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OT PEDIA
ADLS, IADLS, REST AND SLEEP
| Term | Definition 1 | Definition 2 |
|---|---|---|
| WHY ADLS IMPORTANT TO BE MASTERED FIRST | • Because this is what we do everyday. These are foundational skills before doing other complex occupations • The role of cultural values, parental expectations, social routines, and physical environment affect ADL performance. | • Asian culture has later independence in ADLs because high expectations is put more on education • Western culture is more on the individualistic approach and is expected to do everything by themselves. They put more expectations on their work culture. |
| CO-OCCUPATION | Occupation that we do or share with others | |
| ROLE OF CONTEXT TO ADL SKILLS - ROUTINE | Embedding ADLs in daily routines helps make these activities automatic and easier to perform over time. | |
| ROLE OF CONTEXT TO ADL SKILLS - PHYSICAL ENVIRONMENT | This can hinder or support a child’s performance. | |
| ROLE OF CONTEXT TO ADL SKILLS - PARENTAL OVERINVOLVEMENT • Pressed with time: | Parents may choose to do tasks for their child to save time. | |
| ROLE OF CONTEXT TO ADL SKILLS - PARENTAL OVERINVOLVEMENT • Overprotective: | Parents may fear their child will get hurt or fail, leading them to take over activities rather than letting the child try independently. | |
| EXPECTED SKILLS IN SCHOOL | These skills should already be grounded to develop higher-level skills that a child needs in school. • Toilet-trained • Bathing • Dressing • Feeding | In the US, they are strict with privacy, so teachers are not allowed to go with the child inside the restroom, even just holding the hand of a child. You would have to ask for consent |
| ADLS EVALUATION | • Interview • Inventories • Structured and naturalistic observations • Standardized tests | |
| CHOOSING AN ASSESSMENT TOOL OR EVALUATION PROCEDURE | Based on age, skills you want to assess, time considerations, availability and resources, training of OT. | |
| ADVANTAGE OF TELEHEALTH IN EVALUATING SELF-CARE | • Natural environment • Use telehealth to evaluate self-care tasks that is better evaluated at home and difficult to perform in the clinic (e.g., bathing, toileting). | |
| ADL INDEPENDENCE | Determine level of assistance then determine if age-appropriate or age inappropriate | |
| 3 CRITERIA FOR INDEPENDENCE | • ADEQUACY • SAFETY • EFFICIENCY | |
| Levels of Independence Independent | Child does 100% of the task, including setup | |
| Levels of Independence Independent with set-up | After another person setup the task; chile does 100% of the task | |
| Levels of Independence Supervision | Child performs task by himself but cannot be safely left alone; need verbal cueing or physical prompts for 1%-24% tasks | |
| Levels of Independence Minimal assistance of skillful | Child does 51%-75% of task independently but needs physical assistance or other cueing for at least 25% of task | |
| Levels of Independence Moderate assistance | Child does 26%-50% of task independently but needs physical assistance or other cueing for at least 50% of task | |
| Levels of Independence Maximal assistance | Child does 1%-25% of task independently but needs physical assistance or other cueing for 75% of task | |
| Levels of Independence Dependent | Child is unable to do any part of the task | |
| EVALUATION: OBSERVATION | • Break down the steps • Level of independence • Take note of the tools, materials, & equipment used • Performance patterns • Contexts influencing the performance •When documenting, always write the behavior first before writing “with difficulty.” | |
| CASE APPLICATION: EVALUATION • Interview Questions: (Feeding) | • Amount of assistance needed • Set-up (high chair, sa lab ng CG, etc.) • Utensils used • Food repertoire (food preferences, nutrition from food) • Duration of eating • Specific food likes and dislikes (texture, etc.) | • Schedule of mealtime • Enough ba yung kinakain? • Who feeds the child? •Safety: pillage, aspiration (kaya ba itake ang iba’t ibang textures, ex: meat nangunguya na ba) |
| CASE APPLICATION: EVALUATION • Observation - Adam: | • Donning upper body garment – MODERATE ASSISTANCE • Brushing Teeth – MAXIMAL ASSISTANCE (pt was able to brush teeth with max A) | |
