아이들 평가는 이렇게

Assessment

Name:김  Date of Birth:  Medical history : preterm :27주, B.wt : 1150g                  : NICU care - incubator 90days  MRI, CT, SONO Comment : Perinatal ICH(-), 1.5mon경 ICH(+)

1. General Impression

 엄마에게 안겨서 들어오고 poor attention.

특히 큰 소리나 낮은 톤의 음성을 들었을 때 sensitivity함.

엄마, 아빠, 네 간단한 지시 따르기 가능함.  motivation-increase spasticity

2. Ability

supine to prone but extensor pattern 이용

creeping but increased postural tone and associated reaction and movement pulling 해서 이동함.

 

3. Disability

independent sitting

4. Postural Tone

Moderate spasticity

Proximal (low tone) < distal (hyper tone), Lt side <Rt side

Upper extremity > lower extremity

5. Postural pattern

trunk inactivity --→

                                                  --→   poor emotion control                                        ↓

                     Unstable BOS (narrow BOS)

                                 ↓

                       Postural tone increase

                                 ↓

                            heavy arm

               (upper pulling and lower accessory)

                       mass pattern in L/E

                                ↓

                     Poor dissociated movement

6. Contracture and Deformity

Shoulder of short contracture → arm heavy

Rt hand 의 wrist flexion and pronation

ankle instability and plantar flexion and inversion

spine little scoliosis (Rt side shortening)

7. Associated problem

poor head control                        instable jaw → munching pattern

poor postural control                                 → drooling ↑

             ↕                                       → squeezing

poor emotional control                   visual problem

                                                 →strabismus

                                                 →poor eye-hand dissociation

                                          visual field limited

body scheme, awareness ↓               perception and cognition

                                                     ↓

                                           learning disability

8. Main problem

Proximal inactibity →heavy arm

                   →unstable

Poor grading movement

Poor dissociated movement

9. Treatment Goal

▶ Postural tone → Break → wide BOS

   → postural control -proximal stability increase

                      -increased head and trunk control

                      -transfer COG to the forward

                      -symmetry ↑

                      -experienced dissociation

                       (head and shoulder / scapular and arm)

                      -increase L/E preparation

▶ Increased arm movement

  → changing of direction

  → increase range of movement(eye-head coordination)

  → movement of sequence experience increased

  → hand support를 통한 good body awareness - postural stability increased

# Postural Tone

          

                            Level of arousal             proprioceptive

                                                            control

                                                            

   Feedforward           Postural Tone

                            Stability & Mobility             Muscle

   Feedback                                              properties

                           

                              Biomechanical

State of readiness in the muscle state activity. The ability to modulate muscle activity both in response to and as a result of demands from the external and internal environment.

                              

1. Type

  hyper / normal / hypo / fluctuation

 - spasticity

 - athetosis

 - ataxia

 - hypotonia

2. tonal distribution

 - Quadriplegia

 - Diplegia

 - Hemiplegia

3. degree of tonus

    severe

    moderate

    mild

    ...........

          Normal

    ...........

    mild

    moderate

    severe

SHORT GUIDE TO ASSESSMENT

1. General impression:

An overall picture of the child including relationship with care-giver, physical dependency, behaviour etc.

The following items are different for the more able child and for the child who is severely disabled.

2. Functional abilities and inabilities.

Briefly list and describe: this should give a general functional picture of the child.

Able child

List and describe functional activities eg, eating, sequences of movement, play etc.

     Example:

     Abilities:

     1. Crawls but with too much flexion.

     2, Uses both hands but prefers the left.

     3.Can eat independently but does not chew.

     Inabilities:

     1. Cannot stand independently.

     2. Cannot do buttons in dressing/undressing.

     3. No reliable means of communication.

Severely disabled child

Record that the child is totally dependent for all needs but when handled can achieve certain skills which are described, Give a detailed description of the hows and whys of postural patterns in section 3.

3. Basic postural tone and patterns:

In this section describe the different positions prone through to standing and walking (posture and activity) inciuding hand function, communication and eating/drinking skills. Note how child arrears in each position and how he/she does activity.

If the child cannot do certain activities give the reasons why these are not possible.

            Include postural tone at rest and on activity.

            Asymmetries.

            Threatening contractures.

Note: Check especially for head control, trunk stability and use of arms for weight bearing and reach/grasp.

4. Main problems:

Give 3 or 4 only.

5. Aims of treatment:

These should be directly related to the main problems.

GENERAL IMPRESSIONS:

NB: If the child is totally dependent, a short summary of the child's state can be given and postural activity described in detail in the section below (postural patterns). The more able child can be described in the following way with detail of posture and movement below:

SUMMARY OF:

    ABILITIES: what child can independently achieve and how.

    INABILITIES: what child is unable to do and why.

NB: This summary should be a simple list of the child's functional skills ie. What the child can do without assistance or facilitation. You may indicate the predominant pattern of activity and preferred assymetry eg. Rolls to both sides, more to the left; crawls reciprocally but with too much flexion. This list is only for use with the child who is able. The less able child can be summarised as in the section above, 'Generai impressions'.

 POSTURAL TONE:

Quality of tone - at rest/minimal stimulation and tone with actibity, effort, excitement.

Distribution

POSTURAL AND MOTOR PATTERNS:

 Summary of pattern of posture and movement.

 All positions must be observed.

 The following gives a guideline to what you might need to observe/ test in each    position (think about the significance of these activities):

SUPINE:

General Posture:

   -predominant patterns of activity.

-asymmetries 

-alignment

Head:

-midline, turn L/R independently

-lifts clear of surface

Arms:-to midline

-reach forward

Legs:-independent movement

Sequences of movement:

-in and out of position

-in rolling

-to sitting

PRONE:

General Posture:

-predominant patterns of movement

-asymmetries 

-alignment

Head:

-midline, turn L/R independently

Arms: -forearm support

-extended arm support

-mobile weight bearing

-free an arm for reaching

Legs: -independent movement

Sequence of movement

-rolling L/R

-pivoting L/R

-creep

-commando crawl

-4 point kneeling

-crawling

SITTING

a)Pull to sitting(from supine)

-assistance-grasp with hands

-head control/lag

-activity of legs

b)Long sitting: general posture

-patterns of activity

-alignment /asymmetry

-free arm support

-movement of legs

c)Sitting on chair /bench: general posture

-movement of legs

-balance and saving reactions

(forwards, backwards, sideways)

d)Skde sitting:

-movement in/out of position

-same to both sides?

STANDING:

get in/out of position from

-sitting on floor

-sitting on chair

-kneeling

-1/2 kneeling

a) feet in parallel

-Patterns of activity

b) step stand

-Alignment/asymmetry

-Balance

c)single leg stand

WALKING: -pattern

- steps forwards

       sideways

       backwards

- step and stop

- stairs

 

RUNNING:

JUMPING:

HOPPING

MANIPULATION:

-quality/type of grasp

-grasp/release

-isolated finger movements

MAIN PROBLEMS:

Preferably no more than four

MAIN AIMS OF TREATMENT:

Should relate to the main problems