Lecture 1: Intro to Pediatrics Flashcards
What is the American with Disabilities Act?
Protection for all Americans regardless of age/gender
Serious disabilities used to be put away and did not recieve the services necessary to reach their potential
ICF
* created by world health organiaztion
* classification systems for health and disability
Originally in 1980 we had the internal classification of impairments, disabilities and handicaps and have now moved to ICF
Traditional classification systems focus on mortality; ICF focuses on life
What the ICF is trying to show is that “I dont have ankle DF, which means i dont have heel strike on initial contact, and if I don’t have heel strike on initial contact than maybe i dont have good push off that leads to being unable to have good toe off which could mean I’m not walking as fast. Well if I’m not walking as fast than functionally I cannot keep up with my peers.
* So it impliements how its functionally impacting the person
ICF is supposed to be gold standard, however, other systems are still implemented
* but we do tie it to goals in the clinic. “pt will be able to get 160 degrees of shoulder function so they can get things in the cabinet (we tied it to function which is essnetially to point of the ICF model)
Which model/system places mental disorders on par w/ physical illness?
ICF model
Which ICF component encompasses physiological functions of body systems (including psychological functions)
Body functions
Which ICF component encompasses anatomical parts of the body, such as organs, limbs, and their components
Body structures
Which ICF component encompasses problems in body function or structure, such as a significant deviation or loss
Impairment
Which ICF component encompasses execution of a task or an action by an individual
Activity
Which ICF component encompasses involvement in a life situation?
Partiicpation
Which ICF component encompasses difficulties an individual may have executing activtiies?
Activity limitations
Which ICF component encompasses problems an individual may experience in involvement in life situations
Participation restrictions
Which ICF component encompasses physical, social, and attinudinal environment in which people live and conduct their lives?
Environmental factors
KNOW: Just because someone can do an activity doesnt mean they participate in it. For instance maybe they can do it in the clinic, but there isnt carryover into their life at home.
Difference between Peds and adults
* congitive status
* communication
* interventions (add play)
*
If child comes in and says their elbow hurts, well i can rule out loads of other body parts immediately
shouldnt MMT under
3
Tests and measures that can be done
Sensory processing = cant handle touch, light, or sound
How often are reevals done on normal pt
every 10 visits
how often to reeval a pediatric pt
6 months
Evaluation
Interpret of results from tests and measures
* look at scores / everything else and find a diagnosis/prognsis/POC
Integration of subjective and objective data
determination of a diagnosis and progrnosis
development of POC
Synthesis of findings from hx/systems review/tests and measures
consideration of contextual factors
a twisting of the neck that causes the head to rotate and tilt at an odd angle.
torticollis
common pediatric diagnosis
PT treatment diagnosis
- gait abnormality
- limited ROM
Medical diagnosis
* torticolicollis
- spinabifida
Top down approach = want child to walk
* then “why cant they walk” and work down and develop POC
Bottom up
* examine them, find problems and determine the goals
* this is used more - but in realality its somewhere in between
Predicted optimal level of improvement in fucntion and the amount of time needed to reach that level, and also may include a prediction of levels of improvement that may be reached at various intervals during the course of therapy
Prognosis
* this is our best guess
Important to consider the childs environment
Environmental barriers or optimal environmental conditions
Plan of care
Developed in full collaboration with the child, family, and other service providers
Includes measureable goals, objectives, and outcomes
Specific interventions to be used
Proposed frequency and duration services - this is determined from:
- Co-pay
- money
- how often they can get there
- other kids
- etc…
Functional impact that is anticipated from physical therapy interventions
Goals
Actual results of the POC
outcomes
Measureable statements regarding desire results
objectives
Define smart goals
Specific
Measureanle
Attainable
realistic
Timely
initial learning of a new activity
Acquisition
Developing proficiency at the activity
Fluency
PErforming the activity over time
Maintenance
Performing the activity in numberous environments, with new people and different equipment
Generalization
can do this in an open (people are talking) and closed (back room w/ nobody around) environment
* this is a big one to work on w/ peds
* this is a good way to progress goals
Goal attainment scaling (GAS)
you make a goal w/ incremints
good content validity, relability, and responsiveness in studies of children w/ CP
you rate it like below
arbitray because you make these goals
typically places that utilize this are doing it more for research/peds - not seen much in general pop
CPGs are plans to assist in decision making, they are not formulas. not intended for a blueprint for everyone
not a protocol just guidance
lots more in ortho than peds (5)
theres not a ton of research because you need to prove what your doing is not risk to the kid and the kid cannot sign for theemselves
also diagnosis vary greatly
Kids can get formal graduations for when they finish therapy, make them feel special
Discharge or “graduation” from services
1) goals, objects or outcomes are achieved
2) Child or family declines to continue itnervention
