Term
|
Definition
o Medical model: person is center of focus with cause of problem due to condition/disease
o Problem focused approach to treatment; alleviate symptoms; “cure” the problem
o Hospital, outpatient clinic settings
o Multidisciplinary approach |
|
|
Term
|
Definition
o Management of issues to reduce intensity of symptoms/problems
o Treatment focus is to enable function, improve quality of life
o Consider needs of the person within his/her context
o Rehab settings, nursing or long-term care facilities; education settings that work with the multi-handicapped child
o Interdisciplinary approach |
|
|
Term
|
Definition
o Considers the interactions between the person and the context (family, physical environment, social environment, cultural environment, etc.)
How does context support development?
What are the strengths & limitations of the person? What are the individual’s ability for function within the context?
o Treatment focus is on adaptation:
How can context be adapted to promote opportunities for growth & development?
How can tasks be adapted to promote function?
What skills can be developed that allows the child to adapt to demands of the context?
o Education settings & community programming: inclusion
o Interdisciplinary or trans-disciplinary approach |
|
|
Term
Service Delivery Models:
Direct |
|
Definition
| one-to-one sessions with child, child & family |
|
|
Term
Service Delivery Models:
Monitor |
|
Definition
| design program for someone else to carry out; OT responsible for goals, plan, follow-up |
|
|
Term
Service Delivery Models:
Consultative |
|
Definition
| Program suggestions; up to other individual whether or not to implement program |
|
|
Term
|
Definition
Team members function autonomously; each has their own expertise in their own area, professionals do their own evaluating & program planning separately; rely on information from others to fill in the gaps for the client; communicate by phone, e-mail, letters, in medical chart; often separate locations; medical goals are priorities with behavioral & social goals as secondary
Medical model: hospitals (acute care), private practice, out-patient clinics
• Advantages: professionals in control of their own program
• Disadvantages: possible duplication & fragmentation of programming, less chance to communicate with other professionals (less face-to-face communication); family may need to travel between programs & meet with multiple professionals |
|
|
Term
|
Definition
usually in same setting & members of the team have a greater understanding of the professional roles of the other members; professionals do their own evaluating, but have staff meetings & cooperatively decide on the child’s program & functional outcomes & discharge planning; co-treatments a possibility
• Medical model: hospital (acute or long-term care)
• Educational model: school-based practice (IEP's); early intervention programs that include multiple agencies
• Advantages: more communication with other professionals to better implement a more holistic program; reduced fragmentation of programming
• Disadvantages: family needs to work with multiple professionals |
|
|
Term
|
Definition
usually same setting (if multiple settings, a decision is made regarding who will be the “leader” or case manager or primary service provider); most collaborative for team; involves role release & work across discipline boundaries & sharing of training/information
• Educational model: early intervention programs (0-3)
• Advantages: less confusing for families when working with one individual at a time; reduces duplication & fragmentation of services; helps professionals expand their knowledge
• Disadvantages: issues with professional role release; inappropriate to teach highly specialized techniques or skills that are not yet mastered |
|
|
Term
| Major Performance Skills to evaluate when working with Children: |
|
Definition
Motor Skills
Cognitive Process Skills
Emotional Regulation Skills
Communication and Social skills
Performance Contexts |
|
|
Term
|
Definition
(Posture, mobility, coordination, strength & effort, energy, praxis) coordination of gross, fine, oral-motor skills. Movement is first way child interacts with environment:
Sensorimotor:
• Sensory-perceptual processing & modulation (affects behavior), ability to interpret sensory info into meaningful patterns for learning & skill performance
• Visual-perceptual and visual-perceptual-motor function: for learning and skill performance in education, ADLs, play & leisure, preo-vocational development
• Neuromuscular: foundation of motor skills; reflexes, tone, strength, endurance, posture and postural control, Musculoskeletal integrity |
|
|
Term
|
Definition
| Energy/attention, knowledge, temporal organization, organization of space & objects, adaptation: ability to perceive, attend, learn, memory to be able to do performance areas (this area is critical in OT’s development of TX/intervention plan) |
|
|
Term
| Emotional Regulation Skills: |
|
Definition
| actions, behaviors used by child to express feelings and to interact with others. Also involves ability to stay on task, management of frustration and anger, coping strategies, displaying appropriate emotions and responding to the feelings of others (Critical area for motivation, focus & attention to task) |
|
|
Term
| Communication and Social skills |
|
Definition
Psychosocial: interaction (verbal and non-verbal), social relationships, self-concept, maintaining appropriate physical space during interactions, turn-taking, & family interaction
Childhood roles and occupations = Learn developmentally-appropriate:
o Function at home
o Function at school
o Function within the community |
|
|
Term
| Performance Contexts to consider when working with children: |
|
Definition
• Environmental factors that impact a child’s functional performance (can help or hinder child development):
• Family, peers, social situations, culture, socioeconomic situation, physical environment, roles
• Person-environment-performance fit |
|
|
Term
Best Practice for Assessment:
The Ideal |
|
Definition
• Observation of family & child interaction in natural settings
• Availability of using standardized & play-based tools
• Use of context for skill observation
• Flexible, success-based tool
• Allow time for teaching & training |
|
|
Term
Best Practice for Assessment:
The Reality |
|
Definition
• Brief visits
• Parent & child in strange situation = less than optimal responses
• Context less than ideal
• Limited flexibility of tools; especially for the significantly impaired
• Need to use several tools & cross-reference them |
|
|
Term
| Interaction styles between family members |
|
Definition
o Cultural influences
o Temperament styles
o Parenting styles (permissive, disciplinarian, authoritative, etc):
o Parenting practices: Some parents like to be down on the ground, some don’t want to participate
o Styles & practices can be different between caregivers & you may have differing opinions too |
|
|
Term
| Impact of Having a Child with a Disability |
|
Definition
Learning to cope with the “new normal”; a change or divergence from a ‘typical” perception of family life cycle
Demands on the family system change:
o Financial resources: Insurance? Management of medical costs? Loss of time from work?
