Dr. Mansoor Alam is a child developmental specialist from ICD, New Delhi. He is a medicine graduate with specialization in Developmental Disability Management. After his graduation, he joined Spastic Society of Northern India, New Delhi to have a Post-Graduation Diploma in Developmental Therapy under RCI. Later, he went to Bobath Centre in London, (United Kingdom) to have specialized training in Bobath Approach to the treatment of Children with Cerebral Palsy, which is popularly known as Neurodevelopment Treatment (NDT). While, he was in Sydney, Australia, he did an advance course on the Use of Botox in Spasticity Management. He is one of the few professionals in India who attended Gait Analysis Course in Australia. To have in-depth knowledge to work with children neurodevelopmental disabilities, he pursued specialized training programs on GMA (General Movements Assessment), Constrained Induced Manual Therapy (CIMT), Early Intervention, Sensory Integration Therapy, Clinical Pathology and Acupuncture. He has been considered as one of the first combination therapists in India who bridged the gap between medical and rehabilitation science. He has supported more than 200 organizations technically to work scientifically with children with developmental disabilities. He has mentored more than 3000 professionals to work and lead in the field of Childhood Disability. He has conducted more than 50 workshops and conferences in India and abroad. He has presented his works in England, Australia and Pakistan. More than 4000 articles in different Journals / Websites / Books / Research Papers have mentioned his work and his website (www.icddelhi.org) He can be contacted at: Institute for Child Development, C-27, Malviya Nagar, New Delhi-110017 Landline No: 011-41012124, Mobile No: +91-7838809241 Mail: helpicd@gmail.com, Website: www.icddelhi.org

1. Evaluation for Pre-Operative and Post-
Operative Physical Therapy(Physiotherapy)
Dr. Mansoor Alam
Child Development Specialist
Institute for Child Development
New Delhi

2. Documentation
Documentation
Pen and Paper
Video Graphical
Computerized
Screening
Assessment
Evaluation

3. Screening
To examine or test somebody to find out if
he/she has a particular disease / disorders

4. Assessment
Assessment is the systematic basis for making
inferences about the a subject. It is the process
of defining, selecting, designing, collecting,
analysing, interpreting, and using information to
increase learning and development.

5. Evaluation
The process of judging or calculating the
quality, importance, amount, or value of
something: Evaluation of a treatment cannot
take place until all the data has been collected.

6. Pre-Operative Assessments
Pre-operative assessment is necessary prior to
the majority of elective surgical procedures, in
order to ensure that the patient is fit to undergo
surgery, to highlight issues that the surgical or
anaesthetic team need to be aware of during
the peri-operative period, and to ensure
patients' safety during their journey ...

7. Pre-Operative Assessments
Selecting the right candidate
Ability Assessment
Pen and Paper
Computerized
Videography
Information Sharing

8. Selecting the right candidate
1. Range of Motion
a. ROM Chart
b. Modified Ashworth Scale
c. Tardieu Scale
2. Muscle Strength
a. Oxford Scale / MMT
b. Selective Motor Control

9. ROM Chart
 Goniometry
Elbow flexion (0-135/150)
Wrist extension (0-70)
Hip extension (0-30)
Hip adduction (0-35)
Knee flexion (0-135)
Ankle dorsiflexion (0-15)

10. Modified Ashworth Scale
Spasticity Grading Scale
(Spasm, Tightness, Contracture, Deformity)
Scoring System (0-4 Score)
0- No increase in muscle Tone
1-Slight increase in muscle tone, manifested by a catch and release, or by
minimal resistance at the end of the ROM when the affected part-sis/ are
moved in flexion or extension
1+-Slight increase in muscle tone, manifested by a catch followed by a
minimal resistance throughout the remainder ( less than half) of the ROM
2- more marked increase in muscle tone through most of the ROM but
affected part(s) easily moved
3-Considerable increase in tone, passive movement difficult
4-Affected part(s) rigid in flexion or extension

11. Tardieu Scale
 Defines the moment of the catch (eg-tardieu X= 3 or X=4) in the range of
motion (R1) at a fast passive stretch (TardieuV3)
 Spasticity grading( Modified from Sindou and Jeanmonod by lazareff et al)
Score Grade Description
0 Absent No abnormal posture
1 Mild Normal passive movement no disability
2 Moderate Abnormal posture, completely reduced by passive
mobilization
3. Marked Abnormal posture, incomplete reduced by passive
mobilization, limited range of joint movement, high
resistance to muscle stretching, marked disability
4. Severe Abnormal posture, slightly reduced by passive
mobilization, severe disability

12. MMT -Oxford Scale / MRC Scale
 Oxford Scale
0/5: No Contraction
1/5: Visible palpable muscle contraction but no
movement
2/5: Movement with gravity eliminated
3/5: Movement against gravity only
4/5: Movement against gravity with some resistance
5/5: Movement against gravity with full resistance

13. Selective Motor Control
Selective motor control (SMC) is a fundamental
component of typical human motion, allowing
flexible and separate control of joint movement.
Impaired SMC is one of the most common
neuromuscular deficits in bilateral spastic CP,
and often occurs in combination with muscle
weakness, spasticity, and contracture.

