GROWTH AND DEVELOPMENT

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

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GROWTH AND DEVELOPMENT .

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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 CHILD’S 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) .

ADAPTIVE BEHAVIOR.DENVER DEVELOPMENTAL SCREENING TEST  DOMAIN : GROSS MOTOR. ADL. LANGUAGE COMMUNICATION  APPLICATION : DEVELOPMENTAL DELAY  AGE RANGE : 1MO – 6 YEARS . FINE MOTOR.

FINE MOTOR. ADAPTIVE BEHAVIOR. ADL.BAYLEY SCALES OF INFANT DEVELOPMENT  DOMAIN : GROSS MOTOR. LANGUAGE COMMUNICATION AND REFLEX DEVELOPMENT  DIAGNOSIS : DEVELOPMENTAL DELAY  AGE RANGE : 2-30 MONTHS .

FINE MOTOR AND ADAPTIVE BEHAVIOR  APPLICATION : MOTOR DELAY  AGE RANGE : 0-83 MONTHS .PEABODY MOTOR SCALES  DOMAIN : GROSS MOTOR.

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 .

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 .4 MONTHS  GM : HEAD MIDLINE  FM : HANDS MOSTLY OPEN.

7 MONTHS  GM : MAINTAIN SITTING. 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 . ROLLS TO PRONE  FM : TRANSFER CUBE FROM HAND TO HAND.

PRACTICES INITIATIONG SEPARATIONS . PIVOT IN SITTING  FM : PINCER GRASP.10 MONTHS  GM : CREEPS ON ALL FOURS. FINGER FEEDS SPEECH : SHOUTS FOR ATTENTION. BANGS TWO CUBES HELD IN     HAND PS : PLAY PEEK A BOO. WAVES BYEBYE COGNITIVE : CAN RETRIEVE AN OBJECT HIDDEN FROM VIEW EMOTIONAL : PRACTICING PHASE OF SEPARATION-INDIVIDUATION.

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 .

DRESSES AND UN-DRESSES BY SUPERVISION .4 YEARS  GM : WALKS DOWN STAIRS ALTERNATING FEET. COPIES A CROSS. PLANTAR ARCHES DEVELOPING  FM : HANDLES A PENCIL BY FINGER AND WRIST ACTION. CUTS BY SCISSORS  PERSONAL SOCIAL : SHARING AND INTERACTING.

TIPTOES. DRAWS MAN HEAD.5 YEARS  GM : SKIPS. BODY AND EXTREMITIES  PERSONAL : CREATIVE PLAY  SPEECH : FLUENT SPEECH . BALANCES 10 SECONDS ON EACH FOOT  FM : HAND DOMINANCE EXPECTED.

LETTER REVERSALS  PERSONAL : TEACHER IN AN IMPORTANT AUTHORITY TO CHILD. ROLLER SKATES  FM : PRINTS ALPHABET.6 YEARS  GM : RIDES BICYCLE. USE FORK APPROPRIATELY  SPEECH : SHOWS MASTERY OF GRAMMAR .

COMBS HAIR  COGNITIVE : CHILD IS CAPABLE OF LOGICAL THINKING .7 YEARS  GM : CONTINUING REFINEMENT OF SKILLS  PS : EAT WITH FORK AND KNIFE.

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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 .

MORE SOPHISTICATED POSTURAL RESPONSES EMERGE BETWEEN 2 AND 14 MO OF AGE THAT ARE USED AND INCORPORATED INTO VOLITIONAL MOTOR BEHAVIOR .REFLEX DEVELOPMENT  DURING THE FIRST 6-8 MONTHS OF LIFE AS CNS MATURATION PROGRESSES. THERE REFLEXES BECOME GRADUALLY SUPPRESSED  CONCURRENTLY.

PRIMITIVE REFLEX DEVELOPMENT  MORO  STARTLE  ROOTING  POSITIVE SUPPORTING  ASYMMETRIC TONIC NECK REFLEX  SYMMETRIC TONIC NECK REFLEX  PALMAR GRASP  PLANTAR GRASP .

