Feeding , Handwriting , Assistive Technology , Sensory Integration

indication of swallowing problems

gagging

coughing

choking

nasopharyngeal reflux

wet vocal quality

respiratory infections

pharynx

funnels food into esophagus

larynx

valve to trachea, gets closed during swallow

trachea

allows air to flow

esophagus

carries food from pharynx to stomach

oral prepatory phase

oral manipulation of food creating a bolus

oral phase

bolus is moved posteriorly toward pharynx, elicits swallow response

pharyngeal phase

swallow triggered, epiglottis covers airway, esophagus opens

esophageal phase

bolus enters esophagus, into stomach

3-6 month chewing pattern

symmetric oral movements

munching, symmetric up/down movements

8-12 month chewing pattern

vertical chewing movements

disassociation between jaw and tongue

chewing pattern by 5 years

fully functional adult pattern

food texture levels

Level 1: puréed (pudding)

Level 2: mechanically altered (moist, minced, mashed)

Level 3: advanced (requires increased chewing) (animal crackers + asparagus)

Level 4: regular - restriction free

liquid consistency

thin

nectar

honey

positioning

chin tuck reduces risk of aspiration

midline orientation

Development of Handwriting

2: scribbles, circular scribbles, vertical lines

3: horizontal lines

4: circles and intersecting lines

6: diagonal lines, shapes, letters

functional grasps

dynamic tripod

lateral tripod

lateral quadruped

4 finger grasp

legibility components include

letter formation

alignment

spacing

size

slant

stability order to address handwriting

pelvis, trunk, shoulder, arm, wrist, fingers

acquisitional/motor learning model

repetition and practice are important

once mastered, use letters to write words immediately

combine newly acquired letters with mastered letters

sensorimotor model

multi sensory inout reinforces learning

writing surfaces and positions are sensorimotor

biomechanical model

ergonomics

- sitting posture

- paper position

- pencil grasp

- writing instruments

- type of paper

optimal writing posture

feet planted on the floor

table 2 in above flexed elbow with elbow resting on table

alternates to handwriting

keyboarding

word prediction

reduce written assignments

dictate assignments

peer study partner

key line

keep your handwritten letters PG

P = positioning

G = grading

evaluation

identify activities

observation in natural environment

factors influencing participation

trial period

universal design

making all products and environment physically pleasing and usable to the greatest extent possible

7 principles of universal design

equitable use

flexible in use

simple and intuitive use

perceptible info

tolerance for error

low physical effort

size and space approach

universal design of learning

educational standpoint where multiple options of how to learn, demonstrate learning, and engage with learning are used to match diverse student abilities

AAC

allows communication that does not require speech with purpose of enabling communication

the 3 C's of AT

communicate

control

compute

interventions

look at abilities and and difficulties

demands of environment

task

goals

picture based communication

using symbols instead of words

presented on a board or book called a picture exchange communication system

switches

used for turning devices on and off

button switch: minimal control of UE but can press down

plate switch: poor strength, minimal hand movement, light touch

computers

flexible and allow for high quality work

"least change" principle: changes as few things as possible

keyboard

difficulty due to limited UE function

positioning

adapting keyboard

typing speed

mouse

positioning

change sensitivity: track ball or track pad

screen

visual issues

reduce glare and overhead lighting

increase contrast and font size

screen magnifier

voice output tool

instructional technology

literacy skills

reading skills

writing

math

cognitive prosthetic

7 senses

visual

auditory

tactile

olfactory

gustatory

vestibular

proprioception

sensory integration

brain receives and integrates sensory info

registration allows us to pay attention or ignore info

brain organizes sensation and uses the info to produce a goal

sensory modulation

ability to respond appropriately to sensory information

hypo-reactivity

delayed responses to sensory stimuli

oblivious to touch, pain, movement, taste, smells, sights, sounds

hyper-reactivity

over reacts to sensory input resulting in discomfort, avoidance, distraction, anxiety

tactile defensiveness

auditory defensiveness

gravitational insecurity

sensory discrimination and perception problems

difficulty differentiating one sensory stimuli from another

visual-perceptual

tactile

proprioception

vestibular and bilateral problems

bilateral tasks require trunk stability and upright posture to use both hands together

dyspraxia

difficulty motor planning

sensory seeking behavior

proprioceptive seeking- jumping/stomping

tactile seeking- touching things and people

vestibular- intense swinging or spinning

hyposensitivity responses

oblivious

unresponsive

delayed response

hypersensitivity responses

defensive

anxious

unwilling to perform

arousal techniques

tactile and vestibular

calming techniques

proprioception

methods for assessment

standardized assessments

questionnaires

structured clinical observations

interviews

vestibular approaches

swinging

- slow and linear = calming

- fast and unpredictable = alerting

dynamic seating

astronaut program

signs of autonomic activation

blanching and nausea

tactile and proprioceptive approaches

weighted vest

tactile within activities

squishes, massages, joint compression,

walbarger protocol

passive tactile stimulation

leads to more defensiveness