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Chapter 3, Part 22 All of chapter 3

STUDY
PLAY
Development - Definition
-Sequential changes in the function of the individual
-Qualitative or quantitative; Influenced by biologic determinants & biopsychosocial environmental experiences
Fetal sensorimotor development
GESTATIONAL AGE: Age of the fetus or newborn, in weeks- from 1st day of mother's last normal menstrual period (Normal gestational period- 38-42 weeks; Gestational period divided into 3 trimesters)
CONCEPTUAL AGE: Age of a fetus or newborn in weeks since conception
Fetal sensorimotor development -
First Trimester
-Muscle spindle: 1) muscle starts to differentiate 2) tissue becomes specialized
-Touch & tactile system: 1) 1st sensory system to develop 2) response to tactile stimulus
-Vestibular: functioning at end of first trimester (not completely developed)
-Vision: 1)eyelids fused 2) optic nerve & cup being formed
-Auditory: N/A
-Olfactory: N/A
-Taste: taste buds develop
-Movement: 1) sucking, hiccuping 2) fetal breathing 3) quick generalized limb mvt 4) positional changes 5) 7.5 wks- bend neck & trunk away from perioral stroke
Fetal sensorimotor development -
Second Trimester
-Muscle spindle: 1) motor end plate forms 2) clonus response to stretch
-Touch and tactile system: receptors differentiate
-Vestibular system: N/A
-Vision: 1) startle to light 2) visual processing occurs
-Auditory: will turn to auditory sounds
-Olfactory: N/A
-Taste: N/A
-Movement: 1) quickening 2) sleep states 3) grasp reflex 4) reciprocal and symmetrical limb movements
Fetal sensorimotor development -
Third Trimester
-Muscle spindle: some muscles are mature and functional, others still maturing
-Touch & tactile system: 1) touch functional 2) actual temperature discrimination at end of third trimester 3) *most mature sensory system at birth
-Vestibular system: N/A
-Vision: 1) fixation occurs 2) able to focus (fixed focal length)
-Auditory: debris in middle ear, loss of hearing
-Olfactory: nasal plugs disappear, some olfactory perception
-Taste: can respond to different tastes (sweet, sour, bitter, salt)
-Movement: 1) 28 weeks primitive motor reflexes 2) rooting, suck, swallow 3) palmar grasp 4) plantar grasp 5) MORO 6) crossed extension
Development of Sensorimotor integration - Prenatal period
-Responds first to tactile stimuli
-Reflex development
-Innate tactile, proprioceptive, & vestibular reactions
Development of Sensorimotor integration - Neonatal period
-Tactile, proprioceptive & vestibular inputs are critical from birth on for eventual develop. of body scheme
-Vestibular system- fully developed at birth & cont to be refined & impacts infant's arousal level
-Visual system- develops as infant responds to human faces & items of high contrast placed ~10 inches from face
-Auditory system- immature at birth & develops as the infant orients to voices and other sounds
Development of Sensorimotor integration - First six months
-Vestibular, proprioceptive,& visual systems become more integrated; lay foundation for postural control- facilitates a steady visual field
-Tactile & proprioceptive systems- cont to be refined, laying foundation for develop of somatosensory skills
-Visual & tactile systems become more integrated as the child reaches out & grasps objects, laying the foundation for eye-hand coordination
-Infant movement patterns progress from reflexive to voluntary & goal-directed
Development of Sensorimotor integration - Six to twelve months
-Vestibular, visual, & somatosensory responses increase in quantity & quality as infant becomes more mobile
-Tactile& proprioceptive perception- become more refined, allowing for development of fine motor & motor planning skills
-Tactile & proprioceptive response lead to midline skills & eventual crossing of midline
-Auditory, tactile, & proprioceptive perceptions are heightened allowing for development of sounds for the purpose of communication
-*Tactile, proprioceptive, gustatory, & olfactory perceptions are integrated- allowing for primitive self-feeding
Development of Sensorimotor integration - Thirteen to twenty-four months
-Tactile perception more precise allowing for discrimination & localization= refinement of FM skills
-Further integration of all systems promotes complexity of motor planning as child expands his/her repertoire of movement patterns
-Symbolic gesturing & vocalization promotes ideation, indicating the ability to conceptualize
-Motor planning abilities contribute to self concept as the child begins to master the environment
Development of Sensorimotor integration - Two to three years
-**This is a period of refinement as vestibular, proprioceptive, & visual systems further develop, leading to improved balance & postural control
-Further development of tactile discrimination & localization lead to improved fine motor skills
-Motor planning & praxis ideation also progress
Development of Sensorimotor integration - Three to seven years
-Child is driven to challenge sensorimotor competencies thru roughhouse play, playground activties, games, sports, music, dancing, arts & crafts, household chores, & school tasks (opportunities to promote social development & self-esteem)
General principles of motor development
-Occurs in a cephalocaudal/proximal to distal direction
-Progresses from gross to fine movement
-Progresses from stability to controlled mobility
-Occurs in a spiraling manner, with periods of equilibrium and disequilibrium
-Sensitive periods occur when the infant/child is affected by environmental input
GM Prone Position- 0-2 mo
-Turn head from side to side
-Lift head momentarily
-Weight bear on forearms
-attempts to shift weight on forearms resulting in shoulder collapse
GM Prone Position- 5-6 mo
-Shifts weight on forearms and reaches forward
-Bears weight and shifts weight on extended arms
-Equilibrium reactions are present
GM Prone Position- 5-8 mo
-Airplane posturing in prone position; chest and thighs lift off surface
GM Prone Position- 7-8 mo
-Pivots in prone position
-Moves to prone position to sit
GM Prone Position- 9 mo
-Begins to dislike prone position
GM Supine Position- 0-3 mo
-Head held to one side
-Able to turn head side to side
GM Supine Position- 3-4 mo
-Holds head in midline
-Legs come together
GM Supine Position- 4-5 mo
-Head lag is gone when pulled to a sitting position
-Hands are together in space
GM Supine Position- 5-6 mo
-Lifts head independently
-Brings feet to mouth (with hands)
-Able to reach for toy with one or both hands
- Hands are predominately open
GM Supine Position- 7-8 mo
-Equilibrium reactions are present
GM Rolling- 3-4 mo
-Rolls from prone to side accidentally b/c of poor control of weight shift
- Rolls from supine position to side
GM Rolling- 5-6 mo
-Rolls from prone to supine
-Rolls from supine to side
-Rolls from supine to prone
GM Rolling- 6-14 mo
-Rolls segmentally with roll initiated by the head, shoulder, or hips
GM Creeping Development
(crawl-belly on surface & creep- what we typically think of when child is "crawling")
7 mo- Crawls forward on belly
7-10 mo- Reciprocal creep
10-11 mo- Creeps on hands and feet
11-12 mo- Creeps well
Sitting 0-3 mo
(held in sitting)
-Head bobs in sitting
-Back is rounded
-Sits with less support
-Hips are bent and shoulders are in front of hips
Sitting 5-6 mo
(supports self in sitting)
-Sits alone momentarily
-Increased extension in back
-Sits propped forward on arms
-Wide base, legs are bent
- Periodic use of "high guard" position
-Protective responses present when falling to the front
Sitting 5-10 mo
-Sits alone steadily, initially w/ wide base of support
-Able to play with toys in sitting position
Sitting 6-11 mo
-Gets to sitting position from prone
Sitting 7-8 mo
-Equilibrium reactions are present
-Can rotate upper body while sitting w/ lower body remaining stationary
-Protective response present when falling to the side
Sitting 8-10 mo
-Sits well without support
-Increased variety of sitting positions
- Difficult FM tasks may cause return of the wide base of support
Sitting 9-18 mo
-Rises from supine by first rolling over to stomach then pushing up into 4-point position
Sitting 10-12 mo
-Protective extension backwards present
- Able to move in & out of sitting into other positions
Sitting 11-12 mo
-Trunk control and equilibrium responses are fully developed in sitting
- Further increase in variety of positions possible
Sitting 11-24 mo +
-Rises from supine by first rolling to side then pushing up into sitting position
Standing 0-3 mo
-When held in standing position, takes some weight on legs
Standing 2-3 mo
-When held in standing position, legs may give way
Standing 3-4 mo
-Bears some weight on legs, but must be held proximally
- Head is up in midline, no chin tuck
- Pelvis & hips are behind shoulders
-Legs are apart and turned outward
Standing 5-6 mo
-Increased ability to bear weight; decreased support needed; may be held by arms or hands
- Legs are still speed apart & turned outward
-Bounces in standing position
Standing: 5-10 mo
Stands while holding onto furniture
Standing 6-12 mo
-Pulls to standing position at furniture
Standing 8-9 mo
-Rotates trunk over the lower extremities (L.E.)
-L.E. are more active in pulling to a standing position
-Pulls to a standing position by kneeling, then half kneeling
Standing 9-13 mo
-Pulls to standing w/ legs only, no longer needs arms
-Stands alone momentarily
Standing 12 mo
-Equilibrium reactions are present in standing
Walking 8 mo
-Cruises sideways
Walking 8-18 mo
-Walks with two hands held
Walking 9-10 mo
-Cruises around furniture, turning slightly in intended direction
Walking 9-17 mo
-Takes independent steps, falls easily
Walking 10-14 mo
-Stoops while walking and recovers in play
Walking 11 mo
-Walks with one hand held
- Reaches for furniture out of reach when cruising
-Cruises in either direction, no hesitation
Walking 15 mo
-Able to start and stop in walking
Walking 18 mo
-Seldom falls
-Runs stiffly with eyes on the ground
Release 0-1 mo
-No release, grasp reflex too strong
Release 1-4 mo
-Involuntary release
Release 4 mo
-Mutual fingering in midline
Release 4-8 mo
-Transfers object from hand to hand
*5-6 mo: 2-Stage transfer- taking hand grasps before releasing hand lets go
*6-7 mo: 1-Stage transfer- where the taking hand 7 releasing hand perform actions simultaneously
Release 7-9 mo
-Volitional release
Release 7-10 mo
-Presses down on surface to release
-*8mo: releases above a surface with wrist flexion
-*9-10mo: Releases into a container w/ wrist straight
Release 10-14 mo
-Clumsy release into small container; hand rests on edge of container
Release 12-15 mo
-Precise, controlled release into small container with wrist extended
Stairs 15 mo
-Creeps up stairs
Stairs 18-24 mo
-Walks up/down stairs while holding on
-Creeps backwards down stairs
Stairs 2-2.5 years +
-Walks up/down stairs without support, marking time
Stairs 2-3 years
-Walks up stairs, alternating feet
Stairs 3-3.5 years
-Walks down stairs, alternating feet
Jumping/Hopping 2 years
-Jumps down from step
Jumping/Hopping 2.5 years
-Hops on one foot, few steps
Jumping/Hopping 3 years
-Jumps off floor with both feet
Jumping/Hopping 3-5 years
-Jumps over objects
-Hops on one foot
-Gallops, leading with one foot & transferring weight smoothly & evenly
Jumping/Hopping 5 years
-Hops in straight line
Jumping/Hopping 5-6 years
-Skips on alternating feet, maintaining balance
Reflex development and integration
-Predictable motor response elicited by tactile, proprioceptive, or vestibular stimulation
-Primitive reflexes are present at or just after birth & typically integrate throughout the first year
-Persistence/ re-emergence of primitive reflexes are indicative of CNS dysfunction- may interfere w/ motor milestone attainment, patterns of mvmt, musculoskeletal align, & fx
Reflex: Rooting
-Onset: 28 wks gestation
-Integration: 3 mo
- Stimulus: stroke corner of mouth, upper & lower lip
-Response: Movement of tongue, mouth,&/or head toward the stimulus
- Relevance: Allows searching for & locating feeding source
Reflex: Suck-Swallow
-Onset: 28 wks gestation
-Integration: 2-5 mo
-Stimulus: Place finger in mouth w/ head in midline
-Response: Strong, rhythmical sucking
- Relevance Allows ingestion of nourishment
Reflex: Traction
-Onset: 28 wks gestation
-Integration: 2-5 mo
-Stimulus: grasp forearms & pull-to-sit
-Response: Complete flexion of UE
- Relevance: Enhances momentary reflexive grasp
Reflex: Moro
-Onset: 28 wks gestation
-Integration: 4-6 mo
- Stimulus: Rapidly drop infant's head backwards
-Response: 1st phase- arm extension/aBduction, hand opening. 2nd phase- arm flexion & aDduction
- Relevance: Facilitates ability to depart from dominant flexor posture: protective response
Reflex: Plantar Grasp
-Onset: 28 wks gestation
-Integration: 9 mo
- Stimuli: apply pressure w/ thumb to ball of the foot
-Response: Toe flexion
- Relevance: increases tactile input to sole of foot
Reflex: Galant
-Onset: 32 wks gestation
-Integration: 2 mo
-Stimuli: Hold in prone suspension, gently scratch/tap along side spine w/ finger, from shoulders to buttocks
-Response: Lateral trunk flexion & wrinkling of the skin on the stimulated side
- Relevance: facilitates lateral trunk movements necessary for trunk stabilization
Reflex: Asymmetric tonic neck reflex (ATNR)
-Onset: 37 wks gestation
-Integration: 4-6 mo
- Stimuli: Fully rotate infants head & hold for 5 secs
-Response: Extension of extremities on the face side, flexion of extremities on the skull side
- Relevance: promotes visual hand regard
Reflex: Palmar Grasp
-Onset: 37 wks gestation
-Integration: 4-6 mo
-Stimuli: Place examiner's finger in infants palm
-Response: finger flexion, reflexive grasp
-Relevance: Increases tactile input on palm of hand
Reflex:Tonic Labyrinthine- Supine
-Onset: > 37 wks gestation
-Integration: 6 mo
-Stimuli: Place infant in supine
-Response: Increased extensor tone
- Relevance: facilitates total-body extensor tone
Reflex:Tonic Labyrinthine-Prone
-Onset: > 37 wks gestation
-Integration: 6 mo
-Stimuli: Place infant in prone
-Response: Increased flexor tone
-Relevance: facilitates total-body flexor tone
Reflex: Labyrinthine/ Optical (head) righting
-Onset: birth-2 mo
-Integration: PERSISTS
-Stimuli:Hold infant suspended vertically & tilt slowly (~45 degrees) to the side, forward, or backward
-Response: Upright positioning of the head
-Relevance:Orients head in space&maintains it vertical
Reflex: Landau
-Onset: 3-4 mo
-Integration: 1-2 years (12-24 mo)
-Stimuli:Hold infant in horizontal prone suspension
-Response:Complete extension of head, trunk, & extremities
-Relevance:Breaks up flexor dominance; facilitates prone extension
Reflex: Symmetric tonic neck reflex (STNR)
-Onset: 4-6 mo
-Integration: 8-12 mo
-Stimuli:Place infant in crawling position&extend head
-Response: Flexion of hips & knees
-Relevance:breaks up total extensor posture; facilitates static quadruped position
Reflex: Neck righting
(Neck on body- NOB)
-Onset: 4-6 mo
-Integration: 5 years
-Stimuli:place in supine & fully turn head to one side
-Response: Log rolling of the entire body to maintain alignment with the head
-Relevance: maintains head/body alignment; helps initiate rolling (1st ambulation effort)*
Reflex: Body righting
(Body on body- BOB)
-Onset: 4-6 mo
-Integration: 5 years
-Stimuli:place infant in supine, flex 1 hip & knee toward chest & hold briefly
-Response: Segmental rolling of the upper trunk to maintain alignment
-Relevance: facilitates trunk/ spinal rotation
Reflex: Protective extension downward
(downward parachute)
-Onset: 4 mo
-Integration: PERSISTS
-Stimuli:Rapidly lower infant toward supporting surface while suspended vertically
-Response: Extension of lower extremities
-Relevance:allows accurate placement of L.E. in anticipation of a surface
Reflex: Protective extension forward
(forward parachute)
-Onset: 6-9 mo
-Integration: PERSISTS
-Stimuli: suddenly tip infant forward toward supporting surface while vertically suspended
-Response:Sudden extension of U.E., hand opening, & neck extension
-Relevance:allows accuracy placement of U.E. in anticipation of supporting surface to prevent a fall
Reflex: Protective extension sideward
(sideward parachute)
-Onset: 7 mo
-Integration: PERSISTS
-Stimuli: Quickly but firmly tip infant off balance to the side while in the sitting position
-Response: Arm extension and aBduction to the side
-Relevance:protects body to prevent a fall; supports body for unilateral use of opposite arm
Reflex: Protective extension backward
(backward parachute)
-Onset: 9-10 mo
-Integration: PERSISTS
-Stimuli:quickly but firmly tip off-balance backward
-Response: Backward arm extension or arm extension to one side
-Relevance:protects body to prevent a fall; unilaterally facilitates spinal rotation
