Module 8 Flashcards
Preschool neurological assessment
What should we test?
• Gait
• Sensory examination
• Muscle stretch reflexes • Cranial nerves
• Cerebellar tests
Gross Motor
1) Heel walking - over 3 years should be able to do. Note any associated movements
2) Toe walking - over 3 years should be able to do. Note any associated movements.
3) Stand on one leg - by 5 years should be able to do 10 seconds.
4) Hoping on one foot - by 4 should be able to do 5-8 , note leg used first
5) Ability to catch a ball - the average 4-6 year old will catch 3-4 of 5 attempts.
Facioscapulohumeral dystrophy
CLINICAL presentation
Facioscapulohumeral muscular dystrophy is a disorder characterized by muscle weakness and wasting (atrophy). This condition gets its name from the muscles that are affected most often: those of the face (facio-), around the shoulder blades (scapulo-), and in the upper arms (humeral).
Clinical presentation
• Facioscapulohumeral dystrophy shows the earliest and most severe weakness in facial and shoulder girdle muscles.
• The facial weakness differs from that of myotonic dystrophy; rather than an inverted V- shaped upper lip, the mouth in facioscapulohumeral dystrophy is rounded and appears puckered because the lips protrude.
• Inability to close the eyes completely in sleep is a common expression of upper facial weakness; some patients have extraocular muscle weakness
• Scapular winging is prominent, often even in infants.
• Flattening or even concavity of the deltoid contour is seen, and the biceps and triceps
brachii muscles are wasted and weak.
• Muscles of the hip girdle and thighs also eventually lose strength and undergo atrophy, and Gowers sign and a Trendelenburg gait appear.
Spinal Muscular Atrophy
Spinal muscular atrophy (SMA) is a genetic condition that causes muscle weakness and atrophy (when muscles get smaller). SMA can affect a child’s ability to crawl, walk, sit up, and control head movements. Severe SMA can damage the muscles used for breathing and swallowing. There are four types of SMA.
• Spinal muscular atrophy (SMA) is the most common fatal genetic disorder of childhood.
• Spinal muscular atrophy is an autosomal recessive neurodegenerative disorder that affects the motor neurons responsible for movement of the proximal muscles of the trunk and body.
• SMA is a neurodegenerative disorder characterized by progressive loss of the anterior horn cells, or the motor neurons, within the spinal cord and the brainstem nuclei.
• Spinal muscular atrophy affects about 1 out of 10,000 live births [1, 2], with about 1/50 individuals being a carrier for this disease
Spinal Muscular Atrophy
Spinal muscular atrophy (SMA) is a genetic condition that causes muscle weakness and atrophy (when muscles get smaller). SMA can affect a child’s ability to crawl, walk, sit up, and control head movements. Severe SMA can damage the muscles used for breathing and swallowing. There are four types of SMA.
• Spinal muscular atrophy (SMA) is the most common fatal genetic disorder of childhood.
• Spinal muscular atrophy is an autosomal recessive neurodegenerative disorder that affects the motor neurons responsible for movement of the proximal muscles of the trunk and body.
• SMA is a neurodegenerative disorder characterized by progressive loss of the anterior horn cells, or the motor neurons, within the spinal cord and the brainstem nuclei.
• Spinal muscular atrophy affects about 1 out of 10,000 live births [1, 2], with about 1/50 individuals being a carrier for this disease
Tandem gait
tell us a little about this test, why we do it and how often we should do it?
• This is one of the most important tests and should be done at each appointment.
• Will tend to fall to the side of the upper cervical subluxation; especially with eyes closed.
• Usually there is significant improvement after adjustment.
• Helps to make subclinical subluxation patterns easier to detect.
• Once TG with eyes closed is well performed then reassess any other positive neurodevelopmental tests. (Usually takes 3-4 weeks to normalize with treatment)
• Test with eyes closed can be used by parents between appointments to monitor status of child; if they start to have difficulty doing TG with eyes closed then they need to return for treatment!
Explain Fakudas Test, when and why we do it
• Marching on the spot with eyes closed for 30 seconds
• Look for turning to the right or left, movement forwards or to the side
• Test vestibular apparatus
(There are many different ways to do this test)
left - Right Discrimination
Test
· Age 6-8 - have the child identify left and right on their own body.
