537 Feeding

8/2/2019 537 Feeding

1/25

CSUDHCSUDH

MSOT PROGRAMMSOT PROGRAM

OTR 537 L Occupation-BasedOTR 537 L Occupation-Based

Assessments II - PediatricsAssessments II - Pediatrics

Week Ten:Week Ten:

Assessments of Oral-MotorFunction,

Feeding, & Eating

Instructor:Instructor: Eric Hwang, Ph.D.,Eric Hwang, Ph.D.,

OTR/LOTR/L

8/2/2019 537 Feeding

2/25

NBCOT Warm UpNBCOT Warm Up The parents of an 8 month-old child bring him to a freeThe parents of an 8 month-old child bring him to a free

community health developmental screening program. Thecommunity health developmental screening program. Theoccupational therapist evaluates the oral motoroccupational therapist evaluates the oral motordevelopment of the child and determines that the childdevelopment of the child and determines that the childssdevelopment is within normal limits. The therapist basesdevelopment is within normal limits. The therapist basesthis interpretation upon the childs demonstration of:this interpretation upon the childs demonstration of:

A.A. diagonal jaw movementsdiagonal jaw movements

B.B. cup drinking with a firm jawcup drinking with a firm jaw

C.C. effective masticationeffective mastication

D.D. rotary chewingrotary chewing

8/2/2019 537 Feeding

3/25

NBCOT Warm UpNBCOT Warm Up An OT evaluation concludes that a child withAn OT evaluation concludes that a child with

developmental delay has mastered the ability to cut simpledevelopmental delay has mastered the ability to cut simplefigure shapes with scissors. The most appropriate activitiesfigure shapes with scissors. The most appropriate activitiesfor the OT to next introduce to the child are ones thatfor the OT to next introduce to the child are ones thatinvolve using scissors to cut:involve using scissors to cut:

A.A. additional simple figure shapes.additional simple figure shapes.

B.B. complex figure shapes.complex figure shapes.

C.C. simple geometric figures.simple geometric figures.

D.D. circles.circles.

8/2/2019 537 Feeding

4/25

NBCOT Warm UpNBCOT Warm Up A child has been diagnosed with attention deficit disorderA child has been diagnosed with attention deficit disorder

with hyperactivity. Upon evaluation, the OT would mostwith hyperactivity. Upon evaluation, the OT would mostlikely observe that the child demonstrates:likely observe that the child demonstrates:

A.A. non-purposeful activity that interferes with function in age-non-purposeful activity that interferes with function in age-appropriate skills.appropriate skills.

B.B. poor attention to school and play activities over the past 3poor attention to school and play activities over the past 3months.months.

C.C. symptoms of learning disabilities as evidenced bysymptoms of learning disabilities as evidenced bydifficulties with reading and math.difficulties with reading and math.

D.D. an excessively high energy level that can be lessened byan excessively high energy level that can be lessened byeliminating consumption of caffeine or certain foods.eliminating consumption of caffeine or certain foods.

8/2/2019 537 Feeding

5/25

NBCOT Warm UpNBCOT Warm Up An OT provides home-based EI evaluation. A referral forAn OT provides home-based EI evaluation. A referral for

an 18 month-old child notes that the child is able to fingeran 18 month-old child notes that the child is able to fingerfeed effectively but is not able to use a spoon or suck fromfeed effectively but is not able to use a spoon or suck froma straw. The OT puts together supplies to bring to thea straw. The OT puts together supplies to bring to thechildchilds home and plans activities to use during thes home and plans activities to use during thedevelopmental evaluation. It is most important that thedevelopmental evaluation. It is most important that the

therapist includes objects and activities appropriate for thetherapist includes objects and activities appropriate for thedevelopmental age of:developmental age of:

A.A. 6-9 months.6-9 months.

B.B. 18-20 months.18-20 months.

C.C. 12-18 months.12-18 months.

D.D. 9-12 months.9-12 months.

8/2/2019 537 Feeding

6/25

NBCOT Warm UpNBCOT Warm Up An OT provides intervention to develop independentAn OT provides intervention to develop independent

feeding skills in an 18 month-old child with significantfeeding skills in an 18 month-old child with significantdevelopmental delays. The child has mastered the ability todevelopmental delays. The child has mastered the ability tohold a spoon and bang it on the tray of the high chair. Thehold a spoon and bang it on the tray of the high chair. Themost appropriate activity for the OTR to provide next is:most appropriate activity for the OTR to provide next is:

A.A. self-feeding a cracker.self-feeding a cracker.

B.B. stirring with a spoon in imitation of the therapist.stirring with a spoon in imitation of the therapist.

C.C. drinking from a cup held by the therapist.drinking from a cup held by the therapist.

D.D. bringing a filled spoon to mouth.bringing a filled spoon to mouth.

