OT 325 Final
curiosity
At 6 months, why are positions and focus for play important? - They enable the infant to see world from another perspective which builds _______________
Recommended eye examination frequency for kids age birth through 2 who are asymptomatic/low risk?
At 6 to 12 months of age
Recommended eye examination frequency for kids age birth through 2 who are at-risk?
At 6 to 12 months of age or as recommended
more strategies, quicker decision making, more mental flexibility
At 7-12 years old, what can you expect when performing/participating in games and activities?
object permanence
At 8-9 months, what has developed as noted in Piaget's theory of cognitive development as we see infant using the "Jack in the box"?
Recommended eye examination frequency for kids age 3-5 who are asymptomatic/low risk?
At least once between 3 and 5 years of age
Recommended eye examination frequency for kids age 3-5 who are at-risk?
At least once between 3 and 5 years of age or as recommended
standing/walking
At the cortical level (cerebellum) level of CNS maturation, what is the level of motor development?
equilibrium reactions
At the cortical level (cerebellum) level of CNS maturation, what is the level of reflex development?
crawling/sitting
At the midbrain level of CNS maturation, what is the level of motor development?
righting reactions
At the midbrain level of CNS maturation, what is the level of reflex development?
prone/supine lying
At the spinal/brainstem level of CNS maturation, what is the level of motor development?
primitive
At the spinal/brainstem level of CNS maturation, what is the level of reflex development?
7-9 months
At what age attachment built?
two years
At what age should a child be putting two words together?
social development
Attachment is the base for
grasp
Attainment of an object; holding the object within the han
a parenting style where parents are highly demanding and controlling, with little or no affection
Authoritarian
parenting style that gives the child autonomy but help them to see the way/provide guidance-how can you fix your actions for next time?-there are still consequences for your actions
Authoritative
Toddler: Erikson's stage in which a toddler learns to exercise will and to do things independently; failure to do so causes shame and doubt.
Autonomy vs. Shame and Doubt
ASI
Ayres sensory integration
An OT practice approach that uses theory, assessment methods, patterns of sensory integration, and praxis problems, intervention concepts, principles, and techniques developed
Ayres' Sensory Integration (ASI)
less attractive babies tend to receive less attention from caregivers
Baby's appearance
imitates
Back and forth interactions are applicable to modeling vs observation in which the child
adaptive responses
Basis for development of praxis, posture and motor skills, emotional regulation and social participation
Through participating in new experiences, opportunities, and challenges, children may be able to achieve goals that they set for themselves. • Often involves assistance from others
Becoming
Recommended eye examination frequency for kids age 6-17 who are asymptomatic/low risk?
Before first grade and annually thereafter
Recommended eye examination frequency for kids age 6-17 who are at-risk?
Before first grade and annually, or as recommended thereafter
How one feels about participation in an occupation from a psychological or spiritual sense, and the understanding and advocacy of the self as an occupational being. Ex: Role of student, friend
Being
Reduced risk of: asthma, obesity, type 1 diabetes, ear infections, SIDS, and GI infections
Benefits of breastfeeding for infants
Reduced risk of: high BP, type 2 diabetes, ovarian and breast cancer
Benefits of breastfeeding for mother
infant's awareness of the environment, especially social environment
Between 6-12 months, auditory processing has what social role?
sensory responses help to build adaptive responses
Between 6-12 months, babies are mobile, but how do they get around?
hand skills
Between 6-12 months, tactile perception refining leads to
self-feeding (mostly happens with hands, more interested in the purpose of objects such as spoons)
Between 6-12 months, what self-serving occupation is present?
Unoccupied play
Birth to 3 months infant is moving arms, legs, hands, feet, etc learning about and discovering how their body moves swiping/pre-reaching
Cutting a variety of shapes
Both hands cooperate in synchronous and reciprocal interaction during cutting actions
complex and coordinated actions/behaviors
Both phasic and tonic reflexes are critical for the development of a child. They are the foundation needed to construct more _________________
visual perceptual skills to increase discrimination for reading and writing
Bottom up approach
7-8
Brain is a "sensory processing machine" until age ______ years
Which assessment do these scale measures represent? -Orientation to inanimate objects (visual and auditory) -Pull to sit -Cuddliness -Defensive movements -Self-quieting activity
Brazelton Neonatal Assessment
Which assessment do these scale measures represent? -Reflexes: hearing on both sides, eye movement, tracking finger, respond to touch, grasping -Motor abilities -Muscle tone -Capacity for responding to people and objects: visual and auditory -Capacity to control own behavior (self-regulation)
Brazelton Neonatal Assessment
Purpose: to assess neurological condition of newborns suspected of being at risk for developmental delay (testing to see how infant responds to stimuli)
Brazelton Neonatal Assessment Scale
Bronfenbrenner's ecological theory
Bronfenbrenner's environmental systems theory that focuses on five environmental systems: microsystem, mesosystem, exosystem, macrosystem, and chronosystem.
reach and grasp (4-8 months)
By 6 months -- expected to be using hands together
both hands together
By 6 months, children are expected to use
release, stacking, volitional
By 6 months, develops ability to ___________ objects into smaller containers & _________ blocks. This is because release is now _____________.
release
By 6 months, infant should be transferring the object from one hand to the other by fully opening the releasing hand
6
By _____ months, the infant should be transferring the object from one hand to the other by fully opening the releasing hand (when release becomes volitional)
Developmental Letter Progression: Magic C Letters
C, O, Q, G, S, J
During pregnancy, this psychoactive drug use can lead to preterm births, low birth weight, increased risk of miscarriage
Caffeine
Immature sitting
Cannot use his hands, will not be playing while sitting. No extension in lower back, still rounded. Working in sitting more against the effects of gravity
Occupational development and change: Changes originate from multiple forces such as
Caregiving/teaching practices that promote occupational opportunities Ex: teachers drawing on interests while embedding curriculum goals
two
Causes for concern in language production: - Body parts: At _____, your child should be able to point to a number of body parts.
21
Causes for concern in language production: - Following directions - They should be able to follow simple directions by the time they are ___ months
two
Causes for concern in language production: - Two-word phrases: A _____ year old should be putting two words together.
15
Causes for concern in language production: - Vocabulary - Child does not use single words by ___ months of age at the latest.
2
Causes for concern in language production: Excessive jargon or babbling: A ____ year old should not be mainly babbling.
15
Causes for concern in language production: - Understanding simple words: Child does not understand the words: no, bye-bye, and bottle (if appropriate) by the age ____ months.
Repeated patterns of behavior that interfere with optimal learning or engagement in prosocial interactions with peers and adults
Challenging Behavior
cognition
Changes in attentional control and problem-solving
- talking differently to a child verses an adult - providing background information to a person unfamiliar with your story
Changing language based on the needs of the listener example
ZPD and scaffolding
Changing the level of support in Vygotsky's theory. Over the course of teaching, the teacher adjusts the amount of guidance to fit the current performance level. Can come from adults or children.
cognition
Child acquires knowledge about objects through object manipulation
concrete operational (7-12 years)
Child can think logically about concrete objects and can thus add and subtract. The child also understands conservation
Toy inventories to determine play needs
Choose toys appropriate for age/developmental level; accessible; encourage imagination; safe
Are critical in developing bonds (starts as an attachment and becomes a bond): -making eye contact with children -co-feeding (breast feeding)
Co-occupations
During pregnancy, this psychoactive drug use can lead to neurological and cognitive deficits
Cocaine
friction > shut off implants
Cochlear implants and playgrounds warning of plastic slides, which cause
children recognize different sounds
Communication at 6 months?
-grading of the task -providing visual attention -can do the task but with skills already had -not changing the skills just how it is presented ex LTG. Child will utilize provided strategies and modification in order to complete art activities in 1st grade curriculum
Compensatory
Equilibrium Reactions
Compensatory movements used to regain midline stability when alignment of midline with gravity is significantly disturbed. - Rotation and flexion of neck and upper trunk back toward the center - Lower trunk segments counter-rotate to balance rotational effect of upper portion of body - Extremities may extend and abduct - Opposite extremities may assist in bringing head and trunk back toward midline
4 years
Complex rotation by
analysis of contexts, performance skills and patterns
Complex task
Semantic development
Concerned with Grammar, vocabulary and conceptual meaning of words
Cognitive development is driven by child's inner motivation and drive to learn and explore
Constructivism (Piaget)
Palm to Finger with Stabilization (Separation of the Hand)
Continues to work on stabilization until 4 years - The child begins with finger flexion and moves to finger extension, with the 4th and 5th digits flexed into the palm
extrinsic muscles
Contribute to development of hand arches, separation of both sides of hand, and stabilization of web space between thumb and first digit
Grasps that evolve from extrinsic muscles
Contribute to the development of hand arches, separation of both sides of the hand, and stabilization of web space between thumb and the first digit
Stage 3: heavy work
Controlled mobility (gross movements) superimposed on stability
4 to 5 years
Cooperative play, role play, pretend play with elaborative scripts, games with rules
bimanual skills
Coordinated use of two hands together to accomplish an activity
bilateral
Crawling with BUE > then LE "army crawl" is an example of ________ weight shifting
unilateral
Creeping along furniture in upright is an example of ________ weight shifting
contralateral
Creeping with alternating UE and LE is an example of ________ weight shifting
hand function
Critical for interaction with objects, materials, and other persons within everyday environments
3-5
Crude palmar grasp (ulnar palmar) occurs at _____ months
some cultures eat with hands, development of fine motor skills, sometimes there is limited or proficient tool use, integration of play materials (puzzles)
Cultural contributions to hand skills?
Use of experiences and perspectives of children and their families as a tool to support them more effectively
Culturally Responsive Care
Developmental Letter Progression: Big and Little Curves
D, P, B
temperament
Defined as patterns of responsivity and associated emotional states
Universal Design for Learning
Designing lessons that are appropriate for all learners
Extension and flexion against gravity
Development of antigravity movement: stability requires
starting to play with toys in sitting either unsupported or supported, position in quadruped, floor play, build spatial perception (learning how to walk by putting something intriguing), exploring textures of food through feeding
Development of sensory integration from 6-12 months?
supervised tummy time, visual/vestibular/tactile sensation, supine > move limbs freely in unoccupied play, cuddling
Development of sensory integration in a newborn?
parallel play, playing alongside other children, asking children to carry things, dancing, hiking on trails, stability, how body is moving
Development of sensory integration in the 2nd year?
promote position in prone (extension and control, up on FAs more, weight bearing through different parts of body), offer toys for different textures, sensorimotor exploration (textures, shapes, etc.), weight shifting to reach for purposeful action (reaching for toy), need their home base and caregiver to be in sight
Development of sensory integration in the first 6 months?
swinging, sliding, running, jumping, pushing, pulling, bikes with training wheels, scooters, vestibular system is activated, scissors, pencils, buttons, forks, knives, pales, playing cooperatively with other children, soccer, softball, dance, shared interest
Development of sensory integration in years 3-7?
Often used in optometric practices to evaluate school-age children's ability to efficiently perform saccadic eye movements used in reading.
Developmental Eye Movement Test (DEM)
visual-verbal ocular motor assessment tool for the use of saccadic eye movements in reading homegrown vs objective results
Developmental Eye Movement Test (DEM)
just right challenge
Developmental process has the __________________________ using sensory and motor experienicing
-strong reliability and validity -must use the 6th edition -indication of handwriting readiness -30 geometric forms, arranged in developmental sequence
Developmental test of visual motor integration (Beery VMI)
release
Develops ability to release objects into smaller containers & stacking blocks
mother's behavior
Differences in attachment styles dependent on ___________ ____________ during critical developmental period
bimanual skills
Differentiated bimanual actions allow a child to engage in ADLs and other occupations with increased complexity
projecting understanding of R/L in environment and how to project it on someone else or objects within one's environment
Directionality
Yes - Deaf children born to deaf parents who use sign language to communicate, acquire language on par with hearing children born into hearing households (ex: sign language)
Do children with hearing impairments acquire language at comparable rate to hearing children?
engaging in occupations promotes child's identity as a participant in their world
Doing
release
During __________, initially, child will use their mouth to stabilize the object during transfers or will use one hand to pull it out of the other hand
goal setting, more sophisticated skills
During adolescence, what can you expect in a child who is performing/participating in games and activities?
reflexive during this time (pressure to palm)
During pre-reaching, grasp is
sensorimotor
During the first 3 through 7 years, what functions lay the foundation for higher abilities?
their inner drive
During the first 3 through 7 years, what may be strong within the child?
sophistication of playing with blocks, playing on playground, greater and more complicated coordination and motor skills
During the first 3 through 7 years, what skills become more sophisticated?
9 months
During which month does understanding emerge- no more baby talk, please
other children
During years 3-7, games often involve
Which approach is this an example of?
Dynamic systems approach
Which approach is this? Transaction between multiple factors Reciprocal and simultaneous • Continuous performance • Mechanism of change • Self-organization and intentionality (organismic) while also considering environment
Dynamic systems approach
hands
Dynamic tools used most often to accomplish ADLs, school, work, & play activities
occupational impact
Each reflex has a specific purpose during infancy and if not integrated can have an
the ability to keep and manipulate food or fluid in the mouth and swallow it
Eating
- scribbles by 13-14 months - Snips with scissors at 2.5-3 years - 3 years: coordinated and simultaneous use of 2 hands - Scribbles at 2 years, draws person or object at 4-5 years
Education
3 years, 4-7 years
Education happens
This stage takes place from 2-8 weeks
Embryonic
1. Mass of cells is now called an embryo 2. Cells become distinct as human > basic organs form 3. Stage is significant for neural tube and brain development (maintaining nutrients and healthy pre-natal care) -By week 8 all basic organs and body structures formed (except sex organs) -Placenta: life support system between mom and embryo
Embryonic Stage (2-8 weeks)
When are basic structures of brain and nervous system established?
Embryonic Stage (3-8 weeks)
-4 weeks after conception -neural tube forms and later develops into CNS -head begins to be formed followed by: ~eyes, ears, nose, mouth, limb buds ~blood vessel that becomes the heart starts to beat - brain divides into three major divisions
Embryonic Stage: Neural Tube Formation
- All basic organs and body structures formed - Capable of some movement - Responds to stimulation around the mouth: tactile sense
Embryonic stage (end of week 8)
sensory integration
Enables our ability to respond to and act on situations in a purposeful manner
Neural Tube Deficits of CNS: cystic lesion protruding through a deficit in the skull; usually in occipital area
Encephalocele
Goal of legitimate tools in OT
Engaging children and caregivers in meaningful occupations that they: - Need to do - Want to do, or are - Expected to do
Why lie on your side?
Enhances vision, eases effects of gravity so your hands get to midline, can see hands so that you can interact
1. Radiation -Chromosomal abnormalities -Xray on developing fetus (microcephaly) 2. Pollutants, toxic waste -Exposure to lead, mercury, fertilizers, pesticides 3. Chemicals 4. Travel exposures -ex: zika, chicken pox, dengue, HIV, measles
Environmental Factors
each stage builds on tasks of the previous stage, successful mastery leads to sense of self-if a child feels confident in their ability to complete a task then they will engage in other tasks and develop
Erikson's Psychosocial Theory
thin and muscular
Esophagus
reflexive - bolus moves from esophagus to the stomach
Esophogeal phase
inward turning of the eye
Esophoria
An intervention approach designed to change client variables to establish a skill or ability that has not yet developed or to restore a skill or ability that has been impaired ex of LTG. Child will increase visual perceptual/motor skills in order to complete written tasks within modified 2nd grade curriculum as measured by completion of 3/3 obj.
Establish/restore
Describes a common culture, religion, nationality, or language shared by certain groups
Ethnicity
Equilibrium reactions
Ex of external forces that provoke reaction: child is pushed backward- trunk curves forward with forward movements of extremities
-rotation and flexion of neck and upper trunk back toward the center -lower trunk segments counter-rotate to balance rotational effect of upper body -extremities may extend and abduct
Examples of compensatory reactions
Stereognosis: change purse or pencil case
Examples of haptic perception test
self-regulation
Executive Function is like
- Planning / Organizing - Attending and shifting attention - Time management - Working Memory - Self-control - Mental Flexibility - Perseverance
Executive functioning: Higher level cognitive processes
outward turning of the eye
Exophoria
Motor learning
Experiencing, practicing, reinforcing skilled actions, and receiving feedback to achieve a functional, goal-directed activity that promotes motor skill development.
Inner drive
Explore and master the environment
reach
Extension away from the body and movement of the arm to grasp or place objects
power
Extrinsic muscles are for?
ability of the eye to combine information from each eye into one image
Eye teaming
- Must show interest in food exploration independently - Chaining techniques for cognitive delays - Clock orientation for visual impairment
Facilitating Self-feeding
- Inhibitory control - Working memory - Mental flexibility
Facilitating executive function and self-regulation in early childhood requires
What might it mean to be a child of divorce, military family, others?
Family Structure
What concept does this describe? -"Families must coordinate both what and when of participation in routines/rituals!"
Family Systems Model
What concept does this describe? -Change and evolution are inherent in family
Family Systems Model
What concept does this describe? -Family is an open system - influenced by its environment
Family Systems Model
What concept does this describe? -Family must be understood as a whole
Family Systems Model
What concept does this describe? -Family works to sustain predictable patterns in shared occupations
Family Systems Model
What concept does this describe? -Individuals are interdependent and have reciprocal influence on each other's occupations
Family Systems Model
the process of setting up, arranging, and bringing food from the plate or cup to the mouth
Feeding
This stage takes place from 9 weeks to birth
Fetal
1st Trimester 2nd Trimester 3rd Trimester
Fetal Stage (week 9-birth)
voluntary release
Finger extension that allows intentional release of a hand-held object at a specific time
4
Finger to palm with stabilization (separation of the hand); continues to work on stabilization until ___ years
12-15 months
Finger-to-palm translation by
12-15
Finger-to-palm translation without stabilization occurs at ____ months
crying
First sign of communication?
snipping (don't have coordination yet, just quickly snipping)
First step of scissor skills?
- taking turns in conversation - staying on topic
Following rules example
sensory integration
Forms the foundation for occupational engagement and social participation.
sagittal plane
Forward and backward/up and down movements.
6-7 months
Forward protection in sitting?
cuts body in front and back sections
Frontal Plane
Unilateral Weight-Shifting
Frontal Plane - Infant can shift weight to one side of the midline, supported by either trunk or extremities on that side then move the extremities to the opposite side of the body - When used for forward movement, pattern looks like this 2-step process: - Shifting weight and moving with side-to-side motion - Ex: Early walking
In the first 3 months, what sensory inputs are these infants experiencing?
GET THIS
helps infants from swallowing inappropriate foods/objects that could cause choking
Gag reflex
This stage takes place from 0-10 days
Germinal
-Cells develop into a blastocyte with 3 layers that develop into different body structures: Ectoderm-skin and nervous system Endoderm- digestive and respiratory system Mesoderm-muscle and skeletal system
Germinal Stage (0-10 days)
Dressing strategy when dressing?
Give controlled choice or limited set of options
seeing, hearing, cognitive function
Given that language brain growth is the strongest in the first year of life, there is significance in ______________ and _______________ and there is an impact of higher ___________________
Finger-to-palm translation
Grasp an object with the pads of the fingers and thumb and move it into the palm
pre-reaching (0-4 months)
Grasp is reflexive during this time (pressure to palm)
Grasps that evolve from extrinsic muscles
Grasps that provide wrist stability and moves fingers and thumb in gross flexion/extension patterns
pre-reaching (0-4 months)
Hands can open/close & hands to mouth
more
Hands, fingers, lips, feet and mouth are _______ sensitive
extensor tone
Has access to hands, has nice extension all the way down his back, good ______________ _________
stable visual field
Head control in the first 6 months provides...