o Human resources or personal skills of each family member: shift in roles and expectations for family members
o Time resources: time demands shift. Do family members have time to complete activities related to their role within the family?
o Emotional energy: increased stress; personal coping strategies may differ;
Support systems and networks |
|
|
Term
| 4 Principles of Family Centered Practice |
|
Definition
• Principle 1: Respect and accept family diversity: How? Find out what their values are and what they want. Allow them to have input and what is important to them.
• Principle 2: Be flexible, accessible and responsive. How? Work around their schedule. Allow them to get a hold of you.
• Principle 3: Encourage collaboration with parents. How? Talk to the parents and see what their goals are with for the child. Communication system with both sides of the parents. Include parents in the therapy session.
• Principle 4: Primary care giver is the primary decision maker. How? Give them options and allow family to decide. Parents have the right to veto a decision. |
|
|
Term
| Describe psychosocial developmental challenges of a child with a disability. |
|
Definition
• Because of the public’s lack of understanding, misinformation, children with disabilities are often:
• Thought of as less intelligent
• Labeled unfriendly or a “trouble maker”
• Left out of opportunities for social interaction; become isolated
• Left out of opportunities for independence = limited experiences
• As a result, disabled children are set up for development of negative self-identity & behavioral issues; at risk for abuse
At risk for psychosocial issues:
• The child who is different is often teased & rejected by peers (these peers are also developmentally trying to learn who they are)
• Children with a disability are forced to face their differences before becoming secure in their similarities with their peer group
• Need emotional support from caring & knowledgeable adults |
|
|
Term
|
Definition
A person’s innate style of emotional, motor & attention reactivity to environments, events, and people.
o Function: Exhibits developmentally expected ability to regulate emotional, motor, and attentional reactivity as well as age-expected self-regulatory capacities.
o Indicators of Function: Focuses attention; manages activity level & impulses w/ caregiver support given age & situation; Orients to relevant sensory input; able to ignore environmental distractions; Adjusts to daily routines of home, school & community environments; Appropriately shifts attention in activity & conversation; is sensitive & responsive to the demands of the environment & can put aside favored activities to respond appropriately to environmental demands; persists in tasks as expected developmentally
o Dysfunction: Cannon focus attention, manage activity level & impulses w/ caregiver support given age & situation; Does not orient to relevant sensory input; cannot ignore environmental distractions; Doesn’t adjust to daily routines of home, school & community; Can’t shift attention in activity & conversation; Not sensitive or responsive to envir demands & can’t put aside favored activities to respond appropriately; not persistent in tasks as expected developmentally |
|
|
Term
|
Definition
o Function: Given age & development, can take action to modify feeling states to accomplish interpersonal goals.
o Indicators of function: Can identify emotional states in self and others; is aware of own emotional signals; recognizes emotional signals of others; exhibits capacity to control emotional expression to support prosocial goals
o Dysfunction: Cannot identify emotional states in self & others; Is not aware of own emotional signals; does not recognize the emotional signals of others; Does not exhibit capacity to control emotional expression to support prosoical goals |
|
|
Term
|
Definition
o Function: Family routines allow members to complete daily living activities while maintaining harmonious relationship among members.
