Terms in this set (204)
Describe exploratory play in an infant/toddler 0-6 months.
Describe social play in an infant/toddler 0-6 months.
Exploratory Play: grasps, mouths and examines objects
Social Play: Smiles and coos
Describe functional play in an infant/toddler 6-12 months.
Describe social play in an infant/toddler 6-12 months.
Functional Play: Rolls a ball; pushes a car in a track
Social Play: imitates simple gestures
Describe functional play in an infant/toddler 12-18 months.
Describe gross motor play in an infant/toddler 12-18 months.
Describe social play in an infant/toddler 12-18 months.
Functional Play: engages in simple pretend play directed toward self, linked two or three
schemes in simple combinations, demonstrates imitative play from an immediate model
Gross Motor Play: stands unsupported, sits down, bends and recovers balance, walks with
wide stance, uses large muscle groups, throws ball
Social Play: begins peer interactions, parallel play
Describe functional play in an infant/toddler 18-24 months.
Describe pretend/symbolic play in an infant/toddler 18-24 months.
Describe gross motor play in an infant/toddler 18-24 months.
Describe social play in an infant/toddler 18-24 months.
Functional Play: multi-scheme combinations, performs multiple related actions together
Pretend/Symbolic Play: makes inanimate objects perform actions, pretends objects are real or
symbolize other objects
Gross Motor Play: enjoys sensory input
Social Play: expresses affection, wide variety of emotion, enjoys solitary play, engages in
parallel play, laughs when someone does something silly
(Early Childhood)
Describe symbolic play in a child 24-36 months.
Describe constructive play in a child 24-36 months.
Describe gross motor play in a child 24-36 months.
Describe social play in a child 24-36 months.
Symbolic Play: links multiple scheme combinations into meaningful sequences of pretend
play, uses objects for multiple pretend ideas, uses toys to represent animals or people, plays
out drama with stuffed animals or imaginary friends, plays house, assigns roles to others,
takes on specific roles
Constructive Play: participates in drawing and puzzles, imitates adults using toys
Gross Motor Play: likes jumping, rough and tumble play, makes messes
Social Play: associative, parallel play predominates
(Early Childhood)
Describe complex imaginary play in a child 3-4 years.
Describe constructive play in a child 3-4 years.
Describe rough and tumble play in a child 3-4 years.
Describe social play in a child 3-4 years.
Complex imaginary Play: creative scripts for play in which pretend objects have actions that
reflects roles in real or imaginary life, may use complex scripts for pretend sequences;
portrays multiple characters with feelings
Constructive Play: Imitate daily experiences, take on social roles
Rough and Tumble Play: Playground activities, lots of running
Social Play: participates in circle time, games, drawing and art time at preschool, engages in
singing or dancing in groups, associative play: plays with other children, sharing and talking
about play goal
(Early Childhood)
Describe games with rules in a child 4-5 years.
Describe constructive play in a child 4-5 years.
Describe social play/dramatic play in a child 4-5 years.
Games With Rules: Focus on mastering the rules of the game
Constructive Play: Complex Block Structure, builds 10 piece puzzle
Social play/Dramatic play: participates in role play with other children, dress up, tells stories,
continues with pretend play that involves scripts with imaginary characters
(Early Childhood)
Describe games with rules in a child 5-6 years.
Describe dramatic play in a child 5-6 years.
Describe sports play in a child 5-6 years.
Describe social play in a child 5-6 years.
Games with rules: Mastering of rules, also establishment of new rules
Dramatic Play: elaborate imaginary play, role plays stories and themes related to seasons or
occupations, emphasis on reality, reconstructs real world in play
Sports: Participates in ball play
Social Play: participates in group activities, organized play in groups, goals of play
(winning), may compete with social interaction at times
(Middle Childhood)
Describe games with rules in a child 6-10 years.
Describe crafts and hobbies in a child 6-10 years.
Describe organized sports in a child 6-10 years.
Describe social play in a child 6-10 years.
Games with rules: Concerned with status, friendships become more important
Crafts and hobbies: has collections and may have hobbies
Organized Sports: Competes in sports
Social Play: play includes talking and joking, peer play predominates at school and home,
plays with consistent friends
Learning through play can look at what 5 things?
1. Client factors and performance skills: development of GM, FM, VM, cognitive skills
2. Emotional maturity
3. Social skills/coping
4. Self-efficacy (have to have feeling of success and confidence)
5. Environment
Describe the general developmental stages of play.
0-12 months: exploratory and functional play
12-18 months: begins peer interaction; parallel
18-24 months: parallel play, participates in groups of children, beginning to take turns
2-3 years: associative and parallel play
3-4 years: associative play, prefers play with other children; sharing and turn-taking; wants to
be a friend
4-5 years: cooperative play; role play, pretend play with elaborative scripts; games with rules
5-6 years: group activities, organized play, winning- mastering rules
6-10 years: competes in sports; peer play predominant, groups of consistent friends
Adolescents: concern with autonomy and being socialized into adult roles; play through
technology to improve social participation
At what age does a child begin to move away from their parents and more towards
interactions with others?
At what age are children starting to share their tools (i.e. share their shovel but still are
focused on their activity)?
At what age are children pretending to be doctors, firefighters, etc. (pretending and role
playing), they understand fantasy vs. reality play, and play simple games with rules (kids
cheat)?
At what age are children not only learning the rules but they want to win (and are still
cheating)?
12-18 months
2-3 years
4-5 years
5-6 years
Why is it critical to know the stages of play in OT?
Need to know these play stages bc if child is not doing this you may have issues, clinically
observe child and determine what stage they're in
What is the purpose of completing an evaluation?
1. Screening (to determine if further evaluation is needed)
2. Diagnostic
3. Program planning (assess strengths and needs and determine what intervention needs to be
done)
4. Program evaluation (Did they make progress? Is there still a need to continue
intervention?)
What are 2 things that are also considered when choosing play as a context for intervention?
1. Form of performance assessment
2. Includes interview for background info (play interests, activities, play partners, child's
access to all)
Describe how observation of play is conducted.
With familiar toys and people (non-structured and standardized)
What guides the evaluation process with play?
The planned context and strategies used during intervention guide evaluation process
After evaluation, you want to look as assessments to identify your next approach. What do
these assessments look at?
1. Social
2. Sensory
3. Motor
4. Language
5. Pretend play..What skills do you see! (Use Development of play document to guide you)
What are two resources for intervention planning of play as a developmental process?
1. Activity based instruction (Macy & Bricker, 2007)
2. Parent mediated child learning (Dunst, 2006)
Review the 3 year old child from the video
-Lots of pretend play
-Understood a lot of concepts (cognition - press buttons and identify each shape, colors,
telling a story in book, knows where book starts and when book ends, imitating based on past
experiences, was able to keep attention throughout the entire play session)
- GM: variety of grasp patterns, was able to keep upright posture throughout session, showed
variation of movement, weight shifting
- Sensory: Toy provided visual stimulation and auditory stimulation, good tactile
discrimination (able to switch from gross grasp (two hands) to precision grasps with two
fingers, exploring toy)
- Language: speaking in full sentences, aware of those around her, using language to tell
stories
....how you identify your next approach
Why is it important to know the author of an assessment?
