Quiz 3 Flashcards
Biomechanical FOR
-Applied when a person cannot maintain posture through automatic muscle activity
* General goals of biomechanical frame of reference for positioning children for functioning:
o reducing demands of gravity and align the body
o Address performance skills by providing external support for proximal stability
o This reduces need for or demands on postural reactions and compensatory techniques
Biomechanical Approaches for pre-
writing and handwriting
- Paper should be slanted so that it is parallel to forearm of the writing hand (roughly 25-45 degrees to the left)
o Left handed kidsà 25-45 degrees to the right - Writing surface should be at 20-30 degree slant can improve pencil grasp
o Provide a slant board: slant automatically positions hand
in wrist extension and angles hand in slight supination.
o A wrist extended position facilitates finger flexion and grasp. Can also facilitate eye-tracking
Supine position benefits
- Flexor activity develops head control:
o midline control and chin tuck - incorporate shoulder protraction and flexion against gravity
- Hands to midline
- Reduced demands on trunk; more effort can be given to head, oral,
ocular, and shoulder control - A pillow may be placed beneath the head and A roll under the thighs may place hips in a flexed position (allow the soles of the feet to be in contact with the floor)
- Oral motor control is taxed in this position, as it is more difficult to bring the tongue forward and lips together and to stabilize the jaw
Prone Position benefits
- Head righting in a horizontal plane
- Interaction of dorsal extensors and ventral flexors for propping on forearms
- Shoulder stability during weight bearing (propping) and mobility on stability during weight shift
- Increased range of shoulder flexion is necessary when reaching from
horizontal position - Decreased effects of gravity on lateral asymmetries that occur with upright positioning
- Hands more likely to be in visual field by nature of shoulder position when propping
- Wedge provides basic support to enhance prone positioning for a child who cannot prop independently
- Wedge should be wide enough so that it does not tip if the child starts to roll over
- length of the wedge determined by point of support at the chest and hips
- demand on the shoulder for weight bearing is influenced by
o amount of contact of the wedge on the chest.
o lower the contact of the wedge on the chest the greater the demands on the shoulder girdle for weight bearing
Side lying position
- Differentiation of two sides of the body (bottom side weight bearing,
top side mobile) - Hands easily placed in visual field
- Hypertonicity reduced; tonic labyrinthine reflexes inhibited
- Effects of gravity on shoulder flexion/extension reduced
- For a child who cannot maintain side lying position
- Supports on back, between legs, and anterior
Sitting position
- The therapist must first correct or support any inadequacies in the base, especially at the pelvis
- This may decrease tone, compensatory movements, or associated reactions elicited by stress
- Slight anterior pelvis tilt or neutral is preferred
- Make sure femur is properly supported/aligned in its entire length from the back to around 1-inch behind knee (popliteal area)
o Use a short seat depth for children who can self-propel using legs
and feet. Add some anterior tilt if this is the case - Note: if compensatory postures are used for function, provide a home exercise program to elongate the
“tightened” musculature to minimize a child’s risk of increased deformity and secondary complications
Seating: cushions
o Planar: required for minimal body contact with support surface
o Contoured: more contact with body surface . good for child who has
fixed contractures and asymmetries of pelvis and spine
o Custom
* back support : not too high (this causes postural dependency)
* leave the scapula area clear for upward and downward rotation
of the scapula with humeral movement
Seating: when Belts used
- generally : 60- to 90-degree angle to the hips
- If good trunk and pelvic control–> pelvic belt should be positioned below the anterior superior iliac spine (ASIS) and comes from the seat at a 90-degree angle, perpendicular to the floor
- If child can achieve a neutral alignment position but cannot keep it there due to weakness –> pelvic belt that positioned below the ASIS at a 60-degree angle to the seat
- Pelvis obliquity/asymmetry –> padded 4-point belt
motor learning theory
- Movement arises from interaction of multiple processes, including those related to sensory/perception, cognitive, and motor systems
-Motor control: how the body directs movements & how musculoskeletal system interacts to achieve these movements
-Motor Learning:
-strategies and techniques used to teach others how to move
-considers type of practice , experience, motivation, reinforcement, type of
feedback, motor skill, and developmental progress, that can lead to relatively permanent change in person’s capability for skilled action
