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![ASSESSMENT TOOLS USED IN EARLY
INTERVENTION
• Inventories measure a child’s development in five domains:
gross motor, fine motor, language, comprehension, and
person-social. Items tap the better predictors of
developmental status only. A 300-item assessment-level
version may be useful in follow-up
• the Infant Development Inventory (IDI), 3 - 72 months;
• Early Child Development Inventory (ECDI) for 3-18 months;
• Preschool Development Inventory (PDI)] each with 60 yes-
no descriptions. ; 3660 months
Child
Development
Inventories (CDI)
• 12 – 96 months
• The 96 items use a combination of direct assessment,
observation, & parental interview.
• The BDIST taps a range of discrete domains including
receptive & expressive language, fine & gross motor,
adaptive, personal-social, & cognitive/academic.
Battelle
Developmental
Inventory
Screening Test
(BDIST)](https://image.slidesharecdn.com/occupationaltherapyinhighrisk-170525081143/85/Occupational-Therapy-in-high-risk-42-320.jpg)
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Occupational Therapy in high risk
- 1. OCCUPATIONAL THERAPY INTERVENTION OFHIGH RISK INFANT TILL SCHOOL AGE Neha Srivastava MOT (Pediatrics) Occupational Therapist
- 2. HIGH RISK INFANT Anyneonate, regardless of birth weight, size, or gestational age, who has a greater than average chance of morbidity or mortality, especially within the first 28 days of life. (Mosby's Medical Dictionary, 9th edition. © 2009, Elsevier.)
- 3. RISK FACTORS (PEDIATR CLINNORTH AM. 1993 JUN;40(3):479-90).NCBI BIOLOGICAL FACTORS ENVIORMENTAL FACTORS PRENATAL – Chromosomal disorder Congenital infection Congenital malformation Intrauterine growth retardation Maternal substance abuse Bad environment affect the cognitive development. PERINATAL- Premature baby (<37 weeks) Preterm baby(<38 weeks) Post term baby (>42 weeks) Birth asphyxia Caregiver-child interactions, family resources. POSTNATAL- Developmental delay Lung disease Meningitis Physical properties and organization. Within the area of caregiver-child interaction is parenting ability.
- 4. RISK FACTOR GUIDELINESACC TO NNF (NATIONAL NEONATAL FORUM) Highrisk Babies with <1000g birth weight and/or gestation <28 weeks Major morbidities such as chronic lung disease, intraventricular haemorrhage, and periventricular leucomalacia Perinatal asphyxia - Apgar score 3 or less at 5 min and/or HIE Surgical conditions like Diaphragmatic hernia, Tracheo-oesophageal fistula Small for date (<3rd centile) and large for date (>97th centile) Mechanical ventilation for more than 24 hours Persistent prolonged hypoglycaemia and hypocalcaemia Seizures
- 5. HIGHRISKCONT… Meningitis Shock requiring inotropic/vasopressorsupport Infants born to HIV-positive mothers Twin to twin transfusion Neonatal bilirubin encephalopathy Major malformations Inborn errors of metabolism / other genetic disorders Abnormal neurological examination at discharge
- 6. Babies with weight– 1000 g- 1500g or gestation < 33 weeks . Twins/triplets . Moderate Neonatal HIE Hypoglycaemia, Blood sugar<25 m/dl Neonatal sepsis Hyperbilirubinemia > 20mg/dL Hyperbilirubinemia > 20mg/dL or requirement of exchange transfusion Suboptimal home environment NATIONAL NEONATAL FORUM (NNF)
- 7. MILD RISK Preterm, Weight1500 g - 2500g HIE grade I Transient hypoglycaemia Suspect sepsis Neonatal jaundice needing PT IVH grade 1 NATIONAL NEONATAL FORUM (NNF)
- 8. PREDISPOSING FACTORS Pregnancybetween age of 15 to 19 years Elderly women Wrong dates Multiple pregnancy Fetal anomalies hereditary
- 9. PHYSIOLOGICAL CHALLENGES Respiratoryand cardiac Thermoregulation- Hypothermia(less than 36c) Hyperthermia(>38degree C) Digestive Renal
- 10. NEUROLOGICAL CONDITIONS HYPOXIC- ISCHAEMIC ENCEPHALOPA THY(HIE) PERIVENTRICULAR LEUKOMALACIA BRACHIAL PLEXUS INJURIES NEONATAL SEIZURES CEREBRAL PALSY CONGENITAL OBSTRUCTIVE HYDROCEPHALUS ERB’S PALSY Hand bookof neonatal intensive care(5th edition) st.louis: mosby (1976) neurology of newborn(4th edition)
- 11.