| Donning upper body garment – MODERATE ASSISTANCE | • Hold to scrunch shirt - OT • Put on head – with assist from OT, pt was able to pull down • Shoot R arm - Pt • Shoot L arm – with assist from OT • Pull shirt down - Pt | |
| Brushing Teeth – MAXIMAL ASSISTANCE (pt was able to brush teeth with max A) | • Open toothpaste - Pt • Squeeze – with assist from OT to put toothpaste on toothbrush accurately • Brush front teeth - with assist from OT • Brush R side of teeth - with assist from OT • Brush L side of teeth - with assist from OT | • Brush upper teeth - with assist from OT • Brush lower teeth - with assist from OT • Rinse - with assist from OT • *Counting 1-10 all throughout (prompting done by CG at home) • coordination while brushing teeth |
| ADL STANDARDIZED TESTS • Functional Independence Measure | Ages 8 and above | |
| ADL STANDARDIZED TESTS • Functional Independence Measure-II for Children (WeeFIM-II) | (usually kids with physical dysfunction) • Ages below 8 • Self-care • Sphincter control • Transfers • Locomotion • Communication • Social cognition | |
| NO HELPER - 7 | Complete Independence (Timely, Safely) | |
| NO HELPER - 6 | Modified Independence (Device) | |
| HELPER - Modified Dependence 5 | Supervision | |
| HELPER - Modified Dependence 4 | Minimal assistance (subject = 75% or more) | |
| HELPER - Modified Dependence 3 | Moderate assistance (subject = 50% or more) | |
| Helper - Complete Dependence 2 | Maximal assistance (subject = 25% - 49%) | |
| Helper - Complete Dependence 1 | Total assistance (subject = 0% - 24%) | |
| ADL STANDARDIZED TESTS • Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) | • Usually given to children with Physical Dysfunction • Caregiver referenced & norm-referenced • It is intended for use with children and youth (from birth through 20 years of age) with a variety of physical and/or behavioral conditions. | |
| PEDI-CAT Age Range: | used for children from birth to 21 years of age | |
| PEDI-CAT Measures the child’s abilities in three functional domains: | Daily Activities, Mobility and Social/Cognitive domains. | |
| PEDI-CAT Grading • 1 | Unable = Can’t do, doesn’t know how or is too young | |
| PEDI-CAT Grading • 2 | 2 Hard = Does with a lot of help, extra time or effort | |
| PEDI-CAT Grading • 3 | 3 A little hard = Does with a little help, extra time or effort | |
| PEDI-CAT Grading • 4 | 4 Easy = Does with no help, extra time or effort, or child’s skills are past this level | |
| PEDI-CAT Grading • 5 | I don’t know | |
| ADL STANDARDIZED TESTS • Assessment of Motor and Process Skills (AMPS) | • ADL and IADL performance skills in various environments, familiar (home or school) and unfamiliar (occupational therapy clinic) • Rates the 16 ADL motor and 20 ADL process skills. | |
| ADL STANDARDIZED TESTS • School Function Assessment (SFA) | Child’s participation in six different environments: transportation, transitions, classroom, cafeteria, bathroom, and playground. | |
| ADL INTERVENTION • When planning treatment for children with performance problems in ADLs, the occupational therapist must ask himself or herself the following questions: | • Which ADLs are useful and meaningful in current and future contexts? • What are the preferences of the child and/or the family? • Are the activities age-appropriate • Is it realistic to expect the child to perform or master this task? | • Other methods can the child use to perform tasks? • Does this task improve child’s health, safety, social participation? • Do cultural issues influence how tasks are taught? • Can the task be assessed, taught, practiced in a variety of environments? |
| ADL INTERVENTION • Shaping and chaining | ADL is always the easiest to give intervention | |
| INTERVENTION APPROACHES • PROMOTING OR CREATING | • Health promotion • Offer all children the opportunity to engage in ADL occupations that are age-appropriate and not related to a disability status • Does not assume a disability is present or that any aspect would interfere with performance | |
| INTERVENTION APPROACHES • ESTABLISHING, RESTORING, AND MAINTAINING PERFORMANCE | • Build the skills • According to a typical developmental sequence • According to developmental FOR, and child’s age • Identify gaps in skills, client factors • Provide specific interventions to teach, remediate, and establish | |
