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