Motor learning theory: Dynamic
systems theory
- Shifts away from traditional reflex hierarchical view of motor behavior
- Motor control is dependent on non-linear & transaction between env & person
- Relationship between the person, environment and task
- Each individual develops preferred movement patterns for common
functional tasks through active experimentation, experience, and practice - Therapists should consider child’s preferred and most efficient patterns of moving and all of person–task–environment subsystems (control
parameters) affecting child’s task performance when planning intervention
Principles of learning theory
-Practice
* “just right challenge”
* should occur during typical, functional, routines throughout the day; massed practice, discrete trial practice, various strategies
-Experimentation
-Variation
* In skill
* In environment
-Developmentally appropriate support
* zone of proximal development
-Feedback
sporadic feedback is best for longterm learning
Concepts of motor learning theory
- Child
-Person factors - Task
-complexity, degree of structure, and purpose
-influenced by the social and physical demands of the environment - Skill
-consistency in achieving a motor goal with economy of effort - Environment
-A major factor in task performance - Regulatory conditions
-Closed tasks (environment predictable, stable)
-Open tasks (environment unpredictable, always changing)
Play postulates
-Play is intrinsically motivated.
-Play is characterized by self-imposed
goals that can change at the whim
of the player.
-Play is person-centered behavior and is believed to stimulate and
maintain the person’s arousal level.
-Play involves an internal locus of control.
-Play has a pretend quality.
-Characterized by flexibility and freedom from externally imposed rules.
-The child actively engages in play
Arousal-Modulation Theories
of Play
Developed by Dr. Berlyne
-Developed a theory of intrinsic motivation in which play was
associated with exploration.
-Presumed that the CNS has an optimal level of arousal.
Piaget- cognitive approach of play
Sensorimotor play (practice games):
* Characterized by exploration of sensations and movement, e.g., jumping into a puddle.
* Involves the doing of actions purely for the pleasure of practicing them.
* Dominates the first 2 years of
childhood, but occurs throughout childhood whenever new skills are acquired and practiced.
Symbolic play (symbolic games):
*Characterized by imagination during make-believe or pretend play, e.g., feeding a doll with invisible food.
*Begins at 2 years of age and
becomes increasingly complex in the
preschool years with longer
sequences of pretend behaviors
when playing with peers (called
“sociodramatic play”).
Games with rules:
-Explicit rules that are socially constructed and followed during
cooperative play between two or more individuals.
-Predominates the play of children 7 to 11 years of age and continues to be a dominant mode of play throughout life..
Importance of play
✘ Maintains optimal arousal level.
✘ Enhances gross-motor, fine-motor, and oral-motor development.
✘ Promotes self-help skills.
✘ Facilitates social-emotional development.
✘ Facilitates cognitive development.
✗ Promotes creativity.
✗ Promotes problem-solving.
✘ Enhances development of language
Play Development
✘ Sensorimotor play peaks in the second year of life
✘ Exploratory play begins in infancy
✘ At the end of the first year children begin to learn concept of cause and effect
✘ In the second year play focuses on combining objects and developing purpose to play
✘During preschool years children engage in constructive play with identifiable outcomes such as sandbox, puzzle, and block table
✘ During middle childhood and adolescents it develops into more abstract play or creative play like arts and crafts
✘ Symbolic play and pretend play develop at the end of the first year and through the second year peaking at 5 years of age
✘ During middle childhood symbolic play and fantasy play are seen in mental games, secret clubs, and daydreaming, or in secret codes
and riddles
✘ By the age of 3 children are able to learn about social systems and cultural norms
Generational differences in play
✘ sharism- children are more likely to engage in co-creation of ideas at a
fast pace vs. individual construction
✘ Boarder crossing- children are moving between virtual and physical
worlds constantly, resulting in global view of world
✘ Literacies beyond print-children are engaging in more active reading
and writing with processes such a “earmarking” and “tagging” and using
mix and match media rather than creating
✘ Gaming culture- children expect for their worlds to be forgiving and responsive, that they can press “undo” button
✘ Bricoleur culture- children are eager to hack and modify, program, and recycle. The explosion of robotics and programming opportunities for
children allow them to becomes engineers.