8/2/2019 537 Feeding

7/25

NBCOT Warm UpNBCOT Warm Up An OT uses the Rood approach to facilitate motorAn OT uses the Rood approach to facilitate motor

development. A pediatric client has mastered the pronedevelopment. A pediatric client has mastered the proneextension motor pattern. The next pattern that the therapistextension motor pattern. The next pattern that the therapistwould address is:would address is:

A.A. neck co-contraction.neck co-contraction.

B.B. supine withdrawal.supine withdrawal.

C.C. rollover.rollover.

D.D. prone on elbow.prone on elbow.

8/2/2019 537 Feeding

8/25

NBCOT Warm UpNBCOT Warm Up A 7 year-old child with moderate cerebral palsy, athetoidA 7 year-old child with moderate cerebral palsy, athetoid

type, receives OT to improve functional upper extremitytype, receives OT to improve functional upper extremityuse. The child sits on a bench and works on grasp anduse. The child sits on a bench and works on grasp andrelease with the left hand on the table at waist height. Therelease with the left hand on the table at waist height. Thechild stabilizes the right arm with internal rotation, elbowchild stabilizes the right arm with internal rotation, elbowlocked in extension, upward rotation of the scapula, andlocked in extension, upward rotation of the scapula, and

hyperextension of the MPs. To facilitate effective grasphyperextension of the MPs. To facilitate effective graspand release, the therapist provides:and release, the therapist provides:

A.A. bilateral weighted cuffs.bilateral weighted cuffs.

B.B. resistive exercise for right shoulder strengthening.resistive exercise for right shoulder strengthening.

C.C. joint movements of the right arm in total flexion of totaljoint movements of the right arm in total flexion of totalextension.extension.

D.D. The flexor synergy of the left arm for support whileThe flexor synergy of the left arm for support whileworking on grasp and release with the left hand.working on grasp and release with the left hand.

8/2/2019 537 Feeding

9/25

NBCOT Warm UpNBCOT Warm Up An OT completes an EI screening of an 8 month-old child.An OT completes an EI screening of an 8 month-old child.

The results indicate that the child is able to sitThe results indicate that the child is able to sitindependently by propping forward on his arms. The mostindependently by propping forward on his arms. The mostappropriate next step for the OT to take is to:appropriate next step for the OT to take is to:

A.A. do nothing, as the child exhibits typical behavior.do nothing, as the child exhibits typical behavior.

B.B. develop goals to improve sitting balance.develop goals to improve sitting balance.

C.C. complete a sensorimotor evaluation.complete a sensorimotor evaluation.

D.D. provide play activities to develop sitting balance.provide play activities to develop sitting balance.

8/2/2019 537 Feeding

10/25

Feeding & Eating in ChildrenFeeding & Eating in Children

Assessment and intervention to promote aAssessment and intervention to promote achildchilds feeding and eating skills is ans feeding and eating skills is animportant role of OTs.important role of OTs.

What are the component skills thatWhat are the component skills thatdetermine a childdetermine a childs occupationals occupational

performance in feeding andperformance in feeding andeating?eating?

8/2/2019 537 Feeding

11/25

Feeding & Eating in ChildrenFeeding & Eating in Children

Underlying skills relevant to feeding andUnderlying skills relevant to feeding andeating abilityeating ability Oral sensation/sensitivityOral sensation/sensitivity Jaw, lip, cheek and tongue movementsJaw, lip, cheek and tongue movements Respiratory functionRespiratory function Postural controlPostural control Cognitive, psychosocial and communication skillsCognitive, psychosocial and communication skills

OtherOther

8/2/2019 537 Feeding

12/25

Developmental Sequence of Eating SkillsDevelopmental Sequence of Eating Skills

Table 15-2 Case-Smith, p. 451Table 15-2 Case-Smith, p. 451 Type of FoodType of Food

Sucking/Drinking SkillsSucking/Drinking Skills

SwallowingSwallowing

Biting and ChewingBiting and Chewing

8/2/2019 537 Feeding

13/25

Assessment of Feeding & EatingAssessment of Feeding & Eating

Overview of Feeding IssuesOverview of Feeding Issues

Naturalistic Observation of Eating & FeedingNaturalistic Observation of Eating & FeedingPerformancePerformance

Analysis of Feeding through InstrumentsAnalysis of Feeding through Instruments

Contextual FactorsContextual Factors

8/2/2019 537 Feeding

14/25


Overview of Feeding IssuesOverview of Feeding Issues

Parent interview, informal observation,Parent interview, informal observation,written reports about the childwritten reports about the child

Feeding history and caregiver concernsFeeding history and caregiver concerns(Box(Box15-2, Case-smith, p. 455)15-2, Case-smith, p. 455)

