, FUNCTIONAL
MILESTONES AND POTENTIAL
DEVIATIONS IS IMPORTANT TO THE
COMPREHENSIVE MANAGEMENT OF
CHILDREN WITH DEVELOPMENTAL
OR ACQUIRED DISABILITIES
 CONCLUSION

WITH THIS UNDERSTANDING, A

DETAILED TREATMENT PLAN CAN BE
DERIVED AND ASSIST WITH
FACILITATING THE MAXIMAL
DEVELOPMENT POTENTIAL OF THE
INDIVIDUAL CHILD.