OT13: Pediatric Assessments PDF

OT13: Pediatric Assessments ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓ Developing an IE and Occupational Profile Objective findings (clinical observations + results of tools) ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓ...

OT13: Pediatric Assessments ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓ Developing an IE and Occupational Profile Objective findings (clinical observations + results of tools) ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓ 1. Performance in areas of occupation Different school, different format but in general it’s usually 10 a. ADL pages min. ; SPUI- top down approach and v OTPF4 i. “Parent report says amuni amuna but OT report says amuni amuna ii. score/grade - “minimal to moderate IE will tell us the most baseline of the client assistance” iii. Brief description - how it happens; General testing condition ngaa minimal to moderate ○ Sino upod assistance; OT is v talkative ○ Clx’s general behavior during assessment b. play/leisure (as applicable) (pano sila mag behave in general but not i. We want to see the child how they detailed and in overview) participate in that occupation Assessments performed ii. If maayo, ○ Informal assessment - assessments you will give to the child ; simulator feeding 2. Performance skills affecting performance a. “No problems noted” if okay man Subjective findings a. Chief complaint 3. Client factors affecting performance i. The language they spoke will be exactly a. Body fx written b. Specific mental fx b. Goals c. Sensory perceptual fx i. “Ang gusto ko lag gd ya ndi na sya i. Intact and impaired andun parin sa manampak” cite in verbatim in quotation form marks ii. “Gusto ko bla matuto sya mag piano” u can ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. tell the parent na “im with you on this pero Topic 6: Assessment in Cognition kasi sbng ndi kita masalig and di ko ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. maghatag false assurance simo. Pero ari lang Miss Sweet (9-2-24) ang achievable goal sbng” c. Occupational hx Review i. Hx of present condx and past medical hx Schema 1. Pinaka madugo bcs it’s v medical ○ Mental frameworks or structure that help 2. We have to know post natal hx man individuals help organize and interpret 3. In some hospitals they require this information but for some centers it’s not Sensorimotor required ○ Earliest stage of cognitive development 4. Pre, peri, and post natal hx Object permanence ii. Developmental hx Egocentric d. Performance pattern ○ Child’s inability to see a situation from i. Roles other’s pov 1. Pwede as peer, apo, Non-standardized ii. Routine ○ Test that use of interview, observation, and 1. Pre morbid (before may sakit or fx activity to assess the child disgrasya) 2. If developmental in nature, need Piaget: Theory of Cognitive Development lang nila magpakita sainyo In writing cognitive assessments, it is important to include in 3. Routines look different which part of the development the child is. 4. Writing it in table para mas makita “The child is 3yo, showing to be in the sensorimotor stage…” mo structure ya Assessing the kid for 45mns hence, need to be flexible and iii. habits/ rituals creative in assessing. 1. Can be “no rituals or habits noted” 2. If may ASD and OCD there can be Piaget’s Important Ideas: e. Performance context Schema i. Environment ○ Mental frameworks or structures that help ii. Personal individuals organize and interpret 1. What supports and hinders information ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 1  OT13: Pediatric Assessments Assimilation 3. Concrete operational - 7-11/12 y/0 ○ Take the new experience into an existing ○ Children begin to think logically abt concrete schema events ○ No confusions of new information ○ Classify Accommodation ○ Other POV exist ○ Differentiate things by showing examples ○ Decision making is still based on intuition; ○ Need to change our schemas to fit new kung ano asa harap nila, ayun na sagot nila experiences ○ Time, space, and quantity are understood ○ Example: the child has a toy truck then given and can be applied but not as independent a robot toy, they will figure it out and not concepts haboy the toy, adds new category of information 4. Formal operation - 11y/o+ ○ Integrating similar experiences to the new ○ Understand the abstract and deductive one (?) reasoning Equilibration ○ Abstract logic and reasoning ○ Create a balance b/t accommodation and ○ Scientific thinker assimilation ○ Own sense of identity ○ Mature in learning informations ○ moral/ social issues ○ Will take a lot of time to reach this point ○ Can solve more complex problem solving ○ What if may problem w/ assimilation and Strategy and planning accommodation? they are avoidant and ○ Concepts learned in one context can be apprehensive bcs easily confused applied to another Active learned ○ Theoretical, hypothetical and counterfactual ○ Learning is a response to smth new thinking Four stages Criticism 1. Sensorimotor - from birth to 2y/o Culture differences ○ Reflexes Stages inaccurate ○ Object permanence is developed Capabilities underestimated ○ Mobility Lack control ○ Coordination of sense with motor responses, sensory curiosity about the world Types of assessment Thumb sucking Non-standardized ○ Language used for demands and cataloging ○ Informal interview ○ Observation 2. Pre operational: 2-7y/o ○ Functional tasks/activities ○ Think of things symbolically ○ Based on Ms. Sweet’s exp. informal interview Boys know toy cars are for them is the most used since standardized tests are and dolls are for girls pricey and not specific for filos population Explore language - learning lot of Standardized tests words; advanced