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Congenital Anomalies

What are the nine types of limb deficiencies

What are there definitions?

• Polydactyly- an excess of fingers or toes
• Syndactyly- webbing between the fingers or toes
• Bradydactyly- abnormal shortening of the digits
• Microdactyly & Macrodactyly- overgrowth or undergrowth of soft tissue or bone. Macro-large, Micro- small digits
• Amelia- complete absence of one or more limbs
• Phocomelia- fully or partially formed distal limbs with a lack of one or more segments of the proximal limb
• Paraxial deficiency- defect where part or all of the medial or lateral bone is missing
• Transverse hemimelia- failure to develop one or more limb segments across the central axis of the limb


Client factors or performance skills affected by congenital abnormalities

• Specific and global functions, emotional, experience of self and time, temperament and personality. Pain, proprioception and sensation/sensory. Function of the joint- joint mobility, stability, muscle power, muscle tone, muscle endurance, motor reflexes, gait patterns, control of voluntary movement
Performance Skills
• Motor and praxis skills, sensory-perceptual skills


Interventions and assesments used for congenital anomalies

• ROM, alberta infant motor scales, toddler and infant motor evaluation, brunicks, fine motor task assessment
• Education, devices, joint protection, sensory educations, mirror therapy, pain management, ADL training, scar management


Definition and symptoms

A chronic lung disease characterized by inflammation of airways breathlessness and wheezing
wheezing, chest tightness, breathlessness, ccoughing


Client factors and performance skills affected by asthma

Client factors
• Energy drive, sleep, attention, perception, cardiovascular and respiratory system functions-pain
Performance areas
• motor skills-Endurance, paces process skills-attends, initiates, social interaction -produces speech asthma attack moves and walks


Asthma interventions and assesments

• COPD, child occupational self assessment, pediatric interest profile, perceived efficacy and goal setting systems, short child of occupational profile, school setting interview, preferences of activities of children
• Education, role exploration, interest exploration, environmental modifications, school accommodations


Respiratory disorder
definition and symptoms

• Respiratory distress due to lungs being underdeveloped, infants suffering from respiratory
• Cynanosis, apnea, decreased urine output, grunting, nasal flaring, rapid breathing, shortness of breath and grunting while breathing


Respiratory disorder
performance skills and client factors affected

client factors
cardiovascular and respiratory functions,
global mental functions-energy drive and sleep muscle functions-endurance tone
movement functions-pain
performance skills-motor-endurance, paces, moves, lifts, walks, and transports


Respiratory disorder
assessments and interventions

• Clinical observations, interviews, alberta infant motor scales and bayley scales of infant development
• Infant positioning, environmental modifications, caregiver/staff education and coaching,


Neonatal cardiac problems

Five different types definitions and symptoms of each?

• Atrial Septal Defect- ASD is a major congenital malformation that causes increased pulmonary blood flow. Blood flows from LA to RA
• Ventricular Septal Defect- Major congenital malformation that causes increased pulmonary blood flow. Blood flows from LV to RV
• Tetralogy of fallot- Defect of DECREASED pulmonary blood flow. Diagnosis based on same as ASD and VSD and also the presence of cyanosis
• Transposition of great vessels- Mixed pulmonary blood flow. the pulmonary artery leaves the LV and the aorta exits the RV with no communication between pulmonary and systemic circulations
• Dysrhythmias- Irregular cardiac rhythms

• Septal defect- tachycardia, poor exercise tolerance, small frame size, feeding problems, frequent respiratory or lung infection, swelling of legs, feet or stomach and stroke
• TOF- central cyanosis, clubbing of fingers or toes, feeding difficulties, failure to thrive and
• TGV- cyanosis, congestive heart failure and respiratory distress
• Dysrhythmia- fever, anxiety, anemia, pain and irritable


neonatal cardiac problems
client factors and performance skills affected

client factors
global mental-energy drive and sleep cardiovascular and respiratory fuctions movement functions muscle functions-muscle endurance muscle power
performance skills pain vestibular auditory
motor skills-lifts, walks, transports, endurance pace move
social interaction


neonatal cardiac problems
assesments and interventions

alberta infant motor scales, infant motor evaluation, battele developmental inventory, test of playfulness, toddler/infant sensory profile
• Suck-swallow-breath sequence. Positioning, edema management, sensory stimulation, auditory stimulation, bedside feeding, parent education


Fetal alcohol
definitions and symptoms

a congenital syndrome caused by excessive consumption of alcohol by the mother during pregnancy, characterized by retardation of mental development and of physical growth, particularly of the skull and face of the infant.
stunted growth(size height), distorted facial features,learning disabilities, flat midface, thin upper lip


Fetal alcohol
client factors and performance skills affectes

client factors
mental functions specific and global-higher level cognitive,thought, attention, memory etc. sensory functions-auditory body structures-brain cns
peformance skills-social interaction-speaks fluents,questions, replies, discloses and processing skills-initiates, heeds, attends etc.


