Name: Domingo, Nio

Age: 14 y/o

CRS PEDIATRIC CLINIC 2016

Diagnosis: CPSQ with Hydrocepalus
Clinic: MOC

PT NOTES
cross sitting
June 13, 2016

GOAL FOR TODAY: to increase head control in quadruped and trunk control in

for 5 minutes
S> No New complaints
O> (See Vs Chart) All WNL
Vital Signs
Before
After
BP
HR (bpm)
105
80
RR (cpm)
25
29
Temp
36.5
36.6
?
? OI:
? - Bedbound, Non-ambulatory
? - Ectomorph
? - Not in apparent pain and respiratory distress
? - Drowsy, incoherent, cooperative
? - (+) VP Shunt on frontal aspect of the skull
? - (+)(R) Ulnarly deviated wrist
? - (+) Windswept deformity
? - (+) Rashes on popliteal aspect of Knee and (L) elbow
? - (+) Postural Deviation
? All bony landmarks are assessed in supine and sitting position and is WNL
except for:
Anterior
Lateral
Pos
-Head tilted to the (L)
- (B) Hips flexed
-Head tilted to
- Shoulder higher than (L)
-(B) Knee flexor contracture
- Shoulder hig
- Hand ulnarly deviated wrist
-Spine deviated
-(B) Hips flexed
-(L) Pelvis High
-(B) Knee flexor contracture
-(L) Plantarflexion deformity
? Interpretation: (+) Postural deviation 2o to muscle tightness and
deformities
? Significance: Pt. would have difficulty in assuming an upright sitting
position. Posture correction and stretching of muscles should be
incorporated during tx.
PT MANAGEMENT GIVEN:
1. GPS towards radial deviation, CMC and MCP extension, (B) knee
extension, (B) ankle dorsiflexion and eversion x 30 Seconds x 3 sets. OD
2. PROMES on (B) UE and LE towards AP x 10 reps x 1 set, OD
3. Segmental Rolling with pelvic rotation towards and (L) x 10 reps x 1 set,
OD
4. Static stretching of (L) thoracic lateral flexors and Lumbar lateral flexors
while side-lying on a bolster x 2 minutes x 1 set, OD
5. Head control exercises in quadruped position with bone pounding and
weight shifting forwards and backward with facilitation through tickling of
stomach x 5 minutes x 1 set, OD
6. Trunk control exercise in cross sitting position on a mat with manual
contact on pelvis x 5 minutes x 1 set, OD
REACTION TO TREATMENT:
Patient was able to tolerate management without any adverse effects.
A> Patient was seen and treated today. Goal for today was not achieved.
Patient was able to tolerate head control exercises in quadruped position.

However, In quadruped the head control is inconsistend. Pt. cannot

position self in cross sitting due to tightness of Hip adductor
P> Continue same management next session. Goal for next session is same.
Herradura, Phyllis Yna G.
DLSHSI PT Intern
PT NOTES
June 15, 2016
minutes

