Pediatric Patient Note Taking Guide PDF

DPT 0619 Management Across the Lifespan: Pediatric Patient W3a Note Taking Guide for Lecture Slide Deck 3.1: Guide to Physical Therapist Practice in Pediatric Settings POC PT Management: 6 Elements of patient/clie...

DPT 0619 Management Across the Lifespan: Pediatric Patient W3a Note Taking Guide for Lecture Slide Deck 3.1: Guide to Physical Therapist Practice in Pediatric Settings POC PT Management: 6 Elements of patient/client management coordination & communication documentation 1- Exam -hx, systems review ongoing assessment 2- Eval -test, measures (focus here) 3- Diagnosis include child, family, school staff 4- Prognosis 5- Intervention 6- Outcomes -helps provide high quality services and education Team Collaboration/Decisions are KEY; Child/family are essential team members -Support children and families to actively engage throughout all elements of care - Coordination, communication, documentation to ensure person/family- centered services -assist fams in accessing appropriate community Write goals for practice setting: FOCUS on child/family needs, values, function resources Use family-friendly language in documentation and discussions-ensure health literacy -consult w community programs Team collectively identifies when to DC discharge) Slide Deck 3.2: Child Abuse and Neglect 700,000 kids in 2017 Majority: neglect -75% Majority: Maltreated by mother -70% Youngest: most vulnerable ( sticker > token for a prize after receiving a handful of tokens > token for a non tangible reward after receiving a handful of tokens such as “child of the week on a bulletin board” or “free choice” menu (that PT handpicks the choices that are all therapeutic) > verbal praise Negative reinforcement: do not use it o Def: removal of an aversive stimulus contingent on performance of desired behavior, is generally not an accepted technique in physical therapy. ▪ Ex: “We can end session early if you do at least ONE thing I ask”= NO Behavior Programming Techniques: o Goal: Increase the desired behavior o At 1st: continuous schedule of reinforcement ▪ Then: intermittent schedule of reinforcement and secondary rewards = Until behavior is naturally occurring o Shaping: reinforcing behaviors that are increasingly closer to desired behavior o Chaining: links related behaviors to accomplish a more elaborate goal with sequenced elements ▪ works best with discrete tasks that have a clear beginning and end (i.e. ADLs) or selected serial tasks that are strung together (i.e. sliding board transfer) o Backwards shaping: ▪ teaching and reinforcing behaviors in a step-by-step progression where last step is learned first (e.g., learning brushing teeth before learning to put toothpaste on brush). Tips: always consider behavioral techniques o Small accomplishments take much time and effort o Encourage + reward effort = Child keeps trying -ALWAYS positive reinforcement  3.1 charts routines 3.2 child abuse and neglect Slide Deck 3.4: Characteristics of Motivation in Children 4 Indicators of Motivational Level Persistence: Ability to stay with a task for a reasonably long period of time o Children learn persistence when they are successful at a challenging task o Art of building persistence: offering a task that is just challenging enough, but not too hard Choice of challenge: o Self- selection: give children choices; a range of carefully chosen choices o The success of meeting 1 challenge, motivates a child to welcome another challenge o When child successfully completes such a task, child gains a high level of satisfaction o ***KEY: helping children find an appropriate challenge while still allowing the child a choice Amount of Dependency on adults o Children with strong intrinsic motivation do not need adult constantly helping with activities o Providing toys and activities that play to the child's natural creativity and curiosity Emotion: positive display of emotion Extrinsic Motivation: Reward comes from outside the child Children engage in activities because adults tell them to, or an effort to please Reward continuously given by someone else for child to remain motivated to continue activity **More difficult for child to sustain because of reliance upon some outside force Intrinsic Motivation: 1. Children do many things simply because they want to do them. 2. Child makes OWN CHOICE & is satisfied by BOTH act of choosing & engaging with their choice 3. **SELF SUSTAINING: Since the activity is generating the motivation 4. Adults can guide the child's play and activities while still giving the child a range of options 5. Unstructured play is an essential element of the child's motivation, learning, and development Increase a child’s motivation by 1. allowing self-selection 2. providing access to a variety 3. actively involving children in sharing with others 4. identifying the personal interests of a child teachers can give this to students just to learn about them at Slide Deck 3.5: Using Interest Inventories with Children any age! can track motivation! Interest Inventory: self assessment tool; identify the personal interests a child base on age/interest all about me (short answer), circle response, parent input, parent can share w/ other ppl who work w/ child, so many types Children learn from everything they do, are naturally curious, want to explore and discover Exploration of their interests bring pleasure/success → they will want to learn more/do more Increase pleasure/success → increases motivation→ increases learning and participation minimum do one time per year if someone is struggling w/ motivation consider level of independence, instructional level, frustration level & learn more about them & adjust - interview parent, child, anyone who works w/ child  facilitating motivation is key motor persistence skills impacts learning motivation - ability to sustain voluntary action in absence of Slide Deck 3.6: Intrinsically Enhancing Motivation in Children reinforcement for reasonable length of time Motivation Enhances Motor Skill Learning: Considerations for Pediatric PTs (interest & enough Learning environment: MUST be structured with motivation in mind; Promote self-motivation challenge) Motivation influences: foster activity initiation (by child) and persistence (child begin & continue task) Role of Adults: help child enhance and maintain participation promoting self regulation Enhancing Intrinsic Motivation: 7 Strategies (1) Provide a developmentally appropriate environment (2) Allow sufficient time when working to allow for persistence (dont jump in too early) (3) Allow child to be as independent as possible (4) Provide many