3) Child is unable to progress toward the anticipated goas, objectives, and expected outcomes
4) therapist determines that the child and family will no longer benefit from physical therapy
When termination of services occurs before achievement of the goals, objects, or outcomes, the rationale for discontinuation must be documented
* parents will throw you under the bus the the Dr. and you’ll need to be able to back up your decision
Professional works independently of others
Unidisciplinary
This is a PT just working as a PT
members of the same profession work together without significant communication with members of other professions
Intradisciplinary
You’re working in the clinic by them but not actually with them
Professionals work independently but recognize and value the contributions of other team members. Draws on knowledg from different displines, but there may be little interaction or ongoing communication among progessionals
* work independently but talk to one another
Multidisciplinary
Work independently but talk to each other
Individuals from different disciplines work together cooperatively to evaluate and develop programs. Emphasis is on teamwork, and role definitions are reflaxed. There is analysis, synthesis, and harmony between disciplines, creating a coordinated and coherent whole
Interdisciplinary
So they’re actaully working together and developing programs w/ one another
There is teaching and ongoing work among team members that transcend traditional disciplinary boundaries. Team members work together to develop and carry out interventions. Role release occurs when a team member assums the responsabilities of other disciplines from service delivery
Transdisciplinary
She doesnt like this one
* they call it roll release, where they want a team member to assume responsibility for other roles
* “I want 1 therapist to be PT/OT/Speech”. However, were not qualitfied to do all this
All team members work together in equal participation and consensus decision-making. The team interaction of the transdisciplinary model is combined with the integrated service delivery model. Coaching is a form of a collaborative team interaction
Collaborative
Think family members are members of the team
Family members are members of the team and make decisions w/ outcomes / interventions etc… everyone has a role
Collaborative team
Multidisplinary typically has a team leader that calls everyone together and sets up meetings and were all going to talk about our roles and critque eachother
“lets work together to find the best way to address the problems”
Which model has formal channels of communication and all information is shared
Interdisciplinary model
Transdisplinary is for infants that shouldnt be handled by multiple individuals. So one person takes on multiple roles so they dont come into contact w/ loads of people
Service models mostly used in schools
Direct model:
* I am going to treat them. 1:1. Directly doing intervention. I’m the therapist you’re the pt
Integrated model: teaching others how to do things for the pt
* have family invovled in teaching
Consultative model:
* Therapist meets with and demonstrates activities to all appropriate staff that carry out itnerventions to achieve determined goals and objectives
So you’re consulting w/ other people in this model
Monitoring model
* I give them what they need and have someone else follow up on this
* common in school system - tasks are delegated to teacher
* Follow up of children who have impairments that might deterirate over time or limitations that might requre, integrated, or consultative intervention at a later date
* allows a more rapid transition of services if needed
Collaborative:
* ongoing interventions while collborating w/ everyone else in their life
* combination of transdisciplinary team interaction and an integrated service delivery model
Direct model is when you need 1:1 with actual skilled hands
* more PT one
big idfference between adults and peds
Their behavior is entirely different
Don’t ask yes/no question if theres not a yes/no answer
* “Do you want to clea your room” - no
* instead ask “do you want to clean your room or clean the basement”
Use play to get theuerapeutic outcomes
structured behavior management plan is something that is “if you do this” than this
* Im going to put 3 clips on your shirt now, if they’re all there at the end of therapy you get a prize. You lose a clip if you do this behavior
Manipulation of the environment through the use of positive reinforcement of desired behaviors and ignoring unwated behaviors
Behavioral programming
NOTE: kids typically respond better to positive reinforcement. however, there are still times to use the words “no, and stop”.
neuro covers peds but peds doesnt cover neuro
lifespan summary
inconsistency of performance - when they’re first trying something they should be trying it lots of different ways. However, if they’re being inconsistent w/ something they already know how to do then im worried
Perseveration-response repeittion, the inability to stop when appropriate - if they’re walking and they cant stop, or tapping and cant stop moving them im woried
Extraneous movement - kids sitting and cant stop moving
Mirroring or the inability to transpose right-left cues. So if they cant mirrior what you do on both sides
Asymmetry and difficulty in bilatearl coordination - if they arent the same on both sides htem im worried
LOss of dynamic balance and falling after finishing a motor task
Inability to maintain rhythm or movement pattern - “I cant walk and keep the pattern”
Inability to contorl force, whether unable to generate enough force or using too much force
inappropriate motor planning -
7 atypical motor behaviors
any of these in a peds pt is cause for worry
atypical or delayed milestones
play w/ adults more than kids
