Exam 2 Flashcards
Focal delay
Delay in one area
Global delay
Delay in all areas
Divergent/atypical delay
Development that is unusual in pattern
Stages of play
Unoccupied play (0-3 months)
Solitary play (0-2 years)
Spectator/onlooker behavior (2 years)
Parallel play (2+ years)
Associate play (3-4 years)
Cooperative play (4+ years)
Unoccupied play
0-3 months
Baby is making movements with arms, legs, hands, and feet to learn about and discover how their body moves
Solitary play
0-2 years
Child plays alone and are not interested in playing with others
Spectator/onlooker behavior
2 years
Child watches other children playing but will not play with them
Parallel play
2+ years
Child plays alongside or near others but does not play with them
Associate play
3-4 years
Child starts to interact with other during play but there Is not much cooperation required
Ex. Kids playing on playground but doing different things
Cooperative play
4+ years
Child plays with others and has interest in both the activity and other children involved in it
Takata taxonomy of play
Sensorimotor play (birth-2 years)
Symbolic and simple constructive play (2-4 years)
Dramatic, complex, constructive, and pregame (4-7 years)
Games (7-12 years)
Recreational (12-16 years)
Sensorimotor play
Birth-2 years
Activity performed for the enjoyment of physical sensation
Includes repetitive movements to create actions in toys for sensory experiences of hearing, seeing, and feeling
Symbolic and simple constructive play
2-4 years
Child starts to use objects to represent other objects to play pretend or uses materials to create something
Dramatic, complex constructive, and pregame
4-7 years
Cooperative play where children use materials for construction
Dramatization of reality and building
Games stage
7-12 years
Enhancement of constructional and sports skills
Rule-bound behaviors
Recreational stage
12-16 years
Participation in organized sports, interest groups, or hobbies
Playfulness characteristics
Intrinsic motivation
Internal control
Ability to suspend reality
Flexiblity
Spontaneity
Curiosity
Imagination
Creativity
Joy
Ability to take charge
Ability to build on/change flow of play
Total absorption in play
What are the characteristics of play?
Self-chosen/self-directed
Intrinsically motivating
Guided by rules
Occurs in a stress-free state
Imaginative
Active participation
Play characteristics for children with physical disabilities
Limited movement, strengths, or pain
Fear of movement
Limited active play
Engagement in sedentary activities
Minimal play exploration
Difficulty manipulating toys
Play characteristics for children with cerebral palsy
Difficulty across skill areas
Limited and abnormal movements
Decreased cognitive abilities
Exhibit multi-sensory impairments
Lack of opportunities for social play
Limited physical interactions with the environment
Less interactive play time
Play characteristics for children with cognitive impairments
Delayed or uneven skills
Difficult structuring behaviors
Decreased sustained attention
Selecting more structured play materials
Limited or inflexible play repertoires
Minimal curiosity
Destructive or inappropriate use of objects
Limited imagination
Poor symbolic play
Minimal social interaction
Increased engagement in observer play
Play characteristics for children with ASD
Repetitive
Sensorimotor
Lack of language
Limited imitation and motor planning
Poor play organization
Atypical use of objects
Poor imagination
Minimal social play
Pretend play is delayed or absent
Play characteristics for children with visual impairments
Delays in perception of world
Delayed motor exploration
Difficulty with constructive play
Delays in complex play routine development
Minimal imitation or role playing
Sensorimotor play
Less imaginative or symbolic play
Play characteristics for children with hearing impairments
Limited social interactions
Decreased inner language
Decreased understanding of abstract concepts
Restricted imagination
Non-interactive constructive play
Decreased symbolic play
Increased solitary play
Play characteristics for children with sensory processing difficulties
Excessive or avoidance of movement
Decrease exploration
Decreased gross motor or manipulative play
Observation or solitary play
Increased sedentary play
Restricted repertoire of play
Resistance to change
Distractibility
Destructiveness
Adolesence age and grade
12-18 years; Grade 6-12
Early adolesence
Middle school
Middle adolesence
High school
Late adolesence
College years
Puberty in adolesence
Females: onset at 8-13 years and growth peaks at 11 years
Males: onset at 11-12 years and growth peaks at 13 years
Peak motor performance in adolescence
Males: 17-18 years
Female: 14 years
Cognitive development in adolesence
Formal operational stage (12+ years)
- Uses abstract reasoning about hypothetical events
- Considers logical possibilities
- Systematically examines/tests hypotheses
Fosters interest in the future
