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234 Cards in this Set
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ICF=
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International Classification of Functioning, Disability, and Health
Not focused on disease or disorder, but the health of the individual |
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Interactions between components of ICF
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Health condition (disorder/disease)
Participation Body functions and structures Env and personal factors All interacting w/ activities |
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Biomedical paradigm
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Major focus of health research has been to uncover the causes of ill health and disease and test treatment techniques and drugs that can "fix" the underlying disorder.
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Social (ecological) paradigm
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Considers the factors "outside of the body". Determinants of health come from a wide range of env factors that interact w/ person variables.
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Disability
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Umbrella term for impairments, activity limitations, or participation restrictions.
An outcome of the relationship between a person and the environment. |
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Environmental barriers
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Any aspect of the env that constrains satisfactory performance/participation:
Physical Social Cultural Institutional |
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Thrive
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Continuing to grow; not just living, but also doing
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Function
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You can just be there
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Circle of friends:
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People you live with
People who are your friends People who you see regularly People who are paid to be in your life. For someone w/ a disability, may not have what we consider "normal friends." Most are in the category of those who are paid to be in life. |
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Environmental supports
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Any aspect of the environment that enables or encourages satisfactory performance/participation. Physical, social, cultural, institutional.
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Participation
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Nature and extent of a person's involvement in life situations and level of enjoyment.
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Measuring participation
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Person's preferences and interests, doing, where and w/ whom, how much enjoyment, how much satisfaction, etc.
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Human development
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A pattern of change that begins at conception.
Lifelong, multidimensional/system Plastic (individual pathways w/ different trajectories) Studied by many disciplines Contextual and biological |
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Human development is shaped:
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by a dynamic and continuous interaction between biology and experience.
Culture influences every aspect. Kids are participants in their own development |
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Growth of self regulation-
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cornerstone of early childhood development
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Theories of motor development:
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Neural-maturationist (neurofacilitation)- Gessel 20-40s
Cognitive theories- Piaget, Pavlov, Skinner (50-70s) Dynamic systems- Thelan, Ulrich, Heriza (80-90s) Systems theory- woollacott & Shumway-Cook (90s) |
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Neural-maturationist
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Combined early Hierarchical theory and reflex theories.
Movement controlled by highest intact portion of CNS and/or reflex arch. Emphasis placed on exam of stages of reflex development and motor milestones |
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Neural-maturationalist intervention based on
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Assessment w/ norm referenced tools based on motor milestones and reflexes.
Direct hands on therapy to work on the next motor milestone, inhibit/integrate attitudinal reflexes, and facilitate righting and equilibrium reflexes. Reeval based on readministration of milestones and reflex eval |
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Piagetian theory
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Piaget, 1952
Combination of maturation of cognitive and neural structures nad the environment. Stages of development- cognitive development |
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Behavioral theory
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SKinner, 1972
Environment is motivator and shaper of motor and cognitive development. Response to stimulus w/ reinforcer |
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Dynamical systems
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Dynamic cooperation of the many subsystems in a task-specific context.
Development not seen as series of discrete stages, but a series of states of stability and instability and phase shifts in which new stages become stable aspects of motor behavior. Multiple systems and processes developing at any given time. |
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Dynamical systems intervention based on:
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Eval of constraints
Meaningful env support for constraints and opportunity for practice in env. manipulation of control parameters (attractor states- speed, strength, etc) |
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Systems approach theory for motor control
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Combines elements of all theories.
Emphasizes that movement occurs from interaction between individual, task, and env. |
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Movement principles:
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flexion/ext
AntiGravity Elongation/activation Symmetry/assymetry Cephalocaudal Proximodistal Stability/mobility Action plans |
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Interventions for systems approach based on:
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Individual, task and env
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Individual:
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cognition, perception, action
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Task
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Functional grouping
Discrete vs continuous Stability vs mobility |
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Environment
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Regulatory movement determiined by BOS
Non regulatory- performance by env- doesn't depend on env; env may affect movement but isn't shaped by it |
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Flexion/extension
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Begin in flexion, gradually move into extension
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Elongation/activation
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In flexion at first and everything is tight. When start elongating, extensors are long and begin to activate extensors and flexors will lengthen.
