Test of Motor Development & Functional Performance

What are these test used for?

 4

Document children's development level in relation to age related standards

Observe children's activity strengths and limitation

Test for functional skills: dressing, feeding

Educating families on outcomes

What are some of the test used 

Hint: 11

TIMP: Test of Infant Motor Performance

HINT: Harris Infant Neuromotor Test

Miller First Step

Bayley III

Peabody Developmental Motor Scales

Bruninks – Oseretsky Test of Motor Proficiency

GMFM: Gross Motor Function Measure

Pediartric Evaluation of of Disability Inventory

FIM :Functional Independence Measure for children

School Function Assessment

      Pediatric Clinical Test of Sensory Interaction for Balance

What are the Barriers of the standardized test?

hint: 2

Time required to complete

Interpreting results

Which test are used as a screening?

Hint: 4

Denver II

HINT: Harris Infant Neuromotor Test

Miller's First Step 

TIMPSI: Test of Infant Performance Screening Inventory

HINT: Harris Infant Neuromotor Test

How many items are there

What does it identify (age range)

What does it assess(6)

What is it strongest at

22 in less than 30 min

developmental delay in infants 3 - 12 months

Neuromotor milestones, muscle tone, head circumference, movement patterns, behaioral interactions, caregivers assessment of infant development

r/o developmental deviance 

Millers First Step Screening Test

WHo does it evaluate  & What age range

What does it asses (4)

How is function defined (toys)

Evaluates pre-schooler's to identify risk of developmetnal delay (2yrs 9mths TO 6yrs 2mths)

Cognitive, Communicative, Physical, Social Emotional

is the performance with games using toys that are entertaining and exciting for children in this gap

Test of Infant Motor Performance Screening Inventory (TIMPSI)

What does it screen for?

Age range?

Gross motor function in infants

34 wks post menstrual TO 4 mth post term

Which test is testing for Comprehensive Developmental Assessment

Bayley Scale of Infant & Toddler's

(Bayley II & III)

Bayley Scale of Infant & Toddler Development (Bayley III)

BSID & Bayley II

Age range?

What does it assess? 6

How long does it take?

1 mth to 3 1/2 yrs old (42 mths)

Cognition, Language, Social Emotional, Adaptive behavior, Functional Mental Scale, Motor Scale

45-60 min

What test assesses Motor ?

hint: 3

TIMP

Peabody Developmental Motor Scales

Bruininks Oseretsky Test of Motor Proficiency (BOT)

TIMP

age range?

How many items?

Does it include a parent education tool in the developmental f/u clinic, if so what is used?

Is there a shorter test, if so which one?

How long does it take?

Infants < 5 mths

42 items

yes, a video tape

Yes, TIMPSI

TIMP: 25-35 min & TIMPSI: 15-20min

 Peabody Developmental Motor Scales (PDMS)

What does it test?

Age range?

What has been found reliable?

Gross Motor & Fine Motor skills

Birth - 71 mths (6yrs)

Fine motor ratings

In the Peabody

What does the Gross motor assess (5)

What does fine motor assess (5)

Gross Motor: Reflexes, balance, nonlocomotor, locomotor activities, and receipt and propulsion of objects

Fine Motor: grasp, balance, hand function, eye – hand coordination, and manual dexterity

Bruininks Oseretsky Test of Motor Proficiency (BOT)

What does it test?

What components are included? 5

Age group?

Time to Complete?

Fine & Gross motor function

Fine Manual control, Body coordination, Manual Coordination, Strength & Agility

4.5 - 14.5 yrs

BOT2 4 - 21 yrs old

Approx: 1.5 hrs

What is the difference with BOT2

intended to increase its functional relevance and age range

HOw many subset & questions are there in the BOT

8 subsets

46 questions

BOT

What are the 8 subsets?

4 measure of gross motor skills

3 measures fine motor skills

1 measure of both

BOT

What is included in Gross Motor Skills?

Hint:4

Running speed & Agility

Balance

Bilateral Cordination

Strength

BOT

What is included in Fine Motor skills

Hint: 3

Upper Limb Speed & Dexterity

Response to speed

Visual Motor Control

BOT

What is tested in the combination subset?

Upper limb coordination

What is the BOT used for?

Hint:5

1. Making decisions about educational placement
2. Assessing gross and fine motor skills
3. Developing and evaluating motor training programs
4. Assisting clinicians and researchers
5. Screening for special purposes

What test are used for Children w/ Disabilities?

Hint:4

GMFM

Pediatric Evaluation of Disability Inventory (PEDI)

Functional Independence Measure for Children ( WeeFIM)

The School Function Assessment

What does GMFM measure?

What specific children does it address?

What age Range?

