Clinical Case Presentation:

Global
Development
Delay
Prepared by: Forto , Sambrano
November 2021
 Table Of Contents
01 02 03
Basic Medical Medical Surgical
Initial Evaluation
Sciences Background

04 05
Research Article Critical Appraisal
Introduction
You can give a brief description of the
topic you want to talk about here. For
example, if you want to talk about
Mercury, you can say that it’s the smallest
planet in the entire Solar System
01
Basic Medical
Sciences
Anatomy
The brain development of us humans is indeed complex. It is a
wide-long process which includes micro and macro-structural
events, neuronal and glial proliferation and migration,
myelination, and organizational development of cortical layers,
and circuitry. And as studies are conducted the more we
understand that this process provides a greater insight into the
pathophysiology of brain injury and alteration of cerebral
development in preterm infants. Thus, a key factor of
abnormalities in preterm infants is the maturational stage of the
brain at the time of birth
Anatomy
According to a study by Habibullah et al. (2021) The ventricles
and white matter, mainly the corpus callosum, were the most
commonly affected anatomical structures
Physiology
Global developmental delay can be defined as notable
impediments in 2 or more developmental domains/aspects
in an individual: cognition, speech and language, gross and
fine motor skills, activities of daily living, and personal and
social interaction. Usually observed during the first few
months of life when a child is not able to achieve
developmental milestones at the expected time frame. Brain
damage, hearing loss, and genetic syndromes are only some
of the physiological causes that may have an effect on the
development of one's cognitive ability.
Neuroscience
Developmental delays are common early-onset chronic
neurological conditions, which may have prenatal,
perinatal, postnatal, and even idiopathic causes. GDD
often affects not only one part of an individual’s brain but
actually multiple domains. If neuro-developmental delays
persist, the effects on the child may be far-reaching, up
until s/he becomes an adult if not observed and treated
early. Aside from speech and cognitive ability, the child’s
motor skills will also be compromised.
Kinesiology
One of the domains that got affected by global developmental delay is the
physical and motor skills domain which include the gross and fine motor
movements. When this developmental delay is not addressed , the child will
experience late progress in attaining important milestones which affects their
activities of daily living. Child with this condition is characterized with inability to
control his/her head by 4 months, inability to perform roll over and transfer
objects by 5-6 months , and the skills for sitting alone, standing and walking are
expected to achieve later than the normal age of acquisition for these skills.
Stiffness, spasm, uncoordinated, and other problems on movements are
associated with other conditions such as cerebral palsy and autism. The
acquisition of complete significant physical and motor developmental
milestones may differ on how the issue/condition is addressed and in some
cases , px with this condition achieved all the skills when they’re already on the
adult stage.
Principles Relevant to the Case
Global developmental delay (GDD) is a condition to which children
are not able to achieve developmental milestones at the
appropriate stage of development compared to other children of
the same age. Based on a study, GDD can be classified into three
types which can be mild, moderate, and severe, depending on the
level or severity of the condition of the patient. It was also stated
that a severe case would include more than one domain of a child’s
development. These may be in terms of motor, cognitive, or social
development. A child’s delay may be considered as GDD if
developmental milestones are significantly delayed and there are
more than one affected domain.
Principles Relevant to the Case
Generally, physical therapy would be the best treatment for
GDD. it would focus on the needs of the patients and to what
aspect needs development. A child with motor developmental
delay, therapy would focus on motor development of a child.
The management would focus on strengthening, ambulation,
ADL development, and almost every part the patient lacks so
that the child would have decreased difficulty in motor function.
This would also apply to children with cognitive and behavioral
delays. Proper management in stimulation of the mind of the
child and interaction would greatly help the child in
development.
Principles Relevant to the Case
One of the major management done to children with GDD
would be environmental adjustment. Part of developmental
delays may be due to lack of stimulation and improper child
management by the parents. So, proper environmental
adjustment and parental education is needed for the
improvement of the child’s condition.
02
Medical Surgical
Background
 Medical Surgical Background

Pathophysiology /
Etiology Epidemiology
MOI

Disease
Clinical findings Diagnostic test
classification
 Etiology
Etiology based on the case is unknown. Though it was reported that
the mother experienced viral infection during the 1st trimester of
pregnancy.

