Hadders-Algra, Neurological Examination of the Child with Minor Neurological Dysfunction, 3rd Edition, Cover

Neurological Examination of the Child with Minor Neurological Dysfunction, 3rd Edition (Supporting Videos & Assessment Forms Only)

ISBN: 9781898683988

Series: Mac Keith Press Practical Guides

Edition: 3rd

Publication date: September 2010

Page count: 0

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Supporting Videos & Assessment Forms

Assessment forms and videos illustrating typical and atypical performance support the book Neurological Examination of the Child with Minor Neurological Dysfunction and must be used only in conjunction with it. These are FREE with every book purchase – contact admin@mackeith.co.uk for free access if you have purchased the book from another book seller.

File list of Assessment Forms and Supporting Videos

MND Assessment Form (FREE PDF)

The electronic MND Assessment Form

Complete Assessments

Child of 5.5 years

Child of 7 years

Examples of Typical Development

Mouth-opening-finger-spreading phenomenon

Child of 5 years

Evident associated activity in fingers, hands and legs age-appropriate.

Child of 10 years

No associated activity in fingers, hands and legs.

Diadochokinesis

Child of 4 years

Age appropriate performance: possible to produce alternating movements, but only a slow pace; increase of velocity is associated with large elbow excursion and irregular rhythm.

Child of 6 years

Both sides age appropriate performance, left side better than right side. More associated movements during performance of right arm than of left arm.

Child of 8 years

Age appropriate performance. Both aides age appropriate associated movement.

Child of 10 years

Age appropriate performance (left side at the margin).

Child of 12 years

Age appropriate performance. No associated movements.

Fingertip touching

Child of 8 years

Age appropriate performance: Eyes closed: left side one correct placement, right side two correct placements.

Child of 10 years

Eyes closed: right side three correct placements, left side two correct placements indicating performance better than required for age.

Finger opposition test

Child of 4 years

Age appropriate performance: The girl tries; she is able to produce a sequence in one direction with some errors in finger sequence; she is not able to change movement direction.

Child of 6 years

>Both sides age appropriate performance right side (dominant side) better than left side. Minimal associated activity in contralateral hands.

Child of 8 years

Age appropriate performance; it takes the boy some time to understand the details of the task. Both sides a minimal degree of associated movements.

Child of 10 years

Age appropriate performance. No associated movements.

Child of 12 years

Age appropriate performance. No associated movements.

Follow-a-finger test

Child of 4 years

Age appropriate performance: Considerable delay in following difficulties in changing direction, large gaps between finger of assessor and child.

Child of 6 years

Age appropriate performance: follows relatively prompt, variable gaps, jerky performance.

Child of 8 years

Age appropriate performance: gaps at change of direction < 5cm, moderate fluency of movements.

Child of 10 years

Age appropriate performance: gaps at change of direction generally < 2 cm, occasionally 2-5 cm.

Child of 12 years

Age appropriate performance: follows with minimal gaps at change of movement direction.

Circle test

Child of 4 years

Age appropriate performance. Opposite direction: able to produce synchronized and pattered arm movements (coupling temporal and spatial aspects of movement). During large circles mix of round and oval forms, during small circles form less round.

Same direction: during large circles arm movements were coupled in time but not spatially couples; during small circles virtually no coupling. The girl is able to make a prompt transition between circles in opposite and same direction.

Child of 6 years

Age appropriate performance.

Opposite direction: coordinated arm movements, large circles round, small circles mix of oval and round forms.

Same direction: pattern coordination better than required for age, not only present during large circles but also during majority of small circles.

Child of 8 years

Age appropriate performance.

Opposite direction: coordinated arm movements, large circles round, small circles mix of oval and round forms.

Same direction: pattern coordination appropriate during majority of large circles and some small circles. Small circles mix of round and oval forms.

Child of 10 years

Opposite direction: well-coordinated arm movements, round circles.

Same direction: well-coordinated arm movements, large circle round, small circles mix of round and oval forms.