Change in gross motor function

Children w/ CP

5 mths - 16 yrs

How is function defined in the GMFM Test

Is it quality or quantity?

Is Spontaneous movement assessed?

child's degree of achievement of a motor behavior when instructed to perform or when placed in a certain position

Quantity

Book says Yes & Martha Said NO????

Yes/No

 Is the GMFM a criterion referenced test

Yes

Wat are the 5 Dimension tested in the GMFM?

Hint:  positions(8)

Laying

Rolling

Sitting

Kneeling

Standing

Walking

Running

Jumping

What is the difference of the GMFM66

22 items removed, mainly in the lying position

What does the Gross Motor Function Classification System do?

group children by their level of disability

Also used to classify severity of CP in research

What does the PEDI assess?

How many items measured?

its a discriminating device to detect functional limitations and participation in age ppropriate task

a tool for program evaluation & tracking progress

197

PEDI

How is function defined?

What are the functional skills assessed?

hint: 4

 ability to perform ADL's w/ or w/o modifications or assisstance

Assess: Self Care, mobility, social function, and 20 items to assesscaregivers assistance

Functional Independence Measure for Children (WeeFIM)

What does it test & assess

Disability

&

Function

WeeFIM

How is function described?

What functional task does it assess (6)

Function : caregivers assisstance needed to accomplish daily task required b/c of functional limitations

& 

Assess:Self Care, Sphincter control, mobility, locomotion, communication, and social cognition

WeeFIM

Age group?

Is it an excellent tool for overall outcome, program evaluation, and cross discipline communication

6 mths - 12 yrs old

YEs

The School Function Assessment

What does it assess?

How many parts to it?

Is it criterion referenced?

Age group?

assesses and monitors the performance of functional task and activities in elementary school social & academic setting

3 parts

Yes

kindergarten (5/6 yrs old) - 6 grade

What are some examination tools used?

hint :3 based on ?

Maturational based

Milestone based

Dynamic based 

WHat are the emphasis of Maturational based tools?

2

reflex testing

&

Evoked behavior

Can examinations be based solely on Milestone

Yes

What does Dynamic Based View place emphasis on?

2

Spontaneous Movements

&

Self produced movements under more realistic conditions

What are the 3 test for Infant Motor / movement?

General Movement Assessment (GMA)

Movement assessment of Infants (MAI)

Alberta Infant Motor Scales (AIMS)

General Movement Assessment (GMA)

What does it examine?

What is it effective in predicting? (2)

When are the movements examined?

What does it analyze?

Age Group?

Spontaneous movements of patterns

Predict CP, or early detection of motor control deficits

During awake state, non crying

Quality of movement

Preterm to 3 moths (best b/w 2-& 4 mths b/c it the age of figiditing)

General Movement Assessment (GMA)

What do the classifications Include: 5

It Distinguishes:6

Writhing, Fidgety, wiggling-oscillating, saccadie, and ballistic

frequency, amplitude, power, speed flow, irregularity, andabruptness of the movement

Movement assessment of Infants (MAI)

What is the pupose?3

Is it criterion referenced?

What does it evaluate? 4

What does it check for?

Does it examine for spontaneous movement?

to identify motor dysfunction, change in status, and establish an intervention

Yes

Muscle tone, reflexes, Automatic reactions, volitional movement

asymmetrical or rostrocaudal variation for risk scores

Yes

Alberta Infant Scale (AIMS)

What is it used for?

What positions are assessed? 3

Age Group?

What needs to be met to pass each item?

a screening tool to assess risk for motor dysfunction

Prone, sitting, standing

Birth - 18mths

Quality of movement

What test are used in Childhood Examinations?

 2

Toddle & Infant Motor Evaluation (TIME)

Assessment of Motor and Process Skills (AMPS)

Toddle & Infant Motor Evaluation (TIME)

Why was it developed?

Age group?

What does it assess?5 

developed to quantify the theoretic contruct of quality of mevement

4mths to 3 1/2 yrs

Motor organization

Mobility

Stability

Social/Emotional

Functional Performance

 Assessment of Motor and Process Skills (AMPS)

Why was it developed?

What theory is it based on?

Is there a School AMP?

Developed to evaluate motor skillsand series of action leading to the completion of a task

Sensory Intergration theory

Yes

School AMPS

Who is it specific for?

What can it differentiate from?

Children is school setting

children w/ or w/o congenital heart disease & children at risk for delay

What are examples of:

Measure of Components of Motor Control

Pediatric Clinical Test of Somatosensory Interaction for Balance

(P-CTSIB)

Gross Motor Performance Measure

 Selective Control Assessment of the LE (SCALE)

 Shrinner Hospital UE Examination

Which test uses a:

Systematic way of examining a child’s reaction to altered sensory conditions like the Foam & Dome simulation

·      Pediatric Clinical Test of Somatosensory Interaction for Balance (P-CTSIB)

Which test uses the GMFM

Gross motor Performance measure

Which test quantifies selective voluntary motor control which are mediated through the corticopsinal tratcs in children w/ CP?

