MG

Frames of Reference and Assessment Strategies

Exam Preparation and Quiz Questions Guidance

  • Studying for Frames of Reference (FORs): Review content from synchronous Tuesday sessions.
  • Lab Learning to Quiz Questions: Practice clinical reasoning for case-based questions that require applying knowledge and lab experiences to new scenarios.
  • Midterm Question Types:
    • Includes "true or three truths and a lie" questions (identify the false item or the lie).
    • Requires slowing down test-taking to identify the incorrect option.
    • Excellent preparation for board exam-style tests.

Quiz Question 1: Best Assessment (Noah's Case)

  • Scenario: Noah, a 5-year-old starting kindergarten, has difficulty cutting, coloring, and forming letters. His teacher needs information on his fine motor and visual-motor integration skills for classroom accommodations.
  • Assessment Options: Sensory Profile, Peabody Motor Skills (PDMS), Beery VMI, Motor-Free Visual Perception Test (MVPT).
  • Clinical Reasoning Process:
    1. Age Appropriateness: Check if all assessments are suitable for a 5-year-old. All are applicable, though PDMS is at the upper age limit for this age.
    2. Purpose of Assessment & Specific Need:
      • Standardized Assessments: Purpose is to compare a child to statistical norms.
      • PDMS (Peabody Developmental Motor Scales): A motor scale that shows where Noah stands relative to peers, but isn't specific enough for visual motor integration accommodations.
      • Beery VMI (Visual Motor Integration): Specifically assesses visual motor integration skills, providing a targeted picture for classroom accommodations. This is the most appropriate choice given the teacher's request.
      • MVPT (Motor-Free Visual Perception Test): Focuses solely on visual perception without a motor component. This would not meet the teacher's request for visual motor integration skills, which includes a motor aspect.
  • Key takeaway: Clinical reasoning involves assessing age appropriateness, the specific purpose of the assessment, and how it directly addresses the question's need.

Quiz Question 2: Clinical Reasoning & Frame of Reference (Maya's Case)

  • Scenario: Maya, a 6-year-old in first grade, struggles to button and zip her jacket independently (unlike most peers). Her teacher reports frustration due to tasks taking too long.
  • Question: Which rationale best reflects the use of the Developmental Frame of Reference?
  • Analysis of Options: Each option reflects a different frame of reference.
    • A. Developmental Frame of Reference (DFOR):
      • Rationale: Maya demonstrates difficulty with fine motor dexterity needed for dressing fasteners. OT will use a hierarchy of dressing activities, starting with large buttons and gradually progressing to smaller, more complex fasteners.
      • Explanation: DFOR compares a child's progression to their peers and intervenes by following the typical developmental progression of the skill (easier to more complex steps). This aligns with a developmental approach to intervention. (This was the correct answer, with 96\% of students getting it right).
    • B. Sensory Integration/Processing Frame of Reference:
      • Rationale: 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.
      • Explanation: This approach focuses on underlying sensory processing difficulties as the root of the problem.
    • C. Behavioral Frame of Reference:
      • Rationale: Maya becomes more cooperative with dressing tasks when she is praised by her teacher. OT will implement a token reward system to reinforce her participation and success in dressing activities.
      • Explanation: This focuses on external motivators and reinforcement to shape behavior.
    • D. Neurodevelopmental Frame of Reference (NDT):
      • Rationale: Maya has difficulty sitting in alignment with good trunk control and is unable to complete the fine motor task. OT will use supported positioning to promote posterior alignment before progressing to the fine motor task.
      • Explanation: This focuses on foundational motor control, posture, and neurological development to enable higher-level motor tasks.

Neurodevelopmental Frame of Reference (NDT) in Pediatrics

  • Foundational Principles of Development:
    • Cephalocaudal: Development from head to tail.
    • Proximal to Distal: Development from the trunk/core to the extremities.
    • Gross Motor to Fine Motor: Control of large movements precedes precise, small movements.
    • Stability to Mobility: Achieving stability in a posture allows for movement from that posture.
  • NDT Approach Requirements:
    • Deep understanding of normal motor development.
    • Appreciation for the complex interplay between stability and mobility.
    • Ability to dissociate movements: Performing fine motor tasks without consciously thinking about core stability (e.g., sewing, crocheting, building Legos, doing puzzles, tying fishing flies, painting all require core stability).
    • Development of postural control occurs simultaneously in three planes: coronal, sagittal, and transverse planes of movement.
    • Development of righting and equilibrium reactions, involving the inner ear, proprioception, and vestibular sensation, to achieve postural control and typical movement.
  • Core Focus of NDT: Normalizing movement or guiding movement along a typical developmental progression.
  • NDT vs. Developmental FOR:
    • Developmental FOR: Focuses on the task itself (e.g., size of buttons).
    • NDT: Focuses on underlying movement patterns, posture, and balance.
  • Application: Multiple frames of reference can be used concurrently (e.g., supporting core posture with NDT while progressing activities developmentally with DFOR).
  • Specific Diagnoses: NDT is frequently used for diagnoses with atypical movement in the nervous system, such as Cerebral Palsy (CP), Down Syndrome, and other chromosomal anomalies with significant neural atypicality.
  • Intervention Tools: Occupational Therapy Practice Framework (OTPF) levers like modifying, adapting, and grading activities to achieve normal movement.
  • Primary Goal of NDT: Achieve normal movement, encompassing both muscle tone and body alignment.
  • Inhibition of Abnormal Movement: Crucial for conditions like CP, Traumatic Brain Injury (TBI), or pediatric Multiple Sclerosis (MS), where atypical tone can