co-occupations
✘ Occupations often are shared and done with others
✘ Co-occupations involve two or more individuals and are the most interactive of all social occupations
✘ Co-occupations can be parallel (beside each other, not connected; e.g., reading while riding the subway) and shared (participating in the same occupation but not interacting; e.g., using a stationary bike in a gym while others independently exercise
Revised Knox Preschool Play Scale (R-KPPS)
Purpose:
✘ provide a developmental perspective into child’s play behavior
Population
✘ from birth to 6 years old; all diagnoses
Type of instrument
✘ Standard observation
✘ Criterion referenced
✘ Outcome measure
Play is observed through four dimensions:
1. Space Management
2. Material Management
3. Symbolic/ Pretense
4. Participation
✘ Object play in space
* Maneuvering in space
* Spatial skills
✘ Material Management
✘ The amount and type of interaction with people and/or children
(type, duration, and quality)
✘ Type of play
* Solitary
* Parallel
* With other
* In a small group
* Cooperative
The Test of Playfulness ToP
✘ Aim: to evaluate child’s play and playfulness
✘ Population
* Children and adolescence with various diagnoses
* Ages 6 months to 18 years old
✘ Standard observation
✘ Criterion referenced
✘ An Outcome Measure
✘ Structure: 31 items
Four core concepts -Motivation, Sense of Control, Freedom from
Constrains of Reality, and Framing
✘ There are 3 scales, 0-3 points each
✘ Extent: duration of behavior/occurrence
✘ Intensity: the intensity of the observed behavior
✘ Skill: the quality of the way in which behavior is displayed
The Test of Environmental
Supportiveness (TOES)
Aims:
* Evaluate the fit between the environment and the person
* Assess the amount of environmental support that the player receives
* Assist in consulting clients, families, and colleagues
* Assist in developing intervention programs
Population:
* Children aged 6 months to 18 years
* Various diagnoses
* A Standard observation
* Criterion Referenced
* For use in conjunction with the ToP
Procedure:
* Choose whom to observe
* Identify child’s source of motivation
* Choose where to observe
* Identify play mate/s
* Documenting
Items:
* Caregiver, Playmates, Objects, Play space, Sensory environment
-Each item is scored on a scale from -2 to 2
* -2 = strongly favors description on right
* -1 = slightly favors description on right
* 1 = slightly favors description on left
* 2 = strongly favors description on left
* NA = not applicable
Theories to Promote Change in Play
Behaviors
Floor time
* Follow the child’s lead at his or her
developmental level
* Intrinsic motivation
* Playful obstruction
* A floortime technique used to lengthen an interaction. When a child
does not allow you to join in his/her play - you can playfully get in the child’s way so that he/she has to deal with you to get what he/she wants.
✘ Observe for individual differences
✘ Figure out how each child is unique
✘ Behavioral theory: Instead of looking at internal prompts, looks at external prompts and reward target behaviors
NICU Levels of Care
✘ Level 1- routine newborn care
A hospital nursery that is able to
provide neonatal resuscitation and postnatal care of healthy newborns infants and stable late pre-term infants born at 35-37 weeks
gestation
✘ Level 2- intermediate care
This hospital special care nursery
provides care to infants born at or less than 32 weeks gestation with birth weight less that 1500 grams who have physiologic immaturity
issues that are expected to resolve rapidly with continued maturation.
✘ Level 3- neonatal intensive care
This is a hospital NICU able to provide continuous life support and comprehensive care for extremely high-risk newborns and those with critical illness, including infants born
extremely premature. These unite provide critical medical and surgical care and ongoing assisted ventilation.