o Indicators of Function: Participates in family routines according to function or developmental level; Caregivers provide instruction, support, and assistance to children as needed; Positively responds to caregivers’ instructions in family routines; Demonstrates the basic habits for social interaction within family routines; Caregivers report that the family regularly participates in mutual activities that are pleasurable to family members
o Dysfunction: Opposite |
|
|
Term
|
Definition
o Function: Child home provides safety, security, support, and developmental stimulation to the child
o Indicators of Function: Physical home environment is physically safe and has sufficient material to engage child in developmentally appropriate activities; Responds to caregivers nurturing and responsiveness; Demonstrates appropriate behaviors as role modeled by caregivers
o Dysfunction: opposite |
|
|
Term
| Social participation in school |
|
Definition
o Function: School environment is safe, provides the nonhuman and human support for successful academic achievement
o Indicators of Function: Physical environment is safe and has adequate space and materials for learning; Positive interaction with other children facilitated by teachers and staff; Benefits from individualized teaching and interactional styles of teachers and staff
o Dysfunction: opposite |
|
|
Term
|
Definition
o Function: Access to environments where the child can interact with peers in positive, prosoical way regularly
o Indicators: Participates in opportunities to participate in various activities with peers; Has time and space to develop friendships with preferred peers; Has caregivers to support learning of conflict and negotiation with peers
o Dysfunction: opposite |
|
|
Term
| Gesell Developmental Inventory |
|
Definition
•Purpose of Test: screening tool to determine if child is functioning at age level. If developmental delay is indicated, then referral for detailed examination is suggested
-Standardized assessment
•Age Range and type of client to be tested: Infants and children, 4 weeks to 36 months
Scores: Developmental quotient that has cut off scores for normal development, questionable (borderline) development, abnormal development
Strengths and limitations? |
|
|
Term
| Battelle Developmental Inventory - 2 |
|
Definition
• Purpose of Test: screens and evaluates developmental milestones. Evaluates the areas of personal-social, adaptive (self-help), cognitive, motor, communication; identifies children with disabilities
-Standardized Assessment
•Age Range and type of client to be tested: 0 – 7 years-11 months
•Scores: percentile ranks, scales scores. T-scores, z-scores
-Strengths and limitations |
|
|
Term
|
Definition
• Purpose of Test: screening tool to identify children at risk for developmental delays. If developmental delay is indicated, then referral for detailed examination is suggested. Evaluates the areas of Personal-Social, Fine-Motor Adaptive (fine-motor & cognitive skills), Language, Gross-Motor
Standardized Assessment
•Age Range and type of client to be tested: 0 – 6 years
•Scores: pass (age-appropriate skills)/fail (below age-level skills)
-Strenghts and limitations |
|
|
Term
| Bayley-3 (considered gold standard) |
|
Definition
• Purpose of Test: comprehensive tool that assesses mental function, behavior, motor skills; Used to determine if child is functioning at age level. Usually by Psychologist
o Sections: Cognitive, Language, Motor, Social-Emotional, Adaptive Behavior (self-help)
Standardized Assessment
•Age Range and type of client to be tested: 0 – 42 months
•Scores: scaled scores, percentile ranks
-Completion of a training and certification program recommended
o Psychologists/developmental psychologists usually administer the total Bayley, however, OT/PT may complete the motor section with training |
|
|
Term
| Hawaii Early Learning Profile |
|
Definition
Purpose: Designed as a curriculum-based assessment & intervention tool to screen general development in the handicapped infant, using a scale of sequential increments of skills
NON-STANDARDIZED
Population: for children 0-36 months with a diversity of developmental problems
Scoring Methods:
• Draw a vertical line down from child’s age.
• Color skill area on chart if skill is observed.
• + = Present.
• - = Not present,
• +/- = Emerging, A = atypical
• NO Standardized scores; can figure out general age-skill ranges
Interpretation:
• Visual guide to provide approximate developmental age ranges and which skills are absent. Not norm-referenced.
• Has activity booklet that correlates with performance items; activities are written in child's voice with illustrations/photos
• Can be used for educational purposes to plan program.
Strengths:
• Can be used, understood by non-skilled personnel
• Parent-friendly, jargon-free
• Activity suggestions in HELP… at Home notebook
• Provides curriculum/program development
• Good for tracking development of children with moderate to mild delays, developmental delays without physical handicaps
Limitations:
• Not a diagnostic; often misused as a diagnostic tool
• No scores, no standardization
• Not sensitive enough for the physically involved child or child with profound delays
• Some items not in "correct" categories (cognitive& language checklists)
• Fine-motor section not sensitive past 18 months
• Some items not "correct" (i.e. use of scissors at 23 months)
• Does not encompass sensory-behavioral function
• Does not look at the function behind the skill |
|
|
Term
|
Definition
• OPTICAL & LABYRINTHINE righting reactions: start developing at birth in response to gravity on labyrinths of inner ear and by visual stimulation
• Gradually improves in control from birth with full control by 5 months (as seen by pull to sit maneuver)
• By 3 months there is no more head bobbing and they have head control
• By 5+ months, there is abdominal engagement, can sit. |
|
|
Term
|
Definition
• Trunk righting reactions (continuation of righting reactions of the head/neck)
• Derotative reactions emerge at 4 months (rolling) (body on body reactions)
• Rotative reactions by 9 months (supine - side sit - sit- 4-point- pull up to kneel- pull up to stand)
•Spinal extension against gravity:
o L-3 by 3-4 months (child demonstrates body symmetry);
o L-5 by 5-6 months (when child develops postural control in lateral weight shift in frontal plane);
o Straight, with lumbar extension by 7-8 months (when child demonstrates postural control rotation by being able to push up to sit from 4-point position)
o 0-3 flexed pattern- see at 5months then have trunk motor delay
o L-3 look for grooving around the spine about 3month
o L-5 can sit with arms propped out 5-6mths. Spine rounding
o Independent sitting at 7-8months- free for play |
|
|
Term
| Independent sitting is at how old? |
|
Definition
|
|
Term
| Sitting with hands in front is how old? |
|
Definition
|
|
Term
| Full pull to sit manuever by what age? |
|
Definition
|
|
Term
| PARACHUTE REACTIONS emerge when? |
|
Definition
• Emerge sideways and forward by 6 months
• Backwards by 9 months
• Combine trunk control and parachute reactions = balance control against gravity in upright positions
• Balance control is dependent on sensory input from vision, inner ear, and joint receptors
o Difficulties in sensory input can cause delay in development of advanced postural reflexes = can cause delay in gross-motor skill development |
|
|
Term
|
Definition
a neuromotor assessment of infants
o Used as a neurological screening examination of infants, especially for those at neurological risk due to their birth histories.
