Description
Complete Case synopsis on Isabel with a traumatic brain injury I Provided samples of what the case synopsis should look like
Jacob Case Synopsis
Author(s): Milly, Kenny, Stepha, Paul and Lily
Group Assignment
Readings for Jacob’s Case
Lane & Bundy Chap 26-Autism Spectrum Disorders pp.483-501.
Lane & Bundy Chap 3-Play pp.28-41
Clark & Chandler Chap 40 Best Practices in Communication & Social Skills to Enhance Social Participation. Pp.459-468.
The Puzzle of Autism located at: http://www.nea.org/assets/docs/autismpuzzle.pdf Link on Engage
Recommended Reading: Case-Smith, J. &Arbesman, M. (2008). Evidence-based review of interventions for autism used in or of relevance to occupational therapy. American Journal of Occupational Therapy, 62, 416-429.Link on Engage
Identify if addressed in readings or case discussions
Questions with bulleted answers
(Kuhaneck & Walting, 2019) Clark and Chandler Ch. 29 pg. 235
What are the implications of autism spectrum disorders? The DSM-V states the key factors that a Psychiatrist uses to diagnosis include the following criteria: difficulties with social communication and behavior, lack of interest in things, repetitive movements or behaviors, need for routine or sameness, and sensory processing reactions (hyperactive/ hypoactive) that are not typical. These affect occupational performance in all areas of occupation. When these aspects of the diagnosis impact the daily activities and routines of the child and the entire family.
(Kuhaneck & Walting, 2019) Clark and Chandler Ch. 29 pg. 235
How does a diagnosis of autism impact occupational performance? It can significantly affect verbal and non verbal communication, social interactions, educational performance associated with repetitive activities, stereotype movements, resistance to environmental change and or change in daily activities and routines. Unusual responses to sensory to sensory experience can also impact behaviors or resistance to participate that affect occupational performance.
(Kuhaneck & Walting, 2019) Clark and Chandler Ch. 29 pg. 237
How does a diagnosis of autism impact a family? Having a child or sibling with autism can impact the routines and habits of the entire family. As occupational therapy practitioners, we consider the family the experts. This drives the evaluation, the assessments, the goals, interventions, modifications, adaptations and environment. Occupational therapy will help the family receive education/ training, establish tools to assist and prevent behaviors, create visual aids to help stay on task, develop a sensory diet to calm or stimulate their loved one at home. The family should not have the diagnosis interfere with desired or necessary activities that they participate in regularly. Therefore, they are referred to occupational therapy for skilled services to help all areas or deficits impacted by the diagnosis of Autism Spectrum Disorder (ASD). Providing the parents with a strength based approach can be used to enhance these areas of performance can benefit from the therapist knowing the child’s strengths and special interests. The family will also be able to implement the new strategies at home which promote even greater success in completing the goals.
Identify if addressed in readings or case discussions
Questions with bulleted answers What are some of the developmental & occupational performance expectations for a Jacob in relation to OT (see areas of occupation below)
Case Discussions
4 year old (developmental & occupational performance)? The child should speak fluently in complex sentences with an expanded vocabulary. The child is expected to concentrate for longer durations and interact with the environment by virtue of playing with toys. Stable running with ability to dodge other objects. Ability to color within a lineNaps regularly
Case Discussions
5 year old (developmental & occupational performance)? Can follow three step commandsBegins taking turns and negotiating Has well developed language and comprehension to tell a short story. Independent in most ADLS like hygiene, toileting and dressing.
Case Discussions
Developmental expectations of a kindergartener in the classroom environment? Easily picks and holds objects such as pens, crayons and play objects.The kindergartener is able to follow sequences.The child may also identify colors, shapes and count.Engages in imaginative play Nap time routineSelf regulates behavior and some emotionsIndependent in toileting
Areas of Occupation / Co-occupation addressed by the OTPF-3 Table 1 (p. S19-21) ADL: bathing / showering, toileting and toilet hygiene, dressing, swallowing/eating, feeding, functional mobility, personal device care, personal hygiene & grooming, sexual activity. IADL: care of others, care of pets, child rearing, communication management, driving and community mobility, financial management, health management & maintenance, home establishment & management, meal preparation & cleanup, religious and spiritual activities and expression, safety and emergency maintenance, shopping. Rest & Sleep: rest, sleep preparation, sleep participation Education: formal educational participation, informal personal educational needs or interests exploration, informal personal education participation. Work: employment interests & pursuits, employment seeking & acquisition, job performance, retirement preparation & adjustment, volunteer exploration, volunteer participation. Play: play exploration, play participation. Leisure: leisure exploration, leisure participation. Social participation: community, family, peer / friend.Strengths / challenges presented by Jacob and those presented by his family or caregiver:
Domain
Key Supports
Key Hindrance
List or Indicate N/A
List or Indicate N/A
Client Factors – Table 2 OTPF-3 (p. S 22-24) Values / beliefs / spirituality Body functions: mental (specific / global); sensory; neuromuscular & movement-related; muscle functions; movement functions; cardio / hemato / immuno / respir; voice / speech; digest / metab / endocr; genito / repro; skin & related structure functions; body structures
-Early diagnosis at 2.5 years coupled with early interventions. -Strong support system from the mother, school authorities and online support groups.
-Limited preferences to food, clothing or play activities -Desertion by the father compromises the social support system. -The worrying nature of Jacob’s brother’s development also compromises the available support.
Performance Skills Table 3 OTPF-3 (p. S 25-26) Motor Skills; process skills; social interaction skills
-Strong visual learner -Mother keeps regular contact with the school for carry over of performance skills at home setting.
-Challenged in auditory learning -Decreased safety skills
Performance patterns Tables 4 OTPF-3 (p. S 27) Person: Habits, routines, rituals, roles. Group or population : routines, rituals, roles
– Attends a preschool program with special attention to activities for children with autism. Therefore, he may learn how to perform certain activities.
-Lack of play development -Sleep is irregular: struggles to fall asleep and to wake up when it is time to wake *Significant difficulties transitioning from one activity to another -Limited preference for food, clothing and play activities. -Avoids activities due to unpleasant sensory stimuli
Context & Environment Table 5 OTPF-3 (p. S 28) Contexts: cultural, personal, temporal, virtual; Environments: physical and social
– The support accorded by Jacob’s nearby community helps to fight discrimination and allow the development of certain skills. -Mother is involved with local and online support groups -Mother is very research driven and always looking for the best options for Jacob. She volunteers for clinical trials and is interested in evidence that supports alternative interventions. -Mother seeking inclusive educational opportunities
-Wanderism and escapism when he becomes frustrated -Communication skills -Socialization -Safety skills
Activity & Occupational Demands Table 7 OTPF-3 (p.S 32) Relevance and importance to client, objects use and their properties, space / social demands, sequence / timing, required actions / performance skills / required body functions / required body structures;
-Interacts with younger brother which leaves opportunity for a good play partner in his natural environment. -Mother is seeking a comprehensive communication program for Jacob to apply in all settings. -Mother is seeking various educational approaches.
-Brother could possibly demonstrate autistic characteristics like his brother which would impact activity and occupational demands as to what is socially acceptable. -Required functions impaired by sensory processing abilities for executive functioning, performance skills. -Decreased ability to interpret relevance or importance to the client
Evaluation Methods:
Identify source of information
Assessment Tool:
Purpose:
Characteristics:
Reading (Mulligan, chap.7: Occupational therapy evaluation for specialized areas of practice – p. 276)
Childhood Autism Rating (CARS-2) Second Edition
Communication, social and play Behavior Used for assessing the presence and severity of symptoms of autism spectrum disorders. Can be used to assess Jacob’s Communication, social and play Behavior
Behavior rating scale Age Range: 2 years and upAdministration: 5–10 minutes (after the information needed to make the ratings has been collected)Two 15-item rating scales (each designed for a different population); and an unscored Parent/Caregiver QuestionnaireQualification: Level C required.-MA (psychologist, SLP, OT); BA (License occupational therapist)COST: not free/ $299
Reading (Mulligan, chap.7: Occupational therapy evaluation for specialized areas of practice – p. 276) Sralab.org Txautism.net
Vineland Adaptive Behavioral Scales, Second Edition (Vineland-2) 9
Developmental evaluation; motor, cognitive, language and communication, self-help and community living, social-emotional, adaptive Behavior Domains assessed include communication, daily living, motor skills, and socialization. The socialization domain is targeted at measuring impairments associated with autism.
Parent questionnaire Age Range: 3–22 Teacher Rating Form (TRF) Birth–90 Parent/ Caregiver Form, Survey Interview Form, and Expanded Interview FormFour forms: Teacher Rating Form, Parent/Caregiver Rating Form, Survey Interview Form, and Expanded Interview Form.Contains 4 domains, 10 subdomains, and Maladaptive Behavior scales.Administration: 20–60 min. Survey Interview and Parent/Care- giver FormCOST: NOT FREE/ Range from $100-399Standardized
Reading (Mulligan, chap.7: Occupational therapy evaluation for specialized areas of practice – p. 276)
Sensory Integration and Praxis Test
Assess visual space and form perception, tactile, vestibular and proprioceptive processing, sensory motor coordination- based on Jacob’s information on the use to focus intervention – “ on his communication, socialization, mobility, play, and safety skills”. The Sensory Integration and Praxis Tests (SIPT) help us to understand why some children have difficulty learning or behaving as we expected.
Performance -based Age Range: 4 years to 8 years, 11 monthsAdministration: 10 minutes per test; 2 hours for the entire batteryStandardizedQualification: Level C required.COST: not free/KITS & MANUALS: $1,360.00
Reading (Case Smith & O’Brien, Chap. 12: Assessment and Treatment of Activities of Daily Living, Sleep, Rest, and Sexuality)- Pg. 962 Reading (Mulligan, chap.7: Occupational therapy evaluation for specialized areas of practice – p. 276) CBDPedcat.comcerebralpalsy.org
Pediatric Evaluation of Disability Inventory— Computer Adaptive Test (PEDI-CAT)
Assess self care, mobility and social functions within three areas: Functional skills, Caregiver assistance and modification scales. Measures capability and performance of functional activities in Daily Activities, Mobility, Social/Cognitive, and Responsibility dimensions of participation. The purpose of the PEDI-CAT is to determine a person’s ability to perform day-to-day tasks like dressing, brushing teeth, doing up buttons, walking and socialising. It can identify if someone has functional delays and then monitor their improvements during treatment.
Caregiver questionnaire, and observation Scale: Age range: used for newborns to 21-year-olds with a wide-range of developmental disabilities. The PEDI-CAT are questionnaires used to obtain information about a person from their parent or caregiver in the following domains: Daily Activities Mobility Social/CognitiveResponsibility With the PEDI-CAT, there are two different options; the Speedy CAT which has fewer items and takes approximately 10 to 15 minutes, or the Content-balanced CAT which has more items and takes roughly 20 to 30 minutes. StandardizedCost: 89.99-499.00 (https://www.pedicat.com/portfolio/)
Pearsonassessments. com
Sensory Profile 2
Determines how well children process sensory information in everyday situations. Looks at sensory processing, modulation, and behavioral and emotional responses Evaluate a child’s sensory processing patterns in the context of home, school, and community-based activities Eight main areas of sensory input are examined, including auditory, visual, activity level, taste/smell, body position, movement, touch and emotional/social.
There are five versions: ( Age Range: Birth – 14:11) Infant version: Birth to 6 monthsToddler version: 7 months to 36 monthsThe Short, the Child, and the School Companion versions: 3 years to 14 years, 11 months (To be use for Jacob) Administration Options: Paper-and-pencil or online through Q-global Completed by: Caregiver and/or teacher Scoring Options: Manual Scoring or Q-globalCost: not free/ range $230-400Standardized
(Mulligan, chap. 4: Standardized assessment tools) p. 192
Pediatric Volitional Questionnaire (PVQ)
An evaluation of a child’s motivation to engage in play based activities.
Age range: 2-12 years oldAdministration: 30 minutes Observation used to evaluate child’s motivation to playMotivational strengths and weaknessesEnvironmental supports and hindrancesLevel of volition is measured by spontaneity in observed behaviorsS- SpontaneousI- Involved H- HesitantP- Passive
(Mulligan, chap. 4: Standardized assessment tools) p. 188
Miller Function and Participation Scales
Norm referenced; measures fine motor, gross motor, and visual motor skills in the context of function within plat and school related tasks. Strong psychometrics
Age range: 2-7 years of ageAdministration: 75 minutes 60 minutes for workbook activities15 minutes for observation checklistKnowledge if motor development and sensory processing required for administrationScaled scoring of raw scores determine if services are neededPerformance scalesParticipation checklistsThe higher the score the lower the performance is
INTERVENTION: Considerations
How would you describe the variations between the role of the OT in the following settings:
OT in the integrated preschool setting: The role of an occupational therapist in an integrated preschool setting involves “primarily consultation, environmental modification, and facilitation of peer interaction” (Case-Smith and Arbesman, 2008). The occupational therapist will be working with the preschool teacher to assist in self-regulation and social function development.
In a preschool setting: (Clark and Hollenbeck, 2019)
Teacher is responsible for – the delivery of curriculum Occupational therapist is responsible for – identifying, providing, and modifying strategies and accommodations to facilitate success with student handwriting.
OT in the school settingThe occupational therapist’s role in the school setting- consists of enhancing the student’s participation in academics.
IDEA: “requires services to be individualized and selected on the basis of students’ education needs with consideration of hotel east restricted environment” (Clark and Hollenbeck).
Research supports: the social participation aspect in a school setting is vital for overall social participation skill development. An occupational therapist should only take the child out of their natural environment, in this case the classroom, if the child is regressing due to the overstimulation with noise or the child need needs a specific environment that is listed in their IEP.
OT in the clinic setting:
The role of the occupational therapist in a clinical setting may vary from clinic to clinic. They will have these components:
The occupational therapist will work with the client/patient to understand/ determine their valued occupations and activities of daily living (ADL).
Once these activity preferences are determined, the occupational therapist will introduce those activities into therapy and the patient will try to perform those activities but in different ways.
The occupational therapist could offer cueing for the patient or modification in order for the patient to complete the task independently.
Implications of each setting for caretaker/family?
Inclusion: Jacob’s mother is highly intelligent and well versed in all therapeutic interventions and settings that Jacob might be in. However, at one point she might have been nervous that Jacob was going to be placed in an integrated preschool. Typically, parents may worry that their child is in a setting where there are children who do not have a disability because of bullying and ostracizing the child that is different than anyone else in the classroom. Jacob’s mother recently learned that an occupational therapist was going to be present in the classroom and the OT would be aiding and teaching Jacob how to complete tasks just like his peers. His mother could have been having mixed emotions that Jacob was going to be left behind and that he would not be able to create friendships. In an integrated preschool setting, all the team members: speech, OT, and PT, and Jacob’s mother will work together to develop goals and objectives that will improve Jacob’s life. The OT and other interdisciplinary team members will give information and protocols at home for Jacob and his mother to implement. This can be stressful for her to carry over with the various disciplines / recommendations that Jacob is receiving.
Time/ scheduling constraints: Jacobs interdisciplinary team addresses transitioning from an IFSP to establishing an IEP. The mother might have heightened anxiety due to schedule demands of observations and evaluations from different professions is needed to determine qualification of services. If Jacob was deemed to not need services but is delayed in motor planning, cognition, language, etc, Jacob’s mother would need to figure out a strategy to get her child services. If Jacob’s IEP determined that he needs to come out of the classroom to receive services, his mother would need to determine how to improve his social skills, communication and play skills in his natural environment. Which will help Jacob avoid falling behind since he is not going to be getting as much social participation during the school day.
Financial: If Jacob is receiving services in a clinical setting, Jacob’s mother would need to be able to provide insurance and copay, if her insurance required, for every visit. This could have added a financial strain to the family and Jacob’s mother could have also developed anxiety just thinking how she would pay for treatment. Jacob would not be getting the same social participation that he would be getting in the classroom setting and he could potentially not be expanding his social skills at a specific clinic that he was going to for therapy.
Implications each setting has for practice? (i.e. reimbursement, focus, team interaction etc):
Integrated preschool setting: The school district will pay for services and should have equipment necessary to aid children with a disability and for children that do not. Jacob, in this case, would have plenty of opportunity for social interaction with peers. The only circumstance that Jacob would not have an opportunity for social interaction is if his IEP stated that he needed to come out of the classroom for therapy sessions. Jacob’s mother would need to pay for services while he is in this setting. A family centered component of an integrated classroom is that during an IEP, Jacob’s mother would be able to meet Jacob’s teacher and the other team members. She can ask them questions and look for guidance to see how therapy is going in the various disciplines that Jacob is receiving therapy from.
School setting:As long as Jacob has an established IEP the state/school will pay for services done within this setting. Services free of charge include screening, evaluations, assessments, qualification of services, creation of goals, objectives and intervention planning as well as annual IEP meetings. The school setting in which Jacob is attending should have equipment and all team members on staff for him to receive the necessary services. Social participation may become a child if Jacob is deemed that he needs to leave the school setting and go to a therapy gym or the therapist’s office to conduct therapy. He will be away from friends and not have the same social participation as the other children in the class. Another implication may be that Jacob is the only child in the class that has an IEP as well as a disability. He might be labeled by others in the class that he is different and he could be ostracized from his peers. This would impact emotional and social status.
Clinical setting: Relies on payment from insurance and out of pocket. Cost and reimbursement is dependent on the family’s insurance. Jacob’s mother may need to pay a copay and physical bill if her deductible has not been met. She will have to figure out a way to get Jacob to and from home, clinic and the school setting. Social participation may be limited depending on if the clinic will have singular patient sessions or if it will be a group session.
Which theories or frames of reference would you use to guide your intervention?
Top- down approach:
Model of Human Occupation (MOHO) will focus on volition, habituation, performance and the way each of those impact the activities and occupations that Jacob participates in on a daily basis. First focusing on Jacob’s areas of performance to develop a model that guides services to improve his success in all areas of occupations (Brown, 2012).
Bottom- up approach:
The Sensory Integration frame of reference to identify Jacob’s sensory modulation issues to specific sensory input such as tactile input (OT Theory, 2018). Improving Jacob’s ability to process sensory information will give Jacob the opportunity to participate in his occupations at preschool such as engage in play. Engaging in play will assist with further developing Jacob’s skills with play, communication, social interaction, ADL, and mobility.
Cognitive Behavioral Therapy (CBT) frame of reference to guide interventions for Jacob and his family. The CBT model would be ideal to use when working with Jacob because this problem solving approach to mal adaptive behaviors and barriers that impact task performance.Using this approach to modify and/or provide adaptations in Jacob’s classroom environment and activities, so that Jacob will have the necessary support to improve in his preschool occupations such as play, communication and social participation.
The Behavioral model can reinforce skills and appropriate behavior through repetition and positive reinforcement. Highlighting the person’s behavior for how they interpret feedback from the environment. OTs can correct maladaptive behaviors through coaching, shaping and teaching ways to replace them with adaptive behaviors.
Interventions: goals or suspected outcomes of treatment and approach
Identify if addressed in readings or case discussions
Goal or outcome
Approach Table 8 OTPF-3 (p. S 33)*
Types Table 6 OTPF-3 (p. S 29-31)/Methods/ Activities
Case-Smith Ch. 30 p. 799
Jacob will improve his communication skills.
Establish communication activities that Jacob can complete at school.
– Jacob will use a pecs book to communicate with other students during circle time – Educate Jacob’s parents on the use of visual supports to promote carryover.
Case-Smith & Arbesman (2008) Clark & Chandler Ch. 51 p. 433
Jacob will improve his play skills.
Establish play routines to promote engagement in play activities.
– Jacob will engage in a lego activity during floortime to increase participation in play activities using pivotal response training. – Educate Jacob’s parents on the importance of establishing routines that promote participation in play using integrated play groups. – Educate on different activities to use at home for carryover using video modeling.
Case-Smith Ch. 30 p. 799 Clark & Chandler Ch. 29 p. 236
Jacob will improve transitioning from one activity to the other.
Modify the classroom environment to support Jacob’s ability to transition at school.
-Through coaching and training, Jacob will use a picture schedule as a visual support to transition between educational activities. -Educate Jacob’s parents on the use of visual support such as picture schedules to support Jacob’s ability to transition while managing behavior.
Case-Smith Ch. 30 p.790-791
Jacob will improve his sleep hygiene.
Establish a bedtime schedule/routine to improve his sleeping hygiene (habits).
– Provide education to Jacob and his mother on mindfulness techniques that can be used before bed-time. – Provide education on the use of a weighted blanket and how it could enhance Jacob’s ability to stay asleep. -Encourage the use of visual schedules that represent the time for sleep.
Clark & Chandler Ch. 47 pp. 397 & 399
Jacob will improve his ability to modulate gustatory input at school and home settings.
Establish and introduce new foods that meet Jacobs sensory system in order to get valuable nutrition throughout the day.
– Educate Jacob’s mother the specific textured foods he is eating currently and determine with the family what other snacks he may be able to handle throughout the day. Using social stories to develop habits and skills needed to eat at the school cafeteria or in community. – Jacob will play with different textures of food such as jelly during feeding to promote tactile and gustatory input (modification to food and task).
Clark & Chandler Ch. 57 pp. 481-486
Jacob will improve his ability to modulate tactile input threshold.
Establish and introduce new tactile stimuli that meet Jacobs sensory system in order to prevent sensory avoidance/ discrimination.
-Through coaching, Jacob will choose objects of different tactile characteristics to stick into slime. He chooses the mermaids, fish, bubbles (foam balls), silicone sea shells, and beads with letters on them. He has to retrieve the beads to spell his name. -He will choose at least three objects of different tactile components in this activity.
Case-Smith Ch. 20 p. 523
Jacob will prevent sensory avoidance by recognizing unpleasant sensory input from clothing.
Jacob will create and establish visual aids to communicate that a stimuli is triggering him to be hypersensitive or to over react.
-Jacob will use training from sensory diet to identify areas of clothing that trigger fight or flight sensory over responsive behaviors. Those triggers for clothing avoidance will be on visual cards so he can share with his class or teachers about stimuli that he does not like. -He can identify where the location and intensity of tactile stimuli are.
Clark & Chandler Ch. 29 p. 239
Jacob will modify his environment to make social or play activities more successful.
Jacob will create opportunities for social and communication activities with peers by using his cards to guide the next activity of play with his peers.
-Education and training for Jacob and his mother on how to apply his sensory diet recommendations to social and peer activities related to play and communication. Ex: Using cards to tell his peer group he wants to play on the swings (peer initiation and prompting for preferences) for their next play activity instead of basketball.
*Table 8 Create/promote, establish/ restore, maintain, modify, prevent.
*Table 6 Occupations and activities, preparatory methods, education and training, advocacy, group interventions.
TRANSITIONS / DISCHARGE / OUTCOMES
Describe best practice in autism interventions.
Best practice in autism interventions involves communicating and collaborating with the child’s multidisciplinary team in order to effectively support the child and child’s family in all aspects (Case-Smith & Arbesman, 2008). In addition to collaborative team work the occupational therapist must be sure to use evidence-based interventions to support the child’s occupational performance and educate team members about occupational therapy interventions.
How would you assist in the transition process as the occupational therapist within the integrated preschool setting or kindergarten program?
I would assist in transition planning by educating and preparing Jacob and his mother about the changes in routines in roles and provide adaptations in the classroom environment to support Jacob’s participation.
What do you think will be the goals / emphasis of OT:During elementary school:
To engage in group cooperative play
Independent in self-care skills such as toileting, dressing and eating
To be able to self-regulate
To work with the teacher for training and to establish modifications or adaptations for each student with an IEP
Strengths basedDuring junior high:
To be able to continue working on fine and gross motor skills.
To work with the parent to establish a home program regimen for fine and gross motor skills
Community participation: access and utilization of public transportation, interacting with volunteers, volunteering, health and wellness promotionDuring high school:
To develop meaningful relationships
Prepare for work
IADL independence
Community integration: organization of personal, social, vocational competencies to successfully live in the community
What would be your anticipated outcomes of your intervention? Use components from Table 9 OTPF-3 listed below
Improvement of occupational performance in education, social participation, play, rest and sleep
Prevention and reduction of over responsiveness to tactile and gustatory input
Improvement of physical, mental, social emotional and overall health and wellness
Overall improvement of quality of life
Improvement in participation in school occupations and activities
Improvement in role competency as a student, son, peer
Improved overall well-being
Occupational Justice will be ensured through various opportunities and supports placed in his classroom and home environment
References:
American Occupational Therapy Association, (2014). Occupational therapy practice
framework: Domain & process, 3rd ed. American Journal of Occupational Therapy, 68, S 1- S 51.
AbilityLab. (2019, April 26). Vineland Adaptive Behavior Scales. Shirley Ryan AbilityLab. https://www.sralab.org/rehabilitation-measures/vineland-adaptive-behavior-scales
Brown, R. Common Theories, Models of Practice, and Frames of Reference Used in
Occupational Therapy.
