Neurological Assessment and Intervention in Children

Question 1

what is discussed during a subjective assessment

Answer 1

presenting condition - new Dx, parental concerns, referred to physio
referral route - is there an existing intake assessment other clinical interactions
pregnancy complications
birth hx - early/late delivery, twin/birth weight/delivery
developmental history
med history
medication
investigations
family history
social history
siblings - hobbies,

Question 2

how is spina bifida classified

Answer 2

by the diagnostic subtype - occulta, meningocele, myelomeningocele
functional level

Question 3

describe the functional hallmark and ambulatory capacity of spina bifida in the thoracic and upper lumbar region

Answer 3

lack of quads function
require hip-spanning orthosis for ambulation(RGO, HKAFO)
Most will require wheelchair for mobility

Question 4

describe the functional hallmark and ambulatory capacity of spina bifida in the lower lumbar region

Answer 4

lack of glute med and max function
retain quadriceps and medial hamstring function
require crutches and AFOs
most retain community ambulation as adults

Question 5

describe the functional hallmark and ambulatory capacity of spina bifida in the sacral region

Answer 5

retain quads and glute med function

Question 6

describe the functional hallmark and ambulatory capacity of spina bifida in the high sacral region

Answer 6

lack gastroc-soleus function
ambulate w/ AFO and no support

Question 7

describe the functional hallmark and ambulatory capacity of spina bifida in the low sacral region

Answer 7

retain gastroc-soleus function
ambulate w/ o brace or support

Question 8

how is the brachial plexus injury classified

Answer 8

I - classic erbs palsy level C5-C6
II - extended Erb’s palsy level C5-C7
III - total palsy w/o Horner’s syndrome or oculosympathetic paresis level C5-T1
IV - total palsy w/ horner’s syndrome level C5-T1 and sympathetic chain involvement

Question 9

describe the clinical presentation of classic erb’s palsy

Answer 9

C5C6
absent shoulder abduction,
external rotation,
elbow flexion,
forearm supination

Question 10

describe the clinical presentation of extended erb’s palsy

Answer 10

C5-C7
Absence of wrist and digital extension

Question 11

describe the clinical presentation of total palsy w/o horner’s syndrome or oculosympathetic paresis

Answer 11

complete flaccid paralysis involving all plexus roots

Question 12

describe the clinical presentation of total palsy w/ horner’s syndrome

Answer 12

complete flaccid paralysis w/ horners syndrome indicating sympathetic chain involvement and avulsion injury

Question 13

describe the functional mobility scale

Answer 13

to review mobility in children w/ CP
Rated at 5m(home), 50m(school), 500m(community) separately
1 = use w/c can stand for t/f and step supported or w/ walker
2 = uses walker or fram independent
3 = uses crutches independent
4 = uses sticks 1 or 2 independent
5 = independent on level surface, requires rails for stairs
6 = independent on all surfaces

Question 14

what is the typical physio assessment

Answer 14

biomechanics/posture
ROM - tone and contracture
strength and selective motor control
gait
aids, equipment, orthotics
leg length
spinal alignment
foot posture
questionnaire - GOAL, CP-QoL

Question 15

how is a childs walking function assessed

Answer 15

observational/video analysis -can be limited by mis-interpretation of rotation
walking capacity - 6MWT, TUG
3D Gait Analysis - highly standardised

Question 16

What are the possible interventions available for paediatrics

Answer 16

tone management - botox, selective dorsal rhizotomy
orthotics - rigid AFO, flexible AFO, DAFO, SMO, dictus, KAFO
insoles
24 hour postural management
CIMT
Mobility training
Treadmill training
contracture alignment - hip surveillance botox and casting, scoliosis surgey, lower limb casting

Question 17

what must be considered when reviewing the tone

Answer 17

the muscle tone peaks at age 3 then steadily declines

Question 18

benefits of rigid AFO

Answer 18

Control inclination of tibia in stance phase
* Maintain an extended knee in stance
* Protect/control foot structure
* Hold gastroc in optimal position

Question 19

Features of dictus splint

Answer 19

• Less support
• Less impaired
• Foot drop
• Limited foot control

Question 20

what conditions are KAFO used for

Answer 20

• Where impaired knee
  control/weakness is present
• Knee may be locked (mostly)
• E.g. Spina Bifida
• Previously polio

Question 21

purpose of insoles

Answer 21

Equalise for leg length issues
Comfort/accommodation

Question 22

what is the purpose of 24hour posture management

Answer 22

for non ambulant children
provide support, prolonged stretch
weight bearing to prevent contractures and deformities

Question 23

what equipment can be involved in posture management

Answer 23

• Seating (wheelchairs/ activity chairs/relaxation
  chairs)
• Standing frames (prone/ upright/supine)
• Sleep systems
• Orthoses

Question 24

explain the research in posture managemnt

Answer 24

No strong evidence to support effectiveness
in preventing need for surgical intervention
later on (especially for standers and sleep
systems)
* The difficulty with current research is that it
is difficult to isolate the use of individual
equipment

Question 25

where is physio intervention

Answer 25

primary care
childhood disability network team
specialist clinics