Allows them to understand their value
General psychosocial development in adolescence
Focus on developing a sense of identity
Focus on developing purpose in world
Vulnerable to mental health disorders
- Depression
- Anxiety
- Substance use/abuse
Attention deficit disorder
Psychosocial development in early adolesence
Preoccupied with self
Self-evaluate their attractiveness
Compare their own body and appearance with other teens
Interest in as well as anxiety about sexual development
Challenge authority
Ability to self regulate emotionally and limit behaviors but can’t think beyond the immediate needs or wants
Psychosocial development in middle adolesence
Puberty completed
Developing acceptance of their bodies
Interest in appearance, grooming, and trying to be attractive
More apt to developing eating disorders and other body image-related disorders
Moving toward independence form parents
Peers replace parents as most influential
Risk taking behaviors
Psychosocial development in late adolesence
Strengthen relationships with parents
Stable value system
Stable sense of self and self-ability
Improved ability to regulate emotions and anticipate consequences
Realistic and concrete thoughts about future
Cognitive development theory of gender
Gender labeling (2-3 years)
- Child labels everything
- Child may label a person a woman because they have long hair
Gender stability (4-5 years)
- Child begins to understand that gender typically does not change
Gender constancy (6-7 years)
- Child understands that gender is not just about surface appearance
Sensory registration
Detection of sensory information by central nervous system
Beginning point for sensory processing
Sensory discrimination
Ability to identify qualities and details of sensory stimuli to distinguish between different stimuli
Sensory modulation
Ability to grade responses to various degrees, natures, and intensities of sensory input
Sensory processing
The way our nervous system organizes, processes, and analyzes sensory information
Sensory integration
Ability to take information through our senses, put it together with prior information, memories, and knowledge stored in the brain, and make a meaningful response
Importance
- Contributes to skill development
- Linked with emotional state
- Organizes behavior
Adaptive response
An appropriate and successful response to a sensory stimuli that facilitates accomplishing a goal
Enhanced by successful previous experiences
Ex. Answering the phone when you hear the phone ring instead of jumping and covering ears
Dyspraxia
Disorder that leads to problems with coordination
Dyspraxia presentation
Child may not have age-appropriate motor milestones
Difficulty taking advantage of perceptual cues
Destructive in play, tends to break toys
Difficulty with motor activities that are more than one step
Clumsy, awkward, or accident prone
Difficulty keeping personal space organized
Difficulty coordinating and sequencing movements on two sides of the body
Prefers fantasy games or sedentary activities rather than active play
Messy, sloppy or disheveled appearance
Frustrated when unable to complete tasks due to poor motor coordination
Emotional dysregulation
Somatodyspraxia
Difficulty encoding new as opposed to habitual motor response strategies
Gravitational insecurity
Sensory modulation disorder
Fear or anxious reaction to non-threatening movements such as changes in head position, movements requiring balance, and not having feet on the floor
Tactile defensiveness
Over-responsivity to touch
Neural threshold
Level of sensory information necessary to produce appropriate adaptive responses and fully participate in everyday activities
Hyperresponsivity
Neural threshold is lower than normal
Results in defensive or avoidant behavior
Hyporesponsivity
Neural threshold is higher than normal
Results in extreme seeking behavior, inaccuracy, and inefficiency
Sensory modulation disorder
Difficulty achieving and maintaining optimal arousal and adapting challenges in daily life
Sensory over-responsivity in SMD
Responds too much, too frequently, or for too long to sensory stimulation
When overwhelmed by sensory stimulation child is…
- Upset by transitions and unexpected change
- Aggressive
- Irritable
- Unsociable
- Afraid to try new things
- Labeled as fussy or difficult
Sensory under-responsivity in SMD
Less sensitive to and less aware of sensory stimuli than most people
When in the presence of sensation…
- Passive, quiet, and withdrawn
- Difficult to engage in social interactions
- Easily lost in own world
- Excessively slow to respond to directions or complete assignments
- Poor inner drive
Sensory craving in SMD
Seems to want or need more sensory inputs than others
Characteristics
- Constantly wants control over every situation
- Does not wait turn, interrupts constantly
- Intense, demanding, hard to calm
- Prone to create situations others perceive as “bad,” “dangerous,” or disruptive
- Often discharged from school if behaviors are intense enough
