Final Exam!!!! Flashcards
Child 1: 5-year-old male diagnosed with arthrogryposis
General info
Joint deformity of the extremities (typically at least 2 joints)
Joints are typically affected in a symmetrical pattern in the extremities with greater distal than proximal involvement
In classic AMC, all of the joints of the extremities are affected
Cylindrical extremities with few features and no skin creases across joint surfaces.
Skin is thin with little subcutaneous tissue
Joint rigidity and hips may be dislocated or subluxed
Muscle atrophy is common with absence of some muscles or muscle groups
SENSATION IS INTACT
Normal intelligence and speech
Child 1: 5-year-old male diagnosed with arthrogryposis
Assessments
PEDI (self-care, mobility, social/cognitive skills) and Peabody, M-FUN, or BOT (FM subset), ETCH
Child 1: 5-year-old male diagnosed with arthrogryposis
Treatment goals
Early PROM to support active movement and prevent further muscle atrophy
Promote independence in self-care, play, and fine motor skills through use of adaptive equipment
Maximize participation at home and in school and community events
Child 1: 5-year-old male diagnosed with arthrogryposis
Treatment activities
PROM exercises – best if started in the first year of life and before 3 years of age
Positioning to decrease deformity and increase function (splinting and serial casting as needed to increase joint ROM to improve hand functioning)
Assist in determining the need for orthotics and assistive devices (need to be as lightweight as possible to facilitate use and increase compliance)
Facilitate normal movement against gravity and postural reactions in trunk
Promote functional hand use and innovative ways to hold utensils and writing implements
Adapt clothing to increase independence (velcro vs. buttons)
Promote weightbearing in bilateral LE to reduce possible hip dislocation and promote strengthening needed for ambulation
Maximize opportunities for cognitive and social development.
Child 1: 5-year-old male diagnosed with arthrogryposis
typical skills for developmental age - fine motor
Can cut with scissors and turn paper with helping hand
Copy simple lined shapes, draw stick figures, write name
Manipulate fork and spoon to feed
Complete simple puzzles
Copy capital letters, color within the lines
Uses a dynamic tripod grasp – fine finger movements facilitate movement of writing utensil
Child 1: 5-year-old male diagnosed with arthrogryposis
typical skills for developmental age - self care
Grooming: brush teeth and hair, wash hands, bathe self with S
Feeding: drink from cup, self feed with utensils, use napkin to wipe hands and face, can open most food containers
Dressing: can dress/undress by themselves (buckle shoes, zip zipper, unbutton large buttons), take off and put on shoes, choose weather appropriate clothing
Child 1: 5-year-old male diagnosed with arthrogryposis
typical skills for developmental age - gross motor
Hop and stand on one foot
Skip
Climb stairs with alternating foot pattern
Ride a bike
Child 2: 12-year-old girl diagnosed with Down Syndrome
general characteristics
Generalized hypotonia
Atlanto-axial instability/dislocation
Short and stocky stature
Small head with shortened oral cavity
Protruding tongue
Epicanthal eye folds, upward slanting eyes
Low-set ears
Flat nose, wide set eyes with flat bridge
Extremities are shorter
Fingers and toes are broader and shorter
Increased risk for visual acuity problems
Related health problems: cardiovascular abnormalities, obesity, increased risk for respiratory infections, immune system insufficiency, thyroid deficiencies, gastrointestinal problems, increased risk for leukemia
Child 2: 12-year-old girl diagnosed with Down Syndrome
characteristics that affect FM skills
Hypotonia – poor joint stability and poor proximal stability
Ligament and joint laxity – ligaments supporting joints are loose leading to greater risk of subluxation or dislocation
Shorter limbs – affect success with tasks requiring further reaching such as dressing and putting on shoes
Medical conditions – heart problems can decrease endurance
Cognitive level – FM and cognitive skills go hand-in-hand
Sensory registration
Hand characteristics: single simian crease, small hands, wrist bones, curved 5th finger
Child 2: 12-year-old girl diagnosed with Down Syndrome
assessments
PEDI (but at this age it is not norm referenced), BOT, Sensory Profile 2 or SPM
Child 2: 12-year-old girl diagnosed with Down Syndrome
treatment tips
Build a good foundation: Stability, bilateral coordination, and sensation come first; followed by dexterity; then success in daily living skills.
Be functionally focused! Improve functional components while using new abilities to create a bridge with actual participation in age appropriate activities
Active participation
Use a multi-sensory approach
Work on proximal stability and developing controlled movement in midranges
Provide home programs to enhance the child’s daily learning environments. Talk to the family about independence in basic self-care and challenge families to help their child work on independence.