Reflex: Prone tilting
-Onset: 5 mo
-Integration: PERSISTS
-Stimuli: after positioning infant in prone, slowly raise one side of the supporting surface
-Response:Curving of spine toward raised side (opposite pull of gravity); ABduction/ext arms & legs
-Relevance:maintain equilibrium without arm support; facilitate postural adjustments in all positions
Reflex: Supine tilting and sitting tilting
-Onset: 7-8 mo
-Integration: PERSISTS
-Stimuli:after positioning in supine/sitting, slowly raising one side of the supporting surface
-Response:Curving of spine toward raised side (opposite pull of gravity); ABduction/ext of arms& legs
-Relevance:maintain equilibrium without arm support; facilitate postural adjustments in all positions
Reflex: Quadruped tilting
-Onset: 9-12 mo
-Integration: PERSISTS
-Stimuli:after positioning infant on all fours slowly raising one side of the supporting surface
-Response: Curving of spine toward raised side (opposite pull of gravity); ABduction/ext of arms &legs
-Relevance: maintain equilibrium without arm support; facilitate postural adjustments in all positions
Reflex: Standing tilting
-Onset: 12-21 mo
-Integration: persists
-Stimuli:after positioning infant in standing slowly raise one side of the supporting surface
-Response: Curving of spine toward raised side (opposite pull of gravity); ABduction/ext of arms &legs
-Relevance: maintain equilibrium without arm support; facilitate postural adjustments in all positions
Reaching 4 mo
-Hands come together at midline for bilateral reaching with shoulders aBducted with partial internal rotation, forearm pronation, and full finger extension
Reaching 6 mo
-Increased dissociation of body sides, allows for unilateral reaching with less aBduction & internal rotation of the shoulder, & the hand is more open
Reaching 9 mo
-As trunk stability improvs (than at 6 mo), shoulder flex w/ slight external rotation, elbow extens, forearm supination,& slight wrist extens begin to emerge
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Pellet (Prone or sitting)- 3 mo
-No attempt to grasp but VISUALLY attends to object
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Pellet (Prone or sitting)- 6 mo
-Raking grasp and contacting the object
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Pellet (Prone or sitting)- 7 mo
- INFERIOR-SCISSORS grasp: raking object into palm with aDducted totally flexed thumb&all flexed fingers, or 2 partially extended fingers
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Pellet (Prone or sitting)- 8 mo
-SCISSORS grasp- between thumb & side of curled index finger, distal thumb joint slightly flexed, proximal thumb joint extended
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Pellet (Prone or sitting)- 9 mo
-INFERIOR PINCER grasp- between ventral surfaces of thumb & index finger, distal thumb joint extended, beginning of thumb opposition
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Pellet (Prone or sitting)- 10 mo
-PINCER grasp-btwn distal pads of thumb&index finger,distal thumb joint slightly flexed, thumb opposed
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Pellet (Prone or sitting)- 12 mo
-FINE PINCER grasp- between fingertips or fingernails, distal thumb joint flexed
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Cube- Neonate
- Visually attends to object, grasp is reflexive
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Cube- 3 mo
- visually attends to object & may swipe (sustained voluntary grasp possible only upon contact, ulnar side used, no thumb involvement, wrist flexed)
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Cube- 4 mo
-PRIMITIVE SQUEEZE grasp- visually attends to object, approaches if within 1 inch, contact results in hand pulling the object back to squeeze precariously against the other hand or body, no thumb involvement
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Cube- 5 mo
-PALMAR grasp- fingers on top surface of object press it into center of palm with thumb aDducted
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Cube- 6 mo- 7mo
-RADIAL-PALMAR grasp- fingers on far side of the object press it against the opposed thumb &radial side of palm (at 7 mo the wrist is straight)
Grasping skills according to Erhardt Prehension Developmental Levels:
Grasping of Cube- 8 mo- 9mo
-RADIAL-DIGITAL grasp- object held with the opposed thumb & fingertips, space visible between (at 9 mo with wrist extended)
Releasing skills
-Development progresses from: no release (0-1mo) to involuntary release (1-4mo) to two-stage transfer (5-6mo) to one-stage transfer (6-7 mo) to voluntary release (7-9mo)
-by 9 mo, release by full arm extension
-refinement continues up to age 4= graded release
Carrying skills
Involves a combo of movements of the shoulder, body & distal joints of the wrist & hand to hold the item, making appropriate adjustments as necessary to maintain this hold
Bilateral hand use birth-3 mo
-Asymmetric movements until 3 mo
Bilateral hand use 3-10 mo
-Symmetric movements emerge until 10 mo
Bilateral hand use 12-18 mo
-Uses both hands for different functions
Bilateral hand use 18 mo - 2 years
-Manipulation skills emerge
Bilateral hand use 2.5 years
-Able to use 2 hands for very different functions emerge
Manipulating skills according to Exner's Classification System:
Finger to Palm Translation
-12-15 mo
-a linear mvt of an obj from fingers to palm of hand
-picking up coins
Manipulating skills according to Exner's Classification System:
Palm to Finger Translation
-2-2.5 years
-w/ stabilization, a linear mvt of an obj from palm of hand to fingers
-placing coins in a slot
Manipulating skills according to Exner's Classification System:
Simple Rotation
-2-2.5 years
-turning or rolling of an obj held at the finger pads ~90 degrees or less
- unscrewing small bottle cap
Manipulating skills according to Exner's Classification System:
Shift
-3 years
-a linear mvt of an obj on the finger surfaces to allow for repositioning of the obj relative to the finger pads
- separating two pieces of paper
Manipulating skills according to Exner's Classification System:
Complex Rotation
-6-7 years
-rotation of an obj 360 degrees
-turning a pencil over to erase
Manipulating skills according to Exner's Classification System:
In-hand Manipulation with Stabilization
-6-7 years
-several obis are held in hand & manipulation of one obj occurs, while simultaneously stabilizing the others
-picking up pennies & storing in ulnar side of hand
Pre-writing skills 1-1.5 years
-Palmar supinate grasp:
held w/ fisted hand, wrist slightly flexed & slightly supinated away from mid-position; arm moves as a unit
Pre-writing skills 2-3 years
-Digital-pronate grasp:
held w/ fingers, wrist neutral w/ slight ulnar deviation, & forearm pronated; arm moves as a unit
Pre-writing skills 3.5-4 years
-Static tripod posture/ grasp
held w/ crude approximation of thumb, index& middle fingers, ring& little fingers only slightly flexed, grasped proximally with continual adjustments made by other hand, no fine localized movements of digit components; hand moves as a unit
Pre-writing skills 4.5-6 years
-Dynamic tripod posture/ grasp
held w precise opposition of distal phalanges of thumb, index& middle fingers, ring & little fingers flexed to form a stable arch, wrist slightly extended, grasped distally, MCP joints stabilized during fine, localized movements of PIP joints
Scissor skills 2-3 years
-Shows an interest in scissors
-Holds & Snips with scissors
-Opens & closes scissors in a controlled fashion
Scissor skills 3-4 years
-Manipulates scissors in a forward motion
-Coordinates the lateral direction of the scissors
-cuts a straight forward line
-Cuts simple geometric shapes
-(3.4-4.5)- cuts circles
Scissor skills 4-6 years
-Cuts simple figure shapes
Scissor skills 6-7 years
-Cuts complex figure shapes
Psychosocial development and major theorists - Lawrence Kohlberg: Stages of moral development
-Level 1, preconventional morality: occurs up until the age of 8: 1) stage 1, punishment and obedience - the child is obedient in order to avoid punishment 2) stage 2, instrumental relativism - the child makes moral choices based on the benefit to self and sometimes to others
-Level 2, conventional morality: occurs at about 9 or 10 years of age: 1) stage 1, social conformity - the child desires to gain the approval of others 2) stage 2, law and order - rules and social norms are internalized
-Level 3, postconventional morality: age range can vary, and not all will achieve this level (social contracts - the young adult has social awareness and an awareness of the legal implications of decisions/actions)
Psychosocial development and major theorists - Abraham Maslow
-Maslow developed a hierarchy of basic human needs, proposing that if the lower-level needs are not met, the individual is unable to work on higher-level pursuits
-Philosophic: basic survival needs (ie. good, water, rest warmth)
-Safety: the need for physical and physiologic security
-Love and belonging: the need for affection, emotional support and group affiliation
-Self-esteem: the need to believe in one's self as a competent and valuable member of society
-Self-actualization: the need to achieve one's personal goals,after attaining all of the psychosocial developmental milestones
Erik Erikson
- Ego adaptation is the adaptive response of the ego in the development of the personality
- Eight stages of man are identified & include a critical personal-social crisis that when resolved by individual gives one a sense of mastery & results in acquisition of a personality quality
Erikson's 8 Stages:
1) Basic trust vs. mistrust
(birth to 18 months)
-Realizes that survival & comfort needs will be met
-HOPE is integrated into the personality
Erikson's 8 Stages:
2) Autonomy vs. doubt & shame
(2 to 4 years)
-Realizes that he/she can control bodily functions;
- SELF-CONTROLLED WILL integrated into personality
Erikson's 8 Stages:
3)Initiative vs. guilt
(preschool age)
-gains social skills & a gender role identity;
- a SENSE OF PURPOSE is integrated into personality
Erikson's 8 Stages:
4) Industry vs. inferiority
(elementary school age)
-child gains a sense of security through peers & gains mastery over activity of his/her age group;
-FEELING OF COMPETENCY integrated into personality
Cognitive Development - Jean Piaget
-Described the process of cognitive development from birth to adolescence
-Major constructs: 1) adaptation - responding to environmental challenges as they occur 2) mental schemes - organizing experiences into concepts 3) operations - the cognitive methods used by the child to organize schemes and experiences to direct subsequent actions 4) adapted intelligence or cognitive competence 5) equilibrium - the balance between what the child knows and can act on and what the environment provides 6) assimilation - the ability to take a new situation and change it to match an existing scheme or generalization 7) accommodation - the development of a new scheme in response to the reality of a situation, or discrimination
Erikson's 8 Stages:
5) Self-identity vs. role diffusion
(teenage years)
-begins to make choices about adult roles, & w/ the resolution of identity crisis a sense of FIDELITY OR MEMBERSHIP W/ SOCIETY integrated into personality
Erikson's 8 Stages:
6) Intimacy and solidarity vs. isolation
(young adulthood)
-Establishes an intimate relationship w/ a partner & family
-the CAPACITY TO LOVE is achieved
Erikson's 8 Stages:
7) Generativity vs. self-absorption
(middle adulthood)
-Finds security in the contribution of his/her chosen personal/professional roles;
-the CAPACITY TO CARE is achieved
Erikson's 8 Stages:
8) Integrity vs. despair
(maturity)
-Reflects on his/her own value, & shares w/ the younger generation the knowledge gained;
-WISDOM is acquired
Piaget's Hierarchical development of cognition:
Sensorimotor Period
-Birth to 2 years
-Reflexive stage-schemes begin in response to reflexes (1mo)
-Learns cause & effect thru reflexive sensorimotor patterns (2-4mo)
-Emerging voluntary mvt due to coord of vision& hand& early awareness of cause& effect(5-8mo)
-Object permanence-& early development of decentered thought (9-12mo)
-Tool use begins 12-18 mo
-child demos insight& purposeful tool use, & explores problem solving options; ability to represent concepts without direct manipulation emerges (18mo-2yrs)
-PROCESS of sensorimotor: Progresses from reflexive activity--> mental representation-->cognitive functions of combining-->manipulating objs in play
Piaget's Hierarchical development of cognition:
Preoperational Period
-2-7 years
-Classification: Categorizes items through relationships, similarities, differences
-Seriation: relationship of one obj or classification of obis to another
-Conservation: end product of pre operational period- able to recognize continuities of an obj or class of objs in spite of apparent changes
2 Phases of Preoperational Period: 1) Pre conceptual (2-4yrs) Expands vocab & symbolic representations 2) Intuitive Thought Phase: child imitates, copies or repeats what is seen or heard & bases conclusions based on what they believe to be true rather than logic (inductive reasoning denotes transition to next stage)
-PROCESS of Pre operational: Progress from dependence on perception as opposed to logic & egocentric orientation--> logical thought for solving problems. Child enjoys symbolic & verbal play
Piaget's Hierarchical development of cognition:
Concrete Operations
-7 to 11 years
-Reversibility: an expansion of conservation-leads to increased spatial awareness
-Rules: as rules are better understood= better applied
-Empirico-inductive thinking: child solves problems with the information that is obvious & present
-Uses logical thinking on observed or mentally represented objects, inductive thinking, enjoys games with rules which helps them adjust to social demands
Piaget's Hierarchical development of cognition:
Formal Operations
-11 years of age through the teens
-Hypothetico-deductive thinking=ability to analyze & plan
-Child uses logic to hypothesize many ways to solve problems, can draw from past & present experiences to imagine future consequences
Major Milestones in Cognitive Development:
Early Object use: 3-6 mo
-Child focuses on action performed with objects
-banging and shaking toys
Major Milestones in Cognitive Development:
Early Object use: 6-9 mo
- Explores characteristics of objects & combines objects in relational play
-pulling, turning, poking, tearing & placing objs in containers
Major Milestones in Cognitive Development:
Early Object use: 9-12 mo
-Notices the relation between complex actions & consequences& differential use of schemes based on the toy being played with
-opening doors, pushing a train, rolling a ball
Major Milestones in Cognitive Development:
Early Object use: 1-4 years
-Acts on a variety of schemes
-Then links schemes in simple combinations (placing doll in a carriage and pushing her) (12-15 mo)
-Then links multi-scheme combinations into a meaningful sequence (food in bowl, use a spoon, feed a doll) (24-36mos)
-Then links scheme into a complex script (36-42 mos)
Major Milestones in Cognitive Development:
Problem solving Skills: 6-9 mo
-Object permanence appears (finds the object)
-Uses mvt as means to an end (rolling to secure a toy)
-Anticipates mvt of objs in space (looking toward trajectory of object circling his/her head)
-Attends to consequences of actions (banging toy& realizing it makes noise)
-Repeats actions to repeat consequences (banging toy to hear noise)
Major Milestones in Cognitive Development:
Problem solving Skills: 9-12 mo
-Able to use a tool after demonstration
-Behavior becomes more goal directed
-Performs actions to produce a response
Major Milestones in Cognitive Development:
Problem solving Skills: 12-15 mo
-Recruits the help of an adult to achieve a goal
-Attempts to activate a simple mechanism
-Turns & inspects objects
-Uses a trial and error approach to new challenges
Major Milestones in Cognitive Development:
Problem solving Skills: 18-21 mo
-Attends to shapes of things&uses them appropriately
-Begins to think before acting
-uses tool to obtain a favored object
-Replaces trial & error with a thought process in order to attain a goal
-Can use an on/off switch (operate a mechanical toy)
-Can predict effects or presume causes
Major Milestones in Cognitive Development:
Problem solving Skills: 21-24 mo
-Recognizes operations of several mechanisms
-Matches circles, squares, triangles, & manipulates objects into small openings (shape sorters)
Major Milestones in Cognitive Development:
Problem solving Skills: 24-27 mo
-Child discriminates sizes
Major Milestones in Cognitive Development:
Problem solving Skills:
