Full portfolio

CU Denver Anschutz Medical Campus Physical Therapy
Human Growth and Development Portfolio
Samantha Jensen
10/13/2014
This portfolio is being developed to be used as a study aide for the Human Growth and Development course. The information
within has been derived from power points, documents and lecture discussions as well as from the pages of the Functional
Movement Development text.

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Reflexes and Reactions
Definitions
Reflexes: automatic movements in response to sensation, or a sensory stimulus
1. Primitive reflexes: appear prenatally or at birth, are integrated at approximately 4-6 months of age (exceptions:
plantar grasp and STNR)
2. Attitudinal reflexes: stimulus is head/neck position (e.g. ATNR, STNR, TLR)
a. Subcategory of primitive reflexes, never obligatory in typically developing children
Reflex Integration: when the reflex is no longer obligatory or the most common response to the stimulus
Primitive Reflex
Neonatal Positive Supporting
Onset Integration Position Stimulus Response
35 weeks gestation 1-2 months Support infant in
vertical position with
examiner’s hands
under the arms and
around the chest
Allow feet to make
firm contact with
tabletop or other flat
surface
Simultaneous
contraction of flexors
and extensors so as to
bear weight on lower
extremities
 Child may only
support minimal
amount of body
weight
 Characterized by
partial flexion of
hips and knees
Attitudinal Reflexes
Asymmetrical tonic Neck Reflex (ATNR)
Birth to 2 months 4-6 months Place child supine with
head in midline; can
test or observe in
other positions
(sitting, quadruped,
standing)
1. Have child actively
turn head by
following an object
from side to side
2. Passively turn
child’s head slowly
to one side and
hold in extreme
position with jaw
over shoulder
Arm and leg on face
side extend, arm and
leg on skull side flex
(fencer’s position)
Symmetrical Tonic Neck Reflex (STNR)

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4-6 months 8-12 months Place child in ventral
position supported by
trunk over examiner’s
knee or place in
quadruped position
Examiner passively
flexes then extends the
child’s head and neck
1. Head and neck
flexion produces
flexion of the upper
extremities and
extension of the
lower extremities
2. Head and neck
extension produces
extension of the
upper extremities
and flexion of the
lower extremities.
Tonic Labyrinthine Reflex Prone (TLR)
Birth ~6 months Prone Prone positioning Flexor tone dominates,
child has difficulty
extending to lift head,
neck or trunk; cannot
support weight on
arms
Tonic Labyrinthine Reflex Supine (TLR)
Birth ~6 months Supine Supine positioning Extensor tone
dominates, child will
not flex in pull to sit
Postural Reactions
Automatic postural reactions provide the foundation for posture, balance, locomotion and prehension. These reactions appear
during infancy and remain throughout the lifespan. They occur in response to changes in the body’s orientation and pattern of
weight distribution in the base of support.
Category Stimulus Response Notes
Protective Fast or large movement of
center of gravity
Extremities move out into
extension to catch person
Head and trunk righting Change position of body in
space
Produce alignment of the
body with the environment or
alignment in space. Keep the
head and trunk aligned with
each other.
Uses three systems:
 Visual
 Vestibular
 Somatosensory
(proprioceptive or tactile)
Equilibrium Slow shift of the center of
gravity.
Find balance in response to
shift in center of gravity
 Orderly sequence:
Prone supine sitting 
quadruped  standing

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 Lags behind attainment of
movement in the next
higher developmental
posture.
Illustrations of attitudinal reflexes are shown to the left with a timeline of
when these reflexes can be observed.
Below are pictures of babies demonstrating these reflexes.
An illustration to the left depicts the protective extension postural reaction
occurring in multiple different positions.
Illustrations of the equilibrium reactions are depicted to the left.
Below, pictures demonstrate examples of head and trunk righting
reactions. These include neonatal neck on body (NNOB), neonatal body on
body (NBOB), optical righting and landau. Not pictured is labyrinthine
righting.