During pregnancy, this psychoactive drug use can lead to withdrawal symptoms, later behavior, and attention deficits
Heroin
new noises, people, senses, sensations > gradually take care of them to open up their world
How are modulation and arousal immature nervous systems easily overstimulated? How do you soothe this?
we are looking and coming in contact with something that is giving tactile feedback, as they move the arm they are getting information at joints of the body's position and information, connecting touch and creating meaning with the object in terms of vision, helps to build picture to help with haptic perception
How are tactile, proprioceptive, and visual systems elicited with ATNR?
incorporate play
How can you elicit bimanual skills with children?
by matching language and clarifying
How do OTs verbally support social interaction?
pragmatic
How do l assess safety? - vase + flower example
Critical/Professional Reasoning
How do therapists think when they are engaged in practice? - Used to plan, direct, perform, and reflect on care - Informed reasoning and self-reflection are critical throughout the OT process - Metacognition: "thinking about thinking" - Every OT thinking about and/or engaged in OT practice is engaged in critical/professional reasoning - Focus is on the therapist - While the client is always the focus of our care, the professional reasoning process focuses on what the therapist is thinking while caring for the client.
rocking, bouncing, positioning upright
How do we activate the vestibular system?
triumph over gravity
How does neuromuscular maturation occur?
in specific postural patterns -causing cessation, movement or fixation
How is muscle tone distributed tonic/attitudinal reflexes?
poor coordination, clumsiness, limited accuracy and speed
How might somatosensory difficulties impact a child's hand function?
plantar reflex
How to Elicit: Apply pressure on the ball of the foot
rooting reflex
How to Elicit: By gently rubbing a finger on one side of the baby's cheek/ corner of the mouth.
stepping reflex
How to Elicit: Hold a baby upright and have their feet touch a flat surface
Tonic Labyrinthine Reflex
How to Elicit: Hold the baby in one hand and support the trunk. Place the baby in prone and see how their muscles move. Then place the baby supine and see how their muscles move.
Asymmetric Tonic Neck Reflex
How to Elicit: In supine turn baby's head to L or R, you are looking for flexion on the side the head is turned and extension on the other side.
palmar/grasping
How to Elicit: Place anything into the palms of the infant's palms or stroke their palm
Symmetric Tonic Neck Reflex
How to Elicit: Place the child in prone. Neck flexion elicits UE flexion and LE extension. Neck extension elicits UE extension and LE flexion.
sucking reflex
How to Elicit: Place your finger or binky onto the roof of the baby's mouth
moro relex
How to elicit: Gentle head drop while supported in supine or reclined posture. Can also be elicited by sudden movement, loud noise, bright light, or change in body position.
spinal galant reflex
How to elicit: Hold infant in prone suspension and gently drag your finger from their shoulder to their buttock on the same side
landau reflex
How to elicit: Hold the baby in prone and only support the baby's thorax/chest. If needed, activate passive flexion of the neck.
eyeblink reflex
How to elicit: Shining a bright light directly into a baby's eyes
babinski reflex
How to elicit: Stroke the baby's foot from their heel towards their 5th digit (pinky toe) and then across towards their hallux (big toe)
Parenting style: - Remain calm (baby will have better ability to soothe and match our own regulation) - Be responsive - Provide sensitive care - Provide consistent care
How to work with difficult babies?
less opportunity to interact with and explore their environment and would have less opportunity acting within the environment
How would difficulties in hand function impact functioning for a child with disability?
strength: coping from the board weakness: reading
Hyperopia
adaptive response of using a swing
I am not going to fall off of this swing, I have to hold on! Meeting and moving through challenges (at one point you may jump off when you feel comfortable)
Which cranial nerves are involved with swallowing?
IX - glossopharyngeal X- vagus
Trust vs. mistrust, Autonomy vs. shame & doubt, Initiative vs. Guilt
Identity Development (first 3 stages)
-"bunny hop" instead of reciprocally crawl -tendency to slump (posture) -difficulty sitting still or concentrating -poor eye-hand coordination ex. coping from the board
If STNR persists, what will the child have difficulty with?
vertical righting reaction
If appears early (1 month), may indicate excessive tone or spasticity
-hypersensitivity -stimulus bound effect (cannot ignore peripheral stimuli when attempting to focus attention on one thing- must pay attention to everything, very distractible) -sensory overload which could result in child switching off or daydreaming -anxiety
If moro persists what can it be associated with?
blastocyte moves to uterus and attaches to uterine wall -approximately 60% of natural conceptions never becomes implanted resulting in the new like ending before the mother knows she's pregnant -When successful hormonal changes halt menstrual cycle
Implantation (Germinal Stage)
bimanual skills
Importance of dissociation of the two sides of the body
side-lying
In ______________: demands of gravity are reduced, reduces affects of gravity on ability to use hands
touch, smell, and movement
In a newborn, what is important?
scaffolded
In an adaptive response, challenges are necessary, but must be
challenge and mastery
In an adaptive response, child experiences both
feet down
In landau reaction reflex: head down =
feet up
In landau reaction reflex: head up =
physical disabilities
In standing, ________________ may result in: - increased bone density - prevents/minimize contractures - improves respiration/voice control - improves circulation and BP - aids digestion, bowel and bladder function - relieves pressure encountered by other positions - improves well-being and alertness
we build the foundation for social-emotional skills
In the 2-6 month stage
primitive grasp (decreased precision), midline play, and tactile and visual
In the first 6 months, somatosensory maturation in hands leads to
postural control
In the first 6 months, vestibular-proprioceptive- visual connections lead to
awareness and interest in the world, vestibular proprioception, and visual connections build the basis for postural control, greater head control leads to stable visual fields
In the first 6 months, what senses contribute?
weight bearing
Infant assumes and maintains position of weight bearing BEFORE being able to move within that position
bilateral weight shifting
Infant can move forward/back or up/down, using upper or lower extremities bilaterally and shifting weight from upper to lower parts of the body and vice versa
unilateral weight shifting
Infant can shift weight to one side of the midline, supported by either trunk or extremities on that side > then move the extremities to the opposite side of the body
weight bearing
Infant maintains position in space supported by bearing weight on specific part of trunk or extremities
1 year
Infants who are totally deaf tend to vocalize early, but stop by
pronation
Infants will do hand to mouth, foot to mouth, and mouth toys primarily using forearm ____________
hand to mouth
Infants will do hand to mouth, foot to mouth, and mouth toys primarily using forearm pronation
8-9
Inferior pincer grasp occurs at _____ months
take our turn and stop what we are doing to wait for others
Inhibitory control kicks in when we have to
release
Initially, child will use their mouth to stabilize the object during transfers or will use one hand to pull it out of the other hand, then release becomes volitional
Pre-schooler: Erikson's third stage in which the child finds independence in planning, playing and other activities
Initiative vs. Guilt
tonic reflexes
Integrated by 9 months in typically developing children. An exception is made for the STNR reflex that can be integrated by 3 years
palmar grasp reflex
Integrates by 6 months & then voluntary palmar grasp emerges
9-12 months
Integration age of Symmetric Tonic Neck Reflex (STNR)
Typically, 6 months
Integration age of Tonic Labyrinthine Reflex (TLR)
Typically, 4-6 months and is replaced by voluntary grasping
Integration age of palmar/grasping reflex
Typically, by 3-4 months
Integration age of stepping reflex
Typically, by 2-5 months and is replaced by voluntary sucking
Integration age of sucking reflex
Typically, 6 months
Integration age of the Asymmetric Tonic Neck Reflex (ATNR)
typically 2 months, but can take longer
Integration age of the spinal galant reflex
skill and precision, manipulations
Intrinsic muscles are for?
reflex integration
Involuntary, quick responses that occur in response to a stimulus
Yes! Baby can adjust to mother's positions
Is the vestibular system functional at birth?
hand function
It is critical for interaction with objects, materials, and other persons within everyday environments
phasic reflexes
It is typically a movement that occurs after the therapist or caregiver stimulates the baby!
- Work effectively with others - Work effectively with distractions - Work effectively with multiple demands
Key to successful interactions as adult!
Asymmetric Tonic Neck Reflex
Known as the fencer/archer position
Developmental Letter Progression: Verticals and Horizontals
L, F, E, H, T, I, U
vision
Lack of integration or onset of eyeblink reflex indicates issues with
Indicates brain damage
Lack of integration or onset of spinal galant reflex
sucking reflex
Lack of integration or onset: Interferes with development of coordination of sucking, swallowing, and breathing
rooting reflex
Lack of integration or onset: Interferes with exploration of object and head control
Asymmetric Tonic Neck Reflex
Lack of integration or onset: Interferes with reaching, grasping, bilateral hand use, and rolling
Symmetric Tonic Neck Reflex
Lack of integration or onset: Interferes with reciprocal crawling and walking. Children will bunny hop or move their arms and then legs when crawling.
palmar/grasping
Lack of integration or onset: Interferes with releasing objects
plantar reflex
Lack of integration or onset: Interferes with standing, gait/walking (toe walking), putting shoes on because of toe clawing.
Tonic Labyrinthine Reflex (TLR)
Lack of integration or onset: Interferes with turning on side, rolling over, moving from lying down to sitting up, and crawling. If the reflex is seen in older children, they are unable to hold a supine flexion position or assume a pivot prone position.
stepping reflex
Lack of integration or onset: Interferes with walking patterns and leads to toe-walking
babinski reflex
Lack of integration/onset: Indicates brain or spinal cord damage if occurring past the age of 2 years
moro reflex
Lack of integration: Interferes with head control, sitting equilibrium, and protective reactions
landau reflex
Lack of integration: Slows development of prone extension, siting, and standing
vertical righting
Landau reaction reflex is an example of a __________ _________ reaction.
-epiglottis, true and false vocal folds - Function: valve to the trachea that closes during swallowing
Larynx
hand to mouth
Later develop isolated finger movements, opposition of thumbs, etc. once supination and wrist extension are well established.
pre-reaching (0-4 months)
Later tracks objects & swipes/bats
6-11 months
Lateral protective extension in sitting?
knowing R/L sides of one's own body
Laterality
cephalo-caudal proximal- distal
Law of direction
cognition
Learn about object characteristics & spatial relationships
stimulation
Limited ______________ weakens language development
Shift
Linear movement of an object on the finger surface; allows for repositioning of an object on the finger pads
Weight bearing
Maintaining Position: - Infant maintains position in space supported by bearing weight on a specific part of trunk or extremities - Infant assumes and maintains the position of weight-bearing BEFORE being able to move within that position - AKA Tummy Time!
reach and grasp (4-8 months)
Make corrections on way to contact-- opening of hand in preparation to grasp an object develops)
Emotional/Self Regulation
Manage how they are expressed in physiological states and behaviors
Tongue outcome
Manipulate food for chewing; shape food into bolus in prep for swallow
vision perception
Manual exploratory behaviors to learn about visual-spatial skills & learning about the environment
During pregnancy, this psychoactive drug use can lead to potential defects in memory and information processing
Marijuana
What theorist influenced play as an occupation?
Mary Reilly's occupational behavior frame of reference (1960's)
(level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization-lower needs must be met first before the top of the pyramid (self-actualization) can be attained
Maslow's Hierarchy of Needs
Which theory supports this? - Adequate nutrition, shelter, nurturing caretakers to promote physical and mental health development.
Maslow's Hierarchy of Needs
- Increased frustration when not able to do something by themself - Needs help learning self-control and sharing - Increase ideation (motor planning) - Simple pretend play - Attempt to put on jacket, shoes - Talking more (hard to understand half of what they say)
Milestones prevalent in year 2
- Plays beside other children - May become more defiant - 2-4 word sentences - Understand half of what they say - Running and walking up/downstairs - Kick and throw ball - Increased cognition!
Milestones prevalent in year 2
- Ride a tricycle - Run/climb/stairs - Dresses self: may not manage fasteners - Speaks in understandable sentences most of time - Friendships and sharing are important - Shows concern for friends - Separates easily from caregiver - Can say name, age, gender - Puzzles and building block towers - Turns pages of book one at a time
Milestones prevalent in year 3
Motor re-training method that includes using the reflection of the unaffected limb when the child watched a person lift their arm the same neurons are fired in their brain even if the action is not being performed
Mirror Therapy
Activity Synthesis
Modifying or adapting activity to meet therapeutic goals of participation. - How might we modify or adapt this activity for greater success if any one of the skills are missing?
-lateral flexion -rotation in and out of various positions
More complex movements
should be inhibited by 4 months
Moro
birth to five years
Most language development occurs at
reflex hierarchy
Movement occurs as the nervous system matures. Postural control and movement are dependent on how reflexes and reactions are integrated
Palm-to-finger translation
Moving an object from palm to pads of fingers; requires isolated thumb control. Begin with finger flexion and move to finger extension
mobility
Moving in and out of positions easily and with variety
strength: reading weakness: coping from the board
Myopia
- To better understand speech and language disorders and how they develop - To improve diagnostic testing - To establish effective treatments
NIDCD sponsored research related to speech and language delays
10-12
Neat pincer grasp/tip pinch occurs at _____ months
a parenting style characterized by a lack of parental involvement in the child's life
Neglectful
-breathing, hiccupping, sneezing (to maintain oxygen) -crying, shivering, tucking legs into self, pushing (to maintain a constant body temp) -sucking, rooting, swallowing (to support feeding)
Newborn: Survival Reflexes (3 sets of reflexes designed for protection)
pre-reaching (0-4 months)
Newborns show visual regard to close objects → activates arms in response (rarely comes in contact)
During pregnancy, this psychoactive drug use can lead to linked to low birth weight, fetal and neonatal deaths, respiratory problems, SIDS, ADHD
Nicotine
What skills are required for oral motor development?
Non-nutritive skills: managing saliva, sucking on pacifier, toy exploration
back, roll
Now recommended position for child to sleep is on _____. Doesn't have to happen when child can _____ over themselves safely.
we must exhibit cultural humility and respect when working with ethnically diverse groups to achieve collaborative outcomes • Ex: Latino and African American vs Anglo American mothers
OT implication of ethnicity
Stress of divorced parents can lead to impaired occupational functioning
OT implication of family structure
OT is top-down and occupation centered
OTs observe holistic occupations within supportive contexts. Observations of development in the natural environment help OT's understand child's abilities
In interventions in school settings, what are we measuring outcomes of?
Occupational performance, participation, prevention, health and wellness, role competence, and well-being
protective reactions
Once developed, always available for use - (typical and atypical) - Protective extension in sitting - Forward - 6-7 mo - Lateral - 6-11 mo - Backward - 9-12 mo.
Protective Reactions/Protective Extension
Once developed, always available for use - Appears 6-9 months - Forward - 6-7 mo - Lateral - 6-11 mo - Backward - 9-12 mo.
birth - 2 months
Onset of ATNR reflex
Emerges 4-6 months
Onset of Symmetric Tonic Neck Reflex (STNR)
37 Weeks Gestation
Onset of Tonic Labyrinthine Reflex (TLR)
birth
Onset of babinski reflex
Typically, 3-4 months. Early-onset (Around 1 month) may indicate excessive muscle tone or spasticity.
Onset of landau reflex
birth
Onset of stepping reflex
birth
Onset of sucking reflex
Neural Tube Deficits of CNS: defect of the spine, part of meninges and/or cord protrude through opening in spinal column -common complication: hydrocephaly
Open and closed Spina Bifida
begins with tongue elevation against hard palate moving bolus posteriorly
Oral (buccal) phase
small and tight in an infant - function: contains food
Oral cavity
use of lips, cheeks, jaw, tongue, and palate
Oral motor control
feeding, sound, play, oral exploration
Oral motor development
oral manipulation of food resulting in bolus formation
Oral preparatory phase
sitting positons
Overall, with maturing sitting, looking to acquire increased pelvic stability which increases ability to extend trunk, bring shoulders down and forward
4
Palm to finger with stabilization (separation of the hand); continues to work on stabilization until ____ years
2-2.5 years
Palm-to-finger translation by
2-2.5
Palm-to-finger translation without stabilization occurs at _____ years
5-6
Palmar grasp occurs at _____ months
3-7
Palmar grasps (as a whole) occur at _____ months
-Importance of developing close relationships is critical to infant well-being - In 2018, a reported 678, 000 children were victims of abuse/neglect (1% of kids in US) (National Children's Alliance, 2019) -Setting the stage for future parent child relationships based on initial reactions
Parent-Child Relationship
temperament
Parenting styles can have different effects based on the individual child's
hand to mouth
Part of sensory exploration! - Learning about the shape, size, texture, taste, etc.
hand to mouth
Part of sensory exploration!➢Learning about the shape, size, texture, taste, etc.
What cue is this? - OT emphasizes important feature of the form or object
Perceptual cue
- Produces speech - Gesticulates (uses socially appropriate gestures) - Speaks fluently with even pace (understandable)
Performance Skills: Social Interaction Skills
parenting style (in Baumrind's model) characterized by low demandingness and high warmth; they submit to their children's desires, make few rules, and use little punishment
Permissive
space common to both eating and breathing - function: moves food to the esophagus
Pharynx
aware of the individual sounds in language
Phonemic awareness
blending individual sounds into a work OR breaking apart into syllables
Phonological awareness
Which theorist values kids exploring on their own?
Piaget
10-12
Pincer grasp occurs at _____ months
- At 1 year- delight in containerizing, dumping and repeating - Understanding of functional purpose of objects - *At 15-18 months can stack 2 blocks and containerize raisin in small bottle; large, simple puzzles with pegs - 3 years- Strings beads
Play
at 6 months, 1 year, 3 years, 5 years
Play happens
What is play?
Play is hard to define but it has basic traits
- Proximal support (trunk and neck) for distal movement and control, of BUE's, of oral motor skills - Consideration for positioning of pelvis, legs and feet - Proper positioning influences oral motor control and oral intake - Sidelying during breastfeeding early infancy - Semi-reclined by 4-6 months
Positioning adaptations
Emotional/Self Regulation
Positive affect/experiences support coping
Righting, equilibrium, and protective
Postural reactions that enable body to remain upright through changing muscle tone, in response to position of body and its parts (auto motor responses)
1. weight bearing 2. bilateral weight shifting (sagittal plane) 3. unilateral weight shifting (frontal) 4. Contralateral weight shifting (transverse plane)
Posture Control and movement patterns
meaning
Pragmatic development is also about
-Information of pregnancy, labor, delivery, caring for newborn - Advice and education - Medications and vitamins - Examinations and monitoring - Immunizations - Nutritional information - Screenings and diagnosis -Schedule of visits ~medical, educational, social and nutrition -Prenatal classes: nutrition, rest, exercise
Prenatal Care: Education
-protects growth of fetus -increases ease of brith process -prepares parents in order to foster coping ex: early care is about supporting the family as well
Prenatal Diagnosis: early care
Neural Tube Deficits of CNS: consumption of folic acid (vitamin B) before and during early pregnancy helps to form the neural tube and can prevent NTD
Preventing NTD
spiraling continuum
Previously acquired patterns are called forward to adapt to the challenge or new experience - Used to meet the environmental demand with success eliminating the stressful situation - With maturation of CNS, higher level functions emerge
Semantic development
Process of learning the meaning of words and word combinations without considering context
bimanual skills
Progression - Asymmetrical → symmetrical →differentiated
Asymmetrical → symmetrical → differentiated
Progression of bimanual skills
Occupations and co-occupations are important because they
Promote occupational identity, self-efficacy, and self-determination; positive sense of control over their environment
Other considerations for learning without tears
Promotion of skills beyond letter formation: pencil grasp, body awareness (Mat Man), colors and shapes, using small tools (sponges, chalk, magnet pens, etc.) - Active participants!
6-9 months
Protective Reactions appear around
extrinsic muscles
Provide wrist stability and moves fingers and thumb in gross flexion/ extension patterns
Precursor to eye-hand coordination
Purpose of the ATNR reflex?
Increases tactile stimulation to the palm of the hand
Purpose of the palmar grasp reflex?
Adaptive response
Purposeful, goal-directed action on the environment, any response a child can negotiate or explore for success
Developmental Letter Progression: Diagonals
R, K, A, M, N, V, W, X, Y, Z
8-9
Radial digital grasp occurs at _____ months
6-7
Radial palmar grasp occurs at _____ months
7-8
Raking grasp occurs at _____ months
Babinski, Stepping reflex, ATNR, STNR, TLR
Reactions to tactile, proprioceptive and vestibular input resulting in motor actions (reflexive)
How to build role competence?
Read books, write essays, math, recess, lunch. Learn literacy skills, communicate
speech-language pathologist
Referral source if speech and language delayed: ____________
audiologist
Referral source if suspected hearing loss: ______________
Posture
Refers to core (proximal) stability of trunk and neck muscles. Also known as the position of body segments at any given time to provide stability and control.
-occurs as nervous system matures -posture and movement control are dependent on reflex integration
Reflex/hierarchal development of movement
poor gross motor and fine motor coordination, decreased oculomotor skills, joint distraction
Reflexes that remain obligant (are not integrated) can lead to:
cognition
Relating objects to another for more accuracy and purpose
forced or involuntary
Release starts out as
release
Release starts out as a "forced" or involuntary
Vision Perception
Relies on the visual system heavily to learn new motor skills
vision perception
Relies on the visual system heavily to learn new motor skills
reach and grasp (4-8 months)
Rely on eyes (need to look to figure it out)
What cue is this? - Ask child to "look again" - Can child self-correct?
