OCTH 226 - OT with Children Midterm 1

theory

explains or describes a natural phenomena and relationships observed

• ex: stage and interactional/system theorists

model

explains occupational performance across age span and diagnoses

• ex: MOHO, EHP, PEOP

Frame of Reference (FOR)

focused on a specific segment of occupational performance with a specific population

• ex: SI, NDT

Multidisplinary

• group of professionals working independently

• limited methods for sharing views

• specialized consultations

• less costly but less coordinated care

• requires role identification

Interdsiciplinary

• professionals and family work together

• one profession leads

• consensus decision making

• regular communication

• support and complement

• coordination is central !

transdisciplinary

• work closely together to collaborate

• different members assume leadership

• professionals and family share information and coordinate services

• role release and role transfer

• members share and mutual training/development

coaching

• adult learning strategy builds capacity to improve abilities or develop new skills

• moves practitioner to a position of coach rather than a lead player

• client centered

• OT as a guide

IDEA Part B (0-3yr)

family focused

interdisciplinary team

transdisciplinary model

services in natural environment

Part B (preschooler)

3-5 years

require related services (OT, ST, Psych, etc)

interdisciplinary team

inclusion based

Part B (school aged)

6-21 years

require related services (OT, ST, Psych, etc)

interdisciplinary team

inclusion based

transition to adult environment (ITP)

Mainstreaming concepts

old service model

child adapts to existing classroom environment

child’s participation is conditional and temporary

OT focus = skill remediation to “fit” the setting

Inclusion concepts

newer, IDEA-aligned model

classroom adapts to support child

belonging and participation

OT focus = access, participation, and environment adaptation

Mainstreaming

pro: access to gen ed when the student can successfully participate with min support

con: participation is conditional-student is removed if they are struggling

Inclusion concept

pro: affirms belonging and participation by adapting the environment and instruction

con: fails when suppports are insufficient, results in placement without meaningful participation

polydactyly

extra digit on hand or foot

surgically corrected

syndactyly

webbing of tissue between digits on hand or hood

surgically corrected

prematurity

born before 28 weeks of GA

gestational age (GA)

total amount of time from utero to birth

chronological age (CA)

age of child from date of birth

corrected age

CA combined with length of prematurity, can correct up until 2 years old

neurlogical conditions in prematurity

intraventricular hemorrhage

intracranial hemorrhage

retinopathy of prematurity

intracranial hemorrhage

bleed in the brain

intraventricular hemorrhage

bleed in the ventricles; common below 32 weeks

retinopathy of prematurity

maladaptive growth of blood vessels in the retina

respiratory conditions in prematurity

respiratory distress syndrome

bronchopulmonary dysplasia

apnea of prematurity

- because lungs are the last to develop in utero

hyperbillirubinemia

“jaundice”

excess bile

blue light used to treat

gastroesophageal reflux (GER)

burps milk up and can’t keep down

necrotizing enterocolitis

death of cells due to inflammation in digestive system

asthma

common chronic childhood disorder

narrowed airways causing wheezing

Tx: medication, management, reducing triggers

cystic fibrosis

disorder causing disruption of normal movement of salt and water in and out of cells

spina bifida

neural tube defect

can cause physical and intellectual deficits

myelomeningocele

most serious type of spina bifida

sac of fluid is on the back where part of the spinal cord and nerves are inside and damaged

causes: bathroom difficulties, loss of feeling in legs/feet, paraplegia

meningocele

type of spina bifida

sac is in the back but does not house spinal cord or nerves

causes: minor disabilities

spina bifida occulta

“hidden spina bifida”

mildest of spina bifida

small gap in the spine, but no opening or sac

spinal muscular atrophy

genetic disorder characterized by weakness and wasting of skeletal muscles

congenital deformities and abnormalities

Marfan’s Syndrome

Chondrodystrophia/achondroplasia

Osteogenesis Imperfecta

Arthrogyposis multiplex congenita

Marfan syndrome

inherited disorder that affects connective tissue affecting the heart, eyes, blood vessels, and skeleton

achondroplasia

most common form of skeletal dysplasia that impairs the growth of bone in the limbs and causes abnormal growth of the spine and skull

chondrodystrophy

general term for a disorder that interferes with the body’s normal development of cartilage

osteogenesis imperfecta

“brittle bones”

