NBCOT Chapter 5

Major milestones in cognitive development - Symbolic play

-12-16 months: basic "make believe" play, primarily involving self, eg. eating, sleeping -12-18 months: 1) child can project "make believe" play on objects and others 2) child uses a variety of schemes in imitating familiar activities -18-24 months: 1) child increases the use of non-realistic objects in pretending, eg. substituting a block for a train 2) child has inanimate objects perform familiar activities, eg. a doll washing itself

Major milestones in cognitive development - Problem-solving skills

-6-9 months: 1) child finds object after watching it disappear, eg. toy covered by cloth 2) child uses movement as a means to an end, eg. rolling to secure joy 3) child anticipates movement of objects in space, eg. looking toward trajectory of object circling his/her head 4) child attends to consequences of actions, eg. banging toy and realizing it makes noise 5) child repeats actions to repeat consequences, eg. banging toy to hear noise -9-12 months: 1) child is able to use a tool after demonstration, eg. using a stick to secure a toy that is out of reach 2) child's behavior becomes more goal directed 3) child performs an action to produce a response -12-15 months: 1) child recruits the help of an adult to achieve a goal 2) child attempts to activate a simple mechanism 3) child turns and inspects objects 4) child uses a trial and error approach to new challenges -18-21 months: 1) child attends to shapes of things and uses them appropriately 2) child begins to think before acting 3) child uses tool to obtain a favored object 4) child begins to replace trial and error with a thought process in order to attain a goal 5) child can operate a mechanical toy, eg. an on-off switch 6) child can predict effects or presume causes -21-24 months: 1) child recognizes operations of several mechanisms 2) child matches circles, squares, triangles, and manipulates objects into small openings, eg. shape sorters -24-27 months: child discriminates sizes -24-30 months: child can build with blocks horizontally and vertically -27-30 months: 1) child begins to relate experiences to one another, based on logic and knowledge of previous experiences 2) child can make a mental plan of actions without acting it out 3) child can see relationships between experiences, eg. if the balloon is popped, it will make a loud noise -36-38 months: 1) child can build a tower of nine cubes, demonstrating balance and coordination 2) child can organize objects by size, and builds a structure from a mental image -48-60 months: 1) child can build involved structures combining various planes, along with symmetrical designs 2) child is able to utilize spatial awareness, cause-and-effect, and mental images in problem solving

Development of self-dressing skills

-Age 1 year: cooperates with dressing (holds out arms and feet); pulls off shoes, removes socks; pushes arms through sleeves and legs through pants -Age 2 years: removes unfastened coat; removes shoes if laces are untied; helps pull down pants; finds armholes in pullover shirt -Age 2 1/2 years: removes pull-down pants with elastic waist; assists in pulling on socks; puts on front-button coat or shirt; unbuttons large buttons -Age 3 years: puts on pullover shirt with minimal assistance; puts on shoes without fasteners (may be on wrong foot); puts on socks (may be with heel on top); independently pulls down pants; zips and unzips jacket once on track; needs assistance to remove pullover shirt; buttons large front buttons -Age 3 1/2 years: finds front of clothing; snaps or hooks front fastener; unzips front zipper on jacket, separating zipper; puts on mittens; buttons series of three or four buttons; unbuckles shoe or belt; dresses with supervision (needs help with front and back) -Age 4 years: removes pullover garment independently; buckles shoes or belt; zips jacket zipper; puts on socks correctly; puts on shoes with assistance in tying laces; laces shoes; consistently identifies the front and back of garment -Age 4 1/2 years: puts belts in loops -Age 5 years: ties and unties knots; dresses unsupervised -Age 6 years: closes back zipper; ties bows; buttons back buttons; snaps back snaps

Typical developmental sequence of toileting

-Age 1 year: indicates discomfort when we or soiled; has regular bowel movements -Age 1 1/2 years: sits on toilet when placed there and supervised (short time) -Age 2 years: urinates regularly -Age 2 1/2 years: achieves regulated toileting with occasional day time accidents; rarely has bowel accidents; tells someone that he or she needs to go to the bathroom; may need reminders to go to the bathroom; may need to help with getting on the toilet -Age 3 year: goes to bathroom independently; seats him/herself on the toilet; may need help with wiping; may need help with fasteners or difficult clothing -Age 4-5 years: is independent in toileting (eg. tearing toilet paper, flushing, washing hands, managing clothing)

Developmental sequence for household management tasks

-Age 13 months: imitates housework -Age 2 years: picks up and puts toys away with parental reminders; copies parents' domestic activities -Age 3 years: carries things without dropping them; dusts with help; dries dishes with help; gardens with help; puts toys away with reminders; wipes up spills -Age 4 years: fixes dry cereal and snacks; helps with sorting laundry -Age 5 years: puts toys away neatly; makes a sandwich; takes out trash; makes bed; puts dirty clothes in hamper; answers telephone correctly -Age 6 years: does simple errands; does household chores without redoing; cleans sink; washes dishes with help; crosses street safely -Age 7-9 years: begins to cook simple meals; puts clean clothes away; hangs up clothes; manages small amounts of money; uses telephone correctly -Ages 10-12 years: cooks simple meals with supervision; does simple repairs with appropriate tools; begins doing laundry; sets table; washes dishes; cares for pets with reminders -Age 13-14 years: does laundry; cooks meals

Development of Sensorimotor integration - Three to seven years

-Child is driven to challenge his/her sensorimotor competencies through roughhouse play, playground activties, games, sports, music, dancing, arts and crafts, household chores, and school tasks (these provide opportunities to promote social development and self-esteem)

Normal sensorimotor development mobility and stability - Prone position

-Age: 0-2 months - Gross motor skill: 1) turns head side to side 2) lifts head momentarily 3) bends hips with bottom in air 4) lifts head and sustains in midline 5) rotates head freely when up 6) able to bear weight on forearms 7) able to tuck chin and gaze at hands in forearm prop 8) attempts to shift weight on forearms, resulting in shoulder collapse -Age: 5-6 months - Gross motor skill: 1) shifts weight on forearms and reaches forward 2) bears weight and shifts weight on extended arms 3) legs are closer together and thighs roll inward toward natural alignment 4) hips are flat on surface 5) equilibrium reactions are present -Age: 5-8 months - Gross motor skills: airplane posturing in prone position; chest and thighs lift off surface -Age: 7-8 months - Gross motor skills: 1) pivots in prone position 2) moves to prone position to sit -Age: 9 months - Gross motor skill: begins to dislike prone position

Normal sensorimotor development mobility and stability - Supine position

-Age: 0-3 months - Gross motor skill: 1) head held to one side 2) able to turn head side to side -Age: 3-4 months - Gross motor skill: 1) holds head in midline 2) chin is tucked and neck lengthens in back 3) legs come together 4) lower back flattens against the floor -Age: 4-5 months - Gross motor skill: 1) head lag is gone when pulled to a sitting position 2) hands are together in space -Age: 5-6 months - Gross motor skill: 1) lifts head independently 2) brings feet to mouth 3) brings hands to feet 4) able to reach for toy with one or both hands 5) hands are predominantly open -Age: 7-8 months - Gross motor skill: equilibrium reactions are present

Normal sensorimotor development mobility and stability - Standing

-Age: 0-3 months - Gross motor skill: when held in standing position, takes some weight on legs -Age: 2-3 months - Gross motor skill: when held in standing position, legs may give way -Age: 3-4 months - Gross motor skill: 1) bears some weight on legs, but must be held proximally 2) head is up in midline, no chin tuck 3) pelvis and hips are behind shoulders 4) legs are apart and turned outward -Age: 5-10 months - Gross motor skill: stands while holding onto furniture -Age: 5-6 months - Gross motor skill: 1) increased capability to bear weight 2) decreased support needed; may be held by arms or hands 3) legs are still spread apart and turned outward 4) bounces in standing position -Age: 6-12 months - Gross motor skill: pull to standing position at furniture -Age: 8-9 months - Gross motor skill: 1) rotates the trunk over the lower extremities 2) lower extremities are more active in pulling to standing position 3) pulls to a standing position by kneeling, then half-kneeling -Age: 9-13 months - Gross motor skill: 1) pulls to standing position with legs only, no longer needs arms 2) stand alone momentarily -Age: 12 months - Gross motor skill: equilibrium reactions are present in standing

