Peds Models & FOR Flashcards
What is Pediatric Practice
Includes occupational therapy with infants, toddlers, children, and youth
Primary Philosophies of Pediatric Practice
Child- and family-centered care
Strengths focus
Cultural competence
Three primary core beliefs of Child- and Family-Centered Practice
Respect for children and families
Appreciation of the family’s impact on the child’s well-being
Family-professional collaboration
Cultural Competence
Critical in this diverse country where practice WILL include provision of services to cultures different than one’s own
•Cultural diversity in the United States
A Culturally Competent Therapist:
Demonstrates an interest in understanding the family’s culture
•Accepts and embraces diversity
•Participates in traditions or cultural patterns of the family
•Inquires about family routines, cultural practices, traditions, and priorities
•Integrates intervention recommendations into the family’s cultural practices
Influence of cultural practices
Development of occupations and skill development
Choices of occupation
Choices regarding level of independence at specific ages
The OT Process in Pediatric
Much the same as with adults and the elderly
•Referral
•Evaluation
•Occupational profile
•Analysis of occupational performance
•Use of variety of methods
•Top down versus bottom up or combined
•Consideration of context
•Intervention using evidence-based approaches, with measurement of outcomes
•Use of theory to guide clinical decision making
Occupational therapists improve children’s performance and participation
by providing interventions to enhance performance
•by recommending activity adaptations and environmental modifications
•through consultation, coaching, and education
Specific Aspects of Intervention
•Establish a therapeutic relationship
•Focus on inclusion and natural environments
•Use preferred occupations, client engagement, and child-centered care
•Create the just right challenge
•Modify and adapt tasks and environments
•Use evidence-based interventions
•Advocate for and educate others
Optimize Child’s Engagement by
●Begin with the child’s interest.
●Invite the child to select and help design the activity.
●Pose a problem to be solved.
●Use meaningful whole tasks rather than repetition of single step tasks.
Indirect services
➢Consultation
➢Coaching
➢Support others in creating their own solutions
➢Requires good communication and collaboration
Education and advocacy
➢On behalf of specific children with disabilities
•OR
➢Vying for system change on behalf of all children
➢Often interprofessional
Types of service delivery
Direct
Indirect
Telehealth
Foundational Theories Used in Occupational Therapy
●Developmental theories
●Learning and system theories
Developmental Theories
• Adaptation: The child’s ability to adjust to change to fit into the environment
• Schema: How children represent objects, events, and relationships
• Assimilation: Incorporating new knowledge into existing cognitive structures
• Accommodation: New learning, adapting cognitive structure to new information
Vygotsky and the Zone of Proximal Development
➢ Cognitive processing is a social process.
➢ Learning is critically dependent on social interaction
Zone of proximal development:
The distance between the child’s actual developmental level when acting independently and the level of potential development when supported by an adult.
Scaffolding
The process by which therapists support or guide a child’s actions to improve competence.
Maslow’s Hierarchy of Basic Needs
• Physiological needs
• Need for safety
• Need for love and belonging
• Need for a sense of self-esteem
• Need for self-actualization
Behavioral theories
•Instrumental or operant learning
•Applied behavioral interventions
•Shaping
•Incidental teaching
•Pivotal response
Social Cognitive Theories
➢Children can learn by observing the behavior of others.
➢Children determine their own learning by seeking certain experiences.
➢Children learn indirectly by observing how their peers’ behaviors are rewarded or punished.
➢Children learn social skills through group experiences.
Self-Efficacy
The influence of motivation and self-efficacy on learning.
●Self-efficacy beliefs determine
➢the goals that people set for themselves.
➢how much effort they expend.
➢how long they persevere in the face of difficulties.
➢how they respond to failure.
Dynamic Systems Theory
➢Performance depends on
•interactions of the child’s inherent and emerging skills.
•characteristics of the desired tasks or activity.
•the environment.
➢Self-organization is optimal if the task has a goal and outcome.
