Peds ch 1

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Peds ch 1
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  1. occupational therapy
    develops a person's ability to engage in the "occupations" of work, play, and self-care activities
  2. occupation
    developing and implementing a plan of purposeful activity, or occupation, to overcome obstacles and perform competently.
  3. occupational therapy in schools
    designed to assist in the development of underlying performance components (prerequisite skills) enable the child to function in the educational settings
  4. occupational therapy practice framework: domain & process (OTPF)
    an official document of the OTA

    "The framework was developed to articulate occupational therapy's contribution to promoting the health and participation of people, organizations and populations through engagement in occupations
  5. the domain
    outlines the profession's purview and the areas in which its members have an established body of knowledge and expertise
  6. the process
    related to the delivery of occupational therapy services

    performance in areas of occupation

    • ADL
    • IADL
    • education
    • rest and sleep
    • work
    • play/leisure
    • social praticipation
  7. ADL's
    • bathing/showering
    • feeding/eating
    • bowel/bladder management
    • dressing
    • grooming
    • hygeine
    • functional mobility
    • toliet hygeine
  8. IADL's
    • more complex
    • involes others

    • care of others
    • care of pets
    • communication device use
    • communicating mobility-bus, subway
    • health maangement/maintenance
    • safety procedures/emergency responses
    • shopping
  9. education
    formal education participation

    seeking out and participating

    informal personal education participation-needs or interests exploration ex. boy scouts, play sport
  10. rest and sleep
    activities related to obtaining restorative rest and sleep that supports healthy active engagement in other areas of occupation
  11. work
    tasks performed by the ehild that involve "work"

    • school
    • home

    chores-use chores for home therapy
  12. school activities and work
    initial focus on social skills, health and sensorimotor development

    later, mastery of reading, writing, math and higher problem solving
  13. play and leisure
    skills and performance of intrinsically motiviating activities, spontateous enjoyment, or self-expression

    early childhood

    play involves exploration of objects and the environment, initiating others and repetitive activites

    childhood

    play becomes more social and involves games with groups of children

    play skills evolve from swimple play iinteractions of touch and sounds in infancy to sophisticated construction and art activities in adolescence
  14. function/dyfunction continuum
    • remediation
    • improving the related impairments

    adaptation-spina bifada-scooter

    compensation-ex. raise garden table
  15. the therapist will analyze the activity and child's performance
    which aspects of the performance can be remediated

    employ strategies to improve performance

    how can the activity be adapted
  16. social participation
    organized patterns of behavior that are characteristic and expected of an individual or a given position within a social system

    • community
    • family
    • peers
  17. performance skills
    the abilities clients demonstrate in the ations they perform
  18. motor and praxis(motor planning) skills
    motor:

    actions or behaviors a client uses to move and physically interact with tasks, objects, contexts, and invironments. includes planning, sequencing and executing new and novel movements

    praxis(motor planning):

    skilled purposeful movements. ability to carry through learned motor acitivity. motor planning

    ex. riding a bike

    driving your car comnpared to driving a rental
  19. motor skills
    gross motor skills- large movement, walk, run, jump

    fine motor-writing, play instrument, eye movement

    oral motor skills-
  20. sensory-perceptual skills
    sensory and perceptual processing

    neuromuscular abilities ex. adjust shower for warmth, clothes and how they feel

    • positioning of the body-
    • where is our body in space
    • how we know we are upright
  21. cognitive skills
    the childs ability to attend to and learn from the environment

    color blue-find something like this

    actions or behaviors used to plan and manage the performance of an activity

    thinking. problem solving, planing things
  22. emotional regulation skills
    actions or behaviors used to identify, manage and express feelings while engaging in activities or interacting with others

    childs ability to interact with others

    to cope with new or difficult situations

    to manage their behaviors in socially appropriate way
  23. communication and social skills
    actions or bnehaviors a person uses to communicate and interadt with others

    • eye contact
    • non verbal communication
    • personal space
    • verbal interaction
  24. client factors
    values, beliefs and spirituality

    body functions

    body structures
  25. activity demands
    • objects and their properties
    • space demands-ex. kitchen, floor
    • social demands-talk to others
    • sequencew and timing
    • required actions and performance skills
    • required body structures
  26. performance patterns
    habits-automatic behaviors. ex. biting nails

    routines-patterns of behavior ex. getting up in the morning, bed time. an order that keeps you organized

    rituals-symbolic actions with meaning ex. light candles, jewish tradition

    roles-set of expected behaviors ex. as a parent, PTA president

    related to functioning of an indivudual, organization and population
  27. context and environment
    how the child's performance is influenced by and influences the environment

    interrelated conditions within and surrounding the client that influence performance

    what factors are critical to the child's performance

    • cultural
    • physical
    • social
    • personal
    • spiritual
    • temperal
    • virtual
  28. occupational therapy process
    process of service delivery
    • evaluation
    • occupational profile
    • analysis of occupational performance

