Application Of OT Process In Pediatric OT

Question 1

Provide an example of a clinical observations allow the occupational therapy practitioner to make inferences about how the child’s central nervous system is functioning.

Answer 1

Examples include crossing the body at midline, equilibrium reactions, muscle tone, prone extension, and supine flexion.

Question 2

What model is used when conducting assessments with a child with autism.

Answer 2

integrated developmental model

Sensory processing should also be included

Question 3

What are some things to consider when evaluating handwriting in the pediatric population? Name 2.

Answer 3

Determine the writing tasks that are the most difficult for the child.

Track the behaviors that are evident when the child is required to write.

Determine what assistance or cueing (if any) the child needs to complete writing tasks.

Determine whether the child is distracted by any visual or auditory stimuli.

Consider where the child sits in the classroom.

Review the handwriting curriculum (if any) being used.

Location of the teacher when instruction is being given.

Determine how the writing difficulty affects the child’s learning.

Consider ergonomic factors, such as writing posture, upper extremity stability and mobility, and pencil grip.

Question 4

Provide examples of why it is important to consider visual-perceptual skills in handwriting.

Answer 4

How well do the eyes work together?

Where is visual control most efficient and effective?

Which types of eye movements are quick, fluid, and accurate?

Does the child moves their head excessively or skip lines while reading?

Visual–perceptual skills (e.g., through functional activities that require the use of visual discrimination, visual closure, visual figure ground, and visual memory).

Visual–motor integration (e.g., through functional activities that use eye–hand or eye–foot coordination).
Refer to an ophthalmologist as appropriate.

Question 5

Evaluation of a child with ADHD should consider… (name 1)

Answer 5

Executive function

Sensory processing/sensory integration concerns

Motor challenges (motor skills are often a strength)

Question 6

What are some considerations for working with the pediatric population in mental health?

Answer 6

Consider and address psychosocial factors (e.g., observe interactions with staff and others and monitor for signs and symptoms of depression, anxiety, aggression, and impulsivity).

Consider executive function.

Consider any comorbid sensory needs

Emotional regulation

Sensory processing

Address any needs specific to impulse control.

Consider functional performance in all areas of occupational performance.

Consider task completion, time on task, and attention to task.

Address roles, habits, and routines.

Question 7

What are some evaluation considerations for the pediatric population with neuromuscular conditions? Name 2.

Answer 7

Posture, postural control, and movement

Hand skills and upper extremity function

Secondary impairments

Cognitive and language

Sensory functions

Feeding, eating, and swallowing

Functional skills

Developmental skills.

Question 8

What are some behavioral red flags related to vision for the pediatric population?

Answer 8

The child’s need to move closer to objects or surfaces that need visual attention

Squinting, straining, frequently rubbing eyes, closing one eye, and/or excessive head movements

Complaints of headaches

Avoidance of work tasks with a strong visual component, seemingly short attention span, or both.

Question 9

What are some functional performance red flags related to vision for the pediatric population?

Answer 9

Appearing clumsy

Difficulty locating needed items

Trouble learning the alphabet and recognizing spatial concepts

Difficulty with drawing, writing, or reading

Difficulty copying.

Question 10

While often assessed by an audiologist before referral to occupational therapy, what is something OTP’s should consider when assessing a deaf child?

Answer 10

Vestibular dysfunction is common with hearing loss and should be part of the assessment.

It results in decreased balance, low muscle tone, difficulty with visual development, and delayed reflex maturation.

Question 11

What are considerations when assessing q child with severe-profound disabilities?

Answer 11

Determine positioning needs.

Assess feeding and eating skills, deficits, and barriers.

Determine existing and potential family supports.

Determine needed accommodations, adaptations, and assistive technology.

Question 12

Intervention from a sensory processing framework often uses a _____________ approach, teaching the child to recognize sensory and self-regulation needs and how to use specific strategies to support those needs.

Answer 12

“top-down”

Question 13

What are 2 intervention strategies to address visual difficulties in the pediatric population?

Answer 13

Reduce glare.

Decrease busyness of worksheets/ classroom.

Provide visual breaks.

Allow doodling/coloring.

Question 14

What are 2 intervention strategies to address auditory difficulties in the pediatric population?

Answer 14

Use noise-cancelling headphones.

Play music.

Montor tone of voice.

