Seizures - 1) to be prepared and maintain safety, ask the pt if an aura is typically associated w/ their seizures

Aphasia

• Global Aphasia

• Wernicke's Aphasia

Myasthenia gravis - autoimmune disorder that affects neuromuscular transmission, leading to muscle weakness. Symptoms often include muscle fatigue, ptosis (drooping eyelids), diplopia (double vision), and difficulty with speech and swallowing.

Spinal Muscular Atrophy (SAM) - genetic disorder resulting in the degeneration of motor neurons in the spinal cord leading to progressive muscle weakness starting in hands, atrophy, low muscle tone, difficulty w/ oral motor skills, cramps and fasciculations, dysarthria, fatigue

Cerebral Palsy - has visual impairments that need to be screened prior to power mobility training

• Mild Diplegic Cerebral Palsy

• Spastic Diplegic Cerebral Palsy - motor involvement of LEs that may affect toileting and  clothing management

• Moderate Anthetoid Cerebral Palsy

• Mild Ataxic Cerebral Palsy

Parkinson's Disease

Multiple Sclerosis - visual loss and dysphagia are associated w/ cranial nerve dysfunction. Heat tolerance is diminished.

Tardive Dyskinesia

Schizophrenia - antipsychotic medications may cause extrapyramidal symptoms (i.e. lip smacking, tongue protrusion, and facial grimacing) and should be reported to the pt's physician

Osteogenesis Imperfecta - bones can fracture easily such as in a minor fall or injury

Guillain-Barré syndrome - weakness & tingling in hands/feet, double vision & difficulty moving eyes, unstable gait, difficulty chewing/speaking/swallowing, bladder/bowel difficulty, high/low bp, inc heart rate, labored breathing.  1) During initial acute phase intervention methods to prevent complications (positioning and passive ROM) are ideal 2) precaution during intervention: ensure hemodynamic stability - check bp and heart rate prior to body position changes and transfers

Deep Vein Thrombosis - edema, pain, localized warmth in a flaccid extremity

Ehlers-Danlos Syndrome - a connective tissue disorder affecting skin, bones, organs, and blood vessels. Pts may experience joint hypermobility, stretchy skin, bruising easily, and fragile blood vessels.

Autism Spectrum Disorder - scheduling and routines are very beneficial

Absence (petit mal) seizure - common symptoms include abruptly stopping an activity w/ blank stare and fluttering eyelids

Simple focal  (partial) seizure - sudden movement of a body part w/ no change in vital symptoms

Congenital torticollis - type of dystonia, characterized by tight sternocleidomastoid muscle interfering w/ ability to turn head side to side

Constructional Disorder - difficulty or inability to assemble separate parts to build an end-product

Bipolar disorder - (acute manic phase) limit distractions in the environment during task performance

Dyspnea - shortness of breath

Perseveration - inability to stop an activity or action

Glaucoma - peripheral vision affected and closes in to center of vision???

Macular Degeneration -

Alzheimer's Disease

• Stage 1: no impairment

• Stage 2: basic forgetfulness, unlikely to be detected

• Stage 3 mild cog impairment, start to notice decline by family, friends, and coworkers. Inc forgetfulness, short-term memory lapses, struggling w/ planning/organizing.

• Stage 4: mod cog decline, including impaired concentration and decreased knowledge of recent events, struggle w/ complex tasks, forget one's personal history, personality changes (withdrawal, moodiness, depression, inc anxiety), sleep pattern changes

• Stage 5: mod cog decline, can NOT be under their own care. benefits from ADL assistance and assistance preparing meals. Difficulty recalling personal details (phone number), emotional changes (delusions, paranoia), cognitive problems (inability to learn new things)

• Stage 6: moderately severe, constant supervision. Needs help w/ finding clothing, trouble w/ remembering personal history, bladder/bowel difficulty, wandering or getting lost.

• Stage 7: loss of ability to respond to environment, no conversations possible, abnormal reflexes and movement, physical impairment

• Osteogenesis Imperfecta - affects the connective tissue and is characterized by extremely fragile bones that break or fracture easily (brittle bones), often without apparent cause. Besides being associated with brittle bones, the following features are also linked to OI: Blue sclerae, dentinogenesis imperfecta (disorder of tooth development), increased joint mobility, short stature, and hearing loss.

Radial Nerve Injury - can result in weak or absent wrist and finger extensors

Ulnar Nerve Injury - impairs hypothenar muscles and first dorsal interosseous muscles

Type I Chiari Malformation -

Axonotmesis - loss of protective sensation to the affected nerve distribution, requires visual compensatory skills for protection d/t issue typically resolving in 6 months

Trigger Finger initial intervention w/ pt should include static immobilization orthosis to position affected MCP joint at 0 degrees while allowing the DIP and PIP full active ROM and instructions to avoid MCP flexion

Carpal Tunnel Syndrome - initial actions include volar wrist orthosis and Phalen's Test for median nerve

Contractures of Thumb Web Space - pressure garments, night orthotics, HEP -> serial static orthoses and polymer gel sheeting

CMC thumb arthroplasty - (initial intervention plan) ROM program for shoulder, elbows, fingers, and IP joints. (post 1 week) immobilize wrist and thumb CMC and MCP joints while allowing AROM of the IP joint

Acute flare-up of stage 1 rheumatoid arthritis - isotonic and isometric exercises of both hands w/in pain-free ROM to preserve joint mobility and prevent deformities

Impingement syndrome - overhead wall pulleye is contraindicated for pt w/ mod-severe flexor spasticity and scapular immobility

Dysmetria - inability to perform accurate, smooth movements. You can either overshoot (hypermetria) or undershoot (hypometria) your movements when they’re directed at a target.

Research Theories

• Grounded Theory - continuous comparison between collected data and interpretation, results in a set of categories and an emerging theory

• Participation Action Research -

• Critical Theory Study -

• Phenomenological Study -

Hierarchy of Evidence

• Level 1 - Systematic Reviews/Meta-Analysis

• Level 2 - Critically appraised Topics

• Level 3 - Randomized Controlled Trials

• Level 4 - Cohort Studies

• Level 5 - Case-Control Studies and Case Series Reports

• Level 6 - Expert Opinion/Background information

systematic sample, individuals are selected from a population list at specified intervals. Selecting every fifth name on a list is an example of systematic sampling.

Grounded Theory Method involves the discovery of theory through the analysis of data. Grounded theory method is a research method which operates almost in a reverse fashion from traditional social science research. Rather than beginning with a hypothesis, the first step is data collection through a variety of methods. From the data collected, the key points are marked with a series of codes, which are extracted from the text. The codes are grouped into similar concepts in order to make the data more workable. From these concepts, categories are formed, which are the basis for the creation of a theory, or a reverse engineered hypothesis. This contradicts the traditional model of research, where the researcher chooses a theoretical framework, and only then applies this model to the phenomenon to be studied.

