The document discusses developmental milestones in children, emphasizing the importance of motor development, neural structures, and sensory inputs in achieving these milestones. It outlines various aspects of motor control, learning theories, and clinical practices relevant to improving motor skills in infants and children. Additionally, it addresses primitive reflexes, environmental impacts on development, and identifies critical periods for development, noting that delays in reaching milestones should be considered significant.

1. AJITH M,
BPT IV YEAR,
KG COLLEGE OF
PHYSIOTHERAPY.
DEVELOPMENTAL MILESTONES

2. DEVELOPMENTAL MILESTONES
INTRODUCTION :
 It is an ability, that is achieved by any
child by a certain age and thereby indicating the
typical/healthy growth and development .
 These are behaviour or skills that illustrate
a child’s growth in a number of areas .
 Examples : A baby smiles at first time .

3. MOTOR DEVELOPMENT
 Motor abilities and skills are acquired during the
process of motor development .
 Through motor control and motor learning.
 Motor development is product as well as a process.
 The motor development is regulated by ,
 TIME (age), MATURATION (genes), ADAPTATION
(physical constraints) and LEARNING .

4. NEURILATION
 GERMINAL LAYER’S :
 It is a group of cells in an embryo that interact with
each other as the embryo develops and contribute to
the formation of all organ and tissues.
 ECTODERM ( outer layer )
 MESODERM ( middle layer )
 ENDODERM ( inner layer )

5. DERIATIVES OF GERM LAYERS

6. .
 DEVELOPMENT OF NERVOUS SYSTEM :
 Apart from it’s blood vessels and some neurological
elements ,the whole of the nervous is developed from
ECTODERM .
 Which situated in dorsal aspect of embryonic disc in
midline , and overlies the notochordal process
 Central part of ectoderm ,becomes thick and forms
NEURAL PLATE .
 Later it depressed and forms NEURAL GROOVE .

7. .
NEURAL PLATE
NEURAL GROOVE
NEURAL TUBE
 The fusion occurs first at the cervical region .

8. .
 The neural tube is opened cranially and caudally,
which is known as ,
 ANTERIOR NEUROPORE
 POSTERIOR NEUROPORE
 Then closes completely and forms neural tube which
is short at first but develops when embryo grows .

9. VASICULATION
The cranial part shows three dilatations :
 PROSENCEPHALON
 MESENCEPHALON
 RHOMBENCEPHALON
 The cranio caudall arrangement of this vesicles altered
by some flexures .

10. .
 FORMATION OF VENTRICLES OF BRAIN :
 LATERAL VENTRICLES
 THIRD VENTRICLES
 FOURTH VENTRICLES
 FIFTH VENTRICLES

11.  NEURAL CREST :
 Cells at the junction of neural plate ,specialised to
form the primordia of the neural crest .
 It appears as group of cells lying along the
dorsolateral sides of the neural tube .
 Several important structures are derived from the
neural crest .

12. STRUCTURES INVOLVED IN MOTOR
CONTROL
 CEREBRAL CORTEX
 ENDOCRINE SYSTEM ( NEUROTRANSMITTORS )
 BASAL GANGLIA
 CEREBELLUM
 PYRAMIDAL TRACTS
 SPINAL CORD

15. .
MOTOR CONTROL
&
MOTOR LEARNING

16. MOTOR CONTROL
 DEFINITION :
 Ability to regulate or direct the mechanism
Essential to movement .
OR
 Ability to maintain and change posture and
movement.
 It is the complex set of neurological and mechanical
processes.

17. INFANT’S MOVEMENT PROBLEMS ARE :
 The first movement problem is- GRAVITY
 Second movement problem is - LARGER
HEAD
 Later movement problem is - STABILIY &
MOBILITY of the head ,trunk and limbs .
These are done by motor control.

18. .
MOTOR CONTROL TIME FRAME :
 Motor control processes are happens in fraction of
seconds .
NEWELL’S MODEL OF CONTRAINTS :

19. .
INDIVIDUAL :
 Action/movement
 Perception
 Cognition ENVIRONMENT
TASK: Regulatory
 Stability Non-regulatory
 Mobility
 Manipulation

20. THEORIES OF MOTOR CONTRL
DEFINITION :
 It is a group of abstract ideas about the control of
movement .
HIERARCHIC THEORY
PARALEL DISTRIBUTED THEORY
Other than these few other theories are there , out
of that, these two theories are acceptable.

21. .
Role of sensation in motor control :
 Sensation are the ever-presented cues for motor behaviour in the
seemingly reflex – dominant infant.
 A sensory stimulus produces a reflexive motor responses.
 Example: Touching the lip of a newborn produces head turning.
(ROOTING REFLEX )
 These reflexive movement turned into voluntary movement
motor development .( maturation of nervous system ).
 Sensation provides FEEDBACK accuracy for movement .

22. MOTOR LEARNING
DEFINITION :
 It is the process of acquisition and/or modification skilled
action . ( by practice )
 In essence ,it is the process of learning how to do something
well.
 Learning is the dynamic process ,which takes place over
time and different environment.