Repetition cue
Extension of face side limbs and flexion of skull side limbs
Response of the ATNR reflex?
sudden flexion of fingers to grip
Response of the palmar grasp reflex?
- writing issues - dysgraphia
Result of difficulties in phonological development?
quadruped -bilateral weight shift
Rocking on all fours
bilateral
Rocking on all fours is an example of ________ weight shifting
reflex used to locate the source of food
Rooting reflex
contralateral
Rotation in and out of various positions __________ weight shift with lateral and rotational movement components
Complex rotation
Rotation of a small object 180 to 360 degrees once or repetitively
contralateral weight shifting
Rotation within the body axis allows one body segment to rotate in one direction while the adjacent segment rotates in the opposite direction
Contralateral weight shift
Rotation within the body axis, allows one body segment to rotate in one direction while the adjacent segment rotates in the opposite direction - Weight can then be shifted to one UE and opposite LE → while other UE/LE move
❖ Proximal → distal ❖ Reflexive → volitional ❖ Parts of Hand ➢ Ulnar → palmar → radial ❖ Location of object on hand surface -- proximal → distal ➢ Palmar contact → finger surface contact → finger pad contact ❖ Muscle activity used in grasp ➢ Extrinsic muscles → develops control and coordination of intrinsic muscles
SEQUENTIAL DEVELOPMENT OF GRASP:
develops control and coordination of intrinsic muscles
SEQUENTIAL DEVELOPMENT OF GRASP: Muscle activity used in grasp - extrinsic muscles →
palmar, radial
SEQUENTIAL DEVELOPMENT OF GRASP: Parts of Hand ➢ Ulnar → __________ → __________
distal
SEQUENTIAL DEVELOPMENT OF GRASP: Proximal → _________
volitional
SEQUENTIAL DEVELOPMENT OF GRASP: Reflexive → ____________
palmar, finger surface, finger pad
SEQUENTIAL DEVELOPMENT OF GRASP: ❖ Location of object on hand surface -- proximal → distal ➢ ____________ contact → __________ __________ contact → ___________ _______ contact
quick eye movements from one fixation point to another
Saccades
Bilateral Weight-Shifting
Sagittal Plane - Infants can move forward/back or up/down, using upper or lower extremities bilaterally and shifting weight from upper to lower parts of the body and vice versa - Flexion and extension are primary components in bilateral patterns - Rocking on all fours (quadruped) - Squatting - Distal holds and proximal segment moves - Controlled mobility (gross movements) superimposed on stability - "Bunny hop" crawling/creeping
bimanual skills
Scissor skills 1. Snipping 2. Cutting pages and lines 3. Cutting shapes
righting reaction
Seated child leaning forward to rest arms on desk- neck ext is the
cutting pages and lines (able to work towards progressing scissors towards something)
Second step of scissor skills?
___________ infants generally have less trouble sleeping
Secure
3-5 years old
Self care happens
Two basic traits of play?
Self-controlled and self-directed
Communication Management
Sending receiving, interpreting information using a variety of systems and equipment
reach and grasp (4-8 months)
Sensory feedback and exploration ➢Visually guided reaching
reach to grasp (4-8 months)
Sensory feedback and exploration, visually guided reaching: known as
occupational engagement and social participation
Sensory integration promotes - Internal awareness of self and automatic control of one's body - Body schema - Reflex integration - Postural control - Kinesthesia which leads to...
rolling, sitting, crawling, walking
Sequence of developmental milestones in the motor domain
co-occupations or occupations that are done together-meal time-bathing-feeding-reading at night-doing homework
Shared Occupations
3-3.5 years; inconsistency demonstrate shift
Shift by
frontal plane
Side-to-side movements.
_________ during breastfeeding early infancy
Sidelying
moro reflex
Significance: Demonstrates a primitive fight or flight reaction and later integration indicates normal neurological development
Tonic Labyrinthine Reflex
Significance: Develops head and neck control, increases muscle tone, posture, and balance
babinski reflex
Significance: Indicates normal neurological development & demonstrates withdrawal from any contact with skin
stepping reflex
Significance: Initial weight-bearing and it may be a component of voluntary walking later on
palmar/grasping
Significance: Presence at birth and later integration indicates typical/ normal neurological development
plantar reflex
Significance: Presence at birth and later integration indicates typical/ normal neurological development
Symmetric Tonic Neck Reflex
Significance: Production of postural tone, increase in muscle tone needed for stability, and is a precursor for crawling
eyeblink reflex
Significance: Protection for harmful stimuli like bright lights or foreign objects
landau reflex
Significance: Shows development of prone extension, sitting, and standing
rooting reflex
Significance: The baby is looking for food! This reflex is a component of feeding and nursing.
sucking reflex
Significance: The baby thinks that it is food! A fundamental reflex for feeling and nursing
spinal galant reflex
Significance: To rule out brain damage after birth
Asymmetric Tonic Neck Reflex
Significance: Train muscle tone, hand-eye coordination, bilateral integration, and visual tracking
2-2.5 years
Simple rotation by
-determine whole from incomplete parts -focus on important features and ignore extraneous detail -use visual imagery to recall past information
Skills for visual analysis
vertical righting reaction
Slows development of prone extension, sitting, and standing
intrinsic muscles
Small muscles in hand responsible for speed and dexterity
-Who will the infant take after -Sex of the baby: determines what the child will be named, how it will be dressed, and how it will be treated -Future expectations
Social expectations
lack of resources > lack of tools, not having scissors, pencils, spoons, forks, etc.
Socioeconomic status contributions to hand skills?
hand to mouth
Soothing (self-regulation and teething)
Voice
Sound made as air from lungs pushed between vocal folds in larynx, causing them to vibrate
stimulating environment
Speech and language are developed in a
Dysgraphia Support
Spelling instruction and handwriting instruction to improve legibility and fluency
bilateral
Squatting is an example of ________ weight shifting
Turning of head
Stimulus of the ATNR reflex?
pressure to palm (object or touch pressure stroke)
Stimulus of the palmar grasp reflex?
- Offer one new food at a time: Over multiple occasions - Offer small amounts - Offer variety of foods - Have at least one preferred food at each meal - Have child help with prep - Allow choice and making sure that the choice is available - Meals and snacks offered every 2-3 hours - Consider water between meals when thirsty
Strategies for picky eaters
Role Competence
Successful Performance of Habits and Routines
facilitate feeding from breast/bottle
Suck/swallow and tongue thrust reflex
- tongue moves up and down - decreased wide jaw excursions - less liquid loss: nipple suction force increases
Sucking
1st sucking pattern - jaw opens and closes (moves up and down) in large rhythmical movements - tongue moves with jaw forward and backward, more of a licking movement of the nipple - predominates in first 4 months
Suckling
complex process of moving food, liquid, saliva, or medication from mouth through the pharynx, esophagus and into stomach
Swallowing
STNR
Symmetrical tonic neck reflex -neck extension elicits UE extension and LE flexion -neck flexion elicits UE flexion and LE extension
What skills are required for oral motor control?
Symmetry, size, tone, ROM of jaws, lips, cheeks, gums, teeth
T/F: Poverty has a strong impact to health & well-being
T
measure of visual perception, individually administered, resting intervals of 4-6 months to minimize practice effects -unbiased with race and gender
TVPS (test of visual perceptual skills)
- Behavioral inhibition: Temperament remains stable 1. Children who exhibited behavioral inhibition temperament at 14 months > reserved personalities, fewer romantic relationships at age 26, lower social functioning with family and friends 2. Higher levels of internalizing behaviors in adulthood (anxiety, depression) 3. Behavioral inhibition is not associated with education and employment outcomes - Limitations: more research needed (not a diverse population), negative environmental experiences have developmental impact later on in lifespan. Inhibited temperament > reserved, introverted personality as an adult
Takeaways from NIH Research Matters Article
Speech
Talking to express language. Requires coordination muscle control of tongue, lips, jaw, and vocal tract to produce recognizable sounds
- Easy babies - Difficult babies - Slow-to-warmup babies
Temperament Categories (babies)
-Environmental agents such as toxins, disease, drugs, and alcohol that increase risk of deviations in normal development and can lead to serious birth abnormalities or death -Contribute to: low birth rate, brain damage, missing limbs -Most vulnerable period for CNS is from 15-36 days after conception -Limbs most vulnerable from 24-49 days after conception -Prescription and non-prescription medications -Psychoactive drugs
Teratogens
Research indicates that this tool is unbiased regarding race and gender
Test of Visual Perceptual Skills (TVPS)
period of refinement > greater dynamic control and balance (walking > running)
The 2nd year is known as the
sense of self and control
The 2nd year is known to increase
non-prone, prone
The Back to Sleep Campaign led to: - Dramatic reduction in SIDS - Research has shown that full-term infants sleeping _______________ have delays in motor milestones and lower scores on developmental screening measures than infants who slept ________ - Importance of "tummy time" to avoid delayed acquisition of head control
-Important to the developmental process -Sets stage for future psychological development (when brain begins to develop) - Health of the mother, exposure to toxins, genetics, caregiver responsiveness, and access to prenatal care impact development (nature and nurture) 3 Stages: ~Germinal Stage (0-2 weeks) ~Embryonic Stage (3-8 weeks) ~Fetal Stage (9 weeks-birth)
The Prenatal Period (3 stages)
Motor Control
The ability to regulate or direct the mechanisms needed to move. Utilizes the planes of movements and degrees of freedom in joints to understand how we move in response to changes in the environment or the task.
formal operational (12 yrs - adult)
The adolescent can reason abstractly and think in hypothetical terms.
preoperational (2-6 years)
The child uses symbols (words and images) to represent objects but does not reason logically. The child also has the ability to pretend. During this stage, the child is egocentric.
executive function
The critical factors in developing a strong foundation for these essential skills are children's relationships, the activities they have opportunities to engage in, and the places in which they live, learn, and play
Emotional/Self Regulation
The modulation of emotional control and adaptive behaviors
sensory integration
The recognition, modulation, integration, and organization of sensory stimuli including behavioral responses
Vygotsky
Theorist that emphasizes providing a just right challenge and scaffolding?
cutting shapes (manipulating and turning the paper, differentiation to support cutting shapes)
Third step of scissor skills?
crawling
This motor skill further supports stability, core strength, motor control, etc.
anxiety and depression
Those with early temperament are most at risk for
- use of language for different purposes - changing language based on needs of the listener - following rules
Three types of pragmatic development
problem solving wheel
To develop self-regulation, what tool can you use?
Shy/nervous with strangers- fear; cries if caregiver leaves; has favorite things
Top 2-3 things most babies/kids do at 12 months
begins to smile, calms self briefly, looks at parent
Top 2-3 things most babies/kids do at 2 months
Smiles spontaneously, Likes to play with people/might cry when playing stops, Copies facial expressions-smiling or frowning
Top 2-3 things most babies/kids do at 4 months
Knows familiar faces, likes to play with parents, responds to other's emotions
Top 2-3 things most babies/kids do at 6 months
May be fearful of strangers, may be clingy with familiar adults, has favorite toys
Top 2-3 things most babies/kids do at 9 months
Excited by other children, shows more independence, is defiant, plays along side other children; doesn't share
Top 2-3 things most babies/kids do at age 2
Shows affection for friend's w/o prompting; takes turns in games, separates easily from caregivers
Top 2-3 things most babies/kids do at age 3
Prefers to play with others vs. alone; cooperates w/ others
Top 2-3 things most babies/kids do at age 4
Give child time to warm up to new caregiver; bring fave things for comfort; day "no" to unwanted behaviors
Top 3 things to do to support SE development for a 12 month old
Cuddle, talk to and play during co-occupations, attend to different cries
Top 3 things to do to support SE development for a 2 month old
Encourage helping w/ chores; praise good helping; for play dates, give lots of toys & watch for fighting
Top 3 things to do to support SE development for a 2 year old
Go to play groups to encourage getting along, work with child to solve problems when upset, encourage identification of feelings, praise for rule following
Top 3 things to do to support SE development for a 3 year old
Hold and talk to your baby; Set steady routines for sleep/feeding; have quiet play time when reading/singing
Top 3 things to do to support SE development for a 4 month old
Give child simple choices when you can, encourage to use words, share toys, take turns
Top 3 things to do to support SE development for a 4 year old
Play on floor, learn to read baby's moods, show baby how to comfort self
Top 3 things to do to support SE development for a 6 month old
Stay close so baby knows you're near; routines very important; label what you think baby is feeling
Top 3 things to do to support SE development for a 9 month old
cuddling, getting on floor, consistent routines
Top ways to support child between 2-6 months
tube below the larynx that allows air flow to the lungs
Trachea
carry
Transportation of a hand-held object from one place to another
Contralateral Weight-Shift
Transverse Plane - Rotation within the body axis allows one body segment to rotate in one direction while the adjacent segment rotates in the opposite direction - Weight can then be shifted to one UE and opposite LE while other UE/LE move - This highest-level movement pattern enables a simultaneous weight shift and forward progression (one step process of smooth movement) - Reciprocal patterns of UE movement adapted to non-weightbearing situations - Reciprocal arm swing during ambulation using rotation and counter-rotation
Infant: Erikson's first stage during the first year of life, infants learn to trust when they are cared for in a consistent warm manner
Trust vs. Mistrust
Simple rotation
Turning or rolling an object approximately 90 degrees or less
transverse plane
Twisting movements
Tonic Labyrinthine Reflex
Typical Response: - Prone: Flexor tone of neck, UEs, and LEs. Increases when moved into extension - Supine: Extensor tone neck, UEs, and LEs. Increased when moved into flexion
stepping reflex
Typical Response: A baby will move their legs in a way that imitates stepping
palmar/grasping
Typical Response: Flexion of the fingers when the object is placed
plantar reflex
Typical Response: Flexion of toes
rooting reflex
Typical Response: The baby will search for the object, turn its head towards the stimuli, and opens its mouth.
sucking reflex
Typical Response: The child will suck on the object in its mouth
landau reflex
Typical response: Hips and legs extend, UEs extend and abducts, and elbows can flex.
spinal galant reflex
Typical response: Lateral trunk flexion on the same side of the stimulus
eyeblink reflex
Typical response: Rapid opening and closing of eyes
moro reflex
Typical response: The baby's arms will abduct and externally rotate followed by coming back to midline and bring their hands together
babinski reflex
Typical response: Their toes should extend all the way, followed by flexing/curling up
When are children they ready to dress?
Typically, as soon as they can stand
pre-reaching (0-4 months)
UE activated but asymmetric
sensory integration
Unconscious process of the brain that organizes information detected from senses
greeting - ex. hello or goodbye
Use of language for different purposes example
sensations
Used to maintain responsive contact with caregiver through nursing, nuzzling, cuddling
Cognition in a 24-30 month old
Verbally expresses wants; demonstrates imitation/copying - putting food on plate and eating it
3-4, 3-3.5
Vertical Righting Reaction: Emerges at about __________ months and is inhibited or suppressed between ________ years
#1 choice for developmental eye problems in children, 18 20-minute sessions over 5 pre- and post-treatment reading assessments (increase fluency and comprehension with experimental vs. control group)
Vision therapy for eye movement (fixation, saccades, pursuits)
This is the treatment of choice, lenses or prisms in conjunction with vision therapy
Vision therapy for eye teaming (binocular vision): convergence insufficiency
one component model -ability to see things clearly from any distance
Visual acuity
standard eye examination at a distance of 20 feet to determine the smallest letters a person can read: Snellen chart or E chart
Visual acuity test
ability to analyze and interpret visual stimuli, must understand what we are seeing
Visual analysis
effectiveness of the visual system to clearly and comfortably allow the client to see the environment
Visual efficiency
analyze, interpret, and make sense of the environment
Visual information processing
ability to accurately reproduce a visual stimulus
Visual motor integration
ability to integrate visual information skills with fine motor movement
Visual motor skills
slow, smooth eye movements, also known as tracking ex. continuous image of a moving object
Visual pursuits
R/L on self and projecting awareness into space (others, objects within the environment) ex. laterality and directionality
Visual spatial awareness
Phonological development
Vowels, consonants, double consonants, dipthongs (e.g., coin, loud)
isolated finger movements, supination
WIth hand to mouth, later develop ____________ __________ ____________, opposition of thumbs, etc. once _______________ and wrist extension are well established.
unilateral
Walking with wide base without use of UE is an example of ________ weight shifting
Who's theories were acquisitional learning?
Watson and Skinner, Bandura, and Vygotsky
How do we decide to incorporate activities, environment and occupation as means/tools/methods to support development of the child?
We look at frames of reference
different tasks, one hand stabilizing one manipulating
We need to use both hands together but we often see them performing
contralateral weight shifting
Weight can then be shifted to one UE and opposite LE > while other UE/LE move
adduct
Weight shifting becomes easier with ability of hips to _______ and move asymmetrically- dissociation of hips allows transitional movement patterns to easily get in and out of sitting
cruising
Weight shifting is prevalent in what motor skill?
crawling, cruising, walking
What 3 motor skills are most likely happening from 10 months to one year?
9-11 months
What age is this? - Comprehending actions/commands - Sit to stand/Supported standing -> not fully walking - Hand skills
~9 months
What age is this? - Sit up - Crawl - Babbling - Comprehending words/directions - Stop baby talk
6-8 months
What age is this? - Sitting up - Babbling -> mamama - Bimanual hand skills -> holding toy w 2 hands (symmetrical holding pattern)
2 years
What age is this? - Understand 1/2 of what they say - 50 word vocab - 2 step command - 2-3 word sentences - Playing alongside children, not with each other - Parallel play - Defiant - Bimanual hand skills -> (differentiated holding pattern)
hand to mouth
What allows for soothing (self-regulation and teething)?
- praise - attention - description - active listening
What are examples of positive communication?
- vowels - consonants - double consonants - dipthongs
What are meaningful units of language?
to hold positions and/or for redistributing tone in anticipation of or during changes in position
What are postural strategies needed for?
tactile discrimination, tactile protection, vestibular and proprioceptive
What are the body-related senses?
hearing (auditory), vision (visual), smell (olfactory), taste (gustatory), touch (tactile)
What are the exteroceptive senses?
authoritarian, authoritative, permissive, neglectful
What are the four types of parenting styles?
vestibular and proprioception
What are the interoceptive senses?
prone and sitting, propped on hands, awareness of gravity and working against it
What are the preferred positions during the first 6 months?
-physical development (GM/FM/VM) -cognitive development (problem solving) -communication development -social emotional development -adaptive development (ADL/IADL)+play
What are the three developmental domains?
1. breathing, hiccuping, sneezing - maintain oxygen 2. crying, shivering, tucking legs into self, pushing - maintain constant body temperature 3. sucking, rooting, swallowing - to support feeding
What are the three reflexes designed for survival?
exteroceptive and interoceptive
What are the two types of senses?
stability produce postural tone
What are tonic/attitudinal reflexes for?
repetitive shaking, banging, filling, and dumping to understand how things work
What cognitive skills were described as occurring from 10 months to a year?
facial expressions, sounds, movements
What communication skills are prevalent during 6 months of age?
activate muscles/groups through full range (mobility)
What do phasic reflexes do?
non-weight bearing situations ex. reciprocal arm swing during ambulation using rotation and counter-rotation
What do reciprocal patterns of UE movement adapt to?
simultaneous weight shift and forward progression -one step process of smooth movement
What does contralateral weight shift enable?
hunger, thirst, digestion, mood, heart rate, state arousal
What does it mean to be an interoceptive sense/what is regulated?
postural control muscle control strength
What does mobility require?
upright positioning for -reaching -placing -feeding -dressing -playing
What does postural control allow for?
spinal alignment muscle tone strength
What does postural control require?
Primary movement needed for engagement in occupation -mobility -hand skills/manipulation
What does postural control support?
foundation for simple and complex movements
What does postural stability provide?
sensorimotor unit -sensory and motor information
What does postural strategies and movement strategies depend on?
scapular stability
What does supine position promote?
demands on trunk → enabling effort towards head, oral, ocular, and shoulder control
What does supine position reduce?
past experiences present situation anticipated outcome
What does the use of strategies depend on?
the body's midline and its proximal joints
What does tonic or attitudinal reflexes most frequently offset?
development of prone extension, sitting and standing
What does vertical righting reaction slow?
Pragmatic development
What domain of language acquisition is this an example of? - What was speaker's intended meaning OR what was implied by the utterance - E.g., I'm so hungry, I can eat a horse"
picking up small things that they may have not noticed before
What fine motor skills are prevalent at 9 months old?
ulnar fingers before radial fingers and thumb
What fingers activate first?
sitting upright, exploring with hands
What gross motor skills are prevalent at 9 months old?