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Cephalocaudal
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Head control comes first
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Symmetry/assymmetry
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Begin in symmetry, move to asymmetry, then more symmetry.
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Proximodistal
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Move proximal to distal
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Stability/mobility
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Keep BOS at first, then move to walking and being mobile
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Action plans
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learn the best ways to accomplish tasks
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Sensitive periods
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Optimal periods for certain motor skills to develop quickly
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Spiraling patterns of development
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Learn to write w/ a crayon, then pencil, then caligraphy; everything spirals around
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Human development is important so:
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We know what children do.
Leads us to develop interventions that support kid's functional activites and occupations. Movements are self-directed and meaningful to the individual at their particular place in development. |
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Prenatal time frame
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Total of about 266 days
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Germinal period:
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period of the zygoid about 2 weeks from conception to implantation. Fertilization in fallopian tube. Rapid division as moves from uterus to fallopian tube. Zygote attaches to uterine wall. Blastocyst (inner layer of cells) becomes the embryo and outer layer form support systems to support and nourish the embryo.
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Embryonic period
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occurs during 3-8 week of pregnancy.
Allmajor sturctures and systems are established. Endoderm becomes digestive sys, respiratory sys, and vital organs. Mesoderm becomes circ sys, bones and muscles. Ectoderm developes into NS, skin, and hair. By end of month 2 eyes, nose, arms and legs are develop. Can move and respond to touch. Ultrasound often taken here to screen for growth and development. Exposure to env toxins has a particularly traumatic effect. |
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Teratogen
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- substance or event causing damage during prenatal period. Common include nicotine, alcohol, and methylmercury.
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Fetal period
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Spans 7 months. Fetus continues to increase in size and weight. Organ systems refine and mature. Brain continues to develop
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12 weeks gestation
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At 12 weeks fetus can smile, frown, and suck; sex is evident
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15-16 weeks gestation
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15-16 weeks, movement can be felt by mother and a heartbeat is discernable.
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By 24 weeks gestation
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By 24 weeks, fetus respons to sound and is sensitive to light
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22-28 weeks gestation
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22-28 weeks, fetus becomes viable (can survive outside uterus). Below 26 weeks, may not do too well. 26 weeks can survive, but will most likely have severe disability.
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38-42 weeks gestation
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38-42 weeks fetal period ends at birth. (normal fetal development here)
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Genetic influences on development
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Error or mutation in the production or translation of genetic code.
46 chromosoms (2 pair of 23) Addition or deletion of entire chromosome ore gene w/in a chromosome. Range of disability dependent upon addition/deletion or impairment |
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Numerical chromosome disorder:
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Additional chromosome (trisomy)- 47 chromosomes (DS, trisomy 21).
Deletion (monosomy)- 45 chromosomes- usually incompatible w/ life; Turner syndrome |
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Sturcutral chromosome disorder
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Deletion (portion missing): Cri-du-chat syndrome: cry of a cat; high pitched cry for communication and severe cognitive impairments.
Translocation (transfer of portion of one chromosome to another)- form of DS |
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Single gene abnormality
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Cystic fibrosis- lungs immature from birth. Kiss and baby tastes salty.
Muscular dystrophy- usually die in childhood Both become worse w/ age. |
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Alcohol and development
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Fetal alchohol syndrome- hyperactive, sensitive, jittery, cognitive impairments
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Tobacco and development
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Prematurity, LBW, lower global intelligence
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Drugs and development
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Go through withdrawal at birth.
May have high BP, skeletal abnormalities, etc. Marijuana- hyperactive, impulsive, inattentive Cocaine- Premature, LBW, neurobehavioral abnormalities |
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Other env influences on development
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Maternal infection, disease, meds, Rx
Lead, aluminum maternal nutrient deficiency or chronic stress. |
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malnutrition
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Failure to thrive
Neurodevelopmental probs and lack of energy to explore |
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Excessive eating
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Obesity
Physical, emotiona, and social concerns and lack of energy to explore |
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Learned helplessness
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Kids who have a disability and everything is done for them.
