Eval Exam 1

visual discrimination

(ability to detect differences between similar objects)

development of hand skills: factors affecting..

-active + passive ROM -strength/coordination -sensory processing -postural alignment + stability/control -sensory processing -visual perception/ visual motor integration -cognition -cultural considerations

visual- receptive components

-acuity (20/20) -accommodation (the eye's ability to change focus from near to far' compensate for blurred image) -binocular fusion (both eyes aim simultaneously at same target, in coordination; 'lazy eye' (amblyopia)

IFSP

-based on info gathered from evaluation of child + family -includes: current level of dev. functioing of child; family resources, priorities, and concerns about dev.; expected measurable outcomes in family friendly language; services to be provided; frequency, intensity, and duration of services; setting, where it will take place -frequency: every 6 months, annually, and transition from Part C

multidisciplinary

-each professional completes evaluation based on discipline expertise -intervention plan developed + implemented for child, separate from other services -family typically travels to the evaluators

IDEA (individuals with disabilities act)

-early intervention + special education law - administered by OSEP -authorizes grants to stands -discretionary funds to: non profits, higher ed. instituations -in order to operate comprehensive statewide program -programs must be provided in natural environment

Why do OT's analyze activities/occupations?

-evaluate quality of peformance -determine impact of personal/contextual factors on performance (internal/external) -predict future performance -identify ways to grade/adapt -obseration

Interdisciplinary

-evaluates often conducted independently by evaluation -collaboration with other evaluations occur, info sharing -each member of team responsible for part of the plan which may overlap

development of infant reflexes

-goal of developing normal reflexes to facilitate normal occupations (feeding, sleeping, etc) as well as caregivers understanding normal movement of the infant -activities can include: warm temp, deep pressure (hypertonic), kangaroo care/skin to skin, encouraging sensory stimulation to low activity systems, moving distal to proximal, containment in flexion

DDDM

-identify challenges to participation and goals -describe current level of performance -factors affecting participation -conduct assessment -identify strengths and needs/barriers to function -generate hypothesis -develop intervention plan -identify outcomes of intervention -collect, display, and analyze data obtained -monitor progress

evaluating hand skills

-measuring PROM/AROM -evaluating strength -tactile perception -stereognosis -postural alignment/stability -FM coordination -VMI -evaluated in context of play, self care, school functions -consider environment, nonstandardized + standardized assessments -analyze the hand function problems + extent of impairment -need to understand deficits + potential for change -set goals by prioritizing areas of need + occupational relevance

Sitting

-proper sitting -positions to discourage (pushing back; hips extended; falling forward; hips too flexed) -supported sitting (A/P + lateral stability of trunk + neck) -weight shift on hips -arms free

When positioning

-provide central control first so distal parts are free from assisting trunk or influence of associated reactions -use gravity to child's benefit -try to reproduce effective handling positions using adaptive equipment -consider caregiver's needs -utilize team decision making

screening for serivce eligibility

-provides early id for chidlren at risk for developmental delay -helps to identify if further services are warranted

FERPA (family educational rights + privacy act)

-provides for privacy of EI records of infants + toddlers with disabilities -PII: personally identifiable information: FERPA ensures privacy of PII in child education records; info used to trace a persons identity' ensures that no personal info may be disclosed without parental consent

development of hand skills

-reach + carry (requires trunk stability; scapular control) -grasp patterns for precision or power -in-hand manipulation skills -bimanual skills -tool use

Positioning in supine

-scapular stability for distal mobility + provides flexion, pelvic mobility, exploration, blankets, pillows, hand to mout

activity adaptation/assistive technology

-selecting adaptive equip or devices to compensate for gap between performance + activity demands -support participation in play, school, and ADL's

developmental evaluation

-should be in-depth -components may include: 1. objective test of heraing 2. standardized testing of: cognitive ability, communication, motor/physical skills, adaptive skills, social-emotional + behavior functioning, sensory processing 3. curriculum/criteriron referenced assessments

Percentile Rank

-standardized sample whose score is at or below a particular raw score -easily calculated + understood- not equal in size across -use with caution

