Sale!

Test Bank for Occupational Therapy for Children, 6th Edition : Case-Smith

Name: Test Bank for Occupational Therapy for Children, 6th Edition : Case-Smith
SKU: vcing142813
Availability: InStock

Original price was: $35.00.Current price is: $26.50.

Sell by: Hailey Warren

SKU: vcing142813 Category: Test Bank

Description

This is completed downloadable of Test Bank for Occupational Therapy for Children, 6th Edition : Case-Smith

Product Details:

ISBN-10 ‏ : ‎ 032305658X
ISBN-13 ‏ : ‎ 978-0323056588
Author: Jane Case-Smith

The sixth edition of Occupational Therapy for Children maintains its focus on children from infancy to adolescence and gives comprehensive coverage of both conditions and treatment techniques in all settings. Inside you’ll discover new author contributions, new research and theories, new techniques, and current trends to keep you in step with the changes in pediatric OT practice. This edition provides an even stronger focus on evidence-based practice with the addition of key research notes and explanations of the evidentiary basis for specific interventions.

Unique Evolve Resources website reinforces textbook content with video clips and learning activities for more comprehensive learning.
Case studies help you apply concepts to actual situations you may encounter in practice.
Evidence-based practice focus reflects the most recent trends and practices in occupational therapy.
Unique! Chapter on working with adolescents helps you manage the special needs of this important age group.
Unique! Research Notes boxes help you interpret evidence and strengthen your clinical decision-making skills.
Video clips on a companion Evolve Resources website reinforce important concepts and rehabilitation techniques.

Table of Content:

SECTION I Foundational Knowledge for Occupational Therapy for Children
CHAPTER 1 An Overview of Occupational Therapy for Children
OBJECTIVES
KEY TERMS
BEST PRACTICES IN OCCUPATIONAL THERAPY FOR CHILDREN
Child- and Family-Centered Practice
TABLE 1-1 Principles of Client-Centered Intervention
FIGURE 1-1 The family’s unique interests determine their priorities for spending time and resources. Occupational therapy services focus on the child’s ability to participate in valued family activities.
Comprehensive Evaluation
TABLE 1-2 Description of Comprehensive Evaluation of Children
Assessing Participation and Analyzing Performance
Ecologic Assessment
FIGURE 1-2 By evaluating the child at home, the therapist gathers information about how the family uses the child’s technology and how the child accesses home environments and participates in activities of daily living.
FIGURE 1-3 Through observation of a writing activity at school, the occupational therapist gains an understanding of the accommodations and supports needed as well as the child’s performance level.
Evaluating Context
Effective Interventions
Providing Interventions to Enhance Performance
Optimize Child’s Engagement
Provide a Just Right Challenge
FIGURE 1-4 A climbing wall activity challenged this child’s motor planning, bilateral coordination, strength, and postural stability.
FIGURE 1-5 Applying a sensory integration approach, the therapist gradually introduced the child with gravitational insecurity to unstable surfaces and higher levels of vestibular input.
CASE STUDY 1-1 Grading an Activity: Challenging and Eliciting Full Participation
Establish a Therapeutic Relationship
FIGURE 1-6 A hallway conversation helps to establish the therapist’s relationship with the child.
Provide Adequate and Appropriate Intensity and Reinforcement
FIGURE 1-7 In constraint-induced movement therapy, the child’s less involved arm was casted, and she received intensive therapy to build skills in the involved arm and hand.
Adapting Activities and Modifying the Environment
Interventions Using Assistive Technology
FIGURE 1-8 The occupational therapist designed a mouth stick and game board setup so that the child could play the game with his father.
FIGURE 1-9 A switch activates a computer program that simulates a storybook.
Environmental Modification
Consulting, Educating, and Advocating
Consultation Services
Education and Advocacy
Occupational Therapy Services That Support Inclusion
Early Intervention Services in the Child’s Natural Environment
FIGURE 1-10 The occupational therapist coaches the child’s mother to facilitate the child’s perceptual motor skills.
Inclusive Services in Schools
Flexible Service Delivery Models
FIGURE 1-11 Writing adaptations and peer support in the classroom promote the child’s writing performance.
BOX 1-1 Desired Inclusion Outcomes
Cross-Cultural Competence
Cultural Diversity in the United States
FIGURE 1-12 A father bonds with his just-born son.
Influence of Cultural Practices on a Child’s Development of Occupations
TABLE 1-3 Cultural Values and Styles That Influence Children’s Development of Occupations
Scientific Reasoning and Evidence-Based Practice
BOX 1-2 Steps in Evidence-Based Practice
STEP 1
STEP 2
STEP 3
STEP 4
STEP 5
Sensory Integration
Sensory Modalities
Play-Based, Relationship-Focused Interventions
BOX 1-3 Components of the Denver Model Intervention for Children with Autism
Family-Centered Care
SUMMARY
REFERENCES
CHAPTER 2 Foundations for Occupational Therapy Practice with Children
OBJECTIVES
KEY TERMS
OCCUPATIONAL THERAPY PRACTICE WITH CHILDREN
Concepts Influencing Occupational Therapy Practice with Children
Development
Participation in Occupations
FIGURE 2-1 The infant uses sensory motor play with mouth and hands to explore an object.
BOX 2-1 Best Practice Principles of Occupational Therapy to Promote Participation in Everyday Life
Environment
Risk and Resilience
FIGURE 2-2 The infant is motivated to seek and explore a new toy.
Family-Centered Service
World Health Organization International Classification of Functioning, Disability, and Health
FOUNDATIONAL THEORIES
Developmental Theories
Piaget and Cognitive Development
Vygotsky and the Zone of Proximal Development
Maslow and the Hierarchy of Basic Needs
Learning and Systems Theories
CASE STUDY 2-1 Example of Vygotsky: Scaffolding and the Zone of Proximal Development
Behavioral Theories
BOX 2-2 Example of Shaping Techniques
TABLE 2-1 Comparison of Discrete Trial Training and Incidental Teaching in Early Childhood Programs
FIGURE 2-3 In this example, the child selected the activity (finger painting) and the medium (shaving cream). The occupational therapist reinforces the child’s efforts to reach overhead with praise and touch.
Social Cognitive Theories
The Influence of Motivation and Self-Efficacy on Learning
Dynamic Systems Theory
MODELS OF PRACTICE USED BY OCCUPATIONAL THERAPISTS
TABLE 2-2 Principles of Dynamic Systems Theory Applied to Motor Development
FIGURE 2-4 A, Person-environment-occupation model. B, Person-environment-occupation analysis.
Specific Models of Practice
A Systems Approach
FIGURE 2-5 In this functional activity, a slant board is used to promote improved posture and grasp of the pencil. A weight on the pencil provides added proprioceptive input.
Cognitive Approaches
Adaptation and Compensation Interventions
Psychosocial Approaches
Coping Model
Internal and External Coping Resources
Effective Coping
FIGURE 2-6 Teaching yoga to a child with Asperger’s gives him a method to improve his coordination, agility, and bilateral integration. It also gives him a method for exercising that can reduce stress.
Social Skills Training
TABLE 2-3 Occupational Therapy Interventions Designed to Improve Social Skills
Motor Learning and Skill Acquisition
FIGURE 2-7 This activity of threading a string through hooks to create a design involves eye-hand coordination, dexterity, and control of arm in space (strength). It requires multiple steps to achieve a completed product.
FIGURE 2-8 In this task emphasizing bilateral coordination and hand strength, the therapist suggests an outcome but the child decides what she wants to create.
TABLE 2-4 Application of Motor Learning Concepts
Neurodevelopmental Theory
Sensory Integration
TABLE 2-5 Sensory Processing Disorder Categories
FIGURE 2-9 The child’s selection of jumping on an inner tube helps to meet his need for vestibular and proprioceptive input.
FIGURE 2-10 This child exhibits an adaptive response by pulling on the rope.
TABLE 2-6 Core Elements of Sensory Integration Intervention
Developmental Approaches
CLINICAL APPLICATION EXAMPLES
CASE STUDY 2-2 Stacey
TABLE 2-7 Assessments, Interventions, and Expected Outcomes for Stacey
CASE STUDY 2-3 Brian
TABLE 2-8 Assessments, Interventions, and Expected Outcomes for Brian
CASE STUDY 2-4 Chris
TABLE 2-9 Assessments, Interventions, and Expected Outcomes for Chris
REFERENCES
CHAPTER 3 Development of Childhood Occupations
OBJECTIVES
KEY TERMS
DEVELOPMENTAL THEORIES AND CONCEPTS
Neuromaturation
Development as an Interplay of Intrinsic and Environmental Factors
The Influence of Social Interaction
Dynamical Systems Theory
Perceptual Action Reciprocity
Functional Performance: Flexible Synergies
FIGURE 3-1 Hand-to-mouth movement is observed throughout the first year, first for sensory exploration of the mouth and hand and then as a feeding behavior.
FIGURE 3-2 By 7 to 8 months, an infant finger-feeds, prehending small food pieces and bringing hand to mouth.
How Do Children Develop New Performance Skills?
The Role of Motivation and Self-Efficacy
FIGURE 3-3 Infants play in supported standing for extended periods, gaining postural stability and balance when holding onto a stable surface.
Temperament and Emotional Development
Risk and Resiliency
AN OCCUPATIONAL THERAPY PERSPECTIVE
Development of Occupations
Contexts for Development
Cultural Contexts
Social Contexts
Physical Contexts
CHILDREN’S OCCUPATIONS, PERFORMANCE SKILLS, AND CONTEXTS
Infants: Birth to 2 Years
Play Occupations
BOX 3-1 Development of Play Occupations: Infants—Birth to 6 Months
PLAY OCCUPATIONS
Exploratory Play
Social play
PERFORMANCE SKILLS
Regulatory/Sensory Organization
Fine Motor/Manipulation
Gross Motor/Mobility
Cognitive
Social
BOX 3-2 Development of Play Occupations: Infants—6 to 12 Months
PLAY OCCUPATIONS
Exploratory Play
Functional Play
Social Play
PERFORMANCE SKILLS
Regulatory/Sensory Organization
Fine Motor/Manipulation
Gross Motor/Mobility
Cognitive
Social
BOX 3-3 Development of Play Occupations: Infants—12 to 18 Months
PLAY OCCUPATIONS
Relational and Functional Play
Gross Motor Play
Social Play
PERFORMANCE SKILLS
Regulatory/Sensory Organization
Fine Motor/Manipulation
Gross Motor/Mobility
Cognitive
Social
BOX 3-4 Development of Play Occupations: Toddlers—18 to 24 Months
PLAY OCCUPATIONS
Functional Play
Gross Motor Play
Pretend or Symbolic Play
Social Play
PERFORMANCE SKILLS
Regulatory/ Sensory Organization
Fine Motor/Manipulation
Gross Motor/Mobility
Cognitive
Social
Performance Skills
Sensory and Motor Skills
FIGURE 3-4 Inprone position, the infant shifts his weight from side to side when playing with toys; later he learns to pivot while prone to expand where he can reach and what he can visualize.
FIGURE 3-5 A, In dynamic sitting, the infant has sufficient postural stability to reach in all directions. B, By 10 months, the infant easily moves into and out of sitting positions.
FIGURE 3-6 Crawling on all fours allows the infant to explore new spaces. This form of mobility increases shoulder and pelvic stability for upright stance and promote the rotational patterns needed for ambulation.
FIGURE 3-7 Supported stance is a favorite play position for infants 8 to 11 months of age.
FIGURE 3-8 A, Grasping patterns evolve from palmar grasps without active thumb use to radial digital grasps as in B. C, At 4 months, the infant holds the object tight against the palm, with all fingers flexing as a unit. D, At 8 months, the infant holds objects in the radial digits.
Cognitive Skills
Social Skills
FIGURE 3-9 The 2-year-old boy engages in social play, imitating an adult, sequencing action, taking turns, and demonstrating understanding of object permanence on self.
Contexts of Infancy
Cultural Contexts
Physical Contexts
Early Childhood: Ages 2 to 5 Years
Play Occupations
BOX 3-5 Development of Play Occupations: Preschoolers—24 to 36 Months
PLAY OCCUPATIONS
Symbolic Play
Constructive Play
Gross Motor Play
Social Play
PERFORMANCE SKILLS
Regulatory/Sensory Organization
Fine Motor/Manipulation
Gross Motor/Mobility
Cognitive
Social
BOX 3-6 Development of Play Occupations: Preschoolers—3 to 4 Years
PLAY OCCUPATIONS
Complex Imaginary Play
Constructive Play
Rough-and-Tumble Play
Social Play
PERFORMANCE SKILLS
Fine Motor/Manipulation
Gross Motor/Mobility
Cognitive
Social
Performance Skills
Sensory and Motor Skills
BOX 3-7 Development of Play Occupations: Preschoolers—4 to 5 Years
PLAY OCCUPATIONS
Games with Rules
Constructive Play
Social Play; Dramatic Play
PERFORMANCE SKILLS
Fine Motor/Manipulative
Gross Motor/Mobility
Cognitive
Social
BOX 3-8 Development of Play Occupation: Kindergartners—5 to 6 Years
PLAY OCCUPATIONS
Games with Rules
Dramatic Play
Sports
Social Play
PERFORMANCE SKILLS
Fine Motor/Manipulation
Gross Motor/Mobility
Cognitive
Social
FIGURE 3-10 Four-year-old children complete puzzles and enjoy construction activities in small groups.
Cognitive Skills
Social Skills
Contexts
Cultural and Social Contexts
Physical Contexts
FIGURE 3-11 Special places and favorite play partners have high significance to young children.
Middle Childhood: Ages 6 to 10 Years
Play Occupations
FIGURE 3-12 Children seek opportunities to challenge their balance. By 9 and 10 years, postural stability and strength are sufficiently developed to maintain standing balance on a porch railing.
BOX 3-9 Development of Play Occupations: Middle Childhood—6 to 10 Years
PLAY OCCUPATIONS
Games with Rules
Crafts and Hobbies
Organized Sports
Social Play
PERFORMANCE SKILLS
Fine Motor/Manipulation
Gross Motor/Mobility
Cognitive
Social
Performance Skills
Sensory and Motor Skills
FIGURE 3-13 Favorite play activities for all children include swimming, ball play, and outdoor sports.