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Developmental Gross Motor Milestones
Month Prone Supine Sitting Standing
1
(Physical flexion)
Lifts head and turn
head to side.
Hips flexed, head to
the side.
Arms flexed with
hands by face.
Back rounded, head
forward.
Positive support.
Partial flexion in hips
and knees
2
(Maximum
asymmetry)
Head at 45°.
Prone musculature
elongated.
Head to side. Presence
of ATNR. Arms out
further. Less tightness
at hip and knee
flexion.
Head lag in pull to sit.
Rounded.
Decreased weight
bearing and possible
onset on astasia.
3
(Symmetry/ anti-
gravity flexion)
Increased head
shoulder control 45°-
90°.
Increased spinal
extension, lower
pelvis.
Prop up on forearms.
Head rotation.
Head and hands to
midline.
Head to midline. Initial
head lag.
Astasia or minimum
support
4
(Increased
symmetry)
Increased extension,
bilateral adduction of
scapula. First part of
Landau reflex.
Elbow support. May
roll with lateral weight
shift.
Head in midline with
chin tucked. Hands to
knees. Spine flattens.
Minimal head lag.
Sits with support.
More extended upper
spine.
Weight in supported
standing. Standing
with 2 hands held.
Static standing with
extension.
5
(Increased
flexion/extension
control)
Extended arms.
Reaching in prone.
Rolling. Increased
lordosis.
Increased abduction
control. Hands to feet.
Rolling side to side.
Pivoting.
Begins prop sit, which
leads to lower hip
extension. Arms up in
high guard to increase
balance. No head lag.
Full weight on legs
with hand s or trunk
held. May release
extension and may
flex at knees.
6
(6-12 months big
in change in
thoracic
development)
Increased extension
through hips. Side play
with lateral head
righting. Pivoting. May
push hips and knees.
Independent rolling.
Foot to mouth. May
demonstrate
protective extension.
Buttocks off floor.
Begin to sit
independently. Easy to
fall with weight shift.
Smaller base of
support. May begin
bouncing.
7 All fours rocking. Belly
crawling. May fall with
four-point reaching.
Sit with rotation. Begin transitioning
from four-point to sit.
May pull to stand (UE
pattern used).
8 Four point creeping
prone transitioning to
sit.
Supine to sit. Lots of
UE and LE movement.
Long-sitting which
stretches the
hamstrings.
Refined four-point
transitioning to sit.
May try to cruise. Tall
kneeling. Stand
holding on. Begin half
kneel to stand.

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9 Refined four-point. Increased pelvic and
femoral dissociation
(fractionation). W-
sitting.
Pull to stand to half
kneel. Rotation with
cruising. Hold with
one hand. Legs work
more. Stepping with
support. Increased hip
flexion. Heel-toe play.
10
(Transitions)
Creep up steps (can’t
go down)
Protected extension to
back. Very functional.
Climb. Half-kneel play.
Mobility between
pelvis, thorax, and
femurs.
11 Bench sitting. Chair
sitting.
Stand with one hand.
Cruise between 2
surfaces. More
climbing to getting
down.
12 Push toys- may let go.
Independent stand.
Independent steps.
Squat to stand with
minimal support. High
guard.
18 Creeps up and down
stairs.
Transition to standing
from sitting on floor.
Pull or carry toy while
walking. Walking
sideways or
backwards. Develop a
run-like walk.
Momentary 1-foot
balance. Beginning
arm swing and heel
strike.
24
(2 years)
Up and down stair one
foot at a time with rail
support. Jump off a
step (2 foot takeoff).
Stand on one foot 1-3
seconds. Kick a large
ball. Begin to run.
Begin to jump
(alternating feet).
36
(3 years- highest
activity level at
any age in human
lifespan)
Pedaling a tricycle. Climbing a jungle gym.
Start, stop and turn
while running.
Tandem and one foot
standing for at least 3
seconds. Up stairs,
alternating feet.
48
(4 years)
Hop on one foot 4-6
times (girls appear to
have better balance in

