Clinical reasoning
To help the student understand how the assessments work, these diagnostic guides outline the path that the assessments take that lead to relevant treatment...
To help the student understand how the assessments work, these diagnostic guides outline the path that the assessments take that lead to relevant treatment...
1: Was the child developing normally but then had an accident eg fall from a tree, car/ motorbike accident, etc? Yes = Spinal cord injury
Spinal cord injury treatment 
1: Was the child developing normally and without a fever, but then had an accident eg fall from a tree, car/ motorbike accident, etc? No = go to 2
2: Was the child developing normally, but then seemed to get weaker and start to lose skills? (eg was running, now struggling to walk) Yes = Neuromuscular condition
Neuromuscular condition treatment
1: Was the child developing normally but then had an accident eg fall from a tree, car/ motorbike accident, etc? No = go to 2
2: Was the child developing normally but then seemed to get weaker and start to lose skills eg was running now struggling to walk? No = go to 3
3: Was the child developing normally but then had an infection and fever, and now one or more limbs have become weak? Yes = go to Acute Poliomyelitis
Acute Poliomyelitis treatment
1: Was the child developing normally but then had an accident eg fall from a tree, car/ motorbike accident, etc? No = go to 2
2: Was the child developing normally but then seemed to get weaker and start to lose skills eg was running now struggling to walk? No = go to 3
3: Was the child developing normally but then had an infection and fever, since when one or both legs or possibly an arm, have become weak? No = go to 4
4: Does the child have one weak arm? (possibly a difficult delivery or traumatic birth and holds arm straight and turned in) Yes = Erbs Palsy
1: Was the child developing normally but then had an accident eg fall from a tree, car/ motorbike accident, etc? No = go to 2
2: Was the child developing normally but then seemed to get weaker and start to lose skills eg was running now struggling to walk? No = go to 3
3: Was the child developing normally but then had an infection and fever, since when one or both legs or possibly an arm, have become weak? No = go to 4
4: Does the child have one weak arm? (possibly a difficult delivery or traumatic birth and holds arm straight and turned in) No = go to 5
5: Has the child not reached gross motor milestones at the same time as other babies? Does the child have unusual movements, seem weak, stiff or uncoordinated? Yes = go to 6
6: Does the child have increased tone in both legs( scissoring /legs difficult to bend or legs bent towards tummy and are difficult to straighten). NB: One leg may be affected more than the other? Yes = go to 7
7: Does the child have increased tone in both arms? (arms stiff and hard to bend or bent and hard to straighten. nb: one arm may be affected more than the other)? Yes = go to 8
8: Are the arms stiffer or at least as stiff as the legs. Child/toddler probably not walking? Yes = go to 9
9: Did the child have some difficulties around birth eg born too soon, too late, too fast, difficult labour, cord round neck, took some time to cry when first born or was poorly( eg meningitis or infection as a baby? Yes = go to CP Spastic Quadriplegia
1: Was the child developing normally but then had an accident eg fall from a tree, car/ motorbike accident, etc? No = go to 2
2: Was the child developing normally but then seemed to get weaker and start to lose skills eg was running now struggling to walk? No = go to 3
3: Was the child developing normally but then had an infection and fever, since when one or both legs or possibly an arm, have become weak? No = go to 4
4: Does the child have one weak arm? (possibly a difficult delivery or traumatic birth and holds arm straight and turned in) No = go to 5
5: Has the child not reached gross motor milestones at the same time as other babies? Does the child have unusual movements, seem weak, stiff or uncoordinated? Yes = go to 6
6: Does the child have increased tone in both legs( scissoring /legs difficult to bend or legs bent towards tummy and are difficult to straighten). NB: One leg may be affected more than the other? Yes = go to 7
7: Does the child have increased tone in both arms? (arms stiff and hard to bend or bent and hard to straighten. nb: one arm may be affected more than the other)? Yes = go to 8
8: Are the arms stiffer or at least as stiff as the legs. Child/toddler probably not walking? Yes = go to 10
10: Are the legs stiffer than the arms, possibly walking but up on toes or needing some support? Yes = go to 11
11: Did the child have some difficulties around birth eg born too soon, too late, too fast, difficult labour, cord round neck, took some time to cry when first born or was poorly (eg meningitis or infection as a baby? Yes = go to CP Spastic Diplegia
1: Was the child developing normally but then had an accident eg fall from a tree, car/ motorbike accident, etc? No = go to 2
2: Was the child developing normally but then seemed to get weaker and start to lose skills eg was running now struggling to walk? No = go to 3
3: Was the child developing normally but then had an infection and fever, since when one or both legs or possibly an arm, have become weak? No = go to 4
4: Does the child have one weak arm? (possibly a difficult delivery or traumatic birth and holds arm straight and turned in) No = go to 5
5: Has the child not reached gross motor milestones at the same time as other babies? Does the child have unusual movements, seem weak, stiff or uncoordinated? Yes = go to 6
6: Does the child have increased tone in both legs( scissoring /legs difficult to bend or legs bent towards tummy and are difficult to straighten). NB: One leg may be affected more than the other? No = go to 12
12: Are both the child’s legs ‘floppy’, falling into a frog leg posture or legs straight rolling out and not kicking or moving much? Yes = go to 13
13: Does the child have ‘floppy’ arms, (not able to lift arms to get a toy, not moving them much?) Yes =go to 14
14: Does the child have a ‘floppy’ head and weak back? (unable to hold head up properly or sit unaided)? No = go to 16
16: Has the child been like this from birth or since the illness but seems to be getting stronger? No = Low tone cerebral palsy