- 12. RESPIRATORY CONDITIONS RESPIRATORY DISTRESS SYNDROME APNOEA PNEUMONIA BRONCHOPULMO NARY DYSPLASIA (BPD) PULMONARY INSUFFUECIENCY OF THE PRETERM(PIP) TRANSIENT RESPIRATORY DISTRESSOF THE NEWBORN Aggarwal, David et al(2003) classification of acute respiratory disorders of all newborns in a tertiary care center . Journal of National Medical Association.
- 13. VISION AND HEARING CONDITIONS HEARING LOSS,AUDITORY PROCESSING DISORDER RETINOPATHYOF PREMATURITY (ROP) American academy of pediatrics, committee of environment health (1997) Mental retardation and developmental disabilities research reviews; volpe (2001)
- 14.
- 15. Congenital heart defects Atrial SEPTAL DEFECTS (ASD) TRICUSPID ATRESIA HYPOPLASTIC LEFT HEART TEROLOGY OFFALLOT (TOF) CYNOTIC CONGENITAL HEART DISEASE PATENT DUCTUS STENOSIS(P DA) American heart association(2001)
- 16. GOALS • Perinatal prevention •Evaluate and manage • Monitoring and Therapeutic modalities
- 17. CLINICAL MANIFESTATION • Absenceof vernix caseosa • Loose skin and little subcutaneous fat • Absence of lanugo • Abundant hair on the head and long nails • Skin is wrinkles • Cracked and peeling • Umbilical cord is thin
- 18. ASSESSMENT OF HIGHRISK INFANT • INITIAL ASSESSMENT • APGAR SCORE
- 20. EVALUATION OF HIGHRISK INFANT • Demographic data • History – Prenatal, Natal, Post natal • Medical history – Current status of infant Medical equipment used Feeding method and schedule Current medications Level of physiological homeostasis • Family history (e.g. socio economic and cultural factor and support system)
- 21. • Avoid duplicationof assessment items done simply to fill in the blanks on an evaluation form. • Time evaluation - Infant sleep cycle Feeding schedule Caregiving routine • On examination – Muscle tone Primitive Reflexes Active and passive movements Posture of the baby
- 22. ASSESSMENT AND INTERVENTIONOF HIGH RISK NICU EARLY INTERVENTION PRESCHOOL SCHOOL
- 23. NEONATAL INTENSIVE CAREUNIT (NICU)
- 24.
- 25. • Heidelise Als,PhD children's hospital Boston • It is based on synactive theory of development. Naturalistic observation of newborn behavior(NONB) (NIDCAP LEVEL 1) • Structured observation of specific behavior are repeated at 2 min intervals before, during and after routine caregiving. • Assessment of maturation and interplay of infant neurobehavioral sub system. Assessment of preterm infant behavior (APIB) (NIDCAP LEVEL 2)
- 26. Dev. child med2005 Feb;47(2):105-12. The Infant Behavioural Assessment and Intervention Program to support preterm infants after hospital discharge: a pilot study. (Koldewin etal) NICU NETWORK NEUROBEHAVIOURAL SCALE (NNS) (NNNS) examines JoVE, 2014 Age group-34 wk. -45wk range. neurobehavioral organization neurological reflexes motor development - active and passive tone, and signs of stress and withdrawal of the at-risk and drug-exposed infant.
- 27. NEUROLOGIC ASSESSMENT OF THE PRETERMAND FULL TERM NEWBORN INFANT • For preterm and term infants • Assess – functional status of infant ,nervous system by assessing habituation ,posture, muscle tone ,head control, spontaneous movements, abnormal arousal and alertness. NEONATAL NEUROLOGICAL EXAMINATION (NEONEURO) • Normal and abnormal term infants during first week of life only • More then 37 week of gestation. • Examines posture tone, reflexes and auditory /visual orientation to assess infants neurologic integrity NEUROBEHVIOURAL ASSESSMENT FOR PRETERM INFANTS (NAPI) • It for medically stable preterm in range 32 week to 42 week postconceptional age. • Assess neurobehavioral maturity of infant over time and to detect neurologically suspected performance • Areas- motor development and vigor, scarf sign, popliteous angle, alertness and orientation, irritability, vigor of crying and percentage of time spent sleeping.
