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EMPRAC
7: ADJUNCT STRATEGIES IN OT PEDIATRIC PRACTICE III
| Term | Definition | Definition 2 | Definition 3 |
|---|---|---|---|
| SEQUENTIAL-ORAL-SENSORY APPROACH | ● Developed by Dr. Kay Toomey ● Strengths-based, family-centered, and intrinsic motivation-focused ● Assessment in seven areas of functioning ● Empowering children how to problem solve food and actively involving the caregivers | ● Following typical development ● Understanding unique differences ● Eating and feeding are skill-based tasks ● Gradual, step-by-step progression ● Playful interaction ● Multisensory exposure ● Family involvement | |
| seven areas of functioning | organ systems, muscles, sensory integration, learning, development, and nutrition | ||
| KEY STAGES OF SOS | ● Tolerate → interact → taste → eat | ||
| Tolerating the Presence of Food | ○ Placing food on the table nearby ○ Allowing the child to observe others ○ Talking about food ○ No Distress, No Crying, No Fight or Flight Response | ||
| Tolerating the Presence of Food ○ Goal: | letting the child watch you eat something, or running stories about the food to tolerate it | ||
| Interacting with Food | ○ Touching the food with their hands ○ Smelling the food ○ Pretending to feed a toy or stuffed animal | ||
| Tasting the food | ○ Not entirely eating the food ○ Praising for small success | ||
| Tasting the food ○ Goals: | licking the food or holding it on tongue | ||
| TIPS FOR SUPPORTING PROGRESS | ● Visually tolerating, interacting without touching it, smelling, touching, tasting, and eating ● Creating a calm mealtime environment ● Avoiding pressure ● Offering a variety of foods ● Model positive eating habits | ||
| elevated fight or flight response | = For children with ASD, the ANS is not regulated (sympathetic nervous system is high) | ||
| MASGUTOVA NEUROSENSORIMOTOR REFLEX INTEGRATION METHOD (MNRI) | ● Developed by Svetlana Masgutova in 1989 ● Involves assessment, treatment plan, and integration process | ||
| MASGUTOVA NEUROSENSORIMOTOR REFLEX INTEGRATION METHOD (MNRI) ● GOAL: | Support the integration process of primary motor reflex patterns | ||
| Neuroplasticity and Re-patterning | - pairing a specific sensory stimulus with the correct motor response (activating extrapyramidal nervous system, promoting myelination, extending neural synapses) | ||
| Pairing the stimulus and the response | - when presented with a stimulus, the child can perform that response | ||
| Activation of Corticospinal tract: | responsible for voluntary movements (extrapyramidal nervous system). | ||
| Myelination: | increase conduction of impulses (both motor and sensory) | ||
| Neuroplasticity: | Use it or lose it <3 | ||
| HPA-Axis Modulation | - stimulating neuro-regulation mechanisms, normalizing neurotransmitter levels decreasing hypervigilance | ||
| MNRI SCIENTIFIC RATIONALE | ● Neuroplasticity and Re-patterning ● HPA-Axis Modulation | ||
| MNRI EVALUATION PROCESS | ● Detailed history taking ● Physical assessment ● Reflex mapping and profiling ● Integration state of each primary motor reflex pattern ● With no response ● With response ● Category of reflexes | ||
| With no response | = reflex is not yet expected to be present; has emerged, matured, and integrated; never emerged* | ||
| With no response ○ Scenario 1: | not yet expected | ||
| With no response ○ Scenario 2: | was present but because there is no problem it was integrated, gave way to more voluntary and advanced movements | ||
| With no response ○ Scenario 3: | it never emerged even if it’s already expected | ||
| ● With response | = reflex is expected to be active; needs to be re-integrated*; never integrated* | ||
| ● With response ○ Scenario 1: | Reflex is expected to be active | ||
| ● With response ○ Scenario 2: | Needs to be reintegrated, ex: CNS is insulted because there was an injury to CNS, some of the primitive reflexes so it emerged again | ||
| ● With response ○ Scenario 3: | Emerged and never integrated | ||
| Category of reflexes: | ○ Integrated ○ Dysfunctional ○ Pathological | ||
| Integrated | - reflex serves its protective purpose when needed or otherwise inhibited; optimal neurodevelopment | ||
| Dysfunctional | - reflex operates inefficiently; may be asymmetrical, delayed, or lacks energy; nervous system is using compensatory patterns | ||
| Pathological | - pattern is highly distorted, inverted, opposite; significant delay or injury | ||
| MNRI PATHOLOGICAL STATE OF REFLEX | ● Reversed ● Incorrect ● Areflexic | ||
| Reversed | - opposite of what is expected ○ Ex: extend dapat pero nagflex | ||
| Incorrect | - expected for some other stimulus ○ There is movement, but no relation to stimulus | ||
