UST-CRS: Department of Occupational Therapy

OT in Pediatrics
Summary Table

BEHAVIORAL / DEVELOPMENTAL CONDITIONS

Condition Description Etiology / Epidemiology Clinical Features / Differential General Medical / Course / Prognosis OT Evaluation OT Intervention
Diagnosis Associated Diagnoses Surgical Treatment
Problems

Down Syndrome ● Aka Trisomy 21 Risk Factors Acc. to Type Dysmorphic Features Fragile X Syndrome Medical Life Expectancy Standardized Tools Frames of Reference
● Genetic d/o ● Advanced ● Complete: Craniofacial: (mutation in FMR1) Symptom-specific ● 50-55yo; 60yo ● WeeFIM: Functional ● Behavioral
caused by maternal age 95% ● Microcephaly (small ● S: genetic d/o, ● For Dementia: Factors Affecting LE: Independence ● NDT
presence of a (>35yo) ● Trans- head) cognitive problems Donepezil or ● Weight after birth, Measure for ● Acquisitional
complete / ● Carrier Mother vs. location: 3% ● Flattened occiput (ID), hypotonia / Rivastigmine race, secondary Children ● PEO
incomplete 3rd Father ● Mosaic: 2% ● Nuchal folds (back joint laxity ● For Congenital Heart conditions (i.e., ● SP: Sensory Profile
Chromosome 21 ○ Mother: 1:3 neck) ● D: Defects: ECG + congenital heart ● SPM: Sensory General Approaches
in some/all body ○ Father: 1:20 Prevalence ● Epichantal folds ○ FX: mild-severe surgery disease, seizures, Processing ● Tone Facilitation
cells ● Most (inner eyes) ID, “fragile site” ● For Thyroid leukemia) Measure Techniques
● Results to Etiology common ● Upward slanting chromosome X, Problems: Thyroid ● SFA: School ● BMTs
mild-mod ID, ● Maternally derived autosomal eyes (palpebral X-linked hormone Prognosticating Functional ● Specific to
growth retardation, ● T. 21: Extra abnormality fissure) dominant (F replacement therapy Positive Assessment occupations
characteristic separate c. 21 ● Common ● Low set & rounded less impaired), ● For GI problems: ● Early intervention
facial features & genetic ears G soc par diet and/or surgery ● G social support Non-Standardized
congenital Pathophysiology cause of ID ● Small nose; flat ○ DS: mod-severe Negative Dynamic Performance
anomalies Types of Trisomy 21: ● 1 / 400-1500 nasal bridge IDD, P soc par, Non-Pharmacological ● Comorbidities (i.e., Analysis or Functional
1) Complete T.21 newborns ● Open mouth w/ F&M equally ● Neurodevelopmental congenital heart Analysis
● Complete extra protruding tongue affected Treatment (NDT): disease) ● Neuromuscular
copy of c. 21 in all Philippines Musculoskeletal: focuses on quality of ● VLBW at birth Functions
of person’s cells ● 1 in 800 ● Short extremities Prader Willi movement & (<1.5kg) ● GMS, FMS
● Abn. cell division babies ● Broad hands Syndrome coordination ● Poverty (poor ● Work Behaviors
during meiosis 1/2 (2014) ● Simian crease (loss of function c.15; ● Sensory Integration access to services) ● Social
2) Translocation T.21 ● Short fingers (MCP; affect hypothalamus) ● Perceptual-Motor: Communication
● Part or whole IPs) ● S: hypotonia, ID, helps explore ● Sensory Processing
extra c.21 present ● Clinodactyly (5th) hypogonadism, balance, ● Cognitive Skills
& translocated to ● Flexible ligaments short extremities coordination, body ● Occupations
a different c. ● Sandal gap ● D: awareness
● Common: t(14;21) ● Short sternum ○ PW: c.15; ● Traditional Strength
● Abn. cell division commpulsive & Conditioning
before / at Motor / behaviors (i.e., ● Tummy Time: used
conception Musculoskeletal eating, skin for infants (to
3) Mosaic T.21 ● Hypotonia picking), obesity develop strength,
● Only some cells (hallmark) ○ DS: c.21 balance & motor
have extra copy of ● Motor delays (GMS, skills)
c.21 FMS, coordination) Cat’s Cry ● Treadmill Training
● Abn. cell division ● Bony anomalies (Cri-du-Chat) Rehabilitation Specialty
 after fetrilization (atlantooccipital & Syndrome ● PT: strengthening,
atlantoaxial (total / partial deletion endurance, motor
Legends: instability - C1) on short arm of c.5) skills
t. = trisomy ● S: microcephaly, ● OT: FMS, daily tasks
c. = chromosome GI / Endocrinological low set ears, ● ST
● Duodenal Atresia epicanthal folds, ● ABA
Diagnostic ● Hypothyroidism hypotonia mental ● SPED
Procedures ● Hypogonadism retardation
Screening ● Delayed puberty ● D:
● Fetal ○ CC: c.5, oblique
Ultrasonography: Congenital palpebral
⇧nuchal ● AV canal defect fissure, severe
translucency on ● Ventricular septal ID, cat-like cry
neck defect ○ DS: c.21,
● Congenital ● CHD slanted
Anomaly Scan: palpebral
done at 26-28wk Sensory (Eye, fissure,
to detect duodenal Hearing) mild-mod ID
atresia or AV ● Refractive Errors
canal defect ● Congenital Other Trisomy
● Maternal Serum Cataracts Conditions
Screening: blood ● Strabismus ● T.18 (Edward’s):
test to detect a ● Hearing Loss ABN shape head,
chromosomal d/o ● Sensory Processing small jaw & mouth,
● Non-Invasive Difficulties clenched fist,
Prenatal Testing: overlap fingers
detect a Others ● T.13 (Patau): life
chromosomal d/o ● Mild-mod ID expectancy (7-10
● Postnatal ● Seizures days), prominent
Karyotyping ● Behavioral occiput,
problems polydactyly, cleft
Confirmatory ● Sleep apnea lip, malformed
Methods (Invasive) ears
● Prenatal Chorionic Comorbidities
Villus Sampling: ● Dementia-risk
taken from ● Leukemia
placenta to detect
abnormalities
● Amniocentesis:
sample of amniotic
fluid taken

Basic Sciences:
● Human Genome: an organism’s complete set DNA; consists of approx. 2500 genes (that encode for proteins)
● Gene: organized into strands of DNA; play a role in cell devision as they are compacted to form chromosomes
● Cells & Chromosomes:
○ Somatic Cells (human body cells): 46 chromosomes (22 pairs of autosomes; 1 pair of sex chromosome)
○ Germ Cells (sex cells): 23 chromosomes (22 autosomes; 1 sex chromosome)
● Meiosis (Note: Cell Division has Prophase, Metaphase, Anaphase and Telophase)
 ○ A type of cell division that produces gametes / germ cells (egg & sperm cells) in haploid (n=23 chromosomes) from a diploid cell (2n=46 chromosomes).
○ Thru fertilization, a zygote becomes a diploid cell (total=46 chromosomes) w/ 23 chromosomes per parent.
○ Process:
■ Meiosis I: genetic recombination occurs thru crossing over during prophase 1
■ Meiosis II: similar to mitosis
○ Possible Errors:
■ Nondisjunction: failure of 2 chromosomes to separate during meiosis (1 cell has copies; other cell has 0)
■ Anaphase Lag: chromatid/chromosome is lost during mitosis (anaphase) because it fails to quickly move
● Abnormalities in Chromosomes:
○ Polyploid: cells with more than the normal diploid (2n); 3n (triploid), 4n → usually not viable
○ Aneuploidy: cells do not contain haploid (n=23) commonly due to nondisjunction
■ Monosomy: having 1 copy of chromosome, instead of 2 in diploid cells
■ Trisomy: 3 copies of chromosome, instead of 2 → most common form of aneuploidy

