pediatric 101 question untimed test

An Early Intervention (EI) OTR® has been working with a 2 1/2 year old child named Kristin. The OTR® has set up a meeting with the parents to discuss and plan the coordination of the child's transition to Early Childhood Special Education (ECSE) for the next 6 months. The parents have displayed feelings of doubt and concern about being prepared for the transition. What strategies would be MOST EFFECTIVE to ensure Kristin's smooth transition into the preschool setting?Choose the best 3 answer choices: Encourage the parents to engage in mindful and nurturing interactions with their child including touch, handling and movement Help the family establish a morning routine for the child Administer the Sensory Integration Praxis Test to identify sensory integrative dysfunction related to learning and behavior Ensure the transition process at this time includes post-secondary goals that is student-centered Collaborate with the family to make a social story about the process of transitioning from EI to ECSE Practice self-help skills, particularly those expected to be used in the receiving environment, i.e. washing/drying hands, donning/doffing coat

B, E, and F. All of these answer choices support the client-centered approach. Interventions involving both the child and family in preparation for what is expected in the receiving environment to ensure a smooth transitioning process, is also client-centered. "Strategies may include altering or modifying activities, remediating deficits, reducing environmental barriers, and preventing challenges by anticipating needs in the receiving environment. Although barriers exist to participation, practitioners can reduce such barriers through collaboration and accessing resources related to best practice in transition planning". Answer a) promotes parent-infant bonding in the NICU.Answer c) is administered from ages 4 to 8 years 11 months.Answer d) is addressed as at 16 years of age or younger in preparation for post-secondary transition.

At what age can a child be expected to verbalize that they need to use the bathroom? 18-24 months 2-3 years 3-4 years This is not a measured milestone

B. 2-3 years. Children between the ages of 2 and 3 become aware that they need to use the bathroom and can verbalize it, but do not always make it to the bathroom in time. The following developmental stages occur between the ages of 19 months and 4 years:19-24 months: Urinates regularly2-3 years old: Achieves regular toileting with occasional accidents; verbalizes when need to go to bathroom3-4 years old: Goes to bathroom independently; may need help with wiping/fasteners/difficult clothing

Lily is a 4-year-old girl with a diagnosis of Developmental Coordination Disorder. When her teacher tells the class to put away their coloring pages and sit on their carpet squares, Lily wanders around the classroom and requires assistance from the classroom aide to follow the teacher's instructions. What adaptation would help Lily to become more independent during transitions in her classroom? A 1:1 aide A visual schedule Noise reducing headphones Ankle weights

B. A visual schedule. Since Lily has Developmental Coordination Disorder, she has difficulty planning and carrying out the teacher's instructions within the classroom. She might have heard the teacher, but may not be able to visualize what the teacher wants her to do. A visual schedule will provide Lily with visual prompts to pair with the teachers verbal instructions, helping her brain to organize and interpret what the teacher wants her to do.

Charley is a 24-month-old toddler with hemiplegic cerebral palsy affecting his right side. The OTR® places a mitt on Charley's left hand while he is playing in order to encourage him to use his right hand. This is an example of what type of intervention? Neurodevelopmental Treatment Constraint-induced therapy Serial casting Therapeutic exercise

B. Constraint-induced therapy. Also called forced-use therapy, this intervention constrains the normal limb to force the child to use the affected limb.

A 29-month-old boy is lying in a prone extension position on a swing. Which muscles does this boy need to activate to maintain this posture as he swings back and forth? Inner core muscles Inner core and outer core muscles Back extensors Back flexors

B. Inner core and outer core muscles. When swinging prone, the child assumes prone extension- the "Superman" pose. This position activates the Posterior Oblique Synergist outer core muscle group (POS = contralateral latissimus dorsi and gluteus maximus) in combination with the inner core muscles. As soon as the POS activation begins, there is a counterbalance in anti-gravity flexion as the Anterior Oblique Synergist (contralateral obliques and adductors) activate. The combination of vestibular input with inner core and outer core muscle activity creates this sustained anti-gravity posture.

Which type of SI therapy would you expect to utilize with a 7-year-old girl who has a diagnosis of Autism Spectrum Disorder (ASD)? Exposure to loud noises to decrease auditory hypersensitivity Swinging for vestibular input Flashing lights for visual input No SI technique is appropriate to use with a child who has ASD

B. Swinging for vestibular input. Treatment techniques that are used to treat children with autism include sensory integrative techniques, such as swinging or animal walks to provide specific types of sensory input, and visual structure to help compensate for deficits in other sensory areas, such as visual schedules and timers. Exposure to flashing lights or loud noises would likely exacerbate the girl's sensory dysfunction in visual or auditory processing, rather than help to provide appropriate input. These techniques are also likely to cause the girl discomfort and distress.

Sean is a 2nd grade student with a diagnosis of glaucoma with visual impairment. He does not qualify for special education services, but he could benefit from occupational therapy services to provide adaptations to assist him with reading, keyboarding, and managing his lunch tray. Sean could receive occupational therapy services through which federal law? The Individuals with Disabilities Education Act of 2004 The Rehabilitation Act of 1973 The Americans with Disabilities Act The Affordable Care Act

B. The Rehabilitation Act of 1973. Section 504 of this act includes provisions for providing accommodations for students with disabilities in public schools, including occupational therapy services, as long as the student has a medically diagnosed condition.

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

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

A child who presents with generalized hypotonia is having difficulty dressing himself for school in the mornings. The biggest obstacle, which is impacting on his ability to be independent in this ADL, is his poorly developed balance in both sitting and standing. As a result, dressing has become a very tedious and frustrating task for him. What compensatory technique would be the MOST helpful to recommend, so that this child has the opportunity to dress himself independently and efficiently? The most helpful compensatory technique would be to use a universal cuff The most helpful compensatory technique would be to introduce side-lying The most helpful compensatory technique would be to use a button aid The most helpful compensatory technique would be to perform ROM exercises

B. The most helpful compensatory technique would be to introduce side-lying. By using side-lying, the boy's body will be fully supported by the floor/bed. He will therefore be able to use his hands freely to dress himself.

What are the benefits of using a ball seat for a child with ADHD in the classroom? To increase the distance between the child and the desk To stay focused and maintain alignment To provide classroom breaks To provide cues to the student to stay on track

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

In order to improve handwriting skills, a slant board is provided to a 2nd grade student to use when writing. What is the benefit of using this slanted/angled surface? Wrist flexion for pencil grasp Increased tactile input Wrist extension for pencil grasp Increased fine motor skills

C. Wrist extension for pencil grasp. Using a slanted board has many benefits, one of which is, it forces the wrist and hand into tenodesis (wrist extension and finger flexion). Writing with an extended wrist automatically places the hand into a functional position and allows the hand to pull the radial digits into opposition. Maintaining radial digit opposition to the thumb is necessary for promoting an efficient grasp on the pencil. By improving the student's pencil grasp, he can develop the skill of handwriting Other benefits: Helps with stabilizing the paper Promotes good shoulder positioning for handwriting Helps with visual tracking during writing and reading tasks

At what age can a child be expected to dress themselves independently and without supervision? 3-4 4-5 5-6 6-7

5-6. At 5 years old a child can tie and untie knots as well as dress unsupervised. Developmental milestones related to self-dressing skills. These are meant to be general guidelines for when these skills tend to typically emerge.• By 4 1/2 years of age:Unbuttons front-opening clothingButtons front-opening clothing (e.g., button-down shirt)Puts on weather-appropriate clothing without prompting (e.g., puts on coat if cold outside)Tightens shoelaces by pulling up or out• By 5 years of age:Places jacket or coat on designated hook or placeUndresses daily at designated times without remindersTying shoe laces is a complex skill that requires the integration of both sides of the body (bilateral coordination), integration of what is seen and hand movement (visual motor integration), planning, sequencing and manual dexterity. Developmentally, kids are ready from about 5 years of age to start learning to tie shoelaces, although some may not master it for a while.• By 5 1/2 years of age:Dresses independently when askedTucks in shirt

self feeding development

5-7 months: Take cereal/baby food from spoon6-8 months: Attempt to hold bottle, may not retrieve if falls, needs monitoring for safety6-9 months: Holds, tries to eat (self-feed) crackers (6 ½- 7 mos), but sucks more than bites; eats soft foods that dissolve, grab spoon and bangs or sucks on end of it (9mos), imitates stirring with spoon (9 ½ mos)9-13 months: Finger feeds self soft table foods (macaroni, peas, dry cereal), objects if fed by adult12-14 months: Dip spoon in food, bring to mouth, spills food before reaches mouth, cup drinking with firm jaw15-18 months: Scoop food and bring to mouth, Straw use begins at 18 months24-30 months: Interest in fork, stab food (canned fruit). Proficient spoon use and eats cereal w/milk or rice with gravy with utensil.

A 15-month-old toddler who was born at 28-weeks gestation is able to perform the following tasks during mealtimes: He is able to feed himself cheerios using a pincer grasp, he holds a spoon and bangs it on the tray and is starting to dip the spoon into his food, and he can hold and drink from an open cup. Based on these observations, at what age is this child functioning and are there any indications that he is developmentally delayed? 8-10 months, which indicates a significant developmental delay 12-14 months, which is age appropriate 12-14 months, which indicates a developmental delay 15-18 months, which is age appropriate

A 15-month-old toddler who was born at 28-weeks gestation is able to perform the following tasks during mealtimes: He is able to feed himself cheerios using a pincer grasp, he holds a spoon and bangs it on the tray and is starting to dip the spoon into his food, and he can hold and drink from an open cup. Based on these observations, at what age is this child functioning and are there any indications that he is developmentally delayed? 8-10 months, which indicates a significant developmental delay 12-14 months, which is age appropriate 12-14 months, which indicates a developmental delay 15-18 months, which is age appropriate

At what age can you expect a typically developing child to stab food with a fork? 24-36 months 0-6 months 12-18 months 36-48 months

A. 24-36 months. Every child progresses differently with self-feeding, which is why there is such an age range regarding utensil use development. The consensus is that by 36 months, a child can use a fork to pierce soft foods and bring it to their mouth.

What type of grasp does a 6-year-old child typically use to grasp a spoon? 3 jaw chuck/tripod grasp Lateral grip Lumbrical grip Pincer grasp

A. 3 jaw chuck/tripod grasp.A 3 jaw chuck grasp is a grasp pattern emerging in the 10th-12th month that involves holding an object with an opposed thumb and the index and middle fingers where the interphalangeal joints are slightly flexed. The ulnar fingers are slightly flexed to stabilize the radial side of the hand. Tools, such as a spoon or knife are typically grasped using the thumb, index and middle fingers. The fingers need to firmly grasp and stabilize the tool while at the same time move to manipulate it. This is a complex action which young children only start to effectively master at 4-5 years. The tripod grasp is a mature grasp pattern that occurs when a child holds a spoon positioned between their thumb and index fingers while the middle finger is used for stability. B. Many activities involve gripping a small flat surface between the thumb and side of the forefinger. The other fingers are flexed to provide additional support. This combination of movements allows considerable force to be applied to the object. A lateral/a key grip is used to turn a key, when tearing paper, lifting up a box by grasping on the sides. pulling on Velcro fastenings, pulling up trousers and socks.C. A lumbrical grip is used to hold an object without wrapping the fingers around it. .The fingers need to be straight, rather than curved.D. Small objects are picked up between the tip of the thumb and forefinger. From 8-10 months of age infants use this grip to pick up small objects.

