Case Study - Flynn (Occupation Based
Problem List (Refuse to Self-feed (
Case Study - Flynn
- Developmentally appropriate grasps; though impaired hand help manipulation and bimanual skills
- Flynn is non-verbal, point and vocalizing in an attempt to communicate/
- Attempts to introduce communication device results in resistance due to inability to access tablet apps.
- Assists with dressing by pushing arms/legs through sleeves
- Limited participation in grooming and hygiene
- Working on toilet training, but constipation is an issue
- Prefers to finger feed everything so is very messy, and is resistance to utensil use.
- Flynn will eat pureed foods from pouches held by an adult or offered on a spoo,
- He is able to use an open cup but prefers a straw cup or a 360 cup.
- Resistant to UE WB in quadruped
- Poor active movement above should level
- Flynn can sit unsupported on the floor but unable
to sit unsupported on elevated surfaces w/o supervision
- Flynn can raise self into standing using UE and lifting self from one surface to another
- Flynn is not yet crawling but walks inconsistently with either hand held assist or use of kaye walker.
- Hypotonia throughout
- No sensory processing concerns
- Born at 38 weeks gestation via C-section
- Weight 6 lbs 13 ounces
- At birth, Flynn experienced recurrent episodes of apnea, decreased myscle tone and activity.
- Diagnosed with micrognathia, obstructive sleep apnea, and clubfoot
- Visiong and hearing tests are reportedly normal
OT Interventions & Strategies
- Intervention will focus on Hygiene, Feeding, Parent Education, and Physical Issues.
- Introduce the NUK toothbrush as a toy until Flynn gets comfortable.
- Or substitute a soft, sponge-tipped toothette for a brush
- Flynn has weak grasp, the parent can enlarge the toothbrush handle with sponge rubber.
- A hand over hand technique will help Flynn direct the toothbrush in the mouth and reach all teeth.
- Flynn also has decreased tone, and it is important to work with Flynn on physically handling things to build tone and increase trunk stability. This will lead to improving tone in face and mouth.
- Providing greater stability in the neck and shoulder girdle area will provide normal posture and control of head and jaw
- Positioning of the feet, legs, and pelvis influences the child's trunk stability.
- The position and graded muscle control of the child's head and neck influence jaw movements.
- For Flynn, using a Tumble Forms Feeder chair will provide the head and trunk support he needs during mealtime.
- This will decrease the risk of Dysphagia.
Self - Feeding
- For Flynn, the therapist can implement self-feeding activities for only a portion of the meal, or during a small snack section.
- Adaptive positioning will support self-feeding activities.
- Backward chaining method can be implemented with Flynn in order to increase utensil use when feeding.
- Starting with decreased level of spoon usage to becoming fully independent by lifting the spoon and bringing to mouth.
Introducing new foods
- Fynn is a picky eater.
- Therapist and parents can offer small amounts of new food across multiple meal sessions to allow Flynn to adapt to new textures and colors.
- Non-preferred foods can be paired with preferred food.
- To introduce new foods to Flynn, we will attempt around the bowl method.
- Flynn's mom will place familiar food and one unfamiliar food in a bowl which will be a different color.
- Use of a communication device has been unsuccessful.
- This can be modified by simplifying mode of communication to using a communication board that consists of pictures and stickers.
- Using a simple picture sequence will give Flynn environmental cues and also communicate with his caregiver.
- Simplify words, sentences, and communication.
- Provide Flynn with external support
- Change position of child
- Change position of activity
- Instead of sitting on elevated surfaces, sit on the floor and do activities/feed
- Consult with a Physical Therapist who can select activities to alter tone.
- Can be treated by stretching and casting or stretching and tapping.
Approach To Intervention
- Proper feeding --> introducing new food/flavors and techniques to increase self-feed participation.
- Increase participation in grooming and hygiene (mostly hygiene).
- Increase tone and good postural and head control through proper positioning.
- Modify environment to improve proper body mechanics when sitting.
- Improve performance skill in communication.
- Provide parent education on activity modification and adaptation to increase client participation.
Short Term Goal
Within 3 weeks, Flynn will eat 1 new food item, 1 out of 7 days, using a spoon, as per parent report.
Long Term Goal
Within 6 weeks, Flynn will self-feed 3 out of 7 days, using a spoon, as per OT report.
- When grooming, instead of mom being in control of the hairbrush, she can hand the hairbrush to Flynn and let him participate in the act of grooming.
- This will allow Flynn to be in charge and work towards becoming independent in this occupation.
- Handling the hairbrush will allow Flynn to explore and become comfortable with the object.