Dr. Pradeep Dubey - Consultant Pediatrician Dr. Pradeep Dubey MD (Ped.), DCH. MD (Ped.), DCH. Cons. Developmental & Neuro Ped. Dr. Pradeep Dubey MD (Ped.),
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Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Dr. Pradeep DubeyDr. Pradeep Dubey MD (Ped.), DCH.MD (Ped.), DCH.
Cons. Developmental & Neuro Cons. Developmental & Neuro
PedPed..
Dr. Pradeep DubeyDr. Pradeep Dubey MD (Ped.), DCH.MD (Ped.), DCH.
Cons. Developmental & Neuro Cons. Developmental & Neuro
PedPed..
NEUROLOGICAL ASSESSMENTNEUROLOGICAL ASSESSMENT
OF INFANTS OF INFANTS
““DEVCHHAYA” DEVCHHAYA” Early Intervention CentreWright Town - Jabalpur
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
STRABISMUS IN C.P.STRABISMUS IN C.P.STRABISMUS IN C.P.STRABISMUS IN C.P.
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
CRITICAL PERIOD IN BRAIN MATURATION CRITICAL PERIOD IN BRAIN MATURATION CRITICAL PERIOD IN BRAIN MATURATION CRITICAL PERIOD IN BRAIN MATURATION
Kitten blind folded after birth for 3 months
developed acquired amblyopia, Visual Cortex
start processing auditory information.
Strabismus in infants leads to acquired
amblyopia
Congenital deafness – auditory area process
visual information.
“WE USE IT OR WE LOSE
IT”
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
SOME EXPERIMENTSSOME EXPERIMENTSSOME EXPERIMENTSSOME EXPERIMENTS
Phantom limb & Virtual reality mirror boxPhantom limb & Virtual reality mirror box
Kitten’s one eye was stitched – Brain Kitten’s one eye was stitched – Brain
mapping shows concerned part of brain mapping shows concerned part of brain
started processing information of other eye.started processing information of other eye.
Grey matter mass of Med. Students brain Grey matter mass of Med. Students brain
increased in months of exam.increased in months of exam.
Brain port in patient with Vestibular damage Brain port in patient with Vestibular damage
– Secondary pathways unmasked. – Secondary pathways unmasked.
Phantom limb & Virtual reality mirror boxPhantom limb & Virtual reality mirror box
Kitten’s one eye was stitched – Brain Kitten’s one eye was stitched – Brain
mapping shows concerned part of brain mapping shows concerned part of brain
started processing information of other eye.started processing information of other eye.
Grey matter mass of Med. Students brain Grey matter mass of Med. Students brain
increased in months of exam.increased in months of exam.
Brain port in patient with Vestibular damage Brain port in patient with Vestibular damage
– Secondary pathways unmasked. – Secondary pathways unmasked.
NEUROPLASTICITY IS ONE OF THE EXTRA -NEUROPLASTICITY IS ONE OF THE EXTRA -
ORDINARY DISCOVERIES OF 20ORDINARY DISCOVERIES OF 20th th OCENTURYOCENTURY(NORMAN DOIDGE)(NORMAN DOIDGE)
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
NEUROPLASTICITY NEUROPLASTICITY NEUROPLASTICITY NEUROPLASTICITY
Brain tissues are plastic and
responsive .
Adequate and repeated stimuli can
modify brain physiology as well as
morphology
Brain port in patient with Vestibular
damage – Secondary pathways
unmasked.
Grey matter mass of Med. Students
brain increase in months of exam.
““DO WE MAKE THE ROAD BY DO WE MAKE THE ROAD BY
WALKING.”WALKING.”
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Anatomical PeculiaritiesAnatomical Peculiarities
Intracranial Hemorrhage & Intracranial Hemorrhage &
periventricular Leukomalacia.periventricular Leukomalacia.
Birth wt. 800 – 1000 gms. Birth wt. 800 – 1000 gms. 6 – 8%6 – 8%
Birth wt. 800 gms. & less Birth wt. 800 gms. & less 20 – 40% 20 – 40%
Anatomical PeculiaritiesAnatomical Peculiarities
Intracranial Hemorrhage & Intracranial Hemorrhage &
periventricular Leukomalacia.periventricular Leukomalacia.
Birth wt. 800 – 1000 gms. Birth wt. 800 – 1000 gms. 6 – 8%6 – 8%
Birth wt. 800 gms. & less Birth wt. 800 gms. & less 20 – 40% 20 – 40%
PREMATURITY & LBWPREMATURITY & LBWPREMATURITY & LBWPREMATURITY & LBW
US spending 26 billion dollars (120,000 Crors Rs.) annually on Preterm babies and their
related problems
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Low birth weight babies.
Severe H.I.E.
Severe neonatal jaundice
Persistence of Abn. Neuro signs after 2
wks.
Hypodensisties in Ct. even after 4 wks.
Oliguria (<1ml./kg./ hr.) for 24 hrs.
associated with H.I.E.
Low apgar (0-3) after 20 mts.