Walking on a straight line

Child of 4 years

Age appropriate performance: Child needs some space between feet in order to keep balance. Considerable associated activity in all parts of body.

Child of 6 years

Age appropriate performance.

Child of 8 years

At the lower limit of age appropriate performance: does not fall off the line, but needs balancing movements of trunk and arms.

Child of 10 years

Age appropriate performance: no balancing movements of arms and trunk.

Walking on toes

Child of 4 years

Age appropriate performance. Appropriate walking on toes, substantial associated activity in both arms.

Child of 6 years

Age appropriate performance. Clear associated activity in arms, hands and fingers.

Child of 8 years

Age appropriate performance. Minimal associated movements in hands.

Child of 10 years

Age appropriate performance. No associated movements.

Walking on heels

Child of 4 years

Age appropriate performance. Lifts forefoot appropriately from floor; substantial associated activity in both arms and face.

Child of 6 years

Age appropriate performance. Some associated activity: especially dorsiflexion of wrists.

Child of 8 years

Age appropriate performance. Some associated activity in hands and wrists.

Child of 10 years

Age appropriate performance. Associated movements in arms and hands – within the variable range of typical development.

Standing on one leg

Child of 4 years

Age appropriate performance. The girl tries; initially she is able to stand on one leg for only a few second, but after some practise she is able to continue for about 10 seconds.

Child of 6 years

Age appropriate performance. Keeps balance for 20 seconds, but needs small foot movements and balancing movements of trunk and arms.

Child of 8 years

Age appropriate performance. Is able to keep balance for 20 seconds but needs balancing movements of arm and trunk (lower range of typical performance).

Child of 10 years

Age appropriate performance, no balancing movements of trunk and arms.

Hopping

Child of 4 years

Age appropriate performance. The girl tries, but is unable to produce more than 1-2 hops.

Child of 6 years

Age appropriate performance. Hops on the spot, but not on toes.

Child of 8 years

Age appropriate performance. Hops on the spot, but not on toes.

Child of 10 years

Age appropriate performance. Hops on the spot, but not on toes.

Knee-heel test

Child of 4 years

Typical performance in 4 and 5-year-olds. Difficulties in placing and sliding (it is clear that instruction in the last part was ‘describe a large arc with your foot’ – an instruction aiming at the prevention of up-and -down sliding of the leg).

Child of 6 years

Age appropriate performance.

Child of 8 years

Age appropriate performance.

Child of 10 years

Age appropriate performance.

Assessment of eye movements

Child of 10 years

Child with conjugated, smooth movements of the eyes in all directions, including appropriate convergence

Examples of MND

Mild diffuse hypotonia

Child of 6 years

Mildly collapsed posture during sitting. Posture with arms extended in supination: bilateral mild pronation and flexion.

Choreiform movements in proximal and distal muscle during sitting with arms extended

Child of 6 years

Kicking inappropriate for age

Child of 11 years

Inappropriate kicking of right leg.

Tonic, stereotyped dorsiflexion of the big toe (Babiniski sign)

Child of 7 years

Note spontaneous stereotyped dorsiflexion posture of big toe – this may be observed in association with the Babinski sign and other signs of upper motor neuron dysfunction

Deviant posture during standing

Child of 7 years

Increased lumbar lordosis and hyperextension of knees reflecting low muscle tone

Choreiform movements during the test for involuntary movements

Child of 6 years

Choreiform movements in proximal and distal muscles (++).

Response to being pushed during standing inappropriate for age

Child of 10 years

Child tends to fall, no side preference.

Diadochokinesis inappropriate for age

Child of 7 years

Child tries to perform with various strategies:

-extending arm

-moving elbow

-reducing degree of pronation and supination, but difficulty to produce alternating movements remains

Associated movements age appropriate.

Child of 10 years

Right side: just age appropriate performance.

Left side: performance inappropriate for age.

Finger-nose test inappropriate for age

Child of 6 years

Frequently misplaces finger (both left and right side).

Child of 7 years

Eyes closed: high frequency low amplitude intention tremor at end of movement.

