HLS - Newborn Assessment

*Reflex/Reaction Tests - Asymmetrical Tonic Neck Reflex* - Baby is in supine with head in midline, then head is turned to one side *Normal* = *Abnormal* =

*Normal* = Extension of arm and leg on the face side (or increased extensor tone) Flexion of arm and leg on the skull side (or increased flexor tone) *Abnormal* = incomplete response

*Reflex/Reaction Tests - Plantar Grasp* - Press thumb against the ball of the infant's foot *Normal* = *Abnormal* =

*Normal* = PF of all toes *Abnormal* = normal response not seen

Adaptive responses - *Response to handling* - Comment on the infants _________ and _________ responses to handling as with tactile/ vestibular stimulating or changes in position

- behavioral - postural

What compromises the Axial skeleton? (4):

- cranium - sternum - spine - sacrum

*Reflex/Reaction Tests - Primary(Automatic) Walking* *Normal response* - Rhythmical automatic stepping movements - Usually heel strike in ________, and toe-strike in _________

- full-term - preemie

__________ - an action or movement produced by any given stimulus or stimuli Two types: - reflex - reaction

- movement response

The "grimacing" in APGAR testing is _______ reflex irritability

- nasal

The *Dubowitz* test assesses _________ maturity - the more mature the infant, the higher the score will be - Mostly testing passive tone - Typically done on ALL babies

- neuromuscular

*Muscle Tone* - degree of normal residual contraction in a resting muscle - Measured by resistance of a muscle to ________ elongation

- passive

*Reflex/Reaction Tests* - examiners are looking for a ________ test, which means that the responses are present when elicited

- positive

*Adjusted age* is only used when the baby is born ________

- premature

Would catching a ball classify as a reflex or a reaction?

- reaction. It is predictable but varies person to person

What are the 2 kinds of movement responses?

- reflexes - reactions

- *APGAR* is for ________ testing - *Dubowitz* is for ________ testing

- respiratory - neuromuscular

*Spontaneous movements or _________* - Comment on speed, intensity, amount, hand to mouth behavior or abnormal posturing

- symmetry

As a *reflex* disappears, it is indicative of CNS development, as the reflex is now controlable by _________ response

- voluntary

Baby is 4 months old - Was born 6 weeks early - Calculate Adjusted age from the given Chronological age in *Months*

- 4 months - 4 months = 16 weeks - 16 weeks - 6 weeks premature = 10 weeks - 10 weeks = 2.5 months -> *2 months and 2 weeks*

Normal "term" in this class is considered ________ weeks, for simplicity sake

- 40

*Reflex/Reaction Tests - Primary(Automatic) Walking* - Infant is held under the arms in a standing position and leaned forward *Normal* = *Abnormal* =

*Normal* = Rhythmical automatic stepping movements - Usually heel strike in full-term, toe-strike in preemie *Abnormal* = not seen

*Reflex/Reaction Tests - Moro* - Head and shoulders raised off the table. Head dropped back *Normal* = *Abnormal* =

*Normal* = arms abduct, extend, and ER. Fingers abducted followed by a return to flexion for the 1st month *Abnormal* = not seen

*Arm Recoil test - Dubowitz* - With the infant in supine, flex the infant's forearms for 5 seconds, then fully extend by pulling on the hands and then release *Normal* = *Abnormal* =

*Normal* = arms return briskly to full flexion *Abnormal* = arms do not return to flexion

*Active Tone Test - Neck Extensors* - With the infant sitting and leaning forward, the head hanging down on the chest, move the trunk slowly backward and observe the reaction of the head *Normal* = *Abnormal* =

*Normal* = baby should be able to extend the head/neck *Abnormal* = baby is unable to extend head/neck

*Wrist (Square window) test - Dubowitz* - angle between the wrist and forearm *Normal* = *Abnormal* =

*Normal* = can touch thumb to their forearm *Abnormal* = excessive or restricted ROM

*Scarf Sign - Dubowitz* - With the baby supine, taking elbow across body and seeing how far it will go: *Normal* = *Abnormal* =

*Normal* = does not go beyond midline (normal tone) *Abnormal* = goes beyond midline (low tone)

*Passive Tone tests - Ankle Dorsiflexion* - In supine, infant's foot is dorsiflexed onto the anterior aspect of the leg *Normal* = *Abnormal* =

*Normal* = dorsal surface of foot reaches tibia *Abnormal* = excessive or limited ankle DF

*Passive Tone test - Leg Recoil* - Infant in supine, have the hips and knees fully flexed for 5 seconds, then extend the hips by traction on the feet and release *Normal* = *Abnormal* =

*Normal* = flexion of UE and LE, abd hips, spontaneous movement *Abnormal* = deviation from expected movements

*Posture test - Dubowitz* - baby is quiet and in supine *Normal* = *Abnormal* =

*Normal* = flexion of UE and LE, abducted hips, spontaneous movement *Abnormal* = Any deviations from expected posture, tone, any asymmetries, etc

*Reflex/Reaction Tests - Palmar Grasp* - put your index finger into baby's widdle hand *Normal* = *Abnormal* =

*Normal* = flexion of all fingers around examiner's finger *Abnormal* = normal response not seen

