Pediatric conditions and interventions

arthrogryposis (multiplex congenita (AMC))

(Lack ROM) Born with joint contractures, don't move as normal and may be stuck in one position AE: Long-handled sponge soap on a rope towel with handles.

picture calendar

. The teacher can help the student by providing a picture calendar of activities and then checking off the activities as they are completed. In this way, the student will know what to expect for the next activity. If the teacher has 30 students, it will be difficult to make a consistent schedule for each student every day

There are four types of reinforcement:

1. Positive Reinforcement. Think of it as adding something in order to increase a response. The most common types of positive reinforcement are praise and rewards. 2. Negative Reinforcement. Think of it as taking something negative away in order to increase a response. The elimination of this negative stimulus is reinforcing and will likely increase the chances of the desired behavior. 3. Punishment. Punishment refers to adding something aversive in order to decrease a behavior. The most common example of this is disciplining (e.g. spanking) a child for misbehaving. The reason we do this is because the child begins to associate being punished with the negative behavior. The punishment is not liked and therefore to avoid it, he or she will stop behaving in that manner. 4. Extinction. An intervention that makes a behavior less likely to occur or stop occurring altogether. Extinction occurs when reinforcement of a previously reinforced behavior is discontinued (ignored). To be used effectively, you must know what has been reinforcing and maintaining the undesired behavior. Time-out (short for Time-Out-From-Reinforcement) is an extinction procedure, not a punishment. It is a procedure in which a child is placed in a different, less-rewarding situation or setting whenever he or she engages in undesirable or inappropriate behaviors

walking up stairs (developmental)

2 years- It is typical for a child to walk up the stairs without any support from the parent or a wall/railing, but still putting both feet on each step before proceeding to the next step. 3 years- The child should now be able to walk up the stairs using a reciprocal pattern, placing only one foot on each step, without requiring the use of a railing for support. 4 years- The child should now be able to go both up and down stairs using a reciprocal pattern and no rail. By age 4, a child should typically be able to climb up and down stairs using a reciprocal pattern and no rail.Walking up and down the stairs using an alternating stepping pattern without support is a milestone that can be expected from 3-4 years. As every child develops at their own pace, they may achieve these milestones at different ages

The Cognitive Orientation to Occupational Performance (CO-OP) is an evidence-based approach that has been successfully used to treat children with developmental coordination disorder (DCD) and autism spectrum disorder (ASD). What are the main objectives of using this approach in your OT intervention? Select the 3 best answers.

Skill acquisition in child-chosen tasks. Development of cognitive strategies. Generalization and transfer of learned skills and strategies. Cognitive Orientation to Occupational Performance (CO-OP) is a performance-based treatment approach for children and adults who experience difficulties performing the skills they want to, need to or are expected to perform. Focused on enabling success, the CO-OP Approach employs collaborative goal setting, dynamic performance analysis, cognitive strategy use, guided discovery, and enabling principles. It is defined as a "client-centered, performance based, problem solving approach that enables skill acquisition through a process of strategy use and guided discovery".

Developmental Coordination Disorder

disorder involving deficits in the ability to walk, run, or hold on to objects

A floor sitter

floor Sitters offer support in seating a child at floor level. This allows the child to be independent, with their hands free for play, while maintaining optimal trunk alignment

Tier 3 intervention

help of a specialist

what are the common symptoms of a shunt malfunction?

• Headaches .• Vomiting. • Lethargy (sleepiness) • Irritability.• Swelling or redness along the shunt tract. • Decreased school performance .• Periods of confusion. • Seizures

If the child has a seizure, follow these steps for seizure first aid

• Stay calm and stay with the child • Turn the child on their side • Make the child as comfortable as possible, cushion their head and remove glasses• Loosen any tight clothing • Do not ever put anything in the child's mouth • Do not try to "stop" the convulsions or restrain the child • Pay attention to the length of the seizure - when the seizure started and stopped • Call 911 for any seizure lasting more than 5 minutes, or if the child is injured during the seizure

