Growth & Development

Growth & DevelopmentGrowth & Development

Dr. Amendi Nasution, SpRMDr. Amendi Nasution, SpRM7 Oktober 20087 Oktober 2008

UNTAN - PONTIANAKUNTAN - PONTIANAK

FALSAFAH & TUJUANFALSAFAH & TUJUANREHABILITASI MEDIKREHABILITASI MEDIK

Falsafah rehabilitasi medik ialah Falsafah rehabilitasi medik ialah meningkatkan meningkatkan kemampuan fungsionalkemampuan fungsional seseorangseseorang sesuai dengan sesuai dengan potensi yangpotensi yang dimilikidimiliki untuk mempertahankan dan atau untuk mempertahankan dan atau meningkatkan meningkatkan Kualitas hidupKualitas hidup dengan cara dengan cara mencegah atau mengurangi mencegah atau mengurangi Impairment, Impairment, DisabilityDisability dan dan handicap handicap semaksimal semaksimal mungkinmungkin

PENILAIAN POTENSI PENILAIAN POTENSI REHABILITASIREHABILITASI

Kemampuan fungsional seseorangKemampuan fungsional seseorang Potensi yang masih dimilikiPotensi yang masih dimiliki Kualitas HidupKualitas Hidup Diagnosis Kecacatan:Diagnosis Kecacatan:

– ImpairmentImpairment– DisabilityDisability– Handicap Handicap

PENILAIAN POTENSI REHABILITASIPENILAIAN POTENSI REHABILITASI

Penilaian medisPenilaian medis Penilaian kemampuan fungsionalPenilaian kemampuan fungsional

Target Pencapaian Target Pencapaian

FungsionalFungsional

Diagnosis anatomiDiagnosis etiologiDiagnosis fungsional

Upaya Rehabilitasi MedikUpaya Rehabilitasi Medik

Bagian integral dari pelayanan Bagian integral dari pelayanan Kedokteran/Kesehatan yang berkaitan Kedokteran/Kesehatan yang berkaitan

langsung dengan terwujudnya kualitas hidup langsung dengan terwujudnya kualitas hidup seorang pasienseorang pasien

Proses Rehabilitasi MedikProses Rehabilitasi Medik

AdalahAdalah

Proses mengembalikanProses mengembalikan

Seseorang, dari perannya sebagai pasien, Seseorang, dari perannya sebagai pasien, menjadi seorang manusia seutuhnyamenjadi seorang manusia seutuhnya

Pembagian Divisi di Departemen Pembagian Divisi di Departemen Rehabilitasi Medik:Rehabilitasi Medik:

Divisi musculoskeletalDivisi musculoskeletal Divisi neuromuskularDivisi neuromuskular Divisi pediatriDivisi pediatri Divisi cardiopulmonalDivisi cardiopulmonal Divisi geriatriDivisi geriatri Divisi cedera olahragaDivisi cedera olahraga

Growth & DevelopmentGrowth & Development

Deviation from (N)Deviation from (N)

Short termShort term Long termLong term PrognosesPrognoses PrognosesPrognoses

Functional interventionFunctional interventionPreventif interventionPreventif intervention

GrowthGrowth

Growth Growth physical size : physical size : – > infancy> infancy– > prepubescence > prepubescence adolescence adolescence

Infancy: head >> growthInfancy: head >> growth Infancy + adolescence: trunk >>Infancy + adolescence: trunk >> 1 year 1 year puberty: extremities puberty: extremities

GrowthGrowth

Illnesses / disabilities Illnesses / disabilities affect growth: affect growth:– Neurologic impairmentNeurologic impairment– Oral motor dysfunction Oral motor dysfunction caloric needs caloric needs– Endocrine dysfunctionEndocrine dysfunction– Systemic skeletal diseases: cerebral palsy, Systemic skeletal diseases: cerebral palsy,

down syndromdown syndrom

Table. Growth from Birth to MaturityTable. Growth from Birth to MaturityHead Head

CircumferenceCircumferenceWeightWeight Height/StatureHeight/Stature Sitting HeightSitting Height

