Examination and Evaluation Flashcards
Exam/Eval
Involved identification of strengths/abilities, participation restrictions, activity limitations, impairments of body structure/fxn
use this info to determine the diff btwn current performance and capacity, predict optimal level of improvement expected, formulation of short/long term goals
assessments should be ongoing
Muscle Tone/Extensibility
Important to consider both neurologic and passive mechanical components of tone and to measure accordingly
Modified Ashworth- commonly used, but does not differentiate btwn spasticity and extensibility— low levels of reliability in children with CP
- does not quantify spasticity exclusively
May be more beneficial to evaluate resistance at different speeds
Modified Tardieu Scale- measures the point of resistance or catch to a rapidly velocity stretch, giving and indication of the dynamic neural component of tone or overactive stretch reflex
- -moving the limb slowly into lengthened position indicates mechanical component of tone or mm length at rest—ROM
- a large different btwn the initial catch and point of mechanical resistance indicates a large relfexive component to motion limitation and a small difference suggests a more fixed mm contracture
- -** Tardieu scale has been found to be more reliable, but larger variations between dynamic and static differences limit use as an outcome measure
Goni measurements have increased errors- must have change of 15-20d or greater between sessions to be 95% confident that a true change in ROM has occurred
- use caution when using ROM measurements to determine outcomes and make clinical decisions
- Quantitative ROM measures should be documented and consistent procedures should be used
Spinal alignment Range of Motion Measure: SAROMM, discriminative tool used to estimate limitations of splinal alignment and ROM in children with CP
- indicates whether a child has normal alignment and ROM, flexible deviation, or mild/mod/severe fixed limitations
- considered reliable and valid for use with CP
Barry Albright Dystonia Scale- tool for rating dystonia, 5 point ordinal scale based on severity of posturing and involuntary dystonic movements in 8 body regions
Strength
Should use isometric measurements- MMT or use of dynamometer
Also look at functional control (sit to stand and stairs look at concentric and eccentric control)
- quantify number of repetitions of a functional mvmt performed over a specific period of time can quantify functional mm strength
Endurance and efficiency- specifically important as children venture out to community on their own or with peers
- can be assessed by observing ability to walk age appropriate distances or propel w/c a comparable span
- 10 meter, 1/6/10 minute walk test and 600 yard run test have been reliable in children with CP
- reliable and valid shuttle runs have been developed to GMFCS level I and II- acceptable for measuring impairment of aerobic capacity exercise tolerance over time
- sprinting tests look at anaerobic capcity
Selective Control, Postural Control, and Motor Learning
SCALE- Selective Control Assessment of the lower extremity = objective tool used to quantify LE selective voluntary motor control– rates ability to perform specific isolated mvmt patterns as normal, impaired, or unable ‘
Postural control is measured with standardized and nonstandardized tests
- sway/response to perturbations can be assessed by disturbing the supporting surface or by perturbing subject or environment
- visual observation, kinetmatic, kinetic, and center of pressure measures or EMG can be used to assess responses
- EMG- makes it possible to detect abnormal responses in timing of mm activity onset/duration, in the sequencing of agonists, and in co-contraction of antagonists
Berg can be used for children with CP depending on ability of the child and purpose of the measurement
Pain
obtain info about pn routinely
use pain assessment tool for CP- allows for self report of pn and may indicate the range of potentially pnful activities more accurately than proxy report
Activity and Participation
PT must differentiate btwn capacity (can a child perform a task in an ideal environment, representative of highest LOF), performance (does the child perform the task within the context of his daily life), and motivation (is the child interested in performing the task)
**capacity often exceeds performance in children with disabilities
GMFM = most widely used clinical tool for assessment of children with CP, reliable and valid in detecting change in children with CP
- can be used on children 5 months to 16 years
- GMFM-88 = original had 88 items, gain of 5-7% = medium positive clinically important change for an individual child
- GMFM-66 = improved scoring, interpretation and overall clinical/research utility, fewer testing items and estimates difficulty of items
- Gross Motor Ability Estimator- GMAE- computer program that converts scores to an interval and plots score graphically
Gross motor performance measure- GMPM- assesses qualitative aspects of motor skills and can help in detecting the fine increments of motor skill gains that are characteristic of children who are severely affected
Quality Function Measure- Quality FM- further adaptation of GMPM- used to develop video recording to assess quality of alignment, selective control, coordination, stability, and weight shift in the stand and walk/run/jump GMPM dimensions
Walking- abnormal and compensatory gait patterns common in children with CP–gait analysis should include clinical exam of physical impairments including spasticity, ROM, strength, bony deformity, and selective motor control coupled with dynamic assessment of biomechanical and phsyiologic aspects of walking
- some think that computerized 3d motion analysis is gold standard other see it as expensive and is not a requirement for optimal treatment of children with CP
- visual observation can be used for subjective descriptions
- Observational gait scale- moderate interrater reliability and validity
- Edinburgh Gait Score- developed for video gait analysis of people with CP
- Accelerometry- can be used to quantify activity level performance in daily life
*****child and caregiver interview = most important clinical tool
Intervention
From infancy to adulthood PT goals for ppl with CP should focus on the promotion of participation in their specific personal and environmental contexts by maximizing the activity allowed by impairments and compensating for activity limitations when necessary
It cannot be assumed that treatment of a specific impairment will lead to improvement in the ability to perform tasks in daily life— treatment is multifactorial
PT should recognize when tasks and the environment should be adapted rather than the impairments remediated to achieve function and participation!!
