Peds, week 3, Intervention (motor control, sensory intervention, behavior, interoception)

motor control vs motor learning

control- how the CNS organizes movement

learning- strategies/techniques on how we teach others how to move

Bottom up vs top down approach (motor control)

BU

- normalize tone, remidiate sensory dysfunction, improve dyspraxia

- via sensory integration, neurodevelopmental treatment, reflex integration therapy, strength training

- limited research evidence

TD

- focus is on enabling the child to engage in the whole task

- dynamic and systemic brain development and plasticity

Dynamic systems theory (motor control)

movement derives from a variety of sources and takes place within a variety of natural and meaningful contexts

dysfunction occurs when movement patterns lack adaptability to accommodate task demands or environmental constraints

Ecological theory (motor control)

emphasizes interaction between person and environment

importance of perception in everyday activities

What are the three principles of motor control?

1. PEO

2. variability within systems

3. motor learning includes activities that are meaningful in an adapted environment that supports the child in problem solving

Explain degrees of freedom

possible planes of motion in the joints controlled by the musculoskeletal and CNS

limiting these can help improve functional movements and increase learning of complex motor movements (support more proximal can increase DOF more distally)

elbow has 1; hand has many

what is an attractor state

tendency to stay in patterns of the status quo or preffered state, requiring the least amount of degrees of freedom (like a W sit)

this does not challenge the kid

What are important key concepts of motor learning?

- meaningful

- generalizable skill that can be transfered

- intrinisc*** and extrinsic feedback

- variability helps them learn to adapt to change

- learn the WHOLE activity, not just one step or part

- problem solving!!!

- mental practice (keep short with kids)

- vv mirror therapy

How does the type of play evolve with age according to Takata?

birth-2years (sensorimotor)

2-4y (symbolic, simple constructive)

4-7y (dramatic, complex, pregame)

7-12y (games!)

12-16y (recreational)

How is play used in intervention?

as a modality

as an occupation

as a reward

what are the four main types of behavior

attention

escape/avoidance

tangible (I want!!)

sensory

How to manage attention behavior?

teach appropriate ways to get attention

ignore undesired behavior

give intentional positive attention throughout the day

how to manage escape/avoidance behavior?

visual schedual

visuals!!

social story

choices

clear expectations

how to manage tangible behavior?

teach acceptance of no

control access to items

increase interest in other things

give transition warnings

teach how to request what they want appropriatley

how to manage sensory behaviors?

redirect

provide sensory input regularly

teach other strategies

reinforce appropriate behavior

tips for managing all challenging behaviors

- rule out pain/sickness

- routine, consistent

- calm

- positive reinforcement

- do statements

- perspective!!

how to prevent challenging behaviors

- minimize aversive events

- share control, give choices

- structure

- communicate

- support self regulation

- just right challenge

- help meet sensory needs

- use visuals

- no is not a choice

- alternate between liked and not liked tasks

- support transitions

what is important to know about sensory intervention

- communicate and prepare

- modify and honor their responses

- never force

- use multiple sensory systems, get them just right

- have them set up and clean up

- look for adaptive responses

- safety first

- maintain optimal arousal

- grade activities

- make it fun

- modify environment

- overresponsive: low and slow

- underreponsive: fast blast

- seeking: structure

- postural: consider their vestibular, proprioceptive, and ocular senses, use mirror so they have sense of midline, do work on swing and ball

- dyspraxia: ideation, motor planning or execution? tactile and proprioceptive functions? use novel activities. address self esteem.

What does SOAP stand for?

subjective, objective, assessment, plan

What is ASI/OT-SI

Classic intervention is provided in a specialized therapy room with sensory equipment that provides tactile, visual, proprioceptive and vestibular opportunities in a structured manner in collaboration with the primary caregivers.

the intention is that the physical activities produce sensations that lead to adaptive responses, and consequently, to even more complex responses. In the case of children the intervention is centered in play, allowing the construction of sensory experiences and the planning of actions in relation to guided and growing challenges.

Applications have been broadly applied with individuals with a variety of disabilities and age groups. ASI is trademarked to help researchers, therapists, and parents identify the core principles which define ASI and to differentiate this evidence-based intervention from other approaches which may use some aspects of sensory-based activities, but do not meet the criteria for ASI.

www.cl-asi.org

what are the steps of interoceptive awareness

notice the feeling in the body

connect that noticed stimuli with a feeling/emotion

then go from urge to act to decision for action

regulate with an action

experience the outcome

if there is interoceptive dysfunction, how might that present?

trouble with thirst, physical exertion, emotions, hunger, and pain

red flags: walking on broken femur, toilet accidents, emotional breakdowns

what is currently the only evidence based intervention for interoception?

mindfulness

--> improved insula function

what are some activities to work on interoception?