DLM Midterm Review PDF

**Theories of Development** - **Maturational Theory -- Gesell** - Universal & predictable - Primarily determined & pre-programmed by genetics - Resulted in concept of "milestones" - **Psychoanalytical Theory -- Freud** - Development is governed by unconscious proces...

**Theories of Development** - **Maturational Theory -- Gesell** - Universal & predictable - Primarily determined & pre-programmed by genetics - Resulted in concept of "milestones" - **Psychoanalytical Theory -- Freud** - Development is governed by unconscious processes - 5 stages of personality formation - Motivation of behavior is instinct & gratification - **Psychosocial Theory -- Erikson** - Built on Freud's ideas - Believed that environmental factors also influenced development (nature v nurture) - **8 psychosocial stages of development** - 1\. Trust vs Mistrust (Infancy: Birth to 18 mo) - 2\. Autonomy vs Shame & Doubt (Early Childhood: 2 to 3 yrs) - 3\. Initiative vs Guilt (Preschool: 3 to 5 yrs) - 4\. Industry vs Inferiority (School Age: 6 to 11 yrs) - 5\. Identity vs Confusion (Adolescence: 12 to 18 yrs) - 6\. Intimacy vs Isolation (Young Adulthood: 19 to 40 yrs) - 7\. Generativity vs Stagnation (Middle Adulthood: 40 to 65 yrs) - 8\. Integrity vs Despair (Matury: 65+ yrs) - **Cognitive-Development Theory -- Piaget** - Cognitive development is genetically-based & universal - **Development in 4 stages** - 1\. [Sensorimotor]: Birth to 18 mo - Exploring - 2\. [Preoperational]: 2-7 yrs - 3\. [Concrete Operations]: 7-11 yrs - If-then - Black & white - 4\. [Formal Operations]: Adolescence to adulthood - **Learning Theory -- Skinner** - Development from an environmental perspective - Behavior is shaped by environmental factors & corresponding responses (ex = hot stove) - **Sociocultural Theory of Cognitive Development -- Vygotsky** - Stressed the influence of culture & social factors on cognitive development - Believed that language is a fundamental symbolic instrument (root of culture) - Thought environmental responses (learning role in the community) influenced children's developmental outcomes - **Hierarchy of Needs -- Maslow** - Belief that individuals are unique - Temperament - Abilities - Challenges - Have basic needs - Nutrition - Shelter - Nurturing - When met = Participation in daily routines - **Theories of Aging** - Biological Theories - Genetic - Biologic Clock--Human cells functionally deteriorate (ex = childbearing) - Free radical theory--Environment attacks - Cell mutation--Cells get worse - Hormonal theory - Immunity - Environmental Theories - Accumulation of insults from environment (UV rays, radiation, viruses) which cause errors in protein synthesis & DNA errors - Sociological Theories - **Activity Theory:** Active, socially engaged older persons adjust better to the aging process - **Disengagement Theory:** Disengaging leads to isolated & dissatisfaction - **Dependence:** Increasing reliance on others in meeting physical & emotional needs - **Integrated Model of Aging:** Assumes aging is a complex, multifactorial phenomenon in which some or all of the processes discussed contribute to the overall aging of an individual - No one person's development is explained by one theory **Developmental Frames of Reference** - Paradigm → Occupation-based models/theories → Frames of reference/practice models - **Paradigm:** - A broad perspective - A shared set of ideas across a profession or group - Reflects the purpose of a profession - Describes the nature & scope of its practice - Philosophy, values & ethics, knowledge (big idea) - **Occupation-based models/theories:** - A set of ideas intended to explain a phenomenon or serve as a set of principles on which a type of practice is based - A system of ideas intended to explain something - Guides therapeutic evaluation & intervention - Overarching, MOHO, OA, EHP, PEOP - **Frames of reference/practice models:** - Explains how & why a discipline organizes its knowledge & directs its action - Have an evidence base & guide the use of various tools & methods - Practice guidelines in specific domains/conditions (lenses)\--Specific to patient - Provide OTs with specific skills to measure & strategies for intervention - Frames of Reference: - Ayres Sensory Integration - Behavioral--including ABA - Biomechanical - Cognitive - Cognitive Behavioral - Developmental - Motor Control/Motor Learning - Rehabilitation - Neurodevelopmental Treatment - **Developmental Frame of Reference** - Based in the knowledge of typical human development - OTs use their knowledge to compare a child's performance to what is considered "typical" for the age of the child - Allows for developing goals based on what is expected to come next in typical development - Knowledge of development + activity analysis → "Just right challenge" - Important outcome is to change the child's developmental trajectory - Identifies the level of motor (gross, fine, oral), social, emotional, & cognitive skills in which a child engages, then targets the intervention to help the child advance - First identified by **Lela Llorens** during the 19060s & 1970s - Interpretation of developmental theories for facilitating growth & development - Informed by Jean Ayers (sensory integration), Arnold Gesell, Erik Erikson, & Sigmund Freud - Focused on the physical, social, & physiological aspects of life tasks & relationships - Viewed the role of OTs to be: - One of facilitating development - Assisting in the mastery of life tasks - Enabling children to cope with life expectations - Suggests that humans can change through the maturational process or through learning - Development is influenced by many interrelated factors - Genetics - Biology - Child's environment - Individual children may progress differently & still function quite well - Children acquire developmental abilities that reflect cultural priorities - Diagnosis-specific trajectories - **Developmental Milestones:** Skills that children achieve that could inform intervention planning - Age to achieve can vary - Milestones are a GUIDE, not a rule--one piece of the puzzle - Principles: - Development occurs over time & across areas - The typical developmental sequence of skills can be interrupted due to illness, trauma, or birth condition - Gaps in development can be affected by physical, social, emotional, or traumatic events - OT can help fill in those gaps - Repetitive practice of developmental skills as the child is able to master them provides experiences that promote brain plasticity & learning - Developmental frame of reference promotes practice of skills in a developmental sequence & at the level just above where the child is functioning - Strategies & Techniques: - Engage the child in activities at the level they are successful at, & then introduce the next step or level - Challenge the child to engage in tasks that are slightly above their abilities - Use activities that match the child's interests & developmental level - Grade activities so they are slightly more challenging - Allow for repetition of activities so the child feels mastery - Process: - 1\. Identify the level in which the child is achieving--interview, checklists, activity analysis, standardized assessments - 2\. Create goals to address more advanced development - 3\. Provide intervention which focuses on practicing skills & occupations to enhance development **OT & Development** - **Top-Down View on Development** - Occupation-centered lens - Emphasizes OT's unique focus on functional participation in occupation as a means & as an end - Not just quantitative measurement of developmental skills (milestone acquisition, standardized assessments, ROM) - Also includes qualitative examination of child's occupational functioning in contexts in which they participate (occupational alienation/deprivation) - Look at desires, goals, & needs within contexts FIRST - THEN look at the discrete abilities to reveal how those component/skill deficits influence the daily tasks **Learning Models** - **Teaching is a fundamental skill for OTs** - Help clients relearn skills - Develop alternative or compensatory strategies for performing