What age group is assessed?

Selective Control Assessment of the LE (SCALE)

> 4yrs old who do not have severe cognitive or motor deficits

Which test measures joint movement, involuntary movements, reciprocal movements, speed, force, generation through the available range?

Selective Control Assessment of the LE (SCALE)

Which test is designed for children >3 w/ hemiplegia for 3 main purpose?

What are the main purposes? 3

 Shrinner Hospital UE Examination

Determine potential for improvement

direct intervention

evaluate effects of intervention

What is a Continuing process of collecting and organizing relevant information in order to plan and implement effective treatment.

Why do PT's do this?

Assessment

·      PT’s must assess accurately and comprehend the significance of any delay that falls outside the limits of normal variability

What is Developmental testing used for? 5

scrrening tool - promote early intervention

early identification

assist in DX

Facilitate planning of treatment

in research

What are the 3 Method's of assessment?

Interview

History Taking

Clinical observation

WhichMethod of assessment involves meeting and asking questions to the parent/caregiver, and can fill the gaps of the assessment process?

Interview

In this type of method's assessment bias may influence the reliability of the families answers?

History Taking

This assessment  starts when you first meet the pt, while interviewing, and when the child is performing unstructured movements.

Clinical Observations

Defintions!!!

This score x = developmental age?

Actual age?

Used with premature infants?

Age Equivalent score

EX: : a raw score of 52 on the Bayley Mental Scales represents an age equivalent of 4.5 months

Chronological age

Adjusted Age

What scores are interpreted on the basis of absolute criteria, used to measure set of objectives. Can be also viewed as a Ratio b/w th child's actual score and the developmental age

Motor age : Chronological age = Motor Quotient

Criterion Referenced test

 Used to make a comparison between a particular child and the “norm” of a group of children

 Uses norm values as standards for interpreting test scores?

What are some exapmles of these? 3

Norm- Referenced  or Standardized test

Bayley

Denver

Gesell

Uses percentile scores

Norm- Referenced  or Standardized test

 Total # of items that are passed/correct

Need to establish a basal and ceiling levels

Ceiling level may vary from test to test

Raw core

Consistency & Repeatability b/w measures

Intra - rater

Inter - rater

Reliabilty

One rate

> 1 rater

Indicates precision of an individual test score, and gives an estiate of the margin of error?

 Standard Error of Measurement (SEM)

Expressed as deviations from the mean score of a group

Standard Deviation

Extent to which a test measures what it is supposed to measure

Validity

Construct validity

examination of the theory underlying the test

Content Validity

appropriateness of the test

Concurrent Validity & Predictive valiity fall within?

Criterion Related Validity

Concurrent - measures against gold standard

Predictive Validity - score predicts some typeof behavior

 If a test can actually identify correctly those who have a disorder

few false negative = ?

Sesitivity

High Sensitivity

Ability of the test to identify those that do not have the disorder

 few fals e positives

Specificity

High specifiticity

Proportion of true positives among those that have positive results

Positive Predictive Value

·      Proportion of true negatives among those that have negative screening results

Negative Predictive Results

What are the guidelines for selecting a test?

6

Acceptability

Simplicity

Cost

Appropriatness

Reliability

Validity

What are the assessment Categories?

Screening Test: identify deficits indicating further services

Assessment of component function: specific areas of function

Comprehensive Developmental scale: FIM

Milani Caomparetti Motor Development Screening test

Is it Criterion referenced?

Age group?

Does it require special equipment?

Yes

birt to  2 yrs

No

 DenverII Screening Test

What are the 4 areas assessed?

Age group?

What are the 4 scores?

Personal/Social, Fine Motor, Language, Gross Motor

Birth - 6yrs

Pass, Fail, No Oppertunity, Refusal

What does a caution item entail?

What does a Delay item entail?

child fails or refuses where the item bar is completely Left to the age line

>90% could perform this task

What does a Advanced item entail?

an item a child passes when the item is completely to the Right of the age line

< 25% could perform this at that age

What does a Normal item entail?

