Cerebral Palsy , Autism

areas of the body

monoplegia: one extremity

diplegia: legs

hemiplegia: one side

quadriplegia: all extremities

tetraplegia: all extremities head and neck

spastic

hypertonia

stiffness when trying to move

limited ROM

dyskinetic

Excessive, unintentional and abnormal movement affecting entire body

athetoid

slow writhing with abrupt jerky tone fluctuates from low-normal

choreoathetoid

random, unpredictable, jerky involuntary movements triggered by action

dystonic

stereotyped, predictable and twisted postures that are absent at rest

ataxic

poor balance and coordination

clumsy

involuntary tremors

postural instability

mixed

high and low muscle tone

primary symptoms

muscle weakness

muscle tightness

involuntary movement

impaired sensation in affected limbs

abnormal muscle tone in face

weakness of eye muscles

possible seizure disorder

secondary symptoms

contractures, bone deformities, joint dislocation

poor, unsteady gate

difficulty with bowel/bladder control

impairment of visual processing, hearing, speech

intellectual disability

problems with breathing

skin integrity

difficulty feeding

CP MOM TAT

constraint induced movement therapy

positioning

modalities

orthoses

medical

tone

adaptive equipment

taping

performance concerns

rigidity

sensory

motor skills

rigidity

restrictive and repetitive behaviors

insistence on sameness and fixed routines

need for familiarity

sensory challenges

hyper or hypo reactivity

unusual interest in sensory aspects of the environment

excessive smelling or touching

visual fascination

adverse response to sound or textures

common motor concerns

poor gait

poor posture

balance issues

poor coordination

difficulty with imitation

praxis

occupational performance issues

ADLs

education

play

social participation

evaluation

we may need to adapt standardized assessments

allow familiarity

breaks/extra time

motivators/rewards

limit eye contact and interactions

change item order

CLEARLY DOCUMENT ALL ADAPTATIONS

DIR/Floortime

Developmental, Individual Differences, Relationship-based

CO-OP Approach

goal-plan-do-check

improve engagement

problem: hyper focused on a tsk, uninterested in social play

intervention: strategies to capture attention or involve child

improve behavior

problem: insistence on sameness and difficulty transitioning resulting in behaviors

intervention: give advanced notice, build tolerance to unexpected changes

improve comfort

problem: distressed about demands of daily tasks

intervention: sensory strategies to reduce discomfort, grading to find just-right-challenge

improve ideation of play

problem: fixation, repetitive behaviors, and perseveration

intervention: prompting and helping generate new ideas

improve praxis

problem: difficulty planning and executing unfamiliar tasks

intervention: increasing attention to movement or body awareness

improve socialization

problem: lack of social engagement with peers

intervention: strategies to increase play skills

improving sleep

problem: difficulty falling of staying asleep- attention seeking from parents- difficulty self soothing

intervention: calming sensory techniques (proprioception and limiting arousal) - in bed = ignore child- ignore for a certain amount of time before checking in

improving ADLs/IADLs

problem: difficulty with routine-motor delays-behavioral resistance-sensory difficulties

intervention: visual supports/video - motor learning, CO-OP, SI- behavior plan- modification of task

improving limited diet

problem: bothered by sensory aspect of food- insists on same food

intervention: sensory approach - behavioral approach

improving coping and self efficacy

problem: parents are often stressed/overwhelmed

intervention: help parents understand ASD and find community supports

technological supports

communication systems

computer games

voice recognition software

speech-generating device

academic supports

visual, auditory, kinesthetic teaching methods

simplifying content

chunking

social supports

peer modeling

structured play groups

scales for emotional regulation

OT facilitated games

social stories