o Provide guidelines for discussions with parents and recommendations for further diagnostic testing and treatment
•Age Range: birth to 18 months
Scoring: Circle picture of what you observe.
• Items receive a score of 1, 3, or 5.
• Columns are added for a score total,
• Scores are compared to normal, transient, abnormal ranges that correlate to child's chronological or adjusted age. If child falls within abnormal range, then a diagnostic category is assigned.
• Strengths:
o Good measure of muscle tonal qualities that could be affecting child's development
o Good qualitative measure of postural skills and postural function
o Provides a scoring system that can be used to monitor neuromotor function at various intervals
o Good for identifying which infants need referral to neurologist for diagnosis or further testing
o Good as an adjunctive tool with other assessments
• Limitations:
o Need a lot of practice or mentorship to get the "feel" of what responses you are looking for
o Terminology can be "scary" for parents
o Handling can be upsetting to the child; can affect responses |
|
|
Term
What are signs of delays in postural control development?
Newborn to 3 months |
|
Definition
• Physiological flexion tone of limbs due to positioning in utero (not active flexion)
• Flexible but limited ROM of shoulder girdle and hips; springs back into flexor pattern |
|
|
Term
What are signs of delays in postural control development?
After 3 months |
|
Definition
• As child learns to move against gravity and develops extension, physiological flexion posturing decreases
• ROM changes: increased flexibility occurs at shoulders and hips, which allows for more motor skill development
• Positive support reaction (the ability to take body weight on legs when in an upright position): emerges by 3 months, first indication of leg extension to support weight against gravity; different from "primitive standing reflex" (child stand automatically when placed in standing position; disappears by one month)
• By one year, child has enough muscle tone to maintain against gravity positions of body (independent sitting, standing, walking) |
|
|
Term
| How do you know there is a problem with reflex development? what are the signs? |
|
Definition
• Primitive reflexes present
• As child’s nervous system mature, child learns new motor patterns and replaces primitive patterns
• Primitive patterns "disappear" or are "integrated” by 3-4 months;
o Typical for primitive patterns to "reappear" in stress situations or after brain injury
• Persistence of primitive patterns may indicate problems in neuromuscular development
• Child’s movement patterns should never be "stuck" in primitive patterns: if so, this can also be an indication of a problem in neuromuscular development |
|
|
Term
| Primitive Reflexes that are tested on the INFANIB: |
|
Definition
• GRASP REFLEX OF HAND OR FOOT: hand or foot, stimulate palm of hand and fingers close into a fisted position; stimulated under toes and toes will curl
• ASYMMETRICAL TONIC NECK REFLEX (ATNR): extension of limbs on the face side, flexion of limbs on the skull side; puts hand into view
• TONIC LABYRINTHINE REFLEX (TLR):
o Prone: flex head = shoulder protraction, flexion of arms and flexion of legs
o Supine: extend head = extension/retraction of shoulder girdle, extension of legs
Also may have:
•Absent head & trunk righting reactions & no parachute reactions |
|
|
Term
| what are the signs of issues with muscle tone? |
|
Definition
• Too low: floppy, limp, hypotonic
• Too high: stiff, limbs maybe “stuck” (bent/flexed or straight/extended, tight, resistance to free movement, hypertonic
• Mixed: fluctuates between low and high tone during movement demands, at rest usually low tone, may demonstrate tremors |
|
|
Term
|
Definition
| ideas & beliefs that are held to be true |
|
|
Term
| Function-dysfunction continua: |
|
Definition
All frames of reference have ideas they believe are true. Concepts and continua on what is functional and dysfunctional. Help guide our
•Function: expected ability; behavioral indicators of ability
•Dysfunction: disability; behavioral indicators of dysfunction |
|
|
Term
| Postulates regarding change: |
|
Definition
| therapy intervention that helps to facilitate change in the child |
|
|
Term
| Neuro-Developmental Treatment Frame of Reference: |
|
Definition
• Sensorimotor approach used in the treatment of neuromuscular disorders.
