Pediatrics

Question 1

_________ distress syndrome
This syndrome is common in preterm infants.
It is caused by a deficiency of surfactant, which is not produced until the 34th to 36th week of gestation.
It results in compromised oxygen absorption and carbon dioxide elimination.
Many infants recover after a few days of medical intervention; however, some develop chronic lung conditions.

Answer 1

Respiratory

Question 2

Asthma

The occupational therapy treatment implications are as follows:
Educate the client regarding the reduction of exposure to irritants.
Teach the client self-management strategies, including pacing and stress management.
Encourage structured peer-group activities to reduce the likelihood of social isolation.
Educate the client regarding breathing exercises, stretching, and controlled breathing to manage attacks.

Answer 2

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Question 3

The symptoms of ___ are as follows:
The blockage of the small intestine, resulting in abdominal distension (an early symptom found in infants)
Salty-tasting skin, the result of excessive sodium levels
Greasy, foul-smelling stools, which indicate pancreatic insufficiency and problems with vitamin malabsorption
Chronic pulmonary disease is the most serious complication of CF, and it is characterized by a chronic cough, wheezing, and lower respiratory infections.
CF may result in an enlarged right side of the heart, which could lead to heart failure.

Answer 3

CF

Question 4

CF

Occupational therapy treatment implications are as follows:
Educate the client about the disease’s progression.
Instruct the client and his or her family in energy conservation.
Teach techniques to promote efficient breathing.

Answer 4

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Question 5

Erythrocytosis is characterized by too many ___ blood cells and elevated levels of white blood cells; it is referred to as transient leukemia.
One in every 150 children with Down syndrome will experience transient leukemia.

Answer 5

red

Question 6

Hemophilia results in longer ________ time or bleeding episodes.
Signs of hemophilia include
Excessive bleeding
Excessive bruising
Spontaneous bleeding or bleeding without a known cause
Nosebleeds

Answer 6

bleeding

Question 7

Anemia is caused by _____ deficiency in the blood.
It is diagnosed through blood tests and is usually treated through diet (i.e., iron-rich foods).
Anemia may be symptomatic of other conditions, such as lead poisoning, vitamin deficiencies, leukemia, or sickle cell disease.

Answer 7

iron

Question 8

The types of fractures are as follows:
__________: The bone is broken straight through, and no bone fragments are connected to one another.
Comminuted: The bone is broken into many splintered pieces. Compound: The broken bone leads to an external wound at the site of the fracture, and bone often protrudes through the skin.
Epiphyseal: The break occurs between the shaft of the bone and the epiphysis; this type of fracture occurs only in pediatric clients.
Greenstick: The bone is partially broken and partially bent; this type of fracture occurs only in children and is frequently found in children with rickets.
Intrauterine: The bone is broken in utero.

Answer 8

Complete

Question 9

The following comorbidities commonly occur with CP:

Strabismus: eye alignment deviation

Nystagmus: a reflexive back-and-forth movement of the eyes when the head moves

_______: difficulty pronouncing or articulating words

________: associated with poor language development; functionally looks as though the person has difficulty comprehending the meaning of certain words

Answer 9

Dysarthria

Aphasia

Question 10

CP

Occupational therapy treatment implications are as follows:

Children with CP have differences with tone, motor planning, motor control, and coordination that must be taken into consideration in treatment.

Maintain AROM and PROM through stretching, exercise, and orthotics.

Use adaptive equipment and assistive technology to enhance participation and independence in education, play, leisure, and social activities.

Instruct the client in seating and positioning.

Constraint-induced movement therapy may be indicated.

A neurodevelopmental approach could be used for children who have tone issues, poor postural control, poor limb function, poor automatic reactions, or poor proximal stability. Neurodevelopmental preparatory activities would help mitigate the child’s underlying deficits, promote better hand control, and ultimately lead to better function.
Inhibition: Indicated for children with hypertonicity and active primitive reflexes; some examples include sustained pressure to the tendon, flow rocking, joint compression, and sustained weight bearing
Facilitation: Indicated for children with hypotonicity and poor balance reactions; some examples include light moving touch, fast vestibular input, active weight shifting, and quick movements.

Answer 10

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Question 11

Duchenne’s muscular dystrophy (DMD) is the most common form of muscular dystrophy, affecting only boys.

DMD is caused by a deficiency in the production of dystrophin; muscles degenerate without dystrophin.

Boys with DMD develop typically after birth and begin to demonstrate symptoms between ages 2 and 6.

Enlarged muscles and a positive Gower’s sign are present.
Gower’s sign: When asked to get up from sitting on the floor, the child will move the hands on the legs as though crawling up to the thighs and then assume a standing position.

Parents commonly report that children with DMD have difficulty going up and down the stairs and getting up from a lying-down position.

The condition progresses quickly, and children often need to use a wheelchair by age 9.

ADLs become increasingly difficult.

People with DMD typically die in or near their 20s as a result of respiratory problems or cardiovascular complications.

Answer 11

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Question 12

Duchenne’s muscular dystrophy (DMD)

Implications for occupational therapy intervention are as follows:

Maximize and prolong independence in mobility and ADLs as much as possible.

Prevent deformity.

Work on strength and ROM.

Provide psychosocial and vocational support.

Use adaptive equipment if needed.

Answer 12

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Question 13

Meningocele spina bifida involves an extensive spinal opening with an exposed pouch of cerebrospinal fluid and meninges.

Myclomeningocele is the most severe form of spina bifida. In addition to an extensive spinal opening with an exposed pouch of cerebrospinal fluid and meninges, the nerve roots are also exposed.
Children with myclomeningocele spina bifida usually display sensorimotor problems at or below the level of the lesion.
Lower extremity paralysis and loss of sensation is common.
Some children with this condition also have hip, spinal, or foot deformities.
Complications include hydrocephalus and Arnold–Chiari syndrome.

Answer 13

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Question 14

Self-care health care maintenance for children with spina bifida includes the following components:

5–9 years old: begin pressure checks to assess for skin breakdown; communicate with caregivers regarding injury, illness, or changes in body and bowel or bladder habits; keep track of crutches or wheelchair with reminders; perform self-catheterization at school; carry around list of doctors and phone numbers in case of emergency

Answer 14

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Question 15

Self-care health care maintenance for children with spina bifida includes the following components:

10–14 years old: begin to recognize when feeling poorly has to do with condition; name doctors; know medications and doses; keep track of crutches or wheelchair and directs other people in how to help; perform self-catheterization in community venues; take responsibility for health (e.g., know to drink water to avoid bladder infections, and does so)

Answer 15

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Question 16

Self-care health care maintenance for children with spina bifida includes the following components:

15–18 years old: take medication independently and understands side effects; know how to contact doctors and therapists; know how to get and pay for medical supplies and equipment; perform regular skin checks; manage weight; and maintain equipment

Answer 16

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Question 17

Spina Bifida

Implications for occupational therapy treatment are as follows:

Bowel and bladder programs may be indicated

Clients may have cognitive and learning issues.

The family and client should be educated on skin care, urology, and diet.

Assistive devices should be used for mobility.

Answer 17

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Question 18

Occupational therapy for TBI includes acute care, rehabilitation, and community reentry.

Acute care
Sensory stimulation can promote awareness.
ROM exercises can help maintain joint mobility.
Positioning can help prevent skin breakdown and promote distal function.
Splinting can help maximize hand function.

Answer 18

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Question 19

Occupational therapy for TBI includes acute care, rehabilitation, and community reentry.

Community reentry

Home and community visits to assess activity demands and to problem solve strategies on the basis of the client’s occupational performance in those settings

Home or school modifications and introduction of adaptive equipment

Collaboration with school personnel, family, and the rehabilitation team
Reducing the amount of written work
Providing notes before a lesson
Color-coding folders
Using picture schedules
Using daily checklists
Using peer models
Reducing classroom stimuli
Changing the student’s desk to another location
Analyzing tasks to examine when breakdown of skills happens

Answer 19

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Question 20

Levels of intellectual disabilities

____: IQ between 55 and 70; able to learn academic skills at the third- to seventh-grade level; able to work with minimal support

Moderate: IQ between 40 and 55; able to learn academic skills to at least the second-grade level; able to perform unskilled as well as some skilled work tasks

_______: IQ between 25 and 40; able to communicate and perform some basic ADLs and health habits; often requires support to complete routines

Profound: IQ below 25; requires caregiver assistance for basic tasks; also generally has neuromuscular, orthopedic, or behavioral deficits

Answer 20

Mild

Severe

Question 21

Intellectual Disabilities
Implications for occupational
therapy treatment

Early years: support to meet development milestones; enriching the environment; supporting parents

Answer 21

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Question 22

Intellectual Disabilities
Implications for occupational
therapy treatment

General adaptation of the environment

• Use of assistive technology with a specific strategy for implementation
• Switches or communication devices (e.g., Dynavox)
• Mobility devices such as scooters and walkers

Answer 22

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Question 23

Intellectual Disabilities
Implications for occupational
therapy treatment

Adolescence: supporting the development of vocational interests and skills, social skills, sex education, and community mobility skills

Answer 23

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Question 24

Intellectual Disabilities
Implications for occupational
therapy treatment

School age: supporting development of functional skills; collaboration with special educators and other related service personnel; acquisition of student role

Answer 24

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Question 25

ADHD

Implications for occupational therapy intervention are as follows:

Cognitive–behavioral therapy: challenging automatic thoughts, reducing cognitive distortions, challenging underlying beliefs and assumptions, making use of mental imagery, controlling recurrent thoughts, controlling behavior

Behavior modification

Educational interventions, including safety awareness
Social skills training

Modifying classroom environments, especially the organization of space and objects

Self-management techniques

Interventions to enhance sensory modulation and support organizational routines

Answer 25

Q

Question 26

The different types of learning disabilities are as follows:

Dyslexia: difficulty with ________
Dysgraphia: difficulty with ________
Dyscalculia: difficulty with ____

Answer 26

reading
writing
math

Question 27

Learning Disability

Implications for occupational therapy intervention are as follows:

Early childhood: sensory integration, play, socialization, and self-help

School age: sensory integration, perceptual–motor integration, writing skills

Early adolescence: independent living skills, social skills, and the development of compensatory and adaptive techniques

Answer 27

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Question 28

Developmental Coordination Disorder

Implications for occupational therapy treatment are as follows:

Emphasize improving occupational performance across contexts.

Implement modifications and accommodations for written language, including keyboarding.

Provide support in physical education.

Promote safe practice of motor skills.

Provide support for development of a good self-concept and self-esteem.

For some children, provide individual intervention so that they can master skills before being asked to perform them in front of a large group.

Perform assessment with the Cognitive Orientation to daily Occupational Performance (CO–OP; Polatajko et al., 2001).

• The CO–OP is a client-centered problem-solving approach.
• It is a way to coach the child through self-discovery and devise solutions for everyday life situations that are affected by motor performance.
• The CO–OP is characterized by a cooperative relationship between the occupational therapy practitioner and the child.
• The child helps to formulate and select goals and work on ways to generalize skills to other contexts.
• The outcome of the intervention is skill acquisition, generalization, transfer, and positive gains in self-efficacy and independent strategy development.

Answer 28

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Question 29

Visual Impairment

Implications for occupational therapy intervention are as follows:
In infancy, caregivers may need support to respond to their baby’s cues and to establish sleep routines, and the infant may not display typical attachment behaviors (such as imitating social smiles).
Play exploration may need to be supported to promote development in all areas.
Learning may not be affected because cognition may be intact; however, accommodations and modifications may need to be made to tasks and the environment.
The occupational therapy practitioner should do the following:
Provide opportunities for children to learn to use their other senses.
Use sensory integrative therapy.
Support social participation.
Support development of self-care skills.
Support development of tactile and proprioceptive abilities.
Improve fine motor manipulation skills.
Maximize functional use of vision.

Answer 29

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Question 30

Hearing Impairment

Implications for occupational therapy intervention are as follows:
Use sensory integrative therapy.
Support vestibular function.
Maximize use of residual hearing.
Encourage age-appropriate self-care skills.
Enhance fine motor coordination and skills.
Maximize oral–motor coordination.
Maximize visual processing, integration, and perception.
Encourage socialization and peer interaction.
Use backward chaining, in which the therapist performs the first several steps of the task and allows the child to complete the last step of the task.
Use forward chaining, in which the therapist encourages the child to complete the first step of the task, and they practice this step until it is mastered. In the meantime, the therapist completes the rest of the task.

Answer 30

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Question 31

Visual attention: alertness, _________ attention, visual vigilance, divided or shared attention

Visual memory: integrating visual information with ____ experiences

Answer 31

selective

past

Question 32

Visual imagery: the ability to _________ people, objects, or experiences

Visual discrimination: _________, matching, and categorization

Answer 32

imagine

recognition

Question 33

Spatial perception: position in space, _____ perception, topographic orientation

Answer 33

depth

Question 34

Object perception: form constancy, visual closure, visual–______ ground

Answer 34

figure

Question 35

Warren’s model for assessment (Case-Smith & O’Brien, 2010, pp. 377–378): a developmental framework for intervention that consists of a hierarchical model, with each skill building on the preceding skill.
Primary visual skills: oculomotor control, registration of the visual fields, and visual acuity
Visual attention
Scanning
Pattern recognition
Visual memory
Visual cognition

Answer 35

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Question 36

Visual-perceptual Impairments
Intervention strategies

Infants

• Dim lights
• Stimulation of other body senses to influence distance sense
• Emphasis on the human face
• Softer, simpler three-dimensional forms
• Mobiles hung 2 feet above the infant
• Toys that reflect light or flash with sound

Preschool and kindergarten students

• Multisensory approaches using different textures and media
• Activities that encourage body-in-space concepts
• Emphasis on imitation
• Shared storybook reading

Elementary school

• Organize the environment so that it is less visually distracting.
• Alternate positions for visual–perceptual activities.
• Modify work to enhance visual attention to attributes of the assignment (e.g., using bold lines to enhance page margins; reorganizing worksheets).
• Reduce other sensory input.
• Teach strategies, such as a routine for searching in “Where’s Waldo”–type activities, and scanning routines.
• Use chunking, maintenance rehearsal (repetition), and mnemonic devices.
• Use color coding.
• Use directional cues for writing.
• Use games to support visual spatial concepts.
• Use computers to support development of skills and as an accommodation.
• Identify learning styles (e.g., kinesthetic learners may benefit from games, such as bingo, dominoes, or card games, that allow them to move while reviewing skills

Answer 36

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Question 37

Development of prewriting and handwriting in young children

Age 10–12 months: ________ on paper.

Answer 37

Scribbles

Question 38

Development of prewriting and handwriting in young children

Ages 5–6 years: Copies a _______, prints own ______, copies most letters.

Answer 38

triangle

name

Question 39

Development of prewriting and handwriting in young children

Ages 4–5 years: Copies a _____, right oblique line, square, left ________ line, left oblique cross, some letters and numbers; possibly can print own name.

Answer 39

cross

diagonal

Question 40

Development of prewriting and handwriting in young children

Age 3 years: Copies a ________ line, horizontal line, and _______.

Answer 40

vertical

circle

Question 41

Development of prewriting and handwriting in young children

Age 2 years: Imitates horizontal, _______, and circular marks.

Answer 41

vertical

Question 42

Handwriting Readiness
Occupational therapy intervention to support the development of readiness skills

Activities incorporated into therapy sessions and into the child’s classroom

• Fine motor control
• Isolated finger movements
• Prewriting lines and shapes as mentioned earlier
• Left–right discrimination
• Print orientation
• Letter discrimination

Early exposure to technology for children with more significant cognitive or physical disabilities

Answer 42

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Question 43

Handwriting Interventions

Neurodevelopmental approach
This approach is ideal for children who have poor postural control, poor automatic reactions, and limited limb control; children with tone issues and poor proximal stability may also benefit.
The approach includes preparation activities for posture and the upper extremities.
Activities that modulate muscle tone
Activities that promote proximal joint stability
Activities that improve hand function

Answer 43

qAcquisitional approach
Handwriting should be taught directly.
Handwriting should be implemented in brief, daily lessons.
Handwriting instruction should be individualized to the child.
Handwriting instruction should be adjusted on the basis of evaluation and performance data.
Handwriting should be overlearned and used in a functional way.
The different phases of handwriting acquisition are as follows:
Cognitive phase: The child is beginning to understand the demands of handwriting and develop a cognitive strategy for the necessary motor movement.
Associative phase: The child continues to practice and begins to self-monitor; proprioceptive feedback and visual cues are essential at this phase.
Autonomous phase: The child can perform handwriting with minimal conscious attention.

Question 44

Handwriting Interventions
Neurodevelopmental approach

• This approach is ideal for children who have poor postural control, poor automatic reactions, and limited limb control; children with tone issues and poor proximal stability may also benefit.
• The approach includes preparation activities for posture and the upper extremities.
• –Activities that modulate muscle tone
• —Activities that promote proximal joint stability
• –Activities that improve hand function

Answer 44

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Question 45

Handwriting interventions
Acquisitional approach

• Handwriting should be taught directly.
• Handwriting should be implemented in brief, daily -lessons.
• Handwriting instruction should be individualized to the child.
• Handwriting instruction should be adjusted on the basis of evaluation and performance data.
• Handwriting should be overlearned and used in a functional way.
• The different phases of handwriting acquisition are as follows:
• –Cognitive phase: The child is beginning to understand the demands of handwriting and develop a cognitive strategy for the necessary motor movement.
• –Associative phase: The child continues to practice and begins to self-monitor; proprioceptive feedback and visual cues are essential at this phase.
• –Autonomous phase: The child can perform handwriting with minimal conscious attention.

Answer 45

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Question 46

Handwriting Interventions
Sensorimotor approach

• Multisensory input is provided to enhance the integration of the sensory systems at the subcortical level.
• Various sensory experiences, media, and novel instructional materials are incorporated.
• Multiple writing tools, writing surfaces, and positions for writing should be offered.

Answer 46

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Question 47

Handwriting Interventions
Biomechanical approach

Intervention is focused on the ergonomic factors that influence writing production.

• Sitting posture
• –Children should be seated with their feet on the floor, thus providing support for weight shifting and postural adjustments.
• –The table surface should be 2 inches above the flexed elbows when the child is seated in the chair; this position allows for motor synergy and symmetry.
• Paper position
• –The paper should be slanted on the desktop so that it is parallel to the forearm of the writing hand when the child’s forearm is resting on the desk.
• –Left-handed students with a supinated grip should have their papers slanted to the left.
• Pencil grip and adjustment of the writing tool
• –Adaptive equipment to support a functional grip includes pencil grips, triangular grips, moldable grips, wider-barreled pencils, and rubber-band slings.
• –A mature grip should be encouraged in young children; as early as second grade, changing a child’s pencil grip may be stressful.

-Paper modifications

Answer 47

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Question 48

Handwriting Interventions
Psychosocial approach

• Intervention is focused on improving self-control, coping skills, and social behaviors.
• Emphasis is placed on communicating the importance of good handwriting to the child.
• Opportunities to enhance self-confidence are provided.

Answer 48

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Question 49

______ defensiveness is an extreme reaction or overreaction to tactile input. Light touch may be particularly noxious. Children may be extrasensitive on their face, their abdomen, or the palmar surfaces of their hands.

Answer 49

Tactile

Question 50

Dressing Skills

Age 1: Assists with dressing by cooperating during the activity; pulls off shoes and removes socks.

Age 2: Able to doff coat after fasteners have been unfastened; removes shoes if not tied; begins to help with pulling down pants; can locate armholes in shirt.
Age 2½: Able to pull down pants with an elastic waistband; helps with putting on socks, coat, and shirt; able to unbutton large buttons.

Age 3: Able to don a pullover shirt with little assistance; able to put on own shoes (still needs help with tying); able to put on socks; able to zip zipper once it is engaged; able to button large buttons.
Age 3½: Can distinguish between front and back of clothing items; can manage snaps and hooks; can unzip zipper completely; can button buttons and begins to buckle buckles; can put on mittens; dresses with supervision.

Age 4: Removes pullover garment independently; can buckle buckles; can zip zipper completely; may lace shoes (but still need assistance for tying).
Age 4½: Able to weave belt through belt loops.

Age 5: Can tie and untie knots; can dress without supervision.

Age 6: Can tie bows; can manage fasteners in the back of garments.

Answer 50

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