Attention Deficit ● Most common Etiology Prevalence Signs and Sx Oppositional Defiant Pharmacological Course Standardized Tests Frames of Reference
Hyperactivity neurobehavioral Genetic Factors ● 7-8%: elem ● Inattention: sx that d/o ● Stimulants Variable ● Sensory Integration ● Behavioral FOR
Disorder d/o of childhood ● Family Studies: children includes wandering ● S: difficulty [methylphenidate, ● Sx: <4yo; school ○ Sensory Profile ● Acquisitional FOR
● Characterized by ○ Siblings: 2-8x ● 5%: youth off task, lacking conforming to dextroemphetamine] age diagnosis ○ Sensory
persistent and risk ● 2.5%: adults persistence, demands & tasks (1x/day) (interfering with Processing Strategies
frequent patterns ● Twin Studies: PH: difficulty sustaining (i.e., schoolworks) ○ ≥ 6 y/o school ax) Measure ● BMTs
of developmentally ○ ⇧concordance ● 3-5%: focus, being ● D: ○ P: ⇧dopamine, ● Progression: 50% ○ Sensory ● SI Intervention
inappropriate in monozygotic 0-14yo disorganized; not ○ ODD: ⇧epinephrine for may persist thru Integration and ● Social Skills
inattention and ● Two Candidate due to defiance / negativity, attention & adolescence Praxis Test Training
impulsivity, with or Genes: Acc to Sex lack of hostility & thinking Toddler ● Executive Functions ● Teaching-learning:
without ○ DAT1: ● M>F (2-9:1): comprehension defiance ○ CI: cardiac risks ● Observe excessive ○ Behavior Rating Handwriting,
hyperactivity dopamine children ● Hyperactivity: ○ ADHD: since it can ⇧BP motor ax Inventory of Coloring, Cutting,
transporter ● M>F (1.6:1): excessive motor ax difficulty in & HR Elementary Executive EF
gene adults (i.e., fidgeting, sustaining ○ SE: headache, ● Inattention: more Functions ● Self-Management
○ DRD4: tapping, mental effort, stomacache, prominent, (BRIEF) Techniques: Visual
dopamine 4 Acc to Subtype talkativeness) when impulsivity, nausea,insomnia impairing ● Handwriting Skills cues or checklists
receptor ● Combined it isn’t appropriate; forgetting ○ E: lasts for 3-5 / Early Adolescence ○ Evaluation Tool to monitor
seven-repeat (M>F), restlessness instructions 8-12 hours ● Higher risk of of Children’s behaviors
allele gene 50-75% ● Impulsivity: hasty ● Nonstimulants developing of Handwriting ● EMTs: To
- The transport ● Inattentive actions without Autism Spectrum d/o [atomoxetine] antisocial or ● Motor Skills accommodate
gene or (F>M): forethought; high ● S: inattention, (1-2x/day) conduct behavior ○ Peabody inattention,
receptors that 20-30% potential for harm, social dysfunction, ○ ≥ 6 y/o ● Motor hyperactivity Developmental hyperactivity,
take dopamine ● Hyperactive / desire for behavior ○ P: for inattention less prominent Motor Scales inactivity
into the CNS Impulsive immediate problems; ⇧motor & impulsivity ● Restless, ● Education
are lacking. (M>F): <15% gratification, social ax ○ E: seen in 3-6w inattention, P ○ School
intrusiveness ● D: *P=purpose planning & Functional
Neurochemical & ○ ASD: socially *CI=contraindication impulsivity persist Assessment
Neuroanatomical DSM-V Criteria disengaged, *E=effects Adulthood ● COPM
● NC: Dopamine, ● See below isolated, ● Diminished
epinephrine, indifferent to Nonpharmacological hyperactivity Nonstandardized
norepinephrine Subtypes communication ● Psychoeducation: ● Restlessness, ● Functional
● NA: Pre-Frontal ● See below cues; tantrums clear info about inattention, Assessment: Work
Cortex & Locus d/t inability to ADHD; active role of impulsivity persists Behaviors, Motor
Ceruleus Severity tolerate clients in tx process Skills, Cognitive
● See below change; fixed / ● Parent Training: Skills, Executive
Neurophysiological repetitive teaching parents Prognosticating Function,
● ⇧theta ax: “sleep” sterotypic positive parenting, Factors Communication,
waves cause movement strategies (i.e., ● Temperament: Visual Perceptual,
⇩atttention ○ ADHD: behavior behavioral Social Skills,
● ⇧beta ax: ⇧mood tantrums d/t management) inhibition, effortful Sensory
lability & temper impulsivity or P ● Social Skills control or Processing,
tantrums self-control; Training: developing constraint, Sensory Integration
generalized coping strategies for negative
Developmental motor behavior social interaction emotionality,
● Prematurity (<37 ● Behavioral Therapy: and/or excessive
weeks) Intermittent Explosive reduce problematic novelty seeking
● Neurotoxin d/o behavior, improve ● Genetic: Family hx
exposure (i.e., ● S: high levels of adaptive behavior of d/o
lead) impulsive behavior ● Cognitive ● Environmental:
● Tobacco & alcohol ● D: Behavioral: use of negative life
exposure to utero ○ IE: aggression self-instruction, events
● VLBW (<1500g) towards other; self-monitoring, ● Comorbidity:
● Complications at no problems in self-reinforcement, conduct sx,
birh (i.e., attention problem solving & depression,
prolonged labor) ○ ADHD: motivational anxiety d/o
● Perinatal insult to hyperactive strategies
the brain due to Comorbidities
infection, Specific Learning d/o ● Pure ADHD: 30%
inflammation, ● S: problems in ● 1 Comorbid: >80%
trauma educ participation; ● 2 Comorbid: 60%
inattentive Includes:
Psychosocial Factors ● D: ● Developmental
● Severe chronic ○ SLD: d/o: 1) dev
abuse inattention d/t coordination d/o
● Maltreatment frustration, (47%), 2) reading
● Neglect lack of interest, & writing (40%).
● Poverty limited ability Mental retardation
● Under / in academic (13%)
malnutrition tasks ● Psychatric: 1)
○ ADHD: general ODD (60%), 2) tics
Diagnostic inattention (33%), 3)
Procedures asperger’s (7%)
● Medical Exams Personality Disorders
○ EEG: theta & ● S: disorganization, ● Note: optimal
beta brain social intrusivity, outcomes may be
waves emotional & promoted by
○ CT/MRI: brain cognitive ameliorating social
abnormalities dysregulation functioning,
○ Blood Tests: ● D: diminishing
lead levels ○ PD: behavior aggression,
● Standard Pediatric is narcissistic, improving family
Examination or aggressive , or situations
Neurodevelopmen dom­ineering
tal Screening to ○ ADHD:
 rule out im­pulsive,
● Interviews or socially
Questionnaires intrusive, or
(ADHD Rating inappropriate
Scales) behavior
○ Child Behaviour
Checklist: Others
6-18yo; ● Tourette’s: motor
problems in hyperactivity d/t
behavior tics
○ Conner’s Rating ● Anxiety d/o:
Scale: ADHD inattention,
screening restlessness &
○ Vanderbilt motor ax d/t worry
ADHD & rumination
Parenting ● Bipolar d/o:
Scale: ADHD sx episodic ⇧ax, P
concentration,
⇧impulsivity [may
be accompanied
with elevated
mood, grandiosity]

Basic Sciences: DSM-V:

