Pediatric final Flashcards
Important oral structures in eating, feeding, and swallowing
oral cavity
pharynx
larynx
trachea
esophagus
Cranial nerves for eating, feeding, swallowing
CN V trigeminal: Sensory Innervation to the face
CN VII facial: Controls facial movement and expression
CN XII hypoglossal: Controls muscles that move the tongue
Stages of swallowing
-anticipation (see,smell,think about food and start salivating)
-oral preparatory (tongue collects food/liquid forms bolus)
-oral propulsion (propels bollus into pharynx)
-pharyngeal (throat stage: epiglottis flips down, vocal cords close trachea, pharynx muscles squeeze down)
-esophageal (esophagus squeezes food gradually down to stomach)
Bolus
ball of food/liquid/saliva
Describe the positioning considerations for feeding: safety and function
alignment 90-90-90
stability at the trunk
midline orientation
head and neck aligned with slight chin tuck
Oral sensory dysfunction
Not neuromuscular or structural
oral over-registration or defensiveness
oral hypo-registration or under registration
Which sensory system comes first when a child is eating
the visual system
most children eat with their eyes and nose first
What role do the gustatory and olfactory systems play in feeding
gustatory perceives flavor
olfactory perceives odors
smell is an internal smoke alarm, can trigger memory
-inhibits or facilitates taste
Role of the tactile system in feeding
playing with food
largest sensory system and very powerful
it protects (hot/cold) and discriminates (hard/soft)
Proprioceptive system in feeding
allows one to lift spoon to mouth without spilling
tells body how much and what kind of food is in the mouth
decreased awareness could lead to overstuffing, gagging, spitting, fear of how to chew and swallow
Interoception in feeding
sensations alert that internal balance is off
e.g.: feeling thirsty, feeling hungry, feeling full
What is a common jaw control technique when feeding
jaw, lips, tongue
provides jaw control and oral support
can be done from front or from side (arm around back of head)
What are some sensory based feeding approaches
SOS
Food chaining (taste, texture, temperature)
getting messy (playing with food)
oral motor strategies
What is the SOS sensory based feeding approach
Sequential Oral Sensory
tolerates
interacts with
smells
touch
taste
eating
What are some oral motor strategies for sensory based feeding approaches
licking
biting
What are some possible environmental adaptations for mealtime
regularly scheduled meals
shorter meal lengths
sensory stimulation and distractions
order of food presentation
Responsive feeding therapy (RFT) principles
autonomy
relationship
internal motivation
individualized
competence
interventions to improve self feeding
Develop interest
Gradually decrease amount of physical assistance
Create balance between effort and swallowing safety
Adaptive equipment
Backward chaining
Consistency in placement of food
Prepare child for self-feeding
Pediatric feeding disorder
IMPAIRED ORAL INTAKE THAT IS NOT AGE APPROPRIATE AND IS
ASSOCIATED WITH MEDICAL, NUTRITIONAL, FEEDING SKILL,
AND/OR PSYCHOSOCIAL DYSFUNCTION.
What are the four domains of PFD
medical
nutrition
feeding skill
psychological
PFD diagnostic criteria for the Medical domain
A disturbance in oral intake of nutrients,
inappropriate for age, lasting ≥2 weeks,
associated with ≥1 of :
Medical dysfunction
a. Cardiorespiratory compromise during oral feeding
b. Aspiration or recurrent aspiration pneumonitis
PFD diagnostic criteria for the nutritional domain
A disturbance in oral intake of nutrients,
inappropriate for age, lasting ≥2 weeks,
associated with ≥1 of :
Nutritional dysfunction
a. Malnutrition
b. Specific nutrient deficiency or significantly
restricted intake of ≥1 nutrient resulting from
decreased dietary diversity
c. Reliance on enteral feeds or oral supplements to
sustain nutrition and/or hydration
PFD diagnostic criteria in the feeding skill domain
A disturbance in oral intake of nutrients,
inappropriate for age, lasting ≥2 weeks,
associated with ≥1 of :
Feeding Skill dysfunction
a. Need for texture modification of liquid or food
b. Use of modified feeding position or equipment
c. Use of modified feeding strategies
PFD diagnostic criteria for the psychological domain
A disturbance in oral intake of nutrients,
inappropriate for age, lasting ≥2 weeks,
associated with ≥1 of :
Psychosocial dysfunction
a. Active or passive avoidance behaviors by child
when feeding/fed
b. Inappropriate caregiver management of child’s
feeding and/or nutrition needs
c. Disruption of social functioning within a feeding
context
d. Disruption of caregiver-child relationship
associated with feeding
What is the goal of sensory integration
to help children achieve functions through sensory experiences
What are the end products of a functioning sensory system
ability to concentrate
ability to organize
self-esteem
self-control
self-confidence
academic learning ability
capacity for abstract thought and reasoning
specialization of each side of the body and the brain
According to Ayres Sensory Integration what is the foundation for participation (bottom of pyramid)
Sensory integration: rapid and accurate registration, modulation, and discrimination/perception of sensory information
What are the neurological structures for senstation
spinal cord: basic pathways to transmit sensory information
brainstem: integration of sensory information
cerebellum: grading of the force and speed of movement
cerebral cortex: connects previous sensory experiences with current ones to allow engagement in tasks
