By-Dr. Swati Bhattacharya PT

MPT-Neurology

Name Age/sex D.O.B.- Address Father’s name Fathers occupation Mother’s name Mother’s occupation Socio economic status Hand preference

Mother’s history-

Pre-natal

Age at the time of marriage

Consanguineous marriage

Duration of pregnancy

Health during pregnancy

Drugs taken

Exposure to X-rays

Infections/Traumas

Natal

Age at time of delivery

Type of delivery

Duration of labour pain

Place of delivery

Post Natal

Lactation

Complaints Post Delivery

Child’s history Pre term/term/post term-preterm-less than 37 weeks of

gestation; term- 40 weeks ; post term- longer than 40 weeks Birth cry Birth weight ideal- 2.5-3.8kg Head circumference ideal- around 35cms and grows up to

3cm in one month Convulsions Jaundice Any infection

Family history

No. of children

Ordinal no. of children

Type of family

Pedigree chart

Treatment history

Bowel/bladder dysfunction

Drooling

Microcephaly/macrocephaly

Speech problems

Hearing deficits

Vision impairments

Mental retardations

MILESTONE ACHIEVED AT

Prone head raise to just off 1st month

Head control By 3rd month

Rolling•Prone-supine•Supine-prone

4-5 month

Supported sitting 5-6 month

Unsupported sitting 6-7 month

Crawling 8-9 month

Supported standing 9-10 month

Unsupported standing 10-11 month

Walking 12 month

Innate primary reactions•Startle•Rooting•Sucking•Grasping•Moros•Placing lower extremity•Placing upper extremity

Spinal level•Flexor withdrawal•Extensor thrust•Crossed extension

Brain stem level•Asymmetrical tonic neck reaction•Symmetrical tonic neck reaction•Tonic labyrinthine prone•Positive supporting reaction•Associated reactions

MID BRAIN LEVEL•Neck righting acting on head•Body righting acting on head•Labyrinthine righting acting on head

AUTOMATIVE MOVEMENT REACTION•Landau Reflex•Protective extensor thrust or parachute reaction

CORTICAL REFLEXES•Optic Righting

EQUILIBRIUM REACTIONS•Prone•Supine•Sitting•Quadruped•Kneel standing•Standing

Mouthing reflexes- important for baby’s survival, helping them find the source of food.

i. Sucking – a baby will automatically begin to suck when their mouth or lips are touched.

ii. Rooting reflex- is when the baby turns his head towards your hand if their cheek is touched. This helps the baby find the nipple for feeding.

- it begins to fade at around 4 months

Grasp reflex- a baby will grasp a finger or object when it is placed in the palm of his hand.

This reflex is strongest during the 1st 2 months and fades away by 5-6 months.

Even though the baby cannot support his own weight, if his feet are placed on a flat surface, he will begin to step one foot in front of the other.

It disappears usually by 2 months.

Landau reflex or Landau reaction refers to position of the infant when held horizontally in the air in the prone position.

If the head is flexed, hip, knees and elbows are also flexed.

It emerges 3 months after birth and lasts until up to 12 months to 24 months of age.

Clinical significance- absence of reflex occurs in hypertonia, hypotonia and mental abnormality.

a primitive reflex response observed in the normal newborn.

typically suppressed by 3-4 months of age.

Any sudden stimulus (e.g. a sudden loud noise, a blow to the supporting surface, or being dropped 5-10cm through space) causes flexion of the hip and knee joints with fanning of the fingers followed by fist clenching and extension of the upper limbs followed by flexion.

Clinical significance- asymmetry in hemiparesis, early sign of cerebral palsy

The crossed extensor reflex is a withdrawal reflex. When the reflex occurs the flexors in the withdrawing limb contract and the extensors relax, while in the other limb, the opposite occurs.