| INTERVENTION APPROACHES • ESTABLISHING, RESTORING, AND MAINTAINING PERFORMANCE Parameters: | activities should be age appropriate, provide parents of their expectations | |
| INTERVENTION APPROACHES • ESTABLISHING, RESTORING, AND MAINTAINING PERFORMANCE Maintaining: | performance level and understanding the patterns and routines of the child | |
| INTERVENTION APPROACHES • MODIFYING OR ADAPTING THE TASK, METHOD, AND/OR ENVIRONMENT | • Task/task method modification, use of AT, environmental modification • Compensatory strategies • Personal assistance vs Partial participation | |
| Personal Assistance: | There is another person that will do the tasks to achieve quality of life. | |
| Partial Participation: | child does some parts then CG completes the remaining tasks. | |
| Assistive devices: | • Completion at a higher level of efficiency using the device than without it • Should assist in the performance of task • Acceptable to child and family; meet the cost constraints of the family | • Practical and flexible for the environments • Durable and easy to clean; expandable; safe for the child • Have a system of maintenance or replacement with continued use |
| PREVENTING PROBLEMS AND EDUCATING OTHERS | • Anticipating • Preparation of child or family of unexpected events • Provide solutions ahead of time • Educate parents, teachers, peers of child • Reduce anxiety of family when entering a new task or environment. • Advocacies and education | |
| CONSIDERATIONS | • Age-appropriateness of the activity • Consider performance patterns • Grading of activities • Incorporation of techniques based on the approach and FORs used | |
| INTERVENTION: COACHING | • Requires having the children, parents and teachers reflect on their progress in doing ADL tasks • Therapists listens respectfully and objectively to all parties | • Planning strategies to try, modifying routines that doesn’t work, providing feedback • Use of demonstration and modeling on how to do a task |
| SPECIFIC INTERVENTION STRATEGIES • TOILETING | • Self-maintenance milestone • Carries considerable sociologic and cultural significance • A child must be physically and psychologically ready to begin toilet training | |
| Toilet training: | • 18-24m in a typically developing kid • Prerequisite in participation in daycare senders, school, programs, vocational, and recreational programs | |
| TOILETING • SIGNS OF READINESS 1 | • Walking and can sit for short periods of time • Becoming generally more independent, including saying ‘no’ more often • Becoming interested in watching others go to the toilet • Has dry nappies for up to two hours | • Can tell with words or gestures when they do a poo or wee in their nappy • Begins to dislike wearing a nappy, perhaps trying to pull it off when it’s wet or soiled • Has regular, soft, formed bowel movements |
| TOILETING • SIGNS OF READINESS 2 | • Pattern and management is good and regular • Can pull their pants up and down • Can follow simple instructions like ‘Give the ball to daddy’ | |
| TYPICAL DEVELOPMENTAL SEQUENCE FOR TOILETING • 1 • | • Indicates discomfort when wet or soiled • Has regular bowel movements • Sits on toilet when placed there and supervised (<5 min) | |
| TYPICAL DEVELOPMENTAL SEQUENCE FOR TOILETING • 1 1/2 | • Urinates regularly • Shows interest in potty training | |
| TYPICAL DEVELOPMENTAL SEQUENCE FOR TOILETING • 2 | • Stays dry for 2 hours or more • Flushes toilet by self • Achieves regulated toileting with occasional daytime accidents (32.5-35 mo) • Rarely has bowel accidents | |
| TYPICAL DEVELOPMENTAL SEQUENCE FOR TOILETING • 2 1/2 | • Tells someone that he or she needs go the bathroom (31.9-34.7 mo) • May need reminders to go to the • May need help with getting on the • Wakes up dry at night • Washes hands independently (29-31 mo) • Wipes urine independently (32 mo) | |
| TYPICAL DEVELOPMENTAL SEQUENCE FOR TOILETING • 3 | • Goes to the bathroom independently; seats himself or herself on toilet • May need help with wiping • May need help with fasteners or | • TYPICAL DEVELOPMENTAL SEQUENCE FOR TOILETING • 4-5 • Independent in toileting (e.g., tearing toilet paper, flushing, wiping effectively, washing hands, managing clothing) |
| INTERVENTIONS • Preparation/Readiness | • No big changes coming up • Words to associate • Modeling / vicarious learning • Habit forming • Accidents: do not show frustration • Eating habits | |