· Age 8-10 - have the child identify left and right across the mid-line.
· Age 10+ - have the child identify left and right on the examiner.
• Observation
Look for the ability to readily perform the task.
• Significance
Problems with left/right discrimination may result from complex
mixtures of maturational, developmental and basic processing delays. Poor cross crawl may be associated.
Describe the one inch cube activity test
Excellent form of assessing mental and neurological development is observing what a child can do with some one inch cubes.
The age appropriate achievements are set out as:
6 months: palmar grasp of 1 block
8 months: bangs blocks together
1 year: mature finger thumb grasp
15 months: build tower of 2 blocks
18 months: tower of 3- 4 blocks
2 years: build tower of 6-7 blocks when shown.
Visual station orientation
Visual station orientation
Management of auditory processing problems
classroom strategies for teacher
• Secure child’s attention prior to speaking
• Face the class and avoid moving around when speaking
• Demonstrate and provide visual supports
• Reduce noise and choose quiet times and places for verbal teaching and reading
• Cover hard reflective surfaces with soft material
• Reduce noise from talking and moving during work times
• Keep windows and doors shut if there is external noise
• Seat the child at the front of the class
• Seat the child next to a reliable friend whom can provide assistance
• Optimise lip reading
• Monitor child’s attention and responses particularly in noisy situations
Use short direct instructions
• Break explanations or multiple instructions into parts and allow
time to process each part
• Eliminate unnecessary phrases and conversational padding as well as unfamiliar or long words
• Allow time for thinking before expecting answers
• Check instructions have been understood by watching
response rather than asking
• Respond positively if asked for clarification or repeats
• Look for and praise desirable behaviour, small achievements and staying on task
• Promote and build on areas of strength. Foster self esteem.
Retained primitive reflexes
What are the long term effects of a retained moro reflex
How do we test for a retained moro reflex?
• Vestibularrelatedproblems
Motion sickness
Poor balance and coordination
• Occulomotor and visual perceptual problems
Unable to ignore irrelevant visual stimuli
Eyes respond excessively to peripheral visual stimuli Poor pupillary reaction to light
Photosensitivity
Difficulty with contrast e.g. Black text on white paper Tires easily under fluorescent light
• Auditoryproblems
Hypersensitivity to certain sounds
Poor auditory discrimination
Difficulty excluding background noise.
testing for retained moro?
• Child lies supine, with arms resting at side, and palms down, elbows slightly flexed
• Raise the child’s head.
• Ask the child to move their hands from their side to their abdomen when they sense you moving their head (allowing head to “drop” down to surface)
Normal:
Child moves hands to body with good timing and no over-reaction.
Abnormal:
1. Very slow or no reaction 2. Distress, face pallor.
3. Over-reaction of arms, body, face.
4. Abduction or extension of legs (marked finding)
A persistent ATNR maybe associated with?
How to test for ATNR?
- Poor balance with head turn to side
- Homolateral instead of cross pattern movements
- Difficulty crossing midline
- Poor ocular pursuit movements particularly at midline
- Mixed laterality
- Poor handwriting and poor expression of ideas on paper
- Visual perceptual difficulties, particularly symmetrical representation of figures.
1 Schilder’stest Normal:
Child holds arms with good posture, out in front at shoulder height.
Abnormal:
1. Rotation of arms towards head movement (under 45 degrees is mild)
(up to 60 degrees is moderate)
(up to 90 degrees is severe)
2. Arms drift downward (mild) 3. Loss of balance (marked)
2 All 4 ATNR (quad ATNR)
Normal:
Child holds good posture, with no bending or collapsing of elbow.
Abnormal:
1. Can’t maintain body posture (quadraped) and is wobbly. 2. Any bending of elbow opposite side of head turn (mild)
3. Collapsing of elbow on opposite side of head turn (severe)
What are the long term effects of a retained plantar grasp how do we test for it
- Poor manual dexterity – affects independent thumb and finger movement
- Lack of pincer grip which will affect pencil grip when writing
- Speech difficulties
- Hypersensitive palm of hand
- Mouth moves when writing or drawing.
Persistence of galant reflex
how do we test it?
• Fidgeting
• Bedwetting
• Poor concentration
• Poor short term memory
• Scoliosis
Normal response to reflex stimulation in school aged child or older is inhibition of ipsilateral hamstring