    • intervention
    • intervention plan
    • intervention implementation
    • intervention review

    • outcomes
    • how well the child does
  29. evaluation
    done by OT

    pocuses on what the client wants and needs to do

    formal and informal evaluation

    • consists of:
    • occupational profile
    • analysis of occupational performance
  30. occupational profile
    includes information about the clientand the client's needs, problems and concernsabout performance in the areas of accupaation

    summary of information that describes poccupational history and experiences, patterns of daily livingk, interests, values and needs

    who is the client?

    why is the client seeking servies and what are his'her concerns relative to performance in areas of occupation?

    what areas ofoccupation are successful and what are causing problems?

    what contesxts and environmentswsupport or inhibit participation?

    what are the client's priorities and desired outcomes?
  31. evaluation-analys of occuaptional performanceis
    • gather essential and comprehensive information
    • strengths and weaknesses

    liimitations in underlying performance skills, performance in areas of occupation, performance patterns, context, activity demands and client factors

    relate to the child's occupational performance
  32. performance in areas of occupation
    what the child is able to do

    the range of human occupations and activities that make up peopleslivesw

    quantity and quality of skills and performance

    structured and non-structured iobservation, interviews
  33. meaning of occupation
    who is the child

    how does the childs occupation relate to his or her identity

    in what areas of occupation is the child successful

    what areas of occupation are problematic

    what are the childs occupational priorities and desired outcomes
  34. function of occupation
    what is the child unable to do

    how does the current occupational situation affect ongoing developoment

    whi is affected by the childs challenges

    how do the occupations of key person hinder or support the client

    how might key person provide better support to the child
  35. form of occupation
    what actions are required to complete the occupation successfully

    where can the occupation be observed

    when and how oftewn coan it be observed

    what is the quality of the childs performance

    what will phappen as a result of performingthe occupation

    what contexts are supporting/inhibiting engagment in the occupation
  36. intervention planninc (treatment planing)
    the OT interprets how assts and limitations and the environment influence "occupational performance"

    a plan that is developed based on the results of the evaluation process

    describes selected OT approaches and types of interventions to reach the clients identified targety outcomes

    developed collaboratively with the client family significan others

    the design of the intervention plan is directed by:

    • the clients goals, values, beliefs and occupational needs
    • the health and well-being of the client

    the cleints performance skills and performance patternsas they are influenced by the interaction of the context, activity demands and client factors

    the setting or circumstances in which the intervention is provided (context)

    best available evidence
  37. the process of intervention planning
    develop the plan

    the OT develops the plan and the OTA can contribute to the plan

    the olan includes:

    objective and measurable goals with time framemechansims for service delivery

    consider potential discharge needs and plans

    select outcomes measures

    make recommendationsor referrals to others as needed

    intervention approach
  38. short and long term goals
    • STG-relate to performance components
    • ex. button shirt, etc. whill change

    LTG-relate to performance of functional areas of daily living, play and school activities. ex. totally dress-does not change
  39. intervention implementation
    putting the plan into action

    defined as the skilled process of effecting change in the clients occupational performance

    leads to engagement in occupations or activities

    primary goals:

    improve performance components

    enhance performance of functional activites

    modifuling the performance context

    • preventing disability and socail role dysfunction
    • . the earlier the better to work with them
    • increasing self esteem and self-actualization

    promoting positive interactions and relationships
  40. steps towards intervention
    1. determine and carry out the type of OT intervention used

    • therapeutic use of self
    • occupational-based interventions

    purposeful activity

    preparitory methods

    consultation process

    education process

    advocacy

    • 2. monitoring client
    • s response to intervention
  41. reassessment/intervention review
    the intervention process always involves reassessment

    leads to refining and adjusting goals and srategies

    formal or informal

    occurs regularly via observation

    may require objective criteria

    should always be related back to the childs ability to function in the everyday environment
  42. process of intervention review/reevaluation
    reevaluate the plan and how it is carried out with the client relative to achieving targeted outcomes

    modify the plan as needed

    determine the need for continuation, discontinuation, or referral
  43. outcmes
    important dimensions of health, attributed to intervention but include the ability to function, health perceptions and satiswfaction with care

    the end-result of the occupational therapy process

    describes what OT intervention can achieve with clients
  44. types of outcomes(OTPF-table 10)
    • occupational performance
    • adaptation
    • health and wellness
    • participation
    • prevention
    • quality of life
    • role competence
    • self-advocacy
    • occupational justice
  45. arenas of practice for pediatric occupational therapy
    neonatal intensive care unit

    pediatric units of heneral hospitals

    childrens hospitals

    rehabilitation centers

    outpatient facilities
  46. educational
    early intervention programs-1-2

    preschool 2-5

    public schools (regular/spec. ed)

    classrooms

    private schools
  47. community
    earlyintervention programs

    private practice

    homes

    child care centers

    job sites and work settings

    residential settings
  48. theory and practice in occupational therapy
    what is theory?

