EVALUATION
Definition of evaluation
It is an observational study of a subject carrying out a
specific task.
- It is a continuing process of collecting and
organizing relevant information in order to plan and
implement effective treatment.
Importance of Evaluation
1- To plan a treatment program,
2- To identify area of progress or lack of progress.
3- To identify or rule out the existance of a specific
problem.
4-To provide diagnostic information
5- setting up a good relationship with the child to
understand their difficulties and needs.
6- To determine the the status of a patient at the time
of discharge and type of follow up plan.
Pre-requisites of Evaluation
1- Knowledge; human biological , behavioural, motor
development and sequence of reflexive maturation in
normal children.
2- Rational and logical system of data acquisition
complete picture of the client is developed through
analysis and synthesis of data.
3-organized observation
Problem that may occur during
evaluation
 1- The assessment form:
 Follow The SOAP note by Dr. Lowerance Weed
 2- Interaction with the child
 Using toy , Reward, Toy
 3- Response of parents to evaluation results
 Home program, no false hope
principles of Evaluation
 1- the evaluation should focus on the client abilities as well as
disabilities.
 2- The evaluation should be carried out as early as possible.
 3- The evaluation should be accomplished in a sequential
fashion in order to monitor the development course of reflexes
and reaction.
 4 Re evaluation takes place on a weekly or monthly basis.
 5-Therapist should have the ability to observe, to be flexible to
be creative.
 6-oreintation of the child and parent to the enviroment is crucial
Types of Evaluation
 1- Informal (general overview of the child
performance).
 2- Formal (functional test)
 3- Standardized: grading performance (muscle test:

Initial evaluation

interim or progress

discharge evaluation
Problem oriented medical Record
 It is a designed a plan for collecting data and
organized them by problems thus assuring logical
frame work for delivery of health care
 It is not only a tool for planningg care but also a
teaching tool and used for review of care to ensure
quality of patient care.
Importance of POMR
 1- It is legal document and assist in treatment.
 2- It is a methods of communication between
physician and therapist
 3- it helps in thinking in organized manner.
 4- it puts all clinical information in the way that you
can share it with others
 5- it used for quality assurance purposes
 6- it can be used in research
Advantages of POMR




1-Information of clinical, laboratory and therapy.
2- Information about past illness
3- facilitate continuity of care.
4- Assist in evaluation and planning of health care
system
 5- Used in clinical research and medical education
Elements of POMR
 1- Data base
 3- Initial plan





2- Problem list
4- progress notes
Data base consists of all subjective and objective in
formation can be collected from the patient
Sources of data base
1- patient file
2- questioning
3- patient evaluation(Observation, palpation,
measurements and functional tests
 2- Problem list:
 All patient problems should be constructed from the
data base.
 Each problem should be classified whether it is active
( not been solved) or inactive treated temporarily or
permanently
 Date of the initial start of the problem and date of
solving the problem should be recorded.




3- initial plan :
what will be done to begin solving the problem.
Specific plan for each active problem
It should be realistic and aiming for solving the
problem
 4- Progress notes
 These consist of a record of patient care and progress
commonly written under 4 headings SOAP




S --------- subjective
O ------------Objective
A---------------Assesment
P -----------------Plan
NORMAL MOTOR DEVELOPMENT
SENSORY AND MOTOR
DEVELOPMENT
 Sensory and motor development are independent
 Sensation not only provide inputs from the environment
but also create awareness on our bodies, and feedback on
variety of movement that occur
 Early child movement and posture that occur as
stereotyped reflexes provide a foundation for voluntary
movement
 Movements become more integrated and selective as the
child has the ability to perform the isolated movements
 The neonate (Birth till 4 weeks)
 The neonate movements are determined by reflexes
 In most position his body is flexed except for his neck
but periodically he totally extends when he stretches
or when he held upright with his feet on supporting
surface
 Neonatal reflexes can be succeefully observed when
the neonate is comfortable and alert.
Rooting reflex and suckling reflexes:
 If the corner of the mouth or check is touched,
neonate will turn his face towards the stimulus
 The rooting reflex orients the body mouth to mother
nipple
 Moro reflex:
it occurs when the baby head suddenly falls backwards, The arm
immediately abduct with extended elbows , wrist and fingers .
The reflex disappears at the age 6 months
Galant reflex
It can be elicted by pricking on the paravertebral area of the back
from the bottom rib to the iliac crest the trunk flex sideway
towards the stimulus disappear by 2 months
 Crossed extension reflex
 When the nfant in supine With stimulating sole of the foot the
contralateral limb will flex then extend with adduction and
internally rotation
 Flexor withdrawal reflex:
 Stimulate the sole of the foot ---------------the leg quickly flexed
 Extensor thrust
 The leg will extend if you put a pressure on the sole
of flexed leg
 Crossed extension, flexor withdrawal, extensor trust
remain for 1-2 months before integration
 Plantar grasp:
 If you put a pressure on the ball of the foot the toes
will flex remains till age of 9 months
 Grasp reflex when a finger is inserted into the plam of
the hand of the child followed by traction to the
fingers ------------strong total flexion of child arm and
fingers
GROSS MOTOR DEVELOPMENT
 A dynamic posture is essenital frame work for gross
motor activities
 Dynamic posture requires normal posture reflex
mechanisms with normal postural tone ----- stability
and flexiability to allow for postural changes.
 Normal motor development
 Supine
 1 Month
 Flexion pattern
No head control
 Tonic neck reflex
Fisted hand
 Rolling to side as a block
 3 Month:
 Head approach to midline Pronated forearm
 Loosely closed hand
stronger fifth finger
 4 Month:
 Tonic neck reflex
Head in midline
 Start exploration of the hand Alternated flexion and extension of fingers
 6 Month:
 Rolling from supine to prone
 Lifting of the head
lifting of the leg high
 7 Month:
 Symmetrical supine position
 10 Month
 Less tolerated supine
sitting up
Lift head as towards sitting
Prone
 1 Month:
 Suspension from prone------------------Head drops
 Prone position on table head rolls to side flexion
abduction in arm
 Flexion in hips, legs
 2 Month:
 Better alignment of the head
more lift head
 3 Month:
 Lift head with holding on forearm with extend hips
and knees