GOAL FOR TODAY: To tolerate cross sitting with support on his back for 5

S> No New complaints

O> (See Vs Chart) All WNL
Vital Signs
Before
After
BP (mmHg)
80/70
80/75
HR (bpm)
70
100
RR (cpm)
25
25
Temp
36.3
37.2
?
? OI:
? - Bedbound, Non-ambulatory
? - Ectomorph
? - Not in apparent pain and respiratory distress
? - Drowsy, incoherent, cooperative
? - (+) VP Shunt on frontal aspect of the skull
? - (+)(R) Ulnarly deviated wrist
? - (+) Windswept deformity
? - (+) Rashes on popliteal aspect of Knee and (L) elbow
? - (+) Postural Deviation
? All bony landmarks are assessed in supine and sitting position and is WNL
except for:
Anterior
Lateral
Pos
-Head tilted to the (L)
- (B) Hips flexed
-Head tilted to
- Shoulder higher than (L)
-(B) Knee flexor contracture
- Shoulder hig
- Hand ulnarly deviated wrist
-Spine deviated
-(B) Hips flexed
-(L) Pelvis High
-(B) Knee flexor contracture
-(L) Plantarflexion deformity
? Interpretation: (+) Postural deviation 2o to muscle tightness and
deformities
Significance: Pt. would have difficulty in assuming an upright sitting
position. Posture
Due to tightness of Hip adductor
PT MANAGEMENT GIVEN:
1. PROMEs on (B) UE and LE using PNF patterns D1 flexion and Extension and
D2 flexion and Extension x 10 reps x 2 sets, OD
2. Head control exercises in quadruped position with bone pounding and
weight shifting forwards and backward with facilitation through tickling of
stomach x 5 minutes x 1 set, OD
3. Physiologic Standing x 5 minutes x 1 set, OD
4. Cross sitting balance and tolerance x 5 minutes x 1 set, OD
5. Vestibular ball sitting x 5 minutes x 1 set, OD
REACTION TO TREATMENT:

Patient was able to tolerate cross sitting with manual contact at the back for
5 minutes without any adverse effect. Patient was in pain and crying during
the activity while the PT is positioning the patient in cross sitting. Patient was
not able to physiologic standing while the PKS is being applied to (B) knees.
Contracture on (B) knees prevents the PKS from being applied.
A> Patient was able to tolerate cross sitting position with support at the back
for 5 minutes. Goal for today was achieved.
P> Continue same management next session. Goal for next session is to
increase tolerance in cross sitting.
Herradura, Phyllis Yna G.
DLSHSI PT Intern
PT NOTES
June 17, 2016
minutes

GOAL FOR TODAY: To tolerate cross sitting with support on his back for 5

S> No New complaints

O> (See Vs Chart) All WNL
Vital Signs
Before
After
BP (mmHg)
80/70
80/75
HR (bpm)
95
109
RR (cpm)
20
18
Temp
36.4
35.7
?
? OI:
? - Bedbound, Non-ambulatory
? - Ectomorph
? - Not in apparent pain and respiratory distress
? - Drowsy, incoherent, cooperative
? - (+) VP Shunt on frontal aspect of the skull
? - (+)(R) Ulnarly deviated wrist
? - (+) Windswept deformity
? - (+) Rashes on popliteal aspect of Knee and (L) elbow
? - (+) Postural Deviation
? All bony landmarks are assessed in supine and sitting position and is WNL
except for:
Anterior
Lateral
Pos
-Head tilted to the (L)
- (B) Hips flexed
-Head tilted to
- Shoulder higher than (L)
-(B) Knee flexor contracture
- Shoulder hig
- Hand ulnarly deviated wrist
-Spine deviated
-(B) Hips flexed
-(L) Pelvis High
-(B) Knee flexor contracture
-(L) Plantarflexion deformity
? Interpretation: (+) Postural deviation 2o to muscle tightness and
deformities
Significance: Pt. would have difficulty in assuming an upright sitting
position. Posture
Due to tightness of Hip adductor
PT MANAGEMENT GIVEN:
1. PROMEs on (B) UE and LE using PNF patterns D1 flexion and Extension and
D2 flexion and Extension x 10 reps x 2 sets, OD
2. Head control exercises in quadruped position with bone pounding and
weight shifting forwards and backward with facilitation through tickling of
stomach x 5 minutes x 1 set, OD

3. Physiologic Standing x 5 minutes x 1 set, OD

4. Cross sitting balance and tolerance x 5 minutes x 1 set, OD
5. Vestibular ball sitting x 5 minutes x 1 set, OD
REACTION TO TREATMENT:
Patient was able to tolerate cross sitting with manual contact at the back for
5 minutes without any adverse effect. Patient was crying and is in pain during
the cross sitting. Patient was not able to tolerate physiologic standing due to
contractures on (B) knees
A> Patient was able to tolerate cross sitting position with support at the back
for 5 minutes. Goal for today was achieved.
P> Continue same management next session. Goal for next session is to
increase tolerance in cross sitting and minimizing manual contact to 75%
Herradura, Phyllis Yna G.
DLSHSI PT Intern
PT NOTES
June 20, 2016
minutes

GOAL FOR TODAY: To tolerate cross sitting with support on his back for 5

S> No New complaints

O> (See Vs Chart) All WNL
Vital Signs
Before
After
BP (mmHg)
80/70
80/75
HR (bpm)
98
85
RR (cpm)
17
21
Temp
35.9
35.5
?
? OI:
? - Bedbound, Non-ambulatory
? - Ectomorph
? - Not in apparent pain and respiratory distress
? - Drowsy, incoherent, cooperative
? - (+) VP Shunt on frontal aspect of the skull
? - (+)(R) Ulnarly deviated wrist
? - (+) Windswept deformity
? - (+) Rashes on popliteal aspect of Knee and (L) elbow
? - (+) Postural Deviation
? All bony landmarks are assessed in supine and sitting position and is WNL
except for:
Anterior
Lateral
Pos
-Head tilted to the (L)
- (B) Hips flexed
-Head tilted to
- Shoulder higher than (L)
-(B) Knee flexor contracture
- Shoulder hig
- Hand ulnarly deviated wrist
-Spine deviated
-(B) Hips flexed
-(L) Pelvis High
-(B) Knee flexor contracture
-(L) Plantarflexion deformity
? Interpretation: (+) Postural deviation 2o to muscle tightness and
deformities
Significance: Pt. would have difficulty in assuming an upright sitting
position. Posture
Due to tightness of Hip adductor
PT MANAGEMENT GIVEN:

1. PROMEs on (B) UE and LE using PNF patterns D1 flexion and Extension and
D2 flexion and Extension x 10 reps x 2 sets, OD
2. Head control exercises in quadruped position with bone pounding and
weight shifting forwards and backward with facilitation through tickling of
stomach x 5 minutes x 1 set, OD
3. Physiologic Standing x 5 minutes x 1 set, OD
4. Cross sitting balance and tolerance x 5 minutes x 1 set, OD
5. Vestibular ball sitting x 5 minutes x 1 set, OD
REACTION TO TREATMENT:
Patient was able to tolerate cross sitting with support on the back for 5
minutes and cried throughout the activity. Patient was not able to tolerate
physiologic standing due to contractures on (B) knees. All management was
given without adverse effect
B> Patient was able to tolerate cross sitting position with support at the back
for 5 minutes. Goal for today was achieved.
P> Continue same management next session. Goal for next session is to
increase tolerance in cross sitting and minimizing manual contact to 75%
Herradura, Phyllis Yna G.
DLSHSI PT Intern
PT NOTES
June 22, 2016
manual support on his

GOAL FOR TODAY: To improve Head control in cross sitting position with

Back and LE for 10 minutes

O> (See Vs Chart) All WNL
Vital Signs
Before
After
BP (mmHg)
110/90
110/70
HR (bpm)
87
105
RR (cpm)
16
20
Temp
36.4
35.9
?
? OI:
? - Bedbound, Non-ambulatory
? - Ectomorph
? - Not in apparent pain and respiratory distress
? - Drowsy, incoherent, cooperative
? - (+) VP Shunt on frontal aspect of the skull
? - (+)(R) Ulnarly deviated wrist
? - (+) Windswept deformity
? - (+) Rashes on popliteal aspect of Knee and (L) elbow
? - (+) Postural Deviation
? All bony landmarks are assessed in supine and sitting position and is WNL
except for:
Anterior
Lateral
Pos
-Head tilted to the (L)
- (B) Hips flexed
-Head tilted to
- Shoulder higher than (L)
-(B) Knee flexor contracture
- Shoulder hig
- Hand ulnarly deviated wrist
-Spine deviated
-(B) Hips flexed
-(L) Pelvis High
-(B) Knee flexor contracture
-(L) Plantarflexion deformity
? Interpretation: (+) Postural deviation 2o to muscle tightness and
deformities

