Neurological Assessment and Intervention in Infants Flashcards
what is the structure for a subjective assessment
what brings you here? how can we help? whats the main problem?
new diagnosis? parental concerns?
referral?
age
pregnancy complication?
birth history? early/late delivery/twin/birth weight/delivery? Be mindful especially womens birth it may have been traumatising?
developmental hx? can he roll/age/ age he sat up/age he stood? feeding/ sleep cycle?
communication/vision/attention/head and trunk motor controls and milestone?
medical hx - any illnesses, hospitalisations?
medications
Invx - ultrasounds, CT, MRI
famhs
social hx - siblings, home, routine?
what are the positions that are assessed during developmental objective assessment
supine
pull to sit
side lying
prone
sitting
horizontal suspension
protective extensions
standing
what is observed across the 8 positions during an objective developmental assessment
supine - posture, movement aganinst gravity, symmetry, writhing movements, predictable patterns, assess tone and primitve reflexes, assess hands to mouth, hand to hand, reach and grasp,
assess - hands to knees, feet
roll out of supine
what are the typical movement characteristics of a 2/12 old lying in supine
maintains head in midline for short periods
locats objects visually and tracks from L to R
shows antigravity movement - lift hand and legs
cannot reach and grab toys
what are the typical movement patterns of a 6/12 lying in supine
can symmetrically lift and sustain UL and LL against gravity
increased antigravity control of muscles of trunk and increased freedom of movement
exhibits quick visual-motor response of looking, reaching, grasping and transferring objects
what to consider when conducting pull to sitting assessment
- Head control
- Fixing of gaze
- Active assistance
- Grasp
- Symmetry of movement
what are the typical movement patterns of a 2/12 in pull to sit position
head lag at about 15 degrees from upright
shoulder elevation and elbow flexion to assist
engage neck muscle to sustain midline head control
good extension of CxSp and upper ThxSp
what are the typical movement patterns of a 6/12 in pull to sit up position
actively flexing neck and lift head
use UL and abdominals for assistance
good symmetry in head, neck and Upper extremeties
what is observed in side lying position
maintain posture
head/neck control
reach and grasp
tone
what are the typical movement patterns of 2/12 in sidelying position
lift head and upper trunk during passive roll, show lateral head righting
balance activity of trunk flexor and extensor muscles
can change from predominant use of flexors to use extensors
what are the typical movement patterns in 6/12 in sidelying
rolls independently from supine and into prone in either direction
shows active head righting and upper extremity pushing against surface to raise body while reaching other hand
what is assessed during prone position
- ‘Tummy time’
- Head lift and turn
- Upper limb weight bearing
- Trunk/hip extension
- Pivoting
- Transition to 4 point kneeling
- Pelvic initiation
- Flexion of hips/knees
- Tone
what is observed during horizontal suspension
- Ability to sustain extension of neck, thoracic, hips and legs
- Position of head in midline
what is the typical movement patterns of a 2/12 old in horizontal suspension
can activate neck and trunk extension to sustain posture
can maintain brief periods of head control but may not be able to hold head in midline
what is the typical movement patterns of a 6/12 old in horizontal suspension
demonstrates full sustained neck and upper ThxSp, hips and leg extension
what is observed during protective extension
- Forward tipping from prone suspension
- Protective response
- Upper limb propping/reaction from 6 months
what is the typical movement patterns of a 6/12 old in protective extension
easily brings arms forward in protective response
props on one UL when reaching for toy
what is the typical movement pattern of a 2/12 in protective extension
increased head and neck extension
cannot fully bring arms forward for ful protection
what is observed in a sitting position
- Head control
- Trunk posture
- Visual gaze – fixing, maintaining
- Leg position/upper limb propping
- Amount of assistance required
- Protective response/righting reaction
- Movement in and out of sitting
- Reaching out of base of support
what are the typical movement patterns of a 2/12 old in sitting position
head aligned with ear over shoulder
sustains posture w/ assistance
head turning may or may not be present @ 2/12
what are the typical movement patterns of 6/12 in sitting position
stable head and trunk control w/ active extension T/O ThxSp
reach w/ 1 arm use wider BOS in LL
What is assessed during the standing position
- Hold standing: what is happening at lower limbs and trunk
- Stepping reflex
- Bouncing
- Active weight bearing
- Stand and pull to stand
- Stand holding on
- Pull to stand
what are the typical movement patterns of a 2/12 while standing
can sustain weight on LL w/ support at trunk
shows bouts of extension and flexion
good vertical alignment from head-trunk-feet
what are the typical movement patterns of a 6/12 while standing
immediate sustained weight bearing on extended LL turns head
keeps hip flexed and behind shoulders
use UL to assist stabilising trunk
what is the general Tx plan of a patient with CP or at risk of CP
EARLY INTERVENTION
* Harness the highly neuroplastic nature of the infant brain
* Build an alliance with parents and caregivers around
* Goal orientated repetitive exposure to motor activities
understanding of child and condition
supportive and compassionate
What is the general Tx strategy for children with Spina Bifida
muscle charting exercise
may be aware of post op requirements
avoid lying on wound site
what is the assessment and treatment strategy in brachial plexus injury
- Early Assessment ROM – passive & active
- Strength – active ROM with & without gravity
- Head position & movements
- Watch for “trick” movements
- Toronto test score – may predict potential for recovery
- Active movement scale
describe PRECAUTION FOR the Alberta Infant Motor Scale
ONLY used b/w 0-18 months only
NOT USED for children Dx’d
use with caution with preterm children
Describe the purpose of Alberta Infant Motor Scale
assess gross motor skills in children
4 subsets- supine, prone, sitting, standing
Prone - 21 items
Supine - 9 items
sitting - 12 items
Standing - 16 items
56 items in total
gives percentile score against normative values
used to assess gross motor skills
what is the Hammersmith infant neurological exam
for children 3 months to 2 yrs
34 items assess tone, motor patterns, observation of spontaneous movements, reflexes, visual and auditory attention and behaviour
can be useful if suspicious of CP
https://bpna.org.uk/userfiles/HINE%20proforma_07_07_17.pdf
What is the Bayley Scales of Infant and Toddler Development
foe ages 16 days to 42 months
comprehensive MDT Ax of cognition, language and motor skill
provides subset level scaled scores, domain levels, composite scores, percentile ranks, confidence intervals, developmental age equivalents, and growth scale
Peabody Developmental Motor Scale
for ages from birth to 5yrs
give gross motor, fine motor and total motor scores
comprehensive motor scale
expensive and time consuming
gives standardised scores, percentile ranks and age equivalents
benefits of early intervention
harness neuroplasticity and neuromuscular plasticity in early years
create good habits
have +ive assoc. w/ therapy intervention
strong recommendations for high risk CP or CP
begin intervention at time of suspected diagnosis to harness neuroplasticity
task specific motor training - self discovery of environment and solution to overcome movement challenges
selection of challenging but achievable motor tasks that require persistence for success
daily repeated practice for skill acquisition
parental coaching
create enriched environment
CIMT in short intervals for unilateral CP
use of regular standing equipment for psotiioning - decrease potential hip migration and maintain hip abd ROM
