First Section Flashcards
1
Q
Family-Centred Care Tenants
A
1) Families know their children best and want what is best for their children
2) Families are unique and different
3) Optimal Child functioning occurs within supportive families and communities
4) The family is the child’s primary source of strength and support
2
Q
1) Families know their children best and want what is best for their children
If this is your first assumption what will you assess first?
A
do some formal assessments around the occupations that are most important to them
-If it is outside our scope we would help them get connected
3
Q
3) Optimal Child functioning occurs within supportive families and communities WHat will you assess or measure Person-level? Occupation-Level? -Why
A
- Assessing occupation
- assess the family for the purpose of supporting them
- this is a sticky part because families have fear of being judged (there a lot of aspects some don’t come from nurture)
- Family should not be considered the cause but assess to leverage the strength and find them help in the areas of weakness
4
Q
Working with families
-setting goals and evaluating outcomes from a family-centered perspectives means
A
- listening to family concerns
- Establishing current participation
- Setting meaningful goals
- Evaluating family-centered outcomes
- Goals are set collaboratively
- Practitioners are facilitators and view families as full and equal participants
5
Q
System Perspective of Family Occupations
-Key Concepts of a family system model
A
- ->A family system is composed of interdependent individuals or sub-systems
- Within the family, subsystems are defined with their own patterns of interaction and shared occupations
- A family must be understood as a whole, and it is more than the sum of the abilities of each member
6
Q
Family Occupations
A
- Rhythms and rituals within the home provide connection, structure and meaning to participation
- Routines are often adapted to facilitate performance of a child with a disability
e. g. opportunity and cost
7
Q
Feeding as Family
Theme and Subtheme
Example
A
Feeding as a family (theme)
Subtheme G-tube and sleep -Impact on family -Participation of feeding and eating as a family -Outings and travel (mobility)
8
Q
Family Resources
A
- Financial Resources
- Personal skills/human resources
- Time resources
9
Q
Participation and activity limitation Survey
A
in 2015 the national benefits association reported
average income for a household wit a child with a disability was nearly 10 000 ls than the average income (59,980 vs 68,940)
-20% of households with a disabled child fell below the low-income cutt-off 13.4 percent of non-disabled households
-38% of canadians parents with children who have disabilities were forced to reduce the number of hours worked, while an additional 36% had to adjust their work schedule
-76% of Canadian parents listed their child’s disability (this references severe disabilities) as reason for divorce or separation, leading to more single-family homes which often correlates to lower-income
10
Q
Family Resources
Emotional energy Resources
A
- Children with disabilities may require more emotional energy from parents
- Parents may experience anxiety and depression
- Parents may become exhausted and sleep deprived
- Stress levels in families seem to relate to the resources that they have: financial, educational, emotional, or social
11
Q
Sources of Diversity in Families
A
- Ethnic background
- Family Structure
- Socioeconomic status
- Parenting style and practices
12
Q
Therapy assumptions in children’s rehab
A
- The wisdom of dichotomising “fix” versus “function”
- The ethics of ‘it might help but it won’t hurt’ therapy approaches
- The emphasis on early intervention rather than lifespan approach
- The challenges of providing care for new rehab populations
- Discrepancies between performance outcome and patient satisfaction
13
Q
Cultural Considerations
A
Fill in in class
14
Q
Considerations when developing a Home programs
A
-Be realistic - lest you get the “smile and nod” or create a burden of guilt for failing to meet your expectations
-Acknowledge the time and effort the therapy programs absorbs from the family
-Find out information about important and meaningful daily routines and activities
-Identify naturally occuring moments where behaviours can be taught and modified
-Explore possibilities rather than make recommendations
–Weight and discuss the opportunity cost with parents
-Express concern for parents’ well being
Positively reinforce and validate parents’ efforts
15
Q
Blending Therapy into Routines
-Parents have identified that they are best able to carry out home programs when they receive the following types of supports
A
- ->coaching and follow-up support from the therapist at regular intervals;
- Prognostic information and guidance from the therapist about what to realistically expect;
- ->a coordinated team approach rather than multiple home programs;
- ->Regular feedback from the therapist about the child’s progress from the home program
16
Q
Blending Therapy into Routines
A program designed around the child’s goal so that the program is motivating and enjoyable to carryout;
A
- ->emotional and physical support from family members;
- -> Provision of equipment needed to do the activities
- ->a logbook as a reminder to practice
- ->having a program with a small number of exercises that they feel confident and capable to carry out safely and therapeutically
17
Q
How is AME important to
A
- Set the stage
- Assess and evaluate
- Agree and plan
- Monitor and modify
- Evaluate outcome
18
Q
Assessment is
A
A process of gathering information about an area of interest through
- Specific tools and instruments
- Observation, discussion
Assessments must be
- interpreted to be useful to others
- describe a person or situation that helps
- inform a decision
19
Q
Measurement is
A
The assignment of a number to a construct or a thing
-Where smaller quantities represent less and larger represent more according to a clear metric
20
Q
Evaluation is
A
the process of judging the quality, importance, value of something
-Usually involves an assessment and a measurement
21
Q
The FRAP-U FRAMEWORK
A
Frame of Reference
- Appropriate Application or Purpose
- Psychometric fit
- Utility
22
Q
Frame of Reference and AME
A
Where/when does frame of reference come into play in the course of therapy
-Your AME-ing needs to be consistent with your theory or model
23
Q
Step 1: AME
A
Narrow focus on assessments based on Frame of Reference
24
Q
Step 2:
A
Define clearly an appropriate application or purpose
25
What have YOU decided about your main Purpose In This Case
How is it appropriate or not?
