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Spring 2024 > Peds Midterm > Flashcards

Peds Midterm Flashcards

Foundations for Pediatrics/ Neonate/Infant and Toddler

1
Q

OT practice settings with children and youth

A

In-patient
out-patient
NICU
Early Intervention
School System
Community-based

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2
Q

OT process in pediatrics

A

Evaluation
Intervention
Outcome Measure

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3
Q

What are the components of the evaluation?

A

Occupational profile (informal interview and observation)
Assessment of performance and contexts (formal , focused, structured)
occupational analysis

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4
Q

What are the phases of intervention?

A

intervention plan
intervention implementation
intervention review

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5
Q

How is the intervention plan developed?

A

-objective, measurable occupation based goals
-OT intervention approach (create/promote, establish/restore, maintain, modify, prevent)
-service delivery methods and approaches

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6
Q

What needs to be contemplated during the intervention plan?

A

contemplate the “potential” discharge needs and plans

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7
Q

What 3 things are needed during intervention implementation?

A

-intervention that enhances occupational performance utilizes meaningful activity/occupation as a means and an ends
-intervention should consider generalization of skills across environments to increase participation
-intervention needs to monitor the clients response (ongoing eval and re eval)

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8
Q

How can engagement be optimized?

A

-meaningful / occupation based activities
- apply JUST RIGHT challenge
-consider adequate, appropriate reinforcement for repeated practice (it has to be fun/ entertaining)

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9
Q

How can occupational performance be enhanced

A

-consider AT
-consider modifying environment

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10
Q

how can occupational participation be increased?

A

-consider multiple natural environments and context
-consider what is most meaningful to the child (if they dont care they wont do it)
-provide educational/ consultative/ advocacy at various levels (INCLUSION: client, fam, community, systems)

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11
Q

When should outcome measurements be selected?

A

Early in the OT process

measure progress and adjust goals and interventions

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12
Q

What are the two most important variables for promoting child development?

A

sensitivity and responsively to the child’s needs

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13
Q

What is the family centered approach?

A

family involvement and family decision making during the eval, intervention, and outcome measurements (caregver is child’s proxy)

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14
Q

When is the family centered approach best practice?

A

birth to 5 years

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15
Q

what is the family system composed of?

A

individuals who are interdependent and have reciprocal influences on each other’s occupations

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16
Q

What are 3 complementary models of the family centered practice

A

family support, direct services, family collaboration education

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17
Q

What is the client centered approach?

A

emohasizes child or youth involvement in the OT process with family guidance

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18
Q

When is the client centered apprach best practice?

A

youth to 21 years

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19
Q

What do the family centered and client centered approach have in common?

A

they both emphasize child and family strengths

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20
Q

Aspects of OT practice in peds

A

client-centered
family based
strengths based
integrated and inclusive services
natural environments
culturally competent
evidence based
service delivery (direct, indirect, consult)

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21
Q

What is the primary occupation of children?

A

play- its how they learn

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22
Q

what are co-occupations?

A

anything that involves another person

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23
Q

How can we check in on parents of children with special needs?

A

how are they managing stress, are they taking time for themselves

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24
Q

T/F: In the first 3 years of life , the emphasis of family centered services is written out in Part C of IDEA which requires providers to meet with the parents to develop a family directed IFSP regarding the resources that the family needs to promote the childs optimal development

A

TRUE

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25
Q

T/F: School age children with disabilities are required to have an IEP, OTs provide services as determined by the OT and outlined in the IEP

A

TRUE
parents have final say

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26
Q

T/F: As the therapist we are required to seek input and permission of parents/guardians during assessments, intervention plan and decision making

A

TRUE

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27
Q

What are the four components of therapeutic use of self?

A

style, body language, professionalism, communication
or
appearance, communication style, documentation, teamwork

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28
Q

What does theory provide guidance for?