Citing in official documents to give credit as well as determining who the literature is
existing from (i.e. PT, OT), going to find evidence based research from this author
What are 4 useful play assessments?
**Pg. 488-489
1. Test of playfulness
2. Revised Knox Pre-school Play Scale
3. Pediatric Interest Profile (Kid Play Profile sample)
4. Child Occupational Self Assessment (version 2.2)
In relation to the Test of Playfulness (ToP):
Who is the author?
What is the age range?
What is the purpose?
What is the reliability?
What is the validity?
How is it administered?
What is the data collection process for ToP?
Who is this assessment designed for?
Author: Anita Bundy
Age: Age 6 months-18 years
Purpose: By observing children engaged in free play, occupation of play is assessed by the
child's playfulness rather than by cognitive, motor, or language skills the child uses in play or
by the activity in which child engages (about process of play as well as kid's playfulness)
Reliability: O'Brien and Shirley found that ToP scores remained stable over several years,
with moderate test-retest coefficients. Internal consistency showed the Cronbach's equivalent
near 1.00
Validity: version 3 scores correlated (0.46) with Children's Playfulness Scale. ToP and
Pediatric Volitional Questionnaire measured similar constructs. Appeared valid across several
cultural groups. Version 4 was 4 was revised to improve operational definitions, and items
were added to be sensitive to small changes after intervention
An observation, administer in familiar play settings indoors (inside recess) and outdoors
(playground) with familiar playmates present, 15-20 minutes for free play observation, 20-30
minutes including scoring
Data collection process: using an ordinal scale (ToP key-form), get checked for extent of
playfulness, intensity of playfulness, and the skillfulness
Designed for typically developing children regardless of disability
In relation to the Revised Knox Pre-school Play Scale:
Who is the author?
What is the age range?
What is the purpose?
Is it valid and reliable?
What is the data collection process for Knox?
How can you use Knox in EI?
What type of assessment is this?
Susan H. Knox
Less than or equal to 6 years
Purpose: RKPPS is an observational assessment designed to provide a developmental
description of typical play behavior,
useful in identifying interest areas, determining treatment effectiveness, & evaluating
children who cannot cooperate with standardized testing
Yes
Get their dimensions of play in 4 areas. Data collection processes assesses for:
1. Space management
2. Material management
3. Imitation
4. Participation
(Tally it up)
How can you use this in EI?: observe child during play to identify strength areas and need
areas
Observational
In relation to the Pediatric Interest Profile (Kid Play Profile sample):
What is the age range?
Describe the set up of the test.
What type of assessment is it?
Age: 6-9 years (oldest that one assessment goes until is 21)
3 separate assessments
Type of assessment: primarily self-report, follows up with an interview
What is something to be cautious about with using a self-report assessment?
Be careful about lying, they may say what they think you want to hear, they may not have
insight into their issues
In relation to COSA:
Who is the author?
What is the age range?
What is the validity?
What is the reliability?
What type of assessment is it?
Who can administer this assessment?
Author: Jessica Keller, MS, OTR/L; Anna Kafkes, MA, OTR/L, Semonti Basu, MS, OT;
Jeanne Federico, OT;
and Gary Kielhofner, DrPH, OTR, FAOTA
Age: 8-13
Validity: valid measure of occupational self-assessment, demonstrating content & construct
validity
Reliability: not reported, adopted a 4-point scale to improve reliability
Self-report
Who can administer: practitioners comfortable with MOHO
Video analysis
**Review on page 7 and 9 of "Play" ppt.
What is the benefit of using the Revised Knox Preschool Play scale?
Benefits of Knox: first 3 years are broken up into 6 month increments (based on
developmental milestones), assesses different areas of play, very detailed, done through
observation that occurs in the natural setting, doesn't require special toys or materials (toys
the kid is used to - important for this and to be culturally sensitive...what if kid doesn't
normally have access to it or doesn't know what to do with it?)
What is the benefit of using the COSA?
Benefits of using COSA: allows you to see where they think they're at, use to look at kids
judgement and insight, really get the kid's perspective on play, what the kid values, allow
them to identify what they're good at and what they're not good at and put them at value
How do you determine that play behavior is typical or representative of the child's true play?
Want to see kids at different times of the day, in variety of contexts, etc.
What concerns do you want to look for in play characteristics of children?
1. Physical limitations
2. Cognitive limitations
3. Visual limitations (i.e. impaired ability to create hand-eye-coordination, tactile
discrimination)
4. Other limitations of perception (i.e. social)
5. Health conditions with these characteristics (CP, Autism, Down syndrome, LD, ID, etc.)
What are examples of physical limitations that can interfere with play?
Cognitive?
Physical: can't handle playground, manipulate toys, postural tone, balance and strength,
significant gross motor issues that prevent them from using a standard playground (i.e. kid in
a wheelchair) FM: can't explore and manipulate the environment, understand object
characteristics
Cognitive: imaginative, taking turns, ability to motor plan (plan? execute it? ideation?),
following rules and safety (remember and learn rules of game), decreased interaction
What are 5 examples of overall goal areas?
1. Work cooperatively with peers
2. Take turns when playing game
3. Use play scripts of social stories
4. Follow the rules to a game
5. Engage in rough-house play without hurting others
What are 10 example intervention strategies for play?
1. Toy adaptation or environmental modifications that are safe, developmentally appropriate,
and fun- help children to control their space
2. Toy recommendations and play activities that develop specific skills for children of all
abilities and ages-Consider universal access
3. Strengths based approach (p. 492- case)
4. Set up play scenarios that encourage turn taking and problem solving
5. Consider family routines and priorities and ways to get families involved in play
6. Collaborate with schools and caregivers-education and training
7. Encourage sensory rich play
8. Encourage manipulative play to facilitate eye-hand coordination and dexterity
9. Facilitate imaginative and pretend play to encourage creativity/role playing and practice
social skills-model play behaviors
10. Choose toys appropriate for age/developmental level; accessible; encourage imagination;
safe!-Toy inventories to determine play needs (p. 494)
What is "universal access"?
What is a "strength-based approach"?
Why do you want to collaborate with schools and caregivers?
Universal design: activities and adaptations are designed for all (i.e. every student gets a
chrome book - not only kids who have difficulty with writing, etc. - everyone has access to
the same stuff)
Strength: Looking for what they're good at and able to do (and how you can foster that skill),
set them up for success and build on those strengths
What is it that the school needs and how can we support them?
