Pediatrics: Weeks 1-2

What is Family-Centered Care (FCC)?

An approach that considers the child and family together, recognizes the family as an important part of care, and incorporates their needs, priorities, and goals

What does FCC consider besides the child's needs?

Strengths and needs of all family members

What should be the first strategy when implementing family-centered care?

Address basic family needs

What are the three major family-centered factors?

Structure, function, and culture

What does family structure mean?

Who makes up the family and what resources are available

What does family function mean?

The roles and responsibilities of family members in daily routines and caregiving.

What does family culture mean?

Beliefs and values that influence expectations, decision-making, and actions

How should families participate in the PT evaluation?

The PT should ask how the family wants to participate—such as observing, assisting, or practicing strategies

What approach should the PT use when involving families in evaluation?

Coaching approach

What should the PT ask the family about during the evaluation?

Family concerns and goals

What should a PT communicate during an evaluation?

What they are doing, why they are doing it, and their clinical thoughts along the way

What does the evidence suggest about patient- and family-centered care?

It can be a critical approach for improving the quality of healthcare

What outcomes have been associated with family-centered care?

Decreased ICU length of stay and improved developmental/neurophysiological outcomes in certain populations

What legislation governs early intervention and school-based services?

IDEA — Individuals with Disabilities Education Act

What part of IDEA applies to school services?

Part B

What part of IDEA applies to Early Intervention?

Part C

What age range is Early Intervention?

Birth to 3

What document is used for Early Intervention?

IFSP — Individualized Family Service Plan

Who develops the IFSP?

Family and Early Intervention team

What document is used for school-based services?

IEP — Individualized Education Program

Top-down approach

Start with desired participation goal

Identify strengths and weaknesses

Plan strategies to bypass obstacles

Develop and implement intervention plan

Goals of evaluation/assessment

Determine eligibility

Determine functional abilities and quality of performance

Identify supports and resources

Identify strengths and needs

What should pediatric PT goals be based on?

The child/family's desires and functional activities

What three components should you consider when writing a goal?

Behavior (sit, transfer, or walk) + Conditions (environment, equipment, assistive device) + Criteria (how often, how long, how far)

What should the evaluation identify about the child?

Child's strengths, needs, and present level of performance

What should goals focus on?

Functional skills and daily activities

What should be included in the evaluation summary?

Summary on:

Child's unique strengths and needs

Functional skills

Participation in family routines

Accuracy/usefulness of the assessment tool

Matthew was born 28 weeks' gestation and is 8 months old now. What is his corrected age?

Matthew was born 12 weeks preterm ("full term" is 40 weeks)

40 - 28 = 12 weeks

If Matthew is 8 months old now...

8 x 4 = 32 weeks -12 weeks = 20 wks (5 mths)

Matthews developmental skills should be expected of a 5 month old baby instead of 8 month old

What should be included in the behavioral observations section?

Highlight strengths, age-appropriate behavior, and atypical behavior

Difference between norm-referenced and criterion-referenced tests?

Norm-referenced: Compares the child to a normative/reference population

Criterion-referenced: Determines performance relative to specific established criteria or skills

What are basal and ceiling levels used for?

Help establish the appropriate starting and stopping points during standardized testing

What information may be reported when describing developmental delay?

Age equivalent and percentage delay

What are the models of service delivery?

Direct

Integrated

Consultative

Monitoring

Collaborative

What is direct service?

The therapist directly provides intervention to the child

What is integrated service?

Working together with teachers/aides at school; direct service and consultation may be blended

What is consultative service?

The therapist works with the child's team, while the team implements the activities, rather than the therapist directly providing them

What is monitoring?

Staying in contact with the child/team to see how the child is doing, especially when skills may deteriorate

What is collaborative service?

Working with the team/family through approaches such as role release or coaching

What factors should influence procedural interventions?

Age, comorbidities, cognition, family factors, and information from the evaluation

What should always be incorporated into pediatric intervention?

Fun!

What are the criteria for terminating pediatric PT?

Goals/objectives have been met

Child/family declines to continue

Unable to progress toward expected goals/outcomes

PT determines services no longer provide benefit

What is the difference between graduation and discontinuation?

Graduation/termination may occur after successful achievement of goals, while discontinuation can occur for other reasons such as family choice or lack of expected progress

Which document is developed for children receiving early intervention services from birth to age 3?

Individualized Family Service Plan (IFSP)

A child is 10 months old and was born at 34 weeks of gestation. What is the child's adjusted age?

40 weeks − 34 weeks = 6 weeks premature

10 months − 1.5 months = 8.5 months adjusted age

School-based services for children from prekindergarten through Grade 12 are provided under which section of IDEA?

Part B

Which outcome is measured at the activity and participation level?

Walking with classmates at school

Which statement best describes a family-centered approach to pediatric physical therapy

The child and family collaborate with the therapy team in decision-making

Which action best demonstrates a family-centered evaluation?

Asking the family about its concerns, priorities, and goals

In a top-down approach to planning intervention, what should the physical therapist identify first?

The desired participation goal

What is an important characteristic of a transdisciplinary team?

Team members share knowledge and integrate strategies across settings and activities

A 4-year-old child with spastic cerebral palsy is enrolled in preschool. The PT services are provided through which federal mandate?

IDEA Part B - IEP

A PT is working with a 2-year-old child with Down syndrome through an early intervention program. Which service plan is MOST appropriate?

Individualized Family Service Plan (IFSP)

A school-based PT is advocating for a child with spina bifida to receive reasonable classroom accommodations without requiring special education placement. Which law applies?

Section 504 of the Rehabilitation Act

A 7-year-old child with cerebral palsy (GMFCS Level III) uses a walker for mobility at school. The PT recommends classroom modifications to allow safe movement between classes. Which federal law ensures this child receives PT as part of special education services?

