Physical Assessment in Pediatric Rehabilitation
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PHYSICAL ASSESSMENTINPEDIATRIC REHABILITATIONDR MEYSAM. MOHAMMADI
:ارائه شده در
معاینات عصبی در توانبخشی کودکان کارگاه تخصصی 96زمستان
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• Muscle
•Size……. Are there any muscle atrophy?
•Strength..
•Tone....
- Coordination
• Rapid alternating movement
• Finger to finger
• balance
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Muscle Testing
•0: no movement
•1: can see muscle contraction but no
movement
•2: can move with gravity eliminated
•3: can move against gravity
•4: can resist opposition to some extent, but
not full (+, - also)
•5: full strength
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TONE
• Tone is the resistance appreciated when moving a limb
passively
• “Normal Tone”
• Hypotonia
• “Central Hypotonia”
• “Peripheral Hypotonia”
• Increased Tone
• Spasticity (Corticospinal Tract)
• Rigidity (Basal Ganglia, Parkinson’s Disease)
• Dystonia (Basal Ganglia)
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TENDON REFLEXES
Triceps C7, 8
Biceps C5, 6
Supinator C5, 6
Knee L3, 4
Ankle S1, 2
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TESTING THE PLANTAR REFLEX (BABINSKI).
-STROKE THE LATERAL ASPECT OF THE SOLE OF EACH FOOT WITH THE END OF A REFLEX HAMMER OR KEY. -OBSERVE FOR PLANTER FLEXION OF THE FOOT .
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INVOLUNTARY MOVEMENTS
• Hyperkinetic Movements
• Chorea.. Involu/jerk/dance shape/prox
• Athetosis… inv /twisty/distal
• Tics.. Sudden/non rhythmic/repetitive
•Myoclonus..twich/jerk/stretch or seizure induce
• Bradykinetic Movements
• Parkinsonism
• Dystonia.. Invo/sustained or repetitive/postural
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MUSCLE COORDINATION
• Eye Hand coordination
• Two hand coordination
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CEREBELLAR PROBLEMS• Dysmetria *
• Dysdiadochokinesis*
• scanning speech
• Hypotonia*
• Falls to Side of Lesion*
• Nystagmus (Variable Directions)
• intention tremor
• ataxic gait
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CEREBRAL PALSY
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RED FLAGS
• Head control …………………….. 3 month
• Sitting ……………………………….. 6 month
• Rolling …………………………….... 9 month
• Walking …………………………… 18 month
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ASSESSMENT OF REFLEXES
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PALMAR GRASP
Birth
Until
5 - 6
month
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ASYMMETRICAL TONIC NECK REFLEX
Birth
Until
6 month
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6 – 11 month
Is Normal
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• gastroc soleus test
Birth until
4 month
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Birth until 5 month
Help to Early Diagnosis
Symmetry /Asymmetry
30◦ flex
Ext.Rot finger Ext
Then………..Int.Rot
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• Rooting reflex
• Sucking reflex
• Swallowing
• - Drooling
-V, VII, IX, X, XII CN Integration
• -Gag reflex
• Mastication
-Bite reflex
Oral reflexes
0 - 4 Month
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DEVELOPMENTAL MOTOR SPEECH DISORDERS
•Aphasia
•Apraxia of speech… due to:
Planning difficulties
•Dysarthria … due to:
Coordination, Speed, Tone, Power
difficulties
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COMMON DEFORMITIESINCEREBRAL PALSY
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LUMBAR HYPERLORDOSIS
• Hip flexor contracture
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LUMBAR KYPHOSIS
• Hamstrings contracture
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SCOLIOSIS
• test it In different positions
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ELY TEST
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FEMORAL ANTEVERSION
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TEST OF FEMORAL ANTEVERSION
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HIP; ANT AND POST TILT
hip flexors shorten and
the hip extensors lengthen.
Lum.lord
hip flexors lengthen and
the hip extensors shorten
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LATERAL TILT OF HIP
is associated with scoliosis or people who have legs of different length.
It can also happen when one leg is bent while the other remains straight.
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THOMAS TEST
• Iliopsoas shortness
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BACK KNEE
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GENU VALGUM/ VARUM
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HAMSTRINGS SHORTNESS
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QUADRICEPS SHORTNESS
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PES PLANUS
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PES VALGUS
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PES VARUS
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EQUINO VALGUS
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EQUINO VARUS
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GASTROSOLEUS TEST
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gross Motor
•Gait
• Jumping
• Tandem walking
• Romberg • A patient who has a problem with proprioception can
still maintain balance by using vestibular function and vision
•One legged squat
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FINE MOTOR SKILLS
• Grasp
• Strength
• Control
• Dexterity
• Hand dominance
• Writing
• Drawing
• Scissoring
• Cubes
• to turn the page
• Folding
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MUSCLE AND JOINTS
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PINCER GRASP AND PALMAR GRASP
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INTRINSIC AND EXTRINSIC MUSCLES
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GAIT ASSESSMENT
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A NORMAL GAIT REQUIRES
• Vision
• Strength
• Balance/Coordination
• Joint Position
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GAIT!
Observe walking firstly
Walk on heels
Tip-toes
Run
Stand on one leg (x 5 secs) [3 yrs]
Hop [4 yrs]
Walk straight line x 20 steps [5 yrs]
Tandem (heel-toe) walking [7 yrs]
Crouch down (distal muscles)
& stand up (proximal muscles)
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OBSERVE DIFFERENT ASPECTS OF GAIT• Posture of Trunk
• Toe Walking
• Heel Walking
• Tandem Walking
• Hip, knee and ankle strategies
• Arm Swing
• Base of Gait
• Heel Strike
• Time Spent on Each Leg
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GAIT ABNORMALITIES
• Broad-based;• appropriate when learning to walk
• Hypotonia of legs / pelvic girdle
• Cerebellar dysfunction
• Hip joint problems
•Narrow gait; (scissoring?)• Adductor spasm (mild diplegia)
• Hemiplegic gait; (wide swing) • proximal muscle weakness
•Waddling gait;
• High-stepping gait;• Sensory neuropathy
• Distal weakness eg. foot-drop
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CLASSICAL PATTERNS OF ABNORMAL GAIT
• Hemiparetic Gait
• Spastic Diplegia Gait
• Ataxic Gait
• Waddling Gait
• High Stepping Gait
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SENSORY ASSESSMENT
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SENSATION• Exteroceptive
• Proprioceptive
joint laxity …. Crude movement.. Simulation…
• Tactile discrimination
• Stereognosis
• Graphesthesia
• Two point discrimination
• Extinction
• Point location
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DERMATOMES
• Hypesthesia
• Hypersthesia
• Parestesia
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IDENTIFY EXTROCEPTIVE SENSATIONS.
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STEREOGNOSIS
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GRAPHESTHESIA
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کارگاه تخصصی
معاینات عصبی در توانبخشی کودکان
سپاسگزاریم
www.farvardin-group.com
@farvardin_group_channel
@neuroscience4family
@farvardin_group96