• Intervention techniques designed to enhance quality of movement performance within functional environment
• Focus on active participation in goal-directed activities
• Hands-on approach where the therapist “facilitates” appropriate movement patterns
• Postural development determined by maturation of the nervous system, along with sensory input, and proceeds in cephalo-caudal progression, normal development sequence:
• Stability & mobility
• Acquisition of motor control in the three planes
• Ability to dissociate movements
• That normal central nervous system produces a motor response that provides a sensory feedback into the CNS and it is incorporated into movement repertoire: feedback & feed forward mechanism (Dynamic Systems Theory)
• Defines postural control, postural alignment & Base of support as important in developing movement patterns against gravity (Kinesiology concepts of righting & equilibrium reactions)
• All the above leads to variety of motor skills & motor patterns |
|
|
Term
|
Definition
Function: Ability for child to be moved through passive ROM
Indicators of Function: Rolls w/ rotation b/w shoulders & pelvis; Use of reciprocal leg movements in creeping & crawling; Orients head in all planes in space; holds toy in one hand & manipulates with another
Dysfunction: Contractures, deformities, limiting passive ROM
Indicators of Dysfunction: Log rolling; bunny hopping; Pull to stand w/ LE in extension, adduction, and internal rotation; Hand closing associated w/ flexion of the arm and extension of the arm. |
|
|
Term
| Joint alignment & patterns during weight-bearing |
|
Definition
Function: Postural alignment and appropriate distribution of weight in relationship to the base of support during weight bearing
Indicator of Function: Alignment of body parts in relation to each other and to position in space
Dysfunction: lack of postural alignment and abnormal patterns of weight bearing
Indicators of Dysfunction: Malalignment of spinal segments in frontal, sagittal, or transverse planes; Posterior pelvic tilt, spinal flexion; Anterior Pelvic tilt, spinal hyperextension; Asymmetrical posture; Skeletal deformities (scoliosis, kyphosis); Narrow or widened BOS resulting in maladaptive weight bearing patterns |
|
|
Term
|
Definition
Function: Active state of muscle readiness to move
Indicators of Function: Developmentally appropriate use of limbs for support and finer adjustments during skilled activity
Dysfunction: Trunk or extremities stiff or floppy interfering with antigravity movements
Indicators of Dysfunction: Hypermobility & hyperextendability of joints; Decreased degree of tension in muscles; Limbs feel heavy on passive ROM; Limbs and body sink into any support surface; Presence of varying degree of stiffness in various joint interfering w/ antigravity movement; Presence of involuntary movements, or fluctuations in muscle activation; Increased degree of tension in muscles; Resistance to passive ROM; Areas of the body with increased stiffness withdraw from contact w/ the support of surface. |
|
|
Term
|
Definition
Function: Ability to sustain muscle activation for postural support against gravity
Indicators of Function: Adapt muscle stiffness providing flexible movement synergies; Sufficient muscle force production to counteract forces of gravity
Dysfunction: Inability to sustain muscle activation for postural support against gravity
Indicators of Dysfunction: Excessive stiffness in trunk and/or extremities when attempting to sustain posture against gravity; Presence of “fixing” or compensatory muscles synergies when attempting to sustain posture against gravity; Increased postural tone or stiffness to “hold on and stay put” at the expense of movement against gravity; Postural control predominantly static; Stereotypical movement patterns |
|
|
Term
| Balance & Postural control |
|
Definition
Function: Dynamic postural control
Indicators of Function: Maintains and moves in and out of developmental positions
Dysfunction: Compensatory postural control
Indicators of Dysfunction: Lack of accommodation of body segments to BOS; Wide or excessively narrow BOS; Attempts to gain postural control by moving away from the BOS; Use of UE for stability beyond developmentally appropriate age; Use of compensatory patterns such as persistence of the UE in high guard position for maintaining or regaining balance during reactions during weight shifting; persistence of asymmetrical patterns; various fixation patterns present (hand fisting, toe clawing); Exclusive use of “w” sitting position for postural control sitting. |
|
|
Term
|
Definition
Function: Various movement patterns
Indicators of Function: use of varied repertoire of movement patterns based on the demands of the activity
Dysfunction: Stereotypical movement patterns that are consistent compensation in various positions and tasks.
