2. Growth and Development
Objectives
By the end of this session students will be able to:
• Differentiate growth and development
• Identify aspects of child development
• Identify sequences of development in the prenatal period
• Describe aspects of development
• Discus each child reflexes and their roll in development
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3. introduction
qGrowth- change in size resulting from increase in the
number or size of the body.
– Quantitative measured in centimeters and kilogram
– Influenced by extrinsic and intrinsic factors- nutritional
status, climate, seasons, illness and activities
E.g. weight, height, head circumference, dentation
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4. Ø Development- functional maturation of the systems
in terms of acquisition of skills and ability to adapt to
new situations.
Ø It is assessed in terms of acquisition of skills and
ability to adapt to new situations.
Ø Body measurements and developmental landmarks
provide the best and most practical means of
evaluating health of the individual.
Ø Normal or typical motor dev’t starts from
conception at a common sequence & timing to all
humans & lasts life time.
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5. ü After a child is born, change occurs at rapid rate notably
during the first 24 months then new gross and fine
motor skills are learned and refined.
ü Gross motor skills-use large joints to perform a
particular activity.
ü Fine motor skills- small joints eg.hand & finger .
ü Motor skills are acquired & refined as a child grows
older.
ü Dev’tal sequence may be used as a base for evaluating ,
assessing & treating motor delays.
ü The greater the gap b/n chronological & motor age ,
more likely child exhibits dev’tal delay.
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6. Aspects of development are;
Ø Motor
Ø Cognitive
Ø Sensory and
Ø Affective abilities of a child
ü each does not develop pure on its own, but in a
continuous bi-directional relation to each other and in
relation to their physical abilities and their
environment .
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7. The motor aspect.
ü An efferent system depending on the maturation of the Central
Nervous System, and the condition of the muscles and
skeleton.
The sensory aspect.
ü An afferent system and depending on the sensetivity of the
senses. Vestibular, tactile, seeing, hearing, smelling, tasting.
The mental aspect
ü The inner stimulus, the motivation and allertness, but also the
capacity to analyse, to make plans and to solve problems.
The affective aspect
ü The emotional development of a child, how it is been handled
and taking care of.
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8. Development of a child
Physical development –
ü not only getting larger in size ,but also that these parts change
according to the demands of the environment for adaptation.
Central nervous system-
ü not fully developed at birth.
ü Dev’t of skills of mov’t follows upon a progressive change in
nervous sytem.
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9. Respiratory system –
• not fully developed at birth.
• Needs further structural dev’t.
-i.e increase in number of terminal airways & increace in their relative size.
• Retention of secretion within lungs results more disabling effect up on
his ventilator function which prevents normal dev’t.
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10. Emotional dev’t
Ø it is influenced by lack of maternal warmth, love and
stimulation
Ø Developmental milestone of hospitalized or
institutionalized child is slow than his peers.
Ø When child separate from mother
-usually rejects substitute mother
-refuse to be comforted & eat
-cry inconsolably
-regress to bed wetting & thumb sucking
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11. Ø Physical abuse also affects dev’t.
-child presents with multiple bruises & burns.
Ø Child needs guidance, good example & close bond of love within his
family for his dev’t.
Ø Handicapped child may experience rejection within his family.
-so child may suffer emotionally becoming attention seeking,
manipulative & destructive.
Ø Child needs guidance, good example & close bond of love with his
family.
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12. ü Drive toward dev’t is strong when child is mentally
ready for next dev’tal skills.
ü A child who can’t stand at 9 month may loose the
urge to stand & walk
ü but if he is encouraged he could walk.
ü So early treatment is important.
ü PT must be aware of nature of growth & dev’t to set
treatment objectives. also helps parents to understand
& accept the child.
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13. Motor dev’t
Ø Is a process of changing in motor behavior related to
age of the individual.
Ø Motor behavior has two basic ingredients
a. posture
b. movement
Ø Dev’tal changes in motor abilities is determined by
ünervous
ümusculoskeletal &
ücardio respiratory system
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14. Condition for normal development
1. Normal muscle tone
2. Proper postural alignment
3. Intact sensory system/ CNS
4. Symmetry
5. Normal growth
6. Normal state of sleep and awakefulness
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15. Normal muscle tone
Ø Normal tone is described as the state of muscle tone that is high enough
to permit movement against gravity , yet low enough to allow complete
freedom of movement.
Ø Abnormal: hypertonia or hypotonia
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17. An intact sensory system
Ø An intact sensory system provides for the expression of appropriate
responses to movement.
Ø feeling, hearing, vision, tasting and smelling initiate and stimulate
movements
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18. Symmetry
Ø In the first period of life the child should develop
symmetrically.
