Exam 1

Question 1

What is a reflex?

Answer 1

an involuntary, stereotyped response to a particular stimulus. They begin to develop in fetal life and continue to influence motor behavior throughout early infancy. In adults, reflex motor patterns continue to underlie the organized voluntary movements used in daily activities. Reflexes are tested according to developmental sequence and integration of the primitive reflexes is necessary for the development of purposeful movement.

Question 2

Describe in general the reflexes that happen at the Brain Stem Level.

Answer 2

These reflexes involved sustained changes in muscle for the whole body or more than one part of the body. The changed tone is in response to a change of the position of the head in space or in relation to the body.
4 types: ATNR, STNR, TLR, associated reactions

Question 3

Asymmetrical Tonic Neck Reflex

Answer 3

Normal Age Level: birth to 4 to 6 months
Test Position: patient is placed in supine position with the head in midline and the arms and legs are extended
Test Stimulus: turn head to one side
Negative Reaction: There is no reaction of the limbs on either side
Positive Reaction: extension of the arm and leg on the face side and flexion of the arm and leg on the skull side
Importance of reflex: This reflex promotes development of eye-hand glaze and contributes to the formation of reciprocal movements. However, if integration of this reflex does not occur it will prevent weight bearing by preventing: a) Rolling from supine to prone - 1)On the skull side of the scapula retracts preventing the arm from crossing midline. 2) On the face side the arm extends in the direction which rolling is attempted b) A loss of balance in a sitting or quadruped position due to flexion of extremities
Additional notes: In older kids, quadruped (wt bearing) turn head to one side –> bending of arm and ext of opp arm and leg

Question 4

Symmetrical Tonic Neck Flexion

Answer 4

Normal Age: birth to 4 to 6 months of age
Test Position: patient is placed in a quadruped position or over the examiner’s knee
Test Stimulus flexion or extension of the head
Negative Response: no change in the tone of the arms or legs
Positive Response: a) flexion: the arms are flexed or flexor tone dominates and the legs extend or extensor tone dominates b) extension: the arms extend or extensor tone dominates and the legs flex or flexor tone dominates
Importance of Reflex: this reflex promotes four point kneeling by breaking up the extensor pattern. However, if integration of this reflex does not occur it will prevent weight bearing.
Additional notes: Positive Reactions may be subtle. Older kids –> quadruped–> lose balance

Question 5

Tonic Labyrinthine Reflex

Answer 5

Normal Age Level: birth to 4 to 6 months
Test position: patient can either be placed in supine or prone position with head in midline and arms and legs extended
Test Stimulus: can either be placed in supine or prone position
Negative Reaction: a) supine - no increase in extensor tone when the arms and legs are passively flexed b) prone - no increase in flexor tone; the head, trunk, arms, and legs can be extended
Positive Reactions: a) Supine - extensor tone dominates when the arms and legs are passively flexed b) Prone - unable to extend the head, retract the shoulders; extend the trunk, arms, and legs
Importance of Reflex: this reflex allows the infant to log roll from the prone to the supine position. Rolling is accomplished by moving the head, the shoulders and the hips follow at one piece. However, if integration of this reflex does not occur it will prevent weight bearing and normal rolling.

Question 6

Associated Reactions

Answer 6

Normal Age Level: these reactions occur normally throughout life
Test Position: patient is placed in supine position
Test Stimulus: examiner has patient squeeze an object
Negative Reaction: there is no reaction, or a minimal reaction or an increase of tone in other parts of the body
Positive Reaction: there is a mirroring of the opposite limb and/or an increase of tone in other parts of the body
Importance of Reflex: in normal development these reactions promote awareness of both sides of the body. however, if integration of these reactions does not occur they will interfere with bilateral hand movement

Question 7

Generally describe reactions associated with the midbrain level.

