Barrett, 2.5-years-old (Problems (Feeding, Functional Mobility, Muscle…
•Born via C-section (fetal distress, 39 weeks)
•True-knot in umbilical cord at birth
•Diagnosed with HIE at 1 week
•Diagnosed with CP at 11 months
•Diagnosed with CVI at 1-year
•Began taking seizure medication at 1-year
•Diagnosed as quadriplegic CP with dystonia at 2-years
•Received increased gabapentin to decrease tone & aid with sleep at 2.3-years
•Received Botox injections to hip adductors/flexors at 2.5-years
• Received B hip abduction brace at 2.5-years
Current Functional Performance:
•Poor functional mobility due to hypertonia in extremities
•Impaired strength/poor postural control/hypotonic core
•Impaired intentional release
•Impaired bimanual skills
•Retained ATNR & STNR/absent protecting reactions
•Cognitive abilities intact
•Completes gross palmar grasp (cannot maintain position of objects)
•Difficulty sleeping through the night due to pain
•(Feeding performance in "Method of Feeding")
Method of Feeding:
•Able to grasp loaded spoon
•Requires assistance orienting spoon to mouth
•Requires HOH assistance to scoop food
•Total assistance with sippy cup (less w/ straw cup)
•Consumes purées & soft foods with nectar thick liquids
•3 meals/day, 2 snacks
•Sits in customized high chair (due to lack of postural control)
•No swallowing deficits with current diet
•Unable to adequately chew solid food (resulting in difficulty swallowing)
•Parents would like for Barrett to increase in accuracy when bring spoonfuls of food to his mouth, & manipulate spoon independently when scooping food
•Parents would like for Barrett to be able to sit up on his own (including improved head & neck stability) so he can sit in a regular chair during meals
•Parents would like for Barrett to transition from purées to lumpier solid foods
Motor Control & Motor Learning FOR:
•Used for CP in children (& affected occupations)
•Used for lack of postural control
•Beneficial for abnormal muscle tone
•Measures posture, strength, & movement control in assessments
•Allows for practice/refinement of skilled movements
(Tufano & Cole, 2008)
- Whole body vibration (WBV) intervention in extremities to decrease tone, increasing functional mobility (Cheng et al., 2015)
- Symmetric bimanual pick up task (Hung & Spingarn, 2018)
- NeuroGame therapy to improve wrist control for scooping food (Rios et al, 2013)
- Visual perception training program, including visual motor coordination & position in space/spatial relationship training (Milim, Deokju, & Yeongae, 2015)
- Regularly massage extremities
- Have child use mind to give messages of relaxation to different parts of body
(Morris & Kline, 2000)
- Bounce child in lap with back against therapist's chest & pelvis in neutral
- Lay child supine (with pillows under legs); massage neck & perform PROM in nodding & head shaking motions
(Morris & Klein, 2000)
- Provide assistance in oral control when attempting solid foods (PROM of jaw up & down; sustained closure or opening as desired)
- Prepare ground food with baby-food grinder to help transition to lumpier foods
(Morris & Klein, 2000)
Functional Mobility (#2)
•Barrett will be graded on his ability to independently approach & leave the meal table before & after eating
•This will be a grade up approach. Pick up tasks will become more complicated the more he shows improvement.
•Barrett will be graded on how many mistakes he makes when attempting to bring food to his mouth with a spoon.
•This will be a grade up approach. Visual tasks will become more complicated the more he shows improvement.
Postural Control (#2)
•Barrett will be graded on how long he is able to sit up without support
•This will be a grade up approach. If he begins to show improvement, he can receive massages & PROM while siting up instead of laying supine.
Muscle Tone (#1)
•Barrett will be graded on his ability to scoop food independently with his spoon when eating.
•This will be a grade down approach. The more he improves with scooping, the less massages he will receive.
•Barrett will be graded on his ability to swallow various textures of foods.
•This can be a grade up or down approach. If Barrett cannot handle a step up from the soft purées, he will continue with the soft purées until he can. If he can handle a lumpier food, the foods will increase in solidarity.
Barrett is unable to sit up unsupported due to hypotonia in his core.
Within 6 weeks, Barrett will be able to sit for 3 full minutes, unsupported, with standby assistance.
Barrett has trouble independently orienting his spoon to his mouth when eating due to poor hand-eye coordination.
Within 3 weeks, Barrett will be able to orient his spoon to his mouth, with less than 20% error, with standby assistance.
•American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006
•Cheng, H. K., Yu, Y., Wong, A. M., Tsai, Y., & Ju, Y. (2015). Effects of an eight-week whole body vibration on lower extremity muscle tone and function in children with cerebral palsy. Research In Developmental Disabilities, 38256-261. doi:10.1016/j.ridd.2014.12.017
•Hung, Y., & Spingarn, A. (2018). Full length article: Whole body organization during a symmetric bimanual pick up task for children with unilateral cerebral palsy. Gait & Posture, 6438-42. doi:10.1016/j.gaitpost.2018.05.028
•Milim, C., Deokju, K., & Yeongae, Y. (2015). Effects of visual perceptual intervention on visual-motor integration and activities of daily living performance of children with cerebral palsy. Journal Of Physical Therapy Science, 27(2), 411-413. doi:10.1589/jpts.27.411
•Morris, S.E. & Klein, M.D. (2000). Title of chapter. In Pre-feeding skills, 2nd ed. (pp. 403-406). USA: Therapy Skill Builders
•Morris, S.E. & Klein, M.D. (2000). Title of chapter. In Pre-feeding skills, 2nd ed. (pp. 430). USA: Therapy Skill Builders
•Morris, S.E. & Klein, M.D. (2000). Title of chapter. In Pre-feeding skills, 2nd ed. (pp. 484). USA: Therapy Skill Builders
•Rios, D. C., Gilbertson, T., McCoy, S. W., Price, R., Gutman, K., Miller, K. F., & ... Moritz, C. T. (2013). NeuroGame Therapy to improve wrist control in children with cerebral palsy: A case series. Developmental Neurorehabilitation, 16(6), 398-409. doi:10.3109/17518423.2013.766818
•Tufano, R., & Cole, M. B. (2008). Applied theories in occupational therapy : a practical approach. Thorofare, NJ Slack, Inc. c2008.