✘ Level 4- neonatal intensive care
These units have the same capabilities as level 2 units
and in addition they can provide surgical repair of serious congenital or acquired malformations. These units can facilitate transport systems and often provide outreach education to other area NICUs.
Age Classification
Gestational age (GA)- is referred to as the total time elapsed between the
first day of the last menstrual period and the day of birth
* GA is calculated in weeks
* Full term pregnancy is between 38-42 weeks
* An infant born < 38 weeks is considered preterm
* An infant born between 34-37 weeks is called late preterm
* An infant born > 42 weeks is considered post term
Intensive Developmental Care (IDC) Core Measures
every NICU has to follow this
1. Healing environment
2. Partnering with families
3. Positioning and handling
4. Safeguarding sleep
5. Minimizing stress and pain
6. Protecting skin
7. Optimizing nutrition
EI ENVIRONMENT
A N I M A T E E N V I R O N M E N T
* Refers to presence and activities of
people in the NICU
* Medical (staff) + social (family
and friends)
I N A N I M A T E E N V I R O N M E N T
* physical properties of light and sound in the NICU
* factors such as gravity and temperature
Thermo-synchrony
refers to a process during skin to skin contact in which the temperature of the mother’s chest rises by 2 degrees to warm a baby (during kangaroo care)
Light in the NICU
- Preterm infants are unable to protect themselves from room light
due to inability to close their eyes tightly until after 30 weeks
ontinuous dim light is best for babies younger than 28 weeks - After 28 weeks gestation, cycled lighting (dim at night, with day time
levels increased to 250-500 lux) shows evidence of benefits to baby
Newborn State and Caregiving
- Sleep States- Slow State changes, regular breathing, eyes closed, no eye movements, no spontaneous activity except startles and jerky movements, lowest oxygen consumption
- Awake States; Drowsy or Semi dozing - eyelids fluttering, eyes open or closed, mild startles, delayed response to sensory stimuli, fussing may be present, respiration is more
rapid and shallow - Active Alert-Eyes Open, considerable motor activity, thrusting movements of extremities, spontaneous startles, reacts to external stimuli, respiration irregular, crying, respiration rapid, shallow and irregular
Non-Nutritive Sucking
shown in studies to
decrease crying, decrease
heart rate, increase O2
saturation levels
Skin to skin kangaroo care
skin to skin contact promotes reduction in behavioral measures helps after painful procedures.
* It is recommended that skin to skin
contact be used as a non-
pharmacological intervention to relieve acute pain in stable premature infants born 30 weeks gestational age or older
Goals of Early Intervention (EI)
- Use the natural environment to teach parents and maximize treatment skills
- Increase comfort level and knowledge for handling skills
- Assess functional skills and the impact on function
- use a maximum of 3 activities when working with your client
The Newborn Child
Motor: Physiological flexion, motor skills are primarily dependent on
gravity
* Head position determines body position due to reflexes
* Supine – visual orientation
* Prone – hips are flexed, weight is usually forward, ‘tummy time’
* Sitting – not very functional
* Fine Motor- grasp reflex, hands fisted
* Feeding – sucking is a mixture of nutritive & non-nutritive
* Social – Crying is basic communication
* Sensory- prefers to be held in different positions
1-3 Months
- Motor- Gradual increase of head righting
- Prone: lifts head to 45 degrees
- Supine: increased extension & asymmetry
- Increased head extension at shoulder and in prone
- Sitting in supported rounded posture
- Fine Motor- Hand to mouth patterns more observable, hands
fisted but looser, may hold onto something if placed - Feeding: more of a schedule
- Social – smiling, cooing, faces
- Sensory – more accurate vision when seeking out objects
4-6 months
- Motor – better head control, develops rolling,
- Prone – weight shifting, uses head to guide positions
- Supine – brings feet to mouth, reciprocal kicking
- Sitting - once placed, some are Independent; begins to like to
