peds

Jimmy is an 8 year old child receiving occupational therapy services for challenges with sensory processing and fine motor control. Jimmy loves to cook, so his therapist planned a cooking activity for his therapy session. One of the tasks involved was cracking an egg, Jimmy became upset when he approached the task, stating "eggs are slimy". Rather than ask Jimmy to complete the entire task, she asked him to crack the egg on the side of the bowl only and offered him a towel near-by in case there was a mess. This interaction best represents which core principle of the occupational therapy intervention process with children?

"just right challenge"

17. What potential behavior is suggestive of poor suck-swallow-breathe coordination in a young infant?

-Pulling away from the nipple -Losing liquid from sides of the mouth -Primary reliance on non-nutritive suck c. All of the above

7. What characteristics of play are found in children who have been environmentally deprived?

-Self-stimulation -Decreased social play -Limited repertoire of play c. All of the above

12. Which is not a sign of stress in a premature infant?

. Giggling

18. What is the progression of food textures from most to least difficult?

. Meats, raw vegetables, various table foods, soft foods, pureed foods

8. Providing services in what environment makes it easier to generalize skills across contexts?

. Natural environment

2. ________ is the ability of a test to discriminate between typical and clinical populations?

. Validity

liquids only

1-4 months

Easily chewed foods including soft meats coarsely chopped table foods

12 months

most table foods with raw vegetables, foods with skins, tough meats, or small round food that increase risk of choking.

12 months

Dips spoon in food, brings, spoonful of foods to mouth, but spills food by inverting spoon before it goes into mouth

12-14 months:

Coarsely chopped table foods, some raw vegetables most cooked meats

18 months

1. You are evaluating Lisa, an infant born 3 months pre-mature on 5/8/2016. The date of the evaluation is 3/18/2018. What is this child's corrected age?

19 months, 10 days

Liquids and beginning purred foods, formula, or breast milk remains:

5 months

Takes cereal or pureed baby food from spoon.

5-7 months

Liquids and pureed foods

6 months

Attempts to hold bottle but may not retrieve it if it falls, needs to be monitored for safety reasons.

6-8 months

Holds and tries to eat cracker but suck's on it more than bites it. Consumes soft food that dissolves in the mouth grabs at spoon but bangs it or sucks on either end of it.

6-9 months

1. You are completing an evaluation for Suzanne, at the request of the school team. Suzanne's birthday is 8/16/2009. The assessment takes place on 3/4/2018. What is Suzanne's chronological age at the time of the assessment?

8 years, 7 months

Soft Foods, mashed table foods, and melt able solid

8-9 months

Finger foods self a portion of meals consisting of soft table food.

9-13 months

You are the occupational therapy student assigned to complete a developmental assessment on a 7-year-old client named Billy. Billy's parents are concerned that he is sometimes clumsy, has difficulty with balance activities and is having challenges with handwriting and organization at school. You administer the BOT-2 assessment. From the raw scores on the assessment, you compute the Billy's percentile rank score, scaled score and age-equivalent score. Which of these scores is considered the LEAST psychometrically sound?

Age-equivalent score

1. You have received a referral to screen a 3 month old infant for a developmental delay. Which of the following assessment tools would you be likely to use for this purpose?

Ages and Stages Questionnaire

1. You are the occupational therapist assigned to work with Ruby, a 2-year old with feeding difficulties. You are preparing for your first visit to the child's home. Once at the home, what would be your first step in evaluating Ruby's feeding problems?

Ask Ruby's parent questions about feeding, eating and swallowing

generally associated with swallowing issues _________ can actually occur after swallowing if aspirating Less likely with lumpy, more often seen the solid or thin liquids.

Choking

1. You are an occupational therapist working with George, an 8 year old boy living with developmental coordination disorder. As you work with George you collaborate with him to decide what would help him do better at school. Together you outline steps that he can take to meet his goals and develop strategies. Once George has the opportunity to try out the steps, you meet with him to determine how the strategies are work and what might help him in the future. What type of approach does this most closely represent?

