Pediatric conditions and Interventions Flashcards
Autism Spectrum Disorder
Etiology: Unknown
Problems:
- impaired communication and social skills
- repetitive behaviors
- Impaired intellectual development
- Perseveration on specific topics
- excessive routines/rigid
- hard transitions
- decreased eye contact
- decreased safety awareness
- decreased reciprocal interactions
OT interventions:
- Sensory assessment and integration intervention
- feeding/eating therapy
- schedules/timers to anticipate transitions
-social stories
- start treatment w/ less desirable task, followed by preferred task
- development of play skills, sharing, turn-taking
- increase body awareness to improve motor planning via massage, swings, weighted materials, hanging activities
- Educate caregivers on safety modifications
- peer mediated approach (teach typically developing children ways to help those w/ ASD
Child abuse, neglect, and shaken baby syndrome
Etiology: child is victim of physical, emotional, or sexual abuse, or neglect of proper care and nutrition resulting in harm
Problems:
- delayed growth, delayed development, and/or cog deficits
OT Intervention:
- ADL training in self-care
- school-based OT for academic success
- symbolic play, social stories and art activities to promote expression of feelings
- sensory assessment and providing appropriate sensory input to regulate/modulate sensory systems for calming
- coping skills
- BABIES- swaddling, swinging, deep pressure and warmth, massage/gentle touch, soft/soothing music and sounds.
Cystic fibrosis
Etiology: genetic disorder caused by mutations in the gene for the CF transmembrane conductase regulator
Problems:
- Accumulating thick, sticky mucus that causes coughing, SOB, and frequent chest infections.
- Symptoms: poor growth/weight gain, salty sweat, fatty BMs, trouble digesting food, enlarged heart
OT intervention:
- training in daily routine management, including med management, and respiratory treatments
- energy conservation for I/ADLs
- for teens, IND in disease management
Developmental delay
Etiology: usually caused by other conditions/disorders
Problems:
-excessive fxl limitation in one or more of the following areas: self-care, communication, motor development, sensory processing, social skills, cog.
OT intervention:
- determine underlying diagnosis to facilitate intervention
- self-care training
- sensory strategies
- smaller step learning for developing complex skills and concepts
- visual supports
- GM activities
- FM activities
- postural activities
- backward chaining
- coping skills
- social skills
Developmental coordination disorder (dyspraxia)
Etiology: unknown
Problems:
- clumsiness
- excessively delayed motor development that negatively influences daily functional tasks
- not related to any other diagnoses
OT intervention:
- pullover/elastic clothing until child learns to manage fasteners
- alternatives to fork/knife use to cut meats etc.
- adaptive scissors
- activities to develop bilateral coordination and hand use (L/R discrimination and crossing midline)
- sensory-based tasks to develop motor learning/planning
- activities to develop postural control/stability
- teach how to plan and check progress
- environmental modifications
- forwards and/or backwards chaining and task breakdown
Down Syndrome
Etiology: Trisomy 21 (error in cell division causes extra 21st chromosome)
Problems:
- slanted eyes, protruding tongue, flat nose, epicanthal fold over the eyes, shortened fingers/limbs, hypotonia/hyperextension of joints, delayed development of reflexes, delayed/impaired sensory development, cog. impairment, may have heart defect, creases in the hands
OT intervention:
- place food to sides of mouth to encourage lip closure while eating- repetitive activities to promote mastery of skills
- compensatory strategies for ADLs
- early intervention and school-based OT to promote intellectual development, incorporating problem solving, org skills, life skills, vocational skills, social skills training to prepare for transition from school to work
Failure to thrive
Etiology: medical or environmental factors, home environment may influence condition
Problems:
- decreased body weight
- feeding difficulties
- delay in age appropriate development (self-care, play, cog.)
OT intervention:
- oral-motor skills, eating/feeding schedule based on child’s expression of hunger
- food additives for increased nutrition
- small, more frequent meals
- pleasurable eating environments and child-selected dinnerware/utensils
- food play
- meal routine
- compensatory strategies
- remediation
Fetal Alcohol Syndrome
Etiology: excess alcohol intake during pregnancy, resulting in various birth defects
Problems: neural/facial/cranial/cardiac abnormalities
OT intervention:
- monitor vital signs
- organizational, proprioceptive activities (wheelbarrow walking)
- motor planning tasks (obstacle courses and mazes)
- appropriate sensory diet
- calming tasks, deep pressure
- schedules and timers to prepare for transitions
- task breakdown
- GM for body awareness, coordination, alerting behaviors and cog.
- VM and VP activities
Intellectual disability
Etiology: various causes
Problems:
- intellectual functioning significantly below average
- delays in 2+ areas of occupation (play, ADLs etc.)