Primitive reactions

i. Rooting- enables infant to find nipple, allows active contraction of neck muscles

ii. Suck-swallow- enables attainment of nourishment

iii. Moro – breaks up flexion posture to permit extension of trunk and extremities

iv. Flexor withdrawal- serve as protective response to noxious stimuli

v. Plantar grasp- integration needed for standing

At 4 weeks- the infant’s head position is dominated by the tonic neck reflexes. Head lag is noticed in the pull to sitting position

1. Motor examinationa. Involuntary movements

b. Muscle tone- (Modified Ashworth’s Scale)

c. Voluntary motor control

d. Clonus

e. Deep Tendon ReflexesMYO TACTIC REFLEXES

RIGHT SIDE LEFT SIDE

Jaw (C.N.V)

Biceps (C5,C6)

Triceps (C6,T1)

Hamstrings (L4,S1,S2)

Quadriceps (L2,L3,L4)

Archilles (S1-S2)

f. Limb Length Discrepancy

RIGHT LEFT

Apparent• (Umblicus to Medial Malleolus)

True•ASIS to GT•GT to Medial Condyleof Tibia•Medial condyle to Medial malleolus

g. Babinski Sign- occurs after the sole of the foot is firmly stroked. The big toe then moves upward and the other toes fan out.

This sign is positive in infants up to the age of 2 years. Beyond 2 years, the sign becomes negative as the toes flex instead

of fanning out. Clinical significance- sign of brain or nervous system disorder if it

is positive in cases older than 2 years. Disorders may include-i. ALSii. Meningitisiii. Brain injury or tumoriv. SCI, defect or tumorv. Strokevi. Multiple sclerosis

A- the child is awake, alert, interactive with parents and care providers

V- the child responds only if the care provider or parents call the child’s name or speak loudly

P- the child responds only to painful stimuli, such as pinching the nail bed of a toe or finger

U- the child is unresponsive to all stimuli

Centration- tendency to focus on only one aspect of a situation at one time.

Egocentrism- Egocentrism refers to the child's inability to see a situation from another person's point of view. According to Piaget, the egocentric child assumes that other people see, hear, and feel exactly the same as the child does.

Pretend (or symbolic) play: Toddlers often pretend to be people they are not (e.g. superheroes, policeman), and may play these roles with props that symbolize real life objects. Children may also invent an imaginary playmate. 'In symbolic play, young children advance upon their cognitions about people, objects and actions and in this way construct increasingly sophisticated representations of the world' (Bornstein, 1996, p. 293).

Animism: This is the belief that inanimate objects (such as toys and teddy bears) have human feelings and intentions. By animism Piaget (1929) meant that for the pre-operational child the world of nature is alive, conscious and has a purpose. Piaget has identified four stages of animism:

i. Up to the ages 4 or 5 years, the child believes that almost everything is alive and has a purpose.

ii. During the second stage (5-7 years) only objects that move have a purpose.

iii. In the next stage (7-9 years), only objects that move spontaneously are thought to be alive.

iv. In the last stage (9-12 years), the child understands that only plants and animals are alive.

Artificialism: This is the belief that certain aspects of the environment are manufactured by people (e.g. clouds in the sky).

Irreversibility: This is the inability the reverse the direction of a sequence of events to their starting point.

Play: At the beginning of this stage you often find children engaging in parallel play. That is to say they often play in the same room as other children but they play next to others rather than with them. Each child is absorbed in its own private world and speech is egocentric. As yet the child has not grasped the social function of either language or rules.

Intellectually a child should have gained vocabulary which can allow them to have a conversation with people.

Start understanding the response adults give.

At this life stage they are also aware of simple right and wrongs; of how to behave both at school and at home

they are also no longer egocentric.

At this stage their brains are also developing at a much faster speed.

Adolescents usually at age 11+ : are able to logically use symbols related to abstract concepts, such as algebra and science. They can think about multiple variables in systematic ways, formulate hypotheses, and consider possibilities. They also can ponder abstract relationships and concepts such as justice.

Goodenough-Harris Drawing Test-

this test is best suited for children in the age group of 7-10.

the child is asked to draw three pictures- a man, a a woman and a self portrait.

The therapist will ask the child to explain each of the pictures to clarify what each component of the drawing represents to the child.

Reliability of this test is low.

It is a cognitive ability and intelligence test that is used to diagnose developmental or intellectual deficiencies in young children.

The test measures five weighted factors and consists of both verbal and nonverbal subtests.

The five factors being tested are knowledge, quantitative reasoning, visual-spatial processing, working memory, and fluid reasoning.

Verbal Reasoning, Abstract/Visual Reasoning, Quantitative Reasoning, and Short-Term Memory

The test consists of 15 subtests, which are grouped into the four area scores.

