MOPs and FORs

Question 1

What is pediatric practice?

Answer 1

Includes OT with infants, toddlers, children, and youth
Ends with the period of adulthood, which is defined by each state

Question 2

What are the primary philosophies of pediatric practice?

Answer 2

Child- and family-centered care
Strength-based focus
Cultural competence

Question 3

What are the 3 primary core beliefs of child and family centered practice?

Answer 3

Respect for children and families
Appreciation of the family’s impact on the child’s well-being
Family-professional collaboration

Question 4

In pediatrics, what do parents typically want?

Answer 4

A true partnership
A dependable resource for specific, objective information
Flexibility in service delivery and in communication style
Sensitivity and responsiveness to their concerns
Positive, optimistic attitudes
Effectiveness

Question 5

What is strength based focus?

Answer 5

Must evaluate not only a child’s difficulties but also the strengths
Use those strengths to facilitate performance in difficult areas
Help parents to understand their child’s unique strengths
Supports and promotes self efficacy and self determination

Question 6

What is cultural competence?

Answer 6

Critical in this diverse country where practice WILL include provision of services to cultures different than one’s own
Cultural diversity in the United States is growing and changing in makeup. Shifts can occur rapidly.

Question 7

Describe a culturally competent therapist.

Answer 7

Demonstrates an interest in understanding the family’s culture
Accepts and embraces diversity
Participates in traditions or cultural patterns of the family
Inquires about family routines, cultural practices, traditions, and priorities
Integrates intervention recommendations into the family’s cultural practices

Question 8

How does culture influence pediatric practice?

Answer 8

On a child’s development of occupations and skill development
Choices of occupation
Choices regarding level of independence at specific ages

Question 9

What are some examples of guiding questions about cultural values and styles?

Answer 9

Who are the members of the family?
Is there a hierarchy in the family based on gender or age?
Who makes decisions for the family?
Who is the primary caregiver?
Do family members value independence?
Are they reliant on each other?
What are the cultural rules or norms about breast feeding, mealtime, self-feeding, and eating certain foods?

Question 10

What are intervention methods in peds?

Answer 10

Occupational therapists improve children’s performance and participation
- by providing interventions to enhance performance
- by recommending activity adaptations and environmental modifications
- through consultation, coaching, and education

Question 11

What are specific aspects of intervention in peds?

Answer 11

Establish a therapeutic relationship
Focus on inclusion and natural environments
Use preferred occupations, client engagement, and child-centered care
Create the just right challenge
Modify and adapt tasks and environments
Use evidence-based interventions
Advocate for and educate others

Question 12

How do you establish a therapeutic relationship?

Answer 12

Select an activity of interest that motivates the child and gives the child choices.
Respect the child’s emotions.
Convey positive regard toward the child.
Attempt to connect with the child.
Create a climate of trust and emotional safety.
Promote child’s self-actualization.

Question 13

What OT services support inclusion?

Answer 13

Services in the child’s natural environment
Flexible service delivery models
Integrated therapy
Provision of supports and accommodations
Modifying to allow greater participation and access

Question 14

How can you optimize a child’s engagement?

Answer 14

Begin with the child’s interest.
Invite the child to select and help design the activity.
Pose a problem to be solved.
Use meaningful whole tasks rather than repetition of single step tasks.

Question 15

How can you provide the just right challenge?

Answer 15

Matches the child’s developmental skills and interests
Provides a reasonable challenge to current performance level
Engages and motivates the child
Can be mastered with the child’s focused effort

Question 16

How do you modify tasks and the environment?

Answer 16

Requires high levels of collaboration
Requires ongoing evaluation of the impact on the child and others in the environment
Consider child’s sensory processing needs and level of arousal
Consider child’s physical abilities and level of access to places, spaces, and activities
Environment modification should have positive effect on the child and a neutral effect on others in the environment

Question 17

What is EBP?

Answer 17

The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.

Question 18

What are the steps in EBP?