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SES (socioeconomic status)
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Disability
Health insurance Quality day care Adequate housing TV watching All impact development |
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1 month:
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Not doing much.
Beginning to move slightly against gravity |
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2 months:
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Start to bring hands to mouth and hold head in midline/neutral. Symmetry pattern.
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3 months:
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Play in side lying, tuck chin, lift head, push up on elbows.
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4 months:
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Able to grasp, but can't release yet.
Swimming pattern Extend elbows more when on tummy |
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5 months:
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Begin to bring feet and hands to mouth.
Can grasp and pick things up. |
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6 months:
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Begin to see some start of rolling supine to prone (first).
Place in sitting and can maintain sitting. Start mouthing toys. Can release grip. Begin pivoting on belly. |
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7 months:
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More independent sitting.
Can reach and do things more in sitting Belly crawling, beginning of creeping and kneeling. |
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8 months:
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Can begin pulling up to stand.
Begin to rotate wrist to look at things (supinate) |
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9 months:
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Side stepping/cruising.
Begin clapping Pinser grasp Good at sitting |
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10 months:
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Standing w/ support
Begin hide and seek play |
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11 months:
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Pointing begins
Supportive forward walking |
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12 months:
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walking
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ostural control
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Body's orientation in space.
The orientation of body parts in relation to one another. Interaction of individual, task, and env. |
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Consequences of postural instability
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Can't move
Overshoot in reaching Lose balance Don't have locomotion: loss of functional independence falls, make diagnoses more severe. |
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Adaptive/feedback postural control
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Take in sensory info and aapt to environment. If adaptive doesn't work, you may compensate and do it differently than everyone else.
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Anticipatory postural control (feedforward)
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When you do a voluntary movement, CNS programs itself anticipating that you're going to be off balance. Preparation for voluntary movement.
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In postural stance, when perturbed, muscles activate
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distal to proximal.
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Postural instability
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Inability to counterac the destabilizing force using direction specific postural adjustments
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Underlying factors of postural instability:
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Motor components: postural synergies not programmed
Sensory components: Inability of sensory paths to elicit activity in the synergies Cognitive problems |
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Problems in the motor component of postural control
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Motor coordination
Musculoskeletal contributions Loss of anticipatory postural control Critical: Coordination of multiple muscles into postural muscle synergies. |
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Sequencing problems:
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Reversal in muscle recruitment order
Delayed recruitment pattern Delayed activation of responses (timing) Amplitude of muscle response |
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Ankle strategy-
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Conscious or unconscious response to counteract perturbation. It's a strategy b/c it's repeatable under the same conditions.
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Normal response to forward perturbation
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Gastroc first, then hamstring. On a spastic side, will see hanstrings first, then gastroc.
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Toe walkers-
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COM forward of BOS. Need to use hamstrings along w/ gastroc strongly.
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Consequences of abnormal recruitment sequence:
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Muscle force (reduced torque)
Biomechanics (lateral shifts in COM large) |
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Postural response/standing of a child becomes like that of an adult at...
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7 y/o
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Reversal in recruitment order:
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proximal to distal.
Toe walkers activate tib ant before gastroc when falling forward and are more likely to fall backwards. Use reverse walker. Seating in spastic diplegia: will activate neck to hip, antagonists before agonists. |
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Delayed recruitment pattern:
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Response patterns: 36 ms vs. 60-80 m sec
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Consequences of delayed recruitment sequence:
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Muscle force (coactivation- will have no motions at joint.)
Biomechanics (excessive joint motion at hip and knee) |
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Coactivation
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Characterized by simultaneous contraction of muscles on the anterior and posterior part of the body or joints.