Fingertip-touching test inappropriate for age

Child of 10 years

Eyes closed: right side (dominant side) one correct placement, left side no correct placements.

Finger opposition test inappropriate for age

Child of 6 years

Needs long practice, has difficulties in changing movement direction.

Child of 9 years

Difficulties in programming movement sequence. Associated movements: note extension right hand during performance of left hand.

Follow-a-finger test inappropriate for age

Child of 6 years

Gaps at change of movement direction often > 10 cm.

Child of 8 years

Gaps at change of movement direction occasionally too large (> 5 cm), too jerky performance, in particular at change of movement direction.

Circle test inappropriate for age

Child of 9 years

Patterning of circles age appropriate, but difficulties in transition from large to small circles.

Child of 9 years 2

Patterning of large circles with effort but age appropriate, difficulties in transition from large to small circles, and problems to form small circles both in opposite and same direction.

Walking on a straight line inappropriate for age

Child of 6 years

Large effort to perform, using all parts of body to keep on the line, occasionally fails and misplaces feet.

Child of 8 years

Places feet inappropriately in order to increase support surface; large effort to keep on the line.

Walking on heels inappropriate for age

Child of 6 years

Inappropriate lifting of feet, in particular of lateral sides of feet. Note excessive associated movements in arms and face.

Standing on one leg inappropriate for age

Child of 6 years

Loses balance easily, best performance right leg 8 seconds and left leg 12 seconds, which is below the norms appropriate for age.

Child of 10 years

Loses balance, which results in hopping after 8 seconds (right leg) and 18 seconds (left leg).

Hopping inappropriate for age

Child of 6 years

Poor performance, best achievement left leg 5 hops, right leg 2 hops, which is below the norms appropriate for age.

Child of 8 years

Poor performance, best achievement both legs 5 hops, which is below the norms appropriate for age.

Knee-heel test inappropriate for age

Child of 6 years

Mostly inappropriate placing and sliding (but occasionally a good placement and a proper slide).

Deviations of visuomotor control

Child of 10 years

Changing convergent strabism and imbalancement of eye movement

About the Book

This highly practical book brings the examination of minor neurological dysfunction developed by Bert Touwen and his colleagues in Groningen right up to date, which is timely in view of the increasing interest in and use of this approach.

The approach is a detailed and extensive neurological examination with the aim of detecting a possible neurobiological basis for learning, behavioural and motor coordination problems in a child and thus informing decision-making and management. It provides a refined, sensitive and age-appropriate technique, designed to take into account the developmental aspects of the child‚’s rapidly changing nervous system.

This third edition of Bert Touwen‚’s classic handbook has been updated by Mijna Hadders-Algra to reflect contemporary clinical practice. A new chapter assesses the reliability and validity of the methodology, and the book now includes norms for comparison, as well as practical management guidelines based on current clinical practice. Entirely new photographs and diagrams illustrate the assessment techniques clearly.

Readership

Paediatric neurologists, physicians working in neuropaediatrics, developmental paediatrics, child and adolescent psychiatry, and paediatric rehabilitation.

A Practical Guide from Mac Keith Press

Mijna Hadders-Algra (Author)

Mijna Hadders-Algra

Professor Hadders-Algra is an internationally recognised expert in the field of child development and childhood disability. She has published more than 150 articles in peer-reviewed journals, is regularly invited to present at international meetings, and is or has been a member of the board of the European Academy of Childhood Disability, the Committee of Research and Awards of the American Academy of Cerebral Palsy and Developmental Medicine, and the Working Group on Variability and Uncertainty in Toxicology of the British Government.

