Pediatrics NBCOT

Keyline for Pediatric Eval

Really Shouldn’t Eval Going in Really Drunk

Order of Eval process

referral - screen - eval - goals - interventions - re-eval - discharge

Overview of screening

20-30 minutes

determine if a formal eval is needed

Ages and Stages questionnaire

Top Down approach

Occupation based

Bottom Up Approach

Deficit based approach

Do you need to document if you deviate from standardized directions?

Yes

Norm Referenced

Compare a kid to their peers

good for those that follow directions

Criterion Referenced

A checklist comparing kids to different tasks

good for those who cannot follow directions

When does a kid qualify for services

2 standard deviations below the mean

Keyline for reflexes

Mr. Pats Land “Hey, Hey, Real Role-Right PCs

63666624

Moro

You surprised me, I wasn’t expecting you until tomorrow (6M)

Rooting

Rooting animal is looking for food

(3M)

Palmar gasp

place object in palm, kid will grasp

(6M)

ATNR

Asymmetrical tonic neck reflex

Fencer position

(6M)

TLR

Tonic Labyrinthine Reflex

Head flex= Body Flex

Head Ext= Body extend
TLR= Taller

(6M)

STNR

Symmetric Tonic Neck Reflex

Head down butt up

Head up butt down

Sym=somersault

(6M)

Landau

Suspended in prone TLR

A.k.a Superman

(24M)

Protective/Equilibrium reactions

Avoid hurting yourself when falling

What happens if reflexes don’t integrate

it can hurt volitional movement

What kid of reflexes integrate?

Primitive and righting

What reflexes don’t integrate

protective

What reflexes deal with head control?

Moro and rooting

What reflexes deal with releasing objects

palmar

What reflexes deal with rolling and R/L coordination?

ATNR

What reflexes deal with posture, transitions, and tone?

TLR

What reflexes deal with core and GMC

STNR

What reflexes deal with sitting and standing upright?

Landau

Start of development story till exercise

start prone

4 AM wake up and left head

6AM push up head and trunk, raking grasp for phone, roll over and give phone a kiss then sit up with arms for props

Development story from exercise to walking

12- sit ups with arms folded (sit w/out support)

crawl to side of bed and hold onto it to stand

furniture walk to kitchen

Development story from diploma to end

On walk, knock over diploma you got when you were 18

squat to pick it up

remember how you walked across stage without tripping

get to the kitchen and stir your cup of coffee

2 year milestones

Two sets of Two

High/low: up and down objects and when playing

Fast/slow: runs, kicks, throws ball

3 year milestones

Three-easy (better at 2 milestones)

Three strikes (catch ball)

Tri-cycle (pedal tricycle)

¾ dressed (dresses min A)

4 year milestones

4-dinated

1 foot skip, alternates feet up steps, colors in lines

5 year milestones

high-5

toileting

dressing

Keyline for SI

Si is a sprinkle of salt and a spoonful of sugar

vestibular meaning

moving/arousal

proprioception

body position in space

meaning of sensitivity in SI lense

defensiveness

Registration in SI lense

pay attention to what’s important and ignore what is irrelevant

Adaptive response

organization of sensation to produce a goal

Sensory Modulation

Appropriately responding

can be hypo (wake-up) or hyper (calm down)

tactile def, auditory def, gravitational insecurity

Sensory discrimination and perception

difficulty differentiating sensory stimulation

visual perc, tactile perc, proprioceptive issues

vestibular bilateral issues

exactly what it says

bike riding, cutting/writing, incoordination

Dyspraxia

difficulty with motor planning

challenges

• clumsy, sequencing, timing, imitating others

Sensory Seeking

Prop seeking= stomping, jumping, bumping

Tactile seeking=touching

vestibular seeking= swinging, spinning

Interventions for vestibular seeking

swinging

• linear swinging to decrease

• fast and unpredictable swinging to increase

Dynamic seating

Interventions for tactile/prop seeking

weighted vest

tactile activities

joint compression

wilbarger brushing protocol (will brush her with pressure)