• ACL 1 (Total Assist) - Cog profoundly impaired, 24-hour care to elicit or produce automatic activities for locating stimuli, rolling in bed, raising body parts, and swallowing.

  • Intervention: Sensory Stimulation

• ACL 2 (Max Assist, attention for 3 mins max) - severely impaired cognition. 24-hour care for transfers and ADLs. May show righting reactions, can encourage while seated. Pts start to wander, important to prevent unsafe activities

  • Interventions: multisensory activities (sensory/safe environment)

• ACL 3 (Mod Assist, attention for 30 min) - spontaneous manual actions in response to tactile cues. Simple tasks (self-care) can be completed w/ task components in front of them, require tactile cues and is easily distracted. Actions unpredictable

• ACL 4 (Min Assist, attention up to 1 hour) - (Goal-Directed Actions) can complete basic ADLs and familiar tasks (walking familiar places, making a sandwich) w/ visual cues, will not recognize error w/out clear visualization of error. May live alone w/ assistance for safety.

  • Interventions: goal-directed activities w/ visual cues 

• ACL 5 (Standby assist, attention for weeks) - cog mildly impaired, SBA for safety but new learning is possible through trial and error problem solving. Pts may have poor judgement and impulsive behavior. May live alone w/ weekly checks

  • Interventions: possibly memory/planning aids if necessary, assist in future planning d/t impulsive decisions

• ACL 6 (Ind)

Alzheimer's Disease

• Stage 1: "Is there a problem?" (very mild -> mild decline) ADL/IADL intact, mild memory problems, perceived loss of control, anxious and fearful, socially and physically intact

  • new tasks possible w/ grading and cues for success

• Stage 2: "I just want to be alone" (mild -> mod decline) ADL intact w/ mild difficulty, IADL w/ mod difficulty, moderate memory loss, denial/moody/paranoia, difficulty learning new task, lose valued objects

  • no new tasks, simple and clear instructions. Use pictures as reality orientation, maintaining socialization and exercise is important.

• Stage 3: "Go away, who are you?" (mod -> mod severe decline) no ADL/IADL, dissoriented to time and place, sleep disturbance/repetitive behavior, wandering, impaired visual & spatial orientation

  • overlearned tasks w/ 2-3 steps possible, simplify tasks, use good lighting,

• Stage 4: "err no ber" (severe cog & physical decline) no ADL/IADL, generalized motor slowing leading to bedridden, incontinent, unable to communicate (1 word)

  • maintain proper positioning

Gross Motor 0 - 12 months Video

Babies start from hunched over, butt in the arm, arms curled in, and head down; around 12 months they are walking around

• 0 - 2 months "new world" - governed by reflexes, bonding, and visual play (dont have the coordination or skills to play)

  • In prone: lift head briefly, turn head cheek to cheek, bear weight on forearms

  • In supine: turn head side to side, kicks, swipes at objects w/ clenched hands

  • In sitting: rounded back, head bobbing

  • Rooting reflex

  • Suck/swallow reflex

  • ATNR (fencing position)

  • Moro?

• 3 - 4 months "Stronger World" - greater strength (and vsion/depth perception), symmetry, midline control

• In Supine: tracks objects side to side crossing the midline, capitol flexion/chin tuck

• In Prone: lift higher up to elbow and holds head steady

• 5 - 6 months "Sitting World" - prone on extended arms, prop sit, rolling both ways

  • month 5: lift up w/ arms extended in prone, prop sitting (propped up by arms extended)

  • month 6: sits alone, rolling both ways intentionally

• 7 - 10 "The Mobile World" - belly crawl, creep (crawl) on hands and knees, rise to sitting, pull to stand, and cruise

  • In Prone: pivoting in belly crawl (coordinating top and lower half of body), gets to hands and knees position (STNR and rocking back and forth)

  • approx. month 8 babies crawl and can rise into sitting position from prone

• 11 - 12 months "the Walking World" - stand briefly and take few steps forward

Inpatient Rehab -

long term acute care -

Halfway House - pts are typically responsible for rooms, personal items, and house maintenance (IADLs focused in this setting such as laundry, meal prep, etc.)

• Hawaii

Sensory

• planar cushion is the same as a flat cushion, used with someone who has good postural support, is able to independently repositioning,

• Contoured cushion (standard or custom), provides more support and distributes pressure better. Is more expensive especially if it is customized to pt. Transfers can be more challenging d/t customized cushion not adjusting.

Cushion Materials

• Foam: cheap and lightweight, used for general comfort. Poor durability and does not even pressure relief depending on the density of the foam.

• Gel-filled: good postural stability d/t a good base support and better pressure relief than foam; however, it is heavy, can leak, and is temperature sensitive.

• Air-filled: lightweight, best at pressure distribution; however, has terrible postural support and can leak.

• Honeycomb: good pressure relief, fairly stable, easy to clean, not as heavy as gel-filled but is thick.

• Hybrid cushion: different layers of the other materials

• Alternating pressure cushion: mechanical cushion that provides alternating pressure on a schedule, expensive

Wheelchair measurements

• Width: measure client at widest part of their hips or thighs and add 1-2 inches

• Depth: measure from the pt's butt to popliteal fossa (back of knee) and subtract 1-2 inches to prevent chair from digging into back of knee

• height of full wheelchair: footplate should clear the floor by two inches. ankles and knees at 90 degrees, thighs parallel to floor, adjust if using a seat cushion

• height of back: dependent on person, low enough (generally the lower the back, the higher function the pt can have) for the pt to function but high enough to provide support

  • back height for max function = below scapula

• armrests should be at a height that allow for the shoulders neutral position, arms at side, elbows at 90 degrees

  • low armrests can promote slouching forward

Environment

• golden rule of 36 inches (wide) for hallways, walkways, sidewalks, and ramps. Countertops should be 36 inches high. Doors can be included, but 36 inches considers someone walking alongside the wheelchair which is not necessary through a door.

• for a wheelchair to be able to do a 360 turn, the space requires 60 in x 60 in (5 ft. x 5 ft.)

