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PHYSICAL ASSESSMENTINPEDIATRIC REHABILITATIONDR MEYSAM. MOHAMMADI
:ارائه شده در
معاینات عصبی در توانبخشی کودکان کارگاه تخصصی 96زمستان
• Muscle
•Size……. Are there any muscle atrophy?
•Strength..
•Tone....
- Coordination
• Rapid alternating movement
• Finger to finger
• balance
Muscle Testing
•0: no movement
•1: can see muscle contraction but no
movement
•2: can move with gravity eliminated
•3: can move against gravity
•4: can resist opposition to some extent, but
not full (+, - also)
•5: full strength
TONE
• Tone is the resistance appreciated when moving a limb
passively
• “Normal Tone”
• Hypotonia
• “Central Hypotonia”
• “Peripheral Hypotonia”
• Increased Tone
• Spasticity (Corticospinal Tract)
• Rigidity (Basal Ganglia, Parkinson’s Disease)
• Dystonia (Basal Ganglia)
TENDON REFLEXES
Triceps C7, 8
Biceps C5, 6
Supinator C5, 6
Knee L3, 4
Ankle S1, 2
TESTING THE PLANTAR REFLEX (BABINSKI).
-STROKE THE LATERAL ASPECT OF THE SOLE OF EACH FOOT WITH THE END OF A REFLEX HAMMER OR KEY. -OBSERVE FOR PLANTER FLEXION OF THE FOOT .
INVOLUNTARY MOVEMENTS
• Hyperkinetic Movements
• Chorea.. Involu/jerk/dance shape/prox
• Athetosis… inv /twisty/distal
• Tics.. Sudden/non rhythmic/repetitive
•Myoclonus..twich/jerk/stretch or seizure induce
• Bradykinetic Movements
• Parkinsonism
• Dystonia.. Invo/sustained or repetitive/postural
MUSCLE COORDINATION
• Eye Hand coordination
• Two hand coordination
CEREBELLAR PROBLEMS• Dysmetria *
• Dysdiadochokinesis*
• scanning speech
• Hypotonia*
• Falls to Side of Lesion*
• Nystagmus (Variable Directions)
• intention tremor
• ataxic gait
CEREBRAL PALSY
RED FLAGS
• Head control …………………….. 3 month
• Sitting ……………………………….. 6 month
• Rolling …………………………….... 9 month
• Walking …………………………… 18 month
ASSESSMENT OF REFLEXES
PALMAR GRASP
Birth
Until
5 - 6
month
ASYMMETRICAL TONIC NECK REFLEX
Birth
Until
6 month
6 – 11 month
Is Normal
• gastroc soleus test
Birth until
4 month
Birth until 5 month
Help to Early Diagnosis
Symmetry /Asymmetry
30◦ flex
Ext.Rot finger Ext
Then………..Int.Rot
• Rooting reflex
• Sucking reflex
• Swallowing
• - Drooling
-V, VII, IX, X, XII CN Integration
• -Gag reflex
• Mastication
-Bite reflex
Oral reflexes
0 - 4 Month
DEVELOPMENTAL MOTOR SPEECH DISORDERS
•Aphasia
•Apraxia of speech… due to:
Planning difficulties
•Dysarthria … due to:
Coordination, Speed, Tone, Power
difficulties
COMMON DEFORMITIESINCEREBRAL PALSY
LUMBAR HYPERLORDOSIS
• Hip flexor contracture
LUMBAR KYPHOSIS
• Hamstrings contracture
SCOLIOSIS
• test it In different positions
ELY TEST
FEMORAL ANTEVERSION
TEST OF FEMORAL ANTEVERSION
HIP; ANT AND POST TILT
hip flexors shorten and
the hip extensors lengthen.
Lum.lord
hip flexors lengthen and
the hip extensors shorten
LATERAL TILT OF HIP
is associated with scoliosis or people who have legs of different length.
It can also happen when one leg is bent while the other remains straight.
THOMAS TEST
• Iliopsoas shortness
BACK KNEE
GENU VALGUM/ VARUM
HAMSTRINGS SHORTNESS
QUADRICEPS SHORTNESS
PES PLANUS
PES VALGUS
PES VARUS
EQUINO VALGUS
EQUINO VARUS
GASTROSOLEUS TEST
gross Motor
•Gait
• Jumping
• Tandem walking
• Romberg • A patient who has a problem with proprioception can
still maintain balance by using vestibular function and vision
•One legged squat
FINE MOTOR SKILLS
• Grasp
• Strength
• Control
• Dexterity
• Hand dominance
• Writing
• Drawing
• Scissoring
• Cubes
• to turn the page
• Folding
MUSCLE AND JOINTS
PINCER GRASP AND PALMAR GRASP
INTRINSIC AND EXTRINSIC MUSCLES
GAIT ASSESSMENT
A NORMAL GAIT REQUIRES
• Vision
• Strength
• Balance/Coordination
• Joint Position
GAIT!
Observe walking firstly
Walk on heels
Tip-toes
Run
Stand on one leg (x 5 secs) [3 yrs]
Hop [4 yrs]
Walk straight line x 20 steps [5 yrs]
Tandem (heel-toe) walking [7 yrs]
Crouch down (distal muscles)
& stand up (proximal muscles)
OBSERVE DIFFERENT ASPECTS OF GAIT• Posture of Trunk
• Toe Walking
• Heel Walking
• Tandem Walking
• Hip, knee and ankle strategies
• Arm Swing
• Base of Gait
• Heel Strike
• Time Spent on Each Leg
GAIT ABNORMALITIES
• Broad-based;• appropriate when learning to walk
• Hypotonia of legs / pelvic girdle
• Cerebellar dysfunction
• Hip joint problems
•Narrow gait; (scissoring?)• Adductor spasm (mild diplegia)
• Hemiplegic gait; (wide swing) • proximal muscle weakness
•Waddling gait;
• High-stepping gait;• Sensory neuropathy
• Distal weakness eg. foot-drop
CLASSICAL PATTERNS OF ABNORMAL GAIT
• Hemiparetic Gait
• Spastic Diplegia Gait
• Ataxic Gait
• Waddling Gait
• High Stepping Gait
SENSORY ASSESSMENT
SENSATION• Exteroceptive
• Proprioceptive
joint laxity …. Crude movement.. Simulation…
• Tactile discrimination
• Stereognosis
• Graphesthesia
• Two point discrimination
• Extinction
• Point location
DERMATOMES
• Hypesthesia
• Hypersthesia
• Parestesia
IDENTIFY EXTROCEPTIVE SENSATIONS.
STEREOGNOSIS
GRAPHESTHESIA
کارگاه تخصصی
معاینات عصبی در توانبخشی کودکان
سپاسگزاریم
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@farvardin_group_channel
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