Conditions Final Exam

Mental health continuum

Model used for children to describe the range of mental health experiences, from healthy, adaptive functions to severe impairment; maintains that mental health is not merely presence of absence of mental illness; important to intervene along whole continuum not just when disease is present

Public health approach

Model w/ a multi-tiered framework of services, shifting focus from a medical, deficit driven model of individualized therapy to a broader strengths based approach for entire population; recognizes mental health is too complex to delegate to one profession

Tier 1 (promotion)

Tier in public health approach: focuses on universal, whole-school approach to mental health by teaching key social and emotional competencies that contribute to well-being; designed to benefit all students regardless of mental health status

Tier 2 (prevention)

Tier in public health approach: aims to preemptively address emerging mental health issues among at risk students by equipping them w knowledge, skills, and resilience needed to manage stress and emotional challenges

Tier 3 (intensive support)

Tier in public health approach: most intensive interventions, focus on children who have diagnosed mental health conditions or who are highly vulnerable due to disabilities and other factors

Holistic approach

School-based mental health approach: incorporate, social and emotional activities and supports within intervention plans, focusing on the child's overall well-being, even when mental health is not the primary reason for receiving OT services

Occupation and strength based interventions

School based mental health approach: use interest driven activities whenever possible; providing children with opportunities to make choices and show their strengths and feelings of competence, agency and control

Interdisciplinary collaboration

School mental health approach: work with a team of specialists and engage families to ensure a comprehensive approach to the child's development; work with school teams to adopt and implement trauma informed practices

Skill development

School mental health approach: incorporate skills associated with building emotional resilience, such as mindfulness and relaxation techniques as preparatory activities whenever possible

Environment modification

School base mental health strategy/approach: create inclusive, and safe spaces that accommodate sensory and emotional needs - calm cafeteria, peace corners in the classroom

Integrated services

School based mental health strategy/approach: work collaboratively with teachers to integrate program programs to help students self regulate and manage their emotional and sensory needs into their classroom routine

The intentional relationship model

Model for school based mental health: focuses on the therapeutic relationship between the therapist and the client, developed by Renée, Taylor; emphasizes how therapist can intentionally use their interpersonal skills to promote client engagement and participation; identify six therapeutic modes that can be used dynamically, depending on the situation

Advocating mode

Six therapeutic modes: the therapist ensures that the client's rights are enforced, and resources are; involves removing barriers and facilitating access to services that support the clients participation in desired occupations

Collaborating mode

Six therapeutic modes: characterized by treating the client as an active and equal participant in therapy; therapist seeks the client's input and jointly makes decisions fostering a sense of partnership

Empathizing mode

Six therapeutic modes: focuses on bolster during the client's confidence and motivation through positive reinforcement and praise; therapist highlights, client, strengths and successes to promote engagement and perseverance

Instructing mode

Six therapeutic modes: predominantly, educational, involves the therapist, providing direction, feedback, and teaching about specific skills or knowledge relevant to the clients therapeutic goals; directive and often used to impart technical skills

Problem-solving mode

Six therapeutic modes: therapist and client identified challenges and work together to devise practical solutions; this mode is analytical and solution, focused, encouraging critical, thinking, and practical steps to overcome obstacles

Every moment counts

Resource that empower all adults interacting with children to see themselves as mental health promoters; focuses on capacity building and proactive mental health

37 weeks, 28 weeks

Gestational age: Preterm infants are those that are born before ______ weeks. Extremely preterm infants are those born before ______ weeks.

Chronological age is the actual age since birth, whereas corrected age is the age of the infant if born at term.

_____________ age is the actual age since birth, whereas ___________ age is the age of the infant if born at term.

Retinopathy of Prematurity (ROP)

caused by abnormal retinal vessel growth, potentially leading to retinal detachment and vision loss if severe; increased risk of develop developing if born at 31 weeks GA or earlier

48 hours

Low birth weight preterm infants also are at significant risk of

neurologic involvement such as intraventricular hemorrhage (IVH)

(bleeding into the ventricles and potentially into the brain),

particularly during the first ________ of their NICU stay.

