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

2. Dr. Pradeep Dubey - Consultant Pediatrician

3. STRABISMUS IN C.P.

4. Dr. Pradeep Dubey - Consultant Pediatrician 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”

5. Dr. Pradeep Dubey - Consultant Pediatrician 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. 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 20 th OCENTURY (NORMAN DOIDGE)

6. Dr. Pradeep Dubey - Consultant Pediatrician NEUROPLASTICITYNEUROPLASTICITY 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.”

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

8. Dr. 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 CONDITIONS

9. Dr. Pradeep Dubey - Consultant Pediatrician DYSKINETIC - C.P.

10. Dr. Pradeep Dubey - Consultant Pediatrician

11. Mother – Rh negative Precautions for Rh incompatibility MATERNAL BLOOD GROUP

12. Dr. Pradeep Dubey - Consultant Pediatrician Low apgar (0-3) after 20 mts. Low apgar (0-3) after 20 mts. Late seizures in a depressed NB Late seizures in a depressed NB Persistence of Abn. Neuro signs after 2 wks. Persistence of Abn. Neuro signs after 2 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 EEG. Background abnormalities in interictal EEG. Low apgar (0-3) after 20 mts. Low apgar (0-3) after 20 mts. Late seizures in a depressed NB Late seizures in a depressed NB Persistence of Abn. Neuro signs after 2 wks. Persistence of Abn. Neuro signs after 2 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 EEG. Background abnormalities in interictal EEG. INDICATORS OF POOR OUTCOME IN A SICK NEW BORN

13. Dr. 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 SIGNS Abnormalities of tone Ocular abnormalities Lack of response to sound. Abnormalities of tone Ocular abnormalities Lack of response to sound.

14. Dr. 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 SIGNS

15. Dr. Pradeep Dubey - Consultant Pediatrician HEMIPLEGIC C.P.

16. Dr. Pradeep Dubey - Consultant Pediatrician AMIEL TISON - 2 MTHS, 7 MTHS, 12 MTHS AMIEL TISON - 2 MTHS, 7 MTHS, 12 MTHS P.G. I. CHANDIGRAH – 9 MTHS. P.G. I. CHANDIGRAH – 9 MTHS. OTHERS - 8 MONTHS OTHERS - 8 MONTHS AGE FOR ASSESSMENT

17. Dr. Pradeep Dubey - Consultant Pediatrician AMEIL TISON’S METHOD VOJTA’S TECHNIQUE CAPUTE AND ASSOCIATES INFANT NEUROLOGICAL INTERNATION BATTERY (INFANIB) AMEIL TISON’S METHOD VOJTA’S TECHNIQUE CAPUTE AND ASSOCIATES INFANT NEUROLOGICAL INTERNATION BATTERY (INFANIB) NEURO DEVELOPMENTAL EXAMINATION METHODS