Normal sensorimotor development mobility and stability - Sitting

-Age: 0-3 months(held in sitting) - Gross motor skill: 1) head bobs in sitting 2) back is rounded 3) hips are apart, turned out, and bent 4) head is steady 5) chin tucks; able to gaze at floor 6) sits with less support 7) hips are bent and shoulders are in front of hips -Age: 5-6 months (supports self in sitting) - Gross motor skill: 1) sits alone momentarily 2) increased extension in back 3) sits by propping forward on arms 4) wide base, legs are bent 5) periodic use of "high guard" position 6) protective responses present when falling to the front -Age: 5-10 months (sits alone) - Gross motor skill: 1) sits alone steadily, initially with wide base of support 2) able to play with toys in sitting position -Age: 6-11 months - Gross motor skill: gets to sitting position from prone position -Age: 7-8 months - Gross motor skill: 1) equilibrium reactions are present 2) able to rotate upper body while lower body remains stationary 3) protective responses are present when falling to the side -Age: 8-10 months - Gross motor skill: 1) sits will without support 2) legs are closer; full upright position, knees straight 3) increased variety of sitting positions, including "w" sit and side sit 4) difficult fine motor tasks may prompt return to wide base of support -Age: 9-18 months - Gross motor skill: rises from supine position by first rolling over to stomach then pushing up into four-point position -Age: 10-12 months - Gross motor skill: 1) protective extension backwards, first with bent elbows then straight elbows 2) able to move in and out of sitting position into other position -Age: 11-12 months - Gross motor skill: 1) trunk control and equilibrium responses are fully developed in sitting position 2) further increase in variety of positions possible -Age: 11-24 months + - Gross motor skill: rises from supine by first rolling to side then pushing up into sitting position

Normal sensorimotor development mobility and stability - Release

-Age: 0-4 months - Gross motor skill: no release; grasp reflex is strong -Age: 1-4 months - Gross motor skill: involuntary release -Age: 4 months - Gross motor skill: mutual fingering in midline -Age: 4-8 months - Gross motor skill: transfer objects from hand to hand -Age: 5-6 months - Gross motor skill: two-stage transfer; taking hand grasps before releasing hand lets go -Age: 6-7 months - Gross motor skill: one-stage transfer; taking hand and releasing hand perform actions simultaneously -Age: 7-9 months - Gross motor skill: volitional release -Age: 7-10 months - Gross motor skill: presses down on surface to release -Age: 8 months - Gross motor skill: releases above a surface with wrist flexion -Age: 9-10 months - Gross motor skill: releases into a container with wrist straight -Age: 10-14 months - Gross motor skill: clumsy release into small container; hand rests on edge of container -Age: 12-15 months - Gross motor skill: precise, controlled release into small container with wrist extended

Development of stair climbing skills

-Age: 15 months - Skill: creeps up stairs -Age: 18-24 months - Skill: 1) walks up stairs while holding on 2) walks down stairs while holding on -Age: 18-23 months - Skill: creeps backwards down stairs -Age: 2-2 1/2 + years - Skill: 1) walks up stairs without support, marking time 2) walks down stairs without support, marking time -Age: 2-2 1/2 - 3 years - Skill: walks up stairs, alternating feet -Age: 3-3 1/2 years - Skill: walk down stairs, alternating feet

Development of jumping/hopping skills

-Age: 2 years - Skill: jumps down from step -Age: 2 1/2 + years - Skill: hops on one foot, few steps -Age: 3 years - Skill: jumps off floor with both feet -Age: 3-5 years - Skill: jumps over objects -Age: 3 1/2 - 5 years - Skill: hops on one foot -Age: 3-4 years - Skill: gallops, leading with one foot and transferring weight smoothly and evenly -Age: 5 years - Skill: hops in straight line -Age: 5-6 years - Skill: skips on alternating feet, maintaining balance

Normal sensorimotor development mobility and stability - Rolling

-Age: 3-4 months - Gross motor skill: 1) rolls from prone position to side accidentally because of poor control of weight shift 2) rolls from supine position to side -Age: 5-6 months - Gross motor skill: 1) rolls from prone to supine position 2) rolls from supine position to side with right and left leg performing independent movements 3) rolls from supine to prone position with right and left leg performing independent movements -Age: 6-14 months - Gross motor skill: rolls segmentally with roll initiated by the head, shoulder, or hips

Normal sensorimotor development mobility and stability - Creeping

-Age: 7 months - Gross motor skill: crawls forward on belly -Age: 7-10 months - Gross motor skill: reciprocal creep -Age: 10-11 months - Gross motor skill: creeps on hands and feet -Age: 11-12 months - Gross motor skill: creeps well

Normal sensorimotor development mobility and stability - Walking

-Age: 8 months - Gross motor skill: cruises sideways -Age: 8-18 months - Gross motor skill: walks with two hands held -Age: 9-10 months - Gross motor skill: cruises around furniture, turning slightly in intended direction -Age: 9-17 months - Gross motor skill: takes independent steps, falls easily -Age: 10-14 months - Gross motor skill: walking: stoops and recovers in play -Age: 11 months - Gross motor skill: 1) walks with one hand held 2) reaches for furniture out of reach when cruising 3) cruises in either direction, no hesitation -Age: 15 months - Gross motor skill: able to start and stop in walking -Age: 18 months - Gross motor skill: 1) seldom falls 2) runs stiffly with eyes on ground

Self-care development - Feeding: Intervention for oral motor control

-Appropriate positioning to allow for neutral pelvic alignment and trunk stability either in caregiver's lap or chair (infant seat or wheelchair); avoid head extension to prevent asphyxiation as a result of closing of the airway -Hand positioning of the caregiver; place the index finger longitudinally under the child's lip, middle finger under the jaw, and place the thumb on the lateral end of the mandible -Facilitate lip closure by applying slight upward pressure of the index finger under the child's lip -Hand positioning of the index and middle fingers to assist in inhibiting tongue thrust (press bowl of spoon downward and hold on tongue) -Facilitate swallow by lip closure, and by placement and slight downward pressure of the spoon on the middle aspect of the tongue -Facilitate chewing by placement of foods such as long soft cooked vegetables, between the gum and teeth -Integrate preventive measures to work out of abnormal patterns: 1) provide firm downward pressure, using a spoon, on the middle aspect of the tongue in presence of a tonic bite reflex 2) prevent tongue retraction to avoid choking 3) facilitate lip closure for a tongue thrust that can result in loss of liquids and food, drooling, and failure to thrive 4) decrease tactile sensitivity prior to feeding as well as at other times, by providing firm pressure; encourage sucking/chewing on a cloth; rub gums, palate, tongue; promote oral exploration of toys; use a NUK toothbrush; and vary texture of foods, gradually introducing mashed potatoes mixed with other vegetables and soft meats -Consider and utilize the appropriate texture of foods as related to the child's feeding problems. Thick foods are easier to swallow and manage, especially if a tongue thrust is present -A major role of the therapist is to assist the caregiver in considering and promoting a pleasant social atmosphere for feeding by utilizing positioning and handling techniques to promote eye contact and bonding in a relaxed environment -Consider the developmental sequence of feeding skills

Important components in the development of hand skills - Bilateral hand use

-Asymmetric movements prevail until 3 months, and then symmetric movements emerge until 10 months -By 12 to 18 months, the baby uses both hands for different functions -At 18-24 months, manipulation skills emerge -The ability to use two different hands for two very different functions emerges at age 2 1/2

Aging changes

-Cellular changes: 1) increase in size; fragmentation of Golgi apparatus and mitochondria 2) decrease in cell capacity to divide and reproduce 3) arrest of DNA synthesis and cell division -Tissue changes: 1) accumulation of pigmented materials, lipofuscins 2) accumulation of lipids and fats 3) connective tissue changes: decreased elastic content, degradation of collagen; presence of pseudoelastins -Organ changes: 1) decreased functional capacity 2) decrease in homeostatic efficiency

Cognitive Development - Jean Piaget

-Described the process of cognitive development from birth to adolescence -Major constructs: 1) adaptation - responding to environmental challenges as they occur 2) mental schemes - organizing experiences into concepts 3) operations - the cognitive methods used by the child to organize schemes and experiences to direct subsequent actions 4) adapted intelligence or cognitive competence 5) equilibrium - the balance between what the child knows and can act on and what the environment provides 6) assimilation - the ability to take a new situation and change it to match an existing scheme or generalization 7) accommodation - the development of a new scheme in response to the reality of a situation, or discrimination -hierarchical development of cognition: 1) sensorimotor period 2) preoperational period 3) concrete operations 4) formal operations

Neurological system changes and adaptations in the older adult - Clinical implications

