Peds Midterm Flashcards
Foundations for Pediatrics/ Neonate/Infant and Toddler (160 cards)
1
Q
OT practice settings with children and youth
A
In-patient
out-patient
NICU
Early Intervention
School System
Community-based
2
Q
OT process in pediatrics
A
Evaluation
Intervention
Outcome Measure
3
Q
What are the components of the evaluation?
A
Occupational profile (informal interview and observation)
Assessment of performance and contexts (formal , focused, structured)
occupational analysis
4
Q
What are the phases of intervention?
A
intervention plan
intervention implementation
intervention review
5
Q
How is the intervention plan developed?
A
-objective, measurable occupation based goals
-OT intervention approach (create/promote, establish/restore, maintain, modify, prevent)
-service delivery methods and approaches
6
Q
What needs to be contemplated during the intervention plan?
A
contemplate the “potential” discharge needs and plans
7
Q
What 3 things are needed during intervention implementation?
A
-intervention that enhances occupational performance utilizes meaningful activity/occupation as a means and an ends
-intervention should consider generalization of skills across environments to increase participation
-intervention needs to monitor the clients response (ongoing eval and re eval)
8
Q
How can engagement be optimized?
A
-meaningful / occupation based activities
- apply JUST RIGHT challenge
-consider adequate, appropriate reinforcement for repeated practice (it has to be fun/ entertaining)
9
Q
How can occupational performance be enhanced
A
-consider AT
-consider modifying environment
10
Q
how can occupational participation be increased?
A
-consider multiple natural environments and context
-consider what is most meaningful to the child (if they dont care they wont do it)
-provide educational/ consultative/ advocacy at various levels (INCLUSION: client, fam, community, systems)
11
Q
When should outcome measurements be selected?
A
Early in the OT process
measure progress and adjust goals and interventions
12
Q
What are the two most important variables for promoting child development?
A
sensitivity and responsively to the child’s needs
13
Q
What is the family centered approach?
A
family involvement and family decision making during the eval, intervention, and outcome measurements (caregver is child’s proxy)
14
Q
When is the family centered approach best practice?
A
birth to 5 years
15
Q
what is the family system composed of?
A
individuals who are interdependent and have reciprocal influences on each other’s occupations
16
Q
What are 3 complementary models of the family centered practice
A
family support, direct services, family collaboration education
17
Q
What is the client centered approach?
A
emohasizes child or youth involvement in the OT process with family guidance
18
Q
When is the client centered apprach best practice?
A
youth to 21 years
19
Q
What do the family centered and client centered approach have in common?
A
they both emphasize child and family strengths
20
Q
Aspects of OT practice in peds
A
client-centered
family based
strengths based
integrated and inclusive services
natural environments
culturally competent
evidence based
service delivery (direct, indirect, consult)
21
Q
What is the primary occupation of children?
A
play- its how they learn
22
Q
what are co-occupations?
A
anything that involves another person
23
Q
How can we check in on parents of children with special needs?
A
how are they managing stress, are they taking time for themselves
24
Q
T/F: In the first 3 years of life , the emphasis of family centered services is written out in Part C of IDEA which requires providers to meet with the parents to develop a family directed IFSP regarding the resources that the family needs to promote the childs optimal development
A
TRUE
25
T/F: School age children with disabilities are required to have an IEP, OTs provide services as determined by the OT and outlined in the IEP
TRUE
parents have final say
26
T/F: As the therapist we are required to seek input and permission of parents/guardians during assessments, intervention plan and decision making
TRUE
27
What are the four components of therapeutic use of self?
style, body language, professionalism, communication
or
appearance, communication style, documentation, teamwork
28
What does theory provide guidance for?
