A. Paediatric Performance skills and client factors • Gross motor • Fine motor • Cognition and perception • Oro-motor evaluation Occupational dysfunctions  Play  Basic ADL  Education Recommended book(s) for Reference: 1. Pedretti’s Practice skills for physical dysfunction edited by Heidi McHugh Pendleton ,Winifred Schultz Krohn 2. Occupational Therapy for Physical Dysfunction by Mary Vining Radomski, Catherine A Trombly 3. Occupational Therapy and Physical Dysfunction, Principles, Skills and Practice by Ann Turner, Margaret Foster, Sybil E Johnson 4. Introduction to Occupational Therapy by Hussey Subonis ,Chafea O Brien 5. Occupational Therapy and Mental Health edited by Jennifer Creek, Lesley Lougher 6. Mental Health Concepts and Techniques for the Occupational Therapy Assistant by Mary Beth Early 7. Frames of Reference in Psychosocial Occupational Therapy by Mary Ann Bruce, Barbara Borg 8. Willard & Spackman’s Occupational Therapy 9. Occupational Therapy for children by Jane Case Smith 10. Frames of Reference for Pediatric Occupational Therapy by Paula Kramer , Jim Hinojosa

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paediatric occupational therapy gross motor fine motor cognition oro-motor evaluation ADL play education

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The library does not contain the specific OT textbooks listed in the curriculum. I'll provide a thorough, well-structured study guide based on my knowledge and the web search results.

Paediatric Occupational Therapy - Complete Study Guide

This guide covers all topics in your curriculum outline under Performance Skills & Client Factors and Occupational Dysfunctions, with reference to the recommended textbooks.

PART 1: PERFORMANCE SKILLS AND CLIENT FACTORS

1. Gross Motor Skills

Definition: The ability to coordinate large muscle groups of the trunk, arms, and legs for movement, posture, and balance.

Key Components Assessed in Paediatric OT:

Component	Description
Postural control	Ability to maintain and adjust body position against gravity
Balance (static/dynamic)	Maintaining equilibrium at rest and during movement
Bilateral coordination	Using both sides of the body together in a coordinated way
Motor planning (praxis)	Ability to conceive, plan, and execute novel motor tasks
Core stability	Strength and endurance of trunk muscles
Locomotion	Walking, running, jumping, hopping, skipping
Ball skills	Throwing, catching, kicking

Common Conditions Affecting Gross Motor Function:

Cerebral palsy
Developmental coordination disorder (DCD)
Down syndrome
Spina bifida
Acquired brain injury
Global developmental delay

Standardised Assessment Tools:

Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) - measures motor skills in children 4-21 years
Peabody Developmental Motor Scales-2 (PDMS-2) - ages birth to 5 years; separates gross and fine motor
Movement Assessment Battery for Children (MABC-2) - ages 3-16 years; gold standard for DCD
Gross Motor Function Measure (GMFM) - specifically for children with cerebral palsy

Frames of Reference Used:

Neurodevelopmental Treatment (NDT)/Bobath - normalise tone, facilitate normal movement patterns
Motor Learning Frame of Reference - task-specific practice, feedback loops
Biomechanical Frame of Reference - ROM, strength, endurance
Sensory Integration (Ayres) - when sensory processing underlies motor difficulty

Intervention Strategies:

Obstacle courses, climbing, balance boards, trampoline activities
Task-specific training (e.g., practising stair climbing)
Environmental modification (e.g., adapted playground equipment)
Core strengthening through play (wheelbarrow walking, prone on elbows)

Reference: Frames of Reference for Pediatric OT by Kramer & Hinojosa; Occupational Therapy for Children by Case-Smith

2. Fine Motor Skills

Definition: Coordinated use of the small muscles of the hands and fingers for precision tasks.

