Lindsey, Darcy and Sophia's Combined Midterm Review

Where do referrals come from in early intervention?

Pediatrician, lactation specialist, and family (self-refer)

Where do referrals come from in schools?

EI transition, pediatrician, and school professional

Where do referrals come from in outpatient?

pediatrician, self-referral, and inpatient services **may need referral from doctor due to insurance requirements

Process within referral and intake

varies from setting to setting (who does it, what is included)

Purpose within referral and intake

to get enough information about areas of strength and needs + prior services that the therapist can plan a parent interview and evaluation

Who facilitates the intake process?

IT DEPENDS!

• it varies depending on setting and roles

Sometimes in outpatient, an ___ will complete the referral form process with the ____

OTP, family

What is included in occupational profile in schools?

• review special education referral, consent form, and prior written notice

• Screening (school district dependent)

• Child interview/observation

• teacher interview

• IEP team interview

  • All can be formal or informal

What is included in occupational profile in outpatient clinic?

• Physician referral

• Intake form

• Medical documentation review (if provided)

• Parent interview

• Child interview/observation

What should you look for in school based referral?

• strengths

• challenges

• parent input

• current services

• what has been done that is not working?

• What has been done that is working?

What are some school areas of challenge?

Motor, Sensory, Social-emotional, executive functioning

Components of outpatient referral

• Demographics

• Diagnosis

• “Evaluation only”

• “Evaluation and treat”

• Physician signature

In an outpatient referral example, what might be the only components you have to go off of?

“Evaluation and treatment” and “client name”

What is included in outpatient intake forms?

• Medical/birth history

• Developmental milestones

• Current + previous services

• Parent primary areas of concern

• Strengths/interests

• Itemized areas of challenge

• What has been done that has not worked?

• What has been done that has worked?

What are areas of concern noted in the evaluation process?

ADL, sleep, fine motor skills, visual skills (motor, perceptual), sensory processing, executive functioning, behavior, social skills

T/F: Scoring is oftentimes changed depending on age and developmental milestones (example premature birth)

T

What is the very first step in an interview with a child?

Introduce yourself by getting down to the level of the child!

What are two questions you can ask a child at the beginning of the interview?

If they have a preferred name and ask if they know what OT is

What are the first steps in the parent/teacher interview?

1. introduce yourself and ask if they are familiar with OT

2. elevator pitch and add in what OT can potentially do for that child based on your intake information

3. Ask the parent, teacher, and child how they would like to be addressed

What are some strategies for interview preparation?

1. create a written outline for your interview that mirrors the evaluation template

2. begin with the parent walking you through the child’s daily routine

3. outline main areas of concern and confirm this first thing

4. be prepared with an activity for the child to engage in while you speak interview

Steps of a parent interview

1. confirm name, age, DOB

2. Medical hx

3. School hx

4. Social hx

5. Current medications/allergies

6. Why are they interested in seeking services?

Questions in a parent interview?

What are child strengths?

How do they best learn?

What are their likes/dislikes?

What are their daily routines?

What ADLs can they do?

Vision hx, any glasses?

Sensory processing?

Social?

What does the intentional relationship model include in pediatrics?

Advocating, collaborating, empathizing, encouraging, instructing, and problem-solving

_____ _____ are arguably the MOST IMPORTANT documentation you will write

Evaluation reports

Everything builds on or references to the ______ ______

evaluation report

What is the basis for the plan of care, goals, progress notes, and intervention strategies?

Evaluation reports

What is the record of baseline function prior to intervention that determines if progress was made and if intervention was effective?

Evaluation report

Payment for services will be determined by what is written in the ______ _____

evaluation report

What are steps in interview wrap up?

1. thank them for their time

2. restate the major problem areas they expressed

3. give your general impression of what OT could potentially help to address

4. outline next steps: child observation, standardized assessments, etc

5. determine if parent should be present for next steps

What do you do with all of the information gathered from evaluation?

1. Determine standardized assessments

2. Integrate it into eval report

3. develop a plan of care (frequency and duration)

4. create goals

5. planning and organization is key

T/F: Use child name in evaluation

T

T/F: Write objectively not conversationally

T

What skills are required to be school ready?