-Effects on movement: 1) overall speed and coordination are decreased; increased difficulties with fine motor control 2) slowed recruitment of motoneurons contribute to loss of strength 3) both reaction time and movement time are increased 4) older adults are affected by the speed/accuracy trade off (the simpler the movement, the less the change; more complicated movements require more preparation, longer reaction and movement times; faster movements decrease accuracy, increase errors) 5) older adults typically shift in motor control processing from open to closed loop, eg. demonstrate increased reliance on visual feedback for movement 6) demonstrate increased cautionary behaviors, an indirect effect of decreased capacity -General slowing of neural processing; learning and memory may be affected -Problems in homeostatic regulation: stressors (heat, cold, excess exercise) can be harmful, even life-threatening

Psychosocial development and major theorists - Erik Erikson

-Ego adaptation is the adaptive response of the ego in the development of the personality -Eight stages of man are identified and include a critical personal-social crisis that when resolved by the individual gives the individual a sense of mastery and results in the acquisition of a personality quality -Basic trust vs mistrust: the infant/baby realizes that survival and comfort needs will be met; hope is integrated into the personality (birth to 18 months) -Autonomy vs doubt and shame: the child realizes that he/she can control bodily functions; self-controlled will is integrated into the personality (2 to 4 years) -Initiative vs. guilt: the child gains social skills and gender role identity; a sense of purpose is integrated into the personality (preschool age) -Industry vs inferiority: the child gains a sense of security through peers and gains mastery over activities of his/her age group; a feeling of competency is integrated into the personality (elementary school age) -Self-identity vs. role diffusion: the teenager begins to make choices about adult roles, and with the resolution of this identity crisis a sense of fidelity or membership with society is integrated into the personality (teenage years) -Intimacy and solidarity vs isolation: the young adult establishes an intimate relationship with a partner and family; the capacity to love is achieved (young adulthood) -Generativity vs self-absorption: the adult finds security in the contribution of his/her chosen personal/professional roles; the capacity to care is achieved (middle adulthood) -Integrity vs despair: the mature adult reflects on his/her own value, and shares with the younger generation the knowledge gained; wisdom is acquired (maturity)

Categories of play

-Exploratory play (0-2 years): 1) child engages in play experiences through which he/she develops a body scheme 2) sensory integrative and motor skills are also developed as the child explores the properties and effects of actions on objects and people 3) child plays mostly with parents/caregiver(s) -Symbolic play (2-4 years): 1) child engages in play experiences through which he/she formulates, test, classifies, and refines ideas, feelings, and combined actions 2) this form of play is associated with language development 3) objects that are manageable for the child in terms of symbolization, control, and mastery are preferred by the child 4) child is mostly involved in parallel play with peers, and begins to become more cooperative over time -Creative play, (4-7 years): 1) child engages in sensory, motor, cognitive, and social play experiences in which he/she refines relevant skills 2) child explores combinations of actions on multiple objects 3) child begins to master skills that promote performance of school and work related activities 4) child participates in cooperative peer groups -Games, (7-12 years): 1) child participates in play with rules, competition, social interaction, and opportunities for development of skills 2) child begins to participate in cooperative peer groups with a growing interest in competition 3) friends become important for validation of play items and performance, while parents assist and validate in the absence of peers

Visual-motor and visual-perceptual assessments - Motor-Free Visual Perception Test (MVPT-3)

-Focus: a standardized, quick evaluation to assess visual perception (excludes motor components) in five areas including spatial relationships, visual discrimination, figure-ground, visual closure, and visual memory -Method: 1) the number of items administered depends on the child's age (for children aged 4 to 10 years, items 1-40 are administered; for persons aged 10 years or older, items 14-65 are administered) -Scoring and interpretation: 1) raw scores are translated into perceptual ages and perceptual quotients 2) average performance is determined as a standard score of 80-120 and percentile ranks of 25-75 -Population: children and adults aged 4 to 95 years

Important components in the development of hand skills - Manipulating skills according to Exner's Classification System

-Finger-to-palm translation: a linear movement of an object from the fingers to the palm of the hand eg. picking up coins (12-15 months) -Palm-to-finger translation: with stabilization, a linear movement of an object from the palm of the hand to the fingers, eg. placing coins in a slot (2- 2 1/2 years) -Shift: a linear movement of an object on the finger surfaces to allow for repositioning of the object relative to the finger pads, eg. separating 2 pieces of paper (3 - 3 1/2 years) -Simple rotation: the turning or rolling of an object held at the finger pads approximately 90 degrees or less eg. unscrewing a small bottle cap ( 2 - 2 1/2 years) -Complex rotation: the rotation of an object 360 degrees, eg. turning a pencil over to erase (6-7 years) -In-hand manipulation with stabilization: several objects are held in the hand and manipulation of one object occurs, while simultaneously stabilizing the others, eg. picking up pennies with thumb and forefinger while storing them in the ulnar side of the same hand (6-7 years)

Visual-motor and visual-perceptual assessments - Erhardt Developmental Vision Assessment (EDVA) and Short Screening Form (EDVA-S)

-Focus: a behavior rating scale to determine visuomotor development that assesses involuntary visual patterns including eyelid reflexes, pupillary reactions, doll's eye responses and voluntary patterns including fixation, localization, ocular pursuit, and gaze shift -Method: 1) there are 271 test items organized developmentally into seven clusters 2) the clusters are presented and items are sequenced developmentally 3) upon administration of each item, a response is scored for each eye 4) models for assessment and management, and items required for testing are provided -Scoring and interpretation: 1) responses are scored as normal, well-integrated, emerging, or not present 2) a developmental level is provided for each cluster and a final developmental level is estimated 3) EDVA-S comprises 67 components of permanent vision patterns, and is scored in the same manner as EDVA (if a test item is scored emerging or not present, a full evaluation using EDVA is indicated) 4) baseline levels allow for identification of delays, and also determine the sequenced developmental items that have not been attained (a baseline also allows progress to be tracked and interventions to be established) 5) findings will determine indications for an ophthalmic evaluation -Population: birth to 6 months. Since the 6 month level is considered the norm, the EDVA-S can be used for assessing older children

Overall Development Assessments - First STEP Screening Test for Evaluating Preschoolers

-Focus: a checklist and rating scale which identifies preschool students at risk and in need of a more comprehensive evaluation -Method: 1) it assesses five areas/domains as identified by IDEA which include cognition, communication, physical, social and emotional, and adaptive functioning (table-top tasks are administered while sitting across from the child; additional space is needed for gross motor tasks) 2) an optional Social-Emotional Rating Scale is rated by the examiner based on the child's behavior during testing 3) an optional Adaptive Behavior Checklist is rated by the examiner according to the information obtained from a parent or caregiver interview regarding daily functioning 4) an optional Parent/Teacher Scale provides additional information not obtained during the testing -Scoring and interpretation: 1) each item has criteria for grading and scores for each domain are totaled 2) total domain scores are converted to composite scores to determine whether the child's performance is within acceptable level or at risk 3) determination of a child's strengths and areas needing improvement for treatment planning -Population: 2 years 9 months through 6 years 2 months

Social Participation Assessments - Participation scale (P-Scale) (Version 4.8)

-Focus: a measure of restrictions in social participation related to community mobility, access to work, recreation and social interaction with family, peers, neighbors, etc -Method: 1) eighteen item questionnaire addressing the nine domains of participation identified in the International Classification of Function, Disability, and Health 2) Self-care, mobility and social function and their functional sub-units are assessed (the score forms include the areas of functional skills, caregiver assistance and modifications -Scoring and interpretation: scores above 12 on the scale (ranging from 0 to 90) indicate the need for intervention -Population: 15 years and older with physical disabilities

Development assessments of neonates - Neurological Assessment of Pre-term and Full-term newborn infant (NAPFI)

-Focus: a rating scale consisting of a brief neurological examination incorporated into routine assessment; 1) can be used with newborns in an incubator and/or on a ventilator if handling can be tolerated 2) habituation, movement and tone, reflexes, and neurobehavioral responses including state transition, level of arousal and alertness, auditory and visual orientation, irritability, consolability, and cry are assessed -Method: items are administered in a sequence; first in a quiet or sleep state, followed by items not influenced by state, then during the awake state -Scoring and interpretation: 1) the infant's state is recorded, based on six gradings of state, for each item 2) interpretation of scores allows the therapist to document a pattern of responses to reflect neurological functions and identify deviations for diagnosis 3) a comparison of pre-term with full-term infant behavior is provided -Population: pre-term and full-term newborn infants

Visual-motor and visual-perceptual assessments - Preschool Visual Motor Integration Assessment (PVMIA)

