Flynn is a 4 year old boy diagnosed with Congenital Myotonic Dystrophy. He enjoys playing with balls, bubbles, and blocks. However, his parents have reported that he has difficulty with manipulation, bimanual tasks, and maintaining a tabletop position. His pediatrician has confirmed that this is due to hypotonicity of his UEs. Flynn was referred to occupational therapy for refusal in self-feeding. He currently eats with his hands and refuses utensils. He will willingly eat pureed foods, yogurt, and oatmeal on a spoon, however only when fed by a parent. His mother has expressed that he is an intelligent and happy child, however, feeding has become a stressful time for the entire family and she would love to see him be able to feed himself so that she can get through mealtime easier and faster.
-
Model/FOR
PEOP: Analyze elements of the child, environment, and occupation that may be supporting or inhibiting performance. Implement adaptations or modifications to support performance (Lifelong Learning with OT, 2015)
MOHO: Utilize volition, habituation, and performance to increase participation in self-feeding. Flynn's role as a child may motivate him to engage with his parents in feeding activities. Utilizing this parent-child interaction may help improve his performance (Pawar, 2017)
Biomechanical FOR: Improving Flynn's UE strength and ROM to improve functional performance during self-feeding (Colangelo & Shea, 2010)
Motor Learning/Motor Control: Improving planning, sequencing, and execution of motor tasks. Flynn will work on motor control by practicing holding onto a spoon. He will work on motor learning by learning how to sequence grasping, scooping food, and then bringing the food to his mouth (Sheppard, 2008)
Grading
Messy Eating: Grade up by using more liquid foods. Grade down by using solid foods. Rationale: Liquids are messier and more difficult to manipulate than solids
Hypotonicity: Grade up by using heavier objects. Grade down by using lighter objects. Rationale: More strength building for heavier objects.
Fine/Gross Motor Skills: Grade up by grasping thick handle utensils. Grade down by grasping wide handle utensils. Rationale: increases or decreases physical requirement of manipulation skills
Nutritional Value: Grade up by introducing 2-3 new foods. Grade down by introducing 1 new food. Rationale: introducing 1 novel object at a time is less stressful and easier to manage
Goals
Baseline: Flynn's resistance to using utensils results in him throwing things and making a mess during mealtime.
LTG: Within 6 weeks, Flynn will demonstrate table manners by keeping his food and utensils on his tray during feeding with supervision and minimal verbal cues.
Baseline: Flynn is able to use his fingers to bring food to his mouth, but has difficulty with fine motor tasks resulting in difficulty with manipulation of utensils during feeding
STG: Within 3 weeks, Flynn will demonstrate grasping of utensils with supervision during feeding activities.
-
References
Colangelo, C. A., & Shea, M. (2010). A biomechanical frame of reference for positioning children for functioning. In P. Kramer & J. Hinojosa (Eds.), Frames of reference for pediatric occupational therapy (3rd ed., pp. 489-567). Philadelphia: Lippincott Williams & Wilkins.
-
-
-
-
Assessment Results
.
COPM measures the perception of performance and satisfaction from 1 being lowest to 10 being highest. Areas where poor performance and poor satisfaction are perceived indicate a potential need for occupational therapy (COPM, 2019)
The Canadian Occupational Performance Measure (COPM) is a criterion referenced assessment which is designed to analyze the client or family's perception of occupational performance over time. The test is quick and easy to administer and can be obtained through child or caregiver report (COPM, 2019)
After completing COPM with Flynn and his parents. The results have indicated a need to improve performance and satisfaction within ADLs and social participation