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CS 625: Final Exam Paper

Words: 1654, Paragraphs: 76, Pages: 6

Paper type: Essay , Subject: Mental Retardation

Skeletal System
Includes bones and the tissues that connect them (tendons, ligaments, and cartilage).
3 Functions of the Skeletal System
1. Support (gives us shape)
2. Protection of internal organs/fragile tissues
3. Movement (allows attachment of muscles to tendons)
Shoulder
Includes: Humerus
Clavicle
Scapula
“W” sitting
*Children resort to “W” sitting b/c it offers a huge, wide base of support.

*”W” sitting can lead to:
Hip dislocation
Over-stretching the knee
Lack of ability to use the trunk

Skeletal System: Baby vs. Adult
300 bones as a baby.

206 bones as an adult.

Smaller bones fuse together to form larger ones.

Gross Anatomy
Inlcudes the Skeletal and Muscular systems.
Muscular System
639 Muscles in the human body.

3 Types of Muscles:
Skeletal
Smooth (intestines)
Cardiac (autonomous)

3 Functions of the Muscular System
1. Provides movement of the body through strength.
2. Maintains posture.
3. Circulates blood throughout the body.
Front (of body) Muscles
Flexors
Back (of body) Muscles
Extensors
Sternocleidomastoid
*Responsible for lateral neck flexion.

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*Associated with torticollis, it’s like a rubber band.

*Wry Neck = old term for torticollis.

Shoulder Muscles
Deltoids (referred to as “guns”)
Abdominal Muscles
*Rectus Abdominus (runs down center of abdomen).

*Obliques (on either side of the rectus abdominus).

Back Muscles
Back muscles have several points of attachment:

Vertebrae
Skull
Arms
Legs
Pelvis

Upper Leg Muscles
Quadriceps: Responsible for knee extension (front of upper leg).

Hamstrings: Responsible for knee flexion and hyperextension (back of upper leg).
**The hamstring is one of the tightest muscles, and this can lead to “W”sitting, or leaning back in a long sit.

Plantar Flexion
Toe Walking
Dorsiflexion
Heel Walking
Development in Utero
Occurs from caudal (tail) to cephalic (head).
Development from Birth and On
Cephalic (head) to Caudal (tail)

Proximal (most center point) to Distal (farthest from center).

Gross (large muscles) to Fine (small muscles).

Simple to Complex.

Grasping Progression
Ulnar (pinky side of hand) to Radial (thumb side of hand).

Wrists go from Flexed to Straight to Extended.

Grasping: Natal
No voluntary grasp.

No visual attention = No attempt to grasp.

Reflexive only.

Grasping: 3 Months
Sustained voluntary grasp on Ulnar side of hand.
Grasping: 4 Months
Primitive Squeeze Grasp

Pulling objects to the body/no use of thumb.

Grasping: 5-6 Months
Palmar Grasp

Held with fingers and adducted thumb.

Grasping: 7 Months
Radial Palmar Grasp

Held with fingers and opposed thumb.

Grasping: 8 Months
Radial Digital Grasp

Held with opposed thumb and fingertips.

Grasping: 9 Months
Radial Digital Grasp

Wrists Extended

Grasping: 10 Months
3-Jaw Chuck

Object held with thumb and 2 fingers.

Scissor and Pincer Grasps
Scissor: Side of thumb

Pincer: Thumb and index finger

Scissor grasp occurs BEFORE Pincer grasp.

Play Positions: Supine
*Allows child to reach above
*Provides stability of trunk and arms/works the trunk
*Allows for play against gravity
*Develops control of anterior (front) muscles
Play Positions: Prone
*Works on head and shoulder control
*Allows for spinal extension against gravity
*Provides pelvic stability
*Helps develop posterior (back) muscles
Play Positions: Side-Lying
*Works on unilateral movement
*Gravity-assisted position – gravity brings arms and legs together at midline
*Strengthens bilateral hand skills

**Piece of equipment called a “Side-Lyer” used for students with CP/hypertonic muscles.

Play Positions: Sitting
*Provides opportunity to combine sensory input from visual, auditory, tactile and motor control against gravity.
Play Positions: Standing
*Upright Position
*Allows for experiencing body weight and tactile/proprioceptive input through feet.
Tactile
Your TOUCH system.
Vestibular
Your MOVEMENT system. Responsible for your equilibrium.
Proprioceptive
*Built into large muscles and tendons.

*Gives you feedback about your body.

*Sometimes called “Deep Pressure” system.

Motor Planning
Conceiving, planning, and executing a new motor task.
Visual Motor Skills
*Tracking
*Hand-Eye Coordination
Visual Perceptual Skills
Visual discrimination, spatial awareness.

