M4 Neurodevelopmental Frame of Reference and Exam Prep

Lab Immersion Debrief and Upcoming Exam Preparation

This session covers essential topics for the upcoming quiz and midterm, including an in-depth look at the progression of sensory feeding, assessments, goals, and the Neurodevelopmental Frame of Reference.

Prayer of Gratitude

• Gratitude for Experiences: Paused with gratitude for the lab immersion and field work completed, safe travel, and guidance from educators.

• Appreciation for Impact: Thankful for children, grown-ups, and moments of insight and connection that shaped the learning.

• Resilience and Growth: Acknowledged difficulties as challenges that strengthened, and prayed for preparation for future challenges.

• Forward Momentum: Sought help to carry energy forward through the remaining $4$ weeks of class.

• Core Values: Asked for open hearts to growth, minds focused on excellence, and spirits grounded in compassion for those to be served.

• Purpose: Renewed purpose to study diligently, support peers, and use knowledge for healing and hope in communities.

Quiz & Midterm Preparation: Sample Questions Analysis

• Exam Content: Questions will cover all frames of reference discussed (including Neurodevelopmental Frame of Reference, Pediatric Edition) and integrate learning from lab experiences.

• Study Strategy for Frames of Reference: Review content from Tuesday sync sessions.

• Study Strategy for Lab Learning: Case-based questions requiring clinical reasoning; often not explicitly stated content but derived from practical application.

• Question Formats: Expect "three truths and a lie" questions, requiring careful reading to identify the false item, similar to board exam styles.

Sample Question 1: Selecting the Best Assessment

• Scenario (Noah):

  • $5$ years old, starting kindergarten.

  • Teacher notes: Difficulty with cutting, coloring, forming letters.

  • Teacher request: More information about fine motor and visual motor integration skills for classroom accommodations.

• Assessment Options: Peabody Developmental Motor Scales (PDMS-$-2$), Beery-VMI, Motor-Free Visual Perception Test (MVPT).

• Rationale for Selection (Beery-VMI):

  • Age Appropriateness: All assessments are appropriate for a $5$-year-old (though Peabody is at the end of its age range).

  • Purpose of Assessment: Standardized assessments compare a child to statistical norms.

  • PDMS-$-2$: Primarily a motor scale; indicates motor performance relative to peers but doesn't specifically target visual motor integration for accommodations.

  • MVPT (Motor-Free Visual Perception Test): Focuses on visual perception without a motor component, which doesn't address the teacher's request for visual motor integration skills for fine motor tasks.

  • Beery-VMI (Beery-Buktenica Developmental Test of Visual-Motor Integration): Directly assesses visual motor integration, providing specific information relevant to cutting, coloring, and forming letters, which directly leads to classroom accommodations.

• Clinical Reasoning: Evaluate the scenario's specific needs (fine motor, visual motor integration, classroom accommodations) against the unique purpose and focus of each assessment.

Sample Question 2: Identifying Frame of Reference (Intervention)

• Scenario (Maya):

  • $6$ years old, first grade.

  • Challenge: Struggles with buttoning and zipping during morning arrival (most peers manage independently).

  • Emotional Impact: Becomes frustrated when dressing tasks take too long.

• Intervention Options (reflecting different frames of reference):

  • $96\%$ Correct Answer: Developmental Frame of Reference: OT will progress Maya developmentally on the approach to buttons and fasteners, from easier to more complex. This acknowledges she's behind peers but follows the typical developmental progression for skill acquisition.

  • Sensory Integration/Processing Frame of Reference: "Maya has difficulty processing tactile input from clothing textures, which causes her to avoid using her hands for fasteners. OT will provide sensory rich play activities to help her modulate tactile input." (Connects difficulty to tactile processing).

  • Behavioral Frame of Reference: "Maya becomes more cooperative with dressing tasks when she is praised. OT will implement a token reward system to reinforce participation." (Focuses on external reinforcement to modify behavior).

  • Neurodevelopmental Frame of Reference: "Maya has difficulty sitting in alignment with good trunk control and is unable to complete fine motor tasks. OT will use supported positioning to promote posture alignment before progressing to fine motor tasks." (Focuses on proximal stability for distal mobility).