- 28. INTERVENTION IN NICU SENSORYAND CAREGIVING MODIFICATION TACTILE STIMULUS(32wks GA)- KANGAROO MOTHER CARELIGHT STROKE MASAGE USE OF COTTON CLOTHING DURING FEEDING VESTIBULAR- SWADLE HOLDING POSITION ELEVATION OF HEAD SIDE APPROX 3O DEGREE AUDITORY- ENVIORMENTAL MODIFICATION CARE GIVING PRACTICES VISUAL SYSTEM-AVOID ABRUPT LIGHT MINIMIZE VISUAL STIMULATION DECREASE NICU LIGHT SYSTEM
- 29.
- 30. -The effects ofsupine and prone positions on oxygenation in premature infants undergoing mechanical ventilation Iranian Journal Nursing Midwifery Research. 2010 The mean of SPO2 in the prone position significantly was higher than in supine position. PRONE POSITION DEVELOPMENTAL ADVANTAGES Facilitates – Flexor tone Hand to mouth activity Active neck extension Coping with extra uterine enviourment Prevent abnormal hip contractures MEDICAL ADVANTAGES Improved oxygenation and better ventilation Reduced reflux Term and pre term sleeps more in prone position Decreased risk of aspiration
- 32. SUPINE POSITION DEVELOPMENTAL ADVANTAGES Improve visual explorationby infant. Facilitates midline position in hammock. Midline position to reduce lateral flattening of head. Encourage flexion(increased muscle tone). MEDICAL ADVANTAGES Easier access for medical care Supine position in hammock increase sleep time . Reducing the risk of SIDS(Sudden infant death) The Joanna Briggs Institute. Positioning of preterm infants for optimal physiological development 2010; 14(18):1-4 Symptomatic preterm infants with signs of respiratory distress, very low birth weight and severe gastroesophageal reflux may benefit from the prone position during sleep. Results says - Healthy preterm infants should be positioned supine during sleep while in the NICU.
- 33. SIDE LYING POSITION DEVELOPMENTAL ADVANTAGE Encouragemidline orientation. Promotes flexion adduction of extremity. Facilitate hand to mouth pattern for self calming. Facilitates hand to hand activity . MEDICAL ADVANTAGES Better oxygenation for infant with unilateral disease with good lung positioned uppermost This position can be used in to treat pulmonary emphysema
- 34. POSITIONIG EQUIPMENTS USEDBY OCCUPATIONAL THERAPIST DandleROO Dandle Pal -make brest feeding easier
- 35. OROMOTOR AND FEEDINGTECHNIQUES LACTATIONAL COUNSELING OROMOTOR STRENTHNING DEVELOP ORAL REFLEXES SUCK TRAINING American Occupational Therapy Association. (2004). Guidelines for supervision, roles, and responsibilities during the delivery of occupational therapy services. American Journal of Occupational Therapy,. Feeding problems in infancy and early childhood: Identification and management Debby Arts-Rodas RD and Diane Benoit, MD FRCPC(PubMed)
- 36. • Define asthe use of an interactive helping process to assist in maintenance of successful breast feeding by the help of adaptive device and assistive devices. LACTATIONAL COUNSELING • Strength, Coordination , Range of motion , sensitivity • Milk leaking from the mouth • Weak suck • Insufficient milk supply • Nipple pain/soreness • Improper positioning (mother and child). • Oral aversion(tubing) OROMOTOR COMPONENT • Rooting reflex , sucking reflex • swallowing reflexes-*Biting reflex • *Gag reflex • *Coughing reflex DEVELOP ORAL REFLEXES
- 38. SUCK TRAINING FORINFANT NON NURITIVE SUCKING(NNS) • Development • 27-28 wk – single suck with long variable pause. • 30-33 wk more regular pause • .34 wk – swallowing after 6-8 sucks • Rate pattern- 2 suck/sec • Stimulus – sleep as in Spontaneous mouthing movements . • Suck Swallow breath ration-at least 6-8 NNS sucks to prior to swallow. NUTRITIVE SUCKING(NS) • Development • Occur in utero after first trimester • Suck swallow breath coordination at early 32 wks • Rate pattern-1 suck/sec • stimulus – liquid obtainable from liquid . • Suck swallow breath ration:- 1:1:1
- 40. • Follow UpSchedule (AIIMS) Birth weight less than 1800g or GA >32 After 3-7 days of discharge Every 2 weeks of discharge until 3kg 6,10,14 age of post natal age 2 weeks after discharge Other conditions