*Heel to Ear test - Dubowitz* - With the baby in supine, draw the baby's foot as near to the head as it will go without forcing it - Observe the distance between the foot and the head as well as degree if extension at the knee *Normal* = *Abnormal* =

*Normal* = foot should get to level of abs/chest or shoulder *Abnormal* = foot goes all the way to ear OR less than chest

*Active Tone Test - Pull to Sit (Neck flexors)* - With the infant lying supine, grasp the hands and pull the baby up slowly to the sitting position, observing the position of the head in relation to the trunk *Normal* = *Abnormal* =

*Normal* = head may lag behind the trunk and still be normal *Abnormal* = head is fully extended

*Active Tone Test - Ventral Suspension* - Infant is suspended in prone with the examiner's hand under the infant's chest *Normal* = *Abnormal* =

*Normal* = head should stay in same plane as the back. Extremities should maintain some flexion tone *Abnormal* = head falls below or above plane of back. Extremities dangle without flexion tone

Oral motor function reflexes - *Rooting* - Stroke away from lateral corners of the mouth with a light brushing motion *Normal* = *Abnormal* =

*Normal* = head turns towards stimulated side and mouth opens *Abnormal* = does not happen

*Reflex/Reaction Tests - Gallant* - Holding baby in ventral suspension (face down) or prone on a mat and stroking the skin along one side of the trunk between the 12th rib and iliac crest *Normal* = *Abnormal* =

*Normal* = lateral flexion toward stimulated side *Abnormal* = no lateral flexion seen

*Popliteal Angle test - Dubowitz* - With the baby in supine and their pelvis flat, hold their hip to 90 degrees of flexion and extend knee from behind the ankle *Normal* = *Abnormal* =

*Normal* = should be about 90 degrees *Abnormal* = angle is well over/under 90 degrees

*Active Tone test - Vertical Suspension* - With the infant in the standing position, assess the support of the body weight by straightening of the legs and assess the straightening reaction of the trunk *Normal* = *Abnormal* =

*Normal* = shoulder/trunk should have some resistance/tone *Abnormal* = baby slips through the hands of examiner

Baby is 1 year, 8 months, and 17 days old - Was born 5 weeks early. - Calculate Adjusted age from the given Chronological age in *Months*

- 12 months + 8 months + 1 month = 21 months - 21 months = 84 weeks - 84 weeks - 5 weeks premature = 79 weeks - 79 weeks = 19.75 -> *19 months and 3 weeks*

*Pre-term* = born before _______ weeks gestation *Term* = born _______ weeks gestation *Post-term* = born after _______ weeks gestation

- 38 - 38-42 - 42

*APGAR Scoring* - finds breathing problems & other immediate health issues - Appearance - Pulse - Grimace - Activity - Respiration Normal score Results =_______ → routine post delivery care If <_______ → baby may need medical attention (can be due to difficult birth, C-section, fluid in airways, etc.)

- 7-9 - <7

________ - encompasses the process of *change* in structure, function & behavior - Reflected as an increase in functional abilities - Encompasses growth, maturity, learning

- Development

- Posture - Wrist (Square Window) - Arm Recoil - Popliteal Angle - Scarf Sign - Heel to Ear Are the 6 areas tested in the ________ test

- Dubowitz

The ________ test assesses neuromuscular maturity - the more mature the infant, the higher the score will be - Mostly testing passive tone - Typically done on ALL babies

- Dubowitz

________ - A significant functional ability achieved during the process of development

- Milestone *Example*: motor milestone of sitting up

Adaptive responses - *Auditory* - _________ response to sound of bell or voice

- Motor

_________ - degree of normal residual contraction in a resting muscle - Measured by resistance of a muscle to *passive* elongation

- Muscle Tone

________ = born after 42 weeks gestation

- Post-term

What are the 6 areas tested in the *Dubowitz test*?

- Posture - Wrist (Square Window) - Arm Recoil - Popliteal Angle - Scarf Sign - Heel to Ear

________ = born before 38 weeks gestation

- Pre-term

_________ - a movement response to a specific stimuli that is predictable in the purpose of the movement but variable in the form of movement *Example*: being pushed backwards elicits a movement to bring the body back into alignment. - Different people perform the task using different strategies (same goal, different execution) Can be voluntary or involuntary movements Also anticipatory reactions - such as catching or kicking a moving ball

- Reaction

- _________ are *voluntary/involuntary* and predictable. Vary person to person - _________ are *involuntary* and always lead to the same specific motor response

- Reactions - Reflexes

_________ - a stereotyped, obligatory (involuntary), automatic movement response to a specific stimulus - a specific sensory stimulus ALWAYS leads to the same specific motor response - Usually performed without intention - Some disappear (are inhibited) over time, which can indicate the development of CNS - body is able to establish voluntary control

- Reflex

________ = born 38-42 weeks gestation

- Term

*What does APGAR Stand for?* - Normal Score Results = *7-9* → routine post delivery care - If *<7* → baby may need medical attention (can be due to difficult birth, C-section, fluid in airways, etc.)

- appearance - pulse - grimace - activity - respiration

*Muscular tone* - tone of one muscle, muscle group, or limb *Postural tone* - the state of muscular tension in ________ musculature needed to maintain antigravity support

- axial

*Leg Recoil* and *Ankle Dorsiflexion* tests are both ________ tone test

Passive