Rehabilitation and Children PDF

REHABILITATION AND CHILDREN Lifestage Development and Rehabilitation Week #2b Occupational Therapy “The art and science of enabling engagement in everyday living, through occupation; of enabling people to perform the occupations that foster health and well-being; of enabling a just and inclusive s...

REHABILITATION AND CHILDREN Lifestage Development and Rehabilitation Week #2b Occupational Therapy “The art and science of enabling engagement in everyday living, through occupation; of enabling people to perform the occupations that foster health and well-being; of enabling a just and inclusive society so that people may participate to their potential in the daily occupations of life.” (Townsend & Polatjko, 2007) Occupation refers to everything that people do during the course of everyday life - CAOT  OT cont… OT’s provide assessment and treatment for children to improve their ability to function and participate in everyday activities. OT services with children may include the assessment and treatment of feeding skills, swallowing safety, cognition, and engagement in daily life. These include: Productivity- play; school work Self-care- eating, dressing, bathing Leisure- participating in activities with friends and in their communities Occupational Therapists and OTAs work with children and their caregivers to evaluate and provide intervention in the following areas: Motor Skill Performance Social Participation Sensory Processing and Behavior Functional Mobility Feeding Activities of Daily Play Living/Adaptive Skills Assistive Technology Visual Perception/Visual Splints/Positioning Motor Skills Devices  Physiotherapy Physiotherapists (PT) provide assessment and treatment to children with movement dysfunction related to cardiorespiratory, neurological or musculoskeletal conditions. Their focus is to optimize movement potential and function in everyday activities. These may include: Movement through functional play Walking, stair climbing, and balance/proprioception activities Stretching, range of motion, strengthening Wheelchair recommendations, adaptation and usage Chest physiotherapy and breathing techniques Positioning  Rehabilitation Assessment of the Infant or Child Physiotherapist or Occupational Therapist will first evaluate/assess the child to determine needs and goals. This process may include: Occupational history & experiences Patterns of daily activity Observation of child performing occupations and activities Range of motion measurements Strength testing Balance testing Observation of motor patterning and coordination evaluation Determine child’s interests, values and needs Establish problems with regards to performing skills and occupations Establish occupational priorities Assessment cont… The therapist may determine therapeutic goals through: Direct contact with the child Chart reviews Conversations with the parents or guardian Conversations with the child Conversations with educators involved with the child Other health care professionals involved with the child Sample Developmental Assessment Tools: The Alberta Infant Motor Scale (AIMS) assesses gross infant motor skills from ages 0-18 months. It evaluates weight bearing, posture, and antigravity movements of infants. PDMS-2 is composed of six subtests (Reflexes, Stationary, Locomotion, Object Manipulation, Grasping, Visual-Motor Integration) that measure interrelated motor abilities of children from birth through age 5 years of age Alberta Infant Motor Scale PDSM-2 International Classification of Functioning, Disability and Health (ICF) Framework to guide clinical decision making Aids in identification of child and family strengths, and needs. Identifies home, community, environmental considerations Considers service availability and accessibility including family resources. Focus is on participation not disability.  When is a child typically referred to Occupational Therapy? Poor sensory regulation and organization Delayed gross and/or fine motor skills Poor pre-writing and handwriting skills Difficulty with motor planning and sequencing activities Delayed or limited repertoire of play skills Poor oral-motor control for feeding (sucking, chewing, swallowing) Delayed or limited self-care skills (i.e., managing clothing fastenings, self-feeding, preparing a simple snack, managing money) Limited social skills or behavioral-adaptive skills (i.e., coping skills, establishing friendships, cooperative play with peers) Direction of Intervention: Occupational Therapy Interventions can be directed at the person, the environment or the task. Intervention Directed at the Person: Motor skills- ROM, strength, posture, coordination, energy Processing skills- energy, knowledge, temporal organization, spatial organization, and adaptation used while completing a task. Communication/interaction skills- immature or ineffective interaction skills that interfere with a child’s ability to complete social interaction. Mental body functions- information processing skills such as: Visual memory- recall characteristics. If one has trouble putting info. Into short term memory it may not process into long term memory. Visual attention- helps us decide where to move our eyes to. What do we need to notice? Visual discrimination- ability to identify differences (ie. Between similar letters; between objects that are similar) Visual imagery- information that passes through the brain as though something is being perceived, when nothing is really happening- sight, sound, smell, touch  Direction of intervention cont… Interventions Directed at the Task: Altering the task such that the child can be successful. i.e. change a regular zipper to a large zipper for a child who has challenges with fine motor manipulation. Interventions Directed at the Environment: for example alter classroom or home such that the child can reach supplies or toys independently.  