- Child’s sensory needs is like a leaky bucket that never gets full
Sensory Discrimination Disorder
Difficulty discriminating sensory input in one or more of the sensory systems
Presentation of visual discrimination problems
Visual inattention (usually in left visual field)
Directionality problems
Confusing similar letters such as b/d and p/q
Problems spacing and ordering symbols in problems
Possible presentation of auditory discrimination problems
Difficulty with recognizing different phonemes (phonological awareness)
- Affects all aspect of language including reading, writing, and understanding
Difficulty with auditory sequencing leads to child mispronounces words or mixing up order of words in a sentence
Difficulty with auditory memory leads to difficulty following instructions verbally or recalling information from a story read
Difficulty recognizing tone or emotion in speech
Possible presentation of tactile discrimination problems
Difficulty detecting sharp vs dull
Difficulty detecting double vs single input
Difficulty detecting location of stimuli
Difficulty with identifying an object with vision occluded (stereognosis)
Unable to determine number of letter drawn on skin
Possible presentation of vestibular discrimination problems
Child may not know when they are about to fall or are unable to determine in what direction they are falling
Differential diagnosis
- Gravitational insecurity
- Postural insecurity
Possible presentation of proprioception discrimination problems
Child has to look at body to move it
Overshoots or undershoots when completing tasks
Writing lacks precision
Child may use too much or too little force during play
Poor praxis skills
Child may have low tone and use all-or-nothing contraction
Possible presentation of taste/smell discrimination problems
Aversion toward food or different textures, smells, or temperature
Requires constant meal modifications
Inability to eat out at restaurants
Sensory-based motor disorders
Dyspraxia
Postural disorders
Possible presentation in postural disorders
Appears lazy, unmotivated or indifferent
Appears weak and limp
Leans on things for support
Tires easily/appears tired most of the time
Gives up when challenged
Difficulty with physical endurance
Feedback postural activity
Reactive postural adjustments
Feedforward postural activity
Anticipatory postural adjustments
Inpatient rehab
1x/day for 15 minutes for 2 weeks
2x/day for 15 minutes for 3 days
Outpatient rehab
1x/week for 60 minutes for 6 months
2x/week for 45 minutes for 3 months
School-based OT
60 minutes per quarter
1x/week for 15 minutes per year
30 minutes per month
Theory
Set of ideas or concepts to guide action
Help us to predict actions, behaviors, and relationships
Frame of reference
Structure for organizing theoretical material
Helps to translate information into practice
Include the person, environment, and interaction between the two
Model of practice
Mental map that assists clinicians in understanding their practice and viewing the profession
Goal of Sensory Therapies and Research (STAR)
Addresses child’s challenges in through improving parent-child relationship and coaching parents in sensory-based strategies or sensory lifestyle
Key ideas in Sensory therapies and research (STAR)
Regulation and sensory integration are precursors to milestones
Relationships are disrupted when children have sensory impairments
Sensory integration is foundational for development
Disorders addressed by Sensory therapies research (STAR)
Sensory modulation disorders
Sensory based motor disorders
Intervention ins sensory therapies and research (STAR)
Therapist utilizes voice, body position, and nonverbal gestures to help with regulation
Improve relationships and interactions between children and caretakers
Provide multisensory experiences to enhance learning
Tap into the child’s inner drive by allowing the child to select play
Provide the just right challenge
PROCESS
- Play
- Relationship
- Organize and regulate
- Collaborate
- Emotional regulation
- Sensory integration
- Success
ASECRET
- Attention
- Sensation
- Emotional regulation
- Culture
- Relationship
- Environment
- Task
Evaluation in Sensory Therapies and Research (STAR)
Extensive history and intake meeting
Standardized motor assessment
Sensory processing assessment
Structured and unstructured observations in the clinic
Therapy in Ayres Sensory Integration
Most often seen implemented in outpatient therapy with a high frequency of visits (3-5x/week)
Intensive individual therapy to engage child’s inner drive to meet sensory-motor challenges and promote neuroplasticity
Therapist provides sensory opportunities and the child produces an adaptive response
Goals in Ayres Sensory Integration
Identify problems and strengths in sensory integration
Improve sensory integration through active engagement in intensive, individualized, and long-term remediation to improve participation in life activities
Assumptions in Ayres Sensory Integration
Learning is dependent on integration of sensory information
Sensory integration is a developmental and dynamic process
Successful integration results in adaptive responses
Sensory integration promotes neuroplasticity
Sensory integration supports participation in activities
Sensory integration is not
Passive sensory stimulation protocols
Specific sensory strategies
Sensory-focused group intervention
Consultation on modification of environments or routines
Sensory integration deficits identified by Ayres Sensory Integration
Atypical sensory reactivity (over- & under-responsivity)
Somatosensory perception deficits (tactile and proprioception)
Vestibular bilateral integration and sequencing deficits
Dyspraxia: visuodyspraxia, somatodyspraxia, language-based dyspraxia, ideation dyspraxia [generating ideas to initiate actions on novel tasks])
Evaluation in Ayres Sensory Integration
Formal and informal observations and parent questionnaires
Sensory Integration and Praxis Tests (SIPT)
- Battery of 17 standardized tests to assess sensory processing abilities in children 4-8 years
- Gold standard
Evaluation of Ayres Sensory Integration (EASI)
- Set of 20 tests that measure core constructs of ASI for children 3-12 years
Key concepts in motor skill acquisition
Functional tasks help organize behaviors
Successful performance of tasks
Massed practice is best when learning a new skill
Variable/random practice helps to transfer or generalize a skill and improves long-term retention
Distributed practice includes built-in rest breaks
In early stages of learning, therapist focuses feedback on outcome and critical features of task and environment
In late stages of learning therapist summarizes feedback and has a greater error tolerance
Encouraging the child to self-evaluate their performance will improve the child’s skill performance
Task oriented approach is better for skill acqusition than play, exercise, or subcomponent movement approach
Goal of motor skill acquisition
Match between the child, task, and environment
Dynamic systems theory
Proposes that movement emerges from interactions between the person, task, and environment
Subsystems within the person include emotional, cognitive, perceptual, sensory motor, other physical systems
Motor skill
Consistency in achieving a motor goal with an economy of effort
Skill does not imply the use of one pattern a motor goal with an economy of effort
Practice concepts for motor acquisition
Focus on task rather than individual movement patterns
Encourage problem-solving
Extrinsic then intrinsic feedback
Perform closed motor tasks before open motor tasks
Closed tasks
Stable environment
Similar movement each trial
Ex. Writing, bowling, brushing teeth
Open task
Environment is unpredictable
A lot of variation in movement in each trial
Ex. Ice hockey, soccer, carrying lunch tray to table at school
Evaluation for motor skill acquisition
Evaluation of the child
- Ask parents, teachers, and professionals for their observations
Evaluation of the task
- Identify tasks that are important to the child
- Ask child, family, teacher, and professionals to prioritize tasks on which intervention should focus
Evaluation of the environment
- What is the child able to do in different environments
- What does the child have difficulty doing in different environments
- What is interfering with motor skill acquisition
- What is supporting motor skill acquisition
- What can improve the child’s motor skill acquisition and performance
Intervention for motor skill acquisition
Make sure child understands the expectations
Used massed practice for children with cognitive deficits
Encourage independent problem solving
Tasks should be relevant, motivating, and challenging
Practice the whole task
Include variability and unpredictability when practicing open tasks
Key concepts of Four-Quadrant model of facilitated learning (4QM)
Start with Q4 and provide scaffolding appropriate for Q3, Q2, Q1 as needed until child is able to successfully complete the task
Autonomy requires mastery of key skills, decision-making skills that enable generalization, and contextual competence in incorporating learned skills into occupational performance
Scaffolding enhances learning
Child is more likely to transition from Q1 to Q2 if therapist facilitates skill acquisition sand maximizes self-mediation
Child is more likely to develop an effective plan for task performance if therapist uses higher-order questioning, verbal feedback, and physical prompts/gestures
Quadrant 1 in 4QM
Task specification
Requires facilitator to instruct on the task
Does the child know what to do and how to do it?
Explicit instruction/explanation
Demonstration
Physical patterning
Lower order questions
Quadrant 2 in 4QM
Decision-making stage
Requires facilitator to prompt cognitive processes for successful performance
Is the child making decisions? Are they aware of mistakes?
Higher order questions
Feedback
Physical prompts
Nonverbal prompts
Think-aloud modeling
Quadrant 3 in 4QM
Uses self-mediating strategies for recall
Is the child recalling the steps of the task and key features of performance
Priming
Mnemonics
Verbal self-instruction
Visual cues
Kinesthetic self-prompting
Quadrant 4 in 4QM
Autonomy
Successful performance, corrects own errors without over self-mediation
Are there signs of self-prompting?
Mental imagery
Self-instruction
Self-questioning
Self-monitoring
Problem solving
Automaticity
Key concepts in Cognitive Orientation to Occupational Performance (CO-OP)
Focus on occupations the child selects
Uses a general problem-solving framework
Uses process questions to increase child’s awareness
Plan for transfer and generalization of strategies Expands the cognitive motor approach
Steps in Cognitive Orientation to Occupational Performance (CO-OP)
Goal: what do I want the child to do?
Plan: How am I going to do it?
Do: Do it
Check: How well did the plan work? Does the plan need to be modified?
Neuronal group selection theory
Function drives motor development
Repeated exercises create neural networks in the brain
Repeating valued movement experience in therapy changes the brain
Neurodevelopmental treatment
Treatment that using sensorimotor and handling techniques to teach typical movement patterns and alter atypical movement patterns in children with neurological, postural, and movement impairments
Goals of neurodevelopmental treatment
Achieve best energy efficient performance to maximize participation in occupations
Contemporary approaches also focus on self-initiating movement and motor learning
Key concepts in neurodevelopmental treatment
Create functional context
Promote motivation and problem-solving
Adapt environment to meet the child’s need
Embed handling techniques in play activities
Allow time for child to initiate movement
Use preventative measures such as adaptive equipment and orthotic devices to prevent secondary impairment
Attempt to normalize muscle tone before and during functional movement
Function-dysfunction of postural tone
Function
- Ability to sustain muscle activiation for postural support against gravity
Dysfunction
- Inability to sustain muscle activation
- Stiff or floppy
- Compensatory muscle synergies when attempting to maintain postural control
Function-dysfunction of weight-bearing
Function
- Able to push off on weight-bearing side to adjust or maintain body function
- Able to maintain body alignment
Dysfunction
- Lack of postural alignment and abnormal pattern of weight bearing
Function-dysfunction of disassociation of movement
Function
- Able to perform isolated movements
- Full ROM
Dysfunction
- Atypical motor patterns and synergies
Function-dysfunction of postural control and balance
Function
- Dynamic postural control
- Able to transition into different positions
Dysfunction
- Compensatory postural control
- Excessively wide or narrow base of support
Function-dysfunction of coordination
Function
- Performs tasks in smooth, efficient fashion
- Holds with right force
- Typical gait patterns
Dysfunction
- Awkward, clumsy, or uneven task performance
- Overshooting or overshooting
Neurodevelopmental treatment evaluation
Informal and on-going assessment of functional skills, weight-bearing, balance, coordination, tone, posture, and movement
Identify atypical, missing, or inefficient movement patterns and impact on function
Assess tone at rest and during movement
Handling techniques
Proximal points of control provides more support and stability
Distal points of control requires children to perform more of the movement
Used only when the child has adequate postural control against gravity
Hands should be used to guide, not to do
Hand placement on msucles increase muscle recruitment
Hand placement across the joint facilitates alignment
Light touch gives child a greater degree of independence and motor control
Deep touch provides increased support and direction
Compression may be used to relax or activate muscles
Traction may be used to elongate stiff muscles, align joints, and facilitate movement initiation
Slow, sustained traction elongates shortened muscles, releases restricted fascia and reduces intensity of hypertonicity
Test of Playfulness (ToPs)
Observation-based behavior rating scale to assess the child’s play based on playfulness
Based on observing child in free play in a familiar play setting
Designed for typically developing children 6 months-18 years
15-20 minutes for free play observation; 10 minutes for scoring
Domains include intrinsic motivation, internal control, disengagement from constraints of reality, framing
Each domain is ranked from 0 (lowest) to 3 (highest) on areas of extent, intensity, and skillfulness
Test of environmental supports (TOES)
Observation-based checklist of the influence of environment on play to be used as a companion tool to Test of Playfulness