Neurotransmitters A. Persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning
● Dopamine: or development
○ Function: 1) released in response to feelings of pleasure and reward [reinforces you to repeat pleasurable 1. Inattention (≥6sx for ≥6mos; in older adults (≥17yo), ≥5sx): a) fails to give close attention to
action], 2) regulates emotion to take action to achieve rewards details or makes careless mistakes, 2) difficulty sustaining attention, 3) doesn’t seem to listen
○ Implication: ⇩levels of dopamine cause inattention and difficulty in memory formation when spoken to directly, 4) doesn’t follow instructions or fails to finish tasks, 5) difficulty
● Norepinephrine: organizing tasks/ax, 6) loses necessary things, 7) easily distracted by stimuli, 8) often
○ Function: 1) plays role in the body’s stress response [fight, flight, freeze response], 2) regulates sleep, forgetful
alertness, blood pressure 2. Hyperactivity/Impulsivity (≥6sx for ≥6mos; in older adults (≥17yo), ≥5sx): 1) fidgets/squirms,
○ Implication: ⇩amounts of norepinephrine contributed to inattention 2) leaves seat where it is expected, 3) runs about or climbs inappropriately, 4) difficulty
● Serotonin playing quietly, 5) on-the-go, driven by motor, 6) talks excessively, 7) blurts out answers, 8)
○ Function: 1) regulates mood, 2) controls impulsivity difficulty waiting turn, 9) interrupts or intrudes on others
○ Implication: ⇩number of serotonin receptors leads to hyperactivity and impulsivity - Sx aren’t solely a manifestation of opp behavior/defiance/hostility OR failure to understand
B. Sx present before 12yo
Neuroanatomical C. Sx are present in ≥2 settings
Prefrontal Cortex [located at the front of the frontal lobe] D. Impairment in social, academic, occupational functioning
● Function: E. Sx do not occur exclusively during psychotic & other mental d/o
○ Inhibitory Control: Inhibits inappropriate response to distractions, inappropriate behavior, aggressive
impulses and emotional disregulation Subtypes
○ Concentration and Attention: directs behaviors, thoughts ● Combined: Criterion (1) for inattention and Criterion (2) for hyperactivity/impulsivity were met
○ Executive Functions (Organization and Planning): monitors our actions; plans and organizes for the future ● Predominantly Inattentive: Criterion (1) for inattention is met; criterion (2) is not met
● Specific Areas: ● Predominantly Hyperactive/Impulsive: Criterion (2) is met; criterion (1) is not met
○ Dorsal and lateral portion: regulates attention and motor responses
○ Ventral and medial portion: regulates emotions Severity
● Pathophysiology: ● Mild: few sx in excess of those required present; result in no more than minor impairments in
○ ⇩cerebral metabolism of the pre-frontal cortex social or occupational functioning
 ○ Implicated because of its high utilization of dopamine and its reciprocal connections with other brain ● Moderate: sx between mild and severe present
regions ● Severe: many sx in excess of those required present; result in marked impairment in social or
occupational functioning
Neural Network: Attention System → 3 Network Subsystems
● Orienting Subsystem: implicated for our sensory processes
○ Parietal Cortex: responsible for processing somatosensory information from the body
○ Superior Colliculus: where visual, auditory, and somatosensory information are integrated to initiate motor
commands
○ Thalamus: for sustained attention
● Detection Subsytem: responsible for detecting targets that would undergo further information processing
○ Anterior Cingulate Cortex: implicated in empathy, impulse control, emotion and decision making [emotional
expression, attention allocation, and mood regulation]
○ Lateral Prefrontal Cortex: regulates attention and motor responses
● Alerting Subsystem: maintaining general vigilance
○ Locus Coeruleus (containing noradrenergic neurons): maintaining general vigilance or sustained attention
○ Cerebellum: modifying motor output

Autism Spectrum Neurodevelopmental Risk Factors Prevalence DSM-V Differential Pharmacological: Positive Prognosis Standardized Tools Frame of Reference
Disorder disability Genetic ● 1 in 54 See below ● Hearing Loss: lack Risperidone, ● Early Detection Sensory Processing ● Behavioral FOR
characterized by ● Rare Genetic children / delayed Aripiprazole, Metformin (AEA 15-24mo) ● Sensory Processing ● Acquisitional FOR
differences in social Syndromes: ● M>F (4:1) Impairments response to name, for irritability and ● Early Intervention Measure (SPM) → ● Person
communication Fragile X (FMR1 Social attention agitation (side effects: ● Parent/Caregiver SP, Soc Par and Environment
development and a gene; mild to mod ● (-) Joint Attention ● Rett Syndrome: weight gain and Participation: at Praxis skills Occupation (PEO)
pattern of restricted ID, long face), ● (-) Eye Contact during its sedation) least 20 session in ● Sensory Profile II Model
interests and Tuberous ● (-) Empathy regressive phase a yr (SP-II) → SP ● SI
repetitive behavior Sclerosis (tumor Language (1-4yo), young Rehabilitative: ● (+) Social Support patterns or
growth in organs) ● P nonverbal com girls would have ● Applied Behavioral difficulties in daily Strategies
“Spectrum” → ● C.16p11.2 deletion ● P prosody (mono) repetitive Analysis (ABA) ● 3yo [critical age]: life Occupations
behavioral & & duplication; c. ● P phonology behaviors & ● Sensory Integration Ave. Non-Verbal ● Modeling
developmental fx 15q11-q13 ● Atypical linguistic fixated interests Therapy Skills Motor ● Use Social Stories
range from very mild duplication form ● Selective Mutism: ● PT (GMS, Praxis) ● 5yo: Functional ● PDMS ● A/IADL Re/training
to severe ● Twin Studies: EF severe anxiety ● OT (FMS, SI, Social Language ● Teaching-Learning
36-95% risk in Inflexibility disorder where a Communication) - Before 5: more Occupations in Educational,
Diagnostic monozygotic twins ● Perceptua i/fl: (-) person is unable ● SLP (Language and dramatic shifts ● SFA (Education Social, Play
Procedures ● Family Studies: shifting attention to speak in certain speech, pragmatics) - After 5: changes Participation) Participation
Screening: Gold 31% risk in sibling ● Motor i/f: (+) social situations; are linear ● ETCH (Handwriting)
Standard repetitive behaviors can exhibit skills in ● 9yo: Friendship & Performance
● Autism Diagnostic Environmental ● Social Com i/f: (-) other contexts engagement with Development Patterns
Observation ● Advance maternal turn taking ● Social peers ● Brigance ● Habit Training
Schedule (ADOS): (≥40yo), paternal SI Communication ● Routine Setting
12mo-adulthood; (≥50yo) ● S Modulation d/o: d/o: does not have ● Ave=IQ Non-Standardized
45min-1h ● Short intervals w underresponsive, repetitive ● Lack of SSB ● Interview Specific
semi-structured, pregnancy overresponsive, behaviors; no ● AA Play ● Functional ● SST
standardized (<24mo) sensory-seeking sensory problems Assessments ● SI Strategies
qualitative ● Non-specific factor ● Atypical Visual & ● Language d/o: ● LFTs
assessment of during pregnancy: Auditory Process: Present problems ● BMTs
communication, weight gain, HTN, heightened w/ communication; ● Age Appropriate
social interaction metabolic con perception of visual no repetitive Play Ax
and play; combine ● Specific factor: & auditory info; behaviors
 clinical infection pitch perception ● ID: learns more Poor
observation & (bacteria/viral), Motor slowly or ● Late Diagnosis
caregiver report family hx of ● motor stereotypies differently than ● Comorbid d/o
autoimmune d/s [repetitive beh, typicaly ● Lack of social &
● Prenatal valproic atypical mvmt, developing child communication
acid exposure stereotypical play] ● ADHD: attention abilities
● (-) motor coord & d/f & hyperactivity
Obstetric arm fx [(-) running [can’t concentrate]
● Maternal HTN & speed, agility, B ● IQ (<60)
diabetes coord, manual dex, Comorbidities ● P Language
● Threatened abort ball skills; P use of ● Speech & Development
● Antepartum gestures] Language Delays: ● Lack of Nonverbal
hemorrhage ● delay FMS & GMS 87% Communication
● Preterm (<32wk), ● (-) gait & balance ● Academic ● Lack of
LBW (<1500g), d/t deficits in Learning Difficult: Adaptability
SGA, LGA status feedback / 75% ● Low Functioning
response to ● ID: 15-65% ● AI Play
postural ● GI sx: 47%
perturbations; lack ● Sleeping
of alternating Problems: 25-40%
arm-swing ● Obesity: 23%
● (+) dyspraxia ● Bowel Problems:
● P hand mm 12%
strength; postural ● Tics: 9%
hypotonia ● Epilepsy: 8%
Co-Occuring
Conditions
● ADHD: 28.2%
● Anxiety &
Depression
● Aggression: 25%

