c4K Module 1 Flashcards
what is the purpose of doing a neurological examination?
Is there an interference in the NS and has the NS matured properly?
What will you neuro exam contain?
Observation Muscle spindle reflexes CN exam Tone Primary/ automatic reactions (reflexes)
How would you go about completing a CN exam on an infant and when should you do it? 1 2 3 4 5 6 7 8 9 10 11 12
A CN exam should be completed in every initial consult as it only takes a few minutes
1- non functional
2- Reaction to light (grimace or blink)
3,4,6- Dolls eye manouver
5,7,9,10,11,12- put your gloved finger in mouth and feel for symmetry and strength of suck and check gag reflex while you are there.
8- ring a ball or clap and they should turn their head towards sound.
12-Pinch nose and mouth should open
How would you measure tone?
Do this with the horizontal suspension reflex
Head should stay in same plane as back and the back should show some resistance to gravity.
Primitive Reflexes Why is it important to test these? What will be abnormal? How are they suppressed? Name the 3 PR we will test on all infants and when they should disappear?
We test the primitive reflexes to test the integrity of the brain stem + spinal cord and degree of maturity.
Absence or asymmetry may indicate slow neurological development
They are gradually supressed as higher cortical centres in the brain mature
1. Moro (birth till 4-5months)
2. Galant (brith till 2-4 months)
3. Placing Response (birth till standing) bubs hip and knee should flex
Postural Reflexes
What are they important for?
What are the 6 we test for when should they appear?
How do you test them? if you dont remember watch the video AGAIN NOW.
When do they appear?
Independant sitting and walking
- Pull to sit test (if sleepy test may be inacurate)
- newborn (slight head lag, 4-6 weeks neutral, > head to chest.
- some elbow flexion should also be present (if not hypotonia) - Positive support reflex (present 3-4 months)
- bub placed on mat standing, legs should extend and attempt to support weight - Landeu Reflex (4-5 months)
- When infant is placed on examiners hand, head will extend above trunk. AND if you flex head - legs should flex at hips. - ATNR
- rotate head (by themselves if possible)
- absence of this reflex isnt clinically significant if there is already body torque. - Palmar grasp (birth- 4months)
- Rooting and sucking reflex (0-7/8 months)
in asleep child (4/5months)
Orthopaedic Examination HIPS What are the 2 tests, how do you perform them? what is abnormal? Crawling Progress When should a kid be crawling?
HIPS
Ortolani’s test:
Abduction of flexed hips
-both should be able to go flat against the table, if one hip one abduct completely or a clunk is heard (a dislocated hip should be suspected)
Barlow:
Flexing and adducting the hip then applying long axis traction (push)
-if audible clunk heard- congenital hip displasia should be suspected.
Crawling:
Should happen between ages of 6-8 months. A normal crawling pattern will only develop once the positive support reflex has developed.
Spinal Examination
1. Inversion analysis test
What does it mean, what are the contraindications,
How would you explain to the parents?
Explanation: I would like to ask your permission to do a diagnostic test on _____. This test requires me to hang litle _____ upside down for a few seconds. It does not hurt them, often they enjoy it and gives us very important information as to how their spine and nervous system is doing.
- Contraindications: haemorrhageic disease, hydrocephalus, hip instability or neuro symptoms.
- Results:
- Head rotates in 1 direction: C1-C2 subluxation
- Head held in lateral flexion: occipital condyle or cervical facet subluxation (KISS 1)
- Neck held in extension: occipital condylar compression (KISS 2) AS occiput bilat
- Neck held in Flexion: cranial dural restriction or PS occiput
- Babys trunk laterally flexes or twists: thoracic/ rib subluxation/ or body fascial restriction
- Uneven leg lengths: pelvic instability.
Spinal Examination
2. Lumbosacral Region
Position, and required actions
Position:
Prone on: supine mum, mums lap, seated chiro lap or table or contour pillow.
How: Hold bub by ankles, contact L5 SP and lift pelvis of table, feel for motion. If no motion check for rotation with thumbs contacting either side of SP.
If both restricted may be straight posterior.
Spinal Examination
3. Lumbar/ Lower Thoracic Region.
Take a finger contact between lumbar SP and feel for movement as kids spine is taken into ext by ankles. If restriction found check rotation with bilat thumb contact either side of SP.
Spinal Examination
4. Sacrum
Screening?
Logan Basic
Sacrum can subluxate at level of lumbosacral junction (base posterior sacral subluxation)
or it can subluxate at the SI joints (a rotated sacrum as a PL or PR) or at individual segmental sacral levels (as post S2 or S3)
Primary subluxations at sacrum is usually associated with craniosacral dysfunction.
Take contact on base of sacrum and introduce extension with ankles like L5.
If restriction is found check for rotation with thumbs.
If restricted in rotation its PR or PL.
If restricted bilat its a base posterior.
or checking sacral tubercles take contact between sacral vertebrae while introducing extension into childs spine.
Logan Basic:
This protocol involves by definition an anterior inferior sacral subluxation with body rotation of L5 and a PI innominate.
Place the infant prone and squeeze the upper part of the butt cheeks together..
Spinal Examination:
5. Sacroiliac Joints
Rare to find an SI problem in baby as joints haven’t matured and not weight bearing, but check for AS and PI’s.
Joint best palpated by placing your finger over the joint and palpating it at end ranges. Eg End range ext and flexion.
To do this flex knee upwards (restriction) = AS
If restricted into ext (PI)
Spinal Examination
Mid to Upper T spine
T2/ To T8/9
Spine is gently moved into flexion and extension as you gradually move up spine, feeling for motion restriction .
If restriction found introduce some rotation into trunk of kid as you feel for movement. If bilaterally restricted its a straight posterior.
Spinal Examination
Upper cervical spine
What is the process of upper cervical screening
If there is a restriction in upper cervical lateral flexion, followed by restriction in flexion or ext = occiput
if restricted into flex = AS occiput
If LF restriction with no restriction in flexion + extension at condyles, but restriction at C2 spinous process when taking childs head into flexion and extension = C2 restritcion
Then contact SP and rotate head to determine rotated component.
If you have restriction in upper cervical LF, with no restriction in flexion and ext @ condyles and no restriction at C2 = atlas subluxation by process of elimination.
Then rotate bubs head either side to find rotated component.
Summary: Examination Process in the Neonate/ baby Prior to the Examination Observation: (16) Initial Palpation: 5 Supine Examination: 16 Moving child into Prone Position: 8 Prone Examination: 4 Sitting exam: 7 Cranial Exam
Summary: Examination Process in the Neonate/ baby
Prior to the Examination:
-interact with child to begin bonding process
-have parent undress bub to just nappy.
Observation: (16)
-tone
-torsional posture
-fascial symmetry, fullness, movement
-orbits of eyes, symmetry of nostrils, shape of nose and glabella
-jaw and mouth symmetry
-depression of greater wing of sphenoid
-skull symmetry
-quality and strength of cry
-presecence of gag reflex
-pupil when penlight is shone in it
-response with dolls eye test when penlight is shone in eye.
-reponse with clap test
-response when childs nose is pinched
-response with inverted swing test
Initial Palpation: 5
- tone
- anterior and posterior fontanelles
- sutures
- cranial vault symmetry
- assess suck.
Supine Examination: 16 Moving child into Prone Position: 8 Prone Examination: 4 Sitting exam: 7 Cranial Exam
