Chapter 1 Evidence Based Desicion Making in Pediatrics Flashcards
Are children adults in small bodies?
NO Body systems are developing: experiencing ongoing change
Central nervous system – sensorimotor systems
The connections within and between neural structures are developing – “neural networks”
Internal models/representations are developing 3 types of body maps
Body maps
Space maps
Sensory – motor maps (relationships) are being forged
Sensory perceptual systems
name a few things that improve with sensory
(4)
Sensory-perceptual systems
Acuity improves
Processing becomes more elaborate
Intramodal and cross modal processing develops
Feedback used to modify action
Musculoskeletal system
Ossification and architecture
Muscle fiber type becomes defined
Joint mobility
Bone alignment
Cardiorespiratory system what are some things that develop with age think like heart size
Heart increases in size
Aerobic & anaerobic capacity improves
Hemoglobin levels increase
So does Skill Level Changes Over Time? Yes!!!!!!!!!!!!!
Mobility
Postural control
Reach, grasp
manipulation
Communication
Relationships
What Else Influences development? think like society any siblings, mothers love etc…
Development & change occurs within the context of family, society & culture*Social – emotional influences
Attachment & bonds with family/caregiver
Sibling & peer relationships
Function in varied contexts
Cultural influences
What are some decisions we make as PT’s in pediatrics?
. Who needs our services -intervention?
History
Family/Caregiver concerns
Individualized assessment
How will intervention be provided?
Think who we invovle in the care team.
Service delivery models – individual, group, consultation, home program
Family involvement – establishing partnerships with caregivers
Coordination of care – communication with other service providers
What frequency, intensity & duration are indicated
Think how would you give them a frequency if its their first time
Based on current level of function and prediction of later function
Based on reimbursement source
Where will intervention be provided
almost anywhere
Home Outpatient center School Day care setting Grandma’s house Pool Anywhere children are found
What outcomes, goals & objectives are most appropriate?
- What type of intervention is best?
Evidence- based approaches
6.How will the effectiveness of the intervention be evaluated
Selecting Best outcome measures
Have you made a change?
Minimal clinically important difference
What can we use to guide clinical decision-making?“Conceptual Frameworks for Decision-Making think ICF Pathophysiology, Impairment, Activity Limitation/ Functional limitation, Praticpation limitation/Disablity figure 1-4
Know the Evidence
Critically appraised of research
Translating evidence into practice
Use the
ICF to help us Understand how the condition affects the child and family
Patient Management Model: Guide to physical therapists practice
ICF explain the different levels and the two factors that influence these main topics
Body functions & structures – Systems level
Expanded to include loss or abnormality of physiologic or psychological function (physiological includes the things like sensation, vision) Psychological ( awarness,attention, memory, emotional thought,
Impairment( reduced caridorespiratory abilities, decreased ROM, lack of sensation,
Activity – Person level Activity limitation (ADL's) walking, jumping, brushing teeth, getting dressed, fine hand use.
Participation – Person-environment interaction level Participation restriction (school, job, work, home life, thug life, farm life, outlaw life, etc,..)
The two things that can influence these are enviormental factors like how far does the kid have to walk from the classroom to the cafeteria everyday.
Personal factors- such as motivation and desire to do anything.
