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pediatric-assessment-form

Pediatric Assessment form

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pediatric-assessment-form

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  1. lOMoARcPSD|33422704 Pediatric assessment form Pediatric assessment form Human Anatomy & Physiology-I (Jaipur National University) Human Anatomy & Physiology-I (Jaipur National University) Studocu is not sponsored or endorsed by any college or university Studocu is not sponsored or endorsed by any college or university Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  2. lOMoARcPSD|33422704 JNU College of physiotherapy Pediatric assessment form Date: / / Name- ________________________________ Date of birth- ___________________________________ Chronological age - _______________ Corrected age - ________________________ Gender – M/F Address- _____________________________________________ Contact no - _____________________ IDP/ ODP no - ______________________________ Date of delivery (EDD) - _______________ Informant with educational qualification - ___________________________________________________ Weight :– At birth ____ (kg or gm) At present ___ (Kgorgm) Head circumference :-At birth _____ (cm) At present_______ (cm) Height :– At birth ___cm At present______ (cm) Dominance RT/LT:-________ Chest circumference:-At birth _____(cm)At present _____(cm) Chief complains- ___________________________ ___________________________ ___________________________ ___________________________ GMFCS level _____________________________ CFCS level_______________________________ MACS level ______________________________ History Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  3. lOMoARcPSD|33422704 1.Parental history:- Educational Qualification__________________ Occupation____________ Income ___________ 2. Maternal history – Mother’s age_____ Gravid Parity living abortion ____________ Blood group(Rh factor)_________ Level of education___________ Use of contraception__________ Medical history______________ 4. Prenatal history- Other SR no 1 2 3 4 5 1stTrimister 2ndTrimister 3rdTrimster Weight Gain USG finding Weight gain USG finding Quickening Weight gain USG finding Natal-  Place -  Labor (spontaneous/ induced):-  Duration of 2nd stage of labor :-  Type of Delivery:-  Presentation (vertex/breech/other) Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  4. lOMoARcPSD|33422704  Cause Of Caesarian :-  APGAR score –(appearance/color, pulse/heart rate, grimes/reflex irritability , activity/muscle tone, respiratory effort) :- ______________________________________________________ ______________________________________________________  Birth cry :- H/o ICU Admission or resuscitation:- Any complications :- Postnatal history- __________________________________________________________ __________________________________________________________ ______________________________ When AND how did the parents notice that child is having Problem? _______________________________________________ __________________________________________________________ _________ Family history- __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ ___________________________________ Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  5. lOMoARcPSD|33422704 1. Age____(M/F) 2. Age____(M/F) 3. Age____(M/F) Immunization history – (date of immunization) BCG ______ OPV___________ DPT______________ Measles _______________ Others_______________ Medical history:- __________________________________________________________ __________________________________________________________ __________________________________________________________ Surgical history:- __________________________________________________________ __________________________________________________________ Socio economic history :- __________________________________________________________ __________________________________________________________ Environmental history :-_________________________________________________________ _ __________________________________________________________ Development history- Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  6. lOMoARcPSD|33422704 1. Gross Motor Head holding Rolling Crawling Sitting Standing Walking Climbing stairs Running Jumping Milestones Normal milestones 2.5 to 3 months 3 to 3.5 months 5-6 months 6- 7 months 11 to 17 months 12-12 months 18-22 months 2 to 2..5 years 2.5 to 3 years 2. Fine motor Hand regards Reach for object Transfer object from hand to hand Pincer grasp Release object Building blocks Turning pages Dressing and undressing Milestones Normal milestones 1 to 1.5 months 3 to 3.5 months 5-6 months 7 to 8 months 10 to 12 months 1.5 to 10 months 20-24 months 2 to 2.5 years 3. Personal/ social Milestones Normal milestones Social smile Recognize mother 1 to 1.5 months 1 to .5 months Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  7. lOMoARcPSD|33422704 Indicates desire by pointing Come when called 5-6 months 5-7 months Tells name Self feeding Group play Competitive games 15- 18 months 12-13 months 1.2.5 years 3 to3.5 years 4. Language Babbling Respond to name Monosyllables Bisyllables Simple command Identify part of body Form sentence Know color and poems Milestones Normal milestones 2 to 3 months 3 to 5 month 8 to 10 months 15 to 18 months 12 to 15 months 12 -14 months 1. 