NEUROLOGICAL ASSESSMENT
OF INFANTS
Dr. Pradeep Dubey
MD (Ped.), DCH.
Cons. Developmental & Neuro Ped.
“DEVCHHAYA”
Early Intervention Centre
Wright Town - Jabalpur
Dr. Pradeep Dubey - Consultant Pediatrician
Dr. Pradeep Dubey - Consultant Pediatrician
STRABISMUS IN C.P.
Dr. Pradeep Dubey - Consultant Pediatrician
CRITICAL PERIOD IN BRAIN MATURATION
Kitten blind folded after birth for 3 months
developed acquired amblyopia, Visual Cortex
start processing auditory information.
Strabismus in infants leads to acquired
amblyopia
Congenital deafness – auditory area process
visual information.
“WE USE IT OR WE LOSE IT”
Dr. Pradeep Dubey - Consultant Pediatrician
SOME EXPERIMENTS
Phantom limb & Virtual reality mirror box
Kitten’s one eye was stitched – Brain mapping shows
concerned part of brain started processing
information of other eye.
Grey matter mass of Med. Students brain increased in
months of exam.
Brain port in patient with Vestibular damage –
Secondary pathways unmasked.
NEUROPLASTICITY IS ONE OF THE EXTRA -ORDINARY
DISCOVERIES OF 20th OCENTURY
(NORMAN DOIDGE)
Dr. Pradeep Dubey - Consultant Pediatrician
NEUROPLASTICITY
Brain tissues are plastic and responsive .
Adequate and repeated stimuli can modify
brain physiology as well as morphology
Brain port in patient with Vestibular
damage – Secondary pathways unmasked.
Grey matter mass of Med. Students brain
increase in months of exam.
“DO WE MAKE THE ROAD BY WALKING.”
Dr. Pradeep Dubey - Consultant Pediatrician
PREMATURITY & LBW
Anatomical Peculiarities
Intracranial Hemorrhage & periventricular
Leukomalacia.
Birth wt. 800 – 1000 gms.
6 – 8%
Birth wt. 800 gms. & less
20 – 40%
US spending 26 billion dollars (120,000 Crors Rs.)
annually on Preterm babies and their related problems
Dr. Pradeep Dubey - Consultant Pediatrician
HIGH RISK CONDITIONS
Low birth weight babies.
Severe H.I.E.
Severe neonatal jaundice
Persistence of Abn. Neuro signs after 2 wks.
Hypodensisties in Ct. even after 4 wks.
Oliguria (<1ml./kg./ hr.) for 24 hrs.
associated with H.I.E.
Low apgar (0-3) after 20 mts.
Late seizures in a depressed NB
Background abnormalities in interictal EEG.
Dr. Pradeep Dubey - Consultant Pediatrician
DYSKINETIC - C.P.
Dr. Pradeep Dubey - Consultant Pediatrician
Dr. Pradeep Dubey - Consultant Pediatrician
MATERNAL BLOOD GROUP
Mother – Rh negative
Precautions for Rh incompatibility
Dr. Pradeep Dubey - Consultant Pediatrician
INDICATORS OF POOR OUTCOME IN A SICK NEW BORN
Low apgar (0-3) after 20 mts.
Late seizures in a depressed NB
Persistence of Abn. Neuro signs after 2 wks.
Hypodensisties in Ct. even after 4 wks.
Oliguria (<1ml./kg./ hr.) for 36 hrs.
associated with H.I.E.
Background abnormalities in interictal EEG.
Dr. Pradeep Dubey - Consultant Pediatrician
ALARMING SIGNS
Responsiveness / Alertness
Spontaneous motility
Persistant hyper excitability
Feeding difficulty
Constant fisting
Abnormal movements / convulsions.
Abnormal postures
Abnormal Head circumerence
Abnormalities of tone
Ocular abnormalities
Lack of response to sound.
Dr. Pradeep Dubey - Consultant Pediatrician
ALARMING SIGNS
Responsiveness / Alertness
Spontaneous motility
Persistant hyper excitability
Feeding difficulty
Constant fisting
Abnormal movements / convulsions.
Abnormal postures
Abnormal Head circumerence.
Dr. Pradeep Dubey - Consultant Pediatrician
HEMIPLEGIC
C.P.
Dr. Pradeep Dubey - Consultant Pediatrician
AGE FOR ASSESSMENT
AMIEL TISON - 2 MTHS, 7 MTHS, 12 MTHS
P.G. I. CHANDIGRAH – 9 MTHS.
