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CEREBAL PALSY PT ASSESSMENT Sgaar Naik, PT Cerebral Palsy Assessment Sagar Naik, PT Acknowledgement: Dr Saravanan Sir & Dr.

Prerana Maam Assessment of the child gives a baseline to appropriate treatment and management aims and techniques. Re-assessment should be continuing part of treatment, whic h allows for improvement or deterioration to be noted, thus enabling treatment t o be more effective. The therapist must have knowledge of normal development. Du ring physical examination, it is important to discriminate between delay in moto r development and abnormal motor patterns. It is very essential for the therapis t to explain, what he is going to do before handling the child. Assessment needs to be playful, interesting and non-threatening. Assess young child as much as p ossible on parents lap. Observe child among familiar toys as well as with selecte d toys to activate interest as well as reveal dormant abilities. Keep sessions w ithin the bounds of a childs concentration. Have an unhurried atmosphere. Have ea sy, successful actions of a child interspersed with difficult tasks. ph y sio Subjective Examination: Subjective information should be obtained from the parents especially mother or from relatives and through case-sheet. General details includes Name Age & Sex A ddress When did the mother first noticed the dysfunctions Siblings having same t ype of symptoms Prenatal History Age of mother Consanguity marriage Any drugs ta ken during pregnancy Any trauma & stress Any addiction smoking or alcoholism His tory of rubella or cytomegalovirus, toxoplasmosis infection 4a ll.. .

CEREBAL PALSY PT ASSESSMENT Sgaar Naik, PT ph y sio Objective Examination: On Observation: History of previous abortions, still born or death after birth Multiple pregnanc ies (duration between pregnancies) Status & cast of the mother Perinatal History Place of delivery History preterm or full-term delivery History of asphyxia at birth Type of delivery Forceps delivery Presentation of child Breech presentatio n Any history of prolonged labour pain Condition of mother at the time of delive ry Postnatal History Delayed birth cry (when child cried) Weight of the child at birth Low Birth Weight (LBW) History of any trauma to brain during the first 2 years of life History of neonatal meningitis, jaundice, or hypoglycemia Hydrocep halus or Microcephaly Nutritional habits of the child (malnutrition) Feeding dif ficulties Any medical or surgical treatment taken Any physiotherapy treatment pr eviously taken What was the ability level of child at that time? What obstructs the child from progress? What treatment was used? Was the treatment effective or not? Apgar Score from the case-sheet Behaviour of the child Whether child is alert, irritable or fearful in the sessi on or during particular activities Child becomes fatigued easily or not during a ctivity Find out what motivates his action particular situation, person or speci al plaything Communication of the child How child communicates with the parents 4a ll.. .

CEREBAL PALSY PT ASSESSMENT Sgaar Naik, PT Whether child initiates or responds with gestures, sounds, hand or finger pointi ng, eye pointing or uses words and speech Attention span What catches childs atte ntion? For how much time childs attention is maintained on particular thing How d oes parent assist him to maintain attention? What distracts the child? Does chil d follows suggestions to move or promptings to act? Position of the child Which position does the child prefer to be in? Can child get into that position on his own or with help? With assistance, child makes any effort to go in that positio n Symmetry of the child (actively or passively maintained) If involuntary moveme nts present, then in which positions these movements are decreased or increased Postural control & alignment How much parental support is given Postural stabili zation and counterpoising in all postures Proper & equal weight bearing If the c hilds center of gravity appears to be unusually high, resulting in floating legs and poor ability to raise head against gravity Fear of fall in child due to poor balance Use of limbs & hands Limb patterns in changing or going into position a s well as using them in position Attitudes of limbs during playing in all positi ons Whether one or both hands are used, type of grasp and release Accuracy of re ach and hand actions Any involuntary movements, tremors or spasms, which interfe re with actions, are present Sensory aspects Observe childs use of vision, hearin g, of touch, smell and temperature in relevant tasks Does child enjoys particula r sensations Whether child enjoys being moved or having position changed Form of Locomotion How child is carried Any use of wheelchair or walking aids Which dai ly activities motivates child to roll, creep, crawl, bottom shuffle or walk ph y sio 4a ll.. .