Which statement best reflects friendships of students with disabilities?:
A. They experience fewer social interactions, but are satisfied with the number of interactions
B. They experience the same number of social interactions, but they experience less joy
C. They experience far fewer social interactions and social invitations than their peers
without disabilities
D. They experience more social interactions but mostly with adults, which is less rewarding.
C. They experience far fewer social interactions and social invitations than their peers
without disabilities
What is true of friendships four youth with disabilities?:
A. Choice is essential
B. Based on shared interests
C. Occur outside of friendship programs
D. A and C
E. All of the above
E. All of the above
Which is considered a benefit of adolescents participating in community service?:
A. They will get better grades
B. They are more likely to get employed
C. It decreases social opportunities with peers and keeps them out of trouble
D. It may help them transition to the community
A. They will get better grades
What is the rate of youth with disabilities participation in community service?:
A. 5% youth with CP
B. 20% youth with disability
C. 33% of youth with IDD
D. 75% of youth with ASD
C. 33% of youth with IDD
According to Larson, et al., which type of activity did the adolescents with disabilities report
as providing significant opportunities for all skills and developmental experiences?:
A. Clubs and organizations
B. Performance and fine arts
C. Academic clubs and organizations
D. Faith-based youth groups
D. Faith-based youth groups
Which assessment asks the child what he/she likes to do and how competent he/she views
his/her performance?:
A. Children's Assessment of Participation and
Enjoyment (CAPE)
B. Child and Adolescent Scale of Participation (CASP)
C. Child Occupational Self-Assessment (COSA)
D. Youth Experience Survey (YES)
C. Child Occupational Self-Assessment (COSA)
Which assessment provides a parent report of the child's participation in home, school, and
community?:
A. CAPE
B. COSA
C. Participation and Environment Measure
for Children and Youth (PEM-CY)
D. PEDI
C. Participation and Environment Measure
for Children and Youth (PEM-CY)
Which intervention strategy is least likely designed to increase social participation?:
A. Increase ROM
B. Manage money for increased opportunities
C. Modify line dancing routine
D. Modify positioning equipment for child to sit at table
A. Increase ROM
**Bottom up approach
Which activities are most suited to helping a youth with disability transition to adulthood?:
A. Adaptations, physical strength
B. Adult direction, education, discipline
C. Peer mentorship, support, modeling
D. Structure, play opportunities, freedom
C. Peer mentorship, support, modeling
Which statement correctly describes the changes in social participation over time for children
with disabilities?:
A. Children with significant physical disabilities
engage in less recreation over time.
B. Younger children with disability engage in less organized activity than older peers
C. Adolescents with disability engage in more recreational activities as they develop identity.
D. There is not a difference in social participation for children with disability over time.
A. Children with significant physical disabilities
What are 7 things you want to look at to asses social skills?
1. Communication
2. Cooperation
3. Assertion
4. Responsibility
5. Empathy
6. Engagement
7. Self control
Social Skills Improvement System Rating Scales (SSIS):
What does it screen for?
What does it aid in?
What does it assess?
Screens and classifies students of suspected social skills deficits; identifies social skills
strengths
Aids in intervention planning/development: provides baseline, tracks progress
Assess problem behaviors that may interfere with student's social skill development:
- Externalizing
- Bullying
- Hyperactivity/Inattention
- Internalizing
- ASD
SSIS:
What are the 4 rating forms?
What are the evaluator qualifications?
What are the scores yielded?
How long does it take to complete the assessment?
4 Rating forms: Teacher, parent, student (8-12 years); Student (13-18 years):
- Audio recorded option for reading or vision difficulties
Evaluator qualifications- coursework in principles of measurement and administration and
interpretation of tests
Scores yielded: Norm referenced- standard scores and percentile ranks
15-20 minutes for rater to complete form
Why is it important to have an assessment that involves the teacher, child, parents?
To get different points of view
**Review CPA 8 (assessments and questions) and "Legislation and Prevention Based
Services Review"
...
Compare/contrast IDEA Part C (Birth to 3) and IDEA Part B (3-21).
IDEA Part C (Birth to 3):
- Written parental consent for evaluation
- 45 days to complete evaluation/ assessments of child and family, and complete the IFSP
- IFSP review minimally every 6 months to determine progress towards outcomes and to
determine necessary revisions
- New IFSP developed annually based on the 5 domains
- Family centered, collaborative model
IDEA Part B (3-21):
- Written parental consent for evaluation
- 60 days to complete evaluation and review results at the PPT (some states complete in 45
days- CT for example)
- Once child determined to be eligible for special ed. and related services, team has 30 days to
develop IEP with parental involvement as team member
- IEP reviewed annually with modifications made to goals and objectives
- Re-evaluations occur every 3 years
***throughout the time they are 21 (so kind of like it's up until 22)
What is the role of school-based OT?
1. Focus on functional participation in work, self-help and leisure activities
2. Provision of service enables student enhanced participation in their role of learner/student;
classmate, friend.
3. Common self-help areas addressed: eating/feeding; toileting, dressing.
4. Leisure pursuits: playground access, engaging in social and cooperative play, sports
participation
5. Services are functionally, developmentally, and/or educationally relevant
Describe the historic evolution of school-based OT.
Historically, OT was in the school settings when they were following a medically based
model so historically they were working in institutions bc child weren't in public schools,
they were in private institutions working on all their underlying impairments. but then the
"gavel came down" and students were now being placed in public schools and children with
disabilities were now working with typical students. due to this change, we shifted from an
educational model (as opposed to a medical one)
Evaluation in school-based OT must follow what two guidelines?
What are requirements for evaluation in accordance with IDEA and OT Practice standards?
Must follow:
1. Federal and state guidelines
2. AOTA guidelines (i.e. code of ethics, roles in supervision, practice framework)
***Want to go to all the time (especially as a new therapist)
In accordance with IDEA:
1. Evaluator must be competent administering assessments
2. All methods chosen must be used according to purpose and with sound psychometric
properties
3. Methods chosen must assess area of specific need
4. Methods chosen must be culturally sensitive
5. No single method should stand alone in determination of needs
6. OT's should follow OTPF
What is something to consider if an outside specialist says that the child has visual issues?
What are some general things you want to look at during an evaluation?
You don't just put that down as assume all of that - could be due to something else? still want
to assess to see how it affects his occupations.
Things you want to look at: Where is the child now? What kind of progress is he making?
What are two things the evaluation process assists with?
What is the focus of an evaluation?
1. Assist team in determining eligibility for special education
2. Assist with program planning and need for OT as related service
Focus of evaluation: determine factors supporting or hindering learning and participation in
school related activities
Why do you complete screening for an evaluation? (3 things)
1. Better understand student in comparison to peers
2. Provide suggestions for strategies to team
3. Determine need for evaluation
What is response to intervention (RtI)?
What are the 3 tiers to it?
Why do you use RtI?
Response to intervention (RtI): screening model in general education (tier 1 to tier 3), specific
intervention strategy that the teacher in the classroom to help a child who may be falling
behind (first step in the special education process), also includes progress monitoring
Tier 1: i.e. writing without tears
Tier 2: more specialized instruction
Tier 3: more extensive, 6 week programs with a specialist (OT, speech, etc.)
*If child is not progressing, they then move on to special education
Why RtI?: keeping kid in the classroom and aren't unnecessarily being referred to special
education
True or false: An OT evaluation is required to exit a student from OT services.
True or false: An OT evaluation should be used to qualify a student for OT services.
FALSE: OT evaluation is NOT required to exit student from occupational therapy services:
- (Can use observation - If your observation and activity analysis shows they are completing
goals, you don't necessarily have to do an evaluation)
- Service is based on need NOT eligibility
- Needed supports drives decision making
FALSE: OT evaluation should NOT be used to qualify a student for OT services:
- (Again, based on need and not qualification)
- Students eligible for special education under IDEA are eligible for related services requires
to benefit from special education
Can you be "eligible" for OT?
No - You aren't "eligible" for OT, become eligible for special ed services and then get related
services (which would be OT)
**When they get OT they are already eligible for special education
Because a child doesn't do well on an assessment doesn't mean they need OT, why?