Basic Sciences: DSM-V

Neurobiology A. Persistent deficits in social communication & interaction across multiple contexts (≥1
● Not a focal impairment in a specific brain region or system; condition that results from overall brain sx/subdomain)
reorganization early in development 1. d/f in social-emotional reciprocity
Brain Development: Individuals with ASD → 3 Stages 2. d/f in nonverbal communication behaviors
● Infancy & Early Childhood: overgrowth in regions such as the frontal & temporal lobe, amygdala 3. d/f in developing, maintaining, & understanding relationships
● Late Childhood: slowing and arrest of growth B. Restricted, repetitive patterns of behavior, interests / activities (≥2 / 4)
● Pre-Adolescence and Adulthood: degeneration 1. stereotyped or repetitive motor mvmt, use of objects / speech
Accelerated Brain Development: Infancy & Early Childhood 2. insistence on sameness, inflexible adherence to routines or ritualized patterns of verbal /
● Accelerated brain development → altered connectivity nonverbal behavior
○ Overall brain under-connectivity: lack of long-range connectivity → P integration of sensorimotor, social 3. highly restricted fixated interests: abnormal in intensity / focus
communication & cognitive fx 4. Hyper/hypo-reax to sensory input or unusual interest in sensory aspects of environment
○ Local overconnectivity in specific regions (fronto-occipital regions) C. Sx must be present in early developmental period
● In ASD: basic learning or simple motor tasks could be intact; complex cognitive fx or motor planning could be D. Sx cause significant impairment in areas of fx
impaired E. Not better explained by ID, GDD
MRI Study *d/f= deficits
● During finger-tapping task: persistent frontal lobe activation and reduced cerebellar activation
 ○ Lack of transition in neural activation from prefrontal regions to the cerebellum: may be attributed to lack of
long-range connections
■ P integration of sensorimotor, social communication, & cognitive fx
● Impaired mirror neuron systems found in the frontoparietal cortices
○ MNS: commonly activated during action-production or action-observation; plays a role in imitation skills or
observation-based motor learning
○ (-): P imitation skills, difficulties in learning motor and social skills thru observation
Functional Levels
● ASD Level 1 (Requiring Support): 1) Difficulty initiating social interactions; 2) organisation &
planning problems can hamper independence
● ASD Level 2 (Requiring Substantial Support): 1) Social interactions limited to narrow special
interests, 2) frequent restricted / repetitive behaviors
● ASD Level (Requiring Very Substantial Support): 1) Severe deficits in verbal & nonverbal social
communication skill; 2) great distress / difficulty changing actions or focus

Affected Structures
● Cerebellum: ⇧synapses (implicated in: motor control, cognitive & emotional-social fx)
● Prefrontal Cortex: ⇧neurons (implicated in: emotion, thoughts, feelings; social deficits in verbal & nonverbal
communication)
● Temporal Lobe: ⇧gray matter volume (implication: social stimuli → language & faces)
● Frontal Lobe: ⇧gray matter (thinking, decision-making)
● Limbic: behavioral [anterior cingulate gyrus & amygdala], memory & learning [hippocampus], joint attention
[anterior cingulate gyrus]
○ ACG: emotional expression, attention allocation, and mood regulation
○ HIPP: memory & learning
○ AMY: integrative center for emotions, emotional behavior, and motivation

Intellectual Disability Neurodevelopmental Genetic Prevalence DSM V ASD Pharmacological Course Standardized Tools Frame of Reference
(former: mental disability involving Involve abnormalities ● 10-15/1,000 3 Crtiteria Met: ● S: deficits in social Aggression & SIBs ● Emerges before ● WeeFIM: self-care, ● Behavioral FOR
retardation) significant limitation in the autosomal children ● Deficits in communication ● Lithium: tx for P 18yo mobility, cognition ● Acquisitional FOR
in: chromosome; ● High intellectual fx: and/or socpar judgment, agression, ● If severe, ● AMP: motor & ● SI FOR
● Intellectual inherited conditions incidence in [reason, problem ● D: anger identifiable w/in 1st process skill in
Function ● DS: chromosomal school-age solve, plan, abstract ○ ASD: (+) of ● Atypical 2 yrs ADL/IADL Strategies
(reasoning, abnormalities are children think, judge, acad restricted, Antipsychotics ● TVPS: to validate P ● Develop
learning, problem associated w/ (10-14yo) learning and from repetitive (Risperidone, Prognosis spatial operations Performance
solving) measured mod-severe ID experience]; clinical patterns of Ariprazole): Good ● SFA (school Patterns (Habits,
by an IQ level of ● Fragile X: FMR1 Acc to Sex & standardized test behavior, irritability ● Early Diagnosis & functional Roles, Routines)
≤70 gene (X-linked) → ● Mild: M>F ● Deficits in adaptive interests, or ax ● Valproic Acid: manic Tx assessment) ● BMTs
● Adaptive Behavior decline in (2:1) functions = fails to ○ ID: no ep ● Mild to Mod ID ● Knox Preschool ● SI Techniques
(Conceptual, intellectual fx ● Severe: M>F meet socio-cultural problems in ● Carbamazepine: ● (+) Family Support Play Scale ● Activity Adaptation
Social, Practical during pubertal (1.5:1) & dev standards sensory input, seizures, pain ● VABS: Vineland ● Use of Asistive /
Skills) measured period (M>F) [communication, fixations, Poor Adaptive Behavior Adaptive Device
via observation ● Prader-Willi social participation, motor Nonpharmacological ● Late Diagnosis Scal ● Direct Instruction /
(deletion of c.15) independent living] movements, ● Educational Support ● Severe - Profound ● SFA: School Monitoring /
● Cri-du-Chat (lack at home, school or insistence on (EMT in School); ID Functional Consultation
a part of c.5) → community sameness IEP; SPED ● (-) Family Support Assessment ● Prevocational /
Diagnostic severe retardation ● Onset of deficits: ● Family Education ● Deprived Nurtition ● PDMS: Peabody Vocational Skills
Procedure ● Phenylketonuria: dev periods Neurocognitive D/O ● Behavioral Therapy & Nurturance Developmental Training: Materials
Includes: Interview, normal to severe ● S: problems in ● Cognitive Therapy ● Comorbities → Motor Scales Handling, Food
Observation, Norm- intelligence Severity cognitive domains ● Pre/Vocational depression, P ● BOT-MP: Service, Clerical
Referenced Tests ● Others: Rett, Based on adaptive (EF, attention, Training self-image Bruininks-Oseretsky Work
● Intellectual Neurofibromatosis functioning domains: learning, memory, ● SIBs Test of Motor ● Emotion
Functioning: Cattel , Tuberous ● Conceptual (Acad): language) that Proficiency Regulation
Infant IS Sclerosis, memory, language, interfere w/ ax ● SP: Sensory Profile ● EMTs
(2mo-4.5y), Lesch-Nyhan reason, abstract ● D: ● Beery VMI: Visual ● Social Skills
Weschler IS think, problem solve ○ NCD: progress Motor Integration Training
(6-16y), Acquired / ● Social: aware of decline / loss Outcome (6-20) Observation ● Task Modification:
Standford-Binet IS Developmental thoughts & feeling, of fx ● Mild: G6 level; ● Home Assessments Divide task into
(2-18y): ID = Prenatal interpersonal com, ○ IDD: guided to social (Home visit) small steps
<70-75, ● Age: adv paternal, friendships, soc developmental conformity ● School Environment
early maternal judgement delay; ● Mod: G2 level; Assessments
● Maternal chronic ● Practical: performance benefit from social (School visit,
illness (diabetes, self-management in falls below, but & occupational skill Observation)
anomia, HTN, self-care, IADLs, it doesn’t training ● Functional
emhysema, leisure, and/or educ decline ● Severe: benefit Assessments
alcohol / narcotic) from systematic ● Non-OT:
ill during 1st tri See below for Social habit training; can Wechsler Intelligence
● Congenital specifiers Communication d/o talk/learn to Scale (for IQ)
Infection: TORCH, ● S: problems in communicate;
HIV Comorbidities social unable to benefit
● Exposure to ● Mental D/O (⅔ of communication & from voc training
infection, toxin, ID): ADHD, social interaction ● Profound: motor
drugs (opiods, disrupvtive behavior ● D: dev may respond
heroin), alcohol, d/o, schizophrenia, ○ IDD: (-) to min training in
anticonvulstants, mood do, pervasive intellectual, self-help
● Prematurity developmental d/o adaptive
Perinatal Acc to Subtype behavior
● Difficult / ● Mild: disruptive beh,
complicated depression, anxiety
delivery, birth ● Mod-Severe: ASD
trauma ● Profound:
● Neonatal (sepsis, psychiatic sx
severe jaundice,
hypoglycemia)
● Intracranial Note: More physical
hemorrhage and mental problems
● ELBW (<1000g) = higher odds of
Postnatal aggressive behavior
● Brain infection
(meningitis,
encephalitis)
● Head injury /
trauma
● Asphyxia
● Chronic lead
exposure
● Severe /
prolonged
malnutrition

