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,
which allows for improvement or deterioration to be noted, thus enabling treatment to be
more effective.
The therapist must have knowledge of normal development.
During physical examination, it is important to discriminate between delay in motor
development and abnormal motor patterns.
It is very essential for the therapist 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 possible on parents lap.
Observe child among familiar toys as well as with selected toys to activate interest as
well as reveal dormant abilities.
Keep sessions within the bounds of a childs concentration.
Have an unhurried atmosphere.
Have easy, successful actions of a child interspersed with difficult tasks.

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
Address
When did the mother first noticed the dysfunctions
Siblings having same type of symptoms
Prenatal History
Age of mother
Consanguity marriage
Any drugs taken during pregnancy
Any trauma & stress
Any addiction smoking or alcoholism
History of rubella or cytomegalovirus, toxoplasmosis infection
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CEREBAL PALSY PT ASSESSMENT
Sgaar Naik, PT

History of previous abortions, still born or death after birth
Multiple pregnancies (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 presentation
Any history of prolonged labour pain
Condition of mother at the time of delivery
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
Hydrocephalus or Microcephaly
Nutritional habits of the child (malnutrition)
Feeding difficulties
Any medical or surgical treatment taken
Any physiotherapy treatment previously 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

Objective Examination:

On Observation:

Behaviour of the child
Whether child is alert, irritable or fearful in the session or during particular
activities
Child becomes fatigued easily or not during activity
Find out what motivates his action particular situation, person or special
plaything
Communication of the child
How child communicates with the parents
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CEREBAL PALSY PT ASSESSMENT
Sgaar Naik, PT

Whether child initiates or responds with gestures, sounds, hand or finger
pointing, eye pointing or uses words and speech
Attention span
What catches childs attention?
For how much time childs attention is maintained on particular thing
How does parent assist him to maintain attention?
What distracts the child?
Does child 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 position
Symmetry of the child (actively or passively maintained)
If involuntary movements present, then in which positions these movements
are decreased or increased
Postural control & alignment
How much parental support is given
Postural stabilization and counterpoising in all postures
Proper & equal weight bearing
If the childs 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 as well as using them in
position
Attitudes of limbs during playing in all positions
Whether one or both hands are used, type of grasp and release
Accuracy of reach and hand actions
Any involuntary movements, tremors or spasms, which interfere with actions,
are present
Sensory aspects
Observe childs use of vision, hearing, of touch, smell and temperature in
relevant tasks
Does child enjoys particular 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 daily activities motivates child to roll, creep, crawl, bottom shuffle or
walk
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CEREBAL PALSY PT ASSESSMENT
Sgaar Naik, PT

Deformities
Observe any recurring position of the whole child
Any part of the body, which remains in particular position in all postures & in
the movements
The positional preferences typically seen in spastic cerebral palsies are for mid
positions of the body
- In the arm, this generally consists of
Shoulder protraction or retraction, adduction and internal rotation
Elbow flexion
Forearm pronation
Wrist & Fingers flexion
- In the legs, it includes
Hip semi-flexion, internal rotation and adduction
Knee semi-flexion
Ankle plantar flexion
Foot pronation or supination
Toes flexion
Athetoid or dystonic posturing usually incorporates extremes of movement
such as total flexion or extension
Windswept Deformity of hip One hip flexed, abducted and externally rotated;
other hip flexed, adducted and internally rotated and in danger of posterior
dislocation

On Examination:

Sensory Assessment
It is difficult to assess sensation in babies and young children with severe
multiple impairments.
If any hearing or visual or psychological abnormalities are present then
assessment done by specialist is required
Motor Assessment
Growth Parameters
- Height
Until 24 to 36 months of age, length in recumbency is measured using an
infantometer. After the age of 2 years standing height is recorded by a
stadiometer.

Height Centimeters Inches
At birth 50 20
At 1 year 75 30
2 to 12 years (Age in years 6) +77 (Age in years 2) +30

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CEREBAL PALSY PT ASSESSMENT
Sgaar Naik, PT


- Weight of the child

Weight Kilograms Pounds
At birth 3.25 7
3 to 12 months (Age in months +9) / 2 Age in months +11
1 to 6 years (Age in years 2) +8 (Age in years 5) +17
7 to 12 years [(Age in years 7) +5] / 2 (Age in years 7) +5

- Head circumference of the child
The tape is used to measure the occipitofrontal head circumference from
external occipital protuberance to the glabella.

Head circumference Centimeters
At birth 35
3 months 40
1 year 45
2 years 48
12 years 52
Developmental Assessment

Age Developmental Milestones
4 to 6 weeks Social smile
3 months Head holding
6 months Sits with support
7 months Sits without support
5 to 6 months Reaches out for a bright object & gets it
6 to 7 months Transfers object from one hand to other
6 to 7 months Starts imitating cough
8 to 10 months Crawls
10 to 11 months Creeps
9 months Standing holding furniture
12 months Walks holding furniture
10 to 11 months Stands without support
13 months Walks without much of a support
12 months Says one word with meaning
13 months Says three words with meaning
15 to 18 months J oints 2 or 3 words into sentence
13 months Feeds self with spoon
15 to 18 months Climbs stair
15 to 18 months Takes shoes and socks off
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CEREBAL PALSY PT ASSESSMENT
Sgaar Naik, PT

24 months Puts shoes and socks on
24 months Takes some clothes off
3 to 4 years Dresses self fully
2 years Dry by day
3 years Dry by night
3 years Knows full name and sex
3 years Rides tricycle

J oint Range of Motion (active & passive)
- Active head and trunk flexion, extension, rotation observed during head
raise in prone, supine, sitting, standing developmental channels
- Active shoulder elevation, abduction, rotation, flexion and 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 will be observed during function
development
- Active hip flexion and extension will be observed during all functions
- Active knee flexion and extension seen with active hip flexion extension
- Foot movements are also check during functional development
Reactions, Responses and Reflexes
- Sucking Reflex (3 months)
- Rooting 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 pathological)
- Symmetrical Tonic Neck Reflex (STNR) (usually pathological)
- Tonic Labyrinthine Supine (pathological)
- Tonic Labyrinthine Prone (3 months)
- Neck Righting (5 months)
- Positive Supporting (3 months)
- Negative Supporting (3-5 months)
- Protective Reflexes
If reflexes are persistent beyond the usual duration then they are called
positive signs.
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CEREBAL PALSY PT ASSESSMENT
Sgaar Naik, PT

If reflexes, which are supposed to be, present during particular age but are
absent are known as negative signs.
Muscle tone
Reflexes
- Superficial Reflexes
- Deep Tendon Reflexes
Limb Length Discrepancy
- Apparent (umbilicus to lateral malleolus)
- True (ASIS to medial malleolus)
Contractures
Deformities
Gait (if applicable)
Transfer activities (if applicable)
Balance (if applicable)
Assessment of daily activities
Assessment of feeding, dressing, washing, toileting, play and hand function
Ambulation (dependent or independent)
Cognitive Assessment (if applicable)
Response to external environment & Behaviour
Sense of colour, size, shape
Sense of common dangers as fire
Toilet training
Sense of household articles
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