therapeutic reasoning and clinical decision making in OT practice with children and youth
29
T/F: Occupation-based models may be applied independently or with select frame of references depending on the child’s needs and desired outcomes
TRUE
30
Theory by Lev Vygotsky
"reciprocal teaching" Sociocultural theory
31
Key points of the sociocultural theory
zone of proximal development
scaffolding
32
benefits of sociocultural theory
Opportunities for children to learn from more skilled partner
Development varies across cultural and social contexts: cognitive functions are affected by beliefs, values, & tools of intellectual adaptation of an environment
33
zone of proximal development
what a learner can do w/o help & what they can achieve w/ guidance & encouragement
34
scaffolding
supportive activities provided by more skilled partner
35
Piaget's stages of cognitive development
sensorimotor, pre-operational, concrete operational, formal operational
36
Just right challenge
capacity to build new skills & abilities while adjusting for current level of function of the child
37
Characteristics of the just right challenge
-Learning occurs when child successfully accomplishes a challenge
-sensory discrimination
-sensory modulation
38
sensory discrimination
tactile, vestibular, auditory, proprioceptive, visual
39
sensory modulation
postural-occular control, praxis, bilateral integration, sequencing
40
Dynamic systems perspective
considers multiple factors that impact development (internal/external)
41
T/F: dynamic systems perspective is the foundation of motor control/motor learning theory
TRUE
42
Components of the AOTA Code of Ethics
beneficence
nonmaleficence
autonomy
justice
veracity
fidelity
43
Intentional relationship model
created to better understand OTs therapeutic use of self
44
3 strategies to develop therapeutic use of self
-Self awareness
-self reflection
-self care/mindfulness
45
6 modes of IRM
-encouraging
-collaborating
-problem-solving
-instructing
-empathizing
-advocating
46
psychometric properties of standardized assessment tools
validity
reliability
internal consistency
sensitivity
specificity
ability to detect change
47
types of standardized tests
norm referenced
criterion referenced
48
norm referenced
compares performance of an individual to others of a normative sample
49
criterion referenced
compares performance of an individual to a specific criterion or skill
50
Characteristics of criterion referenced
-determines level of mastery of skill
- does not compare the child to a normative sample of peers
-may or may not have a standardized protocol for administration and scoring
-may evaluate one or more area of function
51
types or assessments
-occupational performance measure/skill-based/ contextual
- norm-referenced, standardized
-criterion-referenced, standardized
-norm-referenced &criterion-referenced, standardized
-criterion-referenced, non standardized
-observational/interview/ semi-structured interview
-self-report measure
-ipsative measure (tracks progress over time)
-informal checklist
52
raw score
single score derived from the test
53
standard scores
how many SD a data point is above or below the population standard- helps understand where the child falls compared to other children
54
scaled scores
total number of correct questions (raw score) converted into standardized scale
55
percentiles
how child rates based on percentage
56
age equivalent scores
what age that child should be presenting a skill (P-body)
57
standard error of measurement
as reliability increases , SEM decreases
-estimate of the amount of error inherent in a child's obtained score
58
confidence levels
probability of consistent scores
59
How many standardized assessments should you use for reimbursement in eval
at least one
60
Pros of standardized assessments
Provide standard score and percentiles that may be used for:
-Determining eligibility for services
-Demonstrating outcomes of intervention for reimbursement
Readily available and accepted
Understood and used by interdisciplinary professionalS
61
cons of standardized assessments
Cannot be used in isolation to determine a child’s performance
Provide information about a “snap-shot” or moment in time
May not reflect the child’s ability in a natural setting since the testing environment is contrived
62
what is the ADOS-2
an activity-based assessment administered by trained clinicians to evaluate communication skills, social interaction, and imaginative use of materials
63
Assessment for Occupational Adaptation model?
OA assessment
64
Assessments for MOHO
Pediatric volitional questionnaire
Pediatric interest profiles
Child occupational self-assessment (COSA)
School setting interview
65
Assessment for Ecological Model of Occupation
Home observation for measurement of the environment (HOME)
66
Assessment of CMOP-E + PEO/ other models
COPM
67
Purpose of sensory integration
Promotes optimal sensory experiences that invite action and active participation, influence growth, and development of the nervous system, and leads to adequate behavior adaptation
68
Ecological theory:
development based on child and environmental factors and their interaction
69
Which approach is best practice?
Top-Down, starting with an occupational profile
70
Characteristics of top-down approach
Applies occupation-based assessments/intervention that target: occupational particiaption & environmental adaptation to improve particiaption and QOL
Focuses on ICF levels of activity participation and environmental factors
71
Characteristics of a bottom-up approach
-applies assessments/intervention that target underlying: Client factors, performance patterns, and performance skills to improve or gain new skills
-Focuses on ICF level of body function and body structures
-Skills that are improved or gained must generalize to an activity/occupation in a natural setting
72
Frames of Reference for Pediatric OT
-developmental
-Acquisitional (behavior based)
- coaching (primary method in early intervention)
-motor control/ motor planning
-neurodevelopmental (NDT)
- biomechanical
-Sensory integration
-behavioral
-visual perception
-cognitive
-social participation
73
What are two types of theories that can guide practice in the NICU
Ecological Models (consider role of environment in occupational performance)
Occupational Models ( intervention helps clients adapt to challenges and barriers)
74
When does regular therapy begin int he NICU?