-Focus: a standardized norm referenced assessment which evaluates visual motor integration and visual perceptual skills of preschoolers, including perception in space, awareness of spatial relationships, color and space discrimination, matching two attributes simultaneously and the ability to reproduce what is seen and interpreted -Method: two performance subtests and two behavioral observation checklists: 1) the Drawing subtest requires the child to recognize and reproduce lines and shapes that increase in level of complexity 2) the Block Patterns subtest requires the child to recognize color and shape and reproduce block patterns and match block pictures using 3 dimensional blocks 3) it has a section that first predetermines that the child has the requisite skills to continue with the test items 4) the behavioral observation checklists are completed during testing by the administrator to document observed behaviors in an orderly manner to be used in test interpretation -Scoring and interpretation: 1) the child's fine motor skills and visual perceptual abilities are examined separately, to the extent possible 2) each task has specific criteria listed on the score sheet 3) to attain the precision needed to accurately score the child's final products, templates and a ruler are provided to be used when scoring each subtest 4) raw scores are converted to standard scores and percentile ranges for both subtests and for the total test (impairments indicated by standards scores below 80 and percentile scores below 25) 5) administrator's recorded behavioral observations of the child during the testing are not included in the score. These observations are used in test interpretation and subsequent intervention planning 6) interpretation of the child's performance and current emerging abilities are made based upon the combination of numerical scores, behavioral observations, and error analysis -Population: preschoolers aged 3 1/2 to 5 1/2 years old

General principles of motor development

-Occurs in a cephalocaudal/proximal to distal direction -Progresses from gross to fine movement -Progresses from stability to controlled mobility -Occurs in a spiraling manner, with periods of equilibrium and disequilibrium -Sensitive periods occur when the infant/child is affected by environmental input

Sensory Processing Assessments - Sensory Pofile (SP): Adolescent/Adult SP

-Focus: allows client to identify their personal behavioral responses and develop strategies for enhanced participation -Method: a questionnaire measures individual's reactions to daily sensory experiences -Scoring and interpretation: cutoff scores indicate typical performance and probable, definite, and significant differences (differences, indicate which sensory system is hindering performance; can be used for intervention planning) -Population: 11-65 years

Visual-motor and visual-perceptual assessments - Developmental Test of Visual Perception (2nd, Edition) (DTVP-2) and Developmental Test of Visual Perception - Adolescent and Adults (DTVP-A)

-Focus: assess visual perceptual skills and visual motor integration for levels of performance and for designing interventions and monitoring progress -Methods: 1) DTVP-2 is comprised of eight subtests including eye-hand coordination, copying, spatial relations, visual-motor speed, position in space, figure-ground, visual-closure, form-constancy 2) DTVP-A is comprised of four subtests of visual motor integration, composite index, and motor-reduced visual perception composite index -Scoring and interpretation: 1) raw scores, age equivalents, percentiles, subtest standard scores, and composite quotients are provided 2) three indexes provided - general visual perceptual; motor-reduced visual perception; visual motor integration -Population: children aged 4 to 10 years for the DTVP-2; adolescents and adults aged 11 to 74 years for the DTVP-A

Visual-motor and visual-perceptual assessments - Test of Visual-Perceptual Skills (3rd ed) (TVPS3)

-Focus: assess visual-perceptual skills and differentiates these from motor dysfunction as a motor response is not required -Method: 1) seven visual-perceptual skills including visual discrimination, visual memory, visual-spatial relationships, visual form constancy, visual sequential memory, visual figure-ground and visual closure are assessed 2) tests items are presented in a multiple choice format t and are sequenced in complexity (if subjects have 3 consecutive errors, the test is discontinued) 4) behavior observed during testing is also recorded -Scoring and interpretation: 1) indications of visual perceptual problems are determined by standard scores below 80 and percentile ranks below 25 2) information is used to establish an intervention program which may impact on learning -Population: four through 19 years

Play assessments - Test of Playfulness (TOP)

-Focus: assesses a child's playfulness based on observations according to four aspects of play -Method: 1) observed behaviors are rated according to intrinsic motivation, internal control, disengagement from constraints of reality, and framing 2) the extent, intensity and skillfulness of play are also observed and rated -Scoring and interpretation: scores in the 25 percentile or below indicate the need for intervention -Population: 15 months to 10 years

Social Participation Assessments - School Function Assessment (SFA)

-Focus: assesses and monitors functional performance in order to promote participation in a school environment (it does not measure academic performance) -Method: a criterion referenced questionnaire assesses the student's level of participation, type of support currently required, and performance on school related tasks -Scoring and interpretation: two different scoring mechanisms 1) basic level of criterion cutoff scores - scores falling below the cutoff point indicate a performance that does not meet expectations 2) advanced level scores range from 0 to 100, indicating appropriate grade level functioning

Psychological and Cognitive Assessments - Coping Inventory and Early Coping Inventory

-Focus: assesses coping habits, skills and behaviors, including effectiveness, style, strengths and vulnerabilities to develop intervention plans for coping skills -Method: 1) Coping Inventory: questionnaire assesses coping with self and coping with environment according to three categories of coping styles - productive, active and flexible 2) Early Coping Inventory: questionnaire assesses the effectiveness of behaviors according to sensorimotor organization, reactive behavior, and self-initiated behavior -Scoring and interpretation: 1) determines the level of adaptive behavior and whether or not intervention is needed 2) a coping profile can be grafted for each dimension -Population: 1) coping inventory: 15 years and above 2) Early Coping Inventory: 4 to 36 months

Visual-motor and visual-perceptual assessments - Test of Visual-Motor Skills (TVMS) and Test of Visual-Motor Skills: Upper Level (TVMS-UL)

-Focus: assesses eye hand coordination skills for copying geometric designs -Method: the individual copies and draws geometric designs which become sequentially more complex (there are 23 geometric forms in the TVMS which are scored for 8 possible errors and 16 in the TVMS-UL which are scored for 9-22 possible errors in motor accuracy, motor control, motor coordination, and psychomotor speed) 2) test behavior is also documented -Scoring and interpretation: 1) the resulting score can be translated into a motor age, standard score, and percentile rank 2) characteristics and errors of the drawings are examined and provided clinical information 3) information is used to establish a treatment plan -Population: TVMS - two through 13 years; TVMS-UL - twelve through 40 years

Development assessments of neonates - Assessment of Premature Infants' Behavior (APIB)

-Focus: assesses infant's pattern of developing behavioral organization in response to increasing sensory and environmental stimuli (an extension and refinement of the Neonatal Behavioral Assessment Scale [NBAS]) -Method: a behavior checklist and scale -Scoring and interpretation: 1) scores are obtained prior to administration for a baseline, during administration and following administration 2) scores reflect the degree of facilitation provided by the examiner 3) eye movements and asymmetry of performance are measured 4) function and integration of the physiological, motor, state, attentional/interactive, and regulatory systems are determined 5) interpretation of scores allows the therapist to plan interventions, measure outcomes, and plan follow-up -Population: premature infants

Motor Assessments - Toddler and Infant Motor Evaluation (TIME)

-Focus: assesses the quality of movement -Method: 1) five primary subtest asses mobility, stability, motor organization, social/emotional abilities and functional performance 2) quality rating, component analysis, and atypical positions can be assessed by a clinicians with advanced training -Scoring and interpretation: 1) cutoff scores are indicative of moderate or significant motor delays 2) subtests give more specific information -Populations: birth to 3 years and 6 months

Sideward parachute (protective extension sideward)

-Onset age: 7 months -Integration age: persists -Stimulus: quickly but firmly tip infant off-balance to the side while in the sitting position -Response: arm extension and abduction to the side -Relevance: protects body to prevent a fall; supports body for unilateral use of opposite arm

Visual-motor and visual-perceptual assessments - Beery-Buktenica Developmental Test of Visual Motor Integration (5th ed. (Beery VMI-5)

-Focus: assesses visual motor integration (can be used as a classroom screening tool) -Method: 1) the child copies 24 geometric forms which are sequenced according to level of difficulty 2) once the child fails to meet grading criteria for three consecutive forms, the test is discontinued -Scoring and interpretation: 1) raw score can be translated to percentile ranks, standard score, and age equivalency 2) average scores fall between 80 and 120 and average percentiles fall between 25 and 75 -Population: short form for children ages 2 to 7 years. Full form for children ages 2 to 18 years

Psychological and Cognitive Assessments - Childhood Autism Rating Scale (CARS)

-Focus: determines the severity of autism (ie. mild, moderate, or severe) and distinguishes children with autism from children with developmental delays who do not have autism -Method: an observational tool is used to rate behavior (fifteen descriptive statements include characteristics, abilities, and behaviors that deviate from the norm -Scoring and interpretation: 1) scores below 30 = no autism 2) scores of 30 to 36.5 = mild to moderate autism 3) scores of 37 to 60 = severe autism -Population: children over 2 years of age who have mild, moderate, or severe autism