Atrial septal defect (ASD)

Congenital heart defect with an opening in the septum between the hearts chambers

Ventricular septal defect (VSD)

Congenital defect with an opening in the septum between the hearts, lower chambers

Intraventricular hemmorhage (IVH)

Bleeding into the ventricular system of the brain affecting cerebral spinal fluid production

Periventricular leukomalacia (PVL)

Brain injury, impacting white matter near the ventricles, potentially causing motor and cognitive impairments

Necrotizing Enterocolitis (NEC)

Severe gastrointestinal condition predominantly found in premature infants

Respiratory distress syndrome (RDS)

Also known as hyaline membrane disease; occurs in preemies due to insufficient surfactant leading to breathing issues

Broncopulmonary dysplasia (BPD)

Chronic lung condition commonly seen in premature infants, post oxygen therapy

Apnea

Temporary sensation of breathing frequently seen in premature infants

Bradycardia

Abnormally slow, heart rate often seen in conjunction with apnea in infants

Family

What factor has the greatest influence over an infant health and well-being in relation to the NICU?

Early intervention programs

Services for families when their child has an established risk, a developmental delay, or is at risk for developmental delays; includes a team approach that is multidisciplinary, interdisciplinary, and transdisciplinary; aid in the development of an individualized family service plan (IFSP)

Developmental systems approach

Approach used in early intervention OT; aim to support optimal development through three levels:

1. child social and cognitive competence

2. familial patterns of interaction

3. resources promoting health and development

Transactional model

EI OT model: emphasize that continuous dynamic interactions between the child and their environment

Psychobiological attachment theory

EI OT model: focuses on the importance of forming secure attachments in early childhood for emotional and psychological health

Sensory processing model

EI OT model: addresses how children process sensory information and the impact of sensory integration on daily functioning

Neurodevelopmental disorders

A group of conditions with onset and developmental period inducing deficits that produce impairments of functioning; consist of intellectual disability, communication disorders, autism, spectrum disorder, attention deficit/hyperactivity disorder, neurodevelopmental motor disorders, including tick disorders and specific learning disorders

Intellectual developmental disorder

Disorder characterized by deficits in intellectual functioning, deficits in adaptive functioning that results in failure to meet developmental and sociocultural standards for personal independence and social responsibility, onset during the developmental period; varies in severity

Autism spectrum disorder

Neuro developmental condition that include social communication and interaction deficits as well as repetitive patterns of behavior and interests

level three: requiring: very substantial support

level two: requiring substantial support

level one: requiring support

Theory of mind

What idea is being challenged in this strengths based approach? unique perspective- individuals with autism may bring a fresh and unique perspective to social interactions, often seeing solutions and idea ideas that others might overlook

False - focus on describing environments as high or low functioning based on their suitability and adaptability to individual needs

T/F?

Labeling cognitive functioning as high or low functioning for ASD is part of a strengths based approach

Attention Deficit-Hyperactivity Disorder (ADHD)

Characterized by in attention, hyperactivity, and impulsivity; diagnosed in children and can continue into adulthood; characterized as mild, moderate, or severe

True

T/F: only half of children diagnosed with ADHD remain symptomatic in adulthood

ADHD Inattention

Type of ADHD: often forgetful in daily activities, often has difficulty sustaining attention in tasks or play, often does not seem to listen when spoken to directly, often has difficulty, organizing tasks and activities, often loses things necessary for tasks or activities, often easily distracted by extraneous stimuli

ADHD hyperactivity and impulsivity

Type of ADHD: often fidgets with hands or feet and squirms in seat, often leave seat in classroom or in other seated situations, often interrupt or intrude others, often has difficulty playing or engaging in leisure activities quietly, often on the go or act as if driven by a motor, talks excessively, often has difficulty awaiting turn

ADHD

Medications used for which condition: stimulants (Ritalin, concerta), anti-anxiety medications due to comorbidities w anxiety

Self-determination

Define each person's right to be the primary decision-maker in their life, critical for fostering, a sense of autonomy and confidence

Competence

All therapeutic interactions begin with the assumption that each child is capable. Effective communication is crucial serving as the pathway to self expression and empowerment. It is crucial to presume __________.

False - it is non-progressive

T/F? Cerebral palsy is a progressive disorder

Cerebral palsy

Describes a group of permanent disorders of the development of movement and posture, causing activity limitation that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain; often accompanied by disturbances of sensation, perception, cognition, communication, and behavior

True

T/F? Cerebral palsy severity has lessened and incidence is decreasing in high income countries.

