No tech
any AAC that doesn't require a power source
ex: PECS, communication books, eye gaze board, letter board
Low tech
voice output communication systems, typically physical pictures or battery operated and have a static (non-changing) display
ex: big mack switch, sequencer, Quicktalker1
Mid tech
requires a source of power, has more vocabulary than low tech systems
ex: Quicktalker (ablenet), GoTalker (enable devices), tech/speak (amdi.net)
High tech
systems typically requiring an electronic power source and have a dynamic (changing) display with synthesized voice output
IDEA and AE
- school district provides AT because of FAPE
- must meet standards of state education agency
- provided at public expense, public supervision, and direction
- must have an IEP
- is AT necessary to be educated in LRE?
- will person have access to school p
Supine- benefits
- promotes rest and sleep
- stretching kyphotic spine and rounded shoulders
- allow for facilitation of visual skill development for those with limited head control
- decreases some edema
Supine- potential problems
- may encourage leg deformities
- may lead to pneumonia, breathing difficulties, and snoring
- greater incidence of kidney problems
- facilitate abnormal reflexes
- lead to potential skin breakdown
- doesn't promote interaction with environment
- most dif
Prone- benefits
- develops femur and acetabulum
- promotes sleep and rest
- helps stretch mild tightness of hips/knees, kyphosis and rounded shoulders
- helps develop head and upper trunk control
- facilitates kidney drainage
Prone- contraindications
- moderate to severe hip flexion tightness
- can't independently turn head
- tracheostomies
- NG or G tubes
- compromised respiratory capacity
- hydrocephalus
Prone on forearms- benefits
- improves head, trunk, UB strength
- improves shoulder stability
- facilitates bilateral UE weight bearing, leads to hand development and function
- improve flexibility/stretch tightness
- encourages body extension
- increased UE control
- brings jaw for
Prone on forearms- contraindications
- moderate to severe shoulder flexion/hip tightness
- poor head control
- presence of NG or G tube/tracheostomy
- compromised respiratory status
- UE/LE fractures
- osteomalacia
- arthritis/joint pain
- hydrocephalus
Quadruped on forearms- benefits
- improves head, neck, trunk control and strength
- hip and shoulder stability
- UE WB through shoulders
- improve flexibility and stretch tightness
- increases upper trunk development and UE control
- brings jaw forward
- aids in kidney drainage
Quadruped on forearms- contraindications
- moderate to severe shoulder flexion or hip extension tightness
- mobility skills to prevent falls
- UE/LE fractures
- osteomalacia
- arthritis/joint pain
Sidelying- benefits
- relaxation
- decrease primitive reflex patterns
- midline head position and movement facilitation
- brings shoulders and arms forward, eliminates gravity's influence
- decrease windswept/frog leg deformities
- trunk elongation
- trunk, hip, and knee fle
Sidelying- potential problems
- shoulder pain for those with low tone
- deformities without proper support
Sitting- benefits
- trunk and head control
- free movement of arms and hands
- better view of environment/visual awareness
- social interaction
- gastric emptying, kidney drainage, breathing
- facilitates mobility
- perception and cognition
Sitting- potential problems
- overuse leading to hip and knee flexion contractures
- skin breakdown
- abnormal postures
- modifications for those with deformities
Standing- benefits
- greater access to activities
- physiological functioning
- reduce spasticity
- increase ROM
- prevent LE contractures
- improve head and trunk control
- increase arousal
- increase endurance
Standing- contraindications
- severe medical conditions
- pain/spasticity
Static splint
immobilizes or maintains position at end range
Serial static splint
requires remodeling and provides a slow, progressive increase in ROM
Static progressive splint
uses different inelastic components to provide altering amounts of tension
Dynamic splint
constant elastic tension or traction
Dropout splint
allows motion in one direction while BLOCKing motion in another
Splint wearing schedule
functional improvement: wear during activity
reduce tone: wear prior to or during activity
improve ROM/prevent contractures: wear at night
Importance of pediatric AT for children
development
skill acquisition
compensation
inclusion
avoid learned helplessness
promote self-determination
Assistive technology device
any item, piece of equipment, or product system that increases, maintains, or improves functional capabilities of individuals with disabilities
Assistive technology service
any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device
Role of OT
direct care
consultation
justification of recommended technology
training/coaching of child and caregivers
follow up
education/advocacy
AT goals
improved function
improved health/decreased risk of pathology
improved vocational or educational skills
improved comfort
improved safety
progress of device mastery and implementation
effectiveness of training
Redness in splinting
- at risk for pressure ulcers/tenderness/skin breakdown
- add padding
- reconfigure splint
- decrease wearing time
Service delivery
1. referral
2. initial eval
- identify needs, evaluate skills, identify necessary device characteristics
