Pediatric Rehab Note 1

Growth-Development
Assist. Prof. Merve YILMAZ MENEK

 Growth: increase in body volume and
mass
 Development: Acquisition of biological
functions and maturation
Normal Motor Development
“We are unable to assess abnormal tone, reflexes,

or movement patterns without first understanding
what is normal.”
Characteristics of Motor Development
• Involves change in movement behavior
• Sequential, age-related, continuous
• Depends on underlying processes

What is normal movement ?
• Normal movement is voluntary and controlled
• Normal movement occurs without excess movement
• Normal movement requires normalized muscle

and tone.
• Normal movement requires postural control
• Normal movement is automatic

A Paradox in Development
• Universality: Individuals in a species show great

similarity in development.
• Variability: Individual differences exist.
• No 2 beings are exactly alike.
• Accepted developmental sequence i.e. crawl and walk
doesn’t always happen
• Explore external factors
• Development not always consistent but rather in spurts
Normal Development is dependent on:
• Maturation of the nervous system
• Genetics
• Environmental Experiences
• Sensory Systems
Patterns of Normal Development
• Cephalocaudal
• Proximodistal
• Proximal Extension develops before proximal
flexion
• Movements occur 1st in horizontal, then sitting,
then standing
• Gross to fine- dissociation
• Reflexive to Voluntary
• Development is overlapping and sequential
Principles of Development
1. The first motor human behavior is reflexes.
 Reflexive movements occur quickly after onset of stimuli.
 They involve single muscle or specific group of muscles (not
whole body).
 Reflexes allow “dialogue” with environment.
 Reflexive movements result in sensory consequences
(adaptation).
 Reflexes provide building blocks for future movement.
 Persistence may indicate neurological problems.
Reflexes/Primary Motor Patterns
Reflex response:
"motor output that predictably follows some

specific sensory input“
We are interested in these more for the

impact that they may have on children with
a neurological insult.
In the neurologically normal child will only

be transient.
2. With the baby's development, limb movements
can be independent of each other and joints in
the limb can be moved independently of the
other.
 Alternative or reciprocal kicks develop with this step.
 The baby can move the limbs independently of
each other.
3. Development is seen in cephalocaudal

direction.
4.The tonus development of the lower extremity and lower

trunk occurs before the tonus development of the upper
trunk and upper extremity.
5.There is a certain sequence in the development of two

main muscle groups (flexor and extensors). As seen in term
babies born with physiological flexion, tonus develops in the flexor
muscles before the extensor muscles.
6. In each posture, the development of antigravity

movement and control occurs first in the extensor muscles.
 For example, the baby first uses the cervical extensors in the prone
position and learns to raise her/his head against gravity.
Subsequently she/he can do this with the flexor control in the
supine position.
7. The motor control develops from the medial to the lateral.
 The control develops earlier in the midline of the body.

 Example 1: the baby first brings his/her hands to the midline
and gains control there.
 Example 2: The grip starts on the ulnar side.
8. For full control of the joint, both flexor and extensor muscle
control is needed.
In cephalocaudal development, trunk extensors develop before

trunk flexors.
Therefore, the baby can stand on his elbows in the prone position at
the age of four months and can use the back extensors in the
midline, but can take his foot to his mouth in the supine position
at the age of 5 months.
9.The weight bearing function occurs in the flexed extremities
before extension.
10.Gross motor skills develop before fine motor skills.

The baby first stabilizes her shoulder with large muscles and then gains
control of fine skills with the development of small finger muscles.
11. The direction of development is from proximal to distal.
Proximal parts of the lower and upper extremities provide control

before the distals.
The stages of
childhood;
 Newborn (first 28 days)
 Infant (28 days-2 years)
 Preschool (2-6 years)
 School age (6-12 years)
 Puberty (12-18 years)
• Motor, sensory and cognitive integrity are among the most important
parameters of development in normal children.
• Motor and reflex development, proper postural control, adequate limb

movements and muscle tone, complete sensory and timely completion
of cognitive functions are necessary for the child's functional
independence, social and emotional development.
-Reflexes are the first steps of motor development that occurs
with cognitive, sensory and social development.
-These reflexes are then replaced by reactions
-Mobility is the most important element of motor
development.
-In normal motor development, both distal and proximal body
parts develop simultaneously.
-Proximal stability provides distal mobility. Head and trunk
movements are affected by distals, then distal movements
begin to affect the trunk.
The child's neuromotor evaluation is examined
under the following headings:
-Gross motor development

-Fine motor development
-Sensory development
-Personal and social development
-Language development

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Growth-Development

Assist. Prof. Merve YILMAZ MENEK

“We are unable to assess abnormal tone, reflexes,

• Involves change in movement behavior

• Sequential, age-related, continuous

• Depends on underlying processes

• Normal movement is voluntary and controlled

• Normal movement occurs without excess movement

• Normal movement requires normalized muscle

• Normal movement requires postural control

• Normal movement is automatic

• Universality: Individuals in a species show great

"motor output that predictably follows some

We are interested in these more for the

In the neurologically normal child will only

3. Development is seen in cephalocaudal

4.The tonus development of the lower extremity and lower

5.There is a certain sequence in the development of two

6. In each posture, the development of antigravity

 The control develops earlier in the midline of the body.

In cephalocaudal development, trunk extensors develop before

10.Gross motor skills develop before fine motor skills.

11. The direction of development is from proximal to distal.

Proximal parts of the lower and upper extremities provide control

• Motor and reflex development, proper postural control, adequate limb

-Gross motor development

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