Cognitive Skills
Social Skills
Contexts
Cultural Contexts
Physical Contexts
SUMMARY
REFERENCES
CHAPTER 4 In Transition to Adulthood: The Occupations and Performance Skills of Adolescents
OBJECTIVES
KEY TERMS
ADOLESCENCE
ADOLESCENT DEVELOPMENT
CASE STUDY 4-1 My Sister Is a Teenager
FIGURE 4-1 Sisters Corinne and Caroline
BOX 4-1 Facts about American Teenagers
PHYSICAL DEVELOPMENT AND MATURATION
Physical Activities and Growth: Teenagers with Disabilities
PUBERTY
Psychosocial Development of Puberty and Physical Maturation
TABLE 4-1 Normal Development of Body Image
COGNITIVE DEVELOPMENT
PSYCHOSOCIAL DEVELOPMENT
The Search for Identity: Identity Formation
TABLE 4-2 Summary of the Typical Characteristics of Psychosocial Development
BOX 4-2 Being Disabled Is Not an Identity
Sexual Orientation: Gender Identity
Self-Concept and Self-Esteem
TABLE 4-3 Behavioral Indicators of Self-Esteem
Adolescence and Mental Health
BOX 4-3 Critical Health Behaviors of American Adolescents
ALCOHOL & DRUG USE
TOBACCO USE
INJURY & VIOLENCE (INCLUDING SUICIDE)
NUTRITION
PHYSICAL ACTIVITY
SEXUAL BEHAVIORS
AREAS OF OCCUPATION: PERFORMANCE SKILLS AND PATTERNS
Work: Paid Employment and Volunteer Activities
Work Opportunities for Adolescents with Disabilities
Instrumental Activities of Daily Living
Achieving Competencies in IADLs with a Disability
Leisure and Play
Social Participation
FIGURE 4-2 Examples of goal-directed activities. A, Baseball. B, Snowboarding. C, Basketball.
Peer Relationships
Navigating Social Participation with a Disability
CASE STUDY 4-2 Bullying: Nick’s Story
The Evolution of Adolescent-Parent Relationships
THE ENVIRONMENTS OF ADOLESCENCE
OCCUPATIONAL THERAPY TO FACILITATE ADOLESCENT DEVELOPMENT
BOX 4-4 Environmental and Contextual Factors of Healthy Adolescent Development
SUPPORT
EMPOWERMENT
BOUNDARIES AND EXPECTATIONS OF ADOLESCENTS
CASE STUDY 4-3 A Parent’s Reflections on Her Daughter’s High School and College Experiences
FIGURE 4-3 Brie and friends.
BOX 4-5 Eligibility for OT Services
CASE STUDY 4-4 Understanding that Development Is the Foundation of Effective Occupational Therapy Practice
SUMMARY
REFERENCES
CHAPTER 5 Working with Families
OBJECTIVES
KEY TERMS
REASONS TO STUDY ABOUT FAMILIES
BOX 5-1 Therapists’ Professional Responsibility in Light of Family Diversity
THE FAMILY: A GROUP OF OCCUPATIONAL BEINGS
BOX 5-2 Outcomes of Family Occupations
BOX 5-3 Family Resources
SYSTEM PERSPECTIVE OF FAMILY OCCUPATIONS
BOX 5-4 Key Concepts of a Family System Model
FIGURE 5-1 Matthew and his brother wait for the school bus.
FAMILY SUBSYSTEMS
Parents
FIGURE 5-2 Matthew’s family celebrates Dad’s birthday.
Siblings
FIGURE 5-3 A, Father enjoys holding his child while attending an early intervention program in the evening with his family. B, Playtime with Dad before bed.
FIGURE 5-4 Matthew and his brothers enjoy backyard play. A sandbox is a fail-proof medium that provides equal opportunity for multiple levels of play.
FIGURE 5-5 Although Matthew is the oldest of four boys, his younger brothers already take the initiative to help him participate. A round of miniature golf requires his brothers’ assistance, which does not detract from the fun.
Extended Family
FIGURE 5-6 Matthew’s grandparents enjoy their time with him and offer important support to his parents.
FAMILY LIFE CYCLE
Early Childhood
School Age
FIGURE 5-7 Matthew has an aide at school who supports his participation in both academic and nonacademic activities.
Adolescence
FAMILY RESOURCES AND THE CHILD WITH SPECIAL NEEDS
Financial Resources
Human Resources
Time Resources
Emotional Energy Resources
SOURCES OF DIVERSITY IN FAMILIES
Ethnic Background
Family Structure
Socioeconomic Status
Parenting Style and Practices
RESEARCH NOTE 5-1
ABSTRACT
OBJECTIVE/METHOD
RESULTS
CONCLUSIONS
IMPLICATIONS FOR PRACTICE
AN ECOLOGIC PERSPECTIVE
SUPPORTING PARTICIPATION IN FAMILY LIFE
Development of Independence in Self-Care and Health Maintenance Routines
FIGURE 5-8 Matthew’s bath time routine allows him to practice a range of skills, including play and social interaction.
FIGURE 5-9 A therapist gives the mother recommendations for increasing the child’s skills in self-feeding. Supportive positioning equipment and adapted feeding utensils make the task easier for the child and the mother.
Participation in Recreation and Leisure Activities
FIGURE 5-10 A, Recreational opportunities in the community provide an important family occupation. B, Matthew bowls with a friend.
FIGURE 5-11 A, Most skiing facilities have equipment for children unable to stand independently. B, Wee Can Ski provides equipment for children with a variety of disabilities.
FIGURE 5-12 Keith has a tennis lesson while Dad watches proudly.
FIGURE 5-13 A, Dad pulls his tired children through a theme park. B, Years later, Todd returns the favor.
FIGURE 5-14 Activity centers with soft mats, bolsters, balls, and tunnels for tumbling offer safe and accessible environments for children with physical disabilities.
Socialization and Participation in Social Activities
Fostering Readiness for Community Living
FAMILY ADAPTATION, RESILIENCE, AND ACCOMMODATION
PARTNERING WITH FAMILIES
Establishing a Partnership
TABLE 5-1 Cultural Considerations in Intervention Services
Providing Helpful Information
Providing Flexible, Accessible, and Responsive Services
Respecting Family Roles in Decision Making
COMMUNICATION STRATEGIES
HOME PROGRAMS: BLENDING THERAPY INTO ROUTINES
TABLE 5-2 Communication Methods between Parents and Professionals
WORKING WITH FAMILIES FACING MULTIPLE CHALLENGES
RESEARCH NOTE 5-2
ABSTRACT
OBJECTIVE
METHOD
RESULTS
CONCLUSION
IMPLICATIONS FOR PRACTICE
Families in Chronic Poverty
Parents with Special Needs
CASE STUDY 5-1 Family with Multiple Challenges
SUMMARY
REFERENCES
Appendix 5-A A Parent’s Perspective
INITIAL RESPONSE
ACCESSING SERVICES AND RESOURCES
WHOSE DISTRESS, WHOSE STRUGGLE?
WHERE DO WE GO FROM HERE?
SCHOOL
GIFTS AND DREAMS
CHAPTER 6 Common Conditions That Influence Children’s Participation
OBJECTIVES
KEY TERMS
CARDIOPULMONARY DYSFUNCTIONS
Congenital Heart Disease
FIGURE 6-1 Atrial septal defect.
FIGURE 6-2 Ventricular septal defect.
FIGURE 6-3 Tetralogy of Fallot.
Dysrhythmias
Neonatal Respiratory Problems
Asthma
Cystic Fibrosis
MUSCULOSKELETAL DISORDERS
Congenital Anomalies and Disorders
TABLE 6-1 Age at Onset Effects of Osteogenesis Imperfecta
FIGURE 6-4 Bilateral congenital talipes equinovarus. A, Before correction. B, Undergoing correction in plaster casts.
Limb Deficiencies
FIGURE 6-5 Child with multiple congenital limb deficiencies, including bilateral transverse upper arm deficiency and bilateral proximal femoral focal deficiency.
Juvenile Rheumatoid Arthritis
FIGURE 6-6 Components of a typical synovial joint.
Curvature of the Spine
FIGURE 6-7 Defects of the spinal column. A, Normal spine. B, Kyphosis. C, Lordosis. D, Normal spine in balance. E, Mild scoliosis in balance. F, Severe scoliosis not in balance. G, Rib hump and flank asymmetry seen in flexion caused by rotary component.
NEUROMUSCULAR DISORDERS
Cerebral Palsy
Classification of Cerebral Palsy
FIGURE 6-8 Limb involvement classification and severity in cerebral palsy: Left, Hemiplegia; middle, diplegia; right, tetraplegia or quadriplegia.
TABLE 6-2 Cerebral Palsy Classifications
Seizure Disorders and Epilepsy
Muscular Dystrophies
BOX 6-1 Emergency Treatment of Seizures
FIGURE 6-9 Initial muscle groups involved in muscular dystrophies. A, Pseudohypertrophic. B, Facioscapulohumeral. C, Limb-girdle.
FIGURE 6-10 Child with Gower’s sign.
Neural Tube Defects and Spina Bifida
FIGURE 6-11 Three forms of spina bifida.
CASE STUDY 6-1 Angela
Hydrocephalus
FIGURE 6-12 Ventriculoperitoneal shunt. Catheter is threaded subcutaneously from small incisions at the sites of ventricular and peritoneal insertions.
Peripheral Nerve Injuries
Birth Injuries
Traumatic Injury of Peripheral Nerves
TRAUMATIC BRAIN INJURIES
DEVELOPMENTAL DISABILITIES
Intellectual Disabilities
FIGURE 6-13 Criteria for determining the four degrees of severity in intellectual disabilities.
Autism Spectrum Disorders or Pervasive Developmental Disorders
Autism
Asperger’s Syndrome
Rett Syndrome
Attention Deficit–Hyperactivity Disorder
Learning Disabilities
Developmental Coordination Disorder
Genetic and Chromosomal Abnormalities
Chromosomal Disorders
Genetic Disorders
Inborn Errors of Metabolism
DIABETES
TOXIC AGENTS
Prenatal Toxins
Fetal Alcohol Syndrome Disorders
TABLE 6-3 Effects of Common Teratogens on the Developing Fetus and Child
FIGURE 6-14 Typical facial features of a child with fetal alcohol syndrome (FAS).
Cocaine and Opiates
Heavy Metals
INFECTIOUS CONDITIONS
Maternal Infections
TABLE 6-4 Intrauterine Infections (STORCH)
Acquired Immunodeficiency Syndrome
Encephalitis and Meningitis
BURNS
FIGURE 6-15 Estimation of distribution of burns in children. A, Children from birth to 5 years of age. B, Older children.
FIGURE 6-16 Classification of burn depth.
GENERAL DEVELOPMENTAL CONCERNS
Pediatric Obesity
Suicide and Depression
FIGURE 6-17 Body weight indexes. A, Boys. B, Girls.
SUMMARY
REFERENCES
Suggested Readings
SECTION II Occupational Therapy Evaluation in Pediatrics
CHAPTER 7 Purposes, Processes, and Methods of Evaluation
OBJECTIVES
KEY TERMS
EVALUATION PURPOSES
Comprehensive Evaluation for Intervention Planning
FIGURE 7-1 Family environment: parents playing with their two children at the park.
FIGURE 7-2 Fine motor materials from the Peabody Developmental Motor Scales-2 (PDMS-2) assessment tool.
Application
Screening
CASE STUDY 7-1 Kobe
FIGURE 7-3 Kobe learning to print his letters at school.
TABLE 7-1 Methods and Measures for Kobe’s Evaluation
FIGURE 7-4 Materials for the Developmental Test of Visual Perception (2nd ed.) (DTVP-2).
FIGURE 7-5 Materials for the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2).
FIGURE 7-6 Therapist interviewing an adolescent about her preference for assistive technology.
Eligibility and Diagnostic Purposes
Reevaluation Purposes
Clinical Research
FIGURE 7-7 A, Skilled observation of a child in supine flexion. B, Skilled observation of a child’s posture in a wheelchair.
BOX 7-1 Checklist for Skilled Observations of Neuromotor Status
CASE STUDY 7-2 Jason
FIGURE 7-8 Materials for the Sensory Integration and Praxis Tests.
EVALUATION PROCESS
Referral
Development of the Child’s Occupational Profile
FIGURE 7-9 Occupational therapy assistant evaluating children’s performance during a handwriting activity school.
FIGURE 7-10 Flowchart for the evaluation process using the Occupational Therapy Practice Framework.
Administration of Evaluation
TABLE 7-2 Selection of Appropriate Evaluation Methods
BOX 7-2 Checklist for Selection of Methods and Measures
Analysis of the Child’s Occupational Performance
Development of Recommendations Based on Evaluation Results
CASE STUDY 7-3 Occupational Therapy Evaluation Report for Kobe
BACKGROUND INFORMATION
REFERRAL INFORMATION
OCCUPATIONAL PROFILE
ASSESSMENTS USED
ASSESSMENT SITUATION
ASSESSMENT RESULTS
School Function Assessment
Observations of Neuromotor Status
Visual Perception
SUMMARY AND ANALYSIS OF OCCUPATIONAL PERFORMANCE
RECOMMENDATIONS
BOX 7-3 Behavior Strategies for Testing Young Children
Documentation of Evaluation Results and Recommendations
EVALUATION METHODS
Standardized Assessments
FIGURE 7-11 Materials for the evaluation of children’s handwriting.
FIGURE 7-12 A, Observation of child in his natural environment. B, Observation of peer interaction during play.
Ecologic Assessments
Skilled Observation
FIGURE 7-13 Observation of child performing a functional task at school.
Interviews
BOX 7-4 Basic Strategies for Interviewing Parents, Older Children, and Adolescents
Inventories and Scales
FIGURE 7-14 Examples of items from the Caregiver/Parent–Child Interaction Feeding Scale.
Arena Assessments
SUMMARY
REFERENCES
Appendix 7-A Common Measures Used in Pediatric Occupational Therapy
Adolescent/Adult Sensory Profile
Ages & Stages Questionnaires
Alberta Infant Motor Scale (AIMS)
Bayley Scales of Infant and Toddler Development (3rd Edition)
Bayley Scales of Infant and Toddler Development—Third Edition Motor Scale
Beery-Buktenica Developmental Test of Visual–Motor Integration, 5th Edition (BEERY VMI)
Bruininks-Oseretsky Test of Motor Proficiency (BOT-2)
Canadian Occupational Performance Measure (4th edition)
Child Occupational Self-Assessment (COSA)
Childhood Autism Rating Scale (CARS)
Children’s Assessment of Participation and Enjoyment (CAPE)
Denver Developmental Screening Test (Revised) (Denver-II)
Developmental Test of Visual Perception (Second Edition) (DTVP-2)
Developmental Test of Visual Perception—Adolescent and Adult
Early Coping Inventory
Evaluation Tool of Children’s Handwriting (ETCH)
FirstSTEP: Screening Test for Evaluating Preschoolers
Functional Independence Measure for Children (WeeFIM)
Gross Motor Function Measure (Revised) (GMFM)
Hawaii Early Learning Profile (HELP)
Home Observation for Measurement of the Environment (HOME)
Infant/Toddler Sensory Profile
Knox Preschool Play Scale (Revised)
Miller Function & Participation Scales
Motor-Free Visual Perception Test (MVPT-3)
NCAST Caregiver/Parent–Child Interaction Scales
Occupational Therapy Psychosocial Assessment of Learning (OT PAL)
Peabody Developmental Motor Scales (2nd edition) (PDMS-2)
Pediatric Evaluation of Disability Inventory (PEDI)
Pediatric Volitional Questionnaire (PVQ) (2.1)
Preferences for Activities of Children (PAC)
Quality of Upper Extremity Skills Test (QUEST)
School Function Assessment (SFA)
School Assessment of Motor and Process Skills (School AMPS)
Sensory Integration and Praxis Tests (SIPT)
Sensory Processing Measure (SPM)
Sensory Profile
The Short Child Occupational Profile (SCOPE) (2.2)
Test of Playfulness (ToP)
Test of Environmental Supportiveness (TOES)
Test of Visual-Motor Skills (Revised) (TVMS-R)
Test of Visual-Motor Skills—Upper Level (TVMS-UL)
Test of Visual–Perceptual Skills (Non-Motor) (TVPS-3)
Toddler and Infant Motor Evaluation (TIME)
Transdisciplinary Play-Based Assessment (TPBA)
CHAPTER 8 Use of Standardized Tests in Pediatric Practice
OBJECTIVES
KEY TERMS
INFLUENCES ON STANDARDIZED TESTING IN PEDIATRIC OCCUPATIONAL THERAPY
PURPOSES OF STANDARDIZED TESTS
Assistance with Medical or Educational Diagnoses
Documentation of Developmental and Functional Status
Planning of Intervention Programs
TABLE 8-1 Summary of Selected Pediatric Standardized Tests
TABLE 8-2 Developmental Domains Assessed in Four Screening Tools
Measurement Instruments for Research Studies
CHARACTERISTICS
TYPES OF STANDARDIZED TESTS
BOX 8-1 Calculating the Chronologic Age and Corrected Age
CALCULATING THE CHRONOLOGIC AGE
CALCULATING THE CORRECTED AGE
FIGURE 8-1 A therapist prepares to test a child on the broad jump item from the Bruininks-Oseretsky Test of Motor Proficiency 2.