~30 weeks GA
75
When does OT typically see infants
clustered care times
*Not waking the babies up for therapy*
*e.g. every 3 hours*
76
Frequency of treatment in the NICU
2-3 x/ week x LOS
77
common diagnoses in the NICU
prematurity
IUDE/NAS (exposed to drugs in utero)
RDS
Hypoglycemia
IUGR (growth restriction)
cardiac anomalies
genetic conditions (single genes or chromosomes)
IVH grade I-IV
HIE
Hydrocephalus
Gastroschisis
Spina Bifida
Arthrogyposis
various GI anomalies
78
IUDE/NAS
exposed to drugs in utero
most common rn is meth/fentynol
79
IUGR
growth restriction
can prevent organs from growing-->multi organ failure
80
cardiac anomalies
PDA/ cardiac defects
81
Genetic conditions
single gene: sickle cell anemia
chromosome: downs syndrome
82
IVH grade I-IV
inter ventricular hemorrhage
*no lifting from ankles to change*
83
Hydrocephalus
too much CSF on the ventricles in brain
reservoir for CSF then doctor will drain
84
Gastroschisis
intestines born outside of the body
put organs in a silo
1-3 weeks for reductionp
85
Spina bifida
where some of the spine is not enclosed
*contractures and positioning*
86
arthrogryposis
number of conditions that affect the joints
87
What is OT role in the NICU
Monitor, support, and optimizes development
Prevent adverse outcomes neuro development
For families: education, promote particiaption, facilitate bonding, psychosocial support
88
What are the neuromotor difference between preterm and full term?
predominance of extensor tone (norm is flexion)
effect of gravity during development are exaggerated
89
Synactive theory
goal: get the baby into parasympathetic state where they are relaxed, healing, growing
motor
autonomic
state (level of CNS arousal)
attention/interaction
90
Sensory development in the NICU
outside of the womb they are receiving more stimuli so OT try to mimic womb as much as possible
presence of procedural touch- not enough intentional touch or social touch
these sudden noises and movements can be stressful for baby and parents
91
What are some strategies to combat sensory challenges
respect bed space
silence
gentle noises
static touch before moving
positive touch, handling, massage
educate parents
92
What is one movement or touch parents should be advised to avoid in the NICU
Stroking
93
Benefits of neonatal massage
Decreased stress/pain
Improved temp regulation
Improved sleep
Improved HR, RR, O2, saturations
Improved immune function
Improved digestion
Increased weight gain
Improved bilirubin levels
Promotes parent-infant bonding (include dad too)
Improved neurological development
Improved muscle tone
Improved feeding outcomes
Decreased length of stay
94
what is positive touch
static, four handed caregiver, chest/legs/head, NO STROKING
95
What is a state of arousal
uniform way describe the overall behavioral state of an infant
96
What are the states of arousal
Crying (6)
Active alert
Quiet alert - ready to learn
Drowsy - semi dosing
Light sleep - rapid eye movement
Deep sleep (1)
97
2 types of behavioral cues in the NICU
approach/stability cues
avoidance/stress sign cues
98
approach / stability cues
Relaxed limbs
Smooth body movements
Quiet alert state
Stable respirations, HR, O2
Hands to mouth/midline
99
avoidance /stress signs
Active, random body movements
Finger splay
Air “sitting”
Prolonged extension of extremities
Increased RR, decreased HR, decreased/fluctuating O2 saturation
Change in muscle tone
Sneezing/hiccups/yawning
Startle
Wide eyed
100
T/F: Taste and smell closely linked in-utero
TRUE
101
What are 3 common birth injuries?
brachial plexus, facial paralysis, fractures
102
What are causes of brain injuries in NICU babies?
large babies
prematurity
cephalopelvic disproportions
dystopia
prolonged labor
abnormal birthing presentation
maternal obesity
103
What are normal stages in development
Vestibular system fully functional by 21 weeks
Nasal structures, mouth, and tongue in place by 8 weeks in utero
Taste buds emerge at week 20 in-utero
Hearing structures fully formed in utero: week 24
104
What are the 3 types of deliveries?
