dr. pradeep dubey - consultant pediatrician dr. pradeep dubey md (ped.), dch. md (ped.), dch. cons....

Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician

Dr. Pradeep DubeyDr. Pradeep Dubey MD (Ped.), DCH.MD (Ped.), DCH.

Cons. Developmental & Neuro Cons. Developmental & Neuro

PedPed..

Dr. Pradeep DubeyDr. Pradeep Dubey MD (Ped.), DCH.MD (Ped.), DCH.

Cons. Developmental & Neuro Cons. Developmental & Neuro

PedPed..

NEUROLOGICAL ASSESSMENTNEUROLOGICAL ASSESSMENT

OF INFANTS OF INFANTS

““DEVCHHAYA” DEVCHHAYA” Early Intervention CentreWright Town - Jabalpur


STRABISMUS IN C.P.STRABISMUS IN C.P.STRABISMUS IN C.P.STRABISMUS IN C.P.


CRITICAL PERIOD IN BRAIN MATURATION CRITICAL PERIOD IN BRAIN MATURATION CRITICAL PERIOD IN BRAIN MATURATION CRITICAL PERIOD IN BRAIN MATURATION

Kitten blind folded after birth for 3 months

developed acquired amblyopia, Visual Cortex

start processing auditory information.

Strabismus in infants leads to acquired

amblyopia

Congenital deafness – auditory area process

visual information.

“WE USE IT OR WE LOSE

IT”


SOME EXPERIMENTSSOME EXPERIMENTSSOME EXPERIMENTSSOME EXPERIMENTS

Phantom limb & Virtual reality mirror boxPhantom limb & Virtual reality mirror box

Kitten’s one eye was stitched – Brain Kitten’s one eye was stitched – Brain

mapping shows concerned part of brain mapping shows concerned part of brain

started processing information of other eye.started processing information of other eye.

Grey matter mass of Med. Students brain Grey matter mass of Med. Students brain

increased in months of exam.increased in months of exam.

Brain port in patient with Vestibular damage Brain port in patient with Vestibular damage

– Secondary pathways unmasked. – Secondary pathways unmasked.

Phantom limb & Virtual reality mirror boxPhantom limb & Virtual reality mirror box

Kitten’s one eye was stitched – Brain Kitten’s one eye was stitched – Brain

mapping shows concerned part of brain mapping shows concerned part of brain

started processing information of other eye.started processing information of other eye.

Grey matter mass of Med. Students brain Grey matter mass of Med. Students brain

increased in months of exam.increased in months of exam.

Brain port in patient with Vestibular damage Brain port in patient with Vestibular damage

– Secondary pathways unmasked. – Secondary pathways unmasked.

NEUROPLASTICITY IS ONE OF THE EXTRA -NEUROPLASTICITY IS ONE OF THE EXTRA -

ORDINARY DISCOVERIES OF 20ORDINARY DISCOVERIES OF 20th th OCENTURYOCENTURY(NORMAN DOIDGE)(NORMAN DOIDGE)


NEUROPLASTICITY NEUROPLASTICITY NEUROPLASTICITY NEUROPLASTICITY

Brain tissues are plastic and

responsive .

Adequate and repeated stimuli can

modify brain physiology as well as

morphology

Brain port in patient with Vestibular

damage – Secondary pathways

unmasked.

Grey matter mass of Med. Students

brain increase in months of exam.

““DO WE MAKE THE ROAD BY DO WE MAKE THE ROAD BY

WALKING.”WALKING.”


Anatomical PeculiaritiesAnatomical Peculiarities

Intracranial Hemorrhage & Intracranial Hemorrhage &

periventricular Leukomalacia.periventricular Leukomalacia.

Birth wt. 800 – 1000 gms. Birth wt. 800 – 1000 gms. 6 – 8%6 – 8%

Birth wt. 800 gms. & less Birth wt. 800 gms. & less 20 – 40% 20 – 40%

Anatomical PeculiaritiesAnatomical Peculiarities

Intracranial Hemorrhage & Intracranial Hemorrhage &

periventricular Leukomalacia.periventricular Leukomalacia.

Birth wt. 800 – 1000 gms. Birth wt. 800 – 1000 gms. 6 – 8%6 – 8%

Birth wt. 800 gms. & less Birth wt. 800 gms. & less 20 – 40% 20 – 40%

PREMATURITY & LBWPREMATURITY & LBWPREMATURITY & LBWPREMATURITY & LBW

US spending 26 billion dollars (120,000 Crors Rs.) annually on Preterm babies and their

related problems


Low birth weight babies.

Severe H.I.E.

Severe neonatal jaundice

Persistence of Abn. Neuro signs after 2

wks.

Hypodensisties in Ct. even after 4 wks.

Oliguria (<1ml./kg./ hr.) for 24 hrs.

associated with H.I.E.

Low apgar (0-3) after 20 mts.

Late seizures in a depressed NB

Background abnormalities in interictal

EEG.

HIGH RISK CONDITIONSHIGH RISK CONDITIONSHIGH RISK CONDITIONSHIGH RISK CONDITIONS


DYSKINETIC - C.P.DYSKINETIC - C.P.DYSKINETIC - C.P.DYSKINETIC - C.P.