Answer 7

The righting reactions interact with each other and work toward establishment of normal head and body relationship in space as well as in relation to each other
2 types: Neck righting and Body Righting

Question 8

Neck Righting

Answer 8

Normal Age: birth to 6 months
Test Position: paitent is placed in a supine position with the head in midline and the arms and legs extended
Test Stimulus: the head is rotated to one side either actively or passively
Negative Reactions: the body will not rotate
Positive Reaction: the body rotates as a whole in the same direction as the head
Importance of Reflex: the reflex orients the body in relation to the head. However, if integration does not occur it will prevent the individual from movement against gravity, proper alignment of the body and the ability to maintain balance

Question 9

Body Righting Acting on the Body

Answer 9

Normal Age: 6 to 18 months
Test Position: patient is placed in a supine position with the head in midline and the arms and legs extended
Test Stimulus: The head is rotated to one side either actively or passively (or you can move the hips)
Negative Reaction: the body rotates as a whole unit
Positive Reaction: segmental rotation of the trunk between the shoulders and pelvis occurs (shoulders–>trunk–>hips)
Importance of Reflex: This reflex orients the body in relation to the head. However, if integration of this reaction does not occur it will prevent the individual from movement against gravity, proper alignment of the body, and the ability to maintain balance

Question 10

Generally describe reactions associated with the cortical level.

Answer 10

Reactions at this level are a result of an efficient interaction between the cerebral cortex, basal ganglia, and the cerebellum. This allows the individual to experience bipedal motor skills. (allows people to walk)
Equilibrium Reactions

Question 11

Equilibrium Reactions

Answer 11

These reactions occur when muscle tone is normalized which enables the individual to adapt to changes in the body’s center of gravity
Negative Reactions: the head and thorax do not right themselves; no equilibrium or protective reactions are elicited
Positive Reaction: righting of the head and thorax occurs, abduction and extension of the arm and leg on the raised side occurs, and protective reactions on the lowered side are elicited
Importance or Reflex: These reactions enable the individual to recover balance and maintain the normal position of the head in space which allows the individual to move against gravity. However, if these reactions are not fully developed it will prevent the individual from movement against gravity, proper alignment of the body, and the inability to maintain balance

Question 12

Testing Equilibrium Reactions in Sitting

Answer 12

Normal Age : 10-12 months throughout life (can test as early as 6 months)
Test Position: patient is seated on a chair (or in lap while in chair or therapy ball)
Test Stimulus- the patient is pulled or tilted to one side

Question 13

Testing equilibrium reactions from four point kneeling

Answer 13

(quadruped)
Normal age: 8 months throughout life
Test Position: the patient is placed in quadruped position
Test Stimulus: the patient is pushed to one side

Question 14

Testing equilibrium reactions from kneel-stand

Answer 14

Normal Age: 15 months throughout life
Test Position: the patient is placed in a kneel-stand position
Test Stimulus: patient is pulled or tilted to one side

Question 15

What is motor control?

Answer 15

The ability to regulate or direct the mechanisms essential to movement

Question 16

What does motor control refer to?

Answer 16

• How the central nervous system organizes movement
• How we quantify movement
• The nature of movement

Question 17

Where is motor control found?

Answer 17

person, task, environment

Question 18

What is motor learning?

Answer 18

The study of the movement processes associated with practice, such as experience, motivation, reinforcement, motor skill, and developmental progress, that lead to a relatively permanent change in a person’s capability for skilled action

Question 19

What are the current issues with motor learning?

Answer 19

Role of feedback and types of practice in learning new skills (Random vs Block)
Role of motivation and meaningfulness

Question 20

What is Motor Development?

Answer 20

The study of how motor behavior changes over the lfiespan

Question 21

What are the current issues in motor development?

Answer 21

Age-related differences in motor performance due to development and maturation resulting from genetics, body dimensions, environment, motivation, experience, practice and expectations
Develop in varied ways depending on personal and environmental influences

Question 22

What are some common conditions with motor deficits?

Answer 22

CP, DCD, PDD, Down syndrome, SI disorders, Acquired Brain injuries

Question 23

What is the typical motor development for a newborn?

Answer 23

• primarily relexive
• prone-physiologic flexion, hands fisted, thumbs in, head turned to one side, wt on face, shoulder and hands
• supine - random movements, more movements in LE
• reciprocal walking movements - stepping relfex

Question 24

What is the typical motor development for a 1-2 month old?

Answer 24

• Arms moving toward abduction
• less physiologic flexion - increased hip/knee extension, reciprocal kicking
• wt on ulnar border, hand regard - in prone
• increase in joint range - moving out of contraction
• asymmetry of extremities
• hands to mouth, sucks fingers
• becoming more voluntary, one of the very first voluntary movements seen in infants

Question 25

What is the typical motor development for a 3-5 month old?