-difficulty with hand-eye coordination -difficulty crossing vertical midline -difficulty with visual tracking -difficulty with bilateral intergration
What happens if ATNR persists?
-interferes with turning on side -prevents rolling -may inhibit return "embrace" phase of moro -cannot hold supine flexion -cannot sit up independently from supine -cannot hold head up in prone
What happens if tonic labyrinthine reflex is not integrated?
may indicate excessive tone or spasticity
What happens is vertical righting reaction appears too early (1 month)?
Verbally supporting social interaction
What is OT's role in Language? (Performance skills: Social interactions)
crawling and creeping
What is STNR a precursor for?
have knowledge of body functions and understand broadly the interaction that occurs among these functions to support health, well-being, and participation in life through engagement in occupations
What is an OTs role in language?
proprioception, knowing how much pressure to apply
What is grading force?
skills emerge and develop over time with varied experiences
What is important to note about typical patterns of development?
Shoulder protraction and flexion against gravity
What is required for scapular stability?
posture
What is the biomechanical foundation for movement?
Extrinsic activation dominates (strength) before intrinsic activation (manipulation)
What is this an example of?
Proximal patterns (palmar grasps) precede distal patterns (finger grasps)
What is this an example of?
Ulnar fingers activate before radial fingers and thumb
What is this an example of?
cooing
What may a 3 month old do?
opposite extremities -supine, prone (5-6 months) -sitting (7-8 months) -standing (12-21 months) ex. if child is pushed backwards trunk curves forward with forward movement of extremities
What may assist in bringing head and trunk back towards midline?
equilibrium reaction
What might the protective reaction replace when displacement is more vigorous?
Side to side movements
What movements is the frontal plane responsible for?
forward and backward/ up and down movements
What movements is the sagittal plane known for?
rotation and twisting
What movements is the transverse plane known for?
assume and maintain their position
What must an infant do before being able to move in the position?
prone
What position is supervised until infant can independently roll > place on back for sleep
prone
What position promotes head and neck control?
prone
What position promotes proximal stability and sensory feedback?
prone
What position promotes strength & coordination (weight bearing, weight shifting, etc.)
prone
What position promotes use of eye and visual system?
sensory integration
What promotes body schema?
sensory integration
What promotes internal awareness of self and automatic control of one's body?
sensory integration
What promotes kinesthesia?
sensory integration
What promotes postural control?
sensory integration
What promotes reflex integration?
proprioception
What sense is this? - Feedback from muscles and joint where are limbs are in space
proprioception
What sense is this? - Muscle spindles and golgi tendon organs
proprioception
What sense is this? - Need for motor planning and motor memory
proprioception
What sense is this? - Perception of joint and body movement
proprioception
What sense is this? - Rate and timing of movements
tactile
What sense is this? - Receptors provide information about the qualities of touch and pressure sensations and speed/direction of moving objects over the skin
proprioception
What sense is this? - Sense of effort (grading force used) and its memory
tactile
What sense is this? - Sensory experiences elicited through the skin
tactile
What sense is this? - Subjective experience of touch shaped by experience and one's interpretation of the stimuli
tactile, vestibular, proprioceptive
What senses did Ayres focus on?
mainly babbling
What should a two year old NOT be doing?
a number of body parts
What should a two year old be able to point at?
sensorimotor
What stage of cognitive development would a 6 month old be experiencing, based on Piaget (note the developmentally appropriate toys- texture, color, firmness, etc.)
Autonomy vs. Shame and Doubt
What stage of psychosocial development would a 10-12-month-old be experiencing when learning to crawl, cruise, or walk based on Erikson?
vestibular
What system is this? - Characterized by inner drive to master gravity
vestibular
What system is this? - Functions as a gravity and movement detector
vestibular
What system is this? - Responsible for our orientation in space, balance and equilibrium, and the coordination of head and eye movements, enabling coordinated movement through space.
sensory
What type of integration leads to adaptive responses?
back and forth
What types of interactions are prevalent at 6 months?
The "back to sleep" movement -dramatic reduction in sids -tummy time is more important for head control and neck flexion
What was introduced in 1994?
swiping, hands to midline, exploration of feet to mouth
What will you see in supine positions?
skills/tools that they have already developed
When a child is very upset, it is difficult for them to access
3-3.5 years; preschool age
When can a child cut 6 inch lines?
2.5 years; prior to preschool
When can a child cut 6 inch page of paper?
6-7 years; kindergarten age
When can a child cut a variety of shapes
3.5-4 years; preschool age
When can a child cut circles?
4-5 years; preschool age
When can a child cut squares?
8-10 months
When can a child drop objects systematically (object permanence- enjoys doing this)?
2.5 years
When can a child feed self with spoon without spilling;
1.5 years
When can a child feed with spoon and spilling; drinks from open cup?
9-10 months
When can a child hold an object in each hand and bang together?
10 months
When can a child hold an object in one hand and explore with the other hand?
5 years
When can a child identify letters and speak in longer sentences?
pre-reaching (0-4 months)
When can a child later track objects and swipe or bat
1 year
When can a child place objects in a container (containerizing)?
2.5 years
When can a child put on simple clothing (no fasteners)?
2 years
When can a child remove shoes and pull off clothing simply?
1 year
When can a child remove socks; put on/removes loose fitting hat, push arms through sleeves and legs through pants; use fingers to self feed and brings filled spoon to mouth?
13-14 months
When can a child scribble?
2 years; prior to preschool
When can a child snip with scissors?
2.5-3 years
When can a child snip with scissors?
15-18 months
When can a child stack 2 blocks and containerize raisin in small bottle; complete large, simple puzzles with pegs?
3 years
When can a child string beads?
6 months
When can a child transfer an object from hand to hand by fully opening the releasing hand
2 years
When can a child understand half of what they say?
3 years
When can a child understand most or all of what they say?
2.5 years
When can a child wash hands fully and brush teeth with help?
pre-reaching (0-4 months)
When can hands open/close or be brought to mouth
appear if needed to support voluntary activities disappear or 'released' by CNS damage such as TBI, stroke, seizure disorder
When can reflexes appear or disappear?
head lifts with weight shift towards pelvis area
When developing antigravity movement, center of gravity shifts how?
weight bearing
When developing antigravity movement, increasing stability promotes _________________
deep and proximal
When developing antigravity movement, tonic contractions of muscles that lie ________________________ occur - Position held statically - 2 months: prone - 2 months supine
1 year
When do children find delight in containerizing, dumping and repeating? - Understanding of functional purpose of objects
pre-reaching (0-4 months)
When do newborns show visual regard to close objects → activates arms in response (rarely comes in contact)
when the grasping reflex diminishes
When do palmar grasps occur?
6 to 9 months
When do protective reactions appear?
3 months
When do you see asymmetrical patterns, swiping and batting?
3-10 months
When do you see symmetrical patterns, bilateral reach, grasp, mouthing hands and toys?
4 to 6 months
When does STNR emerge?
6-8 months
When does a child begin to babble: "mamamama" and "dadadada" and "babababa"
2 years
When does a child begin to scribble?
preschool
When does a child cut a 6 inch line?
prior to preschool
When does a child cut a 6 inch page?
preschool
When does a child cut a circle?
preschool
When does a child cut a square?
kindergarten
When does a child cut a variety of shapes?
4-5 years
When does a child draw a person or object?
Age 2
When does a child get a sense of grammar?
3 years
When does a child have coordinated and simultaneous use of 2 hands?
reach to grasp (4-8 months)
When does a child rely on eyes (need to look to figure it out) and make corrections on way to contact: opening of hand in preparation to grasp an object develops)
prior to preschool
When does a child snip with scissors?
1 year
When does a child use the word "up"
1 year
When does a child use words to attract adult attention
4 years
When does complex rotation occur?
9 months
When does comprehension of words/actions further emerge when used in context?
6 months
When does haptic protection emerge?
5-6 years
When does haptic protection mature?
0-4 months
When does pre-reaching occur?
4-8 months
When does reach and grasp occur?
3.5 years, inconsistently
When does shift occur?
2-2.5 years
When does simple rotation occur?
in utero
When does the ATNR reflex emerge?
4-6 months
When does the ATNR reflex integrate?
in utero
When does the palmar grasp reflex emerge?
6 months
When does the palmar grasp reflex integrate?
positioning in prone
When hands are closed, we can't get weight bearing through hands. To reposition, we can bring a wedge in so that he isn't working as hard.
6 months
When is ATNR inhibited?
9 to 12 months
When is STNR integrated?
6 to 9 months
When is STNR visible?
during the first year of life
When is our brain's foundation most impacted by experiences and language?
6-8 months
When is the first sign of comprehension with familiar words- own name, mommy, daddy?
first 6 months
When is there a greater awareness and interest?
when a child guides his or her hand movements using visual and somatosensory information, the infant can anticipate and plan refined movements, has a mental picture/map, somatosensory input continues to refine
When is visual perception developed by 9 months?
when a child develops emerging skills using visual-tactile perception
When is visual perception developed in a 4 month infant?
motor learning
When learning a new skill like riding a bike, people (usually) do not start with a bicycle. They may start with a tricycle or training wheels, then with enough practice and experience move to a bicycle. Even on a bicycle, they may fall off because their body is learning how to maintain their balance and posture while simultaneously using their legs to move the pedals. By falling off the bike and getting back on it to keep going, you are using __________ ___________!
babies gain confidence
When learning to walk, cruise, and crawl, what happens as a positive result of these actions?
2 years
When may a child ask questions and point to named objects?
1 year
When may a child call caregiver by name: "mama" and "dada"
9 months
When may you see this: Blow kisses"; "Cookie?, following directions...
9 months
When may you see this: "Do you want your bottle?"; "wave bye bye", following directions...
18 months
When may you see/hear a name and a request? - "mama car" - "dada binky" - "Taylor car" - "Thank you"
2 years
When may you see/hear sentences of 2-3 words?
18 months
When may you see/hear the first two-word sentences?
By the time they are 21 months old - ex. "come here"
When should a child be able to follow simple directions?
15 months
When should a child be using single words?
15 months ex. no, bye-bye, and bottle (if appropriate)
When should a child know simple words by?
2 years old
When should you encourage IADLs
clarifies
When the OT responds to gestures or verbal message that communication partner doesn't understand to be sure partner can follow conversation
matches language
When the OT uses socially appropriate tone of voice and level of language appropriate to communicate partner's level of understanding
Vertical/Righting Reactions
When the head is not aligned with the body, righting reactions are used to realign the head and the body.
palmar grasps
When the palmar reflex diminishes and becomes integrated between 3-6 months, the infant begins to develop
IN ALL PLANES
Where does weight shift occur?
avoidant attachment
Which attachment does this describe? - Emotionally distant, indifferent, not explorative
Disorganized attachment
Which attachment does this describe? - Extreme, erratic, frightened or frightening
secure attachment
Which attachment does this describe? - Secure, explorative, happy
secure attachment
Which attachment is this? - More responsive to needs (quick, sensitive, consistent) - Infant trusts needs will be met
Disorganized attachment
Which attachment is this? - Severely confused with no strategy to have needs met, no organized method for dealing with stress
Resistant attachment
Which attachment is this? - Stay close, don't explore- yet at same time anxious with caregiver - Very upset upon caregiver leaving; not comforted upon return - May demand to be picked up, crying-struggle to be free on the attempt
avoidant attachment
Which attachment is this? - Subconsciously believes needs probably won't be met - Stranger may be as likely to soothe as caregiver
Resistant attachment
Which attachment may reveal troubles from the start?
left
Which hemisphere is dominant in language acquisition?
extrinsics
Which muscles allow for these grasp patterns? - Power grasp - Hook grasp - Spherical grasp - Disc grasp - Lateral pinch
Trust versus Mistrust and Autonomy vs. Shame and Doubt
Which one of Erikson's theories does this represent? - Caregiver who is responsive enables secure infant who trusts (Goodness of fit) - Caregiver not responsive infant learns to distrust and withdraws - Develop a sense of self (autonomy) as competent or not
Autonomy vs. shame & doubt
Which stage of identity development is this? - 2 years - What can I accomplish. "No, I do!" - "I want this one" - Child can do more themselves
Initiative vs. Guilt
Which stage of identity development is this? - Goal oriented, social participants - Beginning to conform to social roles and moral standards of society
Trust vs. mistrust
Which stage of identity development is this? - Infancy (~7 months) - Am I safe to explore, caregivers reliable?
Piaget
Which theorist emphasizes active exploration for learning (cognitive development)?
self and others
Who does social emotional development involve?
Erikson Psychosocial
Who's theory and which theory is this? Trust versus Mistrust and Autonomy vs. Shame and Doubt
to build independence
Why is it important to encourage fine and gross motor skills for a 9 month old?
it builds language skills and nurtures social development
Why is it important to interact with an infant using back and forth interactions?
allows child to experience thrill of moving body to reach a goal
Why is it important to place toys out of reach for a 6 month old?
the thumb has a more complex role
Why is palm-to-finger translation more complex than finger-to-palm translation?
coming up with steps to come up with idea, sequencing
Why is praxis important in the first 6 months?
In terms of self: - self awareness - self management - self control (self regulation) In terms of others: - empathizing - relationships - perspective taking
Why is social emotional development important?
- Begin working against gravity - Auditory and visual: not very developed - Modulation/Arousal: immature nervous systems are easily overstimulated - Leads to caregiver attachment and ability to form relationships
Why is touch, smell, and movement important in a newborn?
purposeful actions and occupational development, goal directed
Why is voluntary control important in the first 6 months?
to show them how to do it the right way bandura- modeling
Why would you imitate what they child does?
- adaptability to change - regularity - intensity of reactions - attention span - energy levels
With temperament, what do we look at?
signing
Without language delay, young age, __________ to communicate between child and adult further enhances communication and decreases frustration
remember what they are doing on the next turn
Working memory is important because the child must
NIDCD
_________ > Critical Period > Birth to three years
body scheme
_________ ________ is important when it comes to bimanual skills
puberty
_________ and emotional development are linked, this is also a time where we see heightened vulnerability in expressing psychiatric illnesses
crawling
_________________ is such an important aspect, but is no longer a milestone! - Helps to support so many areas moving forward - Went from these are the milestones of 50% of children to 75% of children, we have adjusted them - Must consider the implications, assessments still call for the old milestones
Adaptive response
a child takes in information, processes, integrates, and acts on the information in the environment. Meeting challenges that they find in the world successfully
What do family relationships foster?
a child's readiness to assume a place in society and the community
Opthamologist (MD)
a doctor who treats eyes and their diseases usually through medication or surgery
According to AOTA (2008), play is
a fundamental right - essential to growth, learning, and development
When starting dressing, what should you start with
a loose fitting, pull-on
Postural control
ability of muscle to produce tension, requires spinal alignment, muscle tone, and strength
mental flexibility
ability to adapt to responses from another person
Phonological development
ability to segment speech sounds into meaningful units of language
What is another name for eye focusing?
accommodation
What type of testing is this?
accommodation, eye focusing
Protective reactions
accommodations to vestibular, tactile pressure alterations from the surface and to sensory awareness of impending change *always available for use once developed*
Is constructivism theory an active or passive process?
active
Postural fixation
acts to maintain joint position against internal or external force; obtained by joint co-contraction of antagonist muscles around the joints
Purposeful and goal direction actions on the environment that are successfully achieved
adaptive response
Postural tone
adds to muscle tone in extensor muscles that work against gravity
in-hand manipulation
adjustment or movement of an object within a hand
Which stage in the family life cycle does this describe? -Increased social stigma from peers.
adolescence
Which stage in the family life cycle does this describe? -May be a stressful time with growing social, financial, and sexual needs.
adolescence
Which stage in the family life cycle does this describe? -Parents have difficulty caring for child's growing physical and emotional needs.
adolescence
Which stage in the family life cycle does this describe? -Parents may be increasingly concerned about child's vulnerability.
adolescence
Which stage in the family life cycle does this describe? -Parents need to explore information regarding supportive living/housing; challenges in finding employment
adolescence
Visual information processing
again vision therapy over lenses, prisms
Three jaw chuck
age 10-11 months full opposition of the pad of thumb to pad of both the index and middle fingers. May keep 4th and fifth digits extended (versus true tripod with 4th and 5th digits flexed, denoting separation of the hand-necessary for in hand manipulation skills) similar to tri-pod grasp used to write alter on
Neat pincer grasp/tip pinch
age 10-12 months flexion of all of the joints in the thumb and index fingers so that the tip of the finger and the thumb come together
Pincer grasp
age 10-12 months full opposition of the pad of the index finger to secure the object
Finger-to-palm translation without stabilization
age 12-15 months the child begins finger extension and moves to finger flexion
Simple rotation
age 2 to 2.5 years child turns or rolls an object held at the finger pads approx 90 degrees or less the fingers act as a unit and the thumb is opposed
Palm-to-finger translation without stabilization
age 2-2.5 years the child begins with finger flexion and moves to finger extension
Crude palmar grasp (ulnar palmar)
age 3-5 months, thumb not involved, object is held firmly against the heel of the hand through crudely clumsy and often unsuccessful
Palmar Grasps
age 3-7 months objects secured in the palm by fingers ulnar to radial development more proximal than later grisps
Shift
age 3.5 years, inconsistently involves linear movement of the object on the finger surface to allow for repositioning of the object on the pads of the fingers the fingers move slightly on the MCP and IP joints, and the thumb typically remains opposed or adducted with MCP or IP extension throughout ex. separating two pieces of paper, insert coin into slot, moving a pencil to a different position while writing notes
Complex rotation
age 4 years child rotates a small object 180 to 360 degrees once or respectively the fingers and thumb alternate in producing the movement and the fingers move independently of one another
When should a child begin to see an eye doctor for an eye examination?
age 6 to 12 months
Radial palmar grasp
age 6-7 months the index and middle fingers flex around the object to secure in the palm (thumb begins to oppose) object is secured in the radial side of the palm
Raking grasp
age 7-8 months the hand is positioned in a rake-like manner with all of the fingers flexed at the IP joints around the object
Inferior pincer grasp
age 8-9 months thumb adduction and emerging opposition to secure the object against the extended index finger object is held proximal to the pad of the index finger
radial digital grasp
age 8-9 months thumb opposition to the radial side fingers object is held proximal to the pads of the fingers space is visible between the object and palm and the ulnar side (ring and pinky) are flexed
BADL milestones, bathing, hygiene, and grooming: At 10-12 years (pre-adolescence), a child is independent in
all aspects of personal hygiene and grooming - Haircare, applying deodorant, brushes and flosses, apply make up, etc. - Cueing systems and reminders needed at times
extension
anterior pelvic tilt is built by
Flexion and extension
are primary components in bilateral patterns
Repetition cue
ask the child to look again
How are saccades examined?
asking the client to look from one target to another both vertically and horizontally -4 inches from midline -16 inches from the face -5 rounds of each vertical and horizontal for a total of 10 rounds
2-3 years
associative and parallel play
3-4 years
associative play, prefers play with other children; sharing and turn taking; wants to be a friend
When is the gag reflex diminished/not as strong?
at 4 months
When does cutting of the first teeth occur?
at 6-10 months
How many times should a child between the ages of 3 and 5 go to the eye doctor?
at least once
If the child is at risk, how often should they go to the eye doctor?
at least once or how often it is recommended by the eye doctor
grasp
attainment of the object within the hand; holding within the hand
Medical term for the sense of hearing
auditory
Adolescents
autonomy and being socialized into adult roles; technology to improve social participation
body scheme
awareness of body parts and the position of the body and its parts in relation to themselves and the environment
9 to 12 months
backward protective extension in sitting
Activities oriented toward taking care of one's own body
basic ADLs for children
ADLs also are referred to as basic activities of daily living (BADLs) and personal activities of daily living (PADLs). These activities are "fundamental to living in a social world; they enable _____________________ and well-being"
basic survival
Why can an infant dip the spoon and not scoop?
because they are unable to supinate their forearm
How often should a person from 6 - 17 years of age go to the eye doctor?
before first grade and then annually after that
12-18 months
begins with peer interaction; parallel
Watson and Skinner had which theory?
behavioral, primary focus on observable behaviors AND their consequences
Weight bearing
being able to support some percentage of the body's weight (mass, load), as in full weight bearing (able to support 100% of the body's weight)
Active engagement in occupations within the contexts that children participate provide opportunities for social, educational, and cultural inclusion. Physical and social inclusions are the first step in the process of active engagement and participation. (Being a part of, connected, included, fitting in with their social communities)
belonging
sagittal
bilateral weight-shifting occurs on the _______ plane
Eye teaming
binocular vision
What type of testing is this?
