Introduction to Pediatric

Evaluation and Intervention

Part 1
 Evaluation
Process of obtaining and interpreting
data necessary for intervention
 Evaluation Process
4. Analysis of occupational
1. Referral
performance

2. Development of 5. Development of
occupational profile recommendations

3. Administration of 6. Documentation of
evaluation evaluation results and
recommendations
 Evaluation Methods
Standardized Ecological
Skilled Observation
Assessments Assessments
“Ability to observe keenly
Provides information about
Norm-referenced and and to record accurately
the child’s performance
criterion-referenced measures children’s behavior in an
contexts
objective manner”

Interviews Inventories and Scales

Gathers data on child
Provides a more
development, and interaction of
comprehensive view of the
the child with caregiver and the
child.
environment
Behavior Strategies for Testing
• Be prepared so you can focus on the
behavior and performance of the
child.
• Be sensitive to the emotional needs
of the child and the parents.
• Be purposeful in carrying out the
evaluation.
• Be sure the evaluation site supports
the child’s optimal performance.
Behavior Strategies for Testing
• Build rapport and follow the child’s lead.
• Use positive reinforcement focusing on the child’s effort.
• Begin and end with easy tasks.
• Be clear and concise with your instructions.
• Be organized and keep materials accessible to you but not the
child.
• Try to develop reciprocal interactions with the child and let
the him explore the material before giving instructions.
 Functional Assessment of
Performance Skills and Client Factors
in Pediatrics
 Sensorimotor Development

• Gross motor skills

Prone
Supine Sitting
Rolling Standing
Crawling Cruising
Creeping Walking
 Sensorimotor Development
• Do take note of head control, trunk control, and pelvic
control
• Observe for ease or difficulty during transitions
• Observe gait pattern
• Document if they are age-appropriate or not. Support with a
narrative.
 Sensorimotor Development
Advanced gross motor skills
• Running
• Jumping
• Hopping
• Skipping
• Galloping
• Kicking
• Throwing
• Catching
• Stair Climbing
 Sensorimotor Development
Sitting Balance (short or long sitting)
Normal (4) 3 minutes, adjust position when balance is disturbed or during dynamic
movements by the use of equilibrium reactions

Good (3) 2 minutes, adjust position

Fair (2) 1 min, unable to adjust position without falling; can reach for object
dynamically only by maintaining balance c opposite extremity
Poor (1) unable to maintain sitting, maintain sitting balance using hands to prop
self

Zero (0) flaccid, requires maximal assistance

 Sensorimotor Development
Kneeling and Standing Balance
0 Absent
1 Can assume or maintain
2 Can assume and maintain
3 Can assume, maintain and weight shift
4 Can assume, maintain, weight shift and be challenged
 Sensorimotor Development
Tolerance (with or without assistance)
POOR 0-5 minutes

FAIR 6-10 minutes

GOOD 11-15 minutes

 Sensorimotor Development
An OT should check for the following:
• Reaching
• Grasping
• Gross prehension patterns (hook, spherical, cylindrical)
• Fine prehension patterns (three-jaw chuck, lateral pinch,
pad to pad, tip to tip)
• Carrying
• Releasing
• In-hand manipulation skills
 Sensorimotor Development
An OT should check for the following:
• Pre-writing skills (interest / tool grasp / tracing – imitating
– copying)
• Scissors use skills
 Sensorimotor Development
GRADE JUSTIFICATION
G Can assume, maintain, AND use
F Can assume AND maintain BUT cannot / has
difficulty in use
P Can assume OR maintain, BUT with difficulty /
needs assistance
A Cannot assume or maintain
 Sensorimotor Development
An OT should check for the following:
• Range of motion
• Functional strength (UE / LE)
• Muscle bulk
• Muscle tone
• Functional grip strength
• Functional pinch strength
• Other physical findings (eyes, extremities, posture, gait,
symmetry, drooling, cortical thumb, scars, wounds, leg
length discrepancy, splints, dislocation, subluxation)
 Sensorimotor Development
An OT should check for the following:
• Visual threat, visual tracking, visual localization
• Auditory tracking, auditory localization
• Response to light touch, deep pressure, pain
• Kinesthesia, R/L discrimination, position in space, spatial
relations, figure ground, stereognosis, form constancy
• Visual perceptual skills
• Discuss the stimuli and response (intact or impaired)
Cognitive
Development
 Cognitive Development
An OT should check for the following:
• Matching – sorting – recognizing – identifying (letters,
numerals, shapes, colors, objects, animals, body parts,
etc.)
• Usage of common objects
• Following instructions (verbal / written) (quantifiers /
qualifiers) (number of steps) (given an example) (+/-
/limited)
• Imitation skills (good/poor/delayed
 Cognitive Development
An OT should check for the following:
• Reading – comprehension
• Writing (alphabet / numerals – near-point – far-point –
transition – dictation – composition)
• Arithmetic
Speech and Language
Development
 Speech and Language Development
An OT should check for the following:
• Functional communication (decode, comment, indicate
needs)
• Pragmatics
Psychosocial
Development
 Psychosocial Development
An OT should check for the following:
• Response to name calling
• Eye contact (meaningful / sustain / consistent)
• Separation anxiety / stranger anxiety
• Compliance to authority figures
• Interaction with peers
• Social skills (social greetings, agreeing, disagreeing,
asking, borrowing, sharing, initiating – maintaining –
terminating conversation, turn-taking, customary
utterances)
 Standardized Assessment of
Performance Skills and Client Factors
 Standardized Tests
• Assumed to have undergone a rigorous development process
and are administered and scored in a prescribed manner
• Provide precise measurements of a child’s performance in
specific areas, and this performance is described as a
standard score
 Bottom-Up Assessment
• Frequently administered in rigid, contrived, standardized
contexts
• Are often isolated from meaningful daily environments
• Focused on body structure and function (impairments) levels
 Top-Down Assessment
• Focus is on the child’s participation in his/her contexts to
determine what is important to the child and the
parents/caregivers
• The focus is more aligned with the activities and
participation levels of the ICF (WHO, 2001).
 Assessment Tool
Developmental Test of Visual Motor
Integration, 4th ed. (VMI-4th ed.)
Test of Visual Motor Skills (Revised)
TVMS-R
Test of Visual Perceptual Skills
(Revised) TVPS-R
Bruininks-Oseretsky Test of Motor
Proficiency (BOTMP)
Peabody Developmental Motor Scales
(PDMS)
Sensory Integration and Praxis Test
(SIPT)
Purpose
Visual-motor integration
Visual-motor skills
Visual perceptual skills
Gross motor, upper limb and fine motor
proficiency
Gross motor skills and fine motor skills
Visual, tactile & kinesthetic perception
& motor performance
 Assessment Tool Purpose
Sensory Profile Sensory processing, modulation, and
behavioral and emotional responses
Sensory Processing Measure Sensory processing

Evaluation Tool of Children’s Handwriting skills

Handwriting (ETCH)
Behavior Rating Inventory of Executive functions
Executive Functions (BRIEF)
 Assessment Tool Purpose
Functional Independence Measure 3 domains: self-care, mobility and cognition
for Children (WeeFIM)
WeeFIM 0-3 Module 3 domains: motor, cognitive, behavioral

Pediatric Activity Card Sort (PACS) Used to determine levels of occupational

performance and engagement

School Function Assessment Education participation

(SFA)
Children’s Assessment of Leisure participation
Participation and Enjoyment/
Preferences for Activities of
Children
Thank you! J