| Areflexic | - generating no response at all | ||
| MNRI PARAMETERS FOR EVALUATING REFLEXE PATTERN | ● Pattern ● Direction ● Timing and Dynamics ● Intensity ● Symmetry | ||
| Pattern | - stimulus leading to the correct response or sequence of responses | ||
| Direction | - reflex occurring in the correct sequence, ending in the correct posture, or direction of movement | ||
| Timing and Dynamics | - immediacy or possible delay | ||
| Intensity | - strength of response | ||
| MNRI | ● Priority to reflexes with the greatest potential to impact positive functional change ● Re-educating the nervous system by correctly pairing the exact sensory stimulus with the exact motor response | ● Promoting neuroplasticity (repeating correct patterns) ● Ensure a state of safety and comfort ● Repatterning Process ● Reassessment | |
| Repatterning Process: | sensory activation, passive execution, active execution with resistance, integration and rest) | ||
| MNRI INTERVENTION MAPPING | ● Moro Reflex ● ATNR ● Galant ● Palmar Grasp | ||
| Moro Reflex | (deep pressure, rhythmic core movements, controlled breathing patterns - reduction of hypervigilance, improving emotional regulation & focus) ○ limits emotional regulation and focus | ||
| ATNR | (coordinated, cross-lateral movements - improving eye-hand coordination, reading tracking, bilateral integration) | ||
| Eye-hand coordination | - writing, reading (optimal learning is affected) | ||
| Galant | (tactile integration along the spine, controlled hip flexion - reducing fidgeting, improving bladder control, increasing seated attention) ○ curving of side that where deep pressure was applied (ulnar side) | ||
| Palmar Grasp | (tactile input to the palms - enhancing fine motor skills, handwriting, and speech articulation) | ||
| MNRI WHOLE BODY REFLEX INTEGRATION PROBLEMS | ● DYNAMIC POSTURAL REFLEX PATTERN INTEGRATION ● BIRTH AND POST BIRTH REFLEX INTEGRATION ● ● ● | ||
| DYNAMIC POSTURAL REFLEX PATTERN INTEGRATION | ● Primary motor reflex ● ATNR, Babinski, Landau, Moro, Galant, STR, TLR ○ Most common and expected | ||
| Primary motor reflex patterns | provide protection and security while present and supports optimal development when integrated | ||
| DYNAMIC POSTURAL REFLEX PATTERN INTEGRATION ● Deficits | may include emotional and behavioral dysregulation; motor, communication, and cognitive challenges | ||
| BIRTH AND POST BIRTH REFLEX INTEGRATION | ● Same set of primary motor reflex patterns addressed by the Dynamic and Postural Motor Reflex Integration Program | ● Looks on beginning, process, integration, finish stages ● Lifelong Reflex Integration ● Necessary for balance, grounding, or centering ● Abdominal, balancing, head righting, locomotion, mature gait | |
| Lifelong Reflex Integration | ○ Physiologic and nature and it must persist | ||
| LIFELONG REFLEX INTEGRATION | ● Facial Reflex Integration Program ● Support human survival (breathing, eating), accessing and managing visual, auditory, and other sensory input, coordination systems, nonverbal and verbal communication | ● Biting, sucking, swallowing, gag, head righting, eye tracking, accommodation, corneal, hand-mouth coordination | |
| UPPER LIMB REFLEX INTEGRATION & MANUAL SKILLS DEVELOPMENT PROGRAM | ● To protect us from harm and for exploration ● Form the foundation for learned manual skills - advanced ski (GMS, FMS, motor planning) ● Affects visual and auditory systems, communication | ||
| TACTILE SYSTEM INTEGRATION PROGRAM | ● When integrated, brainstem relaxes defensive reflexes leading to experience of safety and emotional/behavioral regulation ● Lengthening and sweeping, embracing squeeze, rotation, stroking | ● Visual & Auditory Reflex Integration Program ● Neuro-Structural Integration Program | |
| ANIMAL-ASSISTED THERAPY | ● Using animals such as dogs, cats, horses, birds, rabbits, guinea pigs, etc ● Individual/ group sessions in a variety of settings ● Versus service animals providing support and helping owners with daily tasks) | ● Versus emotional support animals providing comfort and companionship) | |
| HUMAN-ANIMAL INTERACTION | ● Shared, dynamic associations between people and animals and the effects of those relationships on health and well-being | ||
| Animal-assisted activities | (informal; motivation, education, recreation; meet-and-greet nature) | ||
| Animal-assisted therapy | (planned, structured) | ||
| BENEFITS OF AAT | ● Increased attendance, raises the morale of long-term care residents ● Other benefits include lower levels of anxiety and depression, improved social skills, increased feelings of self-esteem and self-efficacy, improved quality of life | ||