Item that a child passes, fails, or refuses on the age line

What are the test results for the DenverII

4

Normal 

Caution

Suspect >1 fail, rescreen in 2 weeks

Untestable > 1 refusalDelay

Test of Motor Funtion

8

·      Movement Assessments of Infants (MAI)

·      Alberta Infant Motor Scale (AIMS)

·      Test of Infant Motor Performance (TIMP)

·      Gross Motor Function Measure (GMFM)

·      Gross Motor Performance Measure (GMPM)

·      Peobody Developmental Motor Scales

·      Bruininks Oseretsky Test of Motor Proficiency(BOT)

·      Test of Gross Motor Development

Comprehensive Developmental Scales

·      Looks at the whole child across all areas of development

o   Gesell Developmental Schedules

o   Bayley Scales of Infant Development

o   Bayley II

o   Neonatal Behavioral Assessment Scale

o   Early Intervention Developmental Profile

o   Developmental Programming for Infants and Young Children (DPIYC)

Assessment of Functional Capabilities·     

Looks at child’s skills that are essential within the child’s natural environmentsof home and school

o   Pediatric evaluation of disability inventory (PEDI )

o   Functional Independence Measure for Children (Wee-FIM)

o   Gross Motor Function Classification System for Cerebral Palsy (GMFCS)

DCD

Sensory Processing Dysfunction

What allows you to be able to use the body effectively within the environment, and the ability to organize sensation's from one's own body and from the environment?

Sensory Intergration

What does the CNS do?

3

receives information from receptors (ie. Eyes, ears, skin, nose,etc)

processes/registers the information

responds (output; adaptive response) - relative to processing

As PT's what do we focus on the most of the CNS functions?

Output

Definition:

________ is the body's response to the sensory info recieved & gathered from the environment by the body's receptors

Movement

What receptors gather info formt the environment?

4

 Eyes-visual

Ears-auditory

 Nose-olfactory

Tongue-gustatory

What receptors gather info fromt he body in relation to the environment?

3

 Skin-tactile

Vestibular-position of head in space

Propioception-position of body in space

What are the CNS outputs?

4

Motor

Speech

Cognitive

Psychosocial

T/F

If there is a problem below cognition (motor,speech, psychosocial) it will cause some sort of cognitive impairment

TRUE

What happens to information (input/output) in Sensory Processing/Integrative Dysfunction?

where does it occur?

Falls apart

its the break down of sensory info as it travels through the CNS

[image]

What are the 5 starges?

CNS: Sensory Sys

Sensory: sensory motor pathways develop w/ interaction fo environment

Sensory Motor: Body Scheme, Reflex maturity, Ability to screen input, Postural Security, Awareness of L & R, Motor Planning

Perceptual Motor

Cognition (trouble above will affect it)

Etiology

1.Mom or Dad, family Hx

2. stress, how mom copes with stress

3. if baby doesn’t move, will not have opportunity to learn

4. if we do not eat it, will not produce it (Picky Eater)

Genetics

 Pregnancy & Birth Hx

Enviornmental

Food

When all sensory systems work together you have_____

Sensory Integration

WHat is included in the theory behind Sensory Integration

5

·      Brain plasticity

·      Brain development

o   Infant not born with Giri

o   Prunning period: 

·      Purposeful and goal directed behaviors

·      CNS is designed to create balance/organization

Role of sensory system

Are infants born w/ Giri?

How do they develop?

 it develops by learning, myelination

What is the prunning period?

clean up pathways that are not mastered

Ex: “He used to be able to do something and now he is tripping all over the place”

What is the role of the CNS

to create balance and organization

What are the Primary Sensory Receptors

6

·      Vestibular

·      Propioception

·      Tactile

·      Auditory

·      Visual

·      Oral

Which Sensory Recptors is operational at Birth?

is it the only one?

Vestibular

Vestibular:

Whihc are the recptors?

Does it cross both sides of the body?

Is information recieved only from primary receptors?

What system does it work closely with?

Semicircular Canal & Otholiths

Yes

No, Both primary & Non primary

Proprioception

Vestibular + Proprioception  = 

Somatosensory System &  Body Awareness

Unilateral ear infection causes lateral flexion to which side?

If chronic ear infection persist, What can it present like?

Tubes in the ear relieve what part?

Involved side

Torticollis

Tembanic Membrane

What sensory system is this:

Has largest receptors

Develops in child hood

Provides info about movement

Proprioception

Proprioception:

 Why do the receptors develop in childhood?

What teact does it travel?

Does it only send signal to one part of the brain?

b/c of the interaction and experience in the enviornment

   Dorsal column medial lemniscal system

No, sveral brain structures

What systems travel the Dorsal column medial lemniscal system?

Proprioception and Tactile

What system has the :

Second Largest receptors

Develops in child hood

Send info about pain, temp, & pressure

Is the Protective Sys

Tatile

Which system is the easiest to detect dysfunction?

tactile

What system:

Assist vestibular system

Recieves input from the same CNS structure as vestibular system

Helps with learning, verbal language, spatial relations

Auditory System

Where does the Central Auditory Processesing Disorder occur?

What can they not do with CAPD?

What can cause it

What is unclear?

