Peds Midterm

PDMS-2/3

Gross + fine motor

0-5yrs

60-90 min

Precentile ranks compared to age based norms

BOT 2/2

Gross + fine motor

4-25 yrs

50-90 min

Age based score

COMP

Values + prefomace + satisfaction

Ang age, any amount of time

Sensory Profile

Sensory types

Any age (just diffent types of sheets), norms crition based

TVPS

Visual Percptual

5-21 yrs, 25 min

Scalled scores, age based

Beery VMI

test of visual motor integration

2-99 yrs, percentage age based

things to consider for feeding

family cultural background, the child ages and devlopment, envorment, socioeconomic, and cargivers

oral motor milestone Newborn

• rooting reflex

• suck, swallow, breathe pattern- babies are able to do this automatically (usually)

• suckling

• Physiological function-pos out of the womb (fetal pos)

oral motor milestone: 1-3 months

• improvement of suck, swallow, breathe pattern, less reflexive, more intentional

• Physical flexion decreasing

oral motor milestone: 4-6 months

• true suck pattern emerges

• Chewing patterns develop

  • munching-up & down movement

  • lateral & diagonal jaw movement emerging

  • lateral tongue movement emerging

• can hold their own bottle

• Usually start solids

• sitting to drink from a cup (sippy/straw)

  • 6 months (2 oz of water a day)

oral motor milestone: 7-9 months

• tongue lateralization

• diagonal rotary movements

• circular rotary pattern developing

• drinking from an open cup (small silicone cup)

• finger feeding-self feeding (fine motor, sensory, occupation)

oral motor milestone: 12 months

• independent utensil use (MESSY)

• Rotary chewing

• tongue protrusion

• eats most table foods

• eating on fam schedule

Anatomical structure feeding issues: Jaw

• Jaw thrust

  • tone

• Tonic bite reflex

  • reflexive bite reflex

Anatomical structure feeding issues: Tongue

• thrust-high tone

  • tongue shoots out, hard to move around

• retraction

• Protrusion

  • tongue hanging out

• Tongue ties

  • under tongue line under tongue

Anatomical structure feeding issues: Lips

• retraction-high tone

• drooling-low tone

• lip ties

  • line in lip

• cleft lips or cleft palate

  • anomalies, gaps in the mouth

Self feeding

• head control

• trunk control

• control of reach, grasp, and release

• hand-eye coordination

Sensory mealtimes

• smell

  • do you want near food

• sight

  • what does food look like

• touch/texture

  • slimey, wet, bumpy, smooth

• taste

  • does it taste good to them

• sound

  • environment, cafeteria, at home

Causes of oral hypersensitivity

• Neg early experience

  • hospital stays, force feeding, reflux

• lack of oral experience

  • ng tube, OG tube, G-tube feedings

• Neurological impairments

what is a screening?

how you know and OT Eval is needed, observation, do we think they need OT, tends to be BREIF

What is an assessment?

A tool used durring an eval

What is an evaluaton?

a group of tests to find areas that need worked on the help be client centered and to get the full picture, also used to compare progress

When do we do EVALS?

When first seeing a client, when it is time to do a reevaluation (insurance/school says when), and upon discharge

Evaulation Proccess

Occupational Profile → Occupational Anylisis → interpration → recomendations

What is an occupational profile?

Hx, interprofessional team discussion, talk to parent, talk to child, get idea of what parents, child, and teachers find important

What is an occupational analysis?

Evaluation methods, how and when will it be done, what is this childs supports and barriers to goals

what do you do when interpating an eval?

client values, strengths and needs, support/context, determine outcomes, create goals, select outcome measures/procedures

What are interpersonal skills?

rapport building

client-centered/family-centered

interview skills

sensitivity/responsiveness

no jargon

honesty/transparency

non-verbal skills

top down approach

client performing whole tasks → looking to specific skills

Bottom UP

Specific skills → full task

What does the top-down and bottom-up approach influence

interventions (thinking)

in contex skills

Standardized Assessments

• fixed # of items

• test manual: purpose, population, reliability/validity info

• Uniform guidelines for administration/scoring

• advantages/disadvantages

  • results same on same child (no mater who does)

  • insurance likes

  • takes time

  • costs money

  • may not be done on that pop

What are norm references scores?

