From the Guidelines
To further understand Orlando Patel's presentation, I would gather additional subjective and objective information through a comprehensive assessment plan, as recommended by the American Academy of Pediatrics 1. My assessment plan would begin with a detailed developmental history interview with the parents, focusing on Orlando's prenatal history, birth complications, early developmental milestones, and family history of developmental or neurological conditions, as outlined in the motor delays: early identification and evaluation guidelines 1. I would inquire about any regression in skills, current functional abilities at home and childcare, and specific concerns about his gait pattern. Understanding the family's daily routines, Orlando's play preferences, and environmental factors would provide context for his development.
Some key elements of the motor history to explore include:
- Delayed acquisition of skill: Is there anything Orlando is not doing that his parents think he should be able to do?
- Involuntary movements or coordination impairments: Is there anything Orlando is doing that his parents are concerned about?
- Regression of skill: Is there anything Orlando used to be able to do that he can no longer do?
- Strength, coordination, and endurance issues: Is there anything other children Orlando's age can do that are difficult for him?
Objectively, I would conduct standardized developmental assessments including the Bayley Scales of Infant and Toddler Development or the Peabody Developmental Motor Scales to quantify Orlando's developmental status across domains, as suggested by the guidelines for developmental surveillance and screening 1. A thorough musculoskeletal examination would assess muscle tone, strength, range of motion, and joint integrity, particularly in the lower limbs. Neurological screening would evaluate reflexes, coordination, and sensory processing. Gait analysis using observational methods or video recording would help identify specific movement patterns and compensations during walking.
I would assess Orlando's functional mobility skills including:
- Transitions between positions
- Stair negotiation
- Running attempts
- Jumping abilities Observing his play skills and how he interacts with toys and the environment would provide insights into his motor planning and coordination. Balance assessment through activities like standing on one foot or navigating uneven surfaces would evaluate his postural control. This comprehensive approach would help determine whether Orlando's presentation reflects a developmental delay, neurological condition, musculoskeletal issue, or a variation of typical development, guiding appropriate intervention strategies to address the parents' concerns and support Orlando's development, in line with the recommendations for motor delays: early identification and evaluation 1.
From the Research
Additional Subjective Information
To further understand Orlando's presentation, the following subjective information would be helpful:
- A detailed account of Orlando's daily activities and play habits to assess his physical activity levels and participation in gross motor skills 2
- Information about Orlando's social interactions and emotional expression to identify any potential correlations with his gross motor development 2
- The parents' concerns and expectations from physiotherapy, as well as their understanding of Orlando's developmental delays 3
- Any changes in Orlando's behavior or physical abilities since the initial concerns were raised
Additional Objective Information
The following objective information would be helpful to further understand Orlando's presentation:
- A comprehensive assessment of Orlando's gross motor skills using standardized tools such as the Test of Gross Motor Development-3 (TGMD-3) 4
- An evaluation of Orlando's locomotor and ball skills to identify any specific deficits or delays 4
- Observation of Orlando's postural control, locomotion, and manual skills to assess his overall motor development [(5,2)]
- Assessment of Orlando's mobility and speech-language skills to identify any potential reciprocal influences 6
Assessment Tools
The following assessment tools may be useful in evaluating Orlando's gross motor development:
- Test of Gross Motor Development-3 (TGMD-3) 4
- Hong Kong Comprehensive Assessment Scales for Toddlers (HKCAS-T) 5
- Observational checklists to assess Orlando's daily activities and play habits 2
Collaboration with Other Disciplines
Collaboration with speech-language pathologists may be beneficial in assessing and addressing any potential reciprocal influences between mobility and speech-language skills 6