Physical Therapy Assessment in Pediatrics

Physical Therapy Assessment in Pediatrics: 

Physical Therapy Assessment in Pediatrics Prepared by physiotherapist: suad Radwan AL NASSR Pediatric Hospital

General Impression: 

General Impression Sick Not Sick vs

Assessment: 

Assessment Present state Desired state why?

Purpose of Assessment To:: 

Purpose of Assessment To: Identify and treat life-threatening or traumatic problems. Guide the therapist to the proper way. Determine the priority of care. Obtain signs on which to reassess the effectiveness of treatment.

Medical assessment differ about physical therapy assessment: 

Medical assessment differ about physical therapy assessment pulse Auscultation of the heart Weight, Length Organomegally Dysmorphic features Laboratory Karyo type {Immunity , Metabolic screen}

Assessment parts : 

Assessment parts The 2 major components of examination are: Subjective Assessment Objective Assessment

1. Subjective information: 

1. Subjective information Symptoms [location, types & behavior, severity, time]. Previous history of the condition.( prolonged labor, premature, Seizures ) . Related history as medication, radiological studies, surgical intervention, environment.

2. Objective information: 

2. Objective information Inspection Palpation Percussion

Inspection: 

Inspection General Observation patient's state on entering ; Conscious, irritable, posture, gait. Symmetrical or not.

Observe: 

O bserve Congenital anomalies 3-5% of infants Syndromes

Observe: 

O bserve Respiration Type

PowerPoint Presentation: 

Inspection General comfort and breathing pattern of the patient. Do they appear : * distressed, * diaphoretic, * labored? * Are the breaths regular and deep? Tachypnea / shallow

Respiratory Rate: Neonate 40 – 60 Infant 40 – 50 Toddler 30 – 40 Child 20 – 30 : 

Respiratory Rate: Neonate 40 – 60 Infant 40 – 50 Toddler 30 – 40 Child 20 – 30

Inspection : 

Inspection Using of accessory muscles of breathing (sternomastoids), nasal flaring, this signifies respiratory difficulty. Color of the patient,. Obviously, blue is bad! Cyanosis [ Heart OR Lung disease? ] Monitor oxygen ; keep O2 sat >75%

PowerPoint Presentation: 

Observe color Color of skin

PowerPoint Presentation: 

Nail clubbing = when view fingernail from side, angle of base of nail is >160°.

PowerPoint Presentation: 

Clubbing C yanotic heart diseases. L ung ds: hypoxia, bronchiectasis, CF. • U Colitis, Crohn‘s disease. • B iliary cirrhosis. B irth defect . • I nfective Endocarditis . • N eoplasm [esp. Hodgkin] G I mal-absorption .

Chest Wall: 

Pigeon chest{ Pectus Carinatum}. Funnel chest. Scoliosis & Kyphosis. Barrel chest. Pectus Excavatum Chest Wall

Look at the chest wall movements: : 

Look at the chest wall movements: Are they symmetrical, i.e. the same on both sides, or * Is there a difference ? * Is there any lag or impairment of respiratory movement ?

Inspection: 

Inspection Subcostal or intercostal retractions are common signs of pulmonary pathology.

hear: 

hear Any audible noises associated with breathing as wheezing, stridor(upper airway obstruction).

PowerPoint Presentation: 

Inspection

PowerPoint Presentation: 

Scaphoid abdomen; diaphragmatic hernia

Percussion: : 

Percussion: * The fact that striking a surface which covers an air-filled structure (e.g. normal lung) will produce a resonant note, while repeating the same maneuver over a fluid generates a relatively dull sound.

*If the lung has been displaced by fluid (pleural effusion) or infiltrated with white cells and bacteria (e.g. pneumonia), percussion will generate a dull sound. : 

* If the lung has been displaced by fluid ( pleural effusion ) or infiltrated with white cells and bacteria (e.g. pneumonia ), percussion will generate a dull sound.

Hyper-resonant ??: 

Hyper-resonant ?? pneumo-thorax emphysema

Anterior Fontanel: 

Anterior Fontanel Normal Large Bulging Sunken Closed

PALPATION: 

PALPATION Skin & subcutaneous tissue Temperature, edema, scars. Muscle Tone {type & degree}. Joint mobility, effusion, tenderness.

Palpation: 

Palpation Tactile of crepitation indicate chest secretions. Tenderness of chest indicates abscess, rib fracture.

CNS Assessment Inspect: 

CNS Assessment Inspect Consciousness, orientation. Head size. Dysmorphism (face – eyes, (pupils, irises) ears, neck). Eyes nystagmus. Strange movements as Clonus.

CNS: 

CNS Skin-Abdominal mass Severe positional deformation and contractures indicate arthrogryposis.

CNS Examination: 

CNS Examination 1. Neurological examination Absence of expected movements. Presence of abnormal activity (convulsions) Sensation 2. Developmental assessment Absence of expected functions. Motor milestones. Presence of abnormal activity (primitive reflexes)

CNS: 

CNS Reflexes within the developmental stage. Labyrinthine head righting

Primitive reflexes: 

Primitive reflexes Reflex Normally disappeared by Stepping 6 weeks Placing 6 weeks Moro 3 -4mths Rooting / sucking 4months awake, 7mths asleep Palmar grasp 6 months Tonic neck reflex (appears at 2mth) 6 months Plantar grasp 10 months When primitive reflexes persist longer than they should, the baby may have a Neuro-developmental problem.

Developmental assessment: 

Developmental assessment Functional neurology’; what can the baby DO? History – questions (can your baby do …?) Examination – observation – can the baby can do specific things ? HOW? Systematic process Assess key milestones in all 4 areas of development (GM, FM, Language, Social) Know what is normal

Musculoskeletal system: 

Musculoskeletal system Shape of joint. Color, temperature. Any Asymmetrically. ROM. Muscle power. proprioception. Reflexes; knee jerk.

Check of medical records: 

Check of medical records DIC Tumor Thrombocytopenia.

Check radiological studies: 

Check radiological studies X Ray CT SCAN MRI ULTRA SOUND

References: 

References Nelson textbook of paediatric (2008). Tidy,s physiotherapy (13 edition). http://newborns.stanford.edu/PhotoGallery/StepReflex1.html

Thank you : 

Thank you