Peds 2 exam

Question 1

Congenital Anomalies

What are the nine types of limb deficiencies

What are there definitions?

Answer 1

• Polydactyly- an excess of fingers or toes
• Syndactyly- webbing between the fingers or toes
• Bradydactyly- abnormal shortening of the digits
• Microdactyly & Macrodactyly- overgrowth or undergrowth of soft tissue or bone. Macro-large, Micro- small digits
• Amelia- complete absence of one or more limbs
• Phocomelia- fully or partially formed distal limbs with a lack of one or more segments of the proximal limb
• Paraxial deficiency- defect where part or all of the medial or lateral bone is missing
• Transverse hemimelia- failure to develop one or more limb segments across the central axis of the limb

Question 2

Client factors or performance skills affected by congenital abnormalities

Answer 2

• Specific and global functions, emotional, experience of self and time, temperament and personality. Pain, proprioception and sensation/sensory. Function of the joint- joint mobility, stability, muscle power, muscle tone, muscle endurance, motor reflexes, gait patterns, control of voluntary movement
Performance Skills
• Motor and praxis skills, sensory-perceptual skills

Question 3

Interventions and assesments used for congenital anomalies

Answer 3

Assessments
• ROM, alberta infant motor scales, toddler and infant motor evaluation, brunicks, fine motor task assessment
Interventions
• Education, devices, joint protection, sensory educations, mirror therapy, pain management, ADL training, scar management

Question 4

Asthma

Definition and symptoms

Answer 4

definition
A chronic lung disease characterized by inflammation of airways breathlessness and wheezing
symptoms
wheezing, chest tightness, breathlessness, ccoughing

Question 5

Client factors and performance skills affected by asthma

Answer 5

Client factors
• Energy drive, sleep, attention, perception, cardiovascular and respiratory system functions-pain
Performance areas
• motor skills-Endurance, paces process skills-attends, initiates, social interaction -produces speech asthma attack moves and walks

Question 6

Asthma interventions and assesments

Answer 6

Assessments
• COPD, child occupational self assessment, pediatric interest profile, perceived efficacy and goal setting systems, short child of occupational profile, school setting interview, preferences of activities of children
Interventions
• Education, role exploration, interest exploration, environmental modifications, school accommodations

Question 7

Respiratory disorder

definition and symptoms

Answer 7

Definition
• Respiratory distress due to lungs being underdeveloped, infants suffering from respiratory
Disorder
Symptoms
• Cynanosis, apnea, decreased urine output, grunting, nasal flaring, rapid breathing, shortness of breath and grunting while breathing

Question 8

Respiratory disorder

performance skills and client factors affected

Answer 8

client factors
cardiovascular and respiratory functions,
global mental functions-energy drive and sleep muscle functions-endurance tone
movement functions-pain
performance skills-motor-endurance, paces, moves, lifts, walks, and transports

Question 9

Respiratory disorder

assessments and interventions

Answer 9

Assessments
• Clinical observations, interviews, alberta infant motor scales and bayley scales of infant development
Interventions
• Infant positioning, environmental modifications, caregiver/staff education and coaching,

Question 10

Neonatal cardiac problems

Five different types definitions and symptoms of each?

Answer 10

Definition
• Atrial Septal Defect- ASD is a major congenital malformation that causes increased pulmonary blood flow. Blood flows from LA to RA
• Ventricular Septal Defect- Major congenital malformation that causes increased pulmonary blood flow. Blood flows from LV to RV
• Tetralogy of fallot- Defect of DECREASED pulmonary blood flow. Diagnosis based on same as ASD and VSD and also the presence of cyanosis
• Transposition of great vessels- Mixed pulmonary blood flow. the pulmonary artery leaves the LV and the aorta exits the RV with no communication between pulmonary and systemic circulations
• Dysrhythmias- Irregular cardiac rhythms

Symptoms
• Septal defect- tachycardia, poor exercise tolerance, small frame size, feeding problems, frequent respiratory or lung infection, swelling of legs, feet or stomach and stroke
• TOF- central cyanosis, clubbing of fingers or toes, feeding difficulties, failure to thrive and
dyspnea
• TGV- cyanosis, congestive heart failure and respiratory distress
• Dysrhythmia- fever, anxiety, anemia, pain and irritable

