The following movies demonstrate normal and abnormal postnatal neurological development assessment procedures. The newborn neuromuscular system can be initially assessed by 6 quick tests (posture, square window, arm recoil, popliteal angle, scarf sign and heel to ear). Later developmental assessment includes behaviour, reflexes (primitive and postural), muscular tone, and motor (gross, fine, co-ordination). This is examined in the newborn, 3 months, 6 months, 12 months and at 30 months of age. There are several primitive reflexes (rooting, sucking reflexes, Moro, grasp) that change (are repressed) with development of the central nervous system.These movies were designed by PD Larsen and SS Stensaas, Utah School of Medicine.
WHO Motor Development Milestones
Page Links: Introduction | Introduction to Pediatric Exam | Developmental Anatomy | Newborn Normal | Newborn Abnormal | 3 months | 6 months | 12 months | 18 months | 30 months | Behaviour | Newborn Tone | Moro Reflex | Parachute Reflex Development of Handedness | Neurological Assessment | References | WWW Links | Glossary
Developmental Milestones (663 Kb)
Screening Tools (136 Kb)
Key Principles (397 Kb)
Head Circumference (408 Kb)
First: Stop, Look, and Listen (965 Kb)
Second: Make it a Game (1.0 Mb)
Third: Save the Worst for Last (454 Kb)
General Physician Examination (663 Kb)
Major Events in Brain Development (7.17 Mb)
Brain Growth (2.1 Mb)
Neuronal Growth and Organization (13.2 Mb)
Myelination and Development (16.32 Mb)
Positions - Ventral Suspension
Positions - Vertical Suspension
Reflexes - Deep Tendon Reflexes
Primitive Reflexes - Suck, Root
Primitive Reflexes - Moro (More? Moro Reflex)
Positions
Positions - Ventral Suspension
Positions - Vertical Suspension
Reflexes - Deep Tendon Reflexes
Primitive Reflexes - Suck, Root
Primitive Reflexes - Moro (More? Moro Reflex)
Head
Motor - Head and Trunk Control
Positions - Ventral Suspension
Positions - Vertical Suspension
Reflexes - Deep Tendon Reflexes
Postural Reflexes - Positive Support Reflex
Postural Reflexes - Lateral Propping
Postural Reflexes - Parachute (More? Parachute Reflex)
Head
Behavior - Social and Language
Motor/Reflexes - Deep Tendon Reflexes
Motor/Reflexes - Plantar Reflex
Motor/Postural Reflexes - Parachute (More? Parachute Reflex)
Motor/Coordination - Pincer Grasp
Motor/Coordination - Beads in the Cup
Motor/Coordination - Play Ball
Motor - Transition in and out of Sitting
Behavior/Mental Status - Wants
Behavior/Mental Status - Understanding
Behavior/Mental Status - Points to Pictures
Behavior/Mental Status - Points to Body Parts
Fine Motor/Coordination - Blocks in Cup
Fine Motor/Coordination - Beads in Cup
Fine Motor/Coordination - Stacking Blocks
Fine Motor/Coordination - Pincer Grasp and Handedness
Fine Motor/Coordination - Drawing/Scribbling
Behavior/Mental Status - Establishing Relationship
Behavior/Mental Status - Follows Commands
Behavior/Mental Status - Points to Pictures
Behavior/Mental Status - Names Pictures
Behavior/Mental Status - Response to Questions
Behavior/Mental Status - Pointing to and Naming Body Parts
Fine Motor/Coordination - Using Puppets
Fine Motor/Coordination - Using Measuring Tape
Fine Motor/Coordination - Block Tower
Fine Motor/Coordination - Drawing
Motor/Reflexes - Deep Tendon Reflexes
Newborn: Newborn Behavior | Abnormal Newborn Behavior
3 Month: 3 Month Behavior
6 Month: 6 Month Behavior
12 Month: 12 Month Behavior - Shy | 12 Month Behavior - Social and Language
18 Month: 18 Month Behavior/Mental Status - Wants | 18 Month Behavior/Mental Status - Understanding | 18 Month Behavior/Mental Status - Points to Pictures | 18 Month Behavior/Mental Status - Points to Body Parts
30 Month: 30 Month Behavior/Mental Status - Establishing Relationship | 30 Month Behavior/Mental Status - Follows Commands | 30 Month Behavior/Mental Status - Points to Pictures | 30 Month Behavior/Mental Status - Names Pictures | 30 Month Behavior/Mental Status - Response to Questions | 30 Month Behavior/Mental Status - Pointing to and Naming Body Parts
In the first 12 months no handedness (left/right) preference should be observed (symmetrical use) this feature develops during the second year.