language ○ Tools ○ Pretend play ○ Object representation An OT should check the following ○ Egocentric Ability to follow instructions Self-centered Identification and use of common objects Can’t empathize with Imitation skills Not yet ready for concept of sharing Concepts (MSRI) (Match, Sort, Recognizing, ○ Curious Identifying) ○ Use of proper syntax and grammar to express concepts Ability to follow instructions ○ Imagination and intuition are strong Able ○ Complex abstract thoughts are still difficult ○ Verbal? ○ Conservation is developed ○ Demonstration? Logical thinking ○ Gestures? knowing that a quantity doesn't ○ How many steps? change if it's been altered ○ If ndi sya kasunod by verbal, try demonstration. If wala gyapon, try gestures ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 2  OT13: Pediatric Assessments Unable ○ For exploration Example Searchers for sound Banging toys ○ Very explorative and movement Integrates information from multiple sensory systems ○ When giving toys sa child, make sure it’s not v toxic 6-12 months Responds to name ○ Not responding to name is one of the red Identification and use of common objects flags of autism since there’s a high risk of Ex: simulation feeding- giving them spoon and fork ASD recently Name family members Imitation skills Imitates gestures Verbal - to check, try to let them check by saying hi, ○ When waving goodbye singing, ○ Mainly for greetings Motor - can you follow the teacher to jump? Then if mag jump, okay motor skills ya 12-18 months Acts on objects on variety of schema ○ Trial and error of objects Imitates model ○ Ginagaya yung actions ng parents such as covering mouth when sneezing Symbolic play Concepts (MSRI - Match Sort Recognize Identification) ○ Giving object and pretend na may dual Qualitative- identifying the right objects purpose like banana using it as telephone Quantitative- use of math Use objects Temporal- use of prepositions (over, in, on) Functions of objects Match Recognize body parts ○ One is to one object Sort 18-24 months ○ Organize into categories Links multiple steps together ○ By group ○ Activity: sandwich making Recognize Inanimate object performs action ○ Give choices to the child if di maka answer ○ “The moon is following me” ○ “Water bottle or jug?” Pretend play ○ Pwede “able to recognize but not identify” ○ V imaginative type of play like being a ○ Able to identify is not limited to verbal princess Objects permanence is completely developed ○ Not v anxious w strangers Lesser sepanx 24 to 36 months Combines actions to scenario ○ Greets the guests and pours tea on tea cups Imaginative play What to look out for? ○ Bahay bahayan First 6 months Matches pictures Learns about body and effects of its action Sorts shapes and colors Object permanence Plays house ○ It’s this time na ma emerge sa Location of sounds 3-4 yo ○ Kung diin ang sound, dun mag turn ang head Works puzzle and blocks ng child ○ What type of puzzle? Repeats actions for pleasurable experience 4 piece Use hand and mouth 8 piece ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 3  OT13: Pediatric Assessments Be specific on documentation 2 y/o x 2 = 4-6 minutes ○ Can you build a bridge with blocks? Makes dolls and action figure carry role Categorizes and sorts objects ○ 2-3 qualities Intuitive thought ○ What seems to be obvious will be their reasoning for ther decision Egocentric ○ Can’t relate to others since they’re v self-centered 4-5 y/o Understands game with rules ○ Green light, red light Make up stories ○ Maka answer sa “how are you sa school” Plays with two or three children Participates in planning a play activities ○ “Let’s divide ourselves and you’re it!” Abstract solving ○ Strategizing in games and knowing how to make plan b plan c ○ Easily to adapt 5-6 y/o Memory Competitive games Metacognition Reasons through simple problems ○ Understanding of memory Real-life plays Executive function Organized games ○ Control of attention ○ Follows rules easily How long? Use complex scripts in play How they handle distraction? ○ Maka get sila lines easily ○ Information processing Sorts objects in different ways What type of info mas garetain? ○ Go into 5 characteristics ○ Cognitive flexibility ○ More complex sorting “What would u do in this Copies elaborate block structures situation?” ○ Can follow visual guides of complex blocking ○ If the kid is non verbal, do challenges with structures timer or activities that include strategies 6-10 y/o Standardized assessments Abstract reasoning Take note of population for reva (just in case) ○ More firm on fair ○ Understand metaphors Performs mental operation Hawaii Early Learning Profile, revised (HELP) Non- standardized ○ Able to mental math Educational curriculum-referenced test that assess six Flexible problem solving areas of function including ○ Try to do other ways to get the solution they ○ Cognitive way ○ Language Solves complex problems ○ GMS ○ Math and science problems ○ FMS ○ Amat amat logical ○ Social-emotional Adolescence ○ Self-help Attention Population ○ Expected attention span for each age ○ Children (birth to 3 y/o) Multiple their age to 2 ○ w/ and w/o dev. delays, disabilities, or at risk ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 4  OT13: Pediatric Assessments ○ For preschoolers is available for children Autism ages 3-6 w/ and w/o delays ADHD Learning disability Functional Independence Measure for Children (WEEFIM) Intellectual disability Document the need for assistance and severity of CP disability Down Syndrome Age: 6mo- 7 y/o ○ Has version for adults with different name 18 items ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓ 3 domains (SMC) Topic 7: Assessment of Sensory Processing ○ Self-care ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓ ○ Mobility Sir Jap (9-9-24) ○ Cognition School Functional Assessment (SFA) By Coster, W. et al Used to measure a student’s performance of fx tasks that support their participation in an elementary school program’s academic and social aspects (K-6) Designed to facilitate collab program planning for students with variety of disabling conditions ○ For parents, teachers ○ To know what the student needs when it comes to school Bayley Scales of Infant Development, 3rd Ed. (BSID-III) Assess multiple areas of development to attain a baseline for intervention and to monitor progress ○ Generally for development Gina liwat, from initial to current progress report Evaluates 5 domains ○ Cognitive ○ Language ○ Motor ○ Socio-emo ○ Adaptive behavior skills Population: 1- 42 months Coping Inventory and Early Coping Inventory Assess coping habits, skills, and behaviors, including effectiveness, style, strengths, and vulnerabilities to develop intervention plans for coping skills ○ More on coping ○ Parents ang ma answer Population: ○ Coping inventory: 15 y/o + ○ Early coping inventory: 4- 36 months Miller Assessment for Preschoolers (MAP) Assess sensory and motor abilities consisting of foundation and coordination indexes, cognitive abilities (verbal and non-verbal indexes), and combined abilities which include complex tasks index Population ○ 2 years and 9 months ○ 5 years and 8 months Common Disorders with Cognitive Skills Difficulties ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 5  OT13: Pediatric Assessments ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓ School Functional Assessment (SFA) Topic 7: Assessment of Sensory Processing By Coster, W. et al ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓ Used to measure a student’s performance of fx tasks Sir Jap (9-9-24) that support their participation in an elementary school program’s academic and social aspects (K-6) Sensory Evaluation Designed to facilitate collab program planning for Ayre’s students with variety of disabling conditions ○ Kung ano ag sesory profile nya, that’s what ○ For parents, teachers you will integrate ○ To know what the student needs when it Miller’s is the easiest to understand comes to school Dunn’s model of sensory processing ○ “Whatever they seek, I (therapist) provide” Bayley Scales of Infant Development, 3rd Ed. (BSID-III) ○ A both sensory and bystander or four profile Assess multiple areas of development to attain a in one person baseline for intervention and to monitor progress ○ Uses a sensory profile tool that you can only ○ Generally for development use Gina liwat, from initial to current progress report ○ Kung ano profile ng patient mo, you have to Evaluates 5 domains develop it lang and not change ○ Cognitive Can we mix them together when doing management? ○ Language ○ Yes ○ Motor ○ In clinic we ca use Ayre’s to integrate sensory ○ Socio-emo systems ○ Adaptive behavior skills Population: 1- 42 months Role of assessment in SI theory OT Jean Ayres developed which greatly helped in the Coping Inventory and Early Coping Inventory development of theory Assess coping habits, skills, and behaviors, including ○ Southern California Integration Tests effectiveness, style, strengths, and vulnerabilities to ○ The Sensory Integration develop intervention plans for coping skills ○ Praxis Tests ○ More on coping Diagnostic reasoning is vital part when trying to reach ○ Parents ang ma answer or create an occupational therapy diagnosis Population: ○ FOR -> Assessment -> ot dx -> intervention ○ Coping inventory: 15 y/o + ○ Early coping inventory: 4- 36 months 1960- 1989 Miller Assessment for Preschoolers (MAP) Ayres Space Test (Ayres, 1962) Assess sensory and motor abilities consisting of Southern California Kinesthesia and Tactile foundation and coordination indexes, cognitive Perception Tests (Ayres, 1966) abilities (verbal and non-verbal indexes), and Southern California Sensory Integration Tests (Ayres, combined abilities which include complex tasks index 1972) Population Southern California Postrotary Nystagmus Test ○ 2 years and 9 months (Ayres, 1975) ○ 5 years and 8 months DeGangi‐Berk Test of Sensory Integration (TSI) (DeGangi & Berk, 1983) Common Disorders with Cognitive Skills Difficulties Test of Sensory Functions in Infants (DeGangi & Autism Greenspan, 1989) ADHD Touch Inventory for Elementary School‐Aged Learning disability Children (Royeen & Fortune, Intellectual disability 1990) CP Miller Assessment for Preschoolers (MAP) (Miller, Down Syndrome 1982) Clinical Test of Sensory Interaction and Balance (CTSIB) (Shumway‐Cook &Horak, 1986) *check Appendix 7-A p. 212 (229 of 895) in case smith Sensory Integration and Praxis Tests (Ayres, 1989) ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 5  OT13: Pediatric Assessments 1990-2007 Differential diagnosis: what requires SI ad what Observational measures requires a different intervention approach ○ Clinical observation of motor and postural ○ Use sensory activities skills ○ If purely SI (running, climbing) ○ Sensory processing assessment for young ○ If di sya maka focus, maybe you can use children sensory tools such as a ball Parent questionnaires famous in the Ph ○ Check their ○ Sensory rating scale for infants and young Sensory processing measure children Sensory profile ○ Sensory processing measure ○ Sensory profile (Dunn, 1999( Evaluation process ○ Sensory experiences questionnaire Information that needs to be gathered to reach a conclusion (what to gather) 2007-2014 ○ The sensory systems Specialization and adaptation for specific populations Vestibular and needs Interoception ○ Gravitational insecurity Proprioception ○ Comprehensive observations of ○ Impact on functional