Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OT 826 Enabling Occupation in Children > Third section - readings > Flashcards

Third section - readings Flashcards

You may prefer our related Brainscape-certified flashcards:
Sight Words (Ages 4-6) flashcards UMT for Kids flashcards
1
Q

Oral Cavity

A

Parts:
Lips hard and soft plates, tongue, fat pads of cheeks, upper and lower jaws, and teeth

Function:
Contains the food during drinking and chewing and provides for initial mastication before swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Pharynx

A

Parts:
Base of tongue, buccinator, oropharynx, tendons and hyoid bone

Function:
Funnels food into the esophagus and allows food and air to share the same space.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Larynx

A

Parts:
Epiglottis and false and true vocal cords

Function:
Valve to the trachea that closes during swallowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Trachea

A

Parts:
Tube below the larynx

Function:
Allows air to flow into bronchi and lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Esophagus

A

Parts: Thin and muscular esophagus

Function:
Carries food from the pharynx, though the diaphragm, and into the stomach; collapses at rest and distends as food passes through it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cranial Nerve

I (olfactory)

A

Type:
Sensory

Function:
Sensory fiber for smell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cranial Nerve

V trigeminal

A

Type:
Mixed

Function:
Sensory fibers from cheek, nose, upper lip and teeth
Motor fibers to the muscles of mastication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cranial Nerve

VII Facial

A

Type:
Mixed

Function:
Sensory fibers from taste receptors to the anterior two-thirds of the tongue
-Motor fibers to the muscles of facial expression a and salivary glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cranial Nerve

IX glossopharyngeal

A

Type:
Mixed

Function:
Sensory fibers from taste receptors on the posterior third of the tongue
-Motor fibers to the muscles used in swallowing and to the salivary glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cranial Nerve

X Vagus

A

Type:
Mixed

Function:
Sensory fibers from the pharynx, larynx, esophagus, and stomach
Motor fibers to the muscles of the pharynx and larynx
Autonomic fibers to the smooth muscles and glands to alter gastric motility, heart rate, respiration, and blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cranial Nerve

XII Hypoglossal

A

Type:
Motor

Function:
Motor fibers to the muscles of the tongue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Test:
Upright Modified Barium Swallow study
videofluoroscopic Swallow study

A

Indications

  • Analyze the swallow mechanism
  • Rule out aspiration
  • Determine the point of aspiration
  • Identify safe food and liquid consistencies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Test:

Upper GI Series

A

-Diagnose structural abnormalities of the esophagus, stomach, or intestines, such as malrotation or stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Test:

Esophageal pH probe

A

-Qualifies frequency, acidity, and duration of GER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Test:

GI endoscopy, esophago-gastroduodenoscopy (EGD)

A

-Provides a direct view of GI tract to diagnose inflammation or structural abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Test:

Fiberoptic endoscopic evaluation of swallowing (FEES)

A
  • Analyze the swallow mechanism rule out aspiration
  • Rule out aspiration
  • Identify safe and food liquid consistencies
  • Visualize anatomic structures during swallowing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Common medical conditions associated with feeding and swallowing disorders include

A

prematurity, neuromuscular abnormalities, structural malformations (cleft lip and/or palate), gastrointestinal conditions (gastroesophageal reflux; eosinophilic esophagitis), visual impairments, cardiorespiratory disease, tracheotomies, autism spectrum disorders, sensory processing difficulties, genetic conditions, and allergies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Occupational therapists consider the following essential factors when completing a comprehensive assessment of feeding, eating, and swallowing

A
  • Anatomy and physiology of oral motor and swallowing functions
  • Growth and development milestones for oral feeding and self-feeding skills
  • Nutrition and medical conditions that influence the assessment and intervention process
  • Social, emotional, and behavioural factors that affect feeding and mealtimes
  • Sensory processing skills that support feeding transitions
  • Inclusion of parents and other primary caregivers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Diagnostic test used with children with feeding and swallowing disorders

A
  • Instrumental Evaluation of Swallowing (VFSS-FEES)
  • Upper GI series
  • Upper GI endoscopy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The major components of a comprehensive occupational therapy intervention plan to address feeding, eating, or swallowing problems with children include:

A
  • Safety considerations for feeding and swallowing
  • Environmental influences and adaptations
  • Positioning modifications
  • Adaptive equipment and oral motor techniques used in feeding intervention plans
  • Behaviour techniques
  • Developmental considerations (cognitive, motor, and sensory)
  • Interprofessional collaboration between the occupational therapist and other members of the child’s treatment team
  • Inclusion of parents and other primary caregivers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Occupational therapy intervention to address feeding and eating difficulties in children and youth include approaches to change the

A

environment, child’s positioning, and equipment used in feeding. Occupational therapist may modify food and liquid consistencies, may address feeding/eating delays, dysphagia, and sensory processing, Behavioural interventions may be implemented to address food refusal, tactile sensitivity, and reliance on the bottle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Optimizing Nutrition

Infant characteristics

A
  • Physiological stability with feeding and handling
  • Feeding readiness cues
  • Coordinated suck/swallow breathing (SSB) throughout breast or bottle feeding
  • Endurance to maintain nutritional intake and support growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Optimizing Nutrition

Goals

A

Feeding will be sfe, functional, nurturing, and developmentally appropriate

  • Optimized nutrition will be enhanced by individualizing all feeding care practices
  • Oral aversions will be prevented by ensuring feeding is a positive experience for infant
  • First oral feeds will be at the breast for babies whose mothers are pumping their milk
  • Infants of breastfeeding mothers will be competent at breastfeeding prior to discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Optimizing Nutrition

Neuroprotective Interventions

A
  • Facilitate early, frequent, and prolonged skin-to-skin contact
  • Educate, coach, and mentor parents about positive oral stimulation, infant feeding cues, and feeding techniques
  • Promote positive oral/olfactory stimulation during early skin-to-skin contact by letting infant lick, nuzzle and smell the nipple if interested
  • Minimize negative perioral stimulation (adhesives, suctioning, etc.)
  • Utilize indwelling gavage tubes rather than intermittent tubes
  • Promote non-nutritive sucking (NNS) at mother’s pumped breast during gavage feeds
  • Hold infant and use NNS with appropriate sized pacifier during gavage feeds when mother is not available
  • Provide taste and smell of breast milk, if available, with gavage feeding
  • utilize validated and reliable Feeding-Readiness and infant-Driven Feeding tools, and involve parents in assessments of feeding readiness and quality of feeds
  • Ensure every feeding experience is a positive, pleasant, and nurturing experience
  • Educate parents about the medical importance of breast milk for most infants, especially for ELBW infants
  • Support and encourage mother’s expressed breast milk (EBM) supply
  • Provide donor human milk for ELBW infants (whenever possible) if mother’s milk is not available or is contraindication
  • Ensure first oral feeding is at the breast for baby’s whose mothers have been pumping their breast milk
  • Support and encourage competent breastfeeding well before discharge
  • Promote side-lying position close to parent/caregiver when when bottle-feeding
  • Provide guidance to parents on how to provide supportive oral feeding experience for their infant, including positioning and pacing.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Components Necessary for Safe, Comfortable Feeding

1. Anatomic Integrity and Oral/Pharyngeal Competency

A
  • Airway sufficient for air exchange

- Oral/pharyngeal structures (lips, tongue, palate) intact and functional

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Components Necessary for Safe, Comfortable Feeding

Regulation of states of arousal

A
  • Sufficient Arousal for:
  • Reflexive rooting/sucking response to nipple
  • Active engagement in sucking and swallowing
  • Sustained active participation in feeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Components Necessary for Safe, Comfortable Feeding

3. Reflexive and Active Swallow

A
  • Clearance of oral secretions while at rest

- Active swallowing of liquid bolus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Components Necessary for Safe, Comfortable Feeding

4. Airway protection

A
  • Gag reflex and cough reflex

- Epiglottis and vocal fold function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Components Necessary for Safe, Comfortable Feeding

Appropriate Breathing Rate

A

-Respirations no higher than 60-70 breaths per minute, throughout the feeding, to allow coordinated breathing and swallowing, an additional layer of defense against choking and or aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Components Necessary for Safe, Comfortable Feeding

6. Oral-Motor and postural Tone

A

-Support for motor and respiratory components of feeding; high or low tone can impact oral-motor competence as well as esophageal and diaphragmatic function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Components Necessary for Safe, Comfortable Feeding

7. Tolerance for positioning and handling

A

-Ability to tolerate sensory and motor aspects of feeding: neurological immaturity, central nervous system irritability, or neonatal abstinence syndrome may interfere with sustained ability to engage in organized, rhythmic feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Components Necessary for Safe, Comfortable Feeding