Doors:

• Minimum door width for wheelchairs is 32 inches (allows for bariatric WC accommodations)

• offset hinges allow for an extra 1-2 inches

Ramps

• a ramp should have one foot (12 inches) of slope per 1 inch of rise (i.e., 6 steps w/ 7 in rise each -> 6x7 = 42 in slope)

• 5 ft x 5 ft landing is required to allow for pt to go behind, close, and lock door

• will also need 5 ft x 5 ft landing to rest if the ramp is too big, typically halfway

Wheelchair Attachments:

• Armrests

  • Removeable - good for transfers

  • Height adjustable - good for support,

  • Wrap-around armrests (space saver armrests) reduces the overall width of the wheelchair by 1 inch

  • Armrest Attachements: arm trough (good for stroke or unilateral neglect for safety), lap board (good for keeping an arm safe or for activities), mobile arm support (good for high level spinal cord injuries to assist w/ moving their arm)

• Leg rests

  • removeable leg rests - might be preferable if extra space is needed for transfers

  • swing away leg rests

  • elevating leg rests - good for lower extremity swelling

• Footplates (typically folds up and down)

  • Heel loops - support at back of the foot plate to prevent foot falling off plate from behind

• Anti-tippers - back of wheelchair, helpful for pts w/ lower extremity amputations (center of mass shifts d/t amputation, increases risk of tipping backward)

• Break extender - good for individuals w/ upper extremity amputation, short, or anyone w/ limited mobility/ROM. Also reduces force required to pull break down

• Seat belts and harnesses - only for postural support, not restraining

• Head supports - helps w/ feeding, communication

• Propulsion - manual, attendant, and power chairs (big, bulky, heavy, need a lot of space to maneuver, need a special vehicle for driving)

Positioning - both are good for postural adjustments (if pt can't self-adjust or has difficulty getting out of the chair) and pressure relief

• reclining - angle of back changes, quickly adjusts (helpful for individuals prone to episodes of hypotension or autonomic dysreflexia), must be careful if individual has hip precautions and spasticity (inc hip extension can trigger spasticity)

• tilt-in-space - angle stays the same, individual moves

Religious organizations and private clubs are exempt from ADA accessibility requirements

A rigid frame WC is better than a manual WC for most clients w/ SCI at the thoracic level d/t better functional independence support, it is lightweight and maneuverable but does not collapse/fold

bulbar onset refers to when the muscles of the face, throat, and neck become impaired. This impacts speech and swallowing. In regards to swallowing, the client may present with symptoms of dysphagia and be more at risk for choking and aspiration. Ensuring proper sitting posture is important to reduce these risks.

Close - daily contact, direct contact at site of work.

Routine (“routes” = two choices = two weeks) - contact every 2 weeks, interim (phone/written)

General (“Dollar General” = once a month) - at least monthly direct contact, other methods as needed

Minimal - as needed, may be less than a month

• COTAs can not train volunteers for tasks such as transfers; as they are not health care professionals

• chooses appropriate interventions and assessments

• be honest in termination of services in a timely manner

• doing literature reviews and keeping up to date on information to provide best and safe services

• consider potential risks and benefits conducting research

Non-maleficence: refrain from actions causing harm

• dont harm the patient

• don't neglect or abandon the patient

• avoid complicated relationships or use your role for exploitative pain

Autonomy: right to self-determination, privacy, confidentiality, and consent

• respect patients' desires and right to deny services

• respect patients' right to engage in actions that we believe are harmful to them

• right to make decisions about their care (however, help them stay informed prior to decision-making)

Justice: promote fairness and objectivity in the provision of OT services

• timely services, equal access to care (no preferential treatment)

• uphold the required license, obtain and maintain

• maintain high standards and additional trainings

• be aware of current laws, accurate billing, refrain from gifts that may bias your care, obtain necessary approvals for study, maintain transparency for conflicts of interest

Veracity: verify for the truth. Comprehensive, accurate, and objective info when representing the profession

• honest about services provided in documentation

• honest and refering your references accurately

Fidelity: treat clients and colleagues with respect, fairness, discretion, and integrity

• understand your roles and responsibilities, collaborate with other professions (no slander or gossip)

Core Values

• Altruism - Think about the welfare of others

• Equality - Treat all patients objectively

• Freedom - Patients have choices

• Justice - Every person is included

• Dignity - Respect your patients

• Truth - Provide accurate information

• Prudence - Use good judgement

Spina Bifida oculta (hidden)

• common symptoms: bowel and/or bladder issues (constipation/incontinence), back pain, leg muscle weakness, scoliosis

• may require back brace, walker, or wheelchair

Spina Bifida Aperta (open) - two types (meningocele and myelomeningocele)

• Meningocele - spinal meninges protrude from the spinal opening

• Myelomeningocele - most severe form of spina bifida, both the spinal cord and the spinal meninges protrude through spinal opening

Spina bifida can lead to hydrocephalus (spinal fluid accumulates in brain and creates pressure) on the and ultimately Chiari II malformation (increased pressure in brain causes cerebellum and brain stem are pushed towards the vertebral canal). This malformation can difficulty swallowing, breathing problems, muscle weakness, balance and coordination issues, and developmental delays.

rooting reflex - stroke the corner of the mouth, child turns head and tongue protrudes toward stimulus, integrates (disappears by 3 months)

Suck-swallow reflex - place finger in infants mouth, causes strong and rhythmic sucking, integrates (disappears by 3 months)

Jaw Jerk Reflex - tap on the mandible and the jaw moves

• munching begins at 4-5 months

• at 12 months rotary chewing begins

• by 24 months children can chew most foods and respond to different tastes

• By 4 months of age, most infants have gained fair head control and are able to remain in an upright position with support, and parents are beginning to introduce puréed foods. By this time, the anatomical structure of their jaws and tongues have dropped forward to support munching patterns. They also may open their mouth when a spoon is presented and are able to manage thin purees with minimal difficulties.

• Between 7 and 9 months of age, FINGER feeding begins. Infants are now moving into unsupported sitting, quadruped and crawling. This development supports jaw stability, breath support and fine motor development for self-feeding skills. Infants at this age now begin to be able to successfully manage “lumpy” purees, bite and munch softer foods, and the development of rotary chewing begins.

• Banging a spoon (playing with a spoon) is appropriate for a 10-12-month-old

• 12-14 months- Dips spoon in food, brings spoonful of food to mouth, but spills food by inverting spoon.

• 15-18 months- Scoops food with spoon and brings it to mouth and holds cup and drinks from cup independently.

• The consensus is that by 36 months, a child can use a fork to pierce soft foods and bring it to their mouth.

5-7 months: Take cereal/baby food from spoon
6-8 months: Attempt to hold bottle
6-9 months: Sucks more than bites and grab spoon and bangs or sucks
9-13 months: Finger-feeds self soft table foods (macaroni, peas, dry cereal)
12-14 months: Dip spoon in food, bring to mouth
15-18 months: Scoop food and bring to mouth

Assessing - How do you assess swallowing in infants?

# Answer:

• To assess swallowing in infants, conduct a bedside swallowing evaluation, which includes:

  1. Evaluating the infant's level of alertness and ability to follow directions.

  2. Assessing sensory and motor components of swallowing, including oral sensitivity and motor control of the jaw, lips, tongue, and cheeks.

  3. Observing the infant's ability to manage secretions and performing auscultation.

  4. Conducting trials with different boluses to evaluate swallowing function.

  5. If necessary, recommend further testing such as a modified barium swallow study or fiberoptic endoscopic evaluation of swallowing (FEES).

