Management of Pediatric Clients

Tuesday Lecture

What is the first step in treating a ped?

Determining a goal based on the ICF model

What is the bottom up traditional approach?

Deficit driven; professional determines weakness, strength, and sets goals to work on (could never get discharged)

What is the top down approach?

Outcome driven model; outcome determined first then determine what obstacles are in the way to meet outcome; more episodic care

What approach to types of assessment is better to use?

Top-down

What is the first step when evaluating a ped?

Determine your purpose; what clinical question are you trying to answer?

Why assess a ped?

-Screening

-Diagnosis

-Program eligibility

-develop PT POC

-Evaluate effectiveness

-Evaluate change over time

Settings of peds clinics

Natural; home/daycare, school, clinic, inpatient

How do different settings change the evaluation process?

Doing different kinds of testing or different focuses to fit the childs goals.

Who is typically around during a ped exam?

Family/caregiver, sibling, other professionals

What is the role of the family or caregiver during exam?

Give history or other pertinent information child cannot provide.

What is important to look at for history of peds?

Caregiver concerns, child/family goals, Pregnancy and L&D, PMH, current medical history, development history, social situation

T/F observation occurs before you touch the child

True

How does the environment affect what you get to observe?

free play, playing with caregiver, toys at different areas

What are important observations to look for in a ped?

Supine, prone, sitting, standing, prone. suspension, protective and balance reactions, functional mobility, quality and speed of movement, interaction with environment, temperament, interaction with caregiver, cognition, communication, adaptive behavior, fine motor.

What are tests and measures chosen by when it comes to a ped?

Chosen based on purpose of exam, what you observe, and child original Dx.

T/F Tests and measures are the same for peds and adults

False

Measures in the body function and structures ICF domain?

Pain, strength, ROM, muscle length and tone, rflexes, balance, posture, bony deviations.

How might you test muscle strength in small pediatrics who cannot comprehend MMT directions?

Observation, dynamometry, diagnosis specific scales

Tests and measures that fall under the activity domain?

Observation of transitions, creeping, gait quality, along with motor milestones

Activity domain standardized test examples

Alberta infant motor scales, Peabody developmental motor scale, TUG, pediatric balance scale, 5STS

What is the pediatric balance scale similar to

Berg Balance Scale

What are examples of activity ICF domain test and measures?

Quality of life and health related

Do we use activity ICF T&M often?

No; more common for researchers

Role of standardized testing

Provide information to assist professionals in decision making

What is a barrier to using standardized tests?

Time to administer and cost of tests

What is a norm-referenced standardized tests?

Compares individual performance against reference group like same-age typically developing peers.

What are norm-referenced standardized tests sensistive to?

Change over time or chronic conditions

Norm-referenced standardized tests are used to determine ____ ____ or ____

Program eligibility, diagnosis

What is a criterion-referenced standardized test

Compares performance against described criteria like knowledge, skills, and abilities

What is criterion-referenced standardized test good at showing?

Change over time

What are criterion-referenced standardized tests sensitive to?

Effects of interventions

What does criterion-referenced standardized tests good at determining?

Determines if child is improving, maintaining, or regressing

What is an example of a screening tool?

Ages and Stages Questionnaire (ASQ)

What are comprehensive developmental assessment examples?

DAYC-2, Bayley-III

What are the standardized tests for motor assessment?

PDMS-3, Bruinicks-Oseretsky Test of Motor Proficiency- 3rd edition (BOT-3)

What are standardized tests made for children with disablities?

GMFM, WeeFIM, PEDI

What are some numbers reported in standardized testing?

Raw Score, Basal level, Ceiling level, Age equivalent, Z-Score

What are important things to note about age equivalence?

Gives average estimate age a typically developing child would receive that raw score; often misunderstood by non-professionals

What is a Z-Score?

The number of standard deviation a score falls above or below the mean.

Is the AIMS norm or criterion referenced?

Norm-referenced

Is the PDMS-3 norm or criterion referenced?

