Peds Lectures Flashcards
What is critical in establishing a primary attachment relationship with a caregiver and fostering feelings of security in the infant?
TACTILE sensations are critical in establishing a primary attachment relationship with a caregiver and fostering feelings of security in the infant
What systems/inputs set the stage for the eventual development of body schema?
Tactile and proprioceptive inputs set the stage for the eventual development of body schema
T/F: The vestibular system is fully functional at birth.
True.
T/F: At the end of the second year, beginning independence in self-feeding.
False. At the end of the FIRST year, beginning independence in self-feeding
When does Praxis and Ideation (ability to conceptualize what to do in a given situation) begin to develop?
Second year.
T/F: Child can connect several pretend actions in a play sequence; can also demonstrate they have a plan by the end of the third year.
False. Child can connect several pretend actions in a play sequence; can also demonstrate they have a plan by end of SECOND year.
Is it a sensory registration or modulation problem that interferes with child’s ability to attach meaning to an activity or situation because critical info is not being noticed?
Sensory REGISTRATION problem interferes with child’s ability to attach meaning to an activity or situation because critical info is not being noticed.
Sensory registration: refers to difficulties of a person who frequently does not notice or “register” relevant environmental stimuli.
Considered to be a problem of under-responsiveness or over responsiveness?
It is under-responsiveness or hypo-responsiveness.
Another name for hyper-responsiveness is…
Sensory defensiveness.
What is one of most common observed sensory modulation problems? Hint: Involves tendency to over-react to ordinary touch sensations.
Tactile Defensiveness.
What is haptic perception and when does it emerge?
Child’s interpretation of somatosensory info through active touch to understand object properties and characteristics (stereognosis?) Emerges at 6 months, matures at 5 or 6 years
What does this child have?
Form of over-responsiveness to vestibular sensations involving linear movement, overwhelmed by changes in head position and movement, especially when moving backward or upward through space, move slowly and carefully, may refuse to engage in gross motor activities, resist lifting feet off ground
Gravitational Insecurity
Brain’s process of giving meaning to sensory info such as facial expression is known as…
Sensory perception.
This refers to brain’s ability to distinguish between different sensory stimuli such as 2 points touched on skin simultaneously
Sensory discrimination.
T/F scores within one standard deviation from the mean are NOT significantly from average. There is no need for OT intervention
True
Who funds OT services ?
Regional centers, school districts, California children services (CCS), health insurance, dept of mental health, private pay
T/F: Discrimination or perception problems can occur in any sensory system-best detected by standardized tests
True
Medical necessity required for which funding sources?
Insurance, CCS, MediCal
Support access to related to educational curriculum environment required for which funding source?
School district
Supporting development and participation in natural environments for which funding source?
Regional center
PEO stands for
Person- environment- occupation (model of practice)
Mode of practice focuses on musculoskeletal system- strengthening, alignment/posture, positioning
Biomechanical
Mode of practice- goal directed movements, movement patterns+ environmental conditions+ goal; practice! Feedback!
Motor learning
Modes of practice- normalizing movement patterns, focus on postural control and motor coordination deficits, based on motor learning and dynamic systems theories
NDT
Made of practice- scaffolding, just right challenge, Vygotsky, Piaget, Gibson
Developmental
The muscles and joints inform the brain about the position of body parts is what system/input?
Proprioceptive.
Disorder- social and communication deficits, repetitive and restrictive behaviors; deficits in social-emotional reciprocity, nonverbal communication behaviors, insistence on sameness; symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
Autism spectrum disorder
What are the types of progression relating to the sequencing of grasp patterns?
- Ulnar fingers show activation before radial fingers and thumb
- Palmar grasp (proximal) patterns precede finger grasp (distal) patterns
- Extrinsic muscle activation dominates before intrinsic muscle activation
These are the types of vestibular-bilateral problems…
- Inefficient balance and equilibrium reactions, as well as poor bilateral coordination are likely to affect competence in performing activities such as bicycle riding, roller-skating, skiing, etc.
- Difficulty with bilateral coordination - cutting w/ scissors, buttoning a shirt, jumping jacks, etc
- Bilateral motor difficulties sometimes associated with delays in body midline skill development - hand preference, spontaneous crossing of midline, and R/L discrimination
By what age does the voluntary palmar grasp emerge?
Within the first 3 months
By what age is a child able to use the thumb and finger pad control for tiny and small objects?
Between 9-12 months
Mode of practice- Structure, reinforcement, learning, shaping, positive behavioral support
Behavioral
Mode of practice- top down approaches: increase child’s number of cognitive strategies, selection of strategies, use of strategies, evaluating effectiveness
Cognitive
Mode of practice - organizing sensory information for use
Sensory integration
Mode of practice- addressing skills impacting access and participation of social play, use of peer models, social skills training
Social participation
Mode of practice- environmental assessment and task demands, changes environment to better match child ability, often used in conjunction with remediation focused intervention
Adaptation/ compensatory
Mode of practice- cognitive-behavioral strategies, improve child’s ability to manage stress, typically used with children with social emotional difficulties
Coping
Mode of practice- reciprocal relationship between learner and coach, used in early childhood settings, often used with direct intervention
Coaching / consultation
T/F: Dyspraxia is the ability to conceptualize, plan, and execute a nonhabitual motor act is
False. This is praxis
Condition characterized by difficulty with motor planning that emerges in early childhood and cannot be explained by medical diagnosis, developmental disability, or environmental constraint
Dyspraxia
What grasp is used to control tools or other objects?
Power grasp
What grasp is used to carry objects such as a purse or briefcase?
Hook grasp
What grasp is used to hold a small ball?
Spherical grasp
Poor tactile perception in conjunction with signs of poor motor planning (difficulty relating bodies to physical objects in space, difficulty imitating actions of others, precision of movement poor, difficulties with oral praxis, affecting eating skills or speech articulation)
Somatodyspraxia
What grasp is used to hold a glass, cup, or can with a hand around the object?
Cylindrical grasp
What grasp is used to hold a disk such as a jar lid?
Disk grasp
What grasp is used to exert power on or with a small object?
Lateral Pinch/key grasp
What grasp is used to hold and handle small objects and precision tools such as a pencil?
Pincer grasp
What grasp is used to hold and manipulate a writing utensil or eating utensil?
Three-jaw chuck or tripod grasp
What grasp is used to prehend and hold tiny objects?
Tip pinch
Autism considerations
Visual learning/processing strength can use to compensate
Safety, awareness, elopement, self-injurious behaviors
Perseverations
Special diets
GI problems, picky eater
Sleep problems
Children with dyspraxia have problems with ideation. What is ideation?
Difficulty generating ideas of what to do in a novel situation
generating additional sensory input to compensate for weak processing in a particular sensory system
Adaptive Function.
Examples of seeking Proprioceptive input…
stomping, jumping, bumping - OT hypothesis: child is not aware of positions of body parts without intense proprioceptive stimulation - input provides enhanced feedback about dynamic changes in body position during action
Examples of Tactile seeking behavior…
touching things excessively - compensate for inadequate tactile info by increasing flow of tactile sensations into CNS
Examples of Vestibular seeking behavior…
intense swinging or spinning, and do not easily become dizzy
What are the five basic types of in hand manipulation skills?
- Finger-to-palm translation
- Palm-to-finger translation
- Shift
- Simple rotation
- Complex rotation
These are the 4 main categories for child with autism:
- Hypo-responsiveness
- Hyper-responsiveness
- Sensory interests, repetitions, and seeking
- Enhanced perception
Examples of sensory problems/solutions for kids with autism:
Proprioception seeking very common, Sensory-seeking serve arousal modulation functions . Difficulty with praxis cause repetitive behaviors because these are the only movement strategies available to child. OT needs to identify strategies in which they can receive high levels of stimulation without being socially disruptive
Therapeutic intervention - breaking down target skill into small tasks, providing rewards to reinforce desired behaviors, closely monitor through regular data collection
Applied behavioral analysis
Therapeutic intervention- addresses self-regulation, attention, communication, expression of feelings, and ideas ; context in play and intrinsic motivation; early intervention and intense intervention
Developmental, individual difference, relationship based. (DIR) floor time
3 types of Assessment of SI Functions:
- Interviews and Questionnaires
- Direct Observation
- Structured Clinical Observation
If a kid can’t hold the airplane position (everything extended, legs off floor) for more than 30 seconds, they have…
inefficient vestibular processing
Possible standardized tests for assessing SI problems are…
- Sensory Integration and Praxis Tests (SIPT) gold standard for comprehensive, in depth evaluation of SI
- Miller Function and Participation Scales - include test that challenge praxis, visual motor integration, figure ground perception, some vestibular functions
- BOT-2 measures fine and gross motor skills (like bilateral coordination)
What is the intention of SI?
Improve the efficiency with which the nervous system interprets and uses sensory information for functional use
Disorder- non -progressive abnormalities in the brain; has influence on other body functions, varies on location and degree if insult- occurs before, during, or after birth
Cerebral palsy
Types of cerebral palsy :
- Constant increased muscle tone,
- Writhing involuntary movements
- Lack stability and co -contraction
- Low tone, usually only seen in toddlers-/infants
- Spasticity
- Athetosis
- Ataxia
- Flaccidity
CP considerations
Cognitive functioning, spasticity, safety& postural support, maintain ROM
Disorder - specific mental and physical problems, low tone, hypermobile joints, oral motor problems, delays in all areas of function, mild - moderately low intellectual ability ranges
Down syndrome
What are the basic assumptions underlying SI intervention?
- SI can be used systematically to elicit an AR (adapted response)
- Registration of meaningful SI is necessary before an AR can be made
- An AR contributes to the development of SI
- Better organization of ARs enhances the child’s general behavioral organization
- More mature and complex patterns of behavior emerge from consolidation of simpler behaviors
- The more inner-directed a child’s activities are, the greater the potential for the activities to improve neural organization
Important things to know about application of SI Intervention:
SI is applied on an individual basis. Must foster the inner drive of the child. OT must create environments that continually evokes increasingly complex ARs from the child. Respect child’s needs while helping them successfully meet a challenge
Expected Outcomes of OT using SI Intervention:
- Increase frequency of adaptive responses
- Development of increasingly more complex adaptive responses
- Improvement in fine and gross motor skills
- Improvement in cognitive, language, and academic performance
- Increase in self-confidence and self esteem
- Enhanced occupational engagement and social participation
- Enhanced family life
Down syndrome considerations
At risk for dislocations, low frustration tolerance, be aware of health problems
Disorder - balance control issues, vision and perception, difficulty integrating proprioceptive or vestibular inputs, difficulty with intersensory organization
Developmental coordination disorder DCD
3 stages of development of motor control
- Cognitive stage - skill acquisition
- Associative stage- skill refinement
- Autonomous stage - performs functional movement
Body schema
Neural substrate of Body awareness, develop through sensory motor interaction, related to motor planning
Body awareness
Conscious awareness of location, position, and movement of body and external environment; visually discriminate and label body’s physical and motor dimensions
Body image
image of self as physical entity
Assessment of gross motor skills
BOT (4 1/2-14 1/2)
Peabody
Gross motor function measure (children with CP)
Alberta infant motor skills (birth to independent walking )
Test of infant motor performance (infant <4mo )
Bayley III scales of infant and toddler development: age range? Domains?
Age range: 1-42mo
Domains: cognitive, language. (Receptive, expressive), motor (fine, gross), social emotional/adaptive subtests
DayC-2
Age range?
Domains?
Developmental assessment of young children
Age range: birth-5:11
Domains : cognitive, communication, physical development, social- emotional development, adaptive behavior
Observation/caregiver interview
HELP
Age range?
Domains?
Hawaii early learning profile
Age range: 0-3yo HELP strands
3-6yo HELP for preschoolers
Domains: cognitive, language, gross motor, fine motor, social emotional, self-help
Intervention: constrain unaffected upper extremity which requires use of affected. UE
Used with massed practice. (4-6 hrs a day ) common use for children diagnosed with CP, TBI, CVA
Constraint induced movement therapy
Therapy - engages both limbs simultaneously to encourage limb coordination and movement
Bimanual training
Intervention- cognitive approach, client centered, primary purpose is skill acquisition, embedded in the context of activites, tasks, occupations in which the child is motivated to participate. Goal Plan. Do Check
Cognitive orientation to daily occupational performance. (CO -OP)
Progression of grasp development
Ulnar=> palmar=> radial
Palmar=> finger surface. => finger pad
Visual receptive functions
Visual fixation, visual pursuit, saccadic eye movements (scanning), acuity, Accomodation (focusing near/far), binocular fusion, stereopsis (perception of depth)
Visual cognitive functions
Visual attention- alertness, selective attention, visual vigilance, shared attention
Visual memory. - long and short tremor memory
Visual imagery- picture things in your minds eye
Type of visual discrimination - recognition of forms and objects as the same in various environments, positions and sizes
Form constancy
Type of visual discrimination- identification of forms or objects from incomplete presentations
Visual closure
Type of visual discrimination- differentiation between background and objects
Figure ground
Type of visual discrimination- spatial relationship of figures or objects to oneself or other forms or objects
Position in space
Type of visual discrimination- relative distance between objects, figures, or landmarks and oneself
Depth perception
Type of visual discrimination- determination of location of objects and settings and the route to the location
Topographic orientation
Visual perceptual assessments
Test of visual perceptual skills, sensory integration and praxis test, developmental test of visual perception, beery-Buktenica test of visual motor integration- subtest visual perception
Visual motor assessments
Sensory integration and praxis test, miller function and participation scales, beery
Six prerequisite skills to handwriting
Small muscle skill, eye-hand coordination, ability to hold tools,capacity to form basic strokes smoothly, letter perception, orientation to printed language
Pencil grasp progression
Cylindrical grasp=> digital grasp=> modified tripod grasp => tripod grasp
M-FUN
Age range?
Domains?
Miller function & participation scales
Age range: 2.6yrs-7.11yrs
Domains: visual motor, fine motor, gross motor
Act - provides rights to individuals with developmental disabilities and their families to services and supports they need to live like persons without disabilities
Lanterman Act
early intervention program in California
Early Start
Two administrative partners under early start
Department of Developmental Services (DDS)
California Department of Education (CDE)
Department of Developmental Services (DDS)
responsible for overall administration and supervision of all early intervention services under Part C
Contracts with Regional Centers to serve all children except those with solely low incidence disabilities
What is the “golden rule” for billing?
Bill for what you do and document what you do accurately
What is the Lanterman act?
With CA state budget changes, new laws affect regional centers ability to fund insurance co-payments when families use private health insurance. To receive reimbursement for co-payments from the regional center, the provider must become a vendor for -coy payments.
Purpose of documentation
- Communicate info about client from OT perspective
- Articulate rationale for OT services and how they relate to client outcomes (reflects OT’s clinical reasoning and professional judgment)
- Create chronological record of client status, OT services provided, client response to intervention, and client outcomes
T/F: Progress reports are referral sources and data gathered through evaluation/screening process in accordance with payer, facility, state, and/or federal guidelines.
FALSE. ASSESSMENTS are referral sources and data gathered through evaluation/screening process in accordance with payer, facility, state, and/or federal guidelines.
The main points to include in documenting progress reports
- Summary of services provided
- Summary of progress related to occupational performance and towards goals
- may/may not include new areas of concern
- may/may not include re-assessment data
- Goal achievement
- Recommendations
- New goals, new treatment plan
Core elements of a treatment Goal
- Functional
- Measurable outcome
- measurable time length for achievement
- assistance level
- related to funding source rational for services
ABCDE Goals
Actor: Who Behavior: will do what Condition: under what conditions Degree: how many times, frequency, assistance level Expected time: how long to reach goal
SOAP notes
S: Subjective comments by client/caregiver
O: Objective observations, data, facts. Just what you saw including assistance level needed
A: Assessment/Interpretations. Apply clinical reasoning; justify need for OT, goal progress, new goals
P: relate a Plan for goal achievements. Can make suggestions for tx
SMART?
S – SPECIFIC: what, why and how are you going to do it
M – MEASURABLE: evidence that the goal will be achieved ie data collection
A – ATTAINABLE: goal needs to be challenging but reachable
R – RELEVANT: goal should measure outcomes not activities
T – TIME BOUND: deadline that the goal needs to be achieved by
Format of goal writing…
By DATE, CHILD will demonstrate improved SKILL by being able to TASK with % Accuracy with WHAT ASSISTANCE as needed by measured by OT.
By December 2015, Phoebe will demonstrate improvement with bilateral coordination for reintegration into the classroom by being able to button four 1 inch buttons with 3 verbal and visual cues per button in 4 out of 5 times as measured by observation and charting/OT.