FIGURE 8-2 Administration and scoring protocol for Bruininks-Oseretsky Test of Motor Proficiency 2, subtest 5, item 8.
FIGURE 8-3 A portion of the caregiver questionnaire for the Sensory Profile.
BOX 8-2 Administration and Assessment Procedures and Processes for Hawaii Early Learning Profile: Item 4.81—Snips with Scissors (23 to 25 Months)
BOX 8-3 Administration and Assessment Procedures and Processes for Hawaii Early Learning Profile Item 4.81—Snips with Scissors: Activity Guide Suggestions
TECHNICAL ASPECTS
FIGURE 8-4 One category of activity performance and corresponding rating scale for the School Function Assessment (SFA).
TABLE 8-3 Comparison of Norm-Referenced and Criterion-Referenced Tests
Descriptive Statistics
FIGURE 8-5 The normal curve and associated standard scores.
Standard Scores
Correlation Coefficients
Reliability
Test–Retest Reliability
Inter-rater Reliability
Standard Error of Measurement
Validity
Construct-Related Validity
Content-Related Validity
Criterion-Related Validity
TABLE 8-4 Correlations between the Sensory Profile and the School Function Assessment
Rasch Model of Measurement
BECOMING A COMPETENT TEST USER
Choosing the Appropriate Test
Learning the Test
Checking Inter-rater Reliability
FIGURE 8-6 A child performs a fine motor item from the PDMS-2.
FIGURE 8-7 Two therapists check their inter-rater reliability by scoring the same testing session.
TABLE 8-5 Raters’ Scores for Point-by-Point Agreement
Selecting and Preparing the Optimal Testing Environment
FIGURE 8-8 A child completes a portion of the visual-motor subtest of the Bruininks-Oseretsky Test of Motor Proficiency 2.
Administering Test Items
Interpreting the Test
BOX 8-4 Steps to Becoming a Competent Test User
Evaluating the Clinical Usefulness of the Test
ETHICAL CONSIDERATIONS IN TESTING
Examiner Competency
Client Privacy
Communication of Test Results
Cultural Bias
ADVANTAGES AND DISADVANTAGES OF STANDARDIZED TESTING
Advantages
Disadvantages
CASE STUDY 8-1 Caitlin
TEST RESULTS
OBSERVATIONS AND RECOMMENDATIONS
SUMMARY
RESEARCH NOTE 8-1
ABSTRACT
IMPLICATIONS FOR PRACTICE
REFERENCES
SECTION III Occupational Therapy Intervention: Performance Areas
CHAPTER 9 Application of Motor Control/Motor Learning to Practice
OBJECTIVES
KEY TERMS
FIGURE 9-1 Children playing involves a variety of motor skills.
CASE STUDY 9-1 Teagan
CASE STUDY 9-2 Georgia
CASE STUDY 9-3 Devin
BOX 9-1 Description of Developmental Coordination Disorder
MOTOR CONTROL: OVERVIEW AND DEFINITION
FIGURE 9-2 A and B, Children working on academics.
CASE STUDY 9-4 Rachel
BOX 9-2 Rood’s Sensory Techniques
DYNAMICAL SYSTEMS THEORY
FIGURE 9-3 Dynamical systems theory.
CASE STUDY 9-5 Teagan (cont’d)
Whole Learning
FIGURE 9-4 W-sitting.
Variability
FIGURE 9-5 A and B, Playing with blocks in varied positions promotes motor control.
Problem-solving
Meaning
DEVELOPMENT OF MOTOR CONTROL
FACTORS AFFECTING MOTOR PERFORMANCE
Social-Emotional Factors
FIGURE 9-6 Children can become frustrated when learning new motor skills or tasks.
Physical Factors
FIGURE 9-7 Sitting in an adapted seat with tabletop helps postural control.
CASE STUDY 9-6 Kiera
RELATING DYNAMICAL SYSTEMS THEORY TO BALANCE
Balance: An Overview
Sensory Organization and Control of Balance/Posture
Vestibular System
FIGURE 9-8 What is involved in posture/balance control?
CASE STUDY 9-7 Margi
Proprioceptive/Somatosensory Systems
Visual System
Intersensory Function
FIGURE 9-9 Sway and sensory conditions. 1 = visual, proprioceptive, and vestibular inputs all present and accurate; 2 = visual input is not available; 3 = conflicting visual information is present; 4 = ankle proprioception information is degraded; 5 = visual is not available and proprioceptive information is degraded; 6 = conflicting visual information is present, proprioceptive information is degraded.
Motor Coordination Aspects of Posture/Balance Control
Postural Reflexes
TABLE 9-1 Age of Postural Reactions Acquisition
Postural Synergies
Integrative Responses
Balance Control Issues in Children with Developmental Coordination Disorder
Vision and Proprioception
Improving Balance: Intervention
Primary Components
Body Movement
Use of Vision
External Base of Support
Secondary Components
Position of the Body
Internal Base of Support
Elevation
Examining Balance: Process Characteristics
VISION, VISUAL PERCEPTION, AND MOTOR CONTROL
BOX 9-3 Assessment of Balance
NON-STANDING BALANCE
STATIONARY AND MOVING UPRIGHT BALANCE
A Theoretical Perspective
Eye Movement Control
Tracking/Pursuit Movements
FIGURE 9-10 Williams’ checklist of process characteristics of balance performance.134
Fixation/Search Movements
Body Awareness and Motor Control
FIGURE 9-11 Schematic: components of body awareness.
Body Schema
Body Image
Body Awareness
Internal Aspects
FIGURE 9-12 Laterality refers to developing an understanding of both sides of the body and having a preferred side for tasks. Craft activities can be used to help children develop a sense of laterality.
FIGURE 9-13 Playing hopscotch requires balance.
External Aspects
INFLUENCE OF NON-MOTOR FACTORS
MOTOR LEARNING
Transfer of Learning
Sequencing and Adapting Tasks
BOX 9-4 Williams’ Motor Learning Principles
TRANSFER OF LEARNING
FEEDBACK
Modeling or Demonstration
Verbal Instructions
Knowledge of Results (KR) and Knowledge of Performance (KP)
DISTRIBUTION AND VARIABILITY OF SKILL PRACTICE
WHOLE VERSUS PART PRACTICE
MENTAL PRACTICE
TABLE 9-2 Grading and Adapting Activity
Practice Levels and Types
FIGURE 9-14 Distributed practice. A, Child begins to learn to swing with feet close to the ground and with frequent rests. B, As the child develops, she is able to swing with her feet off the ground, with few rests.
FIGURE 9-15 Variable practice. The child ties her shoes right before she goes outside to play. She is able to tie different sneakers and often she sits on the floor to complete the task.
RESEARCH NOTE 9-1
Error-Based Learning
Feedback
Knowledge of Performance
Knowledge of Results
Verbal Feedback
APPLICATION OF MOTOR CONTROL/LEARNING THEORY IN OCCUPATIONAL THERAPY PRACTICE
CASE STUDY 9-8 Paul
OCCUPATIONAL PROFILE
OCCUPATIONAL PERFORMANCE
SYSTEMS CONTRIBUTING TO PERFORMANCE
Environment
School
Neuromuscular
Sensory
INTERVENTION PLANNING
SUMMARY
REFERENCES
CHAPTER 10 Evaluation and Interventions to Develop Hand Skills
OBJECTIVES
KEY TERMS
COMPONENTS OF HAND SKILLS
CONTRIBUTIONS OF CONTEXT FACTORS TO HAND SKILLS
CONTRIBUTIONS OF BODY FUNCTIONS TO HAND SKILLS
Visual Skills
Somatosensory Functions
Sensory Integration
Visual Perception and Cognition
Skeletal Integrity
Muscle Function
GENERAL DEVELOPMENTAL CONSIDERATIONS
DEVELOPMENT OF HAND SKILLS
Reach and Carry
FIGURE 10-1 This typically developing child demonstrates reach with trunk rotation, full elbow extension, slight forearm rotation, and wrist stability, yet some degree of excess finger extension before grasp.
Grasp Patterns
Classification
FIGURE 10-2 A, Hook grasp used to carry a child’s art case. B, Power grasp with the right hand, used in cutting bread.
FIGURE 10-3 Lateral pinch with the right hand, used to open a lock on a door.
FIGURE 10-4 A, Pincer grasp, used to place “food” for the “climbing polar bears.” B, This child uses variations of a three-jaw chuck grasp with her right hand, depending on task demands.
FIGURE 10-5 Tip pinch with the right hand, used to complete a bead craft project. Normal radial grasps, such as the tip pinch, are accompanied by slight forearm supination.
FIGURE 10-6 Spherical grasp, used in preparation to throw a ball.
FIGURE 10-7 This child uses a cylindrical grasp with his left hand and a disk grasp with his right hand to open a jar. Note the grading of finger abduction with the left hand to provide adequate stability to the jar.
Sequential Development of Grasp Patterns
BOX 10-1 Approaches to Describing the Progression of Grasp Development
FIGURE 10-8 Ulnar-palmar grasp. The index finger and thumb are not used in this pattern.
FIGURE 10-9 This baby uses a radial-digital grasp with both hands to hold a toy for shaking and mouthing.
In-Hand Manipulation Skills
Classification
FIGURE 10-10 A,The child shows the ability to keep the palm in a cupped position to hold several stones for a game. The forearm is in almost full supination. B, Palm-to-finger translation with stabilization is initiated for one of the stones while the other stones are retained in the palm. The translation movement produced by the fingers is accompanied by forearm rotation into midposition. C, Palm-to-finger translation with stabilization is completed for one stone. The other stones are retained in the hand by flexion of the ulnar fingers. The forearm moves toward pronation to assist with placement of the stone on the game board.
Developmental Considerations
Voluntary Release
Bilateral Hand Use
FIGURE 10-11 A, Full finger extension and some wrist movement occur with voluntary release. Note the visual regard of the object being released. B, The child’s shoulder, elbow, and wrist are stable, and less finger extension occurs with release. The child visually monitors release of the object into a small container. C, Stability of the shoulder, elbow, forearm, wrist, and fingers combines with perceptual development to promote accurate placement of objects. This 5-year-old is able to use forearm supination to midposition with controlled finger extension. In this challenging task, only slight overextension of the fingers occurs.
Ball-Throwing Skills
Tool Use
Hand Preference
RELATIONSHIP OF HAND SKILLS TO CHILDREN’S OCCUPATIONS
Play
Activities of Daily Living
FIGURE 10-12 A, Different grasp patterns are used in preparation for putting toothpaste on a toothbrush. The child uses just-right force to stabilize the toothbrush with a modified power grasp (with supination to midposition) while using a cylindrical grasp on the toothpaste container. B, The child has used forearm supination and the in-hand manipulation skill of simple rotation to position the toothpaste container for application of the toothpaste to the toothbrush.
FIGURE 10-13 A, The child grasps the spoon from the table surface with a radial-digital grasp. The forearm is slightly supinated. B, He uses the in-hand manipulation skill of complex rotation to move the handle of the spoon from the palmar surface of his hand toward the web space between the index finger and thumb. Isolation and differentiation of the index finger and thumb are needed to produce this rotation. Forearm movement toward midposition assists. C, The child completes spoon positioning in his hand by moving the spoon so that the end of the handle is stabilized in the web space. Additional flexion of the metacarpophalangeal (MCP) joints of the fingers while extension of the interphalangeal (IP) joints is sustained assists with optimal positioning for eating.
School Functions
GENERAL MOTOR PROBLEMS THAT AFFECT HAND SKILLS
FIGURE 10-14 A, This child, who has involuntary movement, demonstrates the attempt to find stability by locking her left elbow with the arm in extension and by elevating her right shoulder during hand use. She also has difficulty isolating upper extremity movements and using the two hands together at midline. B, During voluntary release this child shows overextension and increased abduction of the fingers, with hyperextension at the MCP joints of the ulnar fingers. He also shows adduction of the thumb rather than slight abduction.
FIGURE 10-15 Poor trunk stability affects the upper extremity range of motion that this child can use. Note the right forearm pronation and wrist flexion. The child is unable to use a three-jaw chuck, or pincer, grasp effectively on the materials. However, she demonstrates awareness of the need to use both hands in this manipulative activity and good visual monitoring of the materials.
OTHER FACTORS THAT AFFECT HAND SKILLS IN CHILDREN WITH DISABILITIES
Somatosensory Problems
Learned Nonuse Phenomenon in Children with Hemiplegia
Hand Skill Problems in Children and Adolescents with Various Developmental Difficulties
Differences in Developmental Trends between Children with and without Disabilities
RESEARCH NOTE 10-1
ABSTRACT
IMPLICATIONS FOR PRACTICE
EVALUATION OF HAND SKILLS IN CHILDREN
Screening for Hand Skill Problems
Evaluation Content
TABLE 10-1 Screening Activities for Hand Skills
BOX 10-2 Problem: Inability to Engage Effectively in Constructive Play (Performance Problems, Body Function Factors, and Causes)
GUIDELINES FOR INTERVENTION
Setting Goals
Considering Roles of the Occupational Therapy Assistant and Others in Intervention
Sequencing of Intervention Sessions
Preparation for Hand Skill Development
Positioning the Child
FIGURE 10-16 This child is seated at a table that is an appropriate height for tabletop activities. She can effectively place her arms on the surface without elevating her shoulders. Arm support on the surface, elbow flexion, and handing her the candles in a vertical position rather than having her grasp them from a table surface encourages the child’s use of forearm supination and fingertip control during grasp and placement of the candles on the clay birthday cake.