performance and proprioception participation ○ Sense and self-regulation checklist Methods of gathering the information to reach a ○ Sensory Processing Scale conclusion (how it needs to be gathered) ○ Test of Ideational Praxis ○ Parent report ○ Motor Planning Maze Assessment ○ Performance measures ○ Skilled observation Adult measures Adult sensory interview Clinical observation Adolescent/ adult sensory profile Skill observations Adult sensory questionnaire ○ Look sa child, performance, Adult sensory processing scal Ecological ○ Specifically observe the interaction between Clinical reasoning in SI the child’s skills ad the physical and social Guided by the SI theory which organizes information environment in natural context gathered If playground, observe them lang Clinical reasoning strategies used when doing an SI and galean sa one side when sliding eval Clinical ○ Diagnostic ○ Structured ○ Ethical Observations of specific actions Before gina pilit ang child pro related to sensory functions subong ndi na masmell kamo sng different things ○ Narrative Aka clinical observation Know their hx ○ Unstructured Kow what matters to them Observations of free play and ○ Interactive interaction b/n child’s skills and Engages in session environment in clinical setting “go free play” Desired outcomes of clinical reasoning in SI Understanding the specific sensory processing Skilled observation difficulties and patterns of dysfunction If may makita ka, iadopt mo ang demand during Understanding the functional performance and intervention process participation issues that are related to sensory Essential accompanying data to any evaluation processing ○ Flexible and context relevant ○ Ex: writing with tight grasp and intense force What are the properties of the area when writing the child is having a problem with? ○ Writing = performance Playground sa house vs. playground ○ Participation = slower to write sa school ○ Sensory processing = madiin magsulat bcs there nila mafeel gasulat sila (?) ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 6  OT13: Pediatric Assessments Explore the different factors such as We look at optimal level of arousal the quality of toys, number of ○ It should be or the normal is on optimal people arousal ○ Based on clinician’s knowledge and clinical reasoning skills ○ Allow adaptation of the demands of the task to fit the child’s abilities Unstructured Information provided by unstructured observation ○ Sensory needs and preferences Sesing (registering, withdrawing seeking using or integrating) ○ Motor difficulties and compensations ○ Behavioral organization ○ Optimal arousal - calm, alert, organized ○ Play preferences and avoidances ○ Under-arousal - sluggish or overactive ○ Functional limitations and strategies utilized You waa pull them up through in the context of chosen activities sensory activities Under responsive - fail to notive Structured sensory stimuli rhat would elicit the A task to achieve a goal attention of most people More specific tasks focusing on specific skills ○ Over aroused Controlled by therapist to collect specific information Anxious Interpretation is biased on an understanding of the Disorganised impact of sensory processing on functional meltdown/shutdown performance escape/ avoidance behavior Some norms exist SI intervention = sensory experiences + adaptive Why is SI important? responses Sensory Integrative Process Occurring in context of play Integrate first ag sensory system to achieve one by one Nurtured by vigilant therapist ang skills sa babaw (based on sensory hierarchy) In an environment to support the provision of sensory We first need to address the first level onto the next experience level until we reach the end product Sensory experience ○ Depending on the child’s needs ○ Pau likes dot textures ○ Has to be child-led ○ Emphasis: tactile, proprioceptive, vestibular input Adaptive response ○ Better posture ○ Context of play: don’t make it boring ○ Has to be v joyful ○ you need to be updated sa interested plays nila Effects of sensation Inhibitory Excitatory Organizing Inhibition Touch ○ ie. massage ○ Deep pressure ○ Firm, sustained touch ○ Soft textures ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 7  OT13: Pediatric Assessments ○ Pressure garments Vestibular Observations focused on ○ Rhythmic movements Overresponsiveness to tactile Hinay and pattern of movement (of Overresponsiveness to vestibular swig) Underresponsiveness to vestibular ○ Slow movements Underresponsiveness to proprioceptoon ○ Linear movements Postural disorder Dyspraxia Excitatory Sensory Discrimination (base this on the checklist) Touch Sa dami ng SI theories, we have difficulty of choosing which ○ Light touch one to choose ○ Vibration Ayres ○ Transient touch ○ Sensory registration problem - difficulties of ○ Sudden, unexpected touch the person who fails to attend or register Vestibular relevant environmental stimuli ○ Rotatory movements Dunn ○ Dysrhythmic movements ○ Potential roles of various neural processes in ○ Fast movements generating patterns of under responsive and over responsive Organizing ○ In her model, it has 4 components Proprioception Low registration ○ Movement against gravity Sensation seeking ○ Heavy work tasks Sensitivity to stimuli ○ Calming effect Sensation avoiding ○ Movements against resistance ○ What work and play or leisure environment ○ Joint stabilizing position - wt bearing or present an optimal match for an individual’s shifting sensory modulation characteristics Miller, Reisman, Mcintosh, and Simon Adaptive response ○ Sensory modulation disorder (SMD) Adaptive response ○ Internal ( differences among individuals; ○ Successful, goal-directed action on the sensory processing, emotion