FIM LEVELS (O’SULLIVAN)

NO HELPER
7 – COMPLETE INDEPENDENCE (TIMELY, SAFELY)
6 – MODIFIED INDEPENDENCE (DEVICE)
HELPER – MODIFIED DEPENDENCE
5 – SUPERVISION (SUBJECT = 100%)
4 – MINIMAL ASSISTANCE (SUBJECT – 75% OR MORE)
3 – MODERATE ASSISTANCE (SUBJECT – 50% OR MORE)
HELPER – COMPLETE DEPENDENCE
2 – MAXIMAL ASSISTANCE (SUBJECT – 25% OR MORE)
1 – TOTAL ASSISTANCE OR NOT TESTABLE (SUBJECT LESS THAN 25%)

REFERENCE: GLABELLA
HEAD CIRCUMFERENCE OCCIPITAL PROTUBERANCE
1–4 = 0.5 in./MONTH = 2 in
5 – 12 mos = 0.25/MONTH = 2 in
ND
2 YEAR OF LIFE = 1in/YR = 1 in
3 – 5 y.o. = 0.5 in/YR = 1.5 in
6 – 20 y.o. = 0.5 / 5 YEARS = 1.5 in
0.1 / YR

HEAD CIRCUMFERENCE NEWBORN: 35 cm

0- 4 mos. – 0.5 inch / MONTH 2”
5-12 mos. – 0.25 in./ MONTH 2”
1-2 y.o. – 1 in./YEAR 1”
3-5 y.o. – 0.5 in/YEAR 1.5”
6-20 y.o. – 0.5 /5 YEARS 1.5”
0.1 / YEAR

3 YEARS & 6 mos. – 2+2+1+0.5 + ( x 0.5) 6 YRS.

5.5 + 0.25 = 5.75 in 2 + 2 + 1 + 1.5 + 0.1 = 6.6
6.6 x 2.54 cm = 16.76 cm
5.75 in x 2.54 =14.605 cm 16.76 cm + 35 cm = 51.76 cm
NORMAL 35 cm + 14.605 in =49.605 cm 57.664 cm
46.605 cm 3
3 52.605 cm
51.664 cm

17 yrs. 5 mos.
2 + 2 + 1 + 1.5 + 1.2 + ( x 0.1 )
7.74166 in. x 2.54 = 19.66383 cm
35 cm + 19.66383 = 54.664
57.664
3 51.664
HEAD CIRCUMFERENCE

DATE OF IE: SEPT. 6, 2012 DATE OF IE: NOV. 17, 2012

DATE OF BIRTH: MARCH 10, 2007 DATE OF BIRTH: JULY 29, 2001
5 YEARS, 6 mos. 11 YRS, 4 mos.
2 + 2 + 1 + 1.5 + ( x 0.1) 2 + 2 + 1 + 1.5 + 0.6 + ( x 0.1)
6.5 + 0.05 = 6.55 in. 7.1 + 0.03333333 = 7.133in
6.55 in x 2.54 cm = 16.657 cm 7.133in x 2.54 cm = 18.1186cm
35 cm + 16.657 = 51.66 cm 18.1186 + 35 cm = 53.12 cm
3 54.66 cm 56.12 cm
48.66 cm 3 50.12 cm

3 YEARS, 8 mos. 9 mos.

2 + 1.25 = 3.25
2 + 2 + 1 + 0.5 + ( x 0.5)
3.25 x 2.54 = 8.26 cm
5.5 + 0.3333333 = 5.833in 8.26 cm + 35 cm = 43.26 cm
5.833” x 2.54 cm = 14.81666cm 46.26 cm
35cm + 14.81666cm = 3 40.26 cm
PEDIA
INITIAL EVALUATION
(DATE)

NAME: AGE: FILE #:

ADDRESS: SEX: BIRTHDATE:
DATE OF IE: ETIOLOGY:
Dx: PT IMP:
REFERRING MD: CONTACT NUMBER:
INFORMANT/RELIABILITY: PRECAUTIONS:

HPI:
MATERNAL Hx:
-MOTHER IS HYPERTENSIVE.. etc.
-AGE OF PREGNANCY
-UNPLANNED/WANTED
-LABOR HOURS
-NON SMOKER
-ALCOHOL DRINKER
-G4P4
-IPAL

BIRTH Hx:
-PREMATURE (30 WEEKS…)
-NSVD (CEPHALIC)
-BIRTH WEIGHT
-APGAR SCORE (IF RECALLED)

NUTRITIONAL Hx:
-BREASTFED (FOR HOW MANY MONTHS)
-BOTTLEFEEDING (EX: 2 mos. – PRESENT)
-SOLID FOOD (EX: 1 YEAR – PRESENT)

IMMUNIZATION Hx:
VACCINE DATE:
1.) BCG -
2.) HEPATITIS A & B -
3.) MMR -
4.) DPT -
5.) OPV -

DEVELOPMENTAL MILESTONES:
ACTIVITY NORMAL FINDINGS
HOLD HEAD 4 mos.
ROLLS OVER (PRONE TO SUPINE) 5-6 mos.
ROLLS OVER (SUPINE TO PRONE) 7 mos. YEAR / MONTH
TRANSFERS OBJECTS 6 mos. ACHIEVED…NOT
ACHIEVED
SITS ALONE 6-7 mos.
STANDS ALONE 10-11 mos.
 WALKS ALONE 15 mos.
WALKS UP THE STAIRS WITH 3 y.o.
ALTERNATING FEET s
SUPPORT
WALKS DOWN THE STAIRS 4 y.o.
WITH ALTERNATING FEET s
SUPPORT

*CHRONOLOGICAL AGE: 2 YRS. & 9 mos.

DEVELOPMENTAL AGE: 7 mos.
AGE OF DELAY: 2 YRS. & 2 mos.

PAST MEDICAL Hx:

- (+) HIGH FEVER: 400C (2010)
- (-) ALLERGIES
- (-) SURGERIES
- (-) SEIZURES
- MEDICATIONS:
DOSAGE INDICATION
TH42X, 75m, 0D VIT. SUPPLEMENT

PHYSICAL EXAMINATION
A. SUBJECTIVE INFO:
C/C: “HINDI PA SIYA MAKAUPONG MAG ISA AT PARANG MAY GALAW SIYANG
KAKAIBA.”
PT TRANSALATION: MOTHER C/O CHILD’S INABILITY TO SIT AND HAS AN ABNORMAL
MOVMENTS.
INFORMANT/RELIABILITY: MOTHER/ GOOD
B. OBJECTIVE INFO:
OI:
- AMBULATORY
- ALERT, COOPERTIVE, COHERENT
- COMMUNICATION (Px SMILES WHENEVER SHE PLAY WITH HER MOTHER AND
THERAPIST).
- NORMOCEPHALIC @ cm
- (+) EYE CONTACT
- (+) DROOLING
- (+) SLOW WRITHING INVOLUNTARY MOVEMENTS OF B UE
- (+) POSTURAL DEVIATION
- (-) PHYSICAL DEFORMITIES
- (-) SYNERGY ON B UE/LE
C. PALPATION:
- NORMOTHERMIC ON ALL EXPOSED BODY PARTS
- FLUCTUATING mm TONE (SEE TONE Ax)
- (-) DISLOCATION OF B UE/LE
- (-) TENDERNESS ON ALL EXPOSED BODY PARTS
- (-) CONTRACTURES / TIGHTNESS OF B UE/LE
NEUROLOGIC EXAMINATION:
A. SENSORY TESTING
1.) TACTILE TESTING
 a.) PAIN
- STD USED: PIN
- RESPONSE: Px WITHDRAWS B LE
b.) LIGHT TOUCH
- STD USED: COTTON
- RESPONSE: Px WITHDRAWS B UE/LE
c.) DEEP PRESSURE
- STD USED: THUMB
- RESPONSE: Px WITHDRAWS B LE ET. B UE
- POSSIBLE AFFECTION OF BA 3,1,2
2.) AUDITORY TESTING
a.) LOCALIZATION OF SOUND
- ATD USED: PT CAN CALL THE Px’s NAME
- RESPONSE: Px LOOKS TOWARD TH DIRECTION OF THE SOURCE OF
SOUND
- SIGNIFICANCE: INTACT BA 41 & 42
3.) VISUAL TESTING
a.) VISUAL TRACKING
- UTD USED: TIP OF A PEN
- RESPONSE: Px FOLLOWS TOY TOWEARDS THE LEFT, R BUT CAN’T
FOLLOW UPWARD
AND DOWNWARD GAZE
- SIGNIFICANCE: POSSIBLE AFFECTATION OF BA 17, 18, 19

B. REFLEXES
a.)

b.) PATHOLOGIC REFLEXES:

- CLONIS
- BABINSKI
c.) PRIMITIVE REFLEXES
- ATNR
- STNR
- MORO
- NECK RIGHTING
- EXTENSOR THRUST
- FOOT PLACEMENT
- PARACHUTE
TONE ASSESSMENT:
FINDINGS: GRADING:
0 – NO RESPONSE (FACUD)
1 – DECREASED RESPONSE (HYPOTONIA)
2 – NORMAL RESPONSE (NORMOTONIA)
3 – EXAGGERATED RESPONSE (MILD Yo MODERATE HYPERTONIA)
4 – SUSTAINED RESPONSE (SEVERE HYPERTONIA)
NOTE: IF THE PATIENT HAS A GRADE OF 3 OR 4, THAT IS THE TIME YOU PALPATE FOR
SPASTICITY.

SPASTICITY ASSESSMANT:
FIDINGS: MODIFIED ASHWORTH SCALE FOR SPASTICITY:
0 – NO IN mm TONE
1 – SLIGHT IN mm TONE MANIFESTED BY A CATCH AND RELEASE OR
BYMINIMAL RESISTANCE AT THE END OF THE ROM WHEN
THE AFFECTED PART IS MOVED IN /1/.
1 + - SLIGHT IN mm TONE MANIFESTED BY A CATCH FOLLOWED BY
MINIMALRESIST. THROUGHOUT THE REMINDER (LESS THAN
HALF) OF THE ROM.
2 – MORE MARKED INCREASE IN mm TONE THROUGH MOST OF THE
ROM BUT THE AFFECTED PART/S IS/ARE EASILY MOVED.

SPASTIC CP – MALE > FEMALE

- 80 % OF ALL CP CASES
- PYRAMIDAL LESIONS
- A.K.A LITTLE’S DISEASE, INFANTILE CPARALYSIS

CP-NON-PROGRESSIVE LESION TO THE IMMATURE BRAIN W/C IS CHARACTERIZED BY

ABNORMALITIES IN MOVEMENT AND POSTURE.

PREGNANCY – 75% CHARACTERIZATION:

CHILD BIRTH – 5% - SPASTICITY
BIRTH – 15% - HYPERREFLEXIA
- CLONVS
- (+) BABINSKI REFLEX

PERIVENTRICULAR LEUKOMALACIA – STRONGEST PREDICTOR OF CP IN NEONATE

BRAIN.
CEREBRUM FUNCTIONS - PERSONALITY, LANGUAGE, INTERPRETS IMPULSES, MOTOR
D FUNCTION, PLANNING et. ORGANIZING.
I
E THALAMUS – REGULATORY PATHWAY FOR PAIN AND TEMP.
N SUBTHALAMUS – REGULATORY PATHWAY FOR MOTOR, SENSORY, RETICULAR
C Fx.
E HYPOTHALAMUS – BODY TEMP., EMOTIONS, SLEEP-WAKE PATTERNS, BODY’S
P HOMEOSTASIS
H EPITHALAMUS – PINEAL GLAND: SECRETES HORMONES
A – CIRCADIAN RHYTHM CEREBRAL HEMISPHERE
L
ME
O PROCENCEPHALON TELENCEPHALON
N
CORTEX
MESENCEPHALON:
MIDBRAIN ( TEGMENTUM : ASCENDING et. DESCENDING TRACTS)
SUPERIOR PEDUNCLE – CONNECTS MIDBRAIN AND CEREBELLUM
SUBSTANTIA NIGRA – PART OF MIDBRAIN THAT CONTROLS mm TONE.
SUPERIOR COLLICULUS – EYES
INFERIOR COLLICULUS – AUDITORY (MOV’T OF HEAD, TRUNK, LE)
PONS – CONNECTS AMYGDALA TO MIDBRAIN
– CN: 5,6,7,8
ARCHICEREBELLUM – VESTIBULOUCULAR REFLEX
– EQUILIBRIUM
– REGULATION OF mm TONE
PALEOCEREBELLUM – TRUNK CONTROL
– POSTURE
– MOVEMENT
NEOCEREBELLUM – SMOOTH COORDINATION OF VOLUNTARY MOVEMENT

BA 6 – SPASTIC
BA 4 – FLACCID
BG – RIGID

MOTOR CORTEX : BA 4,6

BA 4: MOV’T OF SINGLE JT.
BA 6: MOV’T OF MULTIPLE JTS.
HOMONCULLUS – SUPERIOR – LIMBS
– INTERIOR – FACE
PYRAMIDAL TRACTS – MAJOR PATHWAY OF CNS