Ø In the first phase (0-2 years), the symmetry is seen in
the orientation on the midline and during alternating
movements as creeping , walking , climbing etc
Ø In a later phase (3-6 years) the symmetry is also seen
by using both sides in the same time, jumping,
swimming catching a ball
Ø After 5-6 years one side is going to specialise in
more specific activities
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19. Normal growth and a normal physical and mental condition.
ü The normal motor development also needs a healthy body and a healthy
mind.
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20. Normal state of sleep and wakefulness
Ø The general behaviour of the infant is significant for the overall
evaluation.
Ø The predominant state of consciousness is noted whether normal,
lethargic, or hyper excitable.
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21. Prenatal development
ü It is considered to be the period before birth also
known as gestational period
ü It is calculated from the first day of the mothers’ last
menstrual period
– It lasts 38 weeks – 40 weeks approximately 9
months
– It is time of rapid developmental stage
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22. Prenatal stage is divided into 3 stages
1. Germinal period [fertilization-2weeks]
2. Embryonic period[2 weeks-6weeks]
3. Fetal period [7weeks-till birth]
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23. 1. Germinal period [fertilization-2weeks]
-the fertilized egg is called zygote
-undergoes rapid cell division
- travels through the fallopian tube to the
uterus
- by the end of the germinal period the zygote will
be attached uterine wall
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24. 2.The embryonic period[2 weeks-6weeks]
-in this period the developing individual is known as
Embryo
-characterized by rapid morphologic changes
-cells are rapidly dividing, growing and
differentiating to take specialized function
- at the end of this period the embryo is 2 inches
long and recognized as a human being
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25. 3. The fetal period [7weeks-till birth]
-motor behavior first appears
-developing individual is referred to as fetus
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26. Gestational age developmental characteristics
2 &1/2wks - shape and length are determined
- neural plate begins for brain
- heart may begin as a single tube
may beat , no blood circulating
yet
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27. Gestational age developmental
characteristics
3weeks cell differentiate into three layers :
1. Ectoderm-outer layer becomes the skin, hair,
nails, sensory and skin glands and all nervous
tissue
2. Mesoderm- middle layer becomes muscles,
bones, circulatory organs and some of
endocrine glands
3. Endoderm- inner layer becomes digestive
organs, liver, alimentary tract, linings and
more of the endocrine glands
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28. Gestational age developmental characteristics
28 days -head region is differentiated, taking
up one third of the length of the
body
- brain and primitive spinal cord
develops
- rudimentary eyes, ears and nose
appear
- initial limb buds appear
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29. Gestational age developmental characteristics
Second month -embryo becomes more human
looking with the feature becoming
more identifiable
6 weeks -deciduous teeth form
8 weeks -embryo now becomes a fetus
-Organs become functional
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30. Gestational age developmental characteristics
End of third month - more activity begins
- turns head, bends elbow, makes
fist, fans toes, and moves hips
-movements not detected by
mother, however hiccups will be
felt
Fourth month - finger prints appear
- mother begins to feel movement
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31. Gestational age developmental characteristics
Fifth month - fetus turns and moves about easily
-regular sleep and wake patterns
develop
-sucking reflex is present, heart
beat becomes regular
Sixth month - hair grows thicker
-eyes open and close
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32. Gestational age developmental characteristics
Eight and nine month – strong growth phase starts
-fetal movements begin to
slow
down (why?)
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34. PRETERM INFANT
ü Preterm/premature infant –those with gestational age of less than 38
weeks.
(some books say less than 37???)
ü Most fragile & are at high risk of medical complications b/c of their
immaturity.
ü May develop motor delay equivalent to number of weeks premature.
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35. Ø Evaluated & assessed according to an adjusted age.
Adjusted age= chronological age-delay
Delay = 40 weeks-gestational age in week.
Ø Preterm infant is perceived as small & unattractive & less responsive &
more difficult to calm.
Ø Thus has less bonding compared to term.
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36. .
Ø The hierarchic model: depending on the maturation of the central
nervous system.
Ø The holistic Model: depending on the neuron selectiv theory.
37. The hierarchic theory.
ü The maturation of the cns goes bottom up. From the spinal level,
brainstemlevel up to the sub cortical and cortical level, the next level
inhibbits the former level.
ü The movements progress from primitiv mass reflex patterns to voluntary
isolated movements.
ü The motor development progress in cephalo-caudal direction.
ü The sequence of motor development is consistent among infants and the
rate of development is consistent to the individual.
38. Spinal level
Within this level the movements are phasic in total moving patterns and
unvoluntary and based on (surviving) reflexes.
These reflexes are survival reflexes and are present at birth. For example:
Ø The moro reflex / the startle reflex
Ø The grasp reflex
Ø The rooting / search reflex
Ø The cross extension reflex
Ø The galant reflex
Ø Primary walking and footplacing.
39. The brainstem level
Ø The level of the tonic reactions, these reactions react on the position of
the head.