Improving Postural Tone and Control
Improving Muscle Strength
Development of Hand Skills
Promoting Isolated Arm and Hand Movements
RESEARCH NOTE 10-2
ABSTRACT
IMPLICATIONS FOR PRACTICE
Enhancement of Reach and Carry Skills
Problems
Goals
Intervention Strategies
BOX 10-3 Typical Sequence of Reaching Patterns Used to Enhance Shoulder Flexion, Neutral Rotation, and Elbow Extension*
FIGURE 10-17 Facilitation is provided to prompt use of slight humeral external rotation and forearm supination. The object is held vertically to assist this reaching pattern. A lotto card game is used to engage the child and allow for repetition of the pattern.
Enhancement of Grasp Skills
Problems
FIGURE 10-18 When this child combines reach with grasp, he demonstrates significant difficulties with effective hand positioning. Note the slight wrist flexion, the thumb adduction with IP joint extension, and the finger MCP joint hyperextension with IP flexion that he uses in an attempt to achieve stability with this grasp. The arm positioning in abduction and internal rotation (not shown) contribute to use of this grasp pattern.
Goals
Intervention Strategies
Children with Severe Disabilities
Children with Moderate Disabilities
FIGURE 10-19 A, The child shows the ability to use a controlled radial-digital grasp pattern with the wrist in a neutral position, thumb opposition, and appropriate finger flexion when he is not asked to combine reach with grasp. Note that the therapist’s presentation of the object helps ensure that the child will grasp the object with his fingertips. Her grasp also ensures that the object remains stable while the child initiates the grasp pattern. B, The child practices grasping from the therapist’s hand. His arm is stabilized on his leg during this grasp. The therapist’s hand provides some degree of stability to prevent the object from moving during initiation of grasp.
Children with Mild Disabilities
FIGURE 10-20 The child uses a substitution for a standard pincer grasp or tip pinch. Note that with slight adduction of the thumb, the pad of the thumb is more aligned with the middle finger than the index finger. The index finger is slightly too flexed to participate in the grasp.
Enhancement of Voluntary Release Skills
Problems
Goals
Intervention Strategies
FIGURE 10-21 Positioning materials to elicit elbow extension during release encourages the child’s use of wrist extension.
Enhancement of In-Hand Manipulation Skills
Problems
Goals
Intervention Strategies
Children with No In-Hand Manipulation Skills
Children with Beginning In-Hand Manipulation Skills
BOX 10-4 In-Hand Manipulation Activities
PREPARATION ACTIVITIES
SPECIFIC IN-HAND MANIPULATION ACTIVITIES
Children with Basic In-Hand Manipulation Skills
FIGURE 10-22 The peg has been placed in the child’s hand upside down to encourage rotation prior to placement in the game board.
Facilitation of Bilateral Hand Use Skills
Problems
Goals
FIGURE 10-23 A, The child is forming a picture with a set of puzzle blocks. He is encouraged to find the side of the block that fits the design being constructed. The therapist has placed the correct side of the block against the palm of his hand so that he must use complex rotation to find it. B, Prior to using the in-hand manipulation skill of complex rotation, the child must use palm-to-finger translation to move the block toward the distal finger surface. In that process the block begins to be turned. C, Having identified the correct side, the child shifts the object out to the pads of the fingers prior to placement with the other blocks.
Intervention Strategies
Children with Severe Disabilities
FIGURE 10-24 A, This child shows the bilateral skill of stabilizing with a refined grasp with her left hand while placing a penny in the bank with her right hand. Note the appropriate use of force in holding both objects. B, Bilateral manipulation occurs with both hands in this construction activity. The child uses modifications of the power grasp with different forearm positions on the right and left while connecting two parts of the toy.
Children with Moderate Disabilities
Children with Mild Disabilities
Children with Muscle Weakness
Group Intervention for Children with Hand Skill Problems
Generalization of Skills into Functional Activities
RESEARCH ON INTERVENTION FOR HAND SKILL PROBLEMS
Constraint-Induced Movement Therapy for Children with Hemiplegic Cerebral Palsy
SPLINTING
Precautions and Indications for Splint Use
TABLE 10-2 Evidence Table and Research Summary: Constraint-Induced Movement Therapy (CIMT) & Hand-Arm Bimanual Intensive Training (HABIT)
Types of Splints Used with Children
FIGURE 10-25 A, Dorsal splint to support the wrist in extension for stability or to control a mild to moderate pull into flexion. The hand section can be molded to support the palmar arch. B, Short opponens thumb splint made of a thermoplastic material. A similar design can be made with Neoplush. C, A Neoplush thumb splint is worn with orthokinetic cuffs on the forearm and upper arm. Both orthokinetic cuffs are designed to promote extension and inhibit flexion. The active area of the cuff on the forearm is over the wrist and finger extensors. The active area on the cuff on the upper arm is over the triceps.
SUMMARY
REFERENCES
CHAPTER 11 Sensory Integration
OBJECTIVES
KEY TERMS
SENSORY INTEGRATION IN CHILD DEVELOPMENT
NEUROBIOLOGICALLY BASED CONCEPTS
Sensory Support for Development and Brain Function
Adaptive Response
FIGURE 11-1 Adaptive responses help the child acquire skills such as riding a bicycle. Although training wheels reduce the challenge for this boy, his nervous system must integrate vestibular, proprioceptive, and visual information adequately for him to successfully steer the bicycle while it is moving.
Neural Plasticity
Central Nervous System Organization
SENSORY INTEGRATIVE DEVELOPMENT AND CHILDHOOD OCCUPATIONS
Prenatal Period
Neonatal Period
FIGURE 11-2 Tactile sensations play a critical role in generating feelings of security and comfort in the infant and are influential in emotional development and social relationships throughout the lifespan.
First 6 Months
FIGURE 11-3 Strong inner drive to master gravity is evident in this infant’s efforts to lift his head and shoulders off the floor. This is an early form of the prone extension posture.
Second 6 Months
FIGURE 11-4 Because somatosensory processing and visual-motor coordination strongly influence self-feeding skills, sensory integration is an important contributor to the development of dining, a fundamental occupation.
Second Year
FIGURE 11-5 As motor planning develops during the second year of life, the infant experiments with a variety of body movements and learns how to transition easily from one position to another. These experiences are thought to reflect the development of body scheme.
Third through Seventh Years
FIGURE 11-6 Adaptive responses involved in this activity require precise tactile feedback and sophisticated praxis. During activities such as this one, the preschooler becomes adept at handling tools and objects that are encountered in daily occupations throughout life.
FIGURE 11-7 By the time a child reaches school age, sensory integrative capacities are almost mature. The child now can devote full attention to the demands of academic tasks because basic sensorimotor functions, such as maintaining an upright posture and guiding hand movements while holding a tool, have become automatic.
WHEN PROBLEMS IN SENSORY INTEGRATION OCCUR
RESEARCH BASE FOR SENSORY INTEGRATIVE PROBLEMS
TABLE 11-1 Purpose, Methods, Results, and Contributions of Studies of Sensory Integrative Patterns
TABLE 11-2 Factors and Clusters Identified in Research
SENSORY INTEGRATIVE PROBLEMS
Sensory Modulation Problems
FIGURE 11-8 Continuum of sensory responsivity and orientation.
FIGURE 11-9 Dunn’s Model of Sensory Processing.
Sensory Registration Problems
FIGURE 11-10 Miller et al.’s (2001) Ecological Model of Sensory Modulation. Light shading, underresponsivity; medium shading, normal responsivity (a match between the external and internal dimensions); dark shading, overresponsivity; darkest shading, lability, severe overresponsivity alternating with severe underresponsivity.
Sensation-Seeking Behavior
Overresponsiveness
Tactile Defensiveness
Gravitational Insecurity
Overresponsiveness in Other Sensory Modalities
Sensory Discrimination and Perception Problems
Tactile Discrimination and Perception Problems
Proprioception Problems
Visual Perception Problems
Other Perceptual Problems
Vestibular-Proprioceptive Problems
Praxis Problems
Secondary Problems Related to Sensory Integrative Difficulties
ASSESSMENT OF SENSORY INTEGRATIVE FUNCTIONS
Interviews and Questionnaires
FIGURE 11-11 Because parents know their child better than anyone else, they are invaluable sources of information to the therapist, especially in beginning phases of the assessment process.
Informal and Formal Observations of the Child
Informal Observations
Clinical Observations
BOX 11-1 Examples of Commonly Used Clinical Observations
Standardized Testing
TABLE 11-3 Functions Measured by the Sensory Integration and Praxis Tests
FIGURE 11-12 The Constructional Praxis Test is 1 of 17 tests of the Sensory Integration and Praxis Tests (SIPT). The SIPT must be administered individually with strict adherence to standardized procedures.
Consideration of Available Services and Resources
Interpretation of Assessment Findings
RESEARCH NOTE 11-1
OBJECTIVES
METHOD
RESULTS
CONCLUSION
IMPLICATIONS FOR PRACTICE
INTERVENTIONS FOR CHILDREN WITH SENSORY INTEGRATIVE PROBLEMS
BOX 11-2 Guiding Principles from Ayres Sensory Integration® (ASI®) Theory
Individual Ayres Sensory Integration® (ASI) Intervention
CASE STUDY 11-1 Karen
HISTORY
REASON FOR REFERRAL
EVALUATION PROCEDURE
EVALUATION RESULTS
RECOMMENDATION
OCCUPATIONAL THERAPY PROGRAM
FIGURE 11-13 Individual ASI intervention requires the therapist to attend closely to the child on a moment-by-moment basis to ensure that therapeutic activities are individually tailored to changing needs and interests of the child.
FIGURE 11-14 Rather than passively imposing vestibular input on the child, classic sensory integration treatment emphasizes active participation and self-direction of the child.
FIGURE 11-15 The setting in which classical sensory integration treatment takes place provides a variety of sensory experiences. Immersion in a pool of balls presents challenges to sensory modulation.
Training in Specific Skill Development
Group Intervention
BOX 11-3 Expected Outcomes of Ayres Sensory Integration® (ASI®) Intervention
FIGURE 11-16 Group programs provide opportunities for children with sensory integrative disorders to develop coping skills that help them function in social context with peers.
Consultation on Modification of Activities, Routines, and Environments
CASE STUDY 11-2 Drew
HISTORY
REASON FOR REFERRAL
EVALUATION PROCEDURE
EVALUATION RESULTS
RECOMMENDATION
OCCUPATIONAL THERAPY PROGRAM
FIGURE 11-17 Consultation in school involves joint problem solving between the occupational therapist and the teacher.
Expected Outcomes of Occupational Therapy
Increase in the Frequency or Duration of Adaptive Responses
Development of Increasingly More Complex Adaptive Responses
Improvement in Gross and Fine Motor Skills
Improvement in Cognitive, Language, or Academic Performance
Increase in Self-Confidence and Self-Esteem
Enhanced Occupational Engagement and Social Participation
Enhanced Family Life
Measuring Outcomes
Research on Effectiveness of Intervention
RESEARCH NOTE 11-2
OBJECTIVES
METHOD
RESULTS
CONCLUSION
IMPLICATIONS FOR PRACTICE
REFERENCES
CHAPTER 12 Visual Perception
OBJECTIVES
KEY TERMS
DEFINITIONS
THE VISUAL SYSTEM
Anatomy of the Eye
FIGURE 12-1 Cross-section of the eye.
Visual-Receptive Functions
Visual-Cognitive Functions
Visual Attention
Visual Memory
Visual Discrimination
Object (Form) Perception
Spatial Perception
Visual Imagery
Motor and Process Skills
Developmental Framework for Intervention
FIGURE 12-2 Hierarchy of visual-perceptual skills development.
DEVELOPMENTAL SEQUENCE
Visual-Receptive Functions
Visual-Cognitive Functions
Object (Form) Vision
TABLE 12-1 Developmental Ages for Emergence of Visual-Perceptual Skills
Spatial Vision
Role of Vision in Social Development
VISUAL-PERCEPTUAL PROBLEMS
Visual-Receptive Functions
Refractive Errors
Visual-Cognitive Functions
Attention
FIGURE 12-3 Checklist of observable clues to classroom vision problems.
Memory
Visual Discrimination
Object (Form) Vision
Spatial Vision
Diagnoses with Problems in Visual Perception
Effects of Visual-Perceptual Problems on Performance Skills and Occupations
Problems in Reading
Problems in Spelling
Problems in Handwriting and Visual Motor Integration
Problems in Mathematics
EVALUATION METHODS
Evaluation of Visual-Receptive Functions
TABLE 12-2 Vision Screening Tests
Evaluation of Visual-Cognitive Functions
Visual-Spatial Tests
Visual-Perceptual Tests
Visual-Motor Integration Tests
INTERVENTION
Theoretical Approaches
BOX 12-1 Compensatory Instruction Guidelines
Intervention Strategies
Infants
Preschool and Kindergarten
FIGURE 12-4 Kyle making letters with clay.
Elementary School
Organizing the Environment
FIGURE 12-5 Todd in a study carrel.
Visual Attention
FIGURE 12-6 Alternate positions for visual-perceptual activities.
FIGURE 12-7 Todd uses a mask to uncover one line at a time.
Visual Memory
Visual Discrimination
CASE STUDY 12-1 Todd
Decoding Problems in Reading
Visualization
Learning Styles
FIGURE 12-8 Diagnostic learning styles.
BOX 12-2 Suggestions for Tactile and Kinesthetic Learners
TABLE 12-3 Matching Reading Methods to Perceptual Strengths
Visual-Motor Integration
BOX 12-3 Postulates for Change
Computers
SUMMARY
TABLE 12-4 Evidence of Visual-Perceptual and Visual-Motor Treatment
REFERENCES
Appendix 12-A Publications for Classroom Activities
COMPUTER PROGRAMS
CHAPTER 13 Psychosocial Issues Affecting Social Participation
OBJECTIVES
KEY TERMS
TEMPERAMENT: A “PERSON” FACTOR THAT INFLUENCES AND IS INFLUENCED BY THE ENVIRONMENT
CASE STUDY 13-1 Theresa
ATTACHMENT: A DYNAMIC INTERACTION OF BIOLOGY AND ENVIRONMENT
FIGURE 13-1 Temperament types: easy, difficult, and slow-to-warm up child.