ANT. CORTICOSPINAL TRATCS 2 CORTICOSPINAL TRACTS

LAT. CORTICOSPINAL TRACT (BA 3,1,2)

JUNCTION: CERVICOMEDULLARY JUNCTION, MO, SC

TERMINATION: GRAY COLUMN OF SC

ANT. CORTICOSPINAL TRACT – DOES NOT DECCUSATE

LAT. CORTICOSPINAL TRACT – DECCUSATE: LAT. WHITE COLUMN
– TERMINATE: GRAY COLUMN

ETIOLOGY:
1.) PRENATAL FACTORS (CONCEPTION – ONSET OF LABOR)
a.) HEREDITARY f.) MR (MOTHER)
b.) AQUIRED DURING GESTATION g.) MULTIPLE BIRTHS
c.) DM h.) KERNICTERUS
d.) SEIZURES (BILIRUBIN: ACTS ON THE LIVER BY
e.) MOTHER’S AGE CONVERTING BILE TO BILE
ACID)

2.) PERINATAL FACTORS (BIRTH – 4 WKS)

a.) MECH. CAUSE
b.) FETAL ASPHYXIA
 3.) POSTNATAL FACTORS ( 1 mo. – 6 YRS)
a.) TRAUMATIC ( 2 YRS.)
b.) INFECTION SPASTIC – mm TONE IS 3 OR ABOVE
c.) TOXICITY ATHETOID – mm TONE < 3
d.) VASCULAR ACCIDENT
e.) CEREBRAL ANOXIA
f.) BRAIN TUMORS
g.) SICKLE CELL ANEMIA
h.) CONGENITAL D DSS
DISTINGUISHING
FACTORS
TOPOGRAPHIC CLASSIFICATION: (MANIFESTATIONS)
1.) MONOPLEGIA – 1 EXTREMITY --------------------------------- SCISSORING GAIT
– RARE
2.) DIPLEGIA - (LITTLE’S)
– PERIVENTRICULAR LEUKOMALACIA
– BUNNY HOP
PVL – DELAYED WALKING (3 – 4 y.o.)
– N / NEAR N IQ
– STRABISMUS
– TIGHT ADDUCTORS
– TOE WALKING
3.) TRIPLEGIA – SPASTICITY ---------------------------------- PREFERRED SIDE
– MILD COORDINATION
– SCISSORING GAIT
4.) HEMIPLEGIA – CONGENITAL ---------------------------------- TYPICAL ARM POSTURE
R – DELAYED 4 – 6 mos. OF AGE
– GROWTH RETARDATION
– R APHASIA
FOCAL,
– AMBULATORY (3 YRS)
MULTIFOCAL
ISCHEMIC BRAIN – LIMB IMPAIRMENT
NECROSIS – ASTEREOGNOSIS
(MCA) – HOMONYMOUS HEMIANOPSIA
– MODERATE IQ
5.) QUADRIPLEGTA – SEIZURES ------------------------------------- STRAPHANGER SIGN/
– MR BIRD WING
PARASAGITTAL
CEREBRAL
– STRABISMUS
INJURY – STRAPHANGER/ BIRD WING
6.) DOUBLE HEMIPLEGIA – UE > LE

FROG LEG DEFORMITY – DORSIFLEXED

PITCHED FROG DEFORMITY – PLANTAR FLEXED
WIND SWEPT – FADDIR (DISLOCATABLE)
ANTERIOR FONTANELLE – 18 mos. (CLOSE)
POST. FONTANELLE – 9 mos. (CLOSE)
TRIAD OF KERNICTERUS: 1.) HEARING LOSS
2.) LOSS OF UPWARD GAZE
3.) ATHETOSIS
STATUS MARMORATUS – BS – CHOREOATHETOID CP
TRIAD OF MR:
1.) SLOW COGNITION
2.) DIFFICULTY ACQUIRING FUNCTIONAL SKILLS
3.) DMD

TRIAD OF AUTISM:
1.) IMPAIRED COMMUNICATION
2.) IMPAIRED SOCIAL INTERACTION
3.) IMPARED BEHAVIOR

PERIVENTRICULAR LEUKOMALACIA
- EXTEND PAST AREA OF DESCENDING TRACTS
- LE > UE

PERIVENTRICULAR HEMORRAGE:
I. SUBEPENDYMAL
II. SUBEPENDYMAL c LAT. VENTRICLE s VENTRICULAR ENLARGEMENT
III. SUBEPENDYMAL EXTERSION c VENTRICULAR ENLARGEMENT
IV. EXTENDS TO BRAIN PARENCHYMA

CP:
1.) ABNORMAL TONE
2.) ABNORMAL REFLEX
3.) ABNORMAL MOVEMENT
4.) ABNORMAL POSTURE
5.) DMD

CLASSIFICATION OF MR: 2 STEREOTYPE BEHAVIOR OF AUTISTIC:

10 – 19 - PROFOUND MR 1.) SELF - STIMULATING
20 – 34 - SEVERE 2.) SELF - INJURIOUS
35 – 49 - MODERATE
50 – 69 - MILD
70 - BORDERLINE
71 – 80 - BELOW AVERAGE
81 – 90 – AVERAGE
91 – 110 – ABOVE AVERAGE
111 – 130 – SUPERIOR
> 130 - GENIUS

HYPOTHALAMUS
A – AUTONOMIC
B – BEHAVIOR
C – CIRCADIAN RHYTHM
D – DAMDAMIN (EMOTION)
E – ENDOCRINE
F – FOOD INTAKE
G – GINAW! (COLD)
H – H2O INTAKE
I – INIT! (TEMP.)
 PROCENCEPHALON

DIENCEPHALON TELENCEPHALON
-S - CEREBRAL HEMISPHERE
-H - CORTEX
THALAMUS
-E
-T

MESENCEPHALON RHOMBENCEPHALON
CEREBELLUM

MIDBRAIN METENCHEPHALON MYELENCEPHALON

PONS MEDULLA OBLONGATA

TORCH – TOXOPLASMOSIS, RUBELLA, CYTOMEGALOVIRUS, HERPES SIMPLEX

CSF FLOW
“COME LET’S FORMALLY TAKE SYLVIA FOR LUNCH MAMAYA SA AMVER’S (AMBER’S)”
COROID PLEXUS LAT. VETRICLE FORAMEN OF MONRO
RD
3 VENTRICLE SYLVIVS AQUEDUCT 4TH VENTRICLE
LUSCHKA (FORAMEN) MAGENDIE (FORAMEN)
SUBARACHNOID SPACE ARACHNOID VILLI

GLUTARIC ACIDURIA – “GLUTARIC ACID IN THE URINE”

– a.k.a GLUTARIC ACIDEMIA – GLUTARIC ACID IN THE BLOOD

LYSINE – ESSENTIAL AMINO ACID, C6,H14,N2,02

– REQUIRED BY THE BODY FOR OPTIMUM GROWTH
HYDROXYLYSINE – AMINO ACID WITH MOL. FORMULA C6,H14,N2,03
TRYPTOPHAN – AMINO ACID IN THE HUMAN DIET
ENZYME ELECTRON TRANSFER FLAUD PROTEIN (ETF) – PROVIDES INSTRUCTIONS
FOR MAKING AN ENZYME CALLED ELECTRON TRANSFER FLAVOPROTEIN
DEHYDROGENASE (ETFDH).
ELECTRON TRANSFER FLAVOPROTEIN DEHYDROGENASE (ETFDH) – BREAK
DOWN OF FATS AND PROTEINS TO PROVIDE ENERGY.
GLUTARIC ACIDURIA I – DEFECIENCY OF GLUTARYL – COA DEHYDROGENASE
– LEAD TO BUILDING UP OF GLUTARIC ACID IN THE
TISSUES AND ITS EXCRETIONS IN THE URINE
– AUTOSOMAL RECESSIVE
– BASAL GANGLIA
– CHROMOSOME 19 p. 13.2
PATHOPHYSIO: DEFECIENCY OF GLUTARYL – COA DEHYDROGENASE
(-) METABOLIZATION OF LYSINE, HYDROXILYSINE, TRYPTOPHAN
LEVELS OF LYSINE, HYDROZYLYSINE AND TRYPTOPHAN
GA I
 GLUTARIC ACIDURIA II – DEFICIENCY OF ENZYMES INVLOVED IN PROCESSING
FATS AND PROTEINS TO PROVIDE ENERGY.
– ETFDH OR ETF OBIQUINONE OXIDOREDUCTASE
PATHOPHYSIO:
MUTATION OF ETFA, ETFB AND ETFDH GENES

/ (-) BREAKOWN OF PROTEINS AND FATS

INCREASE LEVEL OF NUTRIENTS IN CELLS AND

DAMAGE THEM

GA II
GA III – DEFECIENCY OF PEROXISOMAL GLUTARYL – COA OXIDASE CHROMOSOME 7
– AFFECTS THE MITOCHONDRIA
– PEROXISOMES

CLINICAL MANIFESTATIONS:
METABOLIC ACIDOSIS
KAVSMAL BREATHING PATTERN

NA CO CA VO LE

N C CA V L
A O AR O E
U M RR M T
S A DY I H
E I TH T A
A AM I R
CI N G
A G I
C

DIFF. Dx
TYPE 1:
- MACROCEPHALY - SUBDURAL AND RETINAL
HEMORRHAGE
- ACUTE ENCEPHALOPATHY - ISOLATED ELEV. OK GA
- BG INJURY - 3 – OH - GA
- WHITE MATTER DSE - C5DC IN BODY FLUIDS
- MOV’T DI0

REYT’S SYNDROME – BLEH! (BRAIN, LIVER, ENCEPHALOPATHY, HYPOGLYCMEIA)

– CAUSE: ASPIRIN CONSUMPTION + VIRAL INFECTION
– LIVER

SHAKEN BABY SYNDROME – SUBDURAL HEMATOMA

– RETINAL HEMORRHAGE
– CEREBRAL EDEMA
 PHARMACOLOGICAL Mx:
TYPE 1 TYPE 2
- CARNITINE SUPPLEMENT - CARNITINE
- RIBOFLAVIN - RIBOFLAVIN
- NEUROPROTECTIVE AGENTS - GLYCINE

OT – SPECIAL SITTING – LIMITS ABN MOVEMENT.

2 CLINICAL FINDING OF MACROCEPHALY

BEFORE ENCEPHALOPATHY CRISIS
– NEW BORN HAVING UNUSUAL LARGE HEAD
– PIVOTAL CLINICAL SIGN
AFTER ENCEPHALOPATHY CRISIS
– HAVE GA1
– SPASM, JERKY MOV’T, DECREASE mm TONE
- MORE ON NEUROMOTOR ASPECT

100 mg/dl L – CARNITINE kg/DAY

ATHETOID CP
- HAND SPOONING
DYSTONIA – SUSTAINED mm CONTRACTION ABN MOV’T/POSTURE
- ALL QUADRI AFFECTED c INVOLUNTARY MOV’T
- M:F = 1:1

5 MAJOR FINDINGS OF CP:

1.) ABN TONE – (HYPO, HYPER, FLUCTUATING)
2.) ABN REFLEX – (DTR, PRIMITIVE, PATHOLOGIC)
3.) ABN POSTURE – STRAPHANGER (QUADRI) SPASTIK
– SCISSORING (DIPLEGIA)
- TYPICAL ARM POSTURE (HEMIPLEGIA)
– ASSYMETRIC POSTURE (ATHETOID)
4.) ABN MOTOR PATTERN – BUNNY HOPPING, BOTTOM SHUFFLING MERMAID
CRAWL
5.) DMD
- ATHETOSIS – SLOW QRITHING MOVEMENT ASSOC. WITH CHOREA
– ATHETOID – s ; OSIS POSITION/ PLACE

HALLMARKS OF ATHETOSIS
– ONSET BET. 5 – 10 y.o.
– OFTEN MENTALLY NORMAL
– IMPEDES MOTOR FUNCTION (FINE > GROSS)
– IT DOES NOT PROGRESS
– DOES NOT CAUSE CONTRACTURES (TIGHTNESS POSSIBLE ON MIXED
TYPES)

MOTOR CHARACTERISTICS (LEVITT)

– (+) INVOLUNTARY MOVEMENT : EXCITEMENT, FEELING OF INSECURITY,
EFFORT
– DECREASE INVOLUNTARY MOV’T: FATIGUE, FEVER, DROWSINESS PRONE
 – VOLUNTARY MOV’T : MAY HAVE INITIAL DELAY p MOV’T IS DONE.
– POSTURAL CONTROL: D/T DYSTONIA; TENSION: STIFFNESS c MOV’T
– HYPOTONIA/ HYPERTONIA: NONTENSION: (-) STIFFNESS c MOV’T
– ATHETOID DANCE INABILITY TO WB ON FEET (UPWARD)
– PARALYSIS OF GAZE MOV’T – PARINAUD’S PHENOMENON – (-) UPWARD
GAZE
– DIFFICULTY IN EYE CLOSING
– ATHETOID AS IN TIME – FLOPPY 2-3 y.o. INVOLUNTARY MOVEMENT.