Significance: Pt. would have difficulty in assuming an upright sitting

position. Posture
Due to tightness of Hip adductor
PT MANAGEMENT GIVEN:
1. PROMEs on (B) UE and LE using PNF patterns D1 flexion and Extension and
D2 flexion and Extension x 10 reps x 2 sets, OD
2. Pull to sit exercises (Manual contact on Scapula) while improving head
control with facilitation on anterior aspect of the neck x 5 minutes x 1 set,
OD
3. Cross sitting balance and tolerance while improving head control with
facilitation on posterior aspect of the neck x 5 minutes x 1 set, OD
REACTION TO TREATMENT:
Patient was able to tolerate cross sitting with support on the back for 5
minutes. However, Pt. cried all throughout the activity. Pt. also has no
contraction of cervical flexors and abdominals during pull to sit. Pt. also cried
during PROMEs of the LE
A> Goal for today was achieved. Pt. Tolerated sitting with support on his back
for 5 minutes
P> Continue same management next session. Train head control in Lower
positions like quadruped or prone on elbows. Also increase time in cross
sitting to increase sitting tolerance and to stretch (B) Hip adductors. Goal
for next session is same with improvements on head control in sitting or
quadruped (Palpate for muscle contraction on cervical flexors and
abdominals)
Herradura, Phyllis Yna G.
DLSHSI PT Intern
PT NOTES
June 24, 2016
manual support on his

GOAL FOR TODAY: To improve Head control in cross sitting position with

Back and LE for 10 minutes

O> (See Vs Chart) All WNL
Vital Signs
Before
After
BP (mmHg)
110/90
110/70
HR (bpm)
87
105
RR (cpm)
16
20
Temp
36.4
35.9
?
? OI:
? - Bedbound, Non-ambulatory
? - Ectomorph
? - Not in apparent pain and respiratory distress
? - Drowsy, incoherent, cooperative
? - (+) VP Shunt on frontal aspect of the skull
? - (+)(R) Ulnarly deviated wrist
? - (+) Windswept deformity
? - (+) Rashes on popliteal aspect of Knee and (L) elbow
? - (+) Postural Deviation
? All bony landmarks are assessed in supine and sitting position and is WNL
except for:
Anterior
Lateral
Pos
-Head tilted to the (L)
- (B) Hips flexed
-Head tilted to

- Shoulder higher than (L)

-(B) Knee flexor contracture
- Shoulder hig
- Hand ulnarly deviated wrist
-Spine deviated
-(B) Hips flexed
-(L) Pelvis High
-(B) Knee flexor contracture
-(L) Plantarflexion deformity
? Interpretation: (+) Postural deviation 2o to muscle tightness and
deformities
Significance: Pt. would have difficulty in assuming an upright sitting
position. Posture
Due to tightness of Hip adductor
PT MANAGEMENT GIVEN:
1. PROMEs on (B) UE and LE using PNF patterns D1 flexion and Extension and
D2 flexion and Extension x 10 reps x 2 sets, OD
2. Pull to sit exercises (Manual contact on Scapula) while improving head
control with facilitation on anterior aspect of the neck x 5 minutes x 1 set,
OD
3. Cross sitting balance and tolerance ) while improving head control with
facilitation on posterior aspect of the neck x 5 minutes x 1 set, OD
REACTION TO TREATMENT:
Patient was able to tolerate cross sitting with support on the back with
stroking on Patients posterior side of the neck to promote head control. Pt.
also cried once positioned in cross sitting. No head control was noted even in
the lowest angle during pull to sit. There is no contraction of cervical flexors
and abdominals during the activity
A> Goal for today was achieved. Pt. was showing signs of head control or
initiating it while doing cross sitting done for 10 minutes.
P> Continue same management next session. Goal for next session is same.
Train pt. to improve head control during pull to sit and in cross sitting.
Herradura, Phyllis Yna G.
DLSHSI PT Intern