Hypoxic Ischemic Encephalopathy (HIE)

Type of brain injury that occurs due to oxygen deprivation and reduced blood flow to the brain; commonly affects newborns, but can also occur in older children and adults due to cardiac arrest; can be a cause of CP

Increase, decrease

In CP, as time progresses, postural reflexes tend to (increase/decrease) and volitional movements tend to (increase/decrease).

Spastic CP

Most common form of CP; characterized by stiff tight muscles (hypertonia) due to damage in the motor cortex of the brain; movements can be jerky, difficult and rigid; can be hemiplegia, diplegia, or quadriplegia

Spastic hemiplegia

One side of the body is affected; affected side may have weaker muscles and appear smaller; commonly results from stroke or PVL in one hemisphere of the brain (CP)

Spastic diplegia

Both legs are affected more than the arms, muscle tightness in the hips and legs can cause scissoring, gait and difficulty balancing, often associated with premature birth, and PVL (CP)

Spastic quadriplegia

All four limbs are affected often with involvement of the trunk face and oral muscles; most severe form of spastic CP often leading to difficulty walking, speaking, swallowing and controlling head movements; associated with extensive brain damage; seizures, cognitive, impairments, and vision or hearing difficulties are more common

Athetoid/Dyskinetic

Less common form of CP; characterized by involuntary uncontrolled movements due to damage in the basal ganglia; muscle tone fluctuates between being too tight and too loose, speech and swallowing difficulties are common; more noticeable when trying to move; common causes include birth asphyxia, severe jaundice, or basal ganglia injury

Athetosis

Slow, writing, twisting movements of the hands, feet, face, and tongue

Chorea

Sudden unpredictable jerky movements

Dystonia

Repetitive twisting motions and abnormal postures

Ataxic

Type of CP; characterized by poor coordination, balance issues, and shaky movements due to damage in the cerebellum; difficulty with precise movement, tremors when reaching for objects, trouble walking with a wide based unsteady gate, poor depth, perception, and difficulties with quick movements; may have trouble with speech coordination (dysarthria)

Spastic-dyskinetic

Not common form of mixed CP

Gross Motor Function Classification System (GMFCS)

Can help understand prognosis of walking and also can provide insight on postural supports which may be needed for efficiency with engaging in other activities; for children w CP; not an outcome measurement

Level 1

GMFCS level: children walk at home, school, outdoors, and in the community; they can climb stairs without the use of a railing. Children perform gross motor skills, but speed balance, and coordination are limited.

Level 2

GMFCS level: children walk in most settings and climb stairs, holding onto a railing. They may experience, difficulty walking long distances and balancing on uneven terrain. Children may walk with physical assistance or use a wheeled mobility over long distances. Children have only minimal ability to perform gross motor skills, such as running and jumping.

Level 3

GMFCS level: children walk, using a handheld mobility device in most indoor settings. They may climb stairs, holding onto a railing with supervision or assistance. Children use wheeled mobility when traveling long distances and may propel for shorter distances.

Level 4

GMFCS Level: children use methods of mobility that require physical assistance or powered mobility and most settings. They may walk for short distances at home with physical assistance or use powered mobility or body support walker when positioned. At school outdoors, and in community children are transported in a manual wheelchair or use powered mobility.

Level 5

GMFCS level: children are transported in a manual wheelchair and all settings. Children are limited in their ability to maintain antigravity head and trunk posture and control leg and arm movements.

Botulinum toxin

Medicine that helps manage spasticity; reduces excessive muscle activity

Cerebral palsy

What condition may use these orthopedic procedures: tendon, lengthening, muscle or tendon release, tendon transfer, surgical procedures, hip surveillance to identify at risk children for hip displacement

Contractures

What might splinting be used for in patients with CP?

Contractures

Permanent shortening of a muscle or tendon due to intrinsic muscle tissue abnormalities, imbalance of agonist and antagonist muscles and/or limited active movement; decreased PROM, common impairment in cerebral palsy

False - the average age of a spinal cord injury is becoming older because people are aging in place

T/F? The average age of a spinal cord injury is decreasing

Diving

Most common source of sport related spinal cord injuries

Tetraplegia (aka quadriplegia)

Paralysis (complete or incomplete) involving all 4 extremities

Paraplegia

Paralysis of lower extremities

Complete

A __________ spinal cord injury (AIS A) results in no sensory and motor function in the lowest sacral segments (S4-5)

Incomplete

A ________________ spinal cod injury results in preserved motor or sensory function that includes the lowest sacral segments (S4-5)