  • File list of Assessment Forms and Supporting Videose
  • MND Assessment Form (FREE PDF)
  • The electronic MND Assessment Form
  • Complete Assessments
  • Child of 5.5 years
  • Child of 7 years
  • Examples of Typical Development
  • Mouth-opening-finger-spreading phenomenon
  • Child of 5 years
  • Evident associated activity in fingers, hands and legs age-appropriate.
  • Child of 10 years
  • No associated activity in fingers, hands and legs.
  • Diadochokinesis
  • Child of 4 years
  • Age appropriate performance: possible to produce alternating movements, but only a slow pace; increase of velocity is associated with large elbow excursion and irregular rhythm.
  • Child of 6 years
  • Both sides age appropriate performance, left side better than right side. More associated movements during performance of right arm than of left arm.
  • Child of 8 years
  • Age appropriate performance. Both aides age appropriate associated movement.
  • Child of 10 years
  • Age appropriate performance (left side at the margin).
  • Child of 12 years
  • Age appropriate performance. No associated movements.
  • Fingertip touching
  • Child of 8 years
  • Age appropriate performance: Eyes closed: left side one correct placement, right side two correct placements.
  • Child of 10 years
  • Eyes closed: right side three correct placements, left side two correct placements indicating performance better than required for age.
  • Finger opposition test
  • Child of 4 years
  • Age appropriate performance: The girl tries; she is able to produce a sequence in one direction with some errors in finger sequence; she is not able to change movement direction.
  • Child of 6 years
  • >Both sides age appropriate performance right side (dominant side) better than left side. Minimal associated activity in contralateral hands.
  • Child of 8 years
  • Age appropriate performance; it takes the boy some time to understand the details of the task. Both sides a minimal degree of associated movements.
  • Child of 10 years
  • Age appropriate performance. No associated movements.
  • Child of 12 years
  • Age appropriate performance. No associated movements.
  • Follow-a-finger test
  • Child of 4 years
  • Age appropriate performance: Considerable delay in following difficulties in changing direction, large gaps between finger of assessor and child.
  • Child of 6 years
  • Age appropriate performance: follows relatively prompt, variable gaps, jerky performance.
  • Child of 8 years
  • Age appropriate performance: gaps at change of direction < 5cm, moderate fluency of movements.
  • Child of 10 years
  • Age appropriate performance: gaps at change of direction generally < 2 cm, occasionally 2-5 cm.
  • Child of 12 years
  • Age appropriate performance: follows with minimal gaps at change of movement direction.
  • Circle test
  • Child of 4 years
  • Age appropriate performance. Opposite direction: able to produce synchronized and pattered arm movements (coupling temporal and spatial aspects of movement). During large circles mix of round and oval forms, during small circles form less round.
  • Same direction: during large circles arm movements were coupled in time but not spatially couples; during small circles virtually no coupling. The girl is able to make a prompt transition between circles in opposite and same direction.
  • Child of 6 years
  • Age appropriate performance.
  • Opposite direction: coordinated arm movements, large circles round, small circles mix of oval and round forms.
  • Same direction: pattern coordination better than required for age, not only present during large circles but also during majority of small circles.
  • Child of 8 years
  • Age appropriate performance.
  • Opposite direction: coordinated arm movements, large circles round, small circles mix of oval and round forms.
  • Same direction: pattern coordination appropriate during majority of large circles and some small circles. Small circles mix of round and oval forms.
  • Child of 10 years
  • Opposite direction: well-coordinated arm movements, round circles.
  • Same direction: well-coordinated arm movements, large circle round, small circles mix of round and oval forms.
  • Walking on a straight line
  • Child of 4 years
  • Age appropriate performance: Child needs some space between feet in order to keep balance. Considerable associated activity in all parts of body.
  • Child of 6 years
  • Age appropriate performance.
  • Child of 8 years
  • At the lower limit of age appropriate performance: does not fall off the line, but needs balancing movements of trunk and arms.
  • Child of 10 years
  • Age appropriate performance: no balancing movements of arms and trunk.
  • Walking on toes
  • Child of 4 years
  • Age appropriate performance. Appropriate walking on toes, substantial associated activity in both arms.
  • Child of 6 years
  • Age appropriate performance. Clear associated activity in arms, hands and fingers.
  • Child of 8 years
  • Age appropriate performance. Minimal associated movements in hands.
  • Child of 10 years
  • Age appropriate performance. No associated movements.
  • Walking on heels
  • Child of 4 years
  • Age appropriate performance. Lifts forefoot appropriately from floor; substantial associated activity in both arms and face.
  • Child of 6 years
  • Age appropriate performance. Some associated activity: especially dorsiflexion of wrists.
  • Child of 8 years
  • Age appropriate performance. Some associated activity in hands and wrists.
  • Child of 10 years
  • Age appropriate performance. Associated movements in arms and hands – within the variable range of typical development.
  • Standing on one leg
  • Child of 4 years
  • Age appropriate performance. The girl tries; initially she is able to stand on one leg for only a few second, but after some practise she is able to continue for about 10 seconds.