| AAT APPLICATIONS | ● AAT to be therapeutic with adult offenders in a prison setting ● Improved self-efficacy, enhanced quality of life, and decreased anxiety for patients with psychiatric disorders | ● Positive correlation between the involvement of dogs and living skills ● Increase in social participation and involvement in the community because of service dogs | |
| AAT IN CHILDREN | ● Increased amount of social interactions and language use ● Improved treatment outcomes in the hospital ● Helps in anger management | ||
| AAT Improved treatment outcomes in the hospital | ○ Offers companionship, promotes positive coping mechanisms, calms highly emotional situations, provides sensory input, provides a sense of accomplishment | ||
| BASIS OF AAT | ● Neurophysiological modulation (inducing a relaxation response) ● Animal souls and spiritual healing ● Animals as socialization agents (non-judgmental, natural attachment figures) | ||
| SNS is reduced | = relaxed state | ||
| CONSIDERATIONS IN AAT | ● Certification and insurance ● Collaboration ● Sanitation ● Trained and educated OTs identifying animal body language, reinforcing desired behaviors, interrupting undesired behaviors ● Consent | ||
| EXAMPLES OF AAT | ● Therapy with livestock ● Therapy with dolphin ● Therapy with dogs ● Therapy with cats | ||
| Therapy with livestock | (can easily be included) | ||
| Therapy with dolphin | (dolphin's intelligence, water) | ||
| Therapy with dogs | (interaction with people; ASD, visually impaired) | ||
| Therapy with cats | (free-spirited; provide sensory and emotional support) | ||
| AAT SAMPLE ACTIVITIES | ● Proprioceptive/vestibular integration ● Sequencing and executive function ● Fine motor skills and handwriting ● Caring for the pets | ||
| HIPPOTHERAPY | ● Using the horse as a "live" treatment tool ● Three-dimensional movement of the horse mimics normal movements of the pelvis when walking ● Provision of continuous, graded vestibular, proprioceptive, and tactile input | ● Repetition = neuroplasticity ● Meeting, warming, working, relaxation, farewell ● Anchored in sensory integration ● Supports motor learning | |
| Ideal therapy horse | ○ 10-12 years, 150-160 cm in height, calm and gentle ○ Must have no condition ○ Desensitized to sudden external movements and props | ||
| HIPPOTHERAPY ● Anchored in sensory integration | ○ Riding bareback, stirrups | ||
| HIPPOTHERAPY ● Supports motor learning | ○ Static-dynamic balance, weight transfer, motor planning ○ Positive effect on coordination, reaction time, respiratory control, postural control | ||
| HIPPOTHERAPY | ● Utilized in medical treatment, mainly for children with neuromotor dysfunction ● Utilizes specific treatment goals with outcome measures and reassessments ● Evidence-based ● Individual sessions | ● Horse is led or long lined by a handler ● Utilizes sheepskin, flatbed, or saddle ● Horse is assessed for appropriate gait and conformation ● Handler facilitates the movement of the horse who then influences the rider who has no control of the horse | ● Utilized by Physio, OT or Speech Therapists w/ training in Hippotherapy through the American Hippotherapy Association; Each session requires a therapist, a skill horse handler, and a sidewalker to provide stability and ensure safety of the patient |
| THERAPEUTIC RIDING | ● Teaches horsemanship and riding skills to children or adults with special needs ● A form of therapy with possible progression toward competitive or independent riding goals ● Educational, recreational, and therapeutic | ● Group or individual sessions ● Horse is led, lunged, or ridden independently ● Usually utilizes a saddle exclusively | ● Horse is assessed for height, width, and temperament match with rider ● The rider or leader influences the movement of the horse ● Led by an instructor and/or therapist |
| BENEFITS OF HIPPOTHERAPY | ● Increased motor and neuromuscular re-education in patients with cerebral palsy ● Improved motor function, confidence, and self-esteem in patients with ASD | ● Increased core activation ● Promotion of psychosocial and autonomic regulation (warmth of horse, rhythmic movement) | |
| BENEFITS OF HIPPOTHERAPY ● cerebral palsy | Increased motor and neuromuscular re-education in patients | ||
| BENEFITS OF HIPPOTHERAPY ● ASD | Improved motor function, confidence, and self-esteem in patients | ||
| CONTRAINDICATIONS OF HIPPOTHERAPY ● The American Hippotherapy Association considers the following: | ○ Active mental health disorders that would be unsafe ○ Acute herniated disc with or without nerve root compression ○ Chiari II malformation with neurologic symptoms ○ Atlantoaxial instability ○ Coxarthrosis | ○ Grand mal seizures ○ Hemophilia with a recent history of bleeding episodes ○ Indwelling urethral catheters ○ Medical conditions during acute exacerbations | ○ Open wounds over a weight-bearing surface the ○ Pathologic fractures without successful treatment of underlying pathology ○ Tethered spinal cord with symptoms ○ Unstable spine or joints including unstable internal hardware |