What are the signs of swallowing difficulties in infants?

• Signs of swallowing difficulties in infants include:

1. Coughing or choking during feeding.

2. Gagging or difficulty managing food or liquids.

3. Changes in skin color (flushed or ashen) during or after eating.

4. Refusal to eat or drink.

5. Excessive drooling or difficulty closing the mouth.

6. Arching of the back or unusual body postures during feeding.

7. Frequent respiratory infections, which may indicate aspiration.

8. Signs of distress or discomfort during feeding.

How can occupational therapy help with swallowing issues?

• Occupational therapy can help with swallowing issues by providing direct therapy techniques such as modifying the consistency and amount of food, using postural interventions (like chin tuck or head turn), and employing specific swallowing adaptations (such as the supraglottic swallow technique). Therapists also work on creating a pleasant feeding environment to promote social interaction and bonding during meals.

If a child has an issue with tongue control, various food textures could be a choke hazard because they don’t have the ability to maneuver the food properly within the mouth.

Children with spastic quadriplegia are more likely to experience oral-motor deficits than those with diplegia, but oropharyngeal dysphagia is prevalent even in children with mild CP. The goal of OT is to develop a good oral motor foundation. With jaw stability and lip closure, his tongue movements will improve, which are essential for tongue control and swallowing.

• Tardive dyskinesia- irreversible neurological condition caused by prolonged use of neuroleptic medications; involuntary and repetitive movement of face, mouth, and limbs

• Pseudo-parkinsonism - side-effect that appears as behaviors similar to the symptoms of advanced Parkinson’s disease; that is, rigidity, pill-rolling tremors, masked face, and a shuffling gait

• Valsalva Maneuver - a person "bears down" or holds their breath while engaging in strenuous activity to gain more power; causes SOB and stresses cardiovascular system by elevating bp. Contraindicated for cardiopulmonary conditions

• Emergent awareness - deficits involve difficulty or inability to recognize and correct errors in performance

• Environmental gnosia

• Closed Kinetic Chain Movement - distal upper extremity being stabilized and in constant contact w/ object

• Concrete thinking - interprets events and information in literal sense

• Premotor Perseveration - repetition of movements and difficulty transitioning from one aspect of an activity to another

• Anticipatory Awareness - pts ability to accurately complete a self-assessment and predict performance errors based on current strengths/weaknesses

• Confabulation - misremembering something, filling in memory gaps w/ fabricated memories

Apraxia

• Ideational apraxia: breakdown in the knowledge of what is to be done and how to perform specific activities (best to use physical cues) (tasks that have multiple, sequential movements such as dressing, eating, and bathing)

• Conceptual apraxia is characterized by a difficulty in selecting adequate tool for that action. more specific and is basically the misuse of objects for its intended purpose due to not understanding what the object is used for.

• Accounts payable: payments that are due for purchases by or services rendered to a program, setting, or institution; debts in the budget

• Accounts receivable: payments received by a program, setting, or institution for services rendered, the assets in the budget

• Capital Assets: improvements or purchases that cost more than a set amount ($500 or $1000) and are expected to last more than a year (i.e., ADL kitchen, computer equipment)

• Productivity Standard: amount of direct care and reimbursable services each therapist must provide each day

• Positive Symptoms: any change in behavior or thoughts (hallucinations or delusions)

• Negative Symptoms: where people withdraw from the world around them, no interest in social interactions, appears emotionless or flat

• Dysmetria: undershooting or overshooting a target

• Dyssynergia – breakdown/decomposition in movement resulting in joints being moved separately to reach a desired target.

• Dysdiadochokinesia – impaired ability to perform rapid alternating movements.

• Constructional apraxia refers to the inability to accurately copy drawings or three-dimensional constructions. It is a common disorder after right parietal stroke, often persisting after initial problems such as visuospatial neglect have resolved. Constructional apraxia is characterized by an inability or difficulty to build, assemble, or draw objects.

• Apraxia is a neurological disorder in which people are unable to perform tasks or movements even though they understand the task, are willing to complete it, and have the physical ability to perform the movements.

• Primary visual agnosia is a rare neurological disorder characterized by the total or partial loss of the ability to recognize and identify familiar objects and/or people by sight. This occurs without loss of the ability to actually see the object or person. The symptoms of visual agnosia occur as a result of damage to certain areas of the brain (primary) or in association with other disorders (secondary).

• Ideational apraxia is a disturbance of voluntary movement in which a person misuses objects because they have difficulty identifying the concept (idea) or purpose behind the objects. Due to the conceptual loss, sequencing errors are common in this form of apraxia. Motor movement is not lost in ideational apraxia. However, the person’s movements appear confused because they cannot form a plan on how to sequence those movements when using an object.

• Backward chaining refers to teaching an activity beginning with the last step: you would completely prompt the entire chain of behaviors except the last step. When using backward chaining to teach a patient to make French toast, the OT would prompt every step and have the patient independently use a spatula to move the toast from the pan to a plate. So the most work (independent step) led to the biggest reinforcement (consuming the food). Once the last step is mastered at an independent level, then the OT can teach the last 2 steps, then the last 3 steps, etc.

• Autogenic training (AT) is a well-established self-induced relaxation technique based on autosuggestion. It is a relaxation technique that can be used to help reduce anxiety. It utilizes the power of the mind to help calm and relax the body. Autogenic Training restores the balance between the activity of the sympathetic (flight or fight) and the parasympathetic (rest and digest) branches of the autonomic nervous system. This has important health benefits, as the parasympathetic activity lowers blood pressure, slows heart rate, and promotes functions of the immune system.

STNR promotes coordination of the upper and lower body, while ATNR facilitates visual attention and helps stabilize the trunk during movement.

Radial Digital Grasp - typically develops between 6-12 months

Emotional Regulation - best observed when reacting to the feelings of others

Vestibular - activate the vestibular system by spinning, rocking, moving fast.

Proprioceptive - (stomping while walking is proprioceptive)

Occipital lobe - responsible for impairments of visual reception and visual memory

Figure Ground Perception - ability to distinguish foreground from background

Visual closure - impaired skills would have difficulty identifying an object when there is an inability to see the object entirely

Developmental Sequence of Gross Motor Movement and Mobility Skills: Four Point Positioning -> Rocking on Hands and Knees

Progression of TX for tactile defensiveness: brushing -> firm consistent touch -> light moving touch as tolerated.

between 4-5 y/o - Copying familiar letters and numbers

The first toileting skill developed is recognition of being wet/soiled as uncomfortable

Creative play (coloring, playing w/ dolls, cutting and pasting pictures onto cards) is developed between 4-7 years old

The exploration of relationships between actions and consequences is typical of the cognitive development of a 9- to 12-month-old.

Between the ages of 5-6 years old, a child can complete a 3-step visual motor task of tracing her hand, coloring a picture, and cutting. Cutting complex shapes begins between ages of 5-6.