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childhood). Rhythmic
galloping. Up and
down stairs
alternating feet.
Bounces and catches
ball under control.
Kicks 10-inch ball
toward target. Runs
10 feet and stops well.
60
(5 years)
Bikes usually without
training wheels.
Stand on either foot 8-
10 seconds. Walk
forward on balance
beam. Hop 8-10 times
on one foot. 2-3 foot
standing broad jump.
Skip on alternating
feet. Kick a rolling ball.
Roller skates.
72
(6 years)
Stand on one foot for
longer than 10
seconds eyes open or
closed. Walk on a
balance beam in all
directions. Running.
Jumping, Throwing.
Catching. Can
incorporate game
playing skills.
84
(7 years)
Jumping jacks.
Standing long jump of
about 42 inches.

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Vital Signs
Age Mean Heart Rate Mean Respiratory Rate Mean Blood Pressure
1 year 120 beats/min 20-40 breaths/min 90/56 mm Hg
2 years 110 beats/min 25-32 breaths/min 91/56 mm Hg
6 years 100 beats/ min 21-26 breaths/min 96/57 mm Hg
10 years 90 beats/min 20-26 breaths/min 102/62 mm Hg
16 years 80 beats/min (girls)
75 beats/min (boys)
16-20 breaths/min 117/67 mm Hg
Adult 74-76 beats/min 10-20 breaths/min 120/80 mm Hg
Older Adult 74-76 beats/min *Data unavailable 150/85 mm Hg

Samantha Jensen 10
HG&D Portfolio
Samantha Jensen
Part 2
11/3/2014
This portfolio is being developed to be used as a study aide for the Human Growth and Development course. The information
within has been derived from power points, documents and lecture discussions as well as from the pages of the Functional
Movement Development text.

Samantha Jensen 11
HG&D Portfolio
Tests and Measures in Pediatrics
Name of Test Areas of
Development
covered in test
Type of test Age range of test Strengths and
weaknesses
ASQ-3 1
Ages and Stages
Questionnaire- 3rd
edition
Communication, Gross
Motor, Fine Motor,
Problem Solving and
Personal-Social
Screening/ Self-
Report/
Developmental and
functional/ Norm-
referenced
Parent-completed
Questionnaire
21 different
questionnaires
available that are used
at different ages called
‘intervals’
2, 4, 6, 8, 9, 10, 12, 14,
16, 18, 20, 22, 24, 27,
30, 33, 36, 42, 48, 54
and 60 months of age
1 months- 5 ½ years
1-66 months
Parent bias could give
the kids a higher score
than that which they
deserve giving a
skewed score.
In my experience, the
child I was monitoring
got a full score on the
ASQ but did not
demonstrate some of
the skills his mother
said he possessed
when we did the PDMS
assessment with him.
The parent assessment
could be a benefit to
report on what the
child is able to do that
we may not be able to
observe provided that
the parent is being
honest and scoring
their childfairly.
High validity- 0.82-
0.881
Test-retest reliability
is 0.911
Inter-rater Reliability
is 0.921
English, Spanish and
French 1
Development
weaknesses

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covered in test
AIMS 2
Alberta Infant Motor
Scale
Motor Assessment of
the Developing Infant
58 items in 4
positions:
Prone
Supine
Sitting
Standing
Diagnostic/
Developmental/
Physical Performance/
Norm-Referenced/
Standardized
Observation
Birth through 18
months
Based on chronological
or corrected age if
child was born
prematurely
It is somewhat difficult
to get an infant to do
what you want them to
do. The parents were
present for our AIMS
lab and we would be
trying to get a certain
action out of the infant
and the parents would
insist they can do it,
but we must observe it
to score it. Most babies
reflexively do a lot of
the items on this test
and we were able to
observe many of them.
There were only few
that were hard to
illicit.
Concurrent Validity is
0.97-0.98 2
Test-Retest Reliability
is 0.99 2
Inter-rater Reliability
is 0.99 2
Development
covered in test
weaknesses
PDMS-2 3,4
Peabody
Developmental Motor
Scales- 2nd edition
Gross Motor:
Reflexes
Stationary
Locomotion
Object Manipulation
Fine Motor:
Grasping
Visual-Motor
Integration
Developmental/
Standardized/
Diagnostic/ Norm-
Referenced/Physical
Performance
Birth through 71
months (Age 6)
The child being
monitored is only
being scored on what
we as the therapist are
directly able to
observe. A child may
have a skill, but not
demonstrate it in front
of the therapist
because of various
reasons such as
attitude, shyness, or

