Pediatric Occupational Therapy Handbook A Guide to
Diagnoses and Evidence Based Interventions
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Pediatric
Occupational
Therapy
HANDBOOK
A Guide to Diagnoses
and Evidence-Based
Interventions
PATRICIA BOWYER • SUSAN M. CAHILL
EdD, OTR/L, BCN MAEA, OTR/L
Associate Professor and Associate Clinical Assistant Professor
Director Department of Occupational
Texas Woman’s University at Therapy
Houston University of Illinois at Chicago
The Texas Medical Center Chicago, Illinois
Houston, Texas
11830 Westline Industrial Drive
St. Louis, Missouri 63146
PEDIATRIC OCCUPATIONAL THERAPY HANDBOOK: ISBN: 978-0-323-05341-9
A GUIDE TO DIAGNOSES AND EVIDENCE-BASED
INTERVENTIONS
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or
by any means, electronic or mechanical, including photocopying, recording, or any information
storage and retrieval system, without permission in writing from the publisher. Permissions may be
sought directly from Elsevier’s Rights Department: phone: (+1) 215 239 3804 (US) or (+44) 1865
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Notice
Neither the Publisher nor the Authors assume any responsibility for any loss or injury and/or
damage to persons or property arising out of or related to any use of the material contained in
this book. It is the responsibility of the treating practitioner, relying on independent expertise
and knowledge of the patient, to determine the best treatment and method of application for
the patient.
The Publisher
Library of Congress Cataloging in Publication Data
Bowyer, Patricia.
Pediatric occupational therapy handbook : a guide to diagnoses and evidence-based interventions
/ Patricia Bowyer, Susan M. Cahill.—1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-323-05341-9 (pbk. : alk. paper) 1. Occupational therapy for children—Handbooks,
manuals, etc. I. Cahill, Susan M. II. Title.
[DNLM: 1. Occupational Therapy—Handbooks. 2. Child. 3. Developmental Disabilities—
diagnosis—Handbooks. 4. Disabled Children—rehabilitation—Handbooks. 5. Evidence-Based
Medicine—methods—Handbooks. WS 39 B788p 2009]
RJ53.O25B69 2009
615.8′515083—dc22
2008018946
Vice President and Publisher: Linda Duncan
Senior Editor: Kathy Falk
Senior Developmental Editor: Melissa Kuster Deutsch
Editorial Assistant: Lindsay Westbrook
Publishing Services Manager: Patricia Tannian
Project Manager: John Casey
Design Manager: Amy Buxton
Printed in United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To those who will benefit from the information contained
within—students, practitioners, children and their families.
And to Bobby and Brian, who live in the moment, know
what is important, and help dreams come true.
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Preface
Pediatric Occupational Therapy Handbook: A Guide to Diag-
noses and Evidence-Based Interventions is designed to provide
occupational therapy students and practitioners with an
easily accessible reference for common diagnoses found in
pediatric practice. Students and clinicians currently refer to
multiple sources to gather such information, as well as attempt
to carry and store numerous large textbooks to use as a refer-
ence when in need of information. Pediatric Occupational
Therapy Handbook consolidates all of the essential informa-
tion into a single handy reference, eliminating the cumber-
some task of leafing through multiple books.
Organization
The manual is organized alphabetically by diagnosis. Infor-
mation in each section reflects the occupational therapy prac-
tice framework, as well as policies governing the various areas
of pediatric practice, such as community settings, early inter-
vention services, school systems practice, and clinic-based
services.
Who Will Benefit From This Book?
This guide provides occupational therapy practitioners and
students working in busy clinical settings with a compact,
accessible, A-Z evidence-based resource on a multitude of
pediatric conditions. Because the essential information is
consolidated into this handy reference, the need to search
through multiple resources is eliminated. The information is
based on current research and thus provides the information
and detail necessary for making sound decisions during clini-
cal intervention.
vii
viii Preface
Distinctive Features
The handbook includes a consistent formatting for each
pediatric disease:
• Epidemiology
• Impact on performance skills and client factors
• Precautions
• Suggested assessment tools
• Intervention strategies
• Case examples
• Web resources
• Recommendations for further reading
Acknowledgments
This book is the result of recognizing a need that we observed
in the classroom and in various pediatric practice settings.