Babies begin to roll from as early as 3-4 months from prone to supine. And by 6 months, a baby is typically rolling segmentally from prone to supine and from supine to prone.

Movement Milestones

0 months: uncoordinated moving arms and legs on back

2 months: push up off the ground, some head control

4 months: use all 4 limbs to roll onto back, head control/does not need head support, can hold some toys

6 months: come to sitting using arms to keep self propped up (6 looks like a child sitting), can roll belly <-> back

9 months: can use hands to pull to stand, can crawl, and sit w/out support

1 year: cruising w/ using furniture

1.5 years: walk up stairs, cant go down

2 years: run, up/down stairs (holding on), tip toe, climb, kick, and throws

3 years: run, up/down stairs, climb

4 years: goes to school, can hop/skip on one foot (looks like 4) for a few seconds

5 years: stand on one foot longer, swing, summersault

Fine Motor Milestones

0 - 2 months: hands clenched in palmar grasp reflex, hand to mouth to try to self soothe

2 - 4 months: reach for objects w/ poor coordination, unable to grasp

4 - 8 months: pick up small objects, shake a rattle, trap an object between thumb and side of finger

8 - 12 months: transfer objects between hands, hold baby bottle, pick up tiny objects to finger feed

1 - 2 years: pick up small cubes, stack blocks, play w/ large puzzles, scribble w/ crayon, use a spoon and sippy cup

2 - 3 years: stacks several blocks, open simple containers, wind-up toys, string large beads, copy simple shapes, snip w/ scissors, begin electronics

3 -4 years: simple un/dressing w/ simple fasteners (large buttons), can use a pencil, colors in lines, cut out large shapes

4 - 6 years: able to tie shoes, work w/ zippers and snaps, use a fork and knife, copy letters/numbers/short sentences

7 - 10 years: craft projects (hole punches, glue, needles, staples), cursive writing, proficient in eating and hygiene (nail clippers, styling hair), texting and computer use

10+: inc keyboard speed, electronic devices, and improve fine motor skills in interests (art, music, etc.)

Pencil Grasp Patterns

1) Fisted Grasp (1-2 years)

2) Digital Pronate Grasp (2-3 years)

3) Quadropod Grasp (3-4 years)

4) Static Tripod Grasp (4-5 years)

5) Dynamic Tripod Grasp (5-6 years)

Toileting Milestones

• 1 year 1-year-old whine when wet

• 1.5 years will sit on the toilet if put on toilet

  • (1 half to sit on the toilet)

• 2.5 years can tell others when they have to go

  • (I half 2 go)

• 3 years can sit and toilet, but needs help w/ hygiene

  • (3 help me with the TP)

• 4-5 years independent toileting

  • (4, close the door, dont need help no more)

6-9 months, a baby masters transferring an object between hands, starts to isolate their index fingers and uses an immature pincer grasp.

10-12 months, a baby develops a mature pincer grasp. The child may begin to mark a piece of paper with a crayon.

At 12 months- Scribbles after demo.
At 14-15 months- Spontaneous scribble.

18-24 months- The next pre-writing skill after scribbling, is imitating horizontal and vertical lines at 24 months.

Loop scissors: Trains the child to use the “opening and closing” hand movement.

1. Class I: No objective evidence of cardiovascular disease; no symptoms and no limitations in ordinary physical activity.

2. Class II: Objective evidence of minimal cardiovascular disease; mild symptoms and slight limitation during ordinary activity; comfortable at rest.

3. Class III: Objective evidence of moderately severe cardiovascular disease; marked limitation in activity due to symptoms, even during less-than-ordinary activity; comfortable only at rest.

4. Class IV: Objective evidence of severe cardiovascular disease; severe limitations; experiences symptoms even while at rest.

• a wedge cushion under the head at night can promote better sleep by decreasing the amount of workload on the lungs

• pillow under chest while in prone can increase discomfort, restrict chest wall expansion, and limit breathing

• Supported supine or supported side-lying are options for people w/ SOB when laying flat

Sitting

• people need repositioning every 15-30 minutes to relieve pressure

• Ex: dynamic splints, balanced forearm orthoses (supports weak muscles), opponens splints (support thumb in abduction and opposition), shoulder slings (flaccid arms)

• Used for tendon injuries, joint contractures, spasticity, muscle weakness, and post-surgical recovery

• Benefits: inc. ROM, support and stability, prevent deformations, facilitates functional activities, pain reduction

• 90 degree to the joint for tendon repair is the ideal force to prevent unwanted traction on the joint and sheer stress

• # Question:

  Why does a tendon repair require 90 degrees at the joint?

  # Answer:

  A dynamic orthosis aids in tendon repair by allowing controlled movement while providing support. It promotes early mobilization, which helps prevent adhesion formation and facilitates tendon healing. The orthosis increases tendon excursion, improves strength at the repair site, enhances joint range of motion (ROM), and prevents adhesions. Additionally, it allows for gradual and safe progression of activities, ultimately assisting individuals in resuming meaningful roles and occupations.

• wrist-driven flexor hinge orthosis is designed to assist individuals with limited wrist function, particularly those who have lost active wrist extension. This orthosis allows for wrist flexion and extension through a mechanism that utilizes the movement of the forearm to drive the hand, making it beneficial for tasks requiring grasp and release. Can not be used for C5 SCI

Hands

• Silver ring orthoses can be used to prevent Boutonnierre deformities, but not help hold objects. It provides stability and alignment; and can be used for OA, RA, swan neck, Boutonnierre, and Ehlers-Danlos syndrome

• SaeboStretch resting hand orthosis is a good inhibitory, tone normalizing orthosis option for a person who has minimal to moderate tone

• A boutonniere deformity is caused by a lengthening or rupture of the extensor digitorum communis tendons and is expressed by distal interphalangeal (DIP) hyperextension and proximal interphalangeal (PIP) flexion.

• A swan-neck deformity can result from the rupture of the lateral slips of the extensor digitorum communis or flexor digitorum superficialis tendon and results in DIP flexion and PIP hyperextension.

• A trigger-finger deformity results from a thickening of the flexor digitorum superficialis tendon at the flexor tunnel, also called a tendon sheath. The affected joint tends to stay open upon attempt to close or fist the hand.

• Synovitis of the MP joints can cause damage to the MP ligaments with palmar dislocation in conjunction with, or independent of, ulnar drift.

Shoulder

• Flail Arm: recommended for brachial plexus injury, involves full UE. Provides stability at shoulder and elbow to allow functional positioning of hand

• Figure of 8: used for combined median and ulnar nerve injury to prevent MP hyperextension

• Deltoid Sling: used for UE muscle weakness

• Rotator cuff surgery begins with PROM which may be initiated anytime from 0 to 6 weeks. Intervention then progresses to AAROM/AROM which is commonly initiated from 6 to 8 weeks. This treatment protocol then progresses to strengthening with isometric exercises followed by isotonic.

