Lecture 1: Intro to Pediatrics

Question 1

What is the American with Disabilities Act?

Answer 1

Protection for all Americans regardless of age/gender

Question 2

Serious disabilities used to be put away and did not recieve the services necessary to reach their potential

Question 3

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)

Question 4

Which model/system places mental disorders on par w/ physical illness?

Answer 4

ICF model

Question 5

Which ICF component encompasses physiological functions of body systems (including psychological functions)

Answer 5

Body functions

Question 6

Which ICF component encompasses anatomical parts of the body, such as organs, limbs, and their components

Answer 6

Body structures

Question 7

Which ICF component encompasses problems in body function or structure, such as a significant deviation or loss

Answer 7

Impairment

Question 8

Which ICF component encompasses execution of a task or an action by an individual

Answer 8

Activity

Question 9

Which ICF component encompasses involvement in a life situation?

Answer 9

Partiicpation

Question 10

Which ICF component encompasses difficulties an individual may have executing activtiies?

Answer 10

Activity limitations

Question 11

Which ICF component encompasses problems an individual may experience in involvement in life situations

Answer 11

Participation restrictions

Question 12

Which ICF component encompasses physical, social, and attinudinal environment in which people live and conduct their lives?

Answer 12

Environmental factors

Question 13

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.

Question 14

Question 15

Difference between Peds and adults
* congitive status
* communication
* interventions (add play)
*

Question 16

Answer 16

Question 17

Answer 17

Question 18

If child comes in and says their elbow hurts, well i can rule out loads of other body parts immediately

Answer 18

Question 19

shouldnt MMT under

Answer 19

3

Question 20

Tests and measures that can be done

Sensory processing = cant handle touch, light, or sound

Question 21

How often are reevals done on normal pt

Answer 21

every 10 visits

Question 22

how often to reeval a pediatric pt

Answer 22

6 months

Question 23

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

Question 24

a twisting of the neck that causes the head to rotate and tilt at an odd angle.

Answer 24

torticollis

common pediatric diagnosis

Question 25

PT treatment diagnosis - gait abnormality - limited ROM Medical diagnosis * torticolicollis - spinabifida

Question 26

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

Question 27

Question 28

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

Answer 28

Prognosis * this is our best guess Important to consider the childs environment Environmental barriers or optimal environmental conditions

Question 29

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...

Question 30

Functional impact that is anticipated from physical therapy interventions

Answer 30

Goals

Question 31

Actual results of the POC

Answer 31

outcomes

Question 32

Measureable statements regarding desire results

Answer 32

objectives

Question 33

Define smart goals

Answer 33

Specific Measureanle Attainable realistic Timely

Question 34

initial learning of a new activity

Answer 34

Acquisition

Question 35

Developing proficiency at the activity

Answer 35

Fluency

Question 36

PErforming the activity over time

Answer 36

Maintenance

Question 37

Performing the activity in numberous environments, with new people and different equipment

Answer 37

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

Question 38

Question 39

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

Answer 39

Question 40

Answer 40

Question 41

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)

Answer 41

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

Question 42

Question 43

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

Question 44

Professional works independently of others

Answer 44

Unidisciplinary This is a PT just working as a PT

Question 45

members of the same profession work together **without significant communication** with members of other professions

Answer 45

**Intra**disciplinary You're working in the clinic by them but not actually with them

Question 46

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

Answer 46

Multidisciplinary Work independently but talk to each other

Question 47

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

Answer 47

Interdisciplinary So they're actaully working together and developing programs w/ one another

Question 48

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

Answer 48

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

Question 49

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

Answer 49

Collaborative Think family members are members of the team

Question 50

Family members are members of the team and make decisions w/ outcomes / interventions etc... everyone has a role

Answer 50

Collaborative team

Question 51

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"

Question 52

Which model has formal channels of communication and all information is shared

Answer 52

**Inter**disciplinary model

Question 53

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

Question 54

Service models mostly used in schools

Question 55

Direct model: * I am going to treat them. 1:1. Directly doing intervention. I'm the therapist you're the pt

Question 56

Integrated model: teaching others how to do things for the pt * have family invovled in teaching

Question 57

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

Question 58

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

Question 59

Collaborative: * ongoing interventions while collborating w/ everyone else in their life * combination of transdisciplinary team interaction and an integrated service delivery model

Question 60

Direct model is when you need 1:1 with actual skilled hands * more PT one

Question 61

Question 62

Question 63

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

Question 64

Manipulation of the environment through the use of positive reinforcement of desired behaviors and ignoring unwated behaviors

Answer 64

Behavioral programming NOTE: kids typically respond better to positive reinforcement. however, there are still times to use the words "no, and stop".

Question 65

neuro covers peds but peds doesnt cover neuro

Question 66

lifespan summary

Question 67

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 -

Question 68

7 atypical motor behaviors

Answer 68

any of these in a peds pt is cause for worry

Question 69

atypical or delayed milestones play w/ adults more than kids

Question 70