ASSESMENT PADA

CEREBRAL PALSY
1. HISTORY TAKING
2. ASSESMENT OF REFLEXES
3. ASSESMENT OF DEVELOPMENT
MILESTONE
4. ASSESMENT OF GAIT PATTERN
5. ASSESMENT OF FUNCTIONAL MOBILITY
6. ASSESMENT OF TONE MUSCLE
7. ASSESMENT OF STRENGTENING MUSCLE
8. ASSESMENT OF BALANCE
9. ASSESMENT OF TRUNK IMPAIRMENT
10.ASSESMENT OF UPPER EXTRIMITY
Diagnostic flowchart in cerebral
palsy
 HISTORY TAKING
1. RIWAYAT PRENATAL
2. RIWAYAT PERINATAL
3. RIWAYAT POST NATAL
4. RIWAYAT PERMATUR, MATUR, SEROTINUS
5. RIWAYAT MEDIS
6. RIWAYAT PENGOBATAN YANG SEDANG
BERLANGSUNG (MEDIKAMENTOSA)
7. RIWAYAT TERAPI LAINNYA
8. RIWAYAT KELUARGA
ASSESMENT OF REFLEXES
ASSESMENT OF DEVELOPMENTAL
MILESTONES

DENVER DEVELOPMENT SCREENING

TEST.
 ASSESMENT OF GAIT
PATTERN
Hemiplegia Gait
1. Type 1 (Drop foot type)
2. Type 2 (True equinus with or
without recurvatum knee)
3. Type 3 (Stiff knee gait)
4. Type 4 (In sagittal plane, the
ankle is in equinus, knee in
flexion, hip in flexion and
anterior pelvic tilt is present.
In coronal plane, there is hip
adduction and internal
rotation)
Type II diplegic gait.
(a): Anteroposterior view
showing jump gait with bilateral
hip and knee flexion and ankle
equinus.
(b): Lateral view showing jump
gait with bilateral hip and knee
flexion and ankle equinus
Type IV diplegic gait.
(a): Anteroposterior view showing
crouch gait with bilateral hip and
knee flexion and ankle
dorsiflexion.
(b): Lateral view showing crouch
gait with bilateral hip and knee
flexion and ankle dorsiflexion
 ASSESSMENT OF
FUNCTIONAL MOBILITIY
1. GMFCS (GROSS MOTOR FUNCTION
CLASSIFICATION SYSTEM)
Level I – The child can walk indoors and outdoors and climb stairs without using hands for support
and can perform usual activities such as running and jumping but has decreased speed, balance, and
coordination

Level II – The child can climb stairs with a railing but has difficulty with uneven surfaces, inclines, or in
crowds and has minimal ability to run or jump

Level III – The child walks with assistive mobility devices indoors and outdoors on level surfaces, able
to climb stairs using a railing, and may propel a manual wheelchair but needs assistance for long
distances or uneven surfaces

Level IV – Here, the walking ability is severely limited even with assistive devices such as wheelchairs
most of the time and may propel own power wheelchair, standing transfers, with or without assistance