Central Canal of the SSC

can not follow directions

occur from  chronic ear infection causing scarringa nd damage

can not hear the middle of the what was said (tape recorders)

What systems involves Cranial Nerve: II, III, IV, VI

Is the most important for learning, social development, and spatial orientation

Visual Receptors

What receptors involve cranial nerves:V, VII, IX, X, XI, XII

Has a connection with the hypothalamus & ANS

Strong ties with Limbic System (Mouth, Nose, Ears)

Oral Receptors

What do pickey eaters feel like when eating?

What bothers them?

They are being attacked

Tectures, Smells 

Development Sequence

What is the first stage of sensory processing & when does it occur?

Modulation - achieving homeostasis (0-3mths)

Development Sequence

What stage do they learn how to sooth themselves?

When does it occur?

Self Regulation - shift b/w emotional stages

>3mths

Development Sequence

What stage is skill refinement/perfection as you mature?

Discrimination

What part of development have they mastered the skill

Praxis / Skill

What are the dysfunctions of development?

4

·      Decreased ability to maintain homeostasis, or stategies to maintain it

·      Difficulty scanning input for relevance

·      Learning (academic & skill) is affected

·      Difficulty or inability to change your state to match the demands of the environment

What are the first receptors that mature and get myelinated first:

Eye & Ears

What may cause Developmental Delays

Corpus Collosum doesn;t grow in relation to the brain, causing difficulty sending, sharing, info to either side of brain

What pathways are first to be laid down?

Motor Pathways

Autism

What is the # 1 Sign & Symptom?

Lack of engagement

Is Autism part of the Sensory Process Dysfunction 

Yes

Whata re the 5 disorders categorized under Pervasive Disintegrative Disorder (PDD)?

o   Asperger’s

o   Autism

o   PDD-NOS

o   Rett’s: genetic condition that presents w/ autistic symptoms

Childhood Disintegrative Disorder

_____ _____ _______ is a category of neurological disorders characterized by severe and pervasive impairments in several areas of development.

What age does it usually appear within?

Does it mean you can not be Dx after ?

Pervasive Developmental Disorders

first 3 years of life

NO 

PDD

What are some of the problems associated with?

6

Social interaction

Language

Emotional 

cognitive

Motor

Sensory abilities

Prevalence

How many times more likely to affect boys?

4 x

Causes of ASD

 3

Genetic

Pre & Postnatal events

Abnormal brain growth 

No tie to vaccines

What are the causes of Abnormal Brain Growth?

Uneven pattern of head circumference growth

Excesine White matter found in non-verbal areas in R hemisphere

Underdeveloped areas that connect L to R

Brain function as independent units

'What is  Affect?

motivation & Emotional

What is Emotional Maturity?

Social Engagement and relation

Who quoted:

“The ability to create links between the physical and emotional qualities of sensation and motor behavior, allows the growing infant to begin to perceive and organize patterns.”

“Without the affective connection, comprehending feedback from the environment AND learning from the environment, are compromised.”

What does it represent now?

Stanley Greenspan,M.D.

“Sensory –Affect – Motor Connection”

What are the main areas of inpairments in ASD?

Behavior

Communication

Socialization

What behaviors are seen in ASD

OCD / repetitive behavior 

May adhere to strick routines

Severe behavior of agression & self injuring

Predictable behavior

What 2 models of TX are used for ASD

ABA: works on reinforcement, not really menaingful to the child, just going throught the motion to satisfy others

Floortime: helps more w/ emotional aspect

What are some characteristics of Communication with children that have ASD?

Verbal & Non Verbal affected

Sign Language  and picture communication systems can be used to augment language development

Have difficulty seeing the big picture

What socialization difficulties might children with ASD have?

2

Prefer to be alone

difficulty with verbal language & Non-verbal

Clinical Presentation of ASD

Which developmental sequence is affected?

Tends to over respond or under respond to sensation such as sound, touch, and/or vision.

Under responsive actively seeks touch, sound, and input

Sensory modulations

Clinical Presentation of ASD

 In Motor Planning and sequencing what is observed in children with ASD

Strength & Weakness

Relative strength: carries out multiple step actions, negotiates obstacles, and build complex block design.

Relative Weakness: difficulty carrying out simple movements, simple 1-2 step pattern

Clinical Presentation of ASD

What occurs in auditory Memory?

Able to remember or repeat long statements "scripts"

or

May have difficulty remembering simple words

Clinical Presentation of ASD

Visual Memory

Strength: can remember books, covers, pictures, words, detail, but never really understand the big picture

or

Weakness: difficulty remembering simple pictures or objects

Clinical Presentation of ASD

Toe walking

Why do they not want shoes, or not want to take them off?

What does increased stability do?

 o   Lock at heel for increased proprioceptive feedback.