Which comorbidities are common with Tourette disorder? ADHD, OCD, depression and anxiety ADHD, schizophrenia and ASD ASD, substance abuse and personality disorder OCD, eating disorder and ASD

A. ADHD, OCD, depression and anxiety.Tourette disorder (TD) -also called Tourette syndrome or chronic tic disorder, is a childhood-onset neurobehavioral disorder characterized by multiple motor and vocal tics that fluctuate in severity and last for. Tics are rapid, recurrent, and stereotypical motor movements or vocalizations that are involuntary and nonrhythmic; tics typically occur many times per day and often in bouts or in various combinations. The more common motor tics include eye blinking, head jerking, shoulder shrugging, and facial grimacing; common vocal tics include snorting, sniffing, and grunting. Tics typically emerge at age 5 year, peak in severity during early adolescence, then decline during young adulthood. Common comorbidities of TD include attention deficit hyperactivity disorder, obsessive-compulsive disorder, and symptoms of anxiety and depression.

When working with a child who has a sensory modulation disorder, which piece of equipment would be the best to use when focusing on providing vestibular input? Hammock Wedged cushion Headphones Yoga mat

A. Hammock. This is the only piece of equipment that provides movement. Participation in movement experiences such as jumping, climbing and swinging games that allow the head to move in different ways will support the development of the vestibular system. Slow rhythmic movements such as rocking in a hammock tends to be calming and soothing whereas fast movements with changes in direction such as roller coasters, dancing, riding a bike along a winding path with bends and turns, tend to beactivating and alerting. The symptoms of SPD vary greatly depending upon the sense that is affected, how that sense is affected, and the severity of the condition. SPD may occur in each sensory system: Visual, Auditory, Tactile, Smell, Taste, Vestibular, Proprioception, Interoception (sense that helps you understand and feel what's going on inside your body).There are 3 Types of Sensory Modulation Disorders:1. Sensory Over-Responsive2. Sensory Under-Responsive3. Sensory Craving

An OT is working with a 4-year-old child with Down Syndrome. The OT plans to administer a comprehensive standardized assessment that measures the extent to which this student can integrate their visual and motor abilities. What would be the most appropriate assessment? Beery Developmental Test of Visual-Motor Integration (VMI) Bayley Scales of Infant & Toddler Development Motor Scale Beery Developmental Test of Visual-Motor Integration-Visual Perception Beery Developmental Test of Visual-Motor Integration-Motor Coordination

A. Beery Developmental Test of Visual-Motor Integration (VMI). The Beery VMI helps assess the extent to which individuals can integrate their visual and motor abilities. The Short Format and Full Format tests present drawings of geometric forms arranged in order of increasing difficulty that the individual is asked to copy. Optional Supplemental Tests for More Detailed EvaluationTwo supplemental tests-the VMI Visual Perception Test and the VMI Motor Coordination Test- can each be administered in 5 minutes or less. They are generally given if full- or short-form VMI results indicate a need for further testing. The supplemental tests use the same VMI stimulus forms, so it easy to compare results from all 3 tests, using a profile form provided in the Test Booklet. B. Bayley Scales of Infant & Toddler Development Motor Scale: Assesses the mental, psychomotor and behavior of infants and toddlers ages from 1 month to 42 months.C. Beery Developmental Test of Visual-Motor Integration-Visual Perception- this is a standardized supplement to the Beery VMI and if needed, is administered after the Beery VMI. This is a timed test, where during a three- minute period the task is to identify the exact match for as many of the stimuli figures as possible. To make this as pure a visual-perceptual task as possible, the only motor requirement of the individual is to point to his/her responses.D. Beery Developmental Test of Visual-Motor Integration-Motor Coordination- this is a standardized supplement to the Beery VMI and if needed is administered after the Beery VMI. This is a timed test, where during a 5-minute period the task is to simply trace the stimulus form with a pencil without going outside the double-lined path.

Liam, a 5-year-old boy who has been diagnosed with moderate CP, is currently receiving OT intervention. As Liam presents with poorly developed oral-motor skills which is resulting in excessive drooling and him having difficulty initiating his swallow reflex, his current OT goal is to improve his oral-motor control for eating and swallowing. Which activity would initially be the best to incorporate into Liam's OT sessions, to help him achieve his goal? Blowing a paper boat across a tub of water Playing the harmonica Sipping milk shakes from a regular cup Drinking yogurt through a straw

A. Blowing a paper boat across a tub of water. This is an activity that is meaningful and purposeful for a child as it involves the occupation of play. As Liam is presenting with excessive drooling, the initial intervention needs to be tailored towards his abilities and thus blowing the paper boat is the most appropriate activity as it requires the least resistance. The act of blowing requires lip pursing which will help develop lip closure and in turn assist with swallowing.B. Playing the harmonica is a very difficult task that requires developed oral-motor control and it is too challenging for a 5-year-old. C. Sipping milkshake from a regular cup will not address/improve oral-motor control.D. Drinking yogurt through a straw could be used at a later stage but at this stage the resistance of sipping the thick liquid (resistive textures) would prove difficult for the child.

An OT is working with a 17-month-old boy who presents with a global developmental delay. Developmentally, in terms of using utensils during mealtimes, the boy is able to hold a spoon in his one hand and spontaneously bang the spoon on his highchair. What activity should be introduced NEXT to help this boy progress to the next developmental stage? Dipping the spoon in apple sauce Poking cooked carrots with a fork Eating a cracker with fingers Cutting food with a knife

A. Dipping the spoon in apple sauce. Typically a child progresses from banging a spoon, to dipping a spoon into food, to scooping food with spoon, to piercing food with fork, to using a knife with some assistance, to eventually using a knife and fork with skill. Developmental norms:10-12 Months: Holds spoon to play, bang, mouth, drop13-15 Months: Dips spoon in food. Brings spoon to mouth, turns spoon over but obtains some food. By 36 months: Can use a fork to pierce soft foods and bring to mouth. By 6 Years: Can cut with a fork and knife (entire process of holding utensils, controlling and cutting food, and bringing to mouth)As the OT is working on utensil use, finger feeding would not address the treatment goal.

Emma is a 9-month-old girl who according to her pediatrician, is developing normally. What characteristics would you expect to see as Emma plays on the ground? Exploratory play Walking without support Moro reflex Symbolic play

A. Exploratory play. A 9-month-old typically demonstrates equilibrium reactions while sitting, as well as the ability to sit without support while rotating the upper body, reciprocal creeping, and the ability to engage in exploratory play. The Moro reflex disappears in normally developing infants by the age of 6 months. Walking without support does not typically develop before the age of 10 months. Symbolic/Fantasy play is role playing or make-believe play, such as pretending to be a baby, firefighter, superhero, or monster, and make believe actions, such as driving a car by moving a pretend steering wheel, or using a block of wood as a cell phone.

An OTR® is working with a 4-year-old child who has poorly developed fine motor skills. The focus of the session is on improving the child's ability to perform isolated finger movements. Which type of activity would BEST meet the goal of this session? Fingerprint art Threading large beads Picking up and posting coins Turning a key

A. Fingerprint art.Finger isolation is using one finger to perform a task. To create a fingerprint, the child needs to isolate one finger and flex the rest of the fingers. The separation of the radial and ulnar sides of the hand allows for more skilled fine motor manipulation. Pointing with the index finger, wiggling all of the fingers individually, and counting out the fingers on your hand are finger isolation. This finger isolation is needed for many functional activities, like dexterity in managing pencils, paintbrushes, and other tools, typing on a keyboard, tying shoes, and many other skills. B, C and D incorporate the thumb.B. Beading larger beads promotes a 3-jaw chuck grasp.C. Picking up and posting coins requires tip-to-tip grasp.D. Turning a key uses a lateral pinch.

An OT practitioner is working in the school system with a student who has a developmental delay. The OT practitioner asks the student to hold a regular crayon and observes the student holding the crayon in a static tripod grasp. What is the BEST intervention to incorporate into the NEXT treatment session? Give the student a smaller crayon (crayon that's been broken in half) Provide the student with a built-up handle on the crayon Give the student a vibrating pen to work on grip Encourage the student to hold the crayon with a palmar supinate grasp

A. Give the student a smaller crayon (crayon that's been broken in half).The student is using a static tripod grasp, therefore the next step is to work on using a dynamic tripod grasp. Smaller crayons allow a child to manipulate them more easily. By giving the student a crayon that's been broken in half, it will naturally encourage them to "pinch" the crayon between their thumb and index finger, moving them into a more mature and skilled grasp pattern. Due to its size, the child won't be able to use shoulder and arm movements to manipulate the crayon as they will be forced to rest their forearm on the table which will encourage them to use their wrist and fingers to move the crayon.

An OT practitioner working in a school setting has been asked by the teacher to recommend suitable seating for a student who has difficulty sitting still when seated at their desk. Before the OT practitioner recommends sensory seating for this child, what should the OT practitioner consider FIRST? Is the student restless because their feet can't touch the floor Does the student have a diagnosed sensory issue What is the student's preference for the type of sensory seating Will the seating be covered by insurance

A. Is the student restless because their feet can't touch the floor.It is always important to start by FIRST establishing why the student needs sensory seating. Sensory cushions, regardless of shape, are all designed to be filled with air. This creates a moving surface for the child to sit on. Before suggesting a wobble cushion, it is important to check that the child is not fidgeting because their feet can't touch the floor. If the child's chair is too high for them, they will find sitting still in their chair very difficult. The cushion will make them even higher and even more unstable. Also, children with poor core stability and balance might find the cushions very difficult to sit on. This is because the cushion is unstable and therefore harder to stay seated on compared to a harder surface. Sensory seating (chair or movement cushion) helps children get the extra movement they are 'seeking' whilst sitting in a classroom. The ultimate aim of sensory chairs and fidget cushions is to help children with their attention and ability to focus. It is thought that children who move about are doing this to help keep themselves regulated and/or alert. Some children might move in order to help themselves to focus while others may move because it helps keep their body and/or thinking more organized. The idea is that the motion of the sensory movement decreases other distracting or unsafe movements that the child may be doing to help keep themselves alert and focused. It allows these children to move about in a more appropriate way. Wobble cushions are typically recommended for children with ADHD or ASD. Within the sensory processing disorder model, these children would be called movement/vestibular seekers.

An OT places a 4-month-old infant in a supine position on the floor and turns their head to one side. The OT observes the infant's entire body turning in the same direction as his turned. What reflex is this infant demonstrating? Neck righting reflex Symmetric tonic neck reflex (STNR) Moro reflex Labyrinthine Head Righting

A. Neck righting reflex. The first of the righting reflexes to appear is the neck righting reflex. It is present at birth and strongest at about three months of age. It is triggered by stretching of the neck muscles when there is rotation of the head. With the baby in supine, if the head is turned to one side, the whole body will follow, in what is called a log roll, until it is brought into alignment with the head. B. STNR- When the infant's head is flexed, the influence on tone causes their arms to flex and their lower limbs to extend. When their head is extended, the influence on tone causes their arms to extend and their legs to flex. The STNR emerges at around 4 - 6 months, and should be integrated by the latest 12 months of age. The reflex is important to help the child come into a crawling position.C. Moro• Onset - begins at 28 weeks gestation• Integration - 5-6 months• Position infant halfway between supine and upright sitting with their head in midline, support the infant's head and shoulders with one hand. Allow the neck to drop back to allow the anterior neck muscles to stretch• Response observed - the shoulders abduct, the elbows, wrists and fingers extend. Subsequently, the shoulders adduct, and the elbows and fingers flexD. Labyrinthine Head Righting• Onset - birth to 2 months• Integration - persists throughout life• Testing position - vertical position• Procedure - tilt the child anterior, posterior, and lateral from the vertical• Response observed - the head orients to the vertical position and is maintained steady

An OT screens a child in the classroom who is seen acting aggressively, arguing repeatedly with the teacher, and losing his temper. What diagnosis does this student most likely have? Oppositional defiant disorder Attention-deficit/hyperactivity disorder (ADHD) Elimination disorder Pervasive Developmental Disorders

A. Oppositional defiant disorder. Children with oppositional defiant disorder break rules and act aggressively, argue repeatedly with adults, lose their temper, feel great anger or resentment, ignore adult rules and requests, and display negative behaviors.

