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CNS Examination in Newborn | Newborn Examination (Part-9) | Pediatrics — Transcript

by Learning Pediatrics · 2,189 words · 336 segments · language en · Watch on YouTube

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0:00hello
0:02everyone so after the higher mental
0:04function and cranial of examination we
0:06have to perform the motor system
0:08examination so I'm going to tell you the
0:10details of motor system today in this
0:14video after the crani of examination we
0:17have to perform the motor system
0:19examination in which we have to first
0:21see the posture of the baby then
0:23assessment of the tone and muscle power
0:26then we have to observe the spontaneous
0:27movements of the body then we have to
0:31elicit the Deep tendon and superficial
0:34reflexes so in posture we have to see
0:37the baby is having the normal body
0:39posture or having any abnormal posture
0:43so example in full-term baby baby is
0:46having the both arms and legs flexed in
0:50pre-term baby it's depend on the
0:52maturity of the baby and about the
0:54posture I have already uploaded one of
0:56my video so you can see how the uh baby
1:00mature and the posture changes with the
1:03maturity in opest lonus posture head and
1:07body is AR back it is abnormal posture
1:11seen in the cous condition and when baby
1:14is having the
1:16hypertonia asymmetry in the limb
1:18position can be there whenever there is
1:20a fracture of clavical humorous braal
1:23plexus injury which is very common in
1:24the newborn baby it is a birth injury
1:28occur and it is commonly associated with
1:31the breach
1:35delivery whenever there is a full
1:38extension of the
1:39legs it's may be because of the
1:42hypertonia increased muscle tone if baby
1:46is having the Frog like appearance in
1:48the suine position that means
1:52possibility of the hypotonia decrease
1:54muscle tone can be
1:56there then we have to assess the tone
1:59active tone and passive tone both should
2:01be
2:04assessed for the assessment of tone in
2:07active tone exal tone assessment should
2:09be done and in passive tone lims Stone
2:12assessment should be
2:14done maturation of active tone occur in
2:17syphil codal direction from bir to 12
2:20months example head control comes first
2:23at 3 months then baby learn sitting with
2:25support at 5 month then baby learn
2:27sitting without support at 8 month then
2:30ex standing at 9 to 10 month and after
2:33that walking is start at around 12 to 15
2:36months so maturation of active tone in
2:40cphil codal
2:42Direction while the maturation of
2:44passive tone occur in calic Direction
2:48two to head Direction its maturation is
2:51start at 28 weeks of gastation age and
2:54fully mature in 40 weeks of gastation
2:57age basically it correspond to the mile
3:00ation of motor pathway so in the uh limb
3:03tone limb extensions occur first then
3:08flexer tone occur and first occur in the
3:11lower limb then in the Upper Limb so in
3:15the fullterm baby you will find that
3:17baby is is able to maintain the flax
3:20posture of all four limb while in the
3:22pre-term baby it will be depend on the
3:25maturity of the
3:26baby for the active tone assessment we
3:29have to observe the resting posture a
3:31spontaneous movements and also we have
3:33to observe the movements in response to
3:35given
3:36stimulus then for active exal tone
3:39assessment we have to perform the
3:40horizontal suspension vertical
3:42suspension and pull to seat
3:45test in horizontal suspension we have to
3:47suspend the neonate in the prone
3:50position and we have to observe the
3:51limbs and head position in relation to
3:54trunk normally in the full-term baby
3:57back will remain straight head is in the
3:59mid line and limbs are
4:02flexed in vertical suspension we have to
4:04hold the neonate in upright position
4:08while keeping our hand under the
4:10neonates arm around the chest and
4:13normally in the term baby baby will
4:15maintain the head in the midline for a
4:17short period of time and we will not
4:20have the feeling that baby is sleeping
4:22through our hands if baby is having the
4:24normal tone while in the
4:26hypotonia uh sleep feeling in can be
4:30there and we cannot be able to hold the
4:33baby for a long
4:36time in pull to sit test we have to
4:40gently pull the neonet toward the
4:42sitting position by holding the wrist
