Pediatrics Flashcards
Age of infants
0-12 months
age of toddlers
12-36 toddlers
age of early intervention
0-36 months
school intervention for those 18-21 years old
emphasis on transition planning, vocation, and ADL and IADL skills
What are the four stages of Piaget’s theory of development
- Sensory motor stage 0-2 years
- Preoperational stage 2-7 years
- Concrete operational stage 7-12 years
- Formal operational stage 13 years to adult
what are the 6 sub stages of the Sensorimotor stage
- 0-1 month simple reflex
- 1-4 months first habits and primary circulary reactions
- 4-8 months secondary circular reactions
- 8-12 months coordination of secondary circular reactoins
- 12-18 months tertiary circular reactions
- 18-24 months beginnings of thought
What are the 5 stages of Erikson’s Theory of Development
- Trust vs mistrust 0-18 months
- Autonomy vs shame and doubt 18 months - 3 years
- Initiative vs guilt 3-6 years
- industry vs inferiority 6-12 years
- identity vs confusion 13 years - adult
What does IDEA Part C cover
home, school, community, outpatient
What does IDEA part B cover
school, community, vocational settings
What are the key principles of IDEA in schools
- Collaborative
- Least restrictive environment
- free, appropriate public education (FAPE)
- Due process
Tier 1 in school system
high quality classroom instruction with support
Tier 2 in school system
Targeted support for identified students in smaller groups or part of whole classroom
Tier 3 in schools
intensive 1:1 or small group support for short periods for students who need assistance that would impact classroom activity
describe OT in community setting
- used for reintegration or participation with peers
- helpful for 0-3, prevocational, community access and driving
- good for learning in natural environment
what are chromosomal disorders
too few or too many chromosomes
what are autosomal disorders
fault in one of 22 autosomes
sex chromosome abnormalities
fault in sex chromosome
prenatal environment causes of nongenetic diorders
- intrauterine infection
- maternal exposure
- developmental trauma
perinatal environment and events causing nongenetic disorders
- birth trauma
- intracranial hemorrhage
- anoxia/asphyxia
postnatal events causing nongenetic disrders
- trauma
-disease
multifactorial causes of nongenetic disorders
interaction between multiple environments
common signs of ADHD
-difficulty paying and keeping attention
- difficulty listening
- avoid tasks requiring sustained attention
- excessive fidgeting and talking
communication challenges for those with ASD
- ranges from being nonverbal to speaking tangentially
- not picking up on social cues
- difficulty with prosody
- difficulty with pragmatics
prosody
varying pitch, emphasis, and rhythm
pragmatics
language in social settings
cognitive challenges with ASD
- decreased empathy or looking at other points of view
- acute sense of detail
- cognitive inflexibility
potential causes of behavioral issues
- developmental stage
- temperament
- environment
- unmet emotional needs
- to obtain or avoid something
what is important to distinguish between with hearing impairments
if its hearing loss or behavior difficulties
risks of hearing impairments
- prematurity
- delayed speech skills
- early infections
- head trauma
- neurodegenerative disorders
- craniofacial deformities
what is a common comorbidity with hearing impairements
vestibular dysfunction
visual impairments with difficulties caused by CNS
- fixation
- pursuits
- saccades
- accommodation
- convergence
- binocular vision
visual impairment with developmental vision
often linked with vestibular and balance issues
common postural and motor presentations with visual impairments
- hypotonia
- shoulder and pelvic instability
- head tilt
- hyperextended neck
- high guard posture when walking
3 factors leading to intellectual disability
- significantly impaired intellectual ability
- identification before 18 years
- impairment of adaptive abilities for IADLs
describe mild intellectual disability
- IQ 55-70
- 3-7th grade academic skills
- can work with min support
moderate intellectual disabilty
- IQ 40-55
- 2nd grade academic skills
- can perform unskilled and some skilled work
severe intellectual disability
- IQ 25-40
- can communicate and perform BADLs and health habits
- often requires support to complete routines
profound intellectual disability
- IQ <25
- Caregiver assist with basic tasks
- general neuromuscular, orthopedic or behavioral deficits
common causes of intellectual disabilities
- trauma, toxin, infection
- fetal development problems
- chromosomal disorders
- CNS malformations
What is the progression of types of play
- 0-2 years sensorimotor
- 2-4 years symbolic and simple constructive
- 4-7 years dramatic and complex constructive
- 7-12 years games
- 12-16 years recreation
sensorimotor play
objects for sensory experience- vision, mouth, touching, hearing, smell
symbolic and simple constructive play
- parallel and beginning to share
- symbolic play expressed in simple pretense and constructional use of materials
dramatic and complex constructive play
- cooperative play with purposeful use of materials for construction
- dramatization of reality
games play
- enhancement of constructional and sports skills as expressed in rule-bound behavior, competition and cooperative play
recreation play
team participation and independent action expressed in sports, interest groups and hobbies
solitary play
independent play, uninterested in what others are doing
parallel play
child plays separately from others but close to them and mimicking their actions
cooperative play
- child is interested in both people playing and the activity they are doing
- activity is organized and participants have roles
norm-referenced tests
- the average is derived from a large diverse population
- performance is compared with normal sample
criterion-referenced test
performance is compared with level of performance of a certain skill
what is CO-OP used for
child learning new motor skill or improving on one
what is a key component of COOP
the child is an active participant
child prerequisistes for COOP
- 3 skills that need to be learned or improved
- language fluency
- cognitive ability
- behavioral responsiveness
Problem-solving process for COOP
- discovery of problem
- investigation of the problem
- selection of alternative solutions
- attempt to solve the problem
- comparison of results of the solution
primary objectives of COOP
- skill aqusition
- cognitive strategy use
- generalization
- transfer of learning
passive inappropriate behaviors
noncompliance, withdrawal, avoidance, inattention, lack of response
active inappropriate behaviors
deirect refusal to engage, opposition, aggression toward people, SIB
Positive Behavioral Intervention and Support (PBIS)
- practical interventions aimed to reduce challenging behaviors while promoting development of socially important behaviors
describe functional behavioral analysis
used in schools to identify triggers and consequences of behaviors
5 step process of FBA
- team building and goal setting
- functional assessment of the behavior
- hypothesis development
- development of the comprehensive support plan
- implementation and outcome monitoring of the plan
what is food jagging
eating one food type, getting sick of it, then having trouble eating anything else
feeding habits of infants
bonding, warmth and comfort
feeding habits of 4-24 months
- independence develops
- finger feeding
- variety of foods
- communication
toddler feeding habits
- full participant in meal time
- feeding behaviors
Preparatory phase of eating
mastication, sealing lips
what is mastication
chewing
oral phase of eating
- tongue forms bolus
- tongue elevates causing bolus to begin flowing posteriorly
Pharyngeal phase of eating
- pressure of bolus against anterior facial arches triggers swallow
- velum protects nasal cavity
- bolus passes into esophagus
esophageal phase of eating
food is pushed to stomach
how should neck be positioned for swallowing
neutral or slight chin tuck
what skills should a full-term infant have for eating
- strong oral reflexes
- rooting
- gag and cough
biting and chewing progression
- 6 months = munching
- 8 months tongue transfers food to sides
- 12 months = rotary chewing
tongue progression for eating
-anterior and posterior movement (suckling)
- up and down movement (sucking)
- lateralization
progression of self-feeding
- take cereal from spoon
- suck on cracker
- finger feed
- dip spoon in food
- scoop food
- stab with fork
positioning adaptations for eating
- proximal support
- alignment
- stability at trunk
- midline orientation
- head and neck aligned or slightly flexed
sensory interventions for eating
- graded sensory exploration
- deep pressure
- calming strategies
- gradually thicken foods
oral activities
progression of food textures
- pureed
- course pureed
- wet-ground, mashed
- soft dissolvable
- chopped soft solid
- full diet
development of writing skills
-controlled scribbles
- simple patterns of discrete lines or dots
- straight-line or circular uppercase letters
- uppercase letters
- lowercase letters, numbers, and words
development of prewriting skills
- 10-12 months scribbles
- 2 years imitates horizontal, vertical and circular marks
- 3 years copies vertical and horizontal lines and circles
- 4-5 years copies cross, some letters and numbers , may write name
- 5-6 years copies triangle, prints name, copies lower nad uppercase letters
pencil grip progression
- whole-hand primitive grip
- transitional pencil grip
- mature pencil grip
describe a transitional pencil grip
flexed fingers, pronated forearm
what are the mature pencil grips
tripod, lateral tripod, quadripod, lateral quadripod
types of primitive graps patterns
- radial cross palmar
- palmar supinate grasp
- digital pronate grasp
- brush grasp
- grasp with extended fingers
types of transitional grasp patterns
- static quadrupod grasp
- cross thumb grasp
- static tripod grasp
Early indicators for intellectual disabilities
- delays in motor and speech
- reduced alertness
- unresponsiveness to handling
- feeding difficulties
common types of learning disabilities
-dyslexia
- dysgraphia
- dyscalculia
dyslexia
difficulties iwth reading
dysgraphia
difficulties with writing
dyscalculia
difficulties with math
anxiety impact on performance skills
- changes in energy
- feeling overwhelmed with time management
- adapting performance
- social interactions
impact of depression on function
-school and social dysfunction
- slow or increased psychomotor activity
- decreased concentration, problem solving, coping
impact of bipolar disorder on function
- suicidal thinking or behaviors
- intense emotional states affect school performance
- drastic mood and behavior changes
diagnosis of ODD
4+ of following criteria
- losing temper
- arguing with adults
- actively defies rules
0 blames others for mistakes
0 easily annoyed
- deliberately annoys people
describe congenital CP
result of injury or disease at or before birth
describe acquired CP
result from trauma, intracranial hemmorhage, CNS infection, near drowning or hypoxia
markers of CP
- retention of primitive reflexes
- abnormal muscle tone
- hyerresponsive tendon reflexes
- poor feeding or tongue control
- clonus or involuntary movements
what is clonus
involuntary and rhythmic muscle contractions
common comorbidities of CP
- strabismus
- nystagmus
- dysarthria
- aphasia
describe muscluar dystrophy
-progressive degeneration and weakness
- biomchemical and structural changes of internal membrans and muscle cells
describe limb girdle muscular dystrophy
- affects proximal muscles of pelvis and shoulder girdle
- onset withing 30 years
- slow progression
describe Fascioscapulohumeral muscular dystrophy
- affects face, upper arms, scapular region
- onset in adolescence
- sloped shoulders and limited ability to raise arms above head
- decreased mobility in facial muscles
Duchenne’s muscluar dystrophy
- enlarged muscles, difficulty going up and down stairs and getting up from lying down position
- most common and mostly in boys
- deficiency in production of dystrophin
- positive Gowers sign
what is a positive gowers sign
when getting up from floor, move hands up legs as if crawling up thighs to standing position
congenital muscular dystrophiy
- onset in utero or within 1 year
- brain involvement, hypotonia, generalized weakness
- may also have clubfoot, diaphragmatic involvement, heart and spinal defects
describe the 4 categories of congenital muscular dystrophy
- CMD I- no severe intellectual functioning difficulties
CMD II- muscle and brain abnormalities
CMD III and IV- muscle, brain and eye abnormalities
describe encephalocele
- protrusion in occipital region of brain
- severe deficits, cognitinve impairement, hydrocephalus, motor impairments, seizures
describe anencephaly
- decreased neural development above brain stem
- do not survive infancy
describe spina bifida
congenital defect of vertebral arches and spinal column
describe spinal bifida occulta
- 1 or 2 affected vertebrae, no spinal cord involvement
- may have no symptoms
describe meningocele spina bifida
extensive spinal openning with exposed pouch of cerebreospinal fluid and meninges
describe myelomeningocele spina bifida
- extensive spinal openning with exposed pouch of cerebrospinal fluid, meninges and nerve roots
- sensorimotor problems below level of lesion
proximal senses
- vestibular, tactile and proprioception
- affect early life
distal senses
- vision and hearing
- don’t impact until later childhood
describe sensory processing
- ability to take in sensory info, organize and interpret it, and have an appropriate response
adaptive response to sensory processing
seeking out sensory input they need
describe sensory modulation
- regulation of CNS through own activity
- over or underresponding to activity
Levels of autism
- Level 1- require support
- Level 2- requires substantial support
- Level 3 requires very substantial support
ideational praxis
identify motor goal and how to achieve
motor organization praxis
plan and organize actions in response to environment
feed-forward praxis
sending motor plan to brain, compairing to previous performance, detecting potential errors
execution praxis
performing response with precision
feedback processes praxis
recognition and response to a motor act and its consequences
neurodevelopment approach to handwriting
- modulate muscle tone
- promote proximal joint stability
-improve hand function
development of readiness skills for handwriting
- fine motor control and isolated finger movememnts
- pre-writing lines and shapes
- left- right discrimination
- print orientation
- letter discrimination
acquisitional approach to handwriting
- handwriting taugh directly in brief, daily sessions
- individualized to child
- adjust on basis of eval and performance data
sensorimotor approch to handwriting
- enhance integration of sensory systems
- various sensory experiences and instrucitonal materials
- multiple writing tools, surfaces, positions
biomechanical approach to handwriting
- ergonomic factors
- sitting posture, paper position, pencil grip