| Does your 'purpose' for therapy fit your frame of reference
26
Possible Applications of AMEs
- Setting goals
- Classifying children or their level of functioning
- Describing strengths and difficulties
- Screening for occupational performance to other children
- Assessing/monitoring change
- Predicting a developmental trajectory
27
Step 3
Now that you have FRAA, start looking for AMEs that are suitable candidates
28
Step 4
Assess the psychometrics RELATIVE to FRA
29
Psychometrics are Not An Instrument Property
Venn Diagram
Scale
- Reliability
- Validity
- Scale Content
Situation
- Does one need to describe or evaluate?
- What are the practical realities of the situation?
- Ethical implications of applying the scale
Group
- Does the sample represent the population?
- Fit between scale development group and user's group
30
Defining Play by Characteristics: framing
A play frame sets play transactions apart from "real life"
-Players give cues about how they want to be treated and read the cues of others so that they know how they should interact with them.
31
Defining Play by Characteristics:
| Internal Control
- Player feels in charge of some important aspects of the play transaction
- -->What to play?
- -->Who to play with?
- ->How will the play turn out?
- Players must feel safe to feel internal control
Develop socially through play
32
Defining Play Characteristics:
| Freedom from Unnecessary Constraints of Reality
- Players choose how close the play is to reality
| - "Suspension of reality"
33
Measuring Participation
- Observation
- Children's assessment of Participation and Enjoyment (CAPE)
- Participation and Environment Measure of Children and Youth: PEM-CY
- Pediatric Activity Card Sort (PACS)
- Environments and Experiences: SEAS, MEQAS
34
Play and Leisure:
| Babies
They play alone, play with toes, then gradually reach out to toys
35
Play and Leisure:
| 1 - 2
- watch others play might not be ready to join in
| - start to repeat activities that they enjoy
36
Play and Leisure:
| 2-3
- start playing next to other children
| - not keen on sharing
37
Play and Leisure:
| 3-4
- start to play and share with other children
| - not participating in games with rules
38
Play and Leisure:
| 5+
- start collaborating with each other
| - Rules are very important
39
Play and Leisure:
| Older children and teens
participation in social activities, teams, hobbies
40
Leisure Time and Participation
- involvement in activities of rest, recreation, enjoyment, and social and community engagement undertaken with others and on one's own
- Considerable portion of the day for children and adolescents
- Provides opportunities to:
- ->develop skills and competences
- ->Support mental and physical well-being/health
- -->Form friendships and relationships
- ->Sense of Belonging
- ->Develop self-identity
- -> Express creativity
41
Participation vs enjoyment
Participation
- Easily observable, quantifiable
- Multi-dimensional
- ->attendance, frequency
- ->Involvement - the "experience" (affect, motivation, social connection)
Enjoyment
- Abstract, subjective
- Determinant of participation; motivation
- Child-preferred activities
42
Factors Affecting Leisure Participation
Child/Youth Factors
- perceptions of their competence (athletic and scholastic)
- Physical, cognitive and communication abilities
- Emotional, behavioural, and social abilities
- Activity preferences
Environmental Factors
- Supportive physical and institutional environments
- Presence of supportive relationships
- Presence of support relationships for parents
Family Factors
- Absence of financial and time impact on the family
- Supportive family demographics
- Supportive home environments
- Family preference
43
Leisure Participation-Preference congruence of children with CP a Children's Assessment of Participation and Enjoyment International Network descriptive study
- Used CAPE and PAC
- Proportion of children doing non-preferred activities in each activity type was generally low
- Not doing preferred activities
- ->50% not doing active physical, skill-based and social activities they would prefer doing
- 25% not doing self-improvement activities they prefer
- Doing non-preferred activities
- ->58% doing self-improvement activities they did not prefer
- Children with the most severe mobility limitations experience the greatest discrepancy between preferences and participation
- Family factors - income, supports
Implications for interventions:
- how to support children to address participation barriers
- supporting children so they can develop relationships
44
Leisure Activity Enjoyment of children with autism Spectrum Disorders
The study compared leisure activity enjoyment experienced by typically developing children and those with ASD
- Used CAPE
- Findings
- ->Most enjoyed activities and least enjoyed activities for both groups were the same (most enjoyed, playing computer, video games, playing with pets, going to the movies. going to parties) (least enjoyed, sing learning to dance, paid job, taking art music )
- Significant differences were seen among the children with ASD in enjoyment of informal, recreational and self-improvement activities with less enjoyment
- Significant relationship between severity and enjoyment of overall, formal, physical and social activities
- Significantly different scores in formal and physical activity enjoyment
- Swimming was number 5 for ASD 30th for normal developing children
- Playing games was 6 for normal developing for kids 27 for ASD
Implications for intervention
- Knowing what they prefer
- Knowing that there are less enjoyment with older ASD children
45
Play in Intervention
- Play is a modality: used when specific skills need to be taught or when a specific goal needs to be met
- Play as a intervention goal: improvement of play skills and playfulness enables competent interaction in the world
- Facilitating playfulness: increasing internal motivation, internal control, ability to suspend reality, and how to read cues with play partners
