This slide contain detail description of basic terminologies, neonatal (head to toe examination) assessment, neonatal reflexes, minor physiological handicaps of newborn
Majority of fetal deaths occur in the antepartum period.
There is progressive decline in maternal deaths all over the world. Currently more interest is focused to evaluate the fetal health. The primary objective of antenatal assessment is to avoid fetal death.
This slide contain detail description of basic terminologies, neonatal (head to toe examination) assessment, neonatal reflexes, minor physiological handicaps of newborn
Majority of fetal deaths occur in the antepartum period.
There is progressive decline in maternal deaths all over the world. Currently more interest is focused to evaluate the fetal health. The primary objective of antenatal assessment is to avoid fetal death.
Fourth stage of labor: The hour or two after delivery when the tone of the uterus is reestablished as the uterus contracts again, expelling any remaining contents. These contractions are hastened by breastfeeding, which stimulates production of the hormone oxytocin.
Infancy Physical Development Chapter 4 and 5Infan.docxjaggernaoma
Infancy: Physical Development
Chapter 4 and 5
Infant development progresses rapidly. Infants usually come into this world equipped to begin the journey of life!
1
Principles of Development
Cephalocaudal
Proximodistal
Cephalocaudal – refers to development as progressing from head to toe. Consider muscle development babies begin by being able to lift their head and then it progresses to ultimate control of muscles which would be walking.
Proximodistal refers to center out. Again consider the last area one gains control is the fingers.
2
Skeletal Growth
Skeletal Age
Epiphyses
Fontanels
The best estimate of a child’s physical maturity is skeletal age, which is a measure of development of the bones of the body.
Epiphyses are growth centers, that appear at the ends of the long end of the bones of the body. Cartilage cells continue to be produces at the growth plates of these epiphyses, which increase in number throughout childhood and then as growth continues, get thinner and disappear.
Skull growth is especially rapid between birth and 2 years of age due to large increases in brain size. At birth the bones of the skull are separated by gaps called fontanels. These gaps help during the birth process and also allow for brain development. There are 6 of these – the largest is the anterior gap. It will gradually shrink and fill in during the second year. The other fontanels are smaller and close more quickly. As the skull bones come in contact with one another, they form sutures or seams, these permit the skull to expand easily as the brain grows. The sutures will disappear when skull growth is complete, during the teen years.
3
Brain Development
Synaptic Pruning
Myelination
Cerebral Cortex
Prefrontal cortex
Hemispheres
Lateralization
Brain plasticity
At birth the brain is nearer to its adult size than any other physical structure.
Human brain has 100 to 200 billion neurons or nerve cells that store and transmit information. Between nuerons are tiny gaps or synapses, where fibers from different neurons come close together but do not touch. Neurons send messages to one another by releasing chemicals call neurotransmitters which cross the synapse. During infancy and toddlerhood, neural fibers and synapses increase dramatically. Because developing neurons require space for connective structures, as synapses form surrounding neurons will die. As neurons form connections, stimulation becomes vital for their survival. Neurons that are stimulated by input from the surrounding environment continue to establish new synapses, forming increasingly elaborate systems of communication that support more complex abilities. Neurons that are seldom stimulated soon lose their synapses, through synaptic pruning, which returns neurons not needed at the moment to an uncommitted state so they can support future development.
About half of the brain is made up of glial cells which are responsible for myelination, the coating of.