- Can build with blocks horizontally & vertically
Major Milestones in Cognitive Development:
Problem solving Skills: 27-30 mo
-Begins to relate experiences to one another, based on logic & knowledge of previous experiences
-Can make a mental plan of actions without actually doing it
-Can see relationships between experiences (if balloon is popped then it will make a loud noise)
Major Milestones in Cognitive Development:
Problem solving Skills: 3-4 years (36-48mos)
-Can build tower of 9 cubes, demonstrating balance & coordination
-Can organize objects by size & builds structure from a mental image
Major Milestones in Cognitive Development:
Problem solving Skills: 4-5 years (48-60mos)
-Can build involved structures combining various planes and symmetrical designs
-Utilize spacial awareness, cause and effect, & mental images in problem solving
Major Milestones in Cognitive Development:
Symbolic Play: 12-18 mo
-Basic make believe play mostly involving the self (e.g., eating, sleeping)
-can project "make believe" play on obj & others
-progresses to a variety of schemes in imitating familiar activities (around 18 mo)
Major Milestones in Cognitive Development:
Symbolic Play: 18-24 mo
-Child increases the use of non-relastic objects in pretending (e.g., substituting a block for a train)
-child has inanimate objects perform familiar activities (e.g., a doll washing itself)
Play Development 0-2 years
-EXPLORATORY play
-Uses play to develop a body scheme
-Sensorimotor skills developed as they explore
-Plays mostly with parents/caregivers
Play Development 2-4 years
-SYMBOLIC play
-Parallel play
-engages in play experiences thru formulate, test, classify, & refine ideas, feelings, & combined actions
-This stage is associated with language development
-Objects that are manageable in terms of symbolization, control, & mastery are preferred
-Mostly involved in parallel play with peers& begins to become more cooperative over time
Play Development 4-7 years
-CREATIVE play
-Participates in cooperative peer groups
-Engages in sensory, motor, cognitive & social play experiences in which refines relevant skills
-Explores combo of actions on multiple objects
-Begin to master skills that promote performance of school&work related activities
Play Development 7-12 years
-GAMES
-Participates in play with rules, competition, social interaction & opportunities for development of skills
-Begins to participate in cooperative peer groups with a growing interest in competition
-Friends become important in validation of play items& performance, while parents assist & validate in the absence of peers
Oral Motor Development 40 wks gestation
-rooting reflex, cough and gag reflex (protecting airway& decreasing chance of aspiration)
Oral Motor Development 4-5 mo
-munching occurs- consisting of a phasic bite & release of a soft cookie
Oral Motor Development 9 mo
-mastication of soft and mashed food
-CAN DRINK FROM A CUP
Oral Motor Development 1 year
-good bite on a hard cookie (jaw firm&rotary chewing)
Oral Motor Development 2 years
-able to chew most meats and raw vegetables
Self-feeding Development 5-7 mo
-takes cereal or baby food from spoom
Self-feeding Development 6-8 mo
-attempts to hold bottle (needs supervision)
-(9 mo-holds & tries to eat a cracker but mostly sucks on it. Consumes soft foods & bangs a spoon in hand)
Self-feeding Development 9-13 mo
-Finger feeds self a portion of meals (macaroni, peas)
Self-feeding Development 12-14 mo
-dips spoon in food, brings it to mouth, BUT spills it by inverting spoon before it goes into the mouth
Self-feeding Development 15-18 mo
-CAN USE A SPOON to self-feed: scoops food with spoon and brings it to mouth
Self-feeding Development 24-30 mo
-stabs at food with fork
-proficient with spoon use (eats cereal w milk or rice w/ gravy w/ utensil)
Self-care development - Feeding: Intervention for oral motor control
-Approp positioning to allow for neutral pelvic alignment & trunk stability either in caregiver's lap or chair (infant seat or wheelchair); AVOID head extension to prevent asphyxiation(result of airway closing)
-Hand positioning of the caregiver: place the index finger longitudinally under the child's lip, middle finger under the jaw, & place the thumb on the lateral end of the mandible
-Facilitate LIP CLOSURE by applying slight upward pressure of the index finger under the child's lip
-Hand positioning of the index and middle fingers to assist in INHIBITING TONGUE THRUST=press bowl of spoon downward & hold on tongue
-Facilitate swallow by lip closure, & by placement & slight downward pressure of the spoon on the middle aspect of tongue
-Facilitate chewing by placement of foods such as long soft cooked vegetables, between the gum &teeth
-Integrate preventive measures to work out of abnormal patterns: 1) provide firm downward pressure, using a spoon, on the middle aspect of the tongue in presence of a tonic bite reflex 2) prevent tongue retraction to avoid choking 3) facilitate lip closure for a tongue thrust that can result in loss of liquids & food, drooling, & failure to thrive 4) decrease tactile sensitivity prior to feeding- provide firm pressure; encourage sucking/chewing on a cloth; rub gums, palate, tongue; promote oral exploration of toys; use a NUK toothbrush; & vary texture of foods, gradually introduce mashed potatoes mixed w/ other vegetables & soft meats
-Consider & utilize approp texture of foods as related to child's feeding problems. **Thick foods are easier to swallow & manage, esp if tongue thrust is present
-A major role for OT=assist caregiver in making a pleasant social atmosphere for feeding by utilizing positioning & handling techniques to promote eye contact & bonding in a relaxed environment
-Consider developmental sequence of feeding skills
Self-Dressing Skills 1 year
-cooperates w/ dressing(holds out arms& feet)
-pulls off socks and shoes
-Pushes arms thru sleeves & legs through pants
Self-Dressing Skills 2 years
-removes unfastened coat
-Removes shoes if laces are untied
-helps pull down pants
-finds arm holes in pullover shirt
Self-Dressing Skills 2.5 years
-removes pull-down pants with elastic waist
-assists in pulling on socks
-puts on front button coat or shirt
-**UNbuttons large buttons
Self-Dressing Skills 3 years
-put on pullover shirt with min assist
-puts on shoes without fasteners & socks (but might not be put on correctly)
-independently pulls down pants
-**zips and unzips jacket once on track
-Needs assistance to remove pullover shirt
-**Buttons large front buttons
Self-Dressing Skills 3.5 years
-finds front of clothing
-**snaps or hooks front fastener
-UNzips front zipper on jacket, separating zipper
-puts on mittens
-**buttons series of 3-4 buttons
-UNbuckles shoes or belt
-**dresses w/ supervision(needs help w/front & back)
Self-Dressing Skills 4 years
-removes pull over garment independently
-Buckles shoes or belt
-zips jacket zipper
-Put on socks correctly
-Puts on shoes w/ assistance in tying laces
-laces shoes
-consistently identifies the front & bad of garment
Self-Dressing Skills 5 years
(4.5- puts belt in loops)
-ties and unties knots
-**dresses unsupervised
Self-Dressing Skills 6 years
-closes back zipper
-ties bows
-buttons/snaps fasteners in the back
Toileting 1 year
-indicates discomfort when wet or soiled
-has regular bowel movements
Toileting 1.5 years
-sits on the toilet when placed there & supervised for a short time
- 2yr- urinates regularly
Toileting 2.5 years
-achieves regulated toileting w/ occasional daytime accidents (w/ reminders &some help getting on toilet)
-rarely has bowel accidents
-tells someone they have to go potty
Toileting 3 years
-goes to the bathroom independently, sits independ.
-may need help with wiping/fastners
Toileting 4 years
-independent with toileting (tearing TP, flushing, washing hands, clothing management)
Household Management 13 mo
-imitates housework
Household Management 2 years
-puts toys away with reminders
- copies parents' domestic activities
Household Management 3 years
-carries things without dropping them
-wipes up spills
Household Management 4 years
-fixes dry cereal and snacks
-helps w/ sorting laundry
Household Management 5 years
-puts toys away neatly
-makes a sandwich
-takes out trash
-makes bed
-puts dirty clothes in hamper
-answers phone correctly
Household Management 6 years
-does simple errands
-does household chores without redoing
-cleans sink
-washes dishes w/ help
-crosses street safely
Household Management 7-9 years
-begins to cook simple meals
-puts clean clothes away & hangs up clothes
-uses telephone correctly
Household Management 10-12 years
-cooks simple meals with supervision
-does simple repairs with appropriate tools
-begins doing laundry
-washes dishes and sets table
-cares for pet with reminders
Household Management 13-14 years
-does laundry
-cooks meals
Developmental Assessments of Neonates: Assessment of Premature Infants' Behavior (APIB)
FOCUS: assesses infants' pattern of developing behavioral organization is response to increasing sensory & environmental stimuli
Method: behavior checklist & scale
Developmental Assessments of Neonates:
Neurological Assessment of Pre-term and Full-term New-born Infant (NAPFI)
FOCUS: a rating scale consisting of a brief neurological examination incorporated into routine assessment
Overall Development Assessments:
Denver Developmental Screening Test II
standardized task performance and observation screening tool for early identification of children at risk for developmental delays in four areas including personal-social, fine-motor adaptive, language, and gross motor skills
Overall Development Assessments:
Bayley Scales of Infant Development 3rd (BSID-III)
standardized rating scales that assess multiple areas of development to attain a baseline for intervention and to monitor progress
Overall Development Assessments:
First STEP Screening Test for Evaluating Preschoolers
a checklist & rating scale-identifies preschool students at risk&in need of more comprehensive study
Overall Development Assessments:
Hawaii Early Learning Profile Revised (HELP)
non-standardized scale of developmental levels. Educational test that assesses six areas of function including cognitive, language, gross motor, fine motor, social-emotional, and self-help
Overall Development Assessments:
Miller Assessment for Preschoolers (MAP)
standardized task performance screening tool that assesses sensory and motor abilities consisting of foundation and coordination indexes, cognitive abilities including verbal and nonverbal indexes, and combined abilities which include complex task index
Overall Development Assessments:
Pediatric Evaluation of Disability Inventory (PEDI)
standardized behavior checklist and rating scale that assesses capabilities and detects functional defecits to determine developmental level, monitor the childs progress and / or to complete a program evaluation
Motor Assessments:
Bruninks-Oseretsky Test of Motor Proficiency (BOT-2)
standardized test assesses and provides an index of overall otor proficiency; fine and gross motor composites, including consideration of speed, duration, and accuracy of performance and hand and / or foot preferences
Motor Assessments:
Erhardt Developmental Prehension Assessment (EDPA)
observation checklist based on performance which assesses three clustered areas including involuntary arm-hand patterns; voluntary movements of approach; and prewriting skills
Motor Assessments:
Peabody Developmental Motor Scales
standardized rating scales of gross and fine motor development
Motor Assessments:
Toddler and Infant Motor Evaluation
assesses the quality of movement
Visual- Motor & Visual-Perceptual Assessments:
Beery-Buktenica Developmental Test of Visual Motor Integration (Berry-VMI 5)
assesses visual motor integration
Population: Short form for children 2-7 yrs & full form for 2-18 yrs
Visual- Motor & Visual-Perceptual Assessments:
Development Test of Visual Percetion 2 (DTVP-2) & Developmental Test of Visual Perception-Adolescent & Adult (DTVP-A)
assesses visual perceptual skills and visual motor integration for levels of performance and for designing interventions and monitoring progress
Population: DTVP-2: 4-10 yrs & DTVP-A: 11-74yrs
Visual- Motor & Visual-Perceptual Assessments:
Erhardt Developmental Vision Assessment (EDVA)& Short Screening Form (EDVA-S)
a behavior rating scale to determine visuomotor development that assesses involuntary visual patterns including eyelid reflexes, pupillary reactions, doll's eye responses and voluntary patterns including fixation, localization, ocular pursuit, and gaze shift
Population: birth to 6 months (EDVA-S can be used for assessing older children, since 6 months is the norm)
Visual- Motor & Visual-Perceptual Assessments: Preschool Visual Motor Integration Assessment (PVMIA)
standardized norm referenced assessment which evaluates visual motor integration & visual perceptual skills of preschoolers including perception in space, spatial relations, color &space discrimination, matching 2 attributes simultaneously & ability to reproduce what is seen
Population: preschoolers- 3.5 to 5.5 yrs
Visual- Motor & Visual-Perceptual Assessments: Motor Free Visual Perception Test (MVPT-3)
a standardized quick evaluation to assess visual perception in five areas including spatial relations, visual discrimination, figure-ground, closure, and memory
Population: children & adults- 4 to 95 yrs
Visual- Motor & Visual-Perceptual Assessments: Motor Free Visual Perception Test Vertical (MVPT-V)
eval of individuals with spatial defecits, due to hemi-field visual neglect or abnormal visual saccades
Population: children & adults w/ visual field cuts or without visual impairments
Visual- Motor & Visual-Perceptual Assessments: Test of Visual-Motor Skills (TVMS) & Test of Visual Motor Skills: Upper Level (TVMS-UL)
assesses hand eye coordination skills for copying geometric designs
Population: TVMS- 2 to 13yrs & TVMS-UL- 12 to 40yrs
Visual- Motor & Visual-Perceptual Assessments: Test of Visual Perceptual Skills 3rd Ed (TVPS3)
assesses visual perceptual skills and differentiates these from motor dysfunction as a motor response is not required
-Population- 4 to 19 yrs
Sensory Processing Assessments:
Sensory Profile(SP) & Infant/ Toddler SP
measures reactions to daily sensory experiences
Population: SP: 3 to 10yrs & Infant/ Toddler SP: birth to 36 months
Psychological & Cognitive Assessments: Childhood Autism Rating Scale
determines the severity of autism and distinguishes children with autism from children with developmental delays who do not have autism
Psychological & Cognitive Assessments:
Coping Inventory and Early Coping Inventory
assesses coping habilts, skills and behaviors, including effectiveness, style, strengths, and vulnerabilities to develop intervention plans for coping skills
Play Assessments:
Play History
assesses play behavior and play opportunities
Play Assessments:
Revised Knox Preschoool Play Scale
observations of play skils to differentiate developmental play abilities, strengths and weakness
Play Assessments:
Test of Playfulness
assesses a childs playfulness based on observations according to four aspects of play
Play Assessments:
Transdiciplinary Play Based Assessment
measures childs development, learning style, interaction patterns, and behaviors to determine need for services
School Participation Assessments:
Participation Scale
a measure of restriction in social participation related to community mobility, access to work, recreation and social interaction with family, peers, neighbors
School Participation Assessments:
School Function Assessmet
assesses and monitors functional performance in order to promote participation in a school environment
OT developmental evaluation - Developmental History
-Information regarding the mother's pregnancy and specifics of birth history: 1) Apgar score of the infant's heart rate, respiration, reflex irritability, muscle tone, and color at one, five, and ten minutes after birth, measures on a scale of 0,1, 2 2) number of weeks premature, adjusted age 3) number of days/weeks in incubator, intubated and/or on ventilator, or nasogastric tube
-Medical history: admissions and lengths of hospitalizations for illness, disease, surgery, and medications
-Developmental history considering important developmental milestones, times of achievement, and any difficulties/problems surrounding attainment
-Parent interview to address the above, and the parent's perspective on developmental progress and/or concerns, home situation, family history, school history, support systems, and insurance coverage
OT developmental evaluation - Assessment of Newborn, infant, and child