inherited/genetic bone disorder that is present at birth causing soft, easily broken bones

arthrogryposis multiplex congenita

the development of multiple joint contractures affecting two or more areas of the body prior to birth

impacts limb function and ROM

sprengel’s deformity

an abnormally elevated scapula held by a ligamentous band

Erb’s palsy

upper trunk lesion

“waiter’s tip” posture

paralysis of shoulder and lack of elbow flexion and supination

Klumpke’s palsy

lower trunk lesion

“claw hand”

paralysis of intrinsic hand muscles and reduced forearm sensation

juvenile idiopathic arthritis

chronic autoimmune disease that causes joint pain and inflammation

Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)

broader term; triggered by a variety of different infections that disrupt normal neurological functions resulting in OCD, motor tics, anorexia, anxiety, ADHD, mood swings, sleep disturbances

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections (PANDAS)

autoimmune condition triggered by strep infection disrupting neurological functions resulting in OCD, motor tics, anorexia, anxiety, ADHD, mood swings, sleep disturbances

cerebral palsy (neuromuscular disorder)

occurs from injuries or abnormalities in the brain that occur before, during, or up to 1 yr after birth

have difficulties with motor, sensory, cognitive, and psychosocial functioning

NON progressive

causes of CP

• bleeding in the brain

• severe jaundice

• fetal asphyxia

• anoxia during or after birth

• brain trauma

• prenatal maternal infection

• brain infections

• idiopathic

types of quality of tone in CP

• spastic

• athetosis

• ataxia

• flaccid

• mixed

spasticity

• high muscle tone (hypertonicity)

• increase in resistance to sudden, passive movement and is velocity dependent

• 3 levels: mild, moderate, severe

athetosis

neurological movement disorder characterized by slow, continuous, involuntary, and writhing (worm-like) movements

ataxia

neurological condition causing poor muscle control, clumsiness, and a lack of voluntary coordination during movements

co-occurring conditions of CP

• cognitive impairments

• speech and language

• sensory deficits

• seizures

• feeding problems

• psychosocial challenges

treatments for CP

• orthopedic

• anti-spasticity medication

• neuro-surgical

• OT, PT, ST

• psychological and respite services

monosomy

only one chromosome instead of a pair; non-viable (die before birth)

nondisjunction of autosomes

unequal division of chromosomes during cell division

- trisomy (down syndrome)

Turner syndrome

affects females; a complete or partial absence of one of the two X chromosomes

translocation

chromosomes break off and reattaches

down syndrome (trisomy 21)

• extra chromosome on 21st pair

• creates physical and mental impairments, along with significant health issues

down syndrome characteristics

• hypotonia and hypermobility

• short stature

• poor mouth closure at rest due to tongue protrusion

• broad hands and short fingers, simian crease

• almond shaped eyes, epicanthal folds

• flattened back of head

• low set ears

• cognitive impairments

simian crease and impairments

only 1 palm crease, instead of 3

causes difficulties with hand coordination and poor muscle development

medical and sensory issues with down syndrome

• cardiac abnormalities

• atlanto-axial instability (avoid direct pressure movements)

• weak immune system

• GI issues

• vision and hearing difficulties

• tendency to obesity

Prader-Willi Syndrome

• defect on chromosome 15

• short stature

• obese and insatiable appetite (hyperphagia)

• moderated ID

• hypotonia

• narrow face with almond eyes

• poor thermal regulation

• underdeveloped sex organs

William Syndrome

• chromosome 7 micro deletion

• almond shaped eyes

• small pointed ears

• wide mouth

• upturned nose

• ID and easily distracted

• severe visual perceptual and visuomotor issues

• some motor impairments

• strengths: music and socialization

Neurofibromatosis-1/Recklinghausen’s disease

• autosomal dominant

• growth of multiple tumors on central and peripheral nerves

• cafe au lai spots on the skin

• pain due to growths on nerves

• nerve damage affecting sensory and motor systems

• mild ID & LD

• more often in boys

seizures

• a temporary, involuntary change if consciousness, behavior, motor activity, sensation or automatic functioning

• can be generalized (all body) or partial (small form)

• epilepsy = recurrent seisures

generalized seisure

• tonic clonic = multiple convulsions

• absence = lack of attention and consciousness

• atypical absence

• myoclonic = quick jerks

• atonic = sudden loss of muscle tone and strength

partial seizure

• simple = electrical disturbance in limited area of the brain

• complex = type of epileptic seizure that originates in a specific, localized area of the brain, causes loss of consciousnes

this is the most common found in children

infantile spasms

• 6-24 mos.