8. Appropriate timing of sucking, swallowing and breathing

A

-Management of the liquid bolus successfully during oral and pharyngeal phases of feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Components Necessary for Safe, Comfortable Feeding

9. Endurance

A

-Adequately rested with sufficient energy and lung capacity for sustained quality and efficiency of feeding

34
Q

Components Necessary for Safe, Comfortable Feeding

Motivation

A

-Timing of feeding and tub-fed volumes condensed sufficiently to create hunger

35
Q

Self-initiated mobility allows

A

young children with physical disabilities, including those with cognitive dysfunction, the opportunity to access and explore their surroundings, significantly contributing to visual spatial, sensory motor, social, emotional, and cognitive development.

36
Q

Mobility allows

A

children to engage in desired occupations and participate in activities with peers and family

37
Q

Several factors must be considered during an evaluation for seating and mobility equipment including

A

the purpose or goals for using the device, environments in which the device will be used, features and adaptations that will meet the desired outcomes across the environments, needs and concerns of the care providers and school personnel, and options for transporting the device

38
Q

Occupational therapy evaluation for mobility includes

A
  • observation of the child completing daily living tasks;
  • interview the child and parent to identify goals, desires, and provide contextual information;
  • environmental assessment to determine supports and barriers for mobility;
  • mat assessment to determine physical abilities for mobility;
  • and stimulated assessment
39
Q

Occupational therapy intervention for mobility is a dynamic process which moves between evaluation and intervention. For example

A

occupational therapist and team members complete an evaluation and the team decides on the mobility device. The occupational therapists designs intervention to practice use of the device, encourage participation in a variety of activities, and measure the outcome. The occupational therapists may decide a new piece of equipment is necessary or adjustments need to be made to the current system.

40
Q

Occupational therapists use knowledge of mobility devices to guide selection of mobility devices and associated parts. For example,

A

folding wheelchairs provide trunk support and are easy to transport, but they do not offer customized seating that may be required for children with muscle tone abnormalities. Add-on features, such as seat cushions and backs add additional weight to the folding chair. The child may be positioned better, but it may be more difficult for family or caregivers to manage. Rigid wheelchairs provide more support but may be difficult for children to maneuver

41
Q

Children who lack independent mobility rarely learn that events in the world are contingent on their own behaviour

A

therefore, vitally important to augment mobility for children with disabilities at the same age as their peers are beginning to move around independently

42
Q

Power mobility devices

A
  • introduced at 7 months
  • begin using at 14 months
  • competent use around 20 months

Introducing PM before 3 years of age may be important to facilitate the typical co-development of socialisation with mobility

  • decrease caregivers burden
  • increase independence
43
Q

Power mobility devices presented to parent

A

as a positive intervention, representing greater independent engagement and participation for their child in everyday activities.

44
Q

Satter Eating Competence Model conceptualizes eating competence as having 4 components:

A
  1. eating attitudes,
  2. food acceptance
  3. regulation of food intake and body weight
  4. management of the eating context (including family meals)
45
Q

competent eaters

A

confident, comfortable, and flexible with eating

and are matter-of-fact and reliable about getting enough to eat of enjoyable and nourishing food

46
Q 
Eating Attitudes
(establish and maintain positive and flexible attitudes about eating, which in turn allow being responsively attuned to outer and inner experiences relative to eating )
A

Build relationships: (foodways are intensely personal and private)
Enhance the dignity: (enjoy your eating)
Emphasize providing, not depriving: (avoid prescriptive interventions increase variety, not remove from your diet)
Address Encoded messages (people might take things negative caution word use)
Address Feelings (feelings can act as a barrier- correct misinformation don’t try to change feelings)

47
Q 
Food acceptance
(Rather than trying to get participants to eat certain amounts or types of food, support variety by emphasizing pleasure as a guiding principle in food selection)
A
  • Trust People to Learn and Grow (feel successful they will push themselves)
  • Don’t Get pushy with target food (introduce and then let it go -repeating creates resistance- ask do you want to learn this )
  • Teach food acceptance skills (address budget) (prepare/taste, looking, touching, smelling, handling/spit out into a napkin)
  • Address picky eating: (relieving social pressure on food acceptance and what is socially acceptable)
48
Q

