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57 Cards in this Set
- Front
- Back
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play as a means vs play as an end
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play as a means: playing the game
play as an end: play is the outcome *fun makes play a means and an end |
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What 2 things are critical to the developmental neuroplasticity?
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pleasure
active participation **doing things for the child does not develop neuroplasticity |
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Reactive Neuroplasticity
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CNS changes that take place following an insult such as a brain injury
also in action when opportunities or experiences are absent or limited |
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Sensory Integration
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Jean Ayres
-a neurobiological and occupational framework that includes concepts and principles aimed at understanding and ameliorating primary sensory and motor abilities that underlie learning and behavior -"fix-it" approach -still informs a lot of thinking but is not proven |
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Areas usually assessed in sensory integration
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visual perception
tactile discrimination vestibular/proprioceptive postural control praxis-motor planning sensory sensitivities environmental sensory conditions/practice demands |
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Neurodevelopmental Treatment (NDT)
frame of reference |
Karl and Berta Bobath
A therapeutic method using hands-on guidance of a child's posture and movement to improve functional performance (ex in class) -designed in the 40s for kids with CP |
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Areas usually assessed in NDT
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motor control
neuromuscular functions motor patterns/responses postural mechanisms and control strength/tone range of motion synergistic mm patterns |
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Cognitive/Top-down approaches
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Missiuna, Law, Mandich, Polatajko, Pollock
Cognitive Orientation to daily Occupational Performance (CO-OP) is a therapeutic treatment approach for children who have difficulties performing motor-based skills |
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Areas usually assessed in cognitive/top-down frames of reference
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-effectiveness of cognitive strategies being used
-dynamic performance analysis including assessments of child's motivation, task knowledge and the interaction of the PEO -conditions, requirements, and resources in the environment |
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Indirect Intervention
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interventions implemented by parents, teachers, and other adults with OT working through them
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Indirect intervention vs consulting
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consulting- OT passes info on
indirect-still checking in once a week, etc |
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4 approaches to indirect intervention
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Monitoring
Special Instruction Ecological intervention coaching |
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Monitoring
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keeping track of a situation over time
therapist checks procedures and child progress |
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Special instruction
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teaching simple procedures to caregivers that they implement in the context of child's daily life
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Ecological intervention
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a model that encourages individuals to work together across environments to help children become more skilled
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Coaching
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initially conceptualized in early intervention
indirect intervention approach that enables caregivers to carry out their own roles better occurs between the therapist and the intervener as well as between intervener and child -therapist coach creates opportunities for the parent coach to engage, reflect, and problem solve |
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Basics for using an indirect model of intervention
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-OT must view the child in natural environments in order to help others administer therapeutic techniques
-Least Restrictive Environment -Monitoring easily fits into the Least Restrictive Environment (may reveal that accommodations do not provide enough support, may lead therapist to consider moving to special instruction or another form of service delivery) |
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Creating a plan of action with indirect intervention
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-indirect intervention emphasizes competence in everyday tasks
-plan of action should build on existing support networks -effective intervention involves collaboration between professionals and parents/caregivers |
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3 ways to use indirect intervention
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-supplement to direct intervention
-substitute for direct intervention -means to transition out of intervention |
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What are the 2 models of consultation?
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Expert and collaborative
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Expert consultation
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-clients "purchase" expertise from consultants
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Collaborative consultation
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-type of service delivery
-requires process of defining the problem, which is as important to the outcome of intervention as are the solutions -clients and consultants work together -process is based on certain premises rather than defined activities -roles and relationships between consultant and client are different than in expert consultation |
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Process of collaborative consultation
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1.engage the client
(reflective listening and clarify what is heard) 2.be conscious of what you do not know (rarely know the whole context of the problem, what you know vs what you assume) 3.facilitate problem solving and create possibilities (benefits of collaboration are maximized when ideas and solutions are generated together) 4.prepare client to think to the future (guide client to identify their own problems/solutions, prepare client for dealing with future problems) 5.hand over the process (clients realize they can work through problems) |
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difficulties with collaborative consultation
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1. Who are the clients?
kids are OT clients, but the people working with child are recipients of collaborative consultation 2. What about unwitting clients? therapist must ensure that needs of all members are balanced 3. Whose needs are the priority? 4. What is the aim of the intervention? important not to focus on solutions to individual problems, must see the whole picture 5. What if clients have different expectations of therapy? |
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Benefits of a consultation model
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-more satisfactory to clients in the long term
-provides more efficiency in service delivery -respect the fact that parents are the expert on their child |
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The outcomes of consultation
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-collaboration consultation increases effectiveness, where creation of contextual changes improves child functioning
-clients feel competent, actively engaged, understand the whole process, and are more likely to acquire skills and solve future problems |
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Def Neuromotor disorders
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developmental conditions that
-arise prior to birth or during the birth process and -lead to physical impairment |
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Characteristics of neuromotor disorders
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-result from impairment in the SC or brain
-affect performance of daily occupations -range in severity -often accompanied by coexisting conditions |
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Cause and prevalence of cerebral palsy
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-often caused by hypoxic event
-2.5-3 per 1000 live births |
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Classifications of CP
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Types
-spastic -dyskinetic -ataxic Severity -gross motor function classification systems -manual ability classification systems Distribution -hemiplegia -diplegia -quadriplegia |
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Is CP progressive?