1: Was the child developing normally but then had an accident eg fall from a tree, car/ motorbike accident, etc? No = go to 2
2: Was the child developing normally but then seemed to get weaker and start to lose skills eg was running now struggling to walk? No = go to 3
3: Was the child developing normally but then had an infection and fever, since when one or both legs or possibly an arm, have become weak? No = go to 4
4: Does the child have one weak arm? (possibly a difficult delivery or traumatic birth and holds arm straight and turned in) No = go to 5
5: Has the child not reached gross motor milestones at the same time as other babies? Does the child have unusual movements, seem weak, stiff or uncoordinated? Yes = go to 6
6: Does the child have increased tone in both legs( scissoring /legs difficult to bend or legs bent towards tummy and are difficult to straighten). NB: One leg may be affected more than the other? No = go to 12
12: Are both the child’s legs ‘floppy’, falling into a frog leg posture or legs straight rolling out and not kicking or moving much? No = go to 17
17: Does the child have stiffness (Increased tone) or floppiness/ weakness on one side of the body? (nb the arm may be worse than the leg or vice versa)? Yes = go to 18
18: Did the child have some difficulties around birth eg born too soon, too late, too fast, difficult labour, cord round neck, took some time to cry when first born? Yes = CP left or right sided hemiplegia
1: Was the child developing normally but then had an accident eg fall from a tree, car/ motorbike accident, etc? No = go to 2
2: Was the child developing normally but then seemed to get weaker and start to lose skills eg was running now struggling to walk? No = go to 3
3: Was the child developing normally but then had an infection and fever, since when one or both legs or possibly an arm, have become weak? No = go to 4
4: Does the child have one weak arm? (possibly a difficult delivery or traumatic birth and holds arm straight and turned in) No = go to 5
5: Has the child not reached gross motor milestones at the same time as other babies? Does the child have unusual movements, seem weak, stiff or uncoordinated? Yes = go to 6
6: Does the child have increased tone in both legs( scissoring /legs difficult to bend or legs bent towards tummy and are difficult to straighten). NB: One leg may be affected more than the other? No = go to 12
12: Are both the child’s legs ‘floppy’, falling into a frog leg posture or legs straight rolling out and not kicking or moving much? No = go to 17
17: Does the child have stiffness (Increased tone) or floppiness/ weakness on one side of the body? (nb the arm may be worse than the leg or vice versa)? No = go to 19
19: Does the child have variable unwanted movements which get more noticeable when they try to move. Balance is difficult in sitting and standing. Affects all the body? Yes = go to 20
20: Did the child have some difficulties around birth eg born too soon, too late, too fast, difficult labour, cord round neck, took some time to cry when first born? Yes = Dyskinetic CP
1: Was the child developing normally but then had an accident eg fall from a tree, car/ motorbike accident, etc? No = go to 2
2: Was the child developing normally but then seemed to get weaker and start to lose skills eg was running now struggling to walk? No = go to 3
3: Was the child developing normally but then had an infection and fever, since when one or both legs or possibly an arm, have become weak? No = go to 4
4: Does the child have one weak arm? (possibly a difficult delivery or traumatic birth and holds arm straight and turned in) No = go to 5
5: Has the child not reached gross motor milestones at the same time as other babies? Does the child have unusual movements, seem weak, stiff or uncoordinated? Yes = go to 6
6: Does the child have increased tone in both legs( scissoring /legs difficult to bend or legs bent towards tummy and are difficult to straighten). NB: One leg may be affected more than the other? No = go to 12
12: Are both the child’s legs ‘floppy’, falling into a frog leg posture or legs straight rolling out and not kicking or moving much? No = go to 17
17: Does the child have stiffness (Increased tone) or floppiness/ weakness on one side of the body? (nb the arm may be worse than the leg or vice versa)? No = go to 19
19: Does the child have variable unwanted movements which get more noticeable when they try to move. Balance is difficult in sitting and standing. Affects all the body? No = go to 21
20: Did the child have some difficulties around birth? (eg born early, late, fast or difficult labour, cord round neck, no sound, poorly or infected) No = go to 21
21: Do the child’s movements seem clumsy, imprecise and balance poor? Movements seem disorganised or jerky. They happen on voluntary movement and eye movements are not smooth and coordinated? Yes = go to 22
22: Did the child have some difficulties around birth eg born too soon, too late, too fast, difficult labour, cord round neck, took some time to cry when first born? Yes = Ataxia CP
1: Was the child developing normally but then had an accident eg fall from a tree, car/ motorbike accident, etc? No = go to 2
2: Was the child developing normally but then seemed to get weaker and start to lose skills eg was running now struggling to walk? No = go to 3
3: Was the child developing normally but then had an infection and fever, since when one or both legs or possibly an arm, have become weak? No = go to 4
4: Does the child have one weak arm? (possibly a difficult delivery or traumatic birth and holds arm straight and turned in) No = go to 5
5: Has the child not reached gross motor milestones at the same time as other babies? Does the child have unusual movements, seem weak, stiff or uncoordinated? Yes = go to 6
6: Does the child have increased tone in both legs( scissoring /legs difficult to bend or legs bent towards tummy and are difficult to straighten). NB: One leg may be affected more than the other? Yes = go to 7
7: Does the child have increased tone in both arms? (arms stiff and hard to bend or bent and hard to straighten. nb: one arm may be affected more than the other)? No = go to 23
23: Are the child’s arms completely normal and both moving equally with no ‘floppiness’ (low tone) or resistance to movement (high tone)? No = go to 24
24: Was the child developing normally but stiffness/ weakness in lower limbs developed over time? Yes = Spinal tumour?