Parkinsonism is a clinical syndrome and, typically, when the condition
appears to be idiopathic and responsive to levodopa therapy, is referred
to as Parkinson’s disease1
• The four cardinal features of the parkinsonian syndrome are:2
– Bradykinesia
– Muscular rigidity
– Resting tremor
– Postural instability (and gait impairment)
• These features are not always observed in every patient, at any given
time
To make a diagnosis of PD, the physician must distinguish between
different forms of parkinsonism:1
– Parkinson’s disease
– Secondary parkinsonism
– Parkinsonism as part of another neurodegenerative disorder (e.g., multiple
system atrophy, progressive supranuclear palsy, corticobasal degeneration, or
Lewy body dementia)
SCALES COMMONLY USED IN
PARKINSON’S DISEASE
RESEARCH
SCALES COMMONLY USED IN
PARKINSON’S DISEASE
RESEARCH
Progressive multifocal leukoencephalopathy (PML) is a disease of the white matter of the brain, caused by a virus infection that targets cells that make myelin--the material that insulates nerve cells (neurons). Polyomavirus JC (often called JC virus) is carried by a majority of people and is harmless except among those with lowered immune defenses. The disease is rare and occurs in patients undergoing chronic corticosteroid or immunosuppressive therapy for organ transplant, or individuals with cancer (such as Hodgkin’s disease or lymphoma). Individuals with autoimmune conditions such as multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus -- some of whom are treated with biological therapies that allow JC virus reactivation -- are at risk for PML as well. PML is most common among individuals with HIV-1 infection / acquired immune deficiency syndrome (AIDS). Currently, the best available therapy is reversal of the immune-deficient state, since there are no effective drugs that block virus infection without toxicity. Reversal may be achieved by using plasma exchange to accelerate the removal of the therapeutic agents that put patients at risk for PML. In the case of HIV-associated PML, immediately beginning anti-retroviral therapy will benefit most individuals. Several new drugs that laboratory tests found effective against infection are being used in PML patients with special permission of the U.S. Food and Drug Administration. Hexadecyloxypropyl-Cidofovir (CMX001) is currently being studied as a treatment option for JVC because of its ability to suppress JVC by inhibiting viral DNA replication.
In general, PML has a mortality rate of 30-50 percent in the first few months following diagnosis but depends on the severity of the underlying disease and treatment received. Those who survive PML can be left with severe neurological disabilities.
Sequencing in management of Multiple sclerosisAmr Hassan
Sequencing of DMTs for individual multiple sclerosis patients should be designed in such a way to maximize disease control and minimize risk based on the mechanism of action, pharmacokinetic and pharmacodynamic properties of each therapy. This includes the DMT patients are being switched from to those they are being switched to. The reversibility of immune system effects should be a key consideration for DMT sequence selection. This feature varies across DMTs and should factor more prominently in decision making as newer treatments become available for the prevention of disability accumulation in patients with progressive MS. In this short review, we discuss the landscape of existing therapies with an eye to the future when planning for optimal DMT sequencing. While no cure exists for MS, efforts are being directed toward research in neuroregeneration with the hope for positive outcomes.
A neuromuscular disorder that leads to weakness of skeletal muscles.
Symptoms
Causes
Prevention
Complications
Common tests & procedures
Neurological examination:
Repetitive nerve stimulation test:
Antibody test:
Pulmonary function tests (PFTs): To check any breathing difficulty.
CT scan: To rule out a presence of tumor in thymus.
Magnetic resonance imaging (MRI): MRI of the chest is performed to rule out a presence of tumor in thymus.
Edrophonium (Tensilon) test:
Medication
Procedures
Nutrition
Prediction of outcome of Multiple sclerosisAmr Hassan
Prediction of outcome of Multiple sclerosis
An understanding of the natural history of multiple sclerosis(MS) in a patient is important to begin proper treatment at the correct time, especially when there is a high risk for poor prognosis. Factors that predict unfavorable prognosis are a primary or secondary progressive course, older age at disease onset, short interval between first and second attacks, initial cerebellar or pyramidal symptoms, a large number of functional systems involved at onset, moderate to severe disability within the first 2 years, and the presence of typical plaques or greater lesion volume shown by magnetic resonance imaging results during the first 5 years. However, there are no established laboratory tests able to predict long-term prognosis.
Lifestyle modification in epilepsy
Lifestyle Modifications
Lifestyle modifications can include:
Adequate sleep: Fatigue is one of the most common seizure triggers, and disrupted sleep can make the brain more vulnerable to misfiring.
Avoiding drugs and alcohol: These can be triggers for seizures in patients with epilepsy. Even one or two drinks can provoke seizures.
Minimizing emotional stress: Although there is not definitive proof that stress causes seizures, those who maintain healthy stress levels have reported that they believe it reduces their risk.
Frequency of exercise: In addition to a range of health benefits, regular exercise can help reduce risk of seizure. However, you should consult your physician before starting a new exercise routine, as some exercise can, rarely, cause seizures.