4 Month
If suspended good alignment of head and trunk
Holding head, leg in midline position
Tendency to falls to side
5 Month
Swiming on the floor holding head up with flexed arm
With extended legs
6 Month
Rolling from prone to supine
7 Month
Well lifting of head
Lifting arm
8 Month
Moving from prone to sitting and vice versa.
Getting on hands and knees






9 Month
Pivoting on the trunk
12 month
Easy Crawling
15 Month
Bipedal walking
Moving backward











SITTING
1 Month
From supine to sitting head sags and falls back
Rounded back
2 Month
From supine to sitting head erect for short period
Jerky movement
3 Month
supine to sit head sets forward but bobs in sitting
4 Month
Supine to sit head slightly sags
In sitting head erects forward, Lumbar curve start to
appear no cervical curve











6 Month
From supine to sitting lifting of the head
Sitting on the chair with erected trunk
7 Month
Sitting alone
Leaning forward
Active balance
10 Month
Sitting for long period
Getting to sitting from prone
11 Month ----------------piovting in sitting
STANDING
AND
WALKING
 3 month












Supporting from axilla, partial weight bearing lift feet
4 Month
Supporting from axilla, extend leg tendency to flex legs
7 Month
Supporting from axilla More weight bearing bouncing
9 month
Full weight bearing
Walking sideway, erect position holding rail( holding on )
10 Month----------------Lowering on knee during standing
11Month--------------Walking holding rails
12 Month--------------- Walking holding one rail
15 Month------------------walking alone, ascending up stairs
holding on rail
 21Month
 Squatting, ascending up, descending down stairs
Prerequisites for normal movement




1- Nervous system well formed, intact normally functioned
2- Good environment(adequate appropriate nutrition)
3-Challenges and rewards
4-Ability to learn, act
 Growth: quantitive changes in behaviour like length, weight and head
circumference.
 Development: qualitative changes in behaviour skill like head control, trunk
control, ability to sit, ability to stand.
 Maturation: Righting referred to elaboration of nervous system structures
 Growth Motor: ability of the child to assume and maintain certain position such
as sitting, standing

1- Head Control
 Prerequisites
 1- Intact vestibular system
2- Intact eye and optical pathway
 3- Intact muscular of the neck(muscle , jiont, ligaments)
 4- Intact proprioceptors of neck
 Age and steps:
 1- From birth to one month In prone position Tilting head sideway
to clear nasal airways
 2- From 1-2 month raise head in prone to 45 degree
 3- From 2-3 month prone on elbow raise head 90 degree with
support on forearm
 4- from 3- 4 month prone with raise head and support on arms,
hands
 5- Around 3,4 month----------stiffness of trunk , head ready for sitting
 6- From 3 to 6 month --------- come to supine , with pull to sit ,he can
control his head
 7- From 6 to 7 month--------- come to side lying
 2- Rolling:
 Prerequisites:
 1- head control even partial
 2- proper neck righting reaction
 3- Ability to support on forearm and hand
 Sequence: It start as reflex in first seven month till be voulantary
 Steps: From supine to sidelying , from prone to side lying , from prone
to supine
 Age:
 1- From supine to sidelying From 1 to 4 month
 2- Come to prone 4 to 5 month
 3- come to supine 5 to 7 month
 3- Sitting:
 Prerequisites:
 a- Head control
b- Trunk rotation and pivoting
 c- Ability to extend trunk against gravity
 d- Ability to support weight on arms.
 4- Creeping:
Like Quadruped position
 Head, trunk control, Trunk rotation
Ability to make reciprocal movement
 Ability to support on hands and knee
Age from 6- 8 Month
 5- Standing: Prerequisites