Assessment of tone

-standardized: hypertonia assessment tool (4-19 yrs) grades severity of hypertonia -non-standardized

Assessment of balance

-static + dynamic sitting -mobile learning ,change in body position, equilibrium, how they are on curbs, stairs

Standard error of measure

-statistic used to calculate the expected range of error for the test score of an individual -based on SD of the tests' test-retest reliability -need to know to estimate potential range of client performance -obtained score vs. true score -calculated in test development -increases when SD of test is high or reliability is low -overlap = inconclusive -when a test has a high SD or low reliability, the SEM is larger (greater degree of error)

goals of EI

-strengthen family capacity by engaging, empowering, and building confidence within them -emphasis on child within family unit -promote child's development in family + community activities -building child's skills/adaptive capacities -linking families with community based supports + services -build family functioning within the natural envrionment

Components of asessment and analysis of performance

-synthesize information from the occupational profile -observe client's performance in desired occuaption/activity -note the effectiveness performance skills and patterns and select assessments to identify factors that may be influencing performance skills and patterns -interpret assessment data to identify facilitators and barriers to performance -develop and refine hypotheses about client's ocupational performance strengths and weaknesses -collaborate with client to create goals that address targeted outcomes -delineate areas for intervention based on best practice and evidence

Sidelying

-tone reducing posture -reduces effect of gravity on arm movements -differentiation of 2 sides of body hands in visual field -if increased tone- flex neck (chin tuck) -alternate sides -body awareness (proprioception, alternate sides, creating dev. through positioning)

visual cognitive components

-visual discrimination -object/form perception: -visual closure: -form constancy: -figure-ground:

oculomotor control

-visual fixation (hold gaze on target) -visual tracking (pursuits)(catch, hit, kick, moving ball) -saccadic eye movements (scanning) (moving from word to word) -convergence, divergence (both eyes turn towards + away; "eye teaming:

visual-receptive assessment (eye specialist, school nurse-Snellen)

-visual screening of foundational skills -assessment of refractive status (nearsightedness (myopic); far farsightedness (hyperopic); astigmatism; snellen-acuity @ 20 ft) -visual-cognitive assessments (BOT-2; clinical observation during functional tasks)

7 key principles of EI

1. infant + toddlers learn best through everyday experiences + interactions with familiar people in familiar contexts 2. all families with the necessary supports and resources can enhance their children's learning + development 3. the primary role of the service provider in EI is to work with and support family members + caregivers in a child's life 4. the EI process from inital contacts through transition must by dynamic + individualized to reflect the child's + family memember's preferences, learning styles and cultural beliefs 5. IFSP outcomes must be functional + based on children's + families' needs + priorities 6. the family's priorities needs + intersts are addressed most appropriately by a primary provider who represents + recieves team + community support 7. interventions with young children + family members must be based on explicit principles, validated practices, best available research + relevant laws + regulations

Why do OT's complete evaluations? What is the difference between an assessment and an evaluation? What do you need to know about an assessment?

Eval- initial overview of CL; determine strengths and weakness assessment- standardized test; a tool; skilled observation after assessment you analyze performance

Controlling error

PIE -person -item- does element being tested fit the occupation person performs in real life? -environment: does the testing context match the natural environment?

Qualities of the goal

S- specific What are you going to do? Why are you going to do it? How are you going to do it? M- measurable A- attainable R- relevant T- time bound

what assessment should I use?

What is the need? What is the outcome you are looking for? -diagnostic decision -determine response to intervention -predict a future outcome What are you measuring? -occupational participation -underlying performance issues -some aspect of QOL Who is the clinet? (age, conditon, culture special needs)

standard deviation

about a range and what is considered normal

just right challenge

activities that are neither too difficulty nor too easy for child to complete

age equivalent score

age at which the raw score is at the 50th %; age level at which the avg person in the population performs the same as the individual who is being assessed

Transdiciplinary

best for EI -foundation of this approach is collaboration -flexible boundaries + comfortable sharing roles -one assessment performed by team, integrated report -arena-style assessments: single primary service providers interacts with child while others/families observe assist as needed

visual perception

brain's ability to interpret information 1. visual attention 2. recognize 3. analyze 4. create new experiences or retrieve to use or store for later use 5. create behavior or output