Key Components:

Component	Description
Pinch and grasp patterns	Lateral pinch, tip-to-tip pinch, palmar grasp, tripod grasp
In-hand manipulation	Finger-to-palm translation, palm-to-finger translation, shift, rotation
Bilateral hand use	One hand stabilises while the other manipulates
Hand dominance	Establishment of preferred hand (typically by age 4-5)
Eye-hand coordination	Visual guidance of hand movements
Wrist stability	Proximal stability for distal manipulation

Developmental Milestones - Fine Motor (Key ones):

3-4 months: Grasps rattle
6-7 months: Transfers objects hand to hand
9-10 months: Develops pincer grasp (index + thumb)
12 months: Releases objects voluntarily
18 months: Stacks 3-4 blocks
2 years: Turns pages, uses spoon
3 years: Copies circle, uses scissors with help
4 years: Copies cross, cuts on a line
5-6 years: Copies triangle/square, mature pencil grip

Grasp Pattern Development:

Ulnar palmar grasp (3-4 months) → Palmar grasp (4-5 months) → Radial palmar (5-6 months) → Inferior pincer (8-9 months) → Neat pincer (12 months)

Common Assessment Tools:

Jebsen-Taylor Hand Function Test
Purdue Pegboard Test
Beery VMI (Visual-Motor Integration) - measures eye-hand coordination/copying geometric forms
PDMS-2 Fine Motor Subscale
BOT-2 Fine Manual Control subtests

Conditions Commonly Affecting Fine Motor Skills:

Cerebral palsy (spasticity/dyskinesia)
Developmental Coordination Disorder
Juvenile idiopathic arthritis
Muscular dystrophy
Autism spectrum disorder
Learning disabilities

Intervention:

Pegboards, puzzles, lacing activities, playdough, tweezers and small objects
Pre-writing strokes and handwriting programs (e.g., Handwriting Without Tears)
Scissor skills grading
Adapted tools (built-up handles, angled writing surfaces)
Strengthening through resistive media (clay, theraputty)

Reference: Occupational Therapy for Children by Jane Case-Smith; Pedretti's Practice Skills for Physical Dysfunction

3. Cognition and Perception

This is a combined domain covering both cognitive skills (thinking, memory, attention, problem-solving) and perceptual skills (organising and interpreting sensory information).

A. Cognitive Skills in Paediatrics

Key Cognitive Components:

Component	Definition
Attention	Selective, sustained, divided, alternating attention
Memory	Working memory, short-term, long-term
Executive function	Planning, organisation, inhibition, cognitive flexibility
Problem-solving	Generating and evaluating solutions
Learning	Acquiring new skills through experience
Language/communication	Receptive and expressive language
Orientation	Time, place, person (relevant in acquired brain injury)

Cognitive Developmental Framework (Piaget):

Sensorimotor stage (0-2 yrs): Learning through sensation and movement; object permanence develops
Preoperational stage (2-7 yrs): Symbolic thinking, egocentrism, centration; cannot yet perform logical operations
Concrete operational (7-11 yrs): Conservation, classification, seriation; logical thinking tied to concrete objects
Formal operational (12+ yrs): Abstract reasoning, hypothetical thinking

Key Assessment Tools for Cognition:

Cognitive Assessment of Minnesota (CAM) - for acquired brain injury
Pediatric Evaluation of Disability Inventory (PEDI) - functional capabilities
Wechsler Intelligence Scale for Children (WISC-V) - IQ and cognitive profile
Woodcock-Johnson Tests of Cognitive Abilities
Children's Kitchen Task Assessment (CKTA) - executive function in context

B. Perceptual Skills

Perception = the brain's ability to organise and interpret sensory input, particularly visual input in OT.

Visual Perceptual Skills:

Skill	Definition	Example task affected
Visual discrimination	Distinguishing differences between forms	Matching shapes/letters
Figure-ground	Identifying a figure against a background	Finding an object in a cluttered drawer
Visual closure	Recognising incomplete images	Reading, identifying partially hidden objects
Visual memory	Recalling visual information	Copying from the board
Visual-spatial relations	Understanding direction and position in space	Reading maps, geometry
Form constancy	Recognising shapes despite change in size/orientation	Reading lowercase vs. uppercase letters
Visual sequencing	Ordering visual stimuli	Reading, math sequences

Visual-Motor Integration (VMI): The ability to integrate visual perception with fine motor response. Critical for handwriting and drawing.