What is important about an assessment?
If use assessment to determine if they need OT (bottom up approach), what if the child has a
bad day? It doesn't necessarily tell you what you need to pick him up for, maybe it's not
affecting their occupations at all
**Assessments have to be related to function
What does an occupational profile typically include?
1. Record review - when reviewing a child's file
2. Interview
What do you want to look at during a record review?
Review their IEP, any past assessments (don't want to duplicate assessment if you can't - i.e.
BOT can't be reassessed until 1 year
Who do you typically interview when completing an occupational profile?
What is the importance of completing an occupational profile?
Teacher, caregiver, student when applicable
- Understand strengths
- Understanding perspectives
- Help team members understand OT's role
What are some guiding questions/interview to ask during an occupational profile?
How is student performing in role as student?
Can he learn and document his learning to his teacher?
How is student managing transitions between school settings?
How is student performing in relation to classmates?
What aspects of the environment are most supportive to student's learning?
How might environmental changes improve student's attention?
What is the purpose of an analysis of occupational performance?
Where are assessments of analysis of occupational performance completed?
What types of assessments can be done for an analysis of occupational performance?
Strengths and difficulties identified relative to classroom expectations and curriculum
Assessment in all appropriate school environments
1. Observation of performance and activity analysis (**in settings where concerns are noted)
2. Standardized tools
3. Authentic assessment (work samples, student portfolios) - samples can be maintained week
after week to see progress, identify things they are doing in the school setting (doing well)
What is the purpose of evaluation? (3 things)
1. Diagnostic
2. Program planning
3. Monitor progress
What are examples of the diagnostic purpose of evaluation?
BSID-III
What are examples of the program planning purpose of evaluation?
HELP; SFA; class work samples; classroom observation; teacher/parent/student interviews
What are examples of the monitoring progress of evaluation?
HELP; SFA; SPM; class work samples; observation; teacher/parent/student interviews
What are 4 approaches to evaluation?
1. Top-down approach
2. Strength-based
3. Client-perspective
4. Parent-inclusive
What is the top down approach to evaluation?
Determine performance in occupation and identify strengths, concerns, difficulties BEFORE
completing assessments of factors and skills
What is the strength-based approach to evaluation?
Focus on what is working for student
What are examples of the client-perspective approach to evaluation?
PEGS
COSA
SSI
SCOPE
What does the parent-inclusive approach to evaluation contribute to?
What does it include?
What is important to remember with the parent-inclusive approach to evaluation?
Contribution to IEP development and occupational profile
1. Referral question development
2. Information sharing/goal considerations
Have to establish rapport, trust, working with people who want you to "fix" their kid
What is the difference between EI and school-based?
EI = family-centered
School-based = based on the client but the client is not just the child, also the teacher
**Review class activities on page 7 on "School Based Evaluation Part 1" ppt.
...
How do you document evaluation results?
What does it consist of?
Written report:
- Structure report to answer referral questions
- Describes students participation in educational setting
- Includes discussion of student strengths of occupational performance (want to look at how
that strength affects their occupational performance)
- Discussion of difficulties
- Discussion of skills and factors that support student's strengths and difficulties related to
occupational performance
**Want to understand areas of support and areas of limitations and the affect of the
environment
For kid who "can't pay attention in class" - what do you want to ask the teacher?:
Look at his environment and how distracting that environment is, what is the child's reading
level (*critical!! kid has to be able to read before he can write)
*Recall: when you are reviewing someone else's evaluations that you are currently
evaluating, want to look for connections based on what the referral question is, gives you a
background, see what other assessments have been used in the past (don't want to duplicate
assessments)
...
*Review "in class activity" on pg. 8 of school based pt. 1 ppt.
AT and SSI Sample - what the evaluation has and what it's missing!!
What are questions to consider when reviewing reports?
1. Is the student's participation in educational environment described?
2. Does report discuss students strengths in occupational performance before discussing
difficulties student has?
3. Is there a discussion of skills and factors that support and help explain strengths and
difficulties with occupational performance?
What do you want to consider when looking at the student's participation in the educational
environment?
- Want to identify all of the environments technology is taking place specifically environments that support technology and inhibit technology
- Want to observe every environment, helps you figure out how to set up your assessments to
assess things like writing and typing
- Want to interview family to see how he's using the technology at home, talk to teachers if
you can't get into every environment
*Have to have a good background of the kid!!!!
Can certified OTA's perform evaluations?
What can they do?
No!
What can they do?
- They can carry out intervention plans under the collaborative supervision of the OTR
- They can choose activities for interventions
- Modify activities for interventions (if they do these things they have to document it)
- Can do standardized assessments (have to be proficient and confident, have to understand
assessment tool, want to observe it, Val still cross check's conversion scores)
- *NOT responsible for interpreting results for documentation (that's OTR)
What is the typical length of time for OT evaluations?
Can an outside consultant or MD eye specialist prescribe OT services?
Can the IEP team direct which assessment tool be administered in an OT evaluation?
Average time from start to finish is 6 hours (**and has to be done within the first 45 days)
No, family or PPT only
Parents can request assessments to be done, but they can't direct it
When creating an IEP, who is always included in the process?
Always includes child's parent/caregiver, regular education teacher, special ed. teacher, and
representative from LEA (administrator of building); may also include related service
professional
**Collaborative process
***Nothing gets said or planned outside the PPT
What does an IEP include?
1. Evaluation criteria and procedures (recent evaluations, performance on state/district
assessments, etc.)
2. Gives current level of educational performance (strengths and needs)
3. Annual goals and STO to assess progress (academic and functional - to enable progress in
general education curriculum; 1 year)
4. Educational and related services required
5. Amount and type of participation in regular education
6. Transition planning
7. Dates of implementation and review
**Goal is always to get kid out of special education into general education
What types of transition planning is needed for a child?
From B-3, preschool-school based, and high school transition age (starts at 15, 16 is when
you'll see transition goals and outcome)
If a child comes out high in an area but didn't score high in some subtests, is that a problem?
No it isn't a representation of the child's overall score. It could have been some motor issues
that the child is having problems with but it also could have just been that the child is too
young! Would you expect the child to be able to do some of the tough parts? Construct
validity! The idea of "if the construct is truly assessing motor skills, and the BOT has high
construct validity, you would expect that older kids would do better on the assessment and
that younger kids may struggle with the challenging parts of the subtest"
If a child scores low on an assessment, what's the first thing you do?
NOT say they need OT, but do further assessments
How does the OTPF define education?
What subcategories fall under education in the OTPF?
Activities needed for learning and participating in the educational environment
1. Academics
2. Non-academics
3. Extracurricular
4. Vocational
What are things you want to look at in a child in terms of their academics?
Where are you going to assess a child's academic abilities?
If the child has for example a visual motor issues, what academic issues may he also have?
The things you look at in a child: reading and writing, attention, cognition, communication
effectiveness, visual and motor skills, posture
In the classroom, cafeteria, playground, more specifically reading, writing, and math classes,
art classes, science (i.e. to use all materials)
I.e. visual motor issues: can he copy off the board? can he read the menu in the caf? can he
navigate around the caf/playground?
What are the 4 different types of service delivery models?
1. Direct
2. Integrative/collaborative
3. Indirect/consultative
4. Monitoring
Generally, describe eat service delivery model.