Antagonist muscles Normal in very young healthy children. Task specific, not only explained by abnormal neural response. Stability limits Limits flexibility Linked to cognitive phase of learning before forces linked to a motor task are integrated. Coping strategy to postural instability. |
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Motor incoordination
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Problems modifying postural control.
Appropriate size of muscle response Combination of feedforward and feedback control mechanisms Inability to adapt amplitude of m response to perturbations of increasing distance and velocity. |
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Postural adaptation
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Postural adjustment of environmental conditions and changing task conditions
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Typical adjustment in children w/ CP (sitting):
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Top-down recruitment of postural mm.
Excessive antagonistic coactivation. Incomplete modulation of amplitude to task constraints. |
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Musculoskeletal contributions:
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Alignment
Joint movement constraints Changes in m structure (size and distribution of fibers) Changes in muscle force (recruitment of agonists) |
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Alignment
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Relation of body segment to one another, body position relative to gravity and BOS
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Limited movement at ankle joint
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Reduced ankle strategy
Delay in onset latency of gastroc in response to backward perturbation Reduced distal-proximal m response sequence Increase in use of hip and trunk m for balance. |
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Loss of anticipatory postural control:
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Dependent on previous experience and learning
EMG onset of postural mm preceding activation fo arm muscles during pushing or pulling |
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Sensory disorders:
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Sensory organization
Loss of one sense Loss of sensory redundancy Sensory organization and selection probs |
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Impaired cognitive function
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Dual or multi-tasks- Parkinson's disease and TBI
Motor incoordination in individuals w/ Alzheimer's Sensory disorganization w/ restricted vision in individuals w/ Alzheimer's |
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Parent identified stressors in the NICU
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Sights and sounds of the unit
Infant appearance Parental role alteration Altered relationship w/ their infant |
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Fullterm pregnancy
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38-42 weeks
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Preterm birth
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Before 38 weeks
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Post term birth
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After 42 weeks.
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Gestational age
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Number of weeks fetus was in uteral
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SGA, AGA, LGA describe
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Infant's birth weight for their gestational age
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SGA
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Small for gestational age; below 10th percentile; often associate w/ smoking, poor prenatal care, prematurity
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AGA
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Appropriate for gestational age
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LGA
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large for gestational age; above 90th percentile; Often associated w/ a mother who is diabetic
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1 pound = ___ grams
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454
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Normal birth weight
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2500-3999 g (5.5-8.8 lbs)
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Low birth weight
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1500-2500 g (3.3-5.5 lbs)
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Very low birth weight
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below 1500 g (3.3 lbs)
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Extremely low birth weight
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Below 1000 g (2.2 lbs)
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Apgar scores
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Objective measure of infant well-being at birth
Scored at 1, 5, and 10 minutes Infant scored on: color, pulse, reflex irritability, muscle tone, breathing efforts Numeric score of 1-3, possible range of 0-10 |
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Respiratory Distress syndrome (RDS)
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Respiratory distress or failure caused by immaturity of lungs, insufficient surfactant, collapse of alveoli, fluid in lungs.
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Surfactant production begins:
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about 24, fully developed by 34-36 weeks; coats alveoli to prevent sticking and collapse
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Treatment of RDS
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Surfactant replacement, CPAP, ventilation
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Chronic lung disease (Bronchopulmonary dysplasia-BPD)
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Chronic lung disease affecting primarily premature or sick infants who've been mechanically ventilated and continue to need supplemental oxygen at 36 weeks.
Scarring of lung tissue, lung tissue is stiff, abnormal chest x-ray, increased work of breathing w/ retractions, weheezing, poor feeding and poor weight gain, risk for developmental delay |
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Nasal cannula
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Short, thin tubes placed into the nostrils through which oxygen is administered. Used in cases of mild or hronic lung disease which aren't severe enough to require CPAP or ventilator
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Nasal CPAP
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Aplication of continuously pressurized air and oxygen to the airwaysa nd lungs via small tubes placed in the nostrils or a soft mask placed over the nose.