Childhood demyelinating syndromes
In the past decade, the number of studies related to demyelinating diseases in children has exponentially increased. Demyelinating disease in children may be monophasic or chronic. Typical monophasic disorders in children are acute disseminated encephalomyelitis and clinically isolated syndromes, including optic neuritis and transverse myelitis. However, some cases of acute disseminated encephalomyelitis or clinically isolated syndrome progress to become chronic disorders, including multiple sclerosis and neuromyelitis optica. This review summarizes the current knowledge on monophasic and chronic demyelinating disorders in children, focusing on an approach to diagnosis and management.
Diabetic polyneuropathy
Diabetic polyneuropathy (DPN) is defined as peripheral nerve dysfunction. There are three main alterations involved in the pathologic changes of DPN: inflammation, oxidative stress, and mitochondrial dysfunction.
Excessive daytime sleepiness
The most common causes of excessive daytime sleepiness are sleep deprivation, obstructive sleep apnea, and sedating medications. Other potential causes of excessive daytime sleepiness include certain medical and psychiatric conditions and sleep disorders, such as narcolepsy.
Vagal Nerve stimulation
Vagus nerve stimulation (VNS) is a medical treatment that involves delivering electrical impulses to the vagus nerve. It is used as an add-on treatment for certain types of intractable epilepsy and treatment-resistant depression. Frequent side effects include coughing and shortness of breath. Serious side effects may include trouble talking and cardiac arrest.
Dystonia
Dystonia is a movement disorder in which your muscles contract involuntarily, causing repetitive or twisting movements.
The condition can affect one part of your body (focal dystonia), two or more adjacent parts (segmental dystonia) or all parts of your body (general dystonia). The muscle spasms can range from mild to severe. They may be painful, and they can interfere with your performance of day-to-day tasks.
Dystonia: Causes, Types, Symptoms, and Treatments
Trigeminal neuralgia is sudden, severe facial pain. It's often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums.
Trigeminal neuralgia
Contents
Overview
Symptoms
Causes
Diagnosis
Treatment
Nootropics and smart drugs are natural or synthetic substances that can be taken to improve mental performance in healthy people.
They have gained popularity in today’s highly competitive society and are most often used to boost memory, focus, creativity, intelligence and motivation.
Here’s a look at the ]best nootropics and how they enhance performance.
Nystagmus is a condition of involuntary (or voluntary, in some cases)eye movement, acquired in infancy or later in life, that in extremely rare cases may result in reduced or limited vision. Due to the involuntary movement of the eye, it has been called "dancing eyes"Contents
1 Causes
1.1 Early-onset nystagmus
1.2 Acquired nystagmus
1.3 Other causes
2 Diagnosis
2.1 Pathologic nystagmus
2.2 Physiological nystagmus
3 Treatment
4 Epidemiology
Basics of Neuroradiology
Neuroradiology is an essential tool in management of patients with neurological and neurosurgical disorders. The aim of this presentation will be to acquaint the reader to understand how images are formed on a computed tomography (CT) and magnetic resonance imaging (MRI) along with a review of the relevant neuroanatomy. This understanding will be helpful to the reader in interpretation of images and diagnosis of various neurological disorders.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
4. •Neurological examination in pediatrics varies
according to age e.g. : the approach to neonates
will vary from that of children.
•Observation is key to diagnosis since physical
signs are usually less obvious than in adults.
•Talk to the parents.
5. •A child older than 3 to 5 years might provide
information that not only is valuable, but also may be
more reliable than that related by his or her parents.
•Do not ask leading questions.
•The physician also must be responsive to the
youngster's mood and cease taking a history as soon as
fatigue or restlessness becomes evident.
•In a younger child or one with a limited attention span,
the salient points of the history are best secured at the
onset of the evaluation.
6. •Allow older children play as you observe.
•This may require that you have some toys.
•Communicate with the children.
7. •A review of the perinatal events is always in
order.
•Feeding history.
•A history of abnormal sleeping habits.
•Major childhood illnesses
•Immunizations
•Injuries
•The family history
8.
9.