– Should also be cognizant of environmental and personal factors that could enhance or create barriers to activity or participation
Assessments for motor development
Infant: TIMP, AIMS, and Motor Assessment of infants
Preschool to early school years- PDMS-2, TUG, Timed up/down stairs, Activity Scale for Kids (child/parent report, kids 5-15 y/o with msk disabilities)
PEDI– parent report of functional skills
WeeFIM– function quantified by burden of care
Pediatric Outcomes Data Collection instrument- determines levels of various skills
Measures of Participation
help to ensure outcomes assessed in clinical situations relfected functional improvement at home school and community
Assessment of life habits- Life-H- determines the daily life experiences of the child- aligns with ICF model- 11 domains of daily activities and social roles on level of accomplishment, type of assistance, and level of satisfaction
The Child Help Out: Responsibilities, Expectations, and Supported- CHORES- quantifies the levels of accomplishment and assistance required for self care and family care such as feeding pets or performing household chores
The Children’s Assessment of Participation and Enjoyment (CAPE)- child report instrument, captures diversity, intensity, with whom, location, and enjoyment of participation in formal and informal activities using 5 scales- recreational, active physical, social, skill based, self-improvement and educational— does not incorporate level of assist needed in scoring
The lifestyle assessment questionnaire for CP- measures physical dependence, restriction of mobility, edu exclusion, clinical burden, economical burden, and restriction of social interaction— provides info on impact of disability on participation of the family unit
School Assessments
School Function Assessment- used to assess participation, adaptations, assistance, and activity performance in education setting, providing information about the environment and as well as particpation
Chedoke-McMaster Attitudes towards children with handicaps—measures 3 components of peer attitudes: affective, behavioral, and cognitive
Quality of Life
Pediatric QOL Inventory- CP module- measures health-related QOL specific to CP
– includes 5 dimensions- daily activities, mvmt and balance, pn/hurt, fatigue and eating
Caregiver priorities and child health index of lift with disabilities- CPCHILD- measures health status and well being of children with severe CP
CP QOL Questionnaire- has self report and parent proxy versions to assess 7 domains of QOL- social well being and acceptance, feelings about functioning, participation and physical health, emotional well being, access to services, pn and feeling about disability, family health
Child Health Questionnaire- health related QOL measure that has been used in children with CP
More Measures
MPOC-20- captures parental satisfaction with services, assesses 5 areas of care: enabling and partnership, providing general information, providing specific information about the child, providing coordination and comprehensive care, providing respectful and supportive care
Giving Youth a Voice- evolution of MPOC, designed to provide youth with disabilities an opportunity to give feedback
Canadian occupational performance measure- can be used to document and quantify goals that are relevant to the family and to determine whether they are achieved
Goal Attainment Scaling- used to evaluate whether specific individualized treatment goals or outcomes have been met
Rotterdamn Transition profile- summarizes goals for the transition of adolescents and young adults with CP to independence in life skills and adult health care through participation in finances, education and employment, housing, intimate relationships, transportation, and leisure activities
Intervention: Goals
Specific Goals for children GMFCS level I-III = development of gross motor skills, standing, walking, running, and jumping
– achievement of these goals requires maintenance of msk integrity, prevention of secondary impairment, the enhancement of physical and functional posture and movement, and maintenance of optimal levels of fitness and overall health
Goals should be relevant and achievable and individualized, collaborate with patient and family based on concerns, expectations, priorities, needs and values
should regularly assess outcome obtainment
should focus on everyday activities in environments typical for the child and should take into consideration elements that enable or constrain the child’s potential achievement
Intervention: Family Centered Care
promotes service delivery that recognizes parents as experts in their child’s needs and promotes supportive partnerships for collaboration
improves parent satisfaction and parent-child interaction and reduces associated parental stresses
Treatment Philosophies: NDT
NDT- based on the theory that inhibiting or modifying the impairments of spasticity and abnormal reflex patterns while facilitating mvmt patterns could prevent contracture and deformity, promote functional mvmts, and allow children the greatest degress of independence possible
Current NDT Principles- encouragement of normal movmt patterns through therapeutic handling during functional motor activities with gradual withdrawal of therapist facilitation to encourage active participation of the child
RCT’s on NDT and CP and been inconclusive, however 2 trials found that NDT principles showed improved motor development on the TIMP for premature infants at risk for CP