Fetal alcohol
intervention and assesments

peabody, test of sensory function in infants, sensory integration and praxis test.
family and parent education, fine motor skills pre-writing, k'nex, cutting shapes, building blocks


Identify areas of intervention in early intervention

• Play
• Motor performance- muscle tone, fine motor skills, bilateral manipulation, in-hand manipulation
• Sensory processing- Low registration, sensation seeking, sensation avoiding and sensory sensitivity
• Self-care/adaptive
• Adapted equipment and positioning


Identify the basic properties of the law and how it affects OT practice

Therapist bills from the time spent in direct, face-face contact with the child, family or other caregiver. Billing for time spent in team meetings, on the phone with team members or family and other indirect activities may or may not be reimbursed. Subject to annual budget shortfalls. Paid through Medicaid or private insurance. Travel is not reimbursed. Therapy sessions in community settings are considered indirect service and may not be reimbursable.


Explain the eligibility criteria

• Infants and toddlers who have established risk because of diagnosis are automatically eligible. Diagnoses associated with developmental delay such as CP, Down syndrome or spina bifida. Infants without a specific diagnosis who are suspected of having developmental delay are entitled to an evaluation
• Developmental areas that the team evaluated to determine eligibility are cognition, communication, motor, social-emotional and adaptive.


Explain individualized family service plan

A map of the family’s services and informs anyone who will be working with the child and family which services will be provided, where they will be provided, who will provide them and outcomes. Reviewed every 6 months or more. Family meets with other team members at least once a year


Define the Public Laws relevant to early intervention

• Part C of the individuals with disabilities education act (IDEA) (early intervention)- All children from birth through 2 years of age who have developmental delays are entitled to services. An entitlement program. 16 primary services, individualized family service plan, family-centered and occurs in natural settings
• Part B of IDEA (special education)- defines school programs for eligible students between 3-21 years of age, it is a mandated service. Discipline specific assessment, individualized education program, child-focused in practice, family focused in theory, service coordination recommended but not mandated and occurs in the home, center or school based


chap 23 key terms: Definitions

Early Intervention
Family-Centered intervention
Coaching models
Natural environments

• Early Intervention- Services for children from birth to 3 years of age, who have an established risk, have a developmental delay or considered to be environmentally or biologically at risk. The goal is prevent or minimize the physical, cognitive, emotional and resource limitations of young children disadvantaged by biologic or environmental risk factors
• Part C of the individuals with disabilities education act (IDEA)- All children from birth through 2 years of age who have developmental delays are entitled to services
• Family-centered intervention- Family have control and make choices regarding the care their child receives; family and providers work together to ensure provision of optimal early intervention services
• Service coordination-
• Coaching models- supports the learner and the child to achieve outcomes through a process
• Natural environments- home or community-based settings (childcare center, playground, library, grocery stores or fast-food restaurants)


What is Case Cody?

Cody is a 39 week post-conceptional age (GA) at 25 weeks by date (WBD), 24 weeks by examination (WBE) by spontaneous vaginal delivery (SVD) to a 19 year old now second pregnancy, 1 birth and 1 abortion (G2P1Ab1), venereal disease research laboratory (VDRL) mom with history of intravenous drug abuse (IVDA), smoked 1 packs per day (PPD), pregnancy-induce hypertension (PIH), preterm labor (PTL), prolonged premature rupture of membranes (PPROM), Appropriate for gestational age (AGA) at 545gm. Significant complications have included respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), pulmonary interstitial emphysema (PIE), apnea of prematurity (AOP), patient ductus arteriosus (PDA), hyperbilirubinemia, anemia, methicillin-resistant (MRSE) and CONS sepsis, medical necrotizing entercolitis (NEC), bilateral inguinal hernia (BIH), periventricular leukomalacia (PVL), retinopathy of prematurity (ROP) stage III oral-duodenal (OD)
HFOV- high-frequency oscillating ventilation
SIMV for 8 days-
BiPAP for 14 days
NCPAP for 9 days- nasal continuous positive airway pressure
Fi02- fraction of inspired oxygen


Identify general considerations for feeding in the NICU unit?

10 characteristics

• Coordination of suck and swallows with breathing- interventions include slow-flow nipples and pacing to force breaks for breathing
• Sucking pattern
• Movements of the jaw and tongue- dysfunctional feeding may occur due to abnormal movements
• Sucking bursts are initially continuous for 10 to 30 sucks with a smooth 1:1:1 suck-swallow-breath rhythm in which respiration appears continuous and uninterrupted
• Adequate postural control
• Calm environment
• Burping
• Endurance
• Jaw support
• Thickened formula for easier oral bolus control
• Risk of aspiration if the infant is not actively participating in the feed


Distinguish between neonatal assessments

5 assesments

• Assessment of preterm infant behavior- Als- used for stable preterm infants and term infants
• Naturalistic observations of newborn behavior- for very fragile preterm and term infants
• Neonatal behavioral assessment scale- for term healthy infants
• Neurological assessment of the preterm and full term newborn- dubowitz---for infants who tolerate handling
• Neonatal neurobehavioral evaluations (NNE)-Morgan- has predictive indicator for muscle tone and motor responses


Levels of care facilities

• Level I (basic) nursery- Manages uncomplicated pregnancies with expected normal deliveries and well infants
• Level II (specialty) nurseries- designed to care for newborn infants who require some additional medical management such as phototherapy for jaundice, intravenous antibiotics or tube feedings. A neonatologist is usually on staff, these units typically lack the equipment and additional expertise such as pediatric surgeon or cardiologist
• Level III (subspecialty) nurseries- have necessary equipment and trained personnel in the NICU and other hospital departments to care for all potential neonatal conditions and emergencies
• Level IV- unofficial classification used to designate NICUs that offer current rescue technologies, although some interventions used initially for rescue (ventilation) or inhaled nitric oxide have become a standard of care after continued proven success


Identify ways to modify the environment to support the infant/ prevent positional deformities

6 ways

• NICU positioners include cloth, foam, water-based gel, bean bags and bendable rods
• Z-flo fluidized neonatal positioners- made of microspheres encased in polyurethane. This allows contoured support, adapt and accommodates NICU medical equipment’s, facilitates skin integrity by reducing body pressure point or friction


Define the newborn states (sleep/arousal)

• Deep sleep (non-rapid eye movement (NREM)- slow states changes, regular breathing, startles with some delay and lowest oxygen consumption
• Light sleep (rapid eye movement (REM)- Low activity level, random movements and startles, respirations irregular and abdominal intermittent sucking movements, eyes closed, rapid eye movement, higher oxygen consumption
Awake States
• Drowsy or Semi-dozing- eyelids fluttering, eyes open or closed, mild startles, delayed response to sensory stimuli, fusing, more rapid and shallow breathing
• Quiet Alert- with bright look, focuses attention on source of stimulation, minimal motor activity, may have some delay in response, minimal motor activity
• Active Alert- eyes open, considerable motor activity, thrusting movement of extremities, spontaneous startles
• Crying- intense and difficult to disrupt with external stimuli. Respirations rapid, shallow and irregular


Explain the synactive theory of development

Theory of understanding preterm behaviors and emerging capabilities of preterm infants to organize and control their behavior. Five interdependent subsystems include autonomic, motor, state, attention-interaction and self-regulation. Caregivers use the observations to modify the environment and facilitate the infant’s organization and well-being
- Forms the basis for individualized, developmentally appropriate, family-centered care


Identify equipment used in the nursery

10 types what are they

Thermoregulation equipment
• Radiant warmer- open bed with overhead heat source. Used during medical workup of new admission of critically ill infants
• Incubator (isolette)- used to provide warmth, allows calories to be used for growth and healing
• Open crib- bassinet style bed, no external heat source, infant is dressed in clothes and swaddled
Oxygen therapy with assisted ventilation
• Bag and Mask ventilation- used for resuscitation of an infant at delivery, during acute deterioration or to increase oxygenation
• CPAP- endotracheal or nasopharyngeal tube provides positive pressure and is used to keep the alveoli and airways from collapsing in an infant with RDS, pulmonary edema or apnea
• Mechanical ventilation- controls or assists breathing
• ECMO- Life support system that uses a modified heart-lung byoass to provide nearly total lung rest and minimize barotrauma. It is a rescue technology.
Oxygen therapy without assisted ventilation
• High-flow nasal cannula- warmed and humidified oxygen or room air. Used to improve gas exchange or reduce work of breathing
• Nasal cannula- humidified oxygen delivered by flexible nasal cannula with small prongs that fit into the nares. Used for infants requiring supplemental oxygen without positive pressure support
• Oxygen hood- plastic hood with flow of warm humidified oxygen placed over the infant’s head and possibly upper trunk. Used for infants who are breathing independently but need a higher concentration of oxygen than 21% room air


Explain how the extrauterine environment may stress the infant

5 characteristics

After birth, demands are suddenly made on the preterm newborn to breath, regulate body temperature, move against the effects of gravity, adjust to bright light and unmuffled noise, cope with invasive or painful procedures and endure frequent sleep disruption and deprivation. Infant is unable to adjust to and organize the overwhelming stimuli and demands of the environment.
Review table 22.2