| INTERVENTIONS • Embedded in the routine | • Look at signs → encourage but do not force • Make a routine • Time | |
| INTERVENTIONS • Going to the toilet | • Check physical environment • Check bathroom floor space, location of and height of sink, faucets, towels, soap, toilet paper • W/C accessibility • Sensory aspects: auditory – flush, exhaust fan; olfactory – odor | |
| INTERVENTIONS • Managing LB dressing | • Clothing worn • Fasteners present (elastic? buttons?) | |
| INTERVENTIONS • Sitting/Standing | • Potty or actual toilet or both • Positioning • Ensure safety | |
| INTERVENTIONS • Actual going | • After care • Tools used (bidet? tabo? tissue?) • Flushing • Dressing | |
| INTERVENTIONS • Washing hands | - | |
| INTERVENTION CONSIDERATIONS: | • Evaluate social environment and find the best place, time, and routine for child • If there is catheterization (kids with bladder function difficulties) • Ensure privacy and develop routine • Use of Visual Supports • BMTs | |
| INTERVENTION APPLICATIONS • Motor | • Strong extensor and adduction patterns in the legs (scissor gait) → tone management techniques • Postural control difficulties → grab bars, reducer ring | • FMS difficulties → LBG modifications (elastic, snap, velcro) • LOM in the shoulder → teach anterior approach |
| INTERVENTION APPLICATIONS • Sensory Issues | Auditory sensitivity → ear plug, closing lid | |
| INTERVENTION APPLICATIONS • Cognitive | • Uses too much tissue paper → remove toilet paper roll and use kleenex, or pull off correct amount to be used; or (2) place a tape mark on the wall of how much paper to roll out • Does not stay seated → use of timer/singing songs | |
| MENSTRUAL MANAGEMENT | Part of toileting hygiene for girls who reached puberty stage Should be prepared before menarche for expected changes in the body Choose methods and hygiene habits necessary for managing menstruation | |
| DRESSING | Doffing is easier than donning | |
| DRESSING INTERVENTIONS • Choosing clothing | • Appropriateness • Locating | |
| DRESSING INTERVENTIONS • Orientation | • Body parts • Front-back • R-L • Skills needed: visual perception, planning (children may not acquire this skill yet, so target these skills first before teaching how to dress | |
| DRESSING INTERVENTIONS • Motor | • Tone • Head and trunk control • Dynamic postural control • Bilateral coordination • In-hand manipulation | |
| DRESSING INTERVENTIONS • Sensory | • Tactile overresponsiveness | |
| DRESSING INTERVENTIONS • Perceptual | • Orientation • Body awareness | |
| DRESSING INTERVENTIONS • Cognitive | Sequencing | |
| BATHING INTERVENTIONS • Checking water temperature | • Warm / cold water • Hypersensitive / overresponsive | |
| BATHING INTERVENTIONS • Tool to use | Bathtub? Shower? | |
| BATHING INTERVENTIONS • Skill Deficits | • Motor • Sensory • Perceptual • Cognitive | |
| BATHING INTERVENTIONS • Drying | patting | |
| BATHING INTERVENTIONS • CONSIDERATIONS: | • Constant monitoring until the child demonstrates safety in the tub/shower is necessary • BMTs on expected and unexpected behaviors in the bathroom • Faucets need to be marked for temperature | |
| GROOMING | • Brushing teeth • Washing hands • Combing | |
| GROOMING COMMON INTERVENTION: | Portion steps (front, back, side) | |
| Puberty: | skin care, hair styling, hair removal, application of cosmetics | |
| GROOMING INTERVENTIONS | • Squeezing toothpaste • Brushing • Rinsing mouth, spitting • Clean up • Washing hands and face • Puberty – new self-maintenance tasks | |
| Squeezing toothpaste skills needed | pinch strength | |
| Brushing | • All quadrants – thoroughness • Judgement: Visual Checking • Specific repetition: for those with cognitive problems • Sensitivity • Tongue thrust • Hypersensitive gag reflex • Coordination issues, FMS | |
| Feeding | OTPF4: Setting up, arranging, and bringing food or fluid from the vessel to the mouth (includes self-feeding and feeding others) | |
| Eating and Swallowing | OTPF4: Keeping and manipulating food or fluid in the mouth, swallowing it (i.e. moving it from the mouth to the stomach) | |
| Contextual and Personal Influences on Mealtime: | • Cultural – food choices, practices • Family composition • Family’s socio-economic status • Caregiver’s personality traits • Child’s health • Eating skills • Communication skills | |
