OCTA 231 Pediatrics Exam 2 Flashcards
Food placement on the back of the molars elicits what movements?
Tongue lateralization and Rotary movement
What type of cup was used for jaw control?
Cut away cup
What should the therapist observe for abnormal feeding?
Clenching
Tongue thrust
Lip retraction
Temple Gardin said:
One step at a time
What is the OT goal for handwriting?
Focus on prepping the hand for the use of the pencil.
Hand Dominance:
- developed by 4-6 years
- girls develop faster
- hand dominance have to be established first before encouraging writing
What are the performance skills that may affect handwriting?
Muscle tone Strength Endurance Posture Integrity of structures Visual perception Sensory processing
Prewriting strokes are:
Vertical
Horizontal
Circular
Diagonal (last)
precursors to forming shapes, letters, and numbers
Prewriting strokes
Having a strong trunk is good for:
positioning for upright seated posture
What type of skills are assessed when evaluating handwriting skills?
visual-motor skills
perceptual skills
fine motor skills
the way print is tracked during reading and writing. (top to bottom and left to right of page)
Directionality
ability to organize and interpret what is seen
Visual perception
Visual perceptual tests examines what?
discrimination visual memory form constancy sequential memory figure ground visual closure
a grasp that position the fingers to put insert a key into a door
Lateral pinch
a grasp that position the fingers to palm a ball
Spherical pinch
a grasp that position the fingers to write with a pencil
Tripod grasp
a grasp that position the fingers to hold a cup
Cylinder grasp
a grasp that position the fingers to hold a suitcase
Hook grasp
a grasp that position the fingers to hold a hammer
Power grip
a grasp that position the fingers to pick up small object (penny)
Superior pinch
a grasp that position the fingers to pick an item up using the thumb, middle, and index fingers
3 jar chuck
If child have poor handwriting due to tone problems what can be done?
work from gross to fine (activities out of the chair to seated in chair)
Gross motor activities:
- isometric exercises
- wall push-ups/offs
- obstacle courses
- theraband
- scooter-board & propelling self
- quadruped, prone, or side sit while playing game
Fine motor activities:
- pegboard
- bean bag toss
- beading
- paint and water
If child have poor handwriting due to tactile problems what can be done?
Provide sensory stimulation to the hands after body prepping
Tactile activities:
finding objects in sand, rice, theraputty, etc
If child have poor handwriting due to visual motor problems what can be done?
Prep hand and then expose to variety of activities that require progressively more refined visual motor skills
Visual motor activities:
- rolling theraputty into snowballs
- puppet play
- tweezers to pick up cotton balls
- operation game
- tracing with crayon/chalk
- Tracing on large paper then small paper
Autism spectrum disorder have 7 symptoms grouped into 2 main groups, what are they?
- Deficits in social communication & social interaction
* Restricted, repetitive patterns of behavior, interests, activities
Deficits in social communication and social interaction:
- social emotional reciprocity
- deficits in non verbal communication
- poor eye contact
- mismatched body language
- poor use of gesture
- Problem adjusting behavior to social situation
- problems with making friends or lack of interest in peers
Restricted, Repetitive patterns of behavior, interests, and activities:
- Stereotyped/repetitive movements
- Insistence on sameness/inflexibility
- Highly restricted interests, fixated interests
- Hyper/hypo responsive to sensory input
What are the 3 disorders that are now combined into the autism spectrum disorder?
- Asperger syndrome
- Pervasive developmental disorder
- Childhood disintegrative disorder
What are the autism signs in infancy?
- child does not reach to be picked up
- does not cuddle or respond to it
- does not have social smile
- does not play simple social games
- seems indifferent to parents
What are the autism signs in a 2-3 year old?
- limited eye contact
* does not want to cuddle or may go limp or rigid when held
What are the autism signs in a 4-5 year old?
- may be echolalic (repeat- vocally- something over and over)
- may engage in self stimulatory behaviors (shaking hands, picking at hair, rocking, etc)
an intervention used for autism that focus on behavior interventions using behavioral management techniques
Applied Behavioral Analysis (ABA)
an intervention used for autism that adapts the environment to the child using visual aids (pictures can help child understand what comes next)
TEEACH
an intervention used for autism developed for learning disabled child; need to be certified but can do treatments based on sensory integration or sensory motor techniques
Sensory Integration/ Sensory- Based
an intervention used for autism that strengthens and balance the auditory system by using earphones with a monotone sound playing
Auditory Integration Training (AIT)
hypersensitivity to sound
Hyperacusis
the process in which the brain is taking in all of the various types of sensory input and messages and sorting it all out
Sensory modulation
intervention used for autism where the adult imitates the child; child will then notice adult overtime or the adult will interact with the child’s toy to get child to notice/react
Relationship based interactive intervention
autism intervention that use of play, structure and cues; using play and toys to slowly get reactions and interactions
Structured Play
autism intervention where the child is shown pictures of facial expressions and the child talks about the responses to these expressions (Asperger’s)
Social cognitive skill training
educating the parent about how to deal/communicate with child
Parent directed approach
Jean Ayres defines SI as:
process of organizing sensory information in the brain to make adaptive responses
What are the five senses that Jean Ayres used?