Child 2: 12-year-old girl diagnosed with Down Syndrome
typical skills for dev age: fine motor
Dynamic tripod grasp
Refined FM skills: arts and crafts, writing, play, instruments, computers and video games, baking
Child 2: 12-year-old girl diagnosed with Down Syndrome
typical skills for dev age: gross motor
Refinement of previously learned skills
Participate in social interaction (sports) and to express themselves (dance)
Child 2: 12-year-old girl diagnosed with Down Syndrome
typical skills for dev age: self care
Eating/drinking: more advanced meal prep using other household supplies
Grooming skills with puberty fully present
Child 3: 3.5-year-old child diagnosed with autism
general characteristics
Impairment in reciprocal social interactions
Impairment in verbal and non-verbal communications and imaginative play
Markedly restricted repertoire of activities and interest (stereotypic behaviors)
Disturbances in sensory and perceptual processing and associated impairments
Child 3: 3.5-year-old child diagnosed with autism
assessments
PEDI, Peabody (or M-FUN), SPM Preschool (or Sensory Profile), social skill checklist
Child 3: 3.5-year-old child diagnosed with autism
treatment goals
Teach self-care and motor skills, teach participation and social skills, sensory integration
Many autistic children do better with visual cues than verbal cues, use a picture exchange communication system or pictures to aid in treatment.
PECS
Use a Floortime model – build relationships in order to teach
TEACCH: developing an individualized person and family centered plan for each client or student, rather than using a standard curriculum
Video Modeling: a technique that involved demonstration of desired behavior through video representation of the behavior
ABA: to be successful the program must change the child’s behavior in a meaningful way
Uses operant conditioning
Relies on positive reinforcement
Self Care: task analysis (breaking task into parts), identify needed adaptations
Grading activities: sequence, size and shape of tool
Child 3: 3.5-year-old child diagnosed with autism
typical skills: fine motor
Screw/unscrew lids Turn door knobs Turn pages of book individually Puzzle with large pieces Build towers of 9-10 blocks Holding a crayon Use a fork and spoon Copy down a circle or square Button and unbutton
Child 3: 3.5-year-old child diagnosed with autism
typical skills: gross motor
Walks up/down stairs with one foot on each step (and without support) Catches a bounced ball Runs well Hops on one foot(up to five seconds) Kicks ball forward Pedals tricycle Uses a slide independently
Child 3: 3.5-year-old child diagnosed with autism
typical skills: self care
Understanding common dangers of hot objects, stairs, glass. Settling themselves to sleep at night or during the day.
Brushing teeth independently.
Playing with 2 or 3 children in a group.
Dressing and undressing self (only requiring assistance with laces, buttons, and other fasteners in awkward places)/
Using a napkin to wipe face and hands
Tolerating different clothing textures, seams, tags.
Feeding self without difficulty.
Child 3: 3.5-year-old child diagnosed with autism
typical skills: play
Associative play: Children start engaging in similar activities to those around them
Child 4: 24-month-old boy with CHARGE syndrome
general characteristics
CHARGE: choanal atresia, growth retardation, genital abnormalities and ear abnormalities
Coloboma of the eye causing vision loss
Choanal atresia or stenosis
Cranial nerve abnormalities: missing or decreased sense of smell, swallowing difficulties, facial palsy
Conductive hearing loss
Malformed cochlea causing hearing loss and balance problems
Heart defects (typically complex)
Cleft lip/palate
TE fistula
Kidney abnormalities
Genital abnormalities: small penis, undescended testes, small labia, small or missing uterus
Growth hormone deficiency – short stature
Hockey-stick palmar crease – DPC goes between the 2nd and 3rd finger
Perseverative behavior or OCD
Hypotonia and scoliosis
Child 4: 24-month-old boy with CHARGE syndrome
OT concerns
Bone and muscle malformations of the hand
Increased tightness and shortening of the muscles in the shoulder
Low tone causing loose joints – difficulty holding pen
Upper body hypotonia – tire quickly
Decreased shoulder mobility (cannot lift arms above shoulder level)
Feeding issues (if cleft lip/palate)
Communication (if lack of hearing)
Child 4: 24-month-old boy with CHARGE syndrome
assessments
COPM, Peabody (GM and FM), PEDI, Sensory Profile
Child 4: 24-month-old boy with CHARGE syndrome
treatments
Communication: communication boards, visual references (PECS)
Feeding:
Tongue: chewy tubes, bite-chew games, head stability, comfortable positioning
Oral motor exercises for the jaw: comfortable positioning for successful biting, physical cues to chew
Facial muscles: “wake up” with tacilte/deep pressure, vary food temp, oral games
