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What is the age milestone for a child who should be able to sit without support?
A child is considered to have a developmental red flag if they are not crawling by 6 months.
False
Name two fine motor functions that should be assessed in a child during a developmental evaluation.
Grasping and manipulating objects
Children with cerebral palsy may require support services such as ______ and speech therapy.
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Match the following developmental milestones with the respective age group:
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At what age should a child be able to stand alone without support?
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By 3 years of age, a child should be able to run well.
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What major milestone should a child reach by 5 years of age regarding ball skills?
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At 18 months, a child should not be __________ without support.
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Match the following ages with their corresponding red flag milestones:
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Which score on the quality of muscle reaction scale indicates that the joint is immobile?
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The Babinski reflex results in the fanning of the toes with the big toe curling downwards.
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What is the term used to describe rhythmic sustained involuntary muscular contractions associated with hyperreflexia in upper motor neuron lesions?
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The angle at which a catch or clonus is found during a quick stretch is referred to as R______.
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Match the following definitions with their corresponding terms:
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Which aspect is NOT part of the subjective assessment for home environment?
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Observing a child's ability to perform star jumps is part of the objective assessment.
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What skill is assessed under fine motor functions?
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The _______ is used to measure hypertonicity in a limb.
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Match the following assessments with their focus:
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Which of the following would be assessed for respiratory functions?
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Deep tendon reflexes are part of the motor function assessment.
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What type of skills are included in the participation assessment?
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What age range does the General Movements Assessment cover?
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General movements assessment can reliably predict cerebral palsy risk before 3 months of age.
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What is the purpose of the General Movements Assessment?
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General movements assessment requires infants to be _____ and _____ during the assessment.
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Match the following periods of general movements with their interpretations:
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What is a key advantage of video assessment in the General Movements Assessment?
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The Hammersmith Infant Neurological Examination includes scored developmental milestones.
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What are two components included in the Hammersmith Infant Neurological Examination?
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The best age to perform a General Movements Assessment is _____ weeks after the baby's due date.
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Which of the following is a disadvantage of the General Movements Assessment?
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What is one key component of a subjective assessment for a child?
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A child who is not smiling by 6 months of age may be considered a red flag.
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Name one health professional who may be involved in supporting a child with developmental concerns.
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A child should be able to _______ by 9 months of age to avoid developmental red flags.
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Match the following ages with their corresponding red flag milestones:
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Which of the following factors is NOT part of the medical history to be considered during assessment?
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Children with cerebral palsy do not require any support services.
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What is the purpose of understanding a child's previous medical history during an assessment?
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What does the R1 angle represent in the Modified Tardieu scale?
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The Babinski reflex indicates normal function of the peripheral nervous system.
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What does a score of 5 indicate in the quality of muscle reaction scale?
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The velocity of stretch categorized as V1 is ______.
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Which of the following indicates increased response in deep tendon reflexes?
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Match the following definitions with their corresponding terms:
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Clonus can occur in conditions involving lower motor neuron lesions.
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The angle of muscle reaction (R1) is used to calculate dynamic tone by subtracting R1 from R2, where R2 is the angle measured at ______.
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What is the primary purpose of the Babinski reflex test?
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Which of the following assessments focuses on fine motor functions?
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What is the maximum age for performing the General Movements Assessment?
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The Modified Ashworth test measures spasticity in a limb based on passive movement speed.
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Name one aspect observed during the objective assessment of balance.
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The best time to perform the General Movements Assessment is at 10-12 weeks after the baby's due date.
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The __________ assessment evaluates a child's socialization skills, including eye contact and verbal communication.
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What can be predicted through the General Movements Assessment before 3 months of age?
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Match the following observations with their respective assessment categories:
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The _____ is an app designed to allow parents to video their infants for General Movements Assessment.
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Match the following features of the Hammersmith Infant Neurological Examination (HINE) with their descriptions:
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What is the primary purpose of the Modified Tardieu?
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Home environment assessments include evaluating the outdoor area for wheelchair maneuverability.
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What does a positive response in a tandem walking assessment indicate?
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Assessment of __________ includes measuring the child's strength and unusual positioning of limbs.
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Match the following terms to their definitions:
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What is the primary target population for the Alberta Infant Motor Skills (AIMS) assessment?
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The Alberta Infant Motor Skills (AIMS) includes a neurological examination to understand the causes of deviations.
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What sensitivity percentage does the AIMS assessment claim?
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The angle of _____ is used to measure hypertonicity in a limb.
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Match the following joint movements with their normative reference values for males aged 9-19:
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What is one primary purpose of the General Movements Assessment (GMA)?
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Knee extension is greater for males than females in the 2-8 age group.
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What are the two primary components evaluated in the GMA?
