SUMMARYOFEXAMINATION
Globalscore(max78)
Numberofasymmetries
Behaviouralscore(notpartoftheoptimalityscore)
Cranialnervefunctionscore(max15) Posture score(max18)
Movements score(max6)
Tone score(max24)
Reflexesandreactions COMMENTS score(max15)
(Throughouttheexam,ifaresponseisnotoptimalbutnotpoorenoughtoscore1,giveascoreof2)
NEUROLOGICALEXAMINATION
ASSESSMENTOFCRANIALNERVEFUNCTION
score3 2score1 score0 scoreAsymmetry /Comments
Facialappearance (atrestandwhencryingor stimulated)
Smilesorreactsto stimulibyclosing eyesandgrimacing
Closeseyesbut nottightly,poor facialexpression
Expressionless, doesnotreactto stimuli Eyemovements Normalconjugate eyemovements Intermittent Deviationofeyesor abnormal movements
Visualresponse
Testabilitytofollowablack/white target
Auditoryresponse
Testtheresponsetoarattle
Sucking/swallowing
Watchinfantsuckonbreastorbottle
Ifolder,askaboutfeeding,assoc. cough,excessivedribbling
Followsthetargetina completearc
Reactstostimuli frombothsides
Goodsuckand swallowing
Followstargetin anincompleteor asymmetricalarc
Doubtfulreaction tostimulior asymmetryof response
Continuous Deviationofeyesor abnormal movements
Doesnotfollow thetarget
Noresponse
Poorsuckand/or swallow Nosuckingreflex, noswallowing
Head insitting
Straight;inmidline
Slightlytosideorbackward orforward
Markedlytosideorbackward orforward
Trunk insitting
Slight internalrotationor externalrotation
Marked internalrotationor externalrotationor
Straight Slightlycurvedor benttoside Very rounded rocketing back bent sideway Arms atrest Inaneutral position,central straightor slightlybent
Intermittentdystonic posture dystonicposture hemiplegicposture Hands Handsopen Intermittent adductedthumb orfisting
Legs insitting
Abletositwitha straightbackand legsstraightor slightlybent(long sitting)
insupineand instanding Legsinneutral positionstraightor slightlybent
Feet insupineand instanding
Centralinneutral position
Slight internal rotation or external rotation
Sitwithstraightbackbutknees bentat1520° Internalrotationor externalrotationatthehips
Persistent adductedthumb orfisting
Unabletositstraightunless kneesmarkedlybent (nolongsitting)
Toesstraight midwaybetween flexionand extension
Slightinternal rotationorexternal rotation
IntermittentTendency tostandontiptoesor toesupor curlingunder
Marked internalrotationor externalrotation or fixedextensionorflexionor contracturesathipsandknees
Marked internalrotationor externalrotationattheankle
Persistent Tendencytostandontiptoes or toesupor curlingunder
Quantity Watchinfant lyinginsupine
QualityObserve infant’s spontaneous voluntarymotor activityduringthe courseofthe assessment
Free,alternating, andsmooth
Jerky Slighttremor
Myoclonicspasm
Dystonicmovement
Scarfsign
Taketheinfant’shandandpull thearmacrossthechestuntil thereisresistance.Notethe positionoftheelbowinrelation tothemidline
headNote resistanceatshoulderand elbow
Pronation/supinationSteady theupperarmwhilepronating andsupinating forearm,noteresistance
Hipadductors
Withboththeinfant’slegs extended,abductthemasfaras possibleTheangleformedby thelegsisnoted
Poplitealangle
Keepingtheinfant’sbottomonthe bed,flexbothhipsontothe abdomen,thenextendtheknees untilthereisresistanceNotethe anglebetweenupperandlowerleg
Ankledorsiflexion
Fullpronationand supination, noresistance
Resistancetofull pronation/ supination overcomeable
Fullpronationand supinationnot possible,marked resistance
Range:30°85°
RLRL 2030°
Pullinfanttositbythewrists (supportheadifnecessary)
VentralsuspensionHold infanthorizontallyaround trunkinventralsuspension; notepositionof back,limbsandhead
Armprotection
Score3 Score2 Score1 Score0 scAsym/Co
Arm&hand R extend L Armsemiflexed R L Armfullyflexed R L
Kickssymmetrically Kicksonelegmoreor poorkicking Nokickingevenif stimulatedorscissoring
R LL RR L R L
ForwardparachuteHold infantupverticallyandquicklytilt forwards.Notereaction /symmetryofarmresponses, (after6months)
TendonReflexes
Easilyelicitable
bicepskneeankle
Head control
SECTION2MOTORMILESTONES(notscored;noteasymmetries)
Unableto maintainhead upright
SittingCannotsit
Voluntary grasp noteside
Pleasenoteageat whichmaximum skillisachieved normalto3mnormalupto4mnormalfrom5m
Wobbles Maintained uprightallthe time
Withsupportat hips normalat4m
Props normalat6m
NograspUseswhole hand Indexfingerand thumbbut immaturegrasp
Stablesit normalat78m
Pincergrasp
Pivots(rotates) normalat9m
Observed: Reported(age):
Observed: Reported(age):
Abilityto kickin supine Nokicking Kicks horizontallybut legsdonotlift
Upward (vertically) normalat3m
Touchesleg normalat45m
Touchestoes normalat56m
NorollingRollingtoside normalat4m
Pronetosupine normalat6m
Observed: Reported(age): Rolling -note through which side(s)
Supinetoprone normalat6m
Doesnotlift head OnelbowsOnoutstretched hands Crawlingflaton abdomen Crawlingon handsandknees
Observed: Reported(age): Crawling -noteif bottom shuffling
Supportsweight normalat4m
Standswith support normalat7m
Standsunaided normalat12m
Observed: Reported(age): Walking Bouncing normalat6m
Cruising(walks holdingon) normalat12m
Observed: Reported(age):
Walking independently normalby15m SECTION3BEHAVIOUR(notscored) 1 2 3 4 56 Comment
Conscious state UnrousableDrowsy Sleepbut wakeseasily Awakebutno interest Loses interest Maintains interest Emotional state Irritable,not consolable Irritable,carer canconsole Irritablewhen approached Neitherhappy orunhappy Happy and smiling Social orientation Avoiding, withdrawn Hesitant Accepts approach Friendly