Low tone: different positions (prone/supine,etc.), position on boards/balls, etc., NDT, swings
Decreased ROM: NDT, taping,
Grasping: fine motor activities (pinching, reaching for toys, etc)
Self-Care: dressing, self feeding (forward/backward chaining)
Child 4: 24-month-old boy with CHARGE syndrome
typical skills: fine motor
Turn the pages of a book Build a block tower Drawing Turn door knob, unscrew jar lid, uses cup with one hand, unwraps paper from candy, turns over container to pour out contents May start to show hand preference
Child 4: 24-month-old boy with CHARGE syndrome
typical skills: gross motor
Gait: begins to run, can walk between 2 straight line
Balance: can catch ball against chest, stand on tiptoes, jump, increased strength and coordination
Child 4: 24-month-old boy with CHARGE syndrome
typical skills: self care
Pulls off shoes Unzips large zipper Closes snaps Unbuttons large buttons Drinks from small cup or glass
Child 5: 7 year old girl with a diagnosis of sensory processing disorder
assessments
BOT, SPM or Sensory Profile, Clinical Observations, PEDI
Child 5: 7 year old girl with a diagnosis of sensory processing disorder
treatments
reference sensory chart
Child 5: 7 year old girl with a diagnosis of sensory processing disorder
typical skills: fine motor
Dynamic tripod grasp
Refining skills: arts and crafts, writing, play, instruments, computers and video games, baking
Child 5: 7 year old girl with a diagnosis of sensory processing disorder
typical skills: gross motor
Hop for long distances Catch ball with 2 hands Kicks ball more accurately Runs on balls of feet Begins to ride 2 wheel bike Dances with rhythm of music
Child 5: 7 year old girl with a diagnosis of sensory processing disorder
typical skills: self care
Can tie own shoes and independent in dressing
Independent in tooth brushing
Shower/bathes I
I in bathroom
More advanced meal preparation: use of toasters, packs own lunch
More advanced cleaning: using vacuum cleaner, can do basic chores.
Child 5: 7 year old girl with a diagnosis of sensory processing disorder
typical skills: play
Games with rules – computer games and card games
Organized sports – plays in groups and teams
Cooperative – works with peers to achieve a goal
Competitive – works with peers to compete with other peers
Social play – play with peers dominates, has consistent peers, tries to please others
1) 5 year old male diagnosed with arthrogryposis.
strengths & occupational deficits
Strengths: motivation, problem solving skills, motor planning, able to ambulate independently.
Occupational Deficits: FM tasks such as cutting (he uses adaptive scissors and uses two hands to push the scissors for enough power so cannot stabilize his paper), in-hand manipulation, writing, fasteners on clothing
2) 12 year old girl diagnosed with Down syndrome
strengths & occupational deficits
Strengths: affect/ motivation, eagerness to work, good expressive language skills, good self-regulation
Occupational deficits: poor fine motor skills (fasteners on clothing, opening containers), following directions to prepare simple meals, attention for school work, awareness of hygiene, awareness of safety in community settings
3) 3.5 year old child diagnosed with autism
strengths & occupational deficits
Strengths: positive attitude, receptive language, cognition (able to match colors, completely memorized routine, named colors and food objects during play), independent with self-feeding
Occupational deficits: difficulty sharing and turn taking with peers, difficulty opening containers (such as juice or milk container), restricted food diet (will only eat one breakfast meal (must have hash browns from McDonalds, per teacher report he knows if they are not from McDonalds), difficulty trouble attending to school task
4) 24 month old boy with CHARGE syndrome
strengths & occupational deficits
Strengths: Able to ring sit without support, able to stand at a table without support and starting to cruise, able to take off socks, able scribble on paper with chunky crayon, able to stack 2 blocks
Occupational deficits: unable to walk (hypotonia), receives most nutrition by g-tube, but accepts soft solids by spoon and finger foods (Cheetoes, fries), but does not feed self, UE weakness, conductive hearing loss in right ear (has hearing aid), unable to take off shirt or pants
5) 7 year old girl with a diagnosis of sensory processing disorder
strengths & occupational deficits
Strengths: able to dress herself but cannot button shirt or tie shoes, able to write all upper and lowercase letters of alphabet and words for school homework, but awkward pencil grasp (complains of hand getting tired), enjoys reading books, creative
Occupational deficits: few friends, appears overwhelmed in crowded environments, cannot ride a bike, restrictive choices for clothing (only certain fabrics), restricted food choices