- deficits in intellectual functioning and adaptive behaviors
OT interventions:
- develop behavior modification plans
- alternatives for communication as needed (w/ SLP)
- Reciprocal play
- ADL skills
- handwriting skills and mods
- development of performance patterns that include rituals, habits, roles to enhance engagement in meaningful occupation
Learning disability
Etiology: various causes, often secondary to other conditions
Problems:
- difficulties in learning
OT intervention:
- School-based OT including sensory integration strategies
- CBT techniques
- handwriting, organization training, motor planning tasks
Rett Syndrome
Etiology: neurodevelopment disorder that affects almost exclusively girls; caused by mutation of the MECP2 gene which is needed for brain development
Problems:
- 4 stages
- loss of normal movement/coordination
- loss of communication ability
- abnormal hand movements
- unusual eye movements
- breathing problems
- abnormal behaviors
- cognitive disability
- sleep disturbances
OT intervention
- look for potential use of eye movement or gaze or initiation of movement towards a desired object
- dyspraxia may cause delay between a prompt and a response
- progress is slow, but improvements in self-care and hand skills can happen throughout lifespan
- maximize hand use for fxl activities
- develop ability to access AE
- increase IND in feeding
Spina Bifida
Etiology: malformed development of SC, meninges and brain resulting from abnormal closure of vertebrae; non-curable
Problems:
- poor prognosis for those with high level spinal cord involvement and congenital abnormalities
- visual deficits
- four levels of involvement (mild to severe)
OT intervention:
- Increase BADLs, self-care, and IADLs w/ AE, ADevices, and WC
- bladder and bowel training (self-cath)
- skin integrity edu
- ROM, strengthening, GM/FM activities within patient’s level of ability
- home accessibility and safety training
- consult w/ educators and school-based OT to collab
Traumatic brain injury
Etiology: caused by traumatic injury to the skull that impacts brain tissue
Problems:
- ACUTE: loss of consciousness, slow/slurred speech, vomiting, irritability, lethargy, confusion, severe headache
- LONG-TERM: changes in personality, abnormal muscle tone, hemiplegia, affect changes, memory loss, cog. deficits, impulsiveness/quick-tempered, visual deficits
OT intervention:
- schedules to prepare child for environment
- textures to improve sensory awareness and muscle tone
- develop ADL/play skills (visual attention, memory, UE strength)
- weight shifting/weight bearing tasks
- I/ADL engagement
Visual impairments
Etiology: various causes, including abnormal eye development, strabismus, amblyopia (lazy eye), optic nerve hypoplasia, decreased binocular function, retinopathy of prematurity
Problems:
- difficulty focusing on faces or toys
- hold object close
- tilts head to look at object
- crossed eyes
- jerky eye movement
- decreased school performance
- poor FM and GM skills
CO-OP approach
Cognitive orientation to occupational performance
Five core concepts of CO-OP
- focused on ENABLING success and employs five core concepts:
- collaborative goal setting
- dynamic performance analysis
- cog. strategy use
- guided discovery
- enabling principles
Main objectives of CO-OP (3)
- skill acquisition in child-chosen task
- development of cog. strategies
- generalization and transfer of learned skills and strategies
CO-OP steps
- goal
- plan
- do
- check
hearing loss
the child will demonstrate significant delays in integration, balance, and the ability to carry out complex motor sequences
OT intervention:
- face child squarely at eye level
- make sure you have child’s attention
- position yourself so the child can see your face and hands
- check hearing equipment
- Avoid backlighting
- use normal voice tone and speed
- natural, clear speech, no more than 3 feet from the child’s microphone
- be consistent
Sensorineural vs. conductive hearing loss
Sensorineural: damage to auditory nerve, inner structures, or auditory area of the brain
Conductive: damage to outer ear or ear drum
One of the most common birth defects
Spina bifida
When does the neural tube close during pregnancy
28-32 days after conception
Risk factors for spina bifida
- genetics, teratogen exposure, decrease in FOLIC ACID, infection, maternal age (more common in teenage mothers), firstborn have an increased risk, SES
Spina Bifida basics
- definition: “cleft spine” - incomplete development of brain, SC, and/or meninges, and is classified as a defect of the neural tube
- most common in caudal lumbar and sacral areas, and the impact on function is determined y the size and location of the malformation, whether it is covered by skin and which spinal nerves are involved.
- all nerves located below the malformation are affected to some degree; spinal opening can be repaired shortly after birth, but nerve damage and resulting paralysis are permanent.
2 main types of neural tube defects
- closed (covered by skin)
- open/spina bifida cystica
Closed neural tube defects
- localized and confined to spine
- development of SC affected by malformations of fat, bone, or meninges
- Not exposed/fully covered by skin
- may remain undetected for years
Types:
- SB occulta: one or more vertebrae has a slight defect, covered by skin, no protrusion of SC (often asymptomatic)
- SB lipomyelomeningocele: closed spinal lesion where part of SC and nerves are tangled in a benign fatty tumor which puts pressure on nerves; symptoms include bowl and bladder dysfunction, increased UTIs, spasticity, back and leg pain, weakness and sensory loss
- SB lipomeningocele: lipoma is within or at the edge of the SC (other is outside SC).
