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Peds Final

anskorczewski12's version from 2018-05-05 22:25

Cognitive, intellectual disability

Question Answer
Strategies with CO-OPguided discovery, metacognition (awareness of the cognitive processes for learning, stopping and reflecting on how they are learning with rehearsal, imagery, mnemonics), scaffolding
Guided discoveryproviding opportunity for the child to ask questions and generate ideas that can be further tested/researched (set up area to explore and pose questions during play)
COOP strategy repeating key words related to doing a skillrehearsal (repeating information visually or mentally to aid in retention of important information related to given task/occupation: repeating key words/actions out loud, creating internalized visual images of the task procedure, and visually carrying out the task in a repeated manner)
COOP global strategy sequenceestablish a goal, plan, do it, and check how the plan went
CBTstructured, goal-oriented, change the way we think affects our behaviors, problem-focused, action-oriented
DBTbalancing irrational thoughts; has mindfulness (focusing on present moment), distress tolerance, emotional regulation, interpersonal effectiveness (techniques for communicating with others, DEAR MAN)
IQ score for intellectual disabilitybelow a 70 for mild
Adaptive behaviorindividual’s ability to meet the standards of maturation, learning, personal independence, and/or social responsibility
Intellectual disabilityA disability characterized by significant limitations in both intellectual functioning and in adaptive behavior (before the age of 18)
Focus for severe intellectual disabilitypartial participation (usually coexists with other conditions, and have slow self-care skill acquisition)
Developmental disabilities criteriahave severe chronic disabilities that can be cognitive and/or physical (substantial limitations in three or more major life activities), and diagnosed between 5-22 years
Adaptive behavior difficulties causefailure to meet developmental/social standards for independence and social responsibility, limited functioning in ADLs
Type of Down SyndromeTrisomy 21: (nondisjunction), Mosaicism (a mixture of two types of cells, with and without mutation), translocation (most types have mild to moderate cognitive delays)
Fragile X syndromea genetic condition that causes intellectual disability, behavioral and learning challenges (ADHD, autism, anxiety, sensory, aggression), various physical characteristics (no life threat)


Question Answer
At what age does an infant lift and turn the head to maintain head position in supported sit, hold bottle, and eat pureed foods3-6 mo.
At what age does a child eat soft/mashed food, have strong sucking with no liquid loss from bottle, use long sequences of sucking during drinking, use lateral movements to transfer food in mouth8-9 mo
Phases of feedingoral preparatory phase, oral phase, pharyngeal phase, esophageal phase
Steps of evaluating feeding problemsask parents first (family concerns, cultural norms), hands-on evaluation of muscle tone, neuromuscular status, sensory processing, developmental level), structured observations of oral structures and patters, observation of child with parent
Progression of food texturesLiquidsPureed foodssoft foods/meltable solidseasily chewed foodscoarsely chopped table foods/soft-solids
Contextual factors to consider during feedingcultural norms, socioeconomic status, caregiver factors (controlling/forcing/their eating habits)
Progression of self-feeding0-3 (symmetric oral motor sucking), 3-6 mo (head and neck control, reach and grasp, helps to hold bottle), 6 mo (spoon feeding with purees), 8 mo (meltable finger foods), 8-12 (chewing advances, tongue lateralization emerging, cup drinking introduced, sitting in chair, using pincer grasp), 12-14 mo (develop rotary jaw movements)
Picky eater vs. problem feederproblem feeders eat 20 foods or less
Team members with feedingSLP, behavioral psych, nutritionist, pediatric gastroenterologist (GI), early childhood teacher
Gagging vs. chokinggagging is natural, choking is life threatening
Techniques for non-nutritive oral motor stimblowing bubbles, hard munchables, teething toys, cheese-cloth
Intervention techniquespositioning, environmental adaptations, AE, texture modifications, sensory development, behavioral strategies (create positive interactions, ignore negative behaviors), neuromuscular handling, backward-chaining
Levels of food for dysphagia management1. Pureed (puddling-like) 2. Mechanically altered (moist, semi-solid) 3. Advanced (soft-solid foods, crackers, breads, cooked veggies) 4. No restrictions
SOS programplay-based program teaching children to eat at a pace that respects readiness (they are in charge) need to have at least 30 foods and usually interacts with new foods to graduate
Types of foodspurees (puddings), hard munchables (veggie sticks), meltable hard solids (Cheetos), soft cubes (cheese), soft mechanical (noodles), hard mechanical (pretzels)