OTHERS
- 8 MONTHS
Dr. Pradeep Dubey - Consultant Pediatrician
NEURO DEVELOPMENTAL EXAMINATION METHODS
AMEIL TISON’S METHOD
VOJTA’S TECHNIQUE
CAPUTE AND ASSOCIATES
INFANT NEUROLOGICAL INTERNATION
BATTERY (INFANIB)
Dr. Pradeep Dubey - Consultant Pediatrician
INFANIB: Brief Description
Dr. Pradeep Dubey - Consultant Pediatrician
INFANIB
• Appropriate for use with neonates and
Infants up to 18 months of age.
• 14 Items are assessed in the neonatal
period while 6 others are added between
3- 9 months of age.
Dr. Pradeep Dubey - Consultant Pediatrician
INFANIB: Items Details
Items consists under following categoriesa. Measures of muscle range and resistance to passive
movements (Scarf sign, Popliteal angle etc.)
b. Reflexive Responses (Foot grasp, ATNR etc.)
c.
Equilibrium reactions (Parachute responses etc.) and
d. Quality of certain milestones (Sitting position, Weight
bearing in standing etc)
Dr. Pradeep Dubey - Consultant Pediatrician
Hands: Open/Closed
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Hands: Open/Closed
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Scarf Sign
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Scarf Sign
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Heel-to-Ear
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Heel-to-Ear
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Popliteal Angle
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Popliteal Angle
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Leg Abduction
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Leg Abduction
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Dorsiflexion of Foot
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Dorsiflexion of Foot
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Dorsiflexion of Foot
Response Pediatrician
Dr. Pradeep Abnormal
Dubey - Consultant
Foot Grasp
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Foot Grasp
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Tonic Labyrinthine Supine
Normal Response
Dr. Pradeep Dubey - Consultant
Pediatrician
Tonic Labyrinthine Supine
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Asymmetric Tonic Neck Reflex
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Asymmetric Tonic Neck Reflex
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Asymmetric Tonic Neck Reflex
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Pull to Sit
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Pull to Sit
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Body Derotative
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Body Derotative
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Body Rotative
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Body Rotative
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
All-Fours
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
All-Fours
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Tonic Labyrinthine Prone
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Tonic Labyrinthine Prone
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Sitting
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Sitting
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Sideways parachute
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Sideways parachute
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Backward Parachute
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Backward Parachute
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Standing
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Standing
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Positive Supporting Reaction
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Positive Supporting Reaction
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Forward Parachute
Normal Response
Dr. Pradeep Dubey - Consultant Pediatrician
Forward Parachute
Abnormal Response
Dr. Pradeep Dubey - Consultant Pediatrician
High Risk Neonate
Dr. Pradeep Dubey - Consultant Pediatrician
Normal Infant
Dr. Pradeep Dubey - Consultant Pediatrician
Ataxia
Dr. Pradeep Dubey - Consultant Pediatrician
Spastic
Dr. Pradeep Dubey - Consultant Pediatrician
Hypotonia
Dr. Pradeep Dubey - Consultant Pediatrician
Alignment
Head
rotation
Head Tilt
Spine
Leg
progression
Dr. Pradeep Dubey - Consultant Pediatrician
Atypical Static Postural Alignment
Dr. Pradeep Dubey - Consultant Pediatrician
Equinus
Scissoring
Equinus
Lack Of base of Support
Dr. Pradeep Dubey - Consultant Pediatrician
Foot Deformity
Midfoot break
Hindfoot eversion
Dr. Pradeep Dubey - Consultant Pediatrician
AMIEL TISON’S METHOD
A. GENERAL DISCRIPTION
Head – size shape, fontanell sutures
Eyes – Setting sun, Strabismus, nystagmus
Skin abnormalities – Cafeaulet, Nevi etc.
Cranial nerves
Altered mental status
Spine
Dr. Pradeep Dubey - Consultant Pediatrician
AMIEL TISON’S METHOD
1. Tone
- Scarf sign heel to ear
leg abduction, Popliteal angel
- dorsoflexion of foot Pull to sit.
prone, sitting position
- atnr,
2. Vestibular
- Side ways sparachute, backward &
Function
forward parachute, body rotative
3. Lethargy/Hyper excitability
4. Vision & Hearing
5. Developmental delay
Dr. Pradeep Dubey - Consultant Pediatrician
PROGNOSIS FOR WALKING IN CP
Hemiplegia
100%
Diplegia (Paraplegic)
90%
Ataxia/ Dyskinesia
80%
Quadriplegia
18%
Dr. Pradeep Dubey - Consultant Pediatrician
PRIORITIES OF MANAGEMENT
Communication
Socioemotional Development
Maximal independence in ADL
As near normal appearance as possible
Mobility
Dr. Pradeep Dubey - Consultant Pediatrician
“DEVCHHAYA”
Early Intervention Centre
Prem Mandir Chowk, Wright Town
www.healthychildindia.com
Dr. Pradeep Dubey - Consultant Pediatrician