Cognitive orientation to daily occupational performance (CO-OP)

Identifiable outcomes (e.g., Lego tower) Sandbox, puzzle, block table play. Predominantly during the preschool year. Remains high during middle childhood an adolescence by becomes more abstract. May develop into Arts and Crafts

Constructive play

1. Emily is a 10-month-old child who is not feeding herself with her hands. She drinks from a bottle, and she takes smooth pureed food using a suckle pattern. She bangs and plays with a spoon, but does not attempt to feed herself with the spoon. She does not hold her own bottle. She gags when she is offered crackers, cookies and lumpy foods. She does not have vomiting, recurrent respiratory infections or problems choking on her bottle. Which statement best describes Emily's oral-motor skills?

Emily is delayed in her oral motor skills. She should be able to mash and swallow lumpy foods and use a munching pattern with cookies

Used to evaluate the esophagus, stomach, and duodenum referred to as an esophagastroduoencopy (EGD). Pass a scope through the nose and visualize the structures for the presence of esinophil

Endoscopy

1. You are the occupational therapist making a home visit to a family in a rural community. The grandmother, mother and mother's sister are present during the session. When you arrive, the grandmother is feeding the 8-month-old infant. The OT referral was to work with the family to develop the child's motor skills. What initial actions should you take?

Engage the caregivers in conversation about the child and progress he has made since the last session

Fueled by intrinsic motivation Begins in infancy by the end of the first year Infants actively explore their surroundings, demonstrate a beginning understanding of cause and effect, and are interest in how things work.

Exploration

most often associated with sensory (hyposensitivity) and oral motor issues ________ usually occurs with food in mouth or during swallow High rate of frequency with lumpy foods

Gagging

1. Sally is a 3-year-old girl who demonstrates oral hypersensitivity impacting her participation in feeding and eating. Which pattern of behavior would you expect Sally to exhibit?

Gags frequently, limited variety of foods, refuses tooth-brushing

Daniel is a 9 year old boy referred to occupational therapy due to concerns regarding his participation in play with his peers. Upon receiving the referral, you reflect on Daniel's age and consider the type of play you would expect a typical 9 year old to engage in with peers. You would expect Daniel's play to be classified primarily as:

Game

9. What is included in the IFSP?

Goals Types of services ProvidersService location Duration Transition Plan c. All of the above

1. James is a 6-month-old infant. He continues to be breast fed by his mom. As the occupational therapist working with the family, you recommend that his mother begin to introduce spoon feeding with purees. At what age should James be ready for meltable finger foods?

He should be ready for soft foods and meltable finger foods by 8 months.

Generalized deep pressure Calming strategies: slow linear rocking before oral stimulation Hand to mouth pacifier activity Lollipop or teething ring dipped into a new flavor of food. Gradually thicken food for stronger flavors, or change food temperatures to expand the child's sensory experiences

Hypersensitivity

Often reacts negatively to touch near or within the mouth. The may turn away from feeding or toothbrush activities, restrict food variety, gag frequently or have difficulty with transitioning age appropriate food textures. May also engage the child in songs or games to encourage self-directed touch faceor play dress up

Hypersensitivity

Have low sensory registration and may demonstrate poor oral sensory awareness. Seek oral sensory stimulation by mouthing their hands, toys, or clothing. Decreased awareness of drooling OT Establish oral sensory input intermittently throughout the day. Oral Activities with a rubber massage brush, cold washcloth, or vibrating device can be used to provide oral simulation Strong Flavors Cold Temperatures: helps take appropriately sized bites of food

Hyposensitivity

Represents the formal planning process and resulting legal documents that establish the services and programs that will enable the student to participate in school activities and receive an appropriate education. Written statement for each child with a disability that outlines a students education and functional needs and the supports and services required to meet those needs.

IEP

Birth - 3 years (36 months) is a map of the family's services and informs everyone who will be working with the child and family about which services will be provided, where they will be provided, and who will provide them. Follows completion of the evaluation and assessments. (Home or community setting) Defines the environment in which the child is to receive services an provides in a natural environments. Frequency Intensity, duration of services, and the funding sources. Assist the family in assessing information and resources and coordinate implementation of the IFSP. Provides the foundation of family-centered early intervention services; Plan for special services for young children with developmental delays; Provides the "when, what, where, why, and how" of early intervention services to be provided to a child and their family

IFSP:

You are the OT working with Suzanna, a 3 year old referred to OT due to developmental concerns. You are using the Revised Knox Preschool Play Scale to assess Suzanne's play. In order to conduct this assessment it is BEST to observe the child...