23. .
KEY PHASES OR MOTOR PERFOMANCE AND
LEARNING ARE:
 ACQUISITION
 RETENTION
 TRANSFER

24. THEORIES OF LEARNING
ADAM’S CLOSED LOOP THEORY:
Sensory feedback from ongoing movement
compared within the nervous system with stored
memory of the intended movement .
MEMORY TRACE : Initiation
PERCEPTUAL TRACE : Correctness

25. .
 SCHIMDT’S SCHEMA THEORY :
Motor programs do not contain specific of
movement but contain generalised set of rules for
specific class of movement .
 RECALL SCHEMA :
Recalling some processes ( skills ) that we
have already learned .
Example : Any game we learned .

26. .
RECOGNITION SCHEMA :
 Ability to correct wrong thing , during performing
the learned thing in it .
STAGES OF MOTOR LEARNING :
 Cognitive Stage,
 Associative stage,
 Autonomous stage .

27. .
PRACTICAL APPLICATIONS OF MOTOR LEARNING
REASEARCH :
 INTRINSIC /INHERENT FEEDBACK
 EXTRINSIC /AUGMENTED FEEDBACK
 PRACTICE :
Massed v/s Distributed practice

28. .
 Constant v/s Variable practice
 Random v/s Blocked practice
 Whole v/s Part training
 Mental Practice

29. CLINICAL PRACTICE
NEUROFACILITATION APPROACHES :
 Retraining motor control through facilitation /
inhibition of movement pattern .
 BOBATH
 ROOD
 BRUNNSTREM (STROKE – HEMIPLEGIA)
 PNF
 SENSORY INTEGRATION

30. .
Task Oriented Approaches :
 Subject learns functional task rather than basic
movement pattern.
Example: Reaching and walking .
INTERVENTION STRATAGIES TO IMPROVE
MOTOR CONTROL :
“USE IT or LOSS IT”

31. .
Different strategies for improve motor control of
different task :
 Improvement in flexibility
 Improvement in tone
 Improvement in strength ,power & endurance .
 Improvement in postural control
 Improvement in gait and locomotion

32. .
 ELONGATION
 ALIGNMENT
 ACTIVATION
 FUNCTIONAL USE

33. DEVELOPMENTAL MILESTONES
INTRODUCTION :
 It is an ability, that is achieved by any
child by a certain age and thereby indicating the
typical/healthy growth and development .
 These are behaviour or skills that illustrate
a child’s growth in a number of areas .
 Examples : A baby smiles at first time .

34. PRIMITIVE REFLEXES
 Primitive reflexes are involuntary motor responses
originating in the central nervous system ( brain
stem ).
 Because at maturation brainstem , thalamus and
basal ganglia dominant first .
 And the development of cerebral cortex and
cerebellum taking place later but rapidly.
 Nerve fibres become fully functional only after they
have acquired their MYELIN SHEATH.

35. .
 SUCKING / SUCK SWALLOW REFLEX
 ROOTING REFLEX
 MORO REFLEX
 PALMAR GRASP REFLEX
 PLANTAR GRASP REFLEX

36. .
 ASYMETRICAL TONIC NECK /FENSING REFLEX
 SYMETRICAL TONIC NECK REFLEX
 The disappearance of neonatal reflexes during
development occurs as the nervous system matures
and the neural mechanism merge into more complex
mechanism .

37. .
 It is for this reason that infantile responses reappear
after serious brain damage or in degenerative
conditions and also brain damage at birth ( CP ).
 Plasticity in CNS allows for remodelling of some
damaged brain , position of the damaged brain is
important in the final outcome .

38. .
Three types of neural mechanism , Touwen (1976).
 Primary or basic neural mechanisms.
 Mechanisms which merge into larger and more
complex mechanisms .
 Mechanisms which mature more or less
independently and become linked together at a
particular movement .

39. .
 Babies all develop differently and at their own rates.
 These may be slowed down by illness , malnutrition
or motor disorders .
 Families often demonstrate similar patterns of
development , e.g. Rapid motor development ,
shuffling or late walking.

40. DEVELOPMENTAL MILESTONES
GROSS MOTOR
 PHYSICAL
FINE MOTOR
 COGNITIVE
 SPEECH COMMUNICATION
 SOCIO – EMOTIONAL SKILLS

41. .
COGNITION :
This word derives from lateen word
“cognoscente’’ which means “ to know ’’ or “ to
recognise ’’ or “ to conceptualise ’’.
SPEECH – COMMUNICATION :
It is a process by which we assign and
convey meaning is an attempt to create shared
understanding .

42. .
SOCIO –EMOTIONAL SKILLS :
 The sense of self & relationships domain of
development refers to the social and emotional
development .
 Children go through especially in the first
five years of life .
 During which they begin to understand who
they are , what they are feeling and what they expect
when interacting with others .

43. .
DEVELOPMENTAL PROCESSES:
 Motor development is a result of three
processes ;
 GROWTH .
 MATURATION .
 ADAPTATION .