Environmental /
Sociocultural
● Malnutrition (first
5y = disrupt brain
development)
 ● Teenage
pregnancies
(complications,
prematurity, LBW)
● P postnatal
medical care, P
maternal nutrition,
exposure to toxic
substances
● Others: education,
physical ex, level
of cog stimulation,
socioeconomic
status]

Basic Sciences: IQ Levels

Note: Most individuals with significant intellectual impairment have no discernable ● 1) very superior: ≥ 130, 2) superior: 120-129, 3) high average: 110-119, 4) average: 90-109; 5) low average 80-89; 6)
structural abnormalities of the brain. There are no specific neuropathology, but defects in borderline: 70-79; 7) extremely low: ≤ 69
neuronal processes result in (-) information processing. Specifiers for ID

CNS Malformations (In 10-15% of the Cases) Mild (55-69 IQ) Mod (40-54) Severe (25-39) Profound (<25)
● Cerebral Cortex: higher mental functions, general movement, perception and behavior
○ Frontal Lobe: planning, reasoning, problem solving, regulating emotions Mental Age 5-8yo 1-5yo 2mo-1yo 0-6mo
○ Temporal Lobe: understanding language, processing & organizing info, memory, Range
learning
● Hippocampus: memory Language Functional; ability to use Functional; limited Slight communicative No communicative
● Cerebellum: motor activity; coordination of muscles for speaking* com device use of com device speech speech; few words
● Amygdala: emotions, aggression*
Self-Help Good; need support iadl Partial-near Support for all ADLs Little to partial A
Note: Add information on FORs complete;
maladaptive behavior
present

Social Skills Meaningful, immature Diminished ability to Capable of forming Enjoys attention
relations form relations bonds

Academic Skills Up to G6; ave=G3 Up to G1/G2 Limited concepts; None; visuospatial

SPED (recognize skills (match, sort
image, sight-read, may be acquired)
follow rules)

Vocational Status Adequate for min Close supervision in Activity center Basic simulation ax
self-support un/semi skilled labor programs

Adult Status Can live (I)’ly or min Extended teaching: Dependent, constant Needs constant
supervised (I) in eat, dress, need for supervision supervision
groom
 Difficulties Acad skills, AT, EF, ST Slow dev of concept , Problem-solving, skill (-) motor / sensory
memory, perceiving language, pre-acad generalization
social cues, regulating skills; limited social
emotion & behavior judgment; decision Note: perform best w/
routine & consistent