Mother – Rh negative

Precautions for Rh

incompatibility

MATERNAL BLOOD GROUPMATERNAL BLOOD GROUPMATERNAL BLOOD GROUPMATERNAL BLOOD GROUP


Low apgar (0-3) after 20 mts.Low apgar (0-3) after 20 mts.

Late seizures in a depressed NBLate seizures in a depressed NB

Persistence of Abn. Neuro signs after 2 Persistence of Abn. Neuro signs after 2

wks.wks.

Hypodensisties in Ct. even after 4 wks.Hypodensisties in Ct. even after 4 wks.

Oliguria (<1ml./kg./ hr.) for 36 hrs. Oliguria (<1ml./kg./ hr.) for 36 hrs.

associated with H.I.E.associated with H.I.E.

Background abnormalities in interictal Background abnormalities in interictal

EEG.EEG.

Low apgar (0-3) after 20 mts.Low apgar (0-3) after 20 mts.

Late seizures in a depressed NBLate seizures in a depressed NB

Persistence of Abn. Neuro signs after 2 Persistence of Abn. Neuro signs after 2

wks.wks.

Hypodensisties in Ct. even after 4 wks.Hypodensisties in Ct. even after 4 wks.

Oliguria (<1ml./kg./ hr.) for 36 hrs. Oliguria (<1ml./kg./ hr.) for 36 hrs.

associated with H.I.E.associated with H.I.E.

Background abnormalities in interictal Background abnormalities in interictal

EEG.EEG.

INDICATORS OF POOR OUTCOME IN A SICK NEW BORNINDICATORS OF POOR OUTCOME IN A SICK NEW BORNINDICATORS OF POOR OUTCOME IN A SICK NEW BORNINDICATORS OF POOR OUTCOME IN A SICK NEW BORN


Responsiveness / Alertness

Spontaneous motility

Persistant hyper excitability

Feeding difficulty

Constant fisting

Abnormal movements / convulsions.

Abnormal postures

Abnormal Head circumerence

Responsiveness / Alertness

Spontaneous motility

Persistant hyper excitability

Feeding difficulty

Constant fisting

Abnormal movements / convulsions.

Abnormal postures

Abnormal Head circumerence

ALARMING SIGNSALARMING SIGNS

Abnormalities of tone

Ocular abnormalities

Lack of response to

sound.

Abnormalities of tone

Ocular abnormalities

Lack of response to

sound.


Responsiveness / AlertnessResponsiveness / Alertness

Spontaneous motilitySpontaneous motility

Persistant hyper excitability Persistant hyper excitability

Feeding difficultyFeeding difficulty

Constant fistingConstant fisting

Abnormal movements / convulsions.Abnormal movements / convulsions.

Abnormal posturesAbnormal postures

Abnormal Head circumerence.Abnormal Head circumerence.

Responsiveness / AlertnessResponsiveness / Alertness

Spontaneous motilitySpontaneous motility

Persistant hyper excitability Persistant hyper excitability

Feeding difficultyFeeding difficulty

Constant fistingConstant fisting

Abnormal movements / convulsions.Abnormal movements / convulsions.

Abnormal posturesAbnormal postures

Abnormal Head circumerence.Abnormal Head circumerence.

ALARMING SIGNSALARMING SIGNSALARMING SIGNSALARMING SIGNS


HEMIPLEGIC C.P.HEMIPLEGIC C.P.HEMIPLEGIC C.P.HEMIPLEGIC C.P.


AMIEL TISON - 2 MTHS, 7 MTHS, 12 AMIEL TISON - 2 MTHS, 7 MTHS, 12

MTHSMTHS

P.G. I. CHANDIGRAH – 9 MTHS.P.G. I. CHANDIGRAH – 9 MTHS.

OTHERS - 8 MONTHSOTHERS - 8 MONTHS

AGE FOR ASSESSMENTAGE FOR ASSESSMENTAGE FOR ASSESSMENTAGE FOR ASSESSMENT


AMEIL TISON’S METHODAMEIL TISON’S METHOD

VOJTA’S TECHNIQUEVOJTA’S TECHNIQUE

CAPUTE AND ASSOCIATES CAPUTE AND ASSOCIATES

INFANT NEUROLOGICAL INFANT NEUROLOGICAL

INTERNATION INTERNATION BATTERY (INFANIB)BATTERY (INFANIB)

AMEIL TISON’S METHODAMEIL TISON’S METHOD

VOJTA’S TECHNIQUEVOJTA’S TECHNIQUE

CAPUTE AND ASSOCIATES CAPUTE AND ASSOCIATES

INFANT NEUROLOGICAL INFANT NEUROLOGICAL

INTERNATION INTERNATION BATTERY (INFANIB)BATTERY (INFANIB)

NEURO DEVELOPMENTAL EXAMINATION METHODSNEURO DEVELOPMENTAL EXAMINATION METHODSNEURO DEVELOPMENTAL EXAMINATION METHODSNEURO DEVELOPMENTAL EXAMINATION METHODS


INFANIB: Brief Description


INFANIB

• Appropriate for use with neonates and Infants up to 18 months of age.