Visual-motor and visual-perceptual assessments - Motor-Free Visual Perception Test-Vertical (MVPT-V)

-Focus: evaluation of individuals with spatial deficits, due to hemi-field visual neglect or abnormal visual saccades -Method: thirty-six items vertically placed are used to asses spatial relationships, visual discrimination, figure ground, visual closure, and visual memory (excluding motor components) -Scoring and interpretation: 1) provided perceptual ages and perceptual quotients 2) inadequate performance is determined as a score of 85 or less -Population: children and adults with visual field cuts or without visual impairments (appropriate for individuals with brain injury since it reduces confounding variables)

Play assessments - Transdisciplinary Play-Based Assessment (TPBA)

-Focus: measures child's development, learning style, interaction patterns, and behaviors to determine need for services -Method: 1) non-standardized play assessment employing team observations based on six phases 2) observations are categorized into the developmental domains of cognitive, social-emotional, communication and language, and sensorimotor -Scoring and interpretation: 1) a program plan is developed and can include developmental levels, family assessment, intervention services and strategies to promote an appropriate activity environment 2) a curriculum is available to address particular needs -Population: infancy to 6 years

Sensory Processing Assessments - Sensory Profile (SP) and Infant/Toddler SP

-Focus: measures reactions to daily sensory experiences -Method: 1) obtains caregiver's judgement and observation of a child's sensory processing, modulation, and behavioral and emotional responses in each sensory system via a caregiver questionnaire -Scoring and interpretation: 1) cutoff scores indicate typical performance and probable, definite, and significant differences (differences, indicate which sensory system is hindering performance; can be used for intervention planning) -Population: SP - 3-10 years; Infant/Toddler SP - birth -36 months

Overall Development Assessments - Hawaii Early Learning Profile, Revised (HELP)

-Focus: non-standardized scale of developmental levels. An educational curriculum-referenced test that assesses six areas of function including cognitive, language, gross motor, fine motor, social-emotional, and self-help -Methods: 1) administered in the child's natural environment, in the context of the family, and during typical routines 2) developmentally appropriate items are administered according to established protocols 3) a protocol using a warm-up period, structured play and snack time is recommended -Scoring and interpretation: 1) developmental age range levels of skills in each of the six areas can be approximated 2) specification of skills noted on a chart can be transferred to a checklist for analysis of expected skills that are absent 3) a description of behavior and possible causes of difficulty, all within the context of the family and environment, can be obtained 4) developmental structuring of skills is provided in the form of a sequence of conceptual strands, so skills needed as a foundation for more advanced skills are provided -Population: children, ages birth through 3 years, with developmental delay, disabilities, or at risk, HELP for Preschoolers is available for children ages 3 to 6, with and without delays

Motor Assessments - Erhardt Developmental Prehension Assessment (EDPA) Revised and Short Screening Form (EDPA-S)

-Focus: observation checklist based on performance which assesses three clustered areas including involuntary arm-hand patterns; voluntary movements of approach; and prewriting skills: 1) EDPA allows for charting and monitoring of prehensile development 2) EDPA-S identifies developmental gaps in prehensile development and the need for further assessment -Method: 1) test is administered in sections according to the appropriate age level 2) there are 341 test components in the EDPA categorized according to involuntary arm hand patterns, voluntary movements, and prewriting skills 3) the EDPA-S contains 128 components -Scoring and interpretation: 1) Part one: right and left hand scores are scored as normal or well-integrated, not present or emerging, or abnormal 2) Part Two: scores are placed into a developmental level for each cluster 3) Part three: function is determined for involuntary arm-hand patterns, voluntary movements and prewriting skills 4) gaps in hand skills and developmental levels can be determined (intervention can be planned and provided depending on individual needs) -Population: children of all ages and cognitive levels with neurodevelopmental disorders

Play Assessments - Revised Knox Preschool Play Scale (RKPPS)

-Focus: observations of play skills to differentiate developmental play abilities, strengths and weakness, and interest areas -Method: 1) administered in a natural indoor and outdoor environment with peers (two 30 minute periods of observations are completed indoors and outdoors) 2) observations are organized according to 6 month increments up to age 3 3) four dimensions of play including space management, material management, pretense/symbolic (including imitation), and participation are assessed -Scoring and interpretation: 1) the four dimensions of play are described (each dimension contains behavioral description/factors) 2) the mean scores of all four dimension scores provide a play age score indicative of the child's play maturity 3) the effectiveness of treatment can also be determined -Population: 0 through 6 years (it is useful with children for whom standardized testing may not be appropriate)

Lifespan and Occupational Therapy Developmental Theorists - Anne Mosey: Six major adaptive skills along with subskills

-Sensory integration of vestibular, proprioceptive, and tactile information for functional use: 1) integration of the tactile subsystems (0-3 months) 2) integration of primitive postural reflexes (3-9 months) 3) maturation of righting and equilibrium reactions (9-12 months) 4) integration of two sides of the body, awareness of body parts and their relationship, and motor plan gross movements (1-2 years) 5) motor plan fine movements (2-3 years) -Cognitive skill: the ability to perceive, represent and organize sensory information to think and problem solve; 1) utilization of inborn behavioral patterns for environmental interactions (0-1 months) 2) interrelation of visual, manual, auditory, and oral responses (1-4 months) 3) early exploration of the environment and interest in outcomes of actions: remembers action responses, believes that own actions cause responses, and has an awareness of the relation of these actions and events (4-9 months) 4) utilization of deliberate actions to achieve a goal: object permanence begins, anticipation of familiar events, imitation, interest in sizes/shapes, and perception of other objects as partially causal (9-12 months) 5) utilization of a trial and error approach to problem solving: tool use, begins to realize that alternate routes can be used, remembers the order of a simple sequence, and realizes that others can cause events to happen (12-18 months) 6) formulation of mental pictures: pretends, early cause and effect, manipulates objects in space, has a clearer understanding that others can manipulate the environment (18 months - 2 years) 7) representation of objects in terms of felt experiences: understands that there are consequences to actions that others cannot read his/her mind, and recognizes that events have causes (2-5 years) 8) representation of objects by name: begins to understand that other people may have differing opinions (6-7 years) 9) comprehension that different labels can be used for the same object, use of formal logic and speculation (11-13 years) -Dyadic interaction skill: the ability to participate in a variety of dyadic relationships; 1) family relationships (8-10 months) 2) playmate relationships (3-5 years) 3) superior/authority relationship interactions (5-7 years) 4) friend relationships (10-14 years) 5) peer-superior relationships (15-17 years) 6) intimate/sharing/committed relationships (18-25 years) 7) caring/unselfish relationships (20-30 years) -Group interaction skill: the ability to engage in a variety of primary groups: 1) parallel group - minimal awareness of or interaction with others (18 months -2 years) 2) project group - limited in duration, cooperation, and sharing (2-4 years) 3) egocentric group - cooperation, competition, longer in duration, build self-esteem (9-12 years) 4) cooperative group - compatible group, members concerned with meeting the needs of fellow members (9-12 years) 5) mature group - differing roles, concerned with completion of task as well as meeting the needs of fellow members (15-18 years) -Self-identity skills: the ability to perceive the self as a relatively autonomous, holistic, and acceptable person who has permanence and continuity over time; 1) self as a valued person (9-12 months) 2) assets and limitations of the self (11-15 years) 3) self as self-directed (20-25 years) 4) self as a productive, contributing member of a society (30-35 years) 5) self identity as an independent individual (35-50 years) 6) understanding the aging process of one's self and eventual death as part of the life cycle (45-60 years) -Sexual identity skill: the ability to feel comfortable about one's sexual nature and to engage in continued sexual relationship that takes into account mutual satisfaction of sexual needs; 1) act on the basis of one's pregenital sexual nature (4-5 years) 2) sexually mature as a positive growth experience (12-16 years) 3) give and receive sexual gratification (18-25 years) 4) sustain sexual relationship with mutual satisfaction of sexual needs (20-30 years) 5) accept sex-related physiological changes that occur as a natural part of the aging process (40-60 years)

Overall Development Assessments - Pediatric Evaluation of Disability Inventory (PEDI)

-Focus: standardized behavior checklist and rating scale that assesses capabilities and detects functional deficits, to determine developmental level, monitor the child's progress and/or to complete a program evaluation (Modifications and Caregiver Assistance Scales determine the level of assistance and adaptations needed to enhance partipication -Method: 1) observation, interview, and scoring of the three domains (self-care, mobility and social skills and their functional sub-units are assessed) -Scoring and interpretation: 1) the score forms include the areas of functional skills, caregiver assistance and modifications (the three sections are scored separately) 2) identifies children with patterns of delay 3) progress and outcomes can be monitored -Population: 6 months to 7 years