binocular vision (eye teaming)
Infancy and toddlerhood
birth to 24 months
ADLs are important because they allow for maintaining and improving _________________ and health
bodily functions
_________ control proceeds ___________ control
bowel, bladder
Teeth outcome
break down solid food into smaller particles in prep for swallowing
When does the brain mature faster and brain activity resembles that of a sleeping newborn?
by week 28
Stimulus bound effect
cannot ignore peripheral stimulus when attempting to focus attention on one thing -very distractible bc the child must pay attention to everything
developmental theories explain/describe the inner relationship between __________ (nature) and ___________ (nurture)
capacity, environmental experience
in tune with the child
caregivers are responsible for supporting a child's temperament by being
-Easy (40%) -Slow to warm (15%) -Difficult (10%) -The rest (35%) have mixed characteristics and cannot be classified
categories of temperament
Tongue action of intrinsic muscles
change shape of tongue to form bolus
Shift
changing position of fingers on a pen, buttoning
What is this called?
child occupational self assessment (COSA)
What is the age range for the Beery VMI?
children 2 years - 99:11 years
Why is play on the decline?
children are unable to experience the outdoors like they once were -parents are too scared to let their kids play outside or in neighborhoods -school work demands are greater than ever
Play
children learn that they are in control of their own life -get along with peers and empathy -creative and innovative
Culture
children's developmental abilities are based on cultural priorities
With near vision, what is happening with the ciliary body and lens?
ciliary muscle contracts and changes the shape of the lens
Third thing a child can draw is a
circle
Main domain of constructivism theory?
cognition
In the organismic view, Piaget's early beliefs were what
cognitive change (functional change) resulted from structural change within the developing neurological system > theory of cognitive development
How to get education and training as part of intervention?
collaborate with schools and caregivers
What does the esophagus do at rest?
collapses
Equilibrium reactions
compensatory movements used to regain midline stability when alignment of midline with gravity is significantly disturbed
6 to 10 years
competes in sports, peer play predominant, groups of consistent play
strategies
components of adaptive sequences
Prenatal
conception to birth
How does development relate to OT?
conception to death (womb to tomb)
Action of lips and cheeks
confine food between teeth
Establishing toileting routines
consistency! - observe caregiver use bathroom - play pretend toileting - touching materials in the bathroom (toilet paper, flushing) - implementing toileting after waking up, before leaving house, before bed time, etc. - clothes that are easy to remove - elastic waistbands - comfortable inviting environment - foot rest - exciting towels to use when finishing - don't rush, sing a song, run sink, play music - coaching how much toilet paper to use
What theory believes this? - children progress through stages of cognitive development
constructivism
What theory has this impact on OT? - Understanding the importance of the child's inborn curiosity and drive toward active acquisition of knowledge
constructivism
Which view is this? - Considers relationship between the child and their physical, cognitive and social worlds - Occupation-centered perspective - "Individuals are inseparable from the society with which they are members" (p. 3) - Examines socio-cultural and environmental influences on development
contextual
Strategies for improving sleep in 5-12 year olds
continue consistent and regular routine, make sure environment supports child's ability to sleep, avoid caffeine, keeping tv and computers out of the bedroom
Palm to finger with stabilization (separation of the hand)
continues to work on stabilization until 4 years the child begins with finger flexion and moves to finger extension, with the 4th and 5th digits flexed into the palm
Rotation in and out of a position
contralateral weight shift with lateral and rotational movement components ex. seated child leaning forward to rest arms on desk -neck extension is the righting reaction
transverse
contralateral weight-shifting occurs on the _______ plane
Postural control
controlling body position in space for stability and orientation
What is the leading cause of eye strain?
convergence insufficiency
bimanual skills
coordinated use of the two hands together or simultaneously to accomplish an activity
Transverse plane
cuts the body in top and bottom
Sagittal plane
cuts the body into left and right
Being able to look at letters and put meaning to them so you can read them
decoding
VM integration is key component to
decoding words
Effects of disability on play and family
decrease in physical interactions, cognitive and communication concerns, sensory impairments, integrating sensory input etc... and interactions with environment and others
Goal of vision therapy
decrease symptoms and increase functioning (esp in reading and copying notes)
Sleep problems in adolescence can lead to
depression and anxiety disorders; poor school performance; greater risk for obesity
ADLs promote self-esteem, self-reliance, self-_______________, sense of ______________
determination, autonomy
Sequential changes in functions that occur within biologic maturation and environmental experiences of children
development
What theory is this? - Based on knowledge of typical human development
developmental theory
What theory is this? - Focus is on biological capacity and environmental experience
developmental theory
What theory is this? - Occupational therapists base their interventions for children upon understanding and appreciation of typical development
developmental theory
babinski, eyeblink, spinal galant, landau, moro, palmar grasp, plantar grasp, rooting, stepping, sucking
different types of phasic reflexes
Asymmetric Tonic Neck Reflex (ATNR), Symmetric Tonic Neck Reflex (STNR), and Tonic Labyrinthine Reflex
different types of tonic reflexes
Bilateral integration
differentiated and integrated use of the two sides of the body
irregular in body functions, may be fussy, bowel and bladder management is impacted - respond intensely to events
difficult babies have
What does the endoderm become?
digestive and respiratory system
What writing grasp development is this?
digital pronate
Two types of tactile sense
discrimination and protection
Proximal support (trunk and neck) allows for
distal movement and control of BUE's and of oral motor skills
Fine motor skills in children
distal skills - in-hand manipulation - grasp patterns - bimanual skills - hand separation
What does the esophagus do as food passes?
distends/stretches
ATNR
distributes tone in opposite patterns on either side of the midline
Myopia is difficulty with which oculomotor skill?
divergence
Extrinsic activation (strength)
dominates before intrinsic activation (manipulation)
When dressing at 1 year, they are not _________ yet
donning
How is the three component model of vision used?
during a thorough eye exam
Unexpected difficulty with acquisition and production of spelling and writing skills
dysgraphia
Which stage in the family life cycle does this describe? -Diagnostic process → complicated and lengthy
early childhood
Which stage in the family life cycle does this describe? -Parents request information/ask questions -Education, education, education Ex: play environment; developmentally appropriate toys. How roles, routines, etc., change over time!
early childhood
just right level of activity, easy to soothe, playful, constant activity level - child is available for learning and gains social-emotional development through co-occupations - easily adaptable to different caregivers
easy babies have
What theory does this support? - Family/environment/peer networks/geopolitical contexts (Urie Bronfenbrenner)
ecological theory
What theory is this? - Belief that growth is nurtured
ecological theory
What theory is this? - Capacity to develop across the lifespan
ecological theory
What theory is this? - Children change based on environmental interaction (context) and heredity
ecological theory
What theory is this? - Development involves reciprocal interaction among cognitive, behavioral, and biological aspects along with knowledge of the environment to understand growth and change
ecological theory
What theory is this? - Theories that emphasize influence of the environment
ecological theory
give them opportunities for self-actualization bc basic needs are met-do schoolwork and facilitate ability to engage in extracurricular activities
effect of high SES on a child
parent may be struggling to provide basic needs such as food and shelter so the child cannot work on social interaction, education or self-actualization bc basic needs are not met or parent is not available to facilitate their needs
effect of low SES on a child
When can Malformation of neural tube occur? (Spina Bifida (closed and open)
embryonic stage during neural tube formation
Nonverbal cues allow OT to see how child is experiencing
emotions at mealtime, reaction to what they are eating, food preference
Goal of OT interventions
enable children to actively participate in occupations and co -occupations they need to do, want and are expected to do
Ability to write words using letters
encoding
Analysis cue
encourages child to look more closely (describe further)
When are all body parts formed by?
end of week 12 (by 3 months)
Cochlear implants
enrich the language environment
Piaget's contribution to play
environmental interaction is an active process for children to learn
What do the salivary glands contain?
enzymes -amylase moisten, soften and break down foods also helps to clean teeth and the tongue
What folds down to protect the airway (trachea) during the pharyngeal phase?
epiglottis
conditional
everything, where this is going, thinking about the future for the client
Spiraling Hierarchy
ex. crawl to creep symmetrical UE pattern asymmetrical UE pattern -regression to earlier behaviors as more mature and adaptive versions of skill emerge
1-12 months
exploratory and functional play
reach
extension away from the body and movement of the arm for grasping or placing objects
Strategies for improving sleep in adolescence
external aids such as melatonin, later school start times, limiting use of smart phone, switching out smart phone to alarm clock, taking bath, reading book, writing in journal
strength
extrinsic muscles provide?
How to model play behavior in intervention?
facilitate immaginative and pretend play to encourage creativity/role playing and practice social skills
Importance of ADLs: child contributes to the
family
two or more people that share an emotional bond -carry out typical family functions -emotional bonding -roles, rituals, habits, routines -commitment to pool resources
family
Hyperopia
farsightedness
What is the oral cavity filled with for infants?
fat pads
Important changes in sensory capacities: - Touch (beginning of fetal period) self-soothing - Motion (~5 months) - Vestibular system of the middle ear begins to function > orient self - Hearing: fetus responds to sound outside of the womb around 5-6 months - Seeing: eyes open and close/respond to light → less developed - Self-regulation and survival: Breathing, hiccupping, sneezing > build muscles responsible → maintain Oz levels - Crying, shivering, tucking legs into self, pushing → maintain body temp - Sucking, rooting, swallowing → survival mechanism
fetal period (5 months shown)
- Lungs capable of breathing air outside womb - Age of viability(28weeks): meaning, able to survive outside of the uterus. - Hearing: detects changes in sound! → Important for language development
fetal period (7 months shown)
Key elements of intervention activities include
fine motor: how is the child buttoning, zipping, holding onto the pole gross motor: how are they hitting, kicking, hitting a target, throwing Drawing and copying forms: VMI
voluntary release
finger extension allowing for intentional release of handheld object at a specific time or place
When does a child begin to have voluntary movements with play?
first 6 months
When does a child have inner drive to rise up against gravity?
first 6 months
When is a child banging blocks together to play at midline?
first 6 months
Intervention for visual saccades
fishing game with fish NOT moving around in the container while trying to use the fishing pole to get out a specific colored fish
Intervention for visual pursuits
fishing game with fish moving all around in the container while trying to use the fishing pole to get it out
Is critical in growth and development of SC.
folic acid
What is oral motor development not always related to?
food
Outcome of lips and cheeks
food is chewed during mastication
postural reactions
form the basis for achievement of functional motor skills - automatically provide for maintaining the body in upright position through > changes of muscle tone > in response to position of the body and its parts
Why should OTs evaluate play?
form: categories of activities -pretend, sensorimotor, exploratory, symbolic/dramatic -games, building/construction, social -team sports/digital
practitioners need a basic understanding of many different ___________ to select those most applicable to therapeutic situations
frames of reference
Eating by 5 years old
fully functioning adult patterns for oral control, may use knife when feeding
Studies show ________ achieve toilet-training earlier than ________.
girls, boys
Muscle tone
gives a muscle its rigidity or flaccidity. Muscles need enough tension to weight shift to move
Muscle tone
gives muscle rigidity -enough tension on the muscle for weight shift with enough give or quick changes in movement
What does the self-directed nature of play do?
gives play its creative power
side sit
good for extending one side versus other
How to test for directionality
grab the water bottle on MY left (asking another person)
long sit
greater control around hips and greater pelvic stability (hips adducted)
As we get older, ________________________________ skills improve and help with tasks such as dressing
gross and fine motor
5-6 years
group activities, organized play, winning-mastering rules
Medical term for the sense of taste
gustatory
What creates structure in a family?
habits and routines (lower levels of order must be met to reach higher levels of order)
What does being cradled allow for?
hands to midline
Spherical flipper treatment for accommodation issues
helps with the focusing system, one of the sides will make the focusing system have to work harder to see clearly, one side will cause your eyes to relax to see clearly (one side is a plus and one is a minus), you do this with letters that are near
Additional supportive options for a child to sit at the table
highchair and booster seat, allow for hands free opportunities for caregivers
TLR (total labyrinthine reflex) in prone
hip-knee flexion with shoulder protraction and further flexion
ring sit
hips ABD and ER, knees flexed
Second thing a child can draw is a
horizontal line
When will a child benefit from glasses?
if they have a visual integrity issue
Virtual context of play
impact of internet, games and social networking
key to integration of bringing senses from both sides of the body
importance of midline
Sensory diet
individualized activities and strategies put into action for each child, individualized interventions
Bilateral weight shift
infant can move -forward -back or up -down using UE or LE bilaterally and shifting weight from upper to lower and vise versa
Weight bearing
infant maintains position in space supported by bearing weight on specific part of trunk or extremities
The child's self-determination and motivation to participate in sensory experiences
inner drive
typically 2 years
integration age of babinski reflex
maintained throughout life
integration age of eyeblink reflex
Typically, by 4-9 months
integration age of plantar reflex
Typically, 3-4 months
integration age of rooting reflex
1-2 years
integration of landau reflex
Typically, 6-8 months. However, startle to loud noises is permanent.
integration of moro reflex
A child with STRONG internal protective factors may display
intelligence, positive affect, emotional regulation
"W" or heel sit
internal rotation of hips and AD
Which sense tells us when we are hungry, full, when we need to use the bathroom, when we have a stomach ache, when we have fever?
interoception
_______________________ relates to the regulation of hunger, thirst, digestion, mood, heart rate, and state of arousal
interoception
Senses felt within our body
interoceptive senses
Haptic perception
interpretation of object through active touch
proprioception
is critical for molding of the infant and development of body scheme
Why is play important?
it is natures means of ensuring that kids acquire the skills, abilities, and interests they need to develop successfully into adulthood
ROM
joint flexibility and active range for voluntary movement
An activity that provides enough challenge but still enables the child to complete the activity successfully
just right challenge
Socializing during mealtime helps to build
language and nonverbal communication skills
What do preschool and kindergarten skills encompass?
language appreciation
With far vision, what is happening with the ciliary body and lens?
lens is relaxed, ciliary body is relaxed
May increase speed and accuracy of saccadic fixation
letter chart for saccadic therapy
Interventions for saccades
letter chart for saccadic therapy, use a pencil at the same time with letters as well to improve reading
the ability to use printed and written information to function in society, to achieve one's goals and to develop one's knowledge and potential
literacy
Semantics
literal meaning of phrases and sentences
Important tips for sleeping at the preschool stage
maintain a regular and consistent sleep schedule
Equilibrium Reactions
maintain and restore a person's balance in all activities
Health of family
maintains good health
What were some of your family occupations and how did they change over time?
master routines and habits, change in responsibilities
Play is a context in which what occurs?
mastery achievement adaptation
Pragmatics
meaning in context of discourse
Letter chart for saccadic therapy, additional difficulty - use of
metronome and balance board
sensorimotor stage: Piaget! - sucking - tactile component - proprio. (moving joints through motions) - improved visual focus - listen to where sounds come from - making noise - prone position - tummy time - mirror time - cuddle time - pushing the head up
milestones for a 2 month old
- Bundle of bubbly personality - Thinks things are funny - Concepts of object permanence > Peek a boo! - Curiosity of everything in and out of sight - Ability to track moving object and tell whether they are nearby, far, large or small - Manual dexterity to pass toy from one hand to another - Some are able to sit up, some may be able to do so unsupported - May prop self up on arms with wide BOS, supine (extension), prone (flexion) - Baby hears well and knows familiar faces - Can use noise making toys to guide skills - Rolling in both directions - Weight shifting, roll over and then must roll again to get places - May rock back and forth on hands and knees > crawling - Curious about objects, may bring to mouth, responding to sounds and making sounds
milestones of 6 months
- golden age - baby bliss - not independently mobile - lift head 90°, greater control - vestibular sense continues - weight bearing in prone position (through elbows & arms) - some weight shifting - supports crawling - laughing , prominent smile - play & cry when stop - turn to direction of sound - still exploring toys - roll from belly to back - prep to roll & eventually crawl
milestones of a 4 month old
What writing grasp development is this?
modified tripod
Child is given freedom and spontaneity in choosing activities, child-led activities to promote independence
montessori approach
Poor/limited sleep at 5-12 years can lead to
mood swings, behavioral problems hyperactivity and cognitive problems that impact learning
What is a FoR example that involves practice and repetition?
motor learning and aquisitional FoR
Domains of Early Child Development
motor, cognition, communication, social emotional, adaptive (ADL)
The organismic view is prevalent in developmental evaluations such as
motor, cognitive, social-emotional, communication (language), and self-help
What does a small amount of space in the oral/buccal cavity allow for the infants tongue to do?
move forward and back -sucking action -anterior to posterior movement only
reflexive
movement of one arm is often
Tongue action of extrinsic muscles
moves tongue sideways and in and out
Palm-to-finger translation
moving a coin from your palm back to your fingertips
Mobility
moving in and out of positions easily and with variety
Nonlinear
multiple interacting subsystems including body built characteristics, musculoskeletal, arousal, sensory, perceptual interacting with immediate environment. - Essential to adaptive control of movement. - Characteristics of task influence motor/task demands and OT's modify/adapt demands to increase occupational participation
What approach in learning without tears is this? - Variety of tools and modalities for learning (able to manipulate), verbal sequence of letter formation, songs
multisensory
What does the mesoderm become?
muscle, bones and circulatory system
When does an OT come in to help a child?
must consider their behavior in a natural environment -trouble learning left from right -reserves letters and numbers -cannot recognize same word repeated on the page -poor reading comprehension -sloppy handwriting -erases excessively -trouble copying from board to book -responses orally but not written
What is the most common visual impairment?
myopia
Myopia
nearsightedness
postural control
necessary for functional movement/mobility to occur
Gross and fine motor skills
neck extension, co contraction to sit up on own, support when sitting, swallowing, etc
Pull to sit of infant
neck flex is righting reaction to move head in upright position
Distress
negative in development -alteration of equilibrium without a proper adaptation response so lower level behaviors cannot be adapted to new experiences -prevents a higher level from emerging ex. postural control for walking walking with CP
What creates the automatic suction of the oral cavity?
negative pressure
What does the Brazelton Neonatal Assessment Scale assess
neurological condition
What kind of disability can prove to be difficult or pose a challenge to the feeding relationship between the caregiver and child?
neuromuscular disability
At what age should you rock a baby to soothe them?
newborn
When is a child nursing?
newborn
When is a child nuzzling/cuddling?
newborn
Apgar scores of 7,8,9 =
normal
Caregiver is responsible for
nutrition, encouraging routines and roles, etc.