and attention) environment and external dimension ( context; culture, Brain efficiently organizes incoming sensory environment, relationships, tasks) information Child: active does > passive recipient SI: sensory modulation issue A challenge that can be successfully met Problem Promotes growth and mastery ○ CS react either “over” or “under” Demand of the environment child’s level Tendency to generate responses graded in relation to incoming sensory stimuli (not underreacting or Direct intervention vs. Environmental Adaptation/ overreacting) Modification What happens? Sensory input -> register -> no modulation and no regulation happens Effect: if modulation problem = “too much” Inability to self-regulate, manage behaviors and emotions SI: SMD “Problematic” sensory experience + inhibitory sensory inputs OR excitatory sensory input As an OT you should know when to up-grade and Child down-grade ○ Mej gafocus kay ayres Establish therapeutic alliance with the child Environment ○ Do not impose ○ Mej Dunn ○ Respect the child’s pace and space ○ Kung ano ang sesory profile, we support if the child says no, then no ○ Remain calm ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 8  OT13: Pediatric Assessments Try to label emotion ○ Tendency for self-abusiveness: biting self, Before self-regulation there should rubbing self with heavy pressure, be co-regulation anay head-banging, pinching self, etc. ○ Be playful When getting dressed, doesn’t notice clothing that is Be updated sa plays according to twisted their age Does not notice a runny nose, messy face or messy hands Over Responsive to tactile *When to be akig and not akig? Overly sensitive to temperature including air, food, ○ If di sila maka intindi = do not be mad water, or objects ○ If maka intindi establish boundaries = “that’s ○ Challenges in the shower or bathtub with not nice” soap, washcloths preferences and soap textures Overresponsive to vestibular Withdrawing when touched OA or sensitive to vestibular ○ Dislike of having face or hair washed Experiences gravitational insecurity, overly dizzy with ○ Dislikes of haircuts, having fingernails cut motions ○ Resistance to hair brushing ○ Dasig mag lingin ulo ○ Over-reactive to unexpected touch ○ Unable to tolerate backward and side to side excessively ticklish motions ○ Avoids affectionate touch such as hugs, ○ Illness in moving vehicles avoids washing hands at sink ○ Avoids swings or slides gets motion sick Refusing certain foods, refuses to use glue easily Avoidance to messy play or getting one’s hands dirty Difficulty using swings specially ○ Avoidance of finger painting, dirt, sand, bare those without sandalan and handle feet on grass, etc. sa gitna lang Clothing preferences and avoidances such as resisting ○ Dislike of spinning motions shoes or socks Fear of unstable surfaces ○ Annoyance to clothing seams or clothing ○ difficulty/ fear of balance activities textures ○ Refuses to sit on or try a bike ○ Difficulty with clothing fasteners like Appears “clingy” buttons, zippers and belts ○ For stability Refuses to move from the ground (jumping/ hopping Under responsive to tactile activities) Dugay mag register kung ano gna kaptan nila Refusal to participate in gym class ○ Observation is a series of pattern Overly fearful of heights Falls out of chair, need to touch everything ○ Refusal or dislike of rising in elevators or Uses a tight pencil grip on the pencil escalators Unintentionally rough on siblings, other children, pets ○ Struggles or fearful on ladders, an extreme ○ always touching others or things dislike of high places Bump into others Avoids chasing games ○ Lack of personal space, runs into other Nauseous watching spinning objects children without noticing Poor posture, easily fatigued ○ Difficulty maintaining space in line; bumps ○ Poor coordination, low muscle tone into others without noticing Poor motor planning Craves touch Fearful when a teacher approaches or pushes in the ○ Doesn’t seem to notice unexpected touching child’s chair ○ Not aware of being touched Clumsiness ○ Unaware of being touched Poor attention Seeks out tactile sensory input Difficulty or fearful on stairs ○ Seeks out messy play experiences, prefers to Fearful during situations of constant motion rub or feel certain textures ○ Stuffs food in punts, lick items or own skin Difficulty with FMS/ fine motor tasks Constantly playing in the soap or water at the sink High pain tolerance ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 9  OT13: Pediatric Assessments Under responsive to vestibular Poor awareness of position-in-space Like to be upside down ○ Stomps their feet on ground when walking Still slouching even if in a roller smth Kicks their chair or their neighbors chair in classroom Constant movement including jumping, spinning, Frequent falling, clumsiness, poor balance, constantly rocking, climbing moving and fidgeting ○ Constantly getting up and down from desk in the classroom Postural d/o ○ Loves spinning Miller model Craves movement at fast intervals ○ Usually co occur with SMDs Craves spinning, rocking, or rotary motions Easy to understand + typical makita sa clinics ○ Swinging circular one hour Regulated child but (+) sensorimotor challenge (same After months, fast linear was w dyspraxia) achieved Poor core, low endurance, appear weak Poor balance on uneven surfaces Tactile + proprio systems Constantly fidgeting Difficulties noted Impulsive movement ○ makahulag but not nami Increased visual attention to spinning objects or ○ Slow, cautious movement overhead fans ○ Could appear unwilling to move Bolts or runs away in community or group settings, or Prefer to be sedentary when outdoors or in large open areas such as ○ (-) stability shopping malls ○ (-) body control ○ Walks around when not supposed to (in ○ Insecure and unsafe feeling classroom, during meals) ○ Poor GM coordination -> affect FMS Difficulty maintaining sustained attention ○ Challenges with ocular-motor skills Head banging ○ Poor vestib + poor proprio (body awareness, Hypermobile or all over playground equipment pos’n in space) + tactile system Leans chair back when seated at desk Mx ○ Rock self back and forth when seated ○ Increase postural stability Poor skills involved ○ Increase core strength ○ Poor posture ○ Enhance tactile discrimination ○ Poor coordination ○ Vestibular system may be used ○ Poor motor planning ○ Poor balance ○ Poor attention Dyspraxia A deep need to keep moving in order to function Ideation ○ Always in constant motion Motor planning Frequent falling, clumsiness ○ Give tasks that is something NEW para wala Prefers being in high places memory on how to do it Execution *There is no such thing as over resp proprio Underresponsive to proprioception ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓ Children who love to tiptoe Topic 8: Assessment of Visual Perception ○ No to weighted sacks or bags bcs they tip toe ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓ due to seeking of proprio Miss/ Sir Felshine Relloto (9-9-24) Uses excessive pressure when writing or coloring ○ Difficulty with FMS, poor handwriting “Jumper and crasher” ○ Seeks out sensory input Can’t sleep without being hugged or held Bumps into people or objects, seems aggressive ○ Pinches, bites, kicks, or headbutts others ○ Unexpected bruises ○ Seeks out wrestling games Grind teeth, walks on toes, chews on pencils, shirt, sleeve, toys ○ Prefers crunchy or chewy foods ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 10  OT13: Pediatric Assessments ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓ Developmental ages for emergence of Topic 8: Assessment of Visual Perception visual-perceptual skills ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓ Miss/ Sir Felshine Relloto (9-16-24) 3-5yo figure ground perception Visual Perception form constancy Defined as the total process responsible for the stabilize at 6-7yo reception and cognition of visual stimuli less improvement from 8-9yo Visual stimuli are related with sensory input from other senses 7-9yo Visual perceptual skills include the recognition and position in space identification of shapes, objects, colors and other spatial relationships qualities Improves at 10yo Theoretical Base Visual processing model 5 basic assumptions Input -> processing -> output -> areas of occupation -> Visual perception is a developmental process feedback It is a learned and increase with development, Input experience, and practice ○ Activity demands Can be learned by interacting with and observing ○ Context adults and other children Processing Learning does not necessarily follow a developmental ○ Client factors sequence Attention Difficulty with visual perception can interfere with Memory daily occupations including the development of Output reading and writing ○ Performance skills ○ Performance patterns Developmental theories Habits Developmental of skills are occurring along a Areas of occupation continuum ○ Work Development of skills are age-dependent ○ ADLs Feedback Hierarchy of visual perceptual skills ○ How we process those input to processing to output and areas of occupation Visual receptive functions Receptive - what we see; not processed yet Acquisitional theories Focus on the learning of specific skills or sub skills to function optimally Visual information analysis Ability to extract or organize information from the Acuity environment and to integrate it with other sensory Capacity to discriminate the fine details of objects in information, previous experience and higher cognitive the visual field function Measurement of 20/20 ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 11  OT13: Pediatric Assessments Accomodation ○ Under attentive - fatigue easily Can see images even in blurred ○ Poor sustained attention Focusing must take place at different distances high activity level and easily From near to far (vice versa) distracted ○ Should take a split second Ex: Clap every time you hear the word good Binocular fusion Selective Attention Ability mentally to combine the images from two eyes Ability to choose relevant visual information while into a single percept ignoring less relevant information 2 pre requisites for binocular fusion Conscious, focused attention ○ Two eyes must be aligned on the object of Easily confused regard Critical for encoding information into memory and ○ aka sensory fusion successfully executing goal-directed behavior Size and clarity of two images must Ex: tape played while performing task be compatible Divided or shared attention Convergence Ability to response to two or more simultaneous tasks Ability of both eyes to turn inward toward the medial When a child is engaged in one task that is automatic plane and outward from the medial plane while visually monitoring another task ○ A child built a blocks then nagplay sya car Oculomotor skills while binabantayan yung blocks nya Efficient eye movements that ensure that the scan Child cannot see, recognize, or isolate features and path is accomplished therefore does not know where to focus visual 3 aspects attention ○ Fixation Ex: sort cards by suit and number coordinated aiming of the eyes while shifting rapidly from one Visual vigilance object to another The conscious mental effort to concentrate and ○ Pursuit or tracking persists at a visual tasks continued fixation on a moving Skill is exhibited when a child plays diligently with a object toy or writes a letter ○ Saccadic eye movements/ scanning - Reduced persistence on a visual task and poor cursory Rapid change of fixation fom one examination of visual stimuli point in visual field to another Problem may occur ex: reading a book, cramming ○ Reduced persistence on a visual task review ○ Cannot maintain visual attention Ex: cross out all letter in a story Stereopsis Binocular or monocular depth perception or 3D vision Selective attention Ability to choose relevant visual information while Visual field ignoring less relevant information Extent of physical space visible to an eye in a given Conscious, focused attention position ○ Focusing on one thing Average approx Problems may occur: ○ 65 deg upward ○ Easily confused ○ 75 deg downward ○ Critical encoding information into memory ○ 60 deg inward and successfully executing goal-directed ○ 95 deg outward behavior Visual cognitive function Visual memory Alertness Integrating visual processing information with past Reflects the natural state of arousal experience Child may demonstrate behaviors of over Domain specific attentiveness, under attentiveness or poor sustained ○ Memory of images, events and facts attention Procedural knowledge ○ Over attentive- Easily distracted bcs fixated ○ memory store for “how to and includes on a specific activity strategies to accomplish a task ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 12  OT13: Pediatric Assessments Fail to allow for storage of information, may show Spatial perception (parietal lobe) prolonged response time Being able to identify where things are in space Good memory for life experience but not for factual Position in space material ○ Determination of the spatial relationship of ○ ME! figures and object to oneself or other forms and object Visual sequential memory problem ○ More on object to oneself Difficulty recalling the exact sequence of letters, ○ Where’s the puzzle piece? numbers, symbols, objects Depth perception Visual discrimination ○ Determination of the Ability to detect features of stimuli for recognition, relative distance between matching and categorization objects, figures, or landmarks and the ○ sorting - find the similarities observer and changes in planes of surfaces ○ Categorizing - find the differences Problem Topographic orientation ○ Impaired ability to recognize, match and ○ Tracking of oneself categorize Spatial relations ○ Analysis of forms and patterns in relation to Object perception (temporal lobe) one’s body and space and helps judge Concerned with what things are (Visual information about the distance characteristics) ○ More on our body and the space Visual closure ○ Analysis of forms ○ Identification of forms or objects from ○ Categorical incomplete presentations above/below, right/left, on/off ○ Coordinate Specific location in a way that can be used to guide precise movements ○ Ex: crossing the street ○ Diagnosis with problems in visual perception Figure ground CP ○ The differentiation b/n foreground or Children w/ developmental delay background forms and objects Down syndrome ○ Same colors but different object Standardized assessment tools Description Population Domains Developmental Test of Visual Perception 3rd Edition (DVTP-3) Identifies visual-perception deficits in children and yields scores for both visual perception (no motor ○ response) and visual integration ability Form constancy 4-12yo ○ The recognition of forms and objects as the Composed of 5 subtests administered in following same in various environments, positions and order sizes ○ Eye-hand coordination ○ Copying ○ Figure-ground ○ Visual closure ○ Form constancy Administration time: 20-40mns ○ Self administered or verbally ○ ○ No training required ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 13  OT13: Pediatric Assessments The Beery-Buktenica Developmental Test of Visual-Motor Test of Visual Motor Skills (TVMS-3) Integration, 6th edition New TVMS-3 uses design copying to find out how well Identifies significant difficulties in integrating and individuals can coordinate visually guided, fine-motor coordinating visual perceptual and motor (finger and movements hand movement) abilities For 3-90+ yo Population Domains ○ Full form: 2-100 yo ○ Distortions and inaccuracies in copied ○ Short form: 2-7yo designs help identify deficits in visual Administration time: 10-15mns perception, motor planning and execution Supplemental VP and motor coordination test: 5mns Administration time: 20-30mns each Test of Visual Motor Skills (TVMS-4) Assess visual-perceptual strengths and weaknesses Using a response format suitable for all children, including those w/ disabilities For 5-21yo Administration time: from 25mns+ Preschool Visual Motor Integration Assessment (PVMIA) Evaluates visual motor integration and visual perceptual skills of preschoolers, including ○ perception in space ○ spatial relation ○ color and space discrimination ○ matching and reproduction of what is seen and interpreted For 3.5 to 5.5 yo *** PRELIM LAB EXAM *** Topic 2, 3.3, 4, 6, 7, 8 GET AS MUCH INFO AS POSSIBLE Motor-free visual perception test (MVTP -4) Quick evaluation to assess visual perception (excludes motor components) in five areas including ○ Spatial relationship ○ Visual discrimination ○ Figure ground ○ Visual closure ○ Visual memory For 4-80yo Administration time: 15-20mns 45 items Motor-free visual perception test (MVTP -5) evaluation of individual with spatial deficits due to hemi-field visual neglect or abnormal visual saccade Children and adults with visual field cuts or w/o visual impairments ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 14  OT13: Pediatric Assessments Firstly, look out for their milestones First 6 months Learns about body and effects of its action Object permanence Location of