Direct: therapist is doing intervention to the child, with the child, for the child, seeing the
child in the classroom or in a related service room (i.e. your room) (if see him in classroom,
etc. you can see him in his natural environment, if seeing him one-on-one you're "pulling him
out", need to document that)
Integrative/collaborative: you're goals are created together with teacher and others, get to see
kid in the classroom
Indirect/consultative: services on behalf of the child but does not have to occur with the child,
i.e. child is pulled out to receive services but other session for the week would be a
consultative session with teacher, speech, PT, etc., (child does not need to be present
Monitoring: on behalf of the child in the classroom or the learning environment is, not
necessarily on theIEP (504, accommodation plan, etc.)
In relation to the direct service delivery model:
Who is the therapist's primary contact?
What is the environment for service delivery?
Who is responsible for activities?
Student
One on one or small group.
Class, therapy room, playground
OT, PT Remediation, prevention, compensation
In relation to the integrative/collaborative service delivery model:
Who is the therapist's primary contact?
What is the environment for service delivery?
Who is responsible for activities?
Student, teacher, aide
Natural Learning environment with support of others, Shared goals
OT, PT, Teacher, parent, aide, other school personnel
In relation to the indirect/consultative service delivery model:
Who is the therapist's primary contact?
What is the environment for service delivery?
Who is responsible for activities?
Teacher, aide, parent, student
Learning environment with support .
Student does not need to be present
Teacher, parent, associate, other school personnel
Information exchange and support
In relation to the monitoring service delivery model:
Who is the therapist's primary contact?
What is the environment for service delivery?
Who is responsible for activities?
Teacher, classroom staff
Classroom or other learning environment
OT, PT
What is it important to use consultation?
1. Supports the philosophy of LRE
2. Effective use of resources
3. Facilitates skills of other personnel
4. Collaborative problem solving
*Use it as a teaching method for staff, teaching the team things so that they can carry out
interventions without you there
What are 5 consultation intervention strategies?
1. Reframe teachers perspective
2. Improve student's skill
3. Adapt the task
4. Adapt the environment
5. Adapt the routine
What is a specific example of why you would want to reframe the teacher's perspective?
Why is it important to work with the teacher and reframe their perspective?
Teacher may think the issue is handwriting when it's really motor, vision, cognition, etc.
Reframe teacher's perspective: Helps us understand where the teacher is coming from and
work with them, and how it can be shaped so that the child gets what they need (i.e. seating
placement, adaptive equipment, etc.)
What were 2 provisions to IDEA 2004 in relation to prevention-based services?
1. Early intervening services (**NOT early intervention):
- % of federal funds allocated for EIS for students at risk for learning or behavioral problems
- Using scientifically based academic instruction and behavioral interventions
- "Enhancement" program in general education curriculum (certain amount of money states
given to these programs)
- SST
2. Provision to Intervention (RtI)
- Tiered model of prevention and early intervention
***For general education!!!
What is SST?
Student study team - representatives from each grade attend a monthly meeting, any teachers
that have concerns come to those meetings and express them, decreases the number of
referrals to OT
What are the 3 tiers to RtI?
Tier 1: Universal or core intervention
Tier 2: Targeted intervention (child pulled out to see reading specialist or pulled out for
specific things like that)
Tier 3: Intensive Intervention (One-on-one, more involved, has to be tracked (goals, progress,
etc.)
**Tier 3 = last step before a child goes to special education
What are 5 different intervention types?
1. Occupations and activities
2. Preparatory methods and tasks
3. Education and training
4. Groups
5. Advocacy
What is the difference between occupations and activities?
Activities make up occupations, activities are more structured to then help with the
occupation
Occupations (??): i.e. handwriting, self-help, working on kid's ability to dress for gym,
working on child's participation in recess
What is the purpose of preparatory methods and tasks?
What are some examples of these?
Prepare for activities
I.e. core strengthening: swing, have them on their belly on the swing and hangs on the floor,
reaching for bean bags and throwing them, rolling a weighted ball up and down,
What is the difference between education and training?
Education = imparting knowledge
Training = teaching
What are examples of advocacy?
I.e. fundraising to get an adapted playground for Nolan, prevention, promotion, advocating
for physical activities for children
What are 6 different intervention approaches under IDEA?
1. Establish/restore skills and abilities
2. Modify context to support student
3. Adapt activity demands or environmental modification
4. Develop strategies to prevent anticipated problems
5. Create opportunities using universal design strategies
6. Staff/student/family education and training on: Specific programs and Use of equipment
What are 7 different types of documentation?
1. Evaluation/re-evaluation
2. IEP
3. Service notes
4. Progress summary - quarterly
5. Letters of justification for equipment/adaptive devices
6. Transition plans
7. Discontinuation reports
What does a service note include?
Who is the service note maintained by?
What are two important things to remember about the service note?
Date of of service, skilled intervention/activities/progress towards outcomes (data collection)
Maintained by therapist separate from student file
Must be confidential and in a secure location
How often must a progress summary be completed?
What does a progress summary include?
Quarterly
Frequency and duration; strategies/interventions used; measurable progress, any
modifications to activities/environment; adaptive equip; trainings to family/staff
What age does goals and objectives for transition have to be completed by?
15
When are discontinuation reports completed?
What are they?
Upon exit from services
Summary of current level of function, strategies, modifications or accommodations that
enable participation
What are reasons a child may be discontinued from services?
1. Goals and objectives met
2. No further goals requiring therapy
3. Problem is no longer educationally relevant
4. Students needs may be met by another professional
How does AOTA define "activities of daily"?
Broad term: "Activities oriented towards taking care of one's own body"
What are the benefits to active participation?
Independence, autonomy, influencing self-esteem (by middle school this is critical), not
having this can slow the recovery process, hygiene
What are the keys to participation?
(Things we consider that contributes to assessment and intervention)
Can kid sequence, attend to task, a child's mobility, how motivated they are to do it,
environment, demands for the activity
What is activity analysis?
Sets us up, lets us see what skills the child has and the parameters of the task, also need to
identify where it is done!!!(how the environment supports or hinders the activity)
What are potential strategies for evaluating ADL's in children informally?
Formally?
Informally: in the bathroom in the morning
Formally: parent questionnaire, self-report
What type of data can you obtain from formal and informal evaluation?
Want to know the priorities of the parents and the school, what are the kid's priorities, want to
know cultural implications, want to know what they're currently doing (strengths and
concerns), want to know when and where the activities are performed (are there opportunities
to evaluate and treat in a variety of settings?), how often the activities are happening
Priorities and needs
What is one thing you can obtain from an activity analysis?
From activity analysis you can identify baseline skills for targeted behavior
What are 4 ways to evaluate ADLs?
1. Interviews
2. Observation (structured, naturalistic)
3. Inventories/checklists (with parents, teachers, kids)
4. Task analysis
What does task analysis look at?
- With what aspect of the ADL is the child having difficulty?
- Why is the child having difficulty?
- What is the child's capacity to do the activity?
- What is the priority?
**Want to know if the child can understand language (if they can't you need to know what
kinds of cues to provide - verbal vs. pictures vs. auditory, etc.)
What are the levels of independence for ADL's?