neuromusculoskeletal disorders

Question Answer
Types of CPspastic (diplegia, hemiplegia, quadriplegia, double-hemiplegia), mixed, ataxic, dyskinetic (choreoathetoid, dystonic, athetosis)
Ataxic CP(cerebellum) poor balance, coordination, and stabile alignment of head/tunk/shoulders/pelvis, shifts in m. tone (less than dyskinesia), appear clumsy and involuntary tremor (more success in voluntary movements than others)
Mixed CPcombinations of high and low m. tone problems, typically quadriplegic (ex. Child with spastic CP moves extremities with abrupt hypertonic movements but also exhibits hypotonicity in trunk muscles)
Dyskinetic CPexcessive and abnormal movement, often when initiating movement in one extremity, atypical and unintentional movements in other extremities result
Types of dyskinetic CPchoreoathetoid (constant fluctuations from low to high with jerky involuntary movements that may be seen more proximal), dystonic (sustained twisted postures that are absent at rest and triggered by movement), athetosis (slow, writhing, involuntary movements combo with abrupt irregular, jerky moves)
Spastic CPhypertonia and muscle spasticity, lesion in primary motor cortex, associated with clonus (spasms with contractions), extensor plantar response (Babinski), persistent reflexes, poor control of voluntary movement
Associated problems with CPtypical movements, visual impairments, language concerns (dysarthria or aphasia), failure to thrive, respiratory complications
Dysarthriadifficulty or unclear articulation of speech
Primary problems of CPequilibrium, decreased/loss of motor control, abnormal tone, impaired sensation
Secondary problems of CPjoint mal-positioning, m. imbalance, functional impairment (may use meds, surgery, or splints)
Tertiary problems of CP(we can prevent) skeletal deformity, joint contractures, m. contractures
Classification of tone distributionhemiparesis, diplegia, quadriparesis
Medical interventions for CPbaclophen pump (into spinal cord), botox (into muscle, usually combo with splinting after), phenol blocks (decrease m. tone through nerve, not permenant), posterior dorsal selective rystomy (must have intensive therapy after, cut rootlets)
Mom reports Jenny had damage to her primary motor cortex, Abnormal movements and atypical reflexes present (i.e., ATNR) Hypertonicity in her arms with spasticity greater in her right bicep, wrist flexors, and thumb adductor, Hypertonicity in her legs with spasticity greater in hip adductors, hamstrings, and gastroc/soleus, Delayed or absent righting and equilibrium responses, What type of CPspastic
What type of movements would you expect with athetoid CPLarge sudden fluctuations, “jerky” movements with poor midrange control
Athetosis CPslow, writhing, involuntary motor movements in combination with abrupt, irregular and jerky movements
Manual ability classification scale (MACS)functional classification system that determines the level of hand use (level 1. able to handle objects easily to level 5. does not handle objects and has severely limited ability to perform even simple actions)
Gross Motor Functional Classification Scalefunctional classification of gross motor/mobility (level 1 is walking basically fine to level 5 is needed manual w/c in all settings and unable to maneuver a w/c)
Medical intervention used to reduce spasticity/ muscle tone by injecting directly into the muscleBotox
What common compensatory strategy is often observed for reaching and grasping children with CPExcessive trunk movements including trunk extension and lateral flexion (from difficulty dissociating shoulder movements for reach and grasp and compensate by laterally flexing (avoiding rotation) and extending the trunk (as rotational movements are more difficult for them).
Pediatric CIMTgood for CP, include (verbal guidance, visual displays, positional prompts, physical assistance, modeling)
What strategies to use with P-CIMT to ensure effective shaping and successive approximationsscaffolding, forward/backward chaining, fading
Basis of all NDT treatmentreducing abnormal m. tone and movement, and facilitating normal tone and voluntary movement (CP options-prone extension with wedge, side lying to develop core muscles, improve breathing, allow for wt. shift and reach and supported floor long sit
Facilitating and inhibiting handling techniquesfacilitating (wt. bearing, tapping, vocal cues, strengthening), inhibit (lengthening, wt. bearing, imposed rotation movement patterns (joint stability), exciting the antagonist muscle)
Types of Spina BifidaOcculta (mild, gaps in vertebral arches), cystica (protrusion of cord through vertebral arch)
Common complications with Spina Bifidahydrocephalus (need a shunt where CSF enters the spinal cord), Arnold-chiari type II malformation (cerebellum extends through cranium hole), loss of sensation/motor function below lesion, learning may be affected, expressive language may appear better than receptive (visual perceptual problems), skin integrity


Question Answer
ASD DSM criteriapersistent deficits in social communication/interaction across multiple contexts, restricted, repetitive patters of behavior, interests, or activities (be at least two of. stereotypes motor movements, insistence on sameness, highly restricted interests, hyper- or hypoactivity to sensory input) (key new feature is unusual responses to sensation and elimination of multiple categories) (can be further classified as intellectual impairment or language impairment)
Interventions used with ASDFloortime DIR, ABA, COOP, Sensory integration
Floortime DIR for ASD(based on relationship-based model which says adults can help expand children’s communication by meeting them at their developmental level and building on their strengths) encourages parents to engage children literally at their level – by getting on the floor to play
ABA for ASDuses positive reinforcement to bring about meaningful and positive change in behavior.
Motor challenges with ASDToe-walking, reduction in variability and complexity of movement patterns, balance disturbances, Fine motor (slow labored manual dexterity, late onset of lateralization), Muscle tone (hypotonia), Dyspraxia
Educational interventions for ASDAcademic modifications, visual supports, technologic supports, social supports, social stories, behavior supports, sensory supports, motivational supports, video modeling
What is important to ask family about for ASDsafety and escapism
Echolaliarepeating words or phrases immediately or after a delay
The first priority in treatment for ASD includesdecrease self-injurious behavior, early and intensive intervention to facilitate communication, relationships, and adaptive behavior
Theory of mind deficits for ASDDifficulty understanding what someone else is thinking/feeling
Evaluation for ADHD includesa standardized behavior checklist (Behavior Assessment System for Children), parent and child interviews, tests of cognitive and executive functions (TOVA-boring attention test)
ADHD is often comorbid withlearning problems and sensory processing disorders
ADHD diagnostic criteriaA persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by either inattention or/and hyperactivity that is inconsistent with developmental level and negatively impacts directly on social/academic activities, present in two or more settings, symptoms present prior to 12 years, and the symptoms do not occur during course of schizophrenia or mental disorders
ADHD typeshas 3 main subtypes or clinical presentations (combined, predominantly-inattentive, and predominately hyperactive-impulsive)
Recommended intervention for ADHDmulti-modal approach using a number of different interventions in an effort to reduce ADHD symptoms and enhance daily functioning