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Dr. Pradeep Dubey MD (Ped.), DCH. Cons. Developmental & Neuro Ped .

NEUROLOGICAL ASSESSMENT OF INFANTS. Dr. Pradeep Dubey MD (Ped.), DCH. Cons. Developmental & Neuro Ped. “DEVCHHAYA” Early Intervention Centre Wright Town - Jabalpur. STRABISMUS IN C.P. CRITICAL PERIOD IN BRAIN MATURATION.

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Dr. Pradeep Dubey MD (Ped.), DCH. Cons. Developmental & Neuro Ped .

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  1. NEUROLOGICAL ASSESSMENT OF INFANTS Dr. Pradeep Dubey MD (Ped.), DCH. Cons. Developmental & Neuro Ped. “DEVCHHAYA” Early Intervention Centre Wright Town - Jabalpur

  2. STRABISMUS IN C.P.

  3. 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”

  4. SOME EXPERIMENTS • Phantom limb & Virtual reality mirror box • Kitten’s one eye was stitched – Brain mapping shows concerned part of brain started processing information of other eye. • Grey matter mass of Med. Students brain increased in months of exam. • Brain port in patient with Vestibular damage – Secondary pathways unmasked. NEUROPLASTICITY IS ONE OF THE EXTRA -ORDINARY DISCOVERIES OF 20th OCENTURY (NORMAN DOIDGE)

  5. 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 WALKING.”

  6. PREMATURITY & LBW • Anatomical Peculiarities • Intracranial Hemorrhage & periventricular Leukomalacia. • Birth wt. 800 – 1000 gms. 6 – 8% • Birth wt. 800 gms. & less 20 – 40% US spending 26 billion dollars (120,000 Crors Rs.) annually on Preterm babies and their related problems

  7. HIGH RISK CONDITIONS • 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.

  8. DYSKINETIC - C.P.

  9. MATERNAL BLOOD GROUP Rh Rh • Mother – Rh negative • Precautions for Rh incompatibility

  10. INDICATORS OF POOR OUTCOME IN A SICK NEW BORN • Low apgar (0-3) after 20 mts. • Late seizures in a depressed NB • Persistence of Abn. Neuro signs after 2 wks. • Hypodensisties in Ct. even after 4 wks. • Oliguria (<1ml./kg./ hr.) for 36 hrs. • associated with H.I.E. • Background abnormalities in interictal EEG.

  11. ALARMING SIGNS • Responsiveness / Alertness • Spontaneous motility • Persistant hyper excitability • Feeding difficulty • Constant fisting • Abnormal movements / convulsions. • Abnormal postures • Abnormal Head circumerence • Abnormalities of tone • Ocular abnormalities • Lack of response to sound.

  12. ALARMING SIGNS • Responsiveness / Alertness • Spontaneous motility • Persistant hyper excitability • Feeding difficulty • Constant fisting • Abnormal movements / convulsions. • Abnormal postures • Abnormal Head circumerence.

  13. HEMIPLEGIC C.P.

  14. AGE FOR ASSESSMENT • AMIEL TISON - 2 MTHS, 7 MTHS, 12 MTHS • P.G. I. CHANDIGRAH – 9 MTHS. • OTHERS - 8 MONTHS

  15. NEURO DEVELOPMENTAL EXAMINATION METHODS • AMEIL TISON’S METHOD • VOJTA’S TECHNIQUE • CAPUTE AND ASSOCIATES • INFANT NEUROLOGICAL INTERNATION • BATTERY (INFANIB)

  16. INFANIB: Brief Description

  17. 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.

  18. INFANIB: Items Details Items consists under following categories- • Measures of muscle range and resistance to passive movements (Scarf sign, Popliteal angle etc.) • Reflexive Responses (Foot grasp, ATNR etc.) • Equilibrium reactions (Parachute responses etc.) and • Quality of certain milestones (Sitting position, Weight bearing in standing etc)

  19. Hands: Open/Closed Normal Response

  20. Hands: Open/Closed Abnormal Response

  21. Scarf Sign Normal Response

  22. Scarf Sign Abnormal Response

  23. Heel-to-Ear Normal Response

  24. Heel-to-Ear Abnormal Response

  25. Popliteal Angle Normal Response

  26. Popliteal Angle Abnormal Response

  27. Leg Abduction Normal Response

  28. Leg Abduction Abnormal Response

  29. Dorsiflexion of Foot Normal Response

  30. Dorsiflexion of Foot Normal Response

  31. Dorsiflexion of Foot Abnormal Response

  32. Foot Grasp Normal Response

  33. Foot Grasp Abnormal Response

  34. Tonic Labyrinthine Supine Normal Response

  35. Tonic Labyrinthine Supine Abnormal Response

  36. Asymmetric Tonic Neck Reflex Normal Response

  37. Asymmetric Tonic Neck Reflex Abnormal Response

  38. Asymmetric Tonic Neck Reflex Abnormal Response

  39. Pull to Sit Normal Response

  40. Pull to Sit Abnormal Response

  41. Body Derotative Normal Response

  42. Body Derotative Abnormal Response

  43. Body Rotative Normal Response

  44. Body Rotative Abnormal Response

  45. All-Fours Normal Response

  46. All-Fours Abnormal Response

  47. Tonic Labyrinthine Prone Normal Response

  48. Tonic Labyrinthine Prone Abnormal Response

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