(From highest level to lowest level)
1. Independent
2. Independent with setup
3. Supervision
4. Min assist (51-75%)
5. Mod assist (26-50%)
6. Max assist (1-25%)
7. Dependent
How could you determine someone's level of independence?
Careful activity analysis allows you to collect the data and use these as measures
i.e. Task analysis: can have a checklist for each step and you can see how much they do
(maybe only 6/12 tasks - 50%)
What is the difference between "independent" and "independent with setup"?
Independent: child is independent with activity, setup, and clean up
Independent with setup: other person sets up activity for them
**Review case examples on page 3 of ADL ppt.
...
What are 3 examples of criterion referenced assessments to measure ADL?
What are 2 examples of comprehensive, norm referenced assessments to measure ADL?
What is an example of a MOHO (observation, self-report, interview) assessment to measure
ADL?
Criterion:
1. Do-Eat assessment
2. AMP/School AMPS
3. HELP, Batelle, Bayley
Norm:
1. PEDI/PEDI-CAT
2. Real
MOHO:
1. Barthel Index of ADL (BI)
Curriculum based and criterion referenced:
Choosing options and accommodations for children (COACH)
What is the Real?
What is the purpose of Real?
What is Real?
Age?
Role evaluation of activities of life
Purpose: evaluation of self-care at home, school, and in community
Standardized rating scale of ADL's and IADL's
most common in children ages 2-18 years 11 months
What 4 things does the Real measure?
1. Obtains supplies they need to complete activity
2. Is or is not able to maintain safe body position while performing the activity
3. Sequences steps required
4. Problem-solves and makes appropriate/safe choices during the activity
Describe the Real rating scale.
How long does it take to administer the Real?
What does the Real yield?
What are the limitations to using the Real?
Parent/caregiver rating scale: 0-3 (unable to frequently)
15-20 minutes
Yields ADL/IADL standard scores, % and composite score - used to chart growth and
development
Limitations: not a comprehensive evaluation of all areas of ADL/IADL
Review Sydney video analysis on page 7 of ADL ppt.
...
For intervention strategies:
What does teaching to the task mean?
What does modifications or assistive technology refer to?
What do you want to consider about the cultural context?
What does it mean in regards to practice in variety of environments?
Does learning the task improve health, safety and participation? (are you teaching the task
during the actual occupation? i.e. are you teaching safety during the bathroom activities, are
you teaching child how to use zipper hooks, etc.)
Are there alternate methods for task completions?
Do caregivers consider ADL independence important, have resources and supports available
to them? Can they afford adaptive equipment?
Task assessed, taught, and practiced
What are 4 different intervention strategy approaches for ADLs?
1. Promote/create (**have the kid in mind but also have the other kids of the classroom in
mind (who don't necessarily have a disability)
2. Establish/restore/maintain (i.e. have them practice in front of them on cardboard - with
thick laces or with thread (grade it to make it more and more difficult to make him work
harder), have them do puzzles (have him do it in position of prone, on a scooter board, etc.) looking for opportunities that works on strengthening)
3. Modify/adapt
4. Prevent/educate
Intervention strategies include multiple opportunities for practice with feedback of
performance. Using hygiene as an example what are some examples of things you can do?
1. Sequencing photo cards
2. Fill in blank worksheets
3. "What's wrong" photo cards
4. Q&A cards in small groups or individual sessions (i.e. how often should you wear
deodorant? How often should you bathe? Etc.)
What are 5 intervention methods?
1. Forward chaining/backward chaining
2. Environmental/task cues
3. Adapting task with assistive technology
4. Adapting task or physical environment with adaptive equipment
5. Coaching and education
What are environmental/task cues from least to most intrusive?
1. Verbal
2. Verbal and gestural
3. Verbal and physical
(*dependent on independence levels)
What are 3 examples of ways you can adapt the environment with assistive technology?
1. Talking books, visual schedules, digital and paper stories
2. Video modeling of others
3. Video modeling of self
What chaining method is recommended for kids who get frustrated easily?
Backward - let's them have their eye on the prize
What are 2 prevention and education strategies?
1. Anticipatory provlem solving
2. Coaching/education
What is anticipatory problem solving?
Why would one benefit from anticipatory problem solving?
What is involved with coaching and education?
Preparing child for unexpected events
If they have cognitive skills
Coaching/education:
- Asking the right questions
- Observe, listen, respond, plan together
- Demonstrate/model
- Grading/chaining
- Which strategies will caregivers try?
- How will OT modify routine if strategy doesn't work?
- How will caregiver/teacher and therapist give each other feedback?
How does AOTA define rest and sleep?
What 3 categories are also considered under rest and sleep?
"Activities related to obtaining restorative rest and sleep, to support healthy, active
engagement in other occupations"
Rest, sleep preparation, and sleep participation (how is it you get yourself ready for
functional sleep? - i.e. reading before bed, etc.) and how are you staying asleep)
*If we want our kids to be active during the day they need to sleep at night
**You have to ask the right questions: if a kid is slouching over their desk it could be
postural control but also could be due to sleep
What are some sleeping disorders that parents are seeking help with?
1. Bedtime resistance or falling asleep
2. Waking up at night
3. Irregular patterns of time in sleep
4. Snoring
5. Sleepiness during the day
Night terrors, waking at night, etc. may be things that are temporary, what can we do to help
with this?
What age is resisting going to sleep/waking at night common?
Get down good routine before bed (activity level makes it difficult to calm), sleep preparation
(i.e. calming music), remove toys that may be distracting (bedroom is place for sleep only),
night light to make them feel more comfortable, ritual of reading a bedtime story
2/3 years old
One way to assess sleep includes sleep questionnaires in conjunction with interview about
sleep, what types of questions does this include?
- Regular sleep patterns?
- Where does child sleep?
- With whom or with what?
- When does the child get put to bed?
- What are typical bedtime routines?
- How long does it take for the child to fall asleep?
What is the BEARS algorithm?
B - bedtime problems
E - excessive daytime sleepiness
A - awakening during the night
R - regulatory and duration of sleep
S - snoring (sleep apnea)
Why is feeding, eating and mealtime a complex occupation?
Will need to attend to sensory and motor qualities the child has, the environment, and the
bonding with the family
According to AOTA how it OT related to feeding and eating?
"Occupational therapists and occupational therapy assistants have the knowledge and skills
necessary to take a lead role in the evaluation and intervention of feeding, eating, and
swallowing problems.
Further, therapists have the entry-level knowledge and skills to evaluate oral and pharyngeal
swallowing function."
What are specific roles of the OTR vs. COTA in feeding, eating and swallowing intervention
according to AOTA in 2004?
What are specific roles of the OTR vs. COTA in feeding, eating and swallowing intervention
according to AOTA in 2007?
2004:
- OTR primary responsibility
- COTA provide services under supervision of OTR
2007:
- Both select, administer, and adapt activities that support the intervention plan developed by
the OTR
- Must abide by state and agency regulatory laws when providing intervention
*Significant feeding/eating issues addressed by team
What are the phases of swallowing?
1. Pre-oral: process of food approaching the mouth by person eating or by feeder
2. Oral:
- Oral prep: processing food
- Oral: food transport from front of mouth to pharynx
3. Pharyngeal - swallow reflex is initiated
4. Esophageal - bolus moves from esophagus to stomach
Describe the development of sucking patterns.
