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Oth 600 - Peds
| Term | Definition |
|---|---|
| Neonatal Intensive Care Unit (NICU) | Specialty area of practice that requires specialized knowledge and skills, familiarity with neonatal medical conditions, procedures, and equipment, and understanding of developmental skills of term, preterm, and ill infants. |
| Gestational Age (GA) | Refers to total time elapsed between the first day of the last normal menstrual period and the day of birth, calculated as completed weeks. |
| Preterm Infant | Any infant born before 38 weeks of gestation. |
| Late-Preterm Infant | Infant born between 34–37 weeks of gestation. |
| Chronological Age | The infant’s actual age since birth. |
| Corrected Age | How old the infant would be if born at term; used until age 3 when assessing developmental status. |
| Average Birth Weight | Infants that weigh 2500 g (5.5 lbs). |
| Low Birth Weight (LBW) | Infants weighing 1500–2500 g. |
| Extremely Low Birth Weight (ELBW) | Infants weighing 1000–1500 g. |
| Ultralow Birth Weight (ULBW) | Infants weighing less than 750 g. |
| Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) | Requires certification and advanced training; used for infant assessment before, during, and after care to identify how the infant tolerates care and interaction; outcomes are strong. |
| Neonatal Integrative Care Model (IDC) | Expanded NIDCAP into seven measures, adding optimizing nutrition and partnering with families; most commonly used model. |
| Intrauterine Tactile Environment | Constant proprioceptive input; smooth, wet, usually safe and comfortable. |
| Extrauterine Tactile Environment | Often painful and invasive; dry, cool air; medical touching. |
| Intrauterine Vestibular Environment | Maternal movements and amniotic fluid create an oscillating environment. |
| Extrauterine Vestibular Environment | Horizontal, flat positions; rapid position changes; gravity, restraints, and equipment influence. |
| Intrauterine Auditory Environment | Maternal biological sounds and muffled environmental sounds. |
| Extrauterine Auditory Environment | Loud, mechanical, often constant sound. |
| Intrauterine Visual Environment | Dark, may have red-spectrum light occasionally. |
| Extrauterine Visual Environment | Bright lights; eyes unprotected. |
| Intrauterine Thermal Environment | Constant warmth with consistent temperature. |
| Extrauterine Thermal Environment | Environmental temperature variations; high risk of neonatal heat loss. |
| Protected Sleep – Importance | Neonates need sleep to enable growth of sensory and neural systems and the structural development of the hippocampus, pons, brainstem, and midbrain |
| Neonatal Sleep Stages | Three stages: quiet sleep (QS/NREM), active sleep (AS), and indeterminate sleep (IS). |
| Autonomic Subsystem – Signs of Stress | Physiological instability such as respiratory pauses, gasps, mottled, flushed, or pale coloring. |
| Autonomic Subsystem – Signs of Stability | Physiological stability with smooth, regular respiratory rate and pink, stable color. |
| Motor Subsystem – Signs of Stress | Tremors, startles, twitches, coughs, sneezes, yawns, fluctuating tone, flaccidity, hypertonicity, or hyperflexion. |
| Motor Subsystem – Signs of Stability | No tremors, smooth controlled posture, consistent tone appropriate for age, motor control used for self-regulation. |
| State Subsystem – Signs of Stress | Diffused or disorganized quality of states, twitches, whimpers, irregular breathing, abrupt state changes, weak cry, irritability. |
| State Subsystem – Signs of Stability | Clear, well-defined sleep states, alertness, robust cry, and good calming. |
| Attention/Interaction – Signs of Stress | Effort to attend and interact with stimulus; irregular respiration, color changes, yawns, fluctuating tone, weak cry. |
| Attention/Interaction – Signs of Stability | Responsive to auditory, visual, and social stimuli; bright-eyed purposeful interest alternating between arousal and relaxation. |
| Reflex Development in NICU | Reflex testing can be stressful; appropriate in stable infants or after discharge; often observed during normal handling. |
| Muscle Tone in Neonates | Normally hypotonic; increases with age from feet to head and distal to proximal. Active tone develops before passive flexor tone. |
| Posture and Movement Patterns – Preterm Infants | Preterm infants have incomplete muscle tone, joint structure, and bone density; resting posture often flat, frogged legs, asymmetric. |
| Importance of Positioning in NICU | Lack of appropriate positioning can cause deformities. Positioning should simulate contained, flexed, midline posture like in utero. |
| Therapeutic Benefits of Positioning | Positioning is neuromotor and therapeutic; improved positioning improves sleep; PROM can be used for limitations. |
| Feeding in NICU | Oral feeding is often the last obstacle before discharge; specialty area for OT. |
| Non-Nutritive Sucking | Develops around 30 weeks; self-soothing behavior. |
| Nutritive Sucking | Involves coordinated sucking and swallowing; difficulties can compromise oxygenation and endurance. |