EI services for

children B-3 who: have a developmental delay have a diagnoses disability (that has a high likelihood of causing a developmental delay) are at risk for a developmental delay (each state defines the last qualifier differently) and their families

norm referenced

compares performance with normal sample need to know who is included in normative sample content tends to be general, covering a wide variety of skills may not include functional items protocols that are standard for administering

pragmatic

context, cultural awareness

standard score

conversion of raw score; permits comparison -equal units of measure with a mean + SD (the estimate of variability that normally accompanies the mean due to accumulated error) -often reported as a Z score (SD), IQ scores, developmental quotients, percentiles, and age equivalent scores

The Bell Curve

curve represents 100% of the population -scores within 1 SD from the mean are not significantly different from avg. -usually +/- 1.5 - 2 SD is considered a deviation from mean

scissors 2.5 years

cut across page

scissors 3-3.5 years

cuts on 6 in line

scissors 3.5-4 years

cuts out circle

scissors 4-5 years

cuts out square

scissors 6-7 years

cuts variety of shapes

Content

does it truly test... to what extent items on test measure a particular behavior or domain

Ecological assessment

evaluation in the child's natural environment

Standing

explore, eye to eye, dev. visual perception, blood circulation, digestion, bony density, stretch, breathing, BP, well being

Prone

extension, WB and weightshift, can help reduce palmar reflex, STNR, ATNR, holding up head to just look with eyes

social context

family, peers, community members with whom child interacts

Establishing goals

final step in eval process steps: 1. what is the priority? (educational, developmental, functionally relevant) 2. What is the target behavior to be observed? (What needs to change) 3. Establish baseline for the target behaviors (What is current performance?) 4. Establish the target outcome for the target behavior (What is reasonable time frame to accomplish this?)

Activity Analysis

focus on: identifying demands of activity; objects/tools used; space + social demands of activity; range of skills involved in the activity; influence of culture context recognized within activity

Facilitaition of normal motor development

goal of normal development is directly related to posture, which enables interaction/participation in infant occupations (feeding, positioning, etc) Muscle growth/promotion will increase normal motor development and proper alignment intervention can include sidelying with movement in opposing positions, assisted movement ( where effort is both the infants and the parents) with light stimulus/active reaching towards items; PROM to encourage movement + flexor tone; positioning to improve endurance especially in flexion; gravity eliminated positioning

inhibition of abnormal movement/tone

goals include inhibition of movements that would be detrimental to skin/joint protection, stabilization to increase postural control intervention techniques could include: NDT techniques, containment/deep pressure towards midline; swaddle techniques for comfort and ease of caregiver handling

kangaroo care and safe sleeping/carrying tech for caregivers

goals include postural alignment, skin to skin for self regulation, stabilization of vitals, and weight gain/feeding support kangaroo care in the intervention itself; while providing it, can work on posture/support/positioning and environment mod/sensory stimulation

ROM for prevention/correction of abnormalities

goals include prevention and/or correction of posture/alignment interventions may include light resistance (gravity, swaddle, water) GENTLY; swaddle for joint/posture alignment, gentle ROM within age appropriate limits

promotion of feeding skills

goals include promoting anatomical alignment, safety in feeding ( aspiration risks, readiness, etc); improve parent confidence in feeding regardless of method intervention include gentle distal to proximal oral stim; non nutritive sucking skills; positioning in upright alignment and 'trials' of nutrition; pre-feeding skills such as pacifier and hand to mouth

education on safe handling of the medically fragile infant during ADLs

goals include protection of body systems ( joints, breathing, skin, etc), management of medical equip, and parent/caregiver confidence in providing care intervention can include infant massage (certified vs. general); swaddled/carry techniques, kangaroo care, and bathtime/diapering/care tech

Environmental modification for promotion of development

goals include self regulation, neuro and motor development, and growth (weight gain, etc) as well as sleep cycle/rest promotion interventions may include modification of lights, sounds, temps, clothing/direct contact items (include support devices)

