Cerebral Palsy Evaluation Flashcards
Subjective
Patient Hx
Birth Hx
Neonatal Hx
Developmental Hx
Hx of presenting illness
Pregnancy Hx
Exposure to drugs/toxins
Acute material illness
Gestational Dm
Prenatal infections
Other complications?
Birth Hx
Gestational age
Multiple births
Delivery type
Presentation (breech, cord around neck)
Birth complications? (resuscitation needed?)
APGAR score
Neonatal Hx
NICU admission (time in hospital?)
Treatment provided
Developmental Hx
When was the last milestone achieved?
Standardized testing results
Hx of presenting illness
Delayed milestones
Atypical development
Abnormal tone (floppy or difficult to dress/put into a car seat?)
Asymmetric movements
Use of assistive devices/braces
Review of systems
Vision
Hearing
Epilepsy (seizures)
Constipation/urinary incontinence
Dysphagia
GERD
Pressure ulcers
Behavior
Objective
Observation
Tone
Reflexes
ROM and voluntary control
Muscle strength
Posture
Gait analysis
Observations
Dysmorphic features
Head circumference (may need to be measured)
Postural alignment (head/trunk alignment, upper limb symmetry, lower limb symmetry, LLD, spinal curvature)
ROM
Tone
Muscle strength
Gross/fine motor fxn
Gait
Tone
Hyper/hypotonia/fluctuating tone
Objective tone assessment in younger children can be difficult
Muscle groups and movements affected
Scale used to assess tone
Modified Ashworth scale
Reflexes
Presence of primitive reflexes (Screening)
ATNR
DTR (Exaggerated)
What functions are affected by the persistence/absence of reflexes?
ROM and Voluntary control
Muscle length (PROM)
AROM
Impaired voluntary motor control
ROM and voluntary control
- Muscle length (PROM)
Assess for muscle tightness/contractures/joint deformities
ROM and voluntary control
- AROM
Can help assess voluntary control and muscle strength
ROM and voluntary control
- Impaired voluntary motor control
Presence of flexor/extensor synergies
Muscle strength
MMT
Handheld dynamometry
Functional testing
Posture
Static balance
Dynamic balance
Posture
- static balance
Isometric muscle work
Sustained position
E.g. sitting/standing
Posture
- dynamic balance
Transitions from one position to another depending on the function (sit to stand)
Combination to isometric/isotonic muscle work
Dynamic Balance: Motor Control
Higher degrees of freedom to control
Anticipatory postural adjustments
Compensatory postural adjustments
Dynamic Balance: Motor Control
- Anticipatory postural adjustments
The activation of postural muscles in a feedforward manner before a voluntary movement begins, in anticipation of the destabilizing forces caused by the movement
Dynamic Balance: Motor Control
- Compensatory postural adjustments
Initiated based on sensory feedback and serve as a mechanism to restore the COM position after a perturbation has already occurred
Gait Analysis
Hemiplegia
Diplegia
Standardized Outcome Measures
Body structure/function and activity limitations
- Gross Motor function measure (GMFM-66)
- Pediatric Balance Scale (PBS)
- Static and Dynamic Posture
- Gait
Pediatric Balance Scale (PBS)
Pediatric version of the Berg Balance Scale
Static and Dynamic Posture
Trunk control measurement scale (TCMS)
Segmental Assessment of Trunk Control (SATCO)
Gait
Edinburgh Visual Gait Analysis (EVGS)
