Occupational Therapy Field Work Training 2: Acquisitional Frame of Reference

ACQUISITIONAL FOR

This focuses on the learning of specific skills that are required for optimal performance within the environment and the mastery of these skills. This addresses both motor and cognitive skills. The primary goal of this FOR is the learning and mastery of the skill.

Assumptions:

Believes that one can act and influence the environment
The therapist accepts the child unconditionally
With constant practice leads to mastery of the skill. Learning doesn't necessarily follow a developmental sequence

Target Population:

Children with delays (pediatrics)

Function- Dysfunction:

Function: The task needed can be done independently
Dysfunction: The task needed cannot be done independently

Source: Willard and Spackman

CASE:

Stacey is a 4 year old girl who has cerebral palsy with moderate quadriplegia. She is able to walk short distances using a walker. She has difficulty controlling the movement of her arms and hands. Her parents have set current goals for Stacey that include participation in dressing tasks, drawing, and cutting skills in preparation for kindergarten activities, and increased participation with peers in play.

OCCUPATIONAL AREAS AFFECTED:

ADL
Education
Play
Social Participation

PROBLEM LIST:

Functional Mobility

Motor Skills

Moves
Walks
Transports

Dressing

Motor Skills

Aligns
Stabilizes
Positions
Flows
Paces

Education

Formal education participation

Motor Skills (drawing and cutting)

Aligns
Stabilizes
Positions
Reaches
Grips
Manipulates
Paces

Play

Play participation

Motor Skills

Moves
Walks
Transports
Sligns
Stabilizes
Positions
Flows
Paces

Social Participation

Family, Peer, friend

Process Skills

Paces
Attends
Heeds
Initiates
Continues
Terminates

Social Interaction Skills

Approaches/ starts
Turns toward
Speaks fluently
Regulates
Questions
Matches Language
Heeds
Questions

General OT goals:

Treatment of a child with cerebral palsy requires a multidisciplinary approach.
Goals should address neuromuscular concerns such as maintaining range of motion and tone control.
Functional goals related to self-care skills, mobility, and communication should be addressed to improve the child’s ability to live independently.
Goals related to increase social participation should also be included.
Goals should be routinely reassessed to ensure that they continue to be valid as the child grows older.
Child should be encouraged to take an active role in goal setting.
Child should be given activities like pre-writing and pre-scissoring in preparation for school
Child should be have activities for cognitive skills such as shape sorters, pegboards, puzzles, and numbers and letters.
For play, child should be stimulated more on gross motor play to help her gross motor movement and mobility.

Source: Pediatric Rehabilitation, 3rd edition, by Molnar

ASSESSMENT TOOLS:

There are several tools that can be used to assess the development of children. Tools used differ in areas assessed and their target population. For our case, the appropriate tool to be used is the Brigance Inventory of Early Development as it evaluates areas from ADL, cognitive skills, fine and gross motor skills, and play skills. The following are a list of tools that may be used to assess the development of children.

Bayley Scales of Infant and Toddler Development (3^rd Edition) – norm-referenced tool that measures cognitive, language, motor, social – emotional, and adaptive behavior in infants and toddlers from 1 – 42 months (3 years and 6 months) of age.
·Bayley Scales of Infant and Toddler Development – 3^rd Edition Motor Scale – norm-referenced tool to identify young children with developmental delay of motor function.
Denver Developmental Screening Test (Revised) (Denver II) – for children from birth to 6 years of age who are at risk for developmental problems in personal – social, fine motor adaptive, language, and gross motor skills.
Developmental Test of Visual Pereption (2^nd Edition) – measure visual perception and visual – motor integration skills in children from 4 to 10 years of age.
Hawaii Early Learning Profile (HELP) – used for children from birth to 6 years of age to identify developmental needs, determine intervention goals, and track children’s progress.
Peabody Developmental Motor Scales (2^nd Edition) – norm-referenced and criterion-referenced tool to assess gross and fine motor skills of children from birth to 5 years of age.
Brigance Inventory of Early Development – a tool used to assess a wide range of skills from children birth to seven years of age.