Answer 25

- smoother and more purposeful movements - forearm wt bearing - head bobbing to smooth - 45-90 degrees head/neck extension - Head lag PTS - midline and no lag - Cervical and thoracic spine extension - props to sit (tripod) - Head righting, wt. shifts laterally, swimming -in prone will move into labyrinthine reflex - supported standing with wide base and hands held * still missing trunk rotation * * Head lag - in supine grab wrists and pull infant into sitting head should be in ext. because of lack of neck control * **PTS - pull to sit

Question 26

What is the typical motor development for a 6-8 month old?

Answer 26

Posture against gravity Protective extension forward - arms extend for protection Roll supine - side - prone Pushes into bear/quadruped Sits with erect spine, trunk rotation *key for reaching balance* Tall kneel, creeping, rocking (moving in an out of STNR), pivot prone, curises, hand arches develop via wt shift (become stabilizing force for hand movements), unilateral reach in sit, rakes small objects *important to see w/b in shoulders and hands --> build shoulder girdle **Some may begin to crawl at this age. some babies never crawl

Question 27

What is the typical motor development for a 9-12 month old?

Answer 27

Transitional postures of side sitting, kneeling, 1/2 kneel, pull to stand using UE and standing Increased lumbar extension S-curve that places head and trunk over the hips Hands are free to manipulate toys. Begin bimanual dexterity - each hand doing a different task. 3 jaw chuck, pincer grasp * FM skills take off ** most are beginning to walk. If baby isn't walking by 15 months --> concern

Question 28

What is the significance of reflexes?

Answer 28

Involuntary stereotyped response Early way infant changes distribution of muscle tone building block for movement damage to CNS decreases the ability for someone to inhibit the lower level reflexes so they can dominate movement patterns limiting the ability to move smoothly, freely and in a controlled fashion the key to be able to observe when the lower level reflexes are affecting movement reflexes contribute to the development of muscle control for mobility and stability reflexes take infants through movements that possess essential elements for higher level functioning provide opportunities for interactions with environment If reflexes persist-called poorly integrated or obligatory

Question 29

What is considered the foundational knowledge for NDT and the qualitative aspect of movement?

Answer 29

Typical development Recognizing influence of primitive reflexes Recognize poor quality of movement that affects higher level skills

Question 30

What are the Neuro-Developmental Treatment Principles?

Answer 30

NDT techniques can facilitate typical motor patterns while inhibiting atypical patterns Key points of control (hand placements to influence weight shifting): Give maximal control over movement and influence posture and movement of trunk, shoulder girdle, hip and distal key points of control Used to manually assist in movement patterns

Question 31

What are Key Points of Control?

Answer 31

Therapists controls the quality and characteristics of movement while client follows manual cues and moves with assist Decrease amount of assist as pattern of movement normalizes (so child can feel movement on own) To assess movement: Move client in/out of postures and movement sequences to evaluate ability to perform occupations and evaluate primary and secondary problems

Question 32

How and what do you assess for functional movement?

Answer 32

Facilitate trunk movement, equilibrium reactions and protective reactions Assess: quality of movement, strength, movement control, and effort/flow

Question 33

What are some NDT intervention strategies suggested?

Answer 33

Assessment of these movement patterns (balance and spontaneous movement) allows identification of movement patterns for handling: increase ROM, facilitate balance, graded control of movement, facilitate rotation and transitional movements ** don't have to progress developmentally but need to be within reason

Question 34

What are the principles of treatment for NDT?

Answer 34

Decrease tone should not be static- move to inhibit tone/postures weight bearing with mobility - decreases tone, and increases strength avoid compensation give time to react for success break up total patterns with rotation with extension use key points of control "just right challenge" use a variety of patterns

Question 35

What techniques do you use to change tone in NDT?

