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)