Question 11

neonatal cardiac problems

client factors and performance skills affected

Answer 11

client factors
global mental-energy drive and sleep cardiovascular and respiratory fuctions movement functions muscle functions-muscle endurance muscle power
performance skills pain vestibular auditory
motor skills-lifts, walks, transports, endurance pace move
social interaction

Question 12

neonatal cardiac problems

assesments and interventions

Answer 12

assesments
alberta infant motor scales, infant motor evaluation, battele developmental inventory, test of playfulness, toddler/infant sensory profile
interventions
• Suck-swallow-breath sequence. Positioning, edema management, sensory stimulation, auditory stimulation, bedside feeding, parent education

Question 13

Fetal alcohol

definitions and symptoms

Answer 13

Definition
a congenital syndrome caused by excessive consumption of alcohol by the mother during pregnancy, characterized by retardation of mental development and of physical growth, particularly of the skull and face of the infant.
symptoms
stunted growth(size height), distorted facial features,learning disabilities, flat midface, thin upper lip

Question 14

Fetal alcohol

client factors and performance skills affectes

Answer 14

client factors
mental functions specific and global-higher level cognitive,thought, attention, memory etc. sensory functions-auditory body structures-brain cns
peformance skills-social interaction-speaks fluents,questions, replies, discloses and processing skills-initiates, heeds, attends etc.

Question 15

Fetal alcohol

intervention and assesments

Answer 15

assesments
peabody, test of sensory function in infants, sensory integration and praxis test.
interventions
family and parent education, fine motor skills pre-writing, k’nex, cutting shapes, building blocks

Question 16

Identify areas of intervention in early intervention

Answer 16

• Play
• Motor performance- muscle tone, fine motor skills, bilateral manipulation, in-hand manipulation
• Sensory processing- Low registration, sensation seeking, sensation avoiding and sensory sensitivity
• Self-care/adaptive
• Adapted equipment and positioning

Question 17

Identify the basic properties of the law and how it affects OT practice

Answer 17

Therapist bills from the time spent in direct, face-face contact with the child, family or other caregiver. Billing for time spent in team meetings, on the phone with team members or family and other indirect activities may or may not be reimbursed. Subject to annual budget shortfalls. Paid through Medicaid or private insurance. Travel is not reimbursed. Therapy sessions in community settings are considered indirect service and may not be reimbursable.

Question 18

Explain the eligibility criteria

Answer 18

• Infants and toddlers who have established risk because of diagnosis are automatically eligible. Diagnoses associated with developmental delay such as CP, Down syndrome or spina bifida. Infants without a specific diagnosis who are suspected of having developmental delay are entitled to an evaluation
• Developmental areas that the team evaluated to determine eligibility are cognition, communication, motor, social-emotional and adaptive.

Question 19

Explain individualized family service plan

Answer 19

A map of the family’s services and informs anyone who will be working with the child and family which services will be provided, where they will be provided, who will provide them and outcomes. Reviewed every 6 months or more. Family meets with other team members at least once a year

Question 20

Define the Public Laws relevant to early intervention

Answer 20

• Part C of the individuals with disabilities education act (IDEA) (early intervention)- All children from birth through 2 years of age who have developmental delays are entitled to services. An entitlement program. 16 primary services, individualized family service plan, family-centered and occurs in natural settings
• Part B of IDEA (special education)- defines school programs for eligible students between 3-21 years of age, it is a mandated service. Discipline specific assessment, individualized education program, child-focused in practice, family focused in theory, service coordination recommended but not mandated and occurs in the home, center or school based

Question 21

chap 23 key terms: Definitions

Early Intervention
Part C IDEA
Family-Centered intervention
Coaching models
Natural environments

Answer 21

• Early Intervention- Services for children from birth to 3 years of age, who have an established risk, have a developmental delay or considered to be environmentally or biologically at risk. The goal is prevent or minimize the physical, cognitive, emotional and resource limitations of young children disadvantaged by biologic or environmental risk factors
• Part C of the individuals with disabilities education act (IDEA)- All children from birth through 2 years of age who have developmental delays are entitled to services
• Family-centered intervention- Family have control and make choices regarding the care their child receives; family and providers work together to ensure provision of optimal early intervention services
• Service coordination-
• Coaching models- supports the learner and the child to achieve outcomes through a process
• Natural environments- home or community-based settings (childcare center, playground, library, grocery stores or fast-food restaurants)

Question 22

What is Case Cody?

Answer 22

Cody is a 39 week post-conceptional age (GA) at 25 weeks by date (WBD), 24 weeks by examination (WBE) by spontaneous vaginal delivery (SVD) to a 19 year old now second pregnancy, 1 birth and 1 abortion (G2P1Ab1), venereal disease research laboratory (VDRL) mom with history of intravenous drug abuse (IVDA), smoked 1 packs per day (PPD), pregnancy-induce hypertension (PIH), preterm labor (PTL), prolonged premature rupture of membranes (PPROM), Appropriate for gestational age (AGA) at 545gm. Significant complications have included respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), pulmonary interstitial emphysema (PIE), apnea of prematurity (AOP), patient ductus arteriosus (PDA), hyperbilirubinemia, anemia, methicillin-resistant (MRSE) and CONS sepsis, medical necrotizing entercolitis (NEC), bilateral inguinal hernia (BIH), periventricular leukomalacia (PVL), retinopathy of prematurity (ROP) stage III oral-duodenal (OD)
HFOV- high-frequency oscillating ventilation
iNO-
SIMV for 8 days-
BiPAP for 14 days
NCPAP for 9 days- nasal continuous positive airway pressure
HFNC-
Fi02- fraction of inspired oxygen

Question 23

Identify general considerations for feeding in the NICU unit?

10 characteristics

Answer 23

• Coordination of suck and swallows with breathing- interventions include slow-flow nipples and pacing to force breaks for breathing
• Sucking pattern
• Movements of the jaw and tongue- dysfunctional feeding may occur due to abnormal movements
• Sucking bursts are initially continuous for 10 to 30 sucks with a smooth 1:1:1 suck-swallow-breath rhythm in which respiration appears continuous and uninterrupted
• Adequate postural control
• Calm environment
• Burping
• Endurance
• Jaw support
• Thickened formula for easier oral bolus control
• Risk of aspiration if the infant is not actively participating in the feed

Question 24

Distinguish between neonatal assessments

5 assesments

Answer 24

• Assessment of preterm infant behavior- Als- used for stable preterm infants and term infants
• Naturalistic observations of newborn behavior- for very fragile preterm and term infants
• Neonatal behavioral assessment scale- for term healthy infants
• Neurological assessment of the preterm and full term newborn- dubowitz—for infants who tolerate handling
• Neonatal neurobehavioral evaluations (NNE)-Morgan- has predictive indicator for muscle tone and motor responses

Question 25

Levels of care facilities

Answer 25

• Level I (basic) nursery- Manages uncomplicated pregnancies with expected normal deliveries and well infants
• Level II (specialty) nurseries- designed to care for newborn infants who require some additional medical management such as phototherapy for jaundice, intravenous antibiotics or tube feedings. A neonatologist is usually on staff, these units typically lack the equipment and additional expertise such as pediatric surgeon or cardiologist
• Level III (subspecialty) nurseries- have necessary equipment and trained personnel in the NICU and other hospital departments to care for all potential neonatal conditions and emergencies
• Level IV- unofficial classification used to designate NICUs that offer current rescue technologies, although some interventions used initially for rescue (ventilation) or inhaled nitric oxide have become a standard of care after continued proven success

Question 26

Identify ways to modify the environment to support the infant/ prevent positional deformities

6 ways

Answer 26

• NICU positioners include cloth, foam, water-based gel, bean bags and bendable rods
• Z-flo fluidized neonatal positioners- made of microspheres encased in polyurethane. This allows contoured support, adapt and accommodates NICU medical equipment’s, facilitates skin integrity by reducing body pressure point or friction

Question 27

Define the newborn states (sleep/arousal)

Answer 27

• Deep sleep (non-rapid eye movement (NREM)- slow states changes, regular breathing, startles with some delay and lowest oxygen consumption
• Light sleep (rapid eye movement (REM)- Low activity level, random movements and startles, respirations irregular and abdominal intermittent sucking movements, eyes closed, rapid eye movement, higher oxygen consumption
Awake States
• Drowsy or Semi-dozing- eyelids fluttering, eyes open or closed, mild startles, delayed response to sensory stimuli, fusing, more rapid and shallow breathing
• Quiet Alert- with bright look, focuses attention on source of stimulation, minimal motor activity, may have some delay in response, minimal motor activity
• Active Alert- eyes open, considerable motor activity, thrusting movement of extremities, spontaneous startles
• Crying- intense and difficult to disrupt with external stimuli. Respirations rapid, shallow and irregular

Question 28

Explain the synactive theory of development

Answer 28

Theory of understanding preterm behaviors and emerging capabilities of preterm infants to organize and control their behavior. Five interdependent subsystems include autonomic, motor, state, attention-interaction and self-regulation. Caregivers use the observations to modify the environment and facilitate the infant’s organization and well-being
- Forms the basis for individualized, developmentally appropriate, family-centered care

Question 29

Identify equipment used in the nursery

10 types what are they

Answer 29

Thermoregulation equipment
• Radiant warmer- open bed with overhead heat source. Used during medical workup of new admission of critically ill infants
• Incubator (isolette)- used to provide warmth, allows calories to be used for growth and healing
• Open crib- bassinet style bed, no external heat source, infant is dressed in clothes and swaddled
Oxygen therapy with assisted ventilation
• Bag and Mask ventilation- used for resuscitation of an infant at delivery, during acute deterioration or to increase oxygenation
• CPAP- endotracheal or nasopharyngeal tube provides positive pressure and is used to keep the alveoli and airways from collapsing in an infant with RDS, pulmonary edema or apnea
• Mechanical ventilation- controls or assists breathing
• ECMO- Life support system that uses a modified heart-lung byoass to provide nearly total lung rest and minimize barotrauma. It is a rescue technology.
Oxygen therapy without assisted ventilation
• High-flow nasal cannula- warmed and humidified oxygen or room air. Used to improve gas exchange or reduce work of breathing
• Nasal cannula- humidified oxygen delivered by flexible nasal cannula with small prongs that fit into the nares. Used for infants requiring supplemental oxygen without positive pressure support
• Oxygen hood- plastic hood with flow of warm humidified oxygen placed over the infant’s head and possibly upper trunk. Used for infants who are breathing independently but need a higher concentration of oxygen than 21% room air

Question 30

Explain how the extrauterine environment may stress the infant

5 characteristics

Answer 30

After birth, demands are suddenly made on the preterm newborn to breath, regulate body temperature, move against the effects of gravity, adjust to bright light and unmuffled noise, cope with invasive or painful procedures and endure frequent sleep disruption and deprivation. Infant is unable to adjust to and organize the overwhelming stimuli and demands of the environment.
Review table 22.2

Question 31

List general medical problems common to low birth weight or premie infants (respiratory, cardiac, temperature regulation, immature nervous system, risk for anoxia, possible positional deformities)

Answer 31

• Thermoregulation- Infants are predisposed to excessive heat loss and are vulnerable to cold stress from several causes such as thin skin, reduced insulating subcutaneous fat. Interventions include radiant warmers, incubators, humidity, pre-warming items that contact the baby, positioning aids, clothes and swaddling

Question 32

Identify birth weight classifications

Answer 32

• Average= 2500 grams (5.5 pounds) 1pound=450gm
• Low birth weight= 1500-2500 (3.3-5.5 pounds)
• Very low= 1000-1500 (2.2-3.3pounds)
• Extremely low- under 1000 (2.2)
• Appropriate for gestational age AGA 10% to 90% on growth chart
• Small for gestational age SGA= below 10%
• Large for gestational age LGA= above 90%

Question 33

Define gestational, post conceptual, chronologic and adjusted age

Answer 33

• Gestational age refers to the total number of weeks the infant was in utero before birth. Confirmed by date of last menstrual cycle or ultrasonography or physical exam of the infant
• Full term range is 37 or 38 to 42 weeks
• Pre-term is an infant born before 37 weeks, infant born btw 34-37 weeks is late-preterm
• Infant born after 42 weeks is post-term
• Post-conceptional age- refers to the infant’s age in relation to when conception occurred. Obtained by adding the weeks since birth to the infants gestational age. PCA is commonly used until 40-44 weeks
• Chronologic age refers to the infant’s actual age since birth
• Adjusted age- refers to how old the infant would be if born at term rather than prematurely

Question 34

key terms

• Preterm infants
• Neonatal intensive care unit
• Individualized development and supportive care
• Preterm infant neurobehavioral organization
• Synactive theory of development
• Neonatal medical complications
• Therapuetic positioning
• Nurtritive sucking
• Nonnurtrive sucking
• Cue-based feeding

Answer 34

• -Preterm infants- infants born prematurely
• -Neonatal intensive care unit- a complex and highly specialized hospital unit designed to care for infants who are born prematurely or care critically ill
• -Individualized developmental supportive care- Begins at birth rather than when the baby is medically stable. Support includes a protective and preventive component of care that is not inherent in the traditional rehab model. Protection from inappropriate sensory input is often more important that interventions or interactions.
• -Preterm infant neurobehavioral organization- autonomic, motor, state, attention-interaction, self-regulation
• -Synactive theory of development- refer to the bottom
• -Neonatal medical complications—respiratory distress syndrome, sleep apnea
• -Neuromotor and neurobehavioral development
• -Therapeutic positioning- simulates the flexed, contained, midline posture of the infant in utero
• -Nutritive sucking- bottle feeding, coordinated with breathing
• -Nonnutritive sucking- dry sucking such as on a fist or pacifier. Does not disrupt breathing
• -Cue-based feeding- based on active infant participation rather than caregiver manipulations, more positive outcomes. The infants feeding readiness, neurobehavioral organization and medical status are monitored prior to engaging the child in feeding

Question 35

Sequence of hand use

Answer 35

• 4 months-primitive squeeze, thumb adducted
• 5 months- palmar grasp
• 7 months- radial palmar (opposed grasp)
• 9 months- Radial digital, wrist extended
• 10 months - pincer grasp
• 12 months- fine pincer grasp

Question 36

Progression of grasp development

Answer 36

The part of the hand/fingers used in the grasping pattern: ulnar grasp to palmar grasp to radial grasp
The location of the object on the hand surface: palmar contact to finger surface contact to finger pad contact
The muscle activity used in grasp- use of long finger flexors to increasing control of intrinsic muscles with extrinsic muscles
Ability to stabilize the wrist in a slightly extended position is important for grasp patterns along with slight supination

Question 37

Types of grasp

Answer 37

• Napier proposed two basic terms to describe hand movements that include nonprehensile (involves pushing or lifting an object with the fingers or the entire hand) and prehensile (involve grasp of an object and may be subdivided according to the purpose of the grasp- precision or power) movements.
• Precision grasps- involves opposition of the thumb to fingertips (holds small objects)
• Power grasp involves the use of the entire hand (holds larger objects)
• Grasps with no thumb opposition include hook grasp, power grasp and lateral pinch, patterns that use thumb opposition include tip and palmar pinches
• Hook grasp- Used when strength of grasp must be maintained to carry objects
• Power grasp- Used to control tools or other objects, facilitate precision handling with this grasp, stabilizes with the ulnar, controls object with the radial
• Lateral pinch- used to exert power on or with a small object
• Two standard pinches include the pad-to-pad/two-point pinch/pincer grasp or the three-point pinch/three-jaw chuck grasp
• Tip pinch- opposition of the tip of the thumb and tip of the index finger. Used to obtain small objects
Types of palmar grasps
• Spherical grasp-Finger abduction and some degree of flexion at the MCP and IP joints. The hypothenar eminence lifts to assist the cupping of the hand for control of the object. This suggests the child’s ability to balance control intrinsic and extrinsic hand muscles
• Cylindrical grasp- the transverse arch is flattened to allow the fingers to hold against the object. The fingers are slightly abducted; IP and MCP joint flexion is graded according to the size of the object. When additional force is required more of the palmar surface of the hand contacts the object.
• Disk grasp- Incorporates finger abduction that is graded, hyperextension of the MCP joints and flexion of the IP joints. Only the pads of the fingers contact the object

Question 38

Components of the hand skill

Answer 38

Reach (12-22 weeks)

• Grasp
• Carry
• Voluntary release (9 months)- requires control of extensors
• In-hand manipulation (1-2 years)- Require ability to control the arches of the palm
• Bilateral hand use

Question 39

Neuromaturational Theory

Answer 39

Neuromaturational theory- The brainstem structures develop first as evidenced by reflexive responses of the newborn, which are controlled by neural pathways in the brainstem. Cortical structures appear to develop later as evidenced by the coordinated and planned actions of the child. Increase in control is not only due to development and myelination of the midbrain and cortical structures but also inhibition of brainstem control of movement.
• Movement progresses from primitive reflex patterns to voluntary and controlled movements. Motor reflexes provide the first methods of interaction with the environment. They subside as balance, postural reactions and voluntary motor control emerge
• Low-level skills are prerequisites for certain high level skills. Infants develop motor control in a cephalocaudal direction with head control maturing first followed by trunk control sufficient for independent sitting and finally pelvic control sufficient for standing and walking

Question 40

Treatment approaches
-systems approach
three characteristics
-Cognitive approach
three characteristics
-Coping model
-Social skills training

Answer 40

A systems approach
• Assessment and intervention strategies must recognize the inherent complexity of task performance. A picture of the ways performance components, environmental and task factors affect performance of the tasks the child wants to accomplish
• The focus of assessment and intervention is on the interaction of the person, environment and occupation
• The therapy process focuses on identification and change of child, task or environmental constraints that prevent the achievement of desired activity
• Therapist identifies playful activities that would motivate the child, are developmentally appropriate, match the child and family’s goal, provide a challenge to current skills levels and match an expected outcome
• Focus on changing environments and occupations, best accomplished in a natural or realistic environment
• Therapeutic effect and positive outcomes are determined by the child’s engagement in the activity, makes it meaningful
-Cognitive approaches
• Top down or occupation based approaches
• This model builds on bandura’s research. Supporting the importance of self-efficacy and establishing goals to motivate individual achievement
• Not suitable for individuals under 5 because of the emphasis on the development of metacognitive skills and knowledge
• Therapist does not give instructions, rather they use process questions. Uses a problem solving framework
• Focuses on occupations the child wishes to perform
• Plan for transfer and generalization of the strategies that the child has learned
-Adaptation and Compensation interventions- see above
-Psychosocial approaches
• Focus on the development of self, on family and peer relationships and on the aspects of the social and cultural environment that influence each of these
-Coping model
• Use of coping resources that enable the child to meet challenges posed by the environment. Improve ability to cope with stress.
• Internal coping resources include coping style, beliefs, values, physical and affective states and developmental skills
• External coping resources include human supports and materials and environmental supports
-Social skills training
• Interventions that develop positive coping strategies in children and adolescents with psychosocial dysfunctions can be essential for promoting the ability to participate in social interactions and relationships
• Outcome include improved self-esteem and confidence
• Improves self-esteem, positive affect, problem-solving and social behaviors
-Motor learning and skill acquisition- see above
-NDT- see above

Question 41

Learning and systems theory

Answer 41

Behavioral Theories
• Skinner emphasizes operant conditioning/learning. Stated that behavior is a result of the environmental control of the individual, culture and species. Reinforcement is used to modify behavior. Behavior is strengthened and maintained when it results in positive reinforcement, if absent and therefore is negative, positive behaviors may be extinguished.
• Shaping- involves breaking down a complex behavior into components and reinforcing each behavior individually and systemically until it approximates the desired behavior
• Incidental teaching- a play environment is created to stimulate the young child’s interest and curiosity. It is important that toys used be developmentally appropriate with both novel and familiar toys
• Pivotal response training- to teach children a set of pivotal behaviors believed to be central to learning. Outcome includes increase in motivation, attention, persistence to task, initiation of interaction and positive affect
Social Cognitive Theories
• Explains learning that occurs in social context
• Bandura- children can learn by observing behaviors
• Children learn indirectly by observing how their peers behaviors are rewarded or punished, therefore direct reinforcement is not always needed
The influence of motivation and self-efficacy- When children experience success in learning situations, they are more likely to seek out optimal challenges. Children who experience repeated failure begin to avoid challenges and are less likely to seek out new learning situations. Motivation to learn is developed through outcome expectancy and person goals and casual attributions. Self-efficacy beliefs contribute to motivation.
Dynamic systems theory – infants assemble motor skills for perceiving and acting. To develop motor skills, infants must perceive something in the environment that motivates them to act and use their perceptions to fine tune their environment

Question 42

Define the different developmental theories

Answer 42

Piaget and Cognitive Development-
• Concerned with adaptation of the individual in response to ongoing environmental experiences.
• Adaptation examined through a child’s relationship with human and nonhuman objects.
• Children are intrinsically motivated to learn, they act on rather than react to
• Use of schema to how they represented objects and events
• Cognition developed from simple-complex, concrete-abstract, personal-worldly concerns
Vygotsky and the zone of proximal development
• Social interaction has an influence on cognitive development
• Zone of proximal development- Range of tasks that are too difficult for the child to achieve alone but can achieve with guidance and assistance of adults or more skilled children
• Scaffolding involves adjusting the level of guidance to fit the child’s performance
• When the OT understands the zone of proximal development and scaffolding his learning, they can design an optimal activity to promote the child’s learning
Maslow and the hierarchy of basic needs
• Outlined a hierarchy of basic needs that is believed to follow a longitudinal sequence (refer to notes)
• Each of the needs serve as a motivator to achieve a higher level of human potential. Must satisfy their basic needs before they are motivated by or interested in other life goals

Question 43

Describe the importance of developmental theories in practice of pediatric OT

Answer 43

Developmental theories explain and describe the components of a person as they relate to occupational performance.
Developmental theories emphasize the maturation of the CNS as it interacts with the social and physical environment
Guides OT approaches utilized during the intervention process for successful outcomes

Question 44

Key terms
foundational theories
Who ICF
Risk and Resiliance
Developmental theories
learning and systems theory
motor development and skill aquisition
social skills training
Neurodevelopmental theory
social integration theory
Dynamic systems theory

Answer 44

• -Foundational theories- These are theories that have formed the basis for theories and approaches to guide OT interventions and methods
• -Risk and Resilience- Resilience is defined as the characteristic of an individual who achieves a positive outcome in the context of risk or factors known to be associated with negative outcomes. Resilience is a dynamic process that is refined over time through ongoing transactions between a child and the environment. Risk factors for children include socioeconomic disadvantage, negative parental relationships, parental mental or physical illness and the lack of extended family support. Child protective factors include strong self-esteem, positive communication skills, positive outcomes include intelligence, emotion regulation, temperament, coping strategies and attention
• -WHO-ICF- The ICF views human functioning at 3 levels that include the body (structure + function), person (activities) and society (participation). Environmental factors can have an influence on health and functioning. ICF model- functioning, disability, and health depict the dynamic interaction between the person and their environment at all levels of functioning.
• -Developmental theories- Explain and describe the components of a person as they relate to occupational performance
• -Learning and systems theories- Theories that integrate concepts about people, their environments and their occupations. The primary process that results in developmental change is learning. Developmental theories emphasize maturation of the CNS as it interacts with the social and physical environment. Learning is the acquisition of knowledge, skills and occupations through experience that leads to permanent change in behavior and performance.
• -Dynamic systems theory- An ecological approach that insists that the motor system is self-organizing. Learning does not occur just in the brain and that the body and environment are all constantly changing and simultaneously influencing each other. Behavior such as motor skills are not predetermined in the CNS, motor behavior is an interaction is emerging from the dynamic cooperation of the many subsystems in a task-specific context
• -Adaptation approaches- Adapting the demands of the task or modifying the environment so that they are congruent with the child’s ability level. Adaptations involve modifying the occupation so that it is easier to perform using AT devices or changing the physical or social environment
• -Social skills training- Interventions that develop positive coping strategies in children and adolescents with psychosocial dysfunctions to facilitate occupational performance such as social interactions and relationships. Results offer support for social skills interventions in improving self-esteem, positive affect, problem-solving and social behaviors with individuals with depression, schizo, autism and TBI.
• -Motor Learning and Skill Acquisition- Helping achieve goal-directed functional actions involved in movement and balance. It is an occupation-based approach.
• -Neurodevelopmental theory- Focuses on problems with postural control and motor coordination. Facilitate postural control and movement synergies to inhibit or constrain motor patterns. Focuses on changing movement patterns to achieve the most energy-efficient performance for the individual in the context of age-appropriate tasks.
• -Sensory integrations- Seeks to provide the child with enhanced opportunity for controlled sensory input with a particular emphasis on vestibular, proprioceptive and tactile input in the context of meaningful activity. This intervention facilitates adaptive responses.

Question 45

Define Family centered care?

Answer 45

The family is involved in decisions and care concerning the child. Trust is developed and mutual respect. Family centered care increases parent satisfaction, enhances child psychological adjustment.