Tubes fit tighter to the nostrils than a nasal cannula. Keeps lungs partially inflated between breaths, which makes breathing easier. |
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Ventilator
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machine used to assist breathing via an endotracheal tube inserted into the trachea. Required by infants who can't breath on their own due to lungs that are too immature or sick.
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Conventional vent
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Delivers breaths to an infant that mimic the type of breaths the infant would take on their own
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High frequency vent
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Very small rapid breaths to breath for an infant in a very efficient manner. Reduces barotrauma to lungs.
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IVH
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Bleeding within or around the ventricles of the brain which may extend into the brain tissue and surrounding structures.
Prematurity is the leading risk factor. Originates in germinal matrix, source of cortical cells; area is poorly supported and very vascular. Highest risk before 33 weeks |
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IVH Grades
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1- Hemorrhage limited to germinal matrix; prognosis good
2- Bleeding into normal sized ventricles; prognosis good 3- Bleeding into ventricles that causes ventricle enlargement; Mortality below 10% Complications 30-40% 4- Extension of bleeding into brain tissue; Mortality almost 80%, complications 90% |
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Complications of IVH
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Periventricular leukomalacia (PVL)- hemorrhagic infarction and necrosis of white matter around ventricles; high incidence of spastic diplegia
Porencephalic cyst- fluid filled cyst at site of IVH |
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necrotizing entercolitis (NEC)
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Inflammation of the bowel wall caused by bacterial invasion. Results in swelling, necrosis, and potential perforation of the bowel.
Treated w/ antibiotics, surgery, NPO Complications: bowel rupture, necrosis of bowel, scarring and narrowing, short gut syndrome |
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Retinopathy of prematurity
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Disease of the developing eye.
Blood vessels of retina not mature until close to term age. Changes in oxygen levels in blood may affect te growth of retinal blood vessels. Scar tissue and irregular blood vessel growth can lead to retinal detachment and blindness Laser treatment destroys peripheral retina to stop vessels from growing over scar tissue |
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Extracorporeal membrane oxygenation
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Treatment of last resort when other forms of ventialtion haven't been successful
Can't be used on infants below 34 weeks Removes infant's venous blood, filters CO2 and adds oxygen, then returns blood to circulation bypassing lungs allowing them to rest. |
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Newborn individualized devlopmental care and assessment program (NIDCAP)
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Educational framework taht offers training for professionals in family centered individualized developmental care for infants and their families.
The only theory driven, evidence based approach to devlopmental care that incorporates the evironemtn, infant caregiverinteraction, cargiving strategies, andt eh family |
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Challenges faced by the preterm infant that may impact brain development:
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stress
pain NICU environment Caregiving |
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Stress
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Set of changes in the body and brain that are set into motion when tehre are threats to physical or psychological wel being.
Survival requries apacity to mount a stress response, but frequent or prolonged stress may negatively affect development |
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Toxic stress
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strong, frequent or prolonged activation of the body's stress management system
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tolerable stress
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briefer periods, allows for recovery; related to presence of supportive relationships
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Positive stress
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Short lived stress responses; related to learning; helps develop sense of master, control and management
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During stressful events, the brain...
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Puts future-oriented processes in the body on hold (related to feeding, fighting infectiosn, and learning)
Regulates stress response of the adrenal glands |
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Adrenal glands during stress produce:
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Adrenaline- SNS; acute stress, fight or flight
Cortisol: steroid hormone; breaks down protein for energy, suppresses immun system, suppresses physical growth, inhibits reproductive hromones, affects areas of brain functioning that control attention, memory, planning and behavior control |
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Pain
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Experience of pain in newborn period leads to long term alterations in neural circuits and behavior. may occur peripherallly, at the SC, and somatosensory cortex
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Painful periods early in gestation seem to...
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Dampen responses to subsequent pain.
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Painful experience later in newborn phase...