  • Child of 6 years
  • Age appropriate performance. Keeps balance for 20 seconds, but needs small foot movements and balancing movements of trunk and arms.
  • Child of 8 years
  • Age appropriate performance. Is able to keep balance for 20 seconds but needs balancing movements of arm and trunk (lower range of typical performance).
  • Child of 10 years
  • Age appropriate performance, no balancing movements of trunk and arms.
  • Hopping
  • Child of 4 years
  • Age appropriate performance. The girl tries, but is unable to produce more than 1-2 hops.
  • Child of 6 years
  • Age appropriate performance. Hops on the spot, but not on toes.
  • Child of 8 years
  • Age appropriate performance. Hops on the spot, but not on toes.
  • Child of 10 years
  • Age appropriate performance. Hops on the spot, but not on toes.
  • Knee-heel test
  • Child of 4 years
  • Typical performance in 4 and 5-year-olds. Difficulties in placing and sliding (it is clear that instruction in the last part was ‘describe a large arc with your foot’ – an instruction aiming at the prevention of up-and -down sliding of the leg).
  • Child of 6 years
  • Age appropriate performance.
  • Child of 8 years
  • Age appropriate performance.
  • Child of 10 years
  • Age appropriate performance.
  • Assessment of eye movements
  • Child of 10 years
  • Child with conjugated, smooth movements of the eyes in all directions, including appropriate convergence
  • Examples of MND
  • Mild diffuse hypotonia
  • Child of 6 years
  • Mildly collapsed posture during sitting. Posture with arms extended in supination: bilateral mild pronation and flexion.
  • Choreiform movements in proximal and distal muscle during sitting with arms extended
  • Child of 6 years
  • Kicking inappropriate for age
  • Child of 11 years
  • Inappropriate kicking of right leg.
  • Tonic, stereotyped dorsiflexion of the big toe (Babiniski sign)
  • Child of 7 years
  • Note spontaneous stereotyped dorsiflexion posture of big toe - this may be observed in association with the Babinski sign and other signs of upper motor neuron dysfunction
  • Deviant posture during standing
  • Child of 7 years
  • Increased lumbar lordosis and hyperextension of knees reflecting low muscle tone
  • Choreiform movements during the test for involuntary movements
  • Child of 6 years
  • Choreiform movements in proximal and distal muscles (++).
  • Response to being pushed during standing inappropriate for age
  • Child of 10 years
  • Child tends to fall, no side preference.
  • Diadochokinesis inappropriate for age
  • Child of 7 years
  • Child tries to perform with various strategies:
  • -extending arm
  • -moving elbow
  • -reducing degree of pronation and supination, but difficulty to produce alternating movements remains
  • Associated movements age appropriate.
  • Child of 10 years
  • Right side: just age appropriate performance.
  • Left side: performance inappropriate for age.
  • Finger-nose test inappropriate for age
  • Child of 6 years
  • Frequently misplaces finger (both left and right side).
  • Child of 7 years
  • Eyes closed: high frequency low amplitude intention tremor at end of movement.
  • Fingertip-touching test inappropriate for age
  • Child of 10 years
  • Eyes closed: right side (dominant side) one correct placement, left side no correct placements.
  • Finger opposition test inappropriate for age
  • Child of 6 years
  • Needs long practice, has difficulties in changing movement direction.
  • Child of 9 years
  • Difficulties in programming movement sequence. Associated movements: note extension right hand during performance of left hand.
  • Follow-a-finger test inappropriate for age
  • Child of 6 years
  • Gaps at change of movement direction often > 10 cm.
  • Child of 8 years
  • Gaps at change of movement direction occasionally too large (> 5 cm), too jerky performance, in particular at change of movement direction.
  • Circle test inappropriate for age
  • Child of 9 years
  • Patterning of circles age appropriate, but difficulties in transition from large to small circles.
  • Child of 9 years 2
  • Patterning of large circles with effort but age appropriate, difficulties in transition from large to small circles, and problems to form small circles both in opposite and same direction.
  • Walking on a straight line inappropriate for age
  • Child of 6 years
  • Large effort to perform, using all parts of body to keep on the line, occasionally fails and misplaces feet.
  • Child of 8 years
  • Places feet inappropriately in order to increase support surface; large effort to keep on the line.
  • Walking on heels inappropriate for age
  • Child of 6 years
  • Inappropriate lifting of feet, in particular of lateral sides of feet. Note excessive associated movements in arms and face.
  • Standing on one leg inappropriate for age
  • Child of 6 years
  • Loses balance easily, best performance right leg 8 seconds and left leg 12 seconds, which is below the norms appropriate for age.
  • Child of 10 years
  • Loses balance, which results in hopping after 8 seconds (right leg) and 18 seconds (left leg).
  • Hopping inappropriate for age
  • Child of 6 years
  • Poor performance, best achievement left leg 5 hops, right leg 2 hops, which is below the norms appropriate for age.
  • Child of 8 years
  • Poor performance, best achievement both legs 5 hops, which is below the norms appropriate for age.
  • Knee-heel test inappropriate for age
  • Child of 6 years
  • Mostly inappropriate placing and sliding (but occasionally a good placement and a proper slide).
  • Deviations of visuomotor control
  • Child of 10 years
  • Changing convergent strabism and imbalancement of eye movement