A positive Tinel’s sign at the forearm is consistent with this syndrome which is a medial nerve compression between the two heads of the pronator teres.

Symptoms are similar to carpal tunnel syndrome (CTS) except there is aching pain in the forearm and no night symptoms. A person with CTS has paresthesias occurring at night, does not have pain in the forearm, and has a positive Tinel’s sign at the wrist.

A positive Tinel’s sign that is noted at the Guyon’s canal indicates Guyon’s canal syndrome which is a compression of the ulnar nerve with sensorimotor symptoms reflecting ulnar nerve distribution.

A positive Tinel’s sign at the elbow is indicative of cubital tunnel syndrome. This is an ulnar nerve compression at the elbow that has the symptoms of numbness and tingling along the ulnar aspect of the forearm and hand, and pain at the elbow with extreme elbow flexion.

Positive Froment’s sign: Froment’s sign tests for the action of adductor pollicis, which is weak with ulnar nerve palsy. With ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the FPL (flexor pollicis longus) of the thumb to maintain grip pressure, causing a pinching effect.

Quick hand screening: Ulnar nerve use the “peace sign”,
Radial nerve use “thumbs up”/”hitchhiker”, Median nerve use the "Ok sign" (three entrapment syndromes: carpal tunnel, anterior interosseous syndrome, and pronator teres syndrome)

Radial tunnel syndrome (RTS): Compression of the radial nerve in the proximal forearm resulting in a dull ache and burning sensation along the lateral forearm. With RTS, placing the elbow in extension, forearm in pronation and wrist in flexion along with resisting long finger extension will often provoke symptoms of dull pain or aching and burning in the lateral forearm. Fabricating a long arm orthosis with the wrist in extension, elbow in flexion, and forearm in pronation to neutral rotation is the classic recommended position .

Passive range of motion (ROM) exercises are contraindicated for individuals with rheumatoid arthritis (RA) primarily because they can exacerbate inflammation and pain in the joints; do AROM instead for joint function and anti-deformity.

• expects durable medical equipment to last 5 years

Medicare A (inpatient)

• helps pay for inpatient care you get in hospitals, critical access hospitals, and skilled nursing facilities. It also helps cover hospice care and some home health care.

Medicare B (outpatient)

• Medically necessary services: Services or supplies that meet accepted standards of medical practice to diagnose or treat your medical condition.

• prevention services: Health care to prevent illness (like the flu) or detect it at an early stage when treatment is likely to work best.

Medicare C

• Additional coverage for A and B

Medicare D

• Drug prescriptions

• A sock aid, grab bars, and a reacher are used for self-help and are not covered by Medicare. DME requires that the item must be medically necessary and reasonable to treat an illness or when the patient has a decline in function.

Medicaid - helps cover medical costs for some people with limited income and resources, eligibility and requirements vary by state

• covers shower chairs, may cover toilet safety frame

• preprosthetic phase - manages healing process, prepares limb for prosthetic use, and helps pt adapt to physical and emotional changes

  • consider emotional support, phantom limb pain, hygiene, desensitization, assist in shrinking and shaping limb, and special considerations for individual pt

• Treatment - education on hygiene (wound care, use of long handled mirror, e-stim), education on wrapping and compression stump shrinker, pain management and desensitization (tapping to reduce to reset nerve endings, massage, vibration, fluidotherapy, and Weight-bearing), mirror box therapy, scar management (breakup and flatten scar tissue, use deep heat and massage), ROM (P/AROM to prevent contracture and improve mobility at the site), strengthening (isometrics, e-stim, isotonics and general endurance for reconditioning), muscle learning and re-education

• body-powered prosthetic - proprioceptive feedback, robust, reliable, easy to learn, helps the body to learn what remaining muscles to use to make a prothesis work

• Static, passive prostheses are primarily used for cosmetic appearance. They can be passively adjusted to assist with carrying and grasping items

Amputations

• blank (elbow, shoulder, etc.) disarticulation - think distal portion of body is amputated at said joint

• Forequarter - clavicle, scapula, and entire UE is removed

• transmetacarpal - fingers removed through the metacarpals

• hemipelvecotomy - half the pelvis and LE removed

• complete tarsal - ankle, foot, and toes

• partial tarsal - part or all of foot and toes

• complete phalanges - all or some of toes

• digital - at any MP joint of the finger

Training

• For grasp/release: elbow flexed at 90° with neutral degrees of pronation/supination is the easiest position in which to begin grasp and release activities. It is also the most functional and natural.

# Answer:

The Rancho Los Amigos Levels of Cognitive Functioning Scale includes the following levels:

1. Level I - No Response: Total assistance; no observable response to stimuli.

2. Level II - Generalized Response: Total assistance; generalized reflex responses to stimuli.

3. Level III - Localized Response: Total assistance; localized responses to stimuli, may follow simple commands.

4. Level IV - Confused, Agitated: Maximal assistance; heightened state of activity, confused and disoriented.

5. Level V - Confused, Inappropriate, Non-Agitated: Moderate assistance; responds to simple commands, but with confusion.

6. Level VI - Confused, Appropriate: Moderate assistance; can attend to familiar tasks, follows simple directions with cues.

7. Level VII - Automatic, Appropriate: Minimal assistance; can carry out daily routines but lacks insight into condition.

8. Level VIII - Purposeful, Appropriate: Stand-by assistance; can independently complete familiar tasks and has improved insight.

What interventions improve stability?

# Answer:

Interventions to improve stability in occupational therapy include:

1. Upper extremity weightbearing during self-care activities to enhance shoulder girdle stability.

2. Bed mobility and bedside ADLs to promote functional independence.

3. Strengthening exercises for the upper extremities.

4. Functional ambulation and transfers using appropriate assistive devices.

5. Instruction in the use of assistive devices to support mobility and safety.

• Task-Oriented: tasks are used as a means to facilitate our thoughts and feelings, enhance self-awareness, and insight to learn new behaviors (like psychodynamic model)

• Thematic: tasks and end products are important through a structed activities, skill development is the goal (making a bird house, woodworking project, simple projects that can be graded) (thrive through thematic, skill development allows you to thrive)

• Topical

  • Topical-concurrent: verbal discussion to support current roles (parenting, caretakers, etc.)

  • Topical-anticipatory: verbal discussion to support for something that has not happened yet (retirement planning, coping strategies when family member returns home, etc.)

