See medical notes from parents for further details.

Objective:

Alert and can maintain some eye contact, responds to songs and watches videos intently.

Verbalised several simple sounds and feeds soft solids.

Ataxic movement in upper extremities (flexor pattern), and lower
extremities, flexor pattern (right greater than left).

ROM * slight end range tightness in hip flexors and right ankle
dorsiflexors. Approximately +10 degrees bilateral knee hyperextension

Tone * fluctuating tone upper extremities and trunk, clasp knife tone in lower extremities, startle reflex present, and clonus (7 beats) present bilaterally.

Functional Skills:
Head control * did not show a preference for one side during this
assessment, Parent reports right rotation preference (larger and heavier head limits head control against gravity).

Prone - arms and shoulder retraction, intermittently able to clear head, difficult to facilitate weight bearing on elbows and shift of weight to trunk and pelvis, intermittent head control in midline in supported prone on elbows, pushes through extended arms, and pulls legs beneath her (L>R)

Supine * head able to rotate actively to both sides, hands approach midline,

Some spontaneous bridging observed.

Minimal reaching towards a target observed, parents report occasional reaching with ataxic movements and active grasp (release erratic)

Rolling * Able to roll (prone *> supine) in a dissociated movement,
difficulty clearing arms.

Sitting * good head control (rotates to either side) when place in ring sitting with arms on floor or legs, trunk is erect and can maintain independently 30-60 seconds. Mod support and leg placement needed with chair sitting with table in front and weight bearing on elbows.

No upper extremity protective reactions evident in either position, lateral head righting present but ataxic and delayed. Primitive palmar grasp bilaterally (Left more coordinated than Right)

Transitions between side lying and sitting with minimal facilitation through upper trunk.

Overall Impression: Heya is a 2 year 6 month old child post cerebellar astrocytoma resection with ongoing hydrocephalus and residual neurological deficits. Her range of motion is adequate with end range tightness in her ankles and hips, likely related to her overall fluctuating tone and ataxia (upper extremities more than lower, right more than left). She appears to be developing independent sitting and rolling but requires facilitation for transitional skills. Upper extremity and grasping skills are limited by bilateral upper extremity ataxia and tone.

Communication skills and cognition have not been assessed formally however Heya appears to be able to understand simple commands and is trying to verbalize simple words.

Parents were taught a basic home program over 2 sessions for facilitate pre crawling skills, independent sitting, transitional skills, hand use, and weight bearing through lower extremities.

Further more comprehensive rehabilitation is needed including ongoing physiotherapy (PT). PT intervention would be helpful to facilitated more varied motor skills, manage her ataxia, address seating and positioning needs (such as arm gaitors) and equipment (wedge, a stander, appropriate toys). As well, with a regular therapist, parents and caregivers can learn more about what can help Heya develop her skills during everyday activities, and her potential to regain skills can be assessed in the presence of controlled hydrocephalus.

Assessment and intervention by a paediatric speech language pathologist and occupational therapist is recommended, especially to establish a method of communication for Heya, assess feeding and oral motor skills, and upper extremity function in more detail.


As well, participation in a preschool would be ideal.


Sudha Raman

Registered Physiotherapist (Canada)

4sr3@qlink.queensu.ca