Answer 35

``` gain alignment wt shift w/b rotation change position in space approximation/traction affective changes - social interactions - meaning elongation movement ranges movement rate RIP's level of activity environmental status movement rhythm ```

Question 36

What are persistent primitive reflexes and what are the consequences of them?

Answer 36

Due to brain damage and difficulty moving voluntarily Persistence or reemergence Particularly ATNR, STNR, and TLR Delays postural reflexes (equilibrium and protective reactions) Doesn't necessarily delay motor milestones (depends on severity of injury)

Question 37

What is abnormal tone, motor control and force generation?

Answer 37

Hypertonia, hypotonia, spasticity limited postural reactions, antigravity movements, proximal muscle co-contraction, stability in upright positions "fixing" - locking body segments to provide stability but blocks mature movement patterns, for example fixing head control by hyperextending neck and elevating shoulders prevents protraction of shoulders from midline play Hyperreflexia - blocks the development of graded movements "overflow" (associated reactions) - continuation or excessive overflow decreases precision reactions and may delay protective reactions Contractures - due to spasticity or abnormal soft tissue changes also disrupt development of postural control limits of stability - may be more limited on one side causing child to shift center of balance

Question 38

What are the three components of balance?

Answer 38

vision proprioception vestibular **all developed based on experiences

Question 39

What is altered sensory function/integration?

Answer 39

Good postural control relies on both intact peripheral pathways and the CNS interpretation of the input Visual deficits - result in deficits in static and dynamic balance Vestibular deficits - problems with balance when there is conflicting information Children with CP or LD show deficits in CNS interpretation of the sensory input and have particular difficulty when there is conflicting info (ex motion sickness)

Question 40

How is motor response organized?

Answer 40

To respond to a loss of balance a child must activate the appropriate muscle groups with accurate timing and in the correct amplitude This on set of motor response is delayed in children with Down's Syndrome and with CP Child with CP may activate the wrong muscles or the right muscles with poor timing and amplitude Additionally the child with CP may have poor anticipatory control *don't have the feed forward ability to anticipate reactions

Question 41

What impact does muscle tone have on motor development?

Answer 41

Muscle tone refers to the amount of tension or resistance to movement in a muscle. Muscle tone is what enables us to keep our bodies in a certain position or posture. Changes in muscle tone are what enables us to move. For example, to bend your arm to brush you teeth, you must shorten (increase the tone of ) the biceps muscles on the front of you arm at the same time you are lengthening (reducing the tone of) the triceps muscles on the back of your arm. TO complete a movement smoothly, the tone in all muscle groups involved must be balance. The brain must send messages to each muscle group to actively change its resistance. Abnormal muscle tone is a prominent symptom of cerebral palsy. Spasticity (increase or "high" muscle tone) Advantages of spasticity: a) substitues for strenght, allowing standing, walking, gripping b) may improve circulation and prevent DVT and edema c) may reduce the risk of osteoporosis Disadvantages of spasticity a) orthopedic deformity, such as hip dislocation, contractures, or scoliosis b) impairment of ADLS c) Impairment of mobility d) skin breakdown secondary to positioning difficulties and shearing pressure e)pain or abnormal sensory feedback f)poor weight gain secondary to high caloric expenditure g)sleep disturbances h)depression secondary to lack of functional independence Hypotonia (decreased or "low muscle tone) a) floppy "rag doll" b) poor head control c) decreased mobility e) lordosis posture f) difficulty with breathing and speech g)lethargy h)ligament and joint laxity i)poor reflexes

Question 42

What is the typical development of reach, grasp, and release in a newborn to 2 months?

Answer 42

Orient to stimulus, then improving ability to focus and follow immature nervous system "visual reaching"

Question 43

What is the typical development of reach, grasp, and release from 2.5 - 4 months?

Answer 43

antigravity shoulder flexion hand closed/ballistic shoulder activity (stimming from shoulder) bilateral reaching begins around 4 months prone-on-elbows - strengthens shoulder girdle **batting with hands closed

Question 44

What is the typical development of reach, grasp, and release from 5-6 months?

Answer 44

**Increased forearm rotation and wrist control** Transfer and manipulate objects *co-activation movements - when flexors and extensors work together

Question 45

What is the typical development of reach, grasp, and release from 7 to 9 months

Answer 45

Control of forearm rotation in sitting by 8 months | Voluntary release by 9 months

Question 46

What is the typical development of reach, grasp, and release from 10 - 12 months?

Answer 46

Supinate forearm against resistance Use either or both hands * more options for grasp/release and use of hands

Question 47

What is the typical development of prehension?

Answer 47

Typical grasping patterns - whole hand grasp - ulnar palmar grasp - palmar grasp - radial palmar grasp - raking grasp - pincer grasp (inferior or superior) * development from proximal to distal and medial (ulnar) to lateral (radial)

Question 48

What is the typical development of prehension from birth to 4 months?

Answer 48

Grasp reflex slowly integrated | active grasping with ulnar side of hand by 3 to 4 months

Question 49

What is the typical development of prehension from 5 to 8 months?

Answer 49

development in medial to lateral direction | uses raking grasp by 6 months

Question 50

What is the typical development of prehension from 8 - 12 months?

Answer 50

*more control of fingers distal control = smaller objects pincer grasp crude release by 9 months Controlled release into large container by 10 months *initially release is only on a surface due to the need of stability

Question 51

What is the development of prehension from 1 - 6 years

Answer 51

1 to 1.5 - palmar-supinate grasp 2 to 3 - digital-pronate grasp 3.5 to 4 years - static tripod 4.5 to 6 years - dynamic tripod

Question 52

What is the typical development of manipulation from 5 to 6 months?

Answer 52

typically begins around 5 to 6 months of age oral exploration mouthing, banging, shaking

Question 53

What is the typical development of manipulation from 6 to 8 months?

Answer 53

As mouthing decreases, finger use increase | * if they have poor tactile discrimination mouthing may persist until 5 to 6 years

Question 54

What is the typical development of manipulation from 9 to 12 months?

Answer 54

Transfer hand-to-hand finger object under visual control isolate index finger manipulate one object at a time

Question 55

What is the typical development of manipulation from toddlerhood to preschool?

Answer 55

More advanced skills finger isolation develops use both hands together (bilateral movement, LEGOS)

Question 56

What is the typical development of manipulation from early to middle childhood?

Answer 56

``` Completes fasteners less reliance on vision increased speed and accuracy improved bilateral skills *If you are working with a child who is 9 who has to really look at feet and concentrate on tying shoes then that may be a red flag that he or she isn't receiving tactile info properly ```

Question 57

What are some considerations that need to be made concerning FM skills?

Answer 57

``` Separation of two sides of the hand thumb web space palmar arches isolated thumb finger movements grip and pinch strength positioning of body during task sensory processing (tactile, proprioception) ```

Question 58

What is the dynamic systems theory?

Answer 58

``` Movement is dependent on -task characteristics -interaction among systems - individual - task - environment Dysfunction occurs when flexibility or adaptability of movement is limited and cannot accommodate task demands or environmental constraints Rejects "top-down" perception of nervous system being control center for movement ```

Question 59

What are the key concepts of dynamic systems theory?

Answer 59

``` Degrees of freedom synergistic movement (control body in a situation where we need stability) Attractor state (state that we automatically do because it is easiest ex: "W" sit) ```

Question 60

How can you apply dynamic systems theory to OT?

Answer 60

Children learn when: - the movement is taught as a whole (versus part) - the movement is performed in variable situations - the child is allowed to actively problem solve the actions requiredVariablity - the activity is meaningful to the child * we can work on movement in parts but unless we incorporate this into a whole activity it won't generalize

Question 61

In Dynamic Systems theory what is whole learning?

Answer 61

Learning the entire task is more effective than learning part of the task Children perform more efficiently in whole-task activities The whole activity requires children to use multiple systems

Question 62

In Dynamic Systems theory what is variability?

Answer 62

Variability -Variability requires that children adjust their movements -Variability is essential to functional movement -Performing movements in multiple ways requires that children problem solve and self-correct Problem solving reinforces learning When an activity has meaning, children are more motivated to engage in it

Question 63

What are the three stages of interaction in the development of motor control?

Answer 63

Cognitive Stage 1)Skill acquisition -Errors are common and movement is inefficient -Requires practice, repetition, and feedback Associative Stage 2)Skill Refinement -Increased performance, consistency, and efficiency -decreased errors *increases degrees of freedom ** want parents to do phase at home and in community 3)Autonomous Stage -Retains skills and performs functional movement -skills are transferred to different settings and refined ***Each Stage of movement development involves interactions among the processes of cognition, perception, and action

Question 64

In Motor Learning what is the Transfer of Learning?

Answer 64

Skills are best transferred when they are practiced in their natural context Transfer of learning is easiest when the motor task is performed during a functional activity.

Question 65

In motor learning what is sequencing and adapting tasks?

Answer 65

Discrete tasks are easier to accomplish than continuous tasks Closed tasks are those in which the environment is stationary during task performance Consider cognitive demands of tasks Consider complexity of the environment

Question 66

In motor learning what are the practice levels and types?

Answer 66

- massed practice (blocked practice) - distributed practice - variable or random practice - mental practice (use of imagery)

Question 67

In motor learning what is error based learning?

Answer 67

Children learn by making errors Encourage children to explore, adjust, and evaluate their performance **They have to make mistakes with movement otherwise they won't learn

Question 68

In motor learning what is feedback?

Answer 68

``` Knowledge of performance knowledge of results verbal praise and reinforcement immediate feedback is best most helpful feedback is specific and clear ```

Question 69

What are factors that affect motor performance?

Answer 69

Social emotional factors -therapeutic use of self -children learn best when challenged at a level where success is achievable Physical factors that can impair movement -limited range of motion -hypotonicity/hypertonicity -strength limitations

Question 70

At one month what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 70

GM - head up in prone FM - hands tightly fisted Red flags- none

Question 71

At two months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 71

GM - Chest up in prone position, head bobs erect if held sitting FM - Retains rattle (briefly) if placed in hand, hands unfisted half of time Red flags - Rolling prior to 3 months may indicate hypertonia

Question 72

At three months what are the GM skills, FM skills observed? Are there red flags for motor development?

Answer 72

GM - partial head lag, rests on forearms in prone FM - Hands unfisted most of time, bats at objects, sustained voluntary grasp possible if object placed in ulnar side of hand red flag - none

Question 73

At four months what are the GM skills, FM skills observed? Are there and red flags for motor development?

Answer 73

GM - Up on hands in prone, Rolls front to back, no head lag FM - Obtains/retains rattle, reaches/engages hands in supine, clutches at objects red flag - none

Question 74

At five months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 74

GM - rolls back to front, lifts head when pulled to sit, sits with pelvic support, anterior protection FM - Transfers objects hand-mouth-hand, palmar grasp of dowel, thumb adducted Red flag - poor head control

Question 75

At six months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 75

GM - sits-props on hands FM - Transfers objects hand-hand, immature rake of pellet Red flag - none

Question 76

At seven months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 76

GM - sits without support, supports weight and bounces while standing, commando crawls, feet to mouth, lateral protection FM - Radial-palmar grasp of cube, pulls round peg out, inferior scissors grasp of pellet; rakes object into palm red flag - w-sitting and bunny hopping, may indicate adductor spasticity of hypotonia

Question 77

At eight months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 77

GM - gets into sitting position, reaches with one hand while 4-point kneeling FM - scissors grasp of pellet held between thumb and side of curled index finger, takes second block: holds 1 block in each hand Red flag: none

Question 78

At nine months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 78

GM - pulls to stand, creeps on hands and knees FM - Radial-digital grasp of cube held with thumb and finger tips, Inferior pincer grasp of pellet held between ventral surfaces of thumb and index finger Red Flag: Persistence of primitive reflexes may indicate neuromotor disorder

Question 79

At ten months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 79

GM - cruises around furniture, walks with 2 hands held FM - isolates index finger and pokes, clumsy release of cube into box; hand rest on edge, pincer grasp, held between distal pads of thumb and index finger Red flags: none

Question 80

At eleven months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 80

GM - stands alone, walks with 1 hand held FM - none Red flags - none

Question 81

At twelve months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 81

GM - independent steps, posterior protection FM - Fine pincer grasp of pellet between figner tips, marks with crayon, attempts tower of 2 cubes, precise release of cube, attempts release of pellet into bottle Red flag - failure to develop protective reactions may indicate neuromotor disorder

Question 82

At fourteen months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 82

GM - walks well independently FM - Tower of 2 cubes, attains third cube Red flag - none

Question 83

At sixteen months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 83

GM - Creeps up stairs, run stiff-legged, climbs on furniture, walks backwards, stoops and recovers FM - Precise release of pellet into small container, tower of 3 cubs, initiates scribble Red flag - none

Question 84

At eighteen months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 84

GM - Push/pulls large object, thorws ball while standing, seats self in small chair FM - tower of 4 cubes, crudely initiates single stroke, scribbles spontaneously Red flags - hand dominance prior to 18 months may indicate contralateral weakness

Question 85

At twenty months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 85

GM - completes square pegboard FM - none Red Flag - none

Question 86

At twenty-two months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 86

GM - walks up stair with rail, marking time, squats in play FM - Tower of 6 months Red Flag - none

Question 87

At twenty-four months what are the GM skills, FM skills observed? Are there any red flags for motor development?

Answer 87

GM - Jumps in place, kicks ball, walks down stairs with rail, marking time, throws overhand FM - Trains of cubes without stack, Initiates vertical stroke Red flags - Inability to walk up and down stairs may be the result of lack of opportunity

Question 88

What considerations should you have for an evaluation?

Answer 88

What will the results be used for? - We do a lot of testing to see if a child quailifies for certain services, sometimes do testing to aide Dr. in making a dx Who will see/use the results? - Dr., Teacher, parents, psychologist (clinical and school) and guidance counselor Will reimbursement effect our decisions? Write certain way to support need for OT to be reimbursement

Question 89

How do you obtain information for the profile?

Answer 89

Formally and informally - clinical interviewing of child and family - observation - formal occupational profile (e.g. COPM)

Question 90

What information is collected in an OT eval?

Answer 90

Why is the child/family seeking services? what areas of occupation are successful, and what areas are causing problems/risks? What contexts support or inhibit engagement in desired occupations? What is the child's occupational history? What are the child's priorities and desired targeted outcomes? ** capitalize on motivation and interests

Question 91

What do you do after the data from the eval is collected?

Answer 91

The OT develops a working hypothesis regarding child's problems/concerns *not necessarily through standardized tests -> so we play and observe Identifies strengths and limitations **Talk about strengths and then how they can use those strengths to support them in the strenghtening of their limitations (therapeutic use of self) Preliminarily selects outcome measures ***the COPM can be a great outcome measure ****Meyers is not a fan of using standardized tests as an outcome measure they can be limited in scope. Advocate for using occupation-based outcome measures

Question 92

What Strategies can be used for clinical interviews?

Answer 92

Clarify purpose of interview at the beginning Be sensitive to the child and caregiver Ask open-ended questions Try to discern how culture influences child-rearing *Make treatment decisions based on what you see in the child right now. they don't have to have a dx Remain positive and realistic in your approach Be flexible and be honest *Take it one day at a time Be aware of your own non-verbal communication *Body language - be present with client Avoid use of therapy/medical jargon

Question 93

What is the analysis of occupational performance?

Answer 93

Performance skills and patterns used in performance are identified Factors that effect skills and patterns are evaluated Identifies facilitators/barriers to engagement in occupation

Question 94

How do we analyze occupational performance?

Answer 94

``` Use info. from occupational profile Use skilled observation Use assessments -standardized - have uniform scoring procedure - dx tool screening -non-standardized tests ```

Question 95

What are standardized tests?

Answer 95

Have uniform procedures for administration and scoring Used by OTs to: -make a medical or educational diagnosis -determine eligibility for services (screening) -monitor process (reassess) -make decisions about appropriate interventions

Question 96

What are the characteristics of standardized tests?

Answer 96

uniform procedure (admin. and scoring): - include a test manual - fixed number of items - protocol for administration - must practice and learn how to administer test - fixed guideline for scoring

Question 97

What are the types of standardized tests?

Answer 97

Norm-referenced -"norms derived from normative sample -performance of child is compared against this normative sample -standardized protocols for administration and scoring Criterion-Referenced Test -Provide information about how children perform on specific tasks -May or may not use standardized administration and scoring procedures -Purpose is NOT to compare child to a normative sample

Question 98

How can you become competent in administering assessments?

Answer 98

``` Decide which test you will learn Study the test manual Observe the test being administered practice! Check interrater reliability - point-by-point agreement aim for .9 Select the appropriate test environment Become familiar with the items Evaluate clinical usefulness ```

Question 99

What are the ethical issues in testing?

Answer 99

Relevance - info important for intervention planning Physical Requirements Competence of examiner - lack of competence could hurt child - look better or worse Appropriateness of testing site "Nice to know" vs. "need to know" Confidentiality

Question 100

What are the advantages of standardized testing?

Answer 100

Well-known Commercially available Standard scores understood by everyone Monitor developmental progress

Question 101

What the the disadvantages of standardized testing?

Answer 101

Focus on components of performance Only a brief "snapshot" of the child Testing protocols very inflexible

Question 102

What are the issues with evaluating a young child?

Answer 102

separation-keep parent with you reactions to novel situations - build rapport before testing resistance motivation *If standardized test isn't working we can always assess through observation

Question 103

What are some behavioral management strategies?

Answer 103

``` Be prepared Be sensitive Environment Build rapport Positive reinforcement patience!! ```