DDST3 Ethical Issues

The occupational therapist could use motor control and motor learning frames of reference to justify the occupational therapy treatment. Specifically, the therapist will focus on the neurodevelopmental theory. Due to individuals with Rett syndrome having motor deficits, the neurodevelopmental theory focuses specifically on motor control health conditions in children and adults (Cole & Tufano, 2008). The theory uses sensorimotor components to establish a baseline for occupational performances. The neurodevelopmental theory evaluates the response to sensory input and the quality and strength of movements for individuals with Rett syndrome (Cole & Tufano, 2008). The guidelines for the theory’s intervention for children with developmental disabilities, like Rett syndrome, include education for caregivers, adaptive equipment, and participating in sensory activities (Reed, 2014).

Pediatric physical therapists work to help disabled children and their families grow and become stronger every day. For about a century now, doctors have been making a valiant effort to improve the lives of children. Though it is not the most popular practice, pediatric physical therapy is certainly important to the lives of millions. Since the beginning of pediatrics, new discoveries are constantly being made. Pediatric physical therapy has been making ground breaking developments and progressions in all of its elements since it became popular in the 1920’s.

An evaluation can identify skill deficits linked to a critical developmental area, therefore appropriate interventions can be applied if warranted. The utilization of multiple evaluation instruments is supported through IDEIA, as both strengths and weaknesses can be depicted. An evaluation must be carried out prior to a child receiving special education related services. In addition, IDEIA requires the administration of a multifaceted evaluations with valid assessment instruments, as all areas of suspected disability must be assessed. Cognitive functioning, developmental abilities, communication, adaptive skills, and social and emotional levels are several areas that can be taken into account during the evaluation process (Cambron-McCabe, McCarthy & Eckes, 2014; Smith, 2005; Turnbull,

In order for a student to be diagnosed for any disability, there is a process that involves many people that are important in the child’s life. The school must conduct tests that measure the child’s academic success in the classroom, as well as tests that measure IQ (Wechsler Intelligence Scale for Children), work samples, developmental history (usually get this information from the parents), physical exams (vision, hearing etc.), psychological tests, adaptive skills (BASC) and other areas as needed. Testing is usually done by professionals from various disciplines. In order to qualify for special education services under IDEA, the disability must impact the child’s ability to be academically successful (IDEA, 2004).

Children that takes these tests should be between the ages of 4 years old to 8 years and 11 months old. The SIPT measures a child?s ability to integrate motor planning, sensory input for perception, and spatial actions and provides standard scores (ranging from ?3.0 to 3.0) for normative age groups on each of the 17 subtests (Schaaf, p.548). The authors of this research looked into scoring the tests in a specific manner. Any score of less than 1.0 indicates performance below normative age level. Interpreter reliability ranges from .94 to .99, test?retest reliability over 1?2 week ranges from .33 to .94, and construct validity has been demonstrated in more than 10 factor and cluster studies. (Schaaf,

A 10-year-old student had a diagnosis of Cerebral Palsy (CP) and a GMFCS (Gross Motor Functional Classification System, Level IV for age range 6-12. His school eligibility was moderate intellectual disability with noncompliant and self-injurious behaviors. He stood with support of two people with bilateral ankle foot orthoses with a crouched posture, approximately 55 degrees of hip and knee flexion. He ambulated short distances with a reverse walker and physical support. Measured in supine, his bilateral hip and knee flexion PROM was measured at 25 degrees; however, this is not an accurate measure due to non-compliant behavior during the measurement. His parents adopted him; therefore, there is no family history. A recent hospitalization due to a prolonged seizure resulted in a change in medication, a decline in functional mobility, and currently he does not ambulate. Attempts to stand him have resulted in a further increase in hip and knee flexion bilaterally. The Individual Education Plan team, including his parents discussed his functional decline and decided to implement a standing program. The parent’s goal was for him to walk again. A standing program will be implemented and monitored by the physical therapist and carried out by the school

To illustrate, a 3-year-old boy at UCP-OC was initially seen to have an evaluation, conducted by a licensed occupational therapy. The evaluation consisted of an assessment of the boy’s cognitive, gross motor, oral motor, and fine motor areas. The scale used in the field is known as the Bayley Scale. The boy was assessed and was found to have a cognitive age of 24 months. He then received a variety of interventions to combat low muscle tone, don and doff clothing (putting shirt on, putting socks on), pincer grasp goals, and other goals including, crossing over midline while handwriting, and other fine motor performance areas. A typical session included the use of ADL’s (activities of daily living) to practice dressing, slides, ball pits,

