Tutorial

CP Spastic Quadriplegia
Amalia Khairunnisa
Risdiani Sukmana

I. Patient Identity
NRM : 410-09-04

Date of examination : Monday, October 24th 2016

Time : 9.00 AM
Name : An. AF
Place/Date of Birth

: Jakarta/April 11th 2012

Dads Name : Mr. M

Moms Name

: Mrs. S

Address : Slipi, West Jakarta

Homes Number

:-

Handphones Number: Medic Diagnostic : Cerebral Palsy Spastic Quadriplegia

II. General Examination

Temperature

: Afebris

Blood Pressure

:-

Heart Rate

: 86x/minute

Respiration Rate

: 28x/minute

Nutrient Status
conjungtiva
turgor

: Impression good enough

: pink
: can be back quickly

Head Circumference : 45cm (N= 48cm)

III. Physiotherapy Assessment

A. Anamnesa
- Primary complaint : cannot rolling
- Present Disease History:
At 13 month he had fever and seizures. And then he went to
RSAB Harapan Kita but his doctor referred to RSCM specialist orthopedi
at 10 March 2016 and suggested for surgery the hip. After that he
referred to specialist child and suggested to physiotherapy with CP
spastic quadriplegia diagnosed. He start physiotherapy since
September 16th 2016 until now.
- Prenatal History
: His mother was 31 years old when she
had maturnity, normal pregnancy without problem
- Natal History

: - normal birthing
- spontaneously
- crying
- weight 2700 gr

- Postnatal

: seizures (-)

- Past Disease History : nothing

- Family Disease History: nothing
- Physcho-social History:
1) he is second child
2) the first child 10th years old in elementary
school
3) his father 33 years old and the job is employeer
4) his mother 35 years old and the job is employeer
- Immunization History

: completed

- Growth and Development History:

Before

After

- Prone 7 month
- Rolling 8 month
- Creeping 10 month
- Sitting 10 month

- Just can supine and

cannot rolling

B. General Impression
Attention

: (+) interest to the toys

Emotion

: when he touched by someone he was crying

Motivation

: (-) he doesnt want to take the toys and cannot

raise the toys

Problem Solving : (-) he cannot play the toys according the function
Communication

: (-) he cannot follow instruction

Cognition

: similar to 0 1 month

C. Sensory Ability
Visual

: following the toys a moment

Auditory

: following auditory stimulation a moment

Tactile

: he felt uncomfortable when he touched hard texture

Propioceptif

: he cannot tread on palm of hand and scissors

D. Stability Condition
Static

: cant stable on the sitting steady without hand support

and asimetric trunk

Dynamic : cant do
E. Abilty and Disability
1) Chronological Age
4 years 6 month
2) Developmental age
similar to 0 1 month
Gross motor

: he just can supine

Fine motor

: he cant grasp

Talk History
F. Postural Tone

: he just babling without meaning

: Hipertone

G. Postural Pattern
1) Supine position
head move unfreely
shoulder protraction
elbow flexion
trunk side flexion to dextra
hip adduction and endorotation
knee extention
ankle plantar flexion invertion
2) Prone position
head lifting (+)
shoulder retraction
forearm support (+)
trunk assimetric
hip adduction and endorotation
knee extention
ankle plantar flexion invertion

3) Rolling position(-)
Trunk rotation (-)
4) Sitting positioned
Head control (-)
Trunk assimetric
Elbow flexion
Knee flexion

h. Specific examination
7 Reflex
a)

ATNR

: (+) 1

b)

STNR

: (+) 1

c)

Moro

: (-) 0

d)

Neck righting

: (-) 0

e)

Extensor thrust

: (-) 0

f)

Parasut

: (-) 1

g)

Foot placement

: (-) 1

Total

4 (prognosed to walk is bad)

 Asworth Scale
a)

UE = 1+

b)

LE = 2

Antropometric (leg lenght) from SIAS to Malleolus medialis

a)

Dekstra = 52 cm

b)

Sinistra = 55 cm

Clonus (+)
Tightness achilles (+)

ICF MODEL

Body structure and body

function
Hipertone (b735)
Tactile and proprioceptif
impairment (b260)
Tightness
Head lifting (-) (b730)
Trunk rotasi (-) (b730)
Assimetric Trunk

Environtmental factor
Family supporting
(e310)

CP Spastik
Quariplegi

Activity Limitation and

Partisipation Restriction
Cannot rolling (d410)
Cannot play with his
friend (d880)

Personal factor
An. AF, boy (11th April
2012), 4 years 6 month.
Similiar 0-1 years old

V. Treatment goal
1. Short term

- reduced spastic
- increased tactile and proprioceptif
- facilitation rolling
2. Long term
- sitting steady
- maintenance

VI. Physiotherapy Implementation

program
No.

Kind of exercise

Method

Plan

1.

Exercise therapy

NDT

- Inhibition spastic
- Stimulation tactile and
propioceptif
- Facilitaton rolling

Explaination of Intervention
1. NDT
Spastic inhibition, increase of propioceptive
- Children position

: supine

- PT position : in front of children

- procedure : position the children in side lying with upper extremity
the finger with flexion and extension, wrist move flexion and extension,
after that shoulder and elbow move the adduction and then rotation trunk
with fixation hip, handling in shoulder.
Children position : supine
PT position

:i n front of children

- procedure : for the lower extremity start from toes with the flexion
and extension, and then ankle flexion and extension, knee flexion and
extension.

Sitting in side of the bed

Children position : sitting in side of the bed
PT position
: in the behind of children
- Procedure
: position the children sitting in
the side of bed, let the foot down to the bottom and
then place the antislap under gluteus area, after
that trunk rotation with adduction shoulder. And
then back to netral position give the pressure to
caudal from shoulder, and pressure from elbow to
caudal.

VII. Evaluation
S

: he cannot rolling

: he often crying but tearless

spatic (+)
head move unfreely
assimetric trunk side flexi dextra

: cannot rolling relate head control & trunk rotation because

hipertone

: NDT

IX. Home Program

1) Give toys with many texture
2) Explain his parents to sitting positioned
3) Explain his parents how to carry the child with both arm and leg
doesnt impacted
4) Explain his parent hows to lifting the child, example: first, make
side lying position
5) Explain his parents to positioning the child sitting on the side bed

Thank you for your attention