PA (PURE ATHETOID)
– SSUBLUX, MANDIBLE, SHOULDER, HIPS
– RIGHTING REACTION
EQUILIBRIUM REACTION PRESENT BUT BADLY COORDINATED
PARACHUTE
– LOW – MID TONE (PROX)
CA (CHOREA ATHETOID) – LOW HIGH NORMAL TONE – (DISTAL)
– SAME AS PURE ATHETOID
SA (SPASTIC ATHETOID) NORMAL – HIGH (DISTAL)
– ELBOW, HIP, KNEE, PF CONTRACTURE
– SCOLIO, HIP DISLOC.
– RIGHTING REACTION
– EQUILIBRIUM REACTION DELAYED, TOTALLY ABSENT
– PARACHUTE
AD (ATHETOID c DYSTONIA) VERY LOW VERY HIGH (DISTAL)
– SAME WITH SA
– mm SPASM d/t FLUCTUATION OF TONE

ATAXIC

ANATOMY – BASAL GANGLIA – MODULATE MOTOR OUTFLOWN IN

COLABORATION c CEREBRAL CORTEX IN INITIATING et. DIRECTING SMOOTH
VOLUNTARY MOVEMENT/ ACTIVITY

EMBRYONIC DIVISION
FOREBRAIN/CEREBRUM

-PROCENCEPHALON MECENCEPHALON ROMBENCEPHALON CEREBELLUM

- END BRAIN
- CEREBRAL HEMISPHERES MB METENCEPHALON MYELENCEPHALON

TELENCEPHALON DIENCEPHALON PONS MEDULLA

- CEREBRAL CORTEX S
- SUBCORTICAL WHITE H THALAMUS
MATTER E
- B6 T
 NEUROLOGICAL STRUCTURE BASAL GANGLIA
LENTIFORM --------------------------------- GLOBUS PALLIDUS + PUTAMEN
CORPUS STRIATUM --------------------------------- CAUDATE + LENTIFORM
CAUDATE --------------------------------- CAUDATE NUCLEI
NEOSTRIATUM --------------------------------- CAUDATE NUCLEUS + PUTAMEN
CLAUSTRUM --------------------------------- CLAUSTRUM
AMUYGDALOID BODY --------------------------------- AMYGDALOID NUCLEUS

CORPUS STRIATUM (HUNTINGTON’S CHOREA)

- CAUDATE + LENTIFORM (GP + P) – SEPARATED BY INTERNAL CAPSULE
- MAJOR; LARGEST ON BG
- CAUDATE NUCLEUS (HUNTINGTON’S CHOREA)
- PUTAMEN (CHOREA) IRREG. SPASMODIC LOW APLITUDE MOV’T
LOCATED OUTER PORTION
DARKER PORTION
* HUNTINGTON’S CHOREA HUNTINGTON’S DISEASE
- 30 – 40 y.o.
– SHORT ARM OF CHROMOSOME 4
– HEREDITARY, AUTOSOMAL DOMINANT
– d/t DEPLETION OF GABA, SUBS.P., ACH ON STRIATUM
* SYNDENHAM’S CHOREA (ST. VITUS DANCE)
– Gr. A β HEMOLYTIC STRPTOCOCCUS INFECTION
– MOST COMMON ACQUIRED IN CHILDREN
– CARDINAL FEATURE OR RHEUMATIC HEART DSS
– SELF LIMITED
– GOOD PROGNOSIS
* HEMICHOREA
GLOBUS PALLIDUS – WEDGE SHADE
– LOCATED INNER; LIGHTER COLOR
– (+) MYELIN SHEATH
– LESION ATHETOSIS, RIGIDITY, NONSPECIFIC LESION (HYPER/
HYPOKINETIC)
– PRIMARY OUTPUT
GLUTAMATE – EXCITATORY STN
ACH – EXCITE - STRIATUM
GABA – INHIBIT @ CEREBRUM
DOPAMINE –INHIBIT @ SUBS. NIGRA

CAUDATE
INPUT
PUTAMEN

SUBSTANTIA NIGRA – AT MIDBRAIN

– DOPAMINE INHIBITORY
SUBSTANTIA NIGRA PARS COMPAOTA – DOPAMINE
INPUT OF B6
SUBSTANTIA NIGRA PARS RETICULATA
OUTPUT OF B6
 SUBTHALAMIC NUCLEUS – AT SUBTHALAMUS
– GLUTAMATE – EXCUTATORY
IMPORTANT PARTS:
RETICULAR 1.) ZONA INCERTA
FORMATION 2.) FORELS TEGMENTAL FIELD H
EXTRAPYRAMIDAL 3.) SUBTHALAMIC NUCLEUS OF LUYS
SYSTEM LESION: BALLISMUS
AMYGDALOID BODY/NUCLEUS – TONSIL/ ALMOND SHAPE @TEMPORAL LOBE
– PART OF LYMBIL SYSTEM – FOR MOTIONS
– FOR INVOLUNTARY MOV’T OF HEAD c BODY

“KLUVER BUCY” – HYPERSEXUALITY

– EMOTIONAL INSTABILITY
– PERSONALITY DISORDER

CLAUSTRUM – THIN SHEATH OF GRAY MATTER

– LYING CLOSE TO OUTER PORTION OF PUTAMEN
– RESPONSIBLE FOR TIMING OF SENSORY INPUTS
* EXTERNAL CAPSULE – SEPARATES CLAUSTRUM AND PUTAMEN

RED NUCLEUS – MIDBRAIN (LEVEL OF SUP. COLLICULLS)

– CONTROLS /; INHIBITS / ANTI GRAVITY mm
RETICULAR FORMATION – ROSTRAL / MESENCEPHALIC (STUPOROUS)
– CAUDAL/ PONTINE (CONSTANT WAKEFULNESS)

COLLICULI – SUPERIOR : REFLEX CENTER FOR EYEBALL AND HEAD MOV’T IN RESPONSE
FORMATION TO USED STIMULI
TECTOSPINAL INFERIOR: HEAD AND TRUNK MOV’T IN RESPONSE TO AUDITORY
TRACT FOR VISUAL
REFLEXES

CAUDATE NUCLEUS – LARGE, SUBCONSCIOUS MOV’T

INTERNAL CAPSULE – SEPARATES CAUDATE NUCLEUS AND LENTIFORM
SEPARATES ANT. LIMB – HEAD OF CAUDATE TO LENTIFORM
POST LIMB – BODY OF CAUDATE TO LENTIFORM

DIRECT PATHWAY
- FACILITATE FLOW SIGNALS TO THALAMUS TO ACTIVATE SOME MOV’T
- CORTEX
- EXCITATORY
- IF UNDER ACT: BRADYKINESIA
- IF OVER ACT: DYSTONIA, DYSKINESIA, ATHETOSIS
- LESION: AKINESIA, RIGIDITY, BRADYKINESIA
INDIRECT PATHWAY
- SUPRESS OTHER MOVEMENTS
- INHIBITS
- HEMIBALLISMUS, CHOREA, ATHETOSIS, TREMOR, TICS
- IF UNDER ACT: BALLISMUS, CHOREA
- IF OVER ACT: AKINESIA, RIGIDITY
 CORTEX

STRIATUM

GPe

SNR SNC
STN

Sup. C. GPi

THALAMUS

GLUTAMATE – MAIN EXCITATORY NEUROTRANSMITTER FROM

CEREBRAL CORTEX STRIATUM
ACH – EXCITATORY FROM STRIATUM
GABA – INHIBITORY NEUROTRANSMITTER W/IN THE SRIATUM
DUPAMINE – MAIN INHIBITORY FROM SUBSTANTIA NIGRA (COMPAOIA) TO STRIATUM

DEVELOPMENTAL MILESTONE
- SEQUENTIAL ACQUISITION et. REFINEMENT BY ADVANCING SKILLS

4 DISTINCT AREAS et. DEVELOPMENTAL:

1.) GROSS MOTOR 4.) PERSONAL – SOCIAL BEHAVIOR
2.) FINE MOTOR
3.) LANGUAGE BEAHVIOR

2 TYPES OF CHANGES:
1.) QUANTITATIVE – MEASURABLE
2.) QUALITATIVE – REFERS TO SHIFT IN KIND

5 PRINCIPLES OF MAJOR DEVELOPMENT: (CPASU)

1.) CEPHALOCAUDAL – TOP – BOTTOM DEVELOPMENT
2.) PROXIMAL TO DISTAL – EX: RGR: REACH – GRASP – RELEASE
3.) AUTOMATIC VOLUNTARY
4.) STABILITY MOBILITY 7 mos – CERVICAL LORDOSIS
5.) UNREFINED – REFINED 10 mos – LUMBAR LORDOSIS

DIFFERENT TYPES OF PLAY:

MIDLINE HAND PLAY
PARALLAL PLAY NO PLAYMATE (SAME GAME WITH THE OTHER CHILD s
INTERACTION)
COOPERATIVE PLAY WITH PLAYMATE
CREATIVE PLAY ROLE PLAYING
14 MONTHS – “MONSTER!”

5-7 mos. FORWARD

9 mos. SIDEWARD
12 mos. BACKWARD
TILT: 9 – 12 mos.

GROWTH – IS AN INCREASE IN PHYSICAL SIZE et. DIMENSION RELATIVE TO MATURITY

DEVELOPMENT – IS THE ACQUISITION et. REFINEMENT OF ADVANCING SKILLS
DEVELOPMENTAL MILESTONES

CAUSES OF PREDOMINANCE OF FLEXOR TONE:

1.) CNS IMMATURITY
2.) PREDISPOSED POSITIONING IN THE CROMB.

MAJOR ACCOMPLISHMENT DURING THE 1ST QUARTER:

- LIFTING OF THE HEAD IN PRONE + ROTATION

SECOND QUARTER
SUPINE: MOST. IMP: PELVIC BRIDGING – G. MAX.
ROLLING
PRONE: PIVOT PRONE PROTECTIVE EXTENSION
ARMS + LEG ABDOMEN TO BE GUARDED IN
SITTING
POE POH
SITTING : RING – SITTING
STANDING : SECONDARY STANDING
- ABD LEGS -PLANTIGRADE POSITION
- / KNEES

THIRD QUARTER
SUPLINE: ROLLING
BILAT. LE LIFTING OR
- HEAD et. UPPER TRUNK/+ ROT
- ARMS REACHING OVER
PRONE: LAT. FLEXION
DISSOCIATED PATTERNS
SITTING: UNSUPPORTED SITTING
SITTING QUADRUPED
ROCKING BEHAVIOR – PROVIDES INTENSE SENSORY STIMULUS ON B UE
et. LE (VESTIBULAR APPARATUS)
STANDING: PULL – STAND
HIP /
CRUISING 1ST INDEPENDENT FORM OF AMBULATION

FOURTH QUARTER
-SUPINE et. PRONE
- TRANSITIONAL POSITION
- BEAR WALKING
UE/ UE/
LE/ LE/
 ROM @ HIPS
SIDE – LYING SITTING
THRUST BACKWARD
SITTING: SQUAT SITTING
WALKING: SUPPORTED “HIGH GUARD POSITION”

DIDAOTICS

MATERNAL Hx:
NICOTINE – VASOCONSTRICTION – BECAUSE OF CARBON MONOXIDE
– CAN CHANGE THE BRAIN DEVELOPMENT OF THE CHILD
– ATHEROSCLEROSIS
ERB – DUCHENNE – C5 – C7 NECK IS LATERALLY BEND
KLUMPKE – C8 – T1 DELIVERY (BREACH)
ALCOHOL INTAKE – VASODILATION
AGE OF MOTHER – TOO YOUNG – HORMONAL IMBALANCE
TOO OLD – “HINDI NA GANUN KATINDI ANG KAPIT NG BATA.”