Regulation of Food Intake
(rhythms of hunger, appetite, and satiety to conform to the social structure of meals)

accepting the body weight

A
  • Coach Internal Regulation: (experiences of hunger, appetite, and satiety) - regular, predicting and rewarding opportunities (ROUTINE)
  • Encourage Sensitivity To Eating Rhythms: (make eating more pleasant)
  • Support Self-awareness and choice: (awareness comes choice)
  • Get Strong Permission To eat Enough (eat until your mouth and stomach are satisfied)
  • Identify and Discard Restrained Eating: (DIET DOESNT WORK)
  • Address Disinhibition (excessive and impulsive overeating -neutralize disinhibition— or to avoid exacerbating it—neutralize food insufficiency- emphasize per- mission to choose rewarding food and eat it in satisfying amounts)
  • Address Weight Management: (Offer to help, not with weight loss, but with decision making about weight management)
49
Q

Eating Context
(emphasizes family meals)
-having the skills and resources to procure and/or
prepare rewarding and reasonably nutritious meals, provide predictable opportunities to eat, be comfortable enough with internal regulators to wait for meals, and manage time and self in order to suspend other activities)

A
  • Stress Family Meals (Meals give emotional and social reassurance of structure)
  • Remember your capabilities
  • Define meals achievable (A meal around a blanket on the floor or around a coffee table is still a meal)
  • Join with Individuals where they are (people are at different stages - Encourage the use of fat in food preparation. Encourage liberal use of relatively inexpensive but filling food such as bread, rice, noodles, and potatoes, and endorse using butter, margarine, oils, and spreads to increase the caloric density)
  • Teach Strategic Menu planning: (You are working toward their definition of meals, not yours. For instance, it can represent a major achievement to regularly orchestrate family meals by sharing an odd assortment of food while sitting on a blanket on the floor)
50
Q

feeding approaches

A

(1) behavioral interventions,
(2) parent-directed and educational interventions, and
(3) physiological interventions.

51
Q

Feeding approaches may result in positive outcomes in the areas of

A

1) feeding performance,
2) feeding interaction,
3) and feeding competence of parents and children.

52
Q

Common feeding difficulties include

A

1) eating too little or too much,
2) delay or difficulty in learning the mechanics of eating,
3) restricted food preferences,
4) delay in self-feeding,
5) objectionable mealtime behaviors, and bizarre food habits
also linked to deficits in cognitive development, behavioural problems, and eating disorders

53
Q

Behavioural Interventions

A

-Defined as treatment strategies based on operant learning principles.
-Evidence supports that behavioral interventions can improve acceptance of a variety of foods, mealtime behaviours, weight gain caloric intake, and self feeding skills.
reduce caregivers stress

54
Q

Behavioural Interventions

Treatment strategies include:

A
  1. Differential attention: (Giving positive attention to appropriate feeding behavior and ignoring inappropriate behavior)
  2. Positive reinforcement (use of verbal praise or brief access toa preferred toy or activity immediately after achieving a targeted feeding behavior)
  3. Physical guidance (providing manual assistance with the appropriate feeding response after the occurrence of an incorrect response or after 40–60 s of no response)
  4. extinction or flooding: (therapist keeps the spoon at the child’s lips (without the use of force) until the mouthful is accepted)
  5. Shaping
55
Q

Parent-Directed and Educational Interventions

A
  • providing primary caregivers with information and recommendations regarding how to facilitate appropriate feeding behaviors
  • moderately to strongly effective in improving children’s physical growth and development, increasing the feeding competence of children and their primary caretakers, and improving parent–child interaction
  • effective approach when the therapeutic goals are to improve maternal support, parenting skills, mother–child interaction or the feeding competency of children and mothers.
  • NO CONSENSUS on deliverance of intervention
56
Q

Physiological Interventions

A

-commonly used with preterm infants, children with neuromuscular impairments or children with oral structure abnormalities to improve feeding performance.
-viewed as a complex developmental skill that requires the integration of breathing, sucking, and swallowing in the context of overall motor stability and
incoming sensory stimuli.
-improving children’s biological development, including
physical and sensory functions to support infant feeding

57
Q

Physiological Interventions

Subcategories

A
  1. studies targeting PREPARATORY BEHAVIOURS such as physiological stability for oral feeding (studies investigating the effects of skin-to-skin contact
    (SSC), non-nutritive sucking [NNS], or oral desensitization
  2. the acquisition of FEEDING SKILLS, including sucking and swallowing
  3. targeting environmental support of feeding, including positioning and feeding devices
58
Q

Environmental supports

A

-positioning, sensory stimulation, oral stimulation, oral support, pacing, and manipulation of feeding methods, including modified equipment (such as slow-flow nipple or a squeezable bottle) or feeding schedule.