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lack of motivation.
Takes 45-60 minutes
to administer the
whole test. Depending
on the age and the
temperament of the
child, this may pose a
problem. The kit also
costs $945, so this is a
limiting factor to
administering this
assessment.
Concurrent validity for
gross motor is 0.84 4
Concurrent validity for
fine motor is 0.90 4
is between 0.73 and
0.89 3
Inter-Rater Reliability
is 0.92 3
Development
covered in test
weaknesses
BOT-2 5
Bruinicks-Oseretsky
Test of Motor
Proficiency- 2nd edition
Gross Motor Skills
Fine Motor Skills
Developmental/
Norm-Referenced/
Diagnostic/ Physical
Performance/
Standardized
4 years- 21 years 11
months
This test was slightly
easier to administer as
the age range is older
and the children are a
bit more cooperative.
There is a kit that is
necessary for the
evaluation that costs
$1130, so this is a
limitation to the test.
Some of the materials
could probably be
substituted for other,
cheaper items.
Compared to other

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tests, this test does not
seem to have
significant floor or
ceiling effects. 5
Internal Consistency
Reliability is 0.97 5
ranges from 0.52 to
0.95 5

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Tests and Measures used with Pediatrics and Adults
Name of Test
Valid age
range of
test
Very basic procedures Differences between
pediatric and adult test
procedures
TUG- Timed Up
and Go- Child 7
3-13 years
old
 A practice trial may be given, but make sure the
patient has an adequate rest period. An assistive
device may also be used
 Place an armchair against a wall with a line 3 meters
away from the front of the chair.
 Start position: The individual’s back is against the
back of the chair and arms on the arm rests
 Give the directions, “When I say ‘1, 2, 3, GO’, I would
like you to stand up, walk at your normal speed to
the line on the floor, turn around, walk back to the
chair, and sit back down with your back against the
back of the chair.”
 Have the patient assume the start position and
repeat the instructions
 Time the assessment with a stopwatch.
 Complete two trials with adequate rest between
trials.
The procedure for the adult
and the pediatric and
adolescent TUG assessment
were identical, but the
outcomes were different.
The normative 10-meter
walk time for the adult, ages
(20-70) TUG varied between
5.06 seconds and 8.71
seconds whereas the
normative 10-meter walk
time for pediatrics and
adolescents, ages 3 to 13,
was between 3 seconds and
13 seconds. This is because
much more development
occurs in childhood than
adulthood. 7
TUG- Timed Up
and Go- Adult
20 years-
80 years
Name of Test Valid age
range of
test
Very basic procedures (Do not need to list all
PBS/BBS items)
Differences between
procedures
Pediatric Balance
Scale 6
5-15 years  The 14 tasks completed for the adult Berg Balance
Scale are very similar to those that are used for the
Pediatric Balance Scale as well. They are slightly
modified for this age range and include:
 Sitting to Standing
 Standing to Sitting
 Transfers
 Standing unsupported: 30 seconds
 Sitting with back unsupported and feet supported
on the floor: 30 seconds
 Standing unsupported with eyes closed
 Standing unsupported with feet together: 30
seconds
 Standing unsupported one foot in front
 Standing on one leg:
 Turn 360 degrees
The Pediatric and Adult
balance tests are very
similar and contain the
same scoring system. The
criteria for scoring are
slightly different on a
couple requiring only 30
seconds rather than 2
minutes for completion.
Also, the pediatric scale
goes in a slightly different
order than the Adult berg
balance scale. Finally, one is
set up differently from the
adult counterpart. The
reaching task is completed