Average within age realted skills based on how other kids do compared to this one

What are criterion-based scores?

Based on the child’s skills not compared to other kids, based on skills

what is Reliability?

Getting scores consitantly

the test score should be stable over time and you should get the same score if 2 OT are scoring the same kid @ same time

Dyspraxia

movement planning issues

Postural Disorder

balance & correcting posture (may be a sensory issue)

dunns model of sensory processing

• Sensory registration = high tolerance, passive response

• Sensory seeking = high tolerance, active result

• Sensory sensitivity = low tolerance, passive response

• Sensory avoiding = low tolerance, active response

SOR = Sensory Over-responsivity

low threshold for sensory stimuli

SUR = Sensory Under responsivity

High threshold

They need more sensory input to register what is going on

SS = Sensory seeking/craving

High threshold

want more and more sensory

Sensory Modulation/reactivity

Able to regulate & organize reactions to sensory input in a graded & adaptive manner

Is and aspect of self-regulation but not the same thing

self regulation

knowing how to handle several different settings and having appropriate behaviors

managing emotions and sensory

Sensory Over-responsivity (sensory defensiveness)

ANS is used

Cumulative with repeated exposure

Associated with emotional, behavioral, and attention problems

Looks like fight or flight

Sensory defensiveness

Light touch seems to be the most common overreaction

Overreaction, don’t want to do the activity, leave at certain sounds, over-sensitivity to light or smells

One for each sense (tends to be defensive to this sound)

Gravitational Insecurity

Overreaction to or fearfulness of ordinary movement activities

fear of change in posture, particularly involving moving the head back

walking down open stairways, riding on escalators

Sensory Under responsivity

• Auditory- needing people to repeat a lot

• Tactile- not feeling things touching you well, other people pressing against you, pain tolerance well

• Proprioceptive- bumping into objects, not realizing

• Vestibular- poor balance, not getting dizzy

Sensory seeker- proprioceptive

likes to stomp when walking, crash and jump

seeks out imput from body

Vestivular- sensory seekers

seeks out movement

tactile sensory seeker

seek intense pressure

likes to touch items

oral-sensory seeker

likes to put things in mouth

sensory over responsablity

child acts avoident anxious or fearful

controling behaviors-sensory

child becomes stubbon or defiant with something from envorment

Alerting Activities

• fast movement

• light quick touch

• cold water, air

• visually stimulating environment

• loud music

• sour crunchy foods

• heavy work

Calming

• Slow, rhythmical movements

• deep pressure

• warmth

• soft lighting

• classical music

• oral activities: sucking

• Heavy work to muscles

Sensory diet

• like a nutritional diet → tailored to the child to provide stimuli needed

• planned, scheduled sensory activity program to help child stay alert and oriented

• Implemented throughout the day

• Calming/alerting strategies

Alert Program of self reulation

three stages: awareness, experiment, choose strategies

uses ABC method

Social Stories

teach social skills and how to behave in public

Environmental mods/strategizes

• Opportunities for proprioceptive & vestibular activities

• Availability of tools

• lighting

• music

• visual display or organization

• seating

why do we need to know if it is sensory or behaviors

understand the root cause better interventions

Behavioral Framework

• Bahvior = communication

• ABC model

  • Antecedent → behavior → consequence

  • Functions of behavior

Sensory Indicators

Physiological signs, triggered by input, improve with sensory strategies

Behavioral indicators

Goal-directed, context-dependent, stop if reinforcement is removed

Co-Regulation

When you use yourself as a model to encourage regulation

Ayres intergration

• Sensory processing underlies particpation

• Play-based, active particpation, adaptive response, just right challenge

• Trademarked, and has a fidelity measure (safety, sensory opportunities, motivation)

• CHILD LED, PLAY BASED

Sensory based stratgies

Weighted vests, fidgets, brushing, sensory diets, tools to help with sensory mangement, tolerances and processing

Pros of ASI

• Child-centered engaging

• focuses on participation & adaptive responsive

• Evidence-based for ASD

• Consistent with OT values

Main evidance of ASI

child with ASD, 4-12 years

Some evidance for ADHD, DCD, sensory processing challenges