• Key Takeaway: Understand how the tenets of each frame of reference translate into specific intervention approaches.

Neurodevelopmental Frame of Reference (Pediatric Edition)

• Foundational Principle: Requires a comprehensive understanding of normal motor development.

• Direction of Development: Development is cephalocaudal ($head o tail$) and proximal to distal.

• Stability and Mobility: There is a complex interplay between stability (e.g., core control) and mobility (e.g., fine motor movements).

• Movement Dissociation: The ability to perform fine motor tasks without consciously thinking about or controlling trunk stability (e.g., sewing, crochet, Legos, puzzles, jewelry-making, fly tying, painting require core stability without direct focus).

• Postural Control Development: Occurs across three planes of movement:

  • Orbital

  • Sagittal

  • Transverse

• Reactions: Development of righting and equilibrium reactions, which involve the inner ear, proprioception, and vestibular sensation, crucial for postural control and understanding typical movement.

• Intervention Approach: Moves the child along a typical progression from proximal to distal (e.g., from sitting posture and balance to fine motor skills).

  • Distinction from Developmental Frame: Developmental focuses on the task itself (e.g., size of buttons), while NDT focuses on the underlying motor control.

  • Integration: Multiple frames of reference can be used concurrently (e.g., supporting core posture with NDT while also developmentally progressing activities).

  • Common Use: Particularly effective for diagnoses where movement is atypical due to neurological differences (e.g., Cerebral Palsy, Down syndrome, other chromosomal anomalies).

• Adaptation vs. Elicitation: May require adaptation (bolsters, seating, positioning tools) rather than merely eliciting normal movement, using OTPF levers such as modify, adapt, and grade activities.

Primary Goals of Neurodevelopmental Approach

1. Normalize Movement: Achieve typical movement patterns, focusing on muscle tone and alignment.

   • Inhibition of Abnormal Movement: Essential to achieve normal movement, especially in conditions with atypical tone that can "hijack the system."

     • Examples: Cerebral Palsy (CP), Traumatic Brain Injury (TBI), pediatric Multiple Sclerosis (MS).

     • This often involves inhabiting high tone and spasticity to allow for normal movement to emerge.

Cerebral Palsy (CP) and Atypical Movement

• Abnormal Muscle Tone: A significant feature of CP.

  • Hypertonicity: Muscle tone activated at rest, present even when muscles should be relaxed.

  • Spasticity: Muscle tone activated with velocity; elicited during movement (e.g., attempting to use an arm).

  • Hypotonicity: Low muscle tone, leading to a flaccid state at rest; poses challenges for positioning.

  • Fluctuating/Alternating Tone: No specific pattern; tone can vary and is often unique to the individual; frequently elicited when an individual is excited (excitement can trigger tone, hindering engagement).

• Persistent Reflexes: Retention of more subcortical reflexes (e.g., Asymmetrical Tonic Neck Reflex - ATNR) beyond the typical developmental period.

  • Can "hijack" movement: A child or adult may attempt to reach and turn their head, and the ATNR is elicited, interfering with the intended motion.

• Poor Sensory Processing: Decreased sensation.

• Poor Joint Proprioception: Reduced feedback from joints about body position in space, impacting stability, joint movement, and co-contraction (simultaneous contraction of agonist and antagonist muscles for stability).

Other Neurological Disorders of Childhood: Timing of Onset

• Prenatal: Injury or condition occurring before birth (in utero or in the womb).

  • Examples: Chromosomal anomalies like Down syndrome are considered prenatal/congenital as they are present in the genetic coding.

• Perinatal: Injury or condition occurring around the time of birth (just before or immediately after).

• Congenital: A condition present at birth (overlaps with prenatal/perinatal causes).

  • Example: Down syndrome is congenital, as it's present at birth due to chromosomal differences.

• Acquired: Injury or condition occurring following birth (typically considered within the first $28$ days of life or later).

  • CP can be prenatal, perinatal, or acquired, depending on the cause and timing of the brain injury. A specific example of acquired CP was not given explicitly but is implied by the categories. For example, a TBI sustained after birth would be acquired.