8/2/2019 537 Feeding

15/25


Overview of Feeding IssuesOverview of Feeding Issues CaregiverCaregivers primary concerns about feedings primary concerns about feeding Pertinent medical historyPertinent medical history Diagnostic testing and resultsDiagnostic testing and results(e.g.,(e.g.,

videofluoroscopic swallow study)videofluoroscopic swallow study) Current nutritional statusCurrent nutritional status Developmental and neuromotor statusDevelopmental and neuromotor status

Developmental feeding historyDevelopmental feeding history Current feeding methods and schedulesCurrent feeding methods and schedules ChildChilds behavior reactions during mealss behavior reactions during meals

(Box 15-2, Case-smith, p. 455)(Box 15-2, Case-smith, p. 455)

8/2/2019 537 Feeding

16/25


Naturalistic Observation of Eating &Naturalistic Observation of Eating &Feeding PerformanceFeeding Performance

Analyze how motor, sensory, cognitive, andAnalyze how motor, sensory, cognitive, andcommunication skills contribute tocommunication skills contribute toperformanceperformance..

Observation must be asObservation must be as naturalisticnaturalistic as possible.as possible.

8/2/2019 537 Feeding

17/25


Naturalistic Observation of Eating &Naturalistic Observation of Eating &Feeding PerformanceFeeding Performance (Continued)(Continued)

What areWhat are abnormal movement patternsabnormal movement patternsto observe during feeding/eating?to observe during feeding/eating?

8/2/2019 537 Feeding

18/25


Analysis of Feeding/Eating throughAnalysis of Feeding/Eating throughInstrumentsInstruments

Therapists may use observationalTherapists may use observationalassessments to explore hypothesizedassessments to explore hypothesizedimpairments or functional limitationsimpairments or functional limitationsrelevant to feeding/eating in children withrelevant to feeding/eating in children withspecial needs.special needs.

For exampleFor example

8/2/2019 537 Feeding

19/25


Analysis of Feeding/Eating throughAnalysis of Feeding/Eating throughInstrumentsInstruments (Continued)(Continued)

Oral-Motor Feeding Rating ScaleOral-Motor Feeding Rating Scale Judy Michels Jelm, M.S., CCC-SLPJudy Michels Jelm, M.S., CCC-SLP 1-year-old through adult1-year-old through adult Three oral-motor movementsThree oral-motor movements

Lip/Cheek MovementLip/Cheek Movement Tongue MovementTongue Movement Jaw MovementJaw Movement

8/2/2019 537 Feeding

20/25


Oral-Motor Feeding Rating ScaleOral-Motor Feeding Rating Scale (Continued)(Continued) Eight Function AreasEight Function Areas

Breast FeedingBreast Feeding Bottle FeedingBottle Feeding Spoon FeedingSpoon Feeding Cup DrinkingCup Drinking Biting (soft cookie)Biting (soft cookie) Biting (hard cookie)Biting (hard cookie) ChewingChewing Straw DrinkStraw Drink

8/2/2019 537 Feeding

21/25


Oral-Motor Feeding Rating ScaleOral-Motor Feeding Rating Scale (Continued)(Continued) Eight Related AreasEight Related Areas

Self-FeedingSelf-Feeding Adaptive Feeding EquipmentAdaptive Feeding Equipment

Diet AdaptationDiet Adaptation PositionPosition SensitivitySensitivity Food RetentionFood Retention SwallowingSwallowing Orofacial StructuresOrofacial Structures

8/2/2019 537 Feeding

22/25

Assessment of Feeding & EatingAssessment of Feeding & Eating Analysis of Feeding/Eating throughAnalysis of Feeding/Eating through

InstrumentsInstruments (continued)(continued) SFA: Eating and Drinking ScaleSFA: Eating and Drinking Scale

8/2/2019 537 Feeding

23/25


Contextual FactorsContextual Factors PhysicalPhysical Seating and positioningSeating and positioning SpaceSpace

Noise/distractionsNoise/distractions SocialSocial

Who feeds the child?Who feeds the child?

Who is present?Who is present? Social interaction within familySocial interaction within family What communication/interaction occurs?What communication/interaction occurs?

(Case-Smith, p. 457)(Case-Smith, p. 457)

8/2/2019 537 Feeding

24/25


Contextual FactorsContextual Factors (continued)(continued) TemporalTemporal

Is sufficient time allotted?Is sufficient time allotted? How often is the child fed?How often is the child fed? How long does feeding take?How long does feeding take?

CulturalCultural Cultural beliefs and values in mealtimeCultural beliefs and values in mealtime What foods does the family eat?What foods does the family eat?

(Case-Smith, p. 493)(Case-Smith, p. 493)

8/2/2019 537 Feeding

25/25

Group Learning Activity:Group Learning Activity:

Video Discussion:Video Discussion:

Self-Feeding in the Child with Special NeedsSelf-Feeding in the Child with Special Needs

537 Feeding

Documents

Transcript of 537 Feeding