Neurodevelopment includes each stage of human growth. It is an ontogenetic process during which the nervous system develops, and is affected by biological, endogenous and exogenous factors, as well as sociocultural factors.
From the start, our genetic makeup gives us an individual nature that makes each person a unique being, but it also provides identifying features specific to human beings at the sensory, motor and cognitive level. Through the communion of these systems, through our relationship with our environment, each of us acquires our own way of reacting to stimuli, communicating with others and our surroundings; we begin to build our identity, our expression, our normality.
The human brain has a marvelous network of 86 billion neurons. And each of them can establish connections, communicate, receive and send information, with nearly 10 billion other neurons. This gives us trillions of connections in our brain, thus forming an amazing web of networks that constitutes the foundation for learning, develops capability and facilitates the acquisition of new skills.
Neurodevelopment has genetic makeup derived from our evolution as a species. In the initial stages, the innate motor stadia predominate. They are necessary to support the foundations for proper learning later on. Learning is the result of interaction with the internal and external factors. This is one of the reasons why sensory stimulation and development of child psychomotor education are so important. Children must play and interact based on the possibilities provided by their development, their maturity. During the initial stages from 0 to 6 months old, children must play in both positions (face up and face down), they must experiment in order to continue their sensory, motor and cognitive growth.
It is an extremely important stage for equipping the system with proper posture control in order to move on to voluntary discovery and mobility. It is essential to acquire good postural patterns to properly develop capability and the most demanding skills that enables us to relate and to learn more easily. From head control to elongation of the spine, as well as certain support points that help us achieve proper straightening of the trunk and stable shoulder and pelvic girdles. The exploration stage will come gradually, where motor control becomes highly relevant and searching movements and traveling begin, motivated by the urge to reach that which is desired. It is the start of the maximum motor expression to discover, experiment and challenge the very limits of their development.
With standing and verticality, children face a greater challenge against gravity and new cerebral networks are established that give them greater control over balance and stability. They develop greater postural control, which prepares them for movement on two support points. At around one year of age, children begin to walk in a hesitant and insecure way, which quickly becomes an independent and unique gait, the result of all the cumulative experience up to that point.
Learning begins based on the communion with the surroundings and where emotions play a leading role in achieving new motor and communication challenges.
When there is a deficit or delay in the formation or maturity of the cerebral circuits, development deviates from what is ideal and the symptoms are an expression of an immature brain. Considering the brain as a whole in which we cannot break up its functioning, there may be more difficulties in motor expression, collecting sensory information, interacting with the surroundings, communication and managing emotions.
Pediatric rehabilitation is a systematic intervention designed and personalized to compensate or diminish the impact of the neurological alteration following a neurodevelopment disorder. This improves child development, their functionality and their quality of life. This neurorehabilitation focuses on the clinical approach at the cognitive, behavioral, sensory and motor level.
Physical therapy is responsible for providing an individual assessment in which to establish the therapeutic and treatment objectives that help increase and improve the postural and functional capacity of the child. All of this must always be accompanied by an interview with the family to identify the needs that arise in day-to-day activities; and the child’s sociocultural environment must also be taken into account. This two issues are essential in reaching our objectives.
It is important to conduct follow-up in order to offer guidelines and activities that favor stimulation and brain plasticity through play. Proposing playful and motivating activities with the family enables us to help the brain learn during the greatest number of hours during the day, supporting better postural control and the success of the dynamic activities.
Sensory development workshops; therapeutic approaches that combine the pillars of development from the innate part and the relationship with the surroundings, activities and games that manage to develop learning based on motivation and that take into account the cognitive, sensory and motor aspects will be part of the ideal treatment strategies that enable us to achieve and improve capabilities for children with some sort of neurodevelopment alteration.
Ismael Sanz Esteban is professor of Physical Therapy in the Grado en Fisioterapia