PDMS-3, AIMS, and HINE Assessments

• Changes in all systems begin before birth.

Skeletal System

• Skeletal System: It is dynamic structure with changes caused by growth, external forces/loading, and internal forces/muscle pull.
• Typical changes in hip include asymmetric growth in hemiplegia.
• Increasing height during childhood equals LE length.
• Increasing height in adolescence equals trunk length.
• During bone growth, bone outpaces changes in muscle length, leading to temporary-decreased flexibility.
• Children and adolescents are more susceptible to injury involving stresses at/across epiphysis, epiphyseal plate, and apophysis.
• Nutrition and physical activity have an importance.
• Individuals reach 50% of peak bone mass by age 10, and 90% by age 20.
• Spinal curves develop as infants gain control of and experience in various positions.
• With upright weight bearing/walking: Sacral curvature increases, ilia thicken, acetabular depth increases, and the acetabular roof rotates from near-vertical to forward inclination.
• Femoral angle of inclination decreases leading to better hip abductor force production.
• Femoral torsional changes cause the femur to become less anteverted.
• Tibial torsion transitions from initial internal torsion to external torsion.
• At birth, individuals have Genu varum.
• Genu valgum reaches maximum at 3 years and decreases to adult values after that.
• Initial varus in calcaneus and forefoot may persist until 2 years.

Muscular System

• Strength increases due to increased muscle size as well as maturation
• After birth, growth in muscles is due to the increase in size of fibers.
• Continued differentiation of fiber type includes children younger than 15 years having a significantly greater distribution of Type I fiber in VL compared to adults.
• "Slow-twitch” muscles are needed for postural control.
• “Predominantly fast-twitch" muscles are not needed until young adulthood
• Muscle length must be maintained with skeletal growth by adding sarcomeres.

Factors Affecting Strength

• Linear increases in strength occur, accelerating after puberty in males.
• The greatest strength differences are in upper body strength between males and females.
• Testosterone, growth hormone, insulin, and thyroid hormone play a roll in individual strength
• Preferred physical activity, and amount of PA all affect strength

Neuromuscular System

• The brain increases in size and weight.
• Neuroplastic changes happen continually with activity.
• Myelination of sensory and motor nerves continues.
• Some systems into adolescence for some systems including proprioceptive neurons from LEs.

Cardiopulmonary System

• The heart and lungs increase in size/capacity, where the heart size is closely associated with weight, fat-free mass, and height.
• Arteries and veins grow and adapt to body and activity.
• Changes to walls of arteries can cause increased thickness.
• Pulmonary structures grow and adapt to body growth and activity.
• Age-appropriate adaptations are correlated with physical activity/exercise.

Vital Signs

• Newborn (0-28 days): Normal axillary temperature is equal to 97-100.4, HR: 120 - 140 BPM (normal)
• Premie (0-28 days):Premie HR is 100-199. Normal respiratory rate: 30-60, Normal BP: 60-80/35-55,Premie/LBW BP: 40-60/20-35
• Infants (1 – 12 months) axillary Temp: 97-100.4, HR: 80 - 180 BPM, Respiratory Rate: 30 - 60, Premie BP: 40-60/20-35
• Toddlers (1-3 years) , Axillary Temp: 97-100.4 degrees, Heart rate: 70-160 BPM, Respiratory Rate : 24-34, BP: 80-110/54-73 Toddlers typically gain 4 - 6 lbs a year, growing 3" in a year.
• Preschool (3-5 years) : Axillary Temp: 97-100.4, HR: 70-120 bpm, Respiratory Rate: 20-30, BP: 92-116/56-75 Preschoolers gain 5-6 lbs per year and grow 2.5-3" per year.
• School age (6-12 years): Apical Temp: 97-100.4, HR: 60-105, Respiratory Rate: 18-26 BPM, BP: 94-130/56-85 School age: People typically gain 4-7 lbs per year.
• Average onset of puberty in school ager is 10 yrs for females and 12 yrs for males.
• Adolescent (13-18 years),Axillary Temp: 96.4-99.4, Hr: 50-95, Respiratory Rate: 12-20 , BP: 100-140/60-88

Chronological Age calculations

• To determine adjusted age in a child less than 2, subtract the weeks early to determine ADJUSTED age to use for standardized test.

Assessment labs with typically developing infants/children

• Purpose is to practice administering, scoring, and interpreting three assessment tools.
• The aim is to Become more comfortable with infants and children to observe typical movement and behavior and to practice level measures.
• The Goal is to practice interviewing or history taking establishing rapport.