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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 .

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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 .

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ERECT STANDING PROGRESSION  SUPPORTED STANDING  INDEPENDENT STANDING  CRUISING .

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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 .

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MOTOR DEVELOPMENT GOALS  TO CONTROL THE BODY AGAINST GRAVITY  TO CONTROL THE ABILITY TO MAINTAIN THE BODY’S 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 .

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 7 MONTHS TRANSFERS CUBE FROM HAND TO HAND BANG OBJECTS  10 MONTHS PINCER GRASP BANGS TWO CUBES HELD IN HANDS .

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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 .

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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 .

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

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 Birth 0-3 months 4-6 months 7-12 months Speech & Language development Sounds Differentiating cries .baby uses a different cry for different situations Vocal play . "Where ball?" Two/three word utterances. Use of "adult-like" grammar 1-2 years 2-3 years 3-4 years 4-5 years .gurgling. "doggie" Use of two word questions ."No doggie?". Use of attributes "Big". babbling Speech like babbling including the use of consonants and vowels. First words "mama". "Furry" Combination of four or more words in sentence form Use of long and detailed sentences.

j.p.8 3 3.n.v.n f.4 2.s r.b.t ς(chin) Z (measure) Dz (jar).z .8 4 4+ Sounds m.SEQUENCES OF SOUND ACQUISITION Age (Year) 2 2.k.h.l ς (shy).t g.4 3.d w.

IMAGES.COGNITIVE DEVELOPMENT STAGE REFERS TO INCREASING ABILITY OF THE CHILD TO : 1. INTERPRET SENSORY EVENTS 2.REGISTER AND RETRIEVE INFORMATION FROM MEMORY 3. PROBLEM SOLVING . MANIPULATE SCHEMATA. REASONING. SYMBOLS AND CONCEPT IN THINKING.

By Tiffany Davis. sensorimotor (birth-2 years).adulthood). The Inspiration web above illustrates Piaget's four cognitive development stages.11 years). and formal operational (adolescence .7 years). concrete operational (7 .Figure 1. Meghann Hummel. preoperational (2 . 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 .

 THEY ACQUIRE CAPACITY TO DEAL WITH OBJECTS AND EVENT NOT PRESENT IN THE IMMEDIATE SITUATION . IMAGERY.PREOPERATIONAL STAGE  START WHEN THE CHILD LEARN LANGUAGE  DEVELOP THE TOOLS FOR REPRESENTATIVE SCHEMES SYMBOLICALLY THROUGH LANGUAGE. IMITATION. SYMBOLIC PLAY AND DRAWING.

CLASSIFICATION SYSTEMS AND HIERARCHIES .CONCRETE OPERATIONAL THOUGHT  TI ME WHEN CHILDREN ENTER FORMAL EDUCATION  THEY DEVELOP LOGICAL THINKING AND CAN MANIPULATE GROUPS OF CATEGORIES.

TO USE ABSTRACT REASONING. AND TO DEVELOP HYPOTHETICAL THEORIES .FORMAL OPERATIONAL THOUGHT  CHARACTERIZED BY THE ABILITY TO CONCEPTUALIZE ABOUT MANY SIMULATENEOUS INTERACTING VARIABLES.

 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  NORMAL MOTOR DEVELOPMENT IN HUMANS USUALLY OCCURS ACCORDING TO A PARTICULAR SEQUENCE AND TIMING.

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. INCLUDING PATHOLOGY AND CULTURE AFFECT THE SEQUENCE AND TIMING OF MOTOR DEVELOPMENT IN AN INDIVIDUAL. PHYSIOLOGY AND DEVELOPMENTAL SEQUENCE. . ONE MUST KEEP IN MIND THAT MANY INTRINSIC AND EXTRINSIC FACTORS.

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.

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