10. •The toddler is more difficult to examine. The toddler is
best approached by seating the child in the mother's or
father's lap and talking to the child.
•Because toddlers are fearful of strangers, the physician
must first observe the youngster and defer touching him
or her until some degree of rapport has been established.
11. •Offering a small, interesting toy may bridge the
gap.
•Once frightened, most toddlers are difficult to
reassure and are lost for the remainder of the
examination.
12. •The child's height, weight, blood pressure, and head
circumference must always be measured and recorded.
•The youngster should be undressed by the parents,
with the physician absent.
•The physician should note the general appearance of
the child.
• Note facial configuration,presence of any dysmorphic
feature & Cutaneous lesions.
13. •The condition of the teeth provides information
about antenatal defects or kernicterus.
•The location of the hair whorl and the
appearance of the palmar creases should always
be noted.
14. •The quality of the scalp hair, eyebrows, and nails
also should be taken into account.
•It is important to inspect the midline of the neck,
back, and pilonidal area for any defects,
particularly for small dimples that might indicate
the presence of a dermoid sinus tract.
15. •Examination of chest, heart, and abdomen and
palpation of the femoral pulses should always be
part of the general physical examination.
•Finally, the presence of an unusual body odor
may offer a clue to a metabolic disorder.
16. The neurologic examination of an infant younger
than 1 year of age can be divided into three
parts:
1. Evaluation of posture and tone
2. Evaluation of primitive reflexes
3. Age invariable tests.
17. The neurologic examination of an infant younger
than 1 year of age can be divided into three
parts:
1. Evaluation of posture and tone
2. Evaluation of primitive reflexes
3. Age invariable tests.
18. 1. Evaluation of posture and tone
Evaluation of posture and muscle tone is a
fundamental part of the neurologic
examination of infants. It involves
examination of:
A. Resting Posture
B. Passive Tone
C. Active Tone
19. 1.Evaluation of posture and tone:
A. Resting Posture:
Posture is appreciated by inspecting the undressed
During the first few months of life, normal
hypertonia of the flexors of the elbows, hips,
and knees occurs.
The hypertonia decreases markedly during the
third month of life, first in the upper
extremities and later in the lower extremities.
20. 1.Evaluation of posture and tone:
A. Resting Posture:
At the same time, tone in neck and trunk
increases.
Between 8 and 12 months of age, a further
decrease occurs in the flexor tone of the
extremities together with increased extensor
tone .
21.
22.
23. 1. Evaluation of posture and tone
B. Passive tone
Is accomplished by determining the resistance
to passive movements of the various joints
with the infant awake and not crying.
Because limb tone is influenced by tonic neck
reflexes, it is important to keep the child's head
straight during this part of the examination.
24.
25. 1. Evaluation of posture and tone
B. Passive tone
Passive flapping of the hands and the feet
provides a simple means of ascertaining
muscle tone.
In the upper extremity, the scarf sign is a
valuable maneuver.
In the lower extremity, the fall-away response
serves a similar purpose.
26.
27.
28.
29.
30.
31.
32.
33. 1. Evaluation of posture and tone:
C. Active tone:
The traction response is an excellent means of
ascertaining active tone
The examiner, who should be sitting down
and facing the child, places his or her thumbs
in the infant's palms and fingers around the
wrists and gently pulls the infant from the
supine position.
34. 1. Evaluation of posture and tone:
C. Active tone:
In the healthy infant younger than 3 months of
age, the palmar grasp reflex becomes operative,
the elbows tend to flex, and the flexor muscles
of the neck are stimulated to raise the head so
that even in the full-term neonate the extensor
and flexor tone are balanced and the head is
maintained briefly in the axis of the trunk.
35.
36.
37.
38. The neurologic examination of an infant younger
than 1 year of age can be divided into three
parts:
1. Evaluation of posture and tone
2. Evaluation of primitive reflexes
3. Age invariable tests.
39. The neurologic examination of an infant younger
than 1 year of age can be divided into three
parts:
1. Evaluation of posture and tone
2. Evaluation of primitive reflexes
3. Age invariable tests.
40. 2. Evaluation of primitive reflexes:
The evaluation of primitive reflexes is an
integral part of the neurologic examination of
the infant.