Level V – The child has physical impairments that restrict voluntary control of movements, has very
poor head, neck, and trunk control, has impairment in all areas of motor function, and cannot sit or
stand independently, even with adaptive equipment.
 ASSESSMENT OF
FUNCTIONAL MOBILITIY
2. FUNCTIONAL MOBILITY SCALE (FMS)
1 . The child mostly uses a wheelchair but may stand for
transfers and does some stepping supported by a caretaker
or with the help of a walker.
2. The child uses a walker or frame to ambulate.
3. The child independently walks but with the help of
crutches.
4. The child walks independently but with the help of sticks
(one or two).
5. The child walks independently only on leveled surfaces.
6. The child walks independently on all surfaces.
 ASSESMENT OF MUSCLE
TONES
1.MODIFIED ASHWORTH SCALE
ASSESSMENT OF MUCLE
STRENGTH
 ASSESMENT OF BALANCE
• To conclude the physical examination, assessment of
posture, trunk balance, and position of the pelvis and
lower extremities in standing position (static) and during
walking (dynamic) in both planes gives overall
information regarding motor control and compensatory
mechanisms.
• Children with CP tend to have delayed and reduced
posterior equilibrium responses. A comprehensive
analysis of equilibrium in all planes should be done
before planning for any modality of treatment.
TARDIEU SCALE
 ASSESSMENT OF TRUNK
IMPAIRMENT
1. KYPOSIS
2. LORDOSIS
3. SKELIOSIS
4. KYPOSKELIOSIS
ASSESSMENT OF UPPER
LIMB
 INTERVENSI FISIOTERAPI PADA
CEREBRAL PALSY
1. NEURODEVELOPMENTAL THERAPY (BOBATH)
2. CONSTRAINT INDUCED MOVEMENT THERAPY (CIMT)
3. PATTERNING
4. ELECTRICAL STIMULATION
5. HIPPOHERAPY
6. BODY WEIGHT BEARING TREADMILL TRAINING
7. FUNCTIONAL EXERCISE
8. MUSCLE STRENGTHENING EXERCISE
9. STATIC WEIGHT BEARING EXERCISE
10. STRENTCHING
11. AQUATIC THERAPY
12. NMT
13. WHOLE BODY VIBRATION
14. VIRTUAL REALITY
15. SERIAL CASTING
16. SPLINTING
NEURODEVELOPMENTAL
THERAPY (BOBATH)
 CONSTRAINT INDUCED
MOVEMENT THERAPY (CIMT)
ELECTRICAL
STIMULATION
HIPPOTHERAPY
BODY WEIGHT BEARING TREADMILL TRAINING
FUNCTIONAL EXERCISE
MUSCLE STRENGTHENING EXERCISE
STATIC WEIGHT BEARING
EXERCISE
AQUATIC THERAPY
WHOLE BODY VIBRATION
VIRTUAL REALITY
NEUROMUSCULAR TAPPING
SERIAL CASTING
SPLINTING
 CP SPASTIC QUADRIPLEGIA

ORAL PROBLEM:
POSTURAL TONE: • Open mouth
• Hypertone of the neck • Mouth breathing
(neck hyperextended) • Jaw retraction
• Hypertone on the total • Tongue retraction,
pattern of movement tongue tip
(trunk hyperextended) • Lips reatraction
• Oral hypersensitivity

The 3’rd Bobath Pediatric Basic Course , Hong Children Center, Philippines, 2017
 CP SPASTIC DIPLEGIA
POSTURAL TONE:
• Low tone of the prox
muscles
(neck collaps, inactive trunk)
• Hypertone of the LE
• Assosiated reaction of the
UE
ORAL PROBLEM:
• Open mouth
• Mouth breathing
• Jaw thrust
• Lips low tone
• Tongue protrusion

The 3’rd Bobath Pediatric Basic Course , Hong Children Center, Philippines, 2017
 CP SPASTIC HEMIPLEGIA

POSTURAL TONE:
• Weak neck muscles
tone in one side
• Low tone prox muscles
in one side
ORAL PROBLEM:
• Hypertone in distal
part in one side (arms • Asymmetric of neck
and legs) • Asymmetric jaw
movement
• Asymmetric tongue

The 3’rd Bobath Pediatric Basic Course , Hong Children Center, Philippines, 2017
 CP HYPOTONIA
POSTURAL TONE:
• Low tone on neck and
trunk
• Low tone on extremity
• Lack of anti gravity
muscles

ORAL PROBLEM:
• Low tone of oral motor
• Oral hyposensitivity
• Breathing problem

The 3’rd Bobath Pediatric Basic Course , Hong Children Center, Philippines, 2017
 CP ATHETOSIS

POSTURAL TONE: ORAL PROBLEMS:

• Fluctuative tone • Involuntary movement of
the neck
- hypotone – hypertone • Jaw instability
- hypertone – normal • Involuntary movement of
- below normal – above lips and tounge (grimace)
normal • Fluctuative breathing
- hypotone – near normal • Oral sensitivity
• Involuntary movement
- proximal part
- distal part