Humphrey posits learning requires _________ and ________ (co- occupation and concepts from developmental theory)
observation, imitation
What can these promote: - Internal awareness of self and automatic control of one's body - Body schema - Reflex integration - Postural control - Kinesthesia
occupational engagement and social participation
everyday activities that people do as individuals, in families and communities to occupy time and bring meaning and purpose to life
occupations
Palmar grasp reflex
occurs when something touches the infant's palm (touch pressure stroke or object stimulus). The infant responds by reflexing all fingers grasping tightly
Medical term for the sense of smell
olfactory
birth
onset of eyeblink reflex
birth (it should begin in utero)
onset of moro reflex
birth
onset of plantar reflex
birth
onset of rooting reflex
birth
onset of the palmar/grasping reflex
Birth (It should begin in utero)
onset of the spinal galant reflex
Who would you refer to? - Diagnosis and treatment of eye disease using medication/surgery
opthamologists (MD)
Who would you refer to? - Selecting, fitting for eyeglasses
optician
Who would you refer to? - 3 Component model is emphasized in their education
optometrists
Who would you refer to? - Evaluates visual system to diagnose conditions that affect function/QoL
optometrists
If children aren't introduced to foods around 6-8 months of age, the _________________ development is impaired which can impact __________ milestones
oral motor, speech
Must create balance between effort of self-feeding > impact on ______________ > __________ safety > __________ of meals > __________ intake
oral motor, swallowing, length, nutritional
What view is this an example of? Change and growth come from within - Mechanism of change: building on previous skills through repetition and practice
organismic
What view is this an example of? Development is genetically prewired and is a directional process
organismic
Praxis
organize sequence of motor actions (novel actions)
-help shape identity -help children master routines and habits supporting well-being and physical health -foster readiness to perform in school -foster readiness to assume a place in the community and society
outcomes of family occupations
3-7 months
palmar grasps occur between
What writing grasp development is this?
palmar supinate
18-24 months
parallel play, participates in groups of children, beginning to take turns
A well-adapted child develops due to complex interactions between
parenting practices and styles
Impact of quality interaction between parent and child on development is considered as
parenting practices and styles
Establishing morning routines
parents must get selves up then get kids up, consistent morning routine - Children who are early risers may be able to play quietly in their rooms - Help by showing kids what toys they can play with before parents come in - create book with quiet toys available in room - promote positive mood, look for signs of distress - visuals to help child stay on task, checklist, chore chart - ask child to assist in activities - plan ahead, modeling
primary goal of OT
participation in meaningful occupations and co-occupations
How are pursuits assessed?
patient is asked to follow the target as it moves in an arc both horizontally and vertically and in an X pattern
Muscle activation
pattern and timing of movement
Important of ADLs: routines, ___________ of observable behavior emerge- necessary to meet ______________________
patterns, expected roles
reflexive and swallow triggered
pharyngeal phase
Phonology
phenomes or patterns of speech sounds
In dysgraphia, issue is not intelligence, rather auditory skill of
phonological, auditory, and visual processing
Syntax
phrases and sentences
What are the different contexts of play?
physical social cultural temporal virtual
Finger-to-palm translation
picking a coin up with the pads of fingers and moving it to the palm
life support system between mom and embryo
placenta
The ability for a child to change/adapt in response to their environment or task
plasticity
efficiency of motor systems
plasticity relies on the
Occupational role
player-set of expectations and behaviors -changes over the lifetime ex. child playing at 5 vs when they are 13
Kids who have low tone may
pocket food in their cheeks
Apgar score of less than 4 =
poor condition (life threatening)
Posture
position of body segments at any given time, refers to core (proximal) stability of trunk and neck muscles
posterior
positioning in supine results in ___________ pelvic tilt
flexion
posterior pelvic tilt is built by
10-15% women are diagnosed with this following birth; 1 in 8 diagnosed, may depend on the state as it can be as high as 1 in 5.
postpartum depression
From proximal to distal, what are we looking at?
postural stability, physical strength, endurance, sensory piece (proprioceptive sense), reflexes,
What may giving controlled choices or a limited set of options avoid?
power struggle
The ability to conceptualize, plan, and execute an action that is novel
praxis
Proximal patters (palmar grasps)
precede finger grasps (distal patterns)
Levels of Reflex Development
primitive, righting reactions, equilibrium reactions
Types of professional reasoning
procedural, narrative, pragmatic, ethical, interactive, conditional
Pragmatic development
process of the learning the conventions that govern the use of language within social contexts
TLR (total labyrinthine reflex) in supine
produces increased extensor tone -shoulder adduction and retraction
What is development?
progressing across the life span, begins in utero and ends in death
levels of motor development
prone/supine, crawling/sitting, standing/walking
Feedback from muscles and joints are used to determine where the limbs are in space
proprioception
Involves muscle spindles and Golgi tendon organs
proprioception
Perception of joint and body movements
proprioception
Rate and timing of movements
proprioception
Sense of effort (grading force used) and its memory
proprioception
receptors in joints and muscles are used for the sense of
proprioception
this sense helps a child with body awareness
proprioception
what is needed for motor planning and motor memory
proprioception
Gross motor skills in children
proximal skills - postural control - positioning - seating - standing - kneeling - reflexes present - writing and equilibrium reactions
Sylvie is a child who is having difficulty with scissor skills. She must build strength and coordination in her arms, what must we focus on?
proximal to distal
Seating and Positioning
proximal to distal, what does the seating look like? - slouching - slumped - foot support - moving in and out of positions - prone extension - supine flexion - postural control - upright positions, work on vertical positions
How do we work on proprioception?
pulling activites, pushing activites, carrying activities
Implication of gag reflex being diminished at 4 months?
puree is delayed to 4-6 months
In this assessment - child faces you - move target in horizontal line at eye level - then test in vertical direction
pursuits
How to challenge a child visually?
put them on a balance board so that they have to know where their body is in space
Palm-to-finger translation with stabilization
radial skill side of hand is doing the work, holding coins in pinky and ring fingers while using thumb and index to place coins in machine
Improved VM skills equates to
reading, writing, participation in sports
How do you reduce the affects of gravity and promote the infants head in midline?
recline the chair or high seat back
10-12 months cognition/spoon use
recognizes object function and uses spoon for the intended purpose
In infants, oral preparatory is...
reflexive
In behavior theory (reinforcement), giving attention to something not positive can __________________________________ - Instead, _______________________________ with external rewards and ignore _____________________
reinforce negative behaviors, reinforce positive behaviors, negative behavior
Teach problem solving skills with what type of cues?
repetition, analysis, perceptual
equilibrium, midline
requires ___________ and_________ stability
Mobility
requires postural control, muscle control, and strength
Complex rotation
rotating a pencil to use the eraser
Simple rotation
rotating small peg from horizontal to vertical, small rotation movements, twisting off a bottle cap
Working in vertical positions supports
scapular stability
Which stage in the family life cycle does this describe? -Caregiver goal→ for child to gain independence
school age
Which stage in the family life cycle does this describe? -Children become more aware of their differences
school age
Which stage in the family life cycle does this describe? -Families may experience less support when child enters school > no longer directly involved: sense of loss of control
school age
Which stage in the family life cycle does this describe? -Making & keeping friends becomes critically important
school age
Which stage in the family life cycle does this describe? -The gap between the child's performance and that of typical peers may widen.
school age
Attachment to caregivers fosters sense of __________
security
Opticians
selecting and fitting of eye glasses
IADLs promote
self-determination, self-sufficiency, health, social participation
tactile
sensation critical to support attachment and infant's sense of security
Taste buds actions
sense food in mouth and sense taste
environment
sensitive periods in emotional development can be impacted positively and negatively by the
An intervention program that provides individualized sensory experiences and activities to support the optimal functioning of the child with SI challenges
sensory diet
Enables our ability to response and act on situations in a purposeful manner
sensory integration
Forms the foundation for occupational engagement and social participation
sensory integration
The recognition, modulation, integration, and organization of sensory stimuli including behavioral responses
sensory integration
Unconscious process of the brain that organizes information detected from senses
sensory integration
Teeth action
shred and crush food
Lateral flexion
side to side movements, unilateral weight shift
Value of occupation centered interventions that promote participation in family life, school, and within the community → Importance of context and _____________________ identified
situated learning in the natural environments
What does the ectoderm become?
skin, nails, ears, and central nervous system
milder responses, withdraw from new situations, take time to warm up, ease in and adapt to change, lower in activity level
slow-to-warm-up babies have
Eating is also shaped by...
social and cultural norms -tell each other about their days at the dinner table -do not talk with mouths open
Bandura's theory
social learning theory
Vygotsky's theory
sociocultural theory
influences the degree that families have access to resources
socioeconomic status
reflects factors such as: social prestige of members, parents' educational level, income- influences access to activities/experiences
socioeconomic status
tactile and proprioceptive feedback
somatosensory function combines
Phonetics
speech sounds
Levels of CNS maturation
spinal/brainstem, midbrain, cortical level-cerebellum
Theories that suggest development involves distinct stages
stage specific theories
OT and 3 developmental theories as foundations for investigations
stage-specific, ecological, acquisitional learning
extensor muscle groups, all planes
standing requires ______________ activity to maintain upright and has mobility in __________
Static vs dynamic in handwriting
static: movement is coming from much more proximal, the arm muscles rather than the finger muscles dynamic: little muscles in fingers can manipulate pen so that arm is not responsible for writing
Taste buds outcome
stimulation of saliva secretion
1st sucking pattern
suckling
What is this?
summary of performance skill areas types of intervention
Body segment alignment
synergies, compensatory head or trunk position
Body segment alignment
synergies, compensatory head or trunk position
Medical term for the sense of touch
tactile
this sense helps a child detect light, touch, deep pressure, texture, temperature, vibration and pain
tactile
What senses are critical for the stimulation of rooting?
tactile and olfactory
Receptors provide information about the qualities of touch, pressure sensations, and speed/direction of moving objects over the skin
tactile sense
Sensory experiences are elicited through the skin
tactile sense
The subjective experience of touch is shaped by the experience and one's interpretation of the stimuli
tactile sense
sensations critical to the newborn infant
tactile/proprioception, vestibular/movement, smell
Vygotsky's contribution to play
the 'just right' challenge child gets to the level that they need to be at through adaptation or scaffolding
Postural fixation
the ability for a joint to maintain its position against an internal or external (gravity) force; obtained by co-contraction of agonists and antagonists
Postural control
the ability of a muscle to produce tension and requires spinal alignment, muscle tone, and strength
Plasticity
the brain's ability to change, especially during childhood, by reorganizing after damage or by building new pathways based on experience
What does better control of the jaws, lips, and tongue allow for?
the change in textures of food
Postural stability
the foundation for simple and complex movements
sensorimotor (0-2 years)
the infant explores the world through direct sensory and motor contact. Object permanence and separation anxiety develop during this stage
Ayers Sensory Integration (ASI)
the organization of sensation for use, for something functional, providing foundation for learning and behavior
What is play an antecedent to?
the preparation for work -organizing effect on client's adaptive function
Least restrictive environment
the setting that is most similar to that of children without special needs
Pragmatic development
the study of the use of language: vocabulary, grammar, meaning, AND social context
kinesthesia
the system for sensing the position and movement of individual body parts
Why might a child that is premature develop a vision impairment?
the visual system is one of the last things to develop in utero so it makes it worse if they were premature
perceptual scaffolding
the way in which a familiar word serves as an anchor for learning new words that come immediately before or after it, child can attach meaning to the object
How a caregiver looks at a child directly affects...
the way that a child looks at themself and their abilities
Allows for predictions of possible facts into the future
theory
An explanation of observed behaviors based on data
theory
Explains facts that are already known
theory
May be represented by MODELS used to test theories. Also allow for predictions given actual observed data, explaining a behavior
theory
Set of facts, concepts, and assumptions that are used to describe, explain, or predict phenomena
theory
They describe concepts of a profession
theory
Perceptual cue
therapist emphasizes critical feature-pointing, repositioning
Play is used in OT in 3 primary ways, what are they?
therapy tool, reward (behavioral piece), and occupation
metacognition
thinking about thinking
10-11
three jaw chuck occurs at _____ months
How is curiosity driven in play?
through environmental interaction (Piaget) conflict arises from expected and unexpected, known and unknown which generates the *curiosity*
purpose of block play
to build motor skills & encourage social interaction
Often a prerequisite for participation in daycare, school, recreational programs, vocational programs
toileting
How to help children control their space?
toy adaptation or environment modifications that are safe, developmentally appropriate and fun
How to consider universal access?
toy recommendations and play activities that develop specific skills for children or all abilities and ages
carry
transportation of a hand-held object from one place to another
From birth to year one, infants ________ their weight and increase their length by ______
triple, 50%
What writing grasp development is this?
tripod grasp
Positioning in the first three months
typically held, cradled in flexed position
Adolescent needs have probably been ______________, especially during mid-adolescence
underestimated
Which comes first when learning? Undressing or dressing
undressing
frontal
unilateral weight-shifting occurs on the _______ plane
What do you learn to write first?
uppercase letters, such as L
Visual analysis skills -discrimination
using blocks with different 1. shapes 2. sizes 3. colors 4. thickness ask child what is the same and what is different
Phasic reflexes
usually produce observable movement in response to touch, pressure, movement of body, sight or sound ex. spontaneous kicking, waving, banging
What rises to protect the nasal passage during the pharyngeal phase?
uvula and soft palate
What helps to determine if a test is measuring what it is supposed to?
validity
How can you support a four year old who is having trouble putting their shoes on?
velcro shoes
Coaching method when dressing
verbalizing, labeling (I will pull up the back while you pull up the front)
What is the easiest line to draw?
vertical then horizontal and then diagonal
First thing a child can draw is a
vertical line
the sense that detects movement through sensory receptors in the inner ear
vestibular
what is the first sense that helps us to understand we are falling?
vestibular
Characterized by the inner drive to master gravity
vestibular system
Functions as a gravity and movement detector
vestibular system
Responsible for our orientation in space, balance, equilibrium, coordination of head & eye movements, and enabling coordinated movement through space
vestibular system
Medical term for the sense of vision
visual
What is the only component of the one-component model of vision?
visual acuity
Evaluating a child's literacy skills should include their ability to process
visual information > for OT that means VM skills
What category does visual discrimination, spatial awareness, and visuomotor integration fall into?
visual information processing
What can go hand and hand?
visual motor and visual spatial skills
What is never done in isolation from cognition?
visual perception and visual integration skills
In older children, oral preparatory is...
voluntary control
Client factors involved in literacy skills
voluntary movements, fine motor and gross motor skills
When do sex organs begin to differentiate?
week 12
When do reflexes begin to emerge?
weeks 9-12
Skills required for dressing in children?
weight-shifting, visual skills, body in space skills, postural stability, cross midline, bilateral coordination, fine motor manipulation, cognitive skills for sequencing and problem solving
Social context of play
who is available for play? -interaction with caregivers and peers -parenting style/restrictions placed on play and independence, fears regarding safety
BOS
wide narrow asymmetrical
BOS
wide, narrow, asymmetrical
When does the oral (buccal) phase end?
with the onset of swallowing
Morphology
words - ex. difference between horse (singular) and horses (mutliple) -s was an added morphology
What do we need for emotional regulation?
working memory, inhibitory control, mental flexibility
Language
■ Set of shared rules that allow people to express ideas in a meaningful way (verbally, in writing, signing, gestures) - Evidence for spoken language and academic achievement
Cognition
➢ Manual exploratory behaviors to learn about visual spatial skills & learning about environment ➢ Learn about object characteristics & spatial relationships ➢ Relating objects to another for more accuracy and purpose ➢ Changes in attentional control and problem solving
movement emerges from an interaction between -nervous system -body -environment -task
"Systems" view of development
tailor sit
"crisscross applesauce"
How to test for laterality
"touch your left knee with your right hand"
Procedural
(OT process), step by step thought process. Ex. What evaluation and intervention protocols are applicable to this client's situation? How are clients like this usually handled in my setting?
ATNR Reflex
- (emerges in utero; integrates ~ 4-6 months) - Purpose: encourage the use the reach and grasp (turn head towards object and hand reaches for it). - Integration of reflex allows for toy to brought to the mouth.
What does an infant's vision look like at 4 months?
- Able to focus on something in midline - Downward gaze toward body or toys - Visually directed reach and grasp - Begin vertical and diagonal tracking - Binocular fixation/fusion - Baby more prone at this time - Midline jerk in visual tracking
Areas of Assessment include
- Academic - Non-academic - Extra-curricular - Prevocational/vocational
OT domain: occupations
- Activities of daily Living (ADLs) - Instrumental activities of daily living (IADLs) - Health management - Rest and sleep - Education - Work - Play - Leisure - Social participation
Occupational development and change
- Adult expectations and peer interactions as context for developing occupations - Social influences and interpersonal processes encompassing the activities - Observation, imitation, and social engagement important in making connections with peers during activities - Being aware of and playing with peers in a group expands kid's ideas - The self-organizing process realized as a result of occupational engagement - "Learning how to learn" through experiences with which child is engaged
Preschool and Kindergarten Skills
- Appreciation of books - Phonological awareness - Alphabet - Early writing skills - through pictures and letters - Listening and language skills - To attend to classroom instruction - Participate with peers
ethical
- Are the benefits of therapy worth the cost? - Are the risks of therapy worth the benefits? - How should I prioritize my caseload? - What should I do when other team members are acting in ways that I don't feel comfortable with? - ethical push/pull
Examples of teaching positive strategies around classroom expectations in preschool
- Be a Friend, Be Safe, and Be a Helper - Use Listening Ears, Use Gentle Touches, and Use Walking Feet
Benefits of participating in activities in education
- Building relationships with peers - Enhancing motivation and curiosity - Enhancing self-esteem - Can shape interests in career pursuits
positioning in supine
- Builds flexion, bringing arms to midline, getting midline orientation through that flexion - Important because you can move your head and use your vision to see. - Limbs are free in this position, we can move our distal extremities and get feedback to proprioceptive receptors.
Broca's Area
- Central to motor control And production of - Language Expressive communication
Wernicke's area
- Central to processing sounds - Receptive Communication
How do activities in education build competence in student role?
- Cognitive skills critical thinking - Executive function - Emotional skills of self-regulation - Sharing (documenting and sharing, building relationships with peers) - Competence in use of school materials and tools
equilibrium reactions
- Compensatory movements used to regain midline stability when alignment of midline with gravity is significantly disturbed - Rotation and flexion of neck and upper trunk back toward the center - Lower trunk segments counter-rotate to balance rotational effect of upper portion of body - Extremities may extend and abduct
activities of preschoolers
- Counting - Story time - Writing (their name) - Snack time/lunch time - Toileting routines - Nap time - Playground rules - Dress up - Arts and crafts - Block play - Circle time (orient them to day, time) - Drop off and pick up (to and from school) - Music as well
Examples of Legitimate Tools of Occupational Therapy
- Critical/Professional Reasoning - Conscious Use of Self - Occupations and Activities - Environment - Others (some require additional training)
What does an infant's vision look like at 6 months?
- Dissociate eye movements from head movements - Track hands with eyes, visually guided reach - Able to focus at varying distances, begins diagonal tracking - Corneal reflex: light should be reflected equally off both corneas - Enjoys play at mirror: equal corneal light reflection observed - Object exploration during play - Exploratory play; pushes and flings object; eyes guide reach - Sensorimotor exploration
Bilateral weight shifting
- Distal holds and proximal segment moves - Controlled mobility (gross movements) superimposed on stability - "Bunny hop" crawling/creeping
Attachment
- Emotional bond formed between and infant/caregiver early in life (7-9 months of age) - Infants active part of process
Other play intervention strategies
- Encourage sensory rich play - Encourage manipulative play to facilitate eye-hand coordination and dexterity
OT domain: contexts
- Environmental factors - Personal factors... "...that influence engagement and participation in occupations." (AOTA, 2020. p. 4)...that enable or restrict participation
Theories that suggest progression in pyramid fashion
- Erikson: psychosocial - Piaget: sensorimotor (cognition) - Maslow (Humanistic): heirarchy of needs
standing
- Extension throughout the body, through the LE in standing! - Able to move in all different planes in gravity! - Completely upright and vertical - Alertness: able to see more of our world and be more alert - Free to explore and move from one place to another
Accommodations for dysgraphia
- Extra time on assignments - Speech-to-text, scribes for written assignments - Provide copy of notes - Create an inclusive classroom > universal design
What are we looking at with small muscle development?
- Extrinsic versus intrinsic muscles - Power grip versus prehensile patterns
The developmental theory...
- Facilitates development, - Fills gaps in development - Just challenging slightly - Get through ZPD
Strategies to encourage good sleep habits:
- Follow consistent, calming bedtime routine - Put baby to bed drowsy, but still awake - Give baby time to settle down - Consider pacifier (Remember: helps reduce risk of SIDS) - Keep nighttime care (Feeding, diapering) low key
How to safely disinfect personal devices
- Gentle dish soap and lukewarm water - Lens cleaning wipes - Dry with microfiber cloth to prevent smudging
Organismic view was supported by these theories that suggest development involves distinct stages
- Gesell and PDMS (Developmental Motor Scales) - Erik Erikson: 8 developmental stages that must be achieved; each stage resolved otherwise development is delayed
Whose theories were stage specific?
- Gessell and PDMS - Erikson: psychosocial - Piaget: sensorimotor (cognition) - Maslow (Humanistic): heirarchy of needs
OT domain: performance patterns
- Habits - Routines - Roles - Rituals "...these help establish lifestyles and occupational balance...." (AOTA, 2020, p. 12)
Cutting a 6 inch Page
- Hand holding paper in active supination - Holds paper with stability - Hand with scissors supinated.
Snipping with Scissors
- Hand holding paper is minimally involved - May hold paper awkwardly or with lateral pincer - Hand with scissors often pronated
Cutting a circle
- Hand holding paper moves it in coordination with cutting - Hand holding scissors is supinated 90 degrees or more
Cutting a square
- Hand holding paper moves it in coordination with cutting - Hand holding scissors is supinated 90 degrees or more
Cutting a 6 inch line
- Hand holding paper with stability - Forearm in partial supination - Hand holding scissors supinates to 90 degrees
Stage 4: skilled movements
- Highest level with distal control - Segmental joint movements - Reaching serves as basis for volitional, controlled movement - Shoulder stable in space, direct placement of hand in space (stability on mobility and then skilled use of hands)
interactive
- How can I put this person at ease? - What is the best way for me to encourage this person? - What cultural factors do I need to consider as I engage with this person?
What is Critical/Professional Reasoning?