vaginal, cesarean section, assited deliveries (vaccum and forceps)
105
What are the formal assessments of the NICU
HNNE or Dubowits
Hammersmith Neonatal Neurobehavioral Examination
106
What areas can OT treat
Family
feeding
sleep
bathing
play
environment
107
What can OT treatment facilitate and support
neurobehavioral
neuromotor
muskuloskeletal
sensory
pain
108
what are the gestation terms in weeks
37-41 weeks= typical gestation
less than 28 weeks= extremely preterm
28-32 weeks= very preterm
32-37 weeks= moderate to late preterm
109
teratogens
a factor that can interfere with embryonic/ fetal development
110
impact on OT with premature babies
use their adjusted age when looking at milestones
they can have feeding difficulties
they can have immature sensory systems
111
What are the major complications or prematurity? (neuropathic conditions?)
intraventricular hemorrhage (IVH)
Periventricular leukemia (PVL)
112
Periventricular leukemia (PVL)
necrosis of white matter surrounding lateral ventricles secondary to decreased O2 and blood flow usually results in spastic diplegia (both legs) or quadriplegia
likely to cause CP
113
Grading of IVH
Grade 1: hemorrhage in germinal matrix
Grade 2: bleeding w/in ventricle
Grade 3: bleeding with ventricular dilation
Grade 4: bleeding extends into parenchyma
114
What are the major complications or prematurity? (respiratory conditions?)
Respiratory distress syndrome (RDS)
Bronchopulmonary dysplsia (BPD)
Apnea
115
RDS
caused by immaturity of lungs and decreased surfactant
116
What are the major complications or prematurity? (cardiac conditions?)
Patent Ductus Arteriosus: lack of closure of the ductus arteriosus (connection between pulmonary artery and aorta)- repaired at birth
Bradycardia: slowing of HR to less than 100 beats/min associated with apnea
117
What are the major complications or prematurity? (Sensory system problems)
Retinopathy of prematurity (ROP): contributing factor is high concentration of O2
Hearing impairment: 2-5% very low birth weight infants
Sensorinerual hearing loss: damage to cochlea can be due to antibiotics required to prevent sepsis
118
What are the major complications or prematurity? (System immaturity)
Gastroesophagel reflux (GER)
Hyperbillirubinemia: immature liver
Kernicterus: bilirubin accumulates in basal ganglia can lead to athetoid CP
Necrotizing enterocolitis (NEC): infection in GI tract
2-5% of VLBW infants
Mortality rate 20%
50% requires surgery to remove portions of
bowel
119
What are APGAR scores?
scores given at 1, 5, and 10 minute intervals after birth to show infants overall condition
Activity (muscle tone)
pulse
grimace (reflex irritability)
appearance (skin color)
respiration
highest possible score is a 10
scoring stops when a 7 is achieved
low scores require immediate attention
120
How is adjusted age calculated?
Actual ages in weeks - weeks preterm = corrected age
e.g: 16 weeks old - 8 weeks preterm = 8 weeks adjusted age
121
What is IDEA
law ensuring services to children with disabilities throughout the nation
122
Under which part of IDEA do Infants/toddlers with disabilites (birth-3) receive services
IDEA Part C
123
What is the primary role of AZEIP
work with and support family members and caregivers in children’s lives
124
What does the broad spectrum tool, the DAYC-2 look at
communication
fine motor
gross motor
social/emotional
adaptive
125
How does a child become eligible for AZEIP
Child becomes eligible by having a 50% delay in at least one area of development
Or child has established medical condition or syndrome that may lead to a delay
126
what are the primitive reflexes and the appropriate ages of integration
Rooting (birth-3 months)
Grasp-plantar and palmer (birth-4 months)
Moro (birth-4 months)
Suck/swallow (birth-3 months)
Placing (birth- 6 months)
Primary walking/stepping (birth- 4months)
ATNR (1 month-4 months)
STNR (6 months-8 months)
127
rooting relfex
pinky rubbed on cheek
for breast feeding
128
suck/swallow
pinky in mouth
feel tongue muscle working properly to suck
129
moro reflex
startle reflex
arms out when they fall back
130
primary walking
holding them up and seeing feet placing like walking
131
grasp reflex
touching palm of hand to elicit grasp
(can be palmar or plantar)
132
placing
placing hand on surface
holding them above surface
133
Asymmetrical Tonic Neck Reflex ATNR
head turns to side
that side extends and other flexes
134
Symmetrical Tonic Neck Reflex
head down vs head up
(evelyns example of cat going under fence)
135
what voluntary control of movements is gained as primitive reflexes integrate?