Open neural tube defects
- involves the entire CNS
- neural tissue exposed w/ associated CSF leakage
- Skin covering not intact
- visible at birth
EX:
- SB meningocele: rarest form; spinal fluid and meninges protrude through an abnormal vertebral opening; contains no neural elements; usually no paralysis, but some babies experience complications (partial paralysis or bowel/bladder dysfunction
- SB myelomeningocele: most severe; abnormally developed SC tissue is exposed through opening in spine; no skin covering; almost always paralysis and sensation loss, decreased bowel/bladder fxn, hydrocephalus (can cause brain damage, blindness or seizures), orthopedic deformities, Type II chiari malformation (brain tissue extends into SC, may cause compression on SC and issues w/ feeding, swallowing, breathing, and weakness in UEs; may also see tethered SC with this one (sc will become damaged as a child grows d/t fixed placement; cog and learning issues d/t hydrocephalus, issues w/ memory, reasoning, math, handwriting, organization, problem solving, attention, SI, auditory processing, VP and sequencing; latex allergy is common; increased risk for pressure sores w/ wc use.
Presentations of ADHD
- predominantly inattentive
- predominantly hyperactive/impulsive
- Combined
** need 6 or more symptoms under these categories (either mostly in one or the other or in each)
Classroom strategies for ADHD
Seating:
- single or paired desk (no larger groups)
- student is put closest to the teacher to limit distraction
- near front of class to limit visual distraction
- sensory strategies (dynamic seating)
Classwork:
- rules and routines
- visual reminders
- frequent breaks
- prepare for transitions
- one assignment at a time
Managing behaviors for kiddos with ADHD
- fidgets (proactivity vs. reactivity)
- allow movement
- give wind-down” time between high/low energy tasks
- limit group work to prevent overstimulation
Accommodations for ADHD
- extended time
- HW reduced or differentiated
- breakdown large projects w/ separate due dates
- reducing writing
Teaching tips for children with down syndrome
- adapt cardio activities
- alternative communication
- avoid placing neck in extreme flexion
- discourage hyperflexible postures
- incorporate family
- visual demo’s/cues
- tactile demo’s/cues
- stimulate visual tracking/activity
- auditory cues
- encourage muscle strengthening around joints
Cerebral Palsy (3 types)
- Spastic
- Dyskinetic
- Ataxia
Spastic CP
- Most common
Cause: upper motor neuron disturbance (in the brain and brain stem)- often motor cortex
Types:
- Hemiplegia
- Diplegia
- Quadriplegia
Symptoms:
-positive babinski sign
- diplegia (legs affected more)
- Quadriplegia (all four limbs affected, along with muscles to mouth, tongue, and pharynx)
- Hemiplegia (one side of the body more affected, and arm more than leg)
KEY: Muscles STIFF and TIGHT
Dyskinetic CP
- 6% of CP cases
Cause: lower motor neuron disturbance (spinal cord to muscle fibers and tendons)- most often basal ganglia
2 types:
- Athetoid
- Dystonic
May present with one or more of the following:
1. Chorea: jerky, rapid movement that is random
2. Athetosis: writhing movement
3. Choreoathetosis: both writhing and jerky/rapid movement
4. Dystonia: postures are distorted, repetitive, and twisted
KEY: Involuntary movements
Ataxic CP
- 6% of CP cases
Cause: cerebellum disturbance
Symptoms:
- jerky and uncoordinated movements
- imbalanced position of trunk and limbs during voluntary movements
- difficulty timing movements
- may or may not have muscle tone
KEY: poor BALANCE and SHAKY MOVEMENT
Associated impairments w/ CP
-intellectual disability
- visual impairments
- hearing, speech, and language
- seizures (more likely in cases with severe intellectual and physical disability)
- feeding/growth problems (tonic bite reflex, hypotonia, poor swallow coordination, weak suck, hyperactive gag reflex, tongue thrust, GERD)
- osteopenia
OT intervention with CP
- NDT
- CIMT
- physical exercise
- orthotic devices (AFO to stabilize foot and stretch achilles, resting hand splint to prevent deformity and contractures)
- positioning and seating devices to prevent contractures and joint deformity
- serial casting to reduce tone or increase ROM is contracture is present
Adaptive equipment:
- lofstrand crutches
- walkers/posterior walkers
- WC
- supportive stroller
- car seat/car bed
Assistive Tech:
- computers
- augmentative communication devices
- artificial vision
- ipad with adapted apps
