Jason 2.5 years old (14 weeks premature) - Coggle Diagram
Jason 2.5 years old (14 weeks premature)
Current Functional Performance:
Objective Data <30% delay in development.
Method of feeding:
G tube, thick puree's (oatmeal, mashed potatoes) and soft solids(hot dog, banana, french fries, cheese and bread).
More engagement in self feeding.
Stronger trunk and LE.
Wider and healthier variety of accepted foods.
Caregiver interview and clinical observation.
G-tube due to pre and post natal medical complications.
5 fetal surgeries to address kidney blockages. Chronic kidney and chronic lung disease.
6 months in the NICU.
At 8 months intubated for 2.5 weeks resulting in refusal of oral feeding or pacifier.
Occupation based problem list:
1. doesn't self feed with fingers or utensils. 2. Only uses palmer or raking grasp. 3. Aversion to noxious textures and teeth brushing. 4. low muscle tone and weakness in trunk and lower body.
Occupational Model and Frame of refrence
: Occupational Adaptation
Rational: Jason has never really had the opportunity to feed and eat successfully. He has become accustom to not needing to engage in these occupations. He also could have experienced trauma after needing to be intubated that led to his aversion to certain textures. Because of these things Jason needs the time and the appropriate environment to adapt to this occupation. The use of the G tube provides the opportunity to allow Jason to adapt to these occupations slower but at a pace that will help him be successful in mastering the occupation of feeding and eating.
Frame of Refrence
: 1. Developmental. 2. Sensory Integration
Rational for Developmental: Jason is developmentally delayed not only in feeding but in mobility and fine & gross motor movements as well. Using the developmental frame of reference will guide his interventions to address his developmental delay.
Rational for Sensory Integration: Jason has aversions to certain food textures due to the feeling they have in his mouth. The sensory integration model will help Jason to become accustom to these textures to promote a healthier variety of foods that Jason is willing to eat.
Doesn't self feed
Backward chaining of self feeding to increase independance. This process starts with the highest level of assistance and works backwards until independance is achieved. (Shultz & Schkade 2020) Since this intervention is helping Jason to adapt to self feeding it is reflective of the OA Model.
up or down could be done by implementing or changing the type of a utensil or handle for the utensil, as well as the type of dish used to possibly promote better scooping
: Adaptive positioning and support during feeding that would promote self feeding. This would include a chair that would provide Jason with Postural support and a table or tray for increased arm stability(Shultz & Schkade 2020). This adaptation would pertain to Jason's environment which is one of the properties of the OA Model
Uses only palmer or raking grasp
: Small individual pieces of food that Jason is already accustomed to or is known to like would be given one piece at a time would encourage the use of thumb and thenar muscle group.(Shultz & Schkade 2020) This intervention would reflect the developmental and the sensory integration frame of reference.
up and down could be done through the weight and texture of the food. For example Gerber puffs are light weight with a rough texture making them fairly easy to pick up. A pea is smoother with a rounder shape and has more weight.
strengthen upper and forearm muscles through therapeutic use of play and practice supporting sitting with hands and arms. Development of motor skills starts with gross motor skills and transitions to fine motor. Strengthening of his trunk and upper extremity will allow the stability needed to focus on fine motor development. (Korth & Maune, 2020)This intervention could also help to address Jason's lack of protective reactions. This intervention would relate to the developmental frame of reference.
aversion to noxious textures and brusing teeth
:Oral challenges or averse textures would be introduced to Jason at the beginning of a meal while he is the most hungry. (Shultz & Schkade 2020)Because this intervention is introducing new textures to Jason it is reflective of sensory integration frame of reference.
down: Slightly decreasing the amount of food Jason gets through his G tube can induce hunger and increase motivation.
: Pacing foods by pureeing to different consistencies or adding thickening to a variety of foods for Jason's while using a nuk brush as a utensil.(Shultz & Schkade 2020) The use of a nuk brush will help Jason adapt to a toothbrush. This will help Jason to become accustomed to new flavors and textures and is reflective of the Occupational adaptation Model.
Low muscle tone and weakness in trunk and lower body
:Adaptive positioning, during leisure and play, would help to increase strength and tone for Jason. Increased tone could be achieved through frequent repositioning. This would also benefit his plagiocephaly. (Korth & Maune, 2020) This intervention would reflect the developmental FOR as well as the Occupational adaption model.
up or down would be established through the therapeutic use of positioning cushions or lack there of. Cushions would increase support and grade intervention down. Removing cushions would decrease external stability and require more strength and endurance by Jason to maintain position.
Play therapy that would incorporate his core and legs to increase muscle strength. Games and goal directed play could be used to promote endurance and strength in LE. Jason would also gain more proprioception knowledge during these occupations. (Korth & Maune, 2020) This intervention is reflective of the Developmental and sensory integrative FOR.
Long Term Goals:Jason will be able to tolerate regular easy to chew foods such as bread or pasta while sitting in his high chair and with moderate assistance by the time his G tube is removed. Baseline: Jason only eat thick puree's and soft solids.
Short term goals: Jason will engage in self feeding with his hands while sitting in his highchair and with moderate assistance within 6 weeks. Baseline: Jason does not engage in self feeding at all.
Schultz S., Schkade J. K., (1992) Occupational adaptation: toward a holistic approach for contemporary practice. Part 2. The american journal of occupational therapy Oct. 1992 doi.org/10.5014/ajot.46.10.917
Schultz S., Schkade J. K., (1992) Occupational adaptation: toward a holistic approach for contemporary practice. Part 1. The american journal of occupational therapy Sept. 1992 doi.org/10.5014/ajot.46.9.829
Korth, K. & Maune, N.C. (2020). Chapter 10: Assessment of eating, feeding, and swallowing. In O’Brien, J. & Kuhaneck, H. (Eds). Case-Smith’s Occupational Therapy for Children and Adolescents. (pp.212-238). Elsevier.
American Occupational Therapy Association (2008). Frequently asked questions about ayers sensory integration. Fact sheet.
O’Brien J., Coker-Bolt P. C., Dimitropoulou K., (2020) Chapter 16: Application of motor control and motor learning. In O’Brien, J. & Kuhaneck, H. (Eds). Case-Smith’s Occupational Therapy for Children and Adolescents. Elsevier