59
Q

Children’s roles include,

A

developing personal independence, becoming productive and participating in play or leisure pursuits

60
Q

when evaluating the body of evidence for the intervention and arriving at a strength of recommenda- tion for each diagnostic group:

A

(i) methodological quality regarding likely benefits vs. likely risks;
(ii) inconvenience;
(iii) importance of the outcome that the intervention prevents;
(iv) magnitude of intervention effect (effect size);
(v) precision of estimate of effect;
(vi) burdens;
(vii) costs;
(viii) varying clinician and family values

61
Q

Green light effective interventions existed at

A

the body structures and function ICF level (n = 14/74 indications (19%)),
the activity level (n = 14/27 indications (52%))
and the environment level (n = 12/34 indications (35%)).

62
Q

the proportions of green light to yellow light to red light interventions by ICF levels,

A
  • Activity level contained the largest number of green lights (barely …. there was 14 green 11 yellow and no red)
  • body structure -yellow (the only one that contained red lights)
  • environment –> yellow
  • ONLY 2 at the participation level and none at the personal level (the proportions of green light to yellow light to red light interventions by ICF levels, )
  • -> gaps in the occupational therapy evidence base
63
Q

A. Parent partnership within occupational therapist intervention is effective and worthwhile

A
  • embrace family centred care-where the parent is the decision-maker and the expert in knowing their child
  • Moreover, parents and children carry out intervention effectively at home, and therefore home programs and self- management programs are an effective method for increasing the intensity of therapy
64
Q

Activities-based, ‘top-down’ interventions deliver bigger gains

A
  • Almost always these older studies showed that the ‘bottom-up’ interventions were ineffective with no difference between the experimental and control groups.
  • indicating that daily life skills training using a ‘top- down’ approach is a strength of the occupational ther- apy profession. Examples include: Bimanual Training; CIMT; CO-OP; GAME; Goal-Directed Training; Hand- writing Task Training; Home Programs using Goal- Directed Training; Social Skills Training; and Task Training.
  • profession is to choose interventions that promote activity and participation outcomes (Mayston, 2016) and to use consistent language to describe intervention options
65
Q

top-down’, interventions all have the following key ingredients in common:

A

(i) begin with the child’s goal, to optimise motivation and saliency of practice;
(ii) practice of real- life activities in natural environments to optimise the child’s learning and the variability of the practice;
(iii) intense repetitions to activate plasticity, including home-based practice; and
(iv) scaffolded practice to the ‘just right challenge’ to enable success under self-generated problem-solving conditions, to optimise enjoyment.

66
Q

areas of the evidence-base would benefit from more research:

A
  1. Parent Education (parent’s pre- ferred learning styles and levels of support required to manage the stress of raising a child with a disability)
  2. Head-to-head comparisons: (comparing interventions for the same outcome)
  3. ‘Dose’ comparison studies: (how much intervention is enough)
  4. Participation Interventions: ( clear need to develop interventions that specifically target participation, rather than anticipating activities-based interventions will confer upstream participation gains Changes in participation are multifactorial and involve individual factors, contextual factors, the nature of the participation activity and the environment in which the activity is being performed)
67
Q

Key points for occupational therapy (systematic review paper)

A
  • Collaboration with parents is effective and worth- while.
  • Activities-based, top-down interventions confer larger clinical gains, than bottom-up approaches, when aiming to improve a child’s function.
68
Q

Feeding flower

A
  • Health
  • Motor skill
  • Sensory Function
  • Oral motor skills
  • Speech and language skills
  • Learning
  • Dental Health

Strengths
-watering can

  • family
  • food availability
  • Positive social interaction
  • Environment
  • ->safe
  • ->structured
  • ->predictable
  • ->supportive
69
Q

To improve mechanics of feeding, occupational therapy practitioners often work directly with children on the following goals:

A
  1. Establishing a developmental sequence of self-feeding skills; for example, teaching a child to hold a spoon, scoop food, or bring a spoon to mouth as prerequisite feeding skills
  2. Improving acceptance of a wide variety of foods and textures; for example, using various sensorimotor-based feeding strategies or behavioral modification methods to improve feeding behaviors of children who have restricted food preferences or food aversion
  3. Improving oral–motor skills, for example, sucking, chewing, propelling, and swallowing food effectively,
    efficiently, and safely (Kerwin, 1999).
70
Q

General Interventions

A
  • Feeding occurs multiple times during the day in the natural enviro- we want our interventions to carryover into the daily routine
  • Frame interventions around typical family mealtime - provide caregiver support as needed to cope with burnout/stress
  • Holistic intervention plan can include: enviro adaptations, positioning, equipment, food texture or liquid mods, sensory development, behaviour strategies, self-feeding improvement suggestions. Implement one or 2 at time.
  • Some children may only need consultative therapy others may need intensive
  • Some may need supplemental feeding support for growth and development - if longer than a few weeks a GI tube is recommended
  • Consult with a dietician, be aware of choking hazards
71
Q

Improve Self-feeding

A

-Self feeding delays can be a cause of physical weakness, abnormal tone, cog delays, vision issues, sensory processing issues, poor motivation to eat, or behaviour issues
-OT wants caregiver assistance to decrease during mealtime
Start self feeding for snacktime or a portion of the meal
-Adjust positioning- chair with a postural support and tray- better for grasp, hand to mouth, reduce the endurance demands of self feeding- can rest elbows
-Dycem mat to prevent dishes sliding - compensate for uncoordinated arm movement
-Fat handles or cup with handles, wide base cups, lids, long straws,
-Backward chaining- gradually decrease level of assistance
-Visual issues: consistent orientation of food/drink, contrasting colours of utensils, plates, cups and placemats
-Hypersensitive: use a utensil to minimize food touch

72
Q

Environmental Adaptations

A

-Scheduling and location of meals, meal length, sensory stimulation, order of mealtime activities
-Consistent scheduled meals/snacks- promotes hunger and more interest in eating because they are experiencing times without eating
-Consistent seat at table- wandering can be distracting
Meals longer than 30-40 mins can be stressful for caregiver & child and cause fatigue
-Limit sensory stimuli/distractions - calm enviro with dim lights, limited interruptions, reduced noise and rhythmic music
-Distractions interfere with the child’s ability to learn at mealtime
-Change order of food & liquid, or make sure to have liquid between each bite

73
Q

Positioning Adaptations

A

-Oral motor skills and feeding require coordination and skilled movements - which are supported by overall gross motor stability
-OTs can make positioning adaptations to provide proximal support (trunk and neck support) as it influences distal movement and control
-Feet, leg,pelvis position influences trunk stability
-Positioning can provide support and alignment and stability which improves comfort, oral motor skills and oral intake at mealtime (want positions to promote social and communication interactions during mealtime)
-Side-lying is good for breastfeeding
-At 4-6 months have the child sitting up more in a semi-reclined position
Infant car seats/tumble form feeders chairs: give support and allow for hands free for better food handling
-Regular high chairs are good too- can be easily adapted with rolled towels
Children with neuromuscular disorders may require a WC or adaptive stroller for feeding
-Optimal positioning: vertical head and trunk, hip flexion greater than 90, feet on a flat surface

74
Q

Adaptive Equipment

A
  • Promotes improvement and independence for oral motor skills and self feeding
  • OTs- consider the properties of the spoon/fork/bowl
  • Straws- big, short, tall, smaller (juice box vs. reusable)
  • Handled cups & u shaped cut outs
  • Sippy vs. straw (support head and neck flexion) cups
75
Q

Modifications to Food Consistencies

A
  • Smooth foods with an even consistency are easier to manage
  • Thick/lumpy/pasty foods require more oral motor strength
  • OT should alter the size of the food or sip of liquid when beginning
  • Consider temp, taste and sound associated with chewing aka sensory properties
  • Gagging- texture modification could help
76
Q

Modifications to Liquids

A

-Thin liquids in an open cup are the most difficult to control because they move so quickly
OTs recommend thicker liquids bc they are easier to control and allows child to better organize bolus for swallowing
-Room temp water is the most difficult liquid - odorless, colourless, tasteless aka provides minimal feedback
-Add carbonation to drink- change texture not consistency
-Can add thickener to drinks for easier consumption (honey, nectar)