- How do therapists think when they are engaged in practice? - Professional reasoning- the process OTs use to plan, direct, perform, and reflect on client care - Complex, multi-faceted, quick - Requires metacognitive analysis "thinking about thinking" - Every OT thinking about and/or engaged in OT practice is engaging in professional reasoning - Question is not whether you are doing it, but how well
pragmatic
- How much time do I have to see this client? - What therapy space and equipment are available? - What are my practice competencies?
Strategies to Enhance Phonological awareness
- Identify words that rhyme - Count the number of syllables in a name - Recognize alliteration (words with the same beginning sound) - Segment (break) a sentence into words - Identify the syllables in a word - Blend individual sounds to make a word - Stretch out a word into its individual sounds - Swap in a different sound to the beginning, middle, or end of a word to make a new word
Side lying
- Important because it helps the child maintain contact with the floor, getting input on the floor side that they do not get on the ceiling side. Switch sides. - Hands are in visual field and are in the midline, can do more with them. - You need rotation to start, and then you need lateral flexion to get over into side-lying.
Establishing a positive therapeutic relationship: Sensory Component
- Increasing color contrast to support visual issues - Not wearing perfumes, scented deodorants when working with olfactory issues - difficulty with attention - don't wear paisley pants
Effortful control
- Inhibition of impulsive or dominant actions - Aspect of temperament
What does an infant's vision look like at 2 months?
- Interested in facial participation: social play and peek a boo - Eyes move faster than their head, able to track more readily, isolating eye from head movements - Tracking horizontally, side to side - Briefly fixates in midline - Supine play to promote hands to midline, flexion of trunk, and posterior pelvic tilt
What does Sensory Integration Promote?
- Internal awareness of self and automatic control of one's body - Body schema - Reflex integration - Postural control - Kinesthesia
Critical Periods of Development
- Language exposure - Sensory motor experiences - Stimulation! - Important in the first 3-5 years of life
Back to Sleep Campaign and SIDS; who is at risk?
- Low birth weight & Pre-mature Infants - Sleep apnea - Higher rate of SIDS in low income groups - Cigarette exposure - Soft bedding & Co-Sleeping - Prone position - Overheating from excessive sleepwear and too much bedding
Stage 1: mobility (phasic movement)
- Lowest level of motor control- large undirected movements - Spontaneous kicking, waving, banging - Used for light work (movements of distal parts of body) - With development of more voluntary control, these phasic movements become skilled movements
sitting position
- Means for maintaining vertical - Develops antigravity posture - Frees upper extremities for reach and play - 7-8 months from sitting, child can move to prone and back to sitting- no longer interested in supine! - Mature sitting (equilibrium and midline stability)
OTs must be supportive and empowering of parenting practices and styles. They can do this through
- Modeling, coaching, and feedback - understanding values & beliefs
OT domain: performance skills
- Motor skills - Process skills - Social interaction skills "...observable goal directed actions...analyzed during performance...to understand a smaller aspect of the larger occupation...." " (AOTA, 2020, p. 12)
Stage 2: Stability (weight bearing)
- Muscles that perform tonic contractions that lie deep and proximally (Require less energy than phasic) - The child that now has stability, can weight bear on the distal part of body to maintain posture - Children play with movement within a given posture now - May only hold statically at first or collapse - Video prone on elbows (2 months) - Stages of learning to walk
Human and Nonhuman Environments
- Natural environment and man-made changes to the environment - Access to playground, soccer field, backyard - Access to toys, technology (cell phone, computer), pets
How NOT to disinfect personal devices
- No rubbing alcohol - No household cleaners with high amount of acid
Palmar Grasps
- Objects are secured in the palm by the fingers - Begins with ulnar fingers and moves to radial - These grasps are more proximal compared to later grasps
Formal and informal assessment methods
- Observation in natural context - Related to student learning and access to curriculum/environments
OT's Role In Evaluating Students
- Occupational profile - Strengths and challenges - Formal and informal assessment methods - Areas of assessment
Occupations and Activities
- Occupations: Broad and specific daily life events that are personalized and meaningful to the client. - Activities: Components of occupations that are objective and separate from the client's engagement or contexts. Selected and designed to support development of performance skills and patterns to enhance occupational engagement.
Equilibrium reactions
- Opposite extremities may assist in bringing head and trunk back toward midline - Supine, prone (5-6 months) - Sitting (7-8 months) - Standing (12-21 months)
What to think about when taking into account the eating experience?
- Physical and sensory experience: - Is seating and positioning adequate Does it provide stability? - Are head, neck, shoulders, and pelvis well aligned? - Is space adequate for eating activities? - Are noise and activity levels conducive to eating? - Emotional experiences - Mealtime experiences: parental beliefs and expectations for examples
What are some red flags for dysgraphia?
- Poor phonological - Poor pencil grip - Persistent inconsistent letter formation - Illegible writing - Slow writing fluency - Difficulty copying visual information accurately - Inaccurate spelling
tonic reflexes
- Postures that are assumed in response to changes in the position of their head/trunk or their body in space - Needed to produce postural tone
phasic reflexes
- Present from birth - Has a survival component - Integrated by 4-5 months in typically developing children - Occurs as a response to touch, sight, sound, or movement.
Establishing a positive therapeutic relationship: Developmental/Cognitive Component
- Presenting objects and directions in a specific and clear manner - Use of toys and tools at developmental level of child (or slightly higher) - Scaffolding; "Just right challenge" - the way we teach & approach tasks
Digital Grasps
- Radial Digital Grasp - Inferior Pincer Grasp - Three Jaw Chuck - Pincer Grasp - Neat Pincer Grasp/Tip Pinch
Academic considerations include
- Reading and literacy - Math - Communication (oral and written) - Social interaction - Play - School-related ADL's (self-care) - Underlying skills needed for school success - Motor and process skills - Client factors
Back to Sleep
- Relationship of infant sleep position and early motor development - 1994: AAP introduced the ____________________ Campaign
"Back to Sleep" campaign 1994
- Research has shown that full-term infants sleeping non- prone have delays in motor milestones and lower scores on developmental screening measures than infants who slept prone - Importance of "tummy time" to avoid delayed acquisition of head control
Enhancing Phonological Awareness
- Rhyme time - Road trip rhymes - Word families - Silly tongue twisters - Sound scavenger hunt - Snail talk - Sound counting
temperament
- Role of personality formation in infancy - Individual traits (Genetics) - Readiness to engage in novel experiences - "Goodness of fit" between child and environment - Fairly stable over time.
Environmental adaptations at mealtime
- Scheduling and location of meals - Length of mealtime - Sensory stimulation within the environment, limiting distractions - Changes to order of food presentation - On "grazing"
Grammar development
- Sequencing words in a sentence, language rules, mechanics - Parts of speech
Legitimate tools of OT
- Set of tools, techniques, methods, instruments, or modalities used by an occupational therapist throughout the OT process - Some are unique to OT and others are shared - Different tools are used with different clients (individualized) and in different environments
What does an infant's vision look like at 1 month?
- Slow and jerky tracking movements with eyes - Bottle/breast feeding so that the child can look directly at you (12-15 inches) - Starting to sense dark and light movement: use high contrast colors - Infant attempts to focus on whoever is speaking to them - Vision supports postural control and tone
What is required for handwriting readiness?
- Small muscle development - Eye-hand coordination - Hold writing tools - Form basic strokes - Letter perception - Right-left discrimination/orientation to printed language
Mechanics: Motor Skills Prerequisites
- Supination: movement into and for stability - Wrist stability - Thumb opposition - Isolated thumb and radial finger movement - Dissociation of the radial and ulnar sides - Successive increases/decreases in fingertip forces
Equilibrium Reactions
- Supine, prone (5-6 months) - Sitting (7-8 months) - Standing (12-21 months)
"Body-Related" Senses
- Tactile (discrimination and protection) - Proprioception - Vestibular
Stage 3: heavy work
- The act of successful weight shifting - Ability to transfer some or all weight-bearing load to another joint of to maintain support in one joint as the body's COG changes slightly. - Ex: Rocking on All fours - Ex: Reaching for toy (distal portion of the arm is free)
General considerations for interventions
- The experience - Environmental adaptations - Positioning - Adaptive equipment
contralateral weight shifting
- This highest-level movement pattern enables a simultaneous weight shift and forward progression (one step process of smooth movement) - Reciprocal patterns of UE movement adapted to nonweight-bearing situations - Reciprocal arm swing during ambulation using rotation and counter-rotation
Skills and Client Factors Needed for Cutting/creating a project
- Tools and materials used - Sensory skills - Fine Motor skills - Gross motor skills - Visual skills - Cognitive skills - Emotional regulation
Interventions in School Setting
- Top-down - Embed activities in the natural context - Collaborate with school team - Measure outcomes
How to tackle a student's strengths and challenges
- Top-down approach - Contextual factors facilitating/inhibiting performance
Strategies for challenging behavior vs. culturally responsive care
- Understand child (and family) strengths/needs - Teach positive strategies around classroom expectations - Teach empathy
weight bearing
- Up on hands and knees - 6 months - Must have __________ _________ first! - Move to a point where we can free up our hands.
OT domain: client factors
- Values - Beliefs - Spirituality - Body functions - Body structures
Toileting concepts to consider
- Varies widely among children - Often a prerequisite for participation in day-care, school, recreational programs, vocational programs - Complex task- analysis of contexts, performance skills and patterns - Psychological readiness - Requires time and effort on part of caregiver - Bowel control proceeds bladder control - Studies show girls achieve toilet: training earlier than boys. The range of normalcy for the attainment of individual skills may vary by as much as a year.
positioning in prone
- Weight bearing occurs through the forearms, maintaining contact and stability - As anterior shift in pelvis happens, we bear more weight through our pelvis
Narrative
- What is this person's life story > occupational profile - How has the diagnosis affected the person's life story? - What occupational activities are most important to this person - client 's priorities > parent 's - understand self-esteem and who the child is
unilateral weight shifting
- When used for forward movement, pattern looks like this 2-step process - Shifting weight > and moving with side to side motion - Ex: Early walking
conditional
- Where is this person going? - How will various therapy options play out, given this person's diagnosis/social situation/economic status/culture?
Factors impacting sleep in adolescence?
- Work, studies, extracurricular - And in the last 8 years > smartphones - The blue light emitted simulates daylight and inhibits production of melatonin
Establishing a positive therapeutic relationship: Physical Component
- Working at eye level with the child - Using the therapist's body to support posture of child as positioning device - Prop knee up , criss-cross, pull something from environment - Make self a support for client's goals
ways of managing communication
- Writing tools, mobile devices, keyboards, audio-recorders. - Computers and tablets, communication boards, call lights, emergency systems, braille writers, telecommunication devices for deaf people, augmentative communication systems, etc.
Implication of milestones for OT
- advocating & educating parents - birth to 3: early intervention is critical - age appropriate , understanding baseline helps to know which activities to implement
conscious use of self
- always ask child goals & strengths - Therapist is the agent of change within the therapeutic process - Establishing a positive therapeutic relationship is key - Rapport building - Think of ways you can build rapport upon introduction - Extends beyond the child to the child's support team (parents, caregivers, siblings, teachers, other therapists, etc.)
Circle Time Focuses on
- attendance and names of classmates - seasons - holidays - months of the year - days of the week - counting days on the calendar - oral counting - weather - early literacy skills such as the alphabet and sounds - beginning word reading
What must OTs do during play?
- blend play opportunities that are engaging and produce therapeutic outcomes (scaffold and just right challenge) - development, family centered care and knowledge of family systems and models are important considerations
ASD and play as interaction
- breaking down language (scaffolding) - instead of "put red square in puzzle", tend to child's strengths - If child likes numbers, refer to numbers - Caregiver = play partner/mirror: body positioning is important > conscious use of self - Caregiver has some version of toy child has = modeling play for child so there is not turn taking - Looking for ability to engage with different toys (develop intrinsic motivation for play) - Bring in cognitive domain within the occupation of play
Personal influences on mealtime
- caregiver's responsibility - personal/individual factors (infancy fed, preschool and school age, temperament, health, parenting styles, moods)
BADL milestones, care of personal devices In tween years (8-12 years), child can
- clean contact lenses/glasses - clean braces/retainer - use AE such as hearing aids or splints
IADLs include
- cooking - cleaning - laundry - driving and community mobility - health/medication management - financial management - caring for pets
0-3 months
- cradled in flexion - sucking, suckling, positioning (coordinated sucking, swallowing & breathing - liquid (milk)
15-18 months
- drinking from a cup - scoops food with spoon & brings to mouth (still spills!) - wider range of foods - seated upright (hips at 90º)
Grasp reflex (palmar)
- emerges in utero; - integrates: ~6 months - Purpose: Increases tactile stimulation to the palm of the hand Integrates by 6 months & then voluntary palmar grasp emerges
Contextual influences of mealtime
- family composition - culture: assistance or independence; amount or type of food - socioeconomic status/education level - feeding and mealtime patterns - temporal: when does it occur in respect to different activities - routines
9 months
- feeds self (finger foods) - more upright (hips at 90º) - begins to explore spoon use - begins chewing in rotary pattern - soft foods (mashed or meltable)
activities of elementary schoolers
- focus on life skills - Planting - Gingerbread houses - Snowflakes - Music: Bring instrument - Class pet care - Book buddies - Recess - Cursive - Science/math/reading/writing/social studies - Shoe tying - Art - Computer time - PE/gym: have to bring gym clothes - Spanish/foreign language - Hallway/cafeteria manners - Homework
5 years
- fully functional adult patterns - could use a knife (if parents allow)
In play, how might you use human and non-human environment to support development in the activity of stacking blocks
- guide w/ your arm - cushion - build therapeutic relationship - side-lying position - motivation of OT! - bring in twin , sibling, family -member, teacher, parent, etc.
unilateral weight shift
- infant can shift weight from one side of the midline, supported by wither trunk or extremities on that side → then move extremities to the opposite side of the body ex. early walking - shifting weight and moving with side to side motion
Vertical righting reaction
- landau reaction reflex - emerges at 3-4 months - repressed between 3-3.5 years - head up-feet up - head down-feet down
Bilateral weight shift movement patterns
- mostly flexion and extension - rocking on all fours (quadruped) - squatting - distal holds and proximal segment moves - controlled mobility (gross movements) superimposed on stability - "bunny hop" crawling and creeping
When looking at handwriting, what is important to observe?
- pencil grasp - wrist positioning - bimanual skills - proprioception
Important tasks in psychosocial stage 2
- picking out own clothes and dressing themself - choosing which toys she likes by herself - developing food preferences of her own - mastering toilet training
Establishing bath routines
- safety - preparing everything we need - addressing factor of fear in water - bringing in toys - teaching child to be an active participant in bathing
6 months
- semi reclined (30-45º) - up & down jaw movements (munching) - sucks liquid when presented cup - lateral tongue movements - pureed or strained food without choking
10-12 months
- sitting in high chair with less support (hips at 90º) - easily feeds self with fingers - dips spoon in food - holds cup with 2 hands - chews with rotary jaw movements - chopped table foods
24-30 months
- sitting up at table - drinking from open cup - supination with spoon use: uses spoon with efficiency (no more spilling!) - most table foods
4-6 months
- slightly more upright position - maintain lip closure - improved motor control in jaw - opens mouth when spoon approaches - pureed foods
Establishing bedtime routines
- specific and consistent routines - talking through routines - relaxing environment - soothing music - free of distractions - white noise - dimming the lights - sensations that the child may be experiencing: are sheets itchy, temperature, light
Other intervention strategies
- strengths-based approach - set up play scenarios that encourage turn-taking and problem-solving - consider family routines and priorities - ways to get families involved in play - sensory-rich play - manipulative play for eye-hand coordination and dexterity - universal access
What happens when the fat pads decrease in an infants oral cavity?
- their tongue is less large increasing the space in the oral cavity -this allows more movement and control of the tongue
pragmatic what are my practice competencies?
- time constraints - competency comes into play when selecting levels of modality
BADL milestones, bathing, hygiene, and grooming: At 4-6 years (early school age), a toddler can
- wash and dry hands and face - wash and dry body parts with supervision by 4 years - use tissue to blow nose - put toothpaste on brush/brush teeth by self - assist with hair washing and nail care
Which neurological conditions affect vision?
-ASD (autism spectrum disorder) -DD (developmental delay) -CP (cerebral palsy) -DS (down syndrome) -ID (intellectual disability) -ROP (retinopathy of prematurity)
When partnering with families: what is important to remember about processes that support occupational development?
-Ask permission before sharing information w/ family -Be sure assessment tools match the need, values, experience of the child/family -Conscious use of self: Relationship paramount in EI -Provide services in the natural environment where the concern lies use environment (use environment to promote aspects of development)
Extension and flexion against gravity
-COG shifts - head lifting with weight shift towards pelvis area -increasing stability promotes weight bearing -tonic contractions of muscles that lie deep and proximal -position held statically ex. prone and supine positions
Partnering with Families in EI: Processes that Support Occupational Development
-Family Centered Care -Guided participation -Scaffolding -Co-occupation -Coaching models: builds family capacity -Cultural competency: Considering PEOP when coaching -Conscious use of Self/Therapeutic use of self! -Professional Reasoning
Family Resources
-Financial : hidden ongoing expenses -Human -Time -Emotional Energy
3 visual integrity issues
-Myopia -Hyperopia -Astigmatism
What supplemental tests are under the Beery VMI?
-VMI visual test -VMI motor test
What must an OT do to bring back play?
-be an advocate in schools for it -identify community-based strategies to bring it back
Education/attitude of the family
-bonds with the infant -enjoys feeding the infant -understands and feels competent regarding infants' nutritional needs understands importance of a healthy lifestyle
Behavior of infant
-breastfeeds/bottle feeds successfully -consumes complementary foods to support growth and development
Tonic/Attitudinal reflexes
-changes in position of the whole body in response to changes in head position ex. ATNR, STNR, TLR
Temporal context of play
-changes through history -changes through seasons, times of day
Learning through play
-client factors and performance skills: development of GM, FM, VM, cognitive skills -emotional maturity -social skills/coping -self-efficacy
Health of infant
-develops normal rooting, sucking, and swallowing -develops fine and GM skills -grows and develops at appropriate rate -maintains good health
3 pros of pacifier use
-disposable -reduce the risk of SIDS for a child as they sleep or nap -satisfy the suck reflex
3 cons of pacifier use
-early use can interfere with breastfeeding -can increase the risk of middle ear infections -prolonged use can lead to dental issues
What are some occupations of a family?
-eating dinner together -chores (clear table, put dishes away, put laundry in the basket) -leisure and play -self-care (vacations and personal hygiene) -they must be performed together and meaningful to promote a sense of self -connectedness
What occupations are affected by a visual impairment in a kiddo?
-education (coping from the board, reading, handwriting) -play (being with other students in school or at a recreational game or match) -leisure (activities outside of school that require visual motor or visual perceptual skills)
Optometrists
-evaluated visual system to diagnose conditions that affect function/QoL -3 component model emphasized in their education
Visual Integrity
-eye health -acuity -refraction
What is never done in isolation by the OT without the help of the rehab opthomologist?
-eye teaming and -eye focusing
Effect of vision therapy on occupations
-growing evidence for decrease in symptoms (think of questionnaire) -better attention -improvement in reading
Educational/attitudinal of infant
-has trust -bonds with caregiver -enjoys eating
People who have myopia seem to also have....
-higher IQ -better grades -better vocabulary
What are visual spatial skills used for?
-laterality -directionality
Behavior of family
-meets infant's nutritional needs -responds to infant cues (hunger and satiation) -holds the infant when bottle/breastfeeding -provides pleasant eating environment -seeks help when needed
What skills are needed for eating?
-muscle tone/control/stability -GM and FM -oral motor and swallowing skills -influence of meal time -influence of social contact -communication through both verbal and non-verbal means
What are we seeing as a result of less play?
-obesity -less imaginative children -greater rates or suicide and depression -children that are not ready for the work force
What are the phases of swallowing?
-oral prepatory -oral (buccal) phase -pharyngeal -esophageal
Cultural context of play
-perceptions regarding importance of play -differences in children's use of time -cultural forms of play
Newborn features
-physiological flexion -generalized movement -weight bearing through the chest, shoulders, and face in prone -pelvis posteriorly tilted (tucked- flat back) -shoulders retracted -asymmetric positions
Physical contexts of play
-playground -play spaces -types of toys and materials +availability, variety, complexity, child's responsiveness
What are functional skills for using saccades?
-reading -coping from the board -searching from an object in one's desk
Nonverbal cues used to indicate a child is ready to eat
-ready to receive the spoon or utensil -where are they looking -is their mouth open *important to watch in their natural environment
Cognitive strategies include:
-repetition cue -analysis cue -perceptual cue
What reflexes support the ability to feed at birth?