“Where’s Waldo?” – visual figure ground (important pre-requisite for writing).

Occupational Therapy: What is looked at/worked on?
*Trunk control
*Head control
*Various play positions
*Maintaining positions
*Reaching and grasping
*Crossing midline (playing around with both hands)
*Fine motor skills
*Bilateral integration
*Motor planning
LIfting a Child
*Never hold your breath while lifting.

*Always support the head.

*Provide support around the trunk/waist.

Tone vs. Strength
Tone and strength are NOT interchangeable terms.
Tone
A muscle set.
Muscle is just fiber.
Tone is a matter of how these fibers are lined up.

Little space between fibers = Hypertonia
Lots of space between fibers = Hypotonia

Low Tone
Hypotonia

*Flaccid (fibers set far apart from each other).
*Takes more energy to move the fibers than normal.
*Limited strength & endurance.
*Difficulty sustaining posture.
*Head-lag in pull-to-sit.
*Difficulty initiating weight shifts in any position.
*Delay in trunk-righting.
*Inconsistent protective responses.

High Tone
Hypertonia

Underlying high tone usually = muscular weakness.

Cerebral Palsy (CP) = Classic high tone/underlying weakness.

First tell-tale sign of low tone (hypotonia)
Wide base of support.

This is the FIRST COMPENSATION for low tone.

Atypical Movements
1. Lack variety and variability (stuck in a pattern of motion)
2. Lack of core control (leads to stiffness)
3. Take up a lot of real estate (wide base of support)
4. Doughy feel (when touching muscles)
5. Unable to keep up with peers
6. Always look at ENERGY LEVEL, ENDURANCE, & PERSISTENCE!
3 Sensory Systems
1. Touch/Tactile
2. Vestibular
3. Proprioceptive
Somatosensory Receptors
Provide body-oriented sensory input and perception, and include the tactile/touch, vestibular, & proprioceptive systems.
Tactile/Touch System
*Largest sensory system…the skin is the body’s largest receptor.
*First sensory system to develop in utero & most mature at birth.
*Most newborn reflexes are elicited by tactile stimuli.
*The functions of the tactile system are PROTECTION & DISCRIMINATION.
Vestibular System (Movement System)
*One of the first systems to become functional, and is mature in the full-term neonate.
*Composed of 3 structures in the inner ear:

1. Semicircular Canals – register speed, force, & direction of head rotation.
2 &3. Saccule and Utricle – sensitive to the force of gravity.

The Vestibular System contributes to:
*Regulation of muscle tone and coordination.
*Balance & equillibrium.
*Ocular-motor control (eyeball).
*Arousal and attending level.
*Emotional state.

**SCARIEST system for a teacher to tackle**

Proprioceptive System (Deep Pressure System)
Receptors in the muscles, tendons, & joints that provide the perception of movement and the position of body in space.

*Orientation of the body in space and the relation of body parts to each other.
*Rate and timing of movements.
*Force exerted by muscles.
*How much & how fast a muscle is stretched.

**Involved in MOTOR PLANNING (conceiving, planning, & executing a new motor task).

***EASIEST system for a teacher to address and provide input for***

Sensory Threshold
The point at which the summed sensory input activates the central nervous system (Registration).

Each sensory stimulus is cumulative in that it is added to the sensation that came before it.

It is the COMBINED SENSORY INFORMATION that is processed.

Hyporesponsive (Under-responsive)
NEED MORE INPUT to reach the threshold to be processed.
Hyperresponsive (Over-Responsive)
NEED LESS INPUT to reach the threshold to be processed.
Sensory Defensiveness
Over-activation of protective senses.

What can be seen:
*Tactile Defensiveness
*Oral Defensiveness
*Gravitational Insecurity
*Postural Insecurity
*Visual Defensiveness
*Auditory Defensiveness
*Unusual Sensitivities to taste and/or smell

Levels of severity can be mild, moderate, or severe.

Sensory Diet
Objective is to help the child feel calm, alert, and organized for most of the day using special activities (sensory input) that are SCHEDULED throughout the day.
Arousal
A state of the nervous system describing how ALERT one feels.
Self-Regulation
The ability to attain, maintain, and change arousal appropriately for a task or situation.
Problems with Sensory Modulation
Symptoms usually appear in infancy or early childhood.

Overarousal, Underarousal, Shutdown, Fluctuating Arousal.

Essentially a problem of chemistry in the brainstem.

Problems with Sensory Registration
Symptoms usually appear in infancy or early childhood.