The pages of this book will hopefully be a place where stu-
dents and practitioners can begin the process of implement-
ing evidence-based practice. As with any endeavor of this
nature, there are many who help an idea become a reality. We
would like to thank the Elsevier team who supported us from
beginning to end in making the idea of this book come to
life: Kathy Falk, Melissa Kuster, John Casey, and Tara Knittel.
Your guidance and assistance made it possible. We would
also like to thank our families and mentors. You continually
inspire us to seek new challenges and do great things.
Patricia Bowyer
Susan M. Cahill
Contents
Section I Guide to Pediatric Practice
1 Using the Occupational Therapy Practice Framework
in Pediatric Practice, 3
2 Using Evidence to Guide Occupational Therapy
Practice, 9
Section II Guide to Diagnoses and Interventions
3 Achondroplasia, 17
4 Acquired Brain Injury, 21
5 Acquired Immunodeficiency Syndrome, 25
6 Albers-Schönberg Disease, 29
7 Amblyopia, 33
8 Anemia, 37
9 Angelman Syndrome, 41
10 Anorexia, 45
11 Anxiety, 49
12 Apnea, 53
13 Arthrogryposis Multiplex Congenita, 57
14 Asthma, 63
15 Attention Deficit/Hyperactivity Disorder, 67
16 Autism Spectrum Disorders, 73
17 Bipolar Disorder, 81
18 Brachial Plexus Injury, 85
19 Bronchopulmonary Dysplasia, 89
20 Bulimia, 93
21 Cerebral Palsy, 97
22 Cleft Palate, 107
23 Conduct Disorder, 111
24 Congenital Clubfoot (Talipes Equinovarus), 115
25 Congenital Heart Defects, 119
ix
x Contents
26 Congenital Obstructive Hydrocephalus, 123
27 Cri du Chat Syndrome, 127
28 Cystic Fibrosis, 131
29 Depression, 135
30 Developmental Coordination Disorder, 139
31 Disseminated Intravascular Coagulation, 143
32 Down Syndrome (Trisomy 21), 145
33 Dysrhythmias, 151
34 Edwards’ syndrome (Trisomy 18), 153
35 Epilepsy (Seizure Disorder), 157
36 Fetal Alcohol Syndrome Disorders, 161
37 Fragile X Syndrome, 165
38 Galactosemia, 169
39 Gastroschisis, 173
40 Hemophilia, 175
41 Hydrocephalus, 179
42 Hyperbilirubinemia, 185
43 Hypoxic-Ischemic Encephalopathy, 187
44 Intellectual Disabilities, 191
45 Intraventricular Hemorrhage, 195
46 Juvenile Diabetes, 199
47 Juvenile Rheumatoid Arthritis, 201
48 Klinefelter’s Syndrome, 205
49 Learning Disabilities, 207
50 Legg-Calvé-Perthes Disease, 213
51 Lesch-Nyhan Syndrome, 217
52 Lordosis, 221
53 Marfan Syndrome, 225
54 Meconium Aspiration Syndrome, 229
55 Micrognathia, 233
56 Mononucleosis, 237
57 Muscular Dystrophy, 241
58 Necrotizing Enterocolitis, 247
59 Neonatal Respiratory Distress Syndrome, 251
60 Neurofibromatosis, 255
61 Nystagmus, 261
62 Obesity, 265
Contents xi
63 Oppositional Defiant Disorder, 269
64 Osteogenesis Imperfecta, 273
65 Patau’s Syndrome (Trisomy 13), 277
66 Periventricular Leukomalacia, 283
67 Persistent Pulmonary Hypertension, 287
68 Phenylketonuria, 291
69 Pica, 295
70 Posttraumatic Stress Disorder, 299
71 Pneumonia, 303
72 Prader-Willi Syndrome, 307
73 Retinopathy of Prematurity, 313
74 Rheumatic Heart Disease, 317
75 Scoliosis, 321
76 Separation Anxiety and Social Phobia, 327
77 Sensory Processing Disorder, 331
78 Sepsis, 335
79 Sickle Cell Anemia, 339
80 Spina Bifida, 343
81 Spinal Muscular Atrophy, 347
82 Strabismus, 351
83 Tay-Sachs Disease, 355
84 Tourette Syndrome, 361
Appendices
A Websites for Research, 367
B Assessment Tools, 371
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I
Guide to Pediatric
Practice
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1
Using the Occupational
Therapy Practice Framework
in Pediatric Practice
Pediatric occupational therapists deliver services day in
and day out. Whether speaking with a parent, a teacher, a
physician, or another professional, many occupational thera-
pists find themselves in daily interactions that require the use
of a common language. As members of the occupational
therapy profession, we uphold a common belief system that
values occupation as both a means and an outcome for our
young clients. The commonalities that exist and the beliefs
we share are what make up our profession (Kielhofner,
2004).
