450 Formula: Pediatric

ASD: ADLs

can be bothersome infants may hate baths, dressing or changing children may only want foods with certain textures

motor control deficits

cerebral palsy DCD ASD downs SI disorders acquired brain injury ID

ASD Eval: Standardized assessment adaptations

child become familiar w OT and testing area breaks/xtr time motivators/rewards limit eye contact or verbal interaction change order of item admin clearly document adaptations

ASD: Play

chosen play may appear atypical unusual visual exploration limited creativity and flexibility Difficulty w social cues repetitive play

The 3 C's (CCCAT)

communicate (PECS) control (switches, interact in envir) compute (keyboard, mouse, monitor)

criterion referenced

compares performance on specific tasks

Norm referenced

compares performance to their peers "average"

Motor Learning

learning and refining motor skills over time

Motor Control Difficulties: Limited force control

limited strength or energy

WC seat depth measurements

back to back Seat should end 1-2 inches before hitting back of knees

ATNR (asymmetrical tonic neck reflex)

birth to 4-6 mo. Arm and leg on face side extend; arm and leg on skull side flex (or experience increase flexor tone) Rolling & R/L coordination Fencer Reflex

bottom-up approach

look at the deficits that hinder performance in functional tasks: Deficit based

Hypotonicity

low muscle tone Facilitation

TLR (tonic labyrinthine reflex)

lying on floor neck flexion- extremity/trunk flx neck ext- extr/trunk ext develops postural strength and muscles for head, neck, and trunk control Posture, Transitions and tone

PWC: Mid wheel drive

maneuverable

Blocked Practice

massed practice child practices one skill by repeating similar movement over and over

WC seat back height

measure seat surface w cushion to top of shoulders

Motor Control Difficulties

mild dysfx in muscle tone

ASD: Education

needs for ASD vary Many need accommodations general ed or special ed services

Mrs. Boxcar is fast to engage him

nemonic for ASD

NDT

neurodevelopmental treatment "Normal, Do Touch"

top-down processing

participation in functional tasks: Occupation based

Whole learning

play activities: crafts, dress up games themed activities

Air seat

pressure distribution not good for poor sensation or postural stabil.

ASD: Engage HIM

Engage Model Socialization Ideation Heads up

Wheelchair measurement

1 inch rule seat to back of knee hips to side of chair

Mid back WC seat height

1-2 in below scap

Intervention: Postural weakness

recline tilt-in-space higher backrest custom contour lat trunk support lap tray harness- dynamically stable

ASD: Rigidity

restrict/repeat behavior same and fixed routines familiar routines

Wc armrest measurement

seat surface to bottom of flexed elbow Should be 1 inch higher

Disturbed Practice

skills practiced in a variety of ways by reps of diff but related skills

STNR (symmetrical tonic neck reflex)

somersault look down butt up look up butt tucks Core & Gross motor coordination

Memory Foam Seat

stable base conducts heat away from body Pt may slide

Moro reflex

startle response arms out wide w/ palms forward and open

Landau Reflex (superman)

suspended in prone back and forth between the superman position Sitting & Standing upright

Intervention: increased tone

tilt in space decrease seat-to-back angle to less than 90 Add seatbelt at 90 degree hip guides to keep hip center

Pressure relief

tilt in space or recline PWC foam memory foam air honeycomb

Intervention mobility: Motor control deficits

tremor dampening joystick joystick placed in midline or rotated toward the body Powered elevated seat (ataxia) alt switches, eye gaze, sip n puff

Rooting reflex

turning head in response to touch

side-lying position

useful for weakness- gravity elim position good position for dressing for moving limbs easier

NDT Handling Techniques

uses sensory input such as deep pressure and UE WB w/ the body in good alignment to inhibit: Spasticity primitive reflexes and to facilitate normal movement patterns

MC principles: Variability

variety of tasks with same motor movement VARY: objects or placement requirements of task environ. context

Mobility Keyline

very similar to positioning proximal stability before distal mobility hips @ 90-90-90 Compensate to Keep Up

WC width measurement

widest part of the thighs/hips Add 1-2inches for repositioning, transfers, avoid rubbing/pressure, bulky clothing

WC child WC Tiny tot

14x11.5x18.75 12x11x19.5

WC slim adult

14x16

Narrow WC measurements

16x16 20 height

WC Junior

16x16x18.5

WC Adult standard

16x18x20

WC Measurements

16x18x20 (DxWxH) Orthostatic brace: measure w on

WC hemi-low

17.5 height

Optimal sitting position

90-90-90

PWC: FWD

front wheels- fishtail

Part Practice

Better for more complex skills Natural units of the activity

Whole Practice

Better for simple skills

WC: COG forward

COG forward = increase stability decrease maneuverability

Problem solving

Different degrees of difficulty repeat movements so child must figure it out

ASD: FAST

Focus Alone Same Transitions

Power WC

For UE weakness/paralysis

ASD: Social Participation

Hallmark of ASD Difficulty with: imitation social communication sharing interests w/ peers make believe play LEAD to: social isolation problem finding jobs mental health issues

Mr. Pats Land

Hey (Head) Hey (Head) Real (Release) Roll-right (Roll, R/L Coord) P (Posture, Transition) C (Core, Coord) S (Sitting/Standing)

ASD: Intervention Strategies

Improve: engagement behavior comfort ideation of play praxis socialization

Retained Reflex

Intervention involves encouraging motor patterns that break the reflex patter

AT making the grade

Low tech first

WC: COG rearward

OG forward = decrease stability increase maneuverability

ASD Evaluation

Occ profile assess occ per

Evaluation

Occupational Profile Occupational performance: Observe Assess

ASD Problem Affect

Play & Socialization Normal ADL Routine

ASD: Motor

Poor: gait posture balance coordination praxis/motor planning

Positioning

Proximal stability before distal mobility address prox stab 1st when relevant w/ Hypertonicity

Variable Practice

Random Practice practice of actual task in natural context vs repeating one pattern of movement

OT Process

Referral Screening Evaluation Goal setting Intervention Reevaluation Intervention Discharge

PWC: Rear wheel drive

Rough Terrain

ASD 3 Main Problems

Sensory Rigidity Motor

Motor Control Difficulties: Intention Tremor

Tremor w/ attempted voluntary movement

Intervention: UE weakness

Weakness: lightweight/ultra WC Keep up w peers: Power WC Power assist unit or one-arm drive walker w/ forearm trough Cant manipulate controls: u-shape joystick lap tray

standard deviation

a computed measure of how much scores vary around the mean score

Motor Control Difficulties: Dysdiadokokinesis

diff with rapid change of motion

Positioning devices

foam wedges side lyers play over bolster play on swiss ball rolls & towels under trunk

Tilt in Space PWC

good for extensor tone or hip contracture

Recline PWC

good for hip precautions for opening hip angle

Honeycomb seat

good pressure dist good ventilation lightweight poor envelopment (contour)

Mental Practice

help child prepare to perform a task basic imagery combine with physical practice works best Short

Motor Control

how one directs and regulates movement

ASD: Sensory

hyper or hypo rx to sensory input unusual interests in sensory aspects of environments excessive smelling or touching objects visual fix on light/movement adverse repsonse to specific sounds/textures

Motor Control Difficulties: Dysmetria

impaired ability to estimate distance

Hypertonicity

increased muscle tone Inhibition

Foam seat

inexpensive lightweight traps heat bottoms out

dynamic systems theory

interaction among systems is essential to adaptive control of movement Person Task Environment