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 Turning to look behind left and right shoulders
while standing still
 Pick up object from the floor from a standing
position
 Placing alternate foot on step stool while
standing unsupported
 Reaching forward with outstretched arm while
sitting: >10 inches
from sitting for the
pediatric berg while the
adult reaching assessment
is completed from
standing.6
Berg Balance Scale
Target age
>60 years
old
 Give written instructions or demonstrate each task if
necessary.
 Gather a stopwatch, a ruler, chairs with armrests and
a step stool.
 Ask the patient to complete the following 14
activities
 Sitting to Standing: Ask the patient to stand up
without using hands for support.
 Standing Unsupported: Ask the patient to stand for
two minutes without holding on. If the subject is able
to stand two minutes unsupported, score full points
and proceed to number 4.
 Sitting with back unsupported but with feet
supported on the floor on a stool: Ask the patient
to sitwith arms folded for two minutes.
 Standing to Sitting: Ask the patient to sit down.
 Transfers: Arrange the chair for a pivot transfer. Ask
the patient to transfer one way toward a seat with
armrests and one way toward a seat without
armrests. You may use two chairs or a bed and a
chair.
 Standing unsupported with eyes closed: Ask the
patient to close their eyes and stand still for 10
seconds.
 Standing unsupported with feet together: Ask the
patient to put their feet together and stand without
holding for 1 minute.
 Reaching forward with outstretched arm while
standing: Ask the patient to stand with arm at 90
degrees. Ask them to stretch out their fingers and
reach forward as far as they can. Line ruler up with
the fingers. Tell them not to touch the ruler during
the exam. Record the distance the patient is able to
reach. >10 inches.
 Pick up an object from the floor from a standing
position: Ask the patient to pick up and object (i.e.
shoe/slipper) which is placed in front of their feet.
 Turning to look behind over left and right
shoulders while standing: Ask the patient to turn
and look directly behind their right shoulder. Repeat
to the left. You may ask them to look at a specific

Samantha Jensen 17
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point behind them to encourage.
 Turn 360 degrees: ask the patient to turn
completely around in a full circle. Pause. Then turn in
a circle the other direction. Less than 4 seconds each
way.
 Place alternate foot on step or stool while
standing unsupported: Ask the patient to place
each foot alternately on the step/stool. Continue
until each foot has touched the step/stool four times.
Record time. 8 steps within 20 seconds.
 Standing unsupported one foot in front: Ask the
patient to place one foot directly in front of the other.
Hold for 30 seconds.
 Standing on one leg: Ask the patient to stand on one
leg as long as they can without holding on up to 10
seconds.
range of
test
procedures
Pediatric Reach
Test
2-12 years
old
Sitting: 8
 Have the child sit on a flat surface with no back or
sides, feet flat on the floor, hips in neutral and arms
resting on the lap.
 Ask them to sit for 15 seconds, if this is completed
continue to the following steps.
 Ask the child to sit up tall and extend their arm in
front of them to 90 degrees, elbow extended and
wrist in neutral. Secure the measuring tape to the
finger and record the first number. Ask the child to
reach forward as far as they can. Have them hold the
end position for three seconds and record the final
tape measure reading.
 Repeat on the opposite side
Standing: 8
 Have the child stand comfortably with regular
footwear. Ask the childto stand for 15 seconds. If the
child can stand independently for 15 seconds
continue to the following steps.
 Ask the child to stand up straight and extend their
arm in front of them to 90 degrees, elbow extended
and wrist in neutral. Secure the measuring tape to
the finger and record the initial reading. Have the
child reach forward as far as they can and hold for 3
seconds. Record the final reading on the tape
measure.
 Repeat on the opposite side.
The procedures and scoring
for the two tests are similar
with a couple slight
deviations. The pediatric
reach test can be done from
sitting or standing and
requires the securing of a
tape measure to the child’s
finger and possible a
motivating factor to reach
for or different instructions
for younger children. The
pediatric scale is also
requires testing of both
sides since there may not be
a dominant arm yet. There
is a time constraint for the
pediatric reach test of
holding the reach for 3
seconds whereas the FRT
does not have a time
requirement. 8