    a set of ideas or concepts that people use to guide their actions

    a theory reflects an image or explanation of why or how a phenomenon occurs
  49. scoope of practice
    general guide to the profession

    provide frameworks that delimits the professionss range of interests and fous attention on those aspects of human functioning that are of greatest concern to OT practitioners
  50. model of practice
    refers to the application of theory to occupational therapy practice

    models of practice are not interventions protocols but serve a means to view occupation through the lens of theorywith the focus on the clients occupational performance
  51. models of practice(3)
    mental health
    Model of Human Occupation(MOHO)
    Ecology of Human Performance
    Person-Environment-Occupation Model
    • MOHO
    • incorporates a systems view of the human being that emphasizes two main points:

    • behavior is dynami and context dependent
    • occupation is essential to self-organization

    a persons inner characteristics interat with the environment to create a network of conditions that influence a persons motivation, actions and performance

    • peoples characteristics reflect what they havce done in the past. This model views therapy as a process by which:
    • -people are helped to do things in order to shape their abilities, self-concepts, and identities
    • -MOHO envisions OT as engaging people in occupation, which helps maintain, restore and reorganize their occupational lives
  52. MOHO
    conceptualizes the human as composed of 3 elements:
    volition-will, do by choice

    habituation

    performance capacity (mind, brain, body performance)
  53. Each system MOHO, has changing levels of power and importance
    Volitional system

    • personal causation
    • self-sknowledge
    • values
    • interests
    • choices
    • thoughts and feelings

    hubituation system

    • habits and learned roles that give peoople stability
    • can perform an action without thinking though the action

    performed capacity

    • reflects what the client has done
    • allows an individual to perform an actrion/occupation
    • links physical status with mental/cognitive abilities
    • brings concepts of the mind and body together

    cause and effect are important

    • aninteractive model
    • context is central of occupational
    • environmental interaction is the essence of human occupation
    • client must choose activity and needs to participate
  54. Ecology of Human Performance (EHP)
    mental health
    client centered model

    EHP framework is a model for considering context on OT practice

    EHP framework is that ecology or the interaction between a person and the context, affects human behavior and task performance

    human performance is a transactional process through which the person, the context and the task performance affect each other

    each transaction influences a persons future performance range and options

    therapeutic intervension from an EHP perspective occurs as collaboration among the person, the family and the OT practitioner

    it is designed to facilitate occupational perfoormance through changing the variables
  55. Person-Environment-Occupation Model (PEO)
    the PEO model was developed to facilitate the occupational therapists understanding of the dynamic nature of occupational performance

    • the model has 3 interactricting elements:
    • person
    • environment
    • occupation

    occupational performance isthe outcome of a transactional relationship that exissts among people, their occupations, and the envieironments in whcih they live, work, and play

    occupational performance is changing constatly over a lifetime
  56. Frame of Reference-Physical Challenges
    Rehabilitative Frame of Reference
    Biomechanical Frame of Reference
    Sensorimotor Frame of reference
    • Frame of reference:
    • link theory to intervention strategies

    to apply clinical reasoning to the chosen intervention methods

    tends to be a more narrow view compared to models of practice

    Rehabilitative Frame of Reference

    embraces the philosophy of rehabilitation: to enable a person with physical or mental disability or chronic illness to achieve maximum function in the performance of his or her daily activities

    emphasizes an individuals abilities
  57. Rehabilitative FOR
    OT uses this the most, can't change what is wrong with the client. Use devices

    focuses on compensatory methods, assistive devices and environmental modification theindividual needs to function

    OT practitioners using this model assume that the client's impairment is stabilized and cannot be altered by therapeutic interventions

    theclients capacity to function in daily activities, can be changed through the use of compensatory methods and adaptive equipment

    teaching learning process is a mojor part of OT interests

    teach the client compensatory methjods to perform ADL, ADL, and ways to apply these new techniques to daily activities and participation in life situations

    successful outcomes depends heavily on client commitment and participation in the teaching-learning process

    linked closely with the medical model

    most closely associated with physical disabilities
  58. Biomechanical Frame of Reference
    used to treat individuals with activity limitations due to impairments in biomechanical body structures and functions, including structural instability, decreased strength, limited ROM and poor endurance

    the main tenet of the biomechanical approah is that occupational performance dcn be regained through addressing underlying impairments that limit performance of activities

    treatment focuses on preventing or decreasing impairments through the use o activity and exercise, which may be purposeful or rote

    treatment modalities may not be inherently meaning ful to the client, but focus on the ultimate fgoal of restoring the clinets capability to engage in occupation

    treatment is aimed at reducing biomechanical impairments, however goals must reflect expected improvement in occuaptional performance
  59. biomechanical FOR
    treatment techniques utilized:

    • static splints
    • dynamic splints
    • compressive wraps
    • active exercise
    • specialized massage
    • muscle endurance
    • cardiovascular endurance

    the OT practitioner is trained to see the connection between the biomechanical impairments and occupational performance deficits

    when using this approach, it is important to explain the purpose of the treatment activities in relationshipl to the occupational performance
  60. Sensorimotor FOR
    CNS
    CP, stroke, MD, MS
    approaches share a common foundation of viewing a client who has sustained a central nervous system insult

    various approaches are utilized to promote reorganization of the sensory and motor cortices of the brain

    specific techniques included in the frame of reference

    PNF-Proprioceptive Neuromuscular facilatation

    • NDT-Neuro developmental treatment
    • Rood
    • Sensory integration

    • Developmental
    • reflects current understanding of sensory and motor development

    used to remediate neurologic and developmental motor dysfunction
  61. Goals of NDT
    decrease influence of abnormal postural tone and reactions

    promote functional movement patterns

    prevent contractures and deformities
  62. Sensory Integration (SI)
    sensory integration is the process of organizing sensory information in the brain to make an adaptive response

    adaptive responses are necessary to meet the challenges within our environment

    adaptive responses are believed to be the foundation of purposeful activity

    used when sensory processing deficits make it difficult for a child to produce an approprioate adaptive

    the therapist uses controlled sensory input to facilitate adaptive motor responses
  63. Cognitive disability FOR
    CT-cognitive therapy
    an overarching framework for this model is the pattern of assumptions about what a cleint can do, will do, and may do

    the OT practioner works with the client and uses meaningful activities to access and change cognitions and appraisals that are detrimental to the clients dcompetencies

    the combination of CT and occupational therapy allows therapist the opportunity to examine meaning associated with functional acivities

    the focus of the clients cognitive appraisal process leads th the individualization fo each clients intervention ploans and the developoment of specific objectives

    the pracrtioner identifies the underlying mental structures of a given activity to predict similar performancew in other activities

    Allen Cognitive Levels-assesment tool
  64. Motor Learning: An emerging FOR
    a collection of ideas from the movement sciences used to explain the acquisition and modification ofmovement

    the act of motor learning includes more than simple motor processes-it involves learning new strategies for sensing and perceiving movement

    • motor learning is:
    • the process of acquiring the capability for skilled action
    • results from experiennce or practive
    • inferred based on behavior and not measured dierectly
    • produces permanent changes in behavior
  65. Learning Perspectives
    • behaviorism
    • cognitive therapy
    • cognitive disability FOR
    • multicontext treatment approach
  66. Learning perspective
    Behaviorism
    • classical conditioning
    • stimulus=response relationship

    • operant conditioning
    • behaviors develoop as a result of their effect on the environment
    • reinforcement/punishment

    • vicarious learning/obervational-copying those around you
    • learned behaviors from observing another

    • behavioral interventions may be used by occupational therapy practritioners
    • behavioral-management interventions
    • skill building interventions

    intended to increase pro-social and health -promoting behaviors and decrease anti-social and health-threatening behaviors
  67. learning perspective
    cognitive therapy (CT)
    evolved because behavior therapy could not address many important mental health problems

    CT recognizes the importance of the clients appraisal of events in the development and continuation of mental disorders

    irrational beliefs-paranoia

    what a cleint can do is based on biological factors

    what a client will do is influenced by psychological factors such as motivation, fears, or meaningfulness of the activity being performed

    what a client may do is a reflection of how much support he or she receives fronm the social systems, including family, friends, andcaregivers
  68. Learning perspectives
    Multicontext Treatment Approach
    addresses the issue of generalization in cognitive rehabilitation

    utilized with clients with brain injury and psychiatric disabilities

    views learning as an interaction between internal (person) and external (activity demands and context) variables

    problems in proessing information and learning are understood by analyzing the dynamic interaction between the person, the activity and the context

    when activity demands or context changes, the type of cognitive streategies and self-monitoring skills required for efficient performance change as well

    intervention focuses on increasing efficiency and effectiveness of processing strategies and self-monitoring techniques within purposeful and occupation-based activities

    it combines adaptation of the activity and context with a focus on changing the persons processing strategies and self-awareness skills across a wide range of situations

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