Autonomic dysreflexia

Arterial reflex vasoconstriction occurs below the level of injury in response to a noxious stimuli; increases BP, severe throbbing headache; patient needs to sit up and the cause needs to be removed; common at or above T6

Orthostatic hypotension

A drop in blood pressure when moving into an upright position due to pooling of blood in the lower extremities, along with a decrease in tone in the walls of blood vessels

Spasticity

Excessive reflex activity due to the removal of supraspinal inhibition secondary to lesion in the spinal cord; seen in individuals with upper motor, neuron injuries

Pressure injuries

Localized damage to the skin and underlying soft tissue usually over a bony prominence; number one reason for hospitalization and death in spinal cord injuries

A/an upper motor neuron injury would cause the anal sphincter to be reflexive/spastic, requiring digital stimulation of sphincter to release stool. A/an lower motor neuron injury would cause the anal sphincter to be areflexive/flaccid, making the person at risk for leaking.

A/an upper motor neuron injury would cause the anal sphincter to be _____________, requiring digital stimulation of sphincter to release stool. A/an lower motor neuron injury would cause the anal sphincter to be ____________, making the person at risk for leaking.

C1-2

Individuals injured at this level are ventilator dependent; dependent for ADLs, will require 24 hour attendant care, focus is on independence with high-level technology and instructing others for their care

C3

Injury at this level: ventilator dependent, but may be weaned off if using accessory muscles for breathing, dependent for ADLs; goals are related to high-level technology, may be able to utilize some low tech devices, such as mouthstick due to increased cervical control; instructed caregivers

C4

Injury at this level: diaphragm is innovated, allows for inferior and lateral chest expansion; shoulder, elevation, and strong, accessory muscle muscles for breathing; dependent for ADLs; can use a mouth stick and voice activated control of technology; instructor caregivers

C5

Injury at this level: biceps, brachialis, and supinator muscle muscles are intact; increased ability to perform basic ADLs; feeding and basic grooming with adaptive equipment; maximal assist for transfers and higher ADL skills

C6

Injury at this level: can use wrist extension; has tenodesis to engage in passive finger flexion; improved function with self care, skills, wheelchair mobility, and transfers

C7

Injury at this level: now has control over elbow extensors and triceps; triceps assist and improved mobility, including transfers to functional surfaces, turning in bed, dressing lower body

C8

Injury at this level: has control over finger flexors; overall improved dexterity with ADLs; feeding and basic to moderate complexity, grooming, skills, independent with or without adaptive equipment; functional transfers, require supervision to independence with or without transfer board; wheelchair skills continue to improve

T1-9

Injury at this level: independent with ADLs, including dressing skills; transfers independently to functional services and from chair; perform higher level wheelchair skills; does not have functional standing, but can use standing frame methods; ambulation with long leg splints

T10-L1

Injury at this level: independent with ADLs, functional mobility, and transfers (lateral transfer is primary); independent with propulsion over varied services using wheelchair; standing frame activities; ambulation with long leg splints

L2-S5

Injury at this level: independent with ADLs, functional mobility, and transfers; wheelchair mobility and management is independent

Safety concerns

Fatigue, issues with balance and coordination, and in some cases, impaired judgment are the most common ______________ ____________ for individuals with neurological disorders.

Parkinson's disease

Neuro degenerative disorder, usually affects adults over 50, characterized by Bradykinesia, rigidity, postural impairment; low levels of dopamine and basal ganglia from death of dopamine, neurons in substantial Niagara and basal ganglia, treatments to restore, dopamine levels, but long-term has side effects

Parkinson's disease

Progressive disorder identified by the deep pigmentation of the substantia nigra and the presence of Lewey bodies; movement disorder; symptoms include shaking or tremor, bradykinesia, rigidity in arms, legs, or trunk, posture instability

Parkinson's

Early signs of _____________:

Tremor, small handwriting, loss of smell, trouble sleeping, trouble moving or walking, constipation, soft or low voice, masked face, dizziness or fainting, stooping or hunching over

Multiple sclerosis

Immunological and neurodegenerative disease of the central nervous system; body attacks, the myelin sheath that surrounds the brain and spinal cord neurons; CNS sites where myelin is lost a pure sclerotic which causes the symptoms; affect vision motor sensory cognitive, psychological bowel and bladder symptoms