neuromuscular child

History

Development

Birth

· premature

· problems with birth

Milestones

· head control (3 mths)

· sitting (6 mths)

· standing (9 mths)

· walking (12 mths)

Disease

Duration

· first noticed problem

Progression

· change

· how rapidly

background

Associated problems

· other major problems

Family history

· anyone in family with similar problems

function

· eating

· dressing

· tying shoelaces

· walking

· riding bike

General

CLUES

Walking aids

· wheelchair

· frame

· Kay walker

· walking stick

· seat

Splints

· reciprocating gait orthosis

· twister

inspection

· dysmorphic facies

· truncal asymmetry

Upper limb

cases

· spastic hand

· Volkmann’s contracture

· Erb’s palsy

look

Deformity

· spastic

· internal rotation and adduction of shoulder

· flexion of elbow

· pronation of forearm

· flexion of wrist

· flexion of MCP jts

· thumb in palm

Skin

· palmar hygiene

Contour

Swelling

Wasting

· withered

deformity and contracture

· passive

Shoulder

· abduction

· rotation

Elbow

· passive flexion / extension

· supination / pronation

Wrist

· dorsiflexion

· palmarflexion

Fingers

· extension

· tenodesis

· thumb abduction

Function

Shoulder / elbow

· position hand in space

· hand behind head

· hand behind back

Hand

· stereognosis

· key in hand

· pinch / grip

· tip pinch

· key pinch

· power grip

neurology

Tone

· hypertonicity

· clasp-knife

· hypotonicity

Reflexes

· biceps

· triceps

· Hoffman

Power

Sensation

other

Concealed

· axilla

Cephalad

· cervical spine

· curve

· ROM

Circulation

Collagen

Lower limb

look

Deformity

· lumbar lordosis

· hip adduction if seated

· flexed knees and hips

· anterolateral tibial bow

· pes cavus

· hammer toes

Skin

· buttock

· spinal dysraphism

· scars

· front of groin (Smith-Peterson)

· lateral proximal thigh

· ankle

· ulcers on foot

Contour

Swelling

· calf hypertrophy

Wasting

Gait

Walking

· walk away from you

· run towards you

· toe walking

· heel walking

· hopping

· look for

· spastic

· back knee

· high-stepping

· wide-based

Leg length

· palpate ASIS

Trendelenburg

· Apley’s modification

Special

Romberg’s

· ask patient to stand with feet together

· stand nearby in case patient falls

· look for unsteadiness

· with eyes open (cerebellar)

· with eyes closed (posterior columns)

Gower’s

· ask patient to sit on floor

· observe them rising

· positive if

· cannot rise without assistance

· use hands on thighs

Meryon’s

· lift patient under arms on to couch

· positive if slips through because of shoulder girdle weakness

deformity and contracture

Supine

Hip

· Thomas test

· extension

· flexion

· duction in flexion

· abduction

· adduction

Knee

· FFD

· popliteal angle

· flexion

Ankle

· Silverskold’s test

· dorsiflexion range in flexion

· then into extension

On side

Knee

· Ober’s test

· knee flexed and hip in neutral

· extend knee and observe hip

· positive if hip abducts

Prone

Hip

· rotation

· external together

· internal separately

Knee

· Ely’s test

· hand on buttock

· flex knee

· positive if hip flexes

· manifested by buttock rising

Foot

· foot-thigh angle

neurology

Tone

· hypertonicity

· clasp-knife

· hypotonicity

Reflexes

· abdominal

· knee jerk

· ankle jerk

· clonus

· Babinski

Power

Sensation

other

Concealed

· buttock, esp. natal cleft

· groin, esp. medial

· popliteal fossa

Cephalad

· spine

· curve

· ROM

Circulation

Collagen