Initially: develop front to back sucking pattern
Fatty pads start to shrink, etc. so they start getting jaw movements and we get up down
movements (rotary movements - essential for chewing)
Child starts with liquids, then move to puree, after chewing is developed you progress
through textures of food that require chewing and swallowing
What are 8 underlying causes of poor oral feeding?
1. State issues/Prematurity
2. Impaired postural control
3. Oral motor deficits/Swallowing deficits
4. GI difficulties/Cardio-respiratory issues
5. Structural limitations
6. Sensory issues
7. Lack of hunger
8. Behavioral issues
What are some intervention strategies that revolve around the context?
1. Managing the eating environment
2. Are there foods important to family?
3. Activities that are developmentally appropriate
4. Facilitate social interactions
5. Feeding routine and habits
What are some pre-oral phase strategies? (2)
1. Sensory, cognitive (have to be able to say no), perceptual, psychosocial
2. Extremity control and positioning
What 3 things do you want to consider during sensory preparation?
1. Prepare environment - where can feeding take place with minimal distractions?
2. Prepare body and face - preparing extremities of the body (distal) and work your way up to
the face (*but stay out of the mouth if you're not invited/they don't want you there)
3. Foods chosen
What is one general intervention strategy for the oral phase of feeding?
What 5 things does this specifically include?
Grading along the sensory continuum
1. Taste
2. Smell influences
3. Temperature
4. Texture
5. Mouthing helps!
What is the most stimulating temperature for a child?
What are 2 specific things you may want to use as an intervention strategy in regards to
texture?
At what age should children be eating a full diet?
(Continuum: cold to hot)
Most stimulating: cold (would be the most sensitive to this)
Texture:
1. Modifying food and liquids (thin, nectar, honey) - by thickening it it slows the rate at
which the food is moving and gives the child more time to form the bolus
2. Food progression based on texture/consistency (puree, junior/coarse puree, wet-grounded
mashed, soft/dissolvable, chopped/soft solid, full diet)
Full diet (with being able to handle it physically and sensory): around 2 (should be able to eat
foods that are cut for them)
Important notes for intervention strategies for oral:
- If you've observing a child and he's avoiding a food, what is it that they're avoiding (i.e.
sweet, spicy, etc.)
- Diluted to concentrated consistencies (gradually - i.e. start with just water, then water with
apple juice ice cubes, etc.)
...
In regards to modifying food texture:
Who is it important to also work with as an OT?
What kind of diet might a child with a neurological condition often need?
Describe the gradual introduction of foods for a child.
Important to work closely with Nutritionist or Dietician
Often need high calorie, high protein, and/or high fiber diets
Pureed, smooth foods introduced first, gradually increasing the texture with lumps, etc:
- Smooth: yogurt, strained fruits
- Lumpy: oatmeal (requires greater oral motor control)
- Dense, crunchy, sticky or uneven (more difficult to manage, advanced chewing)
Why is varying textures important?
What types of foods do you want to use to vary texture?
What is important to note about introducing varying textures?
Because it's very alerting when you change it up for them
1. Use foods that increase chewing demands (cheese, chicken, well cooked vegetables)
2. Use foods that dissolve quickly in the mouth
When introducing foods that you know are safe but requires the child to manage it (Still want
to integrate with what is familiar - want child to progress but it has to be in a gradual manner
(not all cheese and chicken, etc. but only one of these along with foods that you already know
they like)
Why is promoting postural stability key to feeding?
What is the ideal position for a child to be sitting in during feeding and eating?
Why is the position of the therapist also important?
What is the value in position modifications before, during, and after meals?
Stabilizing the child may enable better focus
- 90-90-90 rule
- Midline position of head, neck and shoulders (head slightly flexed and Slight chin tuck)
*Child must be comfortable!
Position of therapist/caregiver for mealtime
communication and socialization
Good alignment of internal organs for digestion and swallowing to prevent aspiration
If a child has a swallowing issues, but after eating it's nap time, how do you want to consider
positioning them?
Do not position them on their back, slant them so they're more upright (but can still sleep on
their back)
What is the significance of a positioning device during feeding?
What is one way you can provide positioning for the child?
May hold infant in supported position (bundled) to reduce energy demands to attempt to
maintain posture
Positioning an infant on caregivers lap, adult's thigh acting as a wedge to inhibit extension.
The adult's foot is placed on a stool or foot support to elevate the leg
When doing any kind of assessment/intervention, what do you always want to start with?
Positioning!
What are potential oral motor issues associated with the jaw?
1. Instability (might be due to low tone)
2. Clenching - tonic bite
3. Tooth grinding
What are oral motor movements associated with the tongue?
1. Retraction
2. Protrusion
3. Thrust
What are oral motor movements associated with the lips and cheeks?
Lip and cheek stretches to promote lip closure
What are ways to reduce abnormal patterns of tonic bite and tongue thrust?
What are oral motor activities to facilitate tongue lateralization (to assist with tongue thrust)?
What is another way to assist with tongue thrust?
Well-supported, slightly flexed head
1. Silly faces in mirror
2. Licking lollipops
3. Frosting, pudding, etc off sides of mouth or within cheeks
Placement of spoon/bolus to sides of mouth
What are oral motor preparatory strategies to increase tone?
Full body first- bouncing, Cheek tapping, vibration to cheeks, quick stretch to cheeks; Face
rub, chewing exercises
From video: *she was stabilizing his jaw (chin) - giving him excellent proprioceptive
feedback (before she was entering the mouth)
What are oral motor preparatory strategies to decrease tone?
Overall deep pressure to body first then stroke cheeks and chin towards lip closure; finger
massage to cheeks, massage; downward pressure on tongue may help ↓ tongue thrusting
From video: Baby in chair: first note the postural stability, notice the stabilization of the jaw,
baby pulls away from smaller thing in mouth (recommendation for parent: slow down! wait
until the kid comes to you - fatter was easier for her while thinner was more difficult)
**See videos from pages 7 and 8 of "Feeding and Eating"
...
What might feeding activities incorporate for hyposensitive or decreased oral sensory
awareness?
Cold foods with strong flavors (tangy/spicy, salty, sour)
*Also want to VARY the temperatures (i.e. start with cold to wake them up, then warm it up
a little, back to cold, etc.) - want to do this with other things too like textures, etc.
**Also important to let the kids explore
Drooling is part of a typical development of a child, what are reasons children may drool?
1. Poor stability, poor motor control
2. Decreased awareness/sensation in mouth
3. Allergies/respiratory problems
(From notes:) Reasons a kid could be drooling: low jaw tone, tongue is protruded, overactive
salivary gland, they are teething
What are 5 intervention strategies for drooling?
1. Increasing oral-sensory awareness to help child better
determine when mouth is wet
2. Improve Head and trunk control
3. Improve oral-motor control-rubber massage brush, cold washcloth, vibration
4. Positioning and attempt to achieve closed mouth posture
5. Bandanas, bibs, other age appropriate ways to protect clothing
What can poor oral sensory awareness contribute to?
What can help children take correct size pieces of food?
May contribute to overstuffing of mouth
Strong flavors, cold temps
What are 4 general sensory activities?
