Barrett is a 2.5-year-old diagnosed with spastic quadriplegia with dystonia, as well as Cortical Visual Impairment. During caregiver interview, it was reported from the mother that Barrett was born via C-section and it was discovered that the umbilical cord was knotted in utero, causing a reduction in blood flow and fluid exchange. Around 1.5 he was given medication to help manage his pain and assist with his sleep routine. Around 2 years of age doctors suggested gabapentin to help with the tone in his upper extremities as well as help with his sleep. Most recently at 2.5 years old, Barrett, received Botox injections to his hip adductors and flexors. After using the assessment, Medical and Feeding History Questionnaire, it was determined that Barrett eats better with foods that have the consistency of puree, soft food, and nectar thick liquids (Marcus & Breton, 2013). Barrett has difficulty maintaining and upright position without external support, he required seating with lateral supports and neck pillow to maintain seated positioning. It was observed that he has difficulty scooping food and bringing a loaded spoon to mouth. Mother reported he requires hand-over-hand (HOH) assistance to complete feeding ADL tasks.
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MODELS/FOR
Biomechanical FOR
This FOR is to facilitate positioning of the children to help promote function when they are not able to maintain posture themselves (Colangelo & Shea, 2020). Placing Barrett in a proper and functional position will allow him the ability to engage in his environment and increase in his ability to self-feed.
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GRADING UP & DOWN
Sippy cup
o Grade up
Sippy cup with handles to give Barrett the ability to grasp and release the cup of his own volition.
o Grade down
Skinnier sippy cup with straps to keep Barrett’s hand in contact with the cup. This will decrease Barrett’s impaired skill of intentional release.
Self-feeding
o Grade up
Barrett will eat with a built-up spoon directly in front of his mouth. This is slightly more challenging orientation to achieve with his hypertonic upper extremities.
o Grade down
Barrett will eat with an angled built up spoon in with a lateral orientation to the mouth. This orientation will provide an easier access to his mouth while being less strenuous.
Built up spoon to scoop
o Grade up
Barrett uses a built-up spoon to scoop his food. This assistive device gives Barrett a bigger surface area to grip and the ability to release the spoon when he wishes.
o Grade down
Barrett uses a built-up spoon with a strap to scoop his food. This assistive device allows the spoon to stay attached to his hand with a bigger surface area as well.
Independent sitting
o Grade up- utilize bouncy ball
If Barrett has gained some control of his postural muscles, utilize the bouncy ball to engage more postural muscles with slightly less support from the therapist.
o Grade down- seated against therapist
Barrett is unable to engage his postural muscles and maintain an upright posture. With his back against the therapist’s chest, Barrett will be engaging these muscles in a safe and controlled manner with the therapist trying to facilitate the muscle contractions by moving yourself side to side.
GOALS
STG BASELINE: Barrett can drink from a cup with a straw but is challenged to maintain and drink from a sippy cup.
Within 6 weeks, Barrett will drink from a strapped sippy cup, with less than 3 instances of dropping the cup, during 3 or 4 weekly opportunities, as reported by the parent for increased ability to engage in independent drinking.
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REFERENCES
Colangelo, C.A. & Shea, M. (2020). A biomechanical frame of reference to position children for function. In Kramer, P., Hinojosa, J., & Howe, T (Eds). Frames of Reference for Pediatric Occupational Therapy (pp 247-318). Philadelphia, PA: Wolters Kluwer
Marcus, S. & Breton, S. (2013). Clinical feeding assessment. In Infant and Child Feeding and Swallowing, (pp, 21-37). Bethesda, MD: AOTA Press
Morris, S.E., & Klein, M.D. (2000). Specifics of oral motor treatment. In Pre-feeding Skills, (2nd ed.) (pp, 402-410). San Diego, CA: Therapy Skill Builders
Morris, S.E., & Klein, M.D. (2000). Specifics of oral motor treatment. In Pre-feeding Skills, (2nd ed.) (pp, 460-494). San Diego, CA: Therapy Skill Builders
Piersol, C.V. (2014). Occupation as therapy: selection, gradation, analysis, and adaptation. In Radomski, M.V. & Latham, C.A.T. (Eds). Occupational Therapy for Physical Dysfunction (pp 360-393). Philadelphia, PA: Wolters Kluwer