Late seizures in a depressed NB
Background abnormalities in interictal
EEG.
HIGH RISK CONDITIONSHIGH RISK CONDITIONSHIGH RISK CONDITIONSHIGH RISK CONDITIONS
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
DYSKINETIC - C.P.DYSKINETIC - C.P.DYSKINETIC - C.P.DYSKINETIC - C.P.
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Mother – Rh negative
Precautions for Rh
incompatibility
MATERNAL BLOOD GROUPMATERNAL BLOOD GROUPMATERNAL BLOOD GROUPMATERNAL BLOOD GROUP
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Low apgar (0-3) after 20 mts.Low apgar (0-3) after 20 mts.
Late seizures in a depressed NBLate seizures in a depressed NB
Persistence of Abn. Neuro signs after 2 Persistence of Abn. Neuro signs after 2
wks.wks.
Hypodensisties in Ct. even after 4 wks.Hypodensisties in Ct. even after 4 wks.
Oliguria (<1ml./kg./ hr.) for 36 hrs. Oliguria (<1ml./kg./ hr.) for 36 hrs.
associated with H.I.E.associated with H.I.E.
Background abnormalities in interictal Background abnormalities in interictal
EEG.EEG.
Low apgar (0-3) after 20 mts.Low apgar (0-3) after 20 mts.
Late seizures in a depressed NBLate seizures in a depressed NB
Persistence of Abn. Neuro signs after 2 Persistence of Abn. Neuro signs after 2
wks.wks.
Hypodensisties in Ct. even after 4 wks.Hypodensisties in Ct. even after 4 wks.
Oliguria (<1ml./kg./ hr.) for 36 hrs. Oliguria (<1ml./kg./ hr.) for 36 hrs.
associated with H.I.E.associated with H.I.E.
Background abnormalities in interictal Background abnormalities in interictal
EEG.EEG.
INDICATORS OF POOR OUTCOME IN A SICK NEW BORNINDICATORS OF POOR OUTCOME IN A SICK NEW BORNINDICATORS OF POOR OUTCOME IN A SICK NEW BORNINDICATORS OF POOR OUTCOME IN A SICK NEW BORN
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Responsiveness / Alertness
Spontaneous motility
Persistant hyper excitability
Feeding difficulty
Constant fisting
Abnormal movements / convulsions.
Abnormal postures
Abnormal Head circumerence
Responsiveness / Alertness
Spontaneous motility
Persistant hyper excitability
Feeding difficulty
Constant fisting
Abnormal movements / convulsions.
Abnormal postures
Abnormal Head circumerence
ALARMING SIGNSALARMING SIGNS
Abnormalities of tone
Ocular abnormalities
Lack of response to
sound.
Abnormalities of tone
Ocular abnormalities
Lack of response to
sound.
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Responsiveness / AlertnessResponsiveness / Alertness
Spontaneous motilitySpontaneous motility
Persistant hyper excitability Persistant hyper excitability
Feeding difficultyFeeding difficulty
Constant fistingConstant fisting
Abnormal movements / convulsions.Abnormal movements / convulsions.
Abnormal posturesAbnormal postures
Abnormal Head circumerence.Abnormal Head circumerence.
Responsiveness / AlertnessResponsiveness / Alertness
Spontaneous motilitySpontaneous motility
Persistant hyper excitability Persistant hyper excitability
Feeding difficultyFeeding difficulty
Constant fistingConstant fisting
Abnormal movements / convulsions.Abnormal movements / convulsions.
Abnormal posturesAbnormal postures
Abnormal Head circumerence.Abnormal Head circumerence.
ALARMING SIGNSALARMING SIGNSALARMING SIGNSALARMING SIGNS
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
HEMIPLEGIC C.P.HEMIPLEGIC C.P.HEMIPLEGIC C.P.HEMIPLEGIC C.P.
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
AMIEL TISON - 2 MTHS, 7 MTHS, 12 AMIEL TISON - 2 MTHS, 7 MTHS, 12
MTHSMTHS
P.G. I. CHANDIGRAH – 9 MTHS.P.G. I. CHANDIGRAH – 9 MTHS.
OTHERS - 8 MONTHSOTHERS - 8 MONTHS
AGE FOR ASSESSMENTAGE FOR ASSESSMENTAGE FOR ASSESSMENTAGE FOR ASSESSMENT
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
AMEIL TISON’S METHODAMEIL TISON’S METHOD
VOJTA’S TECHNIQUEVOJTA’S TECHNIQUE
CAPUTE AND ASSOCIATES CAPUTE AND ASSOCIATES
INFANT NEUROLOGICAL INFANT NEUROLOGICAL
INTERNATION INTERNATION BATTERY (INFANIB)BATTERY (INFANIB)
AMEIL TISON’S METHODAMEIL TISON’S METHOD
VOJTA’S TECHNIQUEVOJTA’S TECHNIQUE
CAPUTE AND ASSOCIATES CAPUTE AND ASSOCIATES
INFANT NEUROLOGICAL INFANT NEUROLOGICAL
INTERNATION INTERNATION BATTERY (INFANIB)BATTERY (INFANIB)
NEURO DEVELOPMENTAL EXAMINATION METHODSNEURO DEVELOPMENTAL EXAMINATION METHODSNEURO DEVELOPMENTAL EXAMINATION METHODSNEURO DEVELOPMENTAL EXAMINATION METHODS
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
INFANIB: Brief Description
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
INFANIB
• Appropriate for use with neonates and Infants up to 18 months of age.