- Adaptations: adapted access and safe play space
- Parent education and training regarding importance and value of play
- Societal concern: play for all has diminished, less risk-taking in play, over-structuring and over-scheduling of child's day
46
Play and the Playground Environment
- Participation in play is a critical occupation of childhood
- Play participation may be limited or facilitated by an or all of the
- ->Physical
- ->Social
- ->Cultural
- ->Institutional environments
47
Institutional Environment
```
Proximity of teacher
Recess curriculum
School policies may restrict play
-Type of equipment
-->risk aversive insurance issues
-Amount of time for play
-Access to playgrounds may be contingent umong classroom behaviour
```
48
Physical environment (school playground)
- Modern playgrounds with fixed equipment
- "Loose parts" play
- Access and Safety
49
Social Environment
- Girls are consistently less physically active in their play on playgrounds than boys
- For the largest disability groups (ASD, ADHD, LD, Anxiety), social play interaction skills need to be explicitly taught
- Lack of supervision during unstructured time can leave marginalization students vulnerable to bullying
50
Cultural Environment
- Social culture
- Geographic and socioeconomic composition of school catchment area
- ->those in minority or low-income groups have increased risk for inactivity in their play
- Attitudes towards aggressive play and bullying
51
Play summary
Building capacity in their children or youth
- Building capacity in the family
- Building capacity in the environment
52
Influences on development
- Internal - temperament, social-emotional, cognitive, sensory
- Cultural
- Social
- Physical
- Interplay between abilities and experiences
- Participation of occupation in natural environment supports integration of learning
- Children with disabilities require greater direct support and scaffolding to support new learning
- Positive reinforcement
- Natural course of development
53
Principles for selecting assessments, measures, evaluations in Clinical Practice - FRAP-U
Frame of Reference
Appropriate Application or Purpose
Psychometric fit
Utility
54
Frame of Reference
Narrow your focus on assessments based on your conceptual approach or frame of reference. Is your primary assessment consistent with the primary goal of therapy?
55
Appropriate Application or Purpose
Appropriate: Is your assessment or evaluation within your scope of practice? Is the assessment chosen achievable within the time and resources you have?
Appropriate is necessary but not sufficient. You also need to make sure the assessment or evaluation fits the purpose of therapy. Are you there to generate impact with respect to an occupation? If so, do you need an assessment that helps you determine the goals from the child or parent perspective or both? There are many reasons to choose an AME, what is yours? Be explicit
56
Psychometric fit
-Basic screens of reliability, validity. and generalizability will fare into your selection of AMEs also. Has the measure been validated on a sample of children that apply to your case or situation? Does it contain questions and components that map well to your 'F' approach? Will you look for a measure that is reliable enough to be used across therapists or team members if that is needed? Is the measure reliable enough on test-retest reliability that you can use it to evaluate whether your intervention had an impact?
57
Utility
Are the cost, time constraints and expertise of administering the assessment balanced with the value of implementing the assessment?
58
Neurodevelopmental
| Relative to motor based occupations:
Fill in from textbook (stroke and cerebral palsy)
59
Sensory integration
| Relative to motor based occupations:
Fill in from textbook
60
The era of occupation
when the emphasis of therapy shifted to meaningful occupation (activity and participation) it became most important to have a big affect at this level
61
Motor Learning Tasks - Coach's Principles (Willis)
-Transfer
-Knowledge of Result's/knowledge of performance
Feedback
Verbal Instruction
-Whole versus part practice
-Mental practice
62
-Transfer
- skill experiences are presented in logical progression
- simple, foundational skills are practiced before more complex skills
- Skill practice includes "real" life and simulated settings
- Skill with similar components are more likely to show transfer effect
- Practice in natural context with actual objects is most effective
63
-Knowledge of Result's/knowledge of performance
- Utilize a variety of both KR and KP to facilitate learning
- It is important to balance between feedback that is error-based and that which is based on "appropriate" or "correct" characteristics of the performance
- KP and KR can be prescriptive
- KP and KR should be given close in time to but after completion of the task, but not necessarily given 100% of the time
- Learning is enhanced if KP/KR are given at least 50% of the time
64
Feedback -Modeling or Demonstration
- Demonstrate is best if it is given to the individual before practicing the skill and in the early stages of skill acquisition
- Demonstration should be given throughout practice and as frequently as deemed helpful
- Allow child time to "figure it out"
65
Feedback -Verbal Instruction
- Verbal cues should be brief, to the point and involve 1-3 words
- Verbal cues should be carefully timed to not interfere with performance
- Verbal cues should not emphasize key aspects of movement
66
-Whole versus part practice
-Whole practice may be preferable when the skill/task is simple; Part practice may be preferable when the skill is more complex
-If part practice is used, be sure that the parts practiced are "natural units: that they go together
-To simplify a task, reduce the nature and /or complexity of the objects to be manipulated. For example, use a balloon for catching instead of a ball, etc.