-rooting reflex -suck/swallow and tongue thrust reflex -gag reflex
What is included under eye movement testing?
-saccades -pursuits -fixation
Takata's Taxonomy of Play
-sensorimotor -Symbolic and simple constructive -dramatic, complex constructive and pregame -games -recreational
Lateral flexion
-side to side movements -unilateral weight shift ex. pull to sit of infant -neck flex is righting reaction to move head in upright position
Basic traits of play
-spontaneous, fun, joyful -intrinsically motivating -emphasis on process -pretense -involves active engagement, thinking, problem solving -often social -free choice versus required or expected -captivating and absorbing (no thought)
What might an OT observe with children that have a visual impairment?
-squinting their eyes to see the board -rubbing their eyes -holding a book or piece of paper close to their face -tired/fatigue -retained reflexes -clumsy or uncoordinated -uses finger to read (difficulty with saccades)
What is included under eye teaming?
-strabismus or phoria (exophoria or esophoria) -convergence insufficiency
Development of oral structures is dependent on...
-underlying skills -client factors -environment -cultural values and norms
Parten's Stages of Play
-unoccupied play -solitary play -spectator/onlooker behavior -parallel play -associative play -cooperative play
7 subtests of TVPS
-visual discrimintation -visual memory -spatial relationships -form constancy -sequential memory -figure ground -visual closure
What are the three components of the three-component model of vision/what is looked at during a thorough eye exam?
-visual information processing -visual integrity -visual efficiency
What is included under visual information processing?
-visual spatial awareness -visual analysis -visual motor integration
How to establish goals in child play?
-work cooperatively with peers -take turns when playing a game -use play scripts and social stories -follow the rules to a game -engage in rough-house play without hurting others
Sensorimotor
0-2 years
Breastfeeding complemented with food is recommended for up to
1 year
When can a child cooperates with dressing (pushes arms through sleeves when started, same with pants)
1 year
When can a child pull off shoes and remove socks?
1 year
When does palmar supinate grasp occur?
1-1.5 years
Importance of Language Development
1. Our brain's foundation is built through experiences in early life 2. We learn language socially 3. Language brain growth strongest in first year of life 4. Language makes our world
Principles of Volitional Grasp
1. Ulnar fingers activate before radial fingers and thumb 2. Proximal patterns (palmar grasps) precede distal patterns (finger grasps) 3. Extrinsic activation dominates (strength) before intrinsic activation (manipulation)
What is included under visual efficiency?
1. eye focusing 2. eye teaming (binocular vision) 3. eye movement testing (fixation, saccades, pursuits)
Apgar Scale: 5 vital signs measured
1. heart rate 2. respiratory effort 3. muscle tone 4. reflex responsiveness 5. color
When does a child express discomfort over soiled pants (tactile system)
1.5 years
When does a child show interest in potty training
1.5 years
How long does the Beery VMI take?
10 to 15 minutes
Sleep in school-aged children (5-12 years) - Need ________ hrs/night given increased demands of homework and extracurricular activities
10-11
Feeding _____ months - sit in high chair with less support - drinking from a cup - more mature sucking pattern but jaw instability still present (uses lower lip and tongue to support action on cup - eating more textures: chopped table foods - uses lips to precisely remove food from spoon - good lip closure when swallowing - chews with rotary jaw movement - dips spoon in food
10-12
Adolesence
10-12 to 18-21 years
Sleep in preschoolers (3-5 years) - Need ________ hrs/day
11-13
Scribbling by
12 months
When does an infant take first steps?
12-15 months
Recreational
12-16 years
Letter chart for saccadic therapy, third level of difficulty has reasonable goal of _________________
120 seconds
Letter chart for saccadic therapy, if the initial task completed in ______________ without error, increase level of difficulty
15 seconds
Black infants are ____ less likely to have been breastfed than white infants
15%
Eating _____ months - wider range of foods - jaw stable when drinking from a cup - tongue-tip elevation with swallowing - scoops food with a spoon and brings to mouth as shoulder and wrist stability improve
15-18
When do we tackle potty training?
18 months - 3 years
Using a spoon by ___ months, no spilling by ___ years
18, 2
-most important changes for the brain -body systems and structures established in embryonic stage continue to develop ~brain and spinal cord continue to develop ~weeks 9-12= reflexes begin to emerge; fetus making reflexive movement with arms and legs ~week 12= sex organs begin to differentiate ~end of week 12 (by 3 months)= all body parts formed
1st Trimester (Fetal Stage)
ideation
2 year mark is huge in terms of
Imitates vertical, horizontal, and circular strokes by
2 years
Snips with scissors by
2 years
When does praxis and ideation emerge?
2 years
When is a child interested in helping pull down pants and finds arm holes in shirt
2 years
When is a child interested in removing an unfastened coat and untied shoes
2 years
When is there refinement of fine motor skills d/t increase touch localization and discrimination?
2 years
Spectator/onlooker behavior
2 years child watches and observes other children playing but not playing with them
Snips with scissors
2 years; prior to preschool hand holding paper is minimally involved may hold paper awkwardly or with lateral pincer hand with scissors often pronated
When does digital pronate grasp occur?
2-3 years
Parallel play
2-3 years child plays alongside or near other but does not play with them
When does an infant first smile?
2-4 months
Symbolic and simple constructive
2-4 years
Short form for children ______ years, two supplemental tests: the VMI Visual Test and the VMI Motor Test
2-7
A child may need help getting on toilet until
2.5 years
A child washes hands independently by
2.5 years
Cuts across 6-inch page by
2.5 years
Using a fork by
2.5 years
When does a child tell someone they need to go to the bathroom
2.5 years
When is a child dry at night by?
2.5 years
Cuts 6 inch page of paper
2.5 years; prior to preschool hand holding paper in active supination hold paper stability hand with scissors supinated
How many baby teeth are there?
20
Swallowing involves over _____ muscles in the mouth
20
What is the minimum acuity for driving in CT?
20/40 in one eye
Early adulthood
20s - 30s
When is the grasp reflex present, eyes open, waste matter collected in bowel?
24 weeks
Eating ______ months - most table food except tough food or food with tough skin - strong postural control and core stability - can sit at the table - adult-like drinking pattern - efficient spoon use with supination - sensorimotor; adjusts movements - uses fork to stab food (2-3 years) - verbally expresses wants - imitation and copying
24-30
-Months 4-6 -Heartbeat grows stronger -Other body systems develop -16-20 weeks image shown -Can suck thumb, swallow, hiccup, and move -Preference for position in womb -Clearer facial features -heartbeat via stethoscope -24 weeks: grasp reflex present, eyes open, waste matter collected in bowel
2nd Trimester (Fetal Stage)
Low rates of breastfeeding contribute to more than ___________________ a year in medical costs for infant and mother
3 billion dollars
Solitary play
3 months to 2 years child plays along no interest in playing with others quite yet
maturation
3 through 7 years is known as the major period of
A child may need help with wiping and clothing fasteners until
3 years
Copies vertical line, horizontal line, and circle by
3 years
When can a child button large front buttons and when do they need assist to remove pullover shirt until
3 years
When can a child go to bathroom independently (on and off toilet), could be dependent on type of toilet
3 years
When can a child put on pullover shirt with min assist and put pants on (pull on)/pull pants down independently
3 years
When does a child puts on socks and shoes (may be wrong feet, or heel of sock on top)
3 years
When does a child zip/unzip jacket once zipper engaged
3 years
When may a child need help with front and back- (love pants that have a visual to assist)
3 years
Cuts on 6-inch line by
3-3.5 years
Cuts 6 inch lines
3-3.5 years; Preschool age hand holding paper with stability forearm in supination hand holding scissors supinates to 90 degrees
Associative play
3-4 years child begins to interact with others during play little cooperation required children share and interact intermittently on shared goal
More difficulty falling asleep/nighttime waking at what age?
3-5 (preschool)
Early childhood
3-5 years
When does a child explore playground equipment to push, pull, swing, slide, climb, ride, and jump?
3-7 years
When is there an inner drive to produce adaptive responses to meet sensorimotor demands and peers?
3-7 years
When can a child button 3-4 buttons
3.5 years
When can a child dress with supervision (may need help with front and back)
3.5 years
Cuts out circle by
3.5-4 years
When does modified tripod grasp occur?
3.5-4 years
Cuts circle
3.5-4 years; preschool age hand holding papers moves it in coordination with cutting hand holding scissors is supinated 90 degrees or more
Beery VMI consists of
30 geometric forms arranged in developmental sequence
How long does the TVPS take?
30 minutes
How many teeth does a child between the ages 6 and 12 have?
32
-fingernails, hair, eyelashes, and toenails formed in 3rd trimester -By week 28: brain matures faster, brain activity resembles that of a sleeping newborn -Lungs begin to expand/contract, preparing muscles for breathing -Age of viability; 7 months, able to survive outside of uterus -Lungs breathe air -Eyes open/close and respond to light
3rd Trimester (Fetal Stage)
wash and dry body parts with supervision by ___ years
4
When can a child buckle, now zip (on/off track), snaps, put on shoes, not yet tying laces
4 years
When can a child identify front and back (visual spatial concepts!)
4 years
When can a child independently remove a pull over garment
4 years
Cooperative play
4+ years child plays and has interest in both the activity and the other children involved in play
A child is independent with toileting (entire sequence) by
4-5 years
Copies cross, square, diagonal lines, emerging name by
4-5 years
Cuts out square by
4-5 years
Cuts squares
4-5 years; preschool age hand holding paper moves it in coordination with cutting hand holding scissors is supinated 90 degrees or more
Oral motor at _____ months - uses mouth to explore objects; critical in preparing oral sensory and oral motor development for introduction of new food textures - experience new oral movements in association with developing head and body control
4-6
Semi-reclined by ____ months
4-6
- Improved postural control due to increase in - Vestibular sense - Proprioceptive sense - Tactile sense - Visual sense - Rolls front to and from back - Spends much of play time in prone - At 6 months, sitting up w/ or w/o support - Cephalo-caudal patterns - Improved postural control (visual, prop, etc systems) - Increases mobility - Motor control becomes more voluntary and controlled - Extension in neck to trunk - Hands and knees, rocking (weight-shifted) - Supported sitting - Still developing core strength (flexion and extension) - Stable visual field as baby becomes more mobile - Postural control is improved due to integration of senses
4-6 months
Occurs at ____________ -improved motor control enables more upright position during feeding -typically ready for pureed foods
4-6 months
dramatic, complex constructive and pregame
4-7 years
When does the tripod grasp occur?
4.5-7 years
Middle adulthood
40s - 50s
Finger to palm with stabilization (separation of the hand)
4th and 5th digits flexed into palm continues to work on stabilization until 4 years the child begins with finger extension and moves to finger flexion, with the 4th and 5th digits flexed into the palm
At what age is shoe tying completed if given the experience
5 years
When can a child dress independently
5 years
What is the age range for the TVPS?
5 years through 21-11 years
What age does caffeine begin to effect sleep?
5-12 (school-age)
At what age does TV/Computer interest peak?
5-12 years (school-age)
Copies triangle, prints name, copies upper- and lower-case letters by
5-6 years
Feeding ___ months - maintains lip closure longer in supine, sitting and prone - variety of oral movements used to explore objects - drools when babbling, reaching and teething
6
Oral motor __ months - breast/bottle - sucks small amount of liquid presented from cup - opens mouth when spoon approaches - up and down jaw movements "munching" of puree foods
6
Recommended time for exclusive breastfeeding?
6 months -only 1 in 4 infants actually do this
When should a child begin to see an eye doctor if they are at risk?
6 to 12 months
Using a knife by
6 years
Middle and late childhood
6-11 years
- Independent in motor skills- In and out of sitting without help - May walk holding on to furniture - Take first steps - Communication is improving - Pulls up on stationary objects - Gestures (shaking head no or waving bye bye) - Mama, Da da, uh oh - May be shy around strangers and cry if you leave the room - Becoming more social - Hand book when wanting to hear story - Peek a boo or paddy cake - Explores objects by shaking, banging, punching, or throwing > containerizing - Helps with getting dressed by putting out an arm or leg - Preference for clothes, toys, and people - Begin using objects for functioning (cup for drinking) - Developing core strength (develop through the use of occupation, through dressing for instance as child lifts leg while laying for dressing) - Object permanence (8-9 mo.) - Major domain for this stage is social emotional
6-12 month milestones
When does a child begin to vocalize?
6-12 months
When does self-feeding begin with a pincer grasp?
6-12 months
When is a child creeping/crawling?
6-12 months
Over half of children _____ have TV's in their rooms
6-17
Cuts out variety of shapes by (Both hands move simultaneously and reciprocally)
6-7 years
Cuts a variety of shapes
6-7 years; kindergarten age both hands cooperate in synchronous and reciprocal interaction during cutting actions
When does an infant wave bye-bye?
6-9 months (this is when understanding begins to happen)
US adolescents generally sleep less than recommended 9 hours - average = _______ hours
6.9
Late adulthood
60s - death
When is the age of viability (ability to survive outside of uterus)
7 months
Games
7-12 years
Feeding at ______ months - changes in postural control and UE movement - loses liquid when removing, repositioning or reinserting the cup - uses more lip movements to remove food from a spoon - soft foods, mashed and meltable solids - exposure to different textures of foods that require biting and chewing -*mostly up and down movement of the jaw* ex. cottage cheese, melon
7-9
When do children learn how to disinfect things?
8-12 (pre-adolescent, tween)
What age range is the COSA for?
8-13 years
Typically, infants sleep through night by ___ mo. (70-80%)
9
Brain is almost ___% its size by 5 years
90
Letter chart for saccadic therapy, next (second) level completion within ________________ without error
90 seconds
5
90% of brain formed by age
3-4, 5
A child can use fasteners between _____ years old, independent by ____ years
Constructivism
A philosophy of learning based on the premise that people construct their own understanding of the world they live in through reflection on experiences
Emotional/Self Regulation
A process to manage/change intensity of emotions
- 1 year: Removes socks; puts on/removes loose fitting hat, pushes arms through sleeves and legs through pants; uses fingers to self feed and brings filled spoon to mouth - 1.5 years, feeds with spoon and spilling; drinks from open cup - 2 years: removes shoes and simple pull off clothing; by 2.5 years puts on simple clothing (no fasteners); feeds self with spoon without spilling; washes hands fully and brushes teeth with help - Fasteners between 3-4 years old, independent by 5 years
ADL
Self-regulation
Ability to control one's thoughts, emotions, behaviors
the eye's ability to focus and maintain an image on the retina
Accommodation
Protective Reactions/Protective Extension
Accommodations to vestibular, tactile-pressure alterations from the surface, and to sensory awareness of impending change
protective reactions
Accommodations to vestibular, tactile-pressure alterations from the surface, and to sensory awareness of impending change - May replace equilibrium reaction when displacement is more vigorous
What theory is this? - The environment and the child's interactions shapes behaviors (along with neural systems)
Acquisitional learning theories
What theory is this? - Multi-dimensional process - Consider chronological age, developmental age, and social-emotional age - "Practice makes perfect" - Development occurs through learning/acquiring skills
Acquisitional learning theory
What theory is this? - Provides information that describes what practitioners can do to adjust/modify environment to bring about change in behavior
Acquisitional learning theory
What theory is this? - Significance of meaningful occupation to enhance development (growth)
Acquisitional learning theory
- Card games and board games (Concentration, Go Fish, Old Maid) - Matching Games (Crazy Eights, Uno, Blink, SET) - Games requiring fast responses (Operation, Slap-Jack, Snap) - Board games involving strategy (Sorry! Battleship, Parcheesi, checkers, Chinese Checkers) - Physical activity that requires quick responses, attention and inhibition (Red light-Green Light, Freeze Dance, Musical Chairs) - Fast moving games (Dodgeball, 4-Square, Tetherball) - Guessing games (require working memory) - Puzzles and brainteasers (attention, problem solving, working memory)
Activities to build executive function in 5-7 year olds
- Card games (Hearts, Spades, Bridge, Rummikub, Mexican Train)- working memory, planning and strategy - Games that require quick decision-making • Games involving strategy - (Chess, Othello, Clue)- working memory and cognitive flexibility - Physical activity- (Jumprope, double dutch, Chinese jump rope - Learning to play musical instrument (selective attention, self monitoring, working memory) - Crossword puzzles, Sudoku
Activities to build executive function in 7-12 year olds
- Goal setting and planning, self-monitoring behavior (Metacognition) - Self-monitoring behaviors to encourage: - Self-talk through steps of activity - Be mindful of distractions - Understanding motivations of others - Sports, yoga, meditation, music, computer games, theater - Study Skills/metacognition
Activities to build executive function in adolescence
in-hand manipulation
Adjustment or movement of an object within the hand
Three Jaw Chuck
Age 10-11 months - Full opposition of the pad of the thumb to the index and middle finger pads - May keep ring and pinky fingers extended
Neat Pincer Grasp/Tip Pinch
Age 10-12 months - Flexion of all of the joints in the thumb and index finger (so that the index fingertip and thumb come together)
Pincer Grasp
Age 10-12 months - Full opposition of the pad of the thumb and pad of the index finger to secure the object
Finger-to-Palm Translation Without Stabilization
Age 12- 15 Months - The child begins with finger extension and moves to finger flexion.
Palm-to-Finger Translation Without Stabilization
Age 2-2.5 years - The child begins with finger flexion and moves to finger extension
Crude Palmar Grasp (Ulnar Palmar)
Age 3-5 months - Thumb is NOT involved - The object is held firmly against the heel of the hand - The grasp is clumsy and often unsuccessful
Palmar grasp
Age 5-6 months - Thumb is not assisting with the grasp - Object is secured in the midsection of the palm
Palmar grasp
Age 5-6 months thumb is not assisting with the grasp object is secured in the midsection of the palm
Radial Palmar Grasp
Age 6-7 months - Index and middle fingers flex around the object to secure it into the palm - The thumb begins to oppose - The object is secured in the radial side of the palm
raking grasp
Age 7-8 months - The hand is positioned in a rake-like manner - All of the fingers are flexed at the IP joint around the object
Inferior Pincer Grasp
Age 8-9 months - Thumb adduction and emerging opposition to secure the object against the extended index finger - The object is held proximal to the pad of the index finger
Radial Digital Grasp
Age 8-9 months - Thumb opposition to the radial side fingers - The object is held proximal to the pads of the fingers - Space is visible between the object and the palm - The ulnar side of hand (ring and pinky fingers) are flexed
simple rotation
Age: 2-2.5 years - The child turns or rolls an object held at the finger pads approx.. 90 degrees or less; the fingers act as a unit and the thumb is opposed
Shift
Age: 3.5 years, inconsistently - Involves linear movement of the object on the finger surface to allow for repositioning of the object on the pads of the fingers. - The fingers move slightly at the MCP and IP joints, and the thumb typically remains opposed or adducted with MCP and IP extension throughout.
complex rotation
Age: 4-4.5 years - The child rotates a small object 180 to 360 degrees once or repetitively; the fingers and the thumb alternate in producing the movement and the fingers move independently of one another.
During pregnancy, this psychoactive drug use can lead to fetal alcohol syndrome
Alcohol
What cue is this? - Describe further - Encourages child to attend more closely
Analysis cue
Neural Tube Deficits of CNS: total or partial absence of the brain
Anencephaly
-Quick test used to measure the infant's overall physical condition -Infants rated at 1 min (testing to see how the child is responding to the birthing process) -and 5 min (testing to see how the child is responding to life outside of the womb)
Apgar Scale: Assessing Physical Condition
prefrontal cortex (develops fully around 25)
Area of the Brain that executive function occurs in?
newborn
As early as _________ a child can detect their caregivers voices?
BADL milestones, bathing, hygiene, and grooming: At two years, a toddler can
Assist with body washing and brush teeth with supervision and assistance
hand to mouth
Assists with release of object
hand to mouth
Assists with release of object (mouth holds object so hand can release)
blurry vision near and far
Astigmastism
visual pursuit, vestibular sense
At 2 months, upright position increases what?
changing baby's position, tummy time and upright position
At 2 months, what stimulates the infant's vestibular sense?
50, 2
At 2 years, a child has a vocabulary of ___ words and can follow ___-step instructions
2,000, 5
At 4 years, a child has a vocabulary of about ________ words and can make ___+ word sentences
learning the rules, working memory, inhibitory control
At 5-7 years old, what can you expect when performing/participating in games and activities?
pushing up, sitting up, crawling
At 6 months, positions help to develop strength, coordination, and physical skills needed for?
back (supine) and tummy (prone)
At 6 months, what positions are most appropriate for play?