Question 15

What are 2 intervention strategies to address tactile difficulties in the pediatric population?

Answer 15

Use compression garments.

Offer fidgets.

Use weighted materials.

Use textures.

Consider “feel” of materials and adapt as appropriate for the child.

Question 16

What are 2 intervention strategies to address vestibular difficulties in the pediatric population?

Answer 16

Use slow rocking movements.

Allow the vestibular system to “settle” after an active time and before doing a quiet activity.

Encourage swinging.

Encourage jumping.

Question 17

What are 2 intervention strategies to address proprioceptive difficulties in the pediatric population?

Answer 17

Use deep pressure.

Have the child carry heavy objects.

Have the child chew gum.

Question 18

The purpose of sensory intervention is to alter the child’s central nervous system so they may respond more efficiently and effectively to their environment.

What are the 6 principles of Ayres sensory integration (ASI)?

Answer 18

1. Sensory input can be used systematically to elicit an adaptive response.
2. Registration of meaningful sensory input is necessary before an adaptive response can be made.
3. An adaptive response contributes to the development of sensory integration.
4. Better organization of adaptive responses enhances the child’s general behavioral organization.
5. More mature and complex patterns of behavior involve consolidation of more primitive behaviors.
6. The more inner-directed a child’s activities are, the greater the potential is for the activities to improve neural organization.

Question 19

When providing vestibular input, the occupational therapy practitioner looks for red flags to ensure that too much input is not provided. Name 2.

Answer 19

Child’s report of nausea or dizziness, blanching, hyperactivity, and lethargy.

Proprioceptive input may have a mediating effect on vestibular input, and the occupational therapy practitioner will often offer both types of input at the same time (e.g., encouraging the child to use a platform swing while “climbing” a rope with their hands).

Question 20

People with autism generally fall within one of three categories. What are they (levels)?

Answer 20

Level 1 - requiring support
Level 2 - requiring substantial support
Level 3 - requiring very substantial support

Question 21

What are the 3 types of interventions for a child with autism?

Answer 21

Behavioral intervention: Practitioners should carefully assess specific behaviors the person wishes to change, accompanied by detailed plans for intervention based on behavior modification principles.

Early intervention services: Children as young as 1 year can show signs of potential autism. Early intervention can improve outcomes.

Pharmacological options: Common options include clomipramine, pimozide, clozapine, or fluoxetine for anxiety and hyperactivity. Practitioners should be familiar with the side effects of medications clients are taking.

Question 22

________________ is the ability to conceptualize and identify a motor goal with an idea of how to achieve the goal.

Answer 22

Ideational praxis

Question 23

________________ is the ability to plan and organize a series of intentional motor actions in response to environmental demands.

Answer 23

Motor organization

Question 24

_________________ is the process of sending a motor plan to the brain, comparing previous performance, and detecting potential errors in the plan before or after execution.

Answer 24

Feed-forward praxis

Question 25

____________ is the ability to perform motor responses with precision.

Answer 25

Execution

Question 26

________________ is the recognition of and response to a motor act and its consequences.

Answer 26

Feedback processes

Question 27

What types of intervention focuses might be appropriate for an autistic child?

Answer 27

Sensory integration
Self-regulation
Play
Social connections
Self-concept
Behavior
Executive function.

Question 28

In what ways can an OT suppot a child in developing readiness skills for handwriting?

Answer 28

Fine motor control
Isolated finger movements
Prewriting lines and shapes
Left–right discrimination
Print orientation
Letter discrimination

Question 29

What are some neurodevelopmental approaches to supporting readiness for handwriting?

Answer 29

The approach includes preparatory activities for posture and the upper extremities.

Activities that modulate muscle tone

Activities that promote proximal joint stability

Activities that improve hand function.

Question 30

Give an example of an acquisitional approach to handwriting.

Answer 30

Handwriting should be taught directly.

Handwriting should be implemented in brief, daily lessons.

Handwriting instruction should be individualized to the child.

Handwriting instruction should be adjusted on the basis of evaluation and performance data.

Handwriting should be overlearned and used in a functional way.

Question 31

Give an example of a sensorimotor approach to handwriting.

Answer 31

Multisensory input is provided to enhance the integration of the sensory systems at the subcortical level.

Various sensory experiences, media, and novel instructional materials are incorporated.

Multiple writing tools, writing surfaces, and positions for writing should be offered.