A

therapeutic reasoning and clinical decision making in OT practice with children and youth

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29
Q

T/F: Occupation-based models may be applied independently or with select frame of references depending on the child’s needs and desired outcomes

A

TRUE

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30
Q

Theory by Lev Vygotsky

A

“reciprocal teaching” Sociocultural theory

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31
Q

Key points of the sociocultural theory

A

zone of proximal development
scaffolding

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32
Q

benefits of sociocultural theory

A

Opportunities for children to learn from more skilled partner

Development varies across cultural and social contexts: cognitive functions are affected by beliefs, values, & tools of intellectual adaptation of an environment

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33
Q

zone of proximal development

A

what a learner can do w/o help & what they can achieve w/ guidance & encouragement

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34
Q

scaffolding

A

supportive activities provided by more skilled partner

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35
Q

Piaget’s stages of cognitive development

A

sensorimotor, pre-operational, concrete operational, formal operational

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36
Q

Just right challenge

A

capacity to build new skills & abilities while adjusting for current level of function of the child

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37
Q

Characteristics of the just right challenge

A

-Learning occurs when child successfully accomplishes a challenge
-sensory discrimination
-sensory modulation

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38
Q

sensory discrimination

A

tactile, vestibular, auditory, proprioceptive, visual

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39
Q

sensory modulation

A

postural-occular control, praxis, bilateral integration, sequencing

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40
Q

Dynamic systems perspective

A

considers multiple factors that impact development (internal/external)

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41
Q

T/F: dynamic systems perspective is the foundation of motor control/motor learning theory

A

TRUE

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42
Q

Components of the AOTA Code of Ethics

A

beneficence
nonmaleficence
autonomy
justice
veracity
fidelity

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43
Q

Intentional relationship model

A

created to better understand OTs therapeutic use of self

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44
Q

3 strategies to develop therapeutic use of self

A

-Self awareness
-self reflection
-self care/mindfulness

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45
Q

6 modes of IRM

A

-encouraging
-collaborating
-problem-solving
-instructing
-empathizing
-advocating

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46
Q

psychometric properties of standardized assessment tools

A

validity
reliability
internal consistency
sensitivity
specificity
ability to detect change

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47
Q

types of standardized tests

A

norm referenced
criterion referenced

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48
Q

norm referenced

A

compares performance of an individual to others of a normative sample

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49
Q

criterion referenced

A

compares performance of an individual to a specific criterion or skill

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50
Q

Characteristics of criterion referenced

A

-determines level of mastery of skill
- does not compare the child to a normative sample of peers
-may or may not have a standardized protocol for administration and scoring
-may evaluate one or more area of function

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51
Q

types or assessments

A

-occupational performance measure/skill-based/ contextual
- norm-referenced, standardized
-criterion-referenced, standardized
-norm-referenced &criterion-referenced, standardized
-criterion-referenced, non standardized
-observational/interview/ semi-structured interview
-self-report measure
-ipsative measure (tracks progress over time)
-informal checklist

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52
Q

raw score

A

single score derived from the test

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53
Q

standard scores

A

how many SD a data point is above or below the population standard- helps understand where the child falls compared to other children

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54
Q

scaled scores

A

total number of correct questions (raw score) converted into standardized scale

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55
Q

percentiles

A

how child rates based on percentage

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56
Q

age equivalent scores

A

what age that child should be presenting a skill (P-body)

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57
Q

standard error of measurement

A

as reliability increases , SEM decreases

-estimate of the amount of error inherent in a child’s obtained score

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58
Q

confidence levels

A

probability of consistent scores

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59
Q

How many standardized assessments should you use for reimbursement in eval

A

at least one

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60
Q

Pros of standardized assessments

A

Provide standard score and percentiles that may be used for:

-Determining eligibility for services

-Demonstrating outcomes of intervention for reimbursement

Readily available and accepted

Understood and used by interdisciplinary professionalS

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61
Q

cons of standardized assessments

A

Cannot be used in isolation to determine a child’s performance

Provide information about a “snap-shot” or moment in time

May not reflect the child’s ability in a natural setting since the testing environment is contrived

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62
Q

what is the ADOS-2

A

an activity-based assessment administered by trained clinicians to evaluate communication skills, social interaction, and imaginative use of materials

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63
Q

Assessment for Occupational Adaptation model?

