Conditions in Occupational Therapy Effect On Occupational Performance 5th Edition Ebook PDF
Conditions in Occupational Therapy Effect On Occupational Performance 5th Edition Ebook PDF
Conditions in Occupational Therapy Effect On Occupational Performance 5th Edition Ebook PDF
Ben J. Atchison
Diane Powers Dirette
American Psychiatric Association. (2013). Diagnostic and statistical
manual of mental disorders (5th ed.). Washington, DC: Author.
National Board for Certification of Occupational Therapists. (2012).
Practice analysis of the occupational therapist registered: Executive
summary. Gaithersburg, MD: Author.
Contributors
Preface
1 Thinking Like an OT
Index
Glossary
CHAPTER
1 Thinking Like an OT
Diane Powers Dirette Ben J. Atchison
KEY TERMS
Altruism
Client factors
Context and environment
Core values
Equality
Evidence-based practice
Freedom
Justice
Occupations
Performance patterns
Performance skills
Personalized medicine
Person-first language
Philosophical assumptions
Practice Framework
Prudence
Truth
It is more important to know what kind of person has the disease than what kind of disease the
person has.
—Sir William Osler (Address at Johns Hopkins University, February 1905)
These values are the foundation of the belief system that occupational
therapists (OTs) use as a moral guide when making clinical decisions.
Philosophical Assumptions
The philosophical assumptions of the profession guide OTs in providing
client-centered therapy that meets the needs of the client and society. These
assumptions express our basic beliefs about the client and the context in
which the client functions (Mosey, 1996). These assumptions are as
follows:
Pediatric Conditions
The Pediatric Conditions Unit includes the most common conditions that
children have who are treated by occupational therapists as determined by
the National Board of Certification in Occupational Therapy. These
chapters focus on conditions that are typically diagnosed in childhood, but
many of them affect people throughout their lifespan. Each chapter
provides information about the etiology, incidence and prevalence, signs
and symptoms, course and prognosis, diagnosis, medical/surgical
management, and impact on occupational performance of these conditions.
Case illustrations are used to provide examples of lives affected by the
condition. The conditions included in this unit are the following:
Chapter 2: Cerebral Palsy
Chapter 3: Autism Spectrum Disorders
Chapter 4: Intellectual Disability
Chapter 5: Muscular Dystrophy
Chapter 6: Attention Deficit Disorder/ADHD
Chapter 7: Sensory Processing Disorder
CHAPTER
2 Cerebral Palsy
Mary Steichen Yamamoto
KEY TERMS
Ataxia
Athetoid (dyskinetic)
Clonus
Contracture
Diplegia
Dysarthria
Equinovarus
Equinovalgus
Gastroesophageal reflux
Hemiplegia
Homonymous hemianopsia
Hydrocephalus
Hypertonicity (spasticity)
Hyperreflexia
Hypotonicity
Kyphosis
Lordosis
Nystagmus
Primitive reflexes
Quadriplegia
Scoliosis
Strabismus
Stretch reflex
A couple who had been trying to conceive a child for several years were
thrilled when a family friend asked if they would be interested in adopting
a baby girl that had just been born to a young unmarried woman in her
church. The baby was born 6 weeks early and her weight was 4 lb, but she
appeared to be healthy. After initiating the paperwork for a private
adoption, they brought the baby home and named her Jill. By the time of
Jill’s 6-month well-baby visit, her parents had become concerned. She
appeared to be a bright baby who smiled and cooed and enjoyed reaching
for and playing with toys, but her legs seemed stiff and she was not yet
rolling over. They spoke with their family doctor about their concerns, but
he assured them that Jill was developing normally and they had nothing to
be concerned about. By the time of Jill’s 9-month well-baby visit, her
parents’ concerns were only growing. Jill was still not sitting up and had
not yet learned to roll over or crawl. Her doctor decided to refer Jill to the
county early intervention program for a developmental assessment. Jill was
assessed by the early intervention team consisting of an occupational
therapist, physical therapist, and speech and language pathologist. The
occupational therapist noted some mildly increased tone and incoordination
in her upper extremities and a 2- to 3-month delay in fine motor and self-
help skills. The physical therapist noted that Jill had hypertonicity and
retained primitive reflexes in her lower extremities, which was causing
significant delay in the acquisition of gross motor skills. The speech and
language therapist found Jill’s cognitive, language, and social skills to be at
age level. The team suggested to the parents that they have a pediatric
neurologist assess Jill, as she was demonstrating some of the signs and
symptoms of cerebral palsy. Both the occupational and physical therapist
recommended that therapy services begin as soon as possible. An IFSP
(Individualized Family Service Plan) was developed at a subsequent
meeting, and Jill began receiving weekly physical and occupational therapy
services.Jill’s parents took her to a pediatric neurologist who diagnosed her
with spastic diplegia, a type of cerebral palsy. Her parents were initially
overwhelmed and devastated by the diagnosis. The next year was very
difficult as they grieved the loss of so many dreams that they had for Jill
and faced so much uncertainty about her future. They waded through an
array of possible therapy approaches and medical and surgical
interventions that were recommended trying to decide which would be right
for Jill and their family. They struggled to find time to work on home
exercises that had been prescribed for Jill. The strain became so great that
they even separated for a period but eventually reconciled. By the time Jill
turned 3 years old, she was walking with a walker and able to sit in a chair
independently, although she needed assistance with changing positions. She
was feeding herself but not yet dressing herself. They enrolled her in a
preschool special education classroom where she received therapy services.