§  Does not want shoe on

o   Tactile defensiveness (wants least amount of sensitive foot on ground).

§  Will not take shoes or socks off

o   Increased stability (limit degrees of freedom).

o   Motor planning difficulty (synergy pattern)

Why do children with ASD flap their hands?

3

focus on hands to visually overlook over stimulating enviornment (Predictable & repetitive)

Tactile & Proprioceptive: stimulation at the wrist and fingers

Emotional state: movement chosen to do to compensate

Some S & S ASD

·      Inappropriate laughing or giggling

·      No real fear of dangers

·      Apparent insensitivity to pain

·      May not want cuddling

·      Sustained unusual or repetitive play

·      uneven physical or verbal skills

·      May avoid eye contact

·      May prefer to be alone

·      Difficulty in expressing needs; may use gestures

·      Inappropriate attachments to objects

·      Insistence on sameness

·      Echoes words or phrases

·      Inappropriate response or no response to sound (name)

·      Spins objects or self

·      Difficulty in interacting with others

Is there a cure for ASD?

TX?

There is no cure for autism; however, with

appropriate treatment and education, many children

with the disorder can learn and develop. Early

intervention often can reduce challenges associated

with the disorder, lessen disruptive behavior, and

provide some degree of independence.Treatment

depends on the individual needs of the patient. In

most cases, a combination of treatment methods is

more effective. Autism usually requires lifelong

treatment.

Developmental Programming for Infants and Young Children

What is the EIDP?

o   Developmental assessment for children from birth to 36 months

o   An assessment designed for a team to use in planning intervention

o   Not specifically diagnostic, but provides a range of development

 Who Developed the EIDP?

 Purpose of EIDP
5 

o   To identify strengths and weaknesses

o   Provide a developmental range

o   Identify emerging skills

o   Provides for periodic re-assessment

o   Bridge gap between assessment and intervention

Criteria for Selection

Validation of the Scales

First:

o   The item for inclusion must have appeared in 2 recognized scales

§  OR:

o   it could be an original item if the construct to be assessed did not exist in another recognized scale

Criteria for Item Selection

·      Each item reviewed by member most knowledgeable

·      Items selected had to represent all aspects of development (e.g. Language)

·      Items selected needed to represent the developmental accomplishments for that range of development

Adjusted age?

08    21    42

09    10    12

07    10    25

01    11    17

             1 yr  11 moths    17 days  = 24 months

          CORRECTED AGE: FOR PREMATURITY

Administration of test

·      Determine Chronological Age: In Months

·      Begin with interacting with child and parent

·      What are we looking for in the front end?

·      Proceed with Perceptual Fine Motor Scale

·      Use the 1” cube item in the child’s age range OR in range you feel is closer to ability

When you stop administration of the test?

@ Ceiling (highest passed item) when the child has failed 6 consecutive times or passess items in 2 consecutive age ranges

What is Basal?

From the first passed and the 5 more passess consecutively in easier range or 2 consecutive age groups.

What is the ceiling

·      More difficult items from the initial passed item until child has failed

1. Six consecutive items

or

2. Two age ranges 

is there a developmental Age in this assessment?

NO

Is there is developmental Range?

Yes

The Medically Involved Child

Lecture 7/11/12

Growth & Development of Lungs

When does lungs development start? 

What period is it? 

 starts occurring 24-26 days after conception

Embryonic Period

Growth & Development of Lungs

In what period do the Lung buds continue to grow and subdivide?

What secretes?

What appears?

What begins to form in this period?

What weeks does this occur?

Pseudo Glandular Period

Mucus 

Supportive Cartilage

Diaphragm

Weeks 5-16

Growth & Development of Lungs 

What period does the flattening of the epithelium that becomes aveolar cells occur?

What are aveoli?

What appears?

What occurs at the end of this period?

What weeks does it occur in?

Canicular Period

Where gas exchange occurs

Pulmonary Capillaries appear

Air exhange can exchange

16-26 wks

Growth & Development of Lungs

What period does the out-pouching of the terminal bronchioles form saccules?

Weeks this occurs in?

Saccular Period

26-32

Growth & Development of Lungs

The Medically involved child 7/11/12 Lecture Notes

Which is the final period where saccules branch into many aveolar ducts, ducts are in close proximity to capillaries?

What needs to occur for life to be sustained?

How early does this occur?

What is the biomechanical substance needed within alveoli?

Alveolar Period

Needs sufficient number of alveolar/cappilary units

32 wks

Surfactant

What is Surfactant?

What does it reduce?

When does it appear?

What does it allow?