TABLE 13-1 Patterns of Attachment in Infants and Parents
CHILD ABUSE AND NEGLECT: PROBLEMS WITH THE PARENT-CHILD RELATIONSHIP AND ENVIRONMENT
TABLE 13-2 Risk Factors for Child Abuse
ENVIRONMENTAL FACTORS AND SOCIAL PARTICIPATION
BOX 13-1 Environmental Stress and Its Effects on Children
TIME-LIMITED ENVIRONMENTAL STRESS FACTORS*
LONG-TERM ENVIRONMENTAL STRESS FACTORS*
Time-Limited Environmental Stress and Its Impact on Occupational Performance
CASE STUDY 13-2 Brooke
Chronic Environmental Stress and Its Impact on Occupational Performance
MENTAL HEALTH FACTORS AFFECTING SOCIAL PARTICIPATION
CASE STUDY 13-3 Marcus
SELECTED MENTAL DISORDERS COMMONLY AFFECTING CHILDREN AND ADOLESCENTS
Mood Disorders
Anxiety Disorders
Attention Deficit Disorder
Disruptive Behavior Disorders
Autism Spectrum Disorders
The Occupational Therapist’s Role Relative to Psychotropic Medication
PRACTICE ENVIRONMENTS
Early Childhood Intervention Programs
Public School Systems
TABLE 13-3 Settings for Psychosocial Treatment of Children and Adolescents
CASE STUDY 13-4 Vanessa
CASE STUDY 13-5 Dylan
Mental Health Services
BOX 13-2 Examples of Activity-Based Intervention for Students with Emotional Disturbances
CASE STUDY 13-6 Mario
Residential Treatment Centers
CASE STUDY 13-7 The Diners’ Club
Juvenile Corrections
Inpatient Psychiatric Hospitals
EVALUATION AND INTERVENTION
Evaluation
Intervention
FIGURE 13-2 Pre-Assessment Checklist for Teachers (Revised).
RESEARCH NOTE 13-1
ABSTRACT
IMPLICATIONS FOR PRACTICE:
CASE STUDY 13-8 Max
TABLE 13-4 Levels of Social Appropriateness and Rational Intervention
SUMMARY
CASE STUDY 13-9 Brenda
BOX 13-3 Response Options in Rational Intervention
FACILITATION
MONITORING
GENTLE CORRECTION
MODERATE CORRECTION
STRONG CORRECTION
REFERENCES
CHAPTER 14 Interventions and Strategies for Challenging Behaviors
OBJECTIVES
KEY TERMS
STRATEGIES FOR MANAGING DIFFICULT BEHAVIOR
Behavior Happens
Purposes
CASE STUDY 14-1 Sam and Eli
Being Prepared for Problem Behavior
Ruling Out Pain or Illness
Establishing Predictability and Consistency
Creating a Calm Atmosphere
TABLE 14-1 Selected Single-Subject-Design Studies of Behavior Management Interventions
BOX 14-1 Factors That Influence Behavior
INTERNAL FACTORS
EXTERNAL FACTORS
Attending to Appropriate Behaviors
Using “Do” Statements
Keeping Perspective
BEHAVIOR MANAGEMENT APPROACHES
Preventing Challenging Behavior
Minimizing Aversive Events
Sharing Control
Providing an Environment That Promotes Successful Engagement
CASE STUDY 14-2 Dominic
Increasing Communication Effectiveness
Clarifying Expectations
Supporting Self-Regulation
BOX 14-2 Environmental Modifications to Support Self-Regulation
Matching Demands to Abilities
SUPPORT POSITIVE BEHAVIOR
General Strategies
Meeting Sensory Needs
Building New Skills
Specific Strategies
Increasing Compliance Through Contingency Methods
CASE STUDY 14-3 Stephen
BOX 14-3 Skills That Promote Social Participation
Token Economies
Positive Reinforcement
CASE STUDY 14-4 Stephen
Alternate Preferred and Nonpreferred Activities
CASE STUDY 14-5 Anastasia
Addressing Transitions
General Support Strategies
CASE STUDY 14-6 Meg
INTERVENE WHEN CHALLENGING BEHAVIORS ALREADY EXIST
SUMMARY
CASE STUDY 14-7 Jessie
REFERENCES
CHAPTER 15 Feeding Intervention
OBJECTIVES
KEY TERMS
FEEDING: DEFINITION AND OVERVIEW
The Role of the Occupational Therapist
THE MEALTIME: AN OVERVIEW
Contextual Influences on Mealtime
Personal Influences on Mealtime
DEVELOPMENTAL SEQUENCE OF MEALTIME PARTICIPATION
Progression of Mealtime Participation
Development of Oral Structures
TABLE 15-1 Functions of Oral Structures in Feeding
FIGURE 15-1 Anatomic structures of the mouth and throat.
BOX 15-1 Cranial Nerves for Oral Sensory Motor Function
Phases of Swallowing
ORAL MOTOR DEVELOPMENT ASSOCIATED WITH EATING SKILLS
Coordination of Sucking, Swallowing, and Breathing
TABLE 15-2 Developmental Sequence of Eating Skills
Biting and Chewing
Self-Feeding
TABLE 15-3 Developmental Continuum in Self-Feeding
Drinking
EVALUATION
Feeding Problems: An Overview
FIGURE 15-2 Using a straw to drink requires lip pursing and active lip seal.
BOX 15-2 Feeding History and Caregiver Concerns
Neuromotor Evaluation
Examination of Oral Structures and Oral Motor Patterns
Eating and Feeding Performance
Videofluoroscopic Swallow Study (VFSS)
Medical Conditions Affecting Eating
Contextual Factors
BOX 15-3 Guiding Questions to Evaluate the Contexts for Feeding
PHYSICAL
SOCIAL
TEMPORAL
CULTURAL
INTERVENTION: GLOBAL CONSIDERATIONS
Safety and Health
INTERVENTION STRATEGIES
Environmental Adaptations
Positioning Adaptations
FIGURE 15-3 Face-to-face positioning for feeding.
FIGURE 15-4 Tumble Forms Feeder Chair offers support and an adjustable feeding angle.
FIGURE 15-5 Rifton chair provides a firm base of support to trunk and feet during self-feeding.
Interventions for Sensory Problems
Neuromuscular Interventions for Oral Motor Impairments
FIGURE 15-6 Using a resistive device to improve oral motor skills for advanced food textures.
Adaptive Equipment
RESEARCH NOTE 15-1
ABSTRACT
IMPLICATIONS FOR PRACTICE
Modifications to Food and Liquid Properties
BOX 15-4 Liquid Consistencies Categorized from Thinnest to Thickest
TABLE 15-4 Food Progression Based on Texture and Consistency
BOX 15-5 Levels of Food Texture for Dysphagia Management
Behavioral Interventions
Interventions to Improve Self-Feeding
FIGURE 15-7 The therapist supports and guides the child’s hand during self-feeding using the thumb on hand dorsum and finger in his palm.
INTERVENTION: SPECIFIC REFERRAL PROBLEMS AND MEDICAL DIAGNOSES
Dysphagia
RESEARCH NOTE 15-2
ABSTRACT
IMPLICATIONS FOR PRACTICE
Food Refusal or Selectivity
Delayed Transition to Textured Foods
Delayed Transition from Bottle to Cup
BOX 15-6 Foods Indicated and Contraindicated for Children with Immature Oral-Motor Skills
PROPERTIES OF INDICATED FOODS
PROPERTIES OF CONTRAINDICATED FOODS
FIGURE 15-8 Jaw control and oral support. A, From the side. B, From the front.
Cleft Lip and Palate
FIGURE 15-9 Infant using Habermann feeder.
Other Structural Anomalies
TABLE 15-5 Nipple Characteristics Related to Use with Children Who Have Oral Structural Defects
Transition from Nonoral Feeding to Oral Feeding
SUMMARY
CASE STUDY 15-1 Marco
EVALUATION FINDINGS
INTERVENTION
DISCHARGE STATUS
REFERENCES
CHAPTER 16 Activities of Daily Living
OBJECTIVES
KEY TERMS
IMPORTANCE OF DEVELOPING ADL OCCUPATIONS
FACTORS AFFECTING PERFORMANCE
Child Factors and Performance Skills
Performance Environments and Contexts
Personal and Temporal Contexts: Family Life Cycle and Developmental Stage
CASE STUDY 16-1 Karina
FIGURE 16-1 Partial participation. This child partially participates in hair combing and picks out her barrettes while therapists support her in her hospital bed.
Social Environment
Cultural Context
Physical Environment
Virtual Context
Activity Demands
EVALUATION OF ADLS
Evaluation Methods
TABLE 16-1 Instruments for Assessing ADL Performance in Children and Adolescents
TABLE 16-2 Rating of Self-Care Skill Independence during Task Analysis
Team Evaluations
Measurement of Outcomes
RESEARCH NOTE 16-1
ABSTRACT
IMPLICATIONS FOR PRACTICE
INTERVENTION STRATEGIES AND APPROACHES
Promoting or Creating Supports
TABLE 16-3 Approaches to Improving the Performance of Activities of Daily Living
Establishing, Restoring, and Maintaining Performance
FIGURE 16-2 This simple picture sequence gives Adam the needed cues to wash his hands independently.
Adapting the Task or Environment
Adapting or Modifying Task Methods
FIGURE 16-3 Hierarchy of cues, from most intrusive to least intrusive. A, A hand-over-hand approach is used for squirting soap onto the child’s hands. B, Two fingers are used to guide zipping of the child’s coat. C, The therapist shadows her hand over the top of the child’s hands to cue hand movements for hand washing. D, The therapist verbally cues the child on how to wash the hands.
Adapting the Task Object or Using Assistive Technology
RESEARCH NOTE 16-2
ABSTRACT
IMPLICATIONS FOR PRACTICE
Adapting the Physical Environment
TABLE 16-4 Typical Adaptation Principles Used with Children and Adolescents with Disabilities
Work Surface
FIGURE 16-4 Sample talking book. This frame from Talking Shoes was created with Microsoft PowerPoint.
Positioning
TABLE 16-5 Environmental Adaptations for the Home When Accessibility Is Limited
TABLE 16-6 Stabilization Materials and Application Procedures
FIGURE 16-5 Commercially available chair with positioning components and a desk with an adjustable height and an adjustable inclined work surface.
Prevention/Education
Problem Solving: Cognitive Approach
Anticipatory Problem Solving
FIGURE 16-6 Sitting postures. A, Incorrect sitting resulting from a massive extension pattern and an asymmetrical tonic reflex posture. B, Correct sitting posture. Weight is equally distributed on the sitting base, and the feet and elbows are supported.
Cognitive Orientation Approach
Coaching and Education
CASE STUDY 16-2 Nadia
RESEARCH NOTE 16-3
ABSTRACT
IMPLICATIONS FOR PRACTICE
SPECIFIC INTERVENTION TECHNIQUES FOR SELECTED ADL TASKS
Toilet Hygiene and Bowel and Bladder Management
Typical Developmental Sequence
Typical Factors That Interfere with Toileting Independence
TABLE 16-7 Typical Developmental Sequence for Toileting
Children with Limited Motor Skills and Bodily Functions
Children with Intellectual Limitations
Adaptation Strategies for Improving Toileting Independence
Social Environment and Temporal Context
Physical Environment
Toileting Adaptations
TABLE 16-8 Analysis and Interventions for Toileting
FIGURE 16-7 Electrically powered bidet makes it possible to clean the perineal area independently, without using hands or paper.
Adaptations for Unstable Posture
Menstrual Hygiene
Teaching Methods for Girls with Limitations in Cognition
Teaching Methods for Physical Limitations
Dressing
Typical Development
TABLE 16-9 Typical Developmental Sequence for Dressing
Typical Problems and Intervention Strategies
Limitations in Cognitive and Sensory Perceptual Skills
FIGURE 16-8 This example of a story is used before Mimi goes out for recess, to help her rehearse what she is going to do and help her understand why.
RESEARCH NOTE 16-4
ABSTRACT
IMPLICATIONS FOR PRACTICE
Physical or Motor Limitations
Adaptive Methods for Dressing Children with Motor Limitations
FIGURE 16-9 When dressing a child who is hypertonic, the caregiver should carefully flex the hip and knee before putting on socks and shoes.
Adaptive Methods for Self-Dressing
FIGURE 16-10 The side-lying position may reduce stiffness and make dressing easier.
Bathing or Showering
Typical Development
TABLE 16-10 Adaptation Strategies for Dressing with Different Types of Garments
Establishing or Restoring Performance
Adapting the Task or Environment
Prevention/Education for Bathing Safety
Personal Hygiene and Grooming
Skill Development
FIGURE 16-11 Adapted seating equipment for bathing. A, The hammock chair is adjustable and equipped with oversized suction feet. It fully supports the child who has no sitting balance and poor head control. B, Trunk support ring is lightweight and compact and fits all bathtubs. C, A shower bench aids seating and transfers. D, An inflatable bath collar can be used when the child is in either the supine or the prone position.
Intervention
FIGURE 16-12 A hand-over-hand approach works well for Lydia, who is sensitive to tooth brushing, as she is participating in the activity and directing which part of the teeth she wants to brush first.
Sexual Activity
CASE STUDY 16-3 Josie
Care of Personal Devices
Performance Patterns
Directing Others
TABLE 16-11 Typical Sexuality Concepts Discussed with Children and Adolescents with Disabilities
SUMMARY
TABLE 16-12 Health Care Maintenance for Typically Developing Children and Children with Spina Bifida
CASE STUDY 16-4 Feddah
FIGURE 16-13 Sample task analysis and data collection sheet for hearing aid maintenance.
REFERENCES
SUGGESTED READINGS
CHAPTER 17 Instrumental Activities of Daily Living and Community Participation
OBJECTIVES
KEY TERMS
INTRODUCTION
OCCUPATIONAL DEVELOPMENT OF IADL AND COMMUNITY PARTICIPATION
Late Adolescence (16 to 18 Years)
BOX 17-1 Instrumental Activities of Daily Living and Community Participation: Older Adolescent (16 to 21 Years)
MEAL PREPARATION AND CLEAN-UP
COMMUNITY MOBILITY
HEALTH MANAGEMENT AND MAINTENANCE
HOUSEHOLD MAINTENANCE AND MANAGEMENT
CLOTHING MANAGEMENT
USE OF COMMUNICATION DEVICES
SHOPPING AND MONEY MANAGEMENT
SAFETY AND EMERGENCY RESPONSE
COMMUNITY PARTICIPATION
PERFORMANCE SKILLS
Early Adolescence (12 to 15 Years)
Middle Childhood (6 to 11 Years)
BOX 17-2 Instrumental Activities of Daily Living and Community Participation: Younger Adolescent (12 to 15 Years)
MEAL PREPARATION AND CLEAN-UP
COMMUNITY MOBILITY
HEALTH MANAGEMENT AND MAINTENANCE
HOUSEHOLD MAINTENANCE AND MANAGEMENT
USE OF COMMUNICATION DEVICES
SHOPPING AND MONEY MANAGEMENT
SAFETY AND EMERGENCY RESPONSE
COMMUNITY PARTICIPATION
PERFORMANCE SKILLS AND PATTERNS
Preschool (3 to 5 Years)
BOX 17-3 Instrumental Activities of Daily Living and Community Participation: Middle Childhood (6 to 11 Years)
MEAL PREPARATION AND CLEAN-UP
COMMUNITY MOBILITY
HEALTH MANAGEMENT AND MAINTENANCE
HOUSEHOLD MAINTENANCE AND MANAGEMENT
USE OF COMMUNICATION DEVICES
SHOPPING AND MONEY MANAGEMENT
SAFETY AND EMERGENCY RESPONSE
COMMUNITY PARTICIPATION
PERFORMANCE SKILLS AND PATTERNS
PERSONAL AND ENVIRONMENTAL INFLUENCES ON IADLS AND COMMUNITY PARTICIPATION
Personal Influences
Environmental Influences
FIGURE 17-1 Adolescents participate in afterschool sports and recreation programs.