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accentuates response to pain
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Snesory experience of fetus
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Warm fluid env
Rhythmic sounds Gentle movement throughout day Reduced effects of gravity Predictable 24 hour cycle |
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Sensory experience of preterm infant
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Cool dry env
Visual, auditory, and tactile stim profoundly increased Experience full effect of gravity Irregular movement Lack of durnal rhythmicity |
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adverse developmental ffects experienced by preterm infants in NICU
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Prologned diffuse sleep states and unattended crying
Supine positioning Routine and excessive hadnling Ambient sound Lack of opportunity for sucking Poorly timed social and caregiving interactions |
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Brain development in the full term infant occurs in...
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env mediated by maternal protection from perturbations, ongoing supply of nutrients, continuous temp control, regulating chronobiological rhythms
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Preterm infant's brain being shaped in a setting characterizedd by...
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stark sensory mismatch to developing NS's biologically shaped expctiation for env inputs
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Neurodevelopmental care
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Recognizes infants as participants in own development and views parents and infant's most important nurturers
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Synactive theroy of development
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Infant behavior is meaning ful and communicates to us
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Behavioral subsystems
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Autonomic
Motor State Attention/interaction Self-regulatory |
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Infant states
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Deep sleep
Light sleep Drowsy (transition to waking) Quiet alert Fussy (active alert) Cry |
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Synactive theory of development
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infantbehavioral subsystems interact constabntly w/ one another and imultaneously w/ env.
Observable behaviors w/in each subsystem can act as communication cues. When demands are w/in the infant's current developmental expectations, organized, self-regulatory behaviors are observed. when demands exceed infants expectations and threshold, disorganized, avoidance behaviors are observed |
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Autonomic subsystem
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Respiratory pattern- smooth
Color- good, stable Visceral signs-stable digestion |
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Autonomic avoidance/disorganization behaviors
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Seizures
respiratory pauses color change to mottled, webbed, cyanotic, gray, flushed Gaggin, gasping Spittin gup Hiccups Straining or actually producing a bowel movement Tremors, startling, twitching Coughing Sneezing Yawnign Sighing |
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Motor subsystem
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Muscle tone
Posture Quality of movements |
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Self-regulatory mvoements
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Hand clasp, foot clasp
Finger fold Hand to mouth or face Grasping Suck searching and sucking Hand holding Tucking Leg bracing |
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Avoidance motor behaviros
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Motor flaccidity or tuning out of trunk, extremities, or face (gape face)
Motor hypertonicity w/: extension of trunk (arching), legs (sitting on air; leg bracing) Arms (airplane; salute) Hands/feet (splays) Face (grimicing, tongue extension) Hypertonicity w/ protective maneuvers (hand on face, high guard arms) Hyperflexion (fisting, trunk and extremity tuck) Frantic, diffse activity |
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State and attention/interaction subsystems
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Range of states
Clarity of states State transitions |
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Self-regulatory behaviors for state and attention
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Clear, robust sleep states
Rhytmical, robust crying Good self quieting and/or consolability Shiny-eyed alertness w/ intent and animated facial expressions such as frowning, cheek softening, mouth pursing, cooing, attentional smiling |
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Disorganized state/attention behaviors
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Diffuse sleep or awake states w/ whimpering, facial twitches, and discharge smiling
Strained fussing or crying Panicked or worried alertness Glassy-eyed strained alertness Irritability and diffuse arousal Rapid state oscillations Crying Eyefloating, staring, gaze averting |
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Self-regulatory subsystem
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Efforts and successes
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Supports in physical env
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Lighting
Sound Scents/odors Family comfort Infants clothing Supports to maintain position and aid self-regulation |
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Goals of positioning
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Individualized
Relative symmetry Midline orientation Promote flexor, self-regulatory behavior appropriate alignment Comfort Variety |
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Suppors for interactions
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Cluster caregiving
Transition facilitation Increase support as infant awakens Balance snensory input from caregiver and env Pacing timing and intensity of interactions |
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Standards of measurement
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Test only valid when used for purposes for which it was developed.