• 14 Items are assessed in the neonatal period while 6 others are added between

3- 9 months of age.


INFANIB: Items Details

Items consists under following categories-

a. Measures of muscle range and resistance to passive

movements (Scarf sign, Popliteal angle etc.)

b. Reflexive Responses (Foot grasp, ATNR etc.)

c. Equilibrium reactions (Parachute responses etc.) and

d. Quality of certain milestones (Sitting position, Weight

bearing in standing etc)


Hands: Open/Closed

Normal Response


Hands: Open/Closed

Abnormal Response


Scarf Sign

Normal Response


Scarf Sign

Abnormal Response


Heel-to-Ear

Normal Response


Heel-to-Ear

Abnormal Response


Popliteal Angle

Normal Response


Popliteal Angle

Abnormal Response


Leg Abduction

Normal Response


Leg Abduction

Abnormal Response


Dorsiflexion of FootNormal Response


Dorsiflexion of Foot

Normal Response


Dorsiflexion of Foot

Abnormal Response


Foot Grasp

Normal Response


Foot Grasp

Abnormal Response


Tonic Labyrinthine Supine

Normal Response


Tonic Labyrinthine Supine

Abnormal Response


Asymmetric Tonic Neck Reflex

Normal Response


Asymmetric Tonic Neck Reflex

Abnormal Response


Pull to Sit

Normal Response


Pull to Sit

Abnormal Response


Body Derotative

Normal Response


Body Derotative

Abnormal Response


Body Rotative

Normal Response


Body Rotative

Abnormal Response


All-Fours

Normal Response


All-Fours

Abnormal Response


Tonic Labyrinthine Prone

Normal Response


Tonic Labyrinthine Prone

Abnormal Response


Sitting

Normal Response


Sitting

Abnormal Response


Sideways parachuteNormal Response


Sideways parachute

Abnormal Response


Backward Parachute

Normal Response


Backward Parachute

Abnormal Response


Standing

Normal Response


Standing

Abnormal Response


Positive Supporting ReactionNormal Response


Positive Supporting Reaction

Abnormal Response


Forward Parachute

Normal Response


Forward ParachuteAbnormal Response


High Risk Neonate


Normal Infant


Ataxia


Spastic


Hypotonia


Alignment

Spine

Head Tilt

Head rotation

Leg progression


Atypical Static Postural Alignment


Equinus

Scissoring

Equinus

Lack Of base of Support


Foot Deformity

Midfoot break

Hindfoot eversion


Head – size shape, fontanell Head – size shape, fontanell

suturessutures

Eyes – Setting sun, Strabismus, Eyes – Setting sun, Strabismus,

nystagmusnystagmus

Skin abnormalities – Cafeaulet, Skin abnormalities – Cafeaulet,

Nevi etc.Nevi etc.

Cranial nervesCranial nerves

Altered mental statusAltered mental status

Spine Spine

AMIEL TISON’S METHODAMIEL TISON’S METHODAMIEL TISON’S METHODAMIEL TISON’S METHOD

A. GENERAL DISCRIPTIONA. GENERAL DISCRIPTION


1.1. ToneTone - Scarf sign heel to ear- Scarf sign heel to ear

leg abduction, Popliteal leg abduction, Popliteal

angelangel

- - dorsoflexion of footdorsoflexion of foot Pull Pull

to sit.to sit.

prone, sitting positionprone, sitting position

- atnr,- atnr,

2. Vestibular2. Vestibular - Side ways sparachute, - Side ways sparachute,

backward &backward &

FunctionFunction forward parachute, body forward parachute, body

rotativerotative

3. Lethargy/Hyper excitability 3. Lethargy/Hyper excitability

4. Vision & Hearing 4. Vision & Hearing

5. Developmental delay 5. Developmental delay

AMIEL TISON’S METHODAMIEL TISON’S METHODAMIEL TISON’S METHODAMIEL TISON’S METHOD


PROGNOSIS FOR WALKING IN CPPROGNOSIS FOR WALKING IN CPPROGNOSIS FOR WALKING IN CPPROGNOSIS FOR WALKING IN CP

Hemiplegia 100%

Diplegia (Paraplegic)90%

Ataxia/ Dyskinesia80%

Quadriplegia 18%


PRIORITIES OF MANAGEMENT PRIORITIES OF MANAGEMENT PRIORITIES OF MANAGEMENT PRIORITIES OF MANAGEMENT

CommunicationCommunication

Socioemotional DevelopmentSocioemotional Development

Maximal independence in ADLMaximal independence in ADL

As near normal appearance as As near normal appearance as

possiblepossible

MobilityMobility


www.healthychildindia.comwww.healthychildindia.com

“DEVCHHAYA” Early Intervention CentreEarly Intervention Centre

Prem Mandir Chowk, Wright Town

“DEVCHHAYA” Early Intervention CentreEarly Intervention Centre

Prem Mandir Chowk, Wright Town

dr. pradeep dubey - consultant pediatrician dr. pradeep dubey md (ped.), dch. md (ped.), dch. cons....

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