Klinisch redeneren: kinderen
THEORIE
Clinical reasoning by an expert clinician:
- pattern of recognition in forward reasoning
- collaborative patient-centered model
- reflection in action
Clinical reasoning by a novice clinician:
- therapist centered approach
- hypothetico-deductive reasoning from initial cues to initiate assessment
Hypothesis-oriented pediatric focuses algorithm:
- framework for novice clinicians
- reflection to learn and to become an expert
think enough about the why and how
Initial hypothesis in ICF:
- age and gender: functions – activities – participation
- diagnosis with related dysfunctions and impairments
- building mental image of the child
Initial data collection:
- based on initial mental image
- past medical diagnosis and history
- family centered
- getting insight in patient’s and family’s desired goals and expected outcomes
Problem statement !!!
= hulpvraag: “this family/child is seeking physical therapy to be able to …”
Hypothesize goals:
- short and long-term
- to guide the examination process
- encouraging family involvement in the decision-making process
Examination planning : within the ICF framework
Examination: develop rapport with child and family by explaining the procedures used and
briefly reporting on findings
( assess in aanwezigheid van de moeder)
Evaluation of the examination:
- what are the child’s strengths and interests activity, participation
- what are the physical therapy problem areas (impairments, functional limitations, activity
or participation restricitions) and how do these problem areas impact this child’s function?
- Do any of the identified physical therapy problem areas have the potential to lead to the
development of further problem areas? Can these future problems be prevented? How?
,- Are there any changes coming up for this child and family in the next year? How might
these anticipated changes affect the child and the family?
- What is this child’s anticipated level of function in 1 year? In 5 years? What needs to be
done now to maximize the child’s future independence and function?
Diagnosis and prognosis mbv ICF
General intervention planning (dia 15):
- when physical therapy is indicated related to the child’s capacity to achieve gains in
function or to the child’s needs relative to wellness and prevention, a plan of care is
developed
- plan of care: goals and expected outcomes, specifical physical therapy interventions to be
used, proposed frequency and duration, anticipated dates for re-examination and
readministration of outcome measures and predicted plans of discharge
- motivation or play component! intrinsieke interesse!
what are the components and demands of the task outlined in this functional goal?
what are the components and demands of the environment where this task will
ultimately be performed?
what strengths does the child have that will help to achieve this goal?
what components of the task are missing from the child’s movement repertoire? What is
the functional environment where this task will ultimately be performed?
Reflection: we do not learn from experience, we learn from reflecting on experience
ABC of motivation
Self-determination theory: theory of motivation concerned with supporting our natural or
intrinsic tendencies to behave in effective and healthy ways
3 fundamental psychological needs:
- Autonomy:
offering extrinsic reward for behaviour that is intrinsically motivated undermines the
intrinsic motivation as they grow less interested in it. Initially intrinsically motivated
behaviour becomes controlled by external reward wich undermines their autonomy
other external factors (vb. deadlines), which restrict and control, decrease intrinsic
motivation
situations that give autonomy as opposed to taking it away have a smiliar link to
motivation. Increasing options and choices increase intrinsic motivation
- Belongingness (relatedness)
doing things together increases motivation
- Competence
unexpected positive feedback increases intrinsic motivation -> fulfilling people’s need
for competence, decreases extrinsic motivation
negative feedback has the opposite effect (niet te veel corrigeren)
interplay between extrinsic forces and the intrinsic motives and need is the territory of self-
determination theory
, extrinsic motivation: not always totally negative
- externally regulated behaviour – external demand, reward or punishment (vb. eating to
receive a dessert)
- introjected regulation of behaviour: not fully accepted regulation but taken on regulation
to maintain self-worth (vb. calling your mum because you know it make her happy)
- regulation throug identification: aan verwachtingen willen voldoen (vb. saying hello to
someone even if you are not interested)
- integrated regulation: integrated motivations but the goal is excentric to the self (vb. not
eating meat because you care for the planet) = niet helemaal extrinsiek
intrinsic motivation:
- basic psychological needs: A, B, C
- intrinsic motivation is long-lasting and preferrable for healthy psychological development
hardly research about motivation in pediatric rehabilitation
CASUS (dia 32- 46)
Beep test: several available protocols
use test without norms interpretation is difficult, but useful for follow-up
alternative: 6 minute walk test
Movement ABC-2 (M-ABC-2) (zie extra doc)
BOTsubtest strength & agility:
- fine manual control (fine motor precision, fine motor integration)
- manual coordination (manual dexterity, UL coordination)
- body coordination (bilateral coordination, balance)
- strength and agility ( running speed and agility, strength)
moeten niet allemaal gedaan worden
Checklists:
- Physical Activity Questionnaire for Children (PAQ-C)
een beeld over het niveau van fysieke activiteiten: welke sporten ze hebben gedaan,
actief in de turnles, tijdens de speeltijd, tijdens de middagpauze, na school, ‘savonds, in het
weekend, vrije tijd
- Pediatric Scale for Quality of Life (PEDsQL)
ondervindt een probleem met: gezondheid en activiteiten, gevoelens, omgang met
anderen, met school
Overweight and obesity in children
Oveweight/ obesity = abnormal or excessive fat accumulation that presents a risk to health
Overweight: increased body weight above an arbitrary standard
obesity: an excess body fat which creates increased risk of adverse health outcomes
How do we define overweight/obesity
BMI adults:
underweight: <18,5
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