Motor Assessments - Peabody Developmental Motor Scales (2nd ed.) (PDMS-2)

-Focus: standardized rating scales of gross and fine motor development -Method: 1) gross and fine motor subtests measure reflexes, sustained control, locomotion, object manipulation, grasping and visual motor integration 2) test items are administered one level below the child's expected motor age in order to obtain a basal age level 3) test is discontinued with three consecutive scores of zero -Scoring and interpretation: 1) a developmental profile of gross and fine motor skills is provided 2) standard scores are provided 3) strengths and weaknesses are indicated once the percentile ranks are grafted 4) a motor activity program useful for planning and implementing training is provided -Population: children, ages birth to 6 years, with motor, speech-language, and/or hearing disorders

Overall Development Assessments - Bayley Scales of Infant Development, 3rd Edition (BSID-III)

-Focus: standardized rating scales that assess multiple areas of development to attain a baseline for intervention and to monitor progress (evaluates 5 domains: cognitive, language, and motor which are performance based tasks, and social-emotional and adaptive behavioral skills) -Method: 1) age appropriate items are selected from items on the different domain scales 2) involves parents completing two questionnaires -Scoring and interpretation: 1) composite scores yield qualitative descriptors and performance levels for each domain 2) results are used to plan interventions for any delays -Population: 1 to 42 months

Overall Development Assessments - Denver Developmental Screening Test II

-Focus: standardized task performance and observation screening tool for early identification of children at risk for developmental delays in four areas including personal-social, fine motor-adaptive, language, and gross motor skills -Method: 1) test includes 125 test items 2) test items below the child's chronological age level are administered with sequential progression towards higher level chronological items until the child fails three items 3) behaviors observed during the screening are marked on a checklist 4) questionnaires for home screening of environments and prescreening of development are available to administer to parents/caregivers -Scoring and interpretation: 1) each item scored indicates the chronological age at which it is expected to be performed. The child's performance on that item is compared to determine whether it is age appropriate or delayed, and is marked as pass or fail 2) the test is discontinued when three items are failed 3) the screening allows for interpretation of a child's performance in terms of being normal, abnormal, questionable, or unstable in personal-social, fine motor-adaptive, language, and gross motor abilities 4) interpretation of findings must be considered in the context of other pertinent information and with ongoing observation -Population: 1 month to 6 years

Overall Development Assessments - Miller Assessment for Preschoolers (MAP)

-Focus: standardized task performance screening tool that assesses sensory and motor abilities consisting of foundation and coordination indexes, cognitive abilities including verbal and nonverbal indexes, and combined abilities which include complex tasks index -Method: 1) items are administered that relate to the age of the subject 2) supplemental nonstandardized observations may be administered -Scoring and interpretation: 1) measures are obtained in sensory and motor abilities, cognitive abilities, and combined activities 2) the child's performance is compared with norms 3) percentile equivalents can be obtained for each index and for performance overall 4) results used for treatment planning -Populations: 2 years 9 months to 5 years 8 months

Motor Assessments - Bruininks-Oseretsky Test of Motor Proficiency (2nd ed.) (BOT-2)

-Focus: standardized test assesses and provides an index of overall motor proficiency; fine and gross motor composites, including consideration of speed, duration, and accuracy of performance, and hand and/or foot preferences -Method: 1) there is a long and short form with 8 subtests: fine motor precision, fine motor integration, manual dexterity, bilateral coordination, balance, running speed and agility, upper limb coordination and strength (hand and foot preference is initially determined) -Scoring and interpretation: 1) a total motor composite score consists of four motor areas: fine manual control, manual coordination, body coordination, and strength and agility 2) age equivalency and descriptive categories, and performance scores indicate motor strengths and weaknesses 3) scores may be used as a basis for suggesting treatment goals and to evaluate change -Population: 4 years to 21 years

Important components in the development of hand skills - Releasing skills

-Initially, involuntary dropping, then object is pulled out of one hand by the other hand -Development progresses from no release (0-1 months) to involuntary release (1-4 months) to two-stage transfer (5-6 months) to one-stage transfers (6-7 months) to voluntary release (7-9 months) -By 9 months, release by full arm extension -Refinement continues up to age four with the attainment of graded release

Psychosocial development and major theorists - Lawrence Kohlberg: Stages of moral development

-Level 1, preconventional morality: occurs up until the age of 8: 1) stage 1, punishment and obedience - the child is obedient in order to avoid punishment 2) stage 2, instrumental relativism - the child makes moral choices based on the benefit to self and sometimes to others -Level 2, conventional morality: occurs at about 9 or 10 years of age: 1) stage 1, social conformity - the child desires to gain the approval of others 2) stage 2, law and order - rules and social norms are internalized -Level 3, postconventional morality: age range can vary, and not all will achieve this level (social contracts - the young adult has social awareness and an awareness of the legal implications of decisions/actions)

Psychosocial development and major theorists - Abraham Maslow

-Maslow developed a hierarchy of basic human needs, proposing that if the lower-level needs are not met, the individual is unable to work on higher-level pursuits -Philosophic: basic survival needs (ie. good, water, rest warmth) -Safety: the need for physical and physiologic security -Love and belonging: the need for affection, emotional support and group affiliation -Self-esteem: the need to believe in one's self as a competent and valuable member of society -Self-actualization: the need to achieve one's personal goals,after attaining all of the psychosocial developmental milestones

Muscular system changes and adaptation in the older adult - Clinical implications

-Movements become slower -Increased complaints of fatigue -Connective tissue becomes denser and stiffer: 1) increased risk of muscle sprains, strains, and tendon tears 2) loss of range of motion: highly variable by joint and individual's activity level 3) increased tendency for fibrinous adhesions, contractures -Decreased functional mobility, limitations to movement -Gait may become unsteady due to changes in balance, strength; increased need for assistive devices -Increased risk of falls

Fetal sensorimotor development - Second Trimester

-Muscle spindle: 1) motor end plate forms 2) clonus response to stretch -Touch and tactile system: receptors differentiate -Vestibular system: N/A -Vision: 1) startle to light 2) visual processing occurs -Auditory: will turn to auditory sounds -Olfactory: N/A -Taste: N/A -Movement: 1) quickening 2) sleep states 3) grasp reflex 4) reciprocal and symmetrical limb movements

Fetal sensorimotor development - First Trimester

-Muscle spindle: 1) muscle starts to differentiate 2) tissue becomes specialized -Touch and tactile system: 1) first sensory system to develop 2) response to tactile stimulus -Vestibular system: functioning at the end of the first trimester (not completely developed) -Vision: 1) eyelids fused 2) optic nerve and cup being formed -Auditory: N/A -Olfactory: N/A -Taste: taste bud develop -Movement: 1) sucking, hiccuping 2) fetal breathing 3) quick generalized limb movement 4) positional changes 5) 7 1/2 weeks; bend neck and trunk away from perioral stroke

Fetal sensorimotor development - Third Trimester

-Muscle spindle: some muscles are mature and functional, others still maturing -Touch and tactile system: 1) touch functional 2) actual temperature discrimination at the end of the third trimester 3) most mature sensory system at birth -Vestibular system: N/A -Vision: 1) fixation occurs 2) able to focus (fixed focal length) -Auditory: debris in middle ear, loss of hearing -Olfactory: nasal plugs disappear, some olfactory perception -Taste: can respond to different tastes (sweet, sour, bitter, salt) -Movement: 1) 28 weeks primitive motor reflexes 2) rooting, suck, swallow 3) palmar grasp 4) plantar grasp 5) MORO 6) crossed extension

Sensory system changes and adaptations in the older adult - Age-related changes

-Older adults experience a loss of function of the senses: 1) may lead to sensory deprivation, isolation, disorientation, confusion, appearance of senility and depression 2) may strain social interactions and decrease ability to interact socially and with the environment 3) may lead to decreased functional mobility and increased risk of injury 4) alters quality of life -Vision: there is a general decline in visual acuity; gradual prior to sixth decade, rapid decline between ages 60 and 90; visual loss may be as much as 80% by age 90 -Hearing: occur as early as fourth decade; affects a significant number of elderly (23% of individuals aged 65-74 have hearing impairments and 40% over age 75 have hearing loss; rate of loss in men is twice the rate of women, also starts earlier -Vestibular/balance control: degenerative changes in otoconia of utricle and saccule; loss of vestibular hair-cell receptors; decreased number of vestibular neurons; VOR gain decreases; begins at age 30, accelerating decline at ages 55-60 resulting in diminished vestibular sensation -Somatosensory: 1) decreased sensitivity of touch associated with decline of peripheral receptors, atrophy of afferent fibers- lower extremities more affected than upper 2) proprioceptive losses, increased thresholds in vibratory sensibility, beginning around age 50 - greater in lower extremities than upper extremities, greater in distal extremities than proximal 3) loss of joint receptor sensitivity; losses in lower extremities, cervical joints may contribute to loss of balance 4) cutaneous pain thresholds increased; greater changes in upper body areas (upper extremities, face) than for lower extremities -Taste and smell: 1) gradual decrease in taste sensitivity 2) decreased smell sensitivity