stand and be held in supported standing - Fine Motor Skills - Volitional Grasp Pattern (RGR), eye hand coordination, radial & palmer grasp, shakes toy
- Feeding – reflexive biting patterns, holds bottle
- Social – smiles & laughs; more response to faces, stranger anxiety
- Sensory – link tactile with visual information
6-9 months
- Motor Skills – mobility is key at this age, transitional movement patterns (prone through sitting), increased pelvic stability, adapt posture in anticipation of movement
- Prone – tummy time, trunk rotation and midline crossing activities, crawling and then creeping
- Supine – quickly moves out of this position, no play initiative in this position
- Sits without support, several varieties of sitting (W-Sit, side sit, ring sitting)
- Fine Motor Skills – Bangs toys together, radial movement, inferior radial grasp, radial digital grasp
- Feeding (dissolvable) variety of tongue movements, munching, finger feeds grossly
- Social – babbles, laughs, cries when someone leaves, plays peek-a-boo
- Sensory – Auditory process skills improve, more sensory input
9-12 months
- Motor- increased period of being upright, very mobile, more integrated
responses for protective and righting reactions, first steps, reflexes are
mostly integrated - Cruises on furniture, climbs, walks with high guard initially, toes curled
- Throws objects
- Fine motor – places objects with control, neat pincer, turns the pages of a book, pulls off clothing
- Feeding - Rotary chewing, may use spoon, different grades of biting, eats
soft table foods - Social – Language is developing, may have a few words, understands
concepts - Sensory – Functional use of objects, cause-n-effect, object permanence
1-2 years old
- Gross motor – walks well for short distances, running but uncoordinated, rides a push toy, kicks a ball, maneuvers a change in surface
- Fine Motor – stacks blocks, holds 2 objects in one hand, operates cause-n-effect toys, scribbles, controlled release
- Self Care – helps with dressing & grooming, indicates when wet or soiled
- Feeding – drinks from a cup, straw, eats table food, becomes picky
- Social – temper tantrums, asserts independence
- Play Skills – parallel play, more interested in how things work
- Cognitive – object permanence, language skills 10-20 words and learns new ones daily
2-3 years old
- Gross Motor – negotiates playground, running is more coordinated, reciprocal UE &
LE Movement, catches a ball, jumps off a surface, stairs climbing more reciprocal (up first then down). - Fine Motor - in hand manipulations skills are better, colors, copies a line (horizontal & verticle), hand preference
- Self-Care – toilet training, simple fasteners, assist with self care tasks
- Feeding – uses fork & spoon with pre-set, drinks from open lid cup
- Social – follows rules and structure
- Play Skills – turn taking, role playing, complex concepts
- Cognitive – receptive language, vocabulary 500 words, simple puzzles
Common EI Diagnosis: Prematurity
Less than 37 week gestation
* Automatic qualifier for EI à(31-25 weeks) or <2500grams 5.5
lbs
Complications from prematurity:
* Hyperbiliruben– affects the liver
o Kernicterus – severe brain damage
* NEC (Necrotizing Enterocolitis) GI Tract + Bowel
* GERD contents of the stomach & acid in the esophagus
* Feeding disorders. Do not like tummy time
* ROP (Retinopathy of Prematurity)
Common EI Diagnosis: ERB’S PALSY
Temporary or permanent paralysis of the arm caused by trauma during vaginal delivery or direct trauma to
the plexus
* Upper plexus injury
* Lower plexus injury
* Symptoms – numbness, Weakness, Lack of motion, Pain
PLAGIOCEPHALY
- Low tone & lack of positioning
- “back sleeper” babies
- Usually leads to Torticolois – neck muscles
- Baby’s skull is very soft and pressure can cause mis-shaping
- If left untreated by age 11-12 months can result in permanent mis-
shaping - Facial & jaw misalignment
- Caused by prematurity, multiple births
- Prolonged use of any equipment
Toy Suggestions
-0-3 month old: mirror, high-contrast books, mobile
-3-6 month old: rattle, textured balls, ring stacker
-6-9 months: wooden blocks, simple shape sorter, books, push button toys
-9-12 months: walker, megablocks, textured play, pretend play sets