A

OA assessment

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64
Q

Assessments for MOHO

A

Pediatric volitional questionnaire

Pediatric interest profiles

Child occupational self-assessment (COSA)

School setting interview

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65
Q

Assessment for Ecological Model of Occupation

A

Home observation for measurement of the environment (HOME)

66
Q

Assessment of CMOP-E + PEO/ other models

A

COPM

67
Q

Purpose of sensory integration

A

Promotes optimal sensory experiences that invite action and active participation, influence growth, and development of the nervous system, and leads to adequate behavior adaptation

68
Q

Ecological theory:

A

development based on child and environmental factors and their interaction

69
Q

Which approach is best practice?

A

Top-Down, starting with an occupational profile

70
Q

Characteristics of top-down approach

A

Applies occupation-based assessments/intervention that target: occupational particiaption & environmental adaptation to improve particiaption and QOL

Focuses on ICF levels of activity participation and environmental factors

71
Q

Characteristics of a bottom-up approach

A

-applies assessments/intervention that target underlying: Client factors, performance patterns, and performance skills to improve or gain new skills

-Focuses on ICF level of body function and body structures

-Skills that are improved or gained must generalize to an activity/occupation in a natural setting

72
Q

Frames of Reference for Pediatric OT

A

-developmental
-Acquisitional (behavior based)
- coaching (primary method in early intervention)
-motor control/ motor planning
-neurodevelopmental (NDT)
- biomechanical
-Sensory integration
-behavioral
-visual perception
-cognitive
-social participation

73
Q

What are two types of theories that can guide practice in the NICU

A

Ecological Models (consider role of environment in occupational performance)
Occupational Models ( intervention helps clients adapt to challenges and barriers)

74
Q

When does regular therapy begin int he NICU?

A

~30 weeks GA

75
Q

When does OT typically see infants

A

clustered care times

Not waking the babies up for therapy
e.g. every 3 hours

76
Q

Frequency of treatment in the NICU

A

2-3 x/ week x LOS

77
Q

common diagnoses in the NICU

A

prematurity
IUDE/NAS (exposed to drugs in utero)
RDS
Hypoglycemia
IUGR (growth restriction)
cardiac anomalies
genetic conditions (single genes or chromosomes)
IVH grade I-IV
HIE
Hydrocephalus
Gastroschisis
Spina Bifida
Arthrogyposis
various GI anomalies

78
Q

IUDE/NAS

A

exposed to drugs in utero

most common rn is meth/fentynol

79
Q

IUGR

A

growth restriction

can prevent organs from growing–>multi organ failure

80
Q

cardiac anomalies

A

PDA/ cardiac defects

81
Q

Genetic conditions

A

single gene: sickle cell anemia
chromosome: downs syndrome

82
Q

IVH grade I-IV

A

inter ventricular hemorrhage

no lifting from ankles to change

83
Q

Hydrocephalus

A

too much CSF on the ventricles in brain

reservoir for CSF then doctor will drain

84
Q

Gastroschisis

A

intestines born outside of the body
put organs in a silo
1-3 weeks for reductionp

85
Q

Spina bifida

A

where some of the spine is not enclosed
contractures and positioning

86
Q

arthrogryposis

A

number of conditions that affect the joints

87
Q

What is OT role in the NICU

A

Monitor, support, and optimizes development

Prevent adverse outcomes neuro development

For families: education, promote particiaption, facilitate bonding, psychosocial support

88
Q

What are the neuromotor difference between preterm and full term?