Answer 18

STEP 1: Convert the need for information (about intervention effects, prognosis, and therapy methods) into an answerable question.
STEP 2: Search the research databases using the terms in the research question.
Track down the best evidence to answer that question.
STEP 3: Critically appraise the evidence for its validity, impact, and clinical meaningfulness.
STEP 4: Critically appraise the evidence for its applicability and usefulness to your practice.
STEP 5: Implement the practice or apply the information.
Evaluate the process.

Question 19

How is EBP achieved?

Answer 19

EBP is achieved when occupational therapists make careful decisions that reflect:
- their own experience and education,
- the child’s and family’s priorities, and
- the research evidence.

Question 20

What are indirect services in pediatrics?

Answer 20

Consultation
Coaching
Support others in creating their own solutions
Requires good communication and collaboration

Question 21

What is education and advocacy in pediatrics?

Answer 21

On behalf of specific children with disabilities
OR
Vying for system change on behalf of all children
Often interprofessional

Question 22

What are direct services in pediatrics?

Answer 22

Push in
Pull out
Workload versus caseload
Block scheduling and coteaching

Question 23

What is a theory?

Answer 23

A “plausible or scientifically acceptable general principle or body of principles offered to explain phenomena.”
Explanation of observed behaviors that is based in data.
Describe fundamental princi­ples and create an abstract language system for a profession.

Question 24

What foundational theories are used in OT?

Answer 24

Developmental theories
Learning and system theories

Question 25

What are developmental theories?

Answer 25

Piaget and cognitive development
- Adaptation: The child’s ability to adjust to change to fit into the environment
- Schema: How children represent objects, events, and relationships
- Assimilation: Incorporating new knowledge into existing cognitive structures
- Accommodation: New learning, adapting cognitive structure to new information

Question 26

Give examples of foundational theories.

Answer 26

Vygotsky and the Zone of Proximal Development
Scaffolding
Maslow’s Hierarchy of Basic Needs
Learning and Systems Theories
- behavioral
- social cognitive

Question 27

What is the Vygotsky and the Zone of Proximal Development theory?

Answer 27

Cognitive processing is a social process.
Learning is critically dependent on social interaction

Zone of proximal development:
The distance between the child’s actual developmental level when acting independently and the level of potential development when supported by an adult

Question 28

What is the scaffolding theory?

Answer 28

The process by which therapists support or guide a child’s actions to improve competence.

Question 29

What is Maslow’s Hierarchy of Basic Needs?

Answer 29

Physiological needs
Need for safety
Need for love and belonging
Need for a sense of self-esteem
Need for self-actualization

Question 30

What is the behavioral theory?

Answer 30

Instrumental or operant learning
Applied behavioral interventions
Shaping
Incidental teaching
Pivotal response

Question 31

What is the social cognitive theory?

Answer 31

Children can learn by observing the behavior of others.
Children determine their own learning by seeking certain experiences.
Children learn indirectly by observing how their peers’ behaviors are rewarded or punished.
Children learn social skills through group experiences.

Question 32

What is self-efficacy?

Answer 32

The influence of motivation and self-efficacy on learning.
If children experience success, they are more likely to seek additional challenges.

Question 33

Self-efficacy beliefs determine…

Answer 33

the goals that people set for themselves.
how much effort they expend.
how long they persevere in the face of difficulties.
how they respond to failure.

Question 34

What is the dynamic systems theory?

Answer 34

Performance depends on
- interactions of the child’s inherent and emerging skills.
- characteristics of the desired tasks or activity.
- the environment.
Self-organization is optimal if the task has a goal and outcome.

Question 35

What are models?

Answer 35

A pictorial representation that expresses observations and data about certain portions of a theory.
Are often used to test theories.
Provide structure to guide the process of clinical reasoning.
Promote the use of occupation centered practice and a broad scope of practice.

Question 36

What are some models about human occupation?

Answer 36

Model of Human Occupation (MOHO)
Person-environment-occupation-performance (PEOP)
Canadian Model of Occupational Performance and Engagement (CMOP-E)
Occupational adaptation

Question 37

What is the systems approach?