| Occupations | Meaningful, goal directed, purposeful, provide personal satisfaction, occur over time, occur within the contexts of daily life. |
| How do we help children develop meaningful occupations? | Through occupational therapy interventions that focus on engagement in purposeful, meaningful activities relevant to the child’s daily life. |
| Occupational Therapy Process – Top Down | Assess child’s participation in occupations by interviewing parents, caregivers, and teachers. Evaluation of client factors and specific skills comes later, assuming deficits in client factors affect performance in functional tasks. |
| Occupational Therapy Process – Bottom Up | Focuses on evaluating specific skills and client factors first, then relates them to participation and performance in occupations. |
| Pediatric Occupational Therapy Evaluations – Standardized | Peabody, BOT-2, TVMI. |
| Pediatric Occupational Therapy Evaluations – Questionnaires | Sensory Profile 2, Sensory Processing Measure. |
| Pediatric Occupational Therapy Evaluations – Clinical Observations | Informal and formal observation of child’s performance in daily activities. |
| Pediatric Occupational Therapy Evaluations – Interviews | Parent, teacher, and child interviews to gather information about participation, interests, and context. |
| Context – Physical Space and Layout | Can the child get around the house independently? |
| Context – Community Mobility and Transportation | Can your child easily be with peers at the playground you go to? |
| Context – Materials and Supplies | Do you have easy access to games and toys for your child to play? |
| Context – Safety | Can you safely get your child onto and off of the playground? |
| Context – Social and Attitudinal | Is your child able to play and interact with peers? What support do you have in the community? |
| Child Centered Practice | Preferred interventions (“Thomas the Tank Engine”), client-centered interventions (child’s choice/collaboration), occupation-centered interventions (cooking, art projects), modify and adapt activities for “Just Right Challenge”. |
| Interventions Across Environments | New skills should transfer across settings. Home programs must be feasible. OT collaborates with child and family, sets goals, uses therapeutic activities, supports parents with education and updates, and evaluates outcomes. |
| Just Right Challenge | Matches the child’s developmental skill, provides reasonable challenge to current performance level, engages and motivates child, can be mastered with focused effort. |
| Education/Advocacy | Provide opportunities for skill practice across settings. Consult and coach parents, teachers, aides, and healthcare staff. Educate administrators and collaborate with behaviorists, SLPs, PTs, social workers, and counselors. |
| Evaluation – Purpose | Determine eligibility for EI services and develop goals and outcomes to guide services. |
| Eligibility Determination | Children with medical diagnoses are automatically eligible; children with suspected developmental delay are eligible for evaluation. |
| Multidisciplinary Team Evaluation | Completes comprehensive evaluation within 45 days of referral. |
| Family Interviews in EI | Completed using routines-based interviews (RBI). |
| Standardized Assessments in EI | Consider cognitive, communication, motor, social-emotional, and adaptive (self-care) areas. |
| Routines Based Interview – Step 1 | Interview process is introduced and asks family’s main concerns. |
| Routines Based Interview – Step 2 | Discussion about family and child daily routines. |
| Routines Based Interview – Step 3 | Information about the daily routines of the child and family. |
| Routines Based Interview – Step 4 | Understanding family’s satisfaction with daily routines. |
| Routines Based Interview – Step 5 | Family’s concerns and priorities. |
| Routines Based Interview – Step 6 | Outcome writing. |
| Common Assessments in EI | TPBA-2 (2nd edition), Hawaii Early Learning Profile (HELP), Assessment, Evaluation, and Programming System for Infants and Children (AEPS). Part C regulations require informed clinical opinion using quantitative and qualitative info. |
| IFSP – Purpose | Necessary and functional for child and family’s life; reflects real-life contextualized settings; clear, jargon-free, simple wording; discipline-free outcomes; emphasizes positive language. |
| IFSP Outcomes | Include statement of child’s present level, family resources/priorities/concerns, major outcomes with timelines, services needed, natural environment, projected dates, service coordinator, steps to support transition. |
| Family Concern – Feeding and Eating | Gracie will eat with her family at dinnertime; measured by taking at least 5 bites of soft food from a spoon at least 4 nights/week. |
| Family Concern – Communication | Grace will have a way of letting her family know what she wants/needs; measured by using at least two ways of communication daily with family understanding their meaning. |
| Occupational Therapy Intervention | Work in natural environments, family-centered intervention, coaching families, telehealth model to facilitate. |