• Evaluation: evaluate group interaction

• Instrumental: maintain the highest optimal function and quality of life through socialization and meaningful activities

Development Groups (helps improve group interactions with others; least to most group interaction required)

• Parallel: group interaction is not required during task, but can share tasks or tools or having similar activites that may encourage interaction (slot machines, painting) OT is directive, choses activity and provides structure and positive support

• Project: interaction is required to complete task, short term w/ 2+ people (slideshow, etc.) OT selects activity,

• Egocentric-Cooperative: activity selected by members, long term w/ 5-10ish people, big emphasis on cooperation (AOTA presentation, etc.) role of OT is a role model, assistance as needed

• Cooperative: fulfilling the needs is more important than the tasks (what gives you a sense of fulfillment, completion is secondary, activity is a means not a result) OT is an advisor

• Mature: carry out all social, emotional, and functional roles and tasks (feel a sense of competence and belonging); both completion of the project and the group interaction is equally important. OT is a peer at this level

what are the different types of cerebral palsy?

# Answer:

Cerebral palsy is classified into several types based on the location of the brain injury and the resulting motor control issues:

1. Spastic Cerebral Palsy: Characterized by increased muscle tone and stiffness, resulting from a lesion in the motor cortex. It can manifest as hypertonia and hyperreflexia.

2. Dyskinetic Cerebral Palsy: Caused by a lesion in the basal ganglia, leading to fluctuating muscle tone. It includes subtypes like dystonia (involuntary muscle contractions) and athetosis (writhing movements).

3. Ataxic Cerebral Palsy: Results from a cerebellar lesion, causing hypotonia and coordination difficulties, leading to unsteady movements.

4. Monoplegia: Affects one limb.

5. Hemiplegia: Affects one side of the body (one arm and one leg).

6. Paraplegia: Affects only the lower limbs.

7. Quadriplegia: Affects all four limbs.

8. Diplegia: Primarily affects the lower limbs more than the upper limbs.

What is spastic diplegia?

# Answer:

Spastic diplegia is a form of cerebral palsy characterized primarily by muscle stiffness (spasticity) in the lower extremities, leading to difficulties in movement and coordination. It typically affects the legs more than the arms, resulting in challenges with walking and balance. Individuals with spastic diplegia may have normal intelligence but experience significant motor impairments. The condition is non-progressive, meaning it does not worsen over time, but can lead to complications such as deformities and contractures if not managed appropriately.

The Global Deterioration Scale (GDS) consists of seven stages that describe the progression of cognitive decline in dementia:

1. No Cognitive Decline - No memory problems.

2. Very Mild Cognitive Decline - Forgetfulness of everyday events.

3. Mild Cognitive Decline - Noticeable memory problems affecting work or social life.

4. Moderate Cognitive Decline - Difficulty with complex tasks; forgetfulness of personal history.

5. Moderately Severe Cognitive Decline - Assistance needed for daily activities; confusion about time and place.

6. Severe Cognitive Decline - Significant memory loss; requires assistance with basic needs.

7. Very Severe Cognitive Decline - Loss of ability to respond to the environment; requires full-time care.

Alzheimer's

1. very mild to mild

2. mild to moderate

3. moderate to mod severe cog decline

4. severe cog and physical decline

Rehabilitation - During the rehabilitation phase of burn recovery the client’s wounds will be closed and the main focus of OT intervention would be: scar massage, compression therapy (worn over light dressing), therapeutic exercise & activity (massage w/ lotion prior to exercise to avoid shearing forces and blistering), Edema management (coban/coflex can be used on fingers), ADLs, splinting (reduce contracture, inc. ROM, functional assistance), client education

Icing, quick light stretch, tapping and heavy joint compression are all facilitatory techniques to improve tone of flaccid muscles.

MET 2-3
• Dusting, kneading dough, washing dishes, golfing
• Walking 1mph
• Seated sponge bath

MET 3-4
• Warm standing shower
• Making the bed
• Sweeping
• Mopping

Precautions for a Posterolateral total hip arthroplasty are:
1. No hip flexion greater than 90 degrees
2. No internal rotation of the hip.
3. No hip adduction.

• General Contributors: work causes, lifestyle causes, and personality factors

• Common OT factors: student debt, lack of voice in workplace, lack of encouragement for development at work, productivity requirements, repetitive nature of work, physical and emotional demands

• Stages: Honeymoon, onset of stress, chronic stress, burnout, and habitual burnout

Coping: Recognize, reverse, resilience

• turn to other people, reframe the way you look at work, reevaluate your priorities, exercise, diet

• Strategies: physical self-care, emotional self-care, social self-care, spiritual self-care, intellectual self-care, environmental self-care (clean space), vocational self-care

• Limiting burnout in the workplace: stress management, personal needs assessment, and self-advocacy

Secondary: prevent the early stages of a disease advancing through early diagnosis and treatment; attempts to prevent the disease from progressing by detecting it early.

Tertiary: Attempts to reduce the damage caused by symptomatic disease by focusing on mental, physical, and social rehabilitation. Unlike secondary prevention, which aims to prevent disability; maximize the remaining capabilities and functions of an already disabled patient. Goals of tertiary prevention include: preventing pain and damage, halting progression and complications from disease, and restoring the health and functions of the individuals affected by disease.

Screen

Evaluation

Intervention

Discharge

Reasonings:

Procedural - emphasis is often placed on patient factors and body functions and structures. A connection between the problems identified and the interventions provided is sought using this form of reasoning.

Interactive - Understanding the disability from the patient’s point of view is fundamental to this type of reasoning; used during the evaluation to detect the important information provided by the patient and to further explore the patient’s occupational needs. During intervention, this form of reasoning is used to assess the effectiveness of the intervention. The therapeutic use of self fits well with this form of clinical reasoning as a therapist employs personal skills and attributes to engage the patient in the intervention process.

Conditional - therapist imagines possible scenarios for the patient. The therapist engages in conditional reasoning to integrate the patient’s current status with the hoped-for future. Intervention is often revised on a moment-to-moment basis to proceed to an outcome that will allow the patient to participate in various contexts.

Narrative - storytelling in order to identify problem areas and solutions. It requires interaction between the patient and therapist in order to gain an understanding of the situation. Therapists also use narrative reasoning to plan the intervention session, to create a story line of what will happen for the patient as a result of therapy. The therapeutic use of self is critical when using this type of clinical reasoning

Pragmatic - focuses on logistics such as cost, time, resources, therapist’s skills, patient’s wishes, and physical location. It looks at the problems and focuses on developing practical and realistic solutions. These challenges to providing intervention would be considered when developing an intervention plan.

Intervention Levels

• Adjunctive - prepares the pt for occupational performance; Education, physical agent modalities, and resources are used at this level.

• Enabling Activities - range of motion, muscle conditioning, schedules, pacing activities, coping strategies, time management, and medication management.

• Purposeful Activities - includes compensatory strategies and adaptations to facilitate a patient’s involvement in activities.

• Occupation-based activity - client-centered activities and goals. The therapist’s involvement begins to decrease as the client performs ADLs, IADLs, play, and leisure to his or her own maximum capacity.