• impacts cognitive development

status epilepticus

• 30 min or longer

• requires medical intervention

* Emergency Treatment After Seizures

• stay with them until seizure ends and they are fully awake

• help person sit in a safe place

• ask them what happened in simple terms

• comfort person and speak calmly

• check if there is a medical bracelet

• keep yourself and others calm

* Emergency Treatment During Seizures

• ease person to the floor

• turn person to the side to help them breathe

• clear area around person to keep them safe

• put something soft and flat under their head

• remove eye glasses

• loosen ties or anything around neck

• time the seizure and call 911 if longer than 5 min.

* What Not To Do During Seizure

• do not hold them down

• do not put anything in their mouth (person cannot swallow their tongue)

• do not try to give CPR

• do not offer water or food until fully alert

Treatments for Seizures

• emergency protocol for seizures

• anti-convulsion medications

• ketogenic diet (high fat diet to increase myelination in NS)

• surgical intervention (last resort)

  • hemispherectomy

  • corpus collosotomy

  • electrical stimulation of the vagal nerve or thalamus

types of muscular dystrophies

• Duchenne’s

• Becker’s

• Limb-girdle

• Facioscapulohumeral

limb girdle muscular dystrophy

• autosomal recessive

• affects proximal muscle of the shoulder and hips

• onset is childhood up to 30 years

• slow progression

facioscapulohumeral muscular dystrophy

• autosomal dominant

• onset in adolescence

• affects the face, scapula, and shoulders

Becker’s Muscular Dystrophy

• progressive and often fatal

• onset at 8-12 years old

• has a genetic marker

• they have lots of weakness

Duchenne’s MD

• only affects boys

• most severe form of MD

• onset 2-6 yo

• starts at pelvic girdle to shoulder girdle to all muscles

• difficulty rising from floor (gower’s sign)

• shortened lifespan

Gower’sign

how child with duchenne’s MD gets up from floor

Treatment for Dystrophies

• medications

• therapy (be compensatory and preserve function)

• breathing aids

• surgery

Neurodevelopmental Disorders

• ASD

• ADHD/ADD

• IDD

• LD

• DCD

• Trauma & Stressor Related Disorder (2)

• Feeding/Eating disorders (3)

• Mood Disorder (3)

• Disruptive, Impulsive Control & Conduct Disorder (2)

controlled mature bite

grading the force of the bite to meet the resistance of food

ex: carrot v marshmellow

gag reflex

protective mechanism to avoid aspiration

jaw stability

ability to hold the jaw steady like when drinking in a cup

tongue lateralization

the ability to move the tongue from side to side inside the mouth

munching

up and down motion of the jaw, is replaced with rotary chewing at 9-12 mos.

phasic bite-release

rhythmical movement of jaw

jaw thrust

atypical; forceful opening of the jaw

“underbite”

seen in children with CP (hypotonia)

lip pursing

tight puckering of the lips

seen in children with CP

lip retraction

lips pulled back and limited closure

tongue retraction

tongue pulled back and unable to control bolus

tongue thrust

tongue forcefully pushed out of the mouth and comprises moving food/fluid in oral cavity to elicit swallowing

tonic bite

forceful bite that is not graded and makes it difficult to release food after bite

feeding

the process of setting up, arranging and bringing food or fluids from the plate or cup to the mouth

eating

the ability to keep and manipulate food/fluid in the mouth and swallow it

ASD

• chronic, non-progressive disorder where social communication skills do no develop typically

• language difficulties

• symptoms before 3 yo

• restricted, repetitive, bx

• differential Dx

ASD Criteria A

Social Communication & Interactions (must have ALL 3)

- deficits in socio-emotional reciprocity

- deficits in non-verbal communication

- deficits in developing, maintaining, and understanding relationships

ASD Criteria B

Restricted, Repetitive Patterns of Bx, Interests or Activities (must display at least 2)

- repetitive movements or speech

- insistence on sameness, inflexible to routines

- restricted, fixated interests

- hyper or hypo reactivity to sensory input (recent to DSM5)