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OPD : 10-Oct-2026 11:19AM Demographic Details Child's Name: Avyan Dubey Age: 2 Year 7 Month 7 Days Gender: Male DOB: 2023-10-15 Contact: 8982014573 Current Improvements: Improved strength in right upper limb, range of motion improved, spasticity reduced Interaction history: Eye contact: Sustained Behavioral history: Stubbornness Birth & Perinatal History: Antenatal History Natal and Postnatal History: Past history: Investigations done- Family history: Developmental History: Gross Motor Neck holding: Achieved Age of attainment: Roll over: Achieved Age of attainment: Sitting without support: Achieved Age of attainment: Standing without support: Not achieved Walking without support: Not achieved Fine Motor Language Expressive:- Communication & Language Assessment Non-Verbal Communication Grading:- Need-based communication: Consistent Drag for needs: Consistent Joint attention: Consistent Pointing: Consistent meaningful pointing Understanding gestures: Consistent Following commands (gesture + verbal): 1-step Answering Questions:- Social Response to Name Call Sitting tolerance- (in minutes) ADL Skills (Age-appropriate)- Eating: 1. Dependent Bathing: 1. Dependent Toilet training: 1. Dependent Dressing: 1. Dependent Undressing: 1. Dependent Type of Play : 5. Associative Academic History: Diet History: Food preferences: Mixed Food allergies: No Sleep History Total sleep duration (night): 10-11 hours Daily Screen Time Duration: Zero Examination a. Vitals: b. Anthropometry: c. General Examination d. CNS: Higher Mental Functions Sensory Examination Cranial Nerves (1â€“12) Neuromuscular Concerns Oromotor Examination Examination summary: Tone increased in right upper limb; lower limbs. Core muscle weakness. Started attempting to flex right forearm, grasp improved CVS examination: NAD Respiratory System examination: NAD Per abdomen examination: NAD Impression: 3 Advice Intervention plan: IDP + PT 3/week Medications: Syp Baclof 1mg/ml 1 ml TDS Follow up plan: Next month General recommendation- Zero Screen Time Physical interactive play No Junk food

OPD : 10-Oct-2026 11:19AM Demographic Details

Child's Name: Avyan Dubey
Age: 2 Year 7 Month 7 Days
Gender: Male
DOB: 2023-10-15
Contact: 8982014573
Current Improvements: Improved strength in right upper limb, range of motion improved, spasticity reduced

Interaction history:

Eye contact: Sustained

Behavioral history:

Stubbornness

Birth & Perinatal History: Antenatal History

Natal and Postnatal History:

Past history:

Investigations done-

Family history:

Developmental History:

Gross Motor

Neck holding: Achieved

Age of attainment:
Roll over: Achieved

Age of attainment:
Sitting without support: Achieved

Age of attainment:
Standing without support: Not achieved
Walking without support: Not achieved

Fine Motor

Language

Expressive:-

Communication & Language Assessment

Non-Verbal Communication Grading:-

Need-based communication: Consistent
Drag for needs: Consistent
Joint attention: Consistent
Pointing: Consistent meaningful pointing
Understanding gestures: Consistent
Following commands (gesture + verbal): 1-step

Answering Questions:-

Social

Response to Name Call

Sitting tolerance- (in minutes)

ADL Skills (Age-appropriate)-

Eating: 1. Dependent
Bathing: 1. Dependent
Toilet training: 1. Dependent
Dressing: 1. Dependent
Undressing: 1. Dependent

Type of Play : 5. Associative Academic History:

Diet History:

Food preferences: Mixed
Food allergies: No

Sleep History

Total sleep duration (night): 10-11 hours

Daily Screen Time

Duration: Zero

Examination

a. Vitals:

b. Anthropometry:

c. General Examination

d. CNS: Higher Mental Functions

Sensory Examination

Cranial Nerves (1â€“12)

Neuromuscular Concerns

Oromotor Examination

Examination summary: Tone increased in right upper limb; lower limbs. Core muscle weakness. Started attempting to flex right forearm, grasp improved CVS examination: NAD
Respiratory System examination: NAD
Per abdomen examination: NAD

Impression: 3

Advice

Intervention plan: IDP + PT 3/week
Medications: Syp Baclof 1mg/ml 1 ml TDS
Follow up plan: Next month
General recommendation-
1. Zero Screen Time
2. Physical interactive play
3. No Junk food

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