Norm-referenced

Is the DAYC-2 norm or criterion based?

norm based

What is the developmental quotient?

Ratio between child’s actual score based on the developmental age on a test and the childs chronological age.

What are percentile ranks?

Rankings based on percentage of individuals in the normative sample who recieved a score above or below score recieved

What are standard scores?

Compares score of child to peers, normally distributed, norm-referenced

What to consider when using standardized tests?

Reliability, validity, sensitivity, specificity, standard error of measurement

What makes a test reliable?

Following the directions in the test manual

What is validity?

How well the test represents what it is supposed to be testing.

What is the standard error of measurement?

Range of probable scores, childs true score is in there, measure of variability.

How to choose the right standardized test?

Purpose, Age, Diagnosis, setting, what information is given from the test.

AIMS age group

birth to 18 months

AIMS subscale

supine, prone, sitting, standing

How long does it take to administer AIMS?

20-30 minutes

Purpose of AIMS?

Identify motor delay and evaluate motor development over time

What information is provided from an AIMS

percentile rank compared to normative age matched samples

Is aims a norm or criterion referenced test?

Norm-referenced

AIMS is MOST discriminative when?

Before the infant is standing.

PDMS-3 age range

Birth to 5 years

Is PDMS-3 norm or criterion referenced?

Norm-referenced

How long does it take to administer a PDMS-3?

60-90 minutes

How long do the subtests of the PDMS-3 usually take?

20-30 minutes each

What are the subtests to the PDMS-3?

Gross motor, fine motor, supplemental subtests

Purpose of the PDMS-3

Estimate child gross and fine motor functioning over time or compared to peers

T/F PDMS-3 requires special equipment

True

What measures does the PDMS-3 provide?

Basal and ceiling, age equivalent, percentile, standard score, fross motor, fine motor, and total motor quotients.

What is the age range for the DAYC-2

Birth to 5 years 11 month

DAYC-2 domains

cognition, communication, physical, adaptive behavior, social-emotional

DAYC-2 purpose

Identify children with delays in the 5 domains, monitor progress in special intervention programs, research.

DAYC-2 Administration

Observation, interview with parents/caregivers, no equipment needed

What numbers do you get from a DAYC-2?

Age equivalent, percentile rank, standard score

How much time does the DAYC-2 take to administer?

10-20 minutes per subtest

What is minimal detectable change

Smallest about of change that is reflective of true change and not that which can be accounted for by measurement or test error

What is minimal clinical important difference

Minimal level of change required in response to an intervention before the outcome would be considered worthwhiile in terms of an individuals function or quality of life

How would you document activity/participation diagnosis?

with an inability to …

How would you document activity/participation to activity?

as a result of difficulty in performing…

How do you link to impairments when documenting diagnosis?

secondary to… OR

In the presence of s/s consistent with ___ patology

Where should long-term goals be formulated from?

activity and participation ICF

Where should short term goals come from?

Body function and structures and activity domains of ICF

How should PT’s think about plan of care?

FITT, evidence based, should be intentional, episodic

What are important considerations for pediatric interventions?

Principles of neuroplasticity and motor learning theory.

What is explicit knowledge?

“what to do” or declarative

What is implicit knowledge?

“how to do” or procedural

What is motor learning generalizations?

Using simulation in clinic to closely make the activity in their home environment to try and translate real world change.

What are the three stages of the Fitts and posner model?

Cognitive, associative, autonomous

What are common practice schedules?

Blocked, distributed, massed, and random

What kind of skills are whole practice?

Skills in low complexity wand high in organization

What kind of skills are Part practice

skills high in complexity and low in organization

What are components of an intervention session with a ped?

Set session outcome, activity analysis, pretest of functional outcomes

What are the 4 best practice principles for peds intervention?

Individualized, child active, task-specific, and goal-directed

How to set up for single system preparation?

Address regulatory system, sensory system, musculoskeletal, and other systems

What is multisystem preparation?

ABC- Alignment, Base of support, Center of mass

How to properly progressively challenge a ped

Just the right amount of challenge, not too hard not too easy.