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Main Milestones Of

Child’s Psycho-motor

Neurologic 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 newborn

1. General appearance:

Posture – flexion of head and
extremities, which rest on chest and
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 .

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 . Neuromuscular system: • • • • • • • Extremities usually maintain some degree of flexion Extension of an extremity followed by previous position of flexion Head lag while sitting.2.

Muscular hypotonus of the back muscles .

The ‘heel-to-ear’ manoeuvre .

Potential signs of distress/major abnormalities • Hypotonia • Hypertonia – jittery.twiches. arms and hands tightly flexed. and myoclonic jerks • Marked head lag in all positions . legs stiffly extended • Asymmetric posturing (except tonic neck reflex) • Opisthotonic posturing – arched back • Signs of paralysis • Tremors.

Opisthotonus .

Assesment of reflexes: • • • the unconditioned reflexes that persist throughout life (swallowing reflex. cough reflex.3. which disappear during infancy the righting reflexes that are absent in a newborn and appear during infancy . papillary reflex. sneeze reflex. and tendon reflexes) the transitional reflexes or reflexes of neonate and infancy. blinking or corneal reflex. glabellar reflex. yawn reflex. gag reflex.

Myelocephalic reflexes. Kernig’s reflex. The reflexes of spinal automatism. dance (stepping). Moro reflex. – Sucking reflex.Reflexes of neonate and infancy: • 1. and Babkin’s reflex • 2. trunk incurvation (Galant) reflex. rooting. startle. Doll’s eye reflex. placing. lip or trunk reflex. Babinski’s reflex. Perez reflex • 3. – Asymmetric tonic neck reflex and Symmetric neck-righting reflex . – Reflex of defence. extrusion. grasp. crawling (Bauer’s) reflex. The reflexes of oral automatism.

Rooting reflex .

Babkin’s reflex .

Defence reflex .

Grasp .

Moro’s reflex .

Placing and Dance reflexes .

Crawling (Bauer’s) reflex .

Babinski’s reflex .

Trunk incurvation (Galant) reflex .

Peres’s reflex .

Asymmetric tonic neck reflex .

Mental status 2. tone. Motor functioning: • • • • gross motor fine motor test muscle strength. Reflexes (deep tendon) 5. Sensory functioning 4. Cranial nerves .Steps of neurological assesment in infants and elder children 1. and development test cerebellar functioning 3.

have touch nose with the index finger • Heel-to-shin test: with child standing.Tests for cerebellar function: • Finger-to-nose test: with the child’s arm extended. 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 . 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.

have child describe it as sharp or dull – Touch skin with cold and warm object (such as metal and rubber heads of reflex hammer).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 differentiate between tenperatures – Using two pins. touch skin simultaneously with both or one pin. have child discriminate when one or two pins are used .

achilles. triceps. note pain and involuntary flexion of hip and knees • These special reflexes are elicited when meningeal irritation is suspected. Positive signs require immediate referral. note pain or resistance • Brudzinski sign: with the child supine.Reflexes (deep tendon) • Biceps. Grade 2 (++) is normal. flex the head. ankle clonus • Tendon reflexes are assesed in grades from 0 to 4. brachioradialis. • Kernig sign: flex cchild’s leg at hip and knee while supine. Grade 0 is absent. knee jerk or patellar reflex. .

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

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

Upper Landau’s 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 months • Postural control and co-ordinate hand and finger movements • Note the knock knees and broad base stance .

At 3-4 years: Fully controlled posture .

1 .3 years .1 .3-6 months IV stage .6-9 months V stage .The stages of the psychomotor development of the child • • • • • • I stage .0-1 month II stage .9-12 months VI stage .3 months III stage .



Thank You for Attention .