4:45and in term neonet neonet will be able
4:48to lift the head slightly for a fraction
4:51of second and able to maintain the head
4:55in the
4:57midline here in this image you can see
4:59all three methods to assist the active
5:02Exel tone so horizontal suspension
5:05vertical suspension and P toit
5:09test then we have to assess the passive
5:12tone by the ml ton method in this we
5:15have to measure the Angles and we have
5:17to perform the sum test details of this
5:20method I have already covered in the one
5:23of my video in the CNS examination video
5:27series in tone assessment
5:30so in this we have to assess the angle
5:32at hip adductor angle at knee popal
5:36angle at ankle dorsy reflection angle a
5:39scarf sign arm traction and leg traction
5:42basically passive tone indicate the
5:45extensibility of a
5:49muscle in adductor angle we have to keep
5:52our thumb and the finger over the thigh
5:54and we have to abduct both the legs here
5:58in this image you can see when you feel
6:00the resistance then you have to measure
6:03the angle between both the leg here and
6:07this angle is normally uh 40 to 80° in
6:12newborn
6:14baby after that we have to measure the
6:16popal angle in this image you can see
6:19you have to flex the thigh and you have
6:22to hold the knee with your one hand and
6:26with single finger over the heel you
6:28have to extend
6:30the knee joint and when you will feel
6:33the resistance then you have to measure
6:35the
6:36angle over the knee area this angle and
6:41in term baby this angle is 90° and in
6:44pre-term baby this angle is 150° if
6:49gastation age is 28 weeks so as the
6:53prematurity is
6:55more this angle is more and as the baby
6:59become
7:00mature then angle will decrease details
7:03of popal angle I have already explained
7:06in one of my video on gestational age
7:10assessment now in this video you can see
7:13how to measure the popal
7:23angle now the dorsy flection angle here
7:26in this image you can see we have to
7:28gently f Flex the foot towards the leg
7:32and we have to measure the angle
7:33whenever we feel the resistant between
7:36the dorsum of foot and the anterior
7:39aspect of the leg and normally this
7:41angle is 60 to 70° in the newborn
7:46baby now a scarf sign in this image you
7:50can see we have to gently pull the
7:53neonet arm across the chest when
7:56resistance is made then we have to see
7:58the position of elbow in relation to the
8:00body in fulltime baby you will not be
8:03able to cross even the mid line while in
8:06the extremely premature baby even the
8:08elbow crossing the opposite side of
8:10auxiliary
8:12line now in this video you can see how
8:15to perform the scarf
8:20sign then see the position of elbow in
8:23relation to the body land
8:27mark then we have to perform the arm arm
8:29traction here in this image you can see
8:31we have to hold the neonet wrist and
8:34gently we have to pull the arm to the
8:37vertical position and we have to assess
8:40the resistance also and see the elbow
8:43flexion when the shoulder lift of the
8:48surface now the LA Traction in this
8:51image you can see we have to hold the
8:53ankle of the neonate and gently we have
8:56to raise the leg into the vertical
8:58position
8:59and in this also we have to assess the
9:01resistance and knee flexion occur as the
9:05buttock Elevate of the
9:07surface so by all these uh methods all
9:10the Angles and the signs and traction we
9:13are assessing the passive tone of the
9:16newborn baby this is the AML ton
9:21method here in this image you can see
9:24these are the three angles we have to
9:26measure for the passive limb tone
9:28assessment adductor angle popal angle
9:31and dorsy flexion
9:34angle here in this image you can see we
9:37have to perform the scarf sign arm
9:40traction and leg traction for the
9:42passive limb tone
9:44assessment now we have to assess the
9:47muscle power in this both active muscle
9:50power and resistance against the passive
9:53M should be
9:56assessed now we have to assess the ACT
9:59muscle power when we are performing the
10:01passive movement baby will interfere
10:04that movements by doing the active
10:07movements of the limbs so we can assess
10:11the active muscle
10:12power now the resistance against passive
10:15Movement we have to move the all four
10:18limbs in the full range of movements and
10:21we have to see the resistance which is