Supporting Videos & Assessment Forms

Assessment forms and videos illustrating typical and atypical performance support the book Neurological Examination of the Child with Minor Neurological Dysfunction and must be used only in conjunction with it. These are FREE with every book purchase - contact admin@mackeith.co.uk for free access if you have purchased the book from another book seller.

File list of Assessment Forms and Supporting Videos

MND Assessment Form (FREE PDF)

The electronic MND Assessment Form

Complete Assessments

Child of 5.5 years

Child of 7 years

Examples of Typical Development

Mouth-opening-finger-spreading phenomenon

Child of 5 years

Evident associated activity in fingers, hands and legs age-appropriate.

Child of 10 years

No associated activity in fingers, hands and legs.

Diadochokinesis

Child of 4 years

Age appropriate performance: possible to produce alternating movements, but only a slow pace; increase of velocity is associated with large elbow excursion and irregular rhythm.

Child of 6 years

Both sides age appropriate performance, left side better than right side. More associated movements during performance of right arm than of left arm.

Child of 8 years

Age appropriate performance. Both aides age appropriate associated movement.

Child of 10 years

Age appropriate performance (left side at the margin).

Child of 12 years

Age appropriate performance. No associated movements.

Fingertip touching

Child of 8 years

Age appropriate performance: Eyes closed: left side one correct placement, right side two correct placements.

Child of 10 years

Eyes closed: right side three correct placements, left side two correct placements indicating performance better than required for age.

Finger opposition test

Child of 4 years

Age appropriate performance: The girl tries; she is able to produce a sequence in one direction with some errors in finger sequence; she is not able to change movement direction.

Child of 6 years

>Both sides age appropriate performance right side (dominant side) better than left side. Minimal associated activity in contralateral hands.

Child of 8 years

Age appropriate performance; it takes the boy some time to understand the details of the task. Both sides a minimal degree of associated movements.

Child of 10 years

Age appropriate performance. No associated movements.

Child of 12 years

Age appropriate performance. No associated movements.

Follow-a-finger test

Child of 4 years

Age appropriate performance: Considerable delay in following difficulties in changing direction, large gaps between finger of assessor and child.