valued occupations - Develop new performance skills to support role performance in the context of a condition - Provide therapeutic challenges to improve performance skills to support participation in areas of occupation - Instruct clients, family members, caregivers in activities to enhance client's independence and/or safety in daily occupations - **Phases of Learning** - **1. Acquisition:** Initial instruction - Numerous errors of performance - **2. Retention:** Subsequent sessions; Recall in similar situation - **3. Transfer:** Spontaneously perform in different environments - **Learning Capacity** - Influences the OT process - If transfer of learning does not occur, then modifications, supervision, cueing, etc will be required - Important for establishing appropriate goals & for selecting appropriate intervention methods - **Dynamic Assessment** - An approach to determine an individual's capacity to benefit from instruction - Assessment is an interactive process - Therapist uses feedback, encouragement, & guidance to facilitate an individual's optimal performance using **test-teach-retest** format - Training sandwiched between static pretest & posttest - Complements more traditional assessment methods - Gives therapists the opportunity to observe learning & change - Measures the degree of change that occurs in response to cues, strategies, feedback, or task conditions - Transfer of knowledge can be evaluated by changing one or more attributes of the task & observing whether the client is still able to perform the task - Intervention techniques are embedded within the assessment procedures - Focuses on individual variations/changes rather than on comparison to normative or typical performance - A way to supplement static assessment - Ex = The Dynamic Occupational Therapy Assessment--Children (DOTCA-Ch) - Identifies potential areas of cognitive strength where children may benefit from mediated learning - **Static Assessment** - What we usually do - Focuses on identifying & quantifying the degree of impairment - Performance is measured by the number of errors - Performance is interpreted relative to a normative sample or external criterion - Gives a baseline from which progress can be measured - Limited in providing guidance in selecting effective methods for improving function - **Zone of Proximal Development** - The distance between the actual developmental level as determined by independent problem solving & the level of potential development as determine through problem-solving under adult guidance or in collaboration with more capable peers - Suggests that different people can have the same baseline score on a static test, but may differ in the extent to which they can benefit from instruction - **Zone of Rehabilitation Potential:** Used as a guiding principle in rehabilitation to reflect the client's region of potential restoration of function or degree of neural plasticity - **Dewey's Theory** - Huge impact on educational system--school is important - Cultural setting the key to understanding the human mind - Disagreed with Piaget on "natural unfolding" of development - Believed that development could be directed - Education has responsibility to shape children's intellectual development toward desired societal goals - Disagreed with Piaget on idea of stages - School as the instrument of social progress - Most significant outcome of education should be promotion of "growth" - Creation of lifelong learners - **KWL** - Know, Want to know, Learned - Often used in Problem Based Learning - Requires students to be self-directed learners as students work together to solve purposefully ambiguous cases, drawing on their prior knowledge - In OT Clinical Reasoning (Eval): - Know - Chart review - Referral - Previous knowledge (diagnosis) - Want to know - Client concerns, priorities, desired outcomes - Client strengths/barriers with performance areas, performance skills, environmental factors, personal factors, client factors - Learn - Documentation of results - Implementation plan Occupation - SCIL-OT: Subject-Centered Integrative Learning--Occupational Therapy\ \ \ \ \ \ \ \ \ \  - **Dynamics of Occupation** - Self-Feeding - Taking in adequate nutrition is essential for normal growth & development - Mealtime is family time - Social Participation - Can lead to improved verbal & social-cognitive skills, decreasing feelings of isolation & loneliness leading to improved health & well-being - Play - Essential for quality of life in children - Helps children develop skills such as motor, sensory, cognitive, & emotional - Helps children learn to cope with situations, negotiate with peers, and socialize - Helps children learn problem solving - ADLs - Difficulties in these areas lead to parental stress & caregiver burden - Increased independence with oral hygiene leads to decreased tooth decay & gum disease, decreased risk for cancer/stroke/heart disease, & overall increased health & well-being - Mastery of ADLs leads to increased self-esteem, self-reliance & self-determination - Student - Enhances social participation with friends - Achievement provides opportunities for growth & self-esteem - May help shape future vocational pursuits - Enhances verbal & written communication as well as listening **Evaluation Process** - Focused on: - Finding out what the client wants & needs to do - Determining what the client can do & has done - Identifying supports & barriers to health, well-being, & participation - Occurs during the initial & all subsequent interactions with a client - The type & focus of the eval differ depending on the practice setting - Essential components: - **Occupational Profile:** Summary of the client's occupational history & experiences, patterns of daily living, interests, values, needs, & relevant contexts - "Knowledgeable informants" = who is worried - The individual may not view area of concern as a problem - Guides your evaluation - Once completed a hypothesis is develop to explain why the individual is having difficulty - **Analysis of Occupational Performance:** The client's assets & limitations or potential problems are specifically determined through assessment tools designed to analyze, measure, & inquire about factors that support or hinder occupational performance - What is the individual able to do? What does the individual need to do next? - The OT intervention plan is developed after careful review & **synthesis** of information from the client's occupational profile & the OT's analysis of the client's occupational performance - Addresses many concerns: - Identifying individuals that could benefit from OT - Developing goals to focus on during therapy - Selecting interventions that are the most effective - **Evaluation:** PROCESS of collecting & interpreting data in order to make decisions about whether an individual needs OT - Includes examination of occupations, performance skills, performance patterns, client factors, & contexts/environments - **Screening:** (Usually quick & informal) process to determine whether or not individual needs OT - May or may not use specific assessment tools - **Assessment:** A TOOL or procedure used to collect information about the individual - **Re-Evaluation:** The ongoing process of collecting & interpreting data in order to make adjustments in intervention strategies based upon changes in the individual's unique strengths & weaknesses - Allows for the OT to collaborate with the client & family to establish whether or not there is a need - If yes → Establish goals & determine intervention methods - Purpose: - **1. Screening** - Conducted to determine if an individual can benefit from OT - Doesn't have to be done by an OT - Used to determine if a more comprehensive OT evaluation should be conducted - In some states OTs will conduct screenings as part of system wide initiatives to identify infants/toddlers/young children who may have delays - Texas Child Find - Universal screenings are part of multi-tiered systems supports (MTSS) in public schools in order to identify children in need or at risk for school-failure - **2. Determining the scope & frequency of OT services** - Comprehensive