A

predominance of extensor tone (norm is flexion)

effect of gravity during development are exaggerated

89
Q

Synactive theory

A

goal: get the baby into parasympathetic state where they are relaxed, healing, growing

motor
autonomic
state (level of CNS arousal)
attention/interaction

90
Q

Sensory development in the NICU

A

outside of the womb they are receiving more stimuli so OT try to mimic womb as much as possible

presence of procedural touch- not enough intentional touch or social touch

these sudden noises and movements can be stressful for baby and parents

91
Q

What are some strategies to combat sensory challenges

A

respect bed space
silence
gentle noises
static touch before moving
positive touch, handling, massage
educate parents

92
Q

What is one movement or touch parents should be advised to avoid in the NICU

A

Stroking

93
Q

Benefits of neonatal massage

A

Decreased stress/pain
Improved temp regulation
Improved sleep
Improved HR, RR, O2, saturations
Improved immune function
Improved digestion
Increased weight gain
Improved bilirubin levels
Promotes parent-infant bonding (include dad too)
Improved neurological development
Improved muscle tone
Improved feeding outcomes
Decreased length of stay

94
Q

what is positive touch

A

static, four handed caregiver, chest/legs/head, NO STROKING

95
Q

What is a state of arousal

A

uniform way describe the overall behavioral state of an infant

96
Q

What are the states of arousal

A

Crying (6)

Active alert

Quiet alert - ready to learn

Drowsy - semi dosing

Light sleep - rapid eye movement

Deep sleep (1)

97
Q

2 types of behavioral cues in the NICU

A

approach/stability cues
avoidance/stress sign cues

98
Q

approach / stability cues

A

Relaxed limbs

Smooth body movements

Quiet alert state

Stable respirations, HR, O2

Hands to mouth/midline

99
Q

avoidance /stress signs

A

Active, random body movements

Finger splay

Air “sitting”

Prolonged extension of extremities

Increased RR, decreased HR, decreased/fluctuating O2 saturation

Change in muscle tone

Sneezing/hiccups/yawning

Startle

Wide eyed

100
Q

T/F: Taste and smell closely linked in-utero

A

TRUE

101
Q

What are 3 common birth injuries?

A

brachial plexus, facial paralysis, fractures

102
Q

What are causes of brain injuries in NICU babies?

A

large babies
prematurity
cephalopelvic disproportions
dystopia
prolonged labor
abnormal birthing presentation
maternal obesity

103
Q

What are normal stages in development

A

Vestibular system fully functional by 21 weeks

Nasal structures, mouth, and tongue in place by 8 weeks in utero

Taste buds emerge at week 20 in-utero

Hearing structures fully formed in utero: week 24

104
Q

What are the 3 types of deliveries?

A

vaginal, cesarean section, assited deliveries (vaccum and forceps)

105
Q

What are the formal assessments of the NICU

A

HNNE or Dubowits
Hammersmith Neonatal Neurobehavioral Examination

106
Q

What areas can OT treat

A

Family
feeding
sleep
bathing
play
environment

107
Q

What can OT treatment facilitate and support

A

neurobehavioral
neuromotor
muskuloskeletal
sensory
pain

108
Q

what are the gestation terms in weeks

A

37-41 weeks= typical gestation
less than 28 weeks= extremely preterm
28-32 weeks= very preterm
32-37 weeks= moderate to late preterm

109
Q

teratogens

A

a factor that can interfere with embryonic/ fetal development

110
Q

impact on OT with premature babies

A

use their adjusted age when looking at milestones

they can have feeding difficulties

they can have immature sensory systems

111
Q

What are the major complications or prematurity? (neuropathic conditions?)

A

intraventricular hemorrhage (IVH)
Periventricular leukemia (PVL)

112
Q

Periventricular leukemia (PVL)

A

necrosis of white matter surrounding lateral ventricles secondary to decreased O2 and blood flow usually results in spastic diplegia (both legs) or quadriplegia

likely to cause CP

113
Q

Grading of IVH

A

Grade 1: hemorrhage in germinal matrix

Grade 2: bleeding w/in ventricle

Grade 3: bleeding with ventricular dilation

Grade 4: bleeding extends into parenchyma

114
Q

What are the major complications or prematurity? (respiratory conditions?)

A

Respiratory distress syndrome (RDS)
Bronchopulmonary dysplsia (BPD)
Apnea

115
Q

RDS

A

caused by immaturity of lungs and decreased surfactant

116
Q

What are the major complications or prematurity? (cardiac conditions?)