• Good hand skills

• UE control

• Grasp patterns

• B hand skills

• Visual regulation

• ADL

• Self-regulation

Components for effective handwriting

• posture

• fine motor

• grasp

• visual motor skills

• ability to write one’s own first name

• letter formation

• performance skills

________ % of a child’s school day includes FM activities

31-60

In kindergarten, ____% of FM activity time on paper and pencil activities compared to 10% in Head Start

42%

difference between static tripod grasp and dynamic?

static tripod: controlled movement comes from upper arm and shoulder. dynamic: movement comes from wrist and fingers

What is the appropriate functional position for handwriting?

1. wrist bent up (arm is on a table, hand is bent upward)

2. Open web space (circle between thumb and fingers)

3. Fingers and thumb move the tool

What are two functional grips?

Quadrupod and adapted tripod

Quadrupod grasp

• 3 fingers and thumb direct the tool

• Maintains position of wrist and open web space

Adapted tripod grasp

• 2 fingers and thumb direct the tool

• Maintains position of wrist and open web space

When do you not “fix” grasp patterns?

In a child where it’s functional!!

Why are grasp patterns sometimes abnormal?

• Grasp patterns may be immature

• Muscles within the hand do not work in concert

• Grip patterns are developed through exposure to manipulative and large motor activities

• Grip patterns are habit based as a result of the above

What are Benbow’s underlying developmental skills for hand use?

1. UE support

2. Wrist and hand development

3. Visual control

4. B coordination

5. Spatial analysis

6. Kinesthesia

Writing is a complex activity that involves:

• synthesis and integration of memory retrieval

• organization

• problem-solving

• language and reading ability

• ideation

• graphomotor skills

Handwriting contributes to _______ development

cognitive

_______ is the main reason for OT referral

Handwriting

What is the sequential order of writing?

• Scribble

• Lines and shapes

• First name

• Upper case letters- easier with all starting at top

• Lower case letters- more difficult to learn due to multiple starting points. Child needs to understand directional concepts and developing visual perceptual skills

• Numbers

Teachers typically ______ teaching lower and upper case together

intermix

Optimal positioning for handwriting

1. child seated at desk with feet on the floor

2. desk height appropriate for child (2” above bent elbow when seated at desk)

3. Position of paper- slanted to some angle as forearm of writing hand

4. Upright surface- slant board, chalkboard work, tape paper or project to wall or cupboard space

5. Short pencils or crayons

Why do ergonomics matter in handwriting?

• chair or desk size

• fatigue and discomfort

• inattention

• cognitive reasons

• sensory needs (fidgeting or wiggling)

• physical disabilities

• core weakness

• boredom

• visual difficulties

• retained primitive reflexes

What does OT typically assess with handwriting?

• Legibility and neatness

• Proper formation

• Letter placement

• Spatial orientation (reversals)

• Sequential memory (spell words and form sentences)

• Spacing- between letters and words

• Closure of lines

• Near and far point copying

• Hand grasp and hand dominance

• Speed- writing is timed for

  • lower and upper case alphabet

  • copying a sentence (the quick brown fox….)

  • dictated sentence (at least 9 words)

  • forming own sentences (at least 9 words)

ETCH

criterion-referenced tool designed to evaluate manuscript and cursive handwriting skills

what is the function of the ETCH?

assesses a student’s legibility and speed of handwriting tasks

Fine motor skills

Involves the use of precise and coordinated movement of the fingers and hands

Visual perceptual skills

The skills that are needed to interpret and understand what is seen

Visual motor integration

The coordination of hand movements based upon the perception of visual information. It is the execution of hand movements guided by what the child is seeing.

Grasp

The voluntary act of picking up, holding, and manipulating objects with the hand

The sequence of grasp development is driven by _______ but is also influenced by the child’s environment and experiences

maturation

Grasp develops from being more ______ (held in the palm) to more precise (held in fingertips)

crude

Release

The ability to smoothly release and place an object precisely on/in a targeted area

Release requires a child to partially open their hand while carefully monitoring the ______

placement

T/F: Release is needed for placing objects in a container, stacking blocks, managing a cup and spoon/fork, and working puzzles.

T

Hand strength

Needed for students to push, pull, pinch, squeeze, twist, and sustain a prolonged grasp on tools

What are the 4 types of in-hand manipulation?

1. Translation

2. Shift

3. Simple rotation

4. Complex rotation

Palmar-Supinate Grasp

Shaft held with a fisted hand and arm moves as a unit

What age does palmar-supinate grasp develop?

1-1 ½ years old

Digital Pronate Grasp

Shaft held with fingers and forearm moves as a unit

When does static tripod grasp develop?