As an OTR® working with late adolescent patients who have been diagnosed with Duchenne Muscular Dystrophy (DMD), what is the MOST important factor you should address at this stage of the patients' disease? Pain management Women's rights Assessment for a wheelchair Address gastrointestinal dysmotility issues

A. Pain management.It is a general rule in OT to always treat pain FIRST. Pain, which is considered the fifth vital sign, is important to assess in all individuals with DMD across the life span. Pain management is an important priority in transitions to adulthood and the management of DMD in adulthood. Pain of varying types and intensities may occur in DMD. Effective pain management requires an accurate determination of the cause and may require comprehensive team management. Postural correction, orthotic intervention, PT, adaptive equipment, assistive technology, and pharmacological interventions may all be required. Adaptive equipment and assistive technology should be used to emphasize the prevention and management of pain and optimize comfortable function and movement with transfer, bathing, and toileting equipment. Duchenne muscular dystrophy (DMD) is a rare muscle disorder but it is one of the most frequent genetic conditions affecting approximately 1 in 3,500 male births worldwide. It is usually recognized between three and six years of age. DMD is characterized by atrophy of the muscles of the pelvic area followed by the involvement of the shoulder muscles. As the disease progresses, muscle weakness and atrophy spread to affect the trunk and forearms and gradually progress to involve additional muscles of the body. In addition, the calves appear enlarged in most patients. The disease is progressive and most affected individuals require a wheelchair by the teenage years. Serious life-threatening complications may ultimately develop including cardiomyopathy and breathing respiratory difficulties. B. Duchenne muscular dystrophy is widely considered a condition that affects boys and men. Duchenne muscular dystrophy usually affects males. However, females are also affected in rare instances. Most women who carry a genetic mutation that can cause Duchenne won't develop the condition but they can pass the mutation on to a son who will have DMD, or to a daughter who will become a "carrier" of the mutation like her mother. Some women who are carriers of a Duchenne mutation eventually develop some signs or symptoms, which are usually far more subtle than actual muscular dystrophy. But it's also possible for gir

What is a sensory diet? Physical activities and accommodations designed to meet a child's specific sensory needs A diet consisting of crunchy (vegetable sticks/popcorn) and salty snacks (pretzels/popcorn) to improve oral sensitivity A set of activities designed by Jean Ayres which are to be performed at home A diet consisting of thicker liquids (smoothies, yoghurt) to improve oral sensitivity

A. Physical activities and accommodations designed to meet a child's specific sensory needs. A sensory diet is a tailored plan of physical activities and accommodations designed to meet a child's sensory needs. This type of treatment has nothing to do with food. The goal is to get kids in a "just right" state. For children who tend to get overstimulated, a sensory diet will include activities that help them come down from an overloaded state and feel calm. Conversely, children who feel or seem sluggish will do activities to help them feel more alert. Having the right sensory input helps them pay attention in school, learn new skills, and socialize with other children. Just like every child is different, each child's sensory diet is different. The activities, accommodations and/or strategies that are selected address the child's needs, and individual interests.

An OT practitioner is working with a 6-year-old student who has handwriting difficulties. The student's handwriting is being affected by his poor proximal stability and limited wrist extension. The OT practitioner has made the clinical decision to base their intervention on a remedial approach and included in the student's treatment plan, are adaptations to his work surface. Which work surface and in what position should the student complete handwriting tasks to improve the quality of his handwriting? Standing upright and writing on a chalkboard Sitting on an exercise ball with both arms supported by the desk Lying supine with the trunk supported on a wedge Positioned prone on a inclined mat

A. Standing upright and writing on a chalkboard.In a remediation approach, intervention is targeted towards improving performance components, with the assumption that such improvements will lead to enhanced occupational performance. Since the student has limited wrist extension, writing on a chalkboard will facilitate wrist extension as writing on a vertical surface naturally places the wrist in extension, the ideal position for handwriting. In contrast, a flexed wrist limits finger mobility and pencil control. The vertical reach and resistance of the chalkboard will help to strengthen the student's upper extremity (proximal stability) as he writes.

Miley is a student in the 4-year-old kindergarten class at the local elementary school. Miley's mother approaches the OT practitioner to complain that Miley's development is slow as she cannot tie her shoelaces. How should the OT practitioner respond? The OT practitioner should tell Miley's mother not to worry as Miley is too young to independently tie her shoelaces The practitioner should recommend referral to occupational therapy for fine motor skill development The OT practitioner should give Miley's mother strategies on how to teach her child shoelace tying The OT practitioner should refer Miley for special educational services

A. The OT practitioner should tell Miley's mother not to worry as Miley is too young to independently tie her shoelaces. Children typically develop the skills necessary to learn shoe-tying between the ages of 5 and 6 years.

An elementary school student who is not identified as having special needs is demonstrating delays in both their speech and gross motor development. The student's teacher approaches the school OT and asks if she can do something to help this student. How should the OT respond? The OT should refer the teacher to the special education director The OT should request an occupational therapy evaluation The OT should contact the child's parents The OT should refer the teacher to the physical therapist

A. The OT should refer the teacher to the special education director. Occupational therapy in public schools cannot be provided unless a child qualifies for special education services under IDEA 2004 or for an accommodation plan under Section 504 of the Rehabilitation Act of 1973. Since the student does not have either of these services in place, the special education director will need to observe the student and determine if an evaluation for special education services is warranted. If the student's performance in school is significantly impacted by his speech and gross motor delays, the special education director will request permission for the evaluation from the student's parents and will notify those members of the special education team who may need to evaluate the student.

An OTR® is working with a 6-year-old child who has been diagnosed with a sensory processing disorder. To ensure that the OTR® does not overload the child with sensory input, they need to monitor the child's level of arousal throughout the session. What responses should the OTR® look out for which would indicate that the child has reached his sensory threshold? Select the best 3 answers. The child splays his legs out toward the ground when the therapist pulls him on a scooter board and picks up speed The child hugs the rope ladder tightly as he climbs and stops after advancing 1 rung above the floor The child repeatedly rolls down the incline during a game of bulldozing large foam blocks The child continuously "catches" all the balls in the therapy room The child becomes nauseous and pale The child seeks the bolster swing, climbs on it, and pretends that he is a cowboy

A. The child splays his legs out toward the ground when the therapist pulls him on a scooter board and picks up speed.B. The child hugs the rope ladder tightly as he climbs and stops after advancing 1 rung above the floor.E. The child becomes nauseous and pale.These behaviors, demonstrated during the activities, are indicative of a child who has reached his sensory threshold. A threshold refers to a certain level at which a child responds to sensory information. For some children, they may be hyper-responsive and therefore take on a low sensory load to effectively respond to their environment. For others, they may be hypo-responsive and can take on a higher sensory load of information before they react.

A 4th grade teacher has 20 students in her class, including 3 students diagnosed with ADHD. The teacher decides to incorporate movement breaks into her lessons. What type of intervention is this strategy an example of? Tier 1 intervention Tier 2 intervention Tier 3 intervention RTI

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

When working with a child who has SI difficulties, what are the goals of the intervention when the OT structures the activity to include rolling the child up tight in a yoga mat like a "burrito'? To provide proprioceptive and vestibular input To provide tactile discrimination To provide vestibular input To prepare the body for visual motor skills

A. To provide proprioceptive and vestibular input.Tactile Defensiveness is a sensory processing issue, where the child's neurological system is "hypersensitive" to light touch sensation. Light touch tends to be alerting and arousing whereas deep tactile pressure is a firm, consistent touch which tends to be calming and organizing. The theory behind inhibition is that because multiple sensations and multiple pathways interact with each other in the CNS, by providing one kind of input, it may reduce/inhibit the sensation of the other.The vestibular and proprioceptive systems are interrelated and have some common functions. The proprioceptive system plays an important regulatory role in sensory processing as proprioceptive input can assist in controlling responses to sensory stimuli. Rolling in a yoga mat provides the child with both proprioceptive and vestibular input. Being encased in the mat, gives constant deep pressure (proprioception) and the act of rolling stimulates the vestibular system.

A student in the 3rd grade has difficulty with his visual processing skills and to address this, several strategies were recommended in his IEP. However, after 4 months of implementing these strategies, they no longer seem to be helping the student. What is the NEXT stage of the OT intervention process, in this scenario? Schedule an IEP right away to adjust the student's goals Discuss new interventions with the special education teacher to be implemented in the classroom Continue working on the strategies given in the current IEP until the next IEP meeting Make an amendment to the IEP and send it to the student's parents to sign off on it

B. Discuss new interventions with the special education teacher to be implemented in the classroom. If the student's progress has plateaued, then the NEXT stage would include discussing new interventions with the special education teacher to be implemented in the classroom to yield more progress towards the student's goals. A. and D. The goals for the student's IEP have already been established and remain the same. The only change is what the OT recommends to achieve these goals. This is part of the OT process and involves grading or changing the recommendations that will help the student achieve their IEP goals. There is therefore no indication that amending the IEP or changing the goals of the IEP are necessary. After this NEXT step, if the goals need to be changed, in certain circumstances, when minor changes to a student's IEP are required, an IEP team member may discuss the required changes with the student's parents and other team members without calling a meeting to review the IEP. If the team agrees, changes to the IEP may be made by completing the appropriate forms and documenting communication with other team members.

During the screening process of a 2-year-old child with CP, an OT observes the child frequently gagging and choking while being spoon fed by his mother. What are the MOST likely causes that would result in this child's gagging and choking response to eating? Select the 3 best answers. Weak gag reflex Dysphagia Aversion to a new texture Behavioral response Child is full and they do not want to eat anymore food Dyspepsia

B. Dysphagia.C. Aversion to a new texture.D. Behavioral response.Children with cerebral palsy (CP) commonly have feeding disorders and swallowing problems (dysphagia) that in many instances place them at risk for aspiration with oral feeding, with potential pulmonary consequences. They also commonly have reduced nutrition/hydration status and prolonged stressful meal times. The gag reflex is a reflex that can often be extra sensitive to the point where the child may gag or choke when something touches their tongue or palate. Gagging and choking can either be a sign of aversion to something new and different, or a sign that the child is having trouble swallowing.Common causes:• Offering the wrong texture can cause gagging and choking.• Offering new textures may cause gagging, even if the feeding team has recommended the new texture. Be patient - with the guidance of the feeding team specialists, introduce new textures gradually to build up tolerance of new foods.• Gagging may be an indicator of using the incorrect feeding technique such as placing the spoon too far back on the tongue.• Gagging may be a behavioral response. It could be an emotional reaction from a negative experience such as being tube fed. A. A hyperactive gag reflex is the opposite of a weak gag reflex. By the term itself, it is a high and sensitive reaction in the throat.F. Dyspepsia is the term used for recurring signs and symptoms of indigestion that have no obvious cause.