45. GROSS MOTOR MILESTONES
 Gross motor refers to large muscle movements .
 Skills that are use large muscles
 Example : Walk independently , walk sideways ,
crawl up stairs .
 This development depends upon their environment .
 Each baby is unique and grows at his / her own rate.
 The purpose this checklist is to provide a reference
to help guide you through your child’s development
and what expect certain age .

46. .
HEAD CONTROL:
 Exhibit good head control by four months of age.
 The infant should able to keep the head in line with
the body ( Ear and acromian in same line ) when
pulled to sit from supine position .
 During this time , the infant can able to lift the head
up against gravity past 45 degrees .
 In five months, the infant able lift the head against
gravity in supine position .

47. .
SEGMENTAL ROLLING :
 Infants do LOG ROLL ( 4 - 6 months ) ,before they
are able to demonstrate SEGMENTAL ROTATION
(At 6 – 8 Months ).
 In log rolling head and trunk roll as unit without any trunk
rotation.
 In segmental rolling the separate upper & lower trunk
rotation occurs .
 MECHANICAL ADVANTAGES OF PRONE POSITION :

48. .
SITTING :
 It change in functional orientation of the infant .
 Achieved by 8 month of age .
 In sitting the back should be straight without any
kyphosis .
 No hand support is needed when infant sits
independently .
 The ability to turn head and trunk is important for
interacting with environment for dynamic balance .

49. .
CRUISING AND CREEPING :
 In 9 month of age .
 The infants pulling up to stand and are cruising
around the furniture .
 Coffee table and couch are perfect for this activity.
 At the same time or within one months ( 10 ) ,infant
begins to recibrocally creep forward on their hands
and knees .

50.  CRAWLING :
 In the age of 10 month.
 Infant begins to recibrocally creep forward on their
hands and knees .
 The baby shuffles forwards, backwards or both.
 Crawling is considered the first form of independed
movement.
 It helps develop and enhance our vestibular/balance
system ,cognition, problem solving skills and
coordination .

51.  STANDING :
 Between 7 and 12 months baby should move on to
pulling himself up .
 Before your baby can stand he / she will need to gain
muscle strength and coordination.
 He may only be able to stand for a few moments, so
keep an eye on your baby at this stage.
 Around his first birthday ,confidence and balance
will help to achieve his ultimate goal of standing
without support.

52. .
WALKING :
 The last major gross motor milestone is walking .
 The new walker assume a wide base of support , with legs
adducted and externally rotated .
 It occurs between 12 to 18 months ,however some baby can
at 7 month.
THE MOST IMPORTANT MILESTONES IS HEAD
CONTROL AND SITTING

53. FINE MOTOR MILESTONES
 It give the ages at which major changes occur
in the development of prihention .
 PREHENSION is the act of grasping .
HAND REGARD : ( Eye - hand co-ordination )
 The infant first recognizes the hand at 2 months of
age , when the enter the field of vision .
 Because of physiologic flexor tone in the newborn ,
the hands are initially loosely fisted .

54. .
REFLEXIVE PALMAR GRASP :
 Initially it is a reflexive process .
 Later it replaced by voluntary palmar grasp by 6
month of age .
 The thump does not participate .
RADIAL PALMAR GRASP :
 At 7 months , the thumb begins to adduct .

55. .
 In radial palmar grasp the radial side of the hand is
used to along with thumb to pick up small objects .
 Such as , 1 inch cubes .
RADIAL DIGITAL GRASP :
 Radial palmar grasp is replaced by radial digital
grasp , as the thumb begins to oppose .
 Objects can then be grasped by the ends of the
fingers ,rather than having into the palm of the hand.

56. .
PINCHER GRASP :
 Done by using thumb and index fingers only .
Inferior pincher grasp :
 The thumb is on the lateral side of the index finger .
 As if you were to pinch someone .
Superior pincher grasp : ( evident in 1 year )
 Thumb and index fingers are tip to tip .
 As in picking of raisin or a piece of lint .

57. .
THREE JAW CHUCK GRASP :
 The wrist is extended , middle and index and thumb
are used to grasp blocks and containers .
RELEASE :
 As voluntary control of wrist , fingers ,and thumb
extensors develops the infant is able to demonstrate
the ability of releasing a grasped object .
 Transforming of object from one hand another is
possible at 5 to 6 months .

58. .
 Because one hand is controlled by another .
 True voluntary release with external support is seen
around 7 to 9 months .
 Voluntary release done without external support at
12 months .
 Release continues to be refined and accuracy
improved with ball throwing in childhood .

59. DEVELOPMENTAL DELAY
 The first 3 years of life is considered as “critical
period ” in child’s life .
 Delay in reaching language , thinking ,social –
emotional and motor skills milestones is called
developmental delay.
 At any point of infancy and toddlerhood if delay is
observed it should be considered as “ RED FLAGS ”.
 The principle is “ USE IT or LOSS IT ” and
“USE IT and GROW IT ”.

60. References ;
 K Sembhulingam,
 B D chaurassia,
 Anne shumwaycook ,
 Keshlor,
 Cash’s neuro,
 Susan B O sullivan,
 Lindsey,
 Human embryology ,