A

Patent Ductus Arteriosus: lack of closure of the ductus arteriosus (connection between pulmonary artery and aorta)- repaired at birth

Bradycardia: slowing of HR to less than 100 beats/min associated with apnea

117
Q

What are the major complications or prematurity? (Sensory system problems)

A

Retinopathy of prematurity (ROP): contributing factor is high concentration of O2

Hearing impairment: 2-5% very low birth weight infants

Sensorinerual hearing loss: damage to cochlea can be due to antibiotics required to prevent sepsis

118
Q

What are the major complications or prematurity? (System immaturity)

A

Gastroesophagel reflux (GER)

Hyperbillirubinemia: immature liver

Kernicterus: bilirubin accumulates in basal ganglia can lead to athetoid CP

Necrotizing enterocolitis (NEC): infection in GI tract

    2-5% of VLBW infants 

     Mortality rate 20% 

     50% requires surgery to remove portions of 
     bowel
119
Q

What are APGAR scores?

A

scores given at 1, 5, and 10 minute intervals after birth to show infants overall condition
Activity (muscle tone)
pulse
grimace (reflex irritability)
appearance (skin color)
respiration

highest possible score is a 10

scoring stops when a 7 is achieved

low scores require immediate attention

120
Q

How is adjusted age calculated?

A

Actual ages in weeks - weeks preterm = corrected age

e.g: 16 weeks old - 8 weeks preterm = 8 weeks adjusted age

121
Q

What is IDEA

A

law ensuring services to children with disabilities throughout the nation

122
Q

Under which part of IDEA do Infants/toddlers with disabilites (birth-3) receive services

A

IDEA Part C

123
Q

What is the primary role of AZEIP

A

work with and support family members and caregivers in children’s lives

124
Q

What does the broad spectrum tool, the DAYC-2 look at

A

communication
fine motor
gross motor
social/emotional
adaptive

125
Q

How does a child become eligible for AZEIP

A

Child becomes eligible by having a 50% delay in at least one area of development

Or child has established medical condition or syndrome that may lead to a delay

126
Q

what are the primitive reflexes and the appropriate ages of integration

A

Rooting (birth-3 months)

Grasp-plantar and palmer (birth-4 months)

Moro (birth-4 months)

Suck/swallow (birth-3 months)

Placing (birth- 6 months)

Primary walking/stepping (birth- 4months)

ATNR (1 month-4 months)

STNR (6 months-8 months)

127
Q

rooting relfex

A

pinky rubbed on cheek

for breast feeding

128
Q

suck/swallow

A

pinky in mouth
feel tongue muscle working properly to suck

129
Q

moro reflex

A

startle reflex
arms out when they fall back

130
Q

primary walking

A

holding them up and seeing feet placing like walking

131
Q

grasp reflex

A

touching palm of hand to elicit grasp
(can be palmar or plantar)

132
Q

placing

A

placing hand on surface

holding them above surface

133
Q

Asymmetrical Tonic Neck Reflex ATNR

A

head turns to side
that side extends and other flexes

134
Q

Symmetrical Tonic Neck Reflex

A

head down vs head up
(evelyns example of cat going under fence)

135
Q

what voluntary control of movements is gained as primitive reflexes integrate?

A

righting reactions
then
protective reactions (parachute)
then
equilibrium reactions

136
Q

What are the proximal key points of control in therapeutic handling

A

shoulder girdle
trunk
pelvis

137
Q

what are motor milestones in the first year

A

rolling, sitting, crawling, creeping, pull to stand, independent stand, walking

138
Q

What does postural control require

A

Development of muscle strength to work against gravity

Proximal control for dynamic patterns for co-contraction and mature postural reactions

Typical associated with the motor milestones

needs to have proximal control first to be able to control extremities

139
Q

What is the law of developmental direction

A

cephalocaudal (from head to body)
proximal to distal
gross to fine
postural alignment and distribution of weight in base of support (sitting = wide, standing = narrow)
stability before mobility