10:23feel during the passive movements of the
10:25all po
10:27lims there are grading from minus to +4
10:32for the passive moments so when there is
10:34a no resistance we feel complete Lake of
10:38resistance is there we label as a floppy
10:40baby minus one grading when hardly mild
10:45resistance then plus one when moderate
10:48resistance then plus two is strong
10:51resistance you feel plus three then
10:54extremely strong resistant you are not
10:57able to move the limbs even slightly
11:00then +
11:034 Min -1 and + one grading for the
11:07resistance against the passive M because
11:10of hypotonia plus two is normal and plus
11:13three and +4 because of the hypertonia
11:17you are not able to move the limbs of
11:21the baby and you are feeling the strong
11:23resistance because of
11:28hypertonia here in this video you can
11:30see for the passive muscle power
11:32assessment we have to move the both the
11:35limbs
11:36simultaneously and we have to see the
11:38power of the
11:54muscles now for the active muscle power
11:57we have to give the grading from minus 1
11:59to + 3 when no active moments when you
12:03are doing the passive Ms of limb and
12:05baby is not doing any active moment then
12:09minus when active moments present but
12:12not able to withheld the resistance then
12:16plus one when baby is doing active
12:19movements and able to withstand the
12:22moderate resistance then plus two when
12:25powerful moments are there and difficult
12:28to strain is + three here in this video
12:33you can see how to assess the active
12:34muscle power active M of the baby
12:37basically interfere the passive mement
12:40we have to assess
12:45that then we have to observe the
12:48spontaneous movements so intensity of
12:51the movements we have to grade if
12:54totally absent
12:56minus weak + one is strongly present
13:00plus two very strong spontaneous
13:03movements are present than plus
13:07three then we have to perform the Deep
13:10tendon reflex and it is graded
13:14as from minus1 to +
13:174 when there is a no response absent
13:20response then
13:22minus when response is decreased hardly
13:26visible then plus one
13:29when there is a Brisk response good
13:32contraction is there plus two which is
13:35normal DTR response when very brisk
13:39response is there it is plus three when
13:42exagerated or clonus is there then plus
13:454 we
13:48label so in the Deep tendon reflex we
13:50have to perform the bicep knee cross
13:54adductor reflex ankle
13:57reflex so in the BP reflex we have to
14:00here in this image you can see we have
14:02to hold the neonate's arm in flection
14:05and examiner Place their thumb on the
14:07neonet tendon in the antigal fosa and
14:11then you have to strike the your thumb
14:14and see the response root value for the
14:17bicep is C5 to
14:21C6 here in this video you can see for
14:23the tricep reflex we have to keep the
14:26arm in semiflex position
14:29and we have to strike the tricep tendon
14:32just above the
14:33elbow and in response to this extension
14:37of the elbow ACA root value for tricep
14:39is C7
14:42C8 then we have to perform the knee
14:45reflex here examiner is strike the
14:48partilla tendon while supporting the
14:50neonate's knee in the flex position and
14:53N root value for the knee reflex is L4
15:03then for the crosed adductor reflex
15:06examiner strike the finger which is
15:09positioned over the medial aspect of
15:11neonet s and root value for cross
15:15adductor reflex is L3
15:19L4 then lastly we have to perform the
15:22ankle reflex here examiner strike their
15:25finger which is positioned over the
15:28planter aspect of neonates partially
15:31dorsiflex put and root value for this is
15:35L2
15:37L4 then we have to perform The
15:39Superficial reflex in which gular tap
15:41Coral reflex cuff reflex gig reflex at
15:45the time of suction we can
15:49assess see in this video how to perform
15:52the glab
15:56tape see in this video how to perform
15:59the coral blink
16:03reflex here in this video you can see
16:05when we are suctioning the oral cavity
16:07and baby will have the gig
16:11reflex here in this video you can see
16:14how to perform the planter reflex in
16:16newborn baby extension and Finning of
16:19toes normally
16:24present so this is all about the motor
16:27system examination in the new born baby
16:29thank you so much

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