To simplify a taak, provide auditory or rhythmic accompaniment; this may facilitate learning through assisting the earning in getting the appropriate 'rhythm' of the movement
67
-Mental practice
```
vicarious practice (super under used) - talking though other people doing the motor task and learn alot
Mental practice-they have guided imagery
```
- Mental practice helps to facilitate acquisition of new skills as well as the relearning of old skills
- Mental practice helps the person to prepare a task; it should be relatively short, not prolonged
- Mental practice combined with physical practice works best
68
What are some notable difference in the OT realms versus coaching
one of the biggest differences are the types of people we are trying to improve their performance
- We have to get a strong sense of their knowledges and difficulties (OT break down areas)
- We see a lot more diversity (can be very different from person to person)
- Coaches work more on fundamentals
- Social-emotional thing (might not be highlighted or picked for teams) -the people that are left behind before their issue gets flagged
- The stuff that comes along might take his handwriting to come into play before getting references
- could be some learned helplessness or loninness before
69
OT Context (vs coaching)
1) Time-limited ---- Need to promote the goal even when not there
2) Child more likely to have previous negative experiences - Need to leverage their motivation and promote self-efficacy
3) Are experts in top-down --- The primary gal rests at the top not the bottom (you don't have the ability to break it down to balance)
70
Cognitive Orientation to Daily Occupational Performance (co-op) approach
-A client-centred, performance based, problem solving approach, that enables skill acquisition through a process of strategy use and guided discovery
71
What are the objective of COOP
- Skill acquisition
- Cognitive strategy (so important) -thats the part they can take and apply to new situations
- Generalization
- Transfer
72
Coop Tenants
| Your therapy time is limited?
Then generalization is important
73
Coop Tenants
| Your client have been excluded and unsuccessful?
- Motivation/agency are key
| - Respect their agency (their ability to make decisions and decide what's important to them)
74
Coop Tenants
| The main goal is Performance? Occupation?
A top down approach will be the focus of assessment and intervention
75
Motivation in Coop
Child must be able to select (at least one-two) goals
- the teachers and the parents really have something in mind ( his teacher was concerned about his hand writing) - past the point of a motor issues affecting his education
- Andrew is interested about the bike riding
- The child should have 1 hopefully 2 of 3 of the goals
- This motivation wont go forward if the child can't pick some of the goals
76
Generalization and Transfer
- The child discovers the solutions
- ->Motor learning is deeper
- ->They have developed a new skill
- want it to bleed above to other tasks
- how do we make sure this happens
- They have to get META
- They have to learn their strengths and weakness
- they have to see what they see
- (you can not tell them)
- they need to discover the solution
- their actual learning is much deeper
- develop the skill of analyzing the motor task
77
What AMES? (assessment, measures and evaluations)
- Goals setting -
- ->COPM or PACs but PEGs ok too
- Observing and monitoring occupation:
- ->Daily activity logs
- ->Dynamic performance analysis
Assessing Change
-Pre/post COPM
78
OT's AME from Dynamic Performance Assessment
- From DPA, must have a clear idea of where the breakdown and what you think will be most effective for dealing with it
- Once you know, it's time to help the child discover it!
- The catch is that you should not tell them
- Ask but do not tell
79
OT Methods - Global
Goal Plan Do Check
- Facilitate Child Self -Discovery Through Metacognitive Awareness of Motor Tasks
- Ask Don't Tell
- Coach environment or context strategy changes
I want you to tell me when your done did this happen or did this happen
-You have to change everything into a que for self evaluation
80
Dynamic Performance Analysis (DPA)
-An extension of dynamic assessment
-Focuses on actual performance, in context, and is carried out while observing performance
-Identifies performance problems or breakdowns
Identifies and tests potential; strategies to solve the performance problems
-OT needs to
-->Have a general understanding of the skill in question
-->Understand what is going wrong with the performance
-->Be able to guide potential solutions
-Ask yourself, "Is my client motivated to achieve this goal?"
-Does the client have general task knowledge? How can we achieve this?