• 14 Items are assessed in the neonatal period while 6 others are added between
3- 9 months of age.
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
INFANIB: Items Details
Items consists under following categories-
a. Measures of muscle range and resistance to passive
movements (Scarf sign, Popliteal angle etc.)
b. Reflexive Responses (Foot grasp, ATNR etc.)
c. Equilibrium reactions (Parachute responses etc.) and
d. Quality of certain milestones (Sitting position, Weight
bearing in standing etc)
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Hands: Open/Closed
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Hands: Open/Closed
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Scarf Sign
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Scarf Sign
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Heel-to-Ear
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Heel-to-Ear
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Popliteal Angle
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Popliteal Angle
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Leg Abduction
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Leg Abduction
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Dorsiflexion of FootNormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Dorsiflexion of Foot
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Dorsiflexion of Foot
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Foot Grasp
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Foot Grasp
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Tonic Labyrinthine Supine
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Tonic Labyrinthine Supine
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Asymmetric Tonic Neck Reflex
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Asymmetric Tonic Neck Reflex
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Asymmetric Tonic Neck Reflex
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Pull to Sit
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Pull to Sit
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Body Derotative
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Body Derotative
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Body Rotative
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Body Rotative
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
All-Fours
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
All-Fours
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Tonic Labyrinthine Prone
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Tonic Labyrinthine Prone
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Sitting
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Sitting
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Sideways parachuteNormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Sideways parachute
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Backward Parachute
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Backward Parachute
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Standing
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Standing
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Positive Supporting ReactionNormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Positive Supporting Reaction
Abnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Forward Parachute
Normal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Forward ParachuteAbnormal Response
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
High Risk Neonate
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Alignment
Spine
Head Tilt
Head rotation
Leg progression
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Atypical Static Postural Alignment
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Equinus
Scissoring
Equinus
Lack Of base of Support
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Foot Deformity
Midfoot break
Hindfoot eversion
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
Head – size shape, fontanell Head – size shape, fontanell
suturessutures
Eyes – Setting sun, Strabismus, Eyes – Setting sun, Strabismus,
nystagmusnystagmus
Skin abnormalities – Cafeaulet, Skin abnormalities – Cafeaulet,
Nevi etc.Nevi etc.
Cranial nervesCranial nerves
Altered mental statusAltered mental status
Spine Spine
AMIEL TISON’S METHODAMIEL TISON’S METHODAMIEL TISON’S METHODAMIEL TISON’S METHOD
A. GENERAL DISCRIPTIONA. GENERAL DISCRIPTION
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
1.1. ToneTone - Scarf sign heel to ear- Scarf sign heel to ear
leg abduction, Popliteal leg abduction, Popliteal
angelangel
- - dorsoflexion of footdorsoflexion of foot Pull Pull
to sit.to sit.
prone, sitting positionprone, sitting position
- atnr,- atnr,
2. Vestibular2. Vestibular - Side ways sparachute, - Side ways sparachute,
backward &backward &
FunctionFunction forward parachute, body forward parachute, body
rotativerotative
3. Lethargy/Hyper excitability 3. Lethargy/Hyper excitability
4. Vision & Hearing 4. Vision & Hearing
5. Developmental delay 5. Developmental delay
AMIEL TISON’S METHODAMIEL TISON’S METHODAMIEL TISON’S METHODAMIEL TISON’S METHOD
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
PROGNOSIS FOR WALKING IN CPPROGNOSIS FOR WALKING IN CPPROGNOSIS FOR WALKING IN CPPROGNOSIS FOR WALKING IN CP
Hemiplegia 100%
Diplegia (Paraplegic)90%
Ataxia/ Dyskinesia80%
Quadriplegia 18%
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
PRIORITIES OF MANAGEMENT PRIORITIES OF MANAGEMENT PRIORITIES OF MANAGEMENT PRIORITIES OF MANAGEMENT
CommunicationCommunication
Socioemotional DevelopmentSocioemotional Development
Maximal independence in ADLMaximal independence in ADL
As near normal appearance as As near normal appearance as
possiblepossible
MobilityMobility
Dr. Pradeep Dubey - Consultant PediatricianDr. Pradeep Dubey - Consultant Pediatrician
www.healthychildindia.comwww.healthychildindia.com
“DEVCHHAYA” Early Intervention CentreEarly Intervention Centre
Prem Mandir Chowk, Wright Town
“DEVCHHAYA” Early Intervention CentreEarly Intervention Centre
Prem Mandir Chowk, Wright Town
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