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FRT- Functional
Reach Test- Adult
20 years to
87 years
 A practice trial may be given
 Client must not be wearing shoes or socks
 Position a yardstick at the height of the acromion,
parallel to the floor
 Have the patient stand comfortable with feet
shoulder width apart
 Ask the patient to extend their dominant arm in
front on them to shoulder height with the palm
facing down and the hand in a fist.
 Record the location of the third metacarpal on the
yardstick.
 Ask the patient to reach forward as far as possible
without losing balance, taking a step, lifting the heels
or touching the wall or yardstick
 Record the location of the third metacarpal on the
yardstick
 Subtract the end position from the start position to
obtain the number of inches reached
 Pause before next reach
 Complete 3 trials
range of
test
procedures
10-Meter Walk-
Child
1-12 years
old
 Mark 10 meters on the floor with tape
 Proceed to mark a line at 2 meters and 8 meters
within the 10-meter walkway.
 Ask the patient to walk at their preferred speed until
they reach the line 10 meters away.
 Start the stopwatch after the first 2 meters and stop
it at the 8-meter mark so you will be timing the walk
for the intermediate 6-meter portion.
The procedure for the
Pediatric and the Adult 10-
meter walk is the same. The
only thing that changes is
within the scoring portion of
the assessment. Adult gait
speed should be around 1.4
m/s whereas child speed
should be anywhere from
0.32 at 1 year old to 1.60 at
12 years old. This is again,
due to the amount of
development that occurs in
childhood versus adulthood.
10-Meter Walk-
Adult
20+ years
old, 1.4 m/s
gait speed
occurs first
at age 6,
some may
not reach
until older

Samantha Jensen 19
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REFERENCES
ASQ-
1. http://agesandstages.com/. Accessed October 30, 2014.
AIMS-
2. Piper MC, Pinnell LE, Darrah J, Maguire T, Byrne PJ. Construction and validation of the Alberta Infant Motor Scale (AIMS).
Can J Public Health. 1992;83 Suppl 2:S46-50.
PDMS-
3. Spittle AJ, Doyle LW, Boyd RN. A systematic review of the clinimetric properties of neuromotor assessments for preterm
infants during the first year of life. Dev Med Child Neurol. 2008;50(4):254-66.
4. Wuang YP, Su CY, Huang MH. Psychometric comparisons of three measures for assessing motor functions in preschoolers
with intellectual disabilities. J Intellect Disabil Res. 2012;56(6):567-78.
BOT-2-
5. http://pearsonassess.ca/haiweb/Cultures/en-CA/Products/Product Detail.htm?CS_ProductID=BOT-2&CS_Category=ot-
motor-visual-motor&CS_Catalog=TPC-CACatalog. Accessed October 30, 2014.
Berg Balance Scale-
6. http://www.district287.org/clientuploads/SpecialEd/Forms/PhysicalTherapy/PediatricBalanceScale. Accessed October
30, 2014.
TUG-
7. Williams EN, Carroll SG, Reddihough DS, Phillips BA, Galea MP. Investigation of the timed 'up & go' test in children.
Developmental medicine and child neurology. Aug 2005;47(8):518-524.
FRT-
8. Bartlett D, Birmingham T. Validity and reliability of a pediatric reach test. Pediatric physical therapy : the official publication
of the Section on Pediatrics of the American Physical Therapy Association. Summer 2003;15(2):84-92.

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