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Jason: 2.5 year-old (g-tube due to medical complications pre and post…

- - - - tone
        
        Hypotonic
        
        poor posture in supported sitting
        
        frog-position in supine
      - movement
        
        unable to lift toys above chest level, buy can manipulate favorite toy with UE
        
        push UE through shirts
        
        unable to dress LE; may represent apraxia
      - Strength
        
        Cannot sit without support/ assistance; ;
        
        difficulty positioning and maintaining
        quadruped
        
        Scoots in supine or rolls for mobility
    - - Resistant to brushing teeth, unexposed to advances textures such as solid food
      - Gagging from textured foods
    - - Oral Motor Issues- assessments will show deficits in oral motor control, strength, and reflexes
      - no swallowing, sucking, or jaw anomalies described
    - - Only palmer and raking grasps
  - - - self-inducing vomiting (signs of discomfort)
      - Does not use finger or utensils
      - Does not attempt additional independence in tasks
    - - At home, seated at kitchen table, with toddler chair, during mealtimes
    - - Thick pureed foods, softened foods, and thin liquids from sippy cup
- - - - Graded Up: Remove towel rolls to encourage gradual self-support. Allow Jason to sit for longer periods of time with less support. Add activities that include reaching to challenge balance when bending if ready.
      - Graded Down: Utilize high chair with towels as supports. Support Jason on the hips while he reaches, if needed.
    - - Graded Down: Place favorite toy closer to Jason to reduce complexity; will focus more on UE manipulation with slight posture control
      - Graded Up: Place toy higher or across mid-line to challenge stability and muscle control.
  - - - Graded Up: Begin placing spoon in oatmeal or food item to encourage eating with utensil. Place spoon in Jason's mouth and let him take it out.
      - Graded Down: Limit item to one spoon or finger-foods only. Adapt spoon with larger handle for grasp.
    - - Graded Down: Use only preferred textures to manipulate food items in art.
      - Graded Up: Selected a more complicated art task or include smaller particles for precision grasps.
  - - - Graded Up: Begin trying entirely new solid foods with favorite seasoning or sauce, i.e. hamburger meat
      - Graded Down: mix foods Jason already eats together for new texture i.e. banana and oatmeal mixed
    - - Graded Up: Mix assistive tools or maintain them in Jason's mouth for longer period of time; perhaps ask him to bite down
      - Graded Down: Begin by applying assistive tool (Nuk brush, washcloth, Pro-Prefer, gloved finger, or toothbrush) distally on the body, then to the face, then lips (Case-Smith & O'Brien, 2015)
  - - - Graded Up: Use deeper spoon and remove suction cup bowl
      - Graded Down: Allow Jason to use only finger foods with hands; do not introduce utensils
    - - Graded Up: Fill cup up with liquids to increase weight for advanced strength, control, and head stabilization
      - Graded Down: Slowly introduce straw sippy cup once or twice a day instead of at every feeding
  - - - Grade Up: Dress in long sleeve shirt, or begin LE dressing techniques with compensatory strategies, such as with sitting.
      - Grade Down: Complete UE dressing with verbal cuing, modeling, and positive feedback in short sleeve or open shirt.