Inside and outside in a natural environment

Donny is a 15 month old who is attending OT services at your outpatient clinic. When you first meet Donny he clings to his mother and becomes visibly upset if any attempt is made to separate them. What can you conclude about this behavior?

Its normal

Activities that are neither too difficult nor too easy for child to complete

Just right challenge

Family centered

Keeping a families needs, goals, routines, and expectations at the forefront of intervention. Focuses on investing and establishing a relationship with the family characterized by open communication . Shared decision making, and parental environment. An equal partnership with the family is desired. Demonstrate compassion, exhibit responsiveness and sensitivity and foster parental self efficacy.

You have evaluated a 5-year old boy with a diagnosis of cerebral palsy. He navigates his environment using an electric wheelchair independently. As he approaches his friends, he smiles, calls out to them and eagerly engages in a game of tag with them. Which statement best describes how he would most likely score on the Knox Preschool Play Scale and the Test of Playfulness?

Low on Knox, high on playfulness

1. Which of the following positions should be discouraged for infants and young toddlers when drinking a bottle?

Lying in a flat supine position

is used to analyze swallow mechanism and is particularly important for children who aspire or are at high risk for aspiration because of severe motor, neurologic, developmental, or structural abnormalities. Issues with swallowing problems including gagging, , coughing, choking, Nasopharyngeal reflux, increased congestion, wet vocal quality, and frequent occurrence

Modified Barium Swallow Study

You are working with Susie, a 5-year-old girl. Susie's parents are concerned that she does not seem to play with other children. They report that they try to offer Susie new toys frequently to spark her interest and that they prompt her to play with them in the "correct way". Based upon this description, which suggestion are you most likely make to Susie's parents to better support her playfulness?

More novel ideas

1. You are an OT student observing an occupational therapist working with Jimmy, a 10- year old boy with cerebral palsy. The OT uses therapeutic handling to facilitate postural control and movement synergies and to inhibit motor patterns that could lead to further deformities and dysfunction. You conclude that this therapist is working from which frame of reference?

Neurodevelopmental Therapy

1. Which sequence represents the correct phases of swallowing?

Oral preparatory, oral, pharyngeal, esophageal

1. You are evaluating a 4-year-old child with concerns related to developmental delays in gross and fine motor skills impacting his preschool participation. Which norm-referenced assessment would you be MOST likely to use with this child?

Peabody Developmental Motor Scales - 2nd Edition (PDMS-2)

You are the OT working with James, a 7-year-old. James' parents are concerned that he has few friends and appears to have limited play skills. His teacher reports that he stays on the periphery during recess and usually sits alone. You will not have the opportunity to directly observe James' play, but your first priority is to know more about his play preferences. Which play assessment would be MOST appropriate to address your first priority?

Pediatric interest profile

A toddler attempts to place a shape into a container multiple times using an effective reach and grasp pattern often, but makes errors. Which stage of motor learning does this illustrate?

Perceptual learning

1. You have completed an initial evaluation with Jeremiah, a 10-year-old with ASD. In preparing to communicate the results of the evaluation with Jeremiah's parents. When presenting this information, the occupational therapist should be certain to...

Place the emphasis on sharing information and making joint decisions with the family about a plan of action

1. What is the progression of food textures from easiest to most difficult?

Pureed, soft foods, various table foods, raw vegetables, and meat

1. You are the OT student observing an OT practitioner working with a 5 year old child with ASD in a clinic based session. Before the session, the therapist sets up the room with mats, suspended equipment, and opportunities for climbing and exploring a variety of textures. The therapist explains that once the environment is set up, she will follow the child's lead and collaborate with him in the choice of specific activities. Her goals are to help the child maintain an appropriate level of alertness while challenging his praxis and behavioral organization. You conclude that the OT practitioner is most likely employing which approach?

Sensory Integration

1. You are the occupational therapist working with Steven, an 11-month old who is not yet feeding himself with his hands. He drinks from a bottle but does not actively hold the bottle. He gags if a soft meltable cookie or cracker is introduced, but can swallow pureed cereal without coughing. How would you interpret these findings?

Steven is demonstrating a delay for both oral motor and self-feeding skills

You are working with a 4-year-old boy for whom you have planned an intervention using constructive play. As part of your intervention, you engage the boy in building a tower, using large blocks of varied weight. Each week you offer the child heavier blocks and decrease breaks provided during the activity. What is most likely your goal in this treatment session?