This disappearance should not be construed as
meaning that they are actually lost, for a reflex
once acquired in the course of development is
retained permanently.
41. 2. Evaluation of primitive reflexes:
Rather, these reflexes, which develop during
intrauterine life, are gradually suppressed as
the higher cortical centers become functional.
42. 2. Evaluation of primitive reflexes:
A. Segmental Medullary Reflexes: A number of segmental medullary reflexes
become functional during the last trimester of gestation. They include
(a) respiratory activity.
(b) cardiovascular reflexes.
(c) coughing reflex mediated by the vagus nerve.
(d) sneezing reflex evoked by afferent fibers of the trigeminal nerve.
(e)swallowing reflex mediated by the trigeminal and glossopharyngeal
nerves.
(f) sucking reflex.
43. 2. Evaluation of primitive reflexes:
B. Flexion Reflex:
This response is elicited by the unpleasant stimulation
of the skin of the lower extremity, most consistently the
dorsum of the foot, and consists of dorsiflexion of the
great toe and flexion of the ankle, knee, and hip.
44. 2. Evaluation of primitive reflexes:
B. Flexion Reflex
This reflex has been elicited in immature fetuses and
can persist as a fragment, the extensor plantar
response, for the first 2 years of life. It is seen also in
infants whose higher cortical centers have been
profoundly damaged.
45. 2. Evaluation of primitive reflexes:
C. Moro Reflex
The Moro reflex is best elicited by a sudden
dropping of the baby's head in relation to its
trunk. Moro, however, elicited this reflex by
hitting the infant's pillow with both hands.
46. 2. Evaluation of primitive reflexes:
C. Moro Reflex
The infant opens the hands, extends and abducts
the upper extremities, and then draws them
together. The reflex first appears between 28 and
32 weeks' gestation and is present in all newborns.
It fades out between 3 to 5 months of age.
47. 2. Evaluation of primitive reflexes:
C. Moro Reflex
Its persistence beyond 6 months of age or its
absence or diminution during the first few
weeks of life indicates neurologic dysfunction.
48.
49.
50. 2. Evaluation of primitive reflexes:
D. Tonic Neck Response
The tonic neck response is obtained by rotating
the infant's head to the side while maintaining
the chest in a flat position.
A positive response is extension of the arm and
leg on the side toward which the face is rotated
and flexion of the limbs on the opposite side .
51. 2. Evaluation of primitive reflexes:
D. Tonic Neck Response
Inconstant tonic neck responses can be elicited
for as long as 6 to 7 months of age and can even
be momentarily present during sleep in the
healthy 2- to 3-year-old child .
52.
53.
54.
55. 2. Evaluation of primitive reflexes:
E.Righting Reflex
With the infant in the supine position, the
examiner turns the head to one side. The healthy
infant rotates the shoulder in the same direction,
followed by the trunk, and finally the pelvis.
An obligate neck-righting reflex in which the
shoulders, trunk, and pelvis rotate
simultaneously and in which the infant can be
rolled over and over like a log is always
abnormal.
56.
57. 2. Evaluation of primitive reflexes:
F. Palmar and Plantar Grasp Reflexes
The palmar and plantar grasp reflexes are
elicited by pressure on the palm or sole.
Generally, the plantar grasp reflex is weaker
than the palmar reflex.
58. 2. Evaluation of primitive reflexes:
F. Palmar and Plantar Grasp Reflexes:
The palmar grasp reflex appears at 28 weeks'
gestation, is well established by 32 weeks, and
becomes weak and inconsistent between 2 and 3
months of age, when it is covered up by
voluntary activity.
59. 2. Evaluation of primitive reflexes:
F. Palmar and Plantar Grasp Reflexes:
Absence of the reflex before 2 or 3 months of
age, persistence beyond that age, or a consistent
asymmetry is abnormal.
The reappearance of the grasp reflex in frontal
lobe lesions reflects the unopposed parietal lobe
activity.
60.
61. 2. Evaluation of primitive reflexes:
G.Vertical Suspension
The examiner suspends the child with his or
her hand under its axillae and notes the
position of the lower extremities.
