Intro to Interventions Flashcards
2 Things to focus on for the framework of interventions
- Focus on Key Diagnostic Categories
- Focus on Age
Possible Key Diagnostic Categories
-cortical lesions – CP
-spinal cord lesions – MM
-genetic disorders/general nervous
system involvement – DS
Top-Down Approach
- Goal driven approach
- Child, Family, PT –desired outcome
- PT - skills and abilities needed
- PT - obstacles and impairments
—-> Plan of Care is developed
3 Trainings
- Compensatory Training
- Neuromotor Training
- Functional Training
When might compensatory training be utilized in pediatric rehabilitation?
If there is a point in their development when they have either plateaued or cannot make any more improvements (ie fixed scoliosis)
Neuromotor Training - NDT Approach Philosophical Framework
– Lesions in CNS produce problems in
coordination of posture and movement
→ atypical mm tone = limitations in function
- Intervention strategies target specific
posture and mvt dysfunction impairments through activities and within contexts that are meaningful - Participation limitations are directly related to posture and movement dysfunction
What is most important?
Function and participation
What is a threshold ability?
What you need to begin to work on that activity
Example of threshold ability
standing is threshold ability for standing
What motor learning strategies do you HAVE to have?
instruction, practice and feedback
Verbal Instructions
- Provide information about the task
- Internal: Toward intrinsic sensori-motor information
- External: Toward the result of the action
Practice
- Physical practice of the skill or task
- Amount: time or repetition
- Structure: part vs whole
- Schedule: blocked vs random
Verbal Feedback
- Form: quality vs Quantity
- Frequency: how often and when?
What does activity focused intervention incorporate?
Motor Control and Motor Learning
Three steps of activity focused intervention
– Develop activity-related goals (meaningful to
child)
– Activity-focused intervention
– Integrate impairment-focused intervention (active and passive)
In order to develop prognosis, take into account:
- Diagnosis/progression of condition
- Age
- Levels of involvement
Main ages where growth and development phases allow time to change brain plasticity
0-3 years old
10-14 years old
Other times that are important for PT to be implemented:
- Medical Changes
- Significant Transitions
3 Different Levels of involvement:
- 1 domain involved: cognition good
- > 1 domain involved: cognition may be affected
- All domains involved: cognition poor
What is a motor development curve and why is it important?
- “motor growth curve”
- Developed from a large sample
- Graphic representation
- Used to describe patterns
- Used to estimate future motor capability
Motor Growth Curve for children with DS
– require more time to learn movements
– 14% walk by 18 months
– 40% walk by 24 months
– 92% walk by 36 months
*** so, if they aren’t walking by 2 yo… its ok!
What age does the motor growth curve level off for children with DS
3 years old
Motor Growth Curve for children with CP depends on what?
GMFCS Level
Gross Motor Function Classification System – Cerebral Palsy
- Five classification levels
- Self-initiated movement
- Sitting, transfers, and mobility
- Includes 12-18 years
- Abilities rather than limitations
General GMFCS Headings
- Level I – Walks without limitations
- Level II – Walks with limitations
- Level III – Walks using a device
- Level IV – self-mobility with limitations,
may use power wheelchair - Level V – Dependent mobility in W/C
review Myelomeningocele Functional Classification
Considerations for Intensity of therapy Services
- Episodes of care
- Readiness for Activity and Participation
- Method of Service Delivery
- Relationship between Intensity and Practice
- Link between Skill Level and Method of Service Delivery
3 parts of pediatric intervention session
Prep
Impairment Based Activity
Functional Activity
6 F’s in Treatment Planning
- Functioning * Fitness * Fun * Friends * Family * Future