By kindergarten, Jill was in a regular education classroom with a
paraeducator for safety and support. Jill was a happy child, who had many
friends and did well academically. Jill most likely will continue to need
some type of additional support in order to be an independent adult, but all
involved were optimistic about her future.
Description and Definition
Sigmund Freud, in his monograph entitled “Infantile Cerebral Paralysis,”
points out that a well-known painting by Spanish painter Jusepe Ribera
(1588–1656), which depicts a child with infantile hemiplegia, proves that
cerebral paralysis existed long before medical investigators began paying
attention to it in the mid-1800s (Freud, 1968). Freud’s work as a
neurologist is not generally well known, and at the time that his monograph
was published in 1897, he was already deep into his work in the area of
psychotherapy. However, he was recognized at the time as the prominent
authority on the paralyses of children. Today, cerebral paralysis is known as
cerebral palsy.
Cerebral palsy is not one specific condition but rather a grouping of
clinical syndromes that affect movement, muscle tone, and coordination as
a result of an injury or lesion of the immature brain. It is not considered a
disease, but is classified as a developmental disability since it occurs early
in life and interferes with the development of motor and sometimes
cognitive skills. Historically, cerebral palsy has been classified as and is
still sometimes diagnostically referred to as a static encephalopathy
(Brooke, 2010). This is now considered inaccurate due to recognition of the
fact that the neurological manifestations of cerebral palsy often change or
progress over time. Static encephalopathy is permanent and unchanging
damage to the brain and includes other developmental problems such as
fetal alcohol syndrome, cognitive impairments, and learning disabilities.
Many individuals with cerebral palsy perform well academically and
vocationally without any signs of cognitive dysfunction associated with the
term encephalopathy (Johnson, 2004).
A child is considered to have cerebral palsy if all of the following
characteristics apply:
The injury or insult occurs when the brain is still developing. It can
occur anytime during the prenatal, perinatal, or postnatal periods. There is
some disagreement about the upper age limit for a diagnosis of cerebral
palsy during the postnatal period. An upper age limit ranging from 2 to 8
years of age is applied to postneonatally acquired brain injury (Smithers-
Sheedy et al., 2009).
1. It is not progressive. Once the initial insult to the brain has occurred,
there is no further worsening of the child’s condition or further
damage to the central nervous system. However, the characteristics
of the disabilities affecting an individual often change over time.
2. It always involves a disorder in sensorimotor development that is
manifested by abnormal muscle tone and stereotypical patterns of
movement. The severity of the impairment ranges from mild to
severe.
3. The sensorimotor disorder originates specifically in the brain. The
muscles themselves and the nerves connecting them with the spinal
cord are normal. Although some cardiac or orthopedic problems can
result in similar postural and movement abnormalities, they are not
classified as cerebral palsy.
4. It is a lifelong disability. Some premature babies demonstrate
temporary posture and movement abnormalities that look similar to
patterns seen in cerebral palsy but resolve typically by 1 year of age.
For children with cerebral palsy, these difficulties persist.
Etiology
Historically, birth asphyxia was considered the major cause of cerebral
palsy. When the British surgeon William Little first identified cerebral
palsy in 1860, he suggested that a major cause was a lack of oxygen during
the birth process (Little, 1862). In 1897, Sigmund Freud disagreed,
suggesting that the disorder might have roots earlier in life. Freud wrote,
“Difficult birth, in certain cases is merely a symptom of deeper effects that
influence the development of the fetus” (Freud, 1968). Although Freud
made these observations in the late 1800s, it was not until the 1980s that
research supported his views (Freeman & Nelson, 1988; Illingsworth,
1985). Only a small percentage of cases of cerebral palsy are a result of
birth complications. The majority of children (70% to 80%) who are
diagnosed with cerebral palsy have congenital cerebral palsy, that is, the
injury to the brain occurred prior to their birth (Johnson, 2004).
There are a large number of risk factors that can result in cerebral
palsy, and the interplay between these factors is often complex, making it
difficult to identify the specific cause (Blickstein, 2003). The presence of
risk factors does not always result in a subsequent diagnosis of cerebral
palsy. The presence of one risk factor may not result in cerebral palsy
unless it is present to an overwhelming degree. Current thought is that
often two or more risk factors may interact in such a way as to overwhelm
natural defenses, resulting in damage to the developing brain. The strongest
risk factors are prematurity and low birth weight (Lawson & Badawi,
2003). During the postpartum period, premature and low birth weight
infants are at greater risk for developing complications, especially in the
circulatory and pulmonary systems. These complications can lead to brain
hypoxia and result in cerebral palsy.
Additional risk factors include intrauterine exposure to infection and
disorders of coagulation (National Institute of Neurological Disorders and
Stroke, 2015). Maternal infection is a critical risk factor for cerebral palsy,
both during prenatal development and at the time of delivery. The infection
does not necessarily produce signs of illness in the mother, which can make
it difficult to detect. In a study conducted in the mid-1990s, it was
determined that mothers with infections at the time of birth had a higher
risk of having a child with cerebral palsy (Grether & Nelson, 1997). Table
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.