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Criteria for selection of standardized tests
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Primary complaints and family goals
Current functional status Therapist knowledge and experience Psychometric properties |
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Purposes of the TIMP
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Use by PT/OT to ID infants w/ motor delay before 4 months corrected age
Plan intervention progams Document changes Discriminate/diagnose |
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TIMP-
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Test of functional motor behavior in infants
Used for children up to 16 weeks |
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Conceptual framework
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Help ID items that are critical in development and how you confine yoruself to what the tool can do.
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Conceptual basis of TIMP
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Human infant is a self-organizing being
Multiple systems interact to create actions of the motor ensemble. Self-organization occurs in a task context shaping the movements used to accomplish a purposeful task Self-organization links action w/ perception through movment TIMP tasks pose probs for the infant to solve |
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Age range for TIMP
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32 weeks gestational age to 16 weeks post term
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TIMP constructs
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Postural control
Selective control- when you see that w/ infant w/ suspected neuro disorder, you know they will be fine b/c they're able selectively move one part of the body. Break out of symmetry. |
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TIMP is composed of 2 parts:
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Observed and elicited items
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Observed items
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13
Used to rate spontaneous movement: selective control, midline alignment, quality of movement. head in midline less than 3 months is a big accomplsighment Individual finger movement (selective control) If can move fingers on both hands, won't develop CP. |
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Elicited items
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29
Deal w/ perception-action Assess infant's motor responses to placement in various positions and to visual/auditory stim. Drop one leg and leave the other- for the anti-gravity hip flexion. LMN lesion will have hypotonicity/flaciddity. Could also be weakness or sensorimotor processing. Rolling fromm leg- deals w/ alignment of body segments |
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Construct validity of TIMP
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Sensitive to developmental change w/ incrasing age.
Infants w/ high risk have lower scores Score should increase w/ age |
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Discriminative validity
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Term and low risk preterm vs CNS lesion, chronic lung disease (BPD), low birth weight/ low gestational age.
Kids w/ CNS lesion had lowst TIMP scores |
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Ecological relevance of TIMP
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98% of items were observed during caregiving
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Concurrent validity
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Correlation between TIMP and AIMS
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Predictive validity
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Correlated w/ scores on PDMS at preschool age
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Deviations at 3 weeks of age W/ CP
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Unable to hold head in midline fore even a couple of seconds, lack of anti-gravity arm movmeents during face covering
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Deviations w/ CP at 9 weeks
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Failure to inhibit neck righting, poor AP head control
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Deviations w/ CP at 12 weeks
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Poor prone head control, anti-gravity activity supine and sidelying, reaching and fingering objects, and failure to adopt synergies using extesnion in supine and prone
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TIMP tailored test
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For use in screening or fori nfants to fragile to tolerate full test.
Administer screening set of 11 items Decide wheter to use easy or hard set next. Takes 10-15 min |
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What is screening?
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use of a brief, objective, and validated instrument
Goal to help differentiate children that are probably ok vs those needing additional investigation. Performed at a set point in time Objective vs subjectiv impressions |
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Sensitivity
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Pick up those who do have the problem that's being measured. Overidentifies. Want screening tools to be very sensitive
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Screeningvs serveillance
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Screening was designed to be quick and is a normed, validated tool
Serveillance is what a pediatrician will do. Monitor motor milestones. More informal |
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Process of screening
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Select a population
Select a tool map the process |
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Purpose of screening
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ID kids who may have developmental delays or disabilities.
Guide decisions about referrrals for further eval When appropriate connect families to resources that may help mitigate or mnimize severity of delay or disability |
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Screening assists in sorting kid into 3 categories:
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Needs additional eval- didn't pass screen
Needs close monitoring- passed, but has risk factors need ongoing monitoring in context of well-child care- passed and no known risk factors |
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High sensitivity trade off
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false positives
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High specificity trade off
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false negatives
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PPV=
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True positive/(true pos+false pos)
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NPV=
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true neg/ (false neg+true neg)
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Sensitivity=
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true pos/(true pos+false neg)
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Specificity=
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true neg/(true neg + false pos)
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Developmental screening
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Procedure designed to ID kids who should receive more intensive assessment or diagnosis for potential delays
Early detection improve health and well-being |
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4 purposes for assessments/measures:
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Discriminative
Predictive (ex:TIMP) Evaluative Program planning (ex:SFA) |
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Peabody developmental motor scale (PDMS) purposes:
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Discriminative, evaluative, program planning
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Areas of ICF assessed by PDMS
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Body function and structure
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Ages for PDMS
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Birth-six years
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Purpose of PDMS and how it would assist in clinical decision making:
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Check for gross and fine motor developmental delay and performance of different tasks.