Standing tilting

-Onset age: 12-21 months -Integration age: persists -Stimulus: after positioning infant in standing, slowly raise one side of the supporting surface -Response: curving of the spine toward the raised side (opposite to the pull of gravity); abduction/extension of arms and legs -Relevance: maintain equilibrium without arm support; facilitate postural adjustment in all positions

Traction

-Onset age: 28 weeks gestation -Integration age: 2-5 months -Stimulus: grasp infant's forearms and pull-to-sit -Response: complete flexion of upper extremities -Relevance: enhances momentary reflexive grasp

Suck-swallow reflex

-Onset age: 28 weeks gestation -Integration age: 2-5 months -Stimulus: place examiner's index finger inside infant's mouth with head in midline -Response: strong, rhythmical sucking -Relevance: allows ingestion of nourishment

Rooting reflex

-Onset age: 28 weeks gestation -Integration age: 3 months -Stimulus: stroke the corner of the mouth, upper lip, and lower lip -Response: movement of the tongue, mouth, and/or head toward the stimulus -Relevance: allows searching for and locating feeding source

Moro

-Onset age: 28 weeks gestation -Integration age: 4-6 months -Stimulus: rapidly drop infant's head backward -Response: first phase - arm extension/abduction, hand opening; second phase - arm flexion and adduction -Relevance: facilitates ability to depart from dominant flexor posture; protective response

Plantar grasp

-Onset age: 28 weeks gestation -Integration age: 9 months -Stimulus: apply pressure with thumb on the infant's ball of the foot -Response: toe flexion -Relevance: increases tactile input to sole of foot

Landau

-Onset age: 3-4 months -Integration age: 12-24 months -Stimulus: hold infant horizontal prone suspension -Response: complete extension of head, trunk, and extremities -Relevance: breaks up flexor dominance; facilitates prone extension

Galant

-Onset age: 32 weeks gestation -Integration age: 2 months -Stimulus: hold infant in prone suspension, gently scratch or tap alongside the spine with finger, from shoulders to buttocks -Response: lateral trunk flexion and wrinkling of the skin on the stimulated side -Relevance: facilitates lateral trunk movements necessary for trunk stabilization

Asymmetric tonic neck

-Onset age: 37 weeks gestation -Integration age: 4-6 months -Stimulus: fully rotate infant's head and hold for 5 seconds -Response: extension of extremities on the face side, flexion of extremities on the skull side -Relevance: promotes visual hand regard

Palmar grasp

-Onset age: 37 weeks gestation -Integration age: 4-6 months -Stimulus: place examiner's finger in infant's palm -Response: finger flexion; reflexive grasp -Relevance: increases tactile input on the palm of the hand

Downward parachute (protective extension downward)

-Onset age: 4 months -Integration age: persists -Stimulus: rapidly lower infant toward supporting surface while suspended vertically -Response: extension of the lower extremities -Relevance: allows accurate placement of lower extremities in anticipation of a surface

Neck righting (NOB)

-Onset age: 4-6 months -Integration age: 5 years -Stimulus: place infant in supine and fully turn head to one side -Response: log rolling of the entire body to maintain alignment with the head -Relevance: maintains head/body alignment; initiates rolling (first ambulation effort)

Body righting (on body) (BOB)

-Onset age: 4-6 months -Integration age: 5 years -Stimulus: place infant in supine, flex one hip and knee toward the chest and hold briefly -Response: segmental rolling of the upper trunk to maintain alignment -Relevance: facilitates trunk/spinal rotation

Symmetric tonic neck

-Onset age: 4-6 months -Integration age: 8-12 months -Stimulus: place infant in the crawling position and extend the head -Response: flexion of hips and knees -Relevance: breaks up total extensor posture; facilitates static quadruped position

Prone tilting

-Onset age: 5 months -Integration age: persists -Stimulus: after positioning infant in prone, slowly raise one side of the supporting surface -Response: curving of the spine toward the raised side (opposite to the pull of gravity); abduction/extension of arms and legs -Relevance: maintain equilibrium without arm support; facilitate postural adjustments in all positions

Forward parachute (protective extension forward)

-Onset age: 6-9 months -Integration age: persists -Stimulus: suddenly tip infant forward supporting surface while vertically suspended -Response: sudden extension of the upper extremities, hand opening, and neck extension -Relevance: allows accurate placement of upper extremities in anticipation of supporting surface to prevent a fall

Supine tilting and sitting tilting

-Onset age: 7-8 months -Integration age: persists -Stimulus: after positioning infant in supine or sitting, slowly raise one side of the supporting surface -Response: curving of the spine toward the raised side (opposite the pull of gravity); abduction/extension of arms and legs -Relevance: maintain equilibrium without arm support; facilitate postural adjustment in all positions

Quadruped tilting

-Onset age: 9-12 months -Integration age: persists -Stimulus: after positioning infant on all fours, slowly raise one side of the supporting surface -Response: curving of the spine toward the raised side (opposite to the pull of gravity); abduction/extension of arms and legs -Relevance: maintain equilibrium without arm support; facilitate postural adjustment in all positions

Tonic labyrinthine-prone

-Onset age: >37 weeks gestation -Integration age: 6 months -Stimulus: place infant in prone -Response: increased flexor tone -Relevance: facilitates total-body flexor tone

Tonic labyrinthine-supine

-Onset age: >37 weeks gestation -Integration age: 6 months -Stimulus: place infant in supine -Response: increased extensor tone -Relevance: facilitates total-body extensor tone

Labyrinthine/optical (head) righting

-Onset age: birth to 2 months -Integration age: persists -Stimulus: hold infant suspended vertically and tilt slowly (about 45 degrees) to the side, forward, or backward -Response: upright positioning of the head -Relevance: orients head in space; maintains face vertical

Important components in the development of hand skills - Pre-writing skills

-Palmar-supinate grasp: held with fisted hand, wrist slightly flexed and slightly supinated away from mid-position; arm moves as a unit (1-1 1/2 years) -Digital-pronate grasp: held with fingers, wrist neutral with slight ulnar deviation, and forearm pronated; arm moves as a unit (2-3 years) -Static tripod posture: held with crude approximation of thumb, index, and middle fingers, ring and little fingers only slightly flexed, grasped proximally with continual adjustments by other hand, no fine localized movements of digit components; hand moves as a unit (3 1/2-4 years) -Dynamic tripod posture: held with precise opposition of distal phalanges of thumb, index, and middle fingers, ring and little fingers flexed to form a stable arch, wrist slightly extended, grasped distally, MCP joints stabilized during fine, localized movements of PIP joints (4 1/2-6 years)

Motor development

-Performance of occupational roles can be enhanced or inhibited based on the reflex development and integration in addition to the following areas: -Crossing midline: as the child becomes more mobile movement against gravity and weight-shift increase, leading to eventual crossing of the midline, often in an attempt to reach for a toy, while weight bearing on the opposing upper extremity for balance (begins at 9-12 months) -Laterality: hemispheric specialization for specific tasks varies with different individuals (handedness is considered to be stable by age 5; however, strong preferences can be seen much earlier) -Bilateral integration: as the child experiments with movement, his/her nervous system is stimulated, and these sensations help the child to coordinate the two sides of the body (begins at 9-12 months) -Fine coordination and dexterity -Visual-motor integration is dependent upon the lower level skills of visual attention, visual memory, visual discrimination, kinesthesia, position in space, figure ground, form constancy, and spatial relations -Oral-motor control, which is developed in the area of feeding, provides the foundation for early oral communication and later language development

Reflex development and integration

-Predictable motor response elicited by tactile, proprioceptive, or vestibular stimulation -Primitive reflexes are present at or just after birth and typically integrate throughout the first year -The persistence or re-emergence of these primitive reflexes are indicative of central nervous system (CNS) dysfunction that may interfere with motor milestone attainment, patterns of movement, musculoskeletal alignment, and function