-Performance competence: where is the break down? What are the strengths
-trying different shoe laces example
81
DPA and Strategies
-What are the steps
How much task knowledge did the child have
-Think about where the task break down occurred
82
Child's Methods - Global
GOAL-PLAN-DO-CHECK
Goal: skill acquisition by understanding the steps overcoming limitations to the acquisition
PLAN - Use guided discovery in the context of the occupation being performed to formulate a plan (hypothesis)
DO - Execute
CHECK - Self-assess and evaluate
83
Child Requisites
- Metacognition - the ability to think about thinking
| - In order to discovering, the child must be able to investigate, select, attempt, and compare (Luria)
84
Frame of Reference Provide guiding principles for occupational therapy intervention. (textbook summary)
Each frame of reference providing a description of the population that may benefit from such approaches, details therapeutic methods, and provide assessment tools, to measure specific areas of progress and function. Many of these strategies suggested by the frames of reference are based in research, which occupational therapists may find useful when deciding how to proceed an intervention
85
Frame of reference seek to understand function and dysfunction (textbook summary) `
Frames of reference are based on research guiding principles that describe how occupational therapists intervene and why the specific strategies used to improve function. Guiding principles explain the rationale for intervention so that occupational therapists can measure progress and understand how to proceed. The specific strategies refer to how the therapist intervenes and refers to the approach and methods used in principle
86
Problems in defining play (textbook summary)
variety of types of play that exist and the extensive period during which play occurs, across multiple stages of development. Play looks different in infants and toddlers and adolescents. Sometimes children are quite serious while playing and other times they are silly. Because play encompasses behvaiours over the lifespan and in many different contexts, it is difficult to define
87
Play theories (summary from textbook)
play theories from other disciplines have influenced the profession of occupational therapy. Modern theories recognize play as contributing to development. They suggest play is meant to help a child achieve optimal arousal, develop ego function, or cognitive skills. Sociocultural explanations include the development of social abilities, role development and mastery, and culture. Recent ideas regarding human play suggest one function may be to enable human innovation and the evolution. of human culture. Occupational therapists use these theories to better understanding of play.
88
Play as a tool (textbook Summary)
In using play as a tool, the occupational therapist completes an activity analysis and determines that a specific skill, rather than n play per se. When play is used a s a reward, it is an incentive for the completion of some other form of "therapy work." In this case, play activity functions in the same way as a sticker might, or as a favourite food or candy might. When an occupational therapist uses play as an occupation, the focus is on play itself and the development of play performance or play skill. Specifically, the therapist might focus on playfulness or the attitude during play, or intrinsic motivation and exploration of play preferences.
89
Play the environment and objects (textbook summary)
The environment and the objects, equipment and opportunities within it are critical to creating a play atmosphere for children. To foster play, environmental spaces, toys, and the equipment should have flexibility. Play spaces should provide a variety of experiences and opportunities for creativity, imagination, and change. Children need to be able to control the space, that is, have objects, toys, and people move and change the freedom to move them. Indoor and outdoor playgrounds and group spaces need to be designed to promote universal access for children with physical limitations and to encourage socialization. Physical and social environments can facilitate or inhibit play.
90
Evaluating Play (textbook summary)
Occupational therapists evaluate play by interviewing children, parents, and teachers; observing the child in natural setting; conducting a play assessment; and synthesizing the information to develop an intervention plan. Play assessments may help occupational therapists observe play behaviours more comprehensively.
91
Play as means and ends (textbook Summary)
Play can be used to improve a child's skill (play as a tool). It can be used as a reward (after a child completes other activities). It can also be used as the goal of a therapy and therefore means and ends of therapy. Occupational therapists who use play as the occupation may work on play skills ( in play sessions) to improve the child's play (as the outcome)
92
Advocating for play (textbook summary)
Occupational therapists can advocate for play by offering community classes, presenting in-services, assisting schools to develop accessible playgrounds, serving on community boards, working at children's museums to develop play venues, working with organizations that provide playful family experiences, working with state and national occupational therapy associations, and promoting play in practice, research, and through media
93
Family Systems Theory (textbook summary)
Family systems theory describes families as unique subsystems (parent, child, extended family) whose interactive patterns affect behaviours and physical and mental health of each member as the family works to enable children to become participating members of society
94
Family unquie persepective (textbook Summary)
Families' cultures and background influence their unique perceptions of the work and what they want their children to do;. For interventions to be effective, occupational therapists must listen carefully and respond to what is important to the family
95
Family life cycle (textbook Summary)
The family life cycle defines life stages and the ecologic influences at each stage. Each stage has a normative events that may cause stress. Occupational therapists must enquire about non-normative events to fully understand how the family is functioning
96
Raising a child with special needs (textbook Summary)
Raising a child with special needs influences the co-occupations of family members by influencing time use, stress levels, satisfaction with life, and the meaning found in daily occupation
97
Collaborating with families (textbook summary)
| When collaborating with families occupational therapists focus on family priorities,
partner in decision-making, may coach caregivers to apply specific strategies, and support caregivers in becoming advocates for their children
98
Partnerships with families (textbook summary)
Occupational therapists establish and maintain partnerships with families through respectful interaction, honest and consistent communication and supportive attitudes.
99
Family empowerment (textbook summary)
Families can empowered to facilitate their children's development through effective information sharing, full inclusion in team decision-making, and provision of adequate support
100
Family challenges (textbook summary)
Strategies for supporting the strengths of families facing multiple challenges are similar to those for supporting all families: using clear communication, adapting tasks and routines if modification will ensure a better result, and attending to the specific needs of those caregivers so that they feel competent to fulfill their roles
101
Engaging in desired occupations promotes occupational identity, self-efficacy, and self-determination, which leads to health and wellness. (textbook summary)
As children develop a positive sense of control over their environment by engaging in occupations, they become more satisfied and physical health and wellness.
