Assessment Final - Neuromotor Assessment

Front 1

Neuro assessment includes these (4) systems

Back 1

Motor system

Sensory system

Reflexes

Cranial nerves

Front 2

____ % of infants with brachial nerve damage also have ________ damage

Back 2

5%

phrenic nerve damage

Front 3

Term vs preterm resting posture

Back 3

term - flexed, arms adducted, hips adducted & flexed

preterm - arms and legs extended

--> for each patient think "is this posture appropriate for their GA?"

Front 4

Tone increases in a _______ direction

Back 4

caudocephalad (feet to head)

preterm "frog leg" posture (femur flat on mattress) is ABNORMAL after 32 weeks

Front 5

Cortical thumb - normal or not?

Back 5

Can be normal if NOT all the time and a LOOSE grip is noted

Front 6

Term vs preterm limb movements

Back 6

Term - smooth, may be semi uncoordinated

Preterm - tremors, jitteriness - rapid alternating movement of equal amplitude in all directions

Front 7

What are clonic movements?

Back 7

Movements seen with seizures, fast and slow component, canNOT be stopped with holding. Also seen with abnormal eye movements

Front 8

What type of eye movements do you see with seizures?

Back 8

Horizontal eye deviation (stay to 1 side while baby seizes) is common with seizures

Front 9

What is the best state to examine a baby in?

Back 9

Quiet alert state - ~30-60 min before a feeding

*Hard to examine state in infants < 28 weeks

Front 10

Sleep periods longer in preterm vs term?

When are cycles more appropriate?

Alertness is readily seen by what gestation?

Back 10

Sleep - longer in preterm

Cycles appropriate by 32 weeks

Alertness readily seen by 37 weeks

Front 11

Active sleep state

Back 11

smiles, grimaces - but asleep! More apnea seen in this state bc diaphragm more uncoordinated

Front 12

Drowsy state

Back 12

Variable activity level with mild startles interspersed fromtime to time. Movements usually smooth. May move to sleep if left alone quiet, or awake if talked to/awakened

Front 13

Quiet alert state

Back 13

"ooh" face, focused baby

Front 14

Active alert state

Back 14

not focused, just moving all around

Front 15

Crying state

Back 15

.... The infant is crying :)

Front 16

Entire neuromuscular part of Ballard Exam tests _____ tone

Back 16

passive --> remember infants limbs have to be relaxed to determine passive tone

Front 17

Pull to sit manuever

Back 17

ACTIVE tone

contract shoulder/arm muscles, flex neck, the head falls forward

Front 18

Opisthotonus

Back 18

sometimes seen in bacterial meningitis, severe HIE and IVH, tetanus, and kernicterus

hypertonia - passive movement of limbs results in increased tone

Front 19

Deep tendon reflexes - which ones do we use in babies? What does it help us do?

Back 19

Patellar & biceps (you CAN do routinely, we just don't)

--> Assist in determining integrity of spinal cord and peripheral nervous system

Front 20

What (4) things may cause deep tendon reflexes to be weak or absent? What might cause them to be exaggerated?

Back 20

1. < 28 weeks

2. birth asphyxia

3. sepsis

4. encephalopathy

exaggerated? drug withdrawal

Front 21

What part of the spinal column does the patellar reflex test? Biceps reflex?

Back 21

Patellar - L2-L4

Biceps - C5-C6

Front 22

Clonus: what is it, what is it due to, what does it mean if it's sustained?

Back 22

Rapid movement of a particular joint, due to sudden stretching of a tendon (ie ankle clonus)

Sustained? cerebral irritation

Front 23

Normal beats seen when testing ankle clonus

Back 23

Term - < 5

Preterm - < 10

Sustained = CNS problem

*More than 10 beats at any age is abnormal

Front 24

Rooting reflex

Back 24

primitive

Onset @ 28 weeks, disappears at 3-4 months

Baby turns head toward stroking and opens mouth

Front 25

Sucking reflex

Back 25

primitive

Onset @ 28 weeks, readily elicited at 32-34 weeks, disappears at 12 months

touch lips and mouth opens & sucks

Front 26

Asymmetric tonic neck reflex

Back 26

primitive

Hard to elicit, usually they get into position on own

Onset @ 35 weeks, disappears at 7 months

turn head to side with chin over shoulder for 15 seconds, should extend arm/leg on the side the baby is looking towards

absent / sustained? CNS abnormalities

Front 27

Hand/palmar grasp

Back 27

primitive

Onset @ 28-32 weeks, disappears by 2 months

TEST BOTH hands - finger on palm side (NOT thumb side)

Weak? May be CNS or local nerve/muscle damage

Front 28

Plantar grasp

Back 28

primitive

Disappears by 8-9 months, prelude to walking

Weak? lower spinal cord defect/injury

Front 29

Babinski reflex

Back 29

primitive

Onset @ 34-36 weeks, abnormal after 2 years

Scratch from heel to toe, evaluates spinal cord innervation

*does NOT require a functional brain

Front 30

Truncal incurvation / galant reflex

Back 30

primitive

Feet should NOT touch bed

Onset @ 28 weeks - disappears by 3-4 months

Scratch lightly down 1 cm parallel to spin

Negative? spinal cord lesion/injury

Front 31

Placing reflex

Back 31

Hold infant upright, support chin and head and touch top of one foot to surface - will flex other leg and brig foot up onto surface

Front 32

Stepping reflex

Back 32

Onset @ 37 weeks - more active 72 hrs after birth

hold infant up, lean forward and baby will take steps

Front 33

Ventral suspension

Back 33

hold baby prone with head slightly higher than pelvis, term should briefly lift head and flex extremities

Front 34

Vertical suspension

Back 34

Tests strength of shoulder girdle

Hypotonia? baby will put arms up and slip through hands

Front 35

Moro relfex

Back 35

Onset @ 28 weeks, easily elicited at 37 weeks, disappears at 6 months

Baby abduct arms, open hands, and then flex arms and close fists

Asymmetric or absent? brachial plexus or upper extremity injury, underlying CNS pathology

Front 36

Term sensory awareness

Back 36

Term infant is able to control effects of surrounding environment by regulating his/her physiological and emotional response to stimuli

Front 37

Habituation

Back 37

defense mechanism enabling infant to alter response to repeated stimuli

Front 38

Organized vs disorganized infant

Back 38

Organized - infant maintains stable vital signs, smooth state transitions, and smooth movements

Disorganized - infant exhibits change in HR, color, sudden state changes, may become jittery/hypotonic

Front 39

Approach signals / time out signals

Back 39

Learn & teach parents!