Marked extension or scissoring is an indication
of spasticity.
62.
63. 2. Evaluation of primitive reflexes:
H.Landau Reflex
To elicit the Landau response, the examiner lifts
the infant with one hand under the trunk, face
downward.
Normally, a reflex extension of the vertebral
column occurs, causing the newborn infant to lift
the head to slightly below the horizontal, which
results in a slightly convex upward curvature of
the spine. With hypotonia, the infant's body tends
to collapse into an inverted U shape.
64.
65. 2. Evaluation of primitive reflexes:
H.Landau Reflex
With hypotonia, the infant's body tends to
collapse into an inverted U shape.
66.
67. 2. Evaluation of primitive reflexes:
I.Buttress Response
To elicit the buttress response, the examiner
places the infant in the sitting position and
displaces the center of gravity with a gentle
push on one shoulder.
68. 2. Evaluation of primitive reflexes:
I.Buttress Response
The infant extends the contralateral arm and
spreads the fingers.
The reflex normally appears at approximately 5
months of age. Delay in its appearance and
asymmetries are significant.
69. 2. Evaluation of primitive reflexes:
J.Parachute Response
The parachute reflex is tested with the child
suspended horizontally about the waist, face
down.
The infant is then suddenly projected toward
the floor, with a consequent extension of the
arms and spreading of the fingers.
70. 2. Evaluation of primitive reflexes:
J.Parachute Response:
Between 4 and 9 months of age, this reflex
depends on visual and vestibular sensory input
and is proportional to the size of the optic
stimulus pattern on the floor.
71.
72. 2. Evaluation of primitive reflexes:
K.Reflex Placing and Stepping Responses
Reflex placing is elicited by stimulating the
dorsum of the foot against the edge of the
examining table.
Reflex stepping, which is at least partly a
function of the flexion response, is present in
the healthy newborn when the infant is
supported in the standing position; it
disappears in the fourth or fifth month of life.
77. The neurologic examination of an infant younger
than 1 year of age can be divided into three
parts:
1. Evaluation of posture and tone
2. Evaluation of primitive reflexes
3. Age invariable tests.
78. The neurologic examination of an infant younger
than 1 year of age can be divided into three
parts:
1. Evaluation of posture and tone
2. Evaluation of primitive reflexes
3. Age invariable tests.
79. 3.Age-Invariable Tests
The last part of the neurologic examination
involves tests similar to those performed in
older children or adults, such as the funduscopic
examination and the deep tendon reflexes.
80. •In addition to the standard instruments used in
neurologic examination, the following have
been found useful:
•a tennis ball
•few small toys
•a bell
•some object that attracts the child's attention
(e.g., a pinwheel).
81. •In most intellectually healthy school-aged
children, the general physical and neurologic
examinations can be performed in the same
manner as for adults
•Except that fundus examination, corneal and gag
reflexes and sensory testing, should be postponed
until the end.
82. Olfactory Nerve
Olfactory sensation as transmitted by the
olfactory nerve is not functional in the newborn,
but is present by 5 to 7 months of age.
84. Optic Nerve
•In infants, the optic disc is normally pale and gray,
an appearance similar to optic atrophy in later life.
•Premature and newborn infants have
incompletely developed uveal pigment, resulting
in a pale appearance of the fundus and a clear
view of the choroidal blood vessels.
85. Optic Nerve
•Retinal hemorrhages are seen in one-third of
vaginally delivered newborns.
•They are usually small and multiple, and their
presence does not necessarily indicate intracranial
bleeding.
86. Optic Nerve
Visual acuity can be tested in the older child by
standard means.
In the toddler, an approximation can be
obtained by observing him or her at play or by
offering objects of varying sizes.
87. Optic Nerve
Optokinetic nystagmus can be elicited by
rotating a striped drum or by drawing a strip of
cloth with black and white squares in front of
the child's eyes.
The presence of optokinetic nystagmus confirms
cortical vision; its absence, however, is
inconclusive.
88. Optic Nerve
The blink reflex, closure of the eyelids when an
object is suddenly moved toward the eyes, is
often used to determine the presence of
functional vision in small infants.
