Nivedita.P.Kashyap
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Discover the functional abilities and strengths
of the child
Determine the primary and secondary
impairements
Discover the desired functional and
participation outcomes of the child/family
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Data collection
Date of birth
Date of assessment
Chronological age
Reason for referral
Relevant medical history
Overview of function
Family and environmental characteristics
Assistive technology /adaptive equipement
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Morphology
Functional skills and capacity for change
Gross motor control
Communications
Fine motor control
Social skills/behaviour
Observation of posture and movement
Individual system review related to function
Neuromuscular
Musculoskeletal
Sensory
Respiration
Cvs
Perceptual /cognitive
Areas of concern
- System impairements
- Ineffective posture and movement
- Functional limitations
- Barriers to participation
Plan of care
- Anticipated goals and expected outcomes
- Frequency and duration of intervention
- Stratergies of intervention
- Role of family,medical team and educational professionals
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Team worker in assessment of C.P
1- pediatrition
2- neurologist
therapist
4- Occupational
Therapist
5- Social Worker
7- Dentist 8-speech therapist
3- physical
6- Nutritionist
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History is a key component in evaluating the
child as it provides valuable information for
diagnosis
the timing of achievement of developmental
milestones and the presence of associated
impairments help to decide a functional
prognosis.
Family History: Consanguinity
Medical history: Anti epileptic drugs,
muscle relaxant
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Observing the child’s movements is the initial
and most crucial part of the examination.
The principal rule is “Observe before you touch”.
If the child is young, apprehensive or tearful, let
him or her stay on the mother’s lap while you
watch and talk to the mother
As the child adapts to the environment, slowly
place him on the mat and watch him moving
around. If the child cries a lot and does not
cooperate, continue let him in mother’s lap..
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In addition to the gross observational assessment
the therapist should examine individual aspects
of motor function as part of overall evaluation of
the child.
The foll list of positions provides guidelines by
which to assess functional antigravity control
Supine
Prone
Side-lying
Sitting-short sit,long sit,side sit, ring sit
Quadruped
Kneeling,half kneeling
walking
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When assessing postural control look out for
the following
Does the child have a variety of ways to
transition between postures or only
steriotypic choices?
Does the child actively push into the
supporting surface with the pelvis or
extremities?
Is the child able to repeat movements or
tasks and make small changes in his or her
motor performances?
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Tone is used to describe how a muscle or group of
muscles feel when the joints of the body part are moved
through a particular range.
Slight resistance or amount of tension that you feel
when move muscle.
The child must be calm for assessment of muscle tone
The head should be placed in the neutral position because
turning or flexion can trigger tonic neck reflexes and
interfere with muscle tone.
“Spasticity” is the resistance felt while moving the joint
through a passive range of motion. The “modified
Ashworth or Tardieu scales” are utilized to grade
spasticity.
Methods of assessment: 1- passive movement
2- Shaking to distal part in
all direction
3- Postural fixation(sudden
release of limb)
Factors affecting evaluation of muscle tone;
1-laughing 2- excitement 3- Surface 4light 5- Sleeping 6- head position
Reflexes
The persistence of primitive reflexes and the
absence of advanced postural reactions
should be evaluated. The presence of
primitive reflexes beyond 6 months of age is
a sign of poor prognosis.
This examination reveals contractures and
deformities that interfere with mobility. The
examination is performed in a comfortable
room with adequate space and props to attract
the child’s attention
Range of motion:
ROM test must be done in a slow and smooth
manner.
Sudden stretch of the muscle increases
spasticity, creating the false impression of a
fixed joint contracture.
Evaluation of spine
Mobility of spine in all planes for correct
alignment.
Smooth symmetric movement of the spine.
See for passive spinal flexion, spinal extension,
lateral flexion and rotation
Thoracic movement
Examination of the respiratory excursion of the
thorax is a critical portion of motor assessment for
the child with cerebral palsy.
Respiratory function should be assessed with the
child in various functional positions
Evaluation of shoulder girdle and upper
extremity
- Tightness and limitation of shoulder girdle
- Tightness of pectoralis major
- Dynamic scapular stability
- Passive flexion,abduction and external
rotation of shoulder
- Extension of elbow, supination of forearm
- Extension of wrist and fingers
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Flex wrist
Gradually extend
Palpate contracted / spastic tendon
( FCU or FCR )
Foot propagation angle
Femoral rotation
int. / extr. Rotation
Tibial rotation
Foot – Thigh Angle
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An early immature normal gait is characterised by
Uneven step length
Excessive flexion of hip and knee during swing phase
Immobility of pelvis without pelvic tilting or rotation
Abduction and external rotation of hips throughout
swing phase
Base of support that is wider than the lateral
dimensions of the trunk
Pronation of foot
Foot flat
Hyperextension of knee throughout stance phase
UE in high,medium,low guard position.
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Spastic diplegic
Limited mobility in lumbar spine,pelvis, and hip
joints
Limited asymmetrical pelvic tilt/rotation
Hips stay flexed during stance and full extension
of hip is never achieved
Excessive adduction and internal rotation of hip
In severe cases medial aspect of knee
approximate.
Feet may be in valgus outside the lateral
dimensions of the trunk/close together in narrow
base of support in PF with heels off of the floor.
Speed of walking is reduced.
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Hemiplegic gait
Asymmetry is the most obvious feature
Weight bearing is mostly on unaffected limb
Shifting of weight on involved side is limited
/incomplete
Limbs on involved side are retracted or
rotated posteriorly
Arm swing occurs only on normal side
Involved extremity is held in shoulder
hyperextension and elbow flexion
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Athetoid cp
Lower extremity is usually lifted high into
flexion and placed down in stance into
extension with adduction,internal rotation
and plantar flexion.
Hips stay slightly flexed,lumbar spine is
hyperextended and thoracic spine is
excessively rounded with capital
hyperextension,flexion,and rotation of
cervical spine with jaw forward and rotated to
one side.