evaluation leads to this information - Data from multiple sources--individual, parents, teachers, caregivers, physicians - Data from multiple methods--observation, standardized & non-standardized assessment tools, interviews - Scope will depend on setting - Frequency & duration determined based upon occupational therapists clinical reasoning (experience working with others with similar presentations & developmental trajectories) - **3. Setting goals & developing intervention plans** - **4. Documenting progress toward therapy goals** - Critical to obtain baseline data pre-intervention! - Assessment measures chosen should be in alignment with the needs & reason for referral - **Top-Down Evaluation** - Highlights the significance of occupational performance & participation - Begins by gathering information on what the individual needs & wants to do - First step = Occupational Profile - Then focus on the critical occupations identified - Attend to the environments for expectations for performance - Focus on understanding which skills are posing the greatest limitation - Choose standardized assessments - May identify a pattern of limitation that suggests an underlying skill deficit - Observation = most literal interpretation of top-down eval - Activity analysis - Capturing the Parent's & Child's Perspective +-----------------------------------+-----------------------------------+ | Parent: | Child: | | | | | - Canadian Occupational | - Perceived Efficacy & Goal | | Performance Measure (COPM) | Setting System (PEGS) | | | | | - Short Child Occupational | - Child Occupational | | Profile (SCOPE) | Self-Assessment (COSA) | | | | | | - Children's Assessment of | | | Participation & Enjoyment | | | (CAPE) | +-----------------------------------+-----------------------------------+ - Evaluation period comes to a close when OT submits report to team or parents - Tools to gather info about interests: - Child Interests Activity Checklist - Modified Interest Checklist (MOHO) - NHS Interest Checklist - Evaluation Plan Table - Occupational performance & participation concerns - Hypothesis or potential reasons for deficits - Performance skill/performance pattern/client factor of interest - Assessment tools or strategies - Methods of Evaluation - **Observation** (Activity Analysis) - Assessment Tools - **Standardized Assessment Tools** - Provide scores that are useful for comparing the individual's performance - Do the same way every time--Read instructions from a script, use specific materials from a test kid, & provide a series of cues - Norm-referenced or Criterion-referenced - **Non-Standardized Assessment Tools** - Rating scales & inventories - Checklists - Questionnaires - **Interviews** - Use to confirm/validate your feelings - Conduct with individual (or caregivers, parents, teachers, etc) - Serves as a basis for goal setting - **Interpretation** - Most crucial aspect of the evaluation - Must include a clear picture of individual's occupational strengths & limitations - Ask yourself: - Does the individual need OT? - If so, what are the appropriate outcomes? - Which occupation-based theory or frame of reference will guide the intervention? - What is the best context/environment for OT services? - Does more info need to be collected? - Can be screener in 1st session - Does the individual need to be referred for services other than OT? - **Document Findings** - To communicate info to the client, explain recommendations, & create a record - Legal document--admissible in court - Referral source & info, client information, occupational profile, process & assessment tools used, summary of findings, OTs interpretation, recommendations, signature - **Goals** - Should be observable, measurable, occupation-based, & meaningful - Contain 3 components: - Person - Daily occupation/routine - Specific context - Use the COAST format to write - C = Client - O = Occupation - A = Assistance Level - S = Specific Condition - T = Timeline - Goals vs Objectives +-----------------------------------+-----------------------------------+ | **Long-Term Goals (LTG):** | **Short-Term Objectives (STO):** | | | | | - Outcome or discharge goals | - Objectives | | | | | - What the client hopes to | - Goals that are met in smaller | | accomplish by the time of | increments while progressive | | discharge from OT services in | toward the discharge goals | | the current setting | | +-----------------------------------+-----------------------------------+ - Objectives vs Benchmarks +-----------------------------------+-----------------------------------+ | **Objectives:** | **Benchmarks:** | | | | | - Often focused on collection | - Break a LTG into | | of different target behaviors | chronological steps | | leading to LTG | | +-----------------------------------+-----------------------------------+ **Early Intervention Services** - Programs & services designed to enhance a child's development in a critical developmental period (**birth to 3rd birthday**) - Eligibility for those with established risk, developmental delay, or at risk due to environment/biology - Supports families - Legislation: - 1986--Amendments to the Education of the Handicapped Act - Provided for states to develop systems for family-centered care for infants with disabilities - 1990--EHA amended & retitled the Individuals with Disabilities Education Act (IDEA) - Part C = States must develop & make available comprehensive services for children up to age 3 with developmental disabilities - Federally legislated, state run - Within 45 days of an EI provider receiving a referral: - Evaluation - **Individualized Family Service Plan (IFSP)** developed - Environments where service will occur - Service provider(s) - Frequency, intensity, & duration of services - Funding sources - Goals for child & family - Telehealth can be used (state licensure) - Services must occur in **natural environments** - Incidental learning opportunities - Purpose: - Service children with established risk or developmental delay - Enhance development of infants/toddlers with disabilities - Minimize potential for developmental delay - Recognize the significant brain development that occurs during this time - Enhance capacity of families to meet the special needs of their infants & toddlers - **Coaching model** - Federal Outcomes: - Mandated reporting of % of children with IFSPs who improve: - Positive social-emotional skills - Acquisition & use of knowledge & skills (language, communication, early literacy) - Use of appropriate behaviors to meet their needs - Document % of families who report EI improved: - Family's knowledge of their rights - Family's ability to communicate child's needs effectively - Family's ability to help child develop & learn - OT services in ECI are a primary service - Services to address the functional needs of the child related to: - Self-help - Social interaction - Sensory, motor, & postural development - Outcomes: - Improved developmental performance - Increased participation - Enhanced quality of life - Areas of occupation addressed: - ADLs - Rest/Sleep - Play - Social Participation - EI model recognizes **family as the most essential component of the knowledge community** - Families need resources to support & raise a child with disabilities - **Family-centeredness** - Families treated with respect - Importance placed on family strengths - Families have control & make choices regarding the care their child receives - Families & providers work together for optimal EI services - Develop goals collaboratively - Help parents communicate concerns & identify priorities for their child - Families are participants AND consumers - Understand nature & extent of family involvement depends on many factors - Family needs, values, lifestyles - Likely to fluctuate - Cultural considerations - Cooperative team of professionals - **Transdisciplinary model** - One primary service provider with other team members serving as consultants - OTs become teachers to peers serving as primary service providers - 2 major goals of evaluation: - 1\. Determine eligibility - Automatically eligible - Suspected developmental delay - Timely eval (within 45 days) - Comprehensive - Multi-disciplinary - 2\. Development of goals & potential outcomes to guide services - Evaluation - Initial Evaluation - Intro to family-centered care - Routines Based Interview (RBI) - Play as context - Transdisciplinary Play Based Assessment - Criterion-Referenced Assessments - Information about child's ability to perform certain set of skills that represent a developmental age range - Hawaii Early Learning Profile (HELP) - Assessment, Evaluation, & Programming System for Infants & Children (AEPS) - Norm-Referenced Assessments - Lubbock ECI uses Battelle Developmental Inventory (BDI-2) - Bayley Scales of Infant Development (BSID-III) - Developmental Profile-4 - Clinician's informed clinical opinion is considered an essential aspect of evaluation process **Chronological & Corrected Age** - **Chronological Age** = Age of child that day - Year, Month, Date - Always borrow 30 days, borrow 12 months - **Corrected Age** = The difference between the actual gestational age at birth & the 40 weeks' full term gestational age - Used for prematurity to "correct" for the number of weeks they were born before the due date - Use until child is chronologically 2 years old - Full term is considered 36-37 weeks - Steps: - Date - DOB = ChA (chronological age) - EDD (expected due date) - DOB = PV (prematurity value) - ChA - PV = CA (corrected age) **Developmental Profile 4 (DP-4)** - Parent/caregiver interview - Ages birth through 21 years 11 months - Scales: - Physical - Adaptive Behavior - Social-Emotional - Cognitive - Communication **Evaluation of Play** - Play is: - Self-directed (child-driven) - Intrinsically motivated - Guided by (flexible) rules - Imaginative - Relatively stress-free but active state of mind - Joyful - Social - **OT Perspectives of Play** - OTs have long recognized value of play - Treatment medium - Reflection of development - Occupation of child - **Adolph Meyer** (1922)\--Part of the Big 4 - Hull House playground - Need balance--rest, work, play, sleep - "Serious undertaking not to be confused with diversion or idle use of time" - **Mary Reilly** (1974) - Helped bring play to the forefront of OT - Described along continuum--developmental milestones of play - Play allows children to learn skills & develop interests that influence future choices in work/leisure - Arena for development of - Sensory integration - Physical abilities - Cognitive & language skills - Interpersonal relationships - Hierarchical stages of **Drive of Curiosity\ **(MOHO!) - **Exploratory** - Early childhood (sensorimotor) - Intrinsic motivation - **Competency** - Effectance motivation (like noisy toys) - Experimentation & practice to achieve mastery - **Achievement** - Goal expectancies - Desire to achieve excellence (play to win) - **Play Taxonomies--Takata**\ Play influences development; Development influences play - **Sensorimotor:** Birth-2 years - **Symbolic & Simple Constructive:** 2-4 years - Ex = banana as phone - **Dramatic, Complex Constructive, & Pregame:** 4-7 years - Dressing up, imagination - **Games:** 7-12 years - **Recreational:** 12-16 years - Transition to leisure - **Play Form** - Includes: - Characteristics (using a tool to make something else) - Requirements (fine motor skills, posture, etc) - Products (blocks, legos, etc) - **Children with Disabilities** - Disability as "hindrance" to typical development - Differences in: - Amount of time they play (play less) - Physical forms of play (less rough & tumble play) - Ability to engage in specific developmental stages of play - Look at preferences & participation - Impacts: - Interaction with environment - Social interaction - Amount of cues required - Attention - **Function** - Way as which it serves the person & influences health & well-being - Physical activity - Mental health - Family well-being - **Meaning** - Quality of the experience, a person's state of mind, & value that the play experience has for the individual - Fun + Work - Primary consideration = Is it fun? - Activity--amount of movement/activity level, level of difficulty - Relational--who are they playing with - Child--age & gender - Contextual--doesn't matter who picks it as long as it is fun - **Context** - Play occurs in physical (indoor vs outdoor), social, cultural, personal, temporal (time), & virtual contexts - Virtual Contexts - Sharism: More likely to engage in co creation of ideas as fast pace - Shifting Identities: Boundaries between "mine" & "yours" blurring - Border Crossing: Moving between virtual & physical worlds constantly, resulting in more global view of the world - Literacies Beyond Print: More active reading using digital devices - Gaming Culture: Expect world to be forgiving & responsive (undo button) - Bricoleur Culture: Eager to hack & modify, program & recycle; love robotics & open to engineering - **Leisure** - An occupation that is fun, provides choice & freedom from constraints, & provides opportunities for fulfillment & friendship - Nonobligatory - During discretionary time - Important for developing skills & for own sake - Autonomy, self-determination, mastery - Barriers to leisure for youth with disabilities - **Assessment of Play & Leisure** - **Playfulness** - Test of Playfulness (TOP) - **4 elements of playfulness:** Intrinsic motivation, internal control, ability to suspend reality, framing - Parent/Caregiver's Support of Young Children's Playfulness (PSYCP) - Criterion referenced for 6 mo - 6 yr - **Interests & Participation** - Own perspectives of play/leisure using self-report when possible - Tools: - Pediatric Interest Profiles (PIP) - Child Occupational Self-Assessment (COSA) - Pediatric Activity Card Sort - Leisure Questionnaire - Children's Assessment of Participation & Enjoyment/Preference for Activities of Children (CAPE/PAC) - My Child's Play Tool - Tolerance of Risk in Play Scale - Playable Space Quality Assessment Tool - **Developmental Competencies** - Can observe developmental milestones related to play through assessment - Tools: - Revised Knox Preschool Play Scale - Child-Initiated Pretend Play Assessment - Norm-referenced tool initially developed to address cognitive play skills - Infant-Preschool Play Assessment Scale - Play Assessment Scale - Play in Early Childhood Evaluation System - Transdisciplinary Play Based Assessment - **Tools to Assess Leisure** - Primarily, through informal methods (interview/discussion) - Leisure Competence Measure - Leisure Interest Assessment - Activity Card Sort **The Knox Preschool Play Scale - Revised (PPS-R)** - Designed to give developmental description of typical play behavior from birth through 6 years - 4 dimensions: - **Space Management** - Gross motor - Interest - **Material Management** - Manipulation - Construction - Purpose - Attention - **Pretense-Symbolic** - Imitation - Dramatization - **Participation** - Type - Cooperation - Humor - Language - Technical Considerations - Non-standardized/observation-based assessment tool with standardized procedures for administration & scoring - Excellent interrater reliability & test-retest reliability - Adequate validity - Play age correlates with developmental age - Can be used to differentiate certain populations based on play behavior - NOT a comprehensive assessment of play **Standardized Assessment Tools** - A screen or assessment tool with rigorous development which has provided for: - Establishment of norms or criteria for performance - Comprehensive, clear instructions to ensure uniformity & consistency - Exact materials and/or instructions - Demonstration procedures - Time limit and/or test conditions - Every response anticipated during the testing procedure - Psychometric characteristics - Provide reliable & valid data - Purposes - Screening -- Large numbers, identify need for more testing - Determination of Medical or Educational Diagnoses -- Use of normative scores to compare - Documentation of Status -- Developmental, functional, & participation - Planning Intervention -- Information about level of function can guide starting point - Measuring Program Outcomes -- Efficacy of intervention - Becoming a Competent Test