- 41. EARLY INTERVENTION THERAPY Reviewof literature • Early intervention is a system of coordinated services that promotes the child's age-appropriate growth and development and supports families during the critical early years. • Early Childhood Intervention is not limited to children with these disabilities. • Persistent Effects of Early Childhood Education on High-Risk Children and Their Mothers Craig T. Ramey University of Alabama at Birmingham Frances A. Campbell et al University of North Carolina at Chapel Hill Sharon L. Ramey University of Alabama at Birmingham
- 42. ASSESSMENT TOOLS USEDIN EARLY INTERVENTION • Inventories measure a child’s development in five domains: gross motor, fine motor, language, comprehension, and person-social. Items tap the better predictors of developmental status only. A 300-item assessment-level version may be useful in follow-up • the Infant Development Inventory (IDI), 3 - 72 months; • Early Child Development Inventory (ECDI) for 3-18 months; • Preschool Development Inventory (PDI)] each with 60 yes- no descriptions. ; 3660 months Child Development Inventories (CDI) • 12 – 96 months • The 96 items use a combination of direct assessment, observation, & parental interview. • The BDIST taps a range of discrete domains including receptive & expressive language, fine & gross motor, adaptive, personal-social, & cognitive/academic. Battelle Developmental Inventory Screening Test (BDIST)
- 43. Bayley Infant Neurodevelopmental Screener (BINS) •AGE GROUP-3 - 24 months • The sets contain 11 to 13 items. • The four conceptual areas of ability assessed by the BINS are basic neurological functions/intactness; receptive functions; expressive functions; & cognitive process Denver Developmental Screening Test II (DDST-II) • AGE GROUP-1 month to 6 years of age • Children's development in four areas of functioning: fine motor-adaptive, gross motor, personal-social, and language skills Early Childhood Inventory-4 (ECI4) • AGE GROUP-3 to 5 years • screens for emotional and behavioural disorders in children. • ,except that they do not cover schizophrenia but add reactive attachment disorder, selective mutism, and eating, sleeping, and elimination problem Developmental Screening and Assessment Instruments with an Emphasis on Social and Emotional Development for Young Children Ages Birth through Five Compiled by Sharon Ringwalt May 2008
- 44. Early Intervention services Sensory motor Self-help skills Postural developmen t Mental health counsellingfor children, parents, and familiesMental health counselling for children, parents, and families Assisting technology devices and services Therapeutic early childhood classrooms Adaptive behaviour and play "Predicting the Future of Premature Babies, Testing Previews Future Learning Problems." Vol.29, No. 14 -- Research -- On Campus, OSU's Newspaper for Faculty and Staff. Retrieved July 24, 2016. http://oncampus.osu.edu/v29n14/research.html.
- 45. EARLY INTERVENTION STRATEGIES Encourage Exploration Guide and limit behavior Communicate richlyand responsibly Protect from inappropriate punishing Rehearse and extent new skill Celebrate developmental advantage Mentor in basic skill These 7 stages were given by Ramey and Ramey in 2004 Craig T. Ramey and Sharon L. Ramey “Early Learning and School Readiness: Can Early Intervention Make a Difference? Merrill Palmer, (2004), 471-491
- 46. CASE STUDY • NAME-B/O MAMTA • -18 DAY / MALE / 2.5Kg PRESENTING COMPLAIN • SWELLING AT RIGHT SIDE OF THE NECK 5-6 DAYS • UNABLE TO TURN NECK RIGHT SIDE CHILD HISTORY • Child was FTNVD , HOME DELIEVERY • CRIED IMMIGIATELY AFTER BIRTH • H/O JAUNDICE AT DAY 3 OF THE CHILD ADMITTED TO SAFDARJUNG HOSPITAL FOR PHOTHERAPY FOR 2 DAYS. • MOTHER NOTICED SWELLING AT RIGHT SIDE OF THE NECK AFTER 6-7 OF BIRTH. • NO H/O OF SIMILAR COMPLAIN IN ANY OTHER FAMILY MEMBERS
- 47. ON EXAMINATION • SWELLINGIS VISIBLE ON RIGHT SIDE OF THE NECK THE HARD SWELLING WAS PALPABLE UNDER STERNOCLEIDOMASTOID MUSCLE. • IT IS FOUND THAT RIGHT STERNOCLEIDOMASTOID MUSCLE IS TIGHT. • BABY PERSISTANTALY TURN HIS HEAD TOWARD LEFT SIDE DURING EXAMINATION INVESTIGATION USG –THYROID WAS DONE ON 17/6/2106 AT THE AGE OF DAY 15. THERE WAS THICKENING OF MUSCLE BELLY OF RIGHT SIDE OF STM APPROX 2.2*1.8*1.2 cm WITHOUT ANY ABVIOUS INTRINSIC COLLECTION-SUGGESTIVE OF MUSCLE HYPERTROPHY /PSEUDO TUMOR. USG – SKULL (CRANIAL) - 17/06/2016 THERE WAS NO SUGGESTIVE ABNORMALITY SEEN.