IDEA Part B - IEP

According to neuro-maturational theory, how does development occur?

Development follows a hierarchical sequence driven primarily by CNS maturation

hat is the developmental progression emphasized by neuro-maturational theory?

Cephalocaudal and proximal-to-distal progression

According to neuro-maturational theory, what leads to voluntary movement?

Integration of reflexes

Which theorist is associated with cognitive developmental theory?

Jean Piaget

According to Piaget, how do children learn?

Through interaction with the environment

What age range is the sensorimotor stage?

Birth to 2

Give an example of sensorimotor learning.

- Baby shakes rattle → hears sound → learns cause-and-effect

- Infant sees parent → reaches → eye-hand coordination

- Crawling on carpet vs. tile → balance + texture learning

According to behavioral theory, what shapes behavior?

Environment

What are the major building blocks of behavioral development?

Stimulus, response, and environmental consequences

What type of intervention is associated with behavioral theory?

Applied Behavior Analysis

According to the Piagetian perspective, how does development occur?

Through interaction between cognitive-neural structures and environmental opportunities for action

According to Piagetian perspective, what are the view of "stages"?

Stages represent alternating periods of equilibrium and disequilibrium

What are the major building blocks of Piagetian development?

First actions using reflexes and later from voluntary actions

Which theorist is associated with psychosocial development?

Erik Erikson

How many stages are in Erikson's psychosocial theory?

8

What is the major psychosocial conflict during infancy?

Trust vs. mistrust

What is the major psychosocial conflict during toddlerhood?

Autonomy vs. shame and doubt

What is the major psychosocial conflict during the preschool years?

Initiative vs. guilt

Which theorists are associated with Dynamic Systems Theory?

Thelen and Smith

Is development linear according to Dynamic Systems Theory?

No, nonlinear

What three major factors influence development according to Dynamic Systems Theory?

The child's body systems, task demands, and environmental context

How is motor behavior described in Dynamic Systems Theory?

As self-organization of multiple interacting systems

Is movement controlled by one system according to Dynamic Systems Theory?

No. Movement results from many dynamic, interacting systems.

Which theorist is associated with ecological theory?

Gibson

What is the main concept of ecological theory?

Perception-action coupling.

According to ecological theory, how does movement emerge?

Movement emerges as a child perceives affordances in the environment

How do children learn according to ecological theory?

Exploring their surroundings

What is the PT application of ecological theory?

Provide enriched environments and opportunities for exploration

Which theorist is associated with sociocultural theory?

Vygotsky

What drives development according to sociocultural theory?

Social interaction and culture

The area in which a child can perform a skill with appropriate guidance or support.

Zone of Proximal Development

What is the PT application of sociocultural theory?

Guided play and caregiver participation

A 10-month-old infant demonstrates the ability to pull to stand at a support surface. According to the neuro-maturational theory, which principle best explains this milestone?

A. Development occurs in a cephalocaudal and proximal-to-distal pattern B. Children learn best through scaffolding and guided play C. Exploration of the environment leads to self-organization of motor behavior D. Movement emerges from perception of environmental affordances

Development occurs in a cephalocaudal and proximal-to-distal pattern

During the sensorimotor stage (0-2 years), infants learn primarily through:

A. Abstract reasoning and symbolic thought

B. Linking sensory experiences with motor actions

C. Emotional stages of autonomy vs. shame/doubt

D. Teacher-directed instruction and imitation

Linking sensory experiences with motor actions

A physical therapist places a toy slightly out of reach of a 14-month-old child to encourage problem-solving. This intervention is based on which developmental concept?

A. Motor action = knowledge

B. Zone of proximal development

C. Psychosocial initiative vs. guilt

D. Dynamic systems interaction

A. Motor action = knowledge

A 12-month-old child has the strength to stand but is not walking independently. According to dynamic systems theory, which factor MOST likely explains the delay?

A. Integration of primitive reflexes has not occurred

B. Environmental opportunities for practice are limited

C. Child is in the psychosocial stage of autonomy vs. shame/doubt

D. Motor learning has not progressed beyond the associative stage

B. Environmental opportunities for practice are limited

A PT encourages a child to climb stairs during therapy. According to ecological theory, the child attempts this activity because:

A. Climbing is a required milestone in a hierarchical sequence

B. The environment offers affordances that invite action

C. Emotional security allows the child to explore movement

D. The skill was modeled by peers and reinforced socially

The environment offers affordances that invite action

During therapy, a toddler repeatedly insists on trying to put on their own shoes. According to Erikson's psychosocial theory, this reflects which developmental stage?

A. Trust vs. mistrust

B. Autonomy vs. Shame/doubt

C. Initiative vs. guilt

D. Industry vs. inferiority

Autonomy vs. Shame/doubt

A PT designs a therapy program that combines play-based activities, caregiver guidance, and environmental modifications to promote walking in a 2-year-old child with developmental delay. Which theoretical approach does this BEST reflect?

A. Neuro-maturational theory

B. Sociocultural and dynamic systems theories

C. Ecological theory only

D. Psychosocial theory only

Sociocultural and dynamic systems theories

What are the four major domains of child development?

Physical, cognitive, social/emotional, and language/communication

What is included in physical development?

Growth, motor skills, and reflexes

What is included in cognitive development?

Attention and problem-solving

What is included in social/emotional development?

Relationships and play

What is included in language/communication development?

Expressive and receptive communication skills

Biological Influences

Genetics, prematurity, and congenital conditions

Environmental & Cultural Influences

Family support and caregiving style

Opportunities for play and exploration

Socioeconomic status, healthcare access

Cultural norms & expectations