Systems Review Guide
Page 1 of 3Last Updated: 01/08/2014
Cardiovascular□ No□ Yes / Does the child appear to have adequate circulation throughout? If No, describe: ______
□ No□ Yes / Does the child have a history of hypertension?
□ No□ Yes / Is it controlled? ______
□ No□ Yes / Are there any concerns with the child’s heart rate? If Yes, describe: ______
Cognition/Complex Perception
□ No□ Yes / Does the play in an age appropriate manner?
Gastrointestinal System
□ No□ Yes / Does the child have difficulty with bowel movements?
How often does the child have a bowel movement? ______
How big are the bowel movements? ______
Describe the stool (circle one):HardSoft
□ No□ Yes / Does the child spit up often? If Yes, when does this usually occur? ______
What is the family doing to help with bowel or spit up issues? ______
Integumentary
□ No□ Yes / Does the family have concerns with the child’s skin? If Yes, describe: ______
□ No□ Yes / Does the child have any rashes?
□ No□ Yes / Does the child have any bruises or cuts?
Musculoskeletal System
Morphology:
Height: ______Weight: ______Leg Length: R= ______L= ______Arm Length: R= ______L= ______
General Body Proportions: ______
Head Shape: ______
Structural Oral Motor Factors: ______
Spinal Alignment: ______
Popliteal Angle (measured with hip flexed at 90 degrees): ______
______
Limitations in range of motion or strength: ______
______
Neuromuscular System
Strengths / Limitations
Ability to activate, sustain, and terminate muscle activity
Recruitment of postural (SO) and phasic (FF) motor units.
Type of muscle contractions
Concentric – contractions that shorten muscles, Eccentric – control during elongation of a muscle, Isometric – able to contract a muscle without shortening it.
Co-activation of muscles
Is the child able to maintain postural control due to adequate use of opposing muscle groups?
Reciprocal inhibition of muscles
Does the child have control of movement throughout the range of motion?
Muscle stiffness
Is there too much or too little muscle resistance to movement?
Extraneousmovements
Are there any repetitive, involuntary movements occurring?
Synergy selectivity
Does the child move in limited patterns or have a variety on movements?
Regulatory System
□ No□ Yes / Is the child easily startled?
□ No□ Yes / Is the child easy to calm?
What does the family do to sooth the child? ______
□ No□ Yes / Does the child sweat when hot?
□ No□ Yes / Does the child easily get cold or hot?
Respiratory
□ No□ Yes / Does the child require supplementary oxygen? If Yes, how much & how often? ______
□ No□ Yes / Is the child on an apnea monitor? If Yes, how often does it go off? ______
□ No□ Yes / Is the child able to vocalize during play?
□ No□ Yes / Is the child able to feed & breathe at the same time without difficulty?
Sensory Systems
Somatosensory:
□ No□ Yes / Does the child feel pain? If Yes, describe: ______
How does the child respond to light touch (circle one)?SmilesCriesCalmsDoes not respond
How does the child respond to deep pressure touch (circle one)?SmilesCriesCalmsDoes not respond
Vestibular/Visual:
□ No□ Yes / Does the family have concerns about vision? If Yes, describe:______
□ No□ Yes / Can the child track an object?
□ No□ Yes / Is there any nystagmus observed?
□ No□ Yes / Are both eyes moving at the same rate & direction?
□ No□ Yes / Is the child afraid of movement?
□ No□ Yes / Does the child enjoy large movements?
□ No□ Yes / Is the child able to be still for a few minutes whilst engaging in play?
Auditory:
□ No□ Yes / Does the family have concerns with hearing? If Yes, describe:______
□ No□ Yes / Does the child turn to a sound?
Gustatory:
______
Page 1 of 3Last Updated: 01/08/2014