- Vestibular
- Tactile
- Proprioceptive
- Auditory
- Visual
way of describing how we process sensory info from the environment into a meaningful organized fashion in order to act on it in an adaptive way, functional way that works
Sensory integration
how the brain receives and interprets sensory info to produce an effective response by person
Sensory processing
What are some behaviors that represent impairments with sensory modulation?
- Gravitational insecurity
- Tactile defensiveness
- Sensory seeking
- Sensory hypersensitivity
hypersensitivity to touch
Tactile defensiveness
fear of having feet off ground
Gravitational insecurity
highly interested in movement, lights, colors, sounds, smells and tastes that excite
Sensory seeking
sensitive to movement, lights, colors, sounds, smells and tastes
Sensory hypersensitivity
the sense of balance
vestibular
the sense of body movement
proprioception
Children manifest sensory modulation irregularities by their intolerance to:
- clothing
- food texture
- imposed touch
- household noises
SI dysfunction in infancy is over reactivity to:
touch
taste
smell
What do the therapists do if a child needs excitation?
provide arousing activities like jumping, swinging, etc
What do the therapist do if the child is overaroused?
provide sensory input like a swing or physio ball while engaging in oral-motor activity( blowing bubbles) that will promote healthy inhibition (relaxation)
interventions for sensory processing that challenge a child to make adaptive responses
vestibular, proprioceptive, and tactile activities
What type of tactile input is said to improve attention, arousal, and focusing?
- brushing
* deep pressure
Sensory integration techniques are used to address:
sensory processing issues
What is the most emotionally significant area of delay in an infant?
Oral motor (OM)
What does FTT stand for?
failure to thrive
A child may never develop rotary movement due to what reflex?
Phasic bite reflex - up and down movement
What movement of the tongue will the therapist continue to see in/out pattern and no lateralization?
Sucking movement
jaw appear stuck in open position
jaw thrust
people with jaw thrust have high or low tone?
low tone
forceful protrusion of tongue which often appears thick and bunched resulting in loss of food and liquid
tongue thrust
people with tongue thrust have high or low tone?
low tone
drawing back of lips
lip retraction
people with lip retraction have high or low tone?
low tone
strong pulling back of the tongue that may result in airway blockage
tongue retraction
people with tongue retraction have high or low tone?
high tone
may be due to a strong tonic bite reflex. involuntary closure of jaw
jaw clenching
people with jaw clenching have high or low tone?
high tone
if an infant cannot get enough liquid of looses most of it:
he/she have an inefficent or weak suck
Objectives to Oral Motor Treatment:
- want to optimize child’s development in all areas
- want to prevent maternal-infant problems (bonding)
- want to prevent placement on alternative methods of feeding
- want to normalize OM skills to assist in normal speech motor development
- want to prevent behavior problems
Common OM problems with intellectual and developmental disability:
- delayed OM skills
- lack of food texture progression
- behavior problems
- may not know when hungry or thirsty
- may remain dependent on feeding from others.
Common OM problems with down syndrome:
- low tone-may interfere with jaw stability, poor cheek development, open mouth posture
- tongue thrust due to large tongue
- overall OM delayed
- behavior problems
- delayed cup skills b/c tongue is thrusted under cup
Common OM problems with CP:
- problems positioning to feed
- primitive reflexes continue
- hyperactive gag
- oral hypersensitivity
- tongue thrust, jaw instability, tonic bite, poor lip closure, increased drooling.
Oral motor treatment techniques:
- cut away cup
- jaw control (3 fingers)
- food placement back molar, side of mouth
Backdrop of normal:
- tone
- posture
- equilibrium
- scapula shoulder girdle stability
- control of forearm
- control of elbow
- control of wrist and fingers
- thumb opposition
- Palmer arches
- intact tactile perception of the hand
- freely crossing midline
In first year of life ________ should be going on in order to support readiness of the hand for handwriting activities
weight bearing
What should kids in the 2nd semester of kindergarten begin instruction in if all is normal?
letter formation
reading and writing develops:
parallel to each other
When you first see a child look at:
- tone
- shoulder stability and posture
- sitting posture at desk and chair
- look where movement is coming from when writing (shoulder/elbow/wrist/fingers?)
- tone in hand and fingers
- overall fine motor skills (use of variety of grasp, grip strength, finger isolation, use of palmer arches, use of 2 hands together, hand dominance, and tactile perception of hand and fingers.
- eye-hand coordination
- L/R discrimination (b/d)
- visual perceptual skills-need to understand this on own body before on paper
What position is good for observing weight shifting and addressing tone?
quadruped
What info should we get from the OTR?
- predominately tone problem?
- predominately tactile issues?
- visual motor problems?
- all three? (usually)
True/False: Kids with handwriting issues tend to have tactile issues like hypersensitivity to tactile or even orally
True
True/False: when addressing tone we should work fine to gross?
False
Gross to Fine
How to address palmer arches and finger isolation
- Weight bearing in quadruped
- Wall pushups with fingertips
- Animal crawls
- Hold onto things(marbles) with one hand
- Tweezers or connected chopsticks to pick up things
- Braiding, bracelets, cats-cradle
- Use wedge