BIRTH Hx:
-NSUD ; CEASARIAN
-BREACH / CEPHALIC
-BIRTH WEIGHT
-APGAR SCOPE – (APPEARANCE: BLUISH – 0
PINKISH – 2
PULSE: NO PULSE – 0 NORMAL: 120 – 160 bpm
< 100 – 1
APGAR SCORING: > 100 – 2
0-4 OR 0-3 IMMEDIATE GRIMACE: DOESN’T CRY – 0
RESUSCITATION RESPONSE – 1
4-6 OR 5-7 DEPRESSED CONSISTENT CRYING s – 2
7-10 OR 8-10 N STIMULUS
ACTIVITY: 0 – HYPOTONIC
“MOST CP PATIENTS HAVE N 1 – FLEXED POSTURE
APGAR SCORE” 2 – c MOV’T
RESPIRATION: NO CRY – 0
CRIES FOLLOWING A STIMULUS – 1
GOOD CRY (LOUD) – 2)

PRETERM : < 36 OR < 37 WEEKS

FULL TERM: 38 – 42 WEEKS

EXCESSIVE DROOLING DRY MOUTH GRADING:

– CAN’T PRODUCE SOUND MILO – SIDE OF MOUTH
– CAN’T TASTE FOOD MOD -
SALIVA – FUNCTIONS FOR TASTE BUDS SEVERE – CHEST /
FLOOR
– DYSPHAGIA
– SPEECH PROB

OBJECTTIVE INFO: (CP) SPASTIC

TYPICAL ARM POSTURE (SPASTIC HEMIPLEGIA)
 / SYNERGY: SH ABD STRONGEST FLEXOR
COMPONENT:
ER ELBOW/
ELBOW /
FA SUPINATION STRONGEST EX COMPONENT :
WRIST/ FINGERS / SH ADD FA
PRONATION
/SYNERGY: SH ADD WEAKEST: ELBOW /
IR
ELBOW /
FA PRON.
WRIST / FINGERS/ OR /

GROUP OF mm NOT AFFECTED c SYNERGY:

FINGER EXTENSORS
LATS DORSI
ANKLE EVERTORS
TERES MAJOR
SERRATUS ANTERIOR

OI: HANDS – CORTICAL THUMB (THUMB INSIDE)

– HAND FISTED (THUMB OUT)
– SWAN NECK DEFORMITY
– BUTONNIERE DEFORMITY
FACE: ESTOPIA – INSIDE
EYES
ESTOPIA – OUTSIDE
NYSTAGMUS – COMMOM IN ATAXIC (CEREBULLAR AFFECTATION)
STRABISMUS
PTOSIS

EYES: LAT. GENICULATE

OPTIC TRACT HOMONIMOUS HEMIANOPSIH
OPTIC CHIASM BITEMPORAL HEMIANOPSIH
OPTIC NERVE BLINDNESS OR 1 OR BOTH EYES

LOW SET EARS

FLATTENED NOSE BRIDGE DOWN’S SX
EPICANTAL FOLDS
SIMIAN CREASE
LATERALLY DEVIATED LITTLE FINGER

HIPS: WIND SWEPT 1 HIP FABER

1 HIP FADDIR
COMPLICATION: DISLOCATION OF THE HIP POSITIONED IN FADDIR.

TONE IS GRADE 3 OR ABOVE SPASTIC

(RANGES) GRADE 2 NOT CP

GRADE 3 – 4 ATHETOID
COMMUNICATIONS: VERBAL PRE LINGUISTIC SPEECH, ECHOING, BBUBLING SPEECH,
INCOMPREHENSIBLE SOUNDS
 NON-VERBAL GESTURES, FACIAL EXPRESSIONS, SIGN LANGUAGE
ECHOING – REPEATS THE WORDS HEARD “PERFECT IMMITATION” OF
WORDS
LALLING – “BULOL” IMPERFECT IMMITATION
ECHOLALIA – REPETITION OF WORDS
BUBBLING – MORE ON VOWEL OR CONSONANT TALK

HEAD CIRCUMFERENCE: LANDMARKS: OCCIPITAL PROTUBERANCE GLABELLA

GALEAZZI TEST – 3 – 18 mos.
ORTOLANI – 1ST FEW WEEKS – RELOCATABLE
BARLON – 6 MONTHS – DISLOCATABLE

SPECIAL TESTS
1.) THOMAS TEST – HIP / CONTRACTURE
2.) POPLITEAC ANGLE TEST – HAMSTRING SPASM SLR
OR CONTRACTURE LANDMARK: FEMORAL CONDYLE
PROX. ARM: FEMUR
DISTAL ARM: FIBULA
3.) SILFVERSKIOLD – GASTROC/ SOLEUS CONTRACTURE
4.) EIY’S TEST – RECTUS FEM. TIGHTNESS
5.) PHELP’S TEST – ADDUCTOR SPASTICITY – Px PRONE
– / B KNEES, ABD B HIPS, SUDDEN / OF B KNEES
– (+) BOTH LEGS CROSS
– IF LEGS DON’T CROSS, PALPATE THE
ADDUCTORS
6.) STAHELI’S TEST – HIP / CONTRACTURE

CHEILOSCHISIS – OTHER NAME OF “CLEFF LIP”

BLATOCHISIS – “CLEFT PALATE”
HYPOSPADIAS – MANY OPENING MALE GENITAL
SEPTATE VAGINA – 2 CERVIX
AMBIGUUOUS GENITALIA – SEX REVERSAL
PYLORIC STENOSIS – NARROW DUODENUM
HIRSCHSPRING DISEASE – ABSENCE OF NERVE CELL IN COLON

TONE

GRADE 3 – SPASTIC
1-2 – ATHETOID (PURE OR CHOREA)
2-3 – MIXED (SPASTIC ATHETOID)
2 & 3 – CHOREA THETOSIS
1-4 – ATHETOID WITH DYSTONIA
1-3 – ATHETOID WITH DYSTONIA / ATHETOID WITH TONIC SPASMS
MODIFIED ASHWORTH
0 – NO TONE
1 – CATH et. RELEASE AT THE BEGINNING OF RANGE
(SLIGHT INCREASE OF mm TONE)
1+ - CATCH AT THE BEGINNING MID RANGE
(SLIGHT INCREASE OF mm TONE)
 2 – FROM THE BEGINNING END OF ROM
THERE’S MARKED INCREASE IN RESISTANCE BUT THE AFFECTED PART IS
EASILY MOVED.
3 – INCREASE TONE WITH PASSIVE MOVEMENT DIFFICULTY; CONSIDERABLE
INCREASE IN mm TONE
4 – RIGID IN B / OR /

ATHETOID – FUCTUATING TONE (TONE IS 1-3)

MOBILE WAD OF 3:
- BRACHIORADIAUS
- ECRL
- CCRB

PATHOLOGIC REFLEXES:
BABINSKI - / BIG TOE (+)
(EVEN IF THERE’S NO FANNING)

SPASTICITY – PYRAMIDAL; VELOCITY DEPENDENT (GAMMA)

RIGIDITY – EXTRA-PYRAMIDAL; NOT VELOCITY DEPENDENT (ALPHA)

PRIMITIVE REFLEXES
EXTENSOR THRUST – IF IT DOES NOT SUBSIDE AFGTER 2 MONTHS. THERE WILL BE A
POOR PROGNOSIS

REFEX INTEGRATION LEVEL

EXTENSOR THRUST 0-2 MONTHS SC
MORO 0-4 MONTHS AUTOMATIC MOVEMENT
REACTION (AMR)
NECK RIGHTING 0-6 MONTHS MIDBRAIN
ATNR 4-6 MONTHS BS
STNR
FOOT PLACEMENT
PERSISTS AMR
PARACHUTE

1.) EXTENSOR THRUST – SUPINE, TEST LEG IN FLEXION, APPLY PRESSURE ON SOLE
TO ELIMINATE TICKLE RESPONSE
2.) MORO – ON WEDGE BOARD, SUDDEN NECK EXT.
- REACTION: ABD/FLEXION, ER OF SH, ABD AND EXT OF FINGERS
3.) NECK RIGHTING – SUPINE, TURN HEAD TO ONE SIDE, BODY FOLLOWS
- IF (+) NECK RIGHTING, THERE’S AUTOMATIC (-) ATNR!
4.) ATNR – SUPINE, TURN HEAD TO ONE SIDE
- EXT. ON FACE SIDE; CHECK ON SKULL SIDE
- PROBLEM: ROLLING IF (+)
5.) STNR – QUADRUPED ON LAP
- STABILIZE, CHECK HEAD / OF B UE, / OF B LE
/ HEAD / OF B UE, / OF B LE
6.) FOOT PLACEMENT – HOLP PATIENT IN TRUNK/ HANG IN AXILLARY
- BRUSH DORSUM OF FOOT ON EDGE OF TABLE
- RESPONSE: STEPPING
 - WILL BE SUPPRESSED AFTER VOLUNTARY CONTROL (3-4 y.o)
7.) PROTECTIVE EXTENSOR THRUST (PARACHUTE)
- PRONE ON VESTI BALL
- SUDDEN FORWARD ROCKING TOWARDS FLOOR
- IF (-) PARACHUTE; POSSIBLE (+) ATNR AND STNR HIGHEST PROGNOSIS

FMT
0 – NO ABILITY
1 – BEGINNING ABILITY, PARTIALLY ACHIEVED, UNRELIABLE, INSECURE,
MOMENTARY, INEFFICIENT
2 – RELIABLE WITH ABNORMAL PATTERN, INEFFICIENT
3 – RELIABLE WITH N PATTERN; EFFICIENT WITH GOOD PATTERN

BALANCE
1 – CAN’T ASSUME, CAN’T MAINTAIN
2 – CAN ASSUME, CAN’T MAINTAIN OR VICE VERSA
3 – CAN ASSUME, CAN MAINTAIN c NO WEIGHT SHIFTING
4 – CAN ASSUME, CAN MAINTAIN, WEIGHT SHIFTING + CHALLENGE (MANUAL
PERTURBATION)

TOLERANCE
POOR – 0-15 mins.
FAIR – 16 – 30 mins.
GOOD – 31 – 45 mins.
NORMAL – 46 – 60 mins.

HEAD CONTROL
GRADE 3 – Px WOULD BE ABLE TO REALIGN THE HEAD c TRUNK
ATHETOID – GRADE 2; NO MIDLINE ORIENTATION
TRUNK CONTROL – PULL TO SIT
GRADE 1 – c MAXIMAL SUPPORT
NECL K / - FACILITATORY: STROKING/ TAPPING
VESTIBALL – ROCK IT FORWARD
WEDGE BOARD
ABNORMAL CRAWLING/ CREEPING:
BUNNY HOPING – DIPLEGIA; NO RECIPROCATION; PREDOMINATION OF
ADDUCTOR SPASTICITY
MERMAID CRAWL – SIDEWARD CRAWL (WIND SWEPT DEFORMITY)
COMBAT CRAWL – DOMINATION OF / SYNERGY
BUTTOM SHUFFLING – DIPLEGIA; BACKWARD
RUBBING BUTTOCK
ON THE FLOOR

KPNF – KYPHOSIS, PPT, NOTATION, FLEAWN

LACE – LORDOSIS, APT, CONTERNUT., EXT.
SITTING
INDIAN SITTING – PPT; KYPHOTIC (LOCKED IN PPT)
SHORT SITTING – FUNCTIONAL SINCE THE PELVIS IS MOVABLE TO THE APT et.
PPT.

FOR GRADE 3 – THERE SHOULD BE GARDE 3 TRUNK CONTROL.

FMT
1.) HEAD CONTROL
2.) TRUNK CONTROL
3.) ROLLING OVER – PRONE SUPINE
SUPINE PRONE
4.) POE
5.) CREEPING
6.) QUADRUPPED
7.) CRAWLING
8.) SITTING (ASSUME)
9.) SITTING B/T
10.) KNEELING (ASSUME)
11.) KNEELING B/T
12.) HALF-KNEELING (ASSUME)
13.) HALF – KNEELING B/T
14.) STANDING (ASSUME)
15.) STANDING B/T

RGR
GROSS PREHENSION PATTERNS:
CYLINDRICAL, SPHERICAL, HOOK GRASP
FIVE PREHENSION PATTERNS:
3 – JAW CHUCK, LAT. PREHENSIONM TIP TO TIP, PULP TO PULP
GRADING:
POOR – (-) RGR
(+) REACH; (-) GRASP; (-) RELEASE
FAIR – (+) REACHL (-) GRASP; (-) RELEASE
(-) REACH; (+) GRASP; (+) RELEASE
GOOD – (+) RGR

LEG LENGTH MEASUREMENT:

IMPORTANCE: LANDMARKS
-APPARENT LEG LENGTH: UMBILICUS MED. MALLEOLUS
- TRUE LEG LENGTH: ASIS MED. MALLEOLUS

SEGMENTAL UMBILICUS MED. FEM. CONDYLE MED. MALLEOLUS

ASIS MED. FEM. CONDYLE MED. MALLEOLUS
DONE IN THE PRESENCE OF DEFORMITIES
LOWER CROSS Sx:

TRUNK RECTUS
EXTENSOR ABDOMINUS

GLUTS ILIOPSOAS
SPECIAL TEST:
THOMAS TEST:
FACTOR THAT CAN AFFECT:
- Px BODY BUILD OR GENDER
-PT’S SRENGTH
PHELP’S TEST – IF LEG DOESN’T CROSS; PALPATE ADDUCTORS IF THERE’S
CONTRACTION (ISOLATE THE SUBTALAR)
SYLFVERSKIOLD – PF CONTRACTURE / TIGHTNESS
– DORSIFLEX
– IF THERE’S LIMITATION, MEASURE THE ROM OF DF
– INCREASE OR N – GASTRIL
– DECREASE OR SAME – SOLEUS
ELY’S TEST
STAHELI’S – FOR ILIOPSOAS TIGHTNESS
– Px PRONE, LE DANGLING
– / 1 KNEE et. / HIP (IPSILATERAL SIDE)
– (+) APT OF CONTALATERAL SIDE
– MEASURE THE IPSILATERAL SIDE MINUS 900

PROGNASTICATION:
BLECK’S GRADING: (1 – 2 y.o.)
0 – GOOD
1 – GUARDED/ MIGHT WALK
>2 OR 2 – POOR
MOLNAR GRADING: (2 -7 y.o.)
GOOD – CAN SIT @ 2 y.o.; STAND @ 4 y.o.
FAIR – ABSENCE OF PRIMITIVE REFLEXES 18 – 24 mos.; ABLE TO SIT @ 3 y.o.;
ABLE TO STAND @ 5 y.o.
POOR – ABLE TO SIT @ 4 y.o.; ABLE TO STAND @ 6 y.o.

