Paediatric neuro Flashcards
aim of assessment
provide a baseline picture of child, evaluate child abilities and inabilities, compare function to their chronological age- motor development, place child’s abilities within context of their environment
neurological system
children are growing initially the nervous system operates by reflex activity, neurological conditions may be congenital, developmental or acquired, distribution of tone will interrupt normal motor development
subjective assessment- PC and HPC
PC- may be referred as developmental delay, may prevent MSK problem, associated with cardiorespiratory problem
HPC- often present since birth, parents may be the only ones who have noticed a problem and in young children= developmental delay
subjective assessment- PMH
other associated conditions- epilepsy, hydrocephalus (swelling and pressure on brain), cardiorespiratory condition, shunt- release pressure and fluid on brain, corrective surgery- drug history
subjective assessment- SQ= birthing process and motor history
birthing- traumatic?, very important for many neurological conditions- cerebral palsy and developmental coordination disorder- premature
motor- head control (3/12, rolling- stronger on side- 4-6/12, sitting- 6-9/12, crawling- 9-12/12, walking 12-18/12
subjective assessment- social and cognitive history, family history
social- how well they sleep/eat, how are they getting on at school, friends?, eye contact?/speech?/ hearing?
family history- both parents present (living with grandparents? less attention- slower development), siblings? support networks? work commitments? access to a vehicle?
subjective assessment- parents/child perceptions
do parents/child perceive there to be a problem? what are the parental and child goals?
location
home- see child within their own context- may be most comfortable for child, child developmental centre= formal MDT assessment process, school- special/mainstream, clinic/hospital
objective assessment
start with obs- give toys and observe (make child comfortable), movement patterns, interactions- with therapist and parents?, analysis- aware of everything?, use of arms and legs- AROM/PROM/Tone, could get them to do development stages
fine motor skills
dependant on gross motor and visual development, delay in FMS has an effect on cognitive development- writing/ thinking/ puzzles/ sensory
gross motor skills
are bigger movements- such as rolling over and sitting- that use large muscles in the arms/legs/torso and feet
at beginning and end of fine motor
objective assessment- items to include
GMS and FMS- age appropriate, ROM, muscle tone- MAS, associated reactions and primitive reflexes, muscle strength- need to make interesting enough for child to be entertained, volitional and involuntary movement- co-ordination- tap head and tap teddys head
how?- observations
general movement patterns against afe norms- GMS and FMS, observe interactions, observe at play, can and how do they get there?, can they maintain posture in sit/stand, asymmetrical symptoms, can they move within/without the postural set, do they demonstrate associated reactions or reflex activity
how?- handling
ROM- contractures- fixed? and hypermobility
passive movements- stimulating tone
muscle tone- hypertonicity/spasticity, hypotonicity
muscle strength- oxford scale
how?- standardised assessment tools
normal motor milestones, chailey level of ability, gross motor function measure (GMFM), movement ABC test (MABC)
how?- documentation
POMR- abilities, age appropriate behaviour, inabilities
individualised programme plan- person centred, highlights strengths and abilities, indicates areas of weakness
neurological and neuromuscular disorder
due to- insult on developing CNS pre/peri/postnatally, genetic or congenital conditions, trauma
conditions- cerebral palsy (CP)
a permeant impairment of movement and posture resulting from a non-progressive brain disorder due to hereditary factors or events during pregnancy, delivery, neonatal period and first 2-3/5 years of life, low birth weight, insult can occur pre/peri/post natally
CP classification
part of body- hemiplegia, diplegia, quadriplegia
type of tone- hypertonic (spasticity (80%), high reflexes) and dystonic- twisting and repetitive unplanned voluntary movement
hypotonic- athetoid- slow movement with extreme fluctuation, ataxic- uncoordinated and jerky movement, atresia- uncoordinated
conditions- spina bifida (SB)
congenital abnormality in formation of spinal vertebrae, incidence decreases, it is caused by a lack of folic acid
SB- types
Occulta- 1 or more vertebrae don’t form properly- gap small, cystica meningocele- were membranes around spinal cord push out into spine, cystidia myelomeningocele- most severe, both membrane and spinal cord push out of back
conditions- hydrocephalus
increased CSF ventricles of brain, 75-80% S.B. myelomeningocele have hydrocephalus, treated by shunt
signs= headaches and changes in arousal/treatment, physio deal with changes post op
conditions- (Duchenne) muscular dystrophy- DMD
one of most severely disabling childhood disorders, 1:3500 males, progressive genetic disease of boys, die in early 20’s from respiratory complications, gowers manoeuvre- weakness in legs and arms= lock out joints and use them as stability to climb up legs to stand up
conditions- other
acquired head injury (AHI), learning disability