Strength & endurance

Strength based approaches : increased self efficacy and self-determination , motivation

Strength based

• A child with self efficacy is more likely to make repeated and sustained efforts to achieve his or her goals, despite lack of immediate success.

Strength based

Pretend play, dramatic games Develop at the end of the first year and through the second. Peaking at around 5 years of age and evolving into dramatic and socio-dramatic play. Make believe games form the foundation for self regulation, civility, and empathy and enhance a child's capacity for creativity and cognitive flexibility.

Symbolic play

1. Kim is a new mother who has been asked to attend the IFSP meeting to discuss services for her 12-month-old daughter. Kim is nervous and asks her sister to come with her to the meeting, but they will have to reschedule the meeting. Which statement best reflects the team's procedures?

The team will reschedule the meeting so the sister can attend

Ecologic assessments: uses a top down model that considers cultural influences resources, and value system of the child's environment

Top down

The occupational therapist evaluates the patient's functional status in relation to his or her daily occupations and develops the treatment plan based on the patient's ability to participate in those occupations. To acquire or restore the skills necessary to participate in occupation

Top down

1. What type of evaluation process starts with assessing a child's participation in daily occupations?

Top-Down

is a common evaluation used to screen for anatomic difference such as GI malrotation, structure, vascular ring, or fistula's or pouches which may cause vomiting and other feeding problems

Upper GI

4. Which of the following is the least psychometrically sound standard test score and should not be used alone to report or interpret test results?

a. Age Equivalent

Johnny, a 12-year-old with developmental coordination disorder, was initially evaluated using the BOT-2, and then later re-evaluated using the same test. The results of his first assessment can be found below. On his re-evaluation, Johnny's standard score on the Body Coordination subtest is 43 and his Manual Coordination subtest standard score is 28. Given the information below, what can you conclude about Johnny's re-evaluation score, compared to his initial test score?

a. It cannot be conclusively stated that Johnny has made progress on either Body Coordination or Manual Coordination subtests since his initial evaluation

3. Poor compliance with standardized testing procedures can result in what?

a. Low-inter rater reliability

11. Including a typically developing sibling in the OT intervention does what to the clients effort level?

a. Maximizes effort of the client

16. At age 8-9 months a child should be able to be introduced to all of the following accept?

a. Meat

19. What behavioral consequence makes behaviors more likely to occur?

a. Positive reinforcement

10. Which of the following is not an example of an indirect model of service delivery?

a. Using professional terms to explain the intervention

21. Which of the following is not one of the 4 stages of praxis?

b. Development of tone

5. What was published in 2010 by Dawson and Rogers and is evidence based for effectiveness with toddlers and young children with autism spectrum disorder?

b. Early Start Denver Model

14. What is the recommended intervention activity for children with poor oral sensory awareness?

b. Providing strong flavored food that is cold

13. Which of the following is the best type of auditory stimulation for young neonates?

b. Their parents voices

20. Which of the following are possible indicators of difficulty processing vestibular information?

c. All of the above

6. When providing information and programming to parents you should do all of the following except?

c. Use professional jargon

Wet voice, apnea, decrease heart rate, history of pneumonia, discomfort with feeding. (coughing, choking, wet, breath/sounds, gurgles, raspy wet).

dysphagia

Response to food that may cause choking and aspiration

gagging

One's attitude or approach toward play To develop playfulness, the child must develop intrinsic motivation, internal control, , ability to suspend reality, ability to give verbal and nonverbal cues when interacting with peers and caregivers

playfulness

play Infant develops mastery over own body and learns cause and effect Predominant in infancy as infants develop mastery Play peaks in the second year of life and then declines Continue to use ____________ play when they learn new motor skills

sensoriomotor play

Learn about cultural norms and relations (e.g., play mother and baby) Begins very early with interaction between the infant and parent. And by age 3 child are able to engage in complex social games. Children use role play to learn about social system and cultural norms. Functional roles: Pretending to be a doctor Relational Roles: Such as pretending to be mother and baby Character roles: Those in television, movies, and video games Roles with no specific identity. Combined with motor play develops into rough and tumble play such as playing fighting and pillow fights.

social play