EQUILIBRIUM REACTIONS: IMPORTANCE: SAVING REACTION (IPSILATERAL)

TILTING REACTION(CONTRALATOPA)
- NO ANTERIOR et. POST. STABILITY (WALKER)
- NO LATERAL STABILITY (CRUTCH)
- NO STABILITY IN AL PLANES (WHEELCHAIR)

ASSISTIVE DEVICES:
PARALLEL BARS – MOST STABLE
WALKER – 2ND MOST STABLE
BAC / FA CRUTCH – 3RD
QUAD CANE – 4TH
SINLE TIP CANE – 5TH

MOST COMMON COMPLICATIONS OF CP:

1.) SCOLIOSIS
2.) HIP DISLOCATION
CP SPASTIC MANIFESTATIONS:
CP SPASTIC TYPICALLY MANIFEST SIGNS OF UMN INVOLVEMENT:
1.) HYPERREFLEXIA
2.) CLONUS
3.) EXTENSOR BABINSKI RESPONSE
4.) PERSISTENT PRIMITIVE REFLEXES
5.) OVERFLOW REFLEXES

TYPES OF CP SPASTIC
SPASTIC HEMIPGLEPIA:
- HYPOTONIA (1ST INDICATOR) STANDING: BACKWARD AND
- HEMIPARESIS (ELIDENT BY 4 mos.) UPWARD
- HEMINEGLECT
- CN AFFECTATION
- HAND IMMOBILITY
- HAND DOMINANCE AFFECTATION
- TYPICAL ARM POSTURE
- UE > LE
- CIRCUMDUCTED GAIT / TIP TOEING
- SENSORY + VISUAL DEFICITS

68% 32%
- GOOD AMBULATORY PROGNOSIS
SPASTIC DIPLEGIA:
- Hx OF EARLUY HYPOTONIA
- COMMON ETIOLOGY: LOW BIRTH WEIGHT
- UE MORE ON / SYNERGY; LE MORE ON / SYNERGY
- LE> UE
- DEVELOPMENTAL DELAY: MORE ON GROSS MOTOR
- SCISSORING GAIT
- STRABISMUS SEIZURES

ATHETOID DANCE: UPON WEIGHT BEARING, THERE’S UPWARD et. OUTWARD MOTION OF
LES.

OR

SPASTIC DIPLEGIA CON’T:

- 20% - STRABISMUS
- 50% - SEIZURES ( 2 TYPES: PETIMAL, GRANDMAL)
- PETITMAL 1 PART IS AFFECTED

GRANDMAL – WHOLE BODY mm CONTRACTIONS

DIPLEGIA PROGNOSIS FOR AMBULATION : FAIR GOOD
HIGHEST FUNCTIONAL MOBILITY: WALKING c ASSISTIVE DEVICE

SPASTIC TRIPLEGIA
- 2 LE, 1 UE AFFECTATION
- CROUCH GAIT
 - MILD COORDINATION PROBLEM
- (+) SPASTICITY ON INVOLVED LIMBS
SPASTIC QUADRIPLEGIA (MOST SEVERE CASE)
- UE > LE
- UNLIKE IN DOUBLE HEMI, DOUBLE HEMI HAS MORE ASSOCIATED
REACTIONS
- DIFFICULT DELIVERY WITH PERINATAL ASPHYXIA
- (+) SPASTICITY AND PERSISTENT PRIMITIVE REFLEXES
- OPISTOTONIC POSTURING
- STRAPHANGER – SCAPULAR RETRACTION
– SH ABD, ER
– FA PRONATED
– ELBOW/
– WRIST /
– FINGERS /
- OROMOTOR DYSFUNCTION (FEEDING PROB)
- DROOLING
- SPEECH PROBLEM
- WIND SWEPT DEFORMITY (UNILAT. DISLOCATION)
- FROG LEG DEFORMITY (BILAT. DISLOCATION)

LEG CALVE PERTHE’S DSS – BOYS > GIRLS

– UNILATERAL INVOLVEMENT
– 3 – 12 y.o.
– BONE NECROSIS OF FENORAL HEAD
– DECREASE BLOOD SUPPLY ON FEMORAL HEAD

SLIPPED CAPITAL FEMORAL EPIPHYSIS – 10 – 16 y.o. ; IDIOPATHIC

– BOYS > GIRLS
– OBESE > LEAN
– SHORT et. STOUT > TALL et. THIN

ORTHOSIS:
MILWAUKEE – ABOVE T6
MIAMI – BELOW T6 BUT NOT LESS THAN T8
WILMINGTON
BOSTON BELOW T8
YAMAMOTO

VON ROSEN
ILFELD CONGENITAL HIP
PAVLIK HARNESS DISLOCATION

TORONTO
SCOTTISH – WRIGHT LCPD, SCFE
TRILATERAL
 T N N T

R MONOCULAR BLINDNESS

HOMONIMOUS HEMIANOPSIA
BITEMPORAL (L TEMPORAL, R NASAL)
HEMIANOPSIA

MOST COMMON ETIOLOGY ATHETOID: KERNICTERVS (BILIRUBIN ENCEPHALOPATHY)

RH/ ABO INCOMPATIBILITY

KERNICTERVS – HIGH DEPOSITION OF BILIRUBIN TO B6
EX: M(RH(-)) F(RH(+))

BABY (+)
EX: MOTHER (TYPE O) FATHER (TYPE A)

BABY (+)
SPLEEN: PRIMARY GRAVEYARD OF RBC
LT6 AND ST6 (SMART)
S – SPECIFIC
M – MEASURABLE
A – ATTAINABLE
R – REALISTIC
T – TIME BOUND
ATAXIC
MAIN PROBLEM: BALANCE AND COORDINATION
TO THE TUNE OF “LULLABY”
BABY = AC et. SC = ARMS @ SIDE
TMJ: SLIGHTLY OPEN
RESTING N6 SHOULDER S5 (ABD) AT 300 (HORIZONTAL ADD)
HU – 700 (/) 100 (SUP.)
PRU – 700 (/) 350 (SUP.)
DRU – 10 DEGREES SUPINATION
HIP FABER SLIGHT ER
KNEE AY 2S DEGREES /
ANKLE AY 10 PF
WRIST AY SLIGHT ULNAR DEVIATION
 “3 BLIND MICE” (AFFECTED OF OSTEOARTHRITIS)
(MTP) (MCP)
K 1 1 2X
HIP DIP PIP 2X
C5 C6 L4 L5 2X
AC JOINT 2X

HEALING (“HAPPY BIRTHDAY”)

2 WEEKS BLOOD VESSEL
3 – 4 WEEKS AN6 NERVE
6 WEEKS AN6 TENDON
2 – 5 WEEKS Fx HAND

CHARACTERISTICS OF GERTMAN 5X
(I HAVE TWO HANDS)

I HAVE GERSTMAN THE L et. THE R

FINGER AGNOSIA, AGRAPHIA
ACALCULIA 1,2,3
AREA 39 ANGULATE GYRUS

ORTHOSIS FOR SCOLIOSIS

LOVE STORY:
NAAY MAG-UYAB, SI T6 UG T8. NAG-DATE SILA SA MIAMI BEACH, PAGNAOG NILA
SA BEACH NAKAKITA SILA UG BUWAYA (BWY – BOSTON, WILMINGTON,
YAMAMOTO). ANG NAME NI T8 IS MIL. NAHADLOK SI T6 SO INGON SIYA NI T8
NGA “MIL, WALK ME HOME”. (MILWAUKEE)

TUBERCULOSIS ORTHOSIS – TAYLOR (KAY SMOKER MAN SI TAYLOR SWIFT)

TYPES OF APHASIA (“FUCK RN”)

FLUENCY COMPREHENSION REPITION NAMING

ANOMIA G
G
CONDUCTION
TS
G P
G

P
(TRABSCORTICAL
SENSORY)
P
WERNICKEIS P
TRANSCORTICAL G
G
MOTOR
BROCA
ISOLATION
GLOBAL
P P
P
G
P
(ACTS WITH THE
BIG)
BELL’S PALSY (LESION)
“SHARON CUNETA SAYS GABBY IS PANGIT”
S - STYLOMASTOID
C – CHORDA TYMPANI
S - STAPEDIUS
G – GENICULATE GANGLION
I – INTERNAL ACOUSTIC MIATUS
P – PONS

OSSIFICATION OF CARPAL BONES

“COME HOME TO LUNETA TO SEE THE PHILIPPINES”
C – CAPITATE
H – HAMATE
T – TRIQUETRUM
L – LUNATE
T – TRAPEZIUM
S – SCAPHOID
T – TRAPEZOID
P – PISIFORM

BOUNDARIES OF ANATOMIC SNUFF BOX (LATERAL TO MEDICAL)

“APOLLO EL POBRE EPAL”
- APL
- EPB
- EPAL
- SCAPHOID – FLOOR

HANDLING
I. BODY IS STIFF:
a. HUGGING – (SITTING)
b. SUPINR c LEGS UP
c. PRONE ON THERA BALL
d. FETAL POSTION
e. SLOW RHYTMIC MOV’T
f. BODY MASSAGE
g. WRAP WITH BLANKET
h. EXERCISING IN NEUTRAL ENVIRONMENT

II. SPECIFIC AREAS OF THE CHILD’S BODY ARE STIFF:

– SHOULDERS ARE HELD FORWARD
– ARMS CLOSE TO THE SIDES / CHEST
a. HAMMOCK – SWING
b. FACE TOUCH (LET Px TOUCH PT’S FACE)
– IF UE IN “W” POSITION
c. WEARING A CAPE
d. REACHING A TOY (SITTING)
– ELBOWS ARE BENT; CLOSE TO THE BODY
e. PRONE ON BOLSTER
f. LEANING ON PALM
– IF ELBOWS ARE / AND ARMS ARE THUM – SIDE – DOWN POS’N.
g. SUPINE OR SITTING, LET THE Px TOUCH FACE
 – HANDS ARE FISTED:
h. CORTICAL THUMB – RUBB THENAR mms TO / THUMB.
– STROKE DORSAL ASPECT OR HAND/FINGERS TO
PROMOTE/.
III. PATERNS OR REFLEX MOV’T INTERFERE WITH PURPOSEFUL ACTIVITY
- CHILD IS STIFF/ STRAIGHT LYING ON HIS BACK
a.) TONIC LABYRINTHINE
– SUPLINE: / SYNERGY
– PRONE: / SYNERGY
b.) SUPINE / PUT PILLOW UNDER HEAD AND UNDER KNEES
- CHILD IS STIFF / / ON THIS STOMACH
c.) Px SUPINE ON THERA BALL
d.) SIDE LYING c PILLOW ON CHEST (UNDER ARMPIT)
- CHILD’S HEAD IS ALWAYS TURNED TO THE SIDE
e. PLACE TOY ON THE OPPOSITE SIDE WHERE THE HEAD IS BEING TURNED.
IV. CHILD CAN’T CHANGE BODY POSITIONS STIFFENING
- ROTATION EXERCISE:
a.) SITTING ON LAP OF PT; PT’S 1 HAND SUPPORTING THE PELVIS, THE
OTHER HAND HUGGING Px’S CHEST. TURN THE Px’S TRUNK ON EITHER
SIDES.
b.) PRONE ON THERA BALL. LIFT B ARMS AND ROTATE Px’S TRUNK.
c.) SUPLINE – LET Px TOUCH THE LE OF THE OPPOSITE SIDE
EX: R UE TOUCH L LE AND VICE VERSA
d.) SIDE LYING: ROTATE Px’S TRUNK BY MOVING Px’S PELVIS AND LE
TOWARDS ANT. AND POST. DIRECTIONS.
e.) PRONE – Px ON BILSTER (POE); PT HOLDS Px’s PELVIS AND ROTATES
THE TRUNK.