EVALUATION OF IADL AND COMMUNITY PARTICIPATION
Team Evaluations
Measurement of Outcomes
TABLE 17-1 Instruments for Assessing IADLs and Community Participation for Children and Youth
FIGURE 17-2 Examples of CHORES items and ratings for the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES) Program.
INTERVENTION PLANNING AND IMPLEMENTATION
INTERVENTION MODELS AND STRATEGIES
Client-Centered Intervention
Adaptation/Compensation
Contextualism
CASE STUDY 17-1 Kayla
VOLITION SYSTEM
HABITUATION
PERFORMANCE CAPACITY
Evaluation
INTERVENTION STRATEGIES
Reverse Inclusion
TABLE 17-2 Adapted Instrumental Activities of Daily Living
CASE STUDY 17-2 Brenda
Supported Inclusion
Family Activities
Community Participation
Client-Centered Ecological/Experiential
Focus on Ability and Success
Incorporation of Sexuality and Body Image
Mentoring and Role-Modeling a Positive Future
Inclusive Programming for Youth with Disabilities
Social Skills Training
Support Groups
SUMMARY
TABLE 17-3 The Developmental Role Continuum
REFERENCES
CHAPTER 18 Play
OBJECTIVES
KEY TERMS
PLAY THEORIES
Form
FIGURE 18-1 A first type of sensory motor-exploratory play is the infant’s exploration of his or her own body.
FIGURE 18-2 Play today is often highly structured; for example, this play date takes place at the ice-skating rink.
Function
Meaning
Context
FIGURE 18-3 “Reading” books is an early play activity even before the child is able to actually read.
FIGURE 18-4 Mom’s enthusiasm and encouragement add to the playfulness experienced in bowling.
PLAY IN OCCUPATIONAL THERAPY
PLAY ASSESSMENT
Skills
Development
CASE STUDY 18-1 Ellen
BOX 18-1 Play Status Worksheet
EXPECTED DESCRIPTION
BOX 18-2 Knox Preschool Play Scale
SPACE MANAGEMENT: 6- TO 12-MONTH LEVEL
MATERIAL MANAGEMENT: 12 TO 18 MONTHS
PRETENSE/SYMBOLIC: 12-MONTH LEVEL
PARTICIPATION: 12 MONTHS
Experience
Advantages and Disadvantages of Evaluating Play
Interpreting Play Assessments
FIGURE 18-5 The occupational therapist assesses motor, cognitive, and social skills during a play activity.
CONSTRAINTS TO PLAY
Effects of Disability on Play Behavior
FIGURE 18-6 Impaired fine-motor skills limit exploratory play of this infant with cerebral palsy. Toys that activate to imprecise (full arm) movements are a good choice in play activities.
FIGURE 18-7 Matthew, who has cerebral palsy, participates in the pregame rally by playing the drum.
PLAY IN INTERVENTION
FIGURE 18-8 Matthew takes to the ice using an adapted sled.
Play as a Modality
Play as an Intervention Goal
Facilitating Playfulness
FIGURE 18-9 Mom adapts kickball so that Matthew can play with his brother.
Adaptations
Parent Education and Training
Societal Concerns
REFERENCES
CHAPTER 19 Prewriting and Handwriting Skills
OBJECTIVES
KEY TERMS
THE WRITING PROCESS
Preliteracy Writing Development of Young Children
Writing Development of School-Aged Children
TABLE 19-1 Development of Prewriting and Handwriting in Young Children
Handwriting Readiness
Pencil Grip Progression
TABLE 19-2 Activities to Promote Handwriting Readiness
HANDWRITING EVALUATION
Occupational Profile
Interviews
FIGURE 19-1 Mature pencil grips in elementary school children. A, Dynamic tripod; B, lateral tripod; C, dynamic quadrupod; and D, lateral quadrupod.
BOX 19-1 Questions to Facilitate Discussion among Educational Team Members
Analysis of Occupational Performance
Work Samples
File Review
Direct Observation
FIGURE 19-2 A girl completes a written assignment at her desk.
MEASURING HANDWRITING PERFORMANCE
FIGURE 19-3 Cursive handwriting sample exemplifies improper letterforms and disproportionate letter size.
Domains of Handwriting
Legibility
FIGURE 19-4 Word legibility percentages are calculated using a simple mathematical formula.
Writing Speed
Ergonomic Factors
HANDWRITING ASSESSMENTS
Factors Restricting Handwriting Performance
CASE STUDY 19-1 Natasha
EDUCATOR’S PERSPECTIVE
Writing Process
Handwriting Instruction Methods and Curricula
TABLE 19-3 Evidence on Classroom Instruction
Manuscript and Cursive Styles
TABLE 19-4 Handwriting Programs Research
HANDWRITING INTERVENTION
Planning
Models of Practice to Guide Collaborative Service Delivery
Neurodevelopmental
TABLE 19-5 Assistive Technology That Supports Handwriting Skills
TABLE 19-6 Computer-Assisted Handwriting Instruction
FIGURE 19-5 A girl demonstrates an arm pushup in her school chair.
FIGURE 19-6 Two children participate in a yoga game to get ready for writing.
Acquisitional
TABLE 19-7 Evidence on Modeling for Teaching Handwriting*
FIGURE 19-7 Lined paper with diagrams helps with letter size and the placement of text.
Sensorimotor
TABLE 19-8 Strategies for Handwriting Problems
FIGURE 19-8 A girl works on a homework assignment that is taped to a vertical surface (i.e., kitchen cupboard).
Biomechanical
Sitting Posture
Paper Position
Pencil Grip
FIGURE 19-9 A rubber band sling allows for a slanted, relaxed pencil position.
Writing Tools
Paper
TABLE 19-9 Evidence on Writing Instruments
Psychosocial
TABLE 19-10 Evidence on Behavioral Techniques to Improve Handwriting
Evidence of Occupational Therapy Intervention on Handwriting
Service Delivery
FIGURE 19-10 An angled strip is attached to a student’s desktop.
SUMMARY
REFERENCES
Appendix 19-A Handwriting Assessments
CHILDREN’S HANDWRITING EVALUATION SCALE (CHES-C)
CHILDREN’S HANDWRITING EVALUATION SCALE FOR MANUSCRIPT WRITING (CHES-M)
EVALUATION TOOL OF CHILDREN’S HANDWRITING (ETCH)
MINNESOTA HANDWRITING ASSESSMENT (MHA)
TEST OF HANDWRITING SKILLS
THE PRINT TOOL
APPENDIX 19-B Handwriting Methods in Schools
D’NEALIAN HANDWRITING PROGRAM
ITALIC HANDWRITING SERIES
PALMER METHOD OF HANDWRITING
ZANER-BLÖSER HANDWRITING
Appendix 19-C Handwriting Curriculum Programs
Big Strokes for Little Folks
Callirobics
First Strokes
Getting It Write
Handwriting Without Tears
LOOPS AND OTHER GROUPS
A Kinesthetic Writing System
Peterson Directed Handwriting
Trics for Written Communication: Techniques for Rebuilding and Improving Children’s School Skills
CHAPTER 20 Influencing Participation Through Assistive Technology
OBJECTIVES
KEY TERMS
INTRODUCTION
Influencing Childrens’ Growth and Development with Assistive Technology
Definition and Legal Aspects of Assistive Technology
Models for Assistive Technology Assessment and Decision Making
TABLE 20-1 Other Legislation Related to Assistive Technology
Human Activity Assistive Technology
Student Environment Task Tool
FIGURE 20-1 The Human Assistive Technology (HAAT) model.
TABLE 20-2 SETT Framework Questions
Matching Person and Technology
Child- and Family-Centered Approach
Abandonment
BOX 20-1 Cultural Factors That Affect Assistive Technology Delivery
Learned Helplessness and Self-Determination
SETTING THE STAGE FOR ASSISTIVE TECHNOLOGY SERVICE PROVISION
Practice Settings
Occupational Therapy Process and Assistive Technology in the Schools
TABLE 20-3 Practice Settings In Which Assistive Technology (AT) Services Are Provided
BOX 20-2 Roles and Responsibilities of School Assistive Technology (AT) Teams
The Transdisciplinary Team
RESEARCH NOTE 20-1
ABSTRACT
IMPLICATIONS FOR PRACTICE
Assistive Technology Evaluation and Intervention: A Dynamic Process
Evaluation
Decision Making
BOX 20-3 Guiding Questions In Evaluating a Child for Assistive Technology
MOTOR
SENSORY AND PERCEPTUAL
COGNITIVE AND COMMUNICATION
PSYCHOSOCIAL
CONTEXT
TABLE 20-4 Assistive Technology (AT) Assessments
BOX 20-4 Criteria for Evaluating Assistive Technology Devices
FIGURE 20-2 AT products available from the Technology and Media (TAM) Division of the Council for Exceptional Children, Reston, VA.
Device Procurement
Funding
Implementation of AT Services
Measuring Progress and Outcomes
TABLE 20-5 Assistive Technology (AT) Outcome Measures
UNIVERSAL DESIGN AND ACCESS
FIGURE 20-3 Examples of readily available, universally designed low-tech tools.
Access
Universal Design
BOX 20-5 Principles of Universal Design
PRINCIPLE ONE:
Equitable Use
PRINCIPLE TWO:
Flexibility in Use
PRINCIPLE THREE:
Simple and Intuitive Use
PRINCIPLE FOUR:
Perceptible Information
PRINCIPLE FIVE:
Tolerance for Error
PRINCIPLE SIX:
Low Physical Effort
PRINCIPLE SEVEN:
Size and Space for Approach and Use
Positioning and Ergonomics
FIGURE 20-4 One size does not fit all. It is important to adjust learning environments to promote health and productivity.
BOX 20-6 ERGONOMICS: Budget-Minded Solutions/Tips for Home and School
PARTICIPATION: SUPPORTING LIFE SKILLS WITH ASSISTIVE TECHNOLOGY
FIGURE 20-5 An example of a vibrating snake attached to a switch as a means to provide independent control of sensory input.
FIGURE 20-6 A, An example of a touch switch: the jelly bean switch. B, An example of a switch that is activated by pulling on the multicolored ball.
Alternative and Augmentative Communication
FIGURE 20-7 A, The Sensitrac flat pad switch. Switch is activated by a simple touch. B, The Sensitrac flat pad switch can be easily positioned for a child to access.
FIGURE 20-8 A, The child uses the switch to play with the water toy. B, The child uses the switches to participate in a gardening activity with her peers. C, The child uses the switch to turn on the Bed Bugs game.
BOX 20-7 Basic Communication Rights
FIGURE 20-9 Example of a low-tech communication board.
BOX 20-8 Strategies to Facilitate Communicative Interaction
FIGURE 20-10 Multiple means of representation clockwise from left: an object, a TOBI, a photo, a picture symbol, and a word.
FIGURE 20-11 Example of a tactile symbol communication board.
FIGURE 20-12 AAC devices. A, BigMac communication device. B, Using the BigMac to participate in circle time. C, Talk Trac communication device. D, Using the Talk Trac and Step-by-Step communication devices to go shopping. E, Supertalker.
FIGURE 20-13 Example of a dedicated, dynamic display augmentative and alternative communication device.
FIGURE 20-14 Examples of symbol systems. A, Blissymbols. B, Rebus. C, Picsyms.
FIGURE 20-15 Visual scene display versus grid.
BOX 20-9 Communication Competence
Computers
TABLE 20-6 Benefits of Computers for Young Children
Input
FIGURE 20-16 Example of low-tech keyboard modifications including color-coding and enlarging letters on keys.
TABLE 20-7 Problem Solving for Computer Access (Starting with a Standard Computer Workstation)
FIGURE 20-17 An example of a keyguard for an alternative keyboard. Keyguards also are available for standard keyboards.
Switches
Alternate Keyboards
Mouse Emulators
Voice Recognition
FIGURE 20-18 Examples of alternate keyboards. A, IntelliKeys with alphabet overlay. B, KeyLargo and overlay examples. C, KeyLargo used with a powerbook.
Other Input Systems
Output Systems and Information Processing
Software
Electronic Aids for Daily Living
CHANGING THE LANDSCAPE IN EDUCATION: PLANNING FOR EVERY STUDENT IN THE 21st CENTURY
Universal Design for Learning
Instructional Technology
FIGURE 20-19 Schematic of an EADL setup with the Powerlink.
Assistive Technology for Literacy Skills
BOX 20-10 Key Features to Consider In Evaluating Accessibility of Instructional Software
Reading Skills
FIGURE 20-20 Example of an adapted book with tactile and rebus symbol support.
Assistive Technology for Writing
Assistive Technology for Math
FIGURE 20-21 Writing tools continuum created with graphic organizer software by Judi Sweeney, Onion Mountain Technology (http://www.onionmountaintech.com).
FIGURE 20-22 Example of word prediction software.
FIGURE 20-23 Examples of no-tech, low-tech math supports including TouchMath®, number lines and counters, coin calculators, a calculator with enlarged buttons, a Time Timer, and a standard Judy Clock math manipulative.
Assistive Technology and Transition
BOX 20-11 Components of Effective Transition Plans for Assistive Technology (AT) Users
Evidence-Based Practice and Assistive Technology
SUMMARY
TABLE 20-8 Continuum of Assistive Technology Devices
CASE STUDY 20-1 AT Problem Solving
JEREMY
LINNEA
MARGY
REFERENCES
CHAPTER 21 Mobility
OBJECTIVES
KEY TERMS
DEVELOPMENTAL THEORY OF MOBILITY
FIGURE 21-1 Development of locomotion. A, Infant bears full weight on feet by 7 months. B, Infant can maneuver from sitting to kneeling position. C, Infant can stand holding onto furniture at 9 months. D, While standing, infant takes deliberate step at 10 months. E, Infant crawls with abdomen on floor and pulls self forward, and then (F) creeps on hands and knees at 9 months.
IMPAIRED MOBILITY
FIGURE 21-2 The Pommel Walker allows an 18-month-old child with a developmental delay to explore his environment.
FIGURE 21-3 The Mini-Bot provides early, exploratory, self-initiated mobility experiences. A 2-year-old child with arthrogryposis stands and moves in the Mini-Bot using a joystick or switches.
AUGMENTATIVE MOBILITY
ASSESSMENT AND INTERVENTION
Classification of Mobility Skills
Mobility Assessments
Mobility Evaluation Team Models
MOBILITY DEVICES
CASE STUDY 21-1 Brian
Alternative Mobility Devices
Tricycles
Prone Scooters
FIGURE 21-4 The Discovery Trike can fit a child as young as 12 months. An adult can assist the child by steering the front wheel with the push handle.