Creation of a Unified Language
The profession of occupational therapy has grown and
changed since its beginnings almost 100 years ago. Because
of the changes within the profession as well as in the provi-
sion of occupational therapy services, there has been a need
to provide a structure that helps to organize knowledge and
the language that guides practice; helps unite practitioners,
educators, and researchers; and communicates the profes-
sion’s focus on occupation and daily activities to individuals
outside the profession.
3
4 Section I Guide to Pediatric Practice
The American Occupational Therapy Association
(AOTA) has tried to facilitate the use of common language
among occupational therapy practitioners and to improve
the general public’s understanding of the services we provide.
The result of the initial effort, the Uniform Terminology
(AOTA, 1994), has evolved into the Occupational Therapy
Practice Framework (OTPF or the Framework) (AOTA,
2002).
Occupational Therapy Practice Framework
The Framework begins with an explanation of the profes-
sion’s domain. Figure 1-1 shows the domains of practice.
Understanding the domains of occupational therapy prac-
tice is important because it helps to frame our areas of
assessment and intervention. In Figure 1-1 the domains
that are addressed through occupational therapy are orga-
nized under an overarching concern of practitioners, namely,
engagement in occupation to support participation in mean-
ingful contexts. Occupational engagement in meaningful
contexts is then broken down into more specific areas, which
include performance areas of occupation, performance skills,
performance patterns, context, activity demands, and client
factors.
The next key component of the Framework is used to
direct the service delivery of occupational therapy in all
practice settings, including pediatrics. The Framework is
organized into three categories: evaluation, intervention,
and outcomes (engagement in occupation to support partici-
pation). Box 1-1 and Figure 1-2 provide an overview of the
Framework.
The first area is evaluation (see Box 1-1). Evaluation is
described as the occupational profile and analysis of perfor-
mance. The next area is intervention. This includes the inter-
vention plan, intervention implementation, and intervention
review. Last is the outcomes process. Outcomes are the results
of the intervention process. Assessment of outcomes is
when the practitioner determines how well OT intervention
ENGAGEMENT IN OCCUPATION TO SUPPORT PARTICIPATION IN CONTEXT OR CONTEXTS
Chapter 1 Using the Occupational Therapy Practice Framework
Performance in Areas of Occupation
Activities of daily living (ADL)*
Instrumental activities of daily living (IADL)
Education
Work
Play
Leisure
Social participation
Performance Skills Performance Patterns
Motor skills Habits
Process skills Routines
Communication/interaction skills Roles
Context Activity Demands Client Factors
Cultural Objects used and their properties Body functions
Physical Space demands Body structures
Social Social demands
Personal Sequencing and timing
Spiritual Required actions
Temporal Required body functions
Virtual Required body structures
*Also referred to as basic activities of daily living (BADL) or personal activities of daily living (PADL)
Figure 1-1 Occupational therapy domain. (From American Occupational Therapy Association [AOTA]: Occupational therapy
5
practice framework: domain and process, Am J Occup Ther 56:611, 2002.)