Specific Learning Neurodevelopmental Risk Factors Prevalence Diagnostic Criteria Differential Standard Tx Approach Onset Standardized Tools Frame of Reference
Disorder d/o; ● family hx of LD ● 5-15%: A. Difficulty learning & Normal Variation in ● Demystification: Occurs during ● TVPS: Test of ● Visual Perceptual
● prematurity school-age using acad skills; Acad Attainment: explain nature of elementary school Visual Perceptual ● Acquisitional
Deficits in person’s ● prenatal alcohol children presence of ≥1sx ● S: difficulty in acad dysfunction years; can be seen Skills ● PEO
ability to perceive / exposure across diff. persists for ≥6mos functioning ● Bypass Strategies event before formal ● Beery VMI: Visual
process info ● other dev. & language / (see sx below) ● SLD: adequate (Accommodation): school Motor Integratio Intervention
efficiently / mental health, cultures B. Acad skills are educ opportunity; use of specialized ● SFA: School Approach
accurately neurologic, ● ~4%: adults substantially & exposure to same education approach Course Functional ● Remediation or
chronic medical quantifiably below instruction specific to Lifelong, variable Assessment Maintenance of
Characterized by conditions Acc to Sex expected of dev ● NV: lack of educ underlying academic Visual Perceptual
persistent difficulty ● hx of CNS ● M>F (2-3:1) age; significant opportunity; deficits Pre-School Age Nonstandardized Skills (i.e., Maze
learning academic infection, interference w acad consistent P ● Compensatory: ● Lack of interest in ● School Environment for visual spatial)
skills in reading, irradiation or TBI or occupational instruction audiobooks, language games; Assessments ● Compensatory
written expression or ● poverty; under- performance / text-to-speech, troubles learning ● Functional Strategies (i.e.,
math stimulating env ADLs; confirmed by d/t Neurological / speech-to-text nursery rhymes Assessments: use of boxes or
standardized Sensory Deficits software, change ● Baby talk; Education lines, use of
Etiology:Multifactorial measures ● S: difficulty in font (Comic Sans) mispronounce Participation multisensory tools
; inborn or acquired C. LD begin in learning; influence ● Remediation: drills ● Fails to recognize for numbers,
school-age; may ability to read or to aid automatization and write letters prolonged time for
Genetic not fully manifest write of subskills; ● Trouble to count accomplishing
● 35-40% of until demands ● SLD: (0) abnormal strengthening Elementary School tasks, placement
1st-degree relative exceed limited functions memory skills ● Marked difficulty: in the classroom)
⇧risk capacities ● NV: (+) abnormal ● Developmental letter- sound
● Chromosomal: 6 D. LD not better functions (hearing Therapy: SP correspondence, Models
(phonological accounted for by / visual impair) (language disability), fluent word ● Direct service or
awareness), 15 ID, uncorrected OT (handwriting, decoding, spelling instruction (OT
(1-word identify), visual/auditory Neurocognitive d/o education), PT or math facts meets with the
1-3/6/15/18 (read acuity, other mental ● SLD: occurs (gross motor ● Reading: slow, student on a
& spell); 18 / neurologic d/o, during clumsiness) inaccurate, effortful regular basis)
(phoneme psychosocial developmental ● Curriculum Grades 1-3 ● Monitoring (OT
awareness) adversity, lack of period Modifications: alter ● Unable to read identifies needs
Environmental proficiency in ● NCD: marked school curriculum common 1-syllable and designs
● Exposure to language, decline from ● Strengthening of ● Unable to intervention but
infectious illness inadequate educ former state Strengths: to recognize teacher
(e.g., Influenza) instruction remedy deficiencies irregularly spelled implements plan)
● Prenatal exposure ADHD (i.e., athletic, artistic, words ● Consultation
to toxins (i.e., Specifications ● S: difficulty in acad mechanical) ● May commit (educating the
nicotine) & ● w/ impairment in skills ● Individual & Family reading errors teacher and
infection → alters reading, written ● SLD: difficulty in Counsel: cognitive- Grades 4-6 parents to improve
brain development expression or linguistic skills behavioral therapy ● Mispronounce the client’s
● Labor mathematics ● ADHD: difficulty in ● Medication: parts of long words educational
 Complications performance stimulants ● Confuse words participation
(prematurity, Levels of Severity ID (methyphenidate, that sound alike
VLBW <1500g) ● Mild: some ● SLD: reading / atomoxetine) to treat ● Trouble
● Sociocultural difficulties in ≥ 1 writing / math attention deficits remembering
Deprivation academic domains, below chronlogical names, numbers
Neurologic but may function age [academic fx] ● Trouble completing
● Planum Temporale given ● ID: almost all other hw or tests on time
(on L brain): less compensations skills are below Adolescents / Adults
asymmetry than R ● Mod: marked age [academic & ● Can master word
● L Temporal Blood difficulties in ≥ 1 adaptive function] decoding
Flow: differs from academic domains, ● Reading is slow,
children w/o LD unlikely to become Others effortful
● Visual Magno- proficient w/o ● Developmental ● Marked problems
cellular System: intensive & coordination d/o in reading
concerned with specialized ● Language d/o comprehension &
“where” visual teaching; written expression
stimulus is; accommodations ● P mastery of math
disorganized & needed to complete facts and problem
smaller cell bodies efficiently solving
● Brain Lesions in L ● Severe: severe, ● Numerous spelling
Occipital Lobe several domains, mistakes
● Lesions in unlikely to learn ● Avoid ax with
Splenium of without intensive reading or math
Corpus Callosum: and specialized
blocks teaching for most of Prognosticating
transmission of the school years; Positive
visual info from R even with ● Early Diagnosis
to L hemisphere accommodations, ● Early Remediation
may not be able to / Intervention
complete ● Mild Severity (1-2
academic
Dyslexia: Etiology Prevalence Diagnostic Criteria Reading Programs domains) Materials
reading disability; ● Genetic & Familial ● 5-12%: A. Sx: ● phonemic ● Use of Appropriate ● Clarify / simplify
difficulties in school-aged 1. inaccurate / awareness: to focus Accommodations written directions
accurate or fluent Pathophysiology children slow & effortful on & manipulate or Support Service ● Block out
word recognition & ● Neural Signature: reading [slow, phonemes (speech distracting stimuli
poor decoding inefficient function Acc to LDs hesitant, guess; sounds) in syllables Negative ● Highlight Essential
of L hemisphere ● Most difficult to sound & words ● Late Diagnosis Info
Skills for Reading posterior brain common out words] ● phonics: letter-sound (end of elementary ● Additional Practice
● hear & systems (appear (80%) 2. difficult to correspondences school age) Ax: supplement
discriminate underactivated) understand ● fluency: automatic, ● Remediation not materials ( games,
sounds meaning of rapid recognition of given early peer teaching,
● produce speech see basic sciences what is read words ● Severe Severity direct materials,
sounds [e.g., sequence, (unlikely to learn WS)
● phonics: match relations, Accommodations acad skills even ● Develop reading
printed symbols w inference, ● Extra time in reading with guides or audio
spoken sounds deeper ● Listen to Text: accommodations) recording device
● reading decoding: meaning] voice-to-text ● Comorbid ADHD = ● Use of ATs:
produce sound conversation poorer mental text-to-speech
 associated w w impairment: reading ● Laptop: spelling health outcomes programs, audio
printed letter or ● word reading checkers, access to ● Inattentive books
letter combination accuracy lecture notes behavior (during
● reading rate / ● Tutorial services preschool years) Instruction
fluency ● Teaching
● reading methods: demo,
comprehension feedback, monitor
practice
Clinical Manifestations ● Repeat Directions:
● Cardinal Sign: verbal & visual
labored, effortful ● Maintain daily
reading routine
● Spoken Language ● Step-by-step
Difficulties: ● Mnemonic
Mispronunciations,
lack of fluency, Student
word-finding ● Assignment
difficulties books, calendars
● Instructional aids
● Display samples
● Peer-mediated
learning
● Flexible work
times
● Additional practice

Dysgraphia: see basic sciences Prevalence Diagnostic Criteria ● Using larger pencils
transcription ● 7-15%: B. Sx: with special grips
disability; difficulties school-aged 3. difficult w ● Paper with raised
in spelling accuracy children spelling [add, lines (to help with
& written expression omit, sub words margins)
such as grammar & / letters] ● Extra time on writing
punctuation, clarity & 4. difficult w assignments
organization written ● Alternative methods
expression to show learning &
Subtypes [grammatical / work
● Motor Dysgraphia: pronunciation ● Assistive electronic
lack of fine motor errors, P tech (i.e,
coordination & organization, voice-to-text)
visual perception; lacks clarity] ● Copy of written
illegible & slow materials
handwriting, P w impairment: written ● Typing notes
drawing & tracing, expression ● Letter-formation
slow ● spelling accuracy drills
finger-tapping ● grammar & ● Handwriting-training
● Spatial punctuation programs
Dysgraphia: accuracy
problems of ● clarity / organization
spatial perception of written
 affecting letter expression
spacing & drawing
ability Clinical Manifestations
● Linguistic ● trouble forming
Dysgraphia: letters
impacts language ● tight, awkward,
processing skills; painful pencil grip
affects ● difficulty following
spontaneously line
written text ● trouble w sentence
structure; following
grammar
● difficulty organizing
thoughts on paper

Dyscalculia: see basic sciences Prevalence Diagnostic Criteria Strategies

mathematical ● 3-6%: B. Sx: ● Multisensory
disability; difficulties school-age 5. difficult Structured Math
in number sense, children mastering Instructions: use
arithmetic facts, number sense, sight, hearing,
fluent calculation, facts or movement, touch
mathematical calculation [P ● Accommodations:
reasoning understanding, taking timed-test,
counts w fingers using blocks to
Neurodevelopmental to add 1-digit, solve problems
Functions gets lost, switch ● Use of AT:
● Number Sense: procedures] calculator, digital
mental 6. difficulty w graph, paper
representation of mathematical
quantity: reasoning [math
magnitude, concepts, facts,
commutativity, or procedure
number line application to
● Calculation and solve]
Retrieval of Math
Facts w impairment:
● Language of Math mathematics
● Ability to ● number sense
Understand Word ● memorization of
Problems arithmetic facts
● Visual-Spatial & ● accurate / fluent
Organization Skills calculation
● accurate math
reasoning