Not all subtests are administered to each age group; but six subtests are administered to all age levels.

These subtests are: Vocabulary, Comprehension, Pattern Analysis, Quantitative, Bead Memory, and Memory for Sentences.

The number of tests administered and general test difficulty is adjusted based on the test taker's age and performance on the sub-test that measures word knowledge.

The subtest measuring word knowledge is given to all test takers and is the first subtest administered.

Scoring :

The numbers of correct responses on the given subtests are converted to a SAS score or Standard Age Score which is based on the chronological age of the test subject. This score is similar to an I.Q. score. Based on these norms, the Area Scores and Test Composite on the Stanford-Binet Intelligence Scale each have a mean or average score of 100 and a standard deviation of 16.

Stanford-Binet classification

IQ Range IQ Classification

145-160 Very gifted or highly advanced

130-144 Gifted or very advanced

120-129 Superior

110-119 High average

90-109 Average

80-89 Low average

70-79 Borderline impaired or delayed

55-69 Mildly impaired or delayed

40-54 Moderately impaired or delayed

Reliability - Several reliability tests have been performed on the SB5 including split-half reliability, standard error of measurement, plotting of test information curves, test-retest stability, and inter-scorer agreement. On average, the IQ scores for this scale have been found to be quite stable across time (Janzen, Obrzut, & Marusiak, 2003). Internal consistency was tested by split-half reliability and was reported to be substantial and comparable to other cognitive batteries (Bain & Allin, 2005). The median interscorer correlation was found to be .90 on average (Janzen, Obrzut, & Marusiak, 2003).

Validity - Content validity has been found based on the professional judgments Roid received concerning fairness of items and item content as well as items concerning the assessment of giftedness (Bain & Allin, 2005). With an examination of age trends, construct validity was supported along with empirical justification of a more substantial g loading for the SB5 compared to previous editions. The potential for a variety of comparisons, especially for within or across factors and verbal/nonverbal domains, has been appreciated with the scores received from the SB5 (Bain & Allin, 2005).

The Wechsler Intelligence Scale for Children (WISC), developed by David Wechsler, is an individually administered intelligence test for children between the ages of 6 and 16 inclusive that can be completed without reading or writing.

The Fifth Edition (WISC-V) is the most current version.

16 and over are tested with the Wechsler Adult Intelligence Scale (WAIS), and children ages 3 years to 7 years and 3 months are tested with the Wechsler Preschool and Primary Scale of Intelligence (WPPSI)

A total of five composite scores could be derived with the WISC–V.

i. The WISC-V generated a Full Scale IQ (FSIQ) which represented overall intellectual ability, the four other composite scores were the

ii. Verbal Comprehension index (VCI),

iii. Perceptual Reasoning Index (PRI),

iv. Processing Speed Index (PSI), and

v. Working Memory Index (WMI).

Information: child is asked question such as- “how many days are there in a week?” to assess the basic fund of knowledge

Similarities : child is asked to describe how two objects go together or are alike? (e.g. cat and mouse) which assess higher order conceptual abilities, abstract verbal reasoning and language facility

Vocabulary : child is asked to define words which assess receptive vocabulary (e.g. bicycle)

Comprehension : child is asked questions that require practical reasoning. (e.g. what is the thing you do if you cut your finger? Or why should a promise be kept?

Arithmetic : child is asked to count objects or compute simple word problems without assistance of paper and pencil. (e.g. if I cut an apple in half, how many pieces will I have left?”)

Digit span (verbal optional test) : child repeats series of three to nine numbers forward and series of two to eight numbers backwards which assesses attention and short term memory

Letter-Number Sequencing : children are provided a series of numbers and letters and asked to provide them back to the examiner in a predetermined order.

Block design : child must recreate designs using blocks with sides that are all red, all white or half red/half white, which assesses visual-motor coordination, spatial perception and problem solving

Object assembly : child must assemble puzzle pieces to produce five objects(e.g. child, horse, car, human face, ball) which assesses visual-motor coordination

Mazes (optional): child must draw a line from the middle of the maze to the exit without entering any blind alleys which assesses visual motor skills, inductive reasoning, spatial reasoning and planning.

