routines based intervention

child centered intervention

professional is viewed as expert and responsible for developing and implementing intervention plan

family focused intervention

services are designed by the professional to meet family needs

families are meant to fit into existing services

family centered intervention

families are assisted to identify the range of resources including formal services and informal supports to best meet needs

routines based interventions

using activities that occur naturally during the Childs day as a framework to acquire new skills or improve skills 

importance of routines

• predictable

• functional

• recurring

stages of motor control in order of least complex to complex

• mobility

• stability

• controlled mobility 

• skill

mobility

presence of ROM sufficient to move

strength and control to move through that ranfe

open chained movements

deficits of mobility

result of tissue tightness/poor selective control/poor dissociation

stability

ability to maintain a position with tonic holding around the joint

requires co-contraction/coactivation

deficits of stability

would result in an inability to maintain a position

controlled mobility

ability to move while in a stable position

closed chained movements

static dynamic

progression from controlled mobility where a weight shift occurs and a previously supporting limb/weight bearing surface is freed

BOS is narrowed and maintenance of position requires more refined control

skill

distal component is mobile while proximal muscles provide dynamic stability to guide the limb

functions for skill

• manipulation

• exploration

therapeutic handling can be used for

• facilitation

• inhibit/block movements

• influence impact of abnormal muscle tone

• stretch

• mobilize 

phases of motor learning

• cognitive phase

• associative phase

• autonomous stage

cognitive phase

getting the idea of the movement

learning

handling most useful in this stage

associative stage

practice

longest stage

handling should be intermittent

autonomous stage

automaticity

where you end up

goal directed movements

need a reason to move

motivation

trial and error

allow children to explore

encourage continued trials even after failure

start with observing

variability

movement experiences should be about repeated problem solving NOT about repeated movements 

4 C’s for letter of medical necessity

• concise

• clear

• connected

• contextual

V.I.T.A.L system of cueing

• verbal

• imagery

• tactile

• assists

• lean