102
Neuroplasticity (textbook summary)
Neuroplasticity refers to the creation of new neural synapses, dendritic sprouting, or improved neural connections in the brain. Multisensory activities (occupations) which require children to problem-solve and adapt in flexible natural environments promote neuroplasticity, occupational therapists use occupations, such as play (a natural, meaningful, and whole activity) to engage children, which, in turn, facilitates brain plasticity. For example, the occupational therapist may focus therapy on improving hand skills for self-feeding through play. This is an example of using occupation (play) as means to work on hand skills. Conversely, the occupational therapist may decide to engage the child in a snack to promote self-feeding. This example describes the occupation (self-feeding) as the "end" result.
103
environmental factors (textbook summary)
The child participates and performs in occupations based on their current skills and physical and mental health. The influence of environmental factors on a child's development is profound and influences self-identity and self-actualization. Children grow and develop into competent occupational beings and full participants in the community through an interaction between the child's biologic and emotional being and his or her cultural, social, physical virtual, and temporal contexts. Both internal (eg. child's intelligence, positive affect, emotional regulation) an contextual (e.g. supportive family relationships) protective factors are needed for positive outcomes (e,g school success, positive relationships)
104
co-occupation (textbook summary)
Children learn to be active participants in their daily occupational routines with supportive adults. Participation in co-occupations (engagement that has distinct or overlapping meaning or purpose for two people) forms a foundation for emotional growth, increased autonomy, and intrinsic motivation leading to increased participation . Co-occupations are integral to child development and initially consist of caretakers participating in the same occupation as the child to help the child develop, such as feeding an infant, reading aloud at bedtime, or cooking a meal. The nurturing of co-occupation relationships is important for occupational development
105
Biological Model (textbook Summary)
emphasizes the importance of physical, social, cultural, virtual, and temporal context on a child's development and explains the reciprocal interactions among and between the child, family, community, and geopolitical contexts on a child's occupational participation and performance. This model views the transactions between many systems as influencing a child's development rather than a signal factor. Therefore infants, children, and adolescents all develop somewhat differently and individually based on the set of contexts that influence them.
106
Standardized assessments when they use them (textbook Summary)
-Standardized assessments are used by the pediatric occupational therapists to: screen children for a variety of performance or conditions; assist in the determination of medical or educational diagnosis; assist in the determination of a medical or educational diagnosis; document a child's developmental, functional, and participation status; aid the planning of an intervention program;and to measure outcomes of programs
107
Occupational therapists develop competency in using standardized tests by
understanding basic measurement concepts; familiarizing themselves with test procedures, materials, and setting requirements; observing others administer the test or observing instructional videos; and discussing interpretation of scores with team members. Preparation is key to competency and involves reviewing the test manual and practicing administration of the test.
108
Ipsative assessments vs all the others
Evaluate one's performance or perception against prior evaluation outcomes. It has standardized procedures for therapists to measure the outcomes but does not have a norm or criteria with which to compare the results a norm-referenced test compares the child's performance to that of a normative sample (a large group of children). The purpose of norm-referenced testing, then, is to determine how a child performs in relation to the average performance of the normative sample. The criterion-referenced refers to the fact that a child's performance is compared with a criterion, or level of performance of a skill. The goal of a criterion-referenced test is to determine which skills a child can and cannot accomplish for intervention.
109
Standardized tests have uniform procedures for administering scoring, and interpreting findings
Standardized test manuals also contain information on the purpose of the test, age and populations, how to administer items, score the child's performance and interpret findings. The manual includes a description of the test development and standardization process, characteristics or the normative sample, and studies done to establish reliability and validity
110
Reliability (textbook)
The reliability of a test describes the consistency or stability of scores obtained by the one individual when tested on two different occasions with different sets of items or under other examining conditions. Validity is the extent to which a test measures what it claims to measure. Test that are reliable may be used to measure a child's change over time with therapy and may be administered by different therapists. Test that are valid measure the intended construct, which allows occupational therapists to have confidence in their findings. For example, it is important for testers to know that a test of fine motor development measures fine motor skills and not gross motor or perceptual skills
111
Activity observation and analysis are an enduring pillar of pediatric occupational therapy, steeped in the history and identity of the profession (textbook summary)
The occupational therapist uses them to determine aspects of the activity including personal meaning, which support or hinder performance for a specific child or adolescent as well as detailed occupational occupational performance.
112
Activity analysis make take the form (textbook summary)
of a generic analysis of the standard or expected way the activity is performed or a specific individualized analysis as in the case of a client-focused activity analysis.
113
Occupational therapists use models of practice and frames of reference to provide (textbook summary)
a theoretical perspective and structure to focus activity observation and analysis, they use the frame of reference to create intervention plans.
114
Mastering skills in activity observation and analysis is essential for all aspects of pediatric practice (textbook summary)
Activity analysis involves both technical skill in observing children and youth as well as clinical reasoning skills to synthesize the findings for intervention. Proficiency takes structured practice and personal commitment of occupational therapy students, educators, mentors, and new practitioners.
115
Activity observation and analysis inform (textbook summary)
intervention planning. The occupational barriers are minimized and supports are expanded through modifications and graded therapeutic activities that are tailored to the context, materials and preferences of the individual.