Basic Sciences:
● Brain regions are linked and communicate connections among different cortical regions which are crucial for efficient transfer and adjustment of information.
○ For SLD, there is a decreased connectivity of the brain.
Dyslexia
 ● 3 Systems for Reading:
○ Anterior System (Inferior Frontal Gyrus, Broca’s Area, Brodmann Area 44-45): Motor Speech Area - Utilized in speech production for articulation and word analysis
○ 2 Left Posterior Reading Systems: 1) Parietotemporal - Word Analysis, 2) Occipitotemporal - Word-form Area, for rapid / automatic / fluent identification of words
Dysgraphia
● Parietal (Angular Gyrus in the anterolateral region) - linguistic, guide writing [other functions: attention, self-processing, semantic information processing, emotion regulation, and mentalizing]
● Frontal (Exner’s Area) - motor, control over rhythm and timing
Dyscalculia
● Prefrontal Cortex - cognitive processes involved in calculation
● Parietal (Intraparietal Sulcus): numerical processing

MOTOR CONDITIONS

Condition Description Etiology / Epidemiology Clinical Features / Differential General Medical / Course / Prognosis OT Evaluation OT Intervention
Diagnostic Associated Diagnoses Surgical Treatment
Procedure Problems

Cerebral Palsy General Major Criteria for ● Leading ● A neuromotor Hereditary Ataxia Pharmacotherapy Factors Standardized Tools Frames of Reference
● d/o of movement Diagnosis cause of control deficit that LE Spastic ● Antispasticity: Good (Indicators of MAS ● NDT: Normal
& posture causing 1. neuromotor deficit childhood alters movement or ● S: uncoordinated Baclofen, Eventual Walking) ● Muscle tone mvmnt is learned
ax limitations 2. static brain lesion disability posture (not all CP gait Clonazepam ● 18yo: suppression by experiencing
● Attributed to 3. acquired before patients have ● D: HA ● Neuromuscular of obligatory AMPS (2-100yo) what it feels like;
non-progressive birth / 1st years Prevalence cognitive and (degenerative), CP Blocks (anesthetics, infantile reflexes ● 16 ADL motor brain plasticity
disturbances in ● 1.5-4/1000 sensory deficits) (not progressive) phenol, botulinum ● 2yo: sit maintained ● 20 ADL proces ● Acquisitional:
the developing Etiology/Patho (CDC) toxin); botox every Poor ● Assesses attention, Teaching-Learning
fetal / infant brain See below Signs & Sx Rett Syndrome 3-4mos ● 4yo: no working memory, ● Behavioral
Acc to Sex UMN Signs ● S: spasticity, P ● Pressure Sores: independent sitting insight, EF, ● Rehabilitation
Diagnostic ● M>F (1.5:1) ● ⇧tone & primitive hand function topical medications ● 8yo: no walking processing, speed, Strategies
Note: Procedures reflexes, Babinski ● D: RS (loss of gait, func mob, Stretching (⇧ROM,
● condition; not a ● CT Scan / MRI: to Motor spoken language, Surgery Predictive Values: balance coord, contract)
disease determine the ● Motor delay mental retardation, ● Selective dorsal Presence of: (1 point) problem-solving ● 10 rep, 60s per
● not hereditary cause (i.e., PVL, (transitions), P neck progressive, rhizotomy ATNR rep
● not life-threatening ICH) control, (-) motor common in F), CP ● Muscle lengthening STNR Wee-FIM (6mos-7yo) ● 4x per week
● normal life ● EEG/EMG: to rule control, balance & (nonprogressive) surgery Moro ● Determine amount
expectancy out seizures coordination); weak Extensor Thrust of assistance Proper Positioning
● Cranial suck Metabolic Disorders Neuromotor Therapy Neck Righting needed in self-care, ● Lateral Supports
Ultrasound: Others ● S: Dystonia, ● Bobath: NDT mobility & cognitive ● Bolsters
through the ● Lethargy, irritability extrapyramidal sx, ● Rood Absence of: (1 point)
anterior fontanelle cognitive decline, ● Ayres: SI Foot placement BOTMP-2 (4-21yo) Splints
(if not closed) to Associated Problems ataxia ● Vojta reaction ● Assesses overall ● Antideformity
check for ● Oromotor Difficulty ● D: Progressive w/ ● Doman-Delacato: Parachute reaction motor proficiency Splints
hemorrhage (suck, swallow, biochem Patterning Therapy (GMS, FMS) ● Upright Splint
chew, lip closure, structures affected Results (Prognosis): ● 4 Composites: fine ● Thermoplastic
tongue thrust, drool, but CP does not ≥ 2: Poor manual control, splints (feet)
dysarthria): CPSQ, include this and it 1: Guarded manual ● Airplane Splint
dyskinetic is non-progressive For Weakness / Motor 0: Good coordination, body
● GI: reflux, ● Therapeutic Ex coordination, Tone Inhibition
constipation Leukodystrophies ● Electrical Stimulation strength & agility ● Mobilization
 ● Dental: dysgenesis, (Krabbe Disease, ● ADs (walkers, brace) (Rotatory
malocclusion, Metachromatic PDMS-2 (Birth-5yo) Movements)
gingival hyperplasia Leukodystrophy, and For Spasticity ● Assesses gross & ● Weightbearing on
● Visual: strabismus, Juvenile Onset ● Icing fine motor skill TIPs
refractory errors Alexander Disease) ● Proper Positioning development ● Deep
● Sensory (-): hemi ● S: spasticity ● Brace / Cast ● GM: reflex, Compression
● Pulmonary: ● D: L (cognitive ● Electrical Stimulation stationary, ● Neutral Warmth
deficient ventilation, decline, late onset, ● Exercises locomotion, object
microaspiration Ichthyosis), CP manipulation Tone Facilitation
(early onset) For Contractures ● FM: grasping, VMI ● Icing
Gait Disturbances ● Heating Modalities ● Total Quotient ● Light Touch
● Scissoring Gait: Spinal Muscular ● Stretching Ex ● Tapping
⇧hip adductor tone Atrophy ● Electrical Stimulation SFA ● Weightbearing
● In-Toeing: ⇧hip ● S: UMN lesion, ● Positioning ● Observation of
femoral contractures ● Brace / Cast client’s performance Strengthening
anteversion; ⇧ankle ● D: SMA in school ● Resistive Ex
internal tibial torsion (progressive For Pressure Sores ● Focuses on fine &
weakness, no ● Proper Position manipulative Motor Control
Spastic Diplegia Causes See above ● P body scheme spasticity), CP ● Turning Schedule movements such as ● Transfer ax
[35%] ● Prematurity, ● Limited hand (non-progressive, ● UVR use of pencil & ● Func ax
ischemia, function spasticity) ● Topical Meds scissors
infection, ● Insufficient BOS Other Strategies
endocrine / ● LE > UE Muscular Dystrophy For Swallowing Nonstandardized ● CIMT
metabolic ● VP skill (-) ● S: abnormal LE ● Proper Positioning Tools
Pathophysiology features ● Tube Feeding Assess for: ADs
● Periventricular ● D: MD (no ● Tongue / Lip Ex ● Neuromusculo- ● Silicone utensils
leukomalacia, spasticity; weak at skeletal Functions ● Pencil grips
periventricular cyst birth; Gower’s (Reflex, ROM, ● Bucket seat for
/ scars in white sign); CP Tone, Strength, dressing
matter (non-progressive) Balance) ● Posterior walker
Electrical stimulation ● Typical Postures ● Wheelchair
for mobilization, to (Fisting,
Spastic Quadriplegia Causes See above ● (-) eye movement
avoid contractures Opisthotonus,
[20%] ● Ischemia, ● P head control
Cortical Thumb)
infection, ● Opisthothonus
● Presence of
endocrine / ● Contracture,
Contractures /
metabolic, genetic] deformity
Deformities
Pathophysiology ● Oromotor difficulties
● Mobility (Head,
● Periventricular ● Primary sensory (-)
Trunk, Pelvic)
leukomalacia, (visual, auditory)
● Gait Patterns
multicystic ● ⇧ hypersensitivity
● Motor Functions
encephalomalacia, ● P body awareness
(FMS, GMS,
cortical ● P regulation of
AGMS)
malformation arousal level
● Somatosensory
● P survival function
Function
● Shallow breathing
● Perceptual and
● Seizures
Cognitive Functions
● Mental retardation
● Work Behaviors
● SI
Hemiplegia [25%] Causes See above ● Asymmetry
● Thrombophilic d/o, ● Visual field History Taking
infection, problems ● Maternal history
periventricular ● Work behavior ● Developmental
hemorrhagic problems history
infarction ● Developmental
Pathophysiology disregard (i.e., Gross Motor Function
● Stroke in utero, learned non-use) Classification System
focal infarct or ● Seizures (GMFCS)
cortical / Indicated for kids 2-12
subcortical ● Level I: walks
damage without limitations
● Level II: walks with
Extrapyramidal Causes See above Dyskinetic limitations (i.e.,
(Athethoid, ● Asphyxia, ● ⇧tone with period of outdoor ax; uneven
Dyskinetic) [15%] kernicterus, hypotonia; surface; run/jump)
mitochondrial alternating tone ● Level III: walks
genetic / metabolic ● Writhing involuntary using hand-held
Pathophysiology movements mobility device (i.e.,
● Athetoid: ● Abnormal manual wheelchair)
Kernicterus → movements in ● Level IV:
Hyperbilirubinemia affected UE self-mobility w/
→ damage to BG ● Oromotor difficulties limitations (i.e.,
● Asphyxia, (tongue thrust, assistance w/
symmetric scar in drooling) manual wheelchair;
putamen/thalamus ● Normal railing; assistive
; scars in globus intelligence tech)
pallidus / ● Level V: transported
hippocampus; Athetosis in a manual
mitochondrial ● Fluctuating tone wheelchair in all
scarring in BG ● Asymmetry settings
● Involuntary
movement
● P midline
orientation
● P mvmt grading
● P coordination