BirthBirth 35 cm35 cm Birth (full Birth (full term)term)

3400 gm3400 gm BirthBirth 50 cm50 cm GirlsGirls BoyBoy

4 4 monthsmonths

41 cm41 cm 5 months5 months DoubleDouble 12 12 monthsmonths

75 cm75 cm NewbornNewborn 34 cm34 cm 35 cm35 cm

12 12 monthsmonths

47 cm47 cm 12 months12 months TripleTriple 4 years4 years 100 cm100 cm 5 years5 years 61 cm61 cm 62 cm62 cm

MaturityMaturity 57 cm57 cm Until Until adolescent adolescent growth growth spurtspurt

2 kg 2 kg (annually)(annually)

Early Early school school ageage

5 cm 5 cm (annually)(annually)

10 years10 years 73 cm73 cm 74 cm74 cm

PrepubesPrepubescence/ cence/ adolesceadolescencence

5 – 8 cm5 – 8 cm

(annually)(annually)

18 years18 years 88 cm88 cm 92 cm92 cm

GrowthGrowth

1.1. Head circumference is measured with a Head circumference is measured with a tape placed firmly over the glabella and tape placed firmly over the glabella and supraorbital ridges anteriorly and on the supraorbital ridges anteriorly and on the maximal protuberance of the occiput maximal protuberance of the occiput posteriorly.posteriorly.

– Birth Birth 1 year 1 year– 34 – 35 cm 34 – 35 cm +12 cm +12 cm

GrowthGrowth

HC enlargement caused are:HC enlargement caused are:– Hydrocephalus Hydrocephalus elevated intracranial pressure elevated intracranial pressure– Space Occupying Lesion (SOL)Space Occupying Lesion (SOL)– Intracranial hemorrhageIntracranial hemorrhage

GrowthGrowth

2.2. HeightHeight– Full term newborn: average 50 cmFull term newborn: average 50 cm– First 12 months: First 12 months: 50% 50%– Second year: 12 cmSecond year: 12 cm

3.3. WeightWeight– Full term newborn: average 2500 – 4600 gramFull term newborn: average 2500 – 4600 gram– First years: 3x birth weightFirst years: 3x birth weight

DevelopmentDevelopment

Is the acquisition and refinement of advancing Is the acquisition and refinement of advancing skills.skills.

Under normal circumstances the acquisition of Under normal circumstances the acquisition of new skills proceeds along a predictable sequence new skills proceeds along a predictable sequence and time table.and time table.

Individual variations may occur within certain Individual variations may occur within certain limits, more likely in the timing than in the limits, more likely in the timing than in the sequence of obtaining specific milestones sequence of obtaining specific milestones

Infants & children with physical disabilities it is Infants & children with physical disabilities it is important to note important to note

AccomplishmentAccomplishment Quality of motorQuality of motor

of a task of a task performance performance

Infants & children Infants & children at risk / delayed at risk / delayed

- Early detection- Early detection

- Early intervention- Early intervention

- Preschool program- Preschool program

Gesell and AmatrudaGesell and Amatruda

1.1. Gross motor behavior – preambulatory skills, Gross motor behavior – preambulatory skills, walking, and advanced physical activitieswalking, and advanced physical activities

2.2. Fine motor – adaptive behavior – prehension, Fine motor – adaptive behavior – prehension, manipulatory hand skills, and application of manipulatory hand skills, and application of sensorimotor abilities to tasks of daily lifesensorimotor abilities to tasks of daily life

3.3. Language behavior – vocalization, Language behavior – vocalization, comprehension, expression in spoken or other comprehension, expression in spoken or other modes of communicationmodes of communication

4.4. Personal – social behavior – acquisition of Personal – social behavior – acquisition of societal and cultural standards of behaviorsocietal and cultural standards of behavior

Milestones in Child DevelopmentMilestones in Child DevelopmentAgeAge Gross MotorGross Motor Fine Motor Fine Motor

AdaptiveAdaptivePersonal / Personal /

SocialSocialSpeech and Speech and LanguageLanguage

CognitiveCognitive EmotionalEmotional

NewbornNewborn Flexor tone Flexor tone

predominatespredominates

In prone, In prone,

turns head to turns head to

sideside

Automatic Automatic

reflex walkingreflex walking

Rounded Rounded

spine when spine when

held held

sittingsitting

Hands fisted Hands fisted

Grasp reflexGrasp reflex

State-State-

dependentdependent

ability to fix ability to fix

and follow and follow

bright bright

objectobject

Habituation Habituation

and some and some

control of control of

statestate

CryCry

State-State-

dependent dependent

quieting quieting

and head and head

turning to turning to

rattle or rattle or

voicevoice

SensorimotorSensorimotor

0 – 24 0 – 24

monthsmonths

Reflex stageReflex stage

Basic trust Basic trust

vs. basicvs. basic

mistrustmistrust

(first year)(first year)

Normal Normal

symbioticsymbiotic

phase –phase –

does not does not

differentiatedifferentiate

between selfbetween self

and motherand mother

4 months4 months Head midlineHead midline

Head held Head held

when pulled when pulled

to sitto sit

In prone, lifts In prone, lifts

head to 90head to 90O O

and lifts chest and lifts chest

slightlyslightly

Turns to supineTurns to supine

Hands Hands mostlymostly

openopen

Midline hand Midline hand

playplay

Crude Crude

palmarpalmar

graspgrasp

RocognizesRocognizes

bottlebottleTurns of Turns of

voice and voice and

bell bell

concistentlyconcistently

Laughs, squeals Laughs, squeals

Responsive Responsive

vocalizationvocalization

Blows Blows

bubbles, bubbles,

raspberriesraspberries

AgeAge Gross MotorGross Motor Fine Motor Fine Motor AdaptiveAdaptive

Personal / Personal / SocialSocial

Speech and Speech and LanguageLanguage


7 months7 months MaintainsMaintains sitting, maysitting, may lean on lean on armsarmsRolls to Rolls to proneproneBears all Bears all weight; weight; bounces bounces when held when held erecterect

IntermediateIntermediate graspgraspTransfers Transfers cube from cube from hand to hand to handhandBangs Bangs objectsobjects

DifferentiatesDifferentiates between between familiar familiar person and person and strangerstrangerHolds bottle Holds bottle Looks for Looks for dropped dropped object object “ “Talks” to Talks” to mirror imagemirror image

Uses single-Uses single- words and words and double-double- consonant – consonant – vowel vowel combinationscombinations

At 5 months At 5 months began to began to differentiate differentiate between between mother and mother and self, i.e., self, i.e., beginning of beginning of separation – separation – individuationindividuationHas a sense of Has a sense of belonging to belonging to a central persona central person

10 10 monthsmonths

Creeps on all Creeps on all foursfoursPivots in Pivots in sittingsittingStands Stands momentarilymomentarilyCruisesCruisesSlight bow legSlight bow legIncreased Increased lumbar lumbar lordosis; acute lordosis; acute lumbosacral lumbosacral angulationangulation

Pincer Pincer grasp, grasp, mature mature thumb to thumb to index graspindex graspBangs two Bangs two cubes held cubes held in handsin hands

Plays peek-a-Plays peek-a- boobooFinger feedsFinger feedsChews with Chews with rotary rotary movementmovement

Shouts for Shouts for attentionattentionImitates Imitates speech speech soundssoundsWaves bye-Waves bye- byebyeUses “mama”Uses “mama” and “dada”and “dada” with meaningwith meaningInhibits Inhibits behavior to behavior to “ “no”no”

Can Can retrieve retrieve an object an object hidden hidden from viewfrom view

Practicing phase Practicing phase of separation – of separation – individuation, individuation, practices practices initiating initiating separationsseparations


Personal / Personal / SocialSocial

Speech and Speech and LanguageLanguage


14 14 monthsmonths

Walks alone, Walks alone, arms in high arms in high guard or guard or midguardmidguardWide base, Wide base, excessive excessive knee and hip knee and hip flexionflexionFoot contact on Foot contact on entire soleentire soleSlight valgus of Slight valgus of knee and feetknee and feetPelvic tilt and Pelvic tilt and rotationrotation

Piles twoPiles two cubes cubes Scribbles Scribbles Spon-Spon- taneouslytaneouslyHolds crayon Holds crayon full length in full length in palm palm Casts objectsCasts objects

Uses spoon Uses spoon with over-with over- pronationpronation and spillingand spillingRemoves a Removes a garmentgarment

Uses single Uses single words words UnderstandsUnderstands simplesimple commandscommands

Differentiates Differentiates availableavailable behavior behavior patterns for patterns for new ends, new ends, i.e., pulls i.e., pulls rug on rug on which is a which is a toytoy

Rapprochement Rapprochement phase of phase of separation – separation – individuation; individuation; ambivalent ambivalent behavior to behavior to mothermotherStage of Stage of autonomy vs. autonomy vs. shame and doubt shame and doubt (1 – 3 years) (1 – 3 years) Issue of holding Issue of holding on and letting goon and letting goPleasure in Pleasure in controlling controlling muscles and muscles and sphincterssphincters

18 18 monthsmonths

Arms at low Arms at low guardguardMature support- Mature support- ing base and ing base and heel strikeheel strikeSeats self in Seats self in chairchairWalks Walks backwardbackward

Emerging Emerging hand hand dominancedominanceCrude releaseCrude releaseHolds crayon Holds crayon butt end in butt end in palm palm Dumps raisin Dumps raisin from bottle from bottle spontaneouslyspontaneously

Imitates Imitates houseworkhouseworkCarries, hugs Carries, hugs dolldollDrinks from Drinks from cup neatlycup neatly

Points to Points to named body named body partpartIdentifies one Identifies one picturepictureSays “no”Says “no”JargonsJargons

Capable of Capable of insight, i.e., insight, i.e., solving a solving a problem by problem by mental combi-mental combi- nations, not nations, not physical physical gropinggroping


Personal / SocialPersonal / Social Speech and Speech and LanguageLanguage


2 years2 years Begins running Begins running Walks up and Walks up and down stairs down stairs alonealoneJumps on both Jumps on both feet in placefeet in place

Hand Hand dominance is dominance is usualusualBuilds eight-Builds eight- cube towercube towerAligns cubes Aligns cubes horizontallyhorizontallyImitates verticalImitates vertical linelinePlaces pencil Places pencil shaft between shaft between thumb and thumb and fingerfingerDraws with arm Draws with arm and wrist actionand wrist action

Pulls on garmentPulls on garmentUses spoon wellUses spoon wellOpens door Opens door turning knobturning knobFeeds doll with Feeds doll with bottle or spoonbottle or spoonToilet training Toilet training usually begunusually begun

Two-word Two-word phrases arephrases are commoncommonUses verbsUses verbsRefers to selfRefers to self by nameby nameUses “me”,Uses “me”, “ “mine”mine”Follows simpleFollows simple directionsdirections

PreoperationalPreoperational period (2 – 7 period (2 – 7 years)years)Able to evoke Able to evoke an object or an object or event not event not presentpresentObject Object permanence permanence establishedestablishedComprehendsComprehends symbolssymbols

3 years3 years Runs wellRuns wellPedals tricyclePedals tricycleBroad jumpsBroad jumpsWalks up stairsWalks up stairs alternating feetalternating feet

Imitates three-Imitates three- cube bridgecube bridgeCopies circleCopies circleUses overhandUses overhand throw withthrow with anteropos- anteropos- terior arm andterior arm and trunk motiontrunk motionCatches with Catches with extended armsextended arms hugging hugging against body against body

Most ChildrenMost Children toilet trained daytoilet trained day and nightand nightPours from Pours from pitcherpitcherUnbuttons; Unbuttons; washes and washes and dries hands and dries hands and facefaceParallel playParallel playCan take turnsCan take turnsCan be reasonedCan be reasoned withwith

