children and youth final

Working with OTAs: factors

-Experience of the OTA

-Complexity of the clientele

-Requirements of the practice setting

-State practice act mandates

-OTAS can perform screenings

-can contribute to eval/standardized assessment subtests in which they are trained and comfortable

-administer questionnaires with detailed instructions to parents/caregivers

Skilled Acquisition Frame of Reference

-Motor learning is the acquisition, retention, and transfer of specific movement patterns to a motor solution

-emerges from the individual's interaction with the task and environment, and results from practice

-in OT, focus is the actual movement itself and the functional end goal of the movement

3 stages of learning a motor program

cognitive stage>associative stage> autonomous stage

cognitive stage

-gaining an understanding of the task

-establish task goals

-requires explicit knowledge

-language use/ verbal rehearsal

-learner needs to initiate movement

-too much feedback or coaching can be disruptive

-learners are getting the idea of the task

-Extrinsic feedback is most important

-movements are often halting, inefficient, and inaccurate

Associative Stage

-gradual improvement in performance with practice

-spatial and temporal aspects become well organized

-movement errors decrease

-learners are more relaxed and more accurate

-less working memory involved/ lower cognitive demand

-errors continue but more minor

-intrinsic feedback is most important, esp proprioceptive

Autonomous Stage

-movement is automatic

-explicit thought not required

-motor performance is consistent, fluid, and efficient

-people recognize their own errors and can adapt

-learning must be extended across environments

-paralysis from analysis, the more attention you pay to a skill, the more it worsens your performance

motor skill practice strategies

-whole vs part practice

-distributed vs massed practice

-constant vs variable practice

-specificity and location of practice

school based OT services

students 3 to 21 years

IDEA

Individuals with Disabilities Education Act

FAPE

Free Appropriate Public Education

LRE

Least Restrictive Environment

MPE

multi-factored evaluation

educational model

-focus: the child's role as a student

-goals tied to participation and access to the curriculum

-services written into IEP

-team based, family centered process

clinical model

-focus: development and daily living skills

-goals ties to medical and functional outcomes

-services based on medical necessity

-therapist-driven, family involved

services in school based setting

-pull out: pull children in a separate setting

-push in: provided in general education classroom

indirect services

-work in behalf of students

-work with classroom teacher to help modify instructions or implement an organizational system

integrated services

-services in students natural environment

-lunchroom

-restroom

-lockerroom

multitiered models

-universal learning design

-meeting the needs to all students

-early intervention services

-school wide initiatives

tier 1

universal/core instruction-all students-school wide

tier 2

targeted interventions-small group support, ex: handwriting group

tier 3

individualized direct services-direct support

Neurodiversity and behavioral analysis frame of reference

ABA: -aims to increase adaptive (functional) behavior and decrease maladaptive behavior

ABC's of behavior

-antecedent

-behavior: can be any action

-consequence: any type of result, can be neutral

aspects of ABA

-begins with an analysis of behavior to determine its function, behavior is communication

-several approaches may be used

-discrete trial training is only one such approach

-systematic and repeated trials of ABC to shape the desired behavior

-adult-selected materials presented repeatedly

ABA

-intervention technique using behavioral science FOR

-learning specific skills

-reinforcement and conditioning as extrinsic influences to support desired actions and responses

-activity based with new skills learned through drill based repitition

-most common for ASD where reimbursement is strong

CBT

-intervention technique using behavioral science FOR

-addresses faulty learning

-challenges beliefs and replaces errors in thinking

-talk based with discussion of specific events that help people change their thinking about trigger/challenging event

antecedent interventions

appropriate sensory supports/strategies

-ex: trampoline, sit and spin, bounce on ball, weighted blanket, tunnel, etc

Functional communication training

individual is explicitly taught an alternative way to meet a need/want instead of that which was identified as a problem behavior

pivotal response training

A behavioral intervention usually administered by parents in naturalistic settings; designed to increase the motivation and self-regulation skills of children with ASD

functional behavioral analysis

Formal process for evaluating factors influencing behavior

-team building/goal setting

-functional assessment of behavior

-hypothesis development

-etc.

IDEA re. Transition Services

-must begin when student is 16 or earlier

-student may graduate with peers at 18 or continue through age 21

-designed to be results oriented process

-focused on improving the academic and functional achievement of the child

-facilitates the child's movement from school to post school activities

aspects of transition plan

→post secondary education

→vocational education

→ integrated employment

→continuing and adult education

→adult services

→independent living

→community participation

transition needs

→medical and therapy providers

→social skills supports and groups

→sexual safety and awareness

→living supports

→community groups

→adaptive sports and fitness

strengths based frame of reference

-identify and encourage strengths that can lead to increased participation

-evaluate strengths in addition to understanding difficulties

-develop interventions that enhance strengths and the environment where they can be utilized

-what environments enhance the strengths

-reframing the child's behavior for the parents can lead to

→ increased positive affect/affection

→ increased positively framed statements

→higher self-efficacy and self determination

parent/caregiver coaching model

-focuses on empowering caregivers with knowledge and strategies to support their child's development in daily routines and natural environment

-primary client is the parent or caregiver

-goal is to build the caregivers confidence, capacity, and problem solving skills

coaching approach

-uses collab discussion, reflection, and modeling, during naturally occurring routines

-OTs act as a coach or facilitator, guiding the caregiver to identify what works and why

-emphasized adult learning principles-empowerment, reflection, and real world application

Living Skills Service Delivery

-joint planning> observation> action>reflection> feedback

-not billable to private insurance unless child is also present receiving skilled intervention

NDT FOR

development is

1. cephalocaudal

2. proximal to distal

3. gross motor to fine motor

4. stability to mobility

goal of NDT

-addressed postural and movement challenges

-normalize movement!!!

-tone

-alignment

-inhibition of abnormal movement

biomechanical FOR

improving strength, endurance, ROM< structural integrity will lead to improve function

splinting, exercise, massage

pain, sensory, coordination not primary concerns

Developmental FOR

-lifespan development, focuses on milestones that occur in a predictable, sequential order

sensory integration FOR

-processing and response to sensory stimuli

-supports adaptive behavior and self regulation

PEO model

Person environment occupation ( occupational performance)

Cognitive Behavioral FOR

-mental health conditions or cognitive impairments

-thoughts, behaviors, emotions are connected

Behavioral FOR

-increase adaptive and decrease maladaptive behaviors

-reinforcement

goal attainment scale

A rating system with a range of values used to assess success in meeting goals

-5 point performance scale marking performance from a center target at 0, and performance targets as -2,-1, and performance beyond target as +1,+2