Head, trunk control, Trunk rotation
Ability to make reciprocal movement
Postural reaction, Protective Reaction
Steps: 10-10.5--------------pull to stand from supine
11- 12 month -----------------Standing holding on
13---15 month ---------------Standing alone without support
 6- Walking:
Prerequisites
 Head, trunk control, Trunk rotation
Ability to make reciprocal movement
 Postural reaction, Ability to bear weight on lower limb
SPEECH













4-6 Weeks
Sounds which reflect to emotional and physiological state
12 Weeks
Sounds used for communication with others
8 Months
Simple short sentences
9 months
One meaningful word like ma ma
1 Year
Beginning of understand, Imitate adult
Using expression give it to mama
2 Year -------------More clear explanation
3 Year-------------Putting Words together to form a sentence
 Age :
 12 month------------- Walking with support
 15-18 month------------Walking alone (guard walking: abduction in both upper, lower
limbs with flexion in elbows
 2 years----------- walk up and down stairs
 2.5 years---------- jump, stand on one foot
 3 years---------- jump or run
 4 years------------------ walk in one line





 Development of weight
1- Average weight for full term baby------------ 3.5 Kg
2 First 6 month of life-------------- increase weight by 20 gm/day
3- Rest of first year----------------increase weight by 10 gm/day
4- During 2 years weight decrease to 2.5 Kg
5- In next 2 years ----------increase average weight by 2 Kg/year





Development of Length
At birth ----------- Average length 50 cm
At first year--------Average length increase 25- 30 cm
At two years----------Average length increase 12 cm
In next few years------Average length increase 6-8 cm
 -
FINE MOTOR DEVELOPMENT
 Shoulder stability, good posture and normal arm movements are all
useful for fine motor development
 Vision is not only essential for manipulating skills but also grasps and
release and good sensorimotor control of fingers and hands are
essential.
 Fine motor development occurs in 3 sequences:
 1-Early reflexes and basic voluntary movements
 2- Development progress from the proximal parts of the arm to distal
 3- pronation of forearm before grasp, grasp before release
Early Reflexes and reaction
 Grasp Reaction:
 Neonate does not show true grasp reflex but Tonic reaction of the
fingers. Insertion of finger in hand then traction --------------------strongly
flex in whole arm
 4 Month:
 Grasp reaction ----------- gentle stimulus touch radial or ulnar aspect of
hand
 6-7 Month
 When stimulus touch ulnar side of hand-------pronation
 When stimulus touch radial side of hand-----supination
 Integration of hand with vision---------10- 11 Month
 Avoidance reaction;
 Up to the age of 6 months avoidance reaction occur when infant grasps
object , fingertips touch object
may involuntary open---------------- Droping the object
Age
Skill
1 Month
Hand clenches on contact, Drops object immediately
2 Month
Grasp in pronation
2- 3 Month
Retains rattle briefly
3 Month
Holds rattle actively
4 Month
Reaches with two hands
5-6 Months
Release object by dropping or throwing
6 Months
Grasp cube with palmar grasp
7 Months
Grasp object in half supination
9 Month
Release object in larger container
10-11 Month
Grasp integrated with vision
12Month
Fine pencil grasp, release in small container
12-18 Months
Grasps pencil in fisted hand
18 Months
Builds tower of 3 cubes, pencil held in pronated hand
2.5 Years
Builds tower of 6- 8 cubes, train from lines
3 years
Imitate bridge from 3 cubes, cut with scissor
4.5-6 Years
Hold pencil in tripod
Reaching :
4 Month : infant tries to reach out with flexed arms
5 Month: further reaching out
6 Month: Start to develop eye hand coordination
Eye hand coordination:
5 Month visually initated reaching-------------indication to direction of
reaching
6 Month visually directed reaching he can correct direction of
reaching
12 Month visually locate the object able to rech woith supination










Voluntary Grasp:
3 Month : Infant will grasp a small cube only when it touch him
4 Month: Infant will be able to locate and grasp the cube
Ulnar Palmar Grasp:
Grasp with all flexed fingers and adducted thumb+ pressing the object
against ulnar side of the palm
Radial Palmar Grasp:-------------------6-7 Month:
Radial digital grasp------------ 8 Month
Scissors grip----------------------8 Month
Inferior pincer grasp--------------9 Month
Fine pincer grip-----------------------12 month