CEREBRAL PALSY ASSESSMENT

Assessment of the child gives a baseline to appropriate treatment and

management aims and techniques. Re-assessment should be continuing part of
treatment, which allows for improvement or deterioration to be noted, thus
enabling treatment to be more effective.

Subjective Examination:

 Subjective information should be obtained from the parents especially

mother or from relatives and through case-sheet.
 General details includes
 Name-
 Age-
 Gender-
 Address-

 Telephone no-
 Informant-
 Religion-
 Mother tongue-
 Diagnosis-
 Type of cp-
 Mother’s name-
 Father’s name-
 Age of mother-
 Age of father-
 Mother’s education-
 Father’s education-
 Mother’s occupation-
 Father’s occupation-
 Primary care giver-
 Family income-
 Family history (family tree)-

 Prenatal or antenatal history:

 Age of mother-
 Consanguity marriage-
 Any drugs taken during pregnancy-
 Any trauma and stress-
 Any addiction-smoking or alcoholism-
 History of rubella, toxoplasmosis infection-
 History of previous abortions, or death after birth-
 Multiple pregnancies (duration between pregnancies)-
 Status and cast of the mother-
 Baby born after how many years of marriage-
 Perinatal or natal history:
 No. of foetuses-
 Place of delivery-1) home
2) primary care centre
3) hospital

 History preterm or full term delivery-

 History of asphyxia at birth-
 Type of delivery- 1) normal or vertex delivery-
2) forceps delivery-
3) breech delivery-
4) caesarean-
5) vacuum delivery-

 Delivered by-1) trained dai-

2) untrained dai-
3) nurse-
4) doctor-
 Labour hours-
 Was cord around the neck-
 Any excessive bleeding after delivery-
 Condition of mother at the time of delivery-
 Postnatal history:
 Delayed birth cry-
 Weight of the child at birth-
 History of trauma to brain during the first 2 years of life-
 History of neonatal meningitis, jaundice ,or hypoglycaemia-
 Hydrocephalus or Microcephaly-
 Nutritional habits of the child (malnutrition)-
 Feeding difficulties-
 Colour of the child-
 Apgar score from the case sheet-
 Any medical or surgical treatment taken-
 Any physiotherapy treatment previously taken-

 Chief complaints: 1) delayed mile stones-

2) seizures-
3) walking difficulties-

 Parents observation-

 Objective Examinations:

 On observation:
 Behaviour of the child-

* whether child is alert, irritable or fearful in the session or during

particular activities-

*child becomes fatigued easily or not during activity-

 Communication of the child-

*how child communicates with the parents-

*whether child imitates or responds with sounds, hand or finger

pointing, eye pointing or use words and speech-

 Attention span-
 *for how much time child’s attention is maintained on particular thing-

 Position of the child-

*which position does the child prefer to be in?

*can child get into that position on his own or with help?

*if involuntary movements present, then in which positions these

movements are decreased or increased-

 Postural control and alignment-

*supine position-

*prone position-

*standing position-

-how much parental support is given-

-proper and equal weight bearing-

 Use of limbs and hands-

*limb pattern-

*attitude of limbs during playing-

 *whether one or both hands are used, type of grasp and release-

*any involuntary movements, tremors or spasms, which interfere

with actions, are present-

 Sensory aspects- ( Distal senses)

*observe child’s all things in relevant tasks.

- use of vision-

-hearing-

- of touch-

- smell-

- temperature-

 Form of locomotion-

*how child is carried-

*any use of wheelchair or walking aids-

 Deformities-

*observe any recurring position of the whole child-

 Type of grasp-
 Skin changes-
 Gait-
 Play with toys-
 On Examination:
 Sensory assessment-

*core senses-

*Tactile vestibular-

*Proprioceptive senses-

 Motor assessment-
 Growth parameters-
 Height of the child-

Height Centimetres or Inches

At birth 50 or 20

At 1 year 75 or 30

2 to 12 years (age in years x6) +77 or

(age in years x 2) +30

 Weight of the child-

Weight Kilograms
 At birth 3.25

3 to 12 months (age in months + 9) /2

1 to 6 years (age in years x 2) +8

7 to 12 years {(age in years x 7) + 5} / 2

 Developmental milestone assessment-

Age Developmental Milestones Present Absent

4 to 6 weeks Social smile

3 months Head holding

6 months Sits with support

7 months Sits without support

5 to 6 months Reaches out for a bright object &gets

it

6 to 7 months Transfers object from one hand to

other

6 to 7 months Starts imitating cough

8 to 10 months Crawls

10 to 11 Creeps
months

9 months Standing holding furniture

12 months Walks holding furniture

10 to 11 Stands without support

months

13 months Walks without much of a support

 12 months Says one word with meaning

13 months Says three words with meaning

15 to 18 Joints 2 or 3 words into sentence

months

13 months Feeds self with spoon

15 to 18 Climbs stair
months

15 to 18 Takes shoes and socks off

months

24 months Puts shoes and socks on

24 months Takes some clothes off

3 to 4 years Dresses self fully

2 years Plays with other children

3 years Group play

3 years Knows full name and sex

3 years Rides tricycle

 Head circumference of the child-

Head circumference Centimeters

At birth 35

3 months 40

1 year 45

2 years 48
 12 years 52

 Joint range of motion-

ROM Deformity Contracture

Joint Active Passive Present/absent Present/absent

Rt Lt Rt Lt

Shoulder

Elbow

Wrist

M P Joint

I P Joint

Trunk

Hip

Knee

Ankle

Foot

 Limb length discrepancy-

Limb length discrepancy Rt (cm) Lt (cm)