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The _____ is used for gross motor assessment in infants from birth until they can walk independently.
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Which age range does the normative data for normal joint range of motion include for hip flexion in males?
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Study Notes
Subjective Assessment
-
Main Concerns:
- What the concerns are
- When they started
- If they are intermittent or constant
- If they are worsening, plateauing, or improving
-
Medical History:
- Pregnancy and Neonatal history
- Birth complications (birth weight, prematurity, APGAR score, oxygen support required, vaginal delivery or C-section)
- Relevant past medical history (respiratory, cardiac, surgical history, fracture history etc.)
- Medications
- Hearing and vision assessments
-
Developmental History:
- Gross motor functions (rolling, sitting, standing, crawling, walking)
- Fine motor functions
- Speech
- Cognition
- Smiling
-
Pain:
- Level of pain
-
Other health professionals involved:
- General Practitioner, Occupational Therapist, Speech pathologist, Genetic counsellor etc.
-
Family structure/ supports:
- Support network for the child and family
-
Home Environment:
- Indoor and outdoor environment (including steps, ramps, hilly yards, rails, surfaces such as floorboards/carpet, room for wheelchair manoeuvrability)
-
Home:
- Mobility
- Fatigue
- Participation
- Daily/weekly routines
- Activities of daily living (feeding/ toileting, dressing, self-help skills)
- Sleep
- Extracurricular activities (such as rhyme time, swimming lessons, daycare)
- Cultural and family traditions
- Family goals
Red Flags
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Age-appropriate milestones: It is important to note that the red flags presented are guidelines and individual children develop at different rates.
-
6 Months:
- Not rolling
- Not holding head and shoulders up when on tummy
-
9 Months:
- Not sitting without support
- Not moving (i.e., creeping or crawling motion)
- Does not take weight well on legs when held by an adult
-
12 Months:
- Not crawling or bottom shuffling
- Not pulling to stand
- Not standing holding onto furniture
-
18 Months:
- Not attempting to walk without support
- Not standing alone
-
2 Years:
- Unable to run
- Unable to use stairs holding on
- Unable to throw a ball
- Not toilet-trained by day
-
3 Years:
- Not running well
- Cannot walk up and down stairs
- Cannot kick or throw a ball
- Cannot jump with two feet together
- Difficulty helping with self-care skills (feeding, dressing)
- Difficulty manipulating small objects (e.g., threading beads)
-
4 Years:
- Cannot pedal a tricycle
- Cannot catch, throw, or kick a ball
- Cannot balance well standing on one leg
- Unable to draw lines and circles
-
5 Years:
- Awkward when walking, running, climbing, and using stairs
- Ball skills are very different to their peers
- Unable to hop five times on each foot
- Not independent with eating and dressing
- Cannot draw simple pictures (e.g. stick person)
-
6 Months:
- Not reaching for and holding (grasping) toys
- Hands frequently clenched
-
9 Months:
- Unable to hold and/or release toys
- Cannot move toy from one hand to another
-
12 Months:
- Majority of nutrition still liquid/puree
- Cannot chew solid food
- Unable to pick up small items using index finger and thumb
-
18 Months:
- Not holding or scribbling with a crayon
- Does not attempt to tower blocks
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2 Years:
- No interest in self-care skills (e.g., feeding, dressing)
-
3 Years:
- Concerns from teachers about school readiness
-
4 Years:
- Not toilet trained by day
-
5 Years:
- Concerns from teachers about school readiness
- Not independent with eating and dressing
- Cannot draw simple pictures (e.g., stick person)
Objective Assessment
-
Observation:
- Gross motor functions: Head Control, Supine/ Prone, Rolling/ Sitting/ Standing, Posture, Gait (forwards, backwards, sideways, tiptoes, heel walking, gallop, skip, star jumps), Running, Stairs, Jumping/ hopping/ climbing, Ball skills (kicking, catching, throwing, bouncing), Transitions (sit to stand, floor to standing, chair to chair, bed to chair)
- Fine motor functions: Grasp, hand to hand transfer
-
Respiratory:
- Breathing pattern
- Cough
- Sputum
- Airway clearance routine
-
Neurological:
- Tone, Spasticity, Clonus
- Deep tendon reflexes
- Atypical movement patterns
- Tremor
- Infant patterns (if relevant)
-
Skeletal:
- ROM limbs, neck (passive and active)
- Head shape, hip dysplasia, foot deformities
- Spinal palpation
- Asymmetries, side preference
-
Muscular:
- Strength
- Unusual positioning of limbs
- Movement against gravity
- Endurance of postural muscles
- Sit to stand, on/off floor
-
Sensory:
- Vision/ Hearing
- Tactile (sensitivities)/ Proprioception
- Vestibular
-
Balance:
- Parachute/ protective responses
- Tandem walking
- Balance reactions
- Single leg stance (eyes open, eyes closed)
- Socialisation:
- Eye contact
- Attachment
- Verbal communication
- Non-verbal communication
-
Cognition:
- Play skills, interests in toys/ environment
- Babbling/ language
-
Participation:
- Imaginative play/ turn taking
Modified Ashworth Scale
-
Purpose:
- Used to measure hypertonicity in a limb (independent of velocity)
Modified Tardieu Scale
- Purpose: a measure of limb spasticity
- Definition: Measures spasticity by taking into account resistance to passive movement at both slow and fast speeds.