What is the MOST important factor that should be considered FIRST before introducing solids (pureed foods) to a child? Lip closure Head and neck control Trunk control Pelvic stability

B. Head and neck control.By 4 months of age, most infants have gained fair head control and are able to remain in an upright position with support, and parents are beginning to introduce puréed foods. As they have grown, the anatomical structure of their jaws and tongues have dropped forward to support munching patterns. They also may open their mouth when a spoon is presented and are able to manage thin purees with minimal difficulties. The FIRST factor that needs to be developed is head and need control. For successful and safe feeding, the baby needs to be able to hold their head up and sit up straight while supported in a high chair. Although all the other factors (pelvic stability and trunk control) are important for feeding, they can be achieved by providing external support. Basically, if the head is not stable then the fine movements of the jaw and tongue needed for feeding will be impaired. For effective oral-motor functioning:• Development of head control.• Stability and alignment of the scapular and pelvic girdles (pelvis and shoulders), and alignment and control of trunk.• Stability / mobility points (one area of the body is supported so that another area can move).

An OT practitioner is working with a 6-year-old child who has Spina Bifida Myelomeningocele and associated hydrocephalus. As this child has a shunt in situ, it is important for the OT practitioner to be aware of the signs/symptoms of shunt malfunction. Which signs are MOST commonly associated with shunt malfunction in a child? Distended scalp veins and downward deviation of eyes Headache, vomiting and lethargy Neck stiffness and sensitivity to light Rash and watery eyes

B. Headache, vomiting, lethargy.Common shunt malfunction signs include:• Headaches.• Vomiting.• Lethargy (sleepiness)• Irritability.• Swelling or redness along the shunt tract.• Decreased school performance.• Periods of confusion.• Seizures. A. Distended scalp veins and downward deviation of eyes (sunsetting of the eyes) are associated with hydrocephalus.C. A Stiff neck and sensitivity to light are typically associated with meningitis.D. Measles symptoms including high fever, cough, runny nose, and watery eyes appear 7-14 days after infection. Koplik spots and a rash will also appear

Sam is a 3-year-old boy who enjoys building sand castles on the beach. What type of grasp does Sam use to carry his bucket by the handle, to the beach? Lateral pinch Hook Spherical Cylindrical

B. Hook. A hook grasp is used to carry objects by a handle, such as this bucket. It is also used when hanging from an overhead bar. A hook grasp is useful for sustaining a grip to carry objects. A. Lateral pinch is useful when one needs power to manipulate or hold a small object. Turning a key in the door is an example of lateral pinch.C. A spherical grip is used when the fingers need to be shaped to grasp a round object. This grip is used to grasp a ball shaped or flat round object, such as the lid of a tub.D. A cylindrical/palmar grasp is used to hold objects or tools with a long handle The handle of the tool is held diagonally across the palm of the hand. The thumb is used to stabilize the grasp. In some tasks the thumb is used along the length of the object, such as when holding a hammer.

Felix is a 12-year-old student who was diagnosed with DMD (Duchenne Muscular Dystrophy) at the age of 5-years. He lives with his parents and 2 older siblings in a 2-bedroom apartment which is in walking distance to his school. As Felix is experiencing increasing muscle weakness and fatigue with walking, the need for a power wheelchair has been identified to help him with his mobility. When prescribing a power wheelchair, ease of maneuvering the wheelchair in small spaces is essential. To achieve this goal, what is the BEST modification in terms of placement of the drive wheel? Rear-Wheel Drive Mid-Wheel Drive Front-Wheel Drive The student will have to use a manual wheelchair

B. Mid-Wheel Drive.Power wheelchairs are available in several styles and are differentiated by the electronics, control systems, and placement of the drive wheel. The position of the drive-wheel affects the maneuverability, stability, traction, and performance. Maneuverability depends on the wheelchair's turning radius. For this type of powerchair, the drive wheels are in the middle of the power wheelchair frame. This makes the chair require a second set of casters on the power wheelchair base: two in the front and two more in the back for stabilization. Mid-wheel drive wheelchairs have the smallest turning radius because the chair turns around the center wheels; therefore the rule of thumb is when you are turning, if the front of the wheelchair fits the back will also. This makes it the most maneuverable in small spaces like hallways or getting in and out of bathrooms.

During an initial interview with a parent of a 6-year-old child who was recently diagnosed with a sensory processing disorder, the parent reports that their main concern is that their child has difficulty performing basic functional skills at home such as holding a toothbrush correctly during oral care and eating cereal without spilling. The OT and OTA collaborate to collect information related to the parent's concern using functional activities in a school setting. What is the best way to collect this information? Observe how the child takes turns playing ball with other children on the playground Observe how the child handles scissors during an art activity with construction paper Identify behaviors the child displays during transitions between activities in class Determine any self-stimulating behaviors that occur during quiet, reading time

B. Observe how the child handles scissors during an art activity with construction paper. This observation correspond to identifying motor planning and fine motor difficulties. As the parent reported being concerned with functional tasks that involve motor planning and fine motor skills, the answer should be based on tasks which involve motor planning and fine motor skills. Fine motor skills involve the use of the smaller muscle of the hands, such as when doing up buttons, opening lunch boxes or using pencils or scissors. Fine motor skill efficiency significantly influences the quality of the task outcome as well as the speed of task performance. A, C. and D. Although it is possible that the child demonstrates behavioral problems which may be related to sensory processing disorders, it is the fine motor problems that are related to the parent's concerns and could play a part in establishing priorities and goals should the child be eligible for IEP.

An OTR® working with a COTA® in a school-based setting is teaching the COTA® how to administer a standardized assessment which is typically used to evaluate new students. Which standardized assessment is the MOST appropriate for the COTA® to learn to administer? The COTA® is not permitted to administer any standardized assessments Peabody Developmental Motor Scales Transdisciplinary Play-Based Assessment Allen Cognitive Level Screening Tool

B. Peabody Developmental Motor Scales.The COTA® would be allowed to administer tests that are standardized and have specific, objective instructions. The Peabody Developmental Motor Scales, Bruininks-Oseretsky Test of Motor Proficiency, Motor-Free Visual Perception Test, and Miller Assessment for Preschoolers meet this requirement. A. The COTA® may, if directed by the occupational therapist, and deemed competent, perform designated assessments to contribute to the evaluation, but may not interpret data. The interpretation of assessment results and the overall evaluation is the responsibility of the occupational therapistC. The Transdisciplinary Play-Based Assessment is a non-standardized assessment that utilizes team observations.D. The Allen Cognitive Level Screening Tool is not an assessment used within a school setting.

An OT is working with a 7-year-old boy who has Down Syndrome. One of the therapy goals is to improve the boy's fine motor skills , specifically his in-hand manipulation. What activity would achieve this goal? Engage the child in a game of throwing and catching small bean bags Place 3 coins in the child's hand and ask him to post the coins into a piggy bank, one coin at a time Play a desktop game with the child which requires him to remove small pegs from a pegboard, while you time him with a stopwatch Give the child a selection of colored pencils to choose from and ask him to select one pencil which he can use to complete a coloring-in activity

B. Place 3 coins in the child's hand and ask him to post the coins into a piggy bank, one coin at a time. In-Hand Manipulation refers to the ability to move and position objects within one hand without the assistance of the other hand.

An OT has been working with a child who has been diagnosed with an Autism Spectrum Disorder (ASD) on further developing his hand function. Once the student is able to efficiently grasp objects of different sizes, what would the NEXT goal of OT intervention be? Have the student walk on a balance beam while holding onto a book Place objects in different directions so the student has to move his arm while maintaining his grasp Place objects above student's chest height Provide the student with a universal cuff to hold onto an object

B. Place objects in different directions so the student has to move his arm while maintaining his grasp. Once the student has developed the ability to grasp objects of different sizes, it is important to have him use his newly developed skill for functional tasks.

During a feeding intervention with a 8-year-old child with cerebral palsy, the OT recognizes several problems while the child sits in a chair. What is the first area of concern to address? Decreased endurance while feeding Postural instability Poor lip closure Food and drink spilling from the mouth

B. Postural instability. When working with this child it is important to first address postural stability so they are in an ergonomically aligned position to eat food properly. You need proximal stability for distal ability.

A 5-year-old girl is being treated in the hand therapy clinic following a distal ulnar fracture of her left arm. She is being fitted for a dorsal long forearm splint with Velcro straps. Her parents are concerned that she may try to remove the splint as she is a very curious child and tends to take everything apart, including her Velcro shoes. What is the BEST way, the certified hand therapist could adapt the splint to prevent the child from removing it from her forearm? Provide a sock pocket with a "mouth" opening to be placed over the splint in order to keep the splint covered Replace the Velcro straps with shoelaces and shoelace locks, and apply stickers of her favorite animal or cartoon characters Sew in snap fasteners that is more demanding on the child's hand strength to manipulate and release Use a clamshell-type splint with hook and loop straps

B. Replace the Velcro straps with shoelaces and shoelace locks, and apply stickers of her favorite animal or cartoon characters. Shoelaces for attachment rather than Velcro straps are often more challenging for removal. "Bow Biters," little plastic critters that tie on the lace and then clamp down on the bow after it is tied, can also be used to secure the lace, therefore making removal more difficult. This would prevent her from removing the splint. The cartoon design is fun and appealing and she is more likely to keep the splint on, to show the design to her peers and loved ones.

A three-year-old girl is referred to a school-based occupational therapy program from the county birth-to-three program. The girl's problem list includes withdrawal, irritability, and difficulty using both hands. She has a history of seizures and problems coordinating breathing and swallowing during feeding. She has also been referred to physical therapy for a gait disturbance. What would you expect to see as this girl's primary medical diagnosis? Cerebral palsy Rett Syndrome Down Syndrome Autism Spectrum Disorder

B. Rett Syndrome. All the symptoms listed are characteristic of Rett Syndrome, which primarily affects girls.

Arianna is a 6-year-old girl with a diagnosis of ADHD. During recess, Arianna spends her time swinging on the playground equipment and does not participate in other activities. What therapeutic activity should the OT incorporate into Arianna's OT intervention to provide her with the sensory input she is seeking? Finding small toys in the ball pit Riding a scooter board to knock down plastic bowling pins Feeling for and identifying small objects in a box with eyes occluded Playing catch with a medicine ball

B. Riding a scooter board to knock down plastic bowling pins. .By observing Arianna's behavior on the playground, the OT determines that Arianna is seeking vestibular input. She plans the "human bowling ball" activity using the scooter board to help provide Arianna with vestibular input in a fun, engaging manner.

What type of in-hand manipulation skill does unscrewing a standard bottle cap require? Palm-to-finger-translation Simple rotation Finger-to-palm translation Complex rotation

B. Simple rotation.The question asks what type of in-hand manipulation skill the child uses to unscrew a bottle cap. In-hand manipulation skills are different to types of grasps. In-hand manipulation is the ability to hold and move an object within one hand. In-hand manipulation skills are divided into three major categories: translation, shift, and rotation.1. Translation is the ability to move objects from the fingertips to the palm or the palm to the fingertips such as moving coins from the palm to the fingertips to place in vending machine or picking up pennies and moving them from the fingertips to the palm.2. Shift is the ability to move an object in a linear manner with the fingertips, such as repositioning the pencil in the fingers to position for writing or fanning playing cards in the hand.3. Rotation is the ability to turn an object around in the pads of the fingers and thumb (simple rotation) or turning an object from end to end (complex rotation) such as flipping a pencil from writing end to eraser.A screw top bottle is typically opened with rotation by turning the bottle top between the pads of the fingers and thumb (simple rotation) and typically develops between 2 and 3 years of age. It involves the turning or rolling of an object 90 degrees or less with the fingertips moving as one unit.Rotation in more detail:Rotation is defined as the movement of an object around one or more of its axes. Rotation is divided into simple rotation and complex rotation.- Simple rotation is a movement that occurs when an object is turned between the finger pads and thumb pad in a repetitive movement between thumb and fingers. The movement may occur with only the index finger and the thumb or with the involvement of additional fingers. An example of this movement would be to unscrew a small bottle cap.- Complex rotation is a movement involving rotation of the object or rotation that requires isolated, independent movements of the fingers and/or thumb. The movement is further described as the object being turned between 180 to 360 degrees. An example of this movement would be to turn over a pencil to use the eraser.