Indicators of Dysfunction: Stereotypically, one or both LE persist with extension, adduction, and internal rotation in all positions; Stereotypically, one or both UE persist with should elevation and retraction in all positions |
|
|
Term
| Description of Biomechanical frame of reference |
|
Definition
| Incorporates concepts of physics, kinesiology & physiology on the development of movement. Applied when working with individuals with severe physical disabilities |
|
|
Term
| What are the main goals for Biomechanical frame of reference? |
|
Definition
Enhance postural reactions by reducing demands of gravity and by enhancing postural alignment
Improve distal function & skill by supporting demands of the postural system, accomplished through positioning and adaptive equipment |
|
|
Term
|
Definition
Function: Normal head control & mobility;
Indicators of Function: Head is righted and mobile in all planes
Dysfunction: Poor head control and mobility
Indicators of Dysfunction: Child can maintain head in an upright position by loses head control when initiating a movement; Child is unable to right head or control and head movements |
|
|
Term
|
Definition
Function: Good trunk control
Indicators of Function: Child’s trunk is righted and stable in an upright position and is symmetrical when the child is seated or standing on a horizontal surface
Dysfunction: Poor trunk control
Indicators of Dysfunction: Child’s trunk is right by unstable when limb movements are initiated; Child’s trunk is not righted; child is unable to remain upright or remains upright w/ asymmetry; Child’s respiratory capacity is decreased because of abnormal muscle tone of the respiratory muscles, such as the intercostals |
|
|
Term
|
Definition
Function: Ability to reach in all planes
Indicators of function: Child can place, maintain, and control his or her hands where he or she pleases when in an upright position
Dysfunction: Inability to reach in all planes
Indicators of Dysfunction: Child’s arms are not liberated in and upright position; either they are needed for propping or shoulders are retracted to aid in upper trunk stability, bringing the hands back with them; Child cannot move his or her arms in gravity resisted planes of movement and therefore, cannot place or maintain his or her hands where he or she wants them. |
|
|
Term
|
Definition
Function: Mobility through space
Indicators of Function: Child is mobile through space in all planes (walking; climbing in, out of, and over obstacles); Child can locomote in a horizontal position (crawling or creeping) on a flat surface
Dysfunction: Slow, effortful mobility, or immobility
Indicators of Dysfunction: Child can only locomote by rolling; Child cannot move his or her body through space. |
|
|
Term
|
Definition
Function: Safe, efficient eating
Indicators of function: Child can chew and swallow food successfully without aspirating
Dysfunction: Difficulty with chewing and swallowing
Indicators of Dysfunction: Child is unable to grade jaw movements or control lips and tongue when eating; Child frequently aspirates food. |
|
|
Term
|
Definition
Function: Independence on toilet
Indicators of Function: child can empty bowel and bladder when seated on toilet
Dysfunction: Inability to void in toilet
Indicators of Dysfunction: Child can only void intentionally when lying down; Child cannon maintain sitting balance on a toilet; Child can maintain sitting balance on a toilet but cannot direct the flow of urine into the bowl; Child has no conscious bowel and bladder control. |
|
|
Term
| Accessing Switch for Technological Aids |
|
Definition
Function: ability to independently use technological aides
Indicators of function: Child can approach, contact, and release switch with adequate speed and control using hand and using body part other than hand
Dysfunction: Inability to independently use technological aides
Indicators of Dysfunction: Child cannot approach, switch, or maintain contact and control release; Child cannot sustain approach or release sequence for duration of activity; Child can approach, contact, and release switch with a body part, but the action impedes another function. |
|
|
Term
| Description of Motor Skill Acquisition frame of reference |
|
Definition
Based on concepts from Motor Control, Dynamic Systems Theory and Motor Learning Theories
Emphasis on Person-Task-Environment interaction and motor developmental sequences
Stages of learning and task practice leads to motor skill acquisition
Feedback in critical in learning movement skills; child needs to be an active learner |
|
|
Term
| Motor Skill Acquisition frame of reference Assupmptions |
|
Definition
• Functional tasks help to organize behaviors
• Motor control issues are due to the individual’s use of compensatory strategies to accomplish a task |
|
|
Term
Motor Skill Acquisition frame of reference
Function vs Dysfunction |
|
Definition
Indicators of Function: Child is able to perform a motor task; Child’s environment supports task performance; Task requirements are within a child’s capabilities with or without environmental support; Child-task-environment match
Indicators of Dysfunction: Child is unable to perform a motor task; Environment does not support task performance; Task requirements are beyond the child’s capability with environmental support; Child-task-environment do not match. |
|
|
Term
|
Definition
Person, task, environment
• Child: What are the desired tasks that the child needs to be able to do (interview child, family, teacher, etc.)?
o Observe how child performs the task
o What factors are limiting the child’s ability to perform the movement patterns to complete the task?
o Is child developmentally able to complete this task?
Task:
o Task analysis: What are the motor, cognitive, sensory components of the task?
o What kind of task is it?
o Can the components of the task be modified or adapted to support skill performance?
Environment:
o What are characteristics of the environment (sensory, social, physical, etc.)?
o What kind of environment is it?
o Can environment be modified or adapted to support task performance? |
|
|
Term
| Overall Assessment of functional Skills & Tasks? |
|
Definition
o What can the child do?
o Are skills/tasks developmentally appropriate?
o What tasks does the child need to be able to do? What are the demands of the task?
o What is the environment like? Does it support or inhibit task performance?
