Practical Examination - Cerebral Palsy

Examination in order

General

 presence of wheelchair  , walking aid , communication devices  , orthosis e.g. AFO , KAFO , Wrist

Splint , Spinal Brace

Look at trunk for gastroscopy or a baclofen pump


Pattern of involvement

 Anatomical

    monoplegic

    diplegic

    hemiplegic

     quadriplegic

   

 movement disorder

     spastic

     ataxic

     dyskinetic

                 athetoid - slow writhing movement of fingers , hand or lower limb

                 dystonic - involuntary sustained contraction

                  chorea - random movement of limbs more on rest position

                  ballismus and hemiballismus

                                           infrequent jerky movements , purposeless

                    mixed


Standing -

           posture - UL ,

                          scoliosis - C-curve neck to LS junction

                    (      idiopathic curve with a rib hump )

         

        walking
 
                        aids,

                        head steady or moves up and down / sidewise

                         shoulder and upper body - excessive movement

                          upper limbs - posture

                                                 swinging or held stiff
                     
                           Trunk - flexion , lordosis , lateral tilt

                         Pelvis - level or tilted

                         lateral movement when walking

                         Trendelenburg


                          Lower limbs - position of hip , knee, ankle - walking

                         Foot - Foot progression angle , foot shape ,

                                   describe initial contract , foot flat and lift off.


Lying position

                 Hip examination

                  dislocated ?

                             Contractures

                   

                                 Flexion and Adduction contractures
 
                                 limitation of extension and abduction eventually flexion contracture and 

                                  adduction contracture



                         Knee

                                    contractures

                                              measure popliteal angle

                     Ankle

                               Silfverskiold test

                                  midfoot break on DF , heel neutral

                    Foot

                    deformity , callosity , bony prominences , ulceration



             Prone position

                 Rotational profile

                 Dunken Ely test



























                       





















   










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