| Coaching Approach/Process | Initiation, observation, action, reflection, evaluation, continuation, resolution. |
| Telehealth to Facilitate Coaching Model | Provide feedback, discuss caregiver concerns, problem-solve strategies for skill progression, collaborate among specialists, remote providers, and families. |
| OT Interventions | Play, teach specific skills, arousal and engagement, facilitate generalization to play skills, allows practice for emerging skills, reinforces higher level skills. |
| Adapting Play | Adaptive equipment, seating/standers, adapted toys, adapted environment. |
| Social Interaction and Participation | Support social-emotional development, parent-child interactions, peer interactions. |
| Payment for OT Services | Reimbursement via Medicaid, state/grant funding, private insurance; family responsibility determined by sliding scale; OT travel not reimbursed; telehealth varies by state. |
| Transition Planning | Begins at age 2; EI service coordinator contacts school district; meetings and updated assessments occur at least 6 months before 3rd birthday; if eligible, transition to IEP and school on 3rd birthday. |
| Early Intervention – Definition | Program for children birth–3 aiming to prevent or reduce physical, cognitive, and emotional difficulties in at-risk children. Services occur in natural settings and support families in meeting infant/toddler needs. |
| Legislature – 1986 Public Law 99-457 | Established public education for preschool-age children with disabilities and encouraged infant and toddler programs. |
| Legislature – IDEA Part C 1990 | Individuals with Disabilities Education Act, Part C, created programs for birth-3 children with disabilities. |
| Legislature – IDEA Amendments 1997 | Mandated programs for children birth-3 years old. |
| Legislature – IDEA Revisions 2004 | Individuals with Disabilities Improvement Act of 2004; Mandated full funding and procedural safeguards. |
| IDEA Part C – Services | Includes 16 primary services, including OT, SLP, PT, special instruction, and service coordination. |
| IDEA Part C – Assessment | Completed through interdisciplinary and transdisciplinary models. |
| IDEA Part C – Care Plan | Individual Family Service Plan (IFSP) developed; family-centered; occurs in natural setting of child and family. |
| Role of OT – Legal Definition | Services to address functional needs of child related to self-care, adaptive behavior and play including social interaction, sensory, motor, and postural skills. |
| Role of OT in Early Intervention | Partner with family; work as part of a team; provide services in natural environment to improve developmental performance, participation, quality of life, ADLs, rest and sleep, play, and social participation. |
| Family Centeredness | Treat families with respect, be aware of cultural differences, respect family beliefs and values; emphasize family strengths; involve families in goal-setting and intervention planning; families and service partners work as partners. |
| School-Based OT – Overview | Legislation includes IDEA (Parts B, C, D), Section 504, NCLB, and ESSA. Services delivered via direct, indirect, and consultative approaches. IEP process involves referral, evaluation, and development of the Individualized Education Program. |
| Relevant Legislature | Section 504 of Rehabilitation Act (1973), Education of All Handicapped Children Act (1975), IDEA (1990, 1997, 2004), No Child Left Behind (2002), ESSA (2015), Bipartisan Safer Communities Act (2022). |
| Educational Model | Goals and services target the child’s participation, performance, and function in the student role. OT addresses play, leisure, social participation, ADLs, and work, providing developmental, corrective, and supportive services to support special education |
| Eligibility for Special Education under IDEA | Child shows state-defined developmental delays in physical, cognitive, communication, social/emotional, or adaptive areas, measured by standardized tools. Early intervention targets children without a diagnosed disability |
| OT Services Defined by IDEA | Promote self-help, positioning, sensorimotor, fine motor, psychosocial, and life skills. Improve or restore function, enhance independence, and prevent further impairment through early intervention. |
| Special Education Process | Referral, evaluation, intervention, outcomes. |
| Special Education Process – Handouts Overview | Referral requests evaluation. Evaluation uses multidisciplinary assessments. Eligibility determined by team. IEP developed with goals, services, and supports. Implementation delivers services. Review includes annual and triennial re-evaluation. |
| Transition Planning | Begins at age 2; EI service coordinator contacts school district; meetings and updated assessments occur at least 6 months before 3rd birthday; if eligible, transition to IEP and school on 3rd birthday. |
| Section 504 of the Rehabilitation Act & ADA | Schools receiving federal funds must provide access to education. Disability is a physical or mental impairment affecting major life activities. A 504 plan may offer OT-only services; funding does not give schools a financial benefit. |