18. Dr. Pradeep Dubey - Consultant Pediatrician INFANIB: Brief Description

19. Dr. 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.

20. Dr. 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)

21. Dr. Pradeep Dubey - Consultant Pediatrician Hands: Open/Closed Normal Response

22. Dr. Pradeep Dubey - Consultant Pediatrician Hands: Open/Closed Abnormal Response

23. Dr. Pradeep Dubey - Consultant Pediatrician Scarf Sign Normal Response

24. Dr. Pradeep Dubey - Consultant Pediatrician Scarf Sign Abnormal Response

25. Dr. Pradeep Dubey - Consultant Pediatrician Heel-to-Ear Normal Response

26. Dr. Pradeep Dubey - Consultant Pediatrician Heel-to-Ear Abnormal Response

27. Dr. Pradeep Dubey - Consultant Pediatrician Popliteal Angle Normal Response

28. Dr. Pradeep Dubey - Consultant Pediatrician Popliteal Angle Abnormal Response

29. Dr. Pradeep Dubey - Consultant Pediatrician Leg Abduction Normal Response

30. Dr. Pradeep Dubey - Consultant Pediatrician Leg Abduction Abnormal Response

31. Dr. Pradeep Dubey - Consultant Pediatrician Dorsiflexion of Foot Normal Response

32. Dr. Pradeep Dubey - Consultant Pediatrician Dorsiflexion of Foot Normal Response

33. Dr. Pradeep Dubey - Consultant Pediatrician Dorsiflexion of Foot Abnormal Response

34. Dr. Pradeep Dubey - Consultant Pediatrician Foot Grasp Normal Response

35. Dr. Pradeep Dubey - Consultant Pediatrician Foot Grasp Abnormal Response

36. Dr. Pradeep Dubey - Consultant Pediatrician Tonic Labyrinthine Supine Normal Response

37. Dr. Pradeep Dubey - Consultant Pediatrician Tonic Labyrinthine Supine Abnormal Response

38. Dr. Pradeep Dubey - Consultant Pediatrician Asymmetric Tonic Neck Reflex Normal Response

39. Dr. Pradeep Dubey - Consultant Pediatrician Asymmetric Tonic Neck Reflex Abnormal Response

40. Dr. Pradeep Dubey - Consultant Pediatrician Asymmetric Tonic Neck Reflex Abnormal Response

41. Dr. Pradeep Dubey - Consultant Pediatrician Pull to Sit Normal Response

42. Dr. Pradeep Dubey - Consultant Pediatrician Pull to Sit Abnormal Response

43. Dr. Pradeep Dubey - Consultant Pediatrician Body Derotative Normal Response

44. Dr. Pradeep Dubey - Consultant Pediatrician Body Derotative Abnormal Response

45. Dr. Pradeep Dubey - Consultant Pediatrician Body Rotative Normal Response

46. Dr. Pradeep Dubey - Consultant Pediatrician Body Rotative Abnormal Response

47. Dr. Pradeep Dubey - Consultant Pediatrician All-Fours Normal Response

48. Dr. Pradeep Dubey - Consultant Pediatrician All-Fours Abnormal Response

49. Dr. Pradeep Dubey - Consultant Pediatrician Tonic Labyrinthine Prone Normal Response

50. Dr. Pradeep Dubey - Consultant Pediatrician Tonic Labyrinthine Prone Abnormal Response

51. Dr. Pradeep Dubey - Consultant Pediatrician Sitting Normal Response

52. Dr. Pradeep Dubey - Consultant Pediatrician Sitting Abnormal Response

53. Dr. Pradeep Dubey - Consultant Pediatrician Sideways parachute Normal Response

54. Dr. Pradeep Dubey - Consultant Pediatrician Sideways parachute Abnormal Response

55. Dr. Pradeep Dubey - Consultant Pediatrician Backward Parachute Normal Response

56. Dr. Pradeep Dubey - Consultant Pediatrician Backward Parachute Abnormal Response

57. Dr. Pradeep Dubey - Consultant Pediatrician Standing Normal Response

58. Dr. Pradeep Dubey - Consultant Pediatrician Standing Abnormal Response

59. Dr. Pradeep Dubey - Consultant Pediatrician Positive Supporting Reaction Normal Response

60. Dr. Pradeep Dubey - Consultant Pediatrician Positive Supporting Reaction Abnormal Response

61. Dr. Pradeep Dubey - Consultant Pediatrician Forward Parachute Normal Response

62. Dr. Pradeep Dubey - Consultant Pediatrician Forward Parachute Abnormal Response

63. Dr. Pradeep Dubey - Consultant Pediatrician High Risk Neonate

64. Dr. Pradeep Dubey - Consultant Pediatrician Normal Infant

65. Dr. Pradeep Dubey - Consultant Pediatrician Ataxia

66. Dr. Pradeep Dubey - Consultant Pediatrician Spastic

67. Dr. Pradeep Dubey - Consultant Pediatrician Hypotonia

68. Dr. Pradeep Dubey - Consultant Pediatrician Alignment Spine Head Tilt Head rotation Leg progression

69. Dr. Pradeep Dubey - Consultant Pediatrician Atypical Static Postural Alignment

70. Dr. Pradeep Dubey - Consultant Pediatrician Equinus Scissoring Equinus Lack Of base of Support

71. Dr. Pradeep Dubey - Consultant Pediatrician Foot Deformity Midfoot break Hindfoot eversion

72. Dr. Pradeep Dubey - Consultant Pediatrician Head – size shape, fontanell sutures Eyes – Setting sun, Strabismus, nystagmus Skin abnormalities – Cafeaulet, Nevi etc. Skin abnormalities – Cafeaulet, Nevi etc. Cranial nerves Altered mental status Spine AMIEL TISON’S METHOD A. GENERAL DISCRIPTION

73. Dr. Pradeep Dubey - Consultant Pediatrician 1. Tone - Scarf sign heel to ear leg abduction, Popliteal angel leg abduction, Popliteal angel - dorsoflexion of foot Pull to sit. - dorsoflexion of foot Pull to sit. prone, sitting position prone, sitting position - atnr, - atnr, 2. Vestibular - Side ways sparachute, backward & Functionforward parachute, body rotative Function forward parachute, body rotative 3. Lethargy/Hyper excitability 4. Vision & Hearing 5. Developmental delay AMIEL TISON’S METHOD

74. Dr. Pradeep Dubey - Consultant Pediatrician PROGNOSIS FOR WALKING IN CP Hemiplegia 100% Diplegia (Paraplegic) 90% Ataxia/ Dyskinesia 80% Quadriplegia18%

75. Dr. Pradeep Dubey - Consultant Pediatrician PRIORITIES OF MANAGEMENT Communication Socioemotional Development Maximal independence in ADL As near normal appearance as possible Mobility

76. Dr. Pradeep Dubey - Consultant Pediatrician www.healthychildindia.com “DEVCHHAYA” Early Intervention Centre Prem Mandir Chowk, Wright Town “DEVCHHAYA” Early Intervention Centre Prem Mandir Chowk, Wright Town