140
Q

what is the progression of postural control

A

supine/prone
side lying
sitting
quadruped
kneeling
standing

141
Q

W sitting

A

negative if chronic but ok as transitional position
if they are stuck in W sit, they have poor postural stability

142
Q

What is the dissociation of body segments

A

roll segmentally
lift one leg
reach across midline

143
Q

Atypical muscle tone terms

A

spasticity: hyperexcitability of the stretch reflex
dystonia: involuntary sustained or intermittent muscle contractions
ataxia: poor coordination during voluntary movements
rigidity: resistance to low speed imposed joint movements
hypotonicity: low tone

144
Q

How does a child receive an autism diagnosis based on the DSM-V

A

A. all 3 symptoms must be present
-deficits in social -emotional reciprocity
-deficits in nonverbal communication behaviors for social interaction
-deficits in developing, maintaining, and understanding relationships

B. 2/4 symptoms must be present
-Stereotyped or repetitive motor movements, use of objects, or speech
-Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (struggle w/ variability)
-Highly restricted, fixated interests that are abnormal in intensity or focus
-Hyper- or hypo reactivity to sensory input or unusual interests in sensory aspects of the environment

C. Symptoms present in early developmental period

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. Disturbances not better explained by intellectual disability or global developmental delay

145
Q

hyper-responsiveness in autism

A

exaggerated, negative response to stimuli

Reduced interest and engagement

Decreased academic and social competence

146
Q

hypo-responsiveness in autism

A

diminished or delayed response to stimuli

Poor praxis and social play

Lower communication skills and lower daily living skills

147
Q

What are the levels of severity of autism

A

level 1: requires support
level 2: requires substantial support
level 3: requires very substantial support

148
Q

What is the M-CHAT

A

a screening tool for toddlers between 16 and 30 months of age, to assess risk for ASD

can be administered by any health professional not just OT

can be low, medium and high risk

149
Q

Which assessment is currently the gold standard in assessment of ASD

A

ADOS-2

150
Q

What are social communication skills from DSM-V for autism

A

Eye contact
Gestures
Pragmatic functions (requesting, protesting, commenting)
Speech and language developmental milestones
Play developmental milestones
Social reciprocity
Understanding and responding appropriately in varied social interactions

151
Q

Joint attention

A

Gestures used for sharing interactions (initiating and responding)

Response to (dyadic) joint attention (2-6 months) (with affect)

Initiation of (triadic) joint attention (8-12 months) (with affect)

152
Q

What are RRBs (repetitive behaviors)

A

Lower order behaviors: repetitive sensory-motor behaviors (stimming)

Higher order behaviors: insistence on sameness

153
Q

3 key assumptions of the strengths based model

A

All people have inherent strengths and capacities that they want to develop

Motivation is an essential precursor to engagement in chosen activities

People do not build their lives on weaknesses, but on their strengths, talents, and abilities

154
Q

What are sensory diets

A

personalized activity plan that provides sensory input a person needs to stay focused and organized throughout the day

155
Q

what are social stories (used with children with ASD)

A

describes a situation, skill, or concept in terms of social cues, perspectives, and common responses in a specifically defined style and format

156
Q

characteristics of social stories (used with children with ASD)

A

Provides clients with missing information and allows them to re-evaluate their expectations

Enhances a child’s theory of mind

50-120 words

Behavior directed

157
Q

What is DIR/ Floortime model

A

Developmental, Individual Differences, Relationship-based-floortime

158
Q

what is the objective of the DIR/floortime model

A

build healthy foundations for social, emotional, and intellectual capacities rather than focusing on skills and isolated behaviors

159
Q

characteristics of the DIR/ floortime model

A

Helps to develop an intervention program tailored to unique challenges of a child with ASD

Follow the child’s lead

Challenging to move up the developmental ladder

Expanding (without taking control)

160
Q

What are motor steroptypesin ASD

A

repetitive behaviors such as body rocking, hand flapping, finger wiggling, pacing, head banging, jumping, and spinning

Spring 2024 (3 decks)

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