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

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

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

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

Other knowledge…

Diagnostic issues (CP, muscular dystrophies, CVA, etc.)

Anatomy and physiology Kinesiology Effects of tone on movement

Rate Force Timing Control

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

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

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...

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.

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

MOBILITY How does it happen?

Muscle contraction Agonist, antagonist Rate, timing,

sequencing Beginning, middle

and end ranges of movement

Use of supporting surfaces…

Motivation!

MOBILITY

What does it look like? Transitions

prone prone on elbows sidelying sidesitting kneeling half - kneeling standing walking

MOBILITY

What does it look like? Reach Grasp/Release

Power (palmar) Use of fingers Controlled

release

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

MOBILITY

What does it look like? In-hand manipulation

Translation (in and out of palm, with fingers)

Rotation Shift

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)