A pictorial representation that expresses observations and data about certain portions of a theory.
Models
Models of Occupational Therapy Practice
Provide structure to guide the process of clinical reasoning.
Promote the use of occupation centered practice and a broad scope of practice.
Models About Human Occupation
Consider the interaction between the person, the environment, and the task/occupation.
•Model of Human Occupation (MOHO)
•Person-environment-occupation-performance (PEOP)
•Canadian Model of Occupational Performance and Engagement (CMOP-E)
•Occupational adaptation
Systems approach: Importance of context in assessment and intervention
➢Develop a picture or profile of the child’s performance.
➢Focus on the interaction of person, environment, and occupation.
➢Focus on changing the child, task, or environment.
➢Modify the task or environment to improve the child’s skills.
➢Increase the child’s engagement by using activities that are meaningful.
Frames of Reference
Provide occupational therapists with specific strategies and techniques based on theoretical principles.
Commonly Used Frames of Reference
•Developmental
•Biomechanical
•Motor learning
•Rehabilitation
•Neurodevelopmental
•Sensory integration
•Behavioral
•Cognitive
•Cognitive-behavioral
Developmental
●Based on the ideas and knowledge about the typical progression of developmental skills by age
●Predicts skills will become more complex and more competent over time
●Suggests a temporal sequence during which specific skills should be expected
●Suggests intervention to generate the “next” skill
●Based on older linear vs systems ideas about maturation
Developmental trajectories can be
•Typical
•Delayed
•Slowed
•Delayed and slowed
•Nonlinear or
•Initially typical followed by a “falling off”
Biomechanical
Based on kinesiology and physics.
Motor Control/Learning
●Motor control = directing/regulating movement.
●Motor learning = ways of learning movements.
●Problem-solving method, helping child find the best ways to move to solve a motor problem.
●Analyze movement synergies.
●Consider child’s stage of learning.
●Provide feedback to improve efficiency.
●Provide opportunities for practice.
●Promote independence and generalization.
Rehabilitative
Allows a child or youth to engage in desired occupations with compensations and adaptations
•Providing adaptive equipment or modifications
•Providing appropriate assistive technology
•Requires a thorough analysis of the activity
Neurodevelopmental (NDT)
Analyze missing or atypical movement patterns.
●Use therapeutic handling to facilitate postural control and movement synergies.
●Inhibit or constrain abnormal movement patterns.
●Focus on changing movement patterns.
●Child is active participant.
●Therapists emphasize quality of movement.
Sensory Integration
●Based on neuroscience.
●Children receive, perceive, interpret, and react to sensations, and use sensory information to produce adaptive behaviors in response to environmental demands.
●With sensory integration and experiences of success, development occurs, enhancing neuroplasticity.
●Sensory input can be incorporated into activities systematically to elicit an adaptive response.
●Must be active, child-directed.
Behavioral
Based on animal research examining learning
•Learning occurs through repetition of specific behaviors with appropriate reinforcement
•Use reinforcement to modify or alter behavior
•Puts little emphasis on intrinsic motivation, as motivation to perform a skill is generated by external motivation provided by reinforcement
•Requires careful analysis to determine what to reinforce and when
Cognitive
●Based on the work on self-efficacy
●Use a problem-solving approach to work toward child-derived goals through careful questioning rather than instructing
●Steps include
➢Task analysis
➢Anticipation of the child’s difficulties
➢Exploration and selection of task-specific strategies
➢Application of a strategy to the task
➢Evaluation of strategies
Cognitive
●Steps:
➢Focus on the occupations the child selects.
➢Use a general problem solving framework.
➢Use process questions to increase the child’s awareness of the use of strategies.
➢Plan for transfer and generalization of the strategies.
Cognitive Behavioral
Based on the idea that problem behaviors are caused by beliefs or thoughts (cognition)
•Change the thoughts, change the behavior
•Uses positive self-talk and feedback for successes
