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 AGESPECIFIC 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 UNDRESSES 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

0-3 months

Differentiating cries - baby uses a different cry

for different situations

4-6 months

Vocal play - gurgling, babbling

7-12 months

Speech like babbling including the use of

consonants and vowels. First words "mama", "doggie"

1-2 years

Use of two word questions - "No doggie?",

"Where ball?"

2-3 years

Two/three word utterances. Use of attributes "Big", "Furry"

3-4 years

Combination of four or more words in

sentence form

4-5 years

Use of long and detailed sentences. Use of

"adult-like" grammar

SEQUENCES OF SOUND
ACQUISITION
Age (Year)

Sounds

m,n,h,p,n

2.4

f,j,k,d

2.8

w,b,t

g,s

3.4

r,l

3.8

(shy),t (chin)

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.