Child neurologic exam Flashcards
What are neurological soft signs
nonfocal, functional neurologic findings
Subtle cue underlying CNS deficit (neurological maturation delay)
Example of soft sign finding in walking/running gait
stiff-legged with a foot slapping quality - unusual posturing of arms
should disappear in gait by 3 years
Soft sign finding in motor stance
difficulty maintaining stance (arm extended in front, feet together, eyes closed)
should disappear by 3 years
soft sign finding one foot standing
unable to stand on one foot longer than 5-10 sec
should disappear 5 years
soft sign finding visual tracking
difficulty following object with eyes - nystagmus
should disappear 5 years
Soft sign finding stereognosis
unable to identify common objects placed in own hand
should disappear by 5 years
soft sign finding right-left discrimination
unable to identify right and left on own body
should disappear 5 years
soft sign finding hopping in place
unable to hope rhythmically on each foot
should disappear 6 years
soft sign finding two point discrimination
difficulty localizing discriminating when touched in one or two places
should disappear 6 years
soft sign finding heel walking
difficulty remaining on heels for distance of 10 ft
should disappear 7 years
soft sign finding tip toe walking
difficulty remaining on toes for a distacne of 10 ft
should disappear by 7 years
soft sign finding tandem gait
difficulty walking heel to toe unusual posturing of arms
should disappear by 7 years
soft sign finding finger nose test
unable to alternately touch examiner’s finger and own nose consecutively
should disappear 7 years
soft sign finding graphestesia
unable to identify geometric shapes you draw in child’s open hand
should disappear 8 years
soft sign finding rapid thumb to finger
rapid touching thumb to fingers in sequence is uncoordinated
unable to suppress mirror movements in contralateral hand
should disappear 8 years
Soft sign finding rapid alternating movements of hands
irregular speed and rhythm with pronation and supination of hands patting the knees
should disappear 10 years
What does shaken baby syndrome cause?
brain to move around
stretches and tears nerve tissue and blood vessels
S/S shaken baby syndrome
Fever, irritability, apnea, seizure, retinal hemorrhage, lethargy
True or false; shaken baby syndrome commonly has an absence of visible trauma to the head or visible bruises
true
True or false; like adults infants with meningitis commonly have nuchal rigidity
false; this doesn’t typically occur until 6-9 months of age
S/S of meningitis in young infant
very irritable fever diarrhea poor appetite toxic appearance bulging fontanelle
True or false; cerebral palsy is a permanent disorder and non progressive (static)
true
What causes cerebral palsy
injury to immature periventricular white matter (damage could be caused by number of things including infection, prematurity, genetic factors)
S/S cerebral palsy
Delayed gross motor development, mental/learning, hearing, speech,
feeding difficulties, seizures
Persistent primitive reflexes (exaggerated DTR’s)
Intention tremors
Contrast Spastic Cerebral palsy with Dyskinetic and ataxic
Spastic - hypertonic, tremors, scissor gait, toe walking
Dyskinetic - slow writhing movements, tremors sometimes
Ataxic - abnormalities of movement - balance and position of trunk and extremities issues
When is the peak occurrence of SOLs
3-12 years and 50-70 years
True or false; you should use the same technique and grading scale on reflexes as you do adults
true
