Paediatric Assessment in Physiotherapy.pptx

How to assess all pediatric conditions in physiotherapy practice.

1. Paediatric Assessment in Physiotherapy Hanine Hassan Lecturer

2. Demographic data Chief Complaints History of Presenting Illness Birth History (Prenatal, Perinatal, Postnatal) Family History Immunization History Developmental History

3. Demographic Data Name: Age: Gender: Date of birth: Expected date of delivery: Corrected Age: Birth weight: Birth Head circumference: Birth Height:

4. Presenting complaints- use parents own words + chronological order (since…) HISTORY: Antenatal history: Ask the mother if she went for regular antenatal checkups. Took iron, calcium and folic acid supplementation? Felt fetal movements at which month? Did they increase progressively? Had any history of fever, rash, infection? (TORCH infections) Had history of gestational diabetes, hypertension, any other complications during pregnancy.

5. Natal history: Ask the mother about the duration of labor , was it induced? Ask the mother if the baby -Was born full term, pre term or post term? Normal delivery or caesarian section? Presentation- cephalic or breech? Any other complications during delivery- cord around the neck, prolapsed cord etc. Did the baby cry immediately after birth? I f not, after how long? Was the baby kept in NICU for any reason? When was the baby first breast fed? Was he able to suck properly? Any history of fever, jaundice, seizures? Any history of congenital deformities? Any other complications? Postnatal history: Is similar to history of present illness-It traces the course of illness from when the problem first occurred till the date of assessment. When did the parents first notice the problem, Any history of seizures, meningitis, fever, trauma? Did the parents consult a doctor? Was physiotherapy advised? Was it done regularly? How is the condition progressing? Is the child better or deteriorating?

6. Family history Includes fathers and mothers’ age, number of children their age /any history of abortions, deaths History of similar complaints in the family Consanguinity Draw a family chart.

7. Development history Gross motor – Head control (4 months) Rolling supine to sidelying (4-5 months) Rolling supine to prone (5- 6 months) Rolling prone to supine (5- 6 months) Sitting with support (6- 7 months) Sitting without support ( 7- 8 months) Pull self to stand ( 11 months) Standing with support ( 10- 11months) Standing without support (11- 12 months) Walking with support (11-12 months) Walking without support (12- 13 months) Climb stairs ( 2 -3 years)

8. Fine motor- V o luntary grasp (5 months) Reach (4-5 months) Pincer grasp (1 year) Personal social – Social smile ( 2 months) Recognizes mother ( 2-3 months) Stranger anxiety ( 5-6 months) Communication – Cooing Monosyllables Bisyllables

9. ON OBSERVATION General – Is the child alert, playful, drowsy, irritable, crying Built Facial appearance OBSERVE THE CHILD IN EACH OF THE POSTURES HE IS ABLE TO ATTAIN AND HOW HE ACHIEVES THOSE POSTURES( Transitions) appropriate for the child’s age. For example Supine – Head in midline or not, turning to both sides Visual tracking Position of upper limbs –able to bring to midline or not

10. Position of hands, manipulation skills Position of lower limbs- movement of lower limbs Breathing pattern /rate, any flaring of ribs. Prone- Able to turn head to side in prone? ( for neonate) Able to lift head in prone? Able to sustain posture (for child 5 months or above) Able to achieve prone on forearms?Able to reach for toys with one hand? Sitting D escribe the position in terms independent or dependent, if independent- centre of mass and base of  suppport

11. Standing – Analyse the position, independent/ dependent –  Center of mass Base of support Transitions  –Analyse how the child moves from one position to other Supine to  sidelying , s idelying  to prone, supine to sitting, sit to stand Ambulation – Crawling / walking

12. EXAMINATION 1.Higher cortical functions- Alertness Recognize family members Gives response to play activities Follow commands Is able to communicate needs Is aware of surroundings Well oriented

13. 2.Cranial Nerve examination- Child older than 5 years, tested as in adultsLess than 5 years- II- Blink reflexI II, IV, VI – Eyes follow movement V- Rooting ,sucking reflex, clenching of teeth VII – Facial symmetry while laughing or crying, nasolabial fold, wrinkling forehead VIII – Loud nosies yields MOROS reflex until 4 months Eyes follow direction of sound Startle response

14. IX, X – Gag reflex, swallowing, coordinates sucking, swallowing XII- Symmetry and tone of tongue

15. 3.Sensory examination- Child older than 5 years, tested as in adults Less than 5 years-Check for awareness or response (eye ball movement/ turns head toward side of touch etc)- when touched. Check pain, if absolutely essential. Check for any signs suggesting hyper response or aversive response to touch 4.Neuromuscular examination Tone – ( Modified Ashworth scale) Superficial reflexes- Abdominal, Corneal, Plantar Deep tendon reflexes – If more than 2-3 years old use reflex hammer. Less than 2 yr old, tap using finger

16. 5.Musculoskeletal examination  Range of movement- active and passive of all joints Muscle strength – If child more than 5 years- MMT. If less than 5 years- Document if movement against gravity is present or absent in limbs. Tightness Deformity/contracture Limb length and Limb girth if applicable 6. Cardio respiratory assessment Breathing pattern, Breathing Rate, Chest expansion, Chest symmetry, Flaring of ribs

17. 7. Oromotor assessment Tone of oral musculature Palate- high arched/norma lTongue - shape, tone, position Mouth closure Drooling of saliva Chewing of food in older children and swallowing. Asses if any sensory seeking behavior is present 8) Any other assessment as appropriate, for eg , assessment of balance, coordination, gait

18. VI) SCALES INFANIB GMFM Posture and fine motor assessment of children Functional evaluation – weeFIM / FIM VII) INVESTIGATIONS X –ray Ct scan Electrodiagnostic tests

19. VIII) DIAGNOSIS IX) PROBLEM LIST X) GOALS  –Short term  –Long term XI) MANAGEMENT