Summary of Intervention Approaches
1. Health promotion and wellness to enable or enhance performance in everyday life activities.
2. Establishment, remediation, or restoration of a skill or ability that has not yet developed or is impaired.
3. Maintenance and enhancement of capabilities without which performance in everyday life activities would decline.
4. Compensation, modification, or adaptation of activity or environment to enhance performance.
5. Prevention of barriers to performance, including disability prevention.

2. Respect for the dignity and rights of each individual

3. Empathy – ability to enter into the experience of another person without losing objectivity

4. Compassion or sympathy – willingness to engage with another person’s suffering

5. Humility – recognition of the limits of one’s own knowledge and skill

6. Unconditional positive regard – concern for the individual without moral judgements on their thoughts and actions

7. Honesty – telling the truth to the people they work with; this is an aspect of being respectful

8. A relaxed manner

9. Flexibility – ability to modify own actions to meet the demands of a situation

10. Self-awareness – ability to reflect on one’s own reactions to the world and on the effect one is having on the world in any given situation

11. Humor – a lightness of approach which, used appropriately, can facilitate the therapeutic process.

Modes

• Advocacy

• Collaborating

• Empathizing

• Encouraging

• Instructing

• Problem-solving

Techniques

• Attunement - be completely present with the patient, developing a feeling of connectedness with them

• Providing the pt w/ unconditional positive regard

• Self-disclosure - can help build rapport

• Power Differential

• Tier 1 - group intervention, changing the classroom for all including those "at risk"

• Tier 2 - targeted small group, additional instruction to students who do not respond to intervention in tier 1

• Tier 3 - Intensive individual, 1:1 instruction to target skill deficits. Will be referred to for comprehensive eval for special ed services if student does not respond to tier 3

Eval Process

• Referral

• Consent to evaluate(by guardian)

• Testing (w/in 60 calendar days of consent)

• Determination of Disability - meet w/ guardian to explain results, team (guardian, special ed teach, regular teach, all related services, other staff/family) decides if student qualifies

• Development of IEP (w/in 30 days of determination of disability) - parents review recommendations and accept/reject, parts of IEP reviewed separately (IEP team must include the parent or guardian, the regular education teacher, the special education teacher or speech therapist, the LEA representative.)

Disability Categories

1. ASD
2. Intellectual Disability (previously known as Cognitive Disability)
3. Emotional Behavioral Disability
4. Hearing Impairment
5. Visual Impairment
6. Orthopedic Impairment
7. Other Health Impairment
8. Speech/Language Impairment
9. Significant Developmental Delay (only used for students under the age of 9)
10. Traumatic Brain Injury

IEP Parts: Invitation of Meeting to IEP team, cover page, students strengths/parent concerns, Present level of Performance (PLOP), special factors, annual goals, program summary, assessments, transition services, changes to IEP w/out meeting, extended school year (needed for students to maintain skills developed during school year)

Students must be re-evaluated every 3 years to see if they still qualify for disability

Dismissal from special services if the student makes sufficient progress in all skill areas allowing for access of education in regular classroom.

Dismissal of OT services must be agreed upon between all IEP team members

Special IEP review: student is not making sufficient progress, student has met all goals, significant change in condition, or parents are not satisfied

Transitions from kindergarten, middle school, high school, and post-high school can be reviewed if the IEP team deems it necessary. Students who will be age 18-21 at the beginning of the next school year may continue to attend high school for vocational and independent living skills if the IEP team determines that they continue to require intervention in these areas.

• IFSP is created before Part C services start; IFSP describes the child’s present level of development, the family’s strengths and needs, the specific services to be provided to the child and the family, and a plan to transition to public school.

• 5 parts of service: Identifying a child who needs services and referring them appropriately, Determining if they are eligible for services, Developing the Individualized Family Service Plan (IFSP), Service Delivery, Transitioning the child from early intervention to another program at age 3

• Referral to early intervention, screening, categories of eligibility (functional information, dev. information, academic achievements), child is evaluated in (adaptive, cognitive, communication, physical, and social-emotional), IFSP may include (assistive technology, audiology, OT, PT, ST, psychological services, social work, vision services, etc.) in the NATURAL environment, transition planning begins at 2 years and 6 months.

Part B (3 - 21 years old, free through public school)

• IEP must be developed before services start

• Referral (from any source), screening, evaluation, eligibility, IEP development, transition planning (beginning at 16 or younger if determined by IEP team)

if not eligible under IDEA, student may be covered under Section 504 (focuses on accommodation of the student’s educational environment and adaptations to functional tasks so that the student is able to participate in public school in the least restrictive manner), but cannot get OT under IDEA 2004

To qualify for OT under Section 504

1. The student must be ineligible for special education services under IDEA 2004.
2. The student must have a documented physical or mental disability. This usually means a medical diagnosis documented by a physician or other qualified health professional.
3. The student’s disability must impair his or her ability to:
  a. Walk, breathe, eat or sleep
  b. Communicate, see, hear or speak
  c. Read, concentrate, think or learn
  d. Stand, bend, lift or work

An eval then follows to see if student qualifies for Section 504 special ed services

• OT must focus on functional independence in school through adaptations, skills may be focused on if required to utilize adaptions and accomodations

• Disability must be clearly identified and documented, usually by a physician

• The school does not receive reimbursement of OT services under Section 504

4 R's of Trauma informed care: realize, recognize, respond, and resist re-traumatization

• 2-3 y/o Random snipping Cuts

• 2.5 cut across 6 inch paper (crude)

• 3 cut a 6 inch straight line

• 3.5 y/o can cut circles

• 4.5 years can cut squares and simple figures

• 6 can cut different materials, not paper

By 2 years of age: Can make one snip at a time
By 3 years of age: Can snip forward along a line (not continuous motions forward)
By 4 years of age:
Can cut 6 inches along a straight line (¼ inch wide) after demonstration and without assistance, staying within ¼ inch of the line.
Can cut 6 inches along a curved line (¼ inch wide) after demonstration and without assistance, staying within ¼ inch of the line
Can cut out a circle of at least 6 inches in diameter without assistance, staying within ½ inch of the line
By 5 years of age:
Can cut out a square at least 3 inches wide without assistance, staying within ½ inch of the line
Can cut out a triangle at least 3 inches wide without assistance, staying within ½ inch of the line
Can cut out pictures after demonstration that are at least 6 inches in length and width and whose outlines are no more than ¼ inch wide, while following the general shape
By 6 years of age:
Can cut cloth for at least 6 inches using sharp scissors under close, careful supervision
By 6 ½ years of age:
Can cut out complex pictures by following the outlines without assistance

Myelomeningocele Spina Bifida (SBM) is the most severe form of spina bifida. The physical impairments in SBM include motor and sensory deficits of the lower limbs (weakness or paralysis) leading to difficulties with stance and locomotion and poor balance