Early handedness warrants an assessment of motor function of the non-preferred hand.
Of the adult human population about 10% (8 to 15%) are left-handed or ambidextrous.
There is some evidence though that fetal handedness can reflect the future development of a left/right preference.
Links: Handedness Research Institute |
There are many different neurological assessment tests that have been designed over the years using a number of motor and intelligence (comprehension) skill tests. Some of these assessment tests are applicable to specific early neurological development ages.
Neonatal
Test of Infant Motor Performance (TIMP) can be used in very early development (from 32 weeks post-conceptional age to 4 months post-term). Involves observation of 28 items and elicitation of 31 items measures behaviours of functional relevance.
Einstein Neonatal Neurobehavioral Assessment Scale
Neurobehavioral Assessment of the Preterm Infant
Bayley Scales of Infant Development (BSID) a postnatal (from 1 to 42 months) neurological assessment scale used in screening and diagnosis of development using 178 item mental scale and the 111 item motor scale, the original BSID was revised in 1993 to version 2 (BSID-II).
Peabody Developmental Motor Scale II (PDMS-2) tests a child’s motor competence relative to his or her peers. Involves a series of evaluations: reflexes (8 items), stationary/nonlocomotor (30 items), locomotion (89 items), object manipulation (24 items), grasping (26 items) and visual-motor integration (72 items).
Infant
Alberta Infant Motor Scale (AIMS) birth to 18 months. Identify infants with motor delay (discrimination) and evaluates motor development over time.
Battelle Developmental Inventory Screening Test (BDIST) for children 6 months to 8 years old.
Brief Assessment of Motor Function (BAMF) is a series of 10-point ordinal scales developed for rapid description of gross motor, fine motor, and oral motor performance.
Fagan Test of Infant Intelligence (FTII)
Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT) a developmental test designed in Taiwan.
Denver-II (CDIIT) a historic test redesigned as a version 2, for 3 and 72 months of age. It has been suggested that the test may require additional revision for better accuracy.
Bruininks-Oseretsky Test of Motor Proficiency (1978) ages 4.5 to 14.5 years.
Early Language Milestone Scale-2, Early Intervention Developmental Profile (EIDP), Gross Motor Function Measure (GMFM)
There are also a range of task based tests: Means-End Problem-Solving Task, Operant Discrimination Learning, Mobile/Train Conjugate Reinforcement Tasks, The Transparent Barrier Detour Task, The A-not-B Task
References:
van Hartingsveldt MJ, Cup EH, Oostendorp RA. Reliability and validity of the fine motor scale of the Peabody Developmental Motor Scales-2. Occup Ther Int. 2005;12(1):1-13.
Cintas HL, Siegel KL, Furst GP, Gerber LH. Brief assessment of motor function: reliability and concurrent validity of the Gross Motor Scale. Am J Phys Med Rehabil. 2003 Jan;82(1):33-41.
Bartlett DJ, Fanning JE. Use of the Alberta Infant Motor Scale to characterize the motor development of infants born preterm at eight months corrected age. Phys Occup Ther Pediatr. 2003;23(4):31-45.
Provost B, Crowe TK, McClain C. Concurrent validity of the Bayley Scales of Infant Development II Motor Scale and the Peabody Developmental Motor Scales in two-year-old children. Phys Occup Ther Pediatr. 2000;20(1):5-18.
Wilkinson AR, Jiang ZD. Brainstem auditory evoked response in neonatal neurology. Semin Fetal Neonatal Med. 2006 Dec;11(6):444-51. Epub 2006 Oct 2. Review.
There are several developmental neurological abnormalities that are diagnosed postnatally as learning disorders. (More? Autism | Fragile X | Neural Notes - Autism | Neural Notes - Fragile X)
Most embryology textbooks (by definition) do not cover postnatal developmenty in any detail.
The links below are to useful external online resources on general postnatal growth.
The World Health Organization (WHO) in a recent publication documented early postnatal motor skill development in terms of "milestones". This was released along with new international growth charts (More? Growth Charts). See also the external linkpage for the original data on which the study and graph are based.
Reference: WHO Multicentre Growth Reference Study Group. WHO Motor Development Study: Windows of achievement for six gross motor development milestones. Acta Paediatrica Supplement 2006;450:86-95.
Measure of newborn neuromuscular development.
Demonstrated by: how far the elbow can be moved across the baby's chest.
Links: Children's Hospital Boston - Assessments for Newborn Babies
Alternative Names: Startle response, Startle reflex, Embrace reflex
Demonstrated by:
Placing the infant face up on a soft, padded surface
Head is gently lifted with enough traction to just begin to remove the body weight from the pad. (Note: The infant's body should not be lifted off the pad, only the weight removed.)