Question 32

Give an example of a biomechanical approach to handwriting.

Answer 32

Intervention is focused on the ergonomic factors that influence writing production.

Sitting posture
Children should be seated with their feet on the floor, thus providing support for weight shifting and postural adjustments.
The table surface should be 2 inches above the flexed elbows when the child is seated in the chair; this position allows for motor synergy and symmetry.

Paper position
The paper should be slanted on the desktop so that it is parallel to the forearm of the writing hand when the child’s forearm is resting on the desk.
Left-handed students with a supinated grip should have their papers slanted to the left.

Pencil grip and adjustment of the writing tool
Adaptive equipment to support a functional grip includes pencil grips, triangular grips, moldable grips, wider-barreled pencils, and rubber-band slings.
A mature grip should be encouraged in young children; as early as second grade, changing a child’s pencil grip may be stressful.

Paper modifications (e.g., raised lines, color codes, etc.).

Question 33

Give an example of a psychosocial approach to handwriting.

Answer 33

Intervention is focused on improving self-control, coping skills, and social behaviors.
Emphasis is placed on communicating the importance of good handwriting to the child.

Opportunities to enhance self-confidence are provided.

Question 34

Name 2 interventions for infants with visual-motor issues.

Answer 34

Dim the lights.

Stimulate other body senses to influence distance sense.

Emphasize the human face.

Use soft, simple three-dimensional forms.

Hang mobiles 2 feet above the infant.

Offer toys that reflect light or flash with sound.

Question 35

Name 2 interventions for preschool and kindergarten students with visual-motor issues.

Answer 35

Use multisensory approaches with different textures and media.

Offer activities that encourage body-in-space concepts.

Emphasize imitation.

Share storybook reading.

Question 36

Name 2 interventions for elementary school students with visual-motor issues.

Answer 36

Organize the environment to reduce visual distractions.

Alternate positions for visual–perceptual activities.

Modify work to enhance visual attention to attributes of the assignment (e.g., use bold lines to enhance page margins; reorganize worksheets).

Reduce other sensory input.

Teach strategies, such as a routine for searching in “Where’s Waldo”–type activities, and scanning routines.

Use chunking, maintenance rehearsal (repetition), and mnemonic devices.

Use color coding.

Use directional cues for writing.

Use games to support visual spatial concepts.

Use computers to develop skills and as an accommodation.

Identify learning styles (e.g., kinesthetic learners may benefit from games, such as bingo, dominoes, or card games, that allow them to move while reviewing skills.

Question 37

Name 1 intervention for children with ADHD who have learning differences for early childhood, school age, and early adolescence.

Answer 37

Early childhood: sensory, play, socialization, and self-help

School age: sensory integration/sensory processing, perceptual–motor integration, writing skills

Early adolescence: independent living skills, social skills, and the development of compensatory and adaptive techniques.

Question 38

What are 2 interventions to reduce external stressors for a child with mental health or psychosocial issues?

Answer 38

Eliminate decision making to increase activity engagement and reduce stress.

Offer simple, structured, familiar tasks.

Encourage daily routines.

Arrange for shorter school and work days with reduced tasks and expectations.

Provide a reasonable, just-right challenge.

Question 39

What are 2 interventions to support emotional regulation for a child with mental health or psychosocial issues?

Answer 39

Invite participation; do not force it.

Keep conversations short and direct.

Provide opportunities for self-expression.

Introduce self-regulation and sensory strategies to support participation.

Improve self-esteem and increase motivation.

Provide outlets for different emotions.
Provide opportunities to focus on values, beliefs, spirituality, and emotional regulation.

Question 40

What are 3 types of behavioral interventions?

Answer 40

Be goal directed and appropriate for the intervention context.
Provide services in natural environments whenever possible.
Be motivating and meaningful to the child.
Provide the just-right challenge and grade the activity appropriately.
Provide intervention that’s enjoyable for the child.

Prioritize safety
Develop decision-making skills and facilitate increased social participation
Provide opportunities for the child to make choices as often as is feasible.

Limit the amount of negative attention (e.g., verbal reprimands and punishments) given to the child when the child is engaging in the nonpreferred behavior.

Question 41

What are 3 types of behavioral interventions to reinforce preferred behavior?