3 ½ - 4 years old

Static Tripod Grasp

Held with crude approximation of thumb, index, and middle finger with continual adjustments made by other hand.

• No fine localized movements of fingers, hand moves as a unit

What age does dynamic tripod grasp develop?

4 ½ - 6 years old

Dynamic tripod grasp

Held with precise opposition of distal fingers of thumb, index, and middle fingers.

• Fine, localized movements

• Held with thumb and index finger that point toward the tip

• Crayon rests on side of middle finger

• Last two fingers curl into the palm

Fine motor focuses on _____

Grasp

What is completed/done focuses on ____ _____

Visual motor

What areas for perceptual skills have an impact in?

• Education: reading, writing, and math

• ADLs: dressing and bathing

• IADLs: reading maps, emptying the dishwasher

• Leisure: participating in hobbies and crafts

• Play/Work: sequencing, organizing

Visual discrimination

the ability to identify similarities and difference between letters, numbers, objects, etc

If an individual doesn’t have visual discrimination skills, what might they have difficulties with?

• distinguishing between words or letters

• sorting, matching, organizing

Spatial relations

ability to perceive two or more object’s position in space relative to oneself and in relation to each other

If an individual doesn’t have spatial relation skills, what might they have difficulties with?

• spacing between words

• writing on lined paper

• understanding directions

• left/right confusion

• letter reversals

Visual closure

the ability to identify items although the item is not visually complete or part of the item is visually obstructed

If an individual doesn’t have visual closure skills, what might they have difficulties with?

• reading

• locating items in a busy drawer/container, etc.

Visual sequential memory

the ability to put items seen in consecutive order

If an individual doesn’t have visual sequential memory skills, what might they have difficulties with?

• recalling what was seen when copying from the board, typing a copied text- can lead to slow work and omitting letters

• spelling

• remembering math equations

• multi-step tasks

visual memory

The ability to remember and recall objects, shapes, symbols, movements from pictures, list of words or other information presented visually

If an individual doesn’t have visual memory skills, what might they have difficulties with?

• remembering faces, sight words, street signs/locations

Form constancy

The ability to recognize that an item is the same when in a different orientation, size, and/or color

If an individual doesn’t have form constancy skills, what might they have difficulties with?

• letters, numbers or symbols that are different sizes, colors, or rotated

• distinguishing between similar letters, shapes, and words

Figure ground

the ability to distinguish an item or form while perceiving the foreground from the background

If an individual doesn’t have figure ground skills, what might they have difficulties with?

• finding objects in a drawer

• locating a specific word or sentence on a page

• confusion and fatigue when looking at visually stimulating pages/environments

Dominate hand

used more consistently for finer manipulative skills. this hand may also be called the “worker hand.”

Non-dominate hand

develops skills in manipulating, stabilizing, and positioning objects. This hand may also be called “helper hand.”

How to determine child’s hand dominance?

observe the child completing common daily tasks (such as picking up a glass, opening the door, wiping face, throwing a ball, etc.) to determine if one hand is more skilled/precise/stronger than another

What age is hand dominance established?

by 5-6 years of age

T/F: Tool use is just a fine motor skill and does not require a cognitive action plan for proper and purposeful use of the tool

False

What bilateral hand skill can 3-4 year olds do

• Lace 3 holes

• String small beads by holding bead in one hand and holding string in opposite hand

What bilateral hand skill can 4-5 year olds do

• cut out shapes accurately by grasping scissors correctly and adjusting paper with opposite hand

• fold paper precisely in one-half

• holds writing utensil with preferred hand and stabilizes paper with opposite hand when coloring or drawing

What does normal visual motor development look like during mealtime in 4-5 year old kids?

• Holds cup with one hand

• Uses a napkin

• Holds fork with fingers

• Holds spoon with fingers

What does normal development look like during dressing in 3-4 year old kids?

• Puts on shoes and socks with minimal assistance- may be on incorrect foot

• Buttons large buttons independently

• Snaps independently

• Pulls down pants independently

• Unzips and zips non-separating zipper independently

• Zips down pants independently

What does normal development look like during dressing in 4-5 year old kids?

• buckles clothing independently

• socks and shoes on correct feet with minimal assistance

• Connects two-part separating jacket zipper and zip-ups

• unbuckles independently

Developmental progression of coloring starts with _____ strokes over a wide area

broad