Lifespan Final

• Feeding


  Process of setting up, arranging, and bringing food from table, plate, or cup to mouth
• Eating


  Ability to keep and manipulate food or fluid in the mouth and swallow it
• Swallowing


  Act in which food, fluid, medication, or saliva is moved from the mouth through the pharynx and esophagus into the stomach
• Coordination of swallow


  • Soft palate and epiglottis block airway, elevation of larynx causes upper esophageal sphincter to relax so bolus can go through
• Feeding disorders

  • Gastroesophageal reflux (GERD)
  • Food allergies- Eosinophilic esophagitis
  • Oral motor function incoordination
  • Sensory issues (huge deal)
  • Behavioral issues
• Factors affecting feeding/swallowing

  • Coordination of swallow
  • Feeding disorders
• Changes in infant oral structures

  • Oral structures change a lot in first 12 months
  • 4-6 months: larger oral cavity, thinner and stronger tongue, cheeks lose fatty padding,
  • Others: tongue more mobile, sucking patterns more voluntary, better oral motor control, teeth emerge
• Stages 1-3 of swallow

  1. Pre-oral stage: see/smell food=salivate and grab utensil

  2. Oral preparatory stage: food in mouth->saliva->chewed, contained in cheeks, retrieved by tongue->tongue cups bolus and centers it

  3. Oral stage: tongue squeezes against hard palate to move bolus back
• Assessment of swallow

  • Observation of controlled feeding
  • Electromyography: muscle response
  • Fiberoptic endoscopic swallowing study (FEES): w/ camera
  • Videofluoroscopy (MBS): food w/ barium aspiration pudding
• OT intervention for swallowing/feeding/eating

  • Holistic approach, environmental adaptations, positioning recommendations (elevated- never flat), adaptive equipment, texture/liquid modifications, sensory development activities, behavioral strategies, neuromuscular handling techniques
• Strategies for feeding infants with cleft lip/palate


  • Use special bottles w/ longer nipple and adjustable flow
• Factors affecting performance in ADLs

  • Child factors (anatomy)
  • Performance skills (motor vs sensory)
  • Environment (quiet/loud, social, physical)
  • Context: personal (demog.), temporal (time/life stage), culture (expectations, timing, objects used)
  • Specific demands of self-care activity (analysis and deficits)
• Components of activity analysis for pediatric ADLs


  • Objects used, space used, social demands, sequencing and timing, required actions and skills
• Typical development of eating/swallowing

  1. Infancy (0-6 months): breastfeeding/bottle feeding, sucking and swallowing reflex

  2. 6-9 months: interest in self-feeding (reaching, bringing to mouth), pincer grasp for smaller objects

  3. 9-12 months: self-feeding with fingers and begin to use spoon, better w/ chewing and diff textures

  4. 12-18 months: self-feeding w/ utensils, preferences and selective eating
• Typical development of toileting


  1 year: shows distress when soiled

  2 years: begins potty training, uses toilet with assistance

  30 months: indicates need and if it's #1 or 2, requires help with clothing/wiping

  3 years: toilets on own, maybe diapers at night

  4 years: few accidents, daytime control

  4.5 yrs: toilets independently and manages clothes, reminders during night

  5 yrs: washes hands, nighttime control
• Typical development of UE and LE dressing


  1. 1 year: removes socks, puts on/takes off hat, helps with arms/legs

  2. 2 years: removes shoes and simple clothing, pushes arms thru sleeves

  3. 2.5 years: attempts socks, unbuttons, puts on easy clothing

  4. 3 years: puts on t-shirt w/ min. help, puts on shoes (maybe on wrong feet), dons socks w/ help, pulls down, buttons, (un)zips w/ shank connected

  5. 3.5 years: unzips & separates shank, 3-4 buttons, unbuckles belt, finds front, supervision

  6. 4 years: inserts shank to zip, laces shoes, dons socks

  7. 5 years: dresses independently
• Typical development of bathing/showering


  1. 1-2 years: takes interest in helping

  2. 2-3 years: wipes face/hands

  3. 3-4 years: wash and dry hands, washes self w/ supervision, needs help with hair

  4. 4-5 years: washes all but hair

  5. 5-6 years: bathes/washes hair with cues

  6. 6-8 years: showers/bathes independently
• REM sleep


  Neurogenesis, creating synapses, important for emotional healing (separate emotions from experiences- good for PTSD) but needs to be specific, builds memories, distinguishes emotions- lack of sleep=fear bias (thinking someone is mad at you)- but not important until adolescence, and longest duration is right b4 waking
• NREM sleep (comes 1st)


  Restores energy, ensures cell homeostasis, pruning and strengthening of synapses
• BEARS algorithm for sleep apnea


  • Bedtime, Excessive tiredness, Awakening, Regularity and duration, Snoring
• Changes in infant sleep patterns