Answer 41

1. Use rewards and incentives that are meaningful to the child.
2. Reward the preferred behavior when it is demonstrated.
3. Grade reinforcers so that tangible rewards (e.g., a cracker) are paired with nontangible rewards (e.g., a high five or fist bump), and systematically reduce tangible rewards.
4. Encourage the child to delay gratification and continue to work on a given task (e.g., “Do two more, then you can have a break”).
5. Use prompts when the child requires them at the baseline level of performance.
   Physical prompts: manually guiding the child through the activity.
   Visual prompts: visual cues or other supports to help the child remember how the task should be completed.
   Demonstration: completing the task and then having the child copy the occupational therapy practitioner.
   Modeling: having a peer complete the task and then having the child copy the peer.
   Auditory or verbal prompts: providing verbal prompts to redirect the child.

Question 42

________________ is when the child is encouraged to complete the first step of the task, and to practice this step until it is mastered. The practitioner completes the rest of the steps to complete the task.

Answer 42

Forward chaining

Question 43

_________________is when the practitioner teaches the last step first, performs the other steps, and allows the child to complete the last step of the task.

Answer 43

Backward chaining

Question 44

What are some motor learning-based interventions to support children with neuromuscular conditions.

Answer 44

Self-organize motor actions

Adaptive equipment (ordering and training)

Orthotics and casting

Constraint-induced movement therapy

Bimanual therapy

Physical agent modalities

Positioning, handling

Participation in community recreation
Assistive technology, robotics, etc. (Cook et al., 2020).

Question 45

Practitioners should consider what intervention components when working with a child with vision impairment?

Answer 45

Provide opportunities for children to learn to use their other senses.

Use sensory-based strategies.

Support social participation.

Support development of self-care skills.

Support development of tactile and proprioceptive abilities.

Improve fine motor manipulation skills.

Maximize functional use of vision.

Question 46

What are 2 interventions to support children with hearing impairments?

Answer 46

Use sensory-based strategies.

Support vestibular function.

Maximize use of residual hearing.

Encourage age-appropriate self-care skills.

Enhance fine motor coordination and skills.

Maximize oral–motor coordination.

Maximize visual processing, integration, and perception.

Encourage socialization and peer interaction.

Use backward and forward chaining.

Question 47

What are 2 interventions to support children with severe-profound disabilities?

Answer 47

Positioning to support function and skin integrity

Feeding, eating, and swallowing

Family supports to engage with their child, and encourage independence

Potential complex health needs such as skin breakdown and breathing difficulties.

Accommodations, adaptations, and assistive technology to support learning, participation, and play.

Collaboration with a speech therapist to support functional communication.

Question 48

Name 1 example of an occupational performance outcome in the pediatric population.

Answer 48

Student has improved ability to play.

Adolescent can participate in leisure activities with peers.

Child can explore new ADL activities.

Student can access school tools and materials.

Child or youth can access home and community environments.

Question 49

Name 1 example of a client satisfaction outcome in the pediatric population.

Answer 49

Child or youth is excited about new skill.

Parents are pleased with progress.

Child or youth is motivated to engage in activities supporting occupational performance.

Teacher is satisfied with adaptations used by the student in the classroom.

Question 50

Name 1 example of a role competence outcome in the pediatric population.

Answer 50

Student is able to meet the demands required of a preschooler.

Student is able to participate as a fourth grader.

Youth demonstrates strong social skills with friends.

Adolescent is able to complete job demands.

Question 51

Name 1 example of an adaptation outcome in the pediatric population.

Answer 51

Family knows how to adapt toys and tools for play or leisure activities.

Teacher is able to adapt the classroom environment so all students are learning.

School has adapted the playground for access by all students.

Work tasks are adapted so youth is able to independently meet job demands.

Question 52

Name 1 example of a health and wellness outcome in the pediatric population.

Answer 52

Student is able to maintain psychosocial health in school.

Adolescent can independently manage medication.

Question 53

Name 1 example of a prevention outcome in the pediatric population.

Answer 53

School develops a curriculum to address social skills for students with disabilities.

Violence prevention program is implemented at the local high school.

Appropriate seating and positioning is used to prevent deformities.

Question 54

Name 1 example of a quality of life outcome in the pediatric population.

Answer 54

Student demonstrates self-determination skills across all environments and with unfamiliar adults.

Child or youth is able to participate with peers across school and community environments.

Child or youth is able to complete ADLs independently.