Foundational sensory systems used in sensory integration therapy
Tactile (discriminative & protective touch)
Vestibular (static & dynamic)
Proprioception (conscious & unconscious)
SIPT
Sensory Integration and Praxis Test
Norm-referenced series of tests designed to measure the sensory integration processes that underlie learning and behavior among children 4 years through 8 years, 11 months
What are the guiding principles of the Ayres SI Intervention Methods
- follow typical development
-just right challenge - use sensory rich environments
-child directed but not child dictated
Sensory processing
the way the nervous system receives messages from the senses
Sensory Processing Disorder (SPD)
sensory information goes into the brain but does not get organized into appropriate responses
symptoms may results in motor, behavior, social, emotional, or attention problems
three categories of sensory processing disorder (SPD)
Sensory Modulation Disorder (SMD)
-SOR: sensory over-responsivity
-SUR: sensory under-responsivity
-SC: sensory craving
Sensory- Based Motor Disorder (SBMD)
-Dyspraxia
-Postural Disorder
Sensory Discrimination Disorder (SDD)
-visual, auditory, tactile, taste/smell, position/movement, interoception
What are the neurological thresholds in Winnie Dunn’s Sensory Processing Framework
Quick response- low threshold
(sensitization/high sensitivity)
Slow response- high threshold
(habituation/low sensitivity)
What is habituation in the Winnie Dunn model
extreme end of high threshold
recognizing that familiar stimuli do not require special attention
What is sensitization in the Winnie Dunn model
extreme end of low threshold
enhances an awareness of potentially important stimuli
What is modulation
ability to regulate and grade responses that are appropriate to sensory situation experienced in daily life
balance between habituation and sensitization
What are self regulatory behaviors and the two ends of the spectrum
The way people behave to manage their own needs
passive: let things happen and then respond
active: one works to control the amount of and type of sensory input
intervention for individuals with low registration
More/ much more: require aditional sensory information
less/ much less: prefer predictable activities or repetition
intervention for sensory seeking individuals
More/ much more: provide a variety of sensory experiences
less/ much less: activities that provide graded sensory experiences
Intervention for individuals with sensory sensitivity
more/ much more: relatively consistent and predictable environment
less/ much less: activities that provide additional variety to everyday events
intervention for sensation avoiding individuals
more/ much more: relatively consistent and predictable environment
less/ much less: activities that provide additional variety to everyday events
What are the skills needed in the educational readiness skills
Fine motor skills
visual motor skills
social skills
self-help skills
attention/self regulation
Fine motor skills involve:
reaching
grasping
manipulating objects
What are the norms for fine motor skills
0-3 months: bringing hands to mouth, swinging arms at toys, hands start to open more
3-6 months: reaches for toys with both arms, grasps small object, briefly holds rattle, holds hands in midline
6-9 months: brings toys to mouth, shakes rattle, uses raking grasp, transfers objects between hands
-12 months: releases object voluntarily, develops refined pincer grasp, bangs two toys together, points to objects, turns pages in book
12-18 months: claps hands together, waves bye bye, uses both hands to play, scribbles
18-24 months: build 3-4 block tower, stacks rings on ring stacker
2-3 years: uses digital pronate grasp>tripod grasp, stringing beads
3-5 years: scissor skills, button and unbutton, place small objects into container
timeline of grasping development
raking grasp: 4-6 months
radial digital grasp: 7-9 months
isolation of index finger: 8-10 months
fine pincer grasp: 10-12 months
tripod pencil grasp: 4-5 years
When does hand preference usually emerge
2 years but children often switch hand use up to 5 year
T/F : Crawling is essential in developing muscles and arches on the ulnar side.
True
T/F: Reaching and grasping objects is important for developing the muscles on the radial side of the hand.
true
Basic developmental progression of hand use
radial>ulnar
gross grasp>precision grasp
mass action > refined control of fingers
straight plane>rotation
When do children need to focus on “worker” hand and “helper” hand to foster consistent motor memory for paper/pencil skills and scissor use?
3-5 years
in-hand manipulation
Translation (moving object from fingers to palm or palm to fingers)
Shift (e.g shifting a pen to hold it closer to the tip)
Rotation (rotating an object along one or more axes - e.g. turning a screw top bottle)
What skills are important building blocks to develop pre-writing readiness?
hand and finger strength
crossing midline
pencil grasp
hand-eye coordination
bilateral coordination
upper body strength
object manipulation
visual perception
hand dominance
hand division (using thumb, index and middle finger together to manipulate objects)
What is the first writing stroke in pre writing skills
vertical line
What are the types of attention
focused attention
selective attention
shifting attention
sustained attention
divided attention
visual acuity
acuteness or clearness of vision, which is dependent on the sharpness of the retinal focus within the eye.
(Normal visual acuity is commonly referred to as 20/20 vision, tested on a Snellen chart.)