89. Optic Nerve
The macular light reflex is absent until
approximately 4 months of age.
It is present in approximately one-half of
healthy 5-month-old infants and should be
present in all infants by 1 year of age
90. Optic Nerve
The visual fields can be assessed in toddlers and
in infants younger than 12 months of age.
The baby is placed in the mother's lap and the
physician is seated in front of them, using a
small toy to attract the baby's attention.
Neurologic examination of the
infant
91. Optic Nerve
An assistant standing in back of the infant
brings another object into the field of vision, and
the point at which the infant's eyes or head turns
toward the object is noted.
Neurologic examination of the
infant
92. Oculomotor, Trochlear, and Abducens Nerves:
Extraocular Movements
The physician notes the position of the eyes at rest.
Noting the points of reflection of a flashlight assists
in detecting a nonparallel alignment of the eyes.
The size of the pupils, their reactivity to light, and
accommodation and convergence are noted.
93. Neurologic examination of
the infant
Oculomotor, Trochlear, and Abducens Nerves:
Extraocular Movements
A slight degree of anisocoria is not unusual,
particularly in infants and small children.
Fatigue-induced anisocoria also has been noted
to be transmitted as an autosomal dominant
trait
94. Neurologic examination of
the infant
Oculomotor, Trochlear, and Abducens Nerves:
Extraocular Movements
Following movements are complete in all
directions by approximately 4 months of age,
and acoustically elicited eye movements appear
at 5 months of age .
Depth perception using solely binocular cues
appears by 24 months of age along with stable
binocular alignment and optokinetic nystagmus.
95. Neurologic examination of the
infant
Trigeminal Nerve
The corneal reflex tests the intactness of the
ophthalmic branch of the trigeminal nerve.
A defect should be suspected when spontaneous
blinking on one side is slower and less complete.
The frequency of blinking increases with
maturation and decreases in toxic illnesses.
96. Facial Nerve
•Impaired motor function is indicated by facial
asymmetry.
•The McCarthy reflex, ipsilateral blinking
produced by tapping the supraorbital region, is
diminished or absent in lower motor neuron
facial weakness.
•
Neurologic examination of the
infant
97. Facial Nerve
•Palpebral reflex, bilateral blinking induced by
tapping the root of the nose, it can be
exaggerated by upper motor neuron lesions.
•In hemiparesis or peripheral facial nerve
weakness, the contraction of the platysma
muscle is less vigorous on the affected side, This
sign also carries Babinski's name.
Neurologic examination of the
infant
98. Facial Nerve
An isolated weakness of the depressor of the
corner of the mouth (depressor anguli oris) is
relatively common in children.
It results in a failure to pull the affected side of
the mouth backward and downward when
crying.
Neurologic examination of the
infant
101. Cochlear Nerve
•Hearing can be tested in the younger child by
observing the child's response to a bell.
•Small infants become alert to sound; the ability
to turn the eyes to the direction of the sound
becomes evident by 7 to 8 weeks of age, and
turning with eyes and head appears by
approximately 3 to 4 months of age.
Neurologic examination of the
infant
102. Cochlear Nerve
•Hearing is tested in older children by asking
them to repeat a whispered word or number.
•For more accurate evaluation of hearing,
audiometry or brainstem auditory-evoked
potentials are necessary.
Neurologic examination of the
infant
103. Vestibular Nerve
•Vestibular function can be assessed easily in
infants or small children by holding the youngster
vertically so he or she is facing the examiner, then
turning the child several times in a full circle.
•Clockwise and counterclockwise rotations are
performed. The direction and amplitude of the
quick and slow movements of the eye are noted.
Neurologic examination of the
infant
104. Vestibular Nerve
•The healthy infant demonstrates full deviation of
the eyes in the direction that he or she is being
rotated with the quick phase of the nystagmus
backward. When rotation ceases, these directions
are reversed.
Neurologic examination of the
infant
105. Glossopharyngeal and Vagus Nerves
•The gag reflex tests the afferent and efferent
portions of the vagus.
•This reflex is absent in approximately one-third
of healthy individuals.
•Testing taste over the posterior part of the
tongue is extremely difficult and, according to
some opinions, generally not worth the effort.
