GLOBAL

DEVELOPMENTAL DELAY
Global Developmental Delay
 Thediagnosis of GDD is limited to children younger
than 5 years old but these children often evolve to
meet diagnostic criteria for ID and probably represent
the same population.
 Because the etiological diagnoses of GDD and ID
overlap, it is natural that investigations in pursuit of a
definitive diagnosis for either disorder are similar.
Early detection is crucial for initiating rehabilitation
services and treatment as soon as possible. The
etiology of GDD/ID can be identified in many cases
(40% to 80%).
Diagnostic Criteria
Global developmental delay 
 Significantdelay (at least 2 SDs below the mean with
standardized tests) in at least two developmental domains
from the following: 
 Gross or fine motor 
 Speech/language 

 Cognition 

 Social/personal 

 Activities of daily living 

 Reserved for children <5 years old 
 GROWTH VS DEVELOPMENT

 Growth is an increase in physical measurements. Its rate is variable.

 Development is the acquisition and refinement of skills. Increasing complexity
of behavior is related to maturation of the CNS and to experience, with
adequacy in both areas needed for optimal functioning.
 The developmental examination compares a child’s function with expected
standards for that age
 5 DOMAINS OF DEVELOPMENT

 Gross motor behavior

 Fine motor adaptive behavior
 Language behavior
 Cognitive behavior
 Personal-social-behavior
 PRENATAL DEVELOPMENT
 Normal or typical development of abilities and skills in humans begins at the moment
of conception. In normal conception and pregnancy, the embryo
(conception through the 8th week of gestation) and the fetus (the 9th week of
gestation until birth) develop according to a sequence and timing common to all
humans
 Nervous System
The nervous system arises from the neural plate, which is a dorsal ectodermal thickening
that appears on about day 16 of gestation. By the sixth week, part of the neural tube
becomes the cerebral vesicle, which later becomes the cerebral hemispheres
 28th week
 Neural Tube → Brain + Spinal Cord
 Once neural tube has closed, the 3 primary vesicles complete their development:
 Forebrain Vesicle
 Midbrain Vesicle
 Hindbrain Vesicle
 DEVELOPMENTAL DIRECTION

Reflex control before cortical control

Generalized response before localized response
Proximal control before distal control
Cephalic control before caudal control
Medial control before lateral control
Cervical control before rostral control
Gross motor control before fine motor control
Flexor muscle tone develops before extensor muscle tone
Extensor antigravity control develops before flexor antigravity control
Weight bearing occurs on flexed extremity before extended extremities
 Motor development goals
 Control of the body against gravity

 Ability to maintain the body’s COM within the BOS

 Performance of intrasegmental and intersegmental isolated movements

For example, even though various joints of the upper extremity move in a
coordinated manner to produce an upper extremity functional skill, the individual
joints, such as the elbow joint, must learn to move independently while the other
upper extremity joints do not move. This is intrasegmental dissociation.
Intersegmental dissociation, such as
moving the head without moving the extremities or moving
one lower extremity into flexion while moving the contralateral lower extremity into
extension, must develop as well
 FULL TERM vs. PRETERM
INFANTS
 Infants considered to be term or full term have a gestational age of 38 to
42 weeks.
 A preterm or premature infant, defined as one with a gestational age of less
than 38 weeks,may not exhibit motor skills consistent with his chronologic
age.
 INFANTILE REFELXES

 Motor behavior in neonates and young infants reflects the immaturity of the
CNS and is influenced by primitive reflexes. Maturation is signaled by a
gradual suppression of infantile reflexes as volitional control is acquired.
 Persistence of primitive reflex activity beyond the expected age can be
interpreted as a sign of delayed maturation of the CNS and may be the
earliest indication of a neuromuscular dysfunction.
DEVELOPMENTAL MILESTONES
Differential Dx
 Intellectual disability (intellectual developmental disorder) is a disorder
with onset during the developmental period that includes both intellectual
and adaptive functioning deficitsin conceptual, social, and practical
domains. The following three criteria must be met:
A. Deficits in intellectual functions, such as reasoning, problem solving,
planning, abstract
thinking, judgment, academic learning, and learning from experience,
confirmed by
both clinical assessment and individualized, standardized intelligence testing.
B. Deficits in adaptive functioning that result in failure to meet developmental
and sociocultural standards for personal independence and social
responsibility. Without ongoing support, the adaptive deficits limit functioning
in one or more activities of daily life,
such as communication, social participation, and independent living, across
multiple
environments, such as home, school, work, and community.
C. Onset of intellectual and adaptive deficits during the developmental period
Treatment

PLAY
 Occupation of a child
 Synonym for exploration & experimentation and is a serious affair for the
child
 Closely related c dev’t of communication, hand fxn posture control and
locomotion
2 types of Play
 Free play
 Therapeutic play
Neurodevelopmental Techniques
systems of therapy utilized in patients
with disabilities resulting from
impairments of the CNS (CVA, CP)
specifically the brain
Refers to all systems of therapy that
utilize the neurodevelopmental
approach in the management of brain
disorders
 BASED ON 3 THEORIES INCORPORATED
IN SPECIFIC TREATMENT TECHNIQUES
TO PROMOTE CHANGE IN BEHAVIOR
1. Developmental Theory
2. Neurophysiologic Theory
3. Motor Learning Theory
 Techniqueswhich have developed, promote the
concept that sensation repetition for learning
and sequential development are necessary to
improve muscle control and postural reflexes.

 These approaches were devised for cerebral

palsies, many of which can also be used for
children with developmental delay & adults with
neurologic defects
Bobath Technique
 Neurodevelopmental treatment with reflex inhibition &
facilitation
Features:
 REFLEX INHIBITORY PATTERN- inhibit abnormal tone associated
with abnormal movement patterns & abnormal posture
❖ Sensory motor experience – feedback & guide more normal
motion
❖ Facilitation techniques for mature postural reflexes
❖ Keypoints of control: head & neck, shoulder
and pelvic girdles
❖ Developmental sequences
ROOD TECHNIQUE

 Sensorystimulation for facilitation & inhibition

of motor response
❖ Classification of muscles as “heavy work” or
“light work”
❖ Reflexes are used in therapy
❖ Follows Ontogenetic developmental sequence
 For most types of dysfunction, the gradual rebuilding of
control that occurs when a patient progresses through the
activities of the developmental sequence & the stages of
motor control will rehabilitate the patient to the maximal
level of functioning.