o Evaluate:
• Gross motor skills and mobility
• Upper extremity function & fine motor skills
• Activities of daily living |
|
|
Term
| Understand how muscle tone impacts the development of movement patterns |
|
Definition
o Movement patterns are a combination of muscle tone, biomechanics, sensory function, environmental experiences! Muscle tone issues can lead to issues in mechanical alignment and development of synergy patterns that influence motor control
oAbnormal muscle tone:
Low Tone
High Tone
Mixed Tone
oCompensation patterns: “fix”; “block”
Fix: reliance of closed pack position – Inefficient muscle co-contraction
“hang” on ligaments or soft tissue around joints |
|
|
Term
| Understand the progressive process of atypical movement development in general |
|
Definition
oPathophysiology - the study of the changes of normal mechanical, physiological, and biochemical functions, either caused by a disease, or resulting from an abnormal syndrome
o Original problem (muscle tone base)
o Compensations “fix” and “block”
o Habit motor patterns
o Short term implications
Inefficient postural control
Poor joint alignment & reduced mobility/stability
Motor delays
Sensory issues
o Long term implications
Joint deformities & contractures
Decreased variety of movement patterns
Decreased function
Sensory issues
Psychological & behavioral issues |
|
|
Term
| The progressive process of atypical movement development for children with low tone: |
|
Definition
o Pathophysiology:
Joint hyper-mobility, Reduced experience in physiological flexion;
reduced sensory awareness of body & midline
• Original problem:
o Difficulty moving limbs & body away from gravity:
Dependent on surface for stability & support
Wide base of support posturing of limbs (abduction of limbs)
Reduced awareness of body in space
o Compensations
Lock (“fix”) joints for stability; reliance of closed packed position of joints leads to:
• inefficient muscle co-contraction
• “hang” on ligaments or soft tissue around joints!
Use of wide base of support or leaning onto a support surface for stability leads to:
• difficulty grading of movement, poor midrange control
• difficulty with movement transition between positions
• Inefficient development of postural control & head control
o Habit motor patterns:
Prefers movement in the sagittal plane (developmentally easier)
• Avoid moving off of midline or using rotation!
• “All or nothing” movement range of motion to avoid mid- range control!
• Reliance on wide base of support, leaning on support surface, locking of joints to maintain position, inefficient head/postural control = preference for static postures leads to reduced variety in movement skills; open-mouth posture
• W-sit, ring sit with legs in wide abduction
o Short term implications:
Increased laxity of ligaments, leads to joint instability
Preference for static postures leads to reduced mobility, sensory-motor experiences, motor planning & passive behavior
Low endurance of muscles & cardiovascular system
Open-mouth posture can lead to possible oralmotor control issues
o Long term implications
Lax ligaments/joint instability can lead to increased risk of joint degeneration, subluxation or deformity
Preference for static postures and reduced movement experiences may lead to reduced length of muscles that are constantly positioned in a shortened range = AROM issues
Reduced movement experiences can lead to gross & fine-motor delays
Low endurance can lead to reduced muscle strength, increase risk for respiratory illnesses
Gross & fine-motor delays can lead to decreased function in gait & mobility development, ADLs, school, leisure & future vocational skills
Oral-motor issues may lead to issues in drooling & feeding, speech articulation
Passive behavior may lead to reduced social interactions |
|
|
Term
| the progressive process of atypical movement development for children with high tone |
|
Definition
o Pathophysiology
Extreme high muscle tone at birth indicates significant brain damage
o Original problem
As an infant, muscle tone may appear low tone, but as infant moves, high tone can appear through increased use of extension patterns
Primitive reflexes often obligatory or persistent & influence movement control
Reduced experience of physiological flexion leads to reduced midline orientation, reduced body awareness, reduced sensory experiences
o Compensations
Reliance on unopposed total extension patterns to move; more pronounced in limbs (sometimes muscles of trunk are hypotonic)
Tendency to posture arms in shoulder external rotation, retraction & abduction, elbow flexion, hands fisted
Tendency to posture legs into hip adduction & internal rotation, knee extension, plantar flexion
Child tends to “Hold” these positions for stability which leads to limited joint AROM & movement in midrange Vs. full AROM
Tendency to “Hold” UE & LE into patterns of extension:
• Affects base of support (narrows it)
• Affects development of efficient postural control
• Further reduces sensory experiences
Use primitive patterns for increased function
o Habit motor patterns
Reliance of extensions patterns leads to tendency use of neck/head hyperextension as head control
• Use of neck/head hyperextension may lead to oral motor issues (tongue thrust, jaw thrust, lip retraction, etc.)