User - 1\. Study the test manual - 2\. Observe experienced examiners - 3\. Practice using the test for administration & scoring - 4\. Check interrater agreement with an experienced examiner - 5\. Prepare administration & scoring cue sheets - 6\. Prepare the testing environment & make sure the setup adheres to the test manual - 7\. Consult with experienced examiners about test interpretation - 8\. Periodically recheck interrater agreement - Types of Standardized Tools - **Ipsative Assessment** - Compare the individual's performance only to their own performance - Has standardized procedures - Does not have specific criteria or norms to compare - Examples: - Interviews--COPM, School Setting Interview, COSA - Observation-based assessments--PVQ, Kawa model - Both--SCOPE - **Norm-Referenced Assessment** - Compares ratings of an individual's performance to a normative/standardization sample - Normative sample established through test development - Establishes the degree of ability or disability in relationship to the normative sample - Demographics--The sample size needs to be a representative sample of the greater population, both in number & demographics - Cannot make a comparison if your client is not similar to the standardization sample - Deviation from the standard protocol--must document - Used to measure response to OT intervention over a period of time; assesses changes in one's function or ability - Many recommend time between administration for test-retest reliability - Should not choose normative items for goals or intervention! - They are statistically relevant, not functionally relevant - Examples: - Sensory Integration & Praxis Tests (SIPT) - Beery Developmental Test of Visual Motor Integration (VMI) - Bruininks Oseretsky Test of Motor Proficiency (BOT-2) - Peabody Developmental Motor Assessment (PDMS-2) - **Criterion-Referenced Assessment** - Based on a standard fixed point - Established by experts - Compared to benchmark - Shows the presence or absence of a characteristic, ability, or skill (mastery testing) - Yields an all-or-none score - Determines what they can do or know, not how they compare with others - An established score (cut score) is established through empirical comparative testing or as a judgment regarding competence level - Raw score is compared to cut score to reflect the person's ability relative to the set score for mastery - Should be used to determine the minimal competencies required - Examples: - School Function Assessment (SFA0 - Hawaii Early Learning Profile (HELP) - Peabody Developmental Motor Scales (PDMS-2) - Both normative & criterion - Performance Assessment of Self-Care Skills (PASS) - **Test Psychometrics\ **First, evaluate test validity. Second, evaluate test reliability. - **Reliability:** The degree of consistency between 2 test administrations--Can the evaluator find the same results each time they conduct a test? - Types: - **Test-Retest Reliability:** A measure of test score stability on the same version of the test repeated over 2 occasions (typically 1-2 weeks) - If a purpose of a test is to measure intervention changes, then test-retest reliability must be reported - **Interrater Reliability:** Degree of agreement between the scores from 2 raters following observation & rating of the same subject (.85 or higher is favorable) - Am I scoring the same as another therapist? - **Intrarater Reliability:** Consistency in measurement & scoring by evaluator when 2 test results from 2 similar situations are correlated - Am I scoring clients the same way every time? - **Alternate, parallel** - **Internal consistency** - **Recalibration:** Process of evaluating one's skills in using a specific assessment through comparison with the published standardized procedures - Restudy standardized procedures - Have another trained evaluator review & critique administration skills - Attend a workshop - **Validity:** The degree to which a test accurately measures the specific construct trait, behavior, or performance it was designed to measure--Does it measure what it says it measures? - Types: - **Construct Validity:** The extent to which a test measures a theoretical construct\ (Constructs in OT = Self-care skills, fine motor skills, visual perceptual skills, gross motor skills, functional performance) - **Discriminant Validity:** How well does an assessment discriminate between different groups of individuals - Should differentiate between performance of older & younger children - Children with developmental delays should have lower scores - **Factor Analysis:** Determines the relationships between test items - Ex = Fine motor vs gross motor - **Repeated Administration:** Repeated administration before & after intervention - **Content Validity:** Extent to which the items on a test accurately sample a behavior domain - **Face Validity:** From appearance & without statistical proof, the test items appear to address the purpose of the test & variables to be measured - Established by the subjective, logical judgment by author/participants - Can be considered a primitive form of content validity - The smell test - **Review by Experts** - **Criterion Validity:** Ability of a test to predict how an individual performs on other measurements or activities\ Established by checking test score against a criterion--compare to gold standard - **Concurrent/Congruent:** The extent of agreement between 2 simultaneous measures of the same behaviors/traits - How well scores reflect performance - **Predictive:** The extent to which scores on a current test forecast a measure of future criterion - Established by conducting a test at one point in time & then correlating it with findings of a measure in the future - Difficult to establish & a lengthy process - **Rasch Analysis** - **Ecological Validity** - **Correlation:** What is common between 2 measures - **Correlation Coefficient (r):** A statistic that indicates the degree of agreement/relationship between 2 measures/variables - Varies from -1.00 to +1.00 - Strength is determined by how close the r is to 1.00 - Positive correlation = both variables increase or decrease - Negative correlation = one variable increases & other variable decreases - Interpreting in regards to reliability measures: -.90-.99 = high correlation; preferred, but not frequently observed -.80-.89 = satisfactory or adequate correlation -.70-.79 = weak or minimally acceptable correlation - Below.70 = caution--inadequate or unacceptable correlation - Interpreting in regards to validity measures: -.80-1.00 = very high correlation -.60-.80 = high correlation -.40-.60 = moderate correlation -.20-.40 = low correlation - 0.00-.20 = negligible correlation - Not a percentage! - To obtain a percentage of agreement, square the correlation coefficient (r2) - **Test Sensitivity:** Implies that the instrument will identify all of those who possess the behavior or characteristic in question - Minimizes false negatives - **Test Specificity:** Implies that only those manifesting the target behavior or characteristic will be identified - Minimizes false positives - Vital in diagnostic type of assessments **Methods, Scales, & Scores** - **Response Methods** - **Observation of performance** - Uses standardized protocol - **Checklist scales** - Offer wide range of information but do not provide information about the strength of responses - **Semantic differential** - A subjective evaluation of concepts being tested using a continuum with 2 anchors at each end of the continuum (good--bad, bitter--sweet, active--passive) - **Q-sort** - Test taker sorts a series of items (pictures or words) into stacks according to a stated criteria such as what you currently do & what you currently do not do - Client can create their own categories - **Likert scales** - Test taker chooses a rank-ordered response - Typically 3-7 linearly related test response options - Strongly disagree to strongly agree - Friendly = have a midpoint response - Limit evaluator's understanding - Forced = even \# of options - Attempt to reduce bias & require the test taker to choose - **Types of Scores** - Scaled scores, Z-scores, T-scores, deviation