14. Selective Motor Control-SMC
 SCALE for Lower Limbs
Selective Control Assessment of the Lower
Extremity
 SCUES for Upper Limbs
Selective Control of the Upper Extremity Scale

15. Baseline Documentation
 Postural Ability
 Manual Ability
 Associated Disorders
 Assistive Aids

16. Postural Ability
Functional Postures
Static Postures
Postural Transition
Mobility

17. Postural Ability
Postures
1. Lying
Supine
Prone
Side Lying
2. Sitting
Long Legs Sitting
Cross Legs Sitting
Side Sitting
Squatting
High Sitting
3. Kneeling
Kneeling on Fours
Upright Kneeling
Half Kneeling
4. Standing
Front Support Standing
Back Support Standing
Mobility
1. Pivoting
2. Rolling
3. Creeping
4. Crawling / Bottom Shuffling
5. Lateral Cruising
6. Rollator Walking
7. Tripod / Stick Walking
8. Elbow Crutches Walking
9. Independent Walking
10.Gait

18. Assessment Scales
• GMFCS
• GMFM
• GMPM
• FMS
• Gait Analysis
• Traditional

19. GMFCS-Gross Motor Function
Classification System
The gross motor skills (e.g. sitting and walking)
of children and young people with cerebral
palsy can be categorised into 5 different levels
using a tool called the Gross Motor Function
Classification System (GMFCS) developed by
CanChild in Canada.

20. GMFCS

21. GMFM- Gross Motor Function
Measure
GMFM is an observational clinical tool designed to evaluate
change in gross motor function in children with cerebral palsy.
There are two versions of the GMFM - GMFM-88 and GMFM-66
The scoring system of the GMFM is a four-point scale that consists
of 66 / 88 items divided into five dimensions of gross motor
function:
(a) lying and rolling,
(b) sitting,
(c) crawling and kneeling,
(d) standing,
(e) walking, running and jumping

22. GMPM- Gross Motor Performance
Measure
The GMPM is an observational instrument
used to evaluate gross motor performance (i.e.,
quality of movement) in children with cerebral
palsy. The instrument's primary purpose is to
evaluate change over time in specific
qualitative features or attributes of gross motor
behaviour. The measure was found to be
responsive to change over time.

23. FMS-Functional Mobility Scale

24. Gait Analysis
 Computer Aided Gait Analysis
 Observational Gait Analysis

25. Observational Gait Analysis
 Physician Rating Scale
 Wisconsin Gait Scale
 Gait Profile

26. Manual Ability
 MACS
 AHA
 Sollerman Hand Function Test
 The Purdue Pegboard Test
 The Box and Block Test (BBT)
 The Nine-Hole Peg Test (9HPT or NHPT)
 Jebson Taylor Hand Function Test (JHFT)
 Functional Dexterity Test (FDT)

27. Manual Ability
 Zancolli Classification
 House Classification
 Melbourne Assessment 2 (MA2)
 Trost scale
 Lovett scale

28. MACS-Manual Ability
Classification System

29. AHS-Assisting Hand Assessment
The Assisting Hand Assessment (AHA), and the group of related
assessments (AHA-family), measure and describe how effectively
individuals with a hand/arm impairment use their two hands
together to perform bimanual tasks
AHA is a standardized test intended for children with unilateral
Cerebral Palsy or Brachial Plexus Palsy between the ages of 18
months and 18 years. The Assisting Hand Assessment (AHA) is
an evaluative tool to measure how effectively children with
unilateral hand dysfunction actually use their involved hand
collaboratively with their well-functioning hand to perform bimanual
tasks.

30. Associated Disorders
 Cognition
 Communication
 Convulsion
 Visual Disorder
 Hearing Deficit
 Feeding Disorder
 Obesity

31. Associated Disorders
 Allergy
 Hydrocephaly
 Skin Disorder
 Muscles Atrophy
 Poor Bowel Control
 Poor Bladder Control
 Poor Immune System

32. Assistive Aids
 Orthotic Aids
 Postural Aids
 Mobility Aids
 Adaptive Aids

33. Orthotic Aids
An orthosis by definition, is "an externally
applied device used to modify the structural
and functional characteristics of the
neuromuscular and skeletal system.

34. Postural Aids
Postural aids are devices which help a person with
physical disability to improve stability, alignment and
enhance function
A postural aid can help a child with physical disability
many ways such as
 To improve postural alignment
 To provide stability
 To prove a base to function better
 To decrease abnormal joint position

35. Postural Aids
There are number of postural aids available according
to the need of the individual. Such as
 Corner seat
 Corner chair
 Arm chair
 Potty chair
 Standing frame
 Prone wedge
 Floor cut out table

36. Mobility Aids
A mobility aid is a device designed to assist a
person with disability to move from one place to
another place. e.g. Rollator, Crawler, wheel
chair, cane etc
A mobility aid can help a person with disability
to generate movement, improved stability,
reduce lower-limb loading, etc

37. Adaptive Aids
Adaptive aids are appliances or controls which
help a person with disability to increase his /
her abilities to perform activities of daily living,
participate in community and home activities.
These devices are used to assist individual to
perform activities of daily living such as
bathing, dressing, grooming, toileting, and
feeding and other self-care activities

38. Information Sharing
 Why the procedure is necessary
 What is the name of the procedure
 What are specific muscles and joints to be
involved
 What will be the maximum duration of the
procedure
 Need of Anesthesia or Blood Transfusion
 Risk factors associated with anesthesia

39. Information Sharing
 Other Risk Factors
 Cost of the procedure
 Need of cast
 Duration and type of cast
 Removal of cast
 Hospital stay

40. Post-Operative Evaluation
 Wound Care
 Cast Care
 Pain Management
 Prevention of infection and pressure sore

41. Thank You