2.5 years 2.5 to 3.5 years Provisional diagnosis:- History of Cerebral palsy – (types) Evaluation General exanimation- Body frame/ built :- Vitals :- HR______ BPM RR________ BPM BP____________ mmhg Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  8. lOMoARcPSD|33422704 Temperature ________ c° Skin (integrity (N/Ab N)__________________ color(Red/Pink/Blue/other___________________ Edema(Y/N) :- Site ________ (pitting/ none pitting) Wounds(Y/N) Site-______________ Sutures(Y/N) if yes (Site/dimension: _____________ RS - CVS - CNS - Behavior-( cooperative , attitude) __________________ Cognitive (intelligence, attention, memory (ST/ LT), motor planning, judgment) Cry, wakefulness and sleep: Nature____________________ On observation Supine______ Sitting_______ Standing (Head, Face, Trunk, Extremities)________________ Transitions_______ Oral Posture_______ Structural Abnormalities (Head,Face,Eyes,Skin,Extremities)________ Attitude/p osture at rest and during movement Supine Sitting Head At rest During Trunk At rest During Upper limb At rest During Lower limb At rest During movem ent movem ent movem ent movem ent Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  9. lOMoARcPSD|33422704 Standing Gait ______ Posture____ ON palpation- Upper extremities: Lower extremities: Spine: On examination- Higher function5: A) Hearing: b) Vision C] Speech: Cranial nerves: Nerves Comments Nerves Comments I - Olfactory II - Optic III - Oculomotor IV - Trochlear V - Trigeminal VI - Abducent VII - Facial VIII - Vestibulocochlear IX - Glossopharyngeal X - Vagus XI - Accessory XII - Hypoglossal Reflex evaluation: 1) Neonatal relaxes 2) Automatic reactions 3) Spinal reflexes 4) Brainstem reflexes 5) Midbrain reactions 6) Cortical reactions Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  10. lOMoARcPSD|33422704 Sensory examination: Special sensation: Vision. Auditory. Speech, Vestibular (Intact /Diminished /Absent) Reflex elation Bicep Jerk Triceps Jerk Sj Knee Jerk Ankle Jerk Babinski sign Chador’s sigh Cornel Abdominal Right Left Superficial Deep Cortical Sensory integration function - Tone (MAS ) Upper limb Right Left MMT (strength) Right Left Shoulde r Elbow Wrist Hip Knee Upper limb Shoulde r Elbow Wrist Hip Knee Lower limb Lower limb Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  11. lOMoARcPSD|33422704 ankle ankle Hand Function- S R no 1 2 3 4 5 6 Region Voluntary control(good/fair/poor ) Deformity (if any) UL/LL/SPINAL(with angle) Upper limb Lower limb Trunk/spine Pelvis Oro-motor Heed-neck OUTCOME MEASURE : GMFM PEDI INFANIB Pediatric balance scale Pediatric evaluation of disability Peabody motor development scale Pediatric quality of life Objective evaluation : GAIT____________________________________________________ Posture___________________________________________________ Investigation- X-ray, CT, MRI, EMG, NCV, Neuron-imaging, blood others __________________________________________________________ __________________________________________________________ __________________________________________________________ Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  12. lOMoARcPSD|33422704 __________________________________________________________ __________________________________________________________ ______________________ Confirmation diagnosis- __________________________________________________________ _________________________ ICF- International Classification of Functionality, Disability and Health BODY STRUCTURE BODY FUNCTION Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  13. lOMoARcPSD|33422704 ACTIVITY LIMITATION PARTICIPATION RESTRICTION Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  14. lOMoARcPSD|33422704 CONTEXTUAL FACTORS ENVIROMENTAL FACTORS PERSONAL FACTORS FACILITATOR BARRIER FACILITATOR BARRIER Plan of care- Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  15. lOMoARcPSD|33422704  Age of baby__________________________________________________ ____________________________________  Frequency of treatment______________________________________________ ______________________________  Duration of treatment______________________________________________ ________________________________  Service delivery mode: OPD/IPD/Home service________________________________________________ __________  Impairment posture and movement_____________________________________________ ______________________  Equipments____________________________________________ __________________________________________  Client/Family education______________________________________________ ______________________________ Management –Prioritize A.Parental goal__________________________________________________ _______________ B. Desired goal__________________________________________________ ________________ C. Formulated goal__________________________________________________ _____________ D.Short term goal 3 months Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  16. lOMoARcPSD|33422704 ______________________________________________________ ______________________________________________________ ______________________________________________________ ___________ E. Long term goal - 1 year ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______ Treatment plan 1 2 Parents education Posture advice- symmetry, Biomechanical alignment Lifting and caring techniques Tone reduction of increasing Dissociated movements Prevention of tightness/ deformity/ abnormal movement Voluntary control facilitation Strengthening Balance exercise Coordination exercises Transitions Gait training Use of supportive devices – Orthotic, races, wheel chair Sensory stimulation, integration Respiratory care Proper feeding technique 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

  17. lOMoARcPSD|33422704 17 18 19 20 Home management Referral to other therapy – OT/speech Therapist/ Vocational therapist / orthopedic surgeon/ social worker/canceller/ special educator Advanced therapy – TMT, hydrotherapy, hippo therapy, robotic therapy NDT therapy 21 22 Downloaded by Esra Hamdan (ehamdan2@staff.alquds.edu)

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