The head is then released suddenly, allowed to fall backward momentarily, but quickly supported again (not allowed to bang on the padding).
The infant may have a "startled" look, and the arms fling out sideways with the palms up and the thumbs flexed.
As the reflex ends, the infant draws its arms back to the body, elbows flexed, and then relaxes.
Newborn: present in newborn infants. Absence of the Moro reflex in an infant is abnormal.
Infants to Adult: presence of a Moro reflex in an older infant, child, or adult is abnormal.
(Text modified from: Medline Plus - Moro reflex)
Links: Medline Plus - Moro reflex | Physical Medicine and Rehabilitation Board Review - Reflex Development |
The parachute is the last of the postural reflexes to develop appearing at 8 to 9 months and definitely present by 12 months of age. Asymmetry of the reflex is abnormal and may indicate paresis (partial loss of movement, or impaired movement) in the non-extended extremity.
Demonstrated by:
turning the child up side down.
arms should come forward and the hands spread out to catch the fall.
Preterm Newborns (gestational age of up to 36 weeks 6 days, weighing 2,000 g or less at birth)
6 months - 8.1% have parachute and lateral propping reactions.
9 months - 87.5% have parachute reaction and 90% have lateral propping reaction. (Data:
Ohlweiler L, da Silva AR, Rotta NT. Parachute and lateral propping reactions in preterm children. Arq Neuropsiquiatr. 2002 Dec;60(4):964-6.)
References:
Wenzel D. The development of the parachute reaction: a visuo-vestibular response. Neuropadiatrie. 1978 Nov;9(4):351-9.
Jaffe M, Kugelman A, Tirosh E, Cohen A, Tal Y. Relationship between the parachute reactions and standing and walking in normal infants. Pediatr Neurol. 1994 Jul;11(1):38-40.
Ohlweiler L, da Silva AR, Rotta NT. Parachute and lateral propping reactions in preterm children. Arq Neuropsiquiatr. 2002 Dec;60(4):964-6.
Journals
Reviews
Tieman BL, Palisano RJ, Sutlive AC. Assessment of motor development and function in preschool children. Ment Retard Dev Disabil Res Rev. 2005;11(3):189-96.
Gale CR, O'Callaghan FJ, Godfrey KM, Law CM, Martyn CN. Critical periods of brain growth and cognitive function in children. Brain. 2004 Feb;127(Pt 2):321-9. Epub 2003 Nov 25.
Gale CR, Walton S, Martyn CN. Foetal and postnatal head growth and risk of cognitive decline in old age. Brain. 2003 Oct;126(Pt 10):2273-8.
Lidsky TI, Schneider JS. Lead neurotoxicity in children: basic mechanisms and clinical correlates. Brain. 2003 Jan;126(Pt 1):5-19.
Frisk V, Amsel R, Whyte HE. The importance of head growth patterns in predicting the cognitive abilities and literacy skills of small-for-gestational-age children. Dev Neuropsychol. 2002;22(3):565-93.
Rice D, Barone S Jr. Critical periods of vulnerability for the developing nervous system: evidence from humans and animal models. Environ Health Perspect. 2000 Jun;108 Suppl 3:511-33. Review. (Pubmed Central)
Articles
Cintas HL, Siegel KL, Furst GP, Gerber LH. Brief assessment of motor function: reliability and concurrent validity of the Gross Motor Scale. Am J Phys Med Rehabil. 2003 Jan;82(1):33-41.
van Hartingsveldt MJ, Cup EH, Oostendorp RA. Reliability and validity of the fine motor scale of the Peabody Developmental Motor Scales-2. Occup Ther Int. 2005;12(1):1-13.
Utah School of Medicine PD Larsen and SS Stensaas series of movies demonstrating normal postnatal neurological development assessment PediNeuroLogic Exam
National Library of Medicine (USA) neurologic diseases
Children's Hospital Boston Assessments for Newborn Babies
Baylor College of Medicine Cain Foundation
University of California Irvine School of Medicine Pediatric Neurology Research
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Page under development (notice removed when complete).
It would seem obvious to say that neural development does not stop at birth.
PD Larsen and SS Stensaas from the Utah School of Medicine have made this series of movies demonstrating normal postnatal neurological development assessment.
Introductory movies are audio over slides.
Age related movies are of live assessments.
It has been recently noted that some primitive reflexes reappear with some old age-related neurological conditions.
Related information can be found on pages: Neural Notes, Hearing Notes, Eye Notes, Fetal Alcohol Syndrome.
Note this current project focuses on prenatal development, so postnatal content is not as detailed.
Please email Dr Mark Hill if you wish to make a comment about this current project.