116
Occupational therapists synthesize information gained through observations from the activity Analysis and client-focused analysis to engage, (textbook summary)
in clinical reasoning. The occupational therapists considerers all information to develop a hypothesis regarding what is interfering with the child's ability to participate in occupations. This informs the intervention plan.
117
Child and youth exhibit better motor control when engaged in (textbook summary)
whole , meaningful tasks within natural context using authentic objects. Occupational therapists use motor learning strategies to promote movement by engaging children in meaningful activities that include problem-solving, practice, mental rehearsal, and considering the type of task, objects, feedback, and directions provided.
118
Contemporary Motor control, interventions support a dynamic systems approach that movement derives from an interaction of person factors, task characteristics, and environmental systems. The principle of dynamic systems theory include:
- The interaction among systems is essential to adaptive control of movement
- Motor performance results from an interaction between adaptable and flexible systems.
- Dysfunction occurs when movement patterns lack sufficient adaptability to accommodate task demands and environmental constraints
- Because task characteristics influence motor requirements, practitioners modify and adapt task requirements and affordances to help children succeed.
119
The research evidence supports a dynamic systems approach to motor control intervention by considering the multiple system in which the child moves (textbook summary)
Using an occupational-based model of practice can fram the occupational therapist's use of dynamic systems approach. Interventions that allow the child in the natural setting promote motor performance.
120
The interaction between child, task, and environmental factors influence movement. (textbook summary)
Child factors include cognitive, musculoskeletal, neuromotor, perceptual, and socio-emotional influences. Task characteristic consider nature of task, object properties, goals, and rules. Environmental systems include physical, social, cultural, virtual and personal contexts
121
Motor learning strategies (such as transfer of learning, feedback, sequencing and adapting task, modeling or demonstrating, mental rehearsal) are techniques to promote (textbook Summary)
Motor learning acquisition and motor control. Motor learning strategies help practitioners decide how and when to provide feedback and how to promote generalization of skills (transfer learning). Practice information helps define which which type of practice to provide at each stage of learning. Practitioners are encouraged to use evidence-based motor learning strategies to enhance a child's occupational performance.
122
Contemporary therapy approaches which show significant scientific rigor and use motor control and motor learning principles inform evidence-based interventions Such as (textbook summary)
CIMT and intensive bimanual therapy
123
Cognitive Approaches
Cognition is described as a child's ability to acquire and use information in order to adapt to environmental demands
124
Declarative knowledge
knowledge about things; it is knowledge that is often explicitly known and can be consciously brought to the attention of the learner
125
Procedural Knowledge
Procedural knowledge is the implicit knowledge about how to complete a task
126
Metagcognition
Metacognition refers to an individual's knowledge concerning their own cognitive processes and products or anything related to them. Through metacognition, children generalize and transer cognitive skills to meet changing contextual demands. Metacognition is made up of two components: metacognition knowledge and self-regulation
127
Metacognitive Knowledge
Metacognitive knowledge consists of one's awareness of the cognitive processes that are employed to learn and perform a new task.
128
Self-regulation
Is the individuals influence over their own thought processes, emotional states, motivation, and patterns of behaviour. It is the process of selecting, monitoring, and evaluating the effectiveness of cognitive strategies
129
Cognitive Strategies
Strategies are cognitive processes that are more advanced than the outcome that are a natural consequence of carrying out a task. Strategies are both consciously employed and are controllable by the learner. Goal-directed strategies are used to help the individual achieve a task or fulfill a purpose. Cognitive strategies can be defined as a "mental plan of action that helps a person learn, problem solve and perform. The use of cognitive strategies can improve an individuals learning, problem solving, and task performance in terms of efficiency, speed, accuracy, and consistency.
130
Self-coaching
Encouragement, positive self-talk, strength-based thinking to help increase persistence and/or to control and regulate the learners emotions
131
Self-guidance
Providing instruction to him/herself to assist in completing a new/difficult task, cueing oneself to reminders to prepare for or complete an activity
132
Self-Questioning
Identifying and asking him/herself or visualizing key questions relating to the activity or task performance
133
Imagery
Mental images that are created in to represent physical objects, actions, experiences, or events
134
Association
Relating previous knowledge to relevant information about a task
135
Rote-script
A rote pattern of words or phases that are meaningful to the client and can help to guide a sequence of actions or improve the recall of information
136
Elaboration
Increase and add new information and relate it back to previous knowledge
137
Mnemonic Technique
Associating pictures and words, phrases or images to cue an action or enhance memory recall
138
Rehearsal
Repeating information visually or mentally to aid with retention of important information related to the given task/occupation
139
Reconstruction
Involves mental and verbal processes and involves the learner thinking back to previous task, experience or context to guide their performance in a new situation
140
Anticipation
Preparing for a new activity through imagning or verbalizing possible outcomes, areas of difficulty, or scenarios the learner might encounter
141
Knowledge
Identifying, acknowledging, and reflecting on what the individual knows about a given task
142
Translation
Converting written instructions and directions into different mediums to meet the individuals unique learning needs
143
Finger pointing
Similar to attention to doing but limited to pointing with one's finger directly at relevant task stimuli to enhancing timing within task or refocus the learner's attention
144
Task Simplification
Simplifying or breaking apart the parts of a task into more manageable pieces
145
Lists
Creating and/or using a list of steps to help guide task performance and/or cues actions.