BODY IS FLOPPY
I. STIMULATION EX:
a. BOUNCING(SWING, BED, THERA BALL)
USING THERA BALL: PT SITTING ON THERA BALLS c Px ON
HIS/HER LAP (BOUNCE)
b. CARRY THE PX FACE DOWN. BOUNCE HIM UP AND DOWN AS
YOU WALK
c. USING A TOWEL, SWING HIM SIDE TO SIDE
d. QUICK TAPS ON HIS BACK ON EITHER SIDE OF THE SPINE
e. JOINT COMPRESSION – Px IN SUPINE, RAISE HIS ARM TOWARD
CEILING, SUPPORTING HIS ELBOW. PRESS HIS ARM DOWN INTO
HIS SHOULDER FIRMLY AND QUICKLY.
f. HANDS AND KNEES OVER A SOFT-SEAT SWING.
PUSH DOWN FIRM SEVERAL TIMES ON HIS SHOULDERS AND
ALSO HIS HIPS.
g. JOINT COMPRESSION
II. CANNOT SUPPORT HIMSELF IN DIFFERENT POSITIONS.
a. GENTLY BOUNCE HIS BOTTOM AGAINST YOUR
STOMACH; IF CAN’T MAINTAIN THE POSITION
EVEN WITH HELP, PLACE BOLSTER UNDER
CHEST.
b.
 III. CAN’T DIRECT/ CONTROL HIS MOV’T
a. INCREASE mm. CAN’T MAINTAIN SITTING
b. LOW TONE (FLOPPY)
- POSITION HIM c TRUNK STRAIGHT AND FIRM
- BE SURE THAT HIS FEET ARE RESTING SURFACE
- POSITION HEAD IN MIDLINE
- REST THE NON DOMINANT ARM ON LAP OR A TRAY
- PRESS SHOULDER FOR STABILITY
IV. DOES NOT MAKE ADJUSTMENTS TO MAINTAIN BALANCE
a. MOVE HIM SIDE TO SIDE, WAITING FOR HIM TO CURVE
HIS TRUNK TO MAKE ADJUSTMENTS.

b. ROLL HIM SLOWLY SIDE TO SIDE, FRONT TO BACK OR

DIAGONALLY, GIVING HIM TIME TO RIGHT HIMSELF.

c. TILT BALANCE BOARD SIDE TO SIDE, GIVING HIM

TIME TO RIGHT HIMSELF.
- CAN ALSO USE BOLSTER

DEVELOPMENTAL MOTOR SKILLS:

1.) UNABLE TO LIFT HEAD:
a.

b.

c. TILT HIM TO THE SIDES, WAITING FOR HIM TO RIGHT HIS HEAD. PT FACING
Px.

2.) PUILLS HEAD TO ONE SIDE

a. TALK OR SHOW TOYS ON THE OTHER SIDE
b. POSITION HIM FACING A WALL TO ENCOURAGE HIM TO LOOK ON THE
OTHER SIDE
c. SIDE LYING – ON THE SIDE HE PULLS TOWARD.
3.) UNABLE TO FREE HIS ARMS FROM HIS SIDES
a.
 b. GENTLY ROCK THE BALL

c.

d. SIT HIM IN YOUR LAP

e.

4.) CHILD’S ARMS COLLAPSE UNDER THE WEIGHT OF HIS BODY

a. STIMULATION EX.
b.
c. POE; PRESS DOWNWARD ON HIS SHOULDERS
d. POE WITH BOLSTER

5.) CHILD ARCHES HIS HEAD c HIS WHOLE BODY

a. RELAXATION EX.
b.

c. ON A WEDGE, STRAPPED SELVREVY @ HIP et. SHOULDER LEVELS

d. PRESENT ITEMS BELOW EYE LEVEL
e. SPEND TIME IN PRONE
f. IN POE, ENCOURAGE TO LOOK DOWN

g. STRENGTHEN NECK / BY DOING “PULL-TO-SIT”.

6.) HANDS ARE FISTED AND PULLED IN TOUCHING EACH OTHER
a. RELAX HIS SHOULDERS: PALM UP, MOVE ARMS SIDE TO SIDE
b. POE
 c. GRASP FAT PAD OF THUMB, ROLLING THE THUMB OUT FROM THE HAND
d. HOLD OPEN HAND IN MODIFIED “HAND SHAKE” POSITION.
PLACE HAND ON HIS SIDE (ON THE FLOOR)
7.) TRUNK AND HIPS AUTOMATICALLY /, CAUSING HIM TO ROLL TO HIS SIDE OR
BACK
a. GRASP HIS THIGHS, KEEPING HIPS / AND LEGS FAR
APART. ROLL HIM SDE TO SIDE TO RELAX

b. STRAP HIS HIPS ON WEDGE

c. PRESS HIS PELVIS DOWN

CHILD’S UPPER BACK mm DO NOT ASSIST THE ARMS TO RAISE AND HOLD HIS CHEST OFF
THE FLOOR
a. ENCOURAGE HIM TO LOOK UP et. REACH FOR A TOY

b. ENCOURAGE HIM TO LOOK UP ON A DANGLING TOY

c. SCOOTER BOARD ACTIVITIES TO STRENGTHEN UPPER BACK mms.

CHILD LACK FLEXIBILITY IN HIS PELVIS, MAKING IT DIFFICULT FOR HIM TO RAISE HIS
CHEST OFF THE FLOOR.
a. ROTATION EXERCISES
b. ROTATE HIS HIPS

c. DOWNWARD PRESSURE TO PROMOTE APT

ARMS COLLAPSE WHEN HE TRIES TO BEAR WEIGHT
a. PLACE HIM PRONE ON YOUR LAP. PUSH DOWNWARD ON SHOULDERS; IF ELBOWS
/, YOU MAY NEED TO HOLD AND PUSH DOWN FROM THIS HOLDING POINT.
b. PULL HIM UP UNTIL HIS ARMS /. PUSH DOWNWARD ON
SHOULDER

c. SITTING ON YOUR LAP; ASSIST HIM TO REACH TOWARDS THE FRONT TO PLACE
OPEN HANDS ON A FLAT SURFACE(MIRROR)

RIGID BODY; CAN’T MAKE ADJUSTMENTS TO KEEP FROM FALLING

a. PRESS HIS SHOULDERS DOWN. ROCK HIM SIDE TO SIDE

b. PUSH SIDE TO SIDE. FORWARD AND BACKWARD

ARMS NOT IN LINE c SHOULDER WHEN WEIGHT BEARING

a.

b.

WEIGHT SHIFTING

1. UNABLE TO TURN BODY SLIGHTLY AND WEIGHT SHIFT SO THAT 1 ARM IS FREE
TO MOVE.
a. POE
TIP THE BOARD SIDE TO SIDE (IPSILATERAL)

b. SEAT HIM ON YOUR LAP

HAVE HIM TOUCH HIS REFLECTION ON THE MIRROR.
HOLD Px’S ELBOW TO PREVENT /
EX: PULL L ARM FOR R ARM TO PUSH

c. POH
PUSH HIM GENTLY SIDE TO SIDE. ASSIST HIM TO
RAISE ONE HAND.
 2. CHILD ROLLS TO HIS SIDE WHEN TRYING TO LIFT 1 ARM FROM POE POSITION
a. PRESS ONE SHOULDER AND ASSIST TO RAISE OTHER HAND.

b. TO PREVENT FROM ROLLING. ASSIST HIM TO REACH A

TOY.

c. ASSIST HIM TO GRASP THE TOY. GRADUALLY MOVE THE

TOY AWAY FOR HIM TO / HIS ARM

3. CHILD FALLS WHEN HE TRIES TO LIFT 1 ARM FROM POH POSITION

a. HOLD 1 SHOULDER/ ELBOW. ASSIST HIM TO REaCH TOY ON
OTHER HAND

b. TAP SHOULDER TO REACH TOY

c. ASSIST TO REACH 1 HAND AND THEN THE OTHER TO REACH

TOY

4. CHILD DOWS NOT REACG FOR AN OBJECT WHEN WEIGHT BORNE ON HIS OTHER
ARM.
a. STABILIZE 1 SHOULDER. GRASP OTHER ELBOW AND LIOFT
IT FORWARD

b. TAP 1 ELBOW TO REACH TOY

c. OFFER FOOD

MOVE INTO AND OUT OF SITTING

1. DOES NOT ROTATE HIS BODY TO CHANGE POSITION
a. SEAT HIM STRADDLING ON YOUR THIGH. PUT ONE OF YOUR ARMS ACROSS
HIS CHEST. STABILIZE HIPS. TWIST TRUNK IN 1 DIRECTION AND THEN THE
OTHER.
b. PRONE ON YOUR THIGH. PUT 1 HAND BETWEEN HIS LEGS TO SUPPORT PELVIS.
1 HAND UNDER HIS ARMPIT. ROLL HIM TO HIS SIDE, ROTATE HIM UPWARD TO
SITTING POSITION.
c. QUADRUPED
SHIFT WEIGHT ON 1 SIDE AND ROTATE HIS TRUNK SITTING.
 2. UNABLE TO SHIFT WEIGHT TO ALLOW MOVEMENT
a. SHORT SITTING. PUSH HIM TO HIS R HIP. PLACE YOUR HAND UNDER HIS L
ARMPIT, PULLING UPWARD TO STRETCH HIS TRUNK. REPEAT ON THE OTHER
SIDE.
b. SITTING ON GTHE FLOOR OR ON YOUR LAP. ENCOURAGE HIM TO REACH TOY.
HOLD HIS HIPS.
c. GENTLY ROCK SIDE TO SIDE.

d. SIDE LYING TO SITTING. ASSIST HIM THROUGH THE

MOVEMENT SEQUENCE.

3. CHILD WOBBLES BECAUSE HE LACKS STABILITY IN HIS HIPS et. PELVIS

a. SIDELYING TO SITTING. ASSIST HIM THROUGH THE
MOVEMENT. PRESS FIRMLY DOWN ON THE HIP. 1 HAND
UNDER HIS SHOULDER.

b. YOUR HANDS FIRMLY ON HIS HIP BONE FOR STABILITY.

TURN HIS BODY, ROTATING INTO SIDE SITTING.

4. DOES NOT MAKE ADJUSTMENTS IN HIS TRUNK AND ARMS FOR BALANCE AND
FALLS WHEN CHANGINGH POSITION
a. ROLL SIDE TO SIDE. WAIT FOR HIM TO MAKE
ADJUSTMENTS

b. TILT BOLSTER SIDE TO SIDE. WAIT FOR PATIENT’S

ADJUSTMENTS

BOLSTER

c. USE L ARM TO SUPPORT CHEST. HOLD R LEG AND TILT

HIM TO THE L. ROTATE HIS TRUNK DOWNWARD UNTIL
HIS HANDS TOUCH THE FLOOR. REPEAT ON THE OPPOSITE
SIDE.

DOWN SX “MONGOLOID” OR “BLUMENBACK MONGOLIAN RACE”

NAMED p JOHN LANGDON DOWN
JEROME LEJEUNE – 1959

MITOSIS: (IPMAT) MELOSIS – GERM CELL

- INTERPHASE
- PROPHASE
- METHPHASE
- ANAPHASE 1 2 - NO INTERPHASE
- TELOPHASE

GAMETE – REPRODUCTIVE CELLS

– RESPONSIBLE FOR #, SHAPE OF CHROMOSOMES
ADVANCED MATERNAL AGE – THE ONLY WELL KNOWN RISK FACTOR FOR CONCEIVING
A CHILD c DS.
GENE COL6A1 – OVEREXPRESSION MAY BE THE CAUSE OF HEART DEFECTS
(ENDOCARDIAL CUSHION
CELLS)
TRIAD OF MR: TRIAD OF AUTISM:
1. IMPAIRED COGNITION 1. IMPAIRED BEHAVIOR
2. DIFFICULTY ACQUIRING NEW SKILLS 2. IMPAIRED COMMUNICATION
3. DMD 3. IMPAIRED SOCIAL
INTERACTION

AA INSTABILITY – MOST COMMON INSTABILITY

MANIFESTATIONS:
1. GAIT CHANGES
2. URINARY INFECTIONS
3. INCREASE DIR
4. RELUCTANCE TO MOVE THE NECK

CAUSE OF DEATH – HEART PROBLEM

TYPES OF AUTISM:
1. SELF INJURIOUS
2. SELF STIMULATING

HIPPOCAMPUS – PART OF BRAIN MOST COMMONLY AFFECTED

SCREENING TESTS:
1. NUCHAL TRANSLUCENCY TESTING (80% ACCURACY)
- BETWEEN 11 AND 14 WEEKS OF PREGNANCY
- USES US TO MEASURE THE CLEAR SPACE FOLDS OF TISSUE BEHIND
CHILD’S NECK.
2. TRIPLE SCREEN OR QUADRUPLE SCREEN (a.k.a MULTIPLE MARKER TEST)
- MEASURES THE QUANTITY OF N SUBSTANCES IN ANOTHER’S BLOOD
3. INTEGRATED SCREEN
- 1ST TRIMESTER SCREENING
- BLOOD TESTS c A 2ND TRIMESTER QUADRUYPLE SCREEN
4. GENETIC ULTRASOUND
- 18 – 20 WEEKS
- CHECKS THE FETUS FOR SOME OF THE PHYSICAL TRAITS ABNORMALITIES
ASSOC. WITH DS.