Ø If they are present the position of the head will distribute the tone in the
rest of the body.
Ø They are mildly present in the first 3-4 months.
Ø They are inhibbited by the development of head control.
for example:
• The asymetric tonic neckreflex ( ATNR)
• The symetric tonic neckreflex ( STNR)
40. The subcortical and cortex level
These are the levels of the automatic reactions, starting with the righting,
support and protective extension, later the equilibrium reactions, and the
voluntary controlled movements.
The primary reflexes and the tonic reflexes disappear, they are inhibbited
by the development of the automatic reactions and by the voluntary
controlled movments.
41. The automatic reactions
1. The righting reactions
2. The support functions
3. The protective extension reactions
4. The equilibrium reactions
42. Righting reactions
Ø These reactions are responsible for the development of the postural
control.
Ø They restore the normal position of the head in space and maintain the
normal postural relationship of the head and the rest of the body in all
activities.
Ø They are important to be able to make transfers.
43. The equilibrium reactions
These reactions are there to restore the balance after displacement of the
body out of the centre of gravity.
The body will come back into the same position.
We have equilibrium reactions in all positions, supine, sitting, standing etc.
44. The support reactions
This reaction will occur when the hand or foot is placed on the surface. The
reaction is to extend the limb and stablise the joint by a co-contraction of
the muscles around the joint.
There are support reactions of the upper extremities and of the lower
extremities, and in all directions.
45. Protective extension reaction.
They protective extension can only occur when the support function is
properly developed.
This is an automatic response against falling to a sudden displacement of
the body. The extremities are extended and reaching out for, and placed on
the surface.
The reactions are present forwards, sideways and backwards.
46. The neuron selective theory.
Ø Motor behaviour observed as an output is a product of the interaction of
the infant, its enviroment and the task.
Ø After birth 80% of the brain has still to be developped. There is an
increase in weight due to the increase of the braincells the synapses and
the myelisation. There are individual influences due to its use.
47. The 3 constraints.
q1. The organism: the maturation of the CNS, disproportion of the head,
overweight, musclestrength, disalignment.
q2. The environment. Factors related to specific tasks, culture, handling,
clothing.
q3. The task: what fits best, for example, moving forwards can be done
either by crawling, or shuffling on the buttocks or elephant walking.
49. Reflex
Definition: (is a motor response), a sensory stimulus
transmits information into the CNS, which in turn
activates a motor neuron to produce a motor response.
- Reflexes are functional and adaptive to the
environment through out the cycle
- The evaluation of reflexes and reactions is one of the
method used for the analysis of posture and
movement in infants and children
- Normal motor coordination is based on reflexes and
reactions which is basic for all voluntary movement
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50. - The majority of primitive reflexes are protective in
nature or serve as a survival function
- Rooting and sucking response enable the infant to
locate nourishment and feed
- Moro, crossed extension , flexor withdrawal protect
the infant from noxious environmental stimuli
- Neck on body righting reaction facilitates positioning
the fetus delivery
Ø absence or persistence of primitive reflexes indicates
abnormal and sever pathology
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52. I. Primary reflexes
Ø Over 70 reflexes
Ø Primary reflexes are spontaneous stereotype
responses to specific stimuli.
Ø These responses are mostly present at birth (40
weeks), and should disappear in the first months
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53. 1.Rooting/searching reflex
Stimulation –place finger on the
corners of the mouth
Response- turns head to the
stimulus moves his mouth
laterally and attempting to take
the finger into his mouth
Present at birth disappear at four to
six months
****enable the baby to find the
nipple without guidance
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54. 2.Sucking reflex
Stimulus- place index finger in the
mouth against the hard plate
Response – immediately begin to
suck
- present at birth
disentegrates by 12 month
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55. 3. Moro
stimulation: sudden change in position of head in
relation to the trunk( drop patient
backward from sitting position)
response: extension, abduction of upper extremity
hand opening and crying followed by,
adduction of arms across chest
onset: 28TH week of gestation
integrated: 5 – 6 months
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57. 4 . Startle
stimulation: sudden loud or hash noise
response: sudden extension or abduction of arms
crying
onset: birth
it persists
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58. 5. Grasp
stimulation: maintained pressure to palm of hand
( palmer grasp) or to ball of foot under
toes ( plantar grasp)
response: maintained flexion of fingers or toes
onset: palmar- at birth (fades away after 2 to 3 months)
plantar – 28th week of gestation
integrated: palmar 4 to 6 months
(gone when the support function of the arms has developed
completely)
plantar 9 months
(disappear when the support function of the legs have completed)
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60. 6.Flexor withdrawal
stimulus: tested in supine or sitting position
pin prick to sole of the foot
Response: toes extended, foot dorsiflexes, entire leg flexes
uncontrollably
onset: 28th week of gestation
integrated: 1-2 months
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61. 7. Crossed extension
Stimulation: noxious stimulus to ball of the foot fixed in extension
Tested in supine
response: opposite lower extremity flexes then
adducts and extends
onset: 28TH week of gestation
integrated: 1-2 months
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62. 8. Traction
stimulation: grasp forearm and pull up from supine
into sitting position
response: grasp and total flexion of upper extremity
then lifting head to align to entire body
onset: 28TH week of gestation
integrated: 2 to 5 months
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64. 9. placing reaction
hold the baby so the dorsum of foot touches the edge of
the table
-Response- flex his leg and place the foot flat on the
table, can be elicited from birth
ü The reflex should be symmetrical and tested both
sides.
