PHYSICAL ASSESSMENTINPEDIATRIC REHABILITATIONDR MEYSAM. MOHAMMADI

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• 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)

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjvxP2Xk8vYAhWQKlAKHU1fAu4QjRwIBw&url=http://slideplayer.com/slide/6947870/&psig=AOvVaw3m-Gkf23sFkz-UkfLnv5hn&ust=1515596485824750

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

Two point discrimination

GRAPHESTHESIA

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