Picture completion (performance) : child is asked to identify what parts are missing in a series of pictures (e.g. leg of an elephant) which assess part-whole relationships

Picture arrangement- (performance;timed) child is asked to arrange a set of jumbled pictures to tell a story which assesses visual sequencing, social awareness, planning and appreciation of relationships or events

Coding : a substitution task in which the child must fill a blank row of squares above a row of shapes or numbers with the appropriate symbol keyed to the same number or shape, which assess visual motor coordination, visual working memory and motor efficiency

Symbol search (optional): child must determine whether the example shapes are included among a group of test shapes, which assesses visual-motor coordination and visual perception/analysis

IQ Range IQ Classification

130 and above Very superior

120-129 Superior

110-119 High average

90-109 Average

80-89 Low average

70-79 Borderline

69 and below Extremely low

WISC-V primary and secondary subtest internal consistency estimates ranged from .81(SS) to .94 (FW) while processed scores ranged from .80 (DSb) to .88 (BDp)

For more refer- Review of the Wechsler Intelligence Scale for Children-fifth edition critique, commentary and independent analyses by Gary L Canivez (Eastern Ilionos University) and Marley W Watkins (Dept. of Educational Psychology Baylor University)

is a clinical instrument (psychological diagnostic test) for assessing cognitive development.

The test consists of 16 subtests—10 mental processing subtests and six achievement subtests. Not all subtests are administered to each age group, and only three subtests are administered to all age groups. Children ages two years, six months are given seven subtests, and the number of subtests given increase with the child's age. For any one child, a maximum of 13 subtests are administered. Children from age seven years to 12 years, six months are given 13 subtests.

It follows two models- Luria or CHC (Cattell-Horns-Carroll)

Luria model consists of 4 scales-

i. Sequential processing scale

ii. Simultaneous processing scale

iii. Learning ability

iv. Planning ability

Psychological Assessment 1996. Vol. 8, No. 1,7-17

CHC model consists of 5 scales-

a) Short term memory (sequential)

b) Visual processing (simultaneous)

c) Long term storage and retrieval (learning)

d) Fluid reasoning (planning)

e) Crystallized ability

Simultaneous/visual processing Triangles: the child assembles several foam triangles to match a picture. Face Recognition: the child looks at photographs of one or two faces for 5 seconds and

then selects the correct face/faces shown in a difference pose from a selection. Block Counting: The child counts the number of blocks in a picture of a stack of blocks,

some of the blocks are partially hidden. Conceptual Thinking: The child selects one picture from a set of 4 or 5 which does not

belong with the set. Rover: The child moves a toy dog to a bone on a grid that contains several obstacles

trying to find the quickest path to the bone. Gestalt Closure: The child mentally fills in the gaps in a partially completed inkblot

drawing and names or describes the object/action depicted in the drawing. Pattern Reasoning (ages 5 and 6). Story Completion (ages 5 and 6).

Sequential/short term memory

Word Order: The assessor reads the names of common objects, the child then touches a series of silhouettes of these objects in the same order they were read out in.

Number Recall: The assessor reads a string of numbers and the child repeats the string in the same order. The strings range from 2 to 9 digits.

Hand Movements: the child copies a series of taps the examiner makes on the table with the fist, palm or side of the hand.

Planning/fluid reasoning

Pattern Reasoning (ages 7–18): the child is shown a series of stimulus that form a logical linear pattern with one stimulus missing. The child selects the missing stimulus from several options.

Story Completion (ages 7–18): the child is shown a row of pictures that tell a story, some pictures are missing. The child selects several pictures from a selection that are needed to complete the story and places them in the correct location.

Learning/long term storage and retrieval

Atlantis: the assessor teaches the child nonsense names for pictures of fish, shells and plants. The child then has to point to the correct picture when read out the nonsense name.

Atlantis Delayed: the child repeats the Atlantis subtest 15–25 minutes later to demonstrate delayed recall.

Rebus: the assessor teaches the child the word or concept associated with a rebus (drawing) and the child reads aloud phrases and sentences composed of these rebuses.

Rebus Delayed: the child repeats the Rebus subtest 15–25 minutes later to demonstrate delayed recall of paired associates.

Knowledge(crystallized ability) included in the CHC model only

Riddles: the examiner says several characteristics of a concrete or abstract verbal concept, and the child has to point to it or name it.