Caster Carts
FIGURE 21-5 Prone scooter mobility devices.
FIGURE 21-6 A, Caster cart mobility device. B, Joystick- or switch-controlled multi-directional scooter board.
Aeroplane Mobility Device
Mobile Stander
FIGURE 21-7 The aeroplane mobility device can be handmade and is designed for children younger than 3 years of age.
FIGURE 21-8 Mobile standers. A, The Dynamic Stander’s large push wheels can be propelled by the child or easily removed to position the child close to a table or counter top. (Manufactured by Rifton.) B, The powered Standing Dani by Davis Made, a motorized standing device.
Walkers
FIGURE 21-9 Walkers. A, The Crocodile posterior walker is designed for children from 2 to 14 years of age. (Manufactured by Snug Seat.) B, A young child helps with chores while using the Walkabout, a hands-free, weight-relieving walker. (Manufactured by Mulholland Positioning Systems, Inc.) C, A 2-year-old boy with spastic cerebral palsy uses the Pommel Walker in a forward pitch position, with a widely padded seat and a tray and hand grip to provide upper body support while pushing a toy vacuum.
Alternative Powered Mobility Devices for Young Children
WHEELED MOBILITY SYSTEMS
FIGURE 21-10 Strollers. A, The KidSert. B, The Mountee.
FIGURE 21-11 The Advance Contour Hi Low chair.
Manual Wheelchairs
FIGURE 21-12 Manual wheelchairs. A, Chelsea, age 9 years with paraplegia at the L1 level, selects a TiLite TR for its features of lightweight, durability, and smooth ride. B, Quickie Kidz manual wheelchair features wider rear wheels for maximum pushing surface so that the chair can be propelled with either a push or pull motion. C, Quickie Xtender provides power assist to a manual wheelchair by designing a motor unit into the hub of the quick release wheel. D, The LEVO KID wheelchair provides a sit-to-stand feature in a manual wheelchair with the touch of a button. E, Kids ROCK wheelchair.
Power Wheelchairs
FIGURE 21-13 Power wheelchairs. A, Q610. B, Permobil 450. C, Skippi power wheelchair.
FIGURE 21-14 Useful features for a power wheelchair. A, The Chairman 2K Stander. Standing can be achieved from a sitting position or gradually from supine. B, K450 from Permobil Playman Robo’s seat will lower to the ground and elevate, covering a total of 25 inches height difference for vertical mobility. (Lebanon, Tenn.) C, Permobil K300PS Jr. with tilt. Chairman 2K front- wheel drive power wheelchair with the Corpus seating system and 45° of tilt in space.
Selection of Wheelchair Features
POWERED MOBILITY EVALUATION AND INTERVENTION
CASE STUDY 21-2 Trevor
CASE STUDY 21-3 Amanda
FIGURE 21-15 11-year-old girl in Power Tiger from ASL.
SEATING AND POSITIONING
Understanding the Biomechanics of Seating
Seating Guidelines
BOX 21-1 Exercises to Understand the Biomechanics of Seating
SITTING IN POSTERIOR PELVIC TILT
PELVIC POSITION STABILITY
FIGURE 21-16 A, Infinity DualFlex 10 by Invacare. The Infinity DualFlex 10 is a modular seating system that accommodates a wide range of position needs. B, Ride designs cushion can be custom molded for an individual.
FIGURE 21-17 Hip Grip, a dynamic pelvic stabilization device.
Evaluation
FIGURE 21-18 Prairie Seat simulator.
TRANSPORTATION OF MOBILITY SYSTEMS
FACTORS THAT INFLUENCE THE SUCCESSFUL USE OF MOBILITY DEVICES
SUMMARY
CASE STUDY 21-4 Stephanie
CASE STUDY 21-5 David
CASE STUDY 21-6 Jason
REFERENCES
SUGGESTED READING
SECTION IV Areas of Pediatric Occupational Therapy Services
CHAPTER 22 Neonatal Intensive Care Unit
OBJECTIVES
KEY TERMS
EVOLUTION OF NEONATAL INTENSIVE CARE
Nursery Classification and Regionalization of Care
FIGURE 22-1 Newly born, extremely preterm twins in a NICU. These 24-weeks-gestation infants, in Z-Flo fluidized positioners and on radiant warmers, are receiving nasal continuous positive airway pressure (NCPAP), total parenteral nutrition (TPN), and phototherapy.
Inclusion of Developmental Specialists in the NICU
Sensory Deprivation versus Stimulation
CHANGING FOCUS OF NEONATAL OCCUPATIONAL THERAPY
Traditional Occupational Therapy: Rehabilitation and Stimulation
State-of-the-Art Occupational Therapy: Developmental Support
FIGURE 22-2 A, This infant has seizures, bowel pathology, and infections; “traditional” therapeutic positioning, pre-feeding oral stimulation and developmental therapy will be included as part of her OT treatment plan. B, This infant was born at 22 weeks’ gestation; multiple organ system vulnerabilities from extreme prematurity warrant protective developmental support from birth.
DEVELOPING A MEDICAL FOUNDATION
Abbreviations and Terminology
Classifications for Age
Classifications by Birth Weight
Thermoregulation
Medical Conditions and Equipment
NICU ENVIRONMENT
“Mismatch” of Immature Infant in High-Tech Environment
TABLE 22-1 Common Medical Equipment in the NICU
TABLE 22-2 Comparison of Intrauterine and Extrauterine Sensory Environments
Light in the NICU
Lighting Considerations for NICU Staff and Infants
Lighting Guidelines for the NICU
FIGURE 22-3 Neonatal intensive care unit infant is receiving eye examination by an ophthalmologist to check for development of retinopathy of prematurity. Swaddling and sucking on a pacifier dipped in 24% sucrose solution provide some relief for procedural discomfort.
Sound in the NICU
Environmental Modifications of Sound in the NICU
Caregiving in the NICU
Modifications of Caregiving in the NICU
FIGURE 22-4 24-week-GA infant on high-frequency oscillating ventilation (HFOV). Efforts to protect sleep include placement of the infant in an incubator to decrease random handling and stimuli, clustered care, covering the Isolette to block overhead light (cover folded back for this picture), and supportive positioning in an individually contoured Z-Flo fluidized positioner.
FAMILIES IN THE NICU
Families in Crisis
TABLE 22-3 Newborn States and Considerations for Caregiving
FIGURE 22-5 Swaddled bath. Swaddled preterm infant is immersed in a tub of warm water for a developmentally supportive bath.
Family Inclusion in Developmental Support
FIGURE 22-6 Assessment of this stable preterm infant includes evaluation of neuromotor and neurobehavioral functioning. The assessment can be a valuable teaching tool when performed jointly with the infant’s parents.
Skin-to-Skin Holding (Kangaroo Care)
FIGURE 22-7 Father using skin-to-skin holding technique (kangaroo care) while preterm infant undergoes a head ultrasound to rule out intraventricular hemorrhage.
Discharge Planning
INFANTS IN THE NICU
Evaluation of the NICU Infant
Neurobehavioral Organization of the Preterm Infant
Synactive Theory of Development
FIGURE 22-8 Beginning at conception, emerging and expanding capabilities of developing infant are illustrated in this model of synactive organization of behavioral development.
TABLE 22-4 Synactive Theory of Development: Neurobehavioral Subsystems, Signs of Stress and Stability*
TABLE 22-5 Neurobehavioral Development of Preterm Infants by Gestational Age
Preterm Neurobehavioral Organization: In-turning, Coming-out, and Reciprocity
States of Arousal
TABLE 22-6 Stages and Characteristics of Behavioral Organization in Preterm Infant
Sensory System Development and Sensory Stimulation
Sensory System Development
Supplemental Sensory Stimulation
BOX 22-1 Fetal Sensory System Development: Implications for Environmental and Caregiving Modifications
BASIC BRAIN DEVELOPMENT
MOST FETAL SENSORY SYSTEMS (TACTILE, VESTIBULAR, TASTE, SMELL) ARE FUNCTIONING AT THE AGE OF VIABILITY
NICU Implications
AUDITORY/VISUAL SENSORY SYSTEM FETAL DEVELOPMENT (AT AGE OF VIABILITY) WITH NICU IMPLICATIONS
Auditory System
NICU Implications
Visual System
NICU Implications
FIGURE 22-9 The support provided by containment, sucking, and grasping helps this preterm infant establish eye contact with her mother for a time of quality interaction.
Auditory Stimulation
Visual Stimulation
Traditional Developmental Stimulation
Infant Massage
Evidence-Based Potentially Better Practices (PBPs) to Support Neurodevelopment in the NICU
Neuromotor Development and Interventions
Reflex Development
Muscle Tone
TABLE 22-7 Potentially Better Practices to Support Neurodevelopment in the NICU
Posture and Movement Patterns
Therapeutic Positioning
FIGURE 22-10 Continuously restless infant (1000 grams, small for gestational age) unable to settle in cloth bunting. She relaxed and fell asleep in minutes after being positioned on a Z-Flo full-body positioner with a smaller Z-Flo pad used as a prone roll.
FIGURE 22-11 Hypotonic posture of premature infant. Without therapeutic positioning, “W” configuration of arms, “frogged” posture of legs, and asymmetrical head position may lead to positional deformities.
Range of Motion
FIGURE 22-12 Illustrated developmental cause and consequences lack of therapeutic positioning and subsequent positional deformities in the NICU population. Hospital-acquired positional deformities are largely avoidable with good positioning. References can be found on the Sundance Solutions website listed in the credit.
FIGURE 22-13 A, Blanket rolls are often too shallow and too wide to provide secure boundaries and postural support. B, Commercial positioning devices such as the Snuggle-Up. (Children’s Medical Ventures) made positioning easier; this small preterm infant is supported in sidelying position with midline orientation and flexion of extremities.
Splinting
Feeding
A Word about Breastfeeding
Bottle Feeding
Non-nutritive Sucking
FIGURE 22-14 A, NICU infant in drug withdrawal needing firm circumferential boundaries. The Z-Flo tube’s elasticized Velcro closure and the adjustable cross strap maintain the integrity of the positioner, while Z-Flo’s fluidized properties allow the infant to move within the boundaries. His peripheral intravenous line and feeding tube are easily accommodated. B, Complex positioning on Z-Flo for a critically ill infant with a genetic syndrome including a short proximal esophageal atresia and a hypoplastic diaphragm. He has a gastrostomy tube; the large oral tube is hooked to wall suction for drainage of secretions, with variable effectiveness. The infant required frequent deep manual suctioning and was often extremely agitated with significant oxygen desaturations. Positioning increased calming and sleep, facilitated correct placement of the oral tube with more effective suctioning and less aversive vagal response from the infant, reduced the need for manual suctioning, and delayed intubation. An esophagostomy (spit fistula) was surgically placed the next week.
Nutritive Sucking Patterns
FIGURE 22-15 Newborn infant with congenital muscular dystrophy, a right humeral fracture, and obvious hand deformities. Bilateral soft splints (fabricated from foam pencil grips, small Velfoam straps, and Velcro) had no pressure points. Movement was not restricted; corrected alignment actually increased the infant’s active movement.
FIGURE 22-16 A, Preterm infant with transitional sucking pattern is fed in modified side-lying (breast-feeding) position. B, Infant’s feeding is externally paced as the caregiver tips the bottle to force a breathing break.
Stripping from the Nipple in Nutritive Sucking
Nutritive Sucking and Respiration
Nutritive Sucking and Aspiration
Feeding Readiness and Cue-Based Infant-Driven Feeding
SUMMARY
REFERENCES
APPENDIX 22-A Medical Abbreviations Commonly Used in the Neonatal Intensive Care Unit
A
B
C
D
E
F
G
H
I
K
L
M
N
O
P
Q
R
S
T
U
V
W
NICU Case Study: “King” James
CHAPTER 23 Early Intervention
OBJECTIVES
KEY TERMS
WHAT IS EARLY INTERVENTION?
Legislation Related to Early Intervention
Occupational Therapy Services in Early Intervention Systems
TABLE 23-1 Comparison of Educational Programs by Age Group
CURRENT PRACTICE IN EARLY INTERVENTION
Partnering with Families
BOX 23-1 Questions to Foster Cultural Competence
Partnering with Professionals
BOX 23-2 Principles of Family-Centered Intervention
FIGURE 23-1 A music therapist helps children enhance their body awareness, a goal that is a primary responsibility of the occupational therapist.
Provision of Early Intervention Services
Assessment and Intervention Planning
Evaluation and Planning
Eligibility Determination
FIGURE 23-2 The therapist can assess perceptual motor skills through observation of puzzle completion.
Development of the IFSP
FIGURE 23-3 Important assessment data are gathered through structured observations of the child’s play in his or her everyday environment.
Writing Goals and Objectives
BOX 23-3 Required Components of the Individualized Family Service Plan
BOX 23-4 Questions to Discuss with Families When Establishing Activities for Services in Natural Environments
FIGURE 23-4 Adapted seating promotes good postural alignment for fine-motor play at a table.
FIGURE 23-5 The occupational therapist and child use an activity to enhance fine-motor skills.
FIGURE 23-6 Sample Outcomes Sheet from an IFSP.
Transition Planning
TABLE 23-2 Plan of Strategies Worksheet
CASE STUDY 23-1 Jeremy
BACKGROUND
ASSESSMENT
INTERVENTION
INDIVIDUAL FAMILY SERVICE PLAN REVIEW
ANNUAL REASSESSMENT
SUMMARY
Payment for Occupational Therapy Services
Working in Natural Environments
Settings
FIGURE 23-7 The therapist encourages a child to participate in sensory motor activities on the playground.
FIGURE 23-8 Family involvement supports the child in the natural environment.
FIGURE 23-9 The occupational therapist uses preschool materials to achieve the child’s fine-motor goals.
Occupational Therapy in Natural Environments
FIGURE 23-10 Young children learn through peer interaction and peer imitation.
FIGURE 23-11 Participation in community-based family activities promotes developmental skills.
FIGURE 23-12 Play with peers in natural environments helps the child generalize newly learned skills.
FIGURE 23-13 Peer play helps the child generalize newly learned skills.
FIGURE 23-14 In an inclusive program, a peer models, encourages, and supports the child with developmental delays.
Challenges to Implementing Therapy in Natural Environments
FIGURE 23-15 A, Sensory motor play in the sandbox. B, Children learn many skills through imitation of their peers.
OCCUPATIONAL THERAPY INTERVENTION
Addressing Family and Child Needs in Natural Environments
Family-Centered Intervention
RESEARCH NOTE 23-1
ABSTRACT
IMPLICATIONS FOR PRACTICE
Intervention Approaches
FIGURE 23-16 The Coaching Process.
CASE STUDY 23-2 Alana
BACKGROUND
INTERVENTION
FOLLOW-UP
BOX 23-5 Example of How Coaching Is Not a Linear Process
Working with Medically Fragile Children
FIGURE 23-17 The occupational therapist integrates speech goals into toilet training.