-Neurological status: 1) state of consciousness 2) testing of reflex integration 3) muscle tone
-Musculoskeletal status: 1) skeletal status including extremity and spine deformities 2) range of motion status 3) posture at rest and posture during active movement 4) evaluation and intervention for musculoskeletal dysfunction
-Developmental assessments: there are many published tools that measure neonate, infant and child development
Development assessments of neonates - Neurological Assessment of Pre-term and Full-term newborn infant (NAPFI)
-Focus: a rating scale consisting of a brief neurological examination incorporated into routine assessment; 1) can be used with newborns in an incubator and/or on a ventilator if handling can be tolerated 2) habituation, movement and tone, reflexes, and neurobehavioral responses including state transition, level of arousal and alertness, auditory and visual orientation, irritability, consolability, and cry are assessed
-Method: items are administered in a sequence; first in a quiet or sleep state, followed by items not influenced by state, then during the awake state
-Scoring and interpretation: 1) the infant's state is recorded, based on six gradings of state, for each item 2) interpretation of scores allows the therapist to document a pattern of responses to reflect neurological functions and identify deviations for diagnosis 3) a comparison of pre-term with full-term infant behavior is provided
-Population: pre-term and full-term newborn infants
Overall Development Assessments - Denver Developmental Screening Test II
-Focus: standardized task performance and observation screening tool for early identification of children at risk for developmental delays in four areas including personal-social, fine motor-adaptive, language, and gross motor skills
-Method: 1) test includes 125 test items 2) test items below the child's chronological age level are administered with sequential progression towards higher level chronological items until the child fails three items 3) behaviors observed during the screening are marked on a checklist 4) questionnaires for home screening of environments and prescreening of development are available to administer to parents/caregivers
-Scoring and interpretation: 1) each item scored indicates the chronological age at which it is expected to be performed. The child's performance on that item is compared to determine whether it is age appropriate or delayed, and is marked as pass or fail 2) the test is discontinued when three items are failed 3) the screening allows for interpretation of a child's performance in terms of being normal, abnormal, questionable, or unstable in personal-social, fine motor-adaptive, language, and gross motor abilities 4) interpretation of findings must be considered in the context of other pertinent information and with ongoing observation
-Population: 1 month to 6 years
Overall Development Assessments - Bayley Scales of Infant Development, 3rd Edition (BSID-III)
-Focus: standardized rating scales that assess multiple areas of development to attain a baseline for intervention and to monitor progress (evaluates 5 domains: cognitive, language, and motor which are performance based tasks, and social-emotional and adaptive behavioral skills)
-Method: 1) age appropriate items are selected from items on the different domain scales 2) involves parents completing two questionnaires
-Scoring and interpretation: 1) composite scores yield qualitative descriptors and performance levels for each domain 2) results are used to plan interventions for any delays
-Population: 1 to 42 months
Overall Development Assessments - First STEP Screening Test for Evaluating Preschoolers
-Focus: a checklist and rating scale which identifies preschool students at risk and in need of a more comprehensive evaluation
-Method: 1) it assesses five areas/domains as identified by IDEA which include cognition, communication, physical, social and emotional, and adaptive functioning (table-top tasks are administered while sitting across from the child; additional space is needed for gross motor tasks) 2) an optional Social-Emotional Rating Scale is rated by the examiner based on the child's behavior during testing 3) an optional Adaptive Behavior Checklist is rated by the examiner according to the information obtained from a parent or caregiver interview regarding daily functioning 4) an optional Parent/Teacher Scale provides additional information not obtained during the testing
-Scoring and interpretation: 1) each item has criteria for grading and scores for each domain are totaled 2) total domain scores are converted to composite scores to determine whether the child's performance is within acceptable level or at risk 3) determination of a child's strengths and areas needing improvement for treatment planning
-Population: 2 years 9 months through 6 years 2 months
Overall Development Assessments - Hawaii Early Learning Profile, Revised (HELP)
-Focus: non-standardized scale of developmental levels. An educational curriculum-referenced test that assesses six areas of function including cognitive, language, gross motor, fine motor, social-emotional, and self-help
-Methods: 1) administered in the child's natural environment, in the context of the family, and during typical routines 2) developmentally appropriate items are administered according to established protocols 3) a protocol using a warm-up period, structured play and snack time is recommended
-Scoring and interpretation: 1) developmental age range levels of skills in each of the six areas can be approximated 2) specification of skills noted on a chart can be transferred to a checklist for analysis of expected skills that are absent 3) a description of behavior and possible causes of difficulty, all within the context of the family and environment, can be obtained 4) developmental structuring of skills is provided in the form of a sequence of conceptual strands, so skills needed as a foundation for more advanced skills are provided
-Population: children, ages birth through 3 years, with developmental delay, disabilities, or at risk, HELP for Preschoolers is available for children ages 3 to 6, with and without delays
Overall Development Assessments - Miller Assessment for Preschoolers (MAP)
-Focus: standardized task performance screening tool that assesses sensory and motor abilities consisting of foundation and coordination indexes, cognitive abilities including verbal and nonverbal indexes, and combined abilities which include complex tasks index
-Method: 1) items are administered that relate to the age of the subject 2) supplemental nonstandardized observations may be administered
-Scoring and interpretation: 1) measures are obtained in sensory and motor abilities, cognitive abilities, and combined activities 2) the child's performance is compared with norms 3) percentile equivalents can be obtained for each index and for performance overall 4) results used for treatment planning
-Populations: 2 years 9 months to 5 years 8 months
Overall Development Assessments - Pediatric Evaluation of Disability Inventory (PEDI)
-Focus: standardized behavior checklist and rating scale that assesses capabilities and detects functional deficits, to determine developmental level, monitor the child's progress and/or to complete a program evaluation (Modifications and Caregiver Assistance Scales determine the level of assistance and adaptations needed to enhance partipication
-Method: 1) observation, interview, and scoring of the three domains (self-care, mobility and social skills and their functional sub-units are assessed)
-Scoring and interpretation: 1) the score forms include the areas of functional skills, caregiver assistance and modifications (the three sections are scored separately) 2) identifies children with patterns of delay 3) progress and outcomes can be monitored
-Population: 6 months to 7 years
Motor Assessments - Bruininks-Oseretsky Test of Motor Proficiency (2nd ed.) (BOT-2)
-Focus: standardized test assesses and provides an index of overall motor proficiency; fine and gross motor composites, including consideration of speed, duration, and accuracy of performance, and hand and/or foot preferences
-Method: 1) there is a long and short form with 8 subtests: fine motor precision, fine motor integration, manual dexterity, bilateral coordination, balance, running speed and agility, upper limb coordination and strength (hand and foot preference is initially determined)
-Scoring and interpretation: 1) a total motor composite score consists of four motor areas: fine manual control, manual coordination, body coordination, and strength and agility 2) age equivalency and descriptive categories, and performance scores indicate motor strengths and weaknesses 3) scores may be used as a basis for suggesting treatment goals and to evaluate change
-Population: 4 years to 21 years
Motor Assessments - Erhardt Developmental Prehension Assessment (EDPA) Revised and Short Screening Form (EDPA-S)
-Focus: observation checklist based on performance which assesses three clustered areas including involuntary arm-hand patterns; voluntary movements of approach; and prewriting skills: 1) EDPA allows for charting and monitoring of prehensile development 2) EDPA-S identifies developmental gaps in prehensile development and the need for further assessment
-Method: 1) test is administered in sections according to the appropriate age level 2) there are 341 test components in the EDPA categorized according to involuntary arm hand patterns, voluntary movements, and prewriting skills 3) the EDPA-S contains 128 components
-Scoring and interpretation: 1) Part one: right and left hand scores are scored as normal or well-integrated, not present or emerging, or abnormal 2) Part Two: scores are placed into a developmental level for each cluster 3) Part three: function is determined for involuntary arm-hand patterns, voluntary movements and prewriting skills 4) gaps in hand skills and developmental levels can be determined (intervention can be planned and provided depending on individual needs)
-Population: children of all ages and cognitive levels with neurodevelopmental disorders
Motor Assessments - Peabody Developmental Motor Scales (2nd ed.) (PDMS-2)
-Focus: standardized rating scales of gross and fine motor development
-Method: 1) gross and fine motor subtests measure reflexes, sustained control, locomotion, object manipulation, grasping and visual motor integration 2) test items are administered one level below the child's expected motor age in order to obtain a basal age level 3) test is discontinued with three consecutive scores of zero
-Scoring and interpretation: 1) a developmental profile of gross and fine motor skills is provided 2) standard scores are provided 3) strengths and weaknesses are indicated once the percentile ranks are grafted 4) a motor activity program useful for planning and implementing training is provided
-Population: children, ages birth to 6 years, with motor, speech-language, and/or hearing disorders
Motor Assessments - Toddler and Infant Motor Evaluation (TIME)
-Focus: assesses the quality of movement
-Method: 1) five primary subtest asses mobility, stability, motor organization, social/emotional abilities and functional performance 2) quality rating, component analysis, and atypical positions can be assessed by a clinicians with advanced training
-Scoring and interpretation: 1) cutoff scores are indicative of moderate or significant motor delays 2) subtests give more specific information
-Populations: birth to 3 years and 6 months
Visual-motor and visual-perceptual assessments - Beery-Buktenica Developmental Test of Visual Motor Integration (5th ed. (Beery VMI-5)
-Focus: assesses visual motor integration (can be used as a classroom screening tool)
-Method: 1) the child copies 24 geometric forms which are sequenced according to level of difficulty 2) once the child fails to meet grading criteria for three consecutive forms, the test is discontinued
-Scoring and interpretation: 1) raw score can be translated to percentile ranks, standard score, and age equivalency 2) average scores fall between 80 and 120 and average percentiles fall between 25 and 75
-Population: short form for children ages 2 to 7 years. Full form for children ages 2 to 18 years
Visual-motor and visual-perceptual assessments - Developmental Test of Visual Perception (2nd, Edition) (DTVP-2) and Developmental Test of Visual Perception - Adolescent and Adults (DTVP-A)
-Focus: assess visual perceptual skills and visual motor integration for levels of performance and for designing interventions and monitoring progress
-Methods: 1) DTVP-2 is comprised of eight subtests including eye-hand coordination, copying, spatial relations, visual-motor speed, position in space, figure-ground, visual-closure, form-constancy 2) DTVP-A is comprised of four subtests of visual motor integration, composite index, and motor-reduced visual perception composite index
-Scoring and interpretation: 1) raw scores, age equivalents, percentiles, subtest standard scores, and composite quotients are provided 2) three indexes provided - general visual perceptual; motor-reduced visual perception; visual motor integration
-Population: children aged 4 to 10 years for the DTVP-2; adolescents and adults aged 11 to 74 years for the DTVP-A
Visual-motor and visual-perceptual assessments - Erhardt Developmental Vision Assessment (EDVA) and Short Screening Form (EDVA-S)
-Focus: a behavior rating scale to determine visuomotor development that assesses involuntary visual patterns including eyelid reflexes, pupillary reactions, doll's eye responses and voluntary patterns including fixation, localization, ocular pursuit, and gaze shift
-Method: 1) there are 271 test items organized developmentally into seven clusters 2) the clusters are presented and items are sequenced developmentally 3) upon administration of each item, a response is scored for each eye 4) models for assessment and management, and items required for testing are provided
-Scoring and interpretation: 1) responses are scored as normal, well-integrated, emerging, or not present 2) a developmental level is provided for each cluster and a final developmental level is estimated 3) EDVA-S comprises 67 components of permanent vision patterns, and is scored in the same manner as EDVA (if a test item is scored emerging or not present, a full evaluation using EDVA is indicated) 4) baseline levels allow for identification of delays, and also determine the sequenced developmental items that have not been attained (a baseline also allows progress to be tracked and interventions to be established) 5) findings will determine indications for an ophthalmic evaluation
-Population: birth to 6 months. Since the 6 month level is considered the norm, the EDVA-S can be used for assessing older children
Visual-motor and visual-perceptual assessments - Preschool Visual Motor Integration Assessment (PVMIA)
-Focus: a standardized norm referenced assessment which evaluates visual motor integration and visual perceptual skills of preschoolers, including perception in space, awareness of spatial relationships, color and space discrimination, matching two attributes simultaneously and the ability to reproduce what is seen and interpreted
-Method: two performance subtests and two behavioral observation checklists: 1) the Drawing subtest requires the child to recognize and reproduce lines and shapes that increase in level of complexity 2) the Block Patterns subtest requires the child to recognize color and shape and reproduce block patterns and match block pictures using 3 dimensional blocks 3) it has a section that first predetermines that the child has the requisite skills to continue with the test items 4) the behavioral observation checklists are completed during testing by the administrator to document observed behaviors in an orderly manner to be used in test interpretation
-Scoring and interpretation: 1) the child's fine motor skills and visual perceptual abilities are examined separately, to the extent possible 2) each task has specific criteria listed on the score sheet 3) to attain the precision needed to accurately score the child's final products, templates and a ruler are provided to be used when scoring each subtest 4) raw scores are converted to standard scores and percentile ranges for both subtests and for the total test (impairments indicated by standards scores below 80 and percentile scores below 25) 5) administrator's recorded behavioral observations of the child during the testing are not included in the score. These observations are used in test interpretation and subsequent intervention planning 6) interpretation of the child's performance and current emerging abilities are made based upon the combination of numerical scores, behavioral observations, and error analysis
