Early Interventions for Pediatric Occupational and Physical Therapy: Introduction (10:39)

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Certified physical therapist and professor, Venita Lovelace-Chandler, introduces her educational, career, and research background. Lecture objectives include providing evidence-based best practices for different pediatric diagnoses, current trends, the impact the importance of early intervention, and demonstrate protocols.

Evidence-Based Practice (18:27)

Dallas Medicaid created a policy that it would deny every initial evaluation; attach current articles to an appeal to provide justification for treatment. Peer-reviewed publications exceed 20,000 articles per year making best practice difficult to maintain. Occupational therapy literature focuses on a wise practice which allows for modification of practice depending on unique clinical situations.

Infant Survival and Long Term Complications (09:06)

Modern technology and medical advancement of early intervention improve survival rates; yet, these interventions could lead to complications later in life, including GERD, esophageal cancer, and post-polio syndrome.

Common Cases (27:29)

While incidents of cerebral syndrome have decreased, children diagnosed with Down syndrome have increased. 100% of children born with cardiac complications have impaired motor functioning later in life. New diagnoses include autism spectrum disorder, cognitive impairment, development coordination disorder, sensory disorder, plagiocephaly, and torticollis.

NICU: Direct Interventions (04:34)

Early intervention in the NICU should focus on supporting families, enhance attachment and bonding, and promote the neurobehavioral and physiological organization of the infant's system. Direct interventions to improve movement and postural control include alignment, head position, support for feeding, maintaining health and wellness, and behavioral stability.

NICU: Infant Pain Management (19:06)

Premature infants have increased sensitivity to pain due to the imbalance of nerve track myelination. Newborns whose mothers who are consistently stressed during pregnancy appear to have an increased rate of being diagnosed with Autism Spectrum Disorder; physical pain precedes self-injurious behaviors. The literature on best practice for young children says practitioners should avoid pain, provide family-centered care, participatory activities, use clinical guidelines, and implement standardized testing.

Clinical Guidelines (07:34)

The American Physical Therapy Association published best practice guidelines for torticollis, plagiocephaly, and other pediatric disorders. Insurance companies rely on "The Physical Therapists Guide to Practice" to approve or deny claims. In order to obtain motor advancement physical therapists need to meet with their patients at least twice a week.

Journals and Research Publications (28:30)

The Journal of American Occupational Therapy Association devotes a portion of each issue to pediatrics and provides fact sheets for diagnoses on their website; PT now publishes the latest guidelines. Many expensive journals make articles over a year old free for clinicians. Texas allows PT and OTs to obtain CCUs for reading and summarizing articles.

Questions (06:16)

Developmental delay is an acceptable diagnosis with few clinical guidelines for assessment and treatment. Hypotonia is another common diagnosis that is only a sign or symptom of another disorder. 1% of children with torticollis suffer from brain pathology issues; purring is soothing to babies.

Lab: Infant Positioning (13:44)

Reflex Inhibiting Positions made children deformed in an alternative manner. Participants divide into partners and discuss how to promote an important position in a baby.

Lab: Infant Positioning Summary (21:29)

Best practice methods related to positioning infants with hypotonia include prone position for respiration, baby wearing, hand arch, and standing up. Weight-bearing exercises, infant sleeping positions, and quality of movement help a child to develop properly. Head control, upright mobility, and sitting control comprise goals for early intervention.

Infant Positioning Discussion (21:31)

Current Literature reflects that spending time on interim skills such as crawling, rolling, and creeping is not effective because the children will not be able to participate in society; conference participants argue against the findings. Head control, upright mobility, and sitting control comprise goals for early intervention. Cognitive, social, and personal goals are as important as motor control and mobility.

Goal Development and Infant Positioning (06:30)

The quality of body alignment is essential therapy to provide the best long-term outcomes. Conference participants explore essential positioning, establishing realistic goals, and how to navigate current treatment trends for early intervention.

Low-Tone Treatments (18:11)

Critical goals for low-tone children include getting the child upright, weight bearing, and head control as soon as possible. Motor control theory focuses on the mechanisms essential to movement including various types of muscle contractions. Contractions are isometric, concentric, or eccentric.

Skill Development and Society (22:05)

A video clip demonstrates motor deficits associated with developmental delay. Motor control theory involves muscle strength development, repetition, and skill development. Complexity of task develops skills that translate across environments and improve function across disciplines.

Down Syndrome (16:36)

Physical therapists want patients afflicted with Down syndrome to be classified by clinical presentation instead of by severity. Imaging can show the exact spot of deficit in patients with cerebral palsy. Kathy Martin provided guidelines for screening, assessment tools, prognosis, and interventions on the PTNow website.

Importance of Exercise for Children (18:17)

Kinesthesiologists have a growing interest in treating ADHD. Children with CP need to be strengthened; research has not resolved exercise and strengthening techniques in patients who suffer from Muscular Dystrophy. The Cincinnati Children's Hospital advocates a blend of constraint-induced and bimanual training to obtain best outcome and provides documents on best evidence statements for specific disorders.

Other Resources and Findings (27:38)

Organizations that publish journals include Pediatric Physical Therapy, The APTA, Journal of the American Occupational Therapy, Physical and Occupational Therapy Journal, Pediatrics, and Physiotherapy Theory and Practice. Yasser Salem recently did some pioneering work on Spinal Muscular Atrophy. Meta-analysis compiles multiple research studies to develop a single conclusion that has greater statistical power.

Lab: Best Practices (14:34)

Audience members discuss best practices for weight bearing, isometric contractions, tumble form wedges, Bumbo seats, head control, and prone activity. Visual tracking is important for child development. Add a novel stimulus to help children maintain interest during sessions; independent walking requires control over the pelvic girdle.

Lab: Treadmill Walking and Walkers (11:43)

Pediatric treadmills need to be specifically designed and are unpractical. Lovelace-Chandler simulates treadmill walking with a toddler. Walkers can cause concussive incidents; audience members suggest taking out the seat our or using a hula hoop.

Reverse Tailor Sitting (07:47)

W sitting is caused by a pelvic rotation problem; ask teachers to provide a small bench for a child who will not sit normally. Ensure the baby is performing the active movement.

Current Trends (14:48)

Neuro-Developmental treatment helps a child perform the same events as the rest of their family. Special populations are being bullied in school. The Austin school district decided to treat patients with mild impairments more frequently than those afflicted with severe issues.

Outcomes (09:56)

Outcome measures include participation, family satisfaction, clinical, productivity, and populations. Pain thwarts healing and learning. American Association of Pediatrics, healthychildren. org, pub med, APTA, and the CDC have good informational websites for PTs and OTs.