Tasks before Assessment labs

• Become familiar with assessment tools by watching videos, determine chronological age, know what to expect, and have forms ready

Tasks during Assessment labs

• Observe posture and movement in all positions, complete developmental tests , note other movements and How to encourage or elicit movements using toys.
• Obtain as much BSF or impairment level info as possible (e.g. ROM, strength, muscle tone, reflexes, and sensory)

HAMMERSMITH INFANT NEUROLOGICAL EXAMINATION (HINE)

• HINE used to be the Early neurological examination tool for the diagnosis of Cerebral Palsy (CP).

• Since its introduction, the HINE has been used in different high- and low-risk populations, both for preterm and for term-born infants.

• The HINE is Proposed as a tool for prognosis, diagnosis, and rehabilitation.

• The HINE Includes 26 items in 5 subsets including: Cranial nerves, Posture , Movement, Tone , Reflexes

• It is a simple scoreable method, Designed for evaluating infants between 2-24 months. It can be performed in 5-10 minutes

• The tool has a Good sensitivity and high predictive value for risk of CP in high risk populations under 5 months and has a good inter observer reliability

• Each item in the HINE is scored separately and the final score ranges from 0-3 points for each.

• A maximum Optimality Score is calculated through adding up all of the scores across the categories , with a global score range from 0-78:

• Global scores are reported as optimal if they are:

  • equal or above 67 at 3 months
  • equal or above 70 at 6 months
  • equal or above 73 at 9 to 12 months.

• HINE scores help score as prediction of CP: * 50-73 indicates likely unilateral cerebral palsy at 3,6,9, or 12 months.

• The study shows - 99% will gain ambulation. * 40 - 60 indicates likely GMFCS I-II at the age of 3,6,9, or 12 months< 40 indicates likely GMFCS III-V at the age of 3-6 months.

• The clinical signs more often associated with severe CP:

• abnormal posture

• increase trunk extensor tone

• limb tone in the flexed arms and extended legs

• forward parachute reaction.

Alberta Infant Motor Scale (AIMS)

• The Alberta Infant Motor Scale measures gross motor development birth to ~18 months
• Infants need to be Observed in four "sequences" including : supine, prone, sitting or standing using 58 observation items
• Every Item posture or movement you observe in each sequence must be Mark with an "O' for "Observed" can You use video evidence too
• Create "window" for each sequence (earliest skill observed to latest/highest skill observed)Similar to "basal" and "ceiling" on PDMS
• Calculate score By Give 1 point for each item observed within the window, and all items left or /before the window , the total score in each sequence
• The Final percentile/percentile range must be find on chart on back: Total score on y-axis, age on x-axis. and be on chart, be specific to WEEKS of age (each vertical line = one week

PDMS-3

• The Peebody is a Gross and fine motor developmental assessment, birth-72 months (6 years):
• Start at recommended place for child's age:
  • Administer items in that area to establish "Basal age", then proceed with increasingly difficult items to establish “Ceiling age”: _ basal age: Three consecutive “2s” _ ceiling age: Three consecutive “Os”
• Administer three subtests (Body Control, Body Transport, Object Control) Supplemental Subtest: Physical Fitness: Scoring --: Raw score ,Percentile, Standard Z score, Age equivalent, Gross Motor: Quotient (GMQ), GMQ percentile, GMQ Z score : Online

Determining Percent Delay

• Determine "Age Equivalent” or “Developmental Age" on a standardized exam and Use adjusted chronological age if needed:
• (Chronological age - Age equivalent) divided by Chronological age, x100:
• (Chronological age - Age equivalent.) / Chronological age * X 100:

Gait Progression Milestones

• Total kyphosis Newborn
• Cervical ledodos starts at circa 34 month , Thorasic Kyphosis circa 8 months, Lumenal lordsosis begins about 1 year;
• At one month their Asymmetry turned side disorganized movement
• 2 months: brief hand with C curve but less spine flexion in babies with physiological flexion decrease Extrenee movement increases
• 3 month cervical extensible head control much improved hands open easily and use begin to at Target
• 4 mo - prone with elbow in contact
• 4 month old Sits with less support improved extension head control in all positions minimal -no head lag bring hands to knees/feet
• 5 months
• Full head control
• Prone and hands to feet
• 6 mths pull self to sit on hands, Still not stable' safe' forming
• 7 months crawling rocks back & form or and the begin to ask for help or
• 8 month begin crawling from 9 crawling
• 9 mnth- free hands to reach up, for it 9 months the exploration
• 10 months - Climbing ups and Pull a little bit but Cruise forward