Interventions for hyperresponsiveness

build tolerance through lights auditory and tactile

Interventions for gravitational insecurity

build tolerance with hands on support

Interventions for dyspraxia

verbal direction, visual demonstrations, physical assistance

3- additional things to know for NBCOT in regards to SI intervnetions

Alert programs

social stories

sensory diets

Keyline for Autism

Mrs. Boxcar is fast to engage him

Main three performance patterns of children with autism

rigidity

sensory challenges

motor skill concerns

What does heads up mean in regards to autsim

give the child advanced warning for any kid of schedule changes

Pneumonic for thinking outside the box

FAST Engage HIM

Focused

Alone

Same

Transitions

Engage

Heads up

Ideation

Model social

How to engage child (autism)

capture attention

How to help behaviors via transitions (autism)

Advanced notice

tolerance to unexpected changes

How to help comfort with completing ADLs (autism)

Sensory strategies to reduce discomfort

grading task for just right challenge

How to help with ideation of play (Autism)

promoting to help generation of new ideas

How to help with praxis issues (autism)

increasing attention to movement or body awareness

How to help with socialization (austim)

increase play skills

How to help with sleep (Autsim)

claming, sensory, proprioception, limiting arousal

if behavior based, parents ignore

how to help with ADLs (Autism)

Video support for cog

motor learning

behavior plan

modification for sensory

Motor Difficulties (8)

Dysmetria

Limited Force Control

Intention tremor

dysdiadochokinesia

decreased bilat coord

decreased balance

decreased FMC/GMC

associated reactions

Dynamic systems theory

person

task

environment

Ecological theory

Person, environment, interaction

Three motor control principles

Whole learning

variety of tasks with same motor movements

problem solving

Six motor learning principles

meaningful

transfer of learning (generalization)

grading and adapting

modeling and demonstration

verbal instruction

practice

5 types of practice

Whole vs part

bocked

distributed

variable

mental

blocked practice

repetitive task

not for complex tasks

distributed practice

practice skills in varying tasks but related motor skills

variable practice

actual skill in natural context

best for transfer of learning

mental practice

prepare to perform task with imagery (short)

Keyline for Motor Learning

MC deficits make blocking Dis Very hard

Manual wheelchairs require what

ability to self-propel

forward COG on W/C

increased stability

decreased maneuverability

good for amputations

Backwards COG with w/c

decreased stability

increased maneuverability

reason to recommend a power chair

can’t keep up with peers

UE weakness

Rear wheel helps with what

rough terrain

Mid wheel helps with what

manuverability

what can happen with frontwheel

fishtail

recline and tilt-in-space w/c do what?

posture, pressure relief, orthostat hypo

recline w/c are better for what

hip precautions

tilt-in-space w/c are better for what

extensor tone hip contractures

hand held walkers require

weight bearing through LE

grip and steer

Interventions for postural weakness (w/c)

recline

other physical support

Interventions for UE weakness (w/c)

increased to power chair

add ons for maneuverability

Interventions for increased tone (w/c)

hip flexion

Interventions for motor control (w/c)

adaptive ways to control w/c

Interventions for pressure relief (w/c)

cushions

tilt/recline

Keyline for positioning

Proximal stability before distal mobility

preparatory conditions for crawling

Prone extension

Quadruped

preparatory conditions for standing

tall kneel

half kneel

usupported positions in seated

long sitting

ring/taylor sitting

W sitting

Optimal positioning

upright

90-90-90

Extensor tone

high tone

flat as a board

hypertonic

inhibitory techniques

Flexor Tone

Low tone

Hypotonic

facilitation techniques

What do you address first for someone with FMC/oral MC issues and low tone?

Positioning

Interventions for supportive/adaptive positioning for dressing

flexion and supine increased extensor tone

side-lying to move limbs easier

Interventions for toileting (positioning)

reducer rings