77
Q

Dysphagia (swallowing difficulties) Interventions

A
  • OTs recommend thicken food/drink consistencies
  • Can cause a decrease in oral intake as kids dont like it
  • Position for a chin tuck can be beneficial - laryngeal opening is smaller to reduce aspiration
  • Side lying position for infants
  • Reduce meal length to compensate for fatigue/weakness, smaller sips/bites, more difficult food at beginning of meal
78
Q

SPD Interventions

A
  • Hypersensitivity: turn away from feeding, brushing, gag, restrict food variety, issues transitioning to age appropriate foods- common for children who are received extensive medical treatment aka intubation
  • OTs can: desensitization or application of deep pressure or calming strategies (linear rocking)- create a balance of stimulating and calming sensory input
  • Introduce new flavours and textures gradually
  • Low sensory registration: drooling, overstuff mouth- enhance oral stimulation throughout the day (cold washcloth, vibrating toothbrush, oral motor toy)
79
Q

Behaviour Interventions

A
  • Can continue long after medical/sensory/skill challenges are resolved
  • Refusal to eat contributes to caregiver stress, negative/stressful interactions and makes mealtime a battleground
  • OTs: create new positive interactions around mealtime, offer choices and turn taking to help children feel more in control at mealtime
  • Use of positive reinforcement (social attention, verbal praise, music, stickers, tv) and redirecting/ignoring negative behaviour= improves oral intake
  • Break activity into small achievable steps with clear expectations- want child to trust the OT to decrease negative behaviour (crying, pushing food away or spitting it out)
  • Don’t get upset and end the activity- set a timer or a visual schedule for child to understand when activity is finished
  • Offer new foods across multiple meals in small amounts so can get used to taste & texture
  • Address underlying skill or swallowing issues
  • Adapt the enviro-length of meal, mealtime structure, location
  • Let them explore new foods at their comfort level - pair nonpreferred foods with preferred foods
  • Delayed texture issues: repetitive chewing exercises to build jaw strength , place crumbs to puree food
  • Delayed from bottle to cup: work on jaw stability, lip closure, tongue movement and oral sensitivity, spouted cups, cut out cup, provide extra jaw support (holding jaw)
80
Q

Neuromuscular Interventions for Oral Motor Impairments

A
  • Inexperience with normal feeding can contribute to oral motor weakness and coordination issues
  • Oral motor activities should include various flavours and textures
  • OTs can help with jaw strengthening- sustained biting, repetitive chewing
  • Poor tongue movements- practice licking a lollipop, make silly faces in the mirror, lick whip cream from corners of mouth
  • Nonoral feeding can put child at risk for oral motor and sensory impairment - OTs can provide oral exploration activities and social engagement during feeding to link pleasure with hunger sensation
  • Include tube fed children at mealtime
  • Nonoral to oral is a gradual collaborative HC process
81
Q

Cleft & Lip Palate

A
  • Separation or hole in the oral structures typically at midline during the early weeks of fetal development
  • Cleft lip: separation of the upper lip with small indentation
  • Cleft palate: separation of the anterior hard or posterior soft palate
  • These range in severity, bilateral or unilateral, require surgery to repair
  • NAM (nasal alveolar molding) is a nonsurgical method to reshape the oral structures
  • Most children have oral feeding issues - latching onto the bottle/breast, insufficient milk transfer, prolonged feeding times, poor weight gain and milk leaking from nose
  • Lack of closure between oral and nose causes latching issues to create suction
  • OTs recommend: compensatory positioning (feed child in upright position to improve milk transfer), adaptive feeding techniques and specialized bottles (use up and down movement rather than suction)
  • After surgery still provide guidance with feeding and drinking
  • After surgery OT can: scar massage, address oral hypersensitivity, and reassess oral feeding method
82
Q

Oral Structure Anomalies

A
  • Micrognathia: small recessed jaw
  • Macroglossia: tongue is disportionately larger than the size of mouth/jaw
  • Ankyloglossia: aka tongue tie- decreased tongue mobility and connects it more to the floor of the mouth
  • OT: considers the impact of the size and position of the oral structures on respiration and oral movement patterns during feeding - se different nipples, utensils or positioning adaptations to compensate
  • Dental issues and oral health can affect the willingness to eat (missing teeth or dental decay can be an issue in breaking down food or having pain when eating)

OT 826 Enabling Occupation in Children (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions