Interventions CP Flashcards
time –
Duration of intervention
Frequency -
How often (# of sessions per day, week or month) an intervention occurs
Intensity -
How hard the child works within the intervention session. Recorded as the number of repetitions per minute, day or week or amount of work.
Type -
Kind of intervention focused on any of the dimensions of the ICF.
Dosing -
Frequency, intensity, time and type of intervention
Which intervention approach is used to improve hand function, prevent joint contractures, relieve pain in a specific joint and can improve position of hand/thumb for hygiene -
Orthotics or Casting
Why are CIMT and Bimanual Therapy used together at times for children with CP?
CIMT forces the child to use the affected arm, essentially forcing it to improve at one handed task so that two handed tasks can improve. Bimanual therapy is the result and task practice of CIMT.
When used by an OT, what are guided imagery, myofascial release, yoga and meditation considered?
Complementary Health Approaches
movement interventions for high tone kids
Start with the base of support
Head and trunk control and alignment of spine
Relaxation- joint approximation, thoracic extension with rotation
Gaining range of motion and mobility
Use handling and facilitation to help gain functional developmental patterns
Evidence Based Movement Interventions
Home Programming- Task specific or activity focused
Family Centered Coaching
Intensive NDT
CIMT and BIT
Child Focused and Context Focused
Movement intervention steps
Sequence of Interventions is key!
STEP ONE: Preparation- an activity or controlled input provided to help regulate the child and/or prepare them for movement by practicing components of typical movement/development progressions
STEP TWO: Intervention- look for carryover of skills learned from your preparation to allow for greater/ more successful participation in task
Whatever you are doing for your prep carries over into your treatment
True
Gross motor at start of session and ______ _______ at the end of the session
fine motor
Birth History:
Born 39 weeks via vaginal birth
No complications during pregnancy
Birth weight: 6 lbs 13 oz
Diagnosis:
Developmental Delay
video in power point
What would your intervention look like for her
OT Evaluation
WNL A/PROM in all planes of movement
Limited visual scanning of toys
Limited active reaching & initiation of movement patterns
Difficulty with all developmental milestones
Formal Assessment: Peabody Developmental Motor Scales-2
Grasping: 2 months
Visual-Motor Integration: 4 months
strengthening core. Postureal control in sitting, yoga ball, working on midline reactions.
weight bearing to get rid of ATNR
bimanual arm use
Rolling
Rolling Development: Rolling from back to stomach leading with hips and thighs followed by stomach then shoulders
Prone Development: From stomach, raises upper trunk, shifts weight side to side, lifts free arm towards toy
Sitting Development: Maintains balances while moving hands and arms to grasp toy
Proximal stability yields distal mobility
What does this mean?
How can this help to create a fine motor intervention?
When we start to address fine motor needs we need to make sure we are supporting them proximally. Either they have that skill on their own or I am providing it.
What are the main tenants of a bio-mechanical approach
Postural alignment
Postural stability
Level of motor skills performance
Effects of gravity
Effects of the supporting surface
Posture for functional performance
Which position would allow the least amount of impact on performance due to gravity?
Supported side-lying
Why would you use any of these positions to work on fine motor skills?
Supported Side Lying - if they have trouble bringing hands to midline
Supine - great place to start practicing skills of midline if they don’t sit yet
Prone - lifting head, tricky because you need a little bit of movement against gravity
Sitting - allows both hands to be able to play
Standing - impact of gravity is more. good to work on dominent assist, one hand is supporting and the other hand is playing.
Supine - great place to start practicing skills of midline if they don’t sit yet
Prone - lifting head, tricky because you need a little bit of movement against gravity
Sitting - allows both hands to be able to play
Standing - impact of gravity is more. good to work on dominent assist, one hand is supporting and the other hand is playing.
Neurodevelopmental Therapy (NDT)
Uses biomechanical principles with focus on handling and positioning techniques to promote motor function.
Recognized that spasticity interfered with normal movement patterns.
Through sensory feedback a child could learn Normal Movement
Goals of therapeutic handling
inhibit spastaticity
facilitate more normal muscle tone
Guide child through normal movement patterns
Principles of NDT
Postural alignment
Postural stability
Weight shift and equilibrium responses
Control of isolated and dissociated extremity movements
Enhanced mobility and dynamic stability.
Top- Down Approaches:Dynamic Systems Theory
Motor control is dependent on nonlinear and transactive person factors (i.e., cognitive, musculoskeletal, neurologic, sensory, perceptual, social-emotional), task characteristics (i.e., goals, rules, object properties), and environmental systems (i.e., contexts).
principles of dynamic systems theory
Child learns movement more easily and effectively if:
(1) the movement is taught as a whole (versus part)
(2) the movement is performed in variable situations
(3) the child is allowed to actively problem-solve the actions required
(4) the activity is meaningful to the child.
Child learns movement more easily and effectively if:
(1) the movement is taught as a whole (versus part)
Engaging in a whole activity (occupation) facilitates
Children will engage in task for
Requires children to process and respond
Not pretending with playdough but actually making cookies
Child learns movement more easily and effectively if:
(2) the movement is performed in variable situations
Variability is inherent in activity as well as within and between systems
Adapt to environmental or internal changes
Intervention expects children to perform movement in a variety of ways
same skill in a variety of different objects and environments
Child learns movement more easily and effectively if:
(3) the child is allowed to actively problem-solve the actions required
Children learn and retain motor skills better from
Set up environment to facilitate encouragement for the child to discover and
If the child has to problem solve they will remember that motor plan better.
Child learns movement more easily and effectively if:
(4) the activity is meaningful to the child.
Children are more motivated to engage in difficult motor skills if they find the activity
High object affordance - activities in which the objects used conveyed functional and purposeful information.
CO-OP model engages children in goal setting and problem solving
tie it into the things that the child likes it will be more meaningful.
Occupation Based Approaches
Top down approach
The therapist will select and create activities that:
- reflect the child’s motivation and interests
- consider the context of performance
- working within the child’s strength and limitations
create a balance of using their strengths to address their limitations or needs
Occupation Based ApproachesPediatric Constraint Induced Movement Therapy
Core Elements:
Constraint of less impaired upper extremity
Activities and techniques to
High intensity intervention with
Natural environment - but requires a lot of training for the parents
Systematic reinforcement that encourage - want them to be successful to encourage higher level skills
Transfer of intervention program to caregivers - makes sure parents understand so they are able to carry it over.
pediatric constraint induced movement therapy what is the cycle?
select activity
observe performance
encouraging repetition
reinforcing performance
monitoring refinement of movement
Occupation BasedMotor Learning Theory
Meaningful, goal-directed activity is selected
Repetition and practice.
What activities could address these areas?
Bimanual coordination
Managing fasteners
In hand manipulation
What occupations, performance areas and/or skills will fine motor difficulties impact?
toileting and hygiene
feeding
writing
dressing
Variety of diagnoses
Down syndrome, Cerebral Palsy, Prematurity, Autism, various syndromes, genetic disorders etc.
What are the Impacts development of occupations?
Play
* Dressing
* Self-feeding
Performance skills:
* Fine motor strength/endurance
* Bimanual coordination
* Grasp
* in hand manipulation skills
girls stands places weight on hands on a table
Why wasn’t hand function specifically addressed in this session?
proximal stability leads to distal mobility
What are the main goals of his treatment?
What changes occurred throughout the session?
kid places balls in a gumball machine
What skills did you see?
What would you work on next session?
Preparation
Treatment activity
grasp, release, bang to two together
work on release, dropping things into smaller openings
change the position and keep the general idea of activity but modify to address express support piece.
video
threading bead on a wire
in hand manipulation
bilateral manipulation
What skills did you see?
What would you work on next session?
Preparation
Treatment activity
next session - make string easier to hold. brighter colored blocks and strings. pipe cleaners
