|Diagnosis and History:
Astrocytoma of the R cerebellar hemisphere diagnosed following
progressive neurological deterioration from 1 year of age. Tumour
resected Sept 2005. Recurring increased intercranial pressure
necessitated repeated lumbar puncture. Shunt insertion planned Jan
See medical notes from
parents for further details.
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
Tone * fluctuating tone upper extremities and trunk, clasp knife
tone in lower extremities, startle reflex present, and clonus (7
beats) present bilaterally.
Head control * did not show a preference for one side during
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
Some spontaneous bridging observed.
Minimal reaching towards a target observed, parents report
occasional reaching with ataxic movements and active grasp (release
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
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
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.
Registered Physiotherapist (Canada)