Thread: Milestones & Areas to be concerned about in Cerebral Palsy

THE MILESTONES | 1 - 3 MONTHS
• Attempts to hit or swipe at moving objects with hands
• Change of expression at the sound of a familiar voice
• Enjoys interactions with others
• Attempts to use hands and eyes in coordination
• Appears to recognize familiar faces and objects
• Kicks and pushes with legs when placed supine or prone
• Automatic stepping response when held up with feet on a firm surface
• Recognizes sounds and turns head toward the sound
• Begins to coo and babble
• Will raise chest and head when placed prone
• Will open and close hands and able to mouth the hand or fingers
• Grasp and shake small toys

AREAS OF CONCERNS
• Cannot support head at 3 months
• Will not extend legs when placed on a hard surface by 4 months
• Eyes do not follow objects by 2 to 3 months
• Little babbling and does not mimic by 4 months
• No response or startle reflex to loud sounds or noises
• No smile or change of expression by 2 months
• Appears disinterested in new faces
• Does not bring objects to the mouth by 4 months
• Legs and arms appear weak, no kicking or grabbing


THE MILESTONES | 4 - 7 MONTHS
• Curious of mirror images
• Able to support weight on lower extremity
• Able to cross the midline and hand objects hand-to-hand
• Can track moving objects with eyes
• Shows a response to emotions of others
• Explores to find hidden objects
• Able to roll prone to supine and supine to prone
• Sits without support
• Able to reach out with one hand
• Interacts in social playing and activities

AREAS OF CONCERN
• Stiffness or appearance of spasticity
• Cannot become content
• Unable to roll
• Dislikes being held or hugged
• Unable to sit independently
• Does not eye track
• Unable to support body weight on legs
• Does not look for sounds or sources of noise
• Does not smile
• Not interested in interactive play with others
• Not babbling or mimicking others


THE MILESTONES | 8 - 12 MONTHS
• Says a few words such as mom, dad, dog, uh-ohh
• Imitates others at play
• Babbles with true meaning
• Furniture walks
• Pulls to standing
• Transitions from sitting to crawling position
• Stands for short periods of time without assistance
• Can hit two items together
• Can put toys in a box and take them out
• Explores with index finger
• Attempts to copy words and sounds for attention
• Is aware of familiar people and toys
• Knows parents
• Starts to become fearful of certain situation
• Understands simple words such as no
• Can finger feed
• Can respond with gestures
• Walks two to three steps unassisted

AREAS OF CONCERN
• Not crawling
• Not standing with support
• Drags of favors one side
• Not saying simple words
• Not doing simple gestures
• Cannot go from sitting position to crawling position unassisted
• Not able to put objects in and out of a box


MILESTONES | 1 - 2 YEARS
• Says several single words (15 - 18 months)
• Creates two to four word sentences (18 - 24 months)
• Can kick a ball
• Is climbing on and off furniture unassisted
• Can walk and carry several objects
• Starts to run
• Recognizes familiar names and people
• Listens to and follows simple instructions
• Ascend and descend stairs independently
• Plays with other children
• Can stand on tip-toes
• Repeats words
• Can locate hidden objects
• Knows names and locations of several body parts

AREAS OF CONCERN
• Has not developed an efficient ambulatory routine
• Not talking in at least two word sentences by 2 years
• Not following simple instructions

Atypical behaviors 13 -14 month-olds
• Absence of transition from bottom scooting or bunny hopping to ambulation

Atypical behaviors in 15 - 16 month-olds
• If walking has not occurred, consider for delay in all areas and in-depth assessments need to be undertaken

Atypical behaviors in 17 - 18 month-olds
• Ceiling age for onset of independent ambulation

Atypical behaviors in 20-22 month-olds
• A base of support much wider than the pelvis is associated with low muscle tone
• Poor balance and coordination
• Base of support too narrow is associated with high tone

Atypical behaviors in 2 year olds
• Walking pattern unresponsive to level changes
• Poor leg and trunk alignment
• Insecure balance and frequent falls

Children with locomotor disorders represent a large proportion of the population of children treated by pediatric physical therapists. Thus this table will present an overview of mobility, locomotion and gait through a developmental process.