ü The reflex disappears at the age of 4-5 weeks.
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66. II. Tonic neck reflexes
1.Asymmetric tonic neck reflex [ATNR]
stimulation: rotation of the head to one side
response: flexion of skull limbs and extension
of the jaw limbs ‘bow and arrow or
‘ fencing ‘ posture
onset: birth
[When maturing, the reflex fades away ( after 2- 3
months), and disappears, it is inhibited when head
control has developed.]
integrated: 4-6 months
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68. 2. Symmetric tonic neck reflex [STNR]
stimulation: flexion or extension of the head
response: with head flexion- flexion of the arms
- extension of thelegs
With head extension - extension of arms
flexion of legs
onset: 4-6 months
integrated: 8- 12 months
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69. 3. Symmetric tonic labyrinthine[TLR] or [ STLR]
stimulation: prone or supine position
response: with prone - increased flexor tone / flexion
of all limbs
with supine - extension of all limbs
onset: birth
integrated: 6 month
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71. III. Automatic or postural reactions
1.The righting reaction
2. Equilibrium reaction
3. Support reaction
4. Protective extension
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72. 1. The righting reactions
qin response to body alignment
1.1 Neck righting action on the body
stimulation: passively turn head to one side tested in
supine
response: body rotates as a whole to align body with
the head
onset: 4 to 6 months
integrated: 5 years
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73. Ø Results alignment of body following the head
Ø Important for transfer
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74. 1.2.Body righting acting on the body
stimulation: passively rotate upper or lower
trunk in supine
response: body segment not rotated follows to
align the body segments
onset: 4-6 months
integrated: 5 years
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75. 1.3.Labyrinthine/ head righting
stimulation: occlude vision then alter body position
by tipping body in all direction
response: head orients to vertical position with
mouth horizontal
onset: birth to 2 month
integrated: persists
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76. 1.4.Optical righting
stimulation: body position by tipping body in all
direction
response: head orients to vertical position
mouth horizontal
onset: birth – 2 months
integrated: persists
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77. 1.5.Body righting acting on head
stimulation: place in prone or supine position
response: head orients to vertical position with
mouth horizontal
onset: birth -2 month
integrated: 5 years
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78. 1.6. Landau reaction
Ø When held in a suspended prone position , results in
elevation of the head followed by increase in spinal
extensor tone and often hip extension
Ø At 3 months only the upper parts will extend
Ø At six months the head is extended and the spine,
arms and legs
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79. 2. The equilibrium reaction
Ø The ability to restore balance after displacement of center of gravity
Ø Balance: Is keeping one’s center of gravity within base of support.
Ø Equilibrium reaction develops in all positions during the first 1 and ½ or
2 years and are present throughout life.
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80. Can be
A. the static equilibrium reactions: These are responsible for remaining
in a stable position, using co-contractions.
B. The dynamic equilibrium reactions: These are responsible to restore a
stable position once you lose your balance.
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81. 3. Support reaction
Ø first develop in the arms later will follow the legs
Ø elicited when the palm of the hand or the sole of the foot is placed on a
surface
Ø So the child will develop the ½ puppy and full puppy position and the
half kneeling and standing position.
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82. 4. Protective extension
Ø appear around at 6-7 months for the upper
extremities and at 9-12 months ( walking sideways
supported) for the lower extremities.
Ø can only develop and be adequate when there is a
good support function of the extremities and full
weight bearing is possible.
Ø an automatic response against falling
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83. stimulation: displaced center of gravity outside the
base of support
response: arms or legs extend and abduct to
support and to protect the body from
falling
integrated: persists
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84. mechanism
Neck righting reflexes
-impulse arising in joint receptors in the neck produce contraction of
limbs and body muscles which align the head
Labyrinthine/head righting reflexes
-stimulation of the labyrinthine/ involved receptors evokes contraction of
the neck muscles to orient the head in relationship to gravitational force
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85. Body righting on head reaction
Asymmetric stimulation of skin receptors Due to differential contact with
supporting surface resulting in activity of trunk and limb muscles which
raises the head into upright position
Body righting on body reaction
Asymmetric stimulation of skin receptors causes contraction of trunk
muscles, which raises the body towards the up right position
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