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No
however, abilities may deteriorate over time d/t complications and increased expectations |
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Impairments with CP
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Primary: motor and postural
slow development, atypical movement patterns other common: strabismus, nystagmus, dysarthria, aphasia |
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Causes and Prevalence of spina bifida
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Congenital defect
-failure of neural tube to close -4th week of gestation defects can occur anywhere on SC Cause unknown (genetic predisposition) 1 in 2000 live births, more girls |
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Classifications of Spina Bifida
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Spina Bifida Occulta
-mildest form -gap in 1 or more vertebral arch; cord and meninges remain in SC Spina Bifida Cystica -protrusion of cord and meninges through vertebral arch -meningocyte -myelomeningocele |
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Spina Bifida impairments
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-prone to hydrocephalus (90%)
-many have Arnold-Chiari type II Occupational function -dep on level of lesion/extent of damage -may lose sensation, motor power below lesion -intelligence not affected, learning can be impaired -expressive can be better than receptive language |
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Muscular Dystrophy and Spinal Muscular Atrophy
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-degenerative disorders resulting in PROGRESSIVE mm weakness/atrophy
-differentiated by mm pathology and pattern of genetic inheritance |
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Muscular Dystrophy
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-mm disorder
-most common form is Duchenne-caused by x-linked recessive genetic mutation 3 in 100,000 live births -common types: Duchenne, Becker |
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Spinal Muscular Atrophy
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-disorder of ant horn cell of SC and motor cells of cranial nuclei
-1 in 10,000 live births -onset generally earlier than MD -types: infantile: werdnig-hoffman disease intermediate: dubowitz disease juvenile: kugelberg-welander disease |
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Impairments with MD and SMA
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-presentation varies
-destruction of myofibers and progressive degeneration of mm -smooth mm of organs are affected -DISORDERS LEAD TO PREMATURE DEATH *look at modification and fatigue. Encourage celebration of life |
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What factors influence occupational performance in MD and SMA?
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-type and severity of disorder
-age and expectations of child |
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Developmental Coordination Disorder
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-motor coordination difficulties that impair everyday activities and have no other diagnosable cause
-no clear brain or SC damage -processing difficulty 50-60 per 1000 kids -most common childhood n neuromotor disorder -also called developmental dyspraxia *intervene with visual imagery and specific directions |
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Impairments with DCD
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-don't learn motor skills by watching and imitating
-perform with less precision and consistency -learn to perform with repeated practice |
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Occupational function in DCD
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-usually have history of clumsiness, falling
-often noted during toddler, preschool years *only tools we have are Brunicks and movement assessment battery. Must administer both! |
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Forward chaining vs backward chaining
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fwd: start with 1st step and therapist does the rest
back: therapist does everything up to the last step |
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Direct therapy approaches to neuromotor disorders
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-Task specific instruction
-Cognitive Orientation to daily Occupational Performance (CO-OP) -family centered functional therapy |
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What is the fastest growing developmental disability?
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Autism- 5x more common among boys
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What is autism?
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a life-long developmental disability characterized by
-social reciprocity -communication -overall adaptive functioning usually begins during first 3 years spectrum disorder |
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Theories on the growth rate of autism
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-increased awareness
-more screening tools and services -changes in definition/diagnosis -children with mild symptoms being diagnosed -environmental influence |
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How is autism diagnosed?
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DSM criteria includes impairment in the following areas:
-social interaction -communication -restricted/repetitive patterns of behavior, interests, activities -symptoms present before 3 |
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What are the 3 autism spectrum disorders
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Autistic disorder
Aspberger's PPD-NOS |
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Autistic Disorder
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cognitive- impaired to above avg
communication- delayed social- difficulty with interaction, language Repetitive patterns- may see inappropriate play as self-stim behavior |
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Asperger's
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cognitive- average or above
Communication- not a significant delay Social- difficulty with interaction, language repetitive patterns- intense focus on one subject. may self-stim |
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PDD-NOS
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cognitive-impaired to above average
communication- delayed to normal social- difficulty with interaction, language repetitive patterns- range of appropriate/inappropriate play skills |
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Strengths of individuals with ASD
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-strong memory
-visual learners -black and white thinking -straightforward, honest, objective -can concentrate on topis of specific interest (has to enjoy) |
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Core features of ASD
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impairment with
-social skills -communication skills -stereotypical behavior |
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Social Skills and ASD
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-may not respond to name
-prefer to be alone -difficulty imitating others -socially naive -trouble making and keeping friends -difficulty with nonverbal cues -difficulty understanding social rules |
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Communication skills and ASD
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-crying, tantrums
-taking someone to what they want -picture exchange or communication device -echolalia -literal understanding of language |