The 3’rd Bobath Pediatric Basic Course , Hong Children Center, Philippines, 2017
 CP ATAXIA

POSTURAL TONE:
• Weak neck muscles
tone ORAL PROBLEMS:
(Head titubation) • Disartria
• Low tone prox muscles • Low tone of oral motor
• Poor coactivation • Oral hyposensitivity
(trunk sway) • Breathing problems
• Wide BOS
• Tremor
• Dysmetria

The 3’rd Bobath Pediatric Basic Course , Hong Children Center, Philippines, 2017
Feeding problems in children with cerebral
palsy
Nutritional status of children with cerebral
palsy
VIDE
O
The H-reflex was elicited in m.tibialis
anterior and thenar muscles of human
subjects while bite
 PT TREATMENT IDEAS
FOR FEEDING PROBLEMS
• Positioning
• Postural stability
- Neck stability
- Proximal stability
- Pelvic stabiliy
• Breathing pattern
• Special equipments
Oral Motor Problems
Aspiration Problem
Pneumonia Problem
Airway Clearance Problems
Respiratory Muscles
Problems
Postural Problems
Rib cage Problem
Rib cage Problem
 Physiotherapy Interventions
• Positioning and postural training
• Respiration muscles strengthening
• Rib cage mobilization
• Chest Physiotherapy/CPT
- Facilitate nasal breathing
- Postural drainage
- Percussion, vibration
- Facilitate coughing
 A. Muscle Weakness and
Atrophy
Neurological Basis: Muscular Basis:
• Reduce central • Change in fiber
input to the motor type and
neurons development
• Insufficient • Change in fiber
recruitment of length and cross
motor units section of muscle
• Coactivation effect • Change in passive
on weakness properties
 Weakness Intervention
• Strengthening on particular muscles group
or focus on key muscles without increases
spasticity in functional parameter.
• Neuromuscular fascilitation
• Neuromuscular electro stimulation
• Biofeedback
• Virtual reality
B. Contracture
 Contracture Intervention
Physiotherapy
Interventions:
• Sustained stretching or
prolonged stretching
preferred than passive
strecthing.
• Resting splint in normal
alignment position
• Serial casting preferred than
continues casting
Surgery Interventions:
• Tendo lengthening
• Osteotomy
Shoulder Dislocation:
• Assymmetry of shoulder
• Dystonic CP
Hip Dislocation:
• Assymmetry of hip joint
• Adductor stiffness
• Psoas mayor and stiffness
• Non weight bearing
 Dislocation Intervention
• Reversible Dislocation:
- Release adductor stiffness
- Release psoas stiffness
- Closed reposition
- Hip stabilization

• Irreversible Dislocation:
- Surgery

EXERCISE ORTHOSI SURGERY

 D. Postural Problems
• Hyperlordosis
- Strong extensor spastic pattern
- Ambulatory patient with hip flexion contracture
• Khyposis
- Inactive trunk
• Scoliosis
- Assymmetric Spastic Quadriplegia
- Assymmetric Athetosis
Postural Problem Intervention

• Physiotherapy:
- Postural training

• Orthosis:
- Brace

• Surgery:
- Spinal fusion

EXERCISE ORTHOSI SURGERY

E. LBMD/Low Bone Mineral
Density
LBMD Intervention
 Sleep Problem in CP

• Sleep problems in Cerebral Palsy between 23%

- 46% children.
• Sleep problems included:
- Difficulty initiating sleep and maintaining sleep
- Sleep wake transition
- Sleep breathing disorder
- Sleep bruxism
- Exessive day time sleeping
- Nightmare and sleep talking
 Risk Factors of Sleep Problem in
CP
• Spasticity • Gastro-esophageal
• Pain reflux
• Epilepsy • Environmental
• Breathing problem factors:
• Recurrent - Light
aspiration - Temperature
• Glossoptosis - Sound
- Bedding
 Sleep Problem Intervention

Non Pharmacological Sleep Intervention:

• Sleep routine with regular bedtime and calming bahavior.
• Environment modification (light, temperature, bedding,
sound)
• Relaxation (music, massage)