Over-registration, Under-registration, Delayed registration (processing time), Lack of sustained effect, Impaired discrimination of specific sensations.

Essentially a problem of neural chemistry.

Problems with Sensory Integration
Symptoms usually appear in infancy or early childhood.

The ability of the central nervous system (CNS) to organize and process input from different sensory channels in order to make an adaptive response.

Multichannel intake.

Requires ACTIVE PARTICIPATION & ADAPTIVE RESPONSES.

Conditions commonly associated with Sensory Processing Problems
*Autism and other Pervasive Developmental Disorders
*ADD/ADHD
*Learning disabilities
*Severe and Profound Mental Retardation (Intellectual Disability)
*Process Schizophrenia
Linear Motion
Back and forth, or side to side.

Rhythmical.

Linear Motion is CALMING.

Rotary Motion
Spinning, mixing back/forth-side/side movements.

Arrhythmical.

Rotary Motion is AROUSING! Should only be done by or in the presence of an OT.

Adaptive Equipment
Any adaptation made to existing equipment, or special equipment used for the needs of the child to participate in daily activities to the fullest extent and also for the completion of ADL’s (Activities of Daily Living).
First Goal of Adaptive Equipment
SAFETY!
Second Goal of Adaptive Equipment
LEAST RESTRICTIVE!

Adaptive equipment is only used for the child’s physical needs, not to curb behaviors.

ADAPTIVE EQUIPMENT

Infant Postioner: Supine

*Midline organization
*Gives proprioceptive input
ADAPTIVE EQUIPMENT

Infant Positioner: Prone

*Head-righting
*Weight-bearing through arms
*Works on strengthening back muscles
ADAPTIVE EQUPMENT

Bracing: AFO’s

*Ankle-Foot Orthotics
*Comes up toward the knee
*CLASSROOM TEACHER IS RESPONSIBLE to put on, remove, and do skin checks.
*Do NOT put back on if there is skin redness that doesn’t go away fairly quickly.
*Child needs alternate pair of sneakers without insoles removed incase braces can not be put back on.
ADAPTIVE EQUIPMENT

Bracing: SMO’s

*Supra-Malleolar Orthotics
*Worn when ankles turn in (pronation)
*Micro-trauma to the joint can occur when walking in a pronated position.
*Generally go to just above the ankle.
ADAPTIVE EQUIPMENT

Canes/Crutches

*Quad Canes (4 prongs)
*Loftstrand crutches
*Forearm crutches
ADAPTIVE EQUIPMENT

Walkers

*Anterior Rolling (in front/push)
*Posterior Rolling (behind/pull)
*Walker with loftstrand attachments
ADAPTIVE EQUIPMENT

Gait Trainers

*For children who are not quite ready to weight bear on their legs and feet, but who need to begin working in an upright position.
ADAPTIVE EQUIPMENT

Stander: Prone

*Weight-bearing
*Range of motion
*Standing, but leaning on the belly (table or tray)
ADAPTIVE EQUIPMENT

Stander: Supine

*Head & upper trunk control
*Flexion
ADAPTIVE EQUIPMENT

Seating Systems: Corner Chair

*Provides midline organization
*Shoulders rounded, arms & hands and midline
ADAPTIVE EQUIPMENT

Seating Systems: Rifton Chair

*90?at hips, 90? at knees, feet in contact with foot pads.
ADAPTIVE EQUIPMENT

Seating Systems: Convaid Cruisair

*Used for transporting…children who are not mobile CANNOT be carried around in school settings.
*Simple umbrella stroller can be used in preschool settings
ADAPTIVE EQUIPMENT

Other Seating Systems

*Booster seat
*Bath chair
*Adapted stroller
*Power Tiger (electric wheelchair)
*Astrotilt wheelchair
ADAPTIVE EQUIPMENT

Tricycles

*Seat with back
*Strap to secure foot to pedals
*Handle on back to guide child
ADAPTIVE EQUIPMENT

Toys

*Switches
*Handles
*Knobs

**Adaptations can be incredibly simple**

ADAPTIVE EQUIPMENT

Communication Devices

*Dynavox
*iPad
*Touch-To-Talk
*PECS

**Some devices can be controlled through eye-gaze**

ADAPTIVE EQUIPMENT

Other Reasons for Adaptations

*Feeding (no-slip bowls with high back, wrap-around spoon, etc.)

*Cutting (loop scissors, self-opening scissors, push-down/tabletop scissors

About the author

This academic paper is composed by Samuel. He studies Biological Sciences at Ohio State University. All the content of this work reflects his personal knowledge about CS 625: Final Exam and can be used only as a source for writing a similar paper.

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