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1. PHYSICAL ASSESSMENT
IN
PEDIATRIC REHABILITATION
DR MEYSAM. MOHAMMADI
‫در‬‫شده‬‫ارائه‬:
‫تخصصی‬‫کارگاه‬‫کودکان‬‫توانبخشی‬‫در‬‫عصبی‬‫معاینات‬
‫زمستان‬96

2. • Muscle
•Size……. Are there any muscle atrophy?
•Strength..
•Tone....
- Coordination
• Rapid alternating movement
• Finger to finger
• balance

3. Muscle Testing
•0: no movement
•1: can see muscle contraction but no
movement
•2: can move with gravity eliminated
•3: can move against gravity
•4: can resist opposition to some extent, but
not full (+, - also)
•5: full strength

4. TONE
• Tone is the resistance appreciated when moving a limb
passively
• “Normal Tone”
• Hypotonia
• “Central Hypotonia”
• “Peripheral Hypotonia”
• Increased Tone
• Spasticity (Corticospinal Tract)
• Rigidity (Basal Ganglia, Parkinson’s Disease)
• Dystonia (Basal Ganglia)

7. TENDON REFLEXES
Triceps C7, 8
Biceps C5, 6
Supinator C5, 6
Knee L3, 4
Ankle S1, 2

8. TESTING THE PLANTAR REFLEX (BABINSKI).
-STROKE THE LATERAL ASPECT OF THE SOLE OF EACH FOOT WITH
THE END OF A REFLEX HAMMER OR KEY.
-OBSERVE FOR PLANTER FLEXION OF THE FOOT .

9. INVOLUNTARY MOVEMENTS
• Hyperkinetic Movements
• Chorea.. Involu/jerk/dance shape/prox
• Athetosis… inv /twisty/distal
• Tics.. Sudden/non rhythmic/repetitive
• Myoclonus..twich/jerk/stretch or seizure induce
• Bradykinetic Movements
• Parkinsonism
• Dystonia.. Invo/sustained or repetitive/postural

10. MUSCLE COORDINATION
• Eye Hand coordination
• Two hand coordination

11. CEREBELLAR PROBLEMS
• Dysmetria *
• Dysdiadochokinesis*
• scanning speech
• Hypotonia*
• Falls to Side of Lesion*
• Nystagmus (Variable Directions)
• intention tremor
• ataxic gait

12. CEREBRAL PALSY

14. RED FLAGS
• Head control …………………….. 3 month
• Sitting ……………………………….. 6 month
• Rolling …………………………….... 9 month
• Walking …………………………… 18 month

16. ASSESSMENT OF REFLEXES

17. PALMAR GRASP
Birth
Until
5 - 6
month

18. ASYMMETRICAL TONIC NECK REFLEX
Birth
Until
6 month

19. 6 – 11 month
Is Normal

20. • gastroc soleus test
Birth until
4 month

21. Birth until 5 month
Help to Early Diagnosis
Symmetry /Asymmetry
30◦ flex
Ext.Rot finger Ext
Then………..Int.Rot

23. • Rooting reflex
• Sucking reflex
• Swallowing
• - Drooling
-V, VII, IX, X, XII CN Integration
• -Gag reflex
• Mastication
-Bite reflex
Oral reflexes
0 - 4 Month

24. DEVELOPMENTAL MOTOR SPEECH
DISORDERS
•Aphasia
•Apraxia of speech… due to:
Planning difficulties
•Dysarthria … due to:
Coordination, Speed, Tone, Power

25. COMMON DEFORMITIES
IN
CEREBRAL PALSY

26. LUMBAR HYPERLORDOSIS
• Hip flexor contracture

27. LUMBAR KYPHOSIS
• Hamstrings contracture

28. SCOLIOSIS
• test it In different positions

29. ELY TEST

30. FEMORAL ANTEVERSION

31. TEST OF FEMORAL ANTEVERSION

32. HIP; ANT AND POST TILT
hip flexors shorten and
the hip extensors lengthen.
Lum.lord
hip flexors lengthen and
the hip extensors shorten

33. LATERAL TILT OF HIP
is associated with scoliosis or people who have legs of different length.
It can also happen when one leg is bent while the other remains straight.

35. THOMAS TEST
• Iliopsoas shortness

36. BACK KNEE

37. GENU VALGUM/ VARUM

38. HAMSTRINGS SHORTNESS

39. QUADRICEPS SHORTNESS

41. PES PLANUS

42. PES VALGUS

43. PES VARUS

44. EQUINO VALGUS

45. EQUINO VARUS

46. GASTROSOLEUS TEST

47. gross Motor
• Gait
• Jumping
• Tandem walking
• Romberg
• A patient who has a problem with proprioception can
still maintain balance by using vestibular function and
vision
• One legged squat

48. FINE MOTOR SKILLS
• Grasp
• Strength
• Control
• Dexterity
• Hand dominance
• Writing
• Drawing
• Scissoring
• Cubes
• to turn the page
• Folding

49. MUSCLE AND JOINTS

51. PINCER GRASP AND PALMAR GRASP

52. INTRINSIC AND EXTRINSIC
MUSCLES

54. GAIT ASSESSMENT

55. A NORMAL GAIT REQUIRES
• Vision
• Strength
• Balance/Coordination
• Joint Position

56. GAIT!
Observe walking firstly
Walk on heels
Tip-toes
Run
Stand on one leg (x 5 secs) [3 yrs]
Hop [4 yrs]
Walk straight line x 20 steps [5 yrs]
Tandem (heel-toe) walking [7 yrs]
Crouch down (distal muscles)
& stand up (proximal muscles)

57. OBSERVE DIFFERENT ASPECTS OF GAIT
• Posture of Trunk
• Toe Walking
• Heel Walking
• Tandem Walking
• Hip, knee and ankle strategies
• Arm Swing
• Base of Gait
• Heel Strike
• Time Spent on Each Leg

58. GAIT ABNORMALITIES
• Broad-based;
• appropriate when learning to walk
• Hypotonia of legs / pelvic girdle
• Cerebellar dysfunction
• Hip joint problems
• Narrow gait; (scissoring?)
• Adductor spasm (mild diplegia)
• Hemiplegic gait; (wide swing)
• proximal muscle weakness
• Waddling gait;
• High-stepping gait;
• Sensory neuropathy
• Distal weakness eg. foot-drop

59. CLASSICAL PATTERNS OF ABNORMAL
GAIT
• Hemiparetic Gait
• Spastic Diplegia Gait
• Ataxic Gait
• Waddling Gait
• High Stepping Gait

63. SENSORY ASSESSMENT

64. SENSATION
• Exteroceptive
• Proprioceptive
joint laxity …. Crude movement.. Simulation…
• Tactile discrimination
• Stereognosis
• Graphesthesia
• Two point discrimination
• Extinction
• Point location

65. DERMATOMES
• Hypesthesia
• Hypersthesia
• Parestesia

66. IDENTIFY EXTROCEPTIVE SENSATIONS.

67. STEREOGNOSIS

68. Two point discrimination

69. GRAPHESTHESIA

70. ‫تخصصی‬ ‫کارگاه‬
‫کودکان‬ ‫توانبخشی‬ ‫در‬ ‫عصبی‬ ‫معاینات‬
‫اریم‬‫ز‬‫سپاسگ‬
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