During an early intervention session, a baby girl is observed sitting on the floor with no external support provided. The baby is however, leaning forwards and propping herself on her hands. What is the next developmental stage of sitting, this baby can be expected to achieve? Sitting without any form of support Sitting with arms at sides, for support Sitting and rotating trunk Moving from this position into a crawling position

B. Sitting with arms at sides, for support. This is the sequence of the progression of developing independent sitting:1. Sitting forwards, propping self on arms (forwards), hands not free to play.2. Sitting with a more upright posture and supporting self with arms at sides, hands not free to play.3. Finally sitting independently and hands are free for play.

What is the role of the OT practitioner when providing OT intervention to a child who has been diagnosed with ODD (Oppositional Defiant Disorder)? Select the 3 best answers. Referral to psychiatrist for medication Social skills training Teaching coping strategies Providing awareness that establishing routines is counterproductive Family-based interventions and education Addressing any lifestyle changes is not within the OT scope of practice

B. Social skills training.C. Teaching coping strategies.E. Family-based interventions and education B. Social skills training teaches a child to reciprocate healthy conversations with friends and family by teaching them how to react appropriately in social scenarios.C. Children with ODD have problems controlling anger and hostility. OT practitioners should consider working with students on coping techniques to deal with everyday situations that can lead to stress. OT can teach the child specific problem-solving techniques where they have to work with difficult situations that may cause them to lash out inappropriately. Enhanced problem-solving skills are used to reduce negative behavior in order for the child to participate in daily tasks successfully.E. OTs can help target challenging interactions between children and their parents/caregivers. By doing so, the OT may use interventions that involve positive communication between parents and the child. Improving interactions will reduce the child's capacity to test and push parents' authority through tantrums and manipulation. A. Psychotherapy and medication management (for when the child has other coexisting disorders such as ADD, anxiety, or depression) are not within the OT's scope of practice.D. Many children with ODD struggle with change and transitions. It is important to develop a routine for students to implement. Working together with teachers, students, and parents to develop a structured and predictable schedule at school and home is an important part of OT intervention.F. Addressing lifestyle changes is within the scope of OT. Consider what lifestyle changes or modifications may help improve behavior. Improvements in sleep schedules, eating habits, and exercise may improve a child's ability to cope better.

A 7-year-old student who has Diabetes type 1 and does not meet the criteria for special education services under IDEA 2004 presents with significant reading and writing difficulties which are impacting his school performance. The student has been evaluated by an OT and qualifies for occupational therapy services which have been approved under Section 504 of the Rehabilitation Act. Before the OT commences with their treatment plan, a representative from the school district approaches the OT and requests that the OT limits their services to a total of 4 sessions, to help with the school district's budget. In this situation, how should the OT respond? Agree to this request in order to maintain a good working relationship with the individual Inform the individual that the student is entitled to ongoing OT intervention through Section 504 of the Rehabilitation Act of 1973 Advise the individual to apply for federal funding for the student's OT services through Part C of IDEA Inform the individual that OT services will be provided at a level that will meet the student's needs

D. Inform the individual that OT services will be provided at a level that will meet the student's needs.Ethically the OT has to provide services at a level that will meet the student's needs. OT intervention should be sufficient to allow the student to access their FAPE (free and appropriate public). The occupational therapy treatment plan must be focused on increasing the student's ability to function independently in school through adaptations. and accommodations. B. Therapy provided through a 504 plan is not intended to be ongoingC. The Program for Infants and Toddlers with Disabilities (Part C of IDEA ) is a federal grant program that assists states in operating a comprehensive statewide program of early intervention services for infants and toddlers with disabilities, ages birth through age 2 years, and their families. Occupational therapy provided through 504 plans in public schools:1. The student must be evaluated by occupational therapy and must qualify for occupational therapy services based on that evaluation.2. The occupational therapy treatment plan must be focused on increasing the student's ability to function independently in school through adaptations. Individual skills may be addressed if those skills are required to utilize adaptations and accommodations.3. The student must have a clearly identified and documented disability. This is most often based on a medical diagnosis by a physician or qualified health professional.4. School districts do not receive additional federal funding for the provision of 504 plans, so the school district will not receive any reimbursement for the provision of occupational therapy services under a 504 plan.5. If an evaluation shows that a student requires accommodations under a 504 plan, including occupational therapy services, Section 504 requires the school district to provide the needed accommodations even though the district will not be reimbursed for those accommodations.6. A school district may ask the occupational therapist to limit the amount of service provided to a student through a 504 plan due to the costs the school district incurs. Therapists should remember to provide services at a level that will meet the student's needs. Therapy provided throug

An OT is formulating a treatment plan for a child with a sensory modulation disorder. Using a SI approach, stimulation of which system should be incorporated into the intervention plan as it is considered the unifying system that primes the entire nervous system to function effectively? Visual system Vestibular system Tactile system Auditory system

B. Vestibular system.In her book, Sensory Integration and the Child, Dr. Ayres explains: "The vestibular system is the unifying system. It forms the basic relationship of a person to gravity and to the physical world. All other types of sensation are processed in reference to this basic vestibular information. The activity in the vestibular system provides a "framework" for the other aspects of our experience. Vestibular input seems to "prime" the entire nervous system to function effectively. When the vestibular system does not function in a consistent and accurate way, the interpretation of other sensations will be inconsistent and inaccurate, and the nervous system will have trouble getting "started."The vestibular system is the first sensory system to fully develop (five months after conception). It is the sensory system considered to have the most important influence on our everyday functioning. The vestibular system is the unifying system that directly influences nearly everything we do. This system affects our posture, balance, movement, coordination, attention and arousal. It even impacts how awake and alert we are. We use our vestibular sense to know which way is up or down, or how fast or slow we move. Movement is crucial to its development, and it also plays a role in the overall self-regulation of our nervous system. Vestibular input is extremely powerful and can be alerting or calming to the nervous system.

t what age can a child be expected to begin assisting in pulling down his pants? 12 months 18 months 2 years 3 years

C. 2 years. By the age of two, a child should begin to help pull his pants down, and will pull down elastic-waist pants by age two and a half.

Madison is an active child who loves to run, jump and climb in the playground. At what age can she be expected to be able to fasten her jacket by threading the zipper and zipping it up? 3-4 years 4-5 years 5-6 years 6-7 years

C. 5-6 years. At 5-6 years, a child can hook and zip up a zipper while wearing the clothing. A. At 3-4 years- Unzips front jacket zipper B. At 4-5 years- Zips up jacket zipper.

At what age can you expect a typically developing baby to achieve lip closure around the spoon when being fed? 10-12 months 12-15 months 7-9 months 4-6 months

C. 7-9 months.Oral motor patterns evident at 7-9 months of age:• Lip closure around spoon• Scraping food off spoon with upper lip• Emerging tongue lateralization• Movement of food from side to side

By what age is it stated that an IEP must include documentation pertaining to the student's transition from public school to post-secondary education/employment? By age 13 By age 14 By age 16 By age 18

C. By age 16. IDEA 2004 mandates that the IEP must include documentation addressing transition planning by the age of 16 at the latest. Individual states are allowed to set the age at which transition planning begins earlier, but not later than age 16.

Jane, a mother of a 3-year-old child is concerned that her daughter may be developmentally delayed as she is unable to walk up and down stairs independently. Jane is concerned that her daughter still needs to hold on the railing for support and describes her daughter's method of climbing stairs as placing both feet on a step before moving onto the next step. Jane would like to know at what age a typically developing child can independently climb up and down stairs, alternating their feet without needing any support. How should the OT respond? By age 2, a child should typically be able to climb up and down stairs using a reciprocal pattern and no rail By age 3, a child should typically be able to climb up and down stairs using a reciprocal pattern and no rail By age 4, a child should typically be able to climb up and down stairs using a reciprocal pattern and no rail By age 5, a child should typically be able to climb up and down stairs using a reciprocal pattern and no rail

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

A child with Down syndrome has an inferior pincer grasp and can hold a tiny object between the pads of his finger and the thumb. What is the next fine motor grasp pattern to develop? Ulnar palmar grasp Raking grasp Fine pincer grasp Radial palmar grasp.

C. Fine pincer grasp. Typical progression of the pincer grasp, is moving from using the pads of the fingers to the tips of the fingers. to pick up small objects

An OT is using facilitation techniques incorporating tapping, movement, and compression, while working with a patient who has a diagnosis of athetoid cerebral palsy. What quality of muscle tone would this patient typically present with? Spastic Flaccid Fluctuating Rigid

C. Fluctuating.Athetoid cerebral palsy, also called dyskinetic cerebral palsy, affects 10 to 25 percent of all people with this condition. This type of cerebral palsy is the result of brain damage to the basal ganglia, located in the midbrain region. It is characterized by abnormal regulation of tone, abnormal postural control, and coordination deficits. Abnormal movement patterns may increase with stress, excitement, or purposeful activity. Muscle tone is usually normal or can be decreased during sleep. As a form of athetonia, athetoid cerebral palsy is characterized by involuntary slow and writhing movements, which usually affects the hands, feet, arms and legs. In some cases, this type of cerebral palsy can also affect the facial muscles, causing grimacing or drooling. While spastic cerebral palsy is characterized by increased muscle tone and tension, this type of cerebral palsy causes mixed muscle tone, where some muscles are too tense, while others are too relaxed. Sometimes this involuntary muscle activity affects the whole body at once. The symptoms of athetoid cerebral palsy tend to diminish completely during sleep, though they often heighten during times of waking stress.

What is the BEST way to test if a 5-year-old child has an unintegrated ATNR? Get the child to stand with their arms across their chest and eyes closed and then ask them to fall backwards into your arms Get the child to assume a prone extension position (superman) Get the child to kneel on all fours with their head in neutral position and then ask them to turn their head to one side Get the child to kneel on all fours with their head in neutral position and then ask them to flex and extend their neck

C. Get the child to kneel on all fours with their head in neutral position and then ask them to turn their head to one side.To test for the ATNR- This is done by getting the child to kneel on all fours with their head in neutral position. If their head is turned to one side and their opposite arm flexes then the ATNR is not yet integrated and needs to be addressed. A. To test for the Moro reflex- The child stands with their arms across their chest and eyes closed. Get the child to fall backwards into your arms while their eyes remain closed. If their arms extend outwards instead of remaining on their chest, then it is likely that the Moro reflex is still present.B. Prone extension with arms and legs fully extended activates muscles antagonistic to the tonic labyrinthine prone reflex.D. To test for the STNR- The child is kneeling on all fours with their head in neutral position. If their neck is flexed, their pelvis lifts, and if their neck extends, their pelvis drops, then the STNR is not yet integrated.