opportunities for child and adult to explore together and interact directly (5) Give an acceptable challenge (6) Give the child opportunities to evaluate her own accomplishments (promotes self eval, how do you think you did?) (7) Do not use excessive rewards not harmful for motivation enhance intrinsic motivation for low interest tasks dont have negative effect on intrinsic motivation Factors to Increase Intrinsic Motivation promote of achievement!!! intrinsic examples Promote a mastery climate just right challenge good job note from PT Provide positive feedback coupon choose fun activity Provide choice book of choice Promote goal setting explain to both parent/child lay sit stand during story time star of day Use competition wisely Provide a rationale for activities Promote social interactions substantial undermining effect on motivation Use rewards wisely: use Intrinsic, Non Tangible Rewards no prize boxes, coins to fun activity Slide Deck 3.7: Using Praise Effectively with Children Praise:form of positive reinforcement, combines attention + positive verbal statement; right after activity + reinforcement = pleasant event occurring immediately after behavior encouraging behavior to occur more in future Benefits of Effective Praise Strengthens behavior Builds self-esteem Promotes relationship development Leads to a more positive environment (ped PT goal) How to Praise: Use description, be specific (Great job Amy. I can see that you worked very hard on this Praise effort, not ability: Helps children notice connection between effort & improved performance Cater praise to a child’s age or grade level and preferences Praise with sincerity Promote independence Enhance skill without an overreliance on social comparisons Set achievable goals and expectations 4:1 ratio of behavior specific praise vs non specific praise child name, describe behavior good job improve child self esteem -> improve happiness/mental health -> increase intrinsic motivation -> enhance perseverance -> enhance skill  Slide Deck 3.8: Increasing Participation in Children Benefits of Participation Positive influence on health and quality of life Leads to life satisfaction and sense of competence Essential for a child’s development: psychological, emotional, & skill development Lack of participation…leads to poor health and quality of life How Increase Participation/Facilitate Meaningful Participation: Adults chooses tasks (a menu of therapeutic choices), child picks from menu, picks sequence Feeling of choice or control over the activity Supportive environment to facilitate attention to the activity Focus on the task Sense of challenge from the activity: “just right” challenge Sense of mastery: praise summary consider context in which child learns do tasks and activities develop friends find satisfaction PARTICIPATION key to development things to use to motivate visuals - choices for child, order/task timers games movement challenge - find object technology - music, video games mystery motivator - every time child gets clue  DPT 0619 Management Across the Lifespan: Pediatric Patient W3b Note Taking Guide for Lecture Slide Deck 3.9: Autism Spectrum Disorder: PT Management Exam: Overall Play skills Attention span and stamina Transition to new activities how, is it easy/hard Need for personal space Responses to sensory stimuli; touch, sound, etc. Repetitive behaviors Interactions between the child and caregivers Exam: Systems Review Musculoskeletal system o If toe-walking is present, assess ankle dorsiflexion ROM (increased sensory activity) Neuromuscular system o Strength and postural control o Hypotonia is common Sensory-motor and sensory processing Cardiovascular and pulmonary systems Specific concerns if child is obese or has a highly sedentary lifestyle Consider possible influence of medications Exam: Tests and Measures like fxnal tasks Muscle strength – observation or manual muscle testing if able Joint ROM Balance- static and dynamic Gait Assessment Standardized outcome measures looking for developmental delay Gross Motor and Balance Outcome Measures Test of Gross Motor Development-3rd edition (TGMD-3) developmental Movement Assessment Battery for Children-2 (MABC-2) Bruininks–Oseretsky Test of Motor Proficiency, 2nd edition (BOT-2) Pediatric Balance Scale kids berg Miller Function and Participation Scale (M-FUN) Functional Outcome Measures Pediatric Evaluation of Disability Inventory—Computer Adaptive Test (PEDI-CAT) School Function Assessment Participation Outcome Measures together to increase E Children’s Assessment of Participation and Enjoyment (CAPE) participation Preferences of Children (PAC) Child and Adolescent Scale of Participation (CASP) Assistance to Participation Scale (APS) Participation and Environment Measure from Children and Youth (PEM-CY) Evidence Related to Intervention Strategies Infants & toddlers may demonstrate age-appropriate gross motor skills, then decline in gross motor performance, “decline in rate of skill attainment” not actual regression or loss of skills Motor performance of children with ASD: lower than children matched for chronological age and cognitive level Early impairments: include impaired imitation, increased clumsiness, poor coordination early signs Evidence that children with ASD have impairments in motor imitation capabilities Decreased imitation skills during critical window of development 12-24 months of age Increased effort during imitation tasks; need more trials to complete Increased errors in motor movement during imitation tasks PT focus: functional skills and participation in daily life activities across all settings Intervention Strategies Know child’s preferences for communication & social interaction to increase opportunities for successful engagement Use a picture schedule – creates structure and a predictable environment Create opportunities for motor imitation and repetition of functional tasks Team-based development of goals based on child’s function in natural setting (school, home, community) Team-based strategies for behavior management Team-based strategies for regular physical activity (school-based team and family/caregivers at home and in the community) Adapted recreational activities in community to allow for structured PA opportunities with social and behavioral supports Intervention Strategies: Summary Developmental activities Physical activities to help with motor skills and functional skills Play activities to help with interaction and communication-home, school and work, community Adaptive strategies, including transitions PT focus: functional skills and participation in daily life activities across all settings