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Behavior - Shy
Infants at 12 months of age are often shy and have stranger
anxiety. Most of the neurological exam can be performed with the child
on his parent’s lap. The parent helps reassure the child and facilitates
the exam. This infant is shy and frequently looks to his father for reassurance.
The examiner uses toys to try to engage the child in play and overcome
the shyness.
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Behavior - Social and Language
Infants this age imitate activities, wave
bye-bye, and play pat-a-cake. They can follow simple instructions especially
if the desired action is demonstrated. They feed themselves finger foods.
They usually have one or two meaningful words, usually mama and dada.
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Cranial Nerves
A colorful finger puppet is used to attract the infant’s
attention and test extra ocular range of movement. For testing visual
fields, a finger puppet is again used to get the infant to visually fixate,
and then a dangling measuring tape is used to test
peripheral vision.
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Motor - Tone
Passive range of motion for both the upper and lower extremities
is tested. Transforming the movements into a game makes the exam less
threatening to the infant.
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Motor/Reflexes - Deep Tendon Reflexes
A reflex hammer can be a threatening object to the infant. By turning
the reflex hammer into an imaginary horse and adding sound effects,
the infant is not threatened and cooperates for the exam. Because using
a reflex hammer can be a threat to the child, deep tendon reflexes
are usually done late in the exam and when the child is on the parent's
lap.
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Motor/Reflexes - Plantar Reflex
At 12 months of age the toes can go
up or down. Generally, they are down going. In this age group it's
hard not to get withdrawal of the foot. An abnormality of the plantar
reflex is most diagnostic if there is reproducible asymmetry.
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Motor/Postural Reflexes - Parachute
The parachute is the last of the postural reflexes to develop. It usually
appears at 8 to 9 months and certainly is present by 12 months of age.
The reflex is elicited by turning the child up side down. The arms
should come forward and the hands spread out to catch the fall. Asymmetry
of the reflex is abnormal and may indicate paresis in the non-extended
extremity.
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Motor/Coordination - Pincer
Grasp
Fine motor coordination of the hand progresses in a definite pattern.
At 6-7 months the hand is used as a rake and objects are raked into the
palm with the fingers. At 8-9 months the thumb and the radial fingers are
used to grasp an object and smaller objects are picked up. At 10-12 months,
the fine pincer grasp is developed. This enables an infant to pick up a
small object between the distal thumb and index finger.
Both infants in
this exam have developed a pincer grasp. The first infant uses the
pincer grasp to feed himself a cheerio. The second infant demonstrates
a pincer grasp by grabbing the tip of a measuring tape and pulling
the
tape out. The pincer grasp should be equal in either hand. Handedness
does not develop until after 12 months of age. Early handedness and asymmetric
fine motor skills are seen with a hemiparesis.
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Motor/Coordination - Beads in the Cup
This test is a combination of
understanding instructions, as demonstrated, and using a pincer grasp
to place the small bead in a container.
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Motor/Coordination - Play Ball
The infant plays the simple game of throw
the ball. His throw is not an overhand throw which is seen in an 18 month
old but rather a pushing away and dropping type of throw that is typical
for this age.
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Motor - Transition in and out of Sitting
As far as gross motor skills,
the infant is able to get in and out of the sitting position with ease
and creeps well.
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Motor - Creeping
Crawling is a commando type of crawl which is an arm
over arm propulsion forward with the trunk on the ground and legs dragging.
Crawling is usually seen at 7 to 9 months. Creeping is crawling on hands
and knees with the trunk off of the ground. Creeping is usually seen
at 8 to 12 months.
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Motor - Stoop and Recover
At one year, this infant has developed the
ability to walk without support. Although still wobbly, he can stoop
down to pick up an object and stand back up without falling. He can maintain
his balance as he inspects and manipulates the toy. An infant usually
develops the ability to stoop and recover at 11 to 14 months of age.
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Motor/Gait - Stand, Walks with Support
The first infant
demonstrates the ability to pull himself to a stand while holding on.
The second infant
can stand, pull to a stand and cruise (not demonstrated because the
baby is upset). Cruising is walking along a piece of furniture
while holding on. It usually develops between 10 to 12 months. Along
with cruising, the infant can take steps while holding on but he’s
not ready to walk unsupported.
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Motor/Gait - Toddler's Gait
Independent walking is achieved between
11 and 15 months of age. An infant is delayed if they aren't walking
by 16 months. This 12 month old infant has a typical gait of an infant
that has just learned to walk. He has a wide base, is unsteady, and toddles.
His arms are held at near shoulder level in a high guard position. This
is a protective position and probably aids in his balance. As he matures,
his arms will come down to a low guard position, then into the usual
associated arm movements seen with mature walking.
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Head Circumference
The first attempt to measure the head circumference
is easy but the examiner reads the measurement as 50.6 cm, which is above
the 98th percentile. Second attempt is much more difficult because the
infant doesn't want the tape measure around his head. The measurement
however is read as 47.7 cm, which is at the 50th percentile. A third
attempt verifies that the 47.7 cm measurement is correct. Always take
at least two measurements
and save the head circumference to the last.
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