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NM III cases - Coggle Diagram
NM III cases
DCD- DSM 5
- learning and execution of coordinated motor skills are below age level
- motor difficulties significantly interfere with ADLs
- Onset in the early developmental period
- motor coordination isnt better explained by other delays
MABC2 for test
General body structure and function impairments
- poor strength
- joint laxity
- poor coordination
- slower processing
General activity impairment
- walking( Awkward gait)
- delayed or poor quality motor skills
Participation
- difficulties at school and home
longer term social emotional and fitness consequences
Age 5
They are a 5 year old with DCD that cant participate in normal activities due to impairments in muscle strength, endurance, coordination and vision
Activity limitations:
- difficulty maneuvering
- cant coordinate both sides of their body
- difficulty with visually demanding tasks
- decreased fine motor
- decreased walk and play endurance
Participation:
- participation in age appropriate recriational activities such as soccer
- unable to keep up with peers
- difficulty with speech production makes it difficult to carry out a conversation
Goals at this age:
these goals are for the next 6m
- will independently don and doff shoes with velcro 100% of the time in 3 consecutive sessions
- will catch ball thrown to him from a distance of 7ft 75% of the time
- wil ride 2 wheeled bike without training wheels a distance of 100ft in 3/4 trials
Interventions listed:
- body mechanics and postural stabilization ( with mirror feedback)
- neuromotor development- task training with high reps
- strength, power and endurance training (body weight and low load)
Age of 6:
- decreased muscle tone
- Assessed using BOT2 (muscle strength was assessed using this)
-dx
- muscle weakness
- decreased coordination
- delays in motor environment
- CAN DO DCDQ
Activity limitations:
- fine motor like manipulating small balls
- difficulty visually attending to fine motor tasks that require repetitive hand eye coordination
Participation:
- PE class
- peer recreational
Goal
the goal is to promote recreational activities to foster strength, coordination, and overall fitness
Intervention bucket:
the role pf the PT is now consultant and evaluator. they reccomended thet do some peer recriational activities such as soccer, biking, swimming, running
- they should come in 2 times per year now
Considerations for teens or adults:
- can learn to adapt
- poor fitness due to social isolation
- encourage more individual sport
- poor self esteem and at risk for bullying
Downs syndrome
General presentation:
- Hypotonia
- Laxity
- upward slant
- epicanthal fold
- check AA
- COPD
AGE 3:
- motor impairments
- balance
- motor planning
- muscle strength
- ROM increased which negatively impacts condition
- tone
- limited stair mobility
Activity limitations:
- independent stair navigation
- ambulation on uneven surfaces
- climbing on and off various surfaces
- independent jumping skills
- propulsion or ride on toys
- ball skills
Participation limitations:
- keep up with peers in
- on playground
- gross motor gym and classroom activities
- gross motor play
Goals :
The goals outlined are to be achieved in 1y
- will be able to negotiate up stairs with alternating feet without support 80% of the time
- will negotiate downstairs with alternating feet with one hand on the railing 80%of the time
- will ambulate on uneven surfaces( including X X X X) independently 80% of the time
ball skill goals : kick a playground-sized ball 5 feet with accuracy 80%of the time
Intervention buckets
- aerobic (running in yard, swimming)
- balance and coordination, kick ball
- neuromotor- Jumping and stairs
- strength and endurance- abdominal, walking, stairs
- Obstacle course
Age 16: Diagnosis section
- impaired motor planning, needs visual cues and high reps
- remains partially dependent
- muscle weakness
- decreased balance
- decreased endurance
Activity limitations:
- walking/ running long distances
- bike riding
- IADLS like cooking
Participation :
- independent community mobility
- household management
- peer activities
Goals : all based on functional independence
- in 10w they will increase aerobic endurance in order to run a 9 minute mile for her karate practice
- in 8 w they will increase balance to ride a bicycle independently on the road following traffic rules
Age related changes
- increased risk for thyroid problems
- obesity
- arthritis
- hip dysplasia
- osteoporosis
- depression
Autism spectrum disorder: DSM 5
- impairment in social communication/ interaction
- restricted and repetitive behaviors (stereotyped, inflexibility with routine)
- Symptoms must cause functional impairment, be present in early childhood, not be better explained by something else.
Other
- Remember their neurons don't undergo normal pruning
6 year old-
- peabody developmental motor scale
- love sports and games
dx
- has participation restrictions with his peers during gym and recess
- limitations in higher level coordination skills
Goals:
- demonstrate improved balance and locomotor skills supportive of safe and expedient campus travel with reduced falls
- will travel hallway at same pace as his peers without veering off course during 250 feet route
- Will demonstrate improved mapping and understanding of campus routes to travel to 5 destinations independently
Intervention buckets:
- motor function training (gait, balance,)
- school mod and task repetition
7 years:
- carls decreased balance and difficulty with higher level coordination continue to affect ability to participate in activities with peers especially in PE class and recess
Goals:
- annual- demonstrate ability to independently negotiate curbs, stairs, and surface changes
- will demonstrate hopping, skipping, galloping for more than 15 ft for 2/3 trials
- will demonstrate ability to negotiate various obstacles on different surfaces
Intervention
- PT works on skipping and galloping and playing with kids his age
Spina bifida
- will have neuromuscular deficits (loss of sensation, loss of muscle strength and control)
- Skeletal impairments (clubfoot, shorter legs, scoliosis, hip sublux)
- be aware of hydrocephalus, seizures, tethered cord
AIMS, PEDI, WEEFIM,
- lower motor level, no shunt hx, and no surgery hx are predictors of ambulation
3 year old:
- shy and fearful of movement
- unwiling to communicate with others
- learned slide board transfers
- T12
- impact ability to play with peers
Goals:
- transfer to chair from floor with physical and verbal prompts 3/5 trials
- propel wheelchair on uneven surfaces and down ramps keeping pace with peers with distant supervision 80% of the day
- Task analysis for sideboard can do part practice(
Intervention Buckets
- initial environmental mods(slide boards, grab bars, wedge for floor transfer)
- Exercises to increase conditioning (tricycles)
- wheelchair mods
5 year old T12
- continues to follow wt reduction diet
- monitoring skin breakdown
- participates in PE
Goals:
- Learn the environmental mods needed to transition into their new school
- wil lean to either side of wheelchair to pick up 8in ball oneither side
Interventions:
- UE strength with exercise, push wheelchair around track
- enjoying baseball
7 years old
- cellulitis episode required hospitalization
- transitioned into new school and has been on regular weight loss program
- told to perform wt shifts to prevent pressure areas
Goals:
none really, some positioning mods