Apparent (umbilicus to
lateral malleolus)
 True (ASIS to medial
malleolus)

 Reflexes-
*Superficial reflexes- Normal , Abnormal
1) Corneal-
2) Abdominal-
3) Plantar (Babinski )-check after 1 year-
*Deep tendon reflexes-

Jerks Grades

Rt Lt

Biceps

Brachiordialis

Triceps

Knee

Ankle

 Motor functions-

Body parts Tone Vol. control shortening wasting

Spasticity pre/ab pre / ab

Arm

Forearm

Hand

Fingers
 Thigh

Leg

Foot

Toes

 Primitive reflexes-

Reflexes Positive sign Negative sign

Moro reflex (0 – 3 months)

Palmer Grasp reflex (3 months)

Plantar Grasp reflex (10 months)

Sucking reflex ( 3 months)

Rooting reflex (3 months)

spinal level reflexes

Flexor withdrawal reflex ( 0-2 months)

Crossed extension( 0- 2 months )

Extensor thrust(0- 4 months )

Brainstem level reflexex

ATNR( 0- 3 months )

STNR( 0- 3 months )

TLR( 0- 3 months )

Midbrain level reflexes

Neck righting( 0- 6 months )

Body righting(6 months – 4 years )

 Labyrinthine righting (3 months – 1 year)

Optical righting( 3 months – 1 year )

Cortical level

Cortical (all position)

 Clonus-
*Ankle clonus-
*patellar clonus-
*wrist clonus-
 Active movement-

*Mirror movements-

*Associated abnormal postures-

*Co-ordination-

 Associated symptoms: yes or no

*Hearing-

*Vision-

*Speech-

*Drooling of saliva-

*Mental retardation-

*Skeletal system-

 Seizures:
 *Partial-

*Generalised-

*Absence-

 Early hand preference:

 Higher functions: good, fair, poor

*interaction with examiner-

*interest in surroundings-

*over all activities-

*exact IQ-

 Speech-

*appropriate for age-

*Delayed-

 Hearing-

*normal-

*abnormal-

 Vision-

*fixation-

*squint-

*abnormalities in fundi-

*involuntary eye movements-

 Cranial nerve abnormalities-if present, describe.

 Involuntary movements:

*chorea-

*athetosis-

*dystonia-

*choreaatheosis-

*mixed-

 Gait: possible or not possible

*tandem walk-
*toe walk-
*heel walk-

 Rise from squatting-

*independent-

*with assistance-

*absent-

 Gait patterun-

*non ambulant-

*spastic-

*ataxic-

*dystonic-

*mixed-
 *normal-

 Modified gait abnormal rating scale: (GARS)

1- Variability- stepping with arm movement—

2- Guardedness-difficulty in initiating—
3- Staggering -imbalance, esp. While turning—
4- Foot contact –heel strike, flat foot, on toes—
5- Hip ROM-at least 15 degree flex.—
6- Shoulder extension- 10-15 degree from neutral—
7- Arm heel strike synchrony--

Total score = 21

Mention --

 Functional ability and limitation in motor function in child:

1- Walk without restrictions—

2- Walks without assistive devices—
3- walk with assistive devices—
4- Transported carried around ( use any external aid )—
5- Severely limited dependent on wheel chair—
Mention—

 Transfer activities-

 Balance – good , poor

*sitting balance-
*standing balance-

 Assessment of daily activities- good, fair, poor

*feeding-

*dressing-

*washing-

*toileting-

*playing-

*hand function-

 Cerebellar system- yes or no or can not be tested

*Finger Nose Incordination-

*Heel Knee Incordination-

 Bowel-

*regular-

*intermittent incontinence-
 *continuous incontinence-

*constipation-

 Bladder-

*intermittent dribbling-

*continuous dribbling-

 Investigations- if any describe:

*X-rays-

*CT scan-

*MRI-

*NCV-

*EMG-

*Others- blood-

CSF-

 Diagnosis-

 Prognosis-

 Treatment plan / Management-

 1) Medical treatment-

*Medication-

 2) Surgical treatment-

*Surgery-

 3) Physiotherapy treatment-

 Problem list:

 Aims-
 Goals-
 Short term goals-
 Long term goals-
 Follow up-

 Any new problems- Describe