| OT Service Delivery – Types | Direct services: individual or small group within school; Indirect services: OT works within group of students in special and regular education; Integrated service delivery: OT in child’s natural environment (classroom, playground, cafeteria). |
| Evaluations in School-Based OT | Occupation-based assessments evaluate school participation. Use tools to assess academics, communication, development, language, motor, self-help, social/behavioral, and vocational skills, including handwriting, visual-motor, and sensory function. |
| Intervention Approaches | Focus on performance skills and patterns (motor, process, communication, habits, routines, roles); consider context, activity demands, client factors. Occupational performance areas include education, play/leisure, social participation, ADL/IADL. |
| Top-Down vs Bottom-Up Approach | Top-down: focus on student participation and outcomes in meaningful occupations; Bottom-up: focus on skills, client factors, and performance components affecting participation. |
| OT Intervention – School-Related Outcomes | Support classroom participation, organization, and fine motor skills. Adapt assignments/positioning, teach self-regulation, provide materials to improve fine motor/in-hand skills, aiding success in academics, recess, lunch, and peer interactions. |
| Response to Intervention (RtI) | General education initiative using high-quality instruction and matched interventions. Multi-tiered model supports at-risk students, aiming to integrate general, remedial, and special education into a connected system. |
| RtI – 3-Tiered Intervention Model | Tier 1: Universal/core intervention; Tier 2: Targeted intervention; Tier 3: Intensive intervention. |
| Implications for OT in RtI | OTs advocate their role across three tiers: Tier 1—school-wide, Tier 2—targeted for at-risk students, Tier 3—individualized. Shift from caseload (children seen) to workload model (OT activities benefiting students directly and indirectly). |
| Zones of Regulation – Curriculum History | Developed by OT Leah Kuypers, based on "How Does Your Engine Run." Combines cognitive-behavioral and sensory strategies to teach individuals tools to understand and regulate their emotions. |
| Foundation – Four Zones | Four zones indicate alertness and emotions: Blue-low (sad, tired, sick, bored); Green-regulated (calm, happy, focused, content); Yellow-heightened but controlled (anxious, silly, frustrated, stressed); Red-extreme, no control (rage, panic, terror, elated) |
| Using the Curriculum | Used individually or in small groups to teach emotional regulation. Introduce zones and terminology, behavior impact, triggers, calming/alerting strategies, sensory supports, and integrate the program to maintain self-regulation. |
| Zones of Regulation Terminology | Includes understanding triggers, tools to calm or alert yourself, how behavior impacts others, understanding emotions, and how responses impact others. |
| Interventions/Tools – Sensory Support | Different for individuals; explore and work with clients to learn what system helps with modulation (movement, music, tactile input, heavy input); tools may include balls, weighted vests, putty, playdoh, trampolines. |
| Interventions/Tools – Calming Techniques | Six sides of breathing, Lazy 8 breathing, calming sequence, count to 10, learning to take a deep breath. |
| Interventions/Tools – Thinking Strategies | Size of the problem, inner coach vs inner critic, understanding flexibility (Superflex brain) vs rigid thinking (Rock brain), "How Big Is My Problem". |
| PRINT Tool – Purpose | Evidence-based handwriting assessment; used to evaluate students K-4 with handwriting difficulties; useful for children learning any handwriting curriculum; results provide guidance for intervention. |
| PRINT Tool – Objectives | Understand what the PRINT tool is and who it is used for; understand 7 components of handwriting evaluated; know how to administer the tool; demonstrate scoring and interpretation of upper/lower-case letters and numbers. |
| Components Evaluated by PRINT Tool | Memory, Orientation, Placement, Size, Start, Sequence, Spacing. |
| Memory – PRINT Tool | Ability to remember and write letters and numbers dictated; quick and automatic recall; poor memory impacts production, speed, and accuracy. |
| Orientation – PRINT Tool | Correctly facing letters and numbers; orientation errors cause spelling and legibility mistakes. |
| Placement – PRINT Tool | Ability to write letters/numbers on the baseline; helps with flow of writing; haphazard placement makes writing appear immature, messy, or illegible. |
| Size – PRINT Tool | Children should control writing size appropriate for grade; writing too large causes legibility issues if paper line size is smaller than child's writing size. |
| Start – PRINT Tool | Where each letter starts; common error is starting letter from bottom of line, impacting legibility. |
| Sequence – PRINT Tool | Order and stroke direction of letters; incorrect sequence affects speed and neatness. |