Child of 6 years

Age appropriate performance: follows relatively prompt, variable gaps, jerky performance.

Child of 8 years

Age appropriate performance: gaps at change of direction < 5cm, moderate fluency of movements.

Child of 10 years

Age appropriate performance: gaps at change of direction generally < 2 cm, occasionally 2-5 cm.

Child of 12 years

Age appropriate performance: follows with minimal gaps at change of movement direction.

Circle test

Child of 4 years

Age appropriate performance. Opposite direction: able to produce synchronized and pattered arm movements (coupling temporal and spatial aspects of movement). During large circles mix of round and oval forms, during small circles form less round.

Same direction: during large circles arm movements were coupled in time but not spatially couples; during small circles virtually no coupling. The girl is able to make a prompt transition between circles in opposite and same direction.

Child of 6 years

Age appropriate performance.

Opposite direction: coordinated arm movements, large circles round, small circles mix of oval and round forms.

Same direction: pattern coordination better than required for age, not only present during large circles but also during majority of small circles.

Child of 8 years

Age appropriate performance.

Opposite direction: coordinated arm movements, large circles round, small circles mix of oval and round forms.

Same direction: pattern coordination appropriate during majority of large circles and some small circles. Small circles mix of round and oval forms.

Child of 10 years

Opposite direction: well-coordinated arm movements, round circles.

Same direction: well-coordinated arm movements, large circle round, small circles mix of round and oval forms.

Walking on a straight line

Child of 4 years

Age appropriate performance: Child needs some space between feet in order to keep balance. Considerable associated activity in all parts of body.

Child of 6 years

Age appropriate performance.

Child of 8 years

At the lower limit of age appropriate performance: does not fall off the line, but needs balancing movements of trunk and arms.

Child of 10 years

Age appropriate performance: no balancing movements of arms and trunk.

Walking on toes

Child of 4 years

Age appropriate performance. Appropriate walking on toes, substantial associated activity in both arms.

Child of 6 years

Age appropriate performance. Clear associated activity in arms, hands and fingers.

Child of 8 years

Age appropriate performance. Minimal associated movements in hands.

Child of 10 years

Age appropriate performance. No associated movements.

Walking on heels

Child of 4 years

Age appropriate performance. Lifts forefoot appropriately from floor; substantial associated activity in both arms and face.

Child of 6 years

Age appropriate performance. Some associated activity: especially dorsiflexion of wrists.

Child of 8 years

Age appropriate performance. Some associated activity in hands and wrists.

Child of 10 years

Age appropriate performance. Associated movements in arms and hands – within the variable range of typical development.

Standing on one leg

Child of 4 years

Age appropriate performance. The girl tries; initially she is able to stand on one leg for only a few second, but after some practise she is able to continue for about 10 seconds.

Child of 6 years

Age appropriate performance. Keeps balance for 20 seconds, but needs small foot movements and balancing movements of trunk and arms.

Child of 8 years

Age appropriate performance. Is able to keep balance for 20 seconds but needs balancing movements of arm and trunk (lower range of typical performance).

Child of 10 years

Age appropriate performance, no balancing movements of trunk and arms.

Hopping

Child of 4 years

Age appropriate performance. The girl tries, but is unable to produce more than 1-2 hops.

Child of 6 years

Age appropriate performance. Hops on the spot, but not on toes.

Child of 8 years

Age appropriate performance. Hops on the spot, but not on toes.

Child of 10 years

Age appropriate performance. Hops on the spot, but not on toes.

Knee-heel test

Child of 4 years

Typical performance in 4 and 5-year-olds. Difficulties in placing and sliding (it is clear that instruction in the last part was ‘describe a large arc with your foot’ – an instruction aiming at the prevention of up-and -down sliding of the leg).

Child of 6 years

Age appropriate performance.

Child of 8 years

Age appropriate performance.

Child of 10 years

Age appropriate performance.