Phospholipid that lines the pulmonar alveoli

Reduces surface tension

34 weeks

maintanence of continuous respiration

What does Respiration REQUIRE:

4

o   Organ for gas exchange –have to have lungs

o   “Pump” mechanism - rib cage and respiratory muscles

o   Neural control centers – Brainstem, Spinal Cord

o   Under normal conditions can adapt to changing metabolic needs, ie:Exercise Hyperthermia

What occurs when the Respiratory System is unable to deliver O2 and eliminate CO2 from pulmonary circulation?

Respiratory Failure

_____ is when there is an uncorrectable imbalance in the respiratory system (Gas Exchange) where the ventilator muscle power and respiratory drive (Neural) are inadequate to overcome respiratory load

Chronic Respiratory Failure

What Categorizes Chronic Respiratory Failure

§  Conditions that affect the lung and airways

§  Conditions which cause central dysregulationof breathing

§  Diseases of chest wall and thorax (respiratory pump)

What are some causes of Acute Pespiratory Failure?

Spinal Cord Injury

or

Blunt Trauma

What are the 2 types of Acute Respiratory Disease?

What type of disease is it?

Respiratory distress syndrome (RDS)

& 

Broncopulmonay Dysplasia (BPD)

Airway Disease

Which is responsible for 30% of neonatal deaths and 50-70% of infant deaths, resulting from imature anatomical physiology?

Respiratory Distress Syndrome

Which is a ventilator induced injury, associated Low Birth Weight, & Prematurity?

Bronchopulmonary Dysplasia

What is involved with Central Dysregulation of Breathing?

3

Absence of Brainstem

Unjury to brainstem

Cervical Spine Injury

What nerves keep the Diaphragm alive?

What nerve is injured in cervial psine injury? 2

C3, C4, C5

Phrenic Nerve (Diaphragm)

&

Intercostal Nerve damage (Muscles)

What can cause Failure of Respiratory Pump?

5

§  Compromised neural control of respiration

§  Inadequate force generation of the respiratory muscle disease intrinsic

     SCI

§  Congenital chest wall defects

§  Muscle fatigue

What cell is affected when there is compromise of neural control during respiratory pump failure?

Anterior horn cells

What diseses are associated with Inadequate force generation of respiratory musclers?

Muscular Dystrophy

Muscular Myopathies

What is a congenital chest wall defect?

Born w/o a lung

What are some predispositions of respiratory failure?

4

Respiratory tract infections

§  Structural factors

§  Poor Mechanical Advantage

§  Respiratory Metabolism

What are the 4 Mechanical Disadvantages of the respiratory system?

Type 1: fatigue resistant muscle fibers 

Poor Development of the ability to cough,  cannot clear the mucus

o   Needs to be done for them, if not can lead to respiratory failure

Horizontal rib cage: DS, Hypotonia

Baby’s Position may affect diaphragmatic excursion

What does High metabolic rate Cause:

Hint: Increases 3

Consuption of O2

Heat loss

Water loss secondary to faster RR

Ate Each Age what is the Mean RR:

1

2

3

4

5

6

At what age is it most like an adult RR?

28

25

23

22

21

20

6 yrs old

What is the ideal Arterial Blood Gass parameters?

How many mmHG of PO2 = Rfailure?

How many mmHG of PaCO2 = Rfailure?

75 mm Hg of CO2

100 mm Hg of O2

when the pt is receiving inspired oxygen concentration of 100%

65 mm Hg

45 mmHg

What are some Clinical Signs of Respiratory Failure?

19

§  Decreased inspiratory breath sounds

§  Use of accessory muscles

§  Altered depth & pattern of respiration

§  Weak cough

§  Nasal flaring

§  Wheezing / Expiratory grunting

§  Retained airway secretion / incompetent swallowing

§  Cyanosis

§  Tachycardia

§  Bradycardia

§  Hypotension

§  HTN

§  Cardiac Arrest

§  Fatigue / Decreases level of activity

§  Poor weight gain

§  Changes in mental status

§  Headache

§  Seizures

§  Comas

How many hrs /day for how many weeks depicts Long Term Ventilator Dependency

more than 6hrs /day for at least 3 weeks

T/F

Goals of VD change from increasing survival TO best practice for QoL

True

What does best practice of QoL entail?

4

§  Optimizing developmental potential

§  Reducing incidence of activity limitations

§  Reducing disabilities

§  Maximizing potential for participation in: School, Home, Community

How are Mechanical Ventilators useful to someone in need?

2

Assist or Substitute respiratory effort

What are some clinical decisions to use a MV?

3

§  To preserve physiological function

§  Take advantage of the growth and developmental potential of the lungs

§  Maximize developmental potential of the infant or child

What are the 2 types of Assissted Ventilator Support?

Non Invasive & Invasive

Is non invasive ventilator a positive or negative pressure system?