intelligence quotient scores, developmental index scores, percentile scores & age-equivalent scores - Many based on the normal curve - **Measures of Central Tendency** - **Mean (X̄):** Average - **Median:** Splits the distribution in half with 50% of the scores above the median & 50% below the median - **Mode:** Score that occurs most frequently in the distribution - **Normal Bell-Shaped Curve** - All 3 measures of central tendency are equivalent - This is the goal of finding a sample size, but is very rare to achieve - **Normal Distribution:** Use of normal, bell-shaped curve; symmetrical - **Variability** - **Range:** Lowest to highest score - **Standard Deviation (SD, σ):** - Basis for computing many standard scores - Specific, gradually decreasing areas on normal curve from mean - Estimated variability that normally accompanies a mean due to the accumulated error - 68.26% is within ±1 SD of the mean - 95.44% is within ±2 SD of the mean - 99.72% is within ±3 SD of the mean\ \ \ \ \ \ \ \ \ \  - **Variance:** Mean square deviation; how far an average individual deviates from the group mean - **Test Scores** - **Raw score (RS)** - **Testing error (TE)** - The better the reliability & validity, the smaller the TE - **True score (TS):** Contains no error & is impossible to measure - RS = TS + TE - **Derived Score:** Converted score using a method published within the test manual - Also known as subscale scores, scaled scores, standard scores, obtained scores - **Types of Derived Scores** - **Deviation IQ Score:** Mean of 100 & a standard deviation of 15 - Stanford Binet IQ test - Wechsler Intelligence Scale - **Developmental Index Score:** Mean of 100, SD of 15 or 16 - Peabody Developmental Motor Scales - Bayley Scales of Infant & Toddler Development - **Rasch Scores:** Creates a hierarchic ranking of items from easiest to most difficult - A type of assessment creation methodology - Assumptions: - Construct being measured can be represented as a continuous function - Measures just one construct - Each item represents a sample of the characteristic measured - **Percentile Score:** Percentage of people in a standardization sample whose score is at or below a raw score - NOT equal distribution; technically standard - Computed from raw score (not technically standard) - **Age Equivalence Score:** Age at which the raw score is at the 50th percentile - Generally expressed in years & months (4:10) - Easily understood by caregivers - General idea of overall developmental level but can be misleading & cause distress - Computed from raw score (not technically standard) - **Common Standard Scores** - **Z-scores** (-4.0 to 4.0) - Converts derived scores to a format (standard score) that can be compared to the normative sample of fixed reference group - Tells you how far above or below the mean the individual's score is with regard to the standard deviation - Z = (x -- X)/SD - Subtract the assessment mean from the individual's derived score & divide by the test standard deviation - **T-scores** (0-100) - T = (z x 10) + 50 - **Transformation of Scores** - Transformation of derived scores to standardized scores allows you to compare the results of one assessment to another assessment - Typically transform scores for purposes of reporting results - Raw score → derived score → standardized score - **SEM:** A statistic used to calculate the expected range of error for test score of an individual - Based on the range of scores an individual might obtain if the same test were administered several times simultaneously with no practice or fatigue effects - Impossible--theoretical - Does tell us the possible error variance in individual scores - Creates a normal curve for individual's test scores, with the obtained score in the middle of the distribution - Higher probability the true score is in the middle of the distribution than at the extreme ends - Based on the SD of the test & the test's reliability - Once a SEM has been calculated, that value is added to & subtracted from individual's obtained score - Gives the range of expected scores for that individual--called a **confidence interval** (CI) - Usually provided in 95% CIs - Larger SEM means range of possible scores is greater, which means possible error degree is greater (less confident) - It is desired that it be relatively small - Especially important when comparing 2 sets of scores of the same assessment (comparing scores over time) - If CIs overlap, can't be sure progress was actually made - Provides opportunity to share clinical reasoning related to error in the scoring - **Clinical vs Statistical Significance** - Statistical change does not always equal clinical/meaningful change - Meaningful clinical change - **Minimal Clinical Important Difference (MCID):** The smallest difference in score in the domain of interest which patients perceive as beneficial - Can be measured by performance evaluated by therapists or perception of performance by client/family - Often used to establish goals - **Minimal Detectable Change (MDC):** The smallest change between test scores that fall outside of the measurement error - OTs can demonstrate that the change in the test scores is because of intervention effectiveness, not measurement errors - Uses confidence intervals **Motor Development** - Development of motor skills - Reflexive → Independent volitional skills → Maturation - Development occurs from: - Gross to fine - Proximal to distal - Mass to specific - Ulnar to radial - Asymmetrical to symmetrical (back to asymmetrical with coordination) - Stability to mobility - **Newborn** - Reflexes present at (full-term) birth: - Swallow/suck - Phasic bite--chomping when gums stimulated - Gag - Rooting--nipple on cheek - Grasp (palmar/plantar)\--curling toes - Moro reflex--startle; extend & come back - Asymmetrical tonic neck reflex (ATNR)\--turn head, one arm flexes, one arm extends - **Tummy time** - Newborn - Supervised tummy time beginning day 1 - On caregivers chest - Propped on pillow - Across caregivers lap on tummy - Place bright colored/musical toys in front of baby - Frequent position changes - Limit time in swings/bouncers/car seat (anti-containerize babies) - Dangle bright colored/musical toys in front of baby to encourage reaching - "Face up to wake up" (1992) - Said babies should sleep on back - Decreased SIDS - Caused plagiocephaly (flat head) - 3-5 months - Place objects in a circle around baby to encourage pivoting - Place towel roll under babies chest to assist with press up on extended arms - Support baby at elbows to allow weight bearing through hands - Place baby on a wedge with arms extended to allow weight bearing through hands - Facilitate weight shift & place toy to one side to encourage pivoting on tummy - Bring baby's feet to mouth during play - **Up to 3 months** - Reflexive grasp to less flexion in rest - More volition of suck/swallow - Grasps volitionally - Increased head control - **4-6 months** - Head in midline (can hold head up) - Righting reactions, protective reactions, equilibrium reactions - Brings hands to midline - Voluntary palmar grasp by 5 months - First teeth at 6 months - **7-9 months** - Sideways protective reactions (when sitting) - Dissociation of the thumb & fingers - Hand movement more radial - Radial palmar grasp at 7 months - Lateral grasp at 8 months - Isolation of the index finger for pointing - Holds bottle with both hands - **10-12 months** - Rocking in 4-ped - Pull-to-stand - Toddling (walking with hand held at 12 months) - Flinging objects - Holds arms out during dressing - **The First Year** +-----------------------------------+-----------------------------------+ | **1 month** | - Flexion | | | | | | - Lifts head briefly in prone | | | | | | - Jerky movements | | | | | | - Hands in range of eyes/mouth | | | | | | - Hands in fists | +-----------------------------------+-----------------------------------+ | **3 months** | - More extension | | | | | | - Holds head up between 45 & 90 | | | degrees | | | | | | - In prone, supports upper body | | | with arms | | | | | | - In prone or supine, stretches | | | legs out & kicks | | | | | | - Opens/shuts