- 48. OCCUPATIONAL THERAPY TREATMENT • Neckprom exercises – flexion extention lateral flexion both side Turning of neck both side ( 5 times each movement ) • positioning explained • light circular movement on the tumour- tds After 1.5 month • Mild stretching of STM muscle was started . • home programme was explained to the mother Child was called on regular OPD for the session of occupational therapy initially for 3 times in a week after 2 months sessions were reduced to 2 times in a week ,and now patient is called for follow up once in a week .
- 49. PROGRESS REPORT • Childhas shown remakable improvement • treatment was continued for 3 and half month started from ( 17 june 2016 to 15/9/2016) • Total no of session -17 were taken during this period . • neck holding improved • Neck rom improved, • Very small amount of visiblity of the fibrous mass.
- 50.
- 51. FOLLOW UP PLAN •Patient will be kept under follow up till the age of 7-8 months . • Repeat usg will be advised in paediatric OPD. • Patient called for follow up twice in a month .
- 52. PRESCHOOL AND SCHOOLSYSTEM OCCPATIONAL THERAPY Types of schools Charter schools SPECIAL SCHOOLS VOCATIONAL SCHOOLS ALTERNATI VE SCHOOLS INCLUSIVE SCHOOL
- 53. SCHOOL SYSTEM WORKON IDEA(INDIVIDUAL WITH DISABILITY ACT) 1. Free appropriate public education (FAPE) 2. Least restrictive environment (LRE) 3. APPROPRIATE EVALUATION 4. Individualized Education Programe (IEP) 5. Parent and student participation in decision making 6. Procedural safeguards
- 54. ASSESSMENT OF PERFORMANCE MOTOR PERFORMANCE Peabodydevelopmental motor scales Bruininks-oseterky test of motor performance Development of visual motor integration Sensory responsiveness Sensory profile(Dunn1999) Sensory integration inventory-revised for developmental disabilities Developmental Screening and Assessment Instruments with an Emphasis on Social and Emotional Development for Young Children Ages Birth through Five Compiled by Sharon Ringwalt May 2008
- 55. Assessment of Performance cont.. Perceptualprocessing Motor free performance visualperformance(MVPT)( 2002) Developmental test of visual performance(DTVP- II) (PEARSON) Psychosocial cognitive abilities School environment SFAActivity scale rate behavior and cognition using 10 scale. Behavior evaluation scale - 2(Mccarney 1990) Child behavior checklist (!991) Developmental Screening and Assessment Instruments with an Emphasis on Social and Emotional Development for Young Children Ages Birth through Five Compiled by Sharon Ringwalt May 2008
- 56. OCUUPATIONAL THERAPY ACTIVITIESIN PRESCHOOL AND SCHOOL FINEMOTORACTIVITIES Strenthning- clay, Thera band, roll and taffy Magnet peg boards Visual motor and eye hand co-ordinatio- Cut shapes Lite bites Use hammer and nails Manipulation skills Place stickers Transfer beats and coins keyboards ( Adapted from fine/motor activities and developed by school therapist. Deana (2004)
- 57. • AMUNDSON,S(1999) TRICKSFOR WRITTEN COMMUNICATION ,HOMER PRE REFFERAL FORM: INTERVENTION STRATEGIES(2004) ACTIVITIES FOR WRITING IMPROVE POSTURE- THERAPY BALL SIT UPS SIT AND MOVE GRASPING PATTERNS- STRINGING BEADS PEG BOARDS SPONGE BALL LACING TRIPOD GRASP PEG BOARDS TWEEZER GAMES MODIFIED PENCIL GRIPS COLOR CODER TO IMPROVE LETTER FORMS DOT TO DOT JOINING USE PAPER WITH RAISD LINES USE PAPERS WITH DIFFERENT COLORS
- 61. REFERENCES • Hand bookof neonatal intensive care(5th edition) st.louis : mosby (1976) • neurology of newborn(4th edition) • American academy of pediatrics, committee of environment health (1997) • Mental retardation and developmental disabilities research reviews; volpe (2001) • American heart association(2001) • The Infant Behavioural Assessment and Intervention Program to support preterm infants after hospital discharge: a pilot study. • American Occupational Therapy Association. (2004). Guidelines for supervision, roles, and responsibilities during the delivery of occupational therapy services. American Journal of Occupational Therapy,. • Feeding problems in infancy and early childhood: Identification • Amundson,S(1999) tricks for written communication ,Homer Pre referral form: intervention strategies(2004) • ( Adapted from fine/motor activities and developed by school therapist. Deana (2004)