| FEEDING, EATING, AND SWALLOWING INTERVENTIONS | • Tool use • Scooping • Bringing food to mouth • Drinking | • When there is enough pelvic support, there is good jaw control that’s why it would be easier for them to swallow when they have good pelvic control (6 months). • Think about what is healthy for the kid |
| ORAL MOTOR DEVELOPMENT ASSOCIATED WITH EATING SKILLS 4 months • | hallmark movement for true sucking can be observed Sucking reflex - predominant method for the first 8-10 months •Nutritive •Non-nutritive | |
| ORAL MOTOR DEVELOPMENT ASSOCIATED WITH EATING SKILLS • 4-5 months | munching: characterized by vertical jaw movement and a back-and-forth tongue movement | |
| ORAL MOTOR DEVELOPMENT ASSOCIATED WITH EATING SKILLS • 6 months | jaw stability increases start to transition: food | |
| ORAL MOTOR DEVELOPMENT ASSOCIATED WITH EATING SKILLS • 9 months | infant can transfer food from the center of the mouth to the side using lateral tongue movements | |
| ORAL MOTOR DEVELOPMENT ASSOCIATED WITH EATING SKILLS • 12 months | rotatory chewing develops solids transition from bottle to cup drinking | |
| ORAL MOTOR DEVELOPMENT ASSOCIATED WITH EATING SKILLS • 24 months | can drink from cup efficiently mature chewing is present drinking from straw emerges | |
| First food type: | puree | |
| Guiding Questions to Evaluate the Contexts for Feeding • Physical | • Is seating and positioning adequate? Supportive? Does it provide stability? • Are head, neck, shoulders, and pelvis well aligned? • Is space adequate for eating activities? • Are noise and activity levels conducive to eating? | |
| Guiding Questions to Evaluate the Contexts for Feeding • Social | • Who feeds the child? • Who is present during the meal? • What is the nature of the social interaction among family members during the meal? • What communication or interaction occurs between the caregiver and child during feeding? | |
| Guiding Questions to Evaluate the Contexts for Feeding • Temporal | • Is sufficient time allotted and available for a relaxing meal? • How often is the child fed? • How long does it take? | |
| Guiding Questions to Evaluate the Contexts for Feeding • Cultural | • How do cultural beliefs and values influence mealtime? • What foods does the family eat? | |
| EVALUATION | • Feeding history and caregiver concerns • Assess mealtime participation • Neuromotor evaluation • Oral sensorimotor examination • Observation of actual feeding/eating • Contextual factors | |
| EVALUATION CONSIDERATIONS: | • Check for clinical signs of aspiration. • Consider the child’s nutritional status. • Understand that certain foods have high choking risk and require modifications specifically for younger children. | |
| FEEDING, EATING, AND SWALLOWING INTERVENTION | Identify the problem: motor? Sensory? Both? | |
| Sensory | order of presenting foods and liquids based on the texture and taste - what can the child tolerate? | |
| Steps to eating | 1. Eating 2. Taste 3. Touch 4. Smells 5. Interact With 6. Tolerate | |
| Motor | order of presenting foods and liquids based on the consistency - what can the child manage? | |
| Oral Motor Hierarchy | 1. Rotary chewing 2. Emerging Rotary chewing 3. Munching + swallows 4. Munching + spit 5. Volitional tongue movement 6. Taste | |
| INTERVENTION Sensory: Kid is a picky eater | • Tolerate: Can be on a different plate first, or food is near child • Interact: Using utensils or hands to mix it • Smell • Touch: Touching with lips • Taste: Licking • Eating: Biting, chewing, and swallowing (w/ or w/o water) | |
| Entry-level OT | - basic knowledge and skills to provide occupational therapy services to clients with eating and feeding dysfunction - providing feeding, eating, and swallowing interventions to enable performance | - Process of bringing food or liquids from the plate or cup to the mouth, the ability to keep and manipulate food or liquids in the mouth, and swallowing assessment and management - specialized skills in activity analysis and synthesis |
| Advanced-level OT | - Clients who are medically fragile or who have complicated diagnoses or conditions resulting - includes administering more complex assessments and providing interventions for clients | - Who are medically fragile or who have complicated diagnoses or conditions resulting in feeding, eating, swallowing problems; postsurgical cancer patients, patients in intensive care units, or infants - videofluoroscopy, cervical auscultation, etc. |