• Visual-motor issues
Posturing of upper extremities leads to weight bearing on fisted hands or on dorsum of hands:
• Leads to Reduced sensory experiences for the hand
Use of “tenodesis” to control opening/closing the hand leads to delay in fine-motor control
Posturing of UE leads to tendency to use one arm at a time to reach (reduces midline control & bilateral control)
Posturing of UE & LE leads to reduced thoracic extension = increased use of rectus abdominus for postural control (inefficient postural control) = movement into sagittal plane reinforced
Posturing of LE reinforces use of hip adduction & internal rotation musculature = reduced AROM of LE & an immobile pelvis = difficulty in shifting weight (further reduces postural control)
• Preference for w-sit to avoid a lengthened position of hamstrings & to compensate for pelvic immobility
Posturing of LE reinforces use of plantar flexion with inversion of the foot which further narrows base of support when standing
Small active range of motion is used (usually in midrange)which leads to reduced joint isolation in movement = lack of variety in movement patterns
o Short term implications
Inefficient postural control & posturing of UE & LE leads to reduced mobility, reduced sensory experiences, reduced development of gross & fine motor skills
Inefficient postural control & posturing of UE & LE leads to joint alignment issues
Head control & oral-motor issues can lead to feeding issues
Reduced mobility leads to reduced endurance
Inefficient postural control & posturing may lead to sensory sensitivities such as fear of movement, tactile sensitivity
Because trying to overcome high muscle tone is difficult, children often become easily frustrated & unsuccessful as movement skills; at risk for reduced self-concept
o Long term implications
Reduced AROM, posturing of UE & LE, joint alignment issues leads to reduced PROM, joint subluxation, dislocation, deformities, or contracture; scoliosis
Oral-motor issues may lead to difficulties with speech articulation & phonation
Mobility issues & speech issues can lead to reduced socialization
Tendency toward respiratory illnesses (secondary to reduced mobility, trunk immobility)
Reduced development of mobility, gross & fine motor control leads to decreased function in ADLs, school, leisure & future vocational
Possibilities
Increased need for adaptive equipment for positioning & function
At risk for psychological issues due to reduced socialization, reduced self-concept & reduced independence. |
|
|
Term
| the progressive process of atypical movement development for children with mixed tone |
|
Definition
o Pathophysiology
Tone changes from low to high to low or tremors
Athetosis/ataxia
o Original problem
Low tone when resting; fluctuating tone when movement is initiated
Primitive reflexes persistent or obligatory
Upper extremities usually more involved than lower extremities
o Compensations
Use of hands or feet as a distal “fix” for stability (Lock hands or feet together)
Use LE as a point of stability (adduction or flexion pattern)
Use of wide ranges of motion in attend to control tone (“Fix” in a flexion pattern then shoot into an extension pattern)
• Leads to inefficient development of head control & postural control
• Inefficient coordination & timing of movement
Use of primitive reflexes for function
o Habit motor patterns
Whole body movement in wide ranges of motion & asymmetry using total flexion or total extension patterns leads to inefficient grading of muscle control
• Leads to poor control for reaching & grasping; poor midline control, poor control at mid-range of joint; difficulties in joint isolation; poor joint alignment
• Prefers movement into sagittal plane or frontal plane
Shoulder elevation/retraction or protraction & neck hyperextension to assist with head control
• Leads to inefficient development of weight-bearing on
UE & inefficient muscle co-contraction; shoulder instability; oral-motor issues
Posturing of hands with wrist flexion & MCP extension to hook hands onto a surface for stability
• Leads to difficulties in maintaining grasp& using arms for weight-bearing
Use of ATNR for reaching; Use of STNR for crawling
Use of w-sit for wide-base stability when sitting
Trunk movement asymmetry along with the movement of the arms (Possibly influenced by ATNR leads to inefficient postural control)
Use of knee flexion, ankle dorsiflexion & pronation to hook onto a surface (around chair legs) for stability
Use of portions of righting & equilibrium reactions combined with primitive patterns to use for postural control
Reduced variety of movement patterns
o Short term implications
Oral-motor & head control issues can lead to feeding issues and poor development of speech & phonation (often non-verbal or very difficult to understand)
Delays in gross & fine motor skills development (more loss of fine-motor & upper extremity control)
Delays in mobility
Increased frustration due to poor coordination & difficulties in communication
Instability & lack of movement control, inefficient postural control: at risk for falls
o Long term implications
Constant motion (burning calories), poor oralmotor & feeding skills = at risk for nutrition issues
Poor joint alignment + wide AROM without control + movement asymmetry = at risk for joint subluxation at hip or shoulder, scoliosis
Posturing of LE with w-sit, or knee flexion, ankle dorsiflexion/pronation can lead to reduced PROM of hamstrings, contractures of the foot and breakdown of ankle/foot joint (issues with gait & mobility)
Speech & feeding issues can lead to reduced socialization & independence issues
Poor coordination & lack of gross & fine motor skills leads to reduced skills in ADLs, school, leisure & future vocational development
May need adaptive equipment for mobility, ADLs, school, leisure & vocation function
Psychosocial issues from reduced socialization, independence, communication; emotions often labile |
|
|
Term
| How do you decide what goal areas to select for intervention planning? |
|
Definition
o Prioritize goal areas according to needs of the family, child, and/or school
o Focus goals on any combination of the following:
Child skill development to advance abilities within developmental domains
Task adaptations to advance skill abilities and/or participation in developmentally appropriate activities
Environmental adaptations to advance skill abilities and/or participation in developmentally appropriate activities |
|
|
Term
| What are some developmental limititation questions to ask yourself when developing goals? |
|
Definition
o Within the developmental domains, what is the next level in skill development?
o What components of skill performance is child having difficulty with? Gross motor
o What components might be limiting the child’s ability to developmentally progress? |
|
|
Term
| What are the main goals for Biomechanical frame of reference? |
|
Definition
Enhance postural reactions by reducing demands of gravity and by enhancing postural alignment
Improve distal function & skill by supporting demands of the postural system, accomplished through positioning and adaptive equipment |
|
|