CEREBAL PALSY PT ASSESSMENT Sgaar Naik, PT ph y Height At birth At 1 year 2 to 12 years sio On Examination: Centimeters Sensory Assessment It is difficult to assess sensation in babies and young child ren with severe multiple impairments. If any hearing or visual or psychological abnormalities are present then assessment done by specialist is required Motor A ssessment Growth Parameters - Height Until 24 to 36 months of age, length in rec umbency is measured using an infantometer. After the age of 2 years standing hei ght is recorded by a stadiometer. 4a Inches 50 75 (Age in years 6) + 77 Deformities Observe any recurring position of the whole child Any part of the bo dy, which remains in particular position in all postures & in the movements The positional preferences typically seen in spastic cerebral palsies are for mid po sitions of the body - In the arm, this generally consists of Shoulder protractio n or retraction, adduction and internal rotation Elbow flexion Forearm pronation Wrist & Fingers flexion - In the legs, it includes Hip semi-flexion, internal r otation and adduction Knee semi-flexion Ankle plantar flexion Foot pronation or supination Toes flexion Athetoid or dystonic posturing usually incorporates extr emes of movement such as total flexion or extension Windswept Deformity of hip O ne hip flexed, abducted and externally rotated; other hip flexed, adducted and i nternally rotated and in danger of posterior dislocation ll.. . 20 30 (Age in years 2) + 30

CEREBAL PALSY PT ASSESSMENT Sgaar Naik, PT - Weight of the child Weight At birth 3 to 12 months 1 to 6 years 7 to 12 years Kilograms 3.25 (Age in months + 9) / 2 (Age in years 2) + 8 [(Age in years 7) + 5] / 2 Pounds 7 Age in months + 11 (Age in years 5) + 17 (Age in years 7) + 5 - Head circumference of the child The tape is used to measure the occipitofronta l head circumference from external occipital protuberance to the glabella. Head circumference At birth 3 months 1 year 2 years 12 years Developmental Assessment 4 to 6 weeks 3 months 6 months 7 months 5 to 6 months 6 to 7 months 6 to 7 month s 8 to 10 months 10 to 11 months 9 months 12 months 10 to 11 months 13 months 12 months 13 months 15 to 18 months 13 months 15 to 18 months 15 to 18 months ph y sio 4a Age Social smile Head holding Sits with support Sits without support Reaches out for a bright object & gets it Transfers object from one hand to other Starts imitat ing cough Crawls Creeps Standing holding furniture Walks holding furniture Stand s without support Walks without much of a support Says one word with meaning Say s three words with meaning Joints 2 or 3 words into sentence Feeds self with spo on Climbs stair Takes shoes and socks off ll.. . Centimeters 35 40 45 48 52 Developmental Milestones

CEREBAL PALSY PT ASSESSMENT Sgaar Naik, PT Joint Range of Motion (active & passive) - Active head and trunk flexion, extens ion, rotation observed during head raise in prone, supine, sitting, standing dev elopmental channels - Active shoulder elevation, abduction, rotation, flexion an d extension movements are observed during the functional examination of creeping , reaching and other arm movements - Active elbow flexion and extension observed during childs reach to parts of body or toys - Active wrist and hand movements w ill be observed during function development - Active hip flexion and extension w ill be observed during all functions - Active knee flexion and extension seen wi th active hip flexion extension - Foot movements are also check during functiona l development Reactions, Responses and Reflexes - Sucking Reflex (3 months) - Ro oting Reflex (3 months) - Grasp Reflex (3 months) - Reflex Stepping (2 months) Galants Trunk Incurvation (2 months) - Moro Reflex (0-6 months) - Startle Reflex (remains) - Landau Reflex (3 months - 2 years) - Flexor Withdrawal (2 months) Extensor Thrust (2 months) - Asymmetric Tonic Neck Reflex (ATNR) (usually pathol ogical) - Symmetrical Tonic Neck Reflex (STNR) (usually pathological) - Tonic La byrinthine Supine (pathological) - Tonic Labyrinthine Prone (3 months) - Neck Ri ghting (5 months) - Positive Supporting (3 months) - Negative Supporting (3-5 mo nths) - Protective Reflexes If reflexes are persistent beyond the usual duration then they are called positive signs. ph y sio 4a ll.. . 24 months 24 months 3 to 4 years 2 years 3 years 3 years 3 years Puts shoes and socks on Takes some clothes off Dresses self fully Dry by day Dry by night Knows full name and sex Rides tricycle

CEREBAL PALSY PT ASSESSMENT Sgaar Naik, PT ph y sio If reflexes, which are supposed to be, present during particular age but are abs ent are known as negative signs. Muscle tone Reflexes - Superficial Reflexes - D eep Tendon Reflexes Limb Length Discrepancy - Apparent (umbilicus to lateral mal leolus) - True (ASIS to medial malleolus) Contractures Deformities Gait (if appl icable) Transfer activities (if applicable) Balance (if applicable) Assessment o f daily activities Assessment of feeding, dressing, washing, toileting, play and hand function Ambulation (dependent or independent) Cognitive Assessment (if ap plicable) Response to external environment & Behaviour Sense of colour, size, sh ape Sense of common dangers as fire Toilet training Sense of household articles 4a ll.. .