Assessment of eye movements

Child of 10 years

Child with conjugated, smooth movements of the eyes in all directions, including appropriate convergence

Examples of MND

Mild diffuse hypotonia

Child of 6 years

Mildly collapsed posture during sitting. Posture with arms extended in supination: bilateral mild pronation and flexion.

Choreiform movements in proximal and distal muscle during sitting with arms extended

Child of 6 years

Kicking inappropriate for age

Child of 11 years

Inappropriate kicking of right leg.

Tonic, stereotyped dorsiflexion of the big toe (Babiniski sign)

Child of 7 years

Note spontaneous stereotyped dorsiflexion posture of big toe - this may be observed in association with the Babinski sign and other signs of upper motor neuron dysfunction

Deviant posture during standing

Child of 7 years

Increased lumbar lordosis and hyperextension of knees reflecting low muscle tone

Choreiform movements during the test for involuntary movements

Child of 6 years

Choreiform movements in proximal and distal muscles (++).

Response to being pushed during standing inappropriate for age

Child of 10 years

Child tends to fall, no side preference.

Diadochokinesis inappropriate for age

Child of 7 years

Child tries to perform with various strategies:

-extending arm

-moving elbow

-reducing degree of pronation and supination, but difficulty to produce alternating movements remains

Associated movements age appropriate.

Child of 10 years

Right side: just age appropriate performance.

Left side: performance inappropriate for age.

Finger-nose test inappropriate for age

Child of 6 years

Frequently misplaces finger (both left and right side).

Child of 7 years

Eyes closed: high frequency low amplitude intention tremor at end of movement.

Fingertip-touching test inappropriate for age

Child of 10 years

Eyes closed: right side (dominant side) one correct placement, left side no correct placements.

Finger opposition test inappropriate for age

Child of 6 years

Needs long practice, has difficulties in changing movement direction.

Child of 9 years

Difficulties in programming movement sequence. Associated movements: note extension right hand during performance of left hand.

Follow-a-finger test inappropriate for age

Child of 6 years

Gaps at change of movement direction often > 10 cm.

Child of 8 years

Gaps at change of movement direction occasionally too large (> 5 cm), too jerky performance, in particular at change of movement direction.

Circle test inappropriate for age

Child of 9 years

Patterning of circles age appropriate, but difficulties in transition from large to small circles.

Child of 9 years 2

Patterning of large circles with effort but age appropriate, difficulties in transition from large to small circles, and problems to form small circles both in opposite and same direction.

Walking on a straight line inappropriate for age

Child of 6 years

Large effort to perform, using all parts of body to keep on the line, occasionally fails and misplaces feet.

Child of 8 years

Places feet inappropriately in order to increase support surface; large effort to keep on the line.

Walking on heels inappropriate for age

Child of 6 years

Inappropriate lifting of feet, in particular of lateral sides of feet. Note excessive associated movements in arms and face.

Standing on one leg inappropriate for age

Child of 6 years

Loses balance easily, best performance right leg 8 seconds and left leg 12 seconds, which is below the norms appropriate for age.

Child of 10 years

Loses balance, which results in hopping after 8 seconds (right leg) and 18 seconds (left leg).

Hopping inappropriate for age

Child of 6 years

Poor performance, best achievement left leg 5 hops, right leg 2 hops, which is below the norms appropriate for age.

Child of 8 years

Poor performance, best achievement both legs 5 hops, which is below the norms appropriate for age.

Knee-heel test inappropriate for age

Child of 6 years

Mostly inappropriate placing and sliding (but occasionally a good placement and a proper slide).

Deviations of visuomotor control

Child of 10 years

Changing convergent strabism and imbalancement of eye movement

'This would be an excellent book for therapists, residents, and fellows in pediatrics, child neurology, developmental pediatrics, and pediatric physiatry.' G. Dean Timmons, Neurology, 2011

'This is a well-written book focusing on the neurodevelopmental examination of the child. Overall, this book is a useful pedagogical tool for trainees or midlevel providers on how to perform a neurodevelopmental sensorimotor examination.' Korwyn Williams, MD, PhD, Phoenix Children's Hospital