Occupational Performance Deficits
ex. cutting out shapes, cutting things for artwork
Using technology in class
ex: typing, handling an ipad
Bimanual control of book or Ipad
written assignments, homework
bimanual coordination and control
hypertonicity in hands
Areas of written expression
Physical Education Participation
Independence with Materials
Independence with lunch
Occupational Performance Strength
partial use of L hand
To Address Written Expression
"Children with CP experience restrictions in handwriting due to difficulties of motor coordination" (Hee, 2016).
Reference: HEE YOUNG, K. (2016). An investigation of the factors affecting handwriting articulation of school aged children with cerebral palsy based on the international classification of functioning, disability and health. Journal Of Physical Therapy Science, 28(2), 347-350.
Sophie has weak UE strength. She can benefit from using thera putty to help strengthen her hands.
To address Physical Education Participation:
Activity- Participants in the adaptive PE class be provided with 2 motorized cars. 2 minute stations are set up that address strength, flexibility and endurance. Participants travel in pairs to each station.
1st Station: Using an adapted football that contains grips for better hold, the students perform play of catch for.
2nd station: Dancing station- music and movement.
3rd station: Parachute Play: Other class members hold parachute.
Paleg, G., Rodby-Bousquet, E. and Huang, H. (2015). Go Baby go! Solutions for maximizing augmented mobility for children.
101, p. e18. *
One intervention to help promote self feeding would be to work on Sophie's low tone in her trunk. A way to do this is to have her sit in the therapists lap and bounce a ball in front of her that way she can catch it. This will allow her to engage her abdominal muscles which will strengthen them. This will eventually help her have increase tone in her trunk to be able to self feed.
"One case study examined the effects of positioning in combination with a training program and the use of adaptive equipment on the acquisition of self feeding skills. This study showed that following treatment the child gained the skills to begin self feed with minimal assistance"
Snider, L., Majnemer, A., & Darsaklis, V. (2011). Feeding Interventions for Children with Cerebral Palsy: A Review of the Evidence. Physical & Occupational Therapy In Pediatrics, 31(1), 58-77.
Another way to promote self feeding would be to adapt the space Sophie will be eating. A tray can be added to her wheelchair so her food can be more accessible. This will encourage self feeding.
some mild hypertonicity in the L wrist and L hand intrinsic
hypertonic in R hand, R arm, R wrist, R hand intrinsics
Sophie compensates when her hands and arms get tired by using her head and neck. The straining is visible in her face.
Weak R wrist
Noticeable flexor synergy -which she is able to move through however is limited by her hypertonicity
Ambulates using motorized wheelchair
- The GMFM measures gross motor specifically with children with CP. It is observational and criterion-referenced, and allows the evaluator to determine how much of each task the tester is able to complete, making it a discriminative and responsive test measure(Majnemer, 2006). GMFM test is effective in its accommodation and specialty towards assessing children with CP(Majnemer,2006). 2 scales are also being developed to classify bi-manual fine motor function and manual ability classification scale(Majnemer,2006), essential areas to evaluate in the school setting with CP.
- The BOT-2 is effective in its ability to asses 4 different motor areas. Fine Motor areas address skills needed for writing and drawing tasks required for precise control in finger and hand manipulation(Wuang et al.,2012). The Manual Coordination focuses on reaching and grabbing and object manipulation in terms of speed, dexterity and coordination of upper extremities (Wuang et al., 2012). Body coordination hones in on balance and motor skills related to participation with peers, while Strength and Agility can focus on large muscle group strength needed for proper postural control(Wuang et al., 2012). All areas concentrate on key areas needed for success in the school setting with CP.
Majnemer, A. (2006). Assessment tools for cerebral palsy: New directions. Future Neurology, 1(6), 755-763.
Wuang, Y., Wang, C., & Huang, M. (2012). Health-related quality of life in children with developmental coordination disorder and their parents. Otjr, 32(4), 142-150.
Sophie continues to develop her skills in the area of physical education participation, written expression, and self-feeding. Sophie is currently having difficulty with endurance and postural control in physical education. This limits Sophie in social participation with children her age in physical education activities. Sophie also has hypertonia in her R hand, R wrist, and R instrinsic muscles which is causing a challenge with written expression and self feeding. This reduces the level of independence Sophie requires.