-Population: preschoolers aged 3 1/2 to 5 1/2 years old
Visual-motor and visual-perceptual assessments - Motor-Free Visual Perception Test (MVPT-3)
-Focus: a standardized, quick evaluation to assess visual perception (excludes motor components) in five areas including spatial relationships, visual discrimination, figure-ground, visual closure, and visual memory
-Method: 1) the number of items administered depends on the child's age (for children aged 4 to 10 years, items 1-40 are administered; for persons aged 10 years or older, items 14-65 are administered)
-Scoring and interpretation: 1) raw scores are translated into perceptual ages and perceptual quotients 2) average performance is determined as a standard score of 80-120 and percentile ranks of 25-75
-Population: children and adults aged 4 to 95 years
Visual-motor and visual-perceptual assessments - Motor-Free Visual Perception Test-Vertical (MVPT-V)
-Focus: evaluation of individuals with spatial deficits, due to hemi-field visual neglect or abnormal visual saccades
-Method: thirty-six items vertically placed are used to asses spatial relationships, visual discrimination, figure ground, visual closure, and visual memory (excluding motor components)
-Scoring and interpretation: 1) provided perceptual ages and perceptual quotients 2) inadequate performance is determined as a score of 85 or less
-Population: children and adults with visual field cuts or without visual impairments (appropriate for individuals with brain injury since it reduces confounding variables)
Visual-motor and visual-perceptual assessments - Test of Visual-Motor Skills (TVMS) and Test of Visual-Motor Skills: Upper Level (TVMS-UL)
-Focus: assesses eye hand coordination skills for copying geometric designs
-Method: the individual copies and draws geometric designs which become sequentially more complex (there are 23 geometric forms in the TVMS which are scored for 8 possible errors and 16 in the TVMS-UL which are scored for 9-22 possible errors in motor accuracy, motor control, motor coordination, and psychomotor speed) 2) test behavior is also documented
-Scoring and interpretation: 1) the resulting score can be translated into a motor age, standard score, and percentile rank 2) characteristics and errors of the drawings are examined and provided clinical information 3) information is used to establish a treatment plan
-Population: TVMS - two through 13 years; TVMS-UL - twelve through 40 years
Visual-motor and visual-perceptual assessments - Test of Visual-Perceptual Skills (3rd ed) (TVPS3)
-Focus: assess visual-perceptual skills and differentiates these from motor dysfunction as a motor response is not required
-Method: 1) seven visual-perceptual skills including visual discrimination, visual memory, visual-spatial relationships, visual form constancy, visual sequential memory, visual figure-ground and visual closure are assessed 2) tests items are presented in a multiple choice format t and are sequenced in complexity (if subjects have 3 consecutive errors, the test is discontinued) 4) behavior observed during testing is also recorded
-Scoring and interpretation: 1) indications of visual perceptual problems are determined by standard scores below 80 and percentile ranks below 25 2) information is used to establish an intervention program which may impact on learning
-Population: four through 19 years
Sensory Processing Assessments - Sensory Profile (SP) and Infant/Toddler SP
-Focus: measures reactions to daily sensory experiences
-Method: 1) obtains caregiver's judgement and observation of a child's sensory processing, modulation, and behavioral and emotional responses in each sensory system via a caregiver questionnaire
-Scoring and interpretation: 1) cutoff scores indicate typical performance and probable, definite, and significant differences (differences, indicate which sensory system is hindering performance; can be used for intervention planning)
-Population: SP - 3-10 years; Infant/Toddler SP - birth -36 months
Sensory Processing Assessments - Sensory Pofile (SP): Adolescent/Adult SP
-Focus: allows client to identify their personal behavioral responses and develop strategies for enhanced participation
-Method: a questionnaire measures individual's reactions to daily sensory experiences
-Scoring and interpretation: cutoff scores indicate typical performance and probable, definite, and significant differences (differences, indicate which sensory system is hindering performance; can be used for intervention planning)
-Population: 11-65 years
Psychological and Cognitive Assessments - Childhood Autism Rating Scale (CARS)
-Focus: determines the severity of autism (ie. mild, moderate, or severe) and distinguishes children with autism from children with developmental delays who do not have autism
-Method: an observational tool is used to rate behavior (fifteen descriptive statements include characteristics, abilities, and behaviors that deviate from the norm
-Scoring and interpretation: 1) scores below 30 = no autism 2) scores of 30 to 36.5 = mild to moderate autism 3) scores of 37 to 60 = severe autism
-Population: children over 2 years of age who have mild, moderate, or severe autism
Psychological and Cognitive Assessments - Coping Inventory and Early Coping Inventory
-Focus: assesses coping habits, skills and behaviors, including effectiveness, style, strengths and vulnerabilities to develop intervention plans for coping skills
-Method: 1) Coping Inventory: questionnaire assesses coping with self and coping with environment according to three categories of coping styles - productive, active and flexible 2) Early Coping Inventory: questionnaire assesses the effectiveness of behaviors according to sensorimotor organization, reactive behavior, and self-initiated behavior
-Scoring and interpretation: 1) determines the level of adaptive behavior and whether or not intervention is needed 2) a coping profile can be grafted for each dimension
-Population: 1) coping inventory: 15 years and above 2) Early Coping Inventory: 4 to 36 months
Play Assessments - Play History
-Focus: assesses play behavior and play opportunities
-Method: 1) the primary caregiver provides information about a child in three categories including general information, previous play experience, and actual play that occurs over three days of play (previous play experiences and actual play, consisting of nine aspects that address the form and content of behavior, are analyzed according to materials, action, people, and setting)
-Scoring and interpretation: 1) a description of play is obtained and play dysfunction is determined 2) a treatment plan can be developed based on strengths and deficits
-Population: children and adolescents
Play Assessments - Revised Knox Preschool Play Scale (RKPPS)
-Focus: observations of play skills to differentiate developmental play abilities, strengths and weakness, and interest areas
-Method: 1) administered in a natural indoor and outdoor environment with peers (two 30 minute periods of observations are completed indoors and outdoors) 2) observations are organized according to 6 month increments up to age 3 3) four dimensions of play including space management, material management, pretense/symbolic (including imitation), and participation are assessed
-Scoring and interpretation: 1) the four dimensions of play are described (each dimension contains behavioral description/factors) 2) the mean scores of all four dimension scores provide a play age score indicative of the child's play maturity 3) the effectiveness of treatment can also be determined
-Population: 0 through 6 years (it is useful with children for whom standardized testing may not be appropriate)
Play assessments - Test of Playfulness (TOP)
-Focus: assesses a child's playfulness based on observations according to four aspects of play
-Method: 1) observed behaviors are rated according to intrinsic motivation, internal control, disengagement from constraints of reality, and framing 2) the extent, intensity and skillfulness of play are also observed and rated
-Scoring and interpretation: scores in the 25 percentile or below indicate the need for intervention
-Population: 15 months to 10 years
Play assessments - Transdisciplinary Play-Based Assessment (TPBA)
-Focus: measures child's development, learning style, interaction patterns, and behaviors to determine need for services
-Method: 1) non-standardized play assessment employing team observations based on six phases 2) observations are categorized into the developmental domains of cognitive, social-emotional, communication and language, and sensorimotor
-Scoring and interpretation: 1) a program plan is developed and can include developmental levels, family assessment, intervention services and strategies to promote an appropriate activity environment 2) a curriculum is available to address particular needs
-Population: infancy to 6 years
Social Participation Assessments - Participation scale (P-Scale) (Version 4.8)
-Focus: a measure of restrictions in social participation related to community mobility, access to work, recreation and social interaction with family, peers, neighbors, etc
-Method: 1) eighteen item questionnaire addressing the nine domains of participation identified in the International Classification of Function, Disability, and Health 2) Self-care, mobility and social function and their functional sub-units are assessed (the score forms include the areas of functional skills, caregiver assistance and modifications
-Scoring and interpretation: scores above 12 on the scale (ranging from 0 to 90) indicate the need for intervention
-Population: 15 years and older with physical disabilities
Social Participation Assessments - School Function Assessment (SFA)
-Focus: assesses and monitors functional performance in order to promote participation in a school environment (it does not measure academic performance)
-Method: a criterion referenced questionnaire assesses the student's level of participation, type of support currently required, and performance on school related tasks
-Scoring and interpretation: two different scoring mechanisms 1) basic level of criterion cutoff scores - scores falling below the cutoff point indicate a performance that does not meet expectations 2) advanced level scores range from 0 to 100, indicating appropriate grade level functioning
Lifespan and Occupational Therapy Developmental Theorists - Havighurst
-Proposed that people need to develop certain skills at different ages to meet social standards
-Believed that these developmental tasks rely on biological, psychological, and sociological conditions: 1) proposed that there are certain sensitive periods, when biological, psychological, and sociological conditions are optimal for the accomplishment of a developmental task 2) described "teachable moments", referring to the sensitive periods when conditions are optimal for integration of previous knowledge and the accomplishment of new developmental task with assistance
-Six stages of development are described along with specific developmental tasks for each stage (infancy and childhood; middle childhood; adolescence; early adulthood; middle adulthood; and later adulthood)
-In current society, the tasks of some stages may occur later than described by Havinghurst
Lifespan and Occupational Therapy Developmental Theorists - Havighurst: Six stages of development
TASK OF INFANCY & CHILDHOOD
1) walk 2) take solid food 3) talk 4) control elimination of body wastes 5) develop sex differences and sexual modesty 6) develop physiologic stability 7) understand concepts of social and physical reality 8) develop emotional ties with parents, siblings, and others 9) understand right from wrong, conscience evolves
Lifespan and Occupational Therapy Developmental Theorists - Havighurst: Six stages of development
TASK OF MIDDLE CHILDHOOD
1) develop physical skills needed for games 2) establish health self-concept 3) make friends with children of the same age 4) read, write, and calculate 5) acquire a fund of information necessary for everyday life 6) develop morality and values 7) formulate opinions about social groups & institutions
Lifespan and Occupational Therapy Developmental Theorists - Havighurst: Six stages of development
TASK OF ADOLESCENCE
1) establish relationships with male and female friends of same age, increasing in quantity and quality 2) develop masculine/feminine social role 3) become comfortable with and respect one's changing body 4) decrease emotional reliance on parents/other adults 5) prepare for marriage and family life 6) prepare for economic career 7) develop a value system to shape behavior or develop one's own philosophy 8) behave in a socially responsible manner
Lifespan and Occupational Therapy Developmental Theorists - Havighurst: Six stages of development
TASKS OF EARLY ADULTHOOD
1) choose a partner 2) adjust to a partner 3) start a family 4) raise children 5) manage a home 6) pursue an occupation 7) develop civic responsibility 8) join/form a compatible social group
Lifespan and Occupational Therapy Developmental Theorists - Havighurst: Six stages of development
TASKS OF MIDDLE ADULTHOOD
1) guide adolescents toward becoming responsible & well adjusted adults 2) engage in adult civic and social responsibility 3) progress in an occupational career 4) pursue leisure-time activities 5) relate to partner as a person 6) deal with and accept physiologic changes of middle age 7) accept aging parents
Lifespan and Occupational Therapy Developmental Theorists - Havighurst: Six stages of development
TASKS OF LATER ADULTHOOD
1) cope with decreasing physical strength and health 2) adjust to retirement and reduced income 3) adjust to death of spouse/partner 4) affiliate with one's age-group 5) change social roles 6) arrange for the most appropriate and appealing living environment
Lifespan and Occupational Therapy Developmental Theorists - Lela Llorens
-Individual is viewed from two perspectives: 1) specific period of time, referred to as horizontal development 2) over the course of time, referred to as longitudinal/chronological development
-Both of these perspectives occur simultaneously
-The integration of these two aspects is critical to normal development
-Role of OT=facilitate development & assist in mastery of life tasks&ability to cope w/life expectation
-Lloren's FOR integrated many of the concepts of Gesell, Amatruda, Erikson, Havighurst, and Freud
Lifespan and Occupational Therapy Developmental Theorists - Anne Mosey
-Recapitulations of ontogenesis FOR (development of adaptive skills, essential learned behaviors, is considered critical for successful participation in occupational performance)
-Six major adaptive skills along with subskills are delineated
Lifespan and OT Developmental Theorists - Anne Mosey: 6 major adaptive skills along with sub skills
1) SENSORY INTEGRATION OF VESTIBULAR, PROP & TACTILE INFO FOR FUNCTIONAL USE
1) integration of the tactile subsystems (0-3 months) 2) integration of primitive postural reflexes (3-9 months) 3) maturation of righting and equilibrium reactions (9-12 months) 4) integration of two sides of the body, awareness of body parts and their relationship, and motor plan gross movements (1-2 years) 5) motor plan fine movements (2-3 years)
Lifespan and OT Developmental Theorists - Anne Mosey: 6 major adaptive skills along with sub skills
2) COGNITIVE SKILL
-ability to perceive, represent and organize sensory information to think and problem solve;
1) utilization of inborn behavioral patterns for environmental interactions (0-1 months) 2) interrelation of visual, manual, auditory, and oral responses (1-4 months) 3) early exploration of the environment and interest in outcomes of actions: remembers action responses, believes that own actions cause responses, and has an awareness of the relation of these actions and events (4-9 months) 4) utilization of deliberate actions to achieve a goal: object permanence begins, anticipation of familiar events, imitation, interest in sizes/shapes, and perception of other objects as partially causal (9-12 months) 5) utilization of a trial and error approach to problem solving: tool use, begins to realize that alternate routes can be used, remembers the order of a simple sequence, and realizes that others can cause events to happen (12-18 months) 6) formulation of mental pictures: pretends, early cause and effect, manipulates objects in space, has a clearer understanding that others can manipulate the environment (18 months - 2 years) 7) representation of objects in terms of felt experiences: understands that there are consequences to actions that others cannot read his/her mind, and recognizes that events have causes (2-5 years) 8) representation of objects by name: begins to understand that other people may have differing opinions (6-7 years) 9) comprehension that different labels can be used for the same object, use of formal logic and speculation (11-13 years)
Lifespan and OT Developmental Theorists - Anne Mosey: 6 major adaptive skills along with sub skills
3) DYADIC INTERACTION SKILL
- ability to participate in a variety of dyadic relationships; 1) family relationships (8-10 months) 2) playmate relationships (3-5 years) 3) superior/authority relationship interactions (5-7 years) 4) friend relationships (10-14 years) 5) peer-superior relationships (15-17 years) 6) intimate/sharing/committed relationships (18-25 years) 7) caring/unselfish relationships (20-30 years)
Lifespan and OT Developmental Theorists - Anne Mosey: 6 major adaptive skills along with sub skills
4) GROUP INTERACTION SKILL
-ability to engage in a variety of primary groups: 1) parallel group - minimal awareness of or interaction with others (18 months -2 years) 2) project group - limited in duration, cooperation, and sharing (2-4 years) 3) egocentric group - cooperation, competition, longer in duration, build self-esteem (9-12 years) 4) cooperative group - compatible group, members concerned with meeting the needs of fellow members (9-12 years) 5) mature group - differing roles, concerned with completion of task as well as meeting the needs of fellow members (15-18 years)
Lifespan and OT Developmental Theorists - Anne Mosey: 6 major adaptive skills along with sub skills
5)SELF-IDENTITY SKILLS
-ability to perceive the self as a relatively autonomous, holistic, and acceptable person who has permanence and continuity over time; 1) self as a valued person (9-12 months) 2) assets and limitations of the self (11-15 years) 3) self as self-directed (20-25 years) 4) self as a productive, contributing member of a society (30-35 years) 5) self identity as an independent individual (35-50 years) 6) understanding the aging process of one's self and eventual death as part of the life cycle (45-60 years)
Lifespan and OT Developmental Theorists - Anne Mosey: 6 major adaptive skills along with sub skills
6) SEXUAL IDENTITY SKILL
-ability to feel comfortable about one's sexual nature & engage in continued sexual relationship that takes into account mutual satisfaction of sexual needs; 1) act on the basis of one's pregenital sexual nature (4-5 years) 2) sexually mature as a positive growth experience (12-16 years) 3) give and receive sexual gratification (18-25 years) 4) sustain sexual relationship with mutual satisfaction of sexual needs (20-30 years) 5) accept sex-related physiological changes that occur as a natural part of the aging process (40-60 years)
Definition of Child Abuse
-Any behavior directed toward a child by a parent, guardian, caregiver, other family member, or other adult that endangers or impairs a child's physical or emotional health and development
Types of Child Abuse
-Physical
-Emotional or mental
-Sexual
-Neglect
General signs of Child abuse
-Withdrawal
-Nightmares
-Running away
-Anxiety or depression
-Guilt
-Mistrust of adults
-Fear
-Aggressiveness
Signs and symptoms of physical abuse
-The child reports being physically mistreated
-Unexplained injuries
-Repeated injuries
-Abrasions and lacerations
-Small circular burns such as cigarette or cigar burns
-Burns with a "doughnut" shape on the buttocks that may indicate scalding, or any burn that shows the pattern of an object used to inflict injury, i.e. an iron
-Friction burns such as those from a rope
-Unexplained fractures
-Denial, unlikely explanations, or delays in treatment on the part of the caregiver
Signs and symptoms of emotional or mental abuse
-The child reports being verbally and/or emotionally mistreated
-Aggressive or acting out behavior such as lying or stealing
-Shy, dependent, or defensive appearance
-Verbally abuses others with language that appears to have been directed toward them
Signs and symptoms of sexual abuse
-The child reports being inappropriately approached, touched, and/or assaulted
-Abuse may be physical (eg. touching), non-physical (eg. indecent exposure), or violent (eg. rape), so signs may include emotional and physical indicators
-Precocious sexual behavior or knowledge
-Copying adult sexual behavior
-Inappropriate sexual behavior (eg. putting tongue in other's mouth when kissing)
-Soreness or injury around the genitals
-Reluctance or refusal to let caregivers wash parts of the body
-Sexual play
Signs and symptoms of neglect
-Poorly nourished appearance or inadequately clothed
-Consistently tired or listless behavior
-Inconsistent attendance in school
-Poor hygiene or obsession with cleanliness
-Left alone in dangerous situations, for long periods of time and/or at an inappropriate young age
-Unable to relate well to adults or form friendships
Role of Occupational therapy in child abuse
-Mandatory reporting: all states must have child abuse and neglect reporting laws to qualify for federal funding under CAPTA; all states require reporting of known or suspected cases of child abuse or neglect by healthcare providers. Standard or reporting may vary; failure to report suspected child abuse may be considered a crime; in most states, good faith reporting is immune from liability; all states require reporting to be made to a law enforcement agency or child protective services
-OT intervention: 1) treat physical injuries, emotional injuries, & developmental delays 2) develop a trusting relationship with child and non-abusive caregivers 3) provide support to non-abusive caregivers 4) refer to appropriate disciplines and agencies
General concepts and definitions of aging
-The process of growing old
-Describes a wide array of physiological changes in the body systems
-A complex and variable process
-Common to all members of a given species
-Aging is developmental, occurs across the life span
-Progressive with time
-Evidence of aging: 1) decline in homeostatic efficiency 2) decline in reaction time (increased probability that reactions to injury aren't successful)
-Varies among and within individuals
Aging changes
-Cellular changes: 1) increase in size; fragmentation of Golgi apparatus and mitochondria 2) decrease in cell capacity to divide and reproduce 3) arrest of DNA synthesis and cell division
-Tissue changes: 1) accumulation of pigmented materials, lipofuscins 2) accumulation of lipids and fats 3) connective tissue changes: decreased elastic content, degradation of collagen; presence of pseudoelastins
-Organ changes: 1) decreased functional capacity 2) decrease in homeostatic efficiency
-Gerontology: the scientific study of the factors impacting the normal aging process & effects of aging
-Geriatrics: the branch of medicine concerned with the illnesses of old age and their care
-Ageism: discrimination and prejudice leveled against individuals on the basis of their age - 1) isolates elders socially 2) permits attitudes and policies that discourage elders from full participation in work, leisure and other meaningful occupations 3) perpetuates fears of aging 4) diminishes quality of life
Demographics, mortality and morbidity
-Life span: maximum survival potential, the inherent natural life of the species; in humans 110-120 years
-Senscence: the weakening of the body at a gradual but steady pace during the last stages of adulthood through death
-Life expectancy: the number of years of life expectation from year of birth - 1) 77.8 years in US women live 5.2 years longer than men 2) current trends are contributing to increased life expectancy (advances in health care, improved infectious disease control; advances in infant/child care, decreased mortality rates; improvements in nutrition and sanitation)
-Categories of elderly: 1) young elderly - ages 65-74 2) old elderly - ages 75-84 3) old, old elderly or old and frail elderly - ages > 85
-Persons over 65: represent a rapidly growing segment with lengthening of life expectancy; currently 12.5% of US population; by year 2030, expected over 65 population will be 22% of US population
-Socioeconomic factors: 1) half of all older women are widows; older men twice as likely to be married as older women 2) most live on fixed incomes: social security is the major source of income; poverty rate for persons over 65 is 11.4%; another 8% live near the poverty rate 3) about half of older persons have completed high school 4) non-institutionalized elderly: most live in family setting 5) institutionalized elderly: about 5% of persons over 65 reside in nursing homes; percentage increases dramatically with age (22% of persons over 85)
-Leading causes of death (mortality) in persons over 65, in order of frequency: 1) coronary heart disease (CHD), accounts for 31% of deaths 2) cancer, accounts for 20% of deaths 3) cerebrovascular disease (stroke) 4) chronic obstructive pulmonary disease (COPD) 5) peumonia/flu
-Leading causes of disability/chronic conditions (morbidity) in persons over 65, in order of frequency: 1) arthritis, 49% 2) hypertension, 37% 3) hearing impairments, 32% 4) heart impairments, 30% 5) cataracts and chronic sinusitis, 17% each 6) orthopedic impairments, 16% 7) diabetes and visual impairments, 9% each 8) most older persons (60-80%) report having one or more chronic conditions
-Health care costs: 1) older persons account for 12% of population and 36% of total health care expenditures 2) older persons account for 33% of all hospital stays, 44% of all hospital days of care
Biologic theories of aging
-Genetic: aging is intrinsic to the organism; genes are programmed to modulate aging changes, overall rate of progression
-Individuals vary in the expression of aging changes, eg. graying of hair, wrinkles, etc
-Polygenic controls exist (multiple genes are involved): no one gene can modulate rate of development in all aspects of aging
-Premature aging syndromes (progeria) provide evidence of defective genetic programming; individuals exhibit premature aging changes, ie. atrophy and thinning of tissues, graying of hair, arteriosclerosis, etc. 1) Hutchinson-Gilford syndrome - progeria of childhood 2) Werner's syndrome - progeria of young adults
-Doubling/biologic clock (Hayflick limit theory): functional deterioration within cells is due to limited number of genetically programmed cell doublings (cell replication)
-Free radical theory: free radicals are highly reactive and toxic forms of oxygen produced by cell mitochondria. The release radicals: 1) cause cell damage to cell membranes and DNA cell replication 2) interfere with cell diffusion and transport, resulting in decreased O2 delivery and tissue death 3) decrease cellular integrity, enzyme activities 4) result in cross-linkages - chemical bonding of elements not generally joined together; interferes with normal cell function 5) results in accumulation of aging pigments, lipofuscins 6) can trigger pathologic changes - atherosclerosis in blood vessel wall; cell mutation and cancer
-Cell mutation (intrinsic mutagenesis): errors in the synthesis of proteins (DNA, RNA) lead to exponential cascade of abnormal proteins and aging changes
-Hormonal theory: functional decrements in neurons and their associated hormones lead to aging changes; 1) hypothalamus, pituitary gland, adrenal gland are the primary regulators, timekeepers of aging (thyroxine is the master hormone of the body; controls rate of protein synthesis and metabolism; secretion of regulatory pituitary hormones influence thyroid) 2) decreases in protective hormones (estrogen, growth hormone, adrenal DHEA [dehydroepiandrosterone]) 3) increases in stress hormones (cortisol) - can damage brain's memory center, the hippocampus, and destroy immune cells
-Immunity theory: thymus size decreases, shrivels by puberty, becomes less functional; bone marrow cell efficiency decreases; results in steady decrease in immune responses during adulthood (immune cells, T-cells, become less able to fight foreign organisms; B-cell become less able to make antibodies; autoimmune diseases increase with age)
Environmental theories (stochastic or non-genetic theories) of aging
-Aging is caused by an accumulation of insults from the environment
-Environmental toxins include: ultraviolet, cross-linking agents (unsaturated fats), toxic chemicals (metal ions, Mg, Zn), radiation, and viruses
-Can result in errors in protein synthesis and in DNA synthesis/genetic sequences (error theory), cross-linkage of molecules, mutations
Psychological theories of aging
-Stress theory: homeostatic imbalances result in changes in structural and chemical composition: 1) General Adaptation Syndrome (Selye) - initial alarm reaction, progressing to stage of resistance, progressing to stage of exhaustion 2) closely linked to hormonal theory
-Erikson's bipolar theory of lifespan development: stages of later adulthood -1) integrity - individual exhibits full unification of personality; life is viewed with satisfaction (productive life, sense of satisfaction), remain optimistic, continues to grow 2) despair - individual lacks ego integration; life is viewed with despair (fear of death, feelings of regret and disappointment, missed opportunities)
Sociological theories of aging
-Life experience/lifestyles influence aging process
-Activity theory: older persons who are socially active exhibit improved adjustment to the aging process; allows continued role enactment essential for positive self-image and improved life satisfaction
-Disengagement theory: distancing of an individual or withdrawal from society; reduction in social roles leads to further isolation and life dissatisfaction
-Dependency: increasing reliance on others for meeting physical and emotional needs; focus is increasingly on self
Integrated model of aging
-Assumes aging is a complex, multifactorial phenomenon in which some or all of the above processes may contribute to the overall aging of an individual; aging is not adequately explained by any single theory
Muscular system changes and adaptation in the older adult - Age related changes
-Changes ma be due more to decreased activity levels (hypokinesis) and disuse than from the aging process
-Loss of muscle strength: peaks at age 30, remains fairly constant until age 50; after which there is an accelerating loss, 20-40% loss by age 65 in the non-exercising adult
-Loss of power (force/unit time): significant declines, due to losses in speed of contraction, changes in nerve conduction and synaptic transmission
-Loss of skeletal muscle mass (atrophy): both size and number of muscle fibers decrease, by age 70 lose 33% of skeletal muscle mass
-Changes in muscle fiber composition: selective loss of Type II, fast twitch fibers, with increase in proportion of Type I fibers
-Changes in muscular endurance: muscles fatigue more readily: 1) decreased muscle tissue oxidative capacity 2) decreased peripheral blood flow, oxygen delivery to muscles 3) altered chemical composition of muscle - decreased myosin ATPase activity, glycoproteins and contractile protein 4) collagen changes - denser, irregular due to cross-linkages, loss of water content and elasticity; affects tendons, bone, cartilage
Muscular system changes and adaptation in the older adult - Clinical implications
-Movements become slower
-Increased complaints of fatigue
-Connective tissue becomes denser and stiffer: 1) increased risk of muscle sprains, strains, and tendon tears 2) loss of range of motion: highly variable by joint and individual's activity level 3) increased tendency for fibrinous adhesions, contractures
-Decreased functional mobility, limitations to movement
-Gait may become unsteady due to changes in balance, strength; increased need for assistive devices
-Increased risk of falls
Muscular system changes and adaptation in the older adult - Strategies to slow or reverse changes
-Improve health: 1) correct medical problems that may cause weakness; hyperthyroidism, excess adrenocortical steroids (eg. Cushing's disease, steroid); hyponatremia (low sodium in blood) 2) improve nutrition 3) address alcoholism/substance abuse
-Increase levels of physical activity, stress functional activities, and activity programs: 1) gradually increase intensity of activity to avoid injury 2) plan and include adequate warm-ups and cool downs; appropriate pacing and rest periods
-Provide strength training to increase/ maintain muscle strength required for functional activity: 1) significant increases in strength are noted in older adults with isometric and progressive resistive exercise regimes 2) high-intensity training programs (70-80% of one-repetition maximum) produce quicker and more predictable results than moderate intensity programs; both have been successfully used with the elderly 3) age not a limiting factor; significant improvements noted in 80-90 year old elders who were frail and institutionalized 4) improvements in strength can improve functional abilities and occupational performance 5) maintain newly gained and existing strength and incorporate into functional activities
-Provide flexibility and range of motion exercises to increase range of motion needed for functional activity: 1) utilize slow, prolonged stretching, maintained for 20-30 seconds 2) tissues heated prior to stretching are more distensible, eg, warm pool 3) maintain newly gained range; incorporate into functional activities 4) mobility gains are slower with older adults
Skeletal system changes and adaptations in the older adult - Age-related changes
-Cartilage changes: decreased water content, becomes stiffer, fragments, and erodes; by age 60 or more than 60% of adults have degenerative joint changes, cartilage abnormalities
-Loss of bone mass and density: peak bone mass at age 40; between 45 and 70 bone mass decreased (women by about 25%; men 15%); decreases another 5% by age 90: 1) loss of calcium, bone strength; especially trabecular bone 2) decreased bone marrow red blood cell production
-Intervertebral discs: flatten, less resilient due to loss of water content (30% loss by age 65) and loss of collagen elasticity; trunk length, overall height decreases
-Senile postural changes: 1) forward head 2) kyphosis of thoracic spine 3) flattening of lumbar spine 4) with prolonged sitting, tendency to develop hip and knee flexion contractures
Skeletal system changes and adaptations in the older adult - Clinical implications
-Maintenance of weight bearing is important for cartilaginous/joint health and mobility
-Increased risk of falls and fractures
Skeletal system changes and adaptations in the older adult - Strategies to slow or reverse changes
-Postural exercises: stress components of good posture
-Weight bearing (gravity-loading) exercise can decrease bone loss in older adults, eg. walking, stair climbing, all activities that are performed in standing
-Nutritional, hormonal and medical therapies
Neurological system changes and adaptations in the older adult - Age-related changes
-Atrophy of nerve cells in cerebral cortex: overall loss of cerebral mass/brain weight of 6-11% between ages of 20 and 90; accelerating loss after age 70
-Changes in brain morphology: 1) gyral atrophy - narrowing and flattening of gyri with widening of sulci 2) ventricular dilation 3) generalized cell loss in cerebral cortex; especially frontal and temporal lobes, association areas (prefrontal cortex, visual) 4) presence of lipofuscins, senile or neuritic plaques, and neurofibrillary tangles (NFT); significant accumulations associated with pathology, eg. Alzheimer's disease 5) more selective cell loss in basal ganglia (substantia nigra and putamen), cerebellum, hippocampus, locus coeruleus; brain stem minimally affected
-Decreased cerebral blood flow and energy metabolism
-Changes in synaptic transmission: 1) decreased synthesis and metabolism of major neurotransmitters, eg. acetylcholine, dopamine 2) slowing of many neural processes, especially in polysynaptic pathways
-Changes in spinal cord/peripheral nerves: 1) neuronal loss and atrophy - 30-50% loss of anterior horn cells, 30% loss of posterior roots (sensory fibers) by age 90 2) loss of motoneurons results in increase in size of remaining motor units (development of macro motor units) 3) slowed nerve conduction velocity - sensory greater than motor 4) loss of sympathetic fibers - may account for diminished, autonomic stability, increased incidence of postural hypotension in older adults
-Age-related tremors (essential tremor, ET): 1) occur as an isolated symptom, particularly in hands, head, and voice 2) characterized as postural or kinetic, rarely resting 3) benign, slowly progressive; in late stages may limit function 4) exaggerated by movement and emotion
Neurological system changes and adaptations in the older adult - Clinical implications
-Effects on movement: 1) overall speed and coordination are decreased; increased difficulties with fine motor control 2) slowed recruitment of motoneurons contribute to loss of strength 3) both reaction time and movement time are increased 4) older adults are affected by the speed/accuracy trade off (the simpler the movement, the less the change; more complicated movements require more preparation, longer reaction and movement times; faster movements decrease accuracy, increase errors) 5) older adults typically shift in motor control processing from open to closed loop, eg. demonstrate increased reliance on visual feedback for movement 6) demonstrate increased cautionary behaviors, an indirect effect of decreased capacity
-General slowing of neural processing; learning and memory may be affected
-Problems in homeostatic regulation: stressors (heat, cold, excess exercise) can be harmful, even life-threatening
Neurological system changes and adaptations in the older adult - Strategies to slow or reverse changes
-Correct medical problems: improve cerebral blood flow
-Improve health: diet, smoking cessation
-Increase levels of physical activity: may encourage neuronal branching, slow rate of neural decline, and improve cerebral circulation
-Provide effective strategies to improve motor learning and control: 1) allow for increased reaction and movement times - will improve motivation, accuracy of movement 2) allow for limitations of memory - avoid long sequences of movement 3) allow for increased cautionary behaviors - provide adequate explanation, demonstration when teaching new movement skills 4) stress familiar, well-learned skills; repetitive movements
Sensory system changes and adaptations in the older adult - Age-related changes
-Older adults experience a loss of function of the senses: 1) may lead to sensory deprivation, isolation, disorientation, confusion, appearance of senility and depression 2) may strain social interactions and decrease ability to interact socially and with the environment 3) may lead to decreased functional mobility and increased risk of injury 4) alters quality of life
-Vision: there is a general decline in visual acuity; gradual prior to sixth decade, rapid decline between ages 60 and 90; visual loss may be as much as 80% by age 90
-Hearing: occur as early as fourth decade; affects a significant number of elderly (23% of individuals aged 65-74 have hearing impairments and 40% over age 75 have hearing loss; rate of loss in men is twice the rate of women, also starts earlier
-Vestibular/balance control: degenerative changes in otoconia of utricle and saccule; loss of vestibular hair-cell receptors; decreased number of vestibular neurons; VOR gain decreases; begins at age 30, accelerating decline at ages 55-60 resulting in diminished vestibular sensation
-Somatosensory: 1) decreased sensitivity of touch associated with decline of peripheral receptors, atrophy of afferent fibers- lower extremities more affected than upper 2) proprioceptive losses, increased thresholds in vibratory sensibility, beginning around age 50 - greater in lower extremities than upper extremities, greater in distal extremities than proximal 3) loss of joint receptor sensitivity; losses in lower extremities, cervical joints may contribute to loss of balance 4) cutaneous pain thresholds increased; greater changes in upper body areas (upper extremities, face) than for lower extremities
-Taste and smell: 1) gradual decrease in taste sensitivity 2) decreased smell sensitivity
Sensory system changes and adaptations in the older adult - Vision
-Aging changes include: 1) presbyopia - visual loss in middle and older ages characterized by inability to focus properly and blurred images, due to loss of accommodation, elasticity of lens 2) decreased ability to adapt to dark and light 3) increased sensitivity to light and glare 4) loss of color discrimination, especially for blues and greens 5) decreased pupillary responses, size of resting pupil increases 6) decreased sensitivity of corneal reflex - less sensitivity to eye injury or infection 7) oculomotor responses diminished - restricted upward gaze, reduced pursuit eye movements; ptosis may develop
-Additional vision loss with pathology:
1) cataracts - opacity, clouding of lens due to changes in lens proteins - results in gradual loss of vision, central first then peripheral; increased problems with glare; general darkening of vision; loss of acuity, distortion (surgery is an effective treatment)
2) glaucoma - increased intraocular pressure, with degeneration of optic disc, atrophy of optic nerve; results in early loss of peripheral vision (tunnel vision) (if untreated, it can progress to total blindness; if diagnosis is made early, surgery and/or medication are effective treatments)
3) macular degeneration - loss of central vision associated with age-related degeneration of the macula compromised by decreased blood supply or abnormal growth of blood vessels under the retina; typically individuals retain some peripheral vision; increased sensitivity to glare, and difficulty adjusting to light change; may progress to total blindness
4) diabetic retinopathy - damage to retinal capillaries, growth of abnormal blood vessels and hemorrhage leads to retinal scarring and finally retinal detachment; central vision is impaired, vision is blurred; complete blindness is rare (a complication of diabetes mellitus)
5) CVA, homonymous hemianopsia - loss of 1/2 visual field in each eye (nasal half of one eye and temporal half of other eye); produces the inability to receive information from right or left side; corresponds to side of sensorimotor deficit
6) medications - impaired or fuzzy vision may result with antihistamines, anti-psychotics, anti-depressants, steroids
Sensory system changes and adaptations in the older adult - Hearing
-Aging changes: 1) outer ear - buildup of cerumen (ear wax) may result in conductive hearing loss; common in older men 2) middle ear - minimal degenerative changes of bony joints 3) inner ear - significant changes in sound sensitivity, understanding of speech, and maintenance of equilibrium may result with degeneration and atrophy of cochlea and vestibular structures, loss of neurons
-Types of hearing loss: 1) conductive - mechanical hearing loss from damage to external auditory canal, tympanic membrane or middle ear ossicles; results in hearing loss (all frequencies); tinnitus (ringing of the ears) may be present 2) sensorineural - central or neural hearing loss from multiple factors, eg. noise damage, trauma, disease, drugs, arteriosclerosis, etc 3) presbycusis - sensorineural hearing loss associated with middle and older ages; characterized by bilateral hearing loss, especially at high frequencies at first, then all frequencies; poor auditory discrimination and comprehension, especially with background noise; tinnitus
-Additional hearing loss with pathology: 1) otosclerosis - immobility of stapes results in profound conductive hearing loss 2) Paget's disease 3) hypothyroidism
Sensory system changes and adaptations in the older adult - Vestibular/balance control
-Aging changes: 1) diminished acuity, delayed reaction times, longer response times 2) reduced function of vestibular ocular reflex (VOR); affects retinal image stability with head movements, produces blurred vision 3) altered sensory organization - older adults more dependent upon somatosensory inputs for balance 4) less able to resolve sensory conflicts when presented with inappropriate visual or proprioceptive inputs due to vestibular losses 4) postural response patterns for balance are disorganized - characterized by diminished ankle torque, increased hip torque, increased postural sway
-Additional loss of vestibular sensitivity with pathology: 1) Meniere's disease - episodic attacks characterized by tinnitus, dizziness, and a sensation of fullness or pressure in the ears; may also experience sensorimotor hearing loss 2) Benign paroxysmal positional vertigo (BPPV) - brief episodes of vertigo (less than 1 minute) associated with position change; the result of degeneration of the utricular otoconia that settle on the cupula of the posterior semicircular canal; common in older adults 3) medications - antihypertensives (postural hypotension); anticonvulsants; tranquilizers, sleeping pills, aspirin, NSAIDS 4) cerebrovascular disease - verterbrobasilar artery insufficiency (TIAs, strokes); cerebellar artery stroke, lateral medullary stroke 5) ceregellar dysfunction - hemorrhage, tumors (acoustic neuroma, meningioma); degenerative disease of brain stem and cerebellum; progressive supranuclear palsy 6) migraine 7) cardiac disease
Sensory system changes and adaptations in the older adult - Somatosensory
-Additional loss of sensation with pathology: 1) diabetes, peripheral neuropathy 2) CVA, central sensory losses 3) peripheral vascular disease, peripheral ischemia
Sensory system changes and adaptations in the older adult - Taste and smell
-Conditions resulting in additional loss of sensation: 1) smoking 2) chronic allergies, respiratory infection 3) dentures 4) CVA, involvement of hypoglossal nerve
Sensory system changes and adaptations in the older adult - Clinical implications/compensatory strategies
-Vision: 1) assess for visual deficits - acuity, peripheral vision, light and dark adaptation, depth perception; diplopia, eye fatigue, eye pain 2) maximize visual function - assess for use of glasses, need for environmental adaptations 3) sensory thresholds are increased - allow extra time for visual discrimination and response 4) work in adequate light, increase intensity, reduce glare; avoid abrupt changes in light, eg. light to dark 5) use large, high contrast print for written materials 6) provide magnifying glasses (either portable or attached to a stand/work table) to view objects and complete tasks 7) provide an eye patch for diplopia 8) decreased peripheral vision may limit social interactions; therefore, stand directly in front of the person at eye level when communicating with him/her 9) assist in color discrimination - use warm colors (yellow, orange, red) for identification and color coding 10) provide other sensory cues when vision is limited, eg. verbal descriptions to new environments, touching to communicate you are listening, "talking" clocks and watches 11) provide safety education; reduce fall risk
-Hearing: 1) assess for hearing - acuity, speech discrimination/comprehension; tinnitus, dizziness, vertigo, pain 2) assess for use of hearing aids; check for proper functioning 3) minimize auditory distractions, work in quiet environment 4) speak slowly and clearly, directly in front of person at eye level 5) use nonverbal communication to reinforce your message, eg. gesture, demonstration 6) provide written and demonstrated directions/guidelines for activities 7) orient person to topics of conversation he/she cannot hear to reduce paranoia, isolation 8) provide assistive devices to compensate for functional effects of hearing loss and to ensure person's safety, eg. vibrating and flashing smoke alarms, telephones, doorbells, and clocks
-Vestibular/balance control: 1) increased incidence of falls in older adults 2) fall prevention
-Somatosensory: 1) assess carefully - check for increased thresholds to stimulation, sensory loss by modality, area of body 2) allow extra time for responses with increased thresholds 3) use touch to communicate - maximize physical contact, eg. rubbing, stroking, and tapping 4) provide augmented feedback through appropriate sensory channels, eg. using kitchen utensils with wide textured grips may be easier than narrow smooth handles 5) teach compensatory strategies to prevent injury to anesthetic limbs 6) provide assistive devices and environmental modifications as needed for fall prevention 7) provide feedback devices as appropriate (eg. limb load monitor)
-Taste and smell: 1) assess for identification of odors, tastes (sweet, sour, bitter, salty); somatic sensations (temperature, touch) 2) decreased taste, enjoyment of food leads to poor diet and nutrition 3) older adults frequently increase use of taste enhancers, eg. salt or sugar 4) decreased home safety, eg. gas leaks, smoke
Cognitive changes and adaptations in the older adult - Age-related changes
-No uniform decline in intellectual abilities throughout adulthood: 1) changes do not typically show up until mid 60s; significant declines affecting everyday life do not show up until early 80s 2) most significant decline in measures of intelligence occurs in the years immediately preceding death (termed terminal drop)
-Tasks involving perceptual speed show early declines (by age 39); require longer times to complete tasks
-Numeric ability (tests of adding, subtracting, and multiplying): abilities peak in mid-40s, well maintained until 60s
-Verbal ability: abilities peak at age 30, well maintained until 60s
-Memory: 1) impairments are typically noted in short-term memory; long-term memory retained 2) impairments are task dependent, eg. deficits primarily with novel conditions, new learning
-Learning: all age groups can learn. Factors affecting learning in older adults: 1) increased cautiousness 2) anxiety 3) sensory deficits 4) pace of learning - fast pace is problematic 5) interference from prior learning
Cognitive changes and adaptations in the older adult - Clinical implications
-Older adults utilize different strategies for memory: context-based strategies vs. memorization (young adults)
Cognitive changes and adaptations in the older adult - Strategies to slow or reverse changes
-Improve health: 1) correct medical problems - imbalances between oxygen supply and demand to CNS, eg. cardiovascular disease, hypertension, diabetes, hypothyroidism 2) assess needed pharmacological changes; drug reevaluation; decrease use of multiple drugs; monitor closely for drug toxicity 3) reduce chronic use of tobacco and alcohol 4) correct nutritional deficiencies
-Increased physical activity
-Increase mental activity: 1) keep mentally engaged, "Use it or Lose it"; eg. chess, crossword puzzles, book discussion groups, reading to children 2) maintain an engaged lifestyle - socially active, eg. clubs, travel, work, volunteerism; allow for personal choice in activity 3) use cognitive training activities
-Provide multiple sensory cues to compensate for decreased sensory processing and sensory losses and to maximize learning, eg. provided visual demonstrations, written instructions, and verbal cues
-Provide stimulating, "enriching" environment; avoid environmental dislocation, eg. hospitalization or institutionalization may produce disorientation and agitation in some elderly
-Reduce stress; provide counseling and family support
Cardiopulmonary system changes and adaptations in the older adult - Age-related changes
-Cardiovascular age-related changes: 1) changes due more to inactivity and disease than aging 2) degeneration of heart muscle with accumulation of lipofuscins (characteristic brown heart); mild cardiac hypertrophy left ventricular wall 3) decreased coronary blood flow 4) cardiac valves thicken and stiffen 5) changes in conduction system - loss of pace maker cells in SA node 6) changes in blood vessels - arteries thicken, less distensible; slowed exchange capillary walls; increased peripheral resistance 7) resting blood pressures rise - systolic greater than diastolic 8) decline in neurohumoral control - decreased responsiveness of end-organs to beta-adrenergic stimulation of baroreceptors 9) decreased blood volume, hemopoietic activity of bone 10) increased blood coagulability
-Pulmonary system age-related changes: 1) chest wall stiffness, declining strength of respiratory muscles results in increased work of breathing 2) loss of lung elastic recoil in increased work of breathing 3) changes in lung parenchyma: alveoli enlarge, become thinner; fewer capillaries for delivery of blood 4) changes in pulmonary blood vessels: thicken, less distensible 5) decline in total lung capacity - residual volume increases, vital capacity decreases 6) forced expiratory volume (air flow) decreases 7) altered pulmonary gas exchange - oxygen tension falls with age (at a rate of 4mmHg/decade; PaO2 at age 70 is 75, versus 90 at age 20) 8) blunted ventilatory responses of chemoreceptors in response to respiratory acidosis - decreased homeostatic responses 9) blunted defense/immune responses - decreased ciliary action to clear secretions, decreased secretory immunoglobulins, alveolar phagocytic function
Cardiopulmonary system changes and adaptations in the older adult - Clinical implications
-For cardiovascular changes: 1) changes at rest are minor - resting heart rate and cardiac output relatively unchanged; resting blood pressures increase 2) cardiovascular responses to exercise - blunted, decreased heart rate acceleration, decreased maximal oxygen uptake and heart rate; reduced exercise capacity, increased recovery time 3) decreased stroke volume due to decreased myocardial contractility 4) maximum heart rate declines with age 5) cardiac output decreases, 1% per year after age 20 - due to decreased heart rate and stroke volume 6) orthostatic hypotension - common problem in elderly due to reduced baroreceptor sensitivity and vascular elasticity 7) increased fatigue; anemia common in elderly 8) systolic ejection murmur common in elderly 9) possible ECG changes - loss of normal sinus rhythm; longer PR and QT intervals; wider QRS; increased arrhythmias
-For pulmonary changes: 1) respiratory responses to exercise - similar to younger adult at low and moderate intensities; at higher intensities, responses include increased ventilatory cost of work, greater blood acidosis, increased likelihood of breathlessness, and increased perceived exertion 2) clinical signs of hypoxia are blunted; changes in mentation and affect may provide important cues 3) cough mechanism is impaired 4) gag reflex is decreased, increased risk of aspiration 5) recovery from respiratory illness - prolonged in the elderly 6) significant changes in function with chronic smoking, exposure to environmental toxic inhalants
Cardiopulmonary system changes and adaptations in the older adult - Strategies to slow or reverse changes in cardiopulmonary systems
-Complete a cardiopulmonary assessment prior to commencing an exercise program: 1) this is essential in older adults due to the high incidence of cardiopulmonary pathologies 2) select an appropriate graded exercise testing protocol 3) standardized test batteries and norms for elderly are not available 4) many elderly cannot tolerate maximal testing; submaximal testing commonly used 5) testing and training modes should be similar
-Individualized exercise prescription is essential: 1) choice of training program based on - fitness level, presence or absence of cardiovascular disease, musculoskeletal limitations, individual's goals, roles, and activity interest 2) prescriptive elements (frequency, intensity, duration, and mode) are the same as for younger adults 3) walking, chair and floor exercises, Yoga, Tai-Chi, and modified strength/flexibility calisthenics are well-tolerated by most elderly 4) consider pool programs (exercises, Tai-Chi, walking, swimming) for persons with musculoskeletal and neurological impairments 5) consider multiple modes of exercise on alternate days to maintain interest and reduce likelihood of muscle injury, joint overuse, pain, fatigue, and boredom
-Aerobic training programs can significantly improve cardiopulmonary function in the elderly: 1) decreases heart rate at a given submaximal power output 2) improves maximal oxygen uptake (VO2max) 3) greater improvements in peripheral adaptation, muscle oxidative capacity then central changes 4) improves recovery heart rates 5) decreases systolic blood pressure, may produce a small decrease in diastolic blood pressure 6) increases maximum ventilatory capacity - vital capacity 7) reduces breathlessness, lowers perceived exertion 8) psychological gains, improves sense of well-being, self-image 9) improves functional capacity
-Improve overall daily activity levels for independent living: 1) lack of exercise/activity is an important risk factor in the development of cardiopulmonary disease 2) lack of exercise/activity contributes to problems of immobility and disability in the elderly
Other system changes and adaptations in the older adult - Integumentary changes
-Changes in skin composition: 1) dermis thins with loss of elastin 2) decreased vascularity; vascular fragility results in easy bruising (senile purpa) 3) decreased sebaceous activity and decline in hydration 4) appearance - skin appears dry, wrinkled, yellowed, and inelastic; aging spots appear (clusters of melanocyte pigmentation); increased with sun exposure to sun 5) general thinning and graying of hair due to vascular insufficiency and decreased melanin production 6) nails grow more slowly, become brittle and thick
-Loss of effectiveness as protective barrier: 1) skin grows and heals more slowly, less able to resist injury and infection 2) inflammatory response is attenuated 3) decreased sensitivity to touch, perception of pain and temperature; increased risk for injury from concentrated pressures or excess temperatures 4) decreased sweat production with loss of sweat glands results in decreased temperature regulation and homeostasis
Other system changes and adaptations in the older adult - Gastrointestinal changes
-Decreased salivation, taste, and smell along with inadequate chewing (tooth loss, poorly fitted dentures); poor swallowing reflex may lead to poor dietary intake, nutritional deficiencies
-Esophagus: reduced motility and control of lower esophageal sphincter; acid reflux and heartburn, hiatal hernia common
-Stomach: reduced motility, delayed gastric emptying; decreased digestive enzymes and hydrochloric acid; decreased digestion and absorption; indigestion common
-Decreased intestinal motility; constipation common
Other system changes and adaptations in the older adult - Renal, urogenital changes
-Kidneys: loss of mass and total weight with nephron atrophy, decreased renal blood flow, decreased filtration - 1) blood urea rises 2) decreased excretory and reabsorptive capacities
-Bladder: muscle weakness; decreased capacity causing urinary frequency; difficulty with emptying causing increased retention - 1) urinary incontinence common (affects over 10 million adults; over half of nursing home residents and one third of community dwelling elders); affects older women with pelvic floor weakness and older men with bladder or prostate disease 2) increased likelihood of urinary tract infections
Overview and contributing factors to poor nutrition in the elderly
-Many older adults have primary nutrition problems.
-Nutritional problems in the elderly are often linked to health status and poverty rather than to age itself: 1) chronic diseases alter the overall need for nutrients, the abilities to take in and utilize nutrients, energy demands, and overall activity levels (eg. Alzheimer's disease, CVA, and diabetes) 2) limited, fixed incomes severely limit food choices and availability
-There is an age-related slowing in basal metabolic rate and a decline in total caloric intake; most of the decline is associated with a concurrent reduction in physical activity (both undernourishment and obesity exist in the elderly and contribute to decreased levels of vitality and fitness)
-Contributing factors to poor dietary intake: 1) decreased sense of taste and smell 2) poor teeth or poorly fitting dentures 3) reduced gastrointestinal function (decreased saliva; gastromucosal atrophy; reduced intestinal mobility; reflux) 4) loss of interest in foods 5) isolation, lack of social support, no socialization during meals, loss of spouse, loss of friends 6) lack of functional mobility (inability to get to a grocery store to shop; inability to prepare foods)
Outcomes of poor nutrition in the elderly
-Dehydration is common in the elderly, resulting in fluid and electrolyte disturbances: 1) thirst sensation is diminished 2) may be physically unable to acquire/maintain fluids 3) Environmental heat stresses may be life threatening and should be treated as medical emergencies
-Diets are often deficient in nutrients, especially vitamins A and C, B12, thiamine, protein, iron, calcium, vitamin D, folic acid, and zinc
-Increased use of alcohol or taste enhancers (eg. salt and sugar) influences nutritional intake
-Drug/dietary interactions influence nutritional intake (eg. reserpine digoxin, anti-tumor agents, and excessive use of antacids)
Assessment of nutrition in elderly
-Dietary history: patterns of eating, types of foods
-Psychosocial: mental status, desire to eat, depression, grief, social isolation, social supports
-Body composition: 1) weight/height measures 2) skin fold measurements (triceps/subscapular skin fold thickness) 3) upper arm circumference
-Olfactory and gustatory sensory function
-Dental and periodontal disease, fit of dentures
-Ability to feed self: mastication, swallowing, hand/mouth control, posture, physical weakness and fatigue
-Integumentary: skin condition, edema
-Compliance to special diets
-Functional assessment: basic activities of daily living, feeding; overall exercise/activity levels, amount and type of social participation
Goals and intervention for nutrition and the elderly
-Assist in monitoring adequate nutritional intake
-Assist in maintaining nutritional support: 1) refer to dietitian, nutritional consultants and/or nutritional education programs as needed 2) make recommendations for home health aide to assist with grocery shopping and meal preparation 3) refer to elderly food programs: home delivered, ie. "meals on wheels"; congregate meals/senior center daily meal programs; federal food stamp programs
-Maintain physical function and promote adequate activity levels
-Maintain independence in food preparation and self feeding: 1) teach work simplification and energy conservation techniques to maximize function 2) modify environment and adapt activities to enhance mastery and ensure safety
Elder Abuse - Overview: Facts and figures
-Statistic for elder abuse are difficult to accurately assess due to limited reporting
-Nationally, Adult Protective Services (APS) investigated 461,135 reports of elder and vulnerable adult abuse
-Nationally, APS substantiated 191,908 reports of elder and vulnerable adult abuse
-Definitions vary; however, there are three basic categories: 1) domestic elder abuse 2) institutional elder abuse 3) self-neglect or self-abuse
Signs and symptoms of elder abuse - physical abuse
-An elder's report of being physically mistreated
-Bruises, black eyes, welts and/or lacerations
-Rope marks and/or other signs of restraint
-Bone and skull fractures, sprains and/or dislocations
-Open wounds, cuts, and untreated injuries in various stages of healing
-Internal injuries/bleeding
-Broken eyeglasses
-Under- or overdosing of prescribed drugs
-A sudden change in behavior
-The caregiver's refusal to allow visitors to see an elder alone
Signs and symptoms of elder abuse - sexual abuse
-An elder's report of sexual assault or rape
-Bruises around the breasts or genital area
-Unexplained venereal disease or genital infection
-Unexplained vaginal or anal bleeding
-Torn, stained, or bloody underclothing
Signs and symptoms of elder abuse - emotional/psychological abuse
-An elder's report of being verbally or emotionally mistreated
-Emotionally upset or agitated behavior
-Extremely withdrawn and non-communicative or non-responsive behavior
-Unusual behavior such as sucking, biting or rocking
Signs and symptoms of elder abuse - neglect
-An elder's report of being mistreated
-Dehydration, malnutrition, untreated bedsores, and poor personal hygiene
-Unattended or untreated health problems
-Hazardous or unsafe living conditions
Signs and symptoms of elder abuse - financial or material exploitation
-An elder's report of financial exploitation
-Sudden changes in bank account or banking practice
-The inclusion of additional names on an elder's bank signature card
-Unauthorized withdrawal using an ATM card
-Abrupt changes in a will or other financial documents
-Substandard care or unpaid bills despite the availability of funds
-Discovery of a forged signature
-Sudden appearance of relatives claiming rights to decisions, money, or possessions
-Unexplained transfer of funds
-The provision of unnecessary services
Role of Occupational Therapy in elder abuse
-Mandatory reporting: 1) elder abuse per se may or may not be designated as a specific crime in a state; however, most physical, sexual, and financial/material abuse are crimes in all states 2) healthcare workers are required to report suspected or observed cases of elder abuse 3) failure to report may be considered a crime 4) in most states Adult Protective Services, the area Agency on Aging, or the county Department of Social Services is designated to provide investigation and services
-Occupational therapy intervention: 1) treat for physical and emotional injuries 2) develop a trusting relationship 3) assist in developing a support system 4) refer to appropriate disciplines and/or agencies