Normal Motor Development

• A baby develops in utero: at birth there are elbow hip and spine all flexed from forearm being pronated and hip being abducted and knee flexed or hip Flexion from ankle Doris and a flexed position;
• The Normal baby a couple weeks will Sping pack into Flexion when extended.;
• The Typical physiological flexion decreases as childs get older
• -2months if co-contraction leads to still stiff
• 3 months show symmetry with smooth movements an cervical extensors and being open;
• 4- avoid spinal rotation ,Minimal ton no Head lag brings hands for feet;
• 5 months Full head control for strong Core,
• 6 month, free UE, can not sit for long

Grounded Cognition

• Cognition is where you need help!
• Environment - where you are.
• Social - family, teachers etc,.
• The world around you

Dynamic systems Theory

• Development comes from 3 areas:
• complexity
• continuity in time
• Dynamic Stability

Early intervention

• EI has long-lasting effects on:
• School performance
• Psychosocial skills
• Perceptual-motor skills
• Cognition,Language ,Visuo-motor, Spatial skills

Clinical Reasoning examination

• Regardless of the setting the clinic is in, pediatricis is a highly collaborative field. The most Common Dx seen in Pediatric PT are MSK,Ex: Torticollis, Overuse injuries, Congenital Foot Deformities, Hip dysplasia,:Growth plate fractures, Perthes disease, JIA, Scoliosis, Developmental Disabilities, Ex: Cerebral palsy Genetic/Progressive: Spinal Muscular Atrophy, Duchene's muscular dystrophy, : Neurological Injuries, (non-progressive)Spina Bifida, TBI, Erb's Palsy (Brachial Plexus, Injury,: Cardiopulmonary/Pulmonarycongenital malformations Cystic Fibrosis
• less common but often seen are arthrogyposis/osteongenisis imperfecta, seizure/ genetic / fetal alcohol/ prenatal.

Pediatric Settings

• Child Developmental Services Agency (Early Intervention)
  • Home/Clinic
    • Home is preferred (natural setting)
    • In this area C-DSA is Outpatient clinic.
• Out-patient, acute in in-patientrehab, home with past acute

Pediatric examination

• Establish baseline and effectiveness of care and screen for Neurologic Involvement •The goal: what is wrong with the child, Justify Services: (Medical Necessity) and Prognosis

• establish Plan of Care
• Frequency, Duration, Planned Intervention/Communication/Collaboration
• Consider all relevant considerations:
• School , Accommodations, eligible for help by the government
• The 3 levels of the ICF- The health, body functions , activities/personal And environmental/

What history should you consider in patient evals.

• pregnancy with fetal health,Birth (full term with GA) /health since birth, major motor skills/ family history

ICf Models

The PT role in NICU and DC from NICU:

• PT completes
• infant positioning,
• Manages the to expectations Provides lots of education Regarding
• discharge PTs assess development readiness Adapt EQ and bridge the gap from acute to community PT services

Signs of neglect/abuse

• signs Children 4 and Under
• For a child of any age, -Unexplained bruises,  -sexual behavior;  -Neglect: Food water sleep hygiene, and or lack of attendance

Mandatory reporting Child Abuse/Neglect in North Carolina

What is the Goal for evals.?

• use all avail information And professional judgement .

Typical Newborn Reflexes

• (that can be performed or observed during evaluation. The more obvious ones from that age).*
• ATNR, TLR, Flexor Withdrawal, MORO reflex,palmer , plantar grasp, stepping reaction, and positive support

Tonal Reflexes

• When a TLR when the extenser or tone is high what Will the child NOT bedoing? will not be bringing head of neck;
• ATNR, A head to neck reflex : • If a head of face will cause trunk extended On Face . If the child bring hands TO midline What Will NOT bedoing: • will have difficulties moving TRunck for moving
• Reactions-Righting, Equilibrium, Protective* - develop in each postion gained

What are sz and what do they Look like?

• Seizure Tonic Is a body
• Atypical: staring epsdes and a slow muscle weakness
• a-chronic is A total loss.
• Motor skills? Do they affect motor function, do they exist? jumping
• What should goals look like on patient Notes?*
• The goals what the patient is doing, Should be measurable, Predicitve must fee simple,
• ** Peds-specific Outcome Measures include Aims and Hine The Aims looks to be, Hammersmith for neuro!

Questions cover key aspects of the PDMS-3, AIMS, and HINE assessments, including calculating developmental delays, understanding basal levels, and identifying assessed motor skills. Focuses on the structure, scoring, and interpretation for neurological and motor function in infants and children.