-
Scoring:
- Quality of muscle reaction (scored 0-5):
- 0 - no resistance throughout passive ROM
- 1 - slight resistance but no clear catch
- 2 - clear catch followed by a release
- 3 - fatigable clonus (10 seconds)
- 5 - indicating joint is immobile
-
Velocity of Stretch:
- V1 - slow as possible (minimising stretch reflex)
- V2 - speed of limb falling under gravity
- V3 - moving as fast as possible (faster than the rate of the natural drop of the limb segment under gravity)
- Joint angles:
- The angle of muscle reaction (R1) is defined as the angle in which a catch or clonus is found during a quick stretch (during either V2 or V3)
- The angle of full ROM (R2) is taken at a very slow speed (V1). R1 is then subtracted from R2 and this represents the dynamic tone component of the muscle.
Other Assessments
-
Babinski Reflex:
- A reflex used to determine the adequacy of the higher (central) nervous system.
- The Babinski reflex is obtained by stimulating the outside of the sole of the foot causing extension of the big toe while fanning the other toes.
-
Clonus:
- Definition: Clonus is a rhythmic sustained, involuntary muscular contractions.
- Hyperreflexia in Upper Motor Neuron Lesion (UMNL)
-
**Deep Tendon Reflexes (DTRs) **
- A brisk contraction of a muscle in response to a sudden stretch induced by a sharp tap by a finger or rubber hammer on the tendon of insertion of the muscle.
- Absence of the reflex may be caused by damage to the muscle, peripheral nerve, nerve roots, or spinal cord at that level.
- Increased response: can indicate UMNL involvement.
General Movement Assessment (GMA)
- Target population: infants birth to 20 weeks corrected age
-
Purpose:
- Identify infants at high risk of cerebral palsy
- Predictive
-
Advantages:
- Video assessment is quick and easy to perform
- Videos can be sent from remote locations
- High sensitivity and specificity
-
Disadvantages:
- Needs consensus scoring
- Requires regular practice to maintain accuracy
- Does not inform an intervention plan
- Training is expensive
- Short time period for assessment
Hammersmith Infant Neurological Examination (HINE)
- Target Population: Infants between 2 - 24 months of age
- Criterion referenced:
-
Three parts:
- A neurological examination (scored): cranial nerve function, posture, quality and quantity of movements, muscle tone, and reflexes and reactions
- Developmental milestones
- Behavior (not scored)
Subjective Assessment
- Main Concerns: What the difficulties are, when they started, whether they are intermittent or constant, and if they are worsening, plateauing, or improving.
- Medical History: Pregnancy, neonatal, and birth complications (including birth weight, prematurity, APGAR score, oxygen support, and delivery method). Past medical history (including respiratory, cardiac, surgical, and fracture history). Medications, hearing assessments, and vision assessments.
- Developmental History: Gross motor functions (rolling, sitting, standing, crawling, walking), fine motor function, speech, and cognition (smiling).
- Pain: Ask about the child's pain.
- Other Health Professionals: Who else is involved (GP, occupational therapist, speech pathologist, genetic counselor, etc.)
- Family Structure and Supports: What the family structure looks like and what supports are available.
- Home Environment: Indoor and outdoor features including steps, ramps, surface type, and wheelchair accessibility.
- Home: Assess the child's mobility, fatigue, participation in Activities of Daily Living (feeding, toileting, dressing), sleep, and daily/weekly routines. What activities they are involved in (e.g. library, swimming, daycare), and cultural/family traditions relevant to the assessment.
- Family Goals: What the family's goals are for the child.
Objective Assessment
- Gross Motor Functions: Observation of head control, supine and prone positioning, rolling, sitting, standing, posture, gait (forward, backward, sideways, tiptoes, heel walking), running, stairs, jumping, hopping, climbing, ball skills (kicking, catching, throwing, bouncing), and transitions (sit to stand, floor to standing, chair to chair, bed to chair).
- Fine Motor Functions: Observation of grasp, hand-to-hand transfer.
- Respiratory Functions: Observe breathing patterns, cough, sputum, and airway clearance routine.