Therapeutic positioning for self regulation

goals include self regulation, skin/joint projection, neuro and motor development, positions to promote occupation (feeding, etc) interventions may include: nesting/posture/developmentally appropriate flexion, postures, safe passive positioning; environmental modification; recognition of stress behaviors; promote body alignment/body exploration

nominal

has/have not

criterion referenced

how a person performs on specific tasks used to determine skills that can/cannot be accomplished usually detailed + functionally oriented items chosen may be based on milestones or task analysis, not stasticial validity provides focus for intervention may or may not be standardized

Construct

how consistent are the items in the assessment with an established concept. How well an assessment conforms to theoretical construct

concurrent validity

how well test scores reflect current performance. How assessment measures against a gold standard. score of 0.70 or higher means performance on 1 test predicts performance on the 2nd test compared

inclusive services

integration of child with disabilities into regular classroom

family-centered practice

intervention designed according to family and child priorities

writing goals/objectives

is goal written using parent-friendly language (for school based) is child the focus of the objective? does the objective include one specific and observable target behavior? does objective include positive changes in target behavior AND include conditions and criteria for meeting? goal= occupationally based

conditional reasoning

logistical things, less concrete things much deeper than assessment

environmental adaptations

making the school bathroom accessible to children in wheelchairs

test-retest

measures stability over time

interval scale

numeric scales where we know order AND exact differences ex: rubric, temperature time component

Types of assessment

observation interviewing written questionaire

Evaluation process

occupational profile -who is the client? -why is the client seeking services? -what occupations and activities are successful or are causing problems? -what contexts and environments support or inhibit desired outcomes? -what are the clients priorities and targeted outcomes? assessment of performance analysis of performance enironment

narrative reasoning

occurs throughout treatment process (relationship with client)

visual motor

output; eye hand coordination; visual memory; spatial relations

Intervention

preparation for intervention (preparatory phase) -maximize engagement of child -prepare child to participate elements of intervention (activities/occupations) -therapeutic relationship -occupation as means and end -just right challenge (appropriate grading) -provide supports/reinforcement that encourage practice skill generalization (multiple envrionments/contexts) (education/training) ==progress monitoring and data collection

OSEP (office of special education programs)

provides leadership + financial support to states + local education agencies (LEA)

education

providing information to classroom teacher concerning the child's sensory needs + how this influence his or her learning

consultation

providing strategies to help the teacher provide optimal learning to a child in the classroom

Confidence interval

range of expected scores -95% CI is 2 SD on either side of the obtained score

ordinal scale

rank characteristics on a continuum- more than 2 categories + rank in order, differences between not known -used the most -ex: letter grades

raw score

response to a specific item before it is converted; not directly interpretable

visual closure

see whole from partial information; pencil form pen hidden under papers

scissors 2 year

snip

assessment methods

standardized is better

scale scores

strong comparable score

physical context

surrounding facilitates or constrains exploration

Validity

the degree to which a test accurately measures the specific construct, trait, behavior, or performance it was designed to measure

correlation coefficient

the higher the negative or positive the correlation, the greater the strength used to establish certain types of reliability and validity indicated the degree of agreement between 2 measures -range between -1 and + 1 0.90 = strong 0.80= satisfactory 0.70 + below = weak

therapeutic relationship

the way a therapist motivates and encourages a child

cross cultural competence

thinking, feeling, and acting in ways that acknowledge and respect diversity

Neuromotor assessment

tone balance Motor coordination (GM/FM) sensory ex: walking, skip, COMPs, diadischonitis, functional test for kinesthia

clinical reasoning

using own experience + observation to guide treatement -using specific evidence + research to guide interventions -education level, skill, bias, research (understanding intervention process, understanding effects of disability on participation, evidence based intervention

Motor Control Difficulties in children

who- CP, MD, spina bifida, DS interfere with engagement- self esteem, gross motor skills, postural control, stability how do we assess?- biomechanical, plan + sequence, sensory issues (tactile, proprioception)

inter-rater

will scores remain the same when assessed by 2 different therapist? important to measure during test dev. when scoring requires judgement from rater