| Grand mal seizures | - uncontrolled by medications | ||
| SPECIFIC STRATEGIES AND TECHNIQUES | ● Long, marching stride ● Short, choppy stride - core stabilization ● Frequent halts, changes in speed and/or direction - force the client to anticipate movement, improve motor planning and righting reactions ● Prone | ||
| Long, marching stride | - linear vestibular input | ||
| Short, choppy stride | - core stabilization | ||
| Frequent halts, changes in speed and/or direction | - force the client to anticipate movement, improve motor planning and righting reactions | ||
| SAFETY CONSIDERATIONS | ● Properly fitting helmet (hit just above the brow line) ● Chin strap should be snug ● Fitted with a gait belt | ||
| AQUATIC THERAPY | ● Takes place in pools of various sizes ● Utilizing activities to promote physical and cognitive rehabilitation ● Treatment of acute and chronic injuries, promotion of health maintenance, and overall wellness | ||
| AQUATIC THERAPY RATIONALE | ● Buoyancy and hydrostatic pressure (constant pressure) aid in body support and can be safer (reduction of fall velocity) ● The greater the depth of submersion, the less the effect of gravity on body weight | ● Easier to perform basic maneuvers than to perform on land ● Zero-gravity environment ● Closed skill ● Allows for different muscle groups to activate when performing exercises ● Viscosity ● Hydrostatic pressure ● Warm water | |
| Viscosity | = muscles are being worked every time a movement is made in water; aids in balance (slows down fall); facilitates strength and endurance training ○ there is resistance already | ||
| Hydrostatic pressure | increases the efficiency of the heart by helping in venous return; provides continuous proprioceptive input | ||
| Warm water | = reduction of spasticity, increased joint f lexibility, promotes relaxation, improved circulation ○ More related to ROM | ||
| AQUATIC THERAPY BENEFITS | ● Increased function, health, wellness, and quality of life across the lifespan ● Reduced low back pain and improved physical ability ● Significant decrease in fear avoidance and increase in quality of life | ● Decreased joint/soft-tissue edema assisting in pain management | |
| AQUATIC THERAPY INDICATIONS | ● High pain level ● Gait deviations ● Decreased mobility ● Weakness ● Poor coordination ● Limited weight bearing ● Poor muscle endurance ● Decreased cardiovascular endurance ● Joint contractures | ● Decreased flexibility ● Poor proprioception ● Increased muscle tone ● Decreased muscle tone ● Decreased range of motion ● Edema ● Poor facial control ● Respiratory problems | |
| AQUATIC THERAPY CONTRAINDICATIONS | ● Contagious infections ● Open wounds ● Fever ● Chronic ear infections ● Abnormal blood pressure ● Excessive fear of water | ● Epilepsy ● Gastrointestinal disorders ● Current or recent radiation therapy ● Severe burns ● Diseases grossly affecting thermoregulation | |
| AQUATIC THERAPY SPECIFIC STRATEGIES AND TECHNIQUES ● Application in Adults | ○ Facilitate gait training and prolonged standing tolerance ○ Initiate ROM (warmth) and gentle strengthening exercises | ||
| AQUATIC THERAPY SPECIFIC STRATEGIES AND TECHNIQUES ● Pediatric Applications | ○ Useful for the development of core stability and muscle strength ○ Heightens sensory feedback ■ Pressure increases proprioception (improved coordination and spatial awareness) ○ ADL participation ■ donning and doffing and bathing | ||
| AQUATIC THERAPY EVIDENCE | ● Elderly program for 12 weeks showing enhanced balance, walking speed, and coordination | ● CBR program including warm-up activities, exercises, and cooldown activities showing significant improvements in balance, walking speed, coordination, and grip strength | ● Fewer cognitive errors in the aquatic setting when participants are chest-deep in water ● Increase in both self-esteem and functional independence in adolescents with cerebral palsy |
| PREPARATION CHILDREN | ● Utilization of visuals ● Set up a water play station ● Introduce children to a bath with play toys ● Have them attempt taking a shower ● Supervised on the beach (sandcastle, running back and forth, splashing one another) | ||
| SUPPORT STRATEGIES | ● Earplugs and headband for noise reduction ● Goggles for sensitive eyes ● Presence of support toys ● Warm water ● Floatation aids ● Holding hands or hugs ● Taking small steps ● Using social stories ● Show photos of location | ||
| DRAWBACKS | ● Muscle pain ● Hypersensitivity to chlorine ● Difficulty transferring in and out of the pool |
Created by:
avemaria