PRELIMENARY DIAGNOSTIC TEST:

FIRST
NUCHAL TRANSLUCENCY TESTING – 80% ACCURACY
TRIPLE SCREEN OR QUADRUPLE SCREEN
MATERNAL SERUM SCREENING TEST – ESTRIOL, HC6, PaPPa (60%)
SECOND
CVS (CHORIONIC VILUS SAMPLING) – CAUSES MISCARRIAGE
AMMINO CENTESIS
PUBS (PERCUTANEOUS UMBILICAL BLOOD SAMPLING) – MOST ACCURATE
ATHETOID CP
ATHETOID DYSKINETIC CP – MOST COMMON DYSKENETIC FROM
ATHETONIA – SLOW AND INVOLUNTARY MOVEMENT
DYSKINETIC – “DYS” MEANS “ILL”
“KINETIC” MEANS MOVEMENT
POSTURE: ASSYMETRIC POSTURE / ATNR POSTURING
MAIN PROBLEM: BODY IS UNSTABLE
4 TYPES: 3 TYPES OF CP:
1.) PURE ATHETOID 1. CP STASTIC
2.) CHOREO ATHETOID 2. CP DYSKINETIC
3.) SPASTIC ATHETOID 3. CP MIXED TYPE
4.) ATHETOID c DYSTONIA

EPIDEMIOLOGY: ETIOLOGY:
CP – MOST COMMON DISABLING CONDITION 1.) RH INCOMPATIBILITY
1 – 2.3 / 1000 LIVE BIRTHS 2.) BILIRUBIN
5.2 / 1000 LIVE BIRTHS @ 1 YR. OF AGE ENCEPHALOPATHY
3.) HYPOXIC-ISCHEMIC BRAIN
RISK FACTORS: INJURY
- MATERNAL MR 4.) DIRECT et. INDIRECT
- MATERNAL SEIZURE D/O PATHWAY IMBALANCE
- HYPERTHYROIDISM – THIN/LOW BIRTH WEIGHT
- 2 OR MORE PRIOR FETAL DEATHS
- SIBLING c MOTOR DEFICITS
- FETAL BRADYCARDIA
- MULTIPLE BIRTH PREGNANCIES

TYPES OF ABN TONE: ABN REFLEX:

1.) HYPOTONICITY GALANT REFLEX:
2.) HYPERTONICITY – CPSPASTIC STIMULATE 1 SIDE OF
TRUNK, THERE IS
3.) FLUCTUATING TONE – ATHETOID CP BENDING TOWARDS THE
SIDE BEING STIMULATED

4 TYPES OF CP ATHETOID
- ALL ARE QUADRIPLEGIA

1. PURE ATHETOID
- SUBLUXATION: SHOULDER, MANDIBLE, HIPS
- PROXIMAL > DISTAL
- FLUCTUATING mm TONW (LOW – MID)
2. CHOREO ATHETOID
- MOST COMMON MIXED DYSKINETIC TYPE OF CP
- TONE: LOW – HIGH NORMAL
- SUBLUXATION: SAME AS PA
- SITE OF LESION: LENTIFORM
 3. SPASTIC ATHETOID CP
- MOST COMMON MIXED TYPE OF CP
- DISTAL > PROXIMAL – ASSOC. MOVEMENT
- DISTAL < PROXIMAL – SPASTICITY
- PARACHUTE
RIGHT REACTION DELAYED/TOTALLY ABSENT
EQUILIBRIUM REACTION
- TONE: NORMAL - HIGH
4. ATHETOID WITH DYSTONIA
- Mm SPASM WITH FLUCTUATING TONE
- TONE: VERY LOW – VERY HIGH

PD SC GARSH
PUTAMEN – DYSTONIA
STRIATUM – CHOREA
GLOBUS P. – ATHETOSIS, RIGIDITY
SUBTHALAMUS NUCLEUS – HEMIBALLISMUS

BASAL GANGLIA – INCOLLABORATION OF THE CEREBRAL CORTEX, IT FUNCTION FOR

REFINEMENT OF MOVEMENT
– COLLECTION OF MASSES OF GRAY MATTER SITUATED c IN THE
CEREBRAL HEMISPHERES
NUCLEI – GROUP OF CELL BODIES LOCATED AT THE BASE OF THE FOREBRAIN
GRAY – BECAUSE IT IS MADE UP OF CELL BODIES
GANGLIA – OUTSIDE THE CEREBRUM CORTEX / CEREBRUM

CEREBRUM / FOREBRAIN

PROCENCEPHALON/ MESENCEPHALON ROMBENCEPHALON

END BRAIN/
CEREBRAL HEMISPHERE
MIDBRAIN
METENCEPHALON MYELENCEPHALON
- PONS - MEDULLA
TELENCEPHALON DIENCEPHALON (THES) -CEREBELLUM
- CEBRAL CORTEX - SUBTHALAMUS (NEW SNELL)
- SUBCORTICAL WHITE MATTER - HYPOTHALAMUS
- BG - EPITHALAMUS
- THALAMUS

PARTS OF B6:
CORPUS STRIATUM
- SITUATED LAT. TO THE THALAMUS
- COMBINATION OF CAUDATE NUCLEUS AND LENTIFORM NUCLEUS
(GLOBUS PALLIBUS, PUTAMEN)
- CAUDATE NUCLEUS – NUCLEUS SITUATED LAT. TO THE THALAMUS.
STRIATUM
- PRIMARY RECEIVING AREA
- MAIN SENSORY AREA
GLOBUS PALLIDUS
- PRIMARY OUTPUT AREA
- LIGHTER IN COLOR (MYELINATED)

ETIOLOGY:
KERNICTERUS – “KERIN” OR “KERNEL” – NUCLEI
“ICTERUS” – YELLOW
BILIRUBIN ENCEPHALOPATHY – INCREASE BIRUBIN PRODUCTION IN THE BRAIN
BILIRUBIN – N – 3 – 5mg/dl OR 4-5 mg/dl
HYPERBILIRUBINEMA – DUE TO DESTRUCTION OF RBC
16 – 20 mg/dl – BILIRUBIN TOXICITY
100 – 120 DAYS – LIFE SPAN OF RBC
– AFTER 120 DAYS, RBC RELEASE IT’S HEMOGLOBIN
COMPONENT
– HEMOGLOBIN SPLIT INTO: HEME AND GLOBIN /
GLOBULIN (CONTAINS IRON)

PROTEIN CONTENT OF BLOOD:

GLOBIN/GLOBULIN – 38
ALBUMIN – 84
FIBRINOGEN –7
IMMUNOGLOBULIN –1
100

HEME – UNDERGO INITIAL BREAKDOWN TOP FORM

BILIVEROIN / FREE BILIRUBIN

SPLEEN: GRAVEYARD OF ALL RBC

LIVER: BILIRUBIN FORMS A CHEMICAL REACTION WITH A CHEMICAL CALLED
GLUCORONIC ACID

RELEASES AN ENZYME: GLUCORONYL TRANSFERASE

2 TYPES OF BILIRUBIN
- CONJUGATED – GOES TO THE LIVER
- UNCONJUGATED – SPLEEN (BINDS TO ALBUMIN et. GOES TO CIRCULATION –
BRAIN et. CAUSES KERNICTERUS)

CONJUGATED – BINDS TO H2O FOR TRANSMISSION

– BINDS c URINE – UROBILIN (YELLOW APPEARNCE OF URINE)
BILIRUBIN IN INTESTINE – STERCOBILIN (BROWN COLOR IN FECES)

ANATOMY
CORPUS STRIATUM – LAT. TO THE THALAMUS
– COMPOSED OF LENTIFORM AND CAUDATE
CAUDATE N. – C-SHAPE STRUCTURE LOCATED LAT. TO THALAMUS
3 IMPORTANT PARTS:
1. HEAD
2. BODY
3. TAIL – TERMINATE NEAR AMYGDALOIDN
 LESION: CHOREA (ABRUPT, IRREGULAR, JERKY MOVEMENTS)
TYPES: HUNTINGTON’S CHOREA
- A HEREDITARY D/O
- AUTOSOMAL DOMINANT AFFECTING THE SHORTT ARM OF
CHROMOSOME 4
- BETWEEN 20 – 30 y.o.
- DUE TO LOSS OF MOST OF CELL BODIES OF:
1. ACH 3. P SUBSTANCE
2. GABA

LOSS OF GABA: HUNTINGTON’S CHOREA – DOES NOT RESPOND TO ANY

MEDICATION
LOSS OF ACH: DEMENTIA

SYNDENHAM’S CHOREA a.k.a. ST. VITUS DANCE

- MOST COMMON ACWUIRED IN CHILDREN
- AUTOIMMUNE, SELF LIMITING
- GOOD PROGNOSIS
- CAUSE Gr. A β HEMOLYTIC STREPTOCCOCUS INFECTION
- CARDINAL FEATURE OF RHEUMATIC HEART DISEASES.
HEMICHOREA
- 1 SIDE OF BODY IS AFFECTED

PUTAMEN
- FORMS PART OF LENTIFORM N.
- OUTER PART, DARKER COLOR
INTERNAL CAPSULE:
POST. LIMB OF INTERNAL CAPSULE – SEPARATES THE REST OF CAUDATE
N. FROM GP.
ANT. LIMB OF INTERNAL CAPSULE – SEPARATES CAUDATE et. PUTAMEN
EXTERNAL CAPSULE – SEPARATES CALUSTRUM AND PUTAMEN
LESION: CHOREA

AMYGDALA
- EMOTION, MOTIVATION, SEXUAL DESIRE
- LESION: “KLUVER BUCY” – CAN’T APPREICATE THINGS SEEN
HYPERSEXUALITY
RESTLESSNESS
NO DISTURBANCE NO FEAR AND ANGER
OF MEMORY INCREASE APPETITE, DECREASE
AGGRESSIVENESS EMOTIONAL ENSTAB.

STRUCTURES
FUNCTIONALITY CONNECTED B6:
1. INTERNAL CAPSULE
2. SUBSTANTIA NIGRA
3. SUBTHALAMIC NUCLEUS
SUBTHALAMIC NUCLEUS
- LESION: BALLISMUS (LARGE AMPLITUDE FLEEING OF THE LIMBS)
3 IMPORTANT PARTS:
1. ZONA INCERTA
2. FORELS TIGMENTAL FIELD H
3. SUBTHALAMIC NUCLEUS OF LUYS

SUBSTANTIA NIGRA
2 MAIN PARTS:
1. PARS COMPACTA – INPUT B6; PRODUCE DOPAMINE
2. PARS RETICULATA – OUTPUT OF B6
LESION: PARKINSON’S DSS

CEREBELLUM
- AN OVOID SHAPE BILAT. SYMMETRICAL STRUCTURE SITUATED ON POT.
CRANIAL FOSSA.
FUNCTION: REGULATION OF mm TONE, COORDINATION et. BALANCE
LOBES:
ANT. LOBE OR PALEOCEREBELLUM – 2ND OLDEST PORTION
POST. LOBE OR NEDCEREBELLUM

PALEOCEREBELLUM (ANT. LOBE)

- 2ND OLDEST PORTION
- REGULATION OF mm TONE
- MAINTANCE OF GAIT
- PROPULSIVE MOVEMENTS (RUNNING, SWIMMING)
NEOCEREBELLUM (POST. LOBE)
- NEWEST PORTION
- LARGEST PORTION
- LOCATED BETWEEN THE 10 FISSURE et. THE HORIZONTAL FISSURE
- COORDINATION OF MOVEMENTS
ARCHICEREBELLUM (FLOCULLONODULAR LOBE)
- OLDEST PORTION
- POST. TO THE HORIZONTAL FISSURE
- RESPONSIBLE FOR BALANCE, SPATIAL REACTION
LESION – NYSTAGMUS, HEAD TITUBATION
LAT. LESION – NYSTAGMUS, DYSDIHDOCHOKINESIA, DYSMETRIA, IMPAIRED REBOUND
PAENDMENON (STEWARD HOLMES SIGN)

ETIOLOGY CON’T. . .
JAUNDICE – HIGH DEPOSITION OF BILIRUBIN W/IN THE EXTRACELLULAR FLUID
– 10 EFFECT OF VERNIOTERUS
PHYSIOLOGIC - < 14 DAYS INFANT
PATHOLOGIC - > 14 DAYS INFANT OR > 10 DAYS INFANT

BLOOD INCOMPATIBILITY
1. RH INCOMPATIBILITY – THE PROBLEM IS IN THE PARENTS
EX: MOTHER FATHER
RG (-) RH (+)

BABY RH (+)
 SINCE THE MOTHER et. THE BABY ARE NOT COMPATIBLE, THE ANTIBODIES OR
THE MOTHER ATTACH TO THE FETUS. AND DESTROY THE RBC; PHAGOCYTOSIS
OCCURS AND LEADS TO RBC DEATH W/C RESULTS TO BILIRUBIN RELEASE. (BONE
MARROW COMPENSATION)

PREVENTION:
RHOGAM INJECTION – INJECTION OF IMMUNOGLOBIN O.p. DELIVERY TO
PREVENT OTHER PROBLEMS (IMMEDIATELY p DELIVERY)
PHOTOTHERAPY – FOR SEVERE JAUNDICE
– BLUE LIGHT CONVERTS UNCONJUGATED TO
CONJUGATED TYPE OF BILIRUBIN

2. ABO INCOMPATIBILITY O A B AB

ANTIGEN ANTIBODY O X X X
O - A/B A X X
A A B
B X X
B B A
AB AB - AB

EXAMPLE:
FATHER MOTHER
(A) (O)
BABY
(A)

MOTHER et. BABY ARE INCOMPATIBLE

(SAME MECHANISM c RH INCOMPATIBILITY)

HALLMARKS OF CP ATHETOID:
- ONSET IS 5- 10 y.o.
- DOES NOT PROGRESS
- DOES NOT CAUSE CONTRACTURES
- MENTAL STATUS USUALLY NORMAL
I - FINE > GROSS MOTOR INVOLVEMENT
N
V
O
CLINICAL MANIFESTATIONS:
L MOBILE SPASM – CLAWING OF FINGERS/TOES
U – PRNATION SUPINATION
N – ATHETOID DANCE
T FLEETING IRREGULAR LOCALIZED CONTRACTIONS
A
R TONIC SPASM OR DYSTONIA
Y
TIGGERS DUE TO: EXCITEMENT, ANY FORM OF INSECURITY OR
M INSTABILITY, EXERTING
O
V TOO MUCH EFFIORT
’ DECREASES WHEN: Px IS ASLEEP, FEVER, PRONE LYING, DROWSINESS,
T FATIGUE
S
MOST EFFECTIVE
ASSYMETRIC POSTURING – TO PROVIDE STABILITY
HAND SPOONING – WRIST /, FINGERS /
TONGUE THRUSTING – DUE TO OROFACIAL FLUCTUATION
– ALSO A “COPING MECHANISM”
– LIP PURSING AND EXAGGERATED JAW CLOSURE

ATHETOID DANCE - FABER

WEIGHT IN A FORM OF SCRAPPING

BEARING THE GROUND

FACIAL GRIMACING – MISINTERPRETED FACIAL EXPRESSION

– BECAUSE ONLY FEW mm OF THE FACE ARE AFFECTEDF (mm
TWITCHING)
EXPLOSIVE SPEECH – PRODUCE SOUND DURING INSPORATION
– FLUCTUATING RESPIRATORY mmS.
– EVERYTIME THEY DO IT, THEY CAN’T CREATE SOUNDS OR FORM
WORDS.