| EFFECT OF REST AND SLEEP | Quality of rest and sleep affects attention, memory, and learning → occupational performance | |
| OPTIMAL SLEEP: | regular sleep routines and patterns, with similar amounts of sleep each night | |
| Sleep problems in children: | • bedtime resistance or falling asleep • awakening during the night • irregularity of amount of time in sleep • snoring • sleepiness during the day | |
| SLEEP EVALUATION | • Assessment of a child’s activity level, bedtime routines, sleep habits, and sleep environments • Cultural considerations influence the sleep habits of the family or child | |
| SLEEP INTERVENTION | • Medical • Contextual modifications • Sensory aspects of the routine or environment | |
| Contextual Modifications | • Bedtime routine and habits • ADLs to be performed prior • Visual supports • Depending on the day's activity levels • Positioning | |
| Sensory Aspects | • Auditory stimulation • Temperature • Smells • Visual • Tactile • Security | |
| WHAT ARE IADLS | • Adolescence - peak of doing IADLS • Doing this signifies autonomy and self-determination • Important for community participation - Why? • Successful and independent community living relates to outcomes in employment and communi | • Life skills: managing personal care and health needs, taking care of belongings and space, managing home, cleaning, preparing meals, transportation, living independently w/ others • Children w/ disabilities should be prepared to transition through ADLS |
| OCCUPATIONAL DEVELOPMENT PRESCHOOL (3-5) | • With supervision • Family involvement is essential • Opportunities for problem solving and other EF • Putting away toys and clothes, making the bed, setting the table, preparing cold snacks (no fire) | |
| OCCUPATIONAL DEVELOPMENT MIDDLE CHILDHOOD (6-11) | • Household chores and neighborhood activities • Making choices and showing interests • Clean up after meals, meal prep, putting away groceries, looking after younger siblings • Community activities – lessons, going out | |
| MIDDLE CHILDHOOD (6-11) • BARRIERS | • Lack of opportunities • Difficulty generalizing skills | |
| MIDDLE CHILDHOOD (6-11) • STRATEGIES | • Lack of opportunities • Difficulty generalizing skills | |
| OCCUPATIONAL DEVELOPMENT EARLY ADOLESCENCE (12-15) | • Visual supports • Practice and repetition • Coaching • Accommodations • Social stories - learn when to use this vs social scripts (in social stories they need to generalize or conceptualize that it is about them) | |
| OCCUPATIONAL DEVELOPMENT LATE ADOLESCENCE (16-18) | • Home and health management • Shopping and meal prep • Community participation • Increased responsibility | |
| LATE ADOLESCENCE (16-18) • BARRIERS | • Lack of confidence • Dependency • Weak social skills • Driving, community mobility • Volunteering, working part-time • Shopping, money management • Health management | |
| LATE ADOLESCENCE (16-18) • STRATEGIES | • Visual supports • Coaching • Peer mentors • Assertiveness training, role playing • Use of technology | |
| INFLUENCES ON IADLS AND COMMUNITY PARTICIPATION • Personal influences | • Interests • Preferences • motivation | |
| INFLUENCES ON IADLS AND COMMUNITY PARTICIPATION • Contextual influences | • Natural and built environment (physical) • Supports and relationships (social) • Attitudes, values, and beliefs (cultural) | • Computers and assistive technology (virtual) • Stages of life, time of year, and duration (temporal) • Service systems and policies |
| IADLS EVALUATION • AMPS | • criterion-referenced test for activities of daily living (ADL) and instrumental activities of daily living (IADL) tasks that assess underlying motor and process performance skills used to perform the task • Examiner training | |
| IADLS EVALUATION • PEDI-CAT | Responsibility, social/cognitive domains | |
| TRANSITION PLANNING | • To adulthood • Preparing the youth and family for role and routine change • Evaluate and implement supports for employment and/or continuing education | • Build skills necessary for the new roles • Facilitate social and community integration • Foster self-advocacy skills |
Created by:
avemaria