sounds Repeats actions for pleasurable experience Use hand and mouth Searchers for sound Banging toys Integrates information from multiple sensory systems 6-12 months Responds to name Name family members Imitates gestures (mainly gestures) 12-18 months Acts on objects on variety of schema Imitates model Symbolic play Use objects Topic 2: Interviewing skills Functions of objects Topic 3.3: Hx taking and occupational profile Recognize body parts Topic 4: OBAA Topic 6: Assessment of cognition 18-24 months Topic 7: Ax of sensory Links multiple steps together Topic 8: ax for visual perception Inanimate object performs action Pretend play Assessment of Cognition Objects permanence is completely developed HELP 24 to 36 months “HELP is an assessment tool to evaluate six domains which are Combines actions to scenario thinking skills (cognition), the way they can understand and Imaginative play speak (language), the way they move (FMS nd GMS), the way Matches pictures they ibteract with their peers (SE), and the way they take care Sorts shapes and colors of heraelf” Plays house Domains to evaluate ○ Cognition 3-4 yo ○ Language Works puzzle and blocks ○ FMS Makes dolls and action figure carry role ○ GMS Categorizes and sorts objects ○ Socio-emotional Intuitive thought ○ Self-help Egocentric Bayley 4-5 y/o “Bayley is an assessment tool to evaluate five domains which Understands game with rules are thinking skills (cognition), the way they can understand Make up stories and speak (language), and the way they move (FMS and GMS)” Plays with two or three children different from HELP bcs it has adaptive behavior Participates in planning a play activities skills evaluates 5 domains Abstract solving ○ Cognition ○ Language 5-6 y/o ○ FMS Competitive games ○ GMS Reasons through simple problems ○ Socio-emotional Real-life plays ○ Self-help Organized games population- 0-42mo (3.5yo) Use complex scripts in play ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 15  OT13: Pediatric Assessments Sorts objects in different ways Analyze the interplay among these factors and an Copies elaborate block structures evaluation of whether one factor affects performance more than the others 6-10 y/o Analyze the client’s strengths and weaknesses, taking Abstract reasoning into consideration both subjective and objective Performs mental operation information Flexible problem solving Solves complex problems Topic 7: Sensory Underresponsive to tactile Adolescence Overresponsive to tactile Attention Underresponsive to proprioception ○ Expected attention span for each age Underresponsive to vestibular Multiple their age to 2 Overresponsive to vestibular 2 y/o x 2 = 4-6 minutes PD Dyspraxia Memory Metacognition Topic 8: visual perceptual ○ Understanding of memory 3-5yo Executive function figure ground perception ○ Control of attention form constancy How long? stabilize at 6-7yo How do they handle distraction? less improvement from 8-9yo ○ Information processing What type of info mas garetain? 7-9yo ○ Cognitive flexibility position in space ○ If the kid is non verbal, do challenges with spatial relationships timer or activities that include strategies Improves at 10yo Also, consider the 4 stages of Piaget Sensorimotor - reflexes Pre operations (2-7yo) ○ Symbolic thinking ○ Egocentric ○ Curious Concrete operational (7-12yo) ○ Logical thinking ○ Other’s POV exist Formal operational- 11yo ○ Scientific thinker ○ Theoretical thinking ○ Own sense of identity Deficits in the following results to difficulty in: Visual memory Case example: ○ inability to spell; difficulty following Sarah is a 4-year-old with an autism spectrum disorder. She sequence demonstrates age appropriate development in her motor skills; Visual discrimination however, she has difficulty with motor planning and ○ difficulty performing SMRI sequencing a series of movements. However, her Object vision communication, play, and activities of daily living skills appear ○ difficulty recognizing an object in different to be at a 2-year level. She also has difficulty with perceptual form; difficulty organizing skills and often confuses concepts such as up–down, right–left, Spatial vision and spatial awareness. ○ delayed GMS; difficulty planning movements; no proper spacing on paper; Identify what they are expected to be doing at that age difficulty locating objects and easily lost ○ difficulty for directional language Overall assessment Summarize person, task, and environment factors affecting the client’s performance ☼☽⋆｡°✧Kassie ✧⋆°｡☾☼ 16  Assessment in Pediatric Conditions - Midterms ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦ Tools we can use and available to us: Topic 9: Assessment of Feeding Skills Esp. on bedside, Questionnaires can be use and caregivers ₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦˚.˚◦○˚ ୧.˚ₓₓ˚. ୭ ˚○◦ could be interviewed and sent home to answer questions Miss Resy Current practice here in PH is wala proper practice ng screening tool Swallowing Assessment: Adult ○ Sa interview palang, damo ka na pwede makuha Differences in Adults and Pedia population na info ○ Ma use ka lang screening tool is di ka sure if Objectives dysphagia based sa infos sa interview and you can Identifying the different components of clinical evaluation direct na sa clinical eval of swallowing (adults and pedia ptz) Should be easily usable for HCPs Discuss tools and procedures Assessment tools that has good reliability and validity ○ Barnes Jewish Hospital Stroke Dysphagia Note the ff: ○ Emergency Physician Swallowing Screening Swallowing assessment is team evaluation ○ Toronto Bedside Swallowing Screening Test ○ Average of 3- 5 disciplines in swallowing (TOR-BSST) assessment Open ended Qs As OTs, we are for the r