"CP affects a child's ability to move and maintain posture and balance... the injury does not damage the child's muscles or nerves connecting them to the spinal-cord-only the brains ability to control the muscles" (Geralis 2). Depending on which part of the brain is injured it will affect how the brain will be able to control tone. If tone is missing it will lead to muscle and movement problems. "Missing tone leads to very tight muscles which affects movements of joints and limbs and jerky movements associated with certain types of CP, which is different from tight muscles that you see in other types of CP" (Narayanan video). Doctors who treat the body of a person who has CP wants to relieve pain or prevent it from happening. Also, if a person with CP can walk, doctors would like to make them walk better therefore they can do more things that they would enjoy doing. Dr. Rice treats and assesses children of their abnormal tone difficulties and muscular skeletal problems. At around age 2 children start to develop difficulties with muscle tone that can impact hip development. Some children are not standing or sitting and need earlier treatment than children who progress towards walking independently or with support. Children of that age like to move around and may need help to do it, or have equipment like a walker or a wheelchair, 2-3 years old have rapid development and go from parallel play to integrated play (Rice).

For this assignment, my groupmates and I decided to use the Peabody Developmental Motor Scale. We chose this assessment because our patient was a chronological age of thirteen months (premature 1 week, 9 days) and were aiming to look at her gross motor function in the following areas: reflexes, stationary, locomotion, object manipulation. Our results provided us with raw scores of: 12 for reflexes, 36 for stationary, 53 for locomotion and 1 for object manipulation. Due to our patient, Olivia, being premature we decided to compare her percentile ranks to her chronological age and her corrected age. Upon doing so, we found that our patient was in higher percentile ranks for her corrected age than her chronological age.

The ICF-CY documents and measures the “health and development of children and the youth.” (WHO, 2007) Working in a pediatric facility, I can see the importance and the implications that the ICF-CY can do for our patients. Granted that the ICF has not been widely integrated for use by healthcare practitioners like physical therapists, it has to be used so that it can become a “living document” (Darrah, 2008, p. 151) By incorporating the use of ICF-CY in our practice especially in pediatric rehabilitation, it will help provide a “common language” (Darrah, 2008, p. 151) that educators, healthcare practitioners and families can understand. This will make most an integral and contributing part in the care of our patients for making a “comprehensive and realistic project of life for the person with disability” (Martinuzzi, De Polo, Bortolot, & Pradal, 2015, p. 31). Now, let us apply the ICF model to my

Future consideration: As the patient has learning difficulties and intellectual disabilities, he needs more supports for learning. A comprehensive neurophysiologic and developmental evaluation3 can give him a big hand. A developmental evaluation is needed for physical, occupational, speech and behavioural therapies3. This can stimulate the patient to develop his full potential. Psychotropic medications

Non-standard postures may be more common in children with movement disabilities and this study fails to capture every effort made by the child.

The PDMS-2 is an assessment of motor skills in children from birth to six years. This assessment contains five subtests which determine a child’s gross motor and fine motor abilities. The gross motor scale assesses a child’s bending, extending, stooping, balance, twisting, catching, and kicking a ball. The fine motor scale evaluates a child’s ability to execute precise movements of the small muscles in the body, especially their eyes and the hands. Also, the test measures the child’s ability to manipulate small objects, use a pencil to perform a variety of tasks on paper, and control of a pair of scissors when cutting along lines on paper. Please note the average standard score for each subtest is a range of 8-12.

2-6: A recent study done by Malak et al. (2015), aimed to “examine the gross motor function and estimate what motor abilities are significantly delayed in children with DS even with physical therapy…and to assess their functional balance”. The subjects of the study were 79 children with DS ranging in age from 0-6. The children were then further divided into 3 groups based on age and motor impairment- mild, medium or severe. All the children

First two decades of life is the most vulnerable years of human beings, given the unaccomplished biologic and social growth and development, and lack of ability of autonomy. Therefore, childhood disability deserves a meticulous approach and classification.