146
Task Specification
Discussion regarding the specific of a task, its components, or relevant features prior to engaging in the activity
147
Attention to Doing
Identifying the specific and relevant cues or features that need to be attended to when completing the task
148
Pacing Strategies
Activities that assist with the timing of tasks
149
Stimuli Reduction
Removing or decreasing the amount and number of stimuli
150
Organization
Restructuring and reorganizing task materials or steps so they are group together in a more logical or meaningful way
151
Cognitive approaches focus on the development of strategies to accomplish a chosen task. The theoretical foundations of cognitive interventions are rooted in the fields of (textbook summary)
of developmental and educational psychology and include theories from Vygotsky, luria, meichenbaum and bandura
152
Cognition refers to the process of (textbook Summary)
acquiring knowledge and understanding through thought, experience, and senses. It refers to understanding, discovering, creating, synthesizing, problem solving and perceiving. Metacognition refers to thinking about one's thinking
153
A number of different cognitive interventions have been described in the broader literature; however they all share similar tenants. Bouffard and wall proposed a five step problem-solving framework to guide motor skill acquisition. The identified steps include: (textbook Summary)
-Problem identification
-Problem representation
-Plan construction
-Plan execution and
-Evaluation of progress
Central to cognitive approaches is that the child understand the task and its demands and decides if the task is achievable. Occupational therapists using cognitive approaches help children create and understand the requirements (motor, sensory, cognitive) and expectations for success. Cognitive interventions focus on working on the goals identified by the chil and their family, therefore enhancing motivation, skill retention, generalization, and transfer
154
Cognition strategies are the implicit mental process that guide learning. When the task becomes difficult, relative to the child's skill level then.... (textbook summary)
metacognition strategies are required to select appropriate cognitive strategies, monitor, and evaluate their application. Once the strategies, monitor, and evaluate their application. Once a strategy becomes automatic and can be efficiently used thinking about and monitoring the strategies consciously become unnecessary
155
The seven key features of CO-OP include:
```
Goal Identification
DPA (dynamic performance analysis)
Cognitive Strategy use
Guided Discovery
Enabling Principles
Parent or caregiver involvement
Intervention format
```
156
Goal Identification
Occupational therapists works with child and family to establish meaningful goals. The child's perspective is key, and the child is actively involved in choosing goals. .
157
DPA (dynamic Performance Analysis)
The occupational therapist analyzes the child's abilities, skills, and actions and the task and environmental demands and supports.
The occupational therapist analyses the child's performance of the task on an ongoing basis, documenting performance problems and/or area of skill breakdown. Focus is placed on the fit between client abilities skills, and actions, paired with the task and the environmental demands and supports
158
Cognitive Strategy use:
global and domain specific strategies are taught to the child to be used to problem solve performance issues and monitor outcomes. THe GPDC strategy is used in CO-OP
159
Guided Discovery
The occupational therapist helps the child identify a problem to solve and develops solutions. The occupational therapist provides hints, coaching, feedback, or modeling, so the child identifies problems and solutions him/herself.
is task exploration with purposeful scaffolding. The therapists assumes the role of a facilitator and allows the child to generate their own answer (strategies) through tailoring the task and the environment to the individual
160
Enabling principles:
enabling principles are used during the intervention process to keep the child engaged and included:
1. make it fun
2. promote learning
3. work toward independence
4. promote generalization and transfer
161
Parent or caregiver involvement
Parent or caregiver involvement is essential throughout the CO-OP therapeutic process. The primary role of parents or caregivers is to support the child in learning the occupation and the strategies and to facilitate the generalization and transfer of these to the home, school and other environments.
162
Intervention format:
the CO-OP program involves 1o intervention session that include identifying goals, learning strategies, implementing strategies, and measuring outcomes.
163
Research examined the extent and features/characteristics of the current literature on the use of the CO-OP approach and discussed the current literature in this area
- The Co-op approach can provide occupational therapists with an intervention approach that is guided by a protocol manual and has been test effectively in clinical allied research
- Researchers and occupational therapist who are modifying current CO-OP protocols must ensure that these protocols are based in sound evidence to ensure evidence-based-practice.
- Occupational therapists should follow current published CO-OP protocols when using this approach
- Due to the current limitations in the evidence available thus far, occupational therapists should use caution when using the CO-OP approach outside of published protocols
164
Scaffolding:
intentional and graded adult feedback to promote the skill development of the child. it is a global problem-solving structure that enables learning through everyday activities and helps children to bridge their newly developed skills to different environments and activities
165
CO-OP
Applied through a family and client-centred framework that focuses on performance-based problem solving approach that enables skill acquisition through a process of strategy use and guided discovery.
-uses the global cognitive strategy GPDC coupled with individually relevant domain specific cognitive strategies developed through guided discovery and the implementation of enabling principal to problem solve a performance issue and monitor the outcome
-