Basic Sciences: Risk Factors

Major Events in Human Brain Development: ● Before Pregnancy: maternal (delayed/irregular/long menstruation, unusual interval between pregnancies, parity>/=3),
● 1) Primary Neurulation (3rd-4th week), 2) Procencephalic Development (2nd-3rd mo), medical conditions (ID, seizure, thyroid), paternal (advanced age → athetoid dystonic CP), motor deficit in sibling
3) Neuronal Proliferation (3rd-4th mo), 4) CNS Organization (5th-postnatal), 5) ● During Pregnancy: pre-eclampsia, multiple pregnancies (pre-term, P intrauterine growth, birth defects, complications)
myelinization (birth-postnatal) ● Labor: perinatal asphyxia (prolapse cord, hemorrhage, traumatic delivery, shoulder dystocia, maternal shock), others
○ First Trimester: (prolonged 2nd stage, emergency CS, premature placenta; pre-term (meconium stain, tight nuchal cord)
■ Ectoderm formation → neural plate → neural groove → neural tube ● At Birth: ⇩BW, ⇩age, P intrauterine growth, low placental weight, low APGAR
■ Neural tube becomes prosencephalon (forebrain), mesencephalon (midbrain), ● New Born: seizure, sepsis, respiratory disease, others (hypotension, pneumothorax, sepsis, etc.)
rhombencephalon (hindbrain)
■ Majors parts divide again Etiology: Causes
○ Second Semester ● Prenatal (75%): MCA infarct, maternal infection in 1st-2nd tri (TORCH), metabolic d/o, toxic ingestion, genetic syndrome
 ■ Gyri & sulci appear → cerebral cortex growing → myelin starts to appear ● Perinatal (6-8%): obstructed labor, antepartum hemorrhage, cord prolapse; hypoxic ischemic encephalopathy, neonatal
○ Thrid Trimester stroke, hypoglycemia, jaundice, infection
■ Cerebral cortex supports early learning ● Postnatal: metabolic encephalopathy, infections (meningitis, malaria), injuries (trauma, CVA, MVA, child abuse)

Structures:
● Cerebrum connects to the brainstem which connects to the SC
● Cortex: area of the cerebrum which initiates voluntary movement
○ Neurons from R motor cortex → SC → motor information to L side of body
○ Neurons from L motor cortex → supply R side of body
● Pyramidal vs. Extrapyramidal Group
○ Pyramidal: originate in the cortex and carries motor fiber signals to SC & brainstem
responsible for voluntary control
■ Corticospinal Tracts and Corticobulbar Tracts
○ Extrapyramidal: originates from the brain stem responsible for carrying involuntary
movement patterns
■ Tectospinal [reflex postural mvmts in response to visual stimuli]
■ Rubrospinal [facilitates flexor mm ax; inhibits extensor mm]
■ Vestibulospinal [facilitates extensor mm; inhibits flexor mm]
■ Reticulospinal [medial: facilitates voluntary mvmt, increase mm tone; lateral:
inhibits voluntary mvmt, reduces mm tone]
Problem Areas:
● Problems in Cortex = Spastic CP
○ Hemiplegia: If L upper limb & lower limb motor cortex are affected = ⇧ tone &
stiffness on R upper limb & lower limb
○ Paraplegia / Diplegia: ⇧tone, LE stiff
○ Quadriplegia: BUE & BLE stiffness
● Problem in Cerebellum = Ataxic CP
○ Compromised cerebellum → balance & coordination difficulties → wide-based gait
● Problem in BG = Dyskinetic CP
○ Compromised BG → uncontrolled movement & dystonia
● Problems in one or more brain regions = Mixed CP
Pathophysiology:
● Ischemia: May be due to anatomical factors such as immature autoregulatory mechanisms [to maintain constant blood
flow] & underdeveloped lungs [due to limited production of surfactants]
○ Neuronal Migration deficit → ischemia before 20th week (5mo) → results to brain malformation (lissencephaly,
polymicrogyria, schizencephaly)
○ Periventricular Leukomalacia → ischemia between 26-34th week (6.5-8.5mo)
○ Focal / Multifocal Cerebral Injury → ischemia between 34-40th week (8.5-10mo)
4 Types of Brain Damage
● Periventricular Leukomalacia [periventricular = area around ventricles; leuko = white matter]
○ Occurs in the periventricular watershed zone (found next to lateral ventricles)
■ Since it is near the ventricles, it causes LE because the medial aspect of motor system supplies the LE (as
found in our homonculus).
○ Due to cerebral ischemia (limited O2 supply) or infection between 26-34th week
○ Death of brain tissue around ventricles creates “holes” in the brain
○ More common in premature (90%) than full term (20%)
○ Found in spastic diparesis (71%), quadriparesis (35%), hemiparesis (34%)
● Intraventricular Hemmorhage (IVH)
○ Note: preterm infant has fragile vasculature
○ Changes in pressure & O2 levels → rupture of blood vessels inside / around ventricles
○ Grades of IVH: 1) in germinal matrix, 2) inside ventricles w/o enlargement, 3) inside w/ enlargement, 4) into brain
tissue (white matter)
● Asphyxia: brain injury caused by oxygen deprivation in the brain
● Cerebral Dysgenesis: abnormal brain development / brain malformation

Frames of Reference
● NDT