Important components in the development of hand skills - Scissor use skills

-Prerequisite skills for scissors use include the ability to: 1) open and close a hand 2) isolate or combine the movements of the thumb, index and middle fingers 3) Use hand bilaterally; one hand to use the scissors, one to stabilize the item being cut 4) coordinate arm, hand, and eye movements 5) stabilize the wrist, elbow, and shoulder joints so that movement can occur at the distal joints 6) interact with the environment in the constructive developmental play stages -Stages of development in scissor use, the child sequentially; 1) shows an interest in scissors, 2-3 years 2) holds and snips with scissors, 2-3 years 3) opens and closes scissors in a controlled fashion, 2-3 years 4) manipulates scissors in a forward motion, 3-4 years 5) coordinates the lateral direction of the scissors, 3-4 years 6) cuts a straight forward line, 3-4 years 7) cuts simple geometric shapes, 3-4 years 8) cuts circles, 3 1/2-4 1/2 years 9) cuts simple figure shapes, 4-6 years 10) cuts complex figure shapes, 6-7 years

Self-care development - Feeding: Oral-motor development

-Prior to 33 weeks of gestation an infant is fed by non-oral means -35 weeks of gestation or after: jaw and tongue movements are strong enough to allow for feeding -40 weeks of gestation: rooting reflexes, gag and cough reflex are present for up to four months, protecting the airway and decreasing the chances of aspiration -4-5 months: munching occurs consisting of a phasic bite and release of a soft cookie -6 months: strong up and down movement of the tongue -7-8 months: beginning of mastication of soft and mash foods with diagonal jaw movement -9 months: lateral tongue movements make mastication of soft and mashed foods effective, able to drink from a cup; however, jaw is not firm -12 months: jaw is firm; there is rotary chewing allowing for a good bit on a hard cookie -24 months: able to chew most meats and raw vegetables

Lifespan and Occupational Therapy Developmental Theorists - Anne Mosey

-Recapitulations of ontogenesis frame of reference -The development of adaptive skills, essential learned behaviors, is considered critical for successful participation in occupational performance -Six major adaptive skills along with subskills are delineated (sensory integration of vestibular, proprioceptive, and tactile information for functional use; cognitive skill; dyadic interaction skill; group interaction skill; self-identity skill; sexual identity skill)

Development of Sensorimotor integration - Prenatal period

-Responds first to tactile stimuli -Reflex development -Innate tactile, proprioceptive, and vestibular reactions

Cognitive Development - Jean Piaget: Hierarchical development of cognition

-Sensorimotor period (ages birth to 2 years): 1) reflexive stage - schemes begin in response to reflexes (1 month) 2) primary circular reacting - child learns about cause and effect as a result of reflexive sensorimotor patterns that are repeated for enjoyment (2 to 4 months) 3) secondary circular reaction - voluntary movement patterns emerge due to coordination of vision and hand function, and an early awareness of cause and effect develops (5 to 8 months) 4) coordination of secondary schemata - voluntary movement in response to stimuli that cannot be seen as in object permanence, and early development of decentered thought (9 to 12 months) 5) tertiary circular reactions - the child seeks out new schemes, with improved gross and fine motor abilities; tool use begins (12 to 18 months) 6) purposeful tool use, explores problem solving options. -Preoperational period (ages 2 to 7 years): 1) classification - categorizing objects according to similarities and differences 2) seriation - the relationship of one object or classification of objects to another 3) conservation - the end product of the preoperational period. The child is able to recognize the continuities of an object or class of objects in spite of apparent changes 4) the preoperational period is divided into two phases - preconceptual the child expands vocabulary and symbolic representations ( 2 to 4 years) and intuitive thought phase, the child imitates, copies or repeats what is seen or heard and bases conclusions on what he/she believes to be true rather than on logic. Inductive reasoning denotes a transition to the next stage (4 to 7 years) 5) Child progresses from dependence on perception, as opposed to logic, and egocentric orientation to logical thought, for solving problems. -Concrete operations (ages 7 to 11 years): 1) reversibility - an expansion of conservation, leads to increased spatial awareness 2) rules - as rules are better understood, they are also applied 3) Empirico-inductive thinking - the child solves problems with the information that is obvious and present 4) child uses logical thinking on observed or mentally represented objects, enjoying games with rules which help the child adjust to social demands -Formal operations, (ages 11 through the teen years): 1) hypothetico-deductive thinking, the ability to analyze and plan 2) child uses logic to hypothesize many ways to solve problems, and can draw from past and present experiences to imagine what can have an effect on future situations

Development of Sensorimotor integration - Thirteen to twenty-four months

-Tactile perception becomes more precise allowing for discrimination and localization to further refine fine motor skills -Further integration of all systems promotes complexity of motor planning as the child expands his/her repertoire of movement patterns -Symbolic gesturing and vocalization promotes ideation, indicating the ability to conceptualize -Motor planning abilities contribute to self concept as the child begins to master the environment

Development of Sensorimotor integration - Neonatal period

-Tactile, proprioceptive and vestibular inputs are critical from birth onward for the eventual development of body scheme -Vestibular system, although fully developed at birth, continues to be refined and impacts on the infant's arousal level (helps the infant to feel more organized and content) -Visual system develops as infant responds to human faces and items of high contrast places approximately 10 inches from face -Auditory system is immature at birth and develops as the infant orients to voices and other sounds

Lifespan and Occupational Therapy Developmental Theorists - Havighurst: Six stages of development

-Tasks of infancy and childhood: 1) walk 2) take solid food 3) talk 4) control elimination of body wastes 5) develop sex differences and sexual modesty 6) develop physiologic stability 7) understand concepts of social and physical reality 8) develop emotional ties with parents, siblings, and others 9) understand right from wrong, conscience evolves -Tasks of middle childhood: 1) develop physical skills needed for games 2) establish health self-concept 3) make friends with children of the same age 4) read, write, and calculate 5) acquire a fund of information necessary for everyday life 6) develop morality and values 7) formulate opinions about social groups and institutions -Tasks of adolescence: 1) establish relationships with male and female friends of same age, increasing in quantity and quality 2) develop masculine/feminine social role 3) become comfortable with and respect one's changing body 4) decrease emotional reliance on parents/other adults 5) prepare for marriage and family life 6) prepare for economic career 7) develop a value system to shape behavior or develop one's own philosophy 8) behave in a socially responsible manner -Tasks of early adulthood: 1) choose a partner 2) adjust to a partner 3) start a family 4) raise children 5) manage a home 6) pursue an occupation 7) develop civic responsibility 8) join/form a compatible social group -Tasks of middle adulthood: 1) guide adolescents toward becoming responsible and well adjusted adults 2) engage in adult civic and social responsibility 3) progress in an occupational career 4) pursue leisure-time activities 5) relate to partner as a person 6) deal with and accept physiologic changes of middle age 7) accept aging parents -Tasks of later adulthood: 1) cope with decreasing physical strength and health 2) adjust to retirement and reduced income 3) adjust to death of spouse/partner 4) affiliate with one's age-group 5) change social roles 6) arrange for the most appropriate and appealing living environment

General concepts and definitions of aging

-The process of growing old -Describes a wide array of physiological changes in the body systems -A complex and variable process -Common to all members of a given species -Aging is developmental, occurs across the life span -Progressive with time -Evidence of aging: 1) decline in homeostatic efficiency 2) decline in reaction time (increased probability that reactions to injury will not be successful) -Varies among and within individuals

Development of Sensorimotor integration - Two to three years

-This is a period of refinement as the vestibular, proprioceptive, and visual systems further develop, leading to improved balance and postural control -Further development of tactile discrimination and localization lead to improved fine motor skills -Motor planning and praxis ideation also progress during this period

Development of Sensorimotor integration - First six months

-Vestibular, proprioceptive, and visual systems become more integrated and lay the foundation for postural control, which facilitates a steady visual field -Tactile and proprioceptive systems continue to be refined, laying the foundation for development of somatosensory skills -Visual and tactile systems become more integrated as the child reaches out and grasps objects, laying the foundation for eye-hand coordination -Infant movement patterns progress from reflexive to voluntary and goal-directed

Development of Sensorimotor integration - Six to twelve months

-Vestibular, visual, and somatosensory responses increase in quantity and quality as the infant becomes more mobile -Tactile and proprioceptive perception become more refined, allowing for development of fine motor and motor planning skills -Tactile and proprioceptive response also lead to midline skills and eventual crossing of midline -Auditory, tactile, and proprioceptive perceptions are heightened allowing for development of sounds for the purpose of communication -Tactile, proprioceptive, gustatory, and olfactory perceptions are integrated, allowing for primitive self-feeding