Visual perception
The total process responsible for the reception and interpretation of visual stimuli, allows us to accurately interpret and compare/contrast visual information
components of visual perception
visual discrimination
form constancy
visual memory
visual sequential memory
visual closure
visual spatial relationships
visual figure ground
visual discrimination
The ability to determine differences or similarities in objects based on size, color, shape, etc.
visual constancy
The ability to know that a form or shape is the same, even if it has been rotated, made smaller/larger, or looked at from up close or far away.
visual memory
The ability to recall visual traits of a form or object.
visual sequential memory
the ability to recall a sequence of objects or forms in the correct order
visual closure
the ability to recognize a form or object even when the whole picture of it isn’t available
visual spatial relationships
understanding the relationships of objects within the environment
figure ground
the ability to locate something in a cluttered or busy background
assessments for vision
Beery Test of Visual Motor Integration (VMI)
Motor Free Visual Perception
Test of Visual Perceptual Skills (TVPS)
What are the 3 main components of the Beery VMI
visual motor integration
visual perception
motor coordination
What are the perceptual areas of the TVPS-4
visual discrimination
visual memory
spatial relationships
form constancy
sequential memory
visual figure-ground
visual closure
what are the frames of reference for handwriting without tears
Acquisitional FoR : emphasizes learning/teaching process
Sensory and motor based approaches (biomechanical, sensory processing, motor learning)
M-FUN (The Miller Function & Participation Scales)
developmental tool using observation and demanded performance
child’s motor competency affects his/her ability to engage in home and school activities
What is the age range for the M-FUN
2.5 years - 7 years 11 months
what are the two domains of the M-FUN
performance assessment
participation assessment
executive funtioning
allows us to multi task, remember instructions / details, and come up with and carry out plans
causes of executive functioning delay
ADHD
Depression and anxiety
Bipolar disorder
Schizophrenia
OCD
Autism
TBI
Epilepsy (hemispherectomy)
executive functioning skills
planning
organization
self-control
task initiation
time management
metacognition
working memory
attention
flexibility
perseverance
Development of executive functioning
combines sensory cognitive, communication, and motor skils which children develop and utilize around school age
starts with baby’s response to caregivers, learning through repetition and games
important concepts of foundational theory
-motivation
-choice
-active involvement
-supportive environmental context
-scaffolding to attain “just right”
-self-discovery process
-learning continues through the lifetime
cognitive interventions
cognitive behavioral
video modeling
coaching
four quadrant model of facilitated learning
CO-OP approach
video modeling
applies cognitive theory to teach children with ASD and intellectual disabilities by providing a visual role model using technology
coaching
Based on child and adult cognitive and educational learning theory
Involves a reciprocal process and collaborative relationship between the individual and coach (facilitator)
Engages the child or youth to participate in a meaningful activity or occupation to the maximal extent possible by applying cognitive strategies
Guiding principles of coaching
Acknowledge prior knowledge
Offer choice
Involve in goal setting and collaborative planning
Promote active involvement and practice
Utilize scaffolding by an adult or competent peer to support performance
Observe performance and provide feedback
Involve in self-discovery/reflection
Encourage self-evaluation
Utilize resources and the environment to support participation
Four quadrant model of facilitated learning (4QM)
based on Vygotsky’s theory
employs teaching and learning as an intervention strategy to achieve occupational performance
More easily applied to perceptual motor activities like handwriting
key aspects of Four quadrant model of facilitated learning (4QM)
Considers the interact of the person, occupation, and environment
Student can do the task but lacks the ability to independently plan/perform/evaluate/adapt the task within a specific context
Learner’s needs change dynamically and require a changing level of support
CO-OP Approach (Cognitive orientation to daily occupational performance)
based on cognitive and behavioral psychology, health, human movement science, and occupational therapy
Emphasizes the interaction between individual and environmental factors to support participation in daily activities
Uses a top-down approach in context of daily activities and occupations
Key features of the Co-Op approach
goal
plan
do check
four enabling principles of the CO-OP approach
make it fun
promote learning
work toward independence
promote generalization/ transfer
guided discover in the CO-OP approach
one thing at a time
ask, don’t tell
coach, don’t adjust
make it obvious!
Hippotherapy
refers to how OT, PT, and SLP professionals use evidence-based practice and clinical reasoning in the purposeful manipulation of equine therapy tool to engage sensory, neuromotor and cognitive systems to promote functional outcomes
Why the horse?
horses emotional intelligence
multidimensional movement
horse’s rhythmic movement
movement can be manipulated
motor and sensory input
Hippotherapy vs. therapeutic riding
hippotherapy: purposeful manipulation of equine movement
therapeutic riding: correct riding position and utilization of reigns
positions for clients in hippotherapy
forward sitting
backward sitting
side sitting
prone over barrel
quadruped
types of holds for side walkers in hippotherapy
cuff hold: provides stability for foot/lower leg
heel hold: prevents foot from turning inward and provides support
thigh hold: provides more support and stability for client
pelvis hold: most support
Activities used during hippotherapy sessions
fine motor
gross motor
visual motor
Benefits of hippotherapy
increased strength, muscle coordination, sensory processing
increased motivation and participation in treatment