Osteogenesis Imperfecta

is a group of rare disorders affecting the connective tissue and characterized by extremely fragile bones that break or fracture easily (brittle bones), often without apparent cause. It is the most common heritable disorder of connective tissue. Besides being associated with brittle bones, the following features are also linked to OI: Blue sclerae, dentinogenesis imperfecta (disorder of tooth development), increased joint mobility, short stature, and hearing loss. The visual system is also commonly affected in patients with OI. Ocular and visual pathway problems reported include corneal disorders, glaucoma, retinal detachment, optic neuropathy and others. Four main types of OI have been identified. OI type I is the most common and the mildest form of the disorder. OI type III is characterized by extremely fragile bones, multiple fractures, and malformed bones. Multiple fractures are often present at birth. hearing impairment deformities of the arms and legs vision abnormalities growth rate is slower a lot of bone fractures

simple rotation

is the ability to roll a small object between the thumb and finger tips- using the finger tips and thumb to open a small jar

complex rotation

is the ability to turn an object end over end. An example of this is flipping a pencil over in one hand to use the eraser instead of writing with the tip of the pencil. Another example- Flipping a marker using one hand to put the cap on the end.

Spina bifida occulta

most common and least severe form of spina bifida without protrusion of the spinal cord or meninges is a type of neural tube defect, where the spinal nerves usually aren't involved and typically there are no signs or symptoms but visible indications can sometimes be seen on the skin above the spinal defect, including an abnormal tuft of hair, or a small dimple or birthmark Often, individuals with spina bifida occulta do not present with obvious, outer symptoms but can experience slight instability or neuro impairments

Visual scanning

movements of the eyes from one location or object to another

Symbolic play

play in which children make believe that objects and toys are other than what they are. Also called pretend play.

In-Hand Manipulation

refers to the ability to move and position objects within one hand without the assistance of the other hand.

complex partial seizures.

repetitive movements such as chewing, lip smacking, or clapping, followed by confusion

Tier 2 Intervention

small group--usually 6-8 weeks (fixed duration) with a specialist--use "cut points" to assess problems

Translation

Allows you to move objects from the palm of the hand to the fingertips and vice versa using only one hand. An example of translation is moving coins from your palm to your fingertips to put the coins in a bank

Which comorbidities are common with Tourette disorder?

ADHD, OCD, depression and anxiety

During the screening process of a 2-year-old child with CP, an OT observes the child frequently gagging while being spoon fed by his mother. What are the MOST likely causes that would result in this child's gagging response to eating?

Sign of dysphagia Sign of aversion to a new texture Behavioral response

benefits of a balance disc

It improves core stability and posture Sitting on a balance disk/wobble cushion is similar to sitting on a therapy ball - only smaller, portable and more convenient. Active Sitting - using a balance disc (also called a wobble cushion or instability cushion), creates an unstable surface to sit on. This instability results in the body having to constantly correct itself against gravity, by engaging the back and core muscles. i.e. This added need for balance encourages the postural muscles (pelvic, core and back muscles) to be activated. I.e. The instability engages the core muscles improving posture and core stability.

Pain management

It is a general rule in OT to always treat pain FIRST. Pain, which is considered the fifth vital sign, is important to assess in all individuals with DMD across the life span. Pain management is an important priority in transitions to adulthood and the management of DMD in adulthood. Pain of varying types and intensities may occur in DMD. Effective pain management requires an accurate determination of the cause and may require comprehensive team management. Postural correction, orthotic intervention, PT, adaptive equipment, assistive technology, and pharmacological interventions may all be required. Adaptive equipment and assistive technology should be used to emphasize the prevention and management of pain and optimize comfortable function and movement with transfer, bathing, and toileting equipment.

An OTA is working in a school setting with an 11-year-old girl who presents with a hearing loss. What approach should the OTA use when communicating with this child?

Make sure to have child's attention before speaking It is recommended that you speak within 3 feet of the child; therefore, sitting 5 feet away may limit the child's ability to hear

What are the benefits of using a ball seat for a child with ADHD in the classroom?

Can correct a child's posture and help meet his or her movement needs. Children with ADHD have an increased need for movement and they often seek out this movement in unacceptable ways in the classroom. Ball seats allow children to wiggle and shift position without disturbing their classmates. The seats also help correct poor posture, which facilitates proper position while working and attention to task.

Prior to the Covid-19 pandemic, children with special needs were already experiencing difficulty with their everyday lives. Since the start of the pandemic, which group of children with special needs would you expect to have the MOST difficulty coping during this unprecedented time?

Children with OCD are suspected to be one of the most affected by the Covid-19 pandemic. Due to obsessions and compulsions related to contamination, hoarding, and somatic preoccupation, they are expected to experience heightened distress. For example: With hand washing being a key protective measure against the spread of COVID-19, it is difficult to manage a compulsion to wash their hands obsessively.COVID-19 pandemic and lockdown has brought about a sense of fear and anxiety around the globe.

petit mal seizure

Children with absence seizures (petit mal) develop a loss of awareness with staring or blinking, which starts and stops quickly. There are no convulsive movements. These children return to normal as soon as the seizure stops.

When working with a child who has been diagnosed with Tourette disorder (TD), which is the BEST approach to base your OT intervention on?

Comprehensive Behavioral Intervention The CBIT treatment protocol (one 30-60 min session/wk for six to seven sessions) makes it possible for school-based occupational therapists to implement this therapy for the treatment of children with TD.

Muscular Dystrophy

Congenital muscular dystrophies (CMD) are extremely rare neuromuscular disorders with onset at birth or early infancy, characterized by hypotonia, delayed motor development, and progressive weakness. The clinical presentation is variable and can affect other organs, including the eyes, brain, lungs, and heart

Rett Syndrome

Neurodevelopment of child (girl, as boys die in utero) fails between age 1-4, with poor head growth withdrawal irritability difficulty using both hands history of seizures problems coordinating breathing and swallowing during feeding gait disturbance.

What are the common stress signals the OTR® needs to be aware of during the feeding part of the evaluation, which would indicate that the infant may be in distress?

Extending their upper limb and splaying their fingers as if making the stop sign. Arching their back. Looking away- gaze aversion.

placement of drive-wheels

Front-wheel drive wheelchairs- have the drive wheels in the front of the wheelchair base. The casters are in the rear of the frame, providing a benefit that allows a user to get close to counters or close to surfaces for transfers. The only limitations for closeness are the footrests. Mid-Wheel Drive- the position of the drive-wheel affects the maneuverability, stability, traction, and performance. Maneuverability depends on the wheelchair's turning radius. For this type of powerchair, the drive wheels are in the middle of the power wheelchair frame. This makes the chair require a second set of casters on the power wheelchair base: two in the front and two more in the back for stabilization. Mid-wheel drive wheelchairs have the smallest turning radius because the chair turns around the center wheels; therefore the rule of thumb is when you are turning, if the front of the wheelchair fits the back will also. This makes it the most maneuverable in small spaces like hallways or getting in and out of bathrooms. Rear-Wheel Drive Wheelchairs- The drive wheels are in the rear position of the wheelchair. The casters are in the front of the wheelchair base. These configurations can be good for persons in rural areas with outdoor driving and over some rough terrain. The turning radius is larger so maneuverability in tight areas may be a challenge.

What is the most ergonomically correct position for a 5-year-old girl who is learning to write her name from left to right?

Her feet are on the ground firmly while her elbows are flexed, and she is sitting 2 inches away from the desk. This position ensures that all of the girl's joints are in a stable position to support her body and free up her hand, wrist and forearm for writing

A 2nd grade student with ADHD has difficulty paying attention in the classroom and demonstrates impulsive behavior. The student's teacher asks the OT where is the BEST place for this student to be seated so that they have the best opportunity to learn and are not a distraction to the other students? What recommendation should the OT make?

In the front row and directly in front of where the teacher stands

neck stability

Infants begin to lift their heads in prone when they are about a month old. They can hold their heads up when placed in a sitting position at around 4 months. An infant's neck muscles and head control should be strong and steady by 6 months.

How should the certified hand therapist adapt the splint to prevent the child from removing it from her forearm?

Replace the Velcro straps with shoelaces and shoelace locks, and apply stickers of her favorite animal or cartoon characters

What is the role of the OT practitioner when providing OT intervention to a child who has been diagnosed with ODD (Oppositional Defiant Disorder)?