TRIAD OF KERNICTERUS:
1. HEARING LOSS
2. ATHETOSIS
3. LOSS OF UPWARD GAZE (PARINAUD’S PHENOMENON)
HEARING LOSS – THE EXTENT OF DAMAGE MAY INVOLVE CN VIII

PARINAUD’S PHENOMENON - CN III AFFECTATION

DIFFERENTIAL DX:
SPASTIC ATHETOID
- HYPERTONICITY - FLUCTUATING TONE
- SYMMETRIC POSTURE - ASSYMETRIC POSTURE
- EXCESSIVE CO-CONTRACTION - 9-) CO-CONTRACTION OF
B AGONIST
AND ANTAGONIST mm
- INTROVERT - EXTROVERT
- EASILY ADJUST TO THE DISABILITY THAT THEY HAVE -EASILY FRUSTATED

PT Mx FOR ATHETOID CP
1. VESTI BOARD EX. FOR BALANCE
2. ROM et. STRETCHING EX.
3. GAIT TRAINING
MAIN GOAL: TO PROMOTE MIDLINE ORIENTATION

MEDICAL MX:
1. BACLOFEN (mm SPASM)
2. DANTROLENE (SEVERE mm SPASM) –PERIPHERAL EFFECT
–LESSENS THE Ca CONCENTRATION OF mm
3. DIAZEPAM
4. ANTICHOLINERGIC DRUGS
 PRINCIPLES OF TX:
1. MAINTAIN EACH KEY POINT OF CONTROL LONG ENOUGH TO BE ABLE FOR THE
CHILD TO ADJUST POSTURALIT.
2. STABILITY OF EQUIPMENTS (WELL INFLATED VESTI BALL, LEG ROLLS) BECAUSE
THE SOFTER THE EQUIPMENT, THE MORE UNSTABLE IT IS FOR THE Px.
3. INCORPORATION OF PLAY
4. MOTOR DEMANDS – DON’T USE SMALL OBJETCS BECAUSE FINE MOTOR ARE
AFFECTED IN CP ATHETOID THAN GROSS MOTOR FUNCTION
– USE HEAVY WEIGHT TOYS IN ORDER FOR THE Px TO FEEL THE
JOINT POSITION (PRECAUTION : EXERTING TOO MUCH
EFFORT)
– SIDE LYING: BEST POSITION TO PROMOTE MIDLINE
ORIENTATION
5. VOICE PATTERN – MODIFY YOUR VOICE PATTERN (LOW VOICE TONE)
– IN GIVING INSTRUCTION, IT SHOULD BE SIMPLE et. CLEAR
– LOW TONE – IN ORDER TO CREATE A CALMIONG EFFECT ON
THEM BECAUSE ATHETOIDS ARE UNSTABLE
6. INTERMITTENT JT. COMPRESSION – IT SHOULD BE SUSTAINED TO PROMOTE
STABILITY.

DIDACTICS

CT SCAN – FOR PERVENTRICULAR LEUKOMALACIA

– MULTIDIMENSIONAL
– HEMORRHAGE
MRI – FOR SOFT TISSUE STRUCTURES
– MORE EXPENSIVE
– NOT INDICATIVE FOR CLAUSTROPHOBIC PERSONS
– INDICATIVE FOR OLDER CP PATIENTS
EEG – COMPLETE BLOOD COUNT
CBC – COMPUTE BLOOD COUNT
VISUAL RESPONSE – PRESENT SOME STIMULI
EVOKE – USE A TOOL PLACED ON PATIENTS HEAD TO INDICATE THAT THE
RESPONSE OCCIPITAL LOBE HAS N FUNCTION ON VISUAL ACQUITY.
BRAINSTEM AUDITORY EVOICE RESPONSE
LUMBAR TAP – TO CHECK IF THERE’S INFECTION IN CSF
– L2-L3 (SAFEST)
– CLOUDY COLORED CSF – INCREASE WBC

MATERNAL Hx:
ALCOHOLISM VASODILATION
- FETAL ALCOHOL Sx (MICROCEPHALIC, FACIAL DEFECTS, ANTISOCIAL)

AGE
TOO YOUNG – PRE-ECLAPSIA – INCREASE BP AFTER MID-PREGNANCY
(URINALYSIS – (+) PROTEIN IN URINE)
– GESTATIONAL HYPERTENSION a.k.a PREGNANCY INDUCED HTN
INCREASE BP IN MID-
PREGNANCY s PROTENURIA
(PROTEIN IN URINE)
 SIGNS OF PRE-ECLAPSIA:
- SUDDEN WEIGHT GAIN
- SWELLING
- PERSISTENT H/A
- NAUSEA AND VOMITING
- CHANGES IN VISION

– CHRONIC HYPERTENSION INCREASE BP a PREGNANCY OR AFTER 2-3

MONTHS AFTER DELIVERY

LABOR HOURS:
IMPORTANCE: TO DETERMINE IF THE MOTHER HAS PROLONGED LABOR
CAUSES HYPOXIA
(ELDEST) PRIMIPARUS – 12-18 HOURS. NORMAL LABOR HRS.
(SUCEEDING) MULTIPARUS – 8-12 HOURS.

BIRTH Hx:
- MANNER OF DELIVERY – NSUD
– CEASARIAN
- PRESENTATION: CEPHALIC
BREECH – TRANSVERSE FOOT LEG

VACUUM – CAUSES WOUND ON BABY’S SCALP

FORCEPTS – CAUSES TEAR ON MOTHER’S VAGINA

APGAR – 2 TIMES: IMMEDIATELY AFTER DELIVERY

AFTER 5 MINUTES
GRADE 5: BOARDERLINE
(3RD ASSESSMENT MAY DEPEND ON 2ND ASSESSMENT; AFTER 10 MINUTES)

APPEARANCE – 0 – CYANETIC (BLUSH)

1 – PINKISH TRUNK
BLUISH EXTREMITIES
2 – PINKISH COLOR

PULSE – 0 – ABSENT
1 - < 100 bpm
2 - > 100 bpm

GRIMACE – 0 – NO FACIAL EXPRESSION (NO TWITCHING)

1 – (+) FACIAL EXPRESSION FOLLOWING STIMULUS
2 – FACIAL EXPRESSION

ACTIVITY – 0 – LIMP (HYPOTONIC/FLACCID)

1 – SOME / MOVEMENTS
2 – SPONTANEOUS MOVEMENTS

RESPIRATION – 0 – ABSENT
1 – PERIODS OF APNEA (IRREC. BREATHING)
2 – GOOD CRYING (LOUD)
PERIOD OF GESTATION: 38-42 WEEKS (FULL TERM)
< 36 WEEKS (PREMATURE)
> 42 WEEKS (POST-TERM)
POST TERM: CHILD MAY SWALLOW HIS/HER FECES CAUSES ALVEOLAR
DESTRUCTION AND MAY LEAD TO PNEUMONIA ASPHYXIA
MECONIUM ASPIRATION

NUTRITIONAL Hx:
- BREASTFEEDING
- BOTTLE FEEDING
- SEMI-SOLID FOOD
- SOLID FOOD
- VITAMINS AND MEDICATIONS
- SWALLOWING
- SUCKING
- CHEWING

IMMUNIZATION:
BCG– BACILLUS CALMETTE GUERIN – 1ST GWEN
– PREVENTION AGAINST TUBERCULOSIS
DPT – DIPTERIA PETTUSIS
– FOR WOOFING COUGHS
OPB – ORAL POLIO VACCINE
MMR – MEASLE MUMPS RUBELLA
HEPA B – VACCINES

DEVELOPMENTAL MILESTONES – REVIEW!

PAST MEDICAL Hx:

- PREVIOUS HOSPITALIZATION
- SURGERY

OBJECTIVE:
OI: AMBULATORY, AMBULATORY WITH ASSISTIVE DEVICE WHICH BOUND LEVEL OF
CONSCIOUSNESS
(ALERT – FULLY AWAKE, AWARENESS TO THE ENVIRONMENT ;
LETHARGIC – VERBAL STIMULUS;
OBTUNDED – VERBAL + REPITITIONS + TACTILE;
STUPUROUS – PAINFUL STIMULUS, FORM OF RESPONSE: WITHDRAWAL ;
COMA – NO RESPONSE)

ELEVATED LEVEL OF CONSCIOUSNESS:

- EUPHORIA
- DELIRIUM (HALLUCINATIONS) – VISUAL, AUDITORY, OLFACTORY
– 20 TO HYPERSENSIVITY

COHERENCY – CAN THE PATIENT UNDERSTAND?

FOLLOW SIMPLE COMMANDS?
COOPERATIVE
 NUTRITIONAL STATUS: WELL NOURISHED
UNDER NOURISHED
OVER NOURISHED
FORM OF COMMUNICATION:
NON-VERBAL: GESTURES, FACIAL EXPRESSIONS, SIGN LANGUAGE
VERBAL: PRELINGUISTIC – 1. UNDIFFERENCIATED CRYING
2. DIFFERENTIATED CRYING
3. COOING – INCOMPREHENSIVE SOUNDS
4. BUBBLING – VOWELS + CONSONANTS
5. LALLING / LALLATION – IMPERFECT IMMITATION
OF WORDS “BULOL”.
6. ECHOING – PERFECT IMMITATION ECHOLALIA
BUT DOESN’T KNOW THE MEANING OF IT.
7. EXPRESSIVE JARGON – CREATE SENCE WITH
CORRESPONDING RHYTHM AND PAUSE. BUT IS
NOT UNDERSTANDABLE TO THE LISTENER.
LINGUISTIC – 2 WORDS; SENTENCE FORM
HEAD CIRCUMFERENCE: LANDMARKS: GLABELLA (SUPRAORBITAL RIDGE)
OCCIPITAL PROTUBERANCE
IS THE HEAD SIZE APPROPRIATE TO THE PATIENT’S BODY
WEIGHT?
MICROCEPHALIC – MR
TRIAD OF HYDROCEPHALUS
1. CRACKPOT SIGN
2. SUNSET EYES

AUTISM – MORE SEVERE THAN MR

– BECAUSE MOST AUTISTICS ARE MR BUT NOT ALL MR ARE AUTISTIC.
– IN MR, THE ONLY PROBLEM IS COGNITION
– SELF – STIMULATING
– SELF – INJURIOUS

2 TYPES OF HYDROCEPHALUS
NON – COMMUNICATING – PROBLEM IS ON THE INSIDE DUE TO PREMATURE
CLOSURE OF THE AQUEDUCT OF SYLVIUS
COMMUNICATING – THE PROBLEM IS ON THE OUTSIDE DUE TO REABSORPTION
OF CSR.
MOST COMMON

EYE DEFORMITY – STRABISMUS IS MOST COMMON (NOT ALL HAVE DIPLOPIA)

TYPES:
1. HYPOTROPIA – EYEBALL
2. HYPERTROPIA – EYEBALL
3. ESOTROPIA – EYEBALL MEDIAL (INT. STRABISMUS OR
CONVERGENT STRABISMUS)
4. EXOTROPIA – EYEBALL LATERAL (EXT. STRABISMUS OR
DIVERGENT STRABISMUS)

DIPLOPIA – THE PROBLEM IS MORE ON DOUBLE VISION EVEN IF THE EYEBALL DOE
NOT DEVIATE
NYSTAGMUS – LESION: CEREBELLUM
CN VIII
- RAPID OSCILLATION OF EYEBALL UPON FIXATION
- PROBLEM IN mm COORDINATION

EXTREMITIES: STRAPHANGER VS. BIRD WING