A 4-year-old boy who presents with a global developmental delay is being seen by an OT for intervention. In order to focus on improving this boy's pincer grasp, which activity should the OT recommend for the boy to participate in at home? Have him place his hands in rice or beans Have him throw a ball and put it in a hoop Have him pick up small beans one at a time and put them in a bowl Have him build a tower using Lego blocks

C. Have him pick up small beans one at a time and put them in a bowl.This is a good intervention to promote pincer grasp. Simply placing his hands in a pile of rice or beans is usually used for sensory or dexterity-related development. Neither throwing a ball into a hoop or building towers out of Legos requires the boy to use a pincer grasp. Grasping a ball requires a spherical grasp, and when a child picks up and builds with Lego, they would typically use a tripod (thumb and 2 digits) grasp.

An 8-year-old girl has recently been admitted to the ICU after being involved in a MVA in which she sustained a severe brain injury. What intervention strategy should the OT focus on with this child, at this stage of her recovery? Collaborating with family, school and the rehabilitation team Training in assistive devices Increasing awareness through sensory stimulation Helping the child regain independence in ADLs

C. Increasing awareness through sensory stimulation.The OT should focus on increasing awareness through sensory stimulation. OT for TBI in the acute care setting includes: sensory stimulation to promote awareness, ROM to maintain joint mobility, positioning to prevent skin breakdown, and splinting to maximize hand function

A child with CP presents with dysphagia and dietary texture modification is therefore indicated. According to the dysphagia diet, what does Level 3 ( moderately thick liquids) mean? Liquids that flow off a spoon but more slowly than thinner liquids. The child can sip or suck these liquids from a straw with some effort Watery liquids such as juice, tea, milk, broth. The child can drink them through a nipple, cup, or straw Liquids the child can drink from a cup or sucked through a straw with some effort. These are liquids that may be thick enough to be eaten with a spoon These are usually eaten with a spoon. The child won't be able to drink them from a cup

C. Liquids the child can drink from a cup or sucked through a straw with some effort. These are liquids that may be thick enough to be eaten with a spoon. The dysphagia diet framework consists of eight levels (0-7) and includes both foods and liquids on a single continuum. Drinks/liquids are measured from Levels 0-4, while foods are measured from Levels 3-7.- Level 0 (thin). These are watery liquids such as juice, tea, milk, soda, beer, and broth. You can drink them through a nipple, cup, or straw.- Level 1 (slightly thick)These are thicker than water. They require more effort to drink than thinner liquids but still flow through a straw or nipple.- Level 2 (mildly thick)These liquids flow off a spoon but more slowly than thinner drinks. They can be sipped or sucked from a straw with some effort.- Level 3 (liquidized, moderately thick)You can drink these from a cup or sucked from a straw with some effort. These are liquids that may be thick enough to be eaten with a spoon An example is a thick milkshake. Their texture is smooth without lumps.- Level 4 (pureed, extremely thick)These are usually eaten with a spoon. You can't drink them from a cup. An example is pudding.

A 5-year-old child is playing the game "Connect 4″ which requires him to pick up and post 1" diameter discs into slots. The child appears to have difficulty maintaining his grip on the discs while placing them into the grid. What type of precision grip is required to successfully perform this task? Tip-to-tip prehension Pad-to-side prehension Pad-to-pad prehension Pad-to-tip prehension

C. Pad-to-pad prehension.Placing discs into a grid when playing "Connect 4" requires pad-to-pad prehension. Precision grips can be categorized as pad-to-pad prehension, tip-to-tip prehension, and pad-to-side prehension. Each tends to be a dynamic function with relatively little static holding.Pad-to-Pad Prehension- involves opposition of the pad of the thumb to the pad of the finger.Tip-to-Tip Prehension- the interphalangeal joints of the finger and thumb have the range and available muscle force to create nearly full joint flexion.Pad-to-Side Prehension- also known as key grip (or lateral pinch) because a key is held between the pad of the thumb and side of the index finger. Pad-to-side prehension differs from the other forms of precision handling only in that the thumb is moreadducted and less rotated.

What pencil grasp is this child in the photo, demonstrating? If the picture does not load, please click here. Static Tripod Pencil Grasp Radial/Digital Pronate Pencil Grasp Palmar Supinate Pencil Grasp Dynamic Tripod Pencil Grasp

C. Palmar Supinate Pencil Grasp.Palmar Supinate - The crayon or marker is held in the palm ("palmar") with the thumb on top in a slight forearm-up ("supinated") position. This is considered a "primitive" grasp and typically accompanies the "scribbling" stage. Scribbling movements are typically initiated by the shoulder and elbow, which involve larger muscle groups and a relatively low level of precision.

What is the main difference between IDEA Part B and Part C? Part B- General provisions, including the purpose of IDEA and Part C- Assistance for infants and toddlers with disabilities Part B- Assistance for infants and toddlers with disabilities and Part C- Assistance for all children with disabilities Part B- Assistance for all children with disabilities and Part C- Assistance for infants and toddlers with disabilities Part B- Assistance for infants and toddlers with disabilities and Part C- National activities to improve education of children with disabilities

C. Part B- Assistance for all children with disabilities and Part C- Assistance for infants and toddlers with disabilities. Part A. General Provisions: Part A outlines IDEA's general provisions, including the purpose of IDEA and the definitions used throughout the statute.Part B. Assistance for All Children with Disabilities: Part B includes provisions related to formula grants that assist states in providing a free appropriate public education in the least restrictive environment for children with disabilities ages three through 21.Part C. Infants and Toddlers with Disabilities: Part C includes provisions related to formula grants that assist states in providing early intervention services for infants and toddlers birth through age two and their families.Part D. National Activities to Improve Education of Children with Disabilities: Part D includes provisions related to discretionary grants to support state personnel development, technical assistance and dissemination, technology, and parent-training and information centers.

The current focus of OT intervention is on developing grasp and release techniques with an 8-year-old boy who recently had a right upper extremity prosthesis fitted. The goal is to facilitate self-feeding so that he can regain his independence in this ADL. What is the BEST position for the prosthesis to be placed, in the initial stages of his prosthetic training? Position the child's elbow at 90 degrees of flexion and the shoulder at 10 degrees of internal rotation Position the child's elbow at 100 degrees of flexion and the shoulder at 0 degrees of internal rotation Position the child's elbow at 90 degrees of flexion and the shoulder at 0 degrees of internal rotation Position the child's elbow at 100 degrees of flexion and the shoulder at 10 degrees of internal rotation

C. Position the child's elbow at 90 degrees of flexion and the shoulder at 0 degrees of internal rotation. To facilitate effective grasp and release, the easiest position to start with is to have the child's elbow at 90 degrees of flexion and his shoulder at 0 degrees of internal rotation. This is the most functional position especially for self-feeding.Pre-positioning of the prosthesis involves moving the prosthetic units into their optimal position to grasp an object or perform a given activity. All prosthetic components must be pre-positioned in a proximal-to-distal order. Pre-positioning of the prosthesis involves placing the TD in the optimal position to approach an object. For example: Approaching a glass, the hand should face in toward the midline to grasp the glass as a normal hand would. The fingers of the hand should not be positioned downward because a normal hand does not approach a glass in this position.

At which stage of cognitive development is the child in this photograph functioning? (pic of baby chewing on a toy) Preoperational Trust Sensorimotor Unoccupied play

C. Sensorimotor.Piaget's Theory of Cognitive Development is a description of cognitive development as four distinct stages in children:1. sensorimotor2. preoperational3. concrete4. formal The first stage, sensorimotor, begins at birth and lasts until 18 months-2 years of age. The term "sensorimotor" was used by Piaget, because he believed that infants were dependent on their senses and their physical abilities to understand their world. Because they can see, hear, taste, and smell from birth, they combine these senses with their emerging physical abilities to interact with objects by grasping, shaking, banging, and tasting them. During their early experiences, infants are only aware of what is immediately in front of them. Because they don't understand how things react, they are constantly learning about the world through trial and error by shaking or throwing things and putting things in their mouths. As they become more mobile, infants' ability to develop cognitively increases. A. Preoperational. One of Piaget's stages of cognitive development. It involves the development of language, memory, and imagination. 2 to 7 years old. B. Trust vs. mistrust is the first stage in Erik Erikson's theory of psychosocial development. This stage begins at birth continues to approximately 18 months of age. During this stage, the infant is uncertain about the world in which they live and looks towards their primary caregiver for stability and consistency of care. D. Unoccupied play. This is one of the stages of play developed by Mildred Parten Newhall. In unoccupied play, the child learns about and discovers how their body moves, no toys are involved.

An OT is selecting a standardized assessment to evaluate a 7-year-old student who recently sustained a TBI while playing football and he now presents with an intention tremor, difficulty concentrating on his work, a poor delay of gratification and letter reversals in his written work. The OT has decided to use the Motor-Free Visual Perception Test (MVPT-3) to assess this student's visual perceptual skills. What is the MOST likely clinical reasoning behind selecting the MVPT-3 over the Developmental Test of Visual Perception (DTVP-3)? The DTVP-3 is not standardized for a 7-year-old student The MVPT-3 is the latest assessment to be revised The MVPT-3 assesses visual perception independent of motor ability The MVT-3 is much quicker to administer

C. The MVPT-3 assesses visual perception independent of motor ability.The MVPT-3 assesses an individual's visual perceptual ability without any motor involvement needed to make a response. It is especially useful with those who may have learning, motor, or cognitive disabilities. As the student has an intention tremor and the focus of the assessment is on evaluating his visual perceptual skills, this is the most appropriate test to use in this scenario. It is important to first establish the student's visual perceptual skills before testing his visual motor integration. A. The DTVP-3 can be used to assess children from 4-0 to 12-11.B. The MVPT-4 is the most recent revision of the only non-motor visual perceptual assessment that can be used throughout the lifespan. Data for this version was collected from 2012-2014.D. Typically the MVPT-3 takes 25 mins and the DTVP-3 takes 30 minutes to administer.

An 8-year-old girl with Spina Bifida Myelomeningocele at spinal level L1, has been referred for occupational therapy services to help her gain independence in her BADLs. After an initial evaluation, what is the MOST likely BADL, this girl would need assistance with? The OT would identify a need to develop the girl's dressing skills The OT would identify a need to develop the girl's ability to brush her hair The OT would identify a need to develop the girl's ability to wash herself The OT would identify a need to help the girl identify leisure activities

C. The OT would identify a need to develop the girl's dressing skills. Myelomeningocele Spina Bifida (SBM) is the most severe form of spina bifida. The physical impairments in SBM include motor and sensory deficits of the lower limbs leading to difficulties with stance and locomotion, as well as urinary and bowel dysfunction. Upper limb function, as well as lower limb function, is impaired in two thirds of children with SBM. Upper limb motor deficits in SBM include motor weakness and impaired hand and finger dexterity, motor speed, motor planning, and bimanual coordination. This affects development of eye-hand co-ordination which may interfere with activities of daily living (ADLs), such as buttoning a shirt or opening a lunchbox. Difficulties with spatial relations, body image, and development of hand dominance may also be evident. A variety of cognitive impairments in perception and cognitive development have also been documented. Other common symptoms are: - Weakness or paralysis in the lower limbs - Urinary and bowel incontinence - Type 2 Arnold-Chiari malformation - an abnormal brain development involving the cerebellum.