1. Explore toys and objects with mouth
2. Encourage hands to midline and mouth
3. Vibration
4. Explore food textures
What food textures are alerting for children?
What foods are easier to swallow with limited oral motor?
What types of foods might you want to move from to vary texture?
What is a way you can do this?
Crunchy, hard (safety first)
Smooth foods are easier to swallow
Move from bread sandwiches to cracker sandwiches
Add texture to smooth foods
What are some sensory strategies to consider with utensils?
Utensils with different materials (i.e. handle has bumps on it or is weighted, scoop part is
rubber...for kid who has tonic bite so that it is softer)
What are 6 important strategies for spoon feeding?
1. Place small to mod. amount of food on spoon
2. Present at midline
3. Try not to hit teeth
4. Press bowl of spoon on front 1/3 of tongue
5. Do not remove until lips close around spoon
6. Remove straight out (not upward) (to see if they can maintain lip closure)
What are two things you want to see if the child is able to do with spoon feeding?
1. Hold spoon away from mouth
2. Let child come to the spoon and remove food
What are some considerations for types of spoons?
(1) Shallow bowl (easier to remove foods for low tone kids - difficulty with lip control tongue
control cheek control)
(2) spoon with bumps or chilled metal spoon
(3) rubber coated
4) curved/shorter/larger grip handle...(compensate for bringing food to mouth - facilitate,
compensate)
What are 6 important strategies to cup drinking?
1. Bring cup to lips and rest just at lower lip
2. Wait and watch for the child to come to cup
3. Tip and watch fluid flow
4. Do not pour into child's mouth!!!
5. Jaw control is often used
6. Often use cut-out, 'nosey' cup or flow control cup
What types of cups are used as a transition between bottle and cup?
What do you want to consider about cup drinking in regards to the liquids being used?
What can delayed progression of cup drinking be due to?
Sippy cup
Consider progression of liquids: thin consistencies are most difficult to manipulate (i.e.
water)...might start with very thick liquid and gradually work thinner
Often due to poor jaw stability, decreased lip/tongue control
What is the importance of oral desensitization?
What is a skill to make it more engaging?
How do you work oral desensitization?
What does it allow?
What else do you have to consider in regards to oral desensitization?
Establish trust
Make it fun, playful
Work gradually***
Allow turn taking, choices, active participation and sensory exploration
Consider environment - what are the sensory qualities of the environment? Is it super
distracting?
How would you want to begin an activity for oral desensitization for children with more
generalized hypersensitivity?
1. Start with full body input (deep, firm pressure and proprioception) - arms and shoulders
before face
2. Linear rocking before oral
3. Self soothing with hand to mouth activities or pacifier
**Again consider positioning and environment
What is non-nutritive oral motor used for?
What are ways to do this?
Used to decrease hypersensitivity and advanced food textures outside of mealtime:
1. Jaw strengthening
2. Repetitive chewing
3. Placing crumbs on chewy tubes; adding rice flakes to puree; chewing foods ecased in mesh
4. Slowly introduce to meals
What are preparatory methods for oral desensitization?
1. Warm washcloth-wipe regularly
2. Parent's finger
3. NUK toothbrush or toothbrush
4. Pacifier
5. Firm rubbing and/or deep pressure (to gums or palate, once accepting)
6. Vibration
7. Textured toys/teethers for mouthing
8. Blow toys
9. Jaw strengthening and repetitive chewing exercises (i.e. chewy tubes)
What are feeding activities used for oral desensitization?
Incorporate small amounts of food:
- Room temp/warm foods often easier to handle- change temps to expand sensory
experience
- Once small bites taken outside of meal environment consistently, introduce at meal time
According to Morris and Klein, what are behavioral principles of learning and mealtime
programs?
1. Provide mealtime structure and location ***Attempt to create positive interactions and
child's association of this time
2. Analyze & change the stimulus that triggers the negative or problematic response3. Break down larger skills or behaviors into smaller steps, positive reinforcement, and clear
expectations
4. Offer choices and turn taking to help child feel more in control and increase willingness to
participate
5. Acknowledge how difficult change is for child and family
6. Look for consistent success with activity before increasing challenge
7. Reduce grazing or excessive liquid drinking outside of meals
8. Preferred foods introduced before novel; non-preferred paired with preferred at mealtime
In regards to case study at the end of chapter:
(*review)
Case study with swallowing and feeding issues a medical work up determined he had GERD.
Pediatrician just said to feed when hungry, didnt eat for 3 days, then needed intensive OT
speech for 5 weeks in an intensive environment and then could return to feeding properly
What are 6 interventions to improve self-feeding?
1. Must express interest in self-feeding
2. Interest in exploring foods
3. Adaptive positioning to facilitate grasp or hand to mouth
4. Consider foods that stick to spoon
5. Backward/forward chaining
6. Adaptive equipment
In regards to interventions to improve self-feeding, what are considerations for impaired
vision?
Start with finger foods (so they can feel it) - dish that is raised
Look at outside of mealtime: smell, taste (don't want to have them to have poor experiences
during mealtime so work on this outside)
Have family put foods in the exact same spot (consistent orientation - fork and knife on right,
cup at 2:00, etc.)
Contrast in colors
Example: if the therapist does the scoop and then the child puts it in his mouth, what kind of
chaining is that?
Backward chaining
What are some examples of adaptive equipment used for self-feeding?
1. Dycem
2. Plate guards
3. Weighted, bendable, strapped, or built up handles
4. Rocker knives (rocking motions instead of sawing motion)
5. Universal cuffs (velcro pouch on hand and you can slip a utensil in there)
6. Nosey cup
What are some guiding principles for feeding and eating according to Morris and Klein?
1. Develop trust
2. Follow the child's lead
3. Build upon strengths
4. There are specific intervention that focus on reducing/eliminating barriers
What should intervention focus on in regards to reducing/eliminating barriers?
1. Mealtime
2. Learning
3. Communication
4. Physical influences
5. Sensory influences (track responses to 7 senses)
In regards to the "Get Permission Approach":
What are the different tilts involved with this theory?
Who is responsible for setting the goal?
What is the child's role?
What are preparatory methods involved in this?
Forward vs. negative tilt:
Adult sets the goal and child sets the pace
Listen to child and progress based on what child accepts (finger, toy versus utensil)
Preparatory strategies of sensory input (towel rubs, massage)- particularly when child not
ready
In regards to the "Get Permission Approach":
Who changes the approach when something is not working?
What continuum is involved in this?
What are two important things to consider about the child?
What are some questions to consider with this approach?
Adult changes approach when not working- change it up
Texture continuum- introduce familiar and move up (Case-Smith)
1. Predictable feeding schedule- helps with trust; Safe and comfortable environment
2. Each child is individual- respect autonomy and read body language and understand
communication attempts from child
Questions to consider- collect information on what is working and what is not
What are the strategies to the Get Permission approach?
1. Around the bowl method to introduce unfamiliar with familiar
2. Modeling, imitate for child3. Treat feeding as opportunity for sensory exploration versus just nutrition (sensory, use of
utensils)
4. Feeding is social and promotes bonding
5. Exploration using hands, tools, throughout meal time
What is a cultural side to feeding you must consider with the Get Permission approach?
How do you want to adjust goals?
Continuum of textures, spicy vs sweet. Etc
Adjust goals according to what child is ready for