Performed in a familiar indoor setting
For children with developmental disabilities and typically developing children aged 1.5-15 years
15-20 minutes
Influence of people and nonhuman factors on play are scored on a scale of -2 to +2
Minnesota handwriting assessment
Near-point copy test that can be used for individuals or group
Used to help identify students with poor manuscript skills
For students in grade 1 and 2
Timed 2.5 minutes test for the child’s writing and 10 minutes to score
Child must copy words from a sample on marked lines below
Scoring
- Quality of writing is scored based on legibility, form, alignment, size, and letter/word spacing
- Each letter scan receive up to 1 point for each category
- Score for number of letter completed is assigned (rate score)
Evaluation tool of child’s handwriting (ETCH-M [Manuscript] and ETCH-C [Cursive])
Timed criterion-referenced test for manuscript and cursive tasks to evaluate child’s legibility and speed of writing
Population
- ETCH-M (manuscript) may be used for children grades 1 - 3
- ETCH-C (cursive) may be used for children grade 3 - 6
15-25 minutes to administer; 15-20 minutes to score
Child completes alphabet and numeral writing from memory, near and far-point copying, manuscript-to-cursive transition, dictation, and sentence composition
Speed is measured in letter per minute
Legibility is measured in percentages
Letter formation, spacing size, alignment, and sensorimotor skills are also examined
Sensory profile 2
Observation-based or self report questionnaire to measure sensory processing patterns that support or interfere with function
School companion form incorporates teacher’s perspectives
Populations
- Infant version: Birth - 6 months
- Toddler version: 7-35 months
- Child, short, and school companion: 3-14 years
- Adolescent/adult SP: 11-65 years
Assigns sensory pattern responses (low registration, sensation seeking, sensory sensitivity, sensation avoiding)
Sensory processing measure 2 (SPM-2 and SPM-P [Preschool])
Observer-rated behavior scale of behaviors at home and school to measure function in sensory processing, praxis, and social participation
Populations
- SPM: Children grades K-6
- SPM-P: Preschool children 2-5
15-20 minutes per form
Administration
- Questions include behaviors related to visual systems, auditory, tactile, olfactory-gustatory, proprioceptive, and vestibular systems
- Primary caregiver completes home form
- Primary teacher completes main classroom form
- Other personnel familiar with child completes school environments form
-> Evaluation of school environments outside of main classroom including art class, music class, physical education class, recess/playground, cafeteria, and school bus
- Items are scored on a 4-point Likert scale from never to always
Structured observation of sensory integration -motor (SOSI-M)
Assess proprioceptive and vestibular processing, motor planning, and postural control
For children 5-14
20-40 minutes
Goal Oriented Assessment of Lifeskills (GOAL)
Observation of performance tasks to evaluate motor abilities needed for ADLs
For children 7-17 years
45-60 minutes
Administration
- Fine motor tasks include utensils (using a knife, fork, spoon), locks, paper box (cutting, coloring, folding, taping), notebook (organizing and filling a 3-ring binder)
- Gross motor tasks include clothing (shorts and shirt), ball play, tray carry
- Steps in each activity are scored as pass or fail based on accuracy, independence, and speed
Roll evaluation of activities of life (REAL)
Performance-based rating scale to assess common and ADL and IADL skills
For children 2-18
15-20 minutes
Parent or caregiver rates child’s performance on ADLs (dressing, hygiene and grooming, feeding, toileting, functional mobility, personal care devices) and IADLs (housework/chores, managing money and shopping, meal preparation, personal safety, travelling, school-related skills
Each items is rated on a 4 point scale from 0 (unable) to 3 (frequently)
Pediatric Evaluation of Disability Inventory (PEDI) or PEDI-CAT (computerized behavior rating scale)
Behavior checklist and rating scale to identify functional delays and assess functional capacity
PEDI: children with functional abilities at 6 months - 7.5 years
PEDI-CAT: Children and youth from birth - 20 years with physical or behavioral conditions
Speedy-CAT is 10-15 minutes
20-60 minutes
Observation and interview to assess domains of self-care, mobility, and social functioning
- Subunits for tasks include functional skills, caregiver assistance, and modification
-> Functional skills marked as 0 (unable) or 1 (capable)
-> Modification is rated from E (extensive) or N (no modification)
-> Caregiver assistance is rated from 0 (total assistance) to 5 (independent)
- PEDI-CAT consists of daily activities, mobility, social/cognitive, and responsibility