Assessment of Visual Perception:

Test of Visual Perceptual Skills (TVPS-4) - non-motor perceptual skills
Beery-Buktenica VMI - visual-motor integration
Motor-Free Visual Perception Test (MVPT-4) - isolates visual perception from motor output
Developmental Test of Visual Perception (DTVP-3)

Intervention for Cognitive-Perceptual Deficits:

Remedial approach: Directly training the underlying perceptual skill (e.g., figure-ground worksheets)
Adaptive approach: Modifying the task or environment (e.g., highlighting key information, reducing visual clutter)
Cognitive Orientation to daily Occupational Performance (CO-OP) - metacognitive approach for children with DCD and other conditions
Sensory integration therapy when perceptual issues stem from sensory processing dysfunction

Reference: Occupational Therapy for Physical Dysfunction by Radomski & Trombly; Frames of Reference for Pediatric OT by Kramer & Hinojosa

4. Oro-Motor Evaluation

Definition: Assessment of the structure and function of the oral mechanism, including lips, tongue, jaw, cheeks, and soft palate, as they relate to feeding, swallowing, and speech.

Why OT Evaluates Oro-Motor Function: OTs assess oro-motor function primarily in the context of feeding and eating as an occupation - a critical area of paediatric OT practice.

Components of an Oro-Motor Evaluation:

Structural Assessment:

Lip structure (cleft lip/palate)
Tongue size, movement, frenulum (tongue tie/ankyloglossia)
Jaw symmetry and mobility
Dental occlusion
Palate shape and integrity
Gag reflex presence/sensitivity

Functional Assessment:

Function	What to Observe
Lip closure	Sealing lips around nipple/spoon/cup
Tongue lateralisation	Moving food to molars for chewing
Tongue elevation	Lifting tongue tip to palate
Jaw grading	Controlled jaw opening and closing
Cheek stability	Maintaining pressure during sucking
Rotary chewing	Circular jaw movement for solid foods
Swallowing	Oral, pharyngeal, and oesophageal phases

Feeding Milestones:

0-4 months: Suckling reflex; breast/bottle feeding
4-6 months: Introduction of pureed solids; emerges spoon feeding
7-9 months: Soft mashed textures; tongue lateralisation begins
9-12 months: Finger foods; cup introduction
12-18 months: Chewing lumpy textures; self-feeding with fingers
2 years: Eating most family foods; using spoon independently
3 years: Using fork; eating a wide variety of textures

Common Oro-Motor Problems in Paediatrics:

Hypotonia - poor lip seal, open mouth posture, tongue protrusion
Hypertonia/spasticity (as in CP) - jaw clenching, limited tongue mobility
Dysphagia - swallowing difficulties; can cause aspiration
Oral hypersensitivity - gagging, food refusal, limited diet
Oral hyposensitivity - pocketing food, excessive mouthing, not sensing food texture
Ankyloglossia (tongue tie) - restricted tongue movement
Dyspraxia - difficulty coordinating oro-motor movements

Assessment Tools:

Schedule for Oral Motor Assessment (SOMA) - for infants and young children
Neonatal Oral Motor Assessment Scale (NOMAS) - for neonates
Dysphagia Disorder Survey (DDS) - for individuals with intellectual disability
Clinical observation during feeding (key primary assessment)
Videofluoroscopic Swallowing Study (VFSS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) - interdisciplinary, done with radiology/ENT

Intervention:

Oral desensitisation programmes (for hypersensitivity)
Oral stimulation and strengthening exercises (NUK brush, chewy tubes)
Jaw stability work
Positioning for feeding (upright, supported seating)
Texture grading (food texture modification per IDDSI framework)
Collaboration with SLP (speech-language pathologist) and dietitian
Parent/caregiver education

Reference: Occupational Therapy for Children by Jane Case-Smith; Willard & Spackman's Occupational Therapy

PART 2: OCCUPATIONAL DYSFUNCTIONS

1. Play

Why Play is the Primary Occupation of Childhood: Play is the central occupation through which children develop all other skills - physical, cognitive, social, and emotional. In OT, play is both a means (medium for therapy) and an end (goal in itself).

Definitions and Theories of Play:

Reilly's Occupational Behaviour Model: Play is the foundation for developing competence; children progress from exploration → competency → achievement
Takata's Play Epochs: Developmental stages of play linked to age
Bundy's Model of Playfulness: Focuses on the child's intrinsic motivation, internal control, and freedom from constraints (not just the activity itself)

Play Development Stages:

Age	Type of Play	Characteristics
0-2 yrs	Sensorimotor/exploratory	Mouthing, banging, shaking objects
2-3 yrs	Solitary play	Playing alone, parallel play begins
2-4 yrs	Symbolic/pretend play	Using objects to represent others (banana as phone)
3-4 yrs	Associative play	Playing near others but not organised
4-6 yrs	Cooperative play	Rule-based, organised play with shared goals
6+ yrs	Games with rules	Board games, sports, structured activities

Parallel Play (2-3 yrs): Playing alongside but not with other children - important milestone.

Play Assessment Tools:

Test of Playfulness (ToP) - assesses intrinsic motivation and engagement in play (Bundy)
Revised Knox Preschool Play Scale - observational tool for play development 0-6 years
Children's Assessment of Participation and Enjoyment (CAPE) - participation in recreational activities
Play History - caregiver interview about child's play habits

Occupational Dysfunctions in Play: Children with the following conditions commonly show play dysfunction:

Autism spectrum disorder (limited imaginative/social play; preference for solitary, rigid play)
ADHD (difficulty sustaining engagement, impulsive in group play)
DCD (avoids physical play due to motor challenges)
Sensory processing disorder (avoids certain sensory play environments)
Intellectual disability (delayed play development)
Physical disabilities (limited access to play environments)

OT Intervention for Play Dysfunction:

Creating a "just-right challenge" - activity graded to be achievable but slightly challenging
Playful, child-led sessions (follow the child's lead)
Peer play groups and social skills programmes
Environmental adaptations (accessible playgrounds, sensory-friendly play spaces)
Helping families understand and facilitate play at home
Using play as a therapeutic medium to address underlying skills

Reference: Occupational Therapy for Children by Jane Case-Smith; Frames of Reference for Pediatric OT by Kramer & Hinojosa

2. Basic ADL (Activities of Daily Living)

Definition: Self-care tasks that children perform as part of daily routines. In paediatrics, these are often called "self-care" or "self-maintenance" occupations.

Core Paediatric ADL Areas:

ADL Area	Includes
Feeding/eating	Self-feeding with fingers, spoon, fork, chopsticks; drinking from cup
Dressing	Donning/doffing clothing, fasteners (buttons, zips, laces)
Grooming/hygiene	Washing hands, brushing teeth, brushing hair, bathing
Toileting	Toilet training, wiping, clothing management
Bathing	Tub/shower safety, body washing, hair washing
Functional mobility	Transfers, moving through environments, using mobility aids
Sleep and rest	Sleep routines and positions

ADL Developmental Timeline:

Age	Expected ADL Independence
1-2 years	Finger feeding; holds cup with help; cooperates with dressing
2-3 years	Spoon feeding with spillage; removes shoes/socks; washes hands
3-4 years	Dresses with minimal help; toilet trained; uses fork; pours liquids
4-5 years	Independent dressing (except fasteners); brushes teeth with supervision
5-6 years	Manages buttons and zips; ties shoelaces (emerging); independent basic ADL
6-7 years	Fully independent in most ADL with safety supervision only

ADL Assessment Tools:

Pediatric Evaluation of Disability Inventory (PEDI-CAT) - gold standard; measures functional skills and caregiver assistance in self-care, mobility, social/cognitive
WeeFIM (Functional Independence Measure for Children) - 18 items, 1-8 scale; ages 6 months to 7 years (and older with disability)
Assessment of Motor and Process Skills (AMPS) - observational; quality of motor and process skills during ADL
Vineland Adaptive Behaviour Scales - adaptive behaviour including self-care
Canadian Occupational Performance Measure (COPM) - client/family-centred; identifies perceived problems and priorities

Occupational Dysfunction in ADL: Children may have ADL dysfunction due to:

Neuromotor impairments (CP, spina bifida) - limited ROM, coordination, muscle control
Sensory processing difficulties - avoidance of dressing (tags, textures), intolerance of teeth brushing
Cognitive/intellectual disability - difficulty learning/sequencing ADL steps
Behavioural difficulties - refusal, non-compliance with ADL routines
Autism - rigidity, sensory aversion, difficulty with transitions in routines
Trauma/hospitalisation - regression in previously acquired ADL skills

OT Intervention Approaches for ADL:

Restorative/remedial: Improve underlying impairment (strengthen grip for self-feeding, improve balance for dressing)
Adaptive/compensatory: Modify task, environment, or tools
- Adaptive equipment: built-up spoon handles, plate guards, dressing sticks, button hooks, elastic shoelaces
- Environmental modification: grab bars, non-slip mats, adapted clothing (velcro fasteners, pull-on styles)
Developmental/educational: Teach ADL skills using backward or forward chaining, visual schedules, social stories (especially for autism)
Caregiver education: Train parents in handling, positioning, and facilitating independence

Reference: Pedretti's Practice Skills for Physical Dysfunction; Occupational Therapy for Physical Dysfunction by Radomski & Trombly; WeeFIM/PEDI-CAT manuals

3. Education

Education as Occupation: For school-aged children, education is a primary occupation. OT addresses a child's ability to participate fully in the educational environment - not just academic learning, but the full range of school occupations.

School Occupations OT Addresses:

Handwriting and written communication
Classroom participation (sitting, attending, transitioning between tasks)
Using school tools (scissors, rulers, computers, calculators)
Lunch/snack time management
Locker/bag management
Physical education and recess
Following instructions and classroom routines
Social participation with peers

Handwriting - A Key Education-Linked Fine Motor Skill:

Handwriting requires integration of:

Visual-motor integration
Fine motor control and in-hand manipulation
Postural stability and core strength
Bilateral coordination (one hand holds paper, other writes)
Visual perception
Cognitive/linguistic processing (spelling, formulating ideas)
Attention and executive function

Handwriting Assessment:

Evaluation Tool of Children's Handwriting (ETCH)
Minnesota Handwriting Assessment (MHA)
Handwriting Proficiency Screening Questionnaire (HPSQ)
Print Tool / Printing Assessment (part of HWT program)

Handwriting Intervention Programs:

Handwriting Without Tears (HWT) - multisensory; widely used
Size Matters Handwriting Program
Traditional sensorimotor approaches

Models for OT in Educational Settings:

Education for All Handicapped Children Act / IDEA (US): OT as a related service to support academic achievement
Response to Intervention (RTI) / Multi-Tiered Systems of Support (MTSS): Universal screening, tiered interventions
Participation-based school OT model: Focus on meaningful participation in school occupations rather than isolated skill building

Common Educational Occupational Dysfunctions:

Problem	Common Causes	OT Role
Poor handwriting	DCD, visual-motor deficits, poor grip, attention	Handwriting intervention, adapted tools (slant board, weighted pen)
Difficulty sitting in class	Sensory processing, low tone, ADHD	Seating modification, movement breaks, fidget tools
Scissor skill deficits	Fine motor, bilateral coordination, visual-motor	Graded scissor activities, self-opening scissors
Difficulty organising schoolwork	Executive function deficits, ADHD	Visual schedules, colour-coded folders, assistive technology
Keyboard/computer use	Fine motor, visual-motor, motor planning	Keyboarding instruction, adapted keyboards
Lunch/feeding at school	Oro-motor, fine motor, sensory	Adapted utensils, seating, dietary modifications, social support
Difficulty with PE/recess	Gross motor, DCD, social skills	Gross motor intervention, peer support strategies