Three-wordThree-word sentences aresentences are usualusualUses future tenseUses future tenseAsks what, who, Asks what, who, wherewhereFollows Follows prepositional prepositional commands, i.e., commands, i.e., put it underput it underGives full nameGives full nameMay stutter in May stutter in eagernesseagernessIdentifies self as Identifies self as boy and girlboy and girlRecognizes three Recognizes three colorscolors

PreoperationalPreoperational period continues:period continues:Child is capable of:Child is capable of: deferred imitationdeferred imitation symbolic playsymbolic play drawing of graphicdrawing of graphic imagesimages mental imagesmental images verbal evocation verbal evocation of events of events

Stage of Stage of initiative initiative vs, guilt vs, guilt (3-5 years)(3-5 years) Deals with Deals with issue of issue of genital genital sexualitysexuality


Personal / SocialPersonal / Social Speech and Speech and LanguageLanguage


4 years4 years Walks down Walks down stairs stairs alternating alternating feetfeetHops on one Hops on one footfootPlantar archesPlantar arches developingdevelopingSits up from Sits up from supine supine position position without without rotatingrotating

Handles a pencil Handles a pencil by finger and by finger and wrist action, like wrist action, like adultsadultsCopies a crossCopies a crossDraws a froglikeDraws a froglike person with person with head and head and extremitiesextremitiesThrows Throws underhandunderhandCuts with Cuts with scissorsscissors

Cooperative Cooperative play – sharing play – sharing and interactingand interactingImaginative Imaginative make believe make believe playplayDresses and Dresses and undresses undresses with supervisionwith supervision distinguishing distinguishing front and back offront and back of clothing and clothing and buttoningbuttoningDoes simple Does simple errands out-side errands out-side of homeof home

Gives connected Gives connected account of account of recent recent experiencesexperiencesQuestions why, Questions why, when, howwhen, howUses past tense, Uses past tense, adjectives, adjectives, adverbsadverbsKnows oppositeKnows opposite analogiesanalogiesRepeats four Repeats four digitsdigits

5 years5 years Skips; tiptoesSkips; tiptoesBalances 10Balances 10 seconds on seconds on each footeach foot

Hand dominanceHand dominance expectedexpectedDraws man with Draws man with head, body, head, body, and extremitiesand extremitiesThrows with Throws with diagonal arm diagonal arm and body and body rotationrotationCatches with Catches with handshands

Creative playCreative playCompetitive teamCompetitive team playplayUses fork for Uses fork for stabbing foodstabbing foodBrushes teethBrushes teethIs self-sufficient inIs self-sufficient in toiletingtoiletingDresses without Dresses without supervision supervision except tying except tying shoelacesshoelaces

Fluent speechFluent speechMisarticulations Misarticulations of some soundsof some sounds may persistmay persistGives name, Gives name, address, ageaddress, ageDefines concreteDefines concrete nouns by com-nouns by com- position, position, classification, classification, or useor useFollows three-Follows three- part commandspart commandsHas number Has number concepts to 10concepts to 10

Stage of Stage of industry vs. industry vs. inferiority (5 inferiority (5 years-years- adolescence)adolescence)Adjusts himself Adjusts himself to the to the inorganic laws inorganic laws of the tool of the tool worldworld

Tes-tes untuk development:Tes-tes untuk development:– Denver Development Screening testDenver Development Screening test– The Gross Motor Functional Measure (GMFM)The Gross Motor Functional Measure (GMFM)– Functional Independence Measure for Children Functional Independence Measure for Children

(WEEFIM)(WEEFIM)– The Pediatric Evaluation of Disability Inventory The Pediatric Evaluation of Disability Inventory

(PEDI)(PEDI)

ConclusionConclusion

Knowledge of Knowledge of normal growth patterns, normal growth patterns, functional milestone, and potential functional milestone, and potential deviationsdeviations is important to the is important to the comprehensive management of children comprehensive management of children with developmental or acquired disability.with developmental or acquired disability.

Growth & Development

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