A 5-year-old girl is asked to color-in a picture of a garden which includes a tree, a sun, a flower, and a bunny. As she begins coloring in, she tells the OT that she cannot find the bunny in the picture. What can the OT conclude based on the girl's performance in this activity? The girl may have difficulty with visual acuity The girl may dislike bunnies The girl may have difficulty with visual perception The girl has difficulties with fine motor skills

C. The girl may have difficulty with visual perception. Visual perception is the ability to see and interpret (analyze and give meaning to) the visual information that surrounds us. The process of "taking in" one's environment is referred to as perception. Figure-ground perception is a visual perceptual skill which gives one the ability to focus on one specific piece of information in a busy background. A. Visual acuity refers to the sharpness and clarity of the girl's vision which does not appear to be affected in this scenario.D. Difficulty in fine motor skills is incorrect because she can clearly grab the the markers and color the paper.

An OTR® is working with a 4-year-old-child who has been diagnosed with spastic hemiplegia cerebral palsy. The child's goals are to become independent in self-feeding. Which utensil would be the most useful for the OTR® to introduce to this child? The most helpful would be a knife The most helpful would be a spoon The most helpful would be a spork The most helpful would be a fork

C. The most helpful would be a spork. Spastic hemiplegia is one of the subtypes of spastic CP. The most helpful utensil would be a spork which combines a fork and spoon and is ideal for anyone who has limited movement of one hand. Self-feeding using a spoon and fork should be established by this age.

A 14-month-old boy has recently mastered scooping food with a spoon and bringing it to his mouth. What is next developmental step you can expect this boy to demonstrate? The next developmental step would be finger feeding soft table foods The next developmental step would be to dip a spoon in food The next developmental step would be to drink using a straw The next developmental step would be to grab a spoon and bang it

C. The next developmental step would be to drink using a straw. Typical developmental sequence:6-9 months: grabbing spoon and banging it9-13 months: finger feeding self soft table foods15-18 months: scooping food and bringing it to mouth18 months: straw use

A school‐based OTR® is working with a middle school student who has been diagnosed with ASD. The student presents with the following difficulties: poor social skills, difficulty attending to tasks, and tactile defensive behavior especially when in close proximity to other students. What type of structuring within the classroom would be BEST for this student to help him cope with being in a classroom with other children? The student should be removed from the classroom and be taught in a separate space where he can be by himself The student would benefit from sitting on the floor, in a corner seat The student would benefit from sitting in a quiet corner of the room The student would benefit from being home schooled

C. The student would benefit from sitting in a quiet corner of the room. A distraction free and structured/predictable environment is most conducive to learning for students who can become easily distracted and overwhelmed by too much input.The student may be distracted and disturbed by the free movement of others in the classroom, i.e. other students may bump into him, his chair or table when they move about the classroom. The student may be unable to understand this contact is accidental. Personal space is important. If it is practical, establish a work area in the classroom that is uncluttered, free from distractions and not subject to 'traffic flow' by other students.Structuring the classroom:• Make sure the student has a clear and easy path to the teacher for help.• Position the student in a quiet corner of the room where there is little chance of him being distracted by light, reflections, the door opening and closing etc.• The student might perform better when facing a wall or window providing the view is not too distracting.

A 5-year-old child is asked to trace a squiggly line with his finger, and then to trace over the same line with a pencil. What visual skill does this activity work on? Visual scanning Visual memory Visual tracking Visual acuity

C. Visual tracking. This is typically defined as the ability to efficiently move the eyes from left to right (or right to left, up and down, and circular motions) OR focusing on an object as it moves across a person's visual field. A. Visual scanning is the ability to use vision to search in a systematic manner, such as top to bottom and left to right. A child needs to use visual scanning to avoid obstacles when navigating their environment. Smooth visual scanning is required for reading. B. Visual memory focuses on one's ability to recall visual information that has been seen. Visual memory is a critical factor in reading and writing. When a child is writing a word, he must recall the formation of parts of the letter from memory D. Visual acuity is a measure of the ability of the eye to distinguish shapes and the details of objects at a given distance.

Can an OTA attend an IEP meeting without the presence of the OT, and make changes to a student's IEP during the meeting? Yes, as long as the OTA does not make any recommendations or changes to the IEP No, it is mandatory for the OT to be present at all IEP meetings Yes, the OTA may make changes during the IEP meeting if before the IEP meeting, the OT and OTA discussed and agreed upon potential changes in goals or amount or type of service Yes, the OTA is permitted to make additions or changes to the goals being addressed by occupational therapy if the IEP team requests these amendments

C. Yes, the OTA may make changes during the IEP meeting if before the IEP meeting, the OT and OTA discussed and agreed upon potential changes in goals or amount or type of service. It is entirely appropriate for an OTA to attend an IEP meeting and present information concerning student progress and IEP goals to be addressed by occupational therapy, based on previous collaboration between the supervising OT and the OTA. If, at the IEP meeting, the IEP team requests additions or changes to the goals being addressed by occupational therapy, the supervising OT would need to review those recommendations and agree to any changes; the OTA cannot make that decision alone, without additional collaboration between the OT and OTA. If, before the IEP meeting, the OT and OTA discussed and agreed upon potential changes in goals or amount or type of service, the OTA may make the changes during the IEP meeting.

At what age can a child be expected to begin spontaneously scribbling on paper? 6-9 months 10-12 months 18-24 months 12-18 months

D. 12-18 months. At approximately 12 to 18 months, a child typically begins to spontaneously scribble on paper. There's a difference between marking a page with a crayon and scribbling. Peabody Developmental Motor Scales, 2nd edn - Guide to Item Administration (PDMS-2)- states that a child begins to scribble at around 14 months.At 12 months- Scribbles after demo.At 14-15 months- Spontaneous scribble. A. 6-9 months, a baby masters transferring an object between hands, starts to isolate their index fingers and uses an immature pincer grasp.B. 10-12 months, a baby develops a mature pincer grasp. The child may begin to mark a piece of paper with a crayon.C. 18-24 months- The next pre-writing skill after scribbling, is imitating horizontal and vertical lines at 24 months.

At what age can you expect a child to have the ability to use a standard spoon, fork and knife independently? 3 3.5 5 6

D. 6. The question asks at what age can a child use a spoon, knife and fork- to scoop food, spread butter, cut food with a knife and fork. By age 6 a typically developing child will have acquired all of the skills needed to use the utensils pictured, including the ability to cut food with a knife.4 to 5 Years: Can spread soft substances with a plastic/child-safe knife.5 to 6 Years: Can cut foods with a knife under supervision (dull knife or slightly serrated, not sharp)5 1/2 to 6 1/2 Years: Can cut with a fork and knife (entire process of holding utensils, controlling and cutting food, and bringing to mouth)

Phoenix is an 11-year-old boy with a diagnosis of autism spectrum disorder. He complains that the overhead lights in the classroom bother him so much, he can see them flickering. What adaptation would be the MOST beneficial in helping Phoenix with his hypersensitivity to the overhead lights? Cloth filters covering the lights Sunglasses Natural lighting in Phoenix's classrooms A visor

D. A visor. This adaptation would block the overhead lighting for Phoenix no matter what classroom he is in. A. Cloth filters would be effective in reducing overhead lighting but putting filters on all the lights in the school is not realistic.B. Sunglasses would block too much light for Phoenix indoors and he might not be able to see what he is doing.C. Asking Phoenix's teachers to arrange for natural lighting in their classrooms is also not realistic.

While an OT is evaluating a 9-month-old infant's oral-motor skills, she observes that the infant is starting to chew bananas. What does this observation indicate? An OT needs to work on rotary chewing with the child An OT needs to conduct a sensory motor evaluation An OT needs to help the child sip from a cup An OT determines that the child's oral-motor skills are age appropriate

D. An OT determines that the child's oral-motor skills are age appropriate. Oral Motor skills and feeding at 3-7 months. By 4 months of age, most infants have gained fair head control and are able to remain in an upright position with support, and parents are beginning to introduce puréed foods. By this time, the anatomical structure of their jaws and tongues have dropped forward to support munching patterns. They also may open their mouth when a spoon is presented and are able to manage thin purees with minimal difficulties. Oral Motor skills and feeding at 7-9 months. Between 7 and 9 months of age, infants are now moving into unsupported sitting, quadruped and crawling. This development supports jaw stability, breath support and fine motor development for self-feeding skills. Infants at this age now begin to be able to successfully manage "lumpy" purees, bite and munch softer foods, and the development of rotary chewing begins.

An OT practitioner is teaching a new caregiver how to feed a child with spastic tetraplegia. While feeding the child pureed food using a coated spoon, the child suddenly bites hard down on the spoon, demonstrating an active tonic bite reflex. What is the BEST advice the OT practitioner should give the caregiver in this scenario? Pull on the spoon to get it out of the child's mouth Wiggle the spoon from side to side to ease it out of the child's mouth Gently guide the child's chin upward Apply light pressure to the bottom of the child's chin

D. Apply light pressure to the bottom of the child's chin.A tonic bite reflex is an automatic, sustained jaw closure, accompanied by increased abnormal tone in the jaw muscles. It is difficult to release, and its force can damage the teeth, or the object that has been placed in the mouth. Applying light pressure on the bottom of the child's chin can facilitate their jaw to drop and only then can the spoon be removed from their mouth. A and B. If the spoon is pulled on or wriggled, this will result in an increase in the intensity of the tonic bite. Because the spoon is clamped in the child's mouth and they are unable to let go of it, by attempting to remove it before the involuntary jaw closure is released, this may be painful for the child and/or damage tissue in or around their mouth. C. Gently guide the child's chin to chest as this is a way to naturally open the mouth to release the utensil.

A 5-year-old with CP has been referred to OT for an assessment. While observing the child, the OT notices that the child is walking with an unsteady and wide-based gait, and the child's movements are uncoordinated and clumsy. Based on these observations, with which type of CP has this child MOST likely been diagnosed? Hypotonic cerebral palsy Dyskinetic cerebral palsy Spastic cerebral palsy Ataxic cerebral palsy

D. Ataxic cerebral palsy. Ataxic CP is derived from the word "ataxia," meaning lack of coordination and order. Hypotonia is diminished muscle tone. The infant or child with hypotonic cerebral palsy appears floppy — like a rag doll. Children with dyskinetic forms of cerebral palsy have variable movement that is involuntary (outside of their control).Spastic cerebral palsy is the most common type of cerebral palsy. The muscles of people with spastic cerebral palsy feel stiff and their movements may look stiff and jerky. Spasticity is a form of hypertonia, or increased muscle tone

Using a static tripod grasp, a 6-year-old child with Autism Spectrum Disorder (ASD) is able to write several letters of the alphabet with the correct letter formation and sizing. When grading this activity, what type of grasp should the OT practitioner focus on developing NEXT? Digital pronate grasp Palmar supinate grasp Static tripod grasp Dynamic tripod grasp

D. Dynamic tripod grasp. After a child has mastered the static tripod grasp, the OT can work on dynamic tripod grasp.

A 6-year-old girl can easily identify a circle, a triangle, and a rectangle on separate flashcards. However, when she is presented with a picture which has these exact shapes hidden within the image, she has difficulty locating these shapes. With which visual perceptual skill is this child demonstrating difficulty? Visual discrimination Visual memory Visual spatial orientation Figure-ground

D. Figure Ground. Figure ground refers to a child's ability to distinguish an object against its background. A. Visual discrimination is the skill a child uses to see subtle differences between objects or pictures. This visual perceptual skill can be described as "paying attention to detail". B. The ability to recall or remember the visual details of what you have seen is referred to as visual memory. C. Spatial orientation refers to the ability to identify the position or direction of objects in space.