righting reactions
then
protective reactions (parachute)
then
equilibrium reactions
136
What are the proximal key points of control in therapeutic handling
shoulder girdle
trunk
pelvis
137
what are motor milestones in the first year
rolling, sitting, crawling, creeping, pull to stand, independent stand, walking
138
What does postural control require
Development of muscle strength to work against gravity
Proximal control for dynamic patterns for co-contraction and mature postural reactions
Typical associated with the motor milestones
needs to have proximal control first to be able to control extremities
139
What is the law of developmental direction
cephalocaudal (from head to body)
proximal to distal
gross to fine
postural alignment and distribution of weight in base of support (sitting = wide, standing = narrow)
stability before mobility
140
what is the progression of postural control
supine/prone
side lying
sitting
quadruped
kneeling
standing
141
W sitting
negative if chronic but ok as transitional position
if they are stuck in W sit, they have poor postural stability
142
What is the dissociation of body segments
roll segmentally
lift one leg
reach across midline
143
Atypical muscle tone terms
spasticity: hyperexcitability of the stretch reflex
dystonia: involuntary sustained or intermittent muscle contractions
ataxia: poor coordination during voluntary movements
rigidity: resistance to low speed imposed joint movements
hypotonicity: low tone
144
How does a child receive an autism diagnosis based on the DSM-V
A. all 3 symptoms must be present
-deficits in social -emotional reciprocity
-deficits in nonverbal communication behaviors for social interaction
-deficits in developing, maintaining, and understanding relationships
B. 2/4 symptoms must be present
-Stereotyped or repetitive motor movements, use of objects, or speech
-Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (struggle w/ variability)
-Highly restricted, fixated interests that are abnormal in intensity or focus
-Hyper- or hypo reactivity to sensory input or unusual interests in sensory aspects of the environment
C. Symptoms present in early developmental period
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. Disturbances not better explained by intellectual disability or global developmental delay
145
hyper-responsiveness in autism
exaggerated, negative response to stimuli
Reduced interest and engagement
Decreased academic and social competence
146
hypo-responsiveness in autism
diminished or delayed response to stimuli
Poor praxis and social play
Lower communication skills and lower daily living skills
147
What are the levels of severity of autism
level 1: requires support
level 2: requires substantial support
level 3: requires very substantial support
148
What is the M-CHAT
a screening tool for toddlers between 16 and 30 months of age, to assess risk for ASD
can be administered by any health professional not just OT
can be low, medium and high risk
149
Which assessment is currently the gold standard in assessment of ASD
ADOS-2
150
What are social communication skills from DSM-V for autism
Eye contact
Gestures
Pragmatic functions (requesting, protesting, commenting)
Speech and language developmental milestones
Play developmental milestones
Social reciprocity
Understanding and responding appropriately in varied social interactions
151
Joint attention
Gestures used for sharing interactions (initiating and responding)
Response to (dyadic) joint attention (2-6 months) (with affect)
Initiation of (triadic) joint attention (8-12 months) (with affect)
152
What are RRBs (repetitive behaviors)
Lower order behaviors: repetitive sensory-motor behaviors (stimming)
Higher order behaviors: insistence on sameness
153
3 key assumptions of the strengths based model
All people have inherent strengths and capacities that they want to develop
Motivation is an essential precursor to engagement in chosen activities
People do not build their lives on weaknesses, but on their strengths, talents, and abilities
154
What are sensory diets
personalized activity plan that provides sensory input a person needs to stay focused and organized throughout the day
155
what are social stories (used with children with ASD)
describes a situation, skill, or concept in terms of social cues, perspectives, and common responses in a specifically defined style and format
156
characteristics of social stories (used with children with ASD)
Provides clients with missing information and allows them to re-evaluate their expectations
Enhances a child’s theory of mind
50-120 words
Behavior directed
157
What is DIR/ Floortime model
Developmental, Individual Differences, Relationship-based-floortime
158
what is the objective of the DIR/floortime model
build healthy foundations for social, emotional, and intellectual capacities rather than focusing on skills and isolated behaviors
159
characteristics of the DIR/ floortime model
Helps to develop an intervention program tailored to unique challenges of a child with ASD
Follow the child’s lead
Challenging to move up the developmental ladder
Expanding (without taking control)
160
What are motor steroptypesin ASD
repetitive behaviors such as body rocking, hand flapping, finger wiggling, pacing, head banging, jumping, and spinning
