You are on page 1of 41

Main Milestones Of

Childs 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

2. 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
Quivering or momentary tremors are
assesed as minor abnormalities

Muscular hypotonus of
the back muscles

The heel-to-ear

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


3. 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

Reflexes of neonate and infancy:

1. The reflexes of oral automatism.

Sucking reflex, Dolls eye reflex, rooting,

extrusion, lip or trunk reflex, and Babkins

2. 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 reflex

3. Myelocephalic reflexes.

Asymmetric tonic neck reflex and

Symmetric neck-righting reflex

Rooting reflex

Babkins reflex

Defence reflex


Moros reflex

Placing and Dance


Crawling (Bauers) reflex

Babinskis reflex

Trunk incurvation
(Galant) reflex

Peress reflex

Asymmetric tonic neck


Steps of neurological
assesment in infants and
elder children
1. Mental status
2. Motor functioning:

gross motor
fine motor
test muscle strength, tone, and development
test cerebellar functioning

3. Sensory functioning
4. Reflexes (deep tendon)
5. Cranial nerves

Tests for cerebellar

Finger-to-nose test: with the childs arm
extended, have touch nose with the index
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

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

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 cchilds 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.

development of children
Gross 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 months
Postural control
and co-ordinate
hand and finger
Note the knock
knees and broad
base stance

At 3-4 years:
Fully controlled

The stages of the

psychomotor development
of the child

I stage - 0-1 month

II stage - 1 - 3 months
III stage - 3-6 months
IV stage - 6-9 months
V stage - 9-12 months
VI stage - 1 - 3 years

Thank You for