  • In utero: NREM & REM est. @ 23 weeks neurological development, mostly sleeping- 12 hours REM, 12 hours NREM, 12 hours intermediary
  • Last trimester: 2-3 hrs/day of really wakefulness, more REM (but no paralysis-> moving a lot), lifetime high of 12 hrs REM during last wk (for building synapses)
• Changes in sleep patterns with diff neuro dx


  • ASD: weaker circadian rhythm, less melatonin and sleep in general, 30-50% less REM sleep, no typical sleep patterns
  • Schizophrenia: 2-3x less NREM sleep bc atypical electrical brain waves, abnormal brain maturation, no synaptic pruning
  • PTSD: disrupted sleep, maybe bc high norEP levels block ability to maintain REM, not able to separate emotion, recurring nightmares bc can't resolve emotion to memory- but BP drug helps bc it dec norEP
• OT role in sleep hygiene


  • Promote rest activities, tips for better bedtimes (no phone, meds, dark, do something else after 30 mins)
• Handwriting readiness skills


  • Maturity
  • Environmental Experiences
  • Interest
• First nine items on VMI


  • Vertical line
  • Horizontal line
  • Circle
  • Cross
  • Right oblique line
  • Square
  • Lift oblique line
  • Oblique cross
  • Triangle
• Stages of Prewriting and Handwriting


  • Controlled Scribbles
  • Discrete lines, dots, symbols
  • Straight-line or circular upper case letters
  • Uppercase letters
  • Lowercase letters, numerals, words
• Pencil grip progression

  1. 1-1.5 yrs: cylindrical
  2. 2-3 yrs: digital
  3. 3.5-4 yrs: modified tripod
  4. 4.5-7 yrs: tripod
• Handwriting performance components


  • Visual motor Integration
  • Visual perception
  • Eye and hand coordination
  • Crossing midline
  • Bilateral integration
  • Postural control
  • Proprioception
  • Cognition (i.e. memory)
  • Recognition & Discrimination of letters and numbers
  • Spatial awareness
  • Attention to task
  • Grasp
  • Opposed grasp
  • Wrist and hand function
• Remediation strategies


  Performance components:

  1. Posture

  2. Strength

  3. Coordination

  4. Overall fine motor and visual motor skills
• Compensation strategies


  Adaptations: Paper, Writing surface, Modified writing tools, Grippers, Weights, Alternative utensils
• Consider child's strengths, demands of environment, client factors and performance components, cognitive and language level
• Models of Practice

  • Acquisitional/ Motor Learning
  • Sensorimotor
  • Biomechanical
  • Cognitive
  • Psychosocial
• Acquisitional/Motor Learning model


  1. Initially relies on visual feedback (cognitive phase)

  2. Then to kinesthetic feedback (associative phase)

  3. Then with minimal conscious effort (autonomic phase)

  4. Self monitoring

  5. Acquiring & applying the skill
• Sensorimotor model


  1. Multisensory approach

  2. All sensory systems are accessed & reinforced

  3. New & interesting media might maintain interest & excitement

  4. Writing utensil and writing surface choices impact sensory response & feedback
• Biomechanical model


  1. Sitting posture

  2. Paper position

  3. Writing surface

  4. Pencil grip

  5. Writing tool
• Cognitive model


  1. Self-Instruction

  2. Verbal mediation

  3. Imitation, practice, self-evaluation

  4. Cognitive Orientation to Occupational Performance (CO-OP): Global Strategy: Goal-Plan-Do-Check

  5. Strategy training

  6. Compensatory: visual cues, more structure, more time, writing strips on desk, cue cards, variable lined paper
• Psychosocial model


  1. Improving self-control & coping skills

  2. Create positive social context for practice and peer modeling

  3. Learning through social interaction

  4. Practice writing by writing note to parent

  5. Reward/incentives for good penmanship

  6. Offer choices, success, responsibility to teach that it's a valuable life skill
• Handwriting practice


  1. 10 min per day

  2. Fun and meaningful

  3. Consider music for rhythm

  4. Make it successful

  5. Psychosocial: Callirobics
• Handwriting expectations by grade


  • Preschool (3-4 years): Pre-writing strokes, lines, shapes, starting to write name, tracing and copying
  • Kindergarten: Write name on the line, use capital letter to start and other letters lower case, write lowercase and capital letters
  • 1st grade: Printing is taught in most districts, big emphasis on worksheets
  • 2nd Grade: Review printing quickly, handwriting in daily activities
  • 3rd Grade: Introduction to cursive, taught in very short time increment (1-2 months)
• Dysgraphia


  Associated with a learning disability, great difficulty expressing thoughts in writing, extremely poor handwriting, difficulty with sequencing, difficulty with language expression but can have strong nverbal skills