PEDS - Play, Behavior, Handling & FCC

When does the unoccupied stage of play occur?

0-3 months

What occurs in the unoccupied stage of play?

infant moves and grooves a lot trying to figure out their cute lil body

When does the solitary stage of play occur?

0-2 years

What occurs in the solitary stage of play?

- plays alone --> play with grown ups

- Not a whole lot of interactions with other children

When does the Spectator/onlooker stage of play occur?

18m - 2.5 years

What occurs in the spectator/onlooker stage?

- super observant of other kids playing

- imitates others but doesn't play with them

When does the parallel stage of play occur?

2.5-3 years

What occurs in the parallel stage of play?

- plays next to other kids but not with them

- imitates adults + children

- very imaginative

When does the associate stage of play occur?

3-4 years

What occurs in the associate stage of play?

- begins to interact with others in a limited capacity

- beginning to develop friendships (preferences/favorites)

When does the cooperative stage of play occur?

4-5+ years

What occurs in the cooperative stage of play?

- likes playing in small groups and with kids of same gender

- plays cooperative games w/ rules

What are the 3 kinds of physical activity play?

- Rhythmic Stereotypes

- Exercise Play

- Rough-and-Tumble Play

T/F: Females tend to engage in more exercise and rough&tumble play

False. C'mon now... lol

When do rhythmic stereotypes peak?

infancy (birth - 12m)

When does Exercise play peak?

Starts at 12m and peaks during preschool years

When does Rough&Tumble play peak?

middle childhood-adolescence

What's the definition of rhythmic stereotypes?

gross motor activity without an obvious purpose (foot kicking, waving, rocking)

What's the purpose behind rhythmic stereotypes?

improves motor control in specific motor patterns

What is included within Exercise Play?

running, chasing, jumping & climbing

What's the purpose of exercise play?

- increases arousal level

- primarily for strength and endurance training (general physical fitness)

What is the social function of rough&tumble play?

- introduced by parents

- boys use it to decode social signals such as play vs. aggression

What are the 4 quadrants of sensory integration?

- low registration (oblivious to stim)

- sensory seeking (need stim)

- sensory avoiding (distracted by stim)

- sensory sensitivity (low threshold)

What are the two ways that we can increase a child's head control so that they can have better visual input?

- positioning and adaptations

- encouraging vestibular input

What are the response options to auditory stimuli?

- absence of response

- simple orientation to sound

- movement towards stimulus

- startle response

What is the primary occupation for children?

to play

How do children learn social rules like sharing, waiting their turn, and collaboration?

by playing with others

What is the largest sensory system for children that plays a major role in physical and emotional behavior?

Tactile

What is tactile defensiveness?

averse response to some tactile stimuli (light touch)

When might you see tactile defensiveness?

- Children with DD/neuro impairment

- Children with ASD

- Children with Sensory Avoiding/Sensitivity

What's the clinical presentation of a child exhibiting tactile-defensiveness?

- anxious (me lol)

- emotionally labile

- threatened

- unable to cope (also me)

- compensation with withdrawal, irritability, or distractibility

What are things to AVOID in a child showing tactile defensiveness?

- light touch

- "tickle" or irritating stimuli

What are things to do when a child is showing tactile defensiveness?

- use deep pressure

- provide stability

What are the two things that can result from an impaired vestibular system?

- Averse response to super imposed movement (overreaction, threatened, nausea)

- Sensory-seeking behaviors

How can you alleviate averse responses to super imposed movement?

introduce the movement slowly and closely observe the child's reactions

What are some examples of behaviors that sensory-seeking children perform?

- chewing on things/hand

- spinning

- head banging

- flapping arms

- teeth grinding, self biting

- rocking

What is the when-then rule of performing interventions with a child?

Work hard, play hard.

Making the desired activity (play) available after the task is completed increases the chance the child will do it.

When should you use "No" with a child?

When they're doing something harmful to themselves or others.

No should be seen as a last resort.

Why do you not want to bring a bunch of goodies with you when you treat a child in their home?

- when you leave, you take all of that shit with you

- need to meet them where they're at in their home environment

- show parents what they can be doing with what they have

What are two fundamental things to ensure parents are including in their daily routines?

- Handling - moving child in an age-appropriate way to promote development

- Positioning - position in age-appropriate positions to promote development

Why should you allow the child to "take the lead" during intervention sessions?

- to encourage independence, autonomy, and efficacy

- follows child's passions to keep them cognitively engaged longer

What are the pros of using music during pediatric intervention?

- keeps attention and encourages cooperation

- reciprocal movements through rhythm

What are INEFFECTIVE treatment strategies?

- weighted apparatuses

- brushing/sensory diets

- Fidget/fiddle toys

- auditory integration/therapeutic listening programs

Why do those ineffective treatment strategies still get used???

What's the purpose behind heavy touch/work interventions?

- postural awareness/proprioception

- joint stability

- strength

What are some examples of heavy touch/work interventions?

- wheelbarrow

- bear, crab, spider walks

- pulling therapy

- pushing/sled, scooter board activities

What's the goal of therapeutic handling? (long card!)

hand placement with/without external supports in the best location with the least cueing/support to produce the best postural control or movement out of the child.

What are some guidelines for proper handling of children with spasticity?

- move slowly

- don't pull against tone

- begin proximally

What are some guidelines for proper handling of children in general?

- get the child to do as much as possible

- go slow

- use their attention to engage in activity as well as position

- utilize scaffolding

What are some guidelines for proper handling of children with neurological disorders?

- startle easily and may withdraw

- use palms/pads of hands

- consider how "busy" the room with w/ people and toys

- consider lights in the room as well as types of toys

What are some guidelines for proper handling of children with low postural tone?

- use more vigor/firmness

- use your own excitement to improve arousal while giving them time to respond

- be careful because these children may just use you as a support

What's pivotal to the progression of handling and independence of a child?

you are constantly trying to see how much you can lighten your input/support to see what you can get away with

For rolling to supine, where is the therapist and what are their hands doing?

- Therapist is behind infant

- hand promoting rolling at the pelvis

- might have a hand in their armpit to help them push up

For prone head control/carrying, where is the therapist and what are their hands doing?

- one hand is holding infant under chest/armpits

- other hand is supporting trunk/pelvis

- therapist is adjusting angle of infant to help out with extension without lower extremity compensation/tone

For sitting weight shifting, where is the therapist? What are their hands doing?

- therapist is sitting with infant over one of their legs

- hands at trunk/pelvis

- use leg as a tilt surface to promote anterior/posterior tilt OR play around with their balance

For transitioning from sitting to quadruped, how does the therapist promote this movement through handling?

- place toy in front of infant but out of their reach

- one hand on pelvis, one hand on chest

- rotate their trunk (initiate mvt) and then guide their hip to complete rotation into quadruped

How might you facilitate righting and equilibrium reactions in a child? *don't overthink it*

Utilizing tilting reactions to facilitate righting and equilibrium reactions

For prone on forearms, how can a therapist promote activity performance through proper handling?

- therapist supports child at shoulder girdles

- provides light "bounce" for proprioceptive input and helps forearms as needed

What should a home program include regarding developmental interventions?

Realistic handling and positioning interventions for parents to implement into a daily routine