Brian: 1 year old
Past medical hx
2 weeks in NICU due to difficulty with breathing
6 months old: MRI and CT indicated normal results
Born at 34 weeks via emergency C-section, due to fetal heart arrhythmia
He remained on a heart monitor
with caffeine for one week, then without caffeine for one week.
1 year old: cranial vault surgery to repair prematurely fused cranial suture (craniosynostosis)
Assessments
Client Factors
Body Functions
Occupation-based problems
Model/Frames
Interventions
Goals
STG:
LTG:
Feeding
Eating
Functional mobility
Play
Refuses food other than purees
Only accepts bottle from caregiver
No attempts to use utensil
No finger foods
Sensory functions
Touch
Sensitive to food textures
Picky eater
Mental functions
Difficulty sequencing complex movement
Muscle functions
Torticollis
1 year old: 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
Difficultly maintaining quadruped stance
Stage: Sensorimotor
Eats a large variety of purees
Biomechanical FOR
PEO
Sensory Processing
Cargeiver interview
Denver II
Infant/Toddler Sensory Profile
Eating interventions
Play interventions
Feeding interventions
Functional mobility interventions
Approach: develop sensory acceptance and motor control of jaw, lips, cheeks, tongue through opportunities with mouthing and hand-mouth exploration
Approach: Symmetry/head and trunk stability; positions for feeding that encourage Brian to keep head in midline, upright position, maintaining body symmetry
Approach: developing early munching pattern of chewing to increase food intake beyond purees
Approach: food transitions
Approach: Increasing play participation through exploring toys with teething options
Approach: increasing play exploration and functional mobility
Combined*
Approach: increase trunk control; strengthen LE, increase encurance
Delayed pincer grasp
Performance skills
Motor Skills
Grips
Radial digital and raking grasps only
Walks
Coordination
Process skills
Delayed pincer grasp
Positions
Poor sitting posture
No demonstration of bimanual coordination
Unable to maintain position in quadraped for crawling
Unable to pull up to stand with support
Unable to stand to increase emerging walking skills
Handles
Notices/Respond
Limited imitation skills
Unable to use tools in appropriate manner
Sequence
Unable to perform steps in logical order
Delayed skill of holding one bottle (starts at 8 mos)
Will not use cup
Lack of motivation; Lack of understanding; Parents tolerate behavior so the child has no motive to change
At 8 months should develop skill to drink from cup with adult holding cup
Delayed skill of gumming solid food (starts at 8 months)
Delayed skill to finger feed self soft foods (starts at 7-10 mo)
Inability to handle
At 12 months should develop skills to pick up small cereal pieces
Delayed eating of soft solid food
Needs to advance to soft solid foods
Does not demonstrate bimanual coordination
Inability to experience emerging skills for crawling, pull-to-stand, walking
Inability to explore play environment
Inability to handle/grip toys for play
Does not coordinate B UE while playing with objects
Does not demonstrate simple problem solving
Lack of gross motor skills
Limited ability to explore object properties
Occupational profile
Caregiver priorities and goals
Interaction between person-environment-occupations
Occupations
Person: Brian
Environments/contexts Brian interacts with
Social environment
Mother and father
Physical environment
Home
Public playground
Play dates
Physical, cognitive, emotional, cultural characteristics
Evaluating environmental barriers/supports to occupational performance
Occupational history
Performance patterns
Understanding daily routine for Brian and family
Strengths and weaknesses of occupational performance
Reason for seeking services
Torticollus
Inability to eat solid foods; bottle feeding only from caregiver
Oral sensory processing
Tactile sensory processing
Visual processing
Lifespan Developmental FOR
Caregiver priority
Brian's likes and dislikes of activities
Torticollis
Picky Eater
Fine/Gross motor delay
Results and areas where Brian would receive F for fail
Personal/Social
Gross motor
Inability to feed self
Inability to imitate activities
Inability to drink from cup
Fine Motor/ Adaptive
Inability to bang 2 cubes held in hand
Standing 2 seconds
Inability to pull to stand
Proper use of body mechanics in daily occupations prevents injury and stress
ROM, strength, endurance
Mental and physical functions work together
Clinical observation
Observe Brian in natural environment
Identify family routines and priorities
Maintain normal range for age/gender/and physical characteristics
Restrictions cause child inability to perform specific tasks
Adapt to changes brought on by health conditions
Stages of life and age appropriate occupations
Environment plays role in an individuals motivation
Mastery with typical skills within age of development
Failure to develop age appropriate skills results in regression/conflict
Collaborate with family on intervention approaches
Modifying environment to facilitate growth and stimulation of age-appropriate behavior
Newer research focuses on person-environment-occupations relationships
Two older sisters
Sensitive and avoiding
Sensitive to certain textures
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
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.
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
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
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
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
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
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
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.
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.
Wants brian to self feed and eat age appropriate foods