Pediatric Practice Flashcards
OT Code of Ethics
- Beneficence (well-being of pt.)
- Nonmaleficence (do no harm)
- Autonomy (confidentiality)
- Justice (comply with laws)
- Veracity (exhibit truthfulness/accuracy)
- Fidelity (treat others with fairness/integrity)
Concerns of OT in pediatric practice
- Typical development in children
- Treating the child and family
- Pediatric diagnoses
- Practice models
- Assessments for children with disabilities
- Age-appropriate activities
- Practice settings
- Assistive Tech
Pediatric Areas of Focus
- Physical (Motor/Sensory)
- Emotional
- Social
- Environmental
- The Whole Child (include child’s family, etc.)
Areas of Pediatric Practice (settings)
- Clinics
- Schools
- Home
- Community Settings
Role of OTA in Screening/OT Process
- Collects evaluative data, observational data and client info.
- Can participate in screening
- May administer some screening tests such as WOLD and CHES (with service competency)
- Ideally, collaborates with OT for development of intervention plan
WOLD
Sentence copying test created by Bob Wold, an optometrist, in 1970. Timed test to evaluate speed/accuracy/handwriting when copying a sentence from top of page to lines on rest of page. Can observe posture, grasp, etc.
CHES
Children’s Handwriting Evaluation Scale. Manuscript (grade 1-2) or Cursive (grade 3-8) versions. Copy 2 sentences; checks speed, letter accuracy. To remediate handwriting problems and prevent further difficulties.
Levels of Performance
Functional Independence: completion of age-appropriate activities with/without use of assistive devices or human assistance.
Assisted Performance: Child requires some assistance to perform/participate in age-appropriate task.
Dependent Performance: Child unable to perform age-appropriate task; Caregiver gives max assist.
Tools for Pediatric Intervention
- Occupations (*Play)
- Purposeful activities (goal-directed; voluntary participation; meaningful)
- Activity Analysis (task-focused, child/family focused)
- Activity Synthesis (adaptation, gradation, configuration)
- Therapeutic Use of Self
“RUMBA”
What long-term goals should be: R=Relevant U=Understandable M=Measurable B=Behavioral A=Achievable
Reevaluation/Discontinuation process for pediatrics
- Clinic reevaluates according to billing guidelines
- Schools reevaluate every three years
- OTA contributes work samples, data, admin of assessments if competent; OT conducts reeval.
Assessment vs. Evaluation
Assessment is an actual/specific test, while Evaluation is a broader process.
Purpose of Assessments
- Determine eligibility for services
- Monitor progress (and for discharge)
- Make decisions regarding treatment intervention
Norm-Referenced vs. Criterion-Referenced
NORM=Compared to other children; Standardized (comparing/relating performance to others)
CRITERION=Based on task performance (actual correct answers important)
Purpose of Standardized Assessments
- Provide precise measurements of performance in specific areas
- Report performance as a standard score
- Composed of a fixed # of items
- Fixed protocol for administration
- Fixed guide for scoring
- Can administer these in un-standardized way (adjust to child’s need), but this MUST be reported in results! Means comparative data is not as precise.
Reliability vs. Validity in Standardized Assessments
Reliability = Consistency of scores overall
Validity = Test measures what it says it will (ie: is child’s score poorly reflected due to stress/time/fine motor?)
Screening Tools
(To determine need for services)
Ex:
• Denver Developmental Screening Test
• Developmental Indicators for Assessment of Learning
• First STEP (for evaluating Preschoolers)
• Miller Assessment for Preschoolers
Developmental Assessments
(To determine developmental disabilities)
Ex:
• PDMS II-Peabody Developmental Motor Scales
• Bayley Scales of Infant Development
• BOT-2-Bruininks-Osteretsky Test of Motor Proficiency 2
• HELP-Hawaii Early Learning Profile
• PEDI-Pediatric Evaluation of Disability Inventory
• School Function Assessment (*Very long! Takes hours.)
Handwriting Assessments
- CHES-Children’s Handwriting Evaluation Screening
- WOLD-Handwriting Test (from our lab)
- ETCH-Evaluation Tool of Children’s Handwriting (manuscript and/or cursive)
Visual Motor Tests
- TVPS-Test of Visual Perception Skills
- DVPT-Developmental Visual Perception Test
- Beery VMI-Beery-Buktenica Developmental Test of Visual Motor Integration, 5th ed.
Sensory Tests
- Sensory Profile
* Sensory Processing Measure
Advantages vs. Disadvantages of Standardized Testing
ADVANTAGES: Well-known tests; allow professionals to speak same language; monitor developmental progress; can be used to justify OT services
DISADVANTAGES: Tests performance components, rather than full occ performance; only brief picture of perf.; rigidity of testing procedures (may not work well for all kids)
Formal Interview Methods
(Standardized interview tools; structured “script” and goals; can use to measure progress later):
• Canadian Occupational Performance Measure (COPM)
• Pediatric Evaluation of Disability Inventory (PEDI)
• Sensory Profile
• Vineland Adaptive Behavioral Scales
ABA
Applied Behavioral Analysis
• Therapy for kids with special needs, esp. ASD.
• Repetition until generalization
• Positive reinforcement
• To improve communication, attention/academics, decrease problem behaviors
Interview Goals
- Gather medical info (history, services, reason for referall)
- Build rapport with child/family
- Learn family’s interests/values
- Identify goals, expectations
- Begin observation of child/interaction w/environment and family
- Clarify your role/services/skills
Medical Info to gather at Interview of child
- Complications during pregnancy/birth
- Developmental milestones (what age did they occur)
- Allergies
- Current meds
- Frequent ear infections/colds
- Recent hospitalizations
What to observe while child plays
- How long does child stay with one activity
- Choice of activities
- Social interactions
- Gross/fine motor skills
- Balance and posture
- Imagination/creativity
- Activity level; emotional expression
- Compare child’s performance to typical expectations for age
Levels of Assist
Dependent = needs A with >75% Max A = A with >50-75% Mod A = A with 25-50% Min A = A with up to 25% Independent = no A needed
Common Structured Observations
- Muscle Strength (MMT)
- Muscle Tone (response to passive mvmt)
- Supine Flexion (curling into ball residual reflex)
- Prone Extension (superman residual reflex)
- Co-contraction (shoulders/legs residual reflexes)
- Visual Pursuits (tracking with eyes, etc.)
Motor Coordination Observations
- Rapid alternating movements
- Thumb/finger touching (serial opposition)
- Imitation of postures
- Standing balance on one foot
- Hopping
- Skipping
- Running
- Jumping
Serial Opposition
Ability to touch thumb to all fingers.
Sequence of observing through intervention process
Observation > identify/monitor problem > adjust activity for needs/engagement/challenge > solve problem
Gross Motor Skills to Observe in Child
- Balance
- Gait
- Sitting/Prone
- Reaching while in different positions
- Playing in different positions
- Jumping, walking, crawling, climbing
Fine Motor Skills to Observe in Child
- Left/Right hand use
- Grasp/prehension patterns
- Developed (thumb opposition), or Gross (fisted hand)
Psychosocial Items to Observe in Child
- Attachment to parent (ventures from parent? Plays with parent?)
- Social play (play with others? Alone? Beside others?)
- Emotional expression (crying, laughing)
Language Items to Observe in Child
- What are verbal skills? (speak to anyone, only familiars?)
- Do they engage with language min/mod?
- Are they verbal, using language in appropriate manner?
- Using sign language?
- Is level of language use affecting behavior?