hands | | | | | | - Brings hands to mouth | +-----------------------------------+-----------------------------------+ | **4 months** | - Rolls prone-\> supine | | | | | | - Props self in prone on hands | | | | | | - Toys to mouth | | | | | | - Little/no head lag with pull | | | to sit | +-----------------------------------+-----------------------------------+ | **6 months** | - Pivots in prone | | | | | | - Sits propped | | | | | | - Sits independently | | | | | | - Rolls supine to prone | | | | | | - Ranking & voluntary grasping | | | | | | - Eating from a spoon | +-----------------------------------+-----------------------------------+ | **7 months** | - Sits independently | | | | | | - Rolls supine to prone | | | | | | - Sits independently | | | | | | - Supports whole weight on legs | | | (held for balance) | | | | | | - Emerging voluntary | | | release/transfers objects | | | from hand to hand | | | | | | - Responds to name | | | | | | - May be crawling | +-----------------------------------+-----------------------------------+ | **9 months** | - Gets to sitting independently | | | | | | - Inferior pincer grasp (picks | | | up O-shaped cereal) | | | | | | - Pointing | | | | | | - Banging 2 cubes together | | | | | | - Gets on hands/knees | | | | | | - May creep in quad | | | | | | - May cruise on furniture | | | (early) | +-----------------------------------+-----------------------------------+ | **10 months** | - Stands alone momentarily | | | | | | - Creeps | | | | | | - Cruises | | | | | | - Starts to have stranger | | | anxiety | | | | | | - Understands no | | | | | | - Beginning to nest objects | +-----------------------------------+-----------------------------------+ | **12 months** | - Removes socks | | | | | | - Walks 2-3 steps | | | | | | - Stands independently | | | | | | - Pivots in sitting | | | | | | - Superior pincer grasp | | | | | | - Says "mama" and "dada" and | | | means it | +-----------------------------------+-----------------------------------+ - **Early Childhood (1-3 years)** +-----------------------------------+-----------------------------------+ | **1 year** | - Crawls skillfully; stands | | | alone; walks independently | | | | | | - Releases object voluntarily | | | | | | - Attempts to run | | | | | | - Sits in small chair | | | | | | - Stacks 2-4 objects | | | | | | - Sorts by color/shape | | | | | | - Carries toys from place to | | | place | | | | | | - Uses whole arm movement to | | | scribble | | | | | | - Helps self-feed with frequent | | | spills | +-----------------------------------+-----------------------------------+ | **2 years** | - Walks with more "adult" like | | | gait | | | | | | - Fewer falls when running | | | | | | - Squats while playing | | | | | | - Climbs stairs holding on to | | | railing (not alternating | | | steps) | | | | | | - Throws large ball underhand | | | | | | - Some toilet training | | | | | | - Fists a crayon- loves to | | | scribble | | | | | | - Turns doorknob | | | | | | - Unbuttons large buttons | | | | | | - Stacks 4-6 items | | | | | | - Loves pouring & filing items | | | | | | - Holds cup in one hand | +-----------------------------------+-----------------------------------+ | **3 years** | - Up & down stairs with | | | alternating feet | | | | | | - Momentary balance on one foot | | | | | | - Catches large bounced ball | | | | | | - Kicks a large ball | | | | | | - Jumps in place | | | | | | - Pedals tricycle | | | | | | - Feeds self | | | | | | - Likes to swing | | | | | | - Makes vertical, horizontal, & | | | circular strokes | | | | | | - Beginning tripod grasp | | | | | | - Turns one page of book at | | | time | | | | | | - Builds tower with 8 or more | | | blocks | | | | | | - Beginning hand dominance | | | | | | - Washes & dries hands | | | | | | - Manipulates large buttons & | | | zippers | | | | | | - Achieves bladder control for | | | the most part | +-----------------------------------+-----------------------------------+ - **Preschool (4-5 years)** +-----------------------------------+-----------------------------------+ | **4 years** | - Walks in a straight line | | | taped to the floor | | | | | | - Hops on one foot | | | | | | - Pedals and steers wheeled toy | | | well | | | | | | - Climbs ladders, trees, | | | playground equipment | | | | | | - Jumps over objects 5-6" | | | | | | - Builds a tower with 10 or | | | more blocks | | | | | | - Forms shapes and objects out | | | of clay | | | | | | - Reproduces some shapes and | | | letters | | | | | | - Holds crayon with tripod | | | | | | - Paints and draws with purpose | +-----------------------------------+-----------------------------------+ | **5 years** | - Walks backward, heel-to-toe | | | | | | - Somersaults | | | | | | - Touches toes without flexing | | | knees | | | | | | - Walks a (low) balance beam | | | | | | - Skipping using alternating | | | feet | | | | | | - Catches a ball thrown from 3 | | | feet | | | | | | - Balances on either foot for | | | 10 seconds | | | | | | - Jumps 10x without falling | | | | | | - Cuts on the line with | | | scissors | | | | | | - Fair control of a | | | pencil--some between lines | | | coloring | | | | | | - Build 3D structures copying | | | from a model | | | | | | - Reproduces many shapes & | | | letters, including square & | | | triangle | | | | | | - Hand dominance mostly | | | established | +-----------------------------------+-----------------------------------+ - **Middle Childhood** - Grows 2-3 inches per year (6-11) - Head proportion decreases - Center of gravity moves to umbilicus - Balance improves - Muscle strength improves - Maturation of CNS--increased speed & dexterity - Self-concept emerges & strengthens--stress & achievement anxiety - Hand dominance (usually by 5) supported by hemispheric lateralization - Corpus callosum myelinates - Sensory & motor integration - Increases in functional communication - Frontal lobe growth for increases in cognitive flexibility - 20/20 vision--improvements in visual perception - Improved auditory processing - **Middle Childhood (6-12 years)** +-----------------------------------+-----------------------------------+ | **6 years** | - Increased muscle strength, | | | boys\>girls | | | | | | - Greater control over motor | | | skills (still some | | | clumsiness, better eye-hand | | | coordination) | | | | | | - Likes to play hard | | | | | | - Likes art projects | | | | | | - Traces around hand & other | | | objects | | | | | | - Folds & cuts paper into | | | simple shapes | | | | | | - Ties own shoes (may be a | | | struggle for some) | +-----------------------------------+-----------------------------------+ | **7 years** | - Continues to refine | | | gross/fine motor control | | | | | | - Practice new motor skill over | | | and over - then works on | | | something else | | | | | | - Legs in constant motion | | | | | | - Uses knife and fork with some | | | inconsistency | | | | | | - Letters are increasingly | | | uniform in size/shape | | | (legible handwriting) | | | | | | - Mature pencil grasp | +-----------------------------------+-----------------------------------+ | **8-10 years** | - Well-established eye-hand | | | coordination | | | | | | - Well-established fine motor | | | skills | | | | | | - Coordinated movements | | | | | | - 8 yo- large improvement in | | | agility, balance, speed, and | | | strength | | | | | | - 9 and 10 yo - continued | | | refinement of fine motor | | | skills (especially among | | | girls), likes team sports, | | | likes to draw and takes joy | | | in perfecting handwriting | +-----------------------------------+-----------------------------------+ | **11-12 years** | - Approaching or entering | | | puberty | | | | | | - Continued increase in | | | coordinated movements, | | | although growth spurts may | | | interrupt & increase | | | clumsiness | | | | | | - Perfected all fundamental | | | gross motor skills | | | | | | - Likes activities (sports, | | | organized games) | | | | | | - Continue to refine fine motor | | | skills (models, drawing, | | | cooking, arts/crafts, playing | | | instrument) | +-----------------------------------+-----------------------------------+ - **Commonly Used Motor Assessment Tools** - **Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)** - Most widely used motor proficiency test - Norms based on 2005 US Census data - Uses engaging goal-directed activities to measure a wide array of motor skills - Children ages 4-21 years - Measures motor control, dexterity, movement, balance, strength - **Peabody Developmental Motor Scales (PDMS-2)** - Developmental assessment of gross & fine motor skills - Birth through 5 years (up to 6th birthday) - Includes training/remediation materials - **Test of Infant Motor Performance (TIMP)** - Test of functional motor behavior in infants - Assess infants ages 34 weeks PCA to 4 months post-term - Assessing the postural & selective control of movement needed for functional motor performance in early infancy - **Alberta Infant Motor Scale (AIMS)** - Assesses motor development of babies - Breaks down components of infant movements (up to independent walking) - Supine, prone, sitting, standing - Birth-18 months - **Toddler and Infant Motor Evaluation (TIME)** - Measures gross & fine motor skills - Diagnostic tool, remediation plan, outcome measure - Birth-42 months - Research based on 4-42 months - Development for children with developmental delays (Down syndrome & Prader Willi) - **Test of Gross Motor Development (TGMD)** - Norm-referenced measure of GM skills (locomotor & ball skills) - Ages 3-10/11 - Not common - **GMFM** - Assessment tool designed to measure changes in gross motor function over time or with intervention in children with cerebral palsy - Ages 5 months-16 years - Valid for use with children with Down Syndrome - **Adolescence & Adulthood (13+)** +-----------------------------------+-----------------------------------+ | **Adolescence (13-18)** | - Better able to move body with | | | precision - changes in motor | | | performance correlate with | | | physical growth | | | | | | - More coordinated flow and | | | calibration of movements | | | | | | - Complex interactions of | | | strength, speed, power, | | | reaction time, endurance = | | | performance skills | | | | | | - Females have modest gains | | | until about 15 and then no | | | other improvements without | | | specific training/practice | | | | | | - Males continue to improve | | | until early 20s, mostly in | | | strength and endurance | | | | | | - Move without stiffness | | | | | | - Bilateral coordination skills | | | fully matured | +-----------------------------------+-----------------------------------+ | **Early Adulthood (18-40)** | - Skeletal bone growth complete | | | about 25 years old | | | | | | - Muscular performance at peak | | | between 20 & 30 | +-----------------------------------+-----------------------------------+ | **Middle Adulthood (40-65)** | - After 35, bone loss starts to | | | exceed bone formation | | | (osteoporosis, arthritis) | | | | | | - BMI steadily increases | | | | | | - Sarcopenia--decline in total | | | number of skeletal muscle | | | fibers | | | | | | - Decreased flexibility | +-----------------------------------+-----------------------------------+ | **Older Adults (65+)** | - Dehydration frequent problem | | | | | | - Osteoarthritis & osteoporosis | | | | | | - Physical activity increases | | | remineralization of bone | | | tissue | | | | | | - Kyphosis & lordosis | +-----------------------------------+-----------------------------------+ - **Age expectancy** as of 2012 = 78.8 years - Male = 76.4 years - Female = 81.2 years - **Motor Assessments for Adolescents/Adults** - Hand dexterity assessments - Purdue Pegboard Test - Box & Block Test - Nine-Hole Peg Test - Jebsen Taylor Hand Function Test - Functional Dexterity Test - Other assessments - Assessment of Motor & Process Skills (AMPS) - Berg Balance Scale - Functional Independence Measure (FIM) - Tinetti Balance & Gait Evaluation - Bruininks Motor Ability Test (BMAT) - Motor performance over the lifespan - Increases from childhood to young adulthood, then decreases from young adulthood to old age (similar to cognitive studies) - Process that motor skill learning is specific - Training in specific tasks will strengthen the neural connections - Making behavior more probable the next time - With increased age, fewer neural groups available - Activation of same neural groups executing different kinds of tasks (more efficient) - Childhood = abundance of neurons & lots of room for learning - Less efficient neural groups die - Could be why gray matter is reduced - Use it or lose it--more critical in older adults - Developmental Diagnoses often Associated with Motor Delays/Differences - Developmental delay - Developmental coordination disorder - Dyspraxia - Down syndrome - Intellectual disability - Prematurity - ADHD - Neurological conditions--cerebral palsy, muscular dystrophy - Acquired brain injuries - Stroke - Amyotrophic lateral sclerosis (ALS) - Parkinson's disease **Peabody Developmental Motor Scales (PDMS-3)** - Norm-referenced - Ages birth through 5 years 11 months - 6 subtests: - **Gross Motor** = body control, body transport, object control - **Find Motor** = hand manipulation, eye-hand coordination - Supplemental = physical fitness - Used to identify children who have motor deficits, determine children's strengths and weaknesses in motor skills, and document motor skill progress after intervention **Reflexes & Righting Reactions** - **Development of Motor Skills** - Influences the way children engage in developmentally appropriate tasks & activities - Sensorimotor development in infancy is characterized by reflexes that dominate movement & behavior - Reflex behavior is a survival function for an infant & is controlled primarily by the primitive central nervous system, including the spinal cord & brainstem levels - **Reflexes** - Old Theory = Stereotypic obligatory response to a given stimulus - New theories challenge this--instead of obligatory responses, the responses are based on **"attractor wells"** - Preferred pattern of movement - A very deep attractor well is reflected by a motor pattern that is highly predictable in being elicited in response to a given stimulus ("reflexive behavior") - As the infant matures & gains matured motor behaviors, they experiment with motor strategies to accomplish functional movements - Less predictable & more variable movements - Eventually develops preferred strategies (less deep attractor wells) - Thought of now as "highly preferred strategies that are not obligatory in that they can be altered under various circumstances, such as internal & external environmental characteristics - "Integration" of reflexes occurs to permit more complex & mature neuromotor patterns to develop - No longer a highly predictable or preferred pattern - Maturation of the nervous system + environmental experience & practice promotes the development of more variable patterns of neuromotor behavior that underlie functional accomplishments - The pattern is not erased from memory - Pattern of neonatal reflexes can be brought out in stressful situations & when the nervous system sustains damage - **What is a "reflex"?** - Movement patterns that are "stored" within us - They are normal, innate, & involuntary - They help to teach infants to roll & crawl - Appear in infancy & "disappear" as the child learns new skills - **What creates a reflex?** - Many body systems contribute - CNS--receiving information & providing an output - Musculoskeletal system--reflexive responses within muscle fibers - Cardiopulmonary system--reflexively responds to internal/environmental changes - Respiratory system--reflexively responds to internal/environmental changes - All movements are actually reflexive, modified by influences of the brain. Those brain influences are what we call sensory systems--vestibular, proprioceptive, tactile, visual & auditory awareness & responses - **Why study reflexes?** - Children with cerebral palsy/TBI - Movement influenced by primitive reflexes - Persistence/re-emergence associated with delayed postural reflex development - 1997 study found that motor milestones emergence can be independent of integration of primitive reflexes