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Brian: 1 year old (Past medical hx (2 weeks in NICU due to difficulty with…
Brian: 1 year old
Past medical hx
2 weeks in NICU due to difficulty with breathing
He remained on a heart monitor
with caffeine for one week, then without caffeine for one week.
6 months old: MRI and CT indicated normal results
Born at 34 weeks via emergency C-section, due to fetal heart arrhythmia
1 year old: cranial vault surgery to repair prematurely fused cranial suture (craniosynostosis)
1 year old: torticollis
Assessments
Cargeiver interview
Occupational profile
Evaluating environmental barriers/supports to occupational performance
Occupational history
Performance patterns
Reason for seeking services
Torticollus
Inability to eat solid foods; bottle feeding only from caregiver
Caregiver priorities and goals
Understanding daily routine for Brian and family
Strengths and weaknesses of occupational performance
Collaborate with family on intervention approaches
Denver II
Results and areas where Brian would receive F for fail
Personal/Social
Inability to feed self
Inability to imitate activities
Inability to drink from cup
Gross motor
Standing 2 seconds
Inability to pull to stand
Fine Motor/ Adaptive
Inability to bang 2 cubes held in hand
Infant/Toddler Sensory Profile
Oral sensory processing
Sensitive and avoiding
Tactile sensory processing
Sensitive to certain textures
Visual processing
Clinical observation
Observe Brian in natural environment
Identify family routines and priorities
Wants brian to self feed and eat age appropriate foods
Client Factors
Body Functions
Sensory functions
Touch
Sensitive to food textures
Picky eater
Mental functions
Difficulty sequencing complex movement
Muscle functions
Torticollis
Limited rotation to L side
Fair strength
Difficulty maintaining B UE WB in quadruped
Assymetrical sitting posture
WB through L pelvis
Thoracic curvature to R
Family Values
Values health and wellness
Wants Brian to hit developmental milestones
Family Beliefs
Believes Brian is the baby of the family because he has 2 older sisters
Occupation-based problems
Feeding
Only accepts bottle from caregiver
Delayed skill of holding one bottle (starts at 8 mos)
Lack of motivation; Lack of understanding; Parents tolerate behavior so the child has no motive to change
No attempts to use utensil
Inability to handle
No finger foods
Delayed pincer grasp
Delayed skill to finger feed self soft foods (starts at 7-10 mo)
At 12 months should develop skills to pick up small cereal pieces
Will not use cup
At 8 months should develop skill to drink from cup with adult holding cup
Eating
Refuses food other than purees
Delayed skill of gumming solid food (starts at 8 months)
Delayed eating of soft solid food
Eats a large variety of purees
Needs to advance to soft solid foods
Functional mobility
Difficultly maintaining quadruped stance
Does not demonstrate bimanual coordination
Inability to experience emerging skills for crawling, pull-to-stand, walking
Play
Stage: Sensorimotor
Inability to explore play environment
Lack of gross motor skills
Inability to handle/grip toys for play
Limited ability to explore object properties
Does not coordinate B UE while playing with objects
Does not demonstrate simple problem solving
Model/Frames
Biomechanical FOR
Proper use of body mechanics in daily occupations prevents injury and stress
ROM, strength, endurance
Maintain normal range for age/gender/and physical characteristics
Restrictions cause child inability to perform specific tasks
Mental and physical functions work together
PEO
Interaction between person-environment-occupations
Occupations
Caregiver priority
Brian's likes and dislikes of activities
Person: Brian
Physical, cognitive, emotional, cultural characteristics
Torticollis
Picky Eater
Fine/Gross motor delay
Environments/contexts Brian interacts with
Social environment
Mother and father
Play dates
Two older sisters
Physical environment
Home
Public playground
Sensory Processing
Understanding the sensory processing a child will give insight into their performance or their response to task demands
Misinterpreting stimuli and response is dysfuntion
Sensory processing becomes a disorder when it interferes with occupation
Used to address Brian's tactile, proprioceptive, visual, and gustatory processing systems
Lifespan Developmental FOR
Adapt to changes brought on by health conditions
Stages of life and age appropriate occupations
Mastery with typical skills within age of development
Failure to develop age appropriate skills results in regression/conflict
Environment plays role in an individuals motivation
Modifying environment to facilitate growth and stimulation of age-appropriate behavior
Newer research focuses on person-environment-occupations relationships
Interventions
Eating interventions
Approach: developing early munching pattern of chewing to increase food intake beyond purees
Add thickened and lumpy soft foods into Brian's diet, thickened purees or lumpy cereals that do not require chewing
Grading: increase thickness/lumps in small increments to develop chewing skills; introduce soft solid foods
Approach: food transitions
Reducing postural, sensory, oral motor limits that interfere with Brians ability to handle more complex foods
Using the around the bowl method offer familiar textured foods, followed by the familiar food mixed with the new texture foods, work around the plate and offer Brian familiar and new textured foods
Grading: decrease amount of new food mixture; increase amount of new food; with positive responses provide Brian more solid foods
Play interventions
Approach: Increasing play participation through exploring toys with teething options
Giving Brian toys with a variety of shapes and textures to encourage exploration of toys and in-hand manipulation to increase play
Grading: giving Brian smaller toys for his limited bimanual coordination; giving bryan bigger toys to increase bimanual coordination of UE and development of play
Approach: increasing play exploration and functional mobility
Feeding interventions
Approach: develop sensory acceptance and motor control of jaw, lips, cheeks, tongue through opportunities with mouthing and hand-mouth exploration
Give Brian toys, sippy cup, or feeding utensils that have simple shape and limited surface texture
Grading: Child can bring object to mouth independently or with assistance
Brian is given simple toys or mesh pacifier (with soft solid food) to explore sensations of hand-mouth that result in patterns of feeding. Hand over hand assist can be provided if Brian does not demonstrate hand-mouth contact.
Approach: Symmetry/head and trunk stability; positions for feeding that encourage Brian to keep head in midline, upright position, maintaining body symmetry
Brian in high chair with lap tray and lateral supports to maintain symmetrical posture and increase visual-motor perception during feeding
Grading: lateral supports can be added or removed, head rest can be utilized, support should be based on Brian's physical ability and need
Functional mobility interventions
Combined*
Placing noise-making toys around bryan in order to increase skills needed for crawling and participation in play
Grading: putting Brian prone with pillow support under his chest and toy close by; selecting noisey-toys that are long to encourage use of both hands to increase synergy patterns
Approach: increase trunk control; strengthen LE, increase encurance
Parent will hold Brian up in supported stance (during play/holding toys) with frequent breaks to increase endurance, strength in LE, and trunk control
Grading: while holding Brian the parent can stand him up for 3 seconds, then increase the time he spends weight-bearing
Goals
STG:
In 3 weeks, Brian will eat mix-textured puree, from a bottle, with max assist, for 3/3 daily meals, for 5 consecutive days, per parent report, in order to increase chewing skills for developmentally appropriate eating.
LTG:
In 9 weeks, Brian will eat soft solid foods, from a spoon, with max assist, for 2/3 daily meals, for 5 consecutive days, per parent report, in order to increase chewing skills for developmentally appropriate eating.
Performance skills
Motor Skills
Grips
Radial digital and raking grasps only
Delayed pincer grasp
Walks
Unable to maintain position in quadraped for crawling
Unable to pull up to stand with support
Unable to stand to increase emerging walking skills
Coordination
No demonstration of bimanual coordination
Positions
Poor sitting posture
Process skills
Handles
Unable to use tools in appropriate manner
Notices/Respond
Limited imitation skills
Sequence
Unable to perform steps in logical order