Social skills training teaches a child to reciprocate healthy conversations with friends and family by teaching them how to react appropriately in social scenarios. Children with ODD have problems controlling anger and hostility. OT practitioners should consider working with students on coping techniques to deal with everyday situations that can lead to stress. OT can teach the child specific problem-solving techniques where they have to work with difficult situations that may cause them to lash out inappropriately. Enhanced problem-solving skills are used to reduce negative behavior in order for the child to participate in daily tasks successfully. OTs can help target challenging interactions between children and their parents/caregivers. By doing so, the OT may use interventions that involve positive communication between parents and the child. Improving interactions will reduce the child's capacity to test and push parents' authority through tantrums and manipulation.

An OTA is assigned to work with a 6-year-old student to help him with handwriting adaptations. The student presents with upper limb weakness and currently uses a prone grasp to hold a pencil. Using the remedial approach, which work surface and position would be the MOST beneficial in supporting this student?

Standing upright and writing on a chalkboard. In order to work on the student's prone grasp and upper extremities, the OTA can have the student stand upright and write on a chalkboard. This will allow the student to raise his hand against gravity.

Beery Developmental Test of Visual-Motor Integration (VMI).

The Beery VMI helps assess the extent to which individuals can integrate their visual and motor abilities. The Short Format and Full Format tests present drawings of geometric forms arranged in order of increasing difficulty that the individual is asked to copy. Optional Supplemental Tests for More Detailed Evaluation

MVPT-3

The MVPT-3 assesses an individual's visual perceptual ability without any motor involvement needed to make a response. It is especially useful with those who may have learning, motor, or cognitive disabilities. As the student has an intention tremor and the focus of the assessment is on evaluating his visual perceptual skills, this is the most appropriate test to use in this scenario. It is important to first establish the student's visual perceptual skills before testing his visual motor integration.

During an OT session, a withdrawn 4-year-old girl who has been diagnosed with a developmental delay spontaneously reaches out for a crayon and starts to brush her hair with it. What type of behavior is this child demonstrating?

The child is demonstrating goal-directed behavior. The girl is initiating the task by being spontaneous, and despite using a crayon, she has a goal to comb her hair. Piaget believed that as babies begin to grow and learn about their environment through their senses, they begin to engage in intentional, goal-directed behaviors. In other words, they begin to think about what they want to accomplish, how to accomplish it, and then they do it. Purposeful activities are defined as goal-directed behaviors and guided by client centered goals

grand mal (generalized) and febrile seizures

The child may undergo rhythmic jerking and muscle spasms, sometimes with difficulty breathing and rolling eyes. The child is often sleepy and confused after the seizure and does not remember the seizure afterward.

Shift

This is the ability to move objects between the fingers. Some examples of shift are when you use your fingertips to try and separate two pieces of paper that are stuck together or when you move your fingers to the bottom of a pen to get ready to write

Visual tracking

This is typically defined as the ability to efficiently move the eyes from left to right (or right to left, up and down, and circular motions) OR focusing on an object as it moves across a person's visual field

Tier 1 intervention

Tier 1 intervention includes changes in the classroom that benefit all students, including those considered to be "at risk". Tier 1 intervention is the first step of the Response to Intervention, or RTI, process. RTI Tier 1 interventions are the "first line of defense" for supporting students. Response to Intervention (RTI) was designed to help prevent students from needing special education assistance. Tier 1 instruction is delivered to the whole class.

Ataxic cerebral palsy

a form of cerebral palsy marked by a lack of whole balance in the coordination of muscles

Kinesthesia

also called proprioception, is the ability of a person to feel their body's position in relation to itself. This includes the ability to feel when the body is moving and how much force the body is exerting on objects or other people. Writing letters in the sand with eyes closed, vertical writing on a chalkboard, writing using a weighted pencil, and forming letters with the whole body all utilize kinesthetic activities to address handwriting

Sensorimotor play

children engage in motor movements beginning with early reflexes and moving toward more intentional actions. These early actions are initially the result of trial and error; children learn through their actions that their behavior has an effect on the environment. As children develop, their actions become more sophisticated and as a result more deliberate. For example, sensorimotor play includes the reflexive behavior of an infant grasping a rattle placed in her hand, as well as the intentional behavior of an older infant picking up and shaking a rattle to make sound. The sensorimotor stage typically occurs from infancy through age two