Answer 37

Systems approach: Importance of context in assessment and intervention

• Develop a picture or profile of the child’s performance.
• Focus on the interaction of person, environment, and occupation.
• Focus on changing the child, task, or environment.
• Modify the task or environment to improve the child’s skills.
• Increase the child’s engagement by using activities that are meaningful.

Question 38

What is a frame of reference?

Answer 38

A set of interrelated internally consistent concepts, definitions and postulates that provide a systematic description of and prescription for a practitioner’s interaction within a particular aspect of a profession’s domain of concern.
Provide occupational therapists with specific strategies and techniques based on theoretical principles.
Are lenses or ways of viewing a child’s/family’s behavior or performance.

Question 39

Describe the developmental FOR.

Answer 39

Based on the ideas and knowledge about the typical progression of developmental skills by age
Predicts skills will become more complex and more competent over time
Suggests a temporal sequence during which specific skills should be expected
Suggests intervention to generate the “next” skill
Based on older linear vs systems ideas about maturation

Question 40

Developmental trajectories can be…

Answer 40

Typical
Delayed
Slowed
Delayed and slowed
Nonlinear or
Initially typical followed by a “falling off”

Question 41

Describe the biomechanical FOR.

Answer 41

Based on kinesiology and physics.
Require the understanding of anatomy and physiology related to posture and movement.
Movement occurs against gravity and pressure.
Limb movement requires postural adjustments to allow individuals to remain upright against gravity.
Optimize alignment as basis for movement and control of extremities.
Methods include range of motion, strengthening, positioning, and modification.

Question 42

Describe the motor control/learning FOR.

Answer 42

Motor control = directing/regulating movement.
Motor learning = ways of learning movements.
Problem-solving method, helping child find the best ways to move to solve a motor problem.
Analyze movement synergies.
Consider child’s stage of learning.
Provide feedback to improve efficiency.
Provide opportunities for practice.
Promote independence and generalization.

Question 43

Describe the rehabilitative FOR.

Answer 43

Allows a child or youth to engage in desired occupations with compensations and adaptations
Providing adaptive equipment or modifications
Providing appropriate assistive technology
Requires a thorough analysis of the activity

Question 44

Describe the neurodevelopmental FOR.

Answer 44

Analyze missing or atypical movement patterns.
Use therapeutic handling to facilitate postural control and movement synergies.
Inhibit or constrain abnormal movement patterns.
Focus on changing movement patterns.
Child is active participant.
Therapists emphasize quality of movement.

Question 45

Describe the sensory integration FOR.

Answer 45

Based on neuroscience.
Children receive, perceive, interpret, and react to sensations, and use sensory information to produce adaptive behaviors in response to environmental demands.
With sensory integration and experiences of success, development occurs, enhancing neuroplasticity.
Sensory input can be incorporated into activities systematically to elicit an adaptive response.
Must be active, child-directed.

Question 46

Describe the behavioral FOR.

Answer 46

Based on animal research examining learning
Learning occurs through repetition of specific behaviors with appropriate reinforcement
Use reinforcement to modify or alter behavior
Puts little emphasis on intrinsic motivation, as motivation to perform a skill is generated by external motivation provided by reinforcement
Requires careful analysis to determine what to reinforce and when

Question 47

Describe the cognitive FOR.

Answer 47

Based on the work on self-efficacy
Use a problem-solving approach to work toward child-derived goals through careful questioning rather than instructing

Question 48

What are the steps included in the cognitive FOR?

Answer 48

Task analysis
Anticipation of the child’s difficulties
Exploration and selection of task-specific strategies
Application of a strategy to the task
Evaluation of strategies

Question 49

What is the CO-OP?

Answer 49

Cognitive orientation to daily occupational performance
Steps:
1. Focus on the occupations the child selects.
2. Use a general problem solving framework.
3. Use process questions to increase the child’s awareness of the use of strategies.
4. Plan for transfer and generalization of the strategies

Question 50

Describe the cognitive behavioral FOR.

Answer 50

Based on the idea that problem behaviors are caused by beliefs or thoughts (cognition)
Change the thoughts, change the behavior
Uses positive self-talk and feedback for successes

Question 51

What is neuroplasticity?

Answer 51

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, facilitate brain plasticity.