School-Based OT Collaboration: OT works closely with:

Teachers and teaching assistants
Special educators
Speech-language pathologists
Physiotherapists
School psychologists
Families/parents

Assistive Technology in Education:

Voice-to-text software (for children who cannot write)
Word prediction software
Adapted keyboards and mice
Tablet/stylus use instead of pen/pencil
Audio books
AAC (Augmentative and Alternative Communication) devices

Reference: Willard & Spackman's Occupational Therapy; Introduction to Occupational Therapy by Hussey, Sabonis-Chafee & O'Brien; Occupational Therapy for Children by Jane Case-Smith

KEY FRAMES OF REFERENCE USED ACROSS ALL PAEDIATRIC OT DOMAINS

Frame of Reference	Key Theorist	Application
Neurodevelopmental Treatment (NDT)	Bobath	Normalise tone, facilitate movement in CP
Sensory Integration (SI)	A. Jean Ayres	Sensory processing disorders, self-regulation
Motor Learning	Schmidt	Skill acquisition, practice, feedback
Biomechanical	Multiple	Strengthening, ROM, endurance
Developmental	Multiple	Following normal developmental sequence
Cognitive-Perceptual	Multiple	Visual perception, cognitive rehabilitation
Person-Environment-Occupation (PEO)	Law et al.	Fit between person, environment, and occupation
Model of Human Occupation (MOHO)	Kielhofner	Volition, habituation, performance capacity
Ecology of Human Performance (EHP)	Dunn	Context and task modification
CO-OP	Polatajko	Metacognitive strategy training (esp. DCD)

RECOMMENDED TEXTBOOK STUDY GUIDE

Topic	Primary Textbook(s)
Gross & Fine Motor	Occupational Therapy for Children (Case-Smith); Frames of Reference for Pediatric OT (Kramer & Hinojosa); Pedretti's
Cognition & Perception	OT for Physical Dysfunction (Radomski & Trombly); Frames of Reference for Pediatric OT
Oro-motor	OT for Children (Case-Smith); Willard & Spackman's
Play	Frames of Reference for Pediatric OT (Kramer & Hinojosa); OT for Children (Case-Smith)
Basic ADL	Pedretti's; OT for Physical Dysfunction (Radomski & Trombly); Willard & Spackman's
Education	OT for Children (Case-Smith); Introduction to OT (Hussey et al.); Willard & Spackman's
Mental Health overlay	OT and Mental Health (Creek & Lougher); Mental Health Concepts for OTA (Early); Frames of Reference in Psychosocial OT (Bruce & Borg)

QUICK SUMMARY TABLE

Domain	Key Assessment Tools	Key Intervention Approaches
Gross Motor	MABC-2, PDMS-2, BOT-2, GMFM	NDT, motor learning, sensory integration, task-specific training
Fine Motor	BOT-2, PDMS-2, Beery VMI, Purdue Pegboard	Activity grading, adaptive tools, handwriting programs
Cognition	PEDI-CAT, WISC-V, AMPS, COPM	CO-OP, cognitive strategies, compensatory techniques
Perception	TVPS-4, MVPT-4, Beery VMI, DTVP-3	Remedial perceptual tasks, adaptive/environmental modification
Oro-motor	SOMA, NOMAS, clinical observation	Oral desensitisation, texture grading, oral motor exercises
Play	ToP, Knox Preschool Play Scale, CAPE	Child-led play, sensory play, peer groups, playful therapy
Basic ADL	PEDI-CAT, WeeFIM, AMPS, COPM	Adaptive equipment, chaining, caregiver training
Education	ETCH, Beery VMI, COPM, teacher report	Handwriting programs, seating, assistive technology, classroom adaptations

This covers the full paediatric OT curriculum outline. Let me know if you'd like any section expanded further, converted into a PowerPoint, Word document, or study flashcards.

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