Areas of Intervention
Play
Motor Performance
TABLE 23-3 Relevant Research on Play Skills and Young Children
FIGURE 23-18 Exploratory, sensory motor play enhances development of body scheme, coordination, and a range of motor skills.
FIGURE 23-19 Observation of play with age-appropriate materials is used to assess fine motor skills.
Sensory Processing
TABLE 23-4 Examples of Research on Motor Skills and Young Children
CASE STUDY 23-3 Alex
BACKGROUND
ASSESSMENT
SUMMARY AND INTERPRETATION
INTERVENTION
Self-Care/Adaptive
Adapted Equipment and Positioning
SUMMARY
FIGURE 23-20 The therapist assesses feeding skills during the lunchtime routine in preschool.
FIGURE 23-21 Adapted seating enables a child with postural instability to play with a peer at the table.
REFERENCES
Suggested Readings
Evolve Table
TABLE 23-e1 Relevant Research on Caregiver-Child Relationships
CHAPTER 24 School-Based Occupational Therapy
OBJECTIVES
KEY TERMS
SPECIAL AND GENERAL EDUCATION LEGISLATION
Individuals with Disabilities Education Act (IDEA)
FIGURE 24-1 Timeline of important legislation and developments influencing occupational therapy’s role in schools.
BOX 24-1 Principles of the Individuals with Disabilities Education Act (formerly EHA [P.L. 94-142])
Least Restrictive Environment
Evolution of IDEA
Section 504 of the Rehabilitation Act and the Americans with Disabilities Act
No Child Left Behind
OCCUPATIONAL THERAPY SERVICES FOR CHILDREN WITH DISABILITIES
Occupational Therapy Domain in School-Based Practice
Occupational Therapy Process in School-Based Practice
Referral
Evaluation
FIGURE 24-2 Special Education Process.
Evaluation Strategies
FIGURE 24-3 Top-down versus bottom-up approaches to evaluation and intervention.
BOX 24-2 The School Function Assessment: A Top-Down Measure of Student Participation
SCHOOL FUNCTION ASSESSMENT (SFA)
TABLE 24-1 School-Related Occupational Performance Addressed During Evaluation and Intervention
FIGURE 24-4 The playground is one environment to be evaluated, emphasizing accessibility and safety. Although schools are constructing playgrounds with wheelchair accessibility, many remain only partially accessible. Playgrounds should include equipment that requires a range of skills and a range of sensory input.
Assessment Measures
FIGURE 24-5 Preschool classrooms tend to have high levels of visual and auditory stimuli.
TABLE 24-2 Types of Assessment Tools
Documentation
Eligibility
Individualized Education Program
TABLE 24-3 Process Depicting the Development of the Individualized Education Program (IEP)
TABLE 24-4 Educationally Relevant Levels of Performance and Educational Need
BOX 24-3 Evaluation of Performance As It Relates to Participation in School
FIGURE 24-6 A child with left hemiparesis uses a touch window on the classroom computer. Despite her left-side motor impairments, she did not qualify for related services under IDEA because she was fully functional and met all standards for kindergarten performance.
Occupational Therapy Services
BOX 24-4 “Brownie Busters”: An Occupation-Based Work Group for Children with Multiple Disabilities
PROGRAM DEVELOPMENT
PARTICIPANTS
GROUP SESSIONS
QUALITATIVE RESEARCH FINDINGS
FIGURE 24-7 Brownie Buster group pictures.
Scientifically Based Instructional Practices
Integrated Service Delivery
TABLE 24-5 Recommended Fine Motor Activities to Improve School Functions
TABLE 24-6 Activities to Prepare Children for Writing
FIGURE 24-8 The occupational therapist may help the teacher establish learning centers for sensory exploration.
FIGURE 24-9 A fine-motor learning center may include hanging up T-shirts and pictures using clothespins.
Consultation
TABLE 24-7 Intervention Strategies When Consulting
Annual Review and Reevaluation
CASE STUDY 24-1 William
PARTICIPATION IN THE SCHOOL ENVIRONMENT
PERFORMANCE IN SCHOOL ACTIVITIES
OCCUPATIONAL THERAPY SERVICES
TABLE 24-8 Consultation by Interaction Style
NEW DIRECTIONS IN SCHOOL-BASED PRACTICE: PREVENTION-BASED MULTITIERED SERVICES AND SCHOOL MENTAL HEALTH
Prevention-Based Multitiered Services
FIGURE 24-10 Tiered model of education.
OCCUPATIONAL THERAPY’S ROLE IN SCHOOL MENTAL HEALTH
The School Mental Health Movement
Multitiered Public Health Model of School Mental Health
The Role of Occupational Therapy
Social-Emotional Learning
Positive Behavior Support
FIGURE 24-11 Academic and behavioral tiered levels of intervention.
BOX 24-5 Occupational Therapy Services Focusing on Social-Emotional Learning: Teaching Social Skills
TABLE 24-9 Sample Activities Provided by Occupational Therapy Under a Public Health Model of School Mental Health
SUMMARY
REFERENCES
CHAPTER 25 Service for Children with Visual or Hearing Impairments
OBJECTIVES
KEY TERMS
VISUAL IMPAIRMENT
RESEARCH NOTE 25-1
ABSTRACT
IMPLICATIONS FOR PRACTICE
CASE STUDY 25-1 Natalia, Nicholas, and Hannah
NATALIA
NICHOLAS
HANNAH
Developmental Considerations and the Impact of Visual Impairment
Participation in Co-occupations of Caregiving
Exploration and Play
Learning, Education, and Academic Performance
TABLE 25-1 Comparison of Motor Functioning, Degree of Visual Impairment, and Severity of Co-occurring Disabilities
Use of Information from Other Sensory Systems
Sensory Modulation
BOX 25-1 Postural and Motor Characteristics Seen in Children with Visual Impairment.
Activities of Daily Living and Instrumental Activities of Daily Living
Social Participation and Communication
Occupational Therapy Evaluation
Occupational Therapy Intervention
TABLE 25-2 Signs and Symptoms of Visual Problems*
FIGURE 25-1 Child with low vision tracking around a curb on a playground tricycle.
FIGURE 25-2 Child with severe visual impairment using a push toy as a mobility aid.
Issues in Critical Thinking and Decision Making
TABLE 25-3 Comparison of Characteristic Behaviors in Children with Visual Impairment and Autism to Typically Developing Children and Children with Visual Impairment
Special Techniques and Strategies
Preparation for Adulthood
HEARING IMPAIRMENT
BOX 25-2 Risk Indicators Associated with Permanent Congenital, Delayed-Onset, or Progressive Hearing Loss in Childhood
Developmental Considerations and the Impact of Hearing Impairment
RESEARCH NOTE 25-2
ABSTRACT
IMPLICATIONS FOR PRACTICE
Occupational Therapy Evaluation
BOX 25-3 Findings That Indicate the Possibility of Hearing Loss
Occupational Therapy Intervention
CASE STUDY 25-2 Tori
FIGURE 25-3 Child with behind-the-ear hearing aids working on balance and equilibrium skills.
FIGURE 25-4 Sisters communicating using sign language, discussing playing with their pet cat—a favorite shared occupation.
FIGURE 25-5 Child with a cochlear implant participating in an oral motor group to facilitate oral language skills.
Special Techniques and Strategies
RESEARCH NOTE 25-3
ABSTRACT
IMPLICATIONS FOR PRACTICE
BOX 25-4 Suggestions for Communicating with Hearing-Impaired Children
FIGURE 25-6 A, Diagram of a behind-the-ear hearing aid. B, Diagram of a cochlear implant.
Preparation for Adulthood
MULTISENSORY IMPAIRMENT
Diagnostic Information
Other Services
Occupational Therapy Evaluation and Intervention
Evaluation
Intervention Goals and Methods
Special Techniques and Strategies
Preparation for Adulthood
SUMMARY
REFERENCES
APPENDIX 25-A Vision Impairment
DIAGNOSTIC INFORMATION
Definitions and Prevalence
Visual System
Causes of Blindness and Visual Impairment
Identifying Children with Visual Impairment
Common Pediatric Eye Disorders
OTHER SERVICES
SPECIALIZED ASSESSMENT TOOLS
REFERENCES
Appendix 25-B Hearing Impairment
DIAGNOSTIC INFORMATION
Anatomy of the Ear
HEARING LOSS
Measurement of Hearing Loss
Functional Implications and Intervention
Table 25B-1 Therapy and Education Implications of Typical Hearing Loss Conditions
OTHER SERVICES
SPECIALIZED ASSESSMENT TOOLS
REFERENCES
CHAPTER 26 Hospital and Pediatric Rehabilitation Services
OBJECTIVES
KEY TERMS
HOSPITALIZATION
Characteristics of Children’s Hospitals
Region (Locations) Served
Missions of Children’s Hospitals
Research Regarding Systems and Care Outcomes
Family and Child-Centered Care
Accrediting and Regulatory Agencies
Reimbursement for Services
Occupational Therapy Services Within Children’s Hospitals
Functions of Occupational Therapists
Prevention
FIGURE 26-1 Active assistive range of motion exercises are performed several times each day to prevent joint and muscle contractures with this boy who sustained a severe closed head injury. Stretch is also applied to existing contractures, along with other joint mobilization techniques.
Resumption
Restoration
Evaluation
Determining Intervention Goals
Interventions
Preventing Secondary Disability and Restoring Performance Skills
FIGURE 26-2 Splints are used to prevent or reduce contractures. The use of serial static splints requires regular monitoring and clear instructions for use by family members and other care providers.
Resuming and Restoring Occupational Performance
FIGURE 26-3 A, The occupational therapist provides the child with cues and performance feedback while he carries out an adapted personal ADL sequence. A helmet is required to protect the head because of an open skull fracture. B, Mobility is a fundamental part of ADL routines. After completing a morning care routine, this child walks to breakfast with assistance from the occupational therapist for safety and technique.
FIGURE 26-4 Adapted dressing routines are developed to achieve success and ease learning. For this boy, who has perceptual and cognitive deficits after brain injury, the occupational therapist cues him in a repetitive sequence of steps that accomplish the task.
Adaptations for ADL Skills
Documentation of Occupational Therapy Services
BOX 26-1 Basic Rehabilitation Strategies
MOTOR LIMITATIONS
Limited Range of Motion
Decreased Strength and Endurance
Incoordination
One-Handed Techniques
PERCEPTUAL AND COGNITIVE LIMITATIONS
Perceptual and Cognitive Deficits
Visual Impairment
Scope of Occupational Therapy Services
Organization of Hospital-Based Services
Rehabilitation Services
BOX 26-2 Examples of Rehabilitation Services
ACUTE MEDICAL CARE UNITS
SPECIALTY UNITS (E.G., ORTHOPEDICS, CARDIAC AND PULMONARY SERVICES, AND ONCOLOGY AMONG OTHERS)
ONCOLOGY AND BONE MARROW TRANSPLANT
REHABILITATION SERVICES
OUTPATIENT SERVICES
Rehabilitation Team
Team Interaction
Families
Transition from Rehabilitation to the Community
Medical Model and Team Interaction
CONSULTATION SERVICES
Intensive Care Unit Services
General Acute Care Unit
Failure to Thrive
CASE STUDY 26-1 Michael
PRESENTING INFORMATION
BACKGROUND INFORMATION
MEDICAL AND OCCUPATIONAL THERAPY INTERVENTION
CASE STUDY 26-2 Kevin
PRESENTING INFORMATION
BACKGROUND INFORMATION
MEDICAL AND OCCUPATIONAL THERAPY INTERVENTION
SPECIALTY UNITS
Oncology and Bone Marrow Transplant Units
Oncology Treatment
Transplant Procedures, Complications, and Interventions
CASE STUDY 26-3 Danielle
PRESENTING INFORMATION
BACKGROUND INFORMATION
MEDICAL AND OCCUPATIONAL THERAPY INTERVENTION: ONCOLOGY PHASE OF TREATMENT
REHABILTATION SERVICES: LEVELS OF REHABILITATION SERVICE
TABLE 26-1 Rapid Onset Conditions
TABLE 26-2 Complications in Children with Chronic Disorders
TABLE 26-3 Special Medical Procedures
Outpatient Services
CASE STUDY 26-4 Stephen
PRESENTING INFORMATION
REFERRAL HISTORY
CLINICAL FINDINGS
INTERVENTION ACTIVITIES
DISCHARGE FOLLOW-UP PLAN
FIGURE 26-5 A, The occupational therapist promotes the use of the hemiparetic arm to hold the paper while the child carries out a drawing and writing activity. B, The therapist provides guidance in using both arms while participating in a cookie-baking activity.
TABLE 26-4 Outpatient Clinics and Programs Often Served by Occupational Therapists
CASE STUDY 26-5 Stacie
SUMMARY
REFERENCES
SUGGESTED READINGS
CHAPTER 27 Transition Services: From School to Adult Life
OBJECTIVES
KEY TERMS
OCCUPATIONAL THERAPY CONTRIBUTIONS TO TRANSITION
THE INTERSECTION OF POLICY AND SCIENTIFIC EVIDENCE
Transition Policy
Individuals with Disabilities Education Act
Section 504 of the Rehabilitation Act
FIGURE 27-1 Career exploration through community volunteer opportunities.
Americans with Disabilities Act
Ticket to Work and Work Incentive Improvement Act
Evidence-Based Practice
BOX 27-1 The Complexities of Special Education Research
Collaborative Interdisciplinary and Interagency Teamwork
BOX 27-2 Family-Professional Partnerships
BOX 27-3 Collaboration: What Is It?
FIGURE 27-2 A real job in a daycare setting.
BOX 27-4 Examples of Outcome-Oriented Transition Goals
CASE STUDY 27-1 Mike
Ecologic Approaches
Self-Determination, Self-Regulation, and Social Competence Training
TABLE 27-1 Transition-Focused Evaluations and Services
BOX 27-5 Self-Determination and Student-Directed Planning Meetings
BOX 27-6 Social Competence and Job Performance for Adolescents with Emotional and Behavioral Disabilities
BOX 27-7 Youth Violence: Considerations for Transition Planning
BOX 27-8 Social Competence for Students with Autism As They Make the Transition to Postsecondary Education
BOX 27-9 Transitioning from High School to Postsecondary Education and Training Programs
Recommended Practice: Paid work experience during high school
CASE STUDY 27-2 Brian
FIGURE 27-3 Job carving. A, Creating a job focused on shredding office paper. B, Creating a job focused on cleaning menus.
CASE STUDY 27-3 Renee
Practice-Based Evidence
BOX 27-10 Practice-Based Evidence
BOX 27-11 Effective Practice in a Research Emergent Profession: Occupational Therapy
CASE STUDY 27-4 Todd
FIGURE 27-4 Real work in the community depends on being able to get to and from the job site.
FIGURE 27-5 Individual progress monitoring/performance analysis.
CASE STUDY 27-5 Amanda
FIGURE 27-6 Individual progress monitoring/performance analysis.
BOX 27-12 Universal Design for Learning
SUMMARY
REFERENCES