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Û Subjective Examination:
h Subjective information should be obtained from the parents especially mother or
from relatives and through case-sheet.
h General details includes
• Name
• Age & Sex
• Address
h When did the mother first noticed the dysfunctions
h Siblings having same type of symptoms
h Prenatal History
• Age of mother
• Consanguity marriage
• Any drugs taken during pregnancy
• Any trauma & stress
• Any addiction – smoking or alcoholism
• History of rubella or cytomegalovirus, toxoplasmosis infection
• History of previous abortions, still born or death after birth
• Multiple pregnancies (duration between pregnancies)
• Status & cast of the mother
h Perinatal History
• Place of delivery
• History preterm or full-term delivery
• History of asphyxia at birth
• Type of delivery – Forceps delivery
• Presentation of child – Breech presentation
• Any history of prolonged labour pain
• Condition of mother at the time of delivery
h Postnatal History
• Delayed birth cry (when child cried)
• Weight of the child at birth – Low Birth Weight (LBW)
• History of any trauma to brain during the first 2 years of life
• History of neonatal meningitis, jaundice, or hypoglycemia
• Hydrocephalus or Microcephaly
• Nutritional habits of the child (malnutrition)
• Feeding difficulties
h Any medical or surgical treatment taken
h Any physiotherapy treatment previously taken
• What was the ability level of child at that time?
• What obstructs the child from progress?
• What treatment was used?
• Was the treatment effective or not?
h Apgar Score from the case-sheet
Û Objective Examination:
< On Observation:
h Behaviour of the child
• Whether child is alert, irritable or fearful in the session or during particular
activities
• Child becomes fatigued easily or not during activity
• Find out what motivates his action – particular situation, person or special
plaything
h Communication of the child
• How child communicates with the parents
• Whether child initiates or responds with gestures, sounds, hand or finger
pointing, eye pointing or uses words and speech
h Attention span
• What catches child’s attention?
• For how much time child’s attention is maintained on particular thing
• How does parent assist him to maintain attention?
• What distracts the child?
h Does child follows suggestions to move or promptings to act?
h Position of the child
• Which position does the child prefer to be in?
• Can child get into that position on his own or with help?
• With assistance, child makes any effort to go in that position
• Symmetry of the child (actively or passively maintained)
• If involuntary movements present, then in which positions these movements
are decreased or increased
h Postural control & alignment
• How much parental support is given
• Postural stabilization and counterpoising in all postures
• Proper & equal weight bearing
• If the child’s center of gravity appears to be unusually high, resulting in
floating legs and poor ability to raise head against gravity
• Fear of fall in child due to poor balance
h Use of limbs & hands
• Limb patterns in changing or going into position as well as using them in
position
• Attitudes of limbs during playing in all positions
• Whether one or both hands are used, type of grasp and release
• Accuracy of reach and hand actions
• Any involuntary movements, tremors or spasms, which interfere with actions,
are present
h Sensory aspects
• Observe child’s use of vision, hearing, of touch, smell and temperature in
relevant tasks
• Does child enjoys particular sensations
• Whether child enjoys being moved or having position changed
h Form of Locomotion
• How child is carried
• Any use of wheelchair or walking aids
• Which daily activities motivates child to roll, creep, crawl, bottom shuffle or
walk
h Deformities
• Observe any recurring position of the whole child
• Any part of the body, which remains in particular position in all postures & in
the movements
• The positional preferences typically seen in spastic cerebral palsies are for mid
positions of the body
- In the arm, this generally consists of
Shoulder protraction or retraction, adduction and internal rotation
Elbow flexion
Forearm pronation
Wrist & Fingers flexion
- In the legs, it includes
Hip semi-flexion, internal rotation and adduction
Knee semi-flexion
Ankle plantar flexion
Foot pronation or supination
Toes flexion
• Athetoid or dystonic posturing usually incorporates extremes of movement
such as total flexion or extension
• Windswept Deformity of hip – One hip flexed, abducted and externally rotated;
other hip flexed, adducted and internally rotated and in danger of posterior
dislocation
< On Examination:
h Sensory Assessment
• It is difficult to assess sensation in babies and young children with severe
multiple impairments.
• If any hearing or visual or psychological abnormalities are present then
assessment done by specialist is required
h Motor Assessment
• Growth Parameters
- Height
Until 24 to 36 months of age, length in recumbency is measured using an
infantometer. After the age of 2 years standing height is recorded by a
stadiometer.
Height Centimeters Inches
At birth 50 20
At 1 year 75 30
2 to 12 years (Age in years × 6) + 77 (Age in years × 2) + 30