According to a study there are different types of reasons why a

child may experience GDD. common aetiologies of developmental
delay may be divided into four categories. These are prenatal,
perinatal, postnatal, and other factors.
 Etiology
Prenatal

● Genetic disorders: Down syndrome, fragile X syndrome,

chromosomal microdeletion or duplication
● Cerebral dysgenesis:absent corpus callosum, microcephaly,
hydrocephalus, neuronal migration disorder,
● Vascular: occlusion, hemorrhage
● Drugs:cytotoxic, anti epileptic
● Toxins: alcohol, smoking
● Early maternal infections: rubella, cytomegalovirus, toxoplasmosis
● Late maternal infection: varicella, malaria, HIV
 Etiology
Perinatal

● Prematurity of the child, intrauterine growth retardation,

intraventricular hemorrhage during birth, periventricular
leukomalacia
● Perinatal asphyxia: hypoxic-ischemic encephalopathy
● Metabolic: symptomatic hypoglycemia, bilirubin-induced
neurological dysfunction
 Etiology
Postnatal

● Infections: meningitis, encephalitis

● Metabolic: hypernatremia, hyponatremia, hypoglycemia,
dehydration
● Anoxia: suffocation, near-drowning, seizure
● Trauma: head injury, either accidental or non-accidental
● Vascular: stroke
 Etiology
Others

● Social factors: severe understimulation, maltreatment,

malnutrition (deficiency of iron, folate and vitamin D)
● Maternal mental health disorder
● Unknown reasons
 Epidemiology
A prevalence study was conducted in terms of developmental
delay among Filipino children at ages 6,12, and 24 months. It is
revealed in the study that Filipino children are found to have
developmental delays at a slightly higher rate in comparison to
the universal estimates on the general population. It was
observed in the study that the first 6 months of the
development of the child was normal, however significant
delays were observed around 12 months of the child. Though, it
was observed to have great improvements by 24 months.
 Pathophysiology
The majority of pathophysiology of GDD is usually idiopathic but
in some cases it is not. The main pathophysiology of GDD is still
unknown but some recent studies present there are
mechanisms in the body that would lead to developmental
delay and even disabilities. Genes are also observed to be a
reason for developmental delay towards a child.
 Disease classification
Cognitive Delays
● this is the delay of children in terms of their intellect and
cognitive development. This also interferes with the learning
process of a child making them difficult for them to learn
new skills, topics, and insights which may affect
communication with others. Cognitive delay may be due to
brain injury and pathologies.
 Disease classification
Motor Delays
● Motor related problems are involved in this type of delay. The child
may have a hard time in coordination of large muscle groups for
both the upper and lower extremities. This would result in difficulty
in movement and performing activities such as crawling, walking,
and reaching for objects. Older children may be observed to be
clumsy and have troubles in walking and using the stairs. Motor
delays may be due to deformities of the body that make it difficult
for the child to perform movements. Cerebral palsy may also be a
major reason for motor delay.
 Disease classification
Social, Emotional, and Behavioral Delays
● Children with delays in social, emotional, and behavioral skills may
be observed to have difficulty in understanding social cues,
communicating with others, and having a two-way conversation. In
terms of behavior, children with behavioral delay may be observed
to have tantrums that are very long and difficult to deal with. They
are also seen to have a hard time in dealing with frustrations.
Children who are positive for autism are observed to have
problems and delays in social, emotional, and behavioral skills
 Disease classification
Speech Delays
● Children with speech delays may be observed to have problems
with understanding words, reduced vocabulary words, and
difficulty in speaking complex sentences. It is observed that
children with speech delay may have delays in reception and
expression. Motor problems may be also a reason for speech
delays. Weakness of the mouth muscle and the tongue may give
children a hard time in speaking and forming sentences.
 Disease classification
● Note that a child may elicit more than one type of delay in terms
of the four aspects mentioned.
 Clinical findings
Signs and symptoms:

● The child has underlying condition or diseases

○ Cerebral palsy
○ Autism spectrum
○ Genetic disorder
● The child is late in milestones such as sitting up, crawling, walking.
● Limited reasoning or conceptual abilities for his/her age.
● Fine/gross motor difficulties when moving.
● Poor social skills/judgment during interaction.
● Aggressive behaviour as a coping skill.
● Communication problems.
 Diagnostic procedure/criteria
● Children with developmental disabilities are typically diagnosed in
primary care environments across three main channels: during
routine developmental surveillance or screening; after parental
concern; and after questions are posed by third parties such as
preschool teachers or nursery care providers.
 Research Article: Efficacy of
Intensive Neurodevelopmental
Treatment for Children With
Developmental Delay, With or
Without Cerebral Palsy
Objective
To evaluate the effectiveness of intensive
neurodevelopmental treatment (NDT) on gross motor
function for the children having developmental delay (DD),
with or without cerebral palsy (CP).
Methods
Forty-two children had intensive NDT three times weekly, 60 minutes a
day, for 3 months, immediately followed by conventional NDT once or
twice a week, 30 minutes a day, for another 3 months. We assessed
Gross Motor Function Measure (GMFM) over three time points: before
conventional NDT, before and after intensive NDT, and after 3 months
of additional conventional NDT.
Results
The GMFM score in DD children significantly improved after intensive
NDT, and the improvement maintained after 3 months of conventional
NDT (p<0.05). The children were further divided into two groups: DD
with CP and DD without CP. Both groups showed significant
improvement and maintained the improvements, after intensive NDT
(p<0.05). Also, there was no significant difference in treatment efficacy
between the two groups. When we calculate the absence rate for
comparing the compliance between intensive and conventional NDT,
the absence rate was lower during the intensive NDT.
Conclusion
Intensive NDT showed significantly improved gross motor function and
higher compliance than conventional NDT. Additionally, all
improvements were maintained through subsequent short-term
conventional NDT. Thus, we recommend the intensive NDT program by
day-hospital centers for children with DD, irrespective of accompanying
CP.
References:
Buenavista-Pacifico, M., Reyes, A., Benitez, B., Villanueva-Uy, E., Lam, H., & Enrique M.

Ostrea, J. (2018). The Prevalence of Developmental Delay among Filipino Children at Ages 6,

12 and 24 Months Based on the Griffiths Mental Development Scales. Retrieved November 08,

2020, from https://actamedicaphilippina.upm.edu.ph/index.php/acta/article/view/277

Choo, Y. Y., Agarwal, P., How, C. H., & Yeleswarapu, S. P. (2019). Developmental delay:

identification and management at primary care level. Singapore medical journal, 60(3), 119–123.

https://doi.org/10.11622/smedj.2019025

Global Developmental Delay. (n.d.). Retrieved November 08, 2020, from

https://www.annabellepsychology.com/global-developmental-delay
References:
Khan, I. (2020). Developmental Delay. Retrieved November 08, 2020, from

https://www.ncbi.nlm.nih.gov/books/NBK562231/

Neuro-developmental delay. (2018, February 26). Retrieved November 08, 2020, from

http://www.neurorestart.co.uk/neuro-developmental-delay/

Samarpanphysio. (2019). DEVELOPMENTAL DELAY. Retrieved November 08, 2020, from

https://samarpanphysioclinic.com/2019/06/05/developmental-delay/

Types of Developmental Delays in Children. (n.d.). Retrieved November 08, 2020, from

https://nyulangone.org/conditions/developmental-delays-in-children/types

Physical Therapy Guide to Developmental Delay. (2019). Retrieved November 09, 2020, from

https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-developmentaldelay