From the Guidelines
Assessment Protocol for Physical Medicine and Rehabilitation (PM&R) in Cerebral Palsy (CP)
The assessment protocol for PM&R in a patient with cerebral palsy should include a comprehensive evaluation of the patient's motor function, tone, and range of motion, as well as an assessment of their cognitive and communication abilities, utilizing tools such as the Hammersmith Infant Neurological Examination (HINE) 1.
- Clinical Neurological Examination: A thorough clinical neurological examination is crucial, especially in infants under 5 months corrected age, to identify early signs and symptoms of cerebral palsy 1.
- Neuroimaging: Term-age magnetic resonance imaging (MRI) is highly predictive for detecting risk, with a sensitivity of 86%-89% 1.
- Motor Tests: The Prechtl Qualitative Assessment of General Movements and the HINE are valuable tools for predicting risk in infants under 5 months, with sensitivities of 98% and 90%, respectively 1.
- Standardized Assessments: After 5 months corrected age, the Developmental Assessment of Young Children (DAYC) can be used, with an 83% C index for detecting risk 1.
- Adaptive Equipment: An evaluation of the patient's need for adaptive equipment, such as orthotics or wheelchairs, should be included in the assessment protocol.
- Follow-up and Adjustment: A plan for regular follow-up and adjustment of treatment as needed is essential to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being 1.
From the Research
Assessment Protocol for Physical Medicine and Rehabilitation (PM&R) in Cerebral Palsy (CP)
The assessment protocol for PM&R in patients with CP involves a comprehensive evaluation of motor function, activity limitations, and participation restrictions. The following are some of the key components of the assessment protocol:
- Motor function assessment: This includes the evaluation of voluntary movement control, involuntary movements, muscle tone, and motor reflexes 2.
- Activity limitations assessment: This includes the evaluation of hand and arm use, fine hand use, lifting and carrying objects, maintaining a body position, walking, and moving around using equipment 2.
- Participation restrictions assessment: This includes the evaluation of the patient's ability to participate in daily life activities, social activities, and other activities that are important to them 3.
- Use of standardized assessment scales and tools: Such as the Gross Motor Function Classification System (GMFCS), the EuroQol 5-Dimension 3-Level (EQ-5D-3L), and other tools that are specifically designed for assessing patients with CP 4, 3, 5.
- Instrumented measurements: Such as 3D motion capture, surface electromyography, and other technologies that can provide objective measurements of motor function and activity limitations 2.
Assessment Tools and Technologies
A variety of assessment tools and technologies are available for evaluating patients with CP, including:
- Gaming or technology-assisted therapies 6
- Aerobic training 6
- Hippotherapy 6
- Music therapy 6
- Gait training 6
- Aquatic exercises 6
- Inertial sensors and accelerometers 2
- Biomechanics and sensors 2
- Smartphone and robot technologies 2
Clinical Applications
The assessment protocol for PM&R in patients with CP has several clinical applications, including: