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Child and Adolescent Occupations Impacted by Neuromotor Impairments: Intervention Strategies

Child and Adolescent Occupations Impacted by Neuromotor Impairments: Intervention Strategies. OCCT 752: Occupations, Adaptations and Technology, III. Assessment. Who IS this child…? Determination and prioritization of occupational performance issues Performance Analysis

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Child and Adolescent Occupations Impacted by Neuromotor Impairments: Intervention Strategies

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  1. Child and Adolescent Occupations Impacted by Neuromotor Impairments: Intervention Strategies OCCT 752: Occupations, Adaptations and Technology, III

  2. Assessment • Who IS this child…? • Determination and prioritization of occupational performance issues • Performance Analysis • Activity or task supports or limitations • Environmental supports or limitations • Task supports or limitations • Motivation of child to perform • Understanding of the task or activity

  3. Choosing a Frame of Reference... • Biomechanical • Effects of gravity on movement • Motor control/motor learning • Practice • Repetition • Feedback (including sensory) • In context • Neurodevelopmental treatment (NDT) • Key points of control

  4. Choosing a Frame of Reference... • Lack of research to support use of NDT in traditional sense • Need to integrate useful pieces of NDT with motor control/ motor learning theories and biomechanical knowledge base • Then put it all back in context of broader theoretical model, and include attention to child, task, environment

  5. Other knowledge… • Diagnostic issues (CP, muscular dystrophies, CVA, etc.) • Anatomy and physiology • Kinesiology • Effects of tone on movement • Rate • Force • Timing • Control

  6. Direct Approaches • May be most useful as assessment... • Child’s choice of activity (motivation, goal, challenge, increase potential for practice) • Facilitation of movement via key points of control • Anti-gravity control • Active alignment (weightbearing, placing, holding) • Dissociation of movement • Enhancing sensory component to facilitate feedback/feed-forward mechanisms • Practice and repetition are key

  7. General strategies to enhance direct approaches • Inform the child about what you are going to be doing, and what you want them to do • Use language to describe, sequence what the child wants to do or is doing with their body - it adds feedback • Utilize demonstration and imitation when possible • Time delay - wait briefly for child to respond, once they have been given a cue about what to do next • Fade physical prompting as quickly as possible, so child learns control of own movement, rather than becoming dependent on your cues

  8. Clinical reasoning (things to ask yourself)... • What’s the “goal”? • What position is child in to start (especially pelvis and trunk)? • Where do you have/want stability? • Where do you have/want mobility? • Is the child indicating discomfort? • How much effort is the child exerting and for what? • How is the child responding to touch, movement, activity demands (physically, cognitively, emotionally)? • If you change one thing, observe carefully and ask those questions again...

  9. In addition to direct approaches, you also have to: • Work with teachers and parents to build in opportunities for practice during regular routines and activities • Position for support during activities • Teach parents/teachers what physical supports and prompts assist child in being active participant in activities • Educate parents and others about realistic expectations of change, and encourage focus on functional outcomes rather than discrete changes in range of motion, etc.

  10. STABILITY • How does it happen? • Muscle co-contraction • Use of supporting surfaces • “Fixing” • What does it look like? • Alignment • balance, postural control • Sitting, standing • Placing, holding

  11. MOBILITY • How does it happen? • Muscle contraction • Agonist, antagonist • Rate, timing, sequencing • Beginning, middle and end ranges of movement • Use of supporting surfaces… • Motivation!

  12. MOBILITY • What does it look like? • Transitions • prone • prone on elbows • sidelying • sidesitting • kneeling • half - kneeling • standing • walking

  13. MOBILITY • What does it look like? • Reach • Grasp/Release • Power (palmar) • Use of fingers • Controlled release

  14. MOBILITY • What does it look like? • Object manipulation • Rotation • Translation • Vibration • Bilateral hold • Two-handed hold • Bilateral use of hands • Deformation (of object) • Sequential action with purpose

  15. MOBILITY • What does it look like? • In-hand manipulation • Translation (in and out of palm, with fingers) • Rotation • Shift

  16. Put it back together… • Strategies for: • Analise • Mealtime routines (4 people) • Dressing (3 people) • Play (Art) (3 people) • Max • Mealtime routines (3 people) • Play (4 people)

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