Sophie is a 6-year-old female first-grade student with CP. Sophie can independently and effectively communicate with peers, teachers, and parents. She responds well to verbal praise when she is successful in the classroom. Sophie's teacher stated that she can follow concise verbal instructions. Per teacher report, Sophie has difficulties with areas of written expression, math calculations, & reading comprehension. She also has difficulties with physical education participation, independence with classroom materials, independence with lunch activities, and travel on the bus.
Strengths
Sophie can independently communicate with peers and teachers in the classroom and on the school bus.
Sophie responds well to verbal praise and encouragement in the classroom that promotes a successful environment for Sophie.
Sophie can follow concise, single verbal instructions promoting effective learning in the classroom.
Interventions
- Implement a collaborative program with caregiver and teacher to facilitate a daily bus routine that involves setting Sophie up on the bus in her lateral supports so that she can participate in social interactions with her peers to and from school daily.
- Sitting posture adaptations/adjustments for seat in the classroom, at the lunch table, and on the bus, specifically lateral trunk supports for Sophie.
- Implement a slant board during math and reading activities in order to promote wrist extension and an efficient pencil grab. In addition, this will allow Sophie to increase her eye-hand coordination and visual perception.
- Implement a built-up utensil to increase self-feeding performance during lunch time. A stay-put suction plate can also be implemented into her lunchtime routine to help with stabilizing her plate since she has decreased ROM in both UE. With less attention focused on the task, Sophie can increase her socialization with peers along with her independence during lunchtime.
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Education-based deficits
Prehension and precision grasping deficits affect Sophie’s ability to manipulate/transfer objects during classroom activities and lunch time (i.e. holding writing utensils, cutting/pasting & holding lunch utensils).
Strength deficits affect Sophie's ability to carry lunch tray in lunchroom, participate in PE, and carry back-pack.
Bilateral coordination deficits affect Sophie’s ability to perform cutting skills, writing skills, opening/closing books, turning pages of books, zipping/unzipping backpack, PE participation, and art participation.
UE ROM deficits affect Sophie’s ability to reach and grasp objects needed to participate in classroom activities.
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Postural deficits secondary to visual perception deficits, for example Sophie flexes trunk forward over desk to view and manipulate education tools during classroom activities.
Postural stability deficits affect Sophie’s ability to maintain upright seated posture on school bus.
PLAAPF
Sophie is unable to turn pages in her book with her right hand but successfully can turn the pages with her left hand when the book is propped on the slanted book stand.
Sophie needs assistance to get onto the bus and requires support but once placed into a supportive seated system Sophie demonstrates increased socialization with peers.
Sophie has difficulties with initiating a tripod grasp needed to hold a writing utensil to participate in written expression activities leading to poor handwriting skills. Sophie can sit at the table amongst her peers with lateral supports which increase her performance in social interactions and daily journal entry.
Sophie demonstrated an inferior pincer grasp while self-feeding during lunch. In addition, Sophie has difficulty utilizing utensils due to her flexor synergy and low postural control. Sophie can open her straw and punch it into her juice box, but she requires assistance when carrying her lunch tray to her table.
Sophie demonstrated poor postural stability and lack of head/neck control when sitting at the table, inhibiting her performance when participating in activities such as math and reading comprehension, lunch, and independence with materials. Sophie can hold herself up long enough to begin her occupations but easily becomes fatigued and disengaged when required to focus on prolonged activities at school.
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Grading up or down
- This activity can be graded up by requiring less assistance from the caregiver or educator and an increase Sophie’s independence with bus travel.
- This activity can be graded up by creating a smaller angle of the slant board. If Sophie is successful in utilizing the slant board during writing for long periods of time, she may want to eventually remove the slant board. By decreasing the angle of the board, the change in the activity will mimic a typical environment for writing.
- This can be graded down by providing adjustments to sitting posture in one setting at a time until Sophie adapts to the changes.
- This activity can be graded down by providing Sophie with physical assistance from school aid during lunchtime