See if at appropriate age level. Help choose interventions. |
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Battelle Deveopmental inventory (BDI II) purposes:
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Discriminative, evaluative, program planning
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5 domains of BDI II
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motor, adaptive, communication, cognitive, personal/social
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ICF domains addressed by BDI II
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Body function and structure, participation, and activities
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Ages for BDI II
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Birth-8
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Purpose and how to use BDI II in clinical decision making
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Assess typical child or child w/ disability/delay, plan and provide instruction and intervention, evaluate programs
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Bruininks-Oseretsky Test of Motor Proficiency (BOT2) purposes
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Discriminative, evaluative
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Purpose of BOT 2:
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Goal directed activities to measure a wide array of motor skills. Measure fine and gross motor skills.
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Ages for BOT2
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4-21
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Pediatric Evaluation of Diability inventory (PEDI) purposes
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Evaluative and program planning
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Domains of PEDI
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Functional skills, caregiver assistance, and modification
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Ages for PEDI
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6 mo-7.5 yr. If older and functioning below normal age range, can use this.
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School Function Assessment (SFA) purposes
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Evaluative and program planning
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3 parts of SFA
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Participation, task supports, and activity performance of physical tasks.
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Purpose of SFA
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Help guide program planning for sudents w/ disabilities attending elementary school.
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Child preference indicator
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Program planner uses what family knows about child's preferences. Guide to assess info held byf amily.
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GMFM purpose
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measure change in gross motor function over time in kids w/ CP and DS.
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Ages for GMFM
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5 months on w/ CP/DS
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5 dimensions of GMFM
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Lying and rolling, sitting, crawling and kneeling, standing and waling, running, jumping
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What's the difference between GMFM 66 and 88?
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88- for CP and DS
66 only for CP |
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Children's assessment of participation and enjoyment (CAPE) purpose
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Document child's participation outside of mandatory school activities
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Ages for CAPE
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6-21 y/o
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Areas of ICF assessed by CAPE
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Participation and personal factors
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PEGS purpose
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program planning. Child self reporting to establish goals in everyday activities.
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Ages for PEGS
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5-10 y/o
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FirstSTEP purpose
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ID children who may have mild to severe school related problems.
Screen for developmental delays in 5 tomain areas of IDEA: cognition, communication, motor, social-emotional, and adaptive functioning |
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FirstSTEP ages
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2 y, 9 mo- 6 y, 2 mo
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Ages and stages (ASQ-3)
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Designed to ID infants and young children who show potential developmental problem.
Completed by parents/caregivers. Screening tool. |
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Ages for ASQ-3
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birth- 5 y/o
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5 domains of ASQ-3
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Communication, gross motor, fine motor, problem solving, personal-social
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Denver II
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Used w/ apparently well children between birth-6years by assessing child's performance on various age-appropriate activities.
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Denver II sections (4)
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personal-social, fine motor, language, gross motor, behavior
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Pre-screening Developmental Questionnaire (PDQ-II)
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Parent anwered regarding child's current level of development.
Each question corresponds to Denver II item. |
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Calculating age:
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Year Mo Day (of test) -- Year Mo Day (of birth)
Borrow 30 days for one moth, 12 months for one year 16 days or more, bump them up a month. |
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Adjust for prematurity=
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Only if 24 months or younger
Y, Mo, Day (test) -- Y, Mo, Day (DOB)= Age of child -- Prematurity (divide weks in to mo and days) |