- Neurological Functions: Assess tone, spasticity, clonus, deep tendon reflexes, atypical movement patterns, tremor, and infant patterns (if relevant).
- Skeletal Assessment: Assess range of motion of limbs and neck (passive and active). Assess head shape, hip dysplasia, foot deformities, spinal palpation, asymmetries, and side preference.
- Muscular Assessment: Assess muscle strength, unusual limb positioning, movement against gravity, endurance of postural muscles, and ability to sit/stand and get on/off the floor
- Sensory Assessment: Assess vision, hearing, tactile sensitivity, proprioception, and vestibular function.
- Balance Assessment: Assess parachute and protective responses, tandem walking, balance reactions, and single-leg stance (with eyes open and closed).
- Socialisation Assessment: Assess eye contact, attachment, verbal communication, and non-verbal communication.
- Cognitive Assessment: Assess play skills, interest in toys and environment, babbling, and language development.
- Participation Assessment: Assess imaginative play and turn-taking.
Modified Ashworth Scale
- A scale used to measure hypertonicity in a limb, independent of velocity.
Modified Tardieu Scale
- Measures spasticity based on resistance to passive movement at different speeds.
-
Scoring:
- Quality of muscle reaction: Scored from 0 to 5, with 0 being no resistance and 5 being joint immobility.
- Velocity of Stretch: V1 is slow, V2 is speed of gravity, and V3 is fast as possible.
- Joint Angles: R1 is the angle of muscle reaction during a quick stretch (V2 or V3) and R2 is the angle of full range of motion at very slow speed (V1). The difference between R1 and R2 represents the dynamic tone component of the muscle.
Other Assessments
- Babinski Reflex: A reflex used to assess the adequacy of the central nervous system. A positive Babinski reflex (extension of the big toe with fanning of other toes) suggests a possible neurological issue.
- Clonus: Rhythmic, sustained involuntary muscle contractions. Hyperreflexia in an upper motor neuron lesion.
- Deep Tendon Reflexes: Brisk contraction of a muscle in response to a sudden stretch. Absence can be caused by damage to the muscle, peripheral nerve, nerve roots, or spinal cord. Increased response can indicate an upper motor neuron lesion.
Muscle Strength Assessment
- Refer to the source provided for details on muscle strength grading and testing procedures.
Range of Movement Assessment
- Assess normal vs. shortened range of movement.
- Test position and ROM normative data as provided by the given source.
Objective Assessment - Standardized Assessments
-
Discrimination: Used to differentiate between normal and abnormal motor development.
- Alberta Infant Motor Scale (AIMS): A norm-referenced, performance-based observational measure for infants 0-18 months.
-
Prediction: Used to predict future outcomes.
- Movement Assessment for Infants (MAI):
- Prechtl’s General Movement Assessment (GMA): Assesses spontaneous "general movements" in infants birth to 20 weeks corrected age to identify those at higher risk for neurological problems.
- Hammersmith Infant Neurological Examination (HINE): A criterion-referenced assessment for infants 2-24 months.
- Developmental Assessment of Young Children (DAYC):
-
Evaluation: Used to evaluate the child's disability.
- Paediatric Evaluation of Disability Inventory (PEDI):
- Gross Motor Function Measure (GMFM):
- Construct: Refers to whether the assessment is norm-referenced or criterion-referenced.
Alberta Infant Motor Scale (AIMS)
- Target Population: Infants 0-18 months.
- Purpose: Gross motor assessment for discrimination.
- Advantages: Observational, minimal handling required, quick to administer, outcomes easily understood by parents, detects deviations from the norm, and guides intervention.
- Disadvantages: Doesn't explain the cause of deviations, doesn't assess symmetry, and may have ceiling effects in infants over 9 months.
- Interpretation: Scores are added and plotted on a norm-reference curve for the child's age to determine their percentile rank.
General Movements Assessment (GMA)
- Target Population: Infants birth to 20 weeks corrected age.
- Purpose: Identify infants at high risk for cerebral palsy.
- Advantages: Video assessment, quick and easy to perform, videos can be sent from remote locations, high sensitivity, and specificity.
- Disadvantages: Requires consensus scoring, regular practice to maintain accuracy, doesn't inform an intervention plan, training is expensive, and limited time period for assessment.
- Interpretation: Assessed based on the presence and types of "general movements" during a video assessment.
Hammersmith Infant Neurological Examination (HINE)
- Target Population: Infants between 2 and 24 months.
- Purpose: Predictive assessment.
-
Assessment Areas:
- Neurological Examination: Cranial nerve function, posture, movement quality and quantity, muscle tone, reflexes and reactions.
- Developmental Milestones:
- Behavior: (not scored)
- Construct: Criterion-referenced.
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