Pediatrics Exam 1: Lecture 4

- bottom-up approach

- top-down approach

(2) approaches of assessment

bottom-up approach

which assessment approach is traditional

top-down approach

which approach is preferred by pediatric PTs

- traditional

- deficit driven

- goals & interventions determined last by PT

- useful for identifying impairments

characteristics of bottom-up approach (4)

- identifying a disability or delay

- during diagnostic process

primary use of bottom-up approach (2)

sorting out what the reason is for the problems

What does deficit-driven mean in the bottom-up approach?

- outcome-driven

- identifies obstacles & strengths of the child & family

- identifies strategies to improve performance, bypass obstacles, & reach desired outcomes

- POC

characteristics of top-down approach (4)

naturalistic environment

ideal environment to perform peds examination, especially with younger children

- pre-school

- school

DEA part B (3)

3-5

DEA part B will cover pre-school for ages

5-21

DEA part B will cover school for ages

- early intervention

- arena or play-based assessments

DEA part C (2)

0-3 (not anytime after)

DEA part C will cover early intervention for ages

- identify risk

- diagnose

- determine eligibility for service

- plan interventions

- document change over time

- determine efficacy of programming

- research

purposes of pediatric PT exam (7)

- provide broad view of child's developmental skills

- determine what is outside typical range

- establish realistic goals

- screen for early intervention & prevention

- monitor progress

- clinical research tool

purpose of developmental testing (6)

guide to PT practice model of patient/client management

pediatric examination is based on the

- parent's/child's primary concerns

- their description of present function in their natural environment

- PMHx

- CMHx

- adaptive equipment

- current developmental function

what is involved in the interview portion of a pediatric examination (6)

chronological age

age calculated from DOB in months & days

adjusted age

age calculated by subtracting the weeks of pre-maturity

24 month chronological age

adjusted age is done typically until

use of adaptive equipment or devices

what SHOULD be included in current MHx

- assess through observations

- manipulate environment/toys

- direct contact with child/infant

testing environment considerations (3)

- accurate determination of environmental obstacles, supports needed, & child's strengths

- more likely to offer realistic remediation strategies

- determines appropriate testing tools

observing the child in the natural environment affords (3)

- head/trunk posture & alignment

- dissociation--> rotational control

- note position to position

- symmetry

observation of transitional movement (4)

- pull to sit

- side-lying to supine

- prone to/from standing

- sit to/from standing

types of transitional movements (4)

- NIPS

- FLACC

- wong-baker faces scale

- oucher pain scale

- visual analog scale

- numerical rating

(6) types of pain scales

<1 year

age-range to use NIPS

- 2 months to 7 years

- infants

- older non-verbals

age-range to use FLACC (3)

neonatal infant pain scale

what does NIPS stand for

face, legs, activity, cry, consolability

what does FLACC stand for

3-18 years

age-range for wong-baker faces scale

3-12 years

age-range for oucher pain scale

always

when should you assess pain

- functional strength

- hand-held dynamometry

- symmetry

more applicable approach to test strength in pediatric population (3)

tests & measures: Standardized tests/outcome measures

the means of gathering reliable & valid cellular-level to person level information about the individual's capacity for, & performance during movement related functioning

- standardized norm reference

- criterion-reference tests

(2) types of standardized tests for pediatric examination

impairments

tests & measures are specific to

- child compared against others

- may or may not have relationship to specific instruction

- requires good diagnostic skills

- not concerned with task analysis

characteristics of norm referenced tests (4)

assess "delay" or "deviation" from the group/others

what is the primary purpose of norm reference tests

qualify infant or child for services

norm referenced tests are often used to

- child competes against self

- content specific

- tests directly referenced to objectives of instruction

- geared to provide info for use in planning program

- depends on task analysis

characteristics of criterion-referenced tests (5)

assess change over time

what is the primary purpose of criterion-referenced tests

True

True/False: Not all pediatric patients will need developmental testing.

- age

- setting

- diagnosis

- reason for physical therapy

the need for developmental testing depends on (4)

- what is the purpose of the test

- who is it designed for and what are the characteristics

- what contents need to be addressed

- what is the setting that the exam will take place

how to decide which standardized test to give peds during exam (4)

- acceptability

- availability

- simplicity

- cost

other factors & external constraints on how to decide which test to administer (4)

simplicity

the ease by which a test can be taught & administered

- reliable

- valid

- sensitive

- specific

- predictive value

psychometric properties of the measured when deciding which standardized test to administer to peds during exam (5)

reliable

both inter- & intra-rater reliability provide stability of a test to have consistent repeatable results

must be administered as directed in test manual

what makes a test reliable

valid

measures what it is intended to measure & should be the same as what the examiner wants to measure

sensitivity

measure with high levels of true negative rate & that a negative test will rule OUT the condition or diagnosis

few false negative results

high sensitivity =

specificity

measures with high levels of specificity or true positive rates & that a positive result will rule IN the condition or diagnosis

few false positive results

high specificity =

predictive value

measure designed to predict a later outcome ideally & has an acceptable specificity & sensitivity

specificity

acceptable to have a lower ___

sensitivity

we want a higher ____

raw score

total # of items passed on the test

- basal level

- ceiling level

(2) types of raw scores

basal level

item preceding the earliest failed item

ceiling level

item representing the most difficult success

age-equivalent score

not a true appraisal of a child's ability, but easily understood by families

bell-shaped curve

standardized scores are based on the normal distribution of

screening tests

identifies deficits that will warrant further assessment or referral for services

assessments of components of function

focuses on a specific area of development: GM, FM, reflexes

comprehensive developmental scales

examines multiple areas of development

functional assessment

essential skills needed to function & participate in the natural environment: home, school

- impairment measures (hand-held dynamometry, ROM)

- single-item activity measures

- multi-item activity measures

- multi-item participation outcome measure

standardized outcome measures organizes tests & measures along ICF model to describe standardized measures for (4)

norm referenced

what test does BDI belong to

norm referenced

what test does TIMP belong to

norm referenced

what test does AIMS belong to

norm referenced

what test does PDMS-3 belong to

criterion referenced

what test does GMPM belong to

- criterion referenced

- specific to CP & down syndrome

what test does gross motor function measure (GMFM) belong to (2)

norm referenced

what test does BOT-2 belong to