Play Play is the work of the child. Play occupies most of a child’s waking hours and serves to promote learning and adaptation. Children learn motor, social-emotional, language and cognitive skills through play. Consider this: A 1yr old child playing in a water sprinkler. - She bends down to feel the water in her hands- she is practicing motor planning, squatting, and balancing while feeling the tactile sensation of water on her hands. - She cups her hands on the sprinkler, she must coordinate her hands together to grasp the nozzle. Cognitively she pays attention to the water and tries to figure out what happens when she changes her hand position. The purposes of play includes: Develop/ improve muscular strength, coordination, & balance, and define body boundaries. Provide exercise Communicate with others, develop interpersonal relationships Learn cooperation and sharing Express imagination and initiative Investigate, and manipulate features of the world; sharpen senses and concentration Build self-esteem Intellectual, sensory, and language development Play is often used as a tool for skill development Play must encompass: Intrinsic motivation- drive to action for which the reward is the activity, rather than an external reward. Internal control-child is in control of the action and therefore the outcome. Freedom to suspend reality- pretend engages higher levels of cognitive functioning. Using play as a tool has many advantages: Children are typically willing to cooperate and engage in play. Most goals can be addressed during play because play encompasses a variety of activities. Communication & Teaching In order to provide optimal instruction, the therapist must consider the most appropriate method of communication for the individual and the desired outcome. Teaching/ Communication techniques: Context: Does the child need to perform the skill in a specific context or need to perform in a variety of situations? (i.e. a child may initially need to be able to ties their shoes for gym class, but eventually they need to be able to tie other types of shoe laces or bows on packages)  Teaching / CommunicationTechniques cont…. Directions: Therapist must decide what type of instruction will promote success for the child. Verbal Directions- must match the vocabulary used to the child’s verbal and cognitive comprehension level. Important not to use unnecessary or unrelated information as it may confuse or distract them. If the child has a hearing impairment, it is important not to distract them with printed material while they are watching the mouth movements of the speaker. Written or Pictorial Directions- useful when a child has difficulty processing verbal instruction, speaks a different language, or has a hearing impairment. Also helpful for skills or exercises to be complete at home or in a context without the therapist. Important that diagrams are clear and labeled.  Teaching / CommunicationTechniques cont… Demonstration- may be given with or without verbal direction. Important if giving verbal direction that it coincides with the demonstrated step. - Remember to provide instruction from the viewpoint of the child, ensure demonstration can be viewed and there are minimal environmental distractions. Instruction may also be video taped for review by the child or caregivers. Complexity of Directions- there are often numerous ways to complete a task. Therapist must consider one that is consistent with the habits, patterns and routines of the child. Multistep directions add to the complexity of the task. Is it possible to eliminate a step. Prompts:  may be physical, verbal, or observational stimulation while a task is being performed.  Prompts should be decreased gradually until the child no longer requires them. Physical prompts- full or partial assistance. - Hand over hand guidance for full assistance or light tapping for partial assistance. Verbal prompts- can be words or cues that remind the child of the task. Observational prompts- observe others perform skill and copy what they have observed. Feedback: Intrinsic- sensory information that comes from the body, such as feeling the movement or seeing the results. Extrinsic- from the environment or another person. Learning Strategies: Verbal rehearsal- child repeats instruction without performing the skill Checklist Memory notebook OT Case study: Physiotherapy for spastic CP case study- hydrotherapy