Cerebral Palsy Evaluation

Question 1

Subjective

Answer 1

Patient Hx
Birth Hx
Neonatal Hx
Developmental Hx
Hx of presenting illness

Question 2

Pregnancy Hx

Answer 2

Exposure to drugs/toxins
Acute material illness
Gestational Dm
Prenatal infections
Other complications?

Question 3

Birth Hx

Answer 3

Gestational age
Multiple births
Delivery type
Presentation (breech, cord around neck)
Birth complications? (resuscitation needed?)
APGAR score

Question 4

Neonatal Hx

Answer 4

NICU admission (time in hospital?)
Treatment provided

Question 5

Developmental Hx

Answer 5

When was the last milestone achieved?
Standardized testing results

Question 6

Hx of presenting illness

Answer 6

Delayed milestones
Atypical development
Abnormal tone (floppy or difficult to dress/put into a car seat?)
Asymmetric movements
Use of assistive devices/braces

Question 7

Review of systems

Answer 7

Vision
Hearing
Epilepsy (seizures)
Constipation/urinary incontinence
Dysphagia
GERD
Pressure ulcers
Behavior

Question 8

Objective

Answer 8

Observation
Tone
Reflexes
ROM and voluntary control
Muscle strength
Posture
Gait analysis

Question 9

Observations

Answer 9

Dysmorphic features
Head circumference (may need to be measured)
Postural alignment (head/trunk alignment, upper limb symmetry, lower limb symmetry, LLD, spinal curvature)
ROM
Tone
Muscle strength
Gross/fine motor fxn
Gait

Question 10

Tone

Answer 10

Hyper/hypotonia/fluctuating tone
Objective tone assessment in younger children can be difficult
Muscle groups and movements affected

Question 11

Scale used to assess tone

Answer 11

Modified Ashworth scale

Question 12

Reflexes

Answer 12

Presence of primitive reflexes (Screening)
ATNR
DTR (Exaggerated)
What functions are affected by the persistence/absence of reflexes?

Question 13

ROM and Voluntary control

Answer 13

Muscle length (PROM)
AROM
Impaired voluntary motor control

Question 14

ROM and voluntary control
- Muscle length (PROM)

Answer 14

Assess for muscle tightness/contractures/joint deformities

Question 15

ROM and voluntary control
- AROM

Answer 15

Can help assess voluntary control and muscle strength

Question 16

ROM and voluntary control
- Impaired voluntary motor control

Answer 16

Presence of flexor/extensor synergies

Question 17

Muscle strength

Answer 17

MMT
Handheld dynamometry
Functional testing

Question 18

Posture

Answer 18

Static balance
Dynamic balance

Question 19

Posture
- static balance

Answer 19

Isometric muscle work
Sustained position
E.g. sitting/standing

Question 20

Posture
- dynamic balance

Answer 20

Transitions from one position to another depending on the function (sit to stand)
Combination to isometric/isotonic muscle work

Question 21

Dynamic Balance: Motor Control

Answer 21

Higher degrees of freedom to control
Anticipatory postural adjustments
Compensatory postural adjustments

Question 22

Dynamic Balance: Motor Control
- Anticipatory postural adjustments

Answer 22

The activation of postural muscles in a feedforward manner before a voluntary movement begins, in anticipation of the destabilizing forces caused by the movement

Question 23

Dynamic Balance: Motor Control
- Compensatory postural adjustments

Answer 23

Initiated based on sensory feedback and serve as a mechanism to restore the COM position after a perturbation has already occurred

Question 24

Gait Analysis

Answer 24

Hemiplegia
Diplegia

Question 25

Standardized Outcome Measures

Answer 25

Body structure/function and activity limitations - Gross Motor function measure (GMFM-66) - Pediatric Balance Scale (PBS) - Static and Dynamic Posture - Gait

Question 26

Pediatric Balance Scale (PBS)

Answer 26

Pediatric version of the Berg Balance Scale

Question 27

Static and Dynamic Posture

Answer 27

Trunk control measurement scale (TCMS) Segmental Assessment of Trunk Control (SATCO)

Question 28

Gait

Answer 28

Edinburgh Visual Gait Analysis (EVGS)