A 3-year-old boy is beginning school-based occupational therapy after transferring out of the local birth-to-three program. He has a diagnosis of Trisomy 21. What medical complications is this child likely to present with, based on his diagnoses? Necrotizing enterocolitis (NEC) Bronchopulmonary dysplasia (BPD) Intraventricular hemorrhage (IVH) Heart defect and atlantoaxial instability

D. Heart defect and atlantoaxial instability. Down syndrome is also known as Trisomy 21.People with Down syndrome can have a variety of complications, some of which become more prominent as they get older. These complications can include:• Heart defects. About half the children with Down syndrome are born with some type of congenital heart defect. These heart problems can be life-threatening and may require surgery in early infancy.

Which in-hand manipulation activity would be BEST to use for improving complex rotation? Rotating toys with both hands Holding a key ring in one hand while shifting the ring between your fingers Holding a pen with one hand while removing the cap with the other hand Holding a pencil in one hand and turning it over to use the eraser

D. Holding a pencil in one hand and turning it over to use the eraser. Complex rotation is a movement involving rotation of an object that requires isolated, independent movements of the fingers and thumb. The movement is further described as manipulating the object with finger pads to turn it between 180-360 degrees. An example of this movement would be to turn over a pencil to use the eraser.At 2.5 years old a child develops simple rotation. The turning or rolling of an object held at finger pads approximately 90 degrees or less (unscrewing a small bottle cap).At 6-7 years old a child develops complex rotation. The rotation of an object between 180 and 360 degrees (turning a pencil over to erase).

A school-based OTR® has a student lie in prone-prop position to practice handwriting. What problem is the OTR® compensating for by positioning the student this way for handwriting? Poor upper extremity strength Limited attention to task Impaired visual tracking skills Poor core stability

D. Poor core stability. When a student cannot sit upright in a chair to work on handwriting, a more stable position may help the student free up the writing hand. Prone on elbows is one position that helps stabilize the core. A. If this position was used to address poor upper extremity strength, the student would not be able to "free" one hand to use for writing. With poor upper limb strength, the student would have to remain in a static posture, supporting their weight on both their forearms. B. Limited attention to task is best addressed with structuring the environment and task. Examples: special seating e.g. ball seat, using a quiet space, allowing intermittent break periods, provide child with a fidget. C. Impaired visual tracking can on be addressed by using visual exercises.

Jackson is a 2nd grade student who has been diagnosed with ADHD. In the classroom, he is demonstrating difficulty focusing his attention on his schoolwork and his behavior has been described as being "very active, impulsive and disruptive". The OT is collaborating with the IEP team members to formulate goals to manage Jackson's behavior and help him focus on his schoolwork. What is the BEST strategy the OT should recommend as an accommodation which would address the above goals? Prevent Jackson from seeing the time as this will make it harder for him to focus on his work Ignore Jackson's behavior as it may be attention seeking Encourage Jackson to work on sitting still by offering him a reward at the end of the week Provide frequent opportunities for Jackson to get up and move around

D. Provide frequent opportunities for Jackson to get up and move around.The symptoms of ADHD which include an inability to pay attention for long periods of time, difficulty sitting still, and difficulty controlling impulses, can make it hard for children with this diagnosis to cope with schoolwork.To meet the needs of children with ADHD, schools may offer:• Behavioral classroom management• Special education services• AccommodationsStudents with ADHD tend to struggle with sitting still for long periods of time, so giving them frequent opportunities to get up and move around can be very beneficial. The teacher can provide them with a physical break by having them hand out or collect papers or classroom materials, run an errand to the office or another part of the building, or erase the board. Even something as simple as letting them go get a drink of water at the water fountain can provide a moment of activity. "Brain breaks" are quick, structured breaks using physical movement, mindfulness exercises, or sensory activities. Movement breaks like stretching gives students a chance to get up and move around which allows their minds to settle enough to re-focus. According to research, brain breaks restore attention. The theory is movement increases oxygen into the bloodstream, which leads to improved concentration. Many studies have proven that brain breaks have a positive effect on students' academic performance.IEP and 504 Plans can offer accommodations for students to help them manage their ADHD, including:- Extra time on tests- Instruction and assignments tailored to the child- Positive reinforcement and feedback- Using technology to assist with tasks- Allowing breaks or time to move around- Changes to the environment to limit distraction- Extra help with staying organized

A 7-month-old baby is observed picking up a cheerio, using a specific type of grasp which is characterized by him using finger flexion and no thumb opposition to scrape the cheerio into his palm. What is this grasp called? Primitive squeeze grasp Radial-palmar grasp Radial-digital grasp Raking grasp

D. Raking grasp. Between 5-7 months of age a child will develop a raking grasp. The child consciously uses their fingers to grasp an object. They do not have finger isolation so they use all of their fingers as a whole unit to pull an object into their hand. This movement is termed "raking" and it is how most infants obtain objects of any size, small or large.

Sara is a 6-year-old girl who displays sensory-seeking behavior, including climbing on the furniture, and jumping off tables and countertops. Sara's behavior is an example of what type of disorder? Sensory-Based Motor Disorder Sensory Discrimination Disorder Active Engagement Sensory Modulation Disorder Correct

D. Sensory Modulation Disorder. A child with a Sensory Modulation Disorder has difficulty modulating (regulating) sensory input. Sensory modulation is the ability to respond appropriately to sensory information and remain at an appropriate level of alertness for daily activities. It includes the subtypes: 1. Sensory Over-Responsivity, 2. Sensory-Under Responsivity, and 3. Sensory Craving/ Seeking. In this scenario, Sara is demonstrating sensory-seeking behavior. The nervous system of the sensory-craver needs intense input in order for the sensation to be registered. Sensory-cravers seek out intense sensations constantly but are often disorganized due to high levels of random sensory input. They are constantly touching, crashing, and moving, and they have no awareness of personal space. The child may also: Demonstrate decreased safety due to impulsiveness and excessive risk taking behaviors.

An 8-year-old boy with ASD (autism spectrum disorder) walks into a school assembly with his classmates. As he looks around the large room where all the children in the school are seated, he begins to scream and tries to run away from his teacher. What is the most likely cause of the boy's behavior? Sensory seeking Oppositional defiant disorder Emotional behavioral disturbance Sensory overload

D. Sensory overload The boy is most likely experiencing the symptoms of sensory overload from the crowded, noisy room. The symptoms have likely become so overwhelming that the boy does not remember what he has been taught when he becomes uncomfortable from sensory input and he reacts by attempting to get away from the situation.

An OT observes a 7-month-old infant in sitting, becoming off-balance and reacting with extension and abduction of their limbs toward the side in which they are falling. What reflex is this infant demonstrating? Forward parachute (protective extension forward) Prone tilting Symmetric tonic neck reflex (STNR) Sideward parachute (protective extension sideward)

D. Sideward parachute (protective extension sideward).Sideward parachute (protective extension sideward): Prevent fall; increase support (arm extension) on side opposite force- stop from falling to side. Tip infant off-balance to side. Arm extension and abduction to the side. 7 mos→ Persists

A 4-year-old girl wanders around a sensory integration clinic and then spontaneously picks up a bubble maker. The girl pushes the power button, and as the bubble maker gently vibrates in her hands and bubbles start to come out, she immediately drops it onto the floor and runs away crying. What is the girl's reaction MOST likely indicative of? Dyspraxia Difficulties with fine motor skills Gravitational insecurity Tactile defensiveness

D. Tactile defensiveness. Children who have tactile defensiveness are sensitive to touch sensations and can be easily overwhelmed by, and fearful of, ordinary daily experiences and activities. Sensory defensiveness can prevent a child from play and interactions critical to learning and socialization. Often, children with tactile defensiveness (hypersensitivity to touch/tactile input) will avoid touching, become fearful of, or will be bothered by the following:- textured materials/items- "messy" things- vibrating toys, etc.- a hug- a kiss- certain clothing textures- rough or bumpy bed sheets- seams on socks- tags on shirts- light touch- hands or face being dirty- shoes and/or sandals- wind blowing on bare skin- bare feet touching grass or sand

A 14-year-old girl with a medical diagnosis of scoliosis wears a Milwaukee brace to school. Due to her mobility limitations, she is experiencing discomfort sitting in the school desks and has difficulty taking notes due to her limited neck mobility. Adaptations for the student have been requested but the OT finds out that the girl does not qualify for an IEP. How is the OT able to provide services to this student? The OT can provide services without an IEP. The school is required to cover the cost The OT can provide services under a conditional IEP that allows for special education for students with physical disabilities The OT can recommend that the girl receive occupational therapy services through an outpatient clinic The OT can provide services to the girl through a 504 plan

D. The OT can provide services to the girl through a 504 plan. Section 504 of the Rehabilitation Act of 1973 allows schools to provide adaptations to students in public schools who have a medical diagnosis that limits their functional abilities in school. An IEP does not have to be in place for services to be provided in this manner.

What is the MOST appropriate type of toothbrush for a child who presents with oral hypersensitivity? The most appropriate type would be a NUK toothbrush The most appropriate type would be an electric toothbrush The most appropriate type would be a manual toothbrush The most appropriate type would be a soft sponge-tipped toothette

D. The most appropriate type would be a soft sponge-tipped toothette. Encouraging a child to use a soft sponge-tipped toothette is typically indicated in the child with oral hypersensitivity. We have sensory receptors in our mouths that allow us to recognize information about temperature, texture and taste. Children with healthy oral sensory systems can tolerate eating foods that have mixed textures like cereal and milk, spaghetti and mince or vegetable soup. They manage tooth brushing and visits to the dentist with minimal complaints. Some children struggle with processing and responding to the oral sensory information they encounter in everyday life. They may be over responsive or have increased sensitivity to oral input, causing them to be resistant to oral sensory experiences like trying new foods or brushing their teeth. A soft sponge-tipped toothette, is typically indicated in the child with oral hypersensitivity/defensiveness as the bristles of a regular toothbrush cause discomfort to those with sensory challenges.

Which of the following motor milestones would you expect to observe in a typically developing 11-month-old baby? Rolls from prone to supine Rolls from supine to side Pushes back into 4 point kneeling Walks with hand being held

D. Walks with hand being held. By 11-months of age, an infant typically develops the ability to walk with their hand being held. Milestones at 11-months include:- Cruising with one hand for support- Walks with hand held- Stands independently for a short time- 2 seconds, legs wide, arms up/out

The parents of an 8 year old boy who has been diagnosed with ASD have agreed to incorporate a goal of improving their son's handwriting and visual motor skills into his IEP. However, the parents inform the OT in the middle of the school year that they would like to change the boy's goal to be able to swing independently. How should the OT respond to this request? Educate the parents on occupational therapy and the IEP process Change the goals to swinging instead of handwriting Tell the parents politely that you can not change the goals in the middle of the school year Work on swinging if it relates to an activity of improving visual motor skills

D. Work on swinging if it relates to an activity of improving visual motor skills. Work on swinging if it relates to an activity of improving visual motor skills. The parents are not able to change the goals in the middle of the school year. However, the OT can work on swinging if she combines visual motor skills with it.

While assessing the motor skills of an 11-month-old boy, an OT and OTA observe him walking while holding onto furniture for support and crawling on the floor to retrieve toys. What does this behavior most likely indicate? That this is typical development That there may be low muscle tone That there are preservative tendencies That there are limitations in movement repertoire

That this is typical development. This child is crawling, cruising, and almost walking which is typical for his age. Cruising with one hand for support,walking with his hands held, and standing independently for a short time- with legs wide, arms up/out are all milestones an 11 month old infant can be expected to achieve. Crawling is usually achieved before 11 month.