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Cerebral Palsy Assessment
Assessment of the child gives a baseline to appropriate treatment andmanagement aims and techniques. Re-assessment should be continuing part of treatment,which allows for improvement or deterioration to be noted, thus enabling treatment to bemore effective.
The therapist must have knowledge of normal development.
During physical examination, it is important to discriminate between delay in motordevelopment and abnormal motor patterns.
It is very essential for the therapist to explain, what he is going to do before handlingthe child.
Assessment needs to be playful, interesting and non-threatening.
Assess young child as much as possible on parent’s lap.
Observe child among familiar toys as well as with selected toys to activate interest aswell as reveal dormant abilities.
Keep sessions within the bounds of a child’s concentration.
Have an unhurried atmosphere.
Have easy, successful actions of a child interspersed with difficult tasks.
Subjective Examination:
Subjective information should be obtained from the parents especially mother orfrom relatives and through case-sheet.
General details includes
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Name
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Age & Sex
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Address
When did the mother first noticed the dysfunctions
Siblings having same type of symptoms
Prenatal History
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Age of mother
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Consanguity marriage
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Any drugs taken during pregnancy
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Any trauma & stress
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Any addiction – smoking or alcoholism
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History of rubella or cytomegalovirus, toxoplasmosis infection
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History of previous abortions, still born or death after birth
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Multiple pregnancies (duration between pregnancies)
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Status & cast of the mother
Perinatal History
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Place of delivery
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History preterm or full-term delivery
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History of asphyxia at birth
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Type of delivery – Forceps delivery
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Presentation of child – Breech presentation
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Any history of prolonged labour pain
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Condition of mother at the time of delivery
Postnatal History
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Delayed birth cry (when child cried)
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Weight of the child at birth – Low Birth Weight (LBW)
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History of any trauma to brain during the first 2 years of life
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History of neonatal meningitis, jaundice, or hypoglycemia
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Hydrocephalus or Microcephaly
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Nutritional habits of the child (malnutrition)
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Feeding difficulties
Any medical or surgical treatment taken
Any physiotherapy treatment previously taken
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What was the ability level of child at that time?
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What obstructs the child from progress?
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What treatment was used?
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Was the treatment effective or not?
Apgar Score from the case-sheet
Objective Examination:
On Observation:
Behaviour of the child
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Whether child is alert, irritable or fearful in the session or during particularactivities
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Child becomes fatigued easily or not during activity
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Find out what motivates his action – particular situation, person or specialplaything
Communication of the child
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How child communicates with the parents
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Whether child initiates or responds with gestures, sounds, hand or fingerpointing, eye pointing or uses words and speech
Attention span
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What catches child’s attention?
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For how much time child’s attention is maintained on particular thing
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How does parent assist him to maintain attention?
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What distracts the child?
Does child follows suggestions to move or promptings to act?
Position of the child
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Which position does the child prefer to be in?
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Can child get into that position on his own or with help?
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With assistance, child makes any effort to go in that position
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Symmetry of the child (actively or passively maintained)
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If involuntary movements present, then in which positions these movementsare decreased or increased
Postural control & alignment
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How much parental support is given
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Postural stabilization and counterpoising in all postures
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Proper & equal weight bearing
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If the child’s center of gravity appears to be unusually high, resulting infloating legs and poor ability to raise head against gravity
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Fear of fall in child due to poor balance
Use of limbs & hands
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Limb patterns in changing or going into position as well as using them inposition
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Attitudes of limbs during playing in all positions
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Whether one or both hands are used, type of grasp and release
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Accuracy of reach and hand actions
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Any involuntary movements, tremors or spasms, which interfere with actions,are present
Sensory aspects
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Observe child’s use of vision, hearing, of touch, smell and temperature inrelevant tasks
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Does child enjoys particular sensations
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Whether child enjoys being moved or having position changed
Form of Locomotion
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How child is carried
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Any use of wheelchair or walking aids
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Which daily activities motivates child to roll, creep, crawl, bottom shuffle orwalk
Deformities
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Observe any recurring position of the whole child
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Any part of the body, which remains in particular position in all postures & inthe movements
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The positional preferences typically seen in spastic cerebral palsies are for midpositions of the body-
In the arm, this generally consists of
Shoulder protraction or retraction, adduction and internal rotationElbow flexionForearm pronationWrist & Fingers flexion
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In the legs, it includes
Hip semi-flexion, internal rotation and adductionKnee semi-flexionAnkle plantar flexion
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