3. recommendations and reports
4. implementation
- order and setup, delivery and fitting, training
5. follow up
- maintenance and repairs
6. follow al
Principles of universal design
Equitable Use
Flexibility in Use
Simple and Intuitive Use
Perceptible Information
Tolerance for Error
Low Physical Effort
Size and Space for Approach and Use
Equitable use
the design is useful and marketable to people with diverse abilities
Flexibility in use
accommodates a wide range of individual preferences and abilities
Simple and intuitive use
the design is easy to understand, regardless of the user's experience, knowledge, language skills, or education level
Perceptible information
the design communicates necessary information to the user, regardless of ambient conditions or sensory abilities
Tolerance for error
the design minimizes hazards and the adverse consequences of accidental or unintended actions
Low physical effort
the design can be used efficiently and comfortably with minimum fatigue
Size and space for approach and use
appropriate size and space is provided for approach, reach, manipulation, and use regardless of user's body size, posture, or mobility
Letter of medical necessity
purpose/perspective
- justify need, appeal for perspective, use terms reader will understand
describe the situation
- occupational profile, current/past technologies used, list specific needs, relevant details
describe decision making and recommendation
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Key principles
- proximal stability for distal mobility
- wide base of support for good center of gravity adds to stability
- hip position influences trunk position
- joints in alignment for stability
- symmetrical weight bearing through all extremities provides the mos
NICU- environment vs. intrauterine
- now unable to counteract the forces of gravity
- more static posturing (supine or prone) instead of normal environment within fluid filled uterus
- disruption of normal caudocephalic tone development
- more favorable to extensor muscle development
- ext
NICU- positioning
- supine is easiest
- prone shown to have greater physiological effects including improved respiration, sleep, digestive function, decreased energy expenditure
- prone has negative consequence of flattened posture
- best to use combination of supine, pron
NICU- inadequate positioning
can lead to...
- positional deformities (skull shape)
- development of undesirable neural pathways
- development of abnormal postures and movement patterns that negatively affect motor development
NICU- CP
- neurological disorder with symptoms of lack of muscle coordination, ataxia, and spasticity
- spastic (70-80%), athethoid/dyskinetic (10-20%), ataxia (5-10%), mixed
positioning
- upright position NOT reclined position improves UE functioning
- functionin
NICU- tone
- resistance of muscles to passive elongation or stretch
- assessed using passive movement about a joint
- when abnormal, it affects movement, seating, and positioning
- abnormal tone caused by injury or dysfunction to motor pathways in the brain and/or s
Types of tone
flaccid (absence of tone)
hypotonic (decreased tone)
normal
hypertonic (increased tone)
rigid (stiff/no movement)
Hypotonia
- common with LMN lesions (spina bifida, ALS, lower level SCI)
- presents as floppiness
- w/c seating: need increased support to maintain position and facilitate distal control
Hypertonia
- spasticity, dystonia, rigidity
- common with CP, CVA, SCI, TBI
- variable presentation and more difficult to manage for w/c seating
- mixed hypertonia: occurs with spasticity (more common)
Spasticity
signs
- resistance increases with increasing speed of stretch and varies with joint movement (flexion/extension)
- resistance to movement increases rapidly above a threshold speed or joint angle (spastic catch)
UMN syndrome
- spasticity component of signs that make up UMNS
- result of cortical, subcortical, or SCI level injury/dysfunction
- abnormal reflex behaviors, decreased autonomic nervous system control, impaired muscle control, weakness
Dystonia
- involuntary alteration in pattern of muscle activation during voluntary movement or maintenance of posture
- abnormal twisted postures/repetitive movements
- triggered by attempts at voluntary movement and fluctuates in presence and severity over time
Abnormal reflexes- Galant's Response
persists
- can lead to scoliosis
- delays in symmetrical trunk stabilization for sitting balance
Abnormal reflexes- ATNR
persists
- prevents rolling
- prevents hands to midline
- prevents grasping and looking at object at same time/visual awareness
- alters balance
Abnormal reflexes- STNR
persists
- interferes with crawling
- posturing relative to head movement
Abnormal reflexes- palmar grasp
persists
- interferes with grasp and release
Abnormal reflexes- tonic labyrinthine
persists
- supine: unable to bring hands to midline/mouth
- prone: unable to lift head and clear airway
- decreased activity where balance of flexors/extensors requires
Abnormal reflexes- positive supporting
persists
- sustained LE extension with pressure to ball of foot
- limits ability to take steps
- extensor posturing against footplates of w/c
Abnormal reflexes- Moro
persists
- stimulated when moving w/c into tilted position
- affects positioning if frequent startle response to noises
- affects power w/c driving and joystick control