| Spacing – PRINT Tool | Amount of space between letters and words; handwriting size can affect spacing; difficulties impact legibility. |
| IEP Process – Relevant Law/Act | IDEA (2004) ensures FAPE, specialized instruction, and related services. Section 504 (1973) provides accommodations. ADA (1990/2008) ensures equal access. ESSA (2015) recognizes OT in MTSS. Safer Communities Act (2022) funds mental health and OT. |
| Occupational Therapy’s Role in the IEP | OT supports access and participation. Collaborate on motor skills, self-care, sensory regulation, handwriting, executive function, and social participation. Write goals, recommend accommodations/AT, and design routines and environmental supports. |
| IEP Components/Vocabulary – Present Levels of Performance | Current academic and functional performance; strengths, needs, impact on participation. |
| IEP Components/Vocabulary – Measurable Annual Goals | Specific, measurable goals including criteria, method, and schedule for progress reporting. |
| IEP Components/Vocabulary – Special Education & Related Services | Instruction and services (e.g., OT, PT, SLP) to meet goals; service frequency, location, duration. |
| IEP Components/Vocabulary – Supplementary Aids & Services | Accommodations, modifications, and assistive technology supporting participation. |
| IEP Components/Vocabulary – Participation in General Education/LRE | Extent of involvement with peers in general education settings and any needed supports. |
| IEP Components/Vocabulary – Assessment Accommodations | Supports for classroom and statewide assessments. |
| IEP Components/Vocabulary – Transition Plan | Required by age 16 (some states 14); post-secondary goals and coordinated services/courses. |
| IEP Steps – Overview | Referral/Request for Evaluation, Evaluation, Eligibility, IEP Meeting, IEP Team Meeting, IEP Development, Implementation, Progress Monitoring, Annual Review, Reevaluation (Triennial), Transition Planning. |
| IEP Step – Referral/Request for Evaluation | Parent, teacher, or provider requests evaluation when disability is suspected. |
| IEP Step – Evaluation | Multidisciplinary assessments (academic, cognitive, motor, sensory, social-emotional, etc.) with parent consent. |
| IEP Step – Eligibility | Team determines whether IDEA criteria are met and whether services are needed. |
| IEP Step – IEP Meeting | Scheduled with prior written notice to parents, who are equal members of the team. |
| IEP Step – IEP Team Meeting | Team reviews data; drafts goals, services, accommodations, placement, and progress reporting. |
| IEP Step – IEP Development | Finalizes the written plan, including service details and implementation. |
| IEP Step – Implementation | Services and supports are provided as written in the IEP; progress is monitored via ongoing data collection and parent updates. |
| IEP Step – Annual Review | IEP is reviewed and revised at least once per year. |
| IEP Step – Reevaluation (Triennial) | Occurs at least every 3 years to confirm needs and eligibility. |
| IEP Step – Transition Planning | Begins no later than age 16 (some states 14); includes measurable post-secondary goals and coordinated services. |
| Examples of OT Goals – Fine Motor / School Participation | By June, the student will cut simple shapes within one-quarter inch of the guideline in 4 of 5 trials. |
| Examples of OT Goals – Sensory Regulation | The student will use a self-selected regulation strategy (e.g., deep breathing, fidget) to remain engaged during work in 3 of 4 opportunities. |
| Examples of OT Goals – Self-Care (ADLs at School) | The student will button and unbutton 3 buttons on a jacket within 2 minutes in 4 of 5 trials. |
| Examples of OT Goals – Written Communication | The student will write a complete sentence with correct spacing and legible letter formation in 4 of 5 opportunities. |
| Examples of OT Goals – Executive Function / Organization | The student will independently gather required materials for a classroom task in 4 of 5 opportunities. |
| Examples of OT Goals – Social Participation | The student will initiate a turn-taking activity with a peer in 3 of 5 observed opportunities. |
| Social Thinking – Overview | Developed by Michelle Garcia Winner and Dr. Pamela Cook 20+ years ago to build social thinking and skills in children 4+. Uses visual supports, modeling, naturalistic teaching, and self-management to promote social development. |
| Flexible Social Thinker | Refers to an individual who can adjust thinking in social situations and respond appropriately to social cues. |
| Social Problem Solver | Refers to the ability to analyze social situations and respond with appropriate solutions or strategies. |
| Superflex | Characters that represent different ways our brain can have not-so-flexible thinking in social situations; includes Rock Brain, who gets kids stuck on one thing and thwarts superflexible thinking; used in Social Emotional Learning, PBIS, and RTI programs. |
| Levels for Transition | OT goals can support establishing independence during transitions from high school to vocational or higher education settings. |
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