Neurologic examination of the
infant
106. Spinal Accessory Nerve
Testing the sternocleidomastoid muscle can be
done readily by having the child rotate his or
her head against resistance.
Neurologic examination of the
infant
107. Hypoglossal Nerve
•The position of the tongue at rest should be
noted with the mouth open.
•The tongue deviates toward the paretic side.
•Fasciculations are seen as small depressions
that appear and disappear quickly at irregular
intervals.
Neurologic examination of the
infant
108. Hypoglossal Nerve
•They are most readily distinguished on the
underside of the tongue.
•Their presence cannot be determined with any
reliability if the youngster is crying.
Neurologic examination of the
infant
109. Motor system examination:
•Similarly, the walking and running gaits can be
seen by playing with the youngster and asking
him or her to retrieve a ball and run outside of
the examining room.
•In the course of such an informal examination,
sufficient information can be obtained so that
the formal testing of muscle strength is only
confirmatory.
Neurologic examination of the
infant
110. In toddlers or infants, inequalities of tone have
been found to provide more information than
assessment of muscle strength or reflexes.
A sensitive test for weakness of the upper
extremities is the pronator sign, in which the
hand on the hypotonic side hyperpronates to
palm outward as the arms are raised over the
head. Additionally, the elbow may flex .
Neurologic examination of the
infant
111.
112. In the lower extremities, weakness of the flexors
of the knee can readily be demonstrated by
having the child lie prone and asking the child
to maintain his or her legs in flexion at right
angles at the knee.
An unsustained ankle clonus is common in the
healthy neonate.
Neurologic examination of the
infant
113. Coordination
Coordination can be tested by applying specific
tests for cerebellar function, such as having the
youngster reach for and manipulate toys.
The ability to perform rapidly alternating
movements can be assessed by having the child
repeatedly pat the examiner's hand, or by
having the child perform rapid pronation and
supination of the hands.
Neurologic examination of the
infant
114. Coordination
The heel-to-shin test is not an easy task for many
youngsters to comprehend, and performance
must be interpreted with regard to the child's
age and level of intelligence.
Neurologic examination of the
infant
115. A proper sensory examination is difficult at
any age, and almost impossible in an infant or
toddler.
In infants or toddlers, abnormalities in skin
temperature or in the amount of perspiration
indicate the level of sensory deficit.
Neurologic examination of the
infant
116. The ulnar surface of the examiner's hand has
been found to be the most sensitive, and by
moving the hand slowly up the child's body,
one can verify changes that one marks on the
skin and rechecks on repeat testing.
Object discrimination can be determined in the
healthy school-aged child by the use of coin, or
small, familiar items such as paperclips or
rubber bands.
Neurologic examination of the
infant
117. A positive response to Babinski sign is seen
normally in the majority of 1-year-old children
and in many up to 2 1/2 years of age.
In the sequential examination of infants
conducted by Gingold and her group, the
plantar response becomes consistently flexor
between 4 and 6 months of age
Neurologic examination of the
infant
118. Several beats of ankle clonus can be
demonstrated in some healthy newborns and in
some tense older children.
A sustained ankle clonus is abnormal at any age
and suggests a lesion of the pyramidal tract.
Neurologic examination of the
infant
119. Children with developmental disabilities, such
as minimal brain dysfunction and attention-
deficit disorders, are often found to have soft
signs on neurologic examination
Neurologic examination of the
infant
120. These represent persistence of findings
considered normal at a younger age. Of the
various tests designed to elicit soft signs:
1. Tandem walking: is performed successfully
by 90% of 5-year-old children; 90% of 7-year-
old children also can hop in one place.
Neurologic examination of the
infant
121. 1. Hopping on one foot.
2. Ability of the child to suppress overflow
movements when asked to repetitively touch
the index finger to the thumb.
Neurologic examination of the
infant
122. A positive response to Babinski sign is seen
normally in the majority of 1-year-old children
and in many up to 2 1/2 years of age .
In the sequential examination of infants
conducted by Gingold and her group, the
plantar response becomes consistently flexor
between 4 and 6 months of age
Neurologic examination of the
infant