CSUDH MSOT PROGRAM

OTR 537 L Occupation-Based Assessments II - Pediatrics Week Ten:

Assessments of Oral-Motor Function, Feeding, & Eating

Instructor: Eric Hwang, Ph.D.,

OTR/L

NBCOT Warm Up

The parents of an 8 month-old child bring him to a free community health developmental screening program. The occupational therapist evaluates the oral motor development of the child and determines that the childs development is within normal limits. The therapist bases this interpretation upon the childs demonstration of:
A. B. C. D.

diagonal jaw movements cup drinking with a firm jaw effective mastication rotary chewing

NBCOT Warm Up

An OT evaluation concludes that a child with developmental delay has mastered the ability to cut simple figure shapes with scissors. The most appropriate activities for the OT to next introduce to the child are ones that involve using scissors to cut:
A. B. C. D.

additional simple figure shapes. complex figure shapes. simple geometric figures. circles.

NBCOT Warm Up

A child has been diagnosed with attention deficit disorder with hyperactivity. Upon evaluation, the OT would most likely observe that the child demonstrates:
A. B. C. D.

non-purposeful activity that interferes with function in ageappropriate skills. poor attention to school and play activities over the past 3 months. symptoms of learning disabilities as evidenced by difficulties with reading and math. an excessively high energy level that can be lessened by eliminating consumption of caffeine or certain foods.

NBCOT Warm Up

An OT provides home-based EI evaluation. A referral for an 18 month-old child notes that the child is able to finger feed effectively but is not able to use a spoon or suck from a straw. The OT puts together supplies to bring to the childs home and plans activities to use during the developmental evaluation. It is most important that the therapist includes objects and activities appropriate for the developmental age of:
A. B. C. D.

6-9 months. 18-20 months. 12-18 months. 9-12 months.

NBCOT Warm Up

An OT provides intervention to develop independent feeding skills in an 18 month-old child with significant developmental delays. The child has mastered the ability to hold a spoon and bang it on the tray of the high chair. The most appropriate activity for the OTR to provide next is:
A. B. C. D.

self-feeding a cracker. stirring with a spoon in imitation of the therapist. drinking from a cup held by the therapist. bringing a filled spoon to mouth.

NBCOT Warm Up

An OT uses the Rood approach to facilitate motor development. A pediatric client has mastered the prone extension motor pattern. The next pattern that the therapist would address is:
A. B. C. D.

neck co-contraction. supine withdrawal. rollover. prone on elbow.

NBCOT Warm Up

A 7 year-old child with moderate cerebral palsy, athetoid type, receives OT to improve functional upper extremity use. The child sits on a bench and works on grasp and release with the left hand on the table at waist height. The child stabilizes the right arm with internal rotation, elbow locked in extension, upward rotation of the scapula, and hyperextension of the MPs. To facilitate effective grasp and release, the therapist provides:
A. B. C. D.

bilateral weighted cuffs. resistive exercise for right shoulder strengthening. joint movements of the right arm in total flexion of total extension. The flexor synergy of the left arm for support while working on grasp and release with the left hand.

NBCOT Warm Up

An OT completes an EI screening of an 8 month-old child. The results indicate that the child is able to sit independently by propping forward on his arms. The most appropriate next step for the OT to take is to:
A. B. C. D.

do nothing, as the child exhibits typical behavior. develop goals to improve sitting balance. complete a sensorimotor evaluation. provide play activities to develop sitting balance.

Feeding & Eating in Children

Assessment and intervention to promote a childs feeding and eating skills is an important role of OTs. What are the component skills that determine a childs occupational performance in feeding and eating?

Feeding & Eating in Children

Underlying skills relevant to feeding and eating ability

Oral sensation/sensitivity Jaw, lip, cheek and tongue movements Respiratory function Postural control Cognitive, psychosocial and communication skills Other

Developmental Sequence of Eating Skills

Table 15-2 Case-Smith, p. 451

Type of Food

Sucking/Drinking Skills Swallowing Biting and Chewing

Assessment of Feeding & Eating

Overview of Feeding Issues Naturalistic Observation of Eating & Feeding Performance Analysis of Feeding through Instruments Contextual Factors

Assessment of Feeding & Eating

Overview of Feeding Issues

Parent interview, informal observation, written reports about the child Feeding history and caregiver concerns (Box
15-2, Case-smith, p. 455)

Assessment of Feeding & Eating

Overview of Feeding Issues

Caregivers primary concerns about feeding Pertinent medical history Diagnostic testing and results (e.g.,
videofluoroscopic swallow study)

Current nutritional status Developmental and neuromotor status Developmental feeding history Current feeding methods and schedules Childs behavior reactions during meals
(Box 15-2, Case-smith, p. 455)

Assessment of Feeding & Eating

Naturalistic Observation of Eating & Feeding Performance

Analyze how motor, sensory, cognitive, and communication skills contribute to performance.
Observation must be as naturalistic as possible.

Assessment of Feeding & Eating

Naturalistic Observation of Eating & Feeding Performance (Continued)

What are abnormal movement patterns to observe during feeding/eating?

Assessment of Feeding & Eating

Analysis of Feeding/Eating through Instruments

Therapists may use observational assessments to explore hypothesized impairments or functional limitations relevant to feeding/eating in children with special needs. For example

Assessment of Feeding & Eating

Analysis of Feeding/Eating through Instruments (Continued)

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

Lip/Cheek Movement Tongue Movement Jaw Movement

Assessment of Feeding & Eating

Oral-Motor Feeding Rating Scale Eight Function Areas

Breast Feeding Bottle Feeding Spoon Feeding Cup Drinking Biting (soft cookie) Biting (hard cookie) Chewing Straw Drink

(Continued)

Assessment of Feeding & Eating

Oral-Motor Feeding Rating Scale Eight Related Areas

Self-Feeding Adaptive Feeding Equipment Diet Adaptation Position Sensitivity Food Retention Swallowing Orofacial Structures

(Continued)

Assessment of Feeding & Eating

Analysis of Feeding/Eating through Instruments (continued)

SFA: Eating and Drinking Scale

Assessment of Feeding & Eating

Contextual Factors

Physical

Seating and positioning Space Noise/distractions Who feeds the child? Who is present? Social interaction within family What communication/interaction occurs?
(Case-Smith, p. 457)

Social

Assessment of Feeding & Eating

Contextual Factors

(continued)

Temporal

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

Cultural

Cultural beliefs and values in mealtime What foods does the family eat?
(Case-Smith, p. 493)

Group Learning Activity:

Video Discussion:

Self-Feeding in the Child with Special Needs