Expressive Vocabulary: measures the Childs ability to say the correct names of objects and illustrations.

Verbal Knowledge: the child selects from an array for 6 pictures the one that corresponds to a vocabulary word or answers a general information question.

Types of scores given :

i. Age equivalent

ii. Percentile ranks

iii. Age-based standard scores

Kaufman Assessment Battery for Children (KABC)

Range of standard scores Name of category

131-160 Upper extreme

116-130 Above average

85-115 Average range

70-84 Below average

40-69 Lower extreme

Subtest reliabilities are generally good to excellent. In terms of validity, the test presents substantial evidence in terms of content, relationships within the test itself and relationships with other tests. (http://www.ecasd.k12.wi.us/student_services/assessments/KABC-II.pdf)

Kaufman, A.S., & Kaufman, N.L. (1983). Kaufman Assessment Battery for Children. Circle Pines, MN: American Guidance Service.

Kaufman, A.S., & Kaufman, N.L. (2004). Kaufman Assessment Battery for Children Second Edition. Circle Pines, MN: American Guidance Service.

Kaufman, A.S., & Kaufman, N.L. (2004b). Kaufman test of Educational Achievement comprehensive form second edition. Circle Pines, N: American Guidance Service.

Othman, O.A. (1991) The KABC-II also correlates strongly with the DAS -II according to a study by Omar Othman 1991 which included kindergartners, first graders and second graders.

Luria, A.R. (1966). Human brain and psychological processes. New York: Harper & Row.

http://www.ux1.eiu.edu/~cfglc/Adobe%20pdf/Publications-Papers/Canivez%20&%20Watkins%20(in%20press)%20WISC-V%20Review.pdfReview of Eastern Illinois University

“The Conners 3 is a well-designed instrument with excellent technical properties that promises to be instrumental in the evaluation, diagnosis, and treatment response of children with ADHD and co-morbid disorders.”

The rating scales are available for parent (Conners 3–P), teacher (Conners 3–T) and self-report (Conners 3–SR).

Conners 3-P and 3-T concerns with children of age group 6-18 whereas Conners 3-SR concerns in children with age group 8-18

Classroom behaviour

1. Constantly fidgeting

2. Hums and makes other odd noises

Illinios test of psycholinguistic abilities (ITPA)- used to delineate areas of difficulty related to communication skills.

Dichotic listening tests

It includes awareness, discrimination and recognition of sensory stimuli from the environment and the CNS’s use of this sensory information to direct motor behaviour.

The Motor-free Visual Perception Test- developed by Calarusso and Hammill to provide a rapid measure of visual sensory processing that does not require hand movements of the child.

Children are shown a series of test plates that measure simple visual discrimination, visual form constancy, visual matching, visual memory.

Bailey scale of infant development Bellveue index of depression Brazetan Neonatal behavioural scale Children depression inventory Conners Parent rating scale Conners teaching rating scale- drug effects Denver development screening test- Developmental test of visual motor integration- Dubowiez scale- Keymath revised test

The test consists of up to 125 items, divided into four parts:

Social/personal: aspects of socialization inside and outside the home – e.g. smiling.

Fine motor function: eye/hand co-ordination, and manipulation of small objects – e.g. grasping and drawing.

Language: production of sounds, and ability to recognize, understand and use language – e.g. ability to combine words

Gross motor functions: motor control, sitting, walking, jumping, and other movements

Ages covered by the tests range from 2 months to 71 months.

Bellman M, Byrne O, Sege R; Developmental assessment of children. BMJ. 2013 Jan 15;346:e8687. doi: 10.1136/bmj.e8687.

Interpretation of the test

The data are presented as age norms, similar to a growth curve.

Draw a vertical line at the child's chronological age on the charts; if the infant was premature, subtract the months premature from chronological age.

The more items a child fails to perform (passed by 90% of his/her peers), the more likely the child manifests a significant developmental deviation that warrants further evaluation

http://www.oepf.org/sites/default/files/journals/jbo-volume-15-issue-6/15-6%20Shanks.pdf

IQ Score WJ III Classification

131 and above Very superior

121 to 130 Superior

111 to 120 High average

90 to 110 Average

80 to 89 Low average

70 to 79 Low

69 and below Very low