Negative Pressure System

What are some of the Non Invasive NPV? 2

What are the 3 advantages?

C-Pap & Bipap

Avoid invasive tracheostomy

 Avoid risk of infection

Ventilator is NOT disrupted when suctioning occurs

Which Ventilator is commonly used?

What does it control?

Invasive PPV

Inspiration

How are they inserted?

T/F - They are not the preferred method for children?

Tracheostomy

or

Endotracheal (mouth)

False - it is the preferred method

What are the Control Variables?

4

Pressure

Volume

Flow

Time

What do the control variables provide?

Pressure - What is it set at?

Volume - what does it amintain?

Flow - what is it maintained at?

Time- What does it maintain

Pressure- set at peak inspiratory pressure

Volume - constant volume irrespective of lung mechanics

Flow- constant tidal volume

Time - time b/w inspirations and expirations

What are the Phase Variable

4

Trigger

Limit

Cycle

Baseline

What do the phase variable indicate?

Trigger - What does it trigger>

Limit - What does it preset?

Cycle - when is the cycle over?

Baseline - when is controlled?

 Trigger– preset threshold to trigger inspiration

Limit –preset level before inspiration ends

Cycle– end of inspiration

Baseline–controlled during expiratory time

What are the modes of Invasive PPV?

7

Continuous

Continuous Spontaneous

Intermitten

Assisst Control

Synchronized Intemitten Mandatory Ventilation

Proportional assisted ventilation

Which mode of Invasive PPV is:

Is at a fixed rate and are not synchronized to the pt

Intermitten

Which mode of Invasive PPV is

mandatory breaths are triggered by the patients inspiratory effort

Assist Control

Which mode of Invasive PPV is:

all breaths are spontaneous, something is triggered

Continuous Spontaneous

Which mode of Invasive PPV is:

mandatory full support

If taken off, pt will expire

Continuous

Which mode of Invasive PPV is:

every vent breath is proportional to the patients respiratory effort

Proportional assisted ventilation

Which mode of Invasive PPV is:

Patient can take spontaneous breath w/ breaths at a present volume & rate

Synchronized Intemitten Mandatory Ventilation

What is the Transition to unassisted breathing?

Is it individualized?

Weaning

Yes

What are the 4 aspects of Weaning:

What does the pt need to maintain when breathing spontaneously?

 can Weaning be affected is Ventilator used too long?

Whys is it done by Tiral & Error?

Activities do not need to be altered at this time?

Adequate aveolar Ventilation

Yes

Looks at hypoxic levels

False

What are some of the concerns with Children on Chronic Long term Ventilators?

5

medically frail

at risk for physical mental & psychosocial disabilities

Activity limitations

Motor Learning limitation

at risk for secondary complications

Whata re some of the secondary risk for chronic long term VD?

5

§  Recurrent hypoxic episodes –neurologic damage

§  Recurrent infections

§  Poor weight gain: b/c of oral & feeding problems

§  Poor physical growth:  need calories/nutrition, & WB activities

§  Deccreas Sensory defensiveness, muscular strength & soft tissue strength

What are the 4 Common Disorders of the Respiratory tract?

Atelectasis

Respiratory Muscle weakness

Asthma

Cystic Fibrosis

What is Atelectasis?

Incomplete expansion of the lungs

or

Lung Collapse

Atelectasis

What is the primary reason?

Secondary Reason?

What is the most IMPORTANT thing to prevent this?

pulmonary immaturity

Gas in lungs segment is reabsorbed w/o refilling (Obstruction, Respiratory compromise, MS or NM disease)

Mobility

Atelectasis

Which is the common reason a PT would be Rx?

hint: secondary effect

obstruction by mucus or other debris

Atelectasis

·      Decreased chest wall excursion

·      Tachypenea

·      Inspiratory retractions

·      Cyanosis

·      Trachea deviates toward involved lung

Atelectasis

Do they treat the cause?

What are the treatments?

Yes

Remove obstruction –AC

 Treat infection

Bronchiodialator  

Atelectasis

What does the PT intervention include?  6

What else shoud be addressed?

Bronchial drainage

Percussion

Vibration

Insentive Spirometer - use toys

Deep breathing, max inspiratory efforts

Splint incision in post op parients

Muscular pattern of respitration

Chest configuration

What should be used before performing deep breathing efforts?

Use bronchodilator

FYI: could also help with children that have aspirated an object

What are the Characteristics of Asthma?

What % of children doe sit affect?

airway inflammation / obstruction

Increased airway responsiveness to a variety of stimuli

10%

What occurs as airway obstruction continues?

4

Decreased expiratory flow

 Lung volumes increase

Airway resistance increases

Ventilation/perfusion inadequately leads to arterial hypoxia

What is transient wheezing of infant associated with?