Case-Smith, J., & Arbesman, M. (2008). Evidence-Based Review of Interventions for
Autism Used in or of Relevance to Occupational Therapy. American Journal of Occupational Therapy, 62(4), 416-429. doi:10.5014/ajot.62.4.416
Cerebral Palsy Alliance. (2017, January). PEDI and the PEDI-CAT.
https://cerebralpalsy.org.au/our-research/about-cerebral-palsy/assessments-and-outcome-measures/pedi-and-the-pedi-cat/
Clark, G., Rioux, J., & Chandler, B. (2019). Best practices for occupational
therapy in schools. Bethesda, MD: AOTA Press/The American Occupational
Therapy Association.
CRE Care. (2020). The Pediatric Evaluation of Disability Inventory (PEDI). https://www.pedicat.com/
Dunn, W. (2020, October 1). Sensory profile 2. Pearson Assessments. https://www.pearsonassessments.com/store/usassessments/en/Store/Professional-Assessments/Motor-Sensory/Sensory-Profile-2/p/100000822.html
Mulligan, S. (2014). Occupational therapy evaluation for children: A pocket guide. Wolters Kluwer/Lippincott Williams & Wilkins Health.
O’Brien, J. C., & Miller-Kuhaneck, H. (2020). Case-Smith’s occupational therapy for children and adolescents. Elsevier.
OT Theory. (2018). Sensory Integration frame of reference.
https://ottheory.com/therapy-model/sensory-integration-frame-reference
Tslat. (2019). Vineland Adaptive Behavior Scales – Second Edition (VinelandTM-II). https://www.txautism.net/evaluations/vineland-adaptive-behavior-scales-second-edition-vinelandtm-ii
Willow Case Synopsis
Alexa LaGrande, Jennifer Moore, Stephanie Ksionda, Omorodion Robinson, Milagros Abreu
Group Assignment
Checklist for the readings:
Readings for Willow’s Case
Decision making in pediatric PT– (Engage)
Lane & Bundy Chap 5 Preschool pp. 460-477.
Lane & Bundy Chap 25 Neuromotor Disorders pp. 460-477.
Myers, C. T., Schneck, C. M., Effgen, S. K., McCormick, K. M., & Shasby, S. B. (2011). Factors associated with therapists’ involvement in children’s transition to preschool. American Journal of Occupational Therapy, 65, 86-94. (Link on Engage)
Jackson, L. L. (2009, Sept. 28). Inclusive early care and education: An opportunity for occupational therapy. OT Practice,14-17. (Link on Engage)
*Alexa and Jen* REFERRAL
Identify source of information
Questions with bulleted answers
What are the implications of spina bifida? Spina bifida occurs in a developing baby and is considered a neural tube defect, which causes the spinal cord to develop improperly or causes failure of the spinal cord to close completely. This damage to the spinal cord can cause physical impairments in areas such as fine/gross motor skills, mobility, and bowel/bladder function. It can also cause intellectual impairments that impact social skills and learning. There are four types of spina bifida, which include the following: myelomeningocele, meningocele, closed neural tube, and occulta. Myelomeningocele is the most severe form of spina bifida, and causes a protrusion consisting of a fluid filled sac that contains some of the spinal cord and its nerves, which have become damaged.
What are some of the precautions / contraindications for spina bifida? Positioning is important, individuals with Spina Bifida may have paralysis and be unable to reposition themselves in order to prevent skin breakdown, pressure ulcers, and postural deformities. Latex allergy is common in individuals with Spina Bifida
How does a diagnosis of spina bifida impact occupational performance? Impaired gross/fine motor skills impact how Willow will participate in her occupations such as play, and basic ADLs including dressing and bathing.Limited independent mobility can lead to delayed socialization skills and limited independence in occupational tasks/activities.
How does a diagnosis of spina bifida impact a family? Family/caregivers of children with Spina may experience higher levels of stress, anxiety and/or depression due to the increased level of care the child will need. Parental stress can impact the child’s and the parents quality of life and can impact the child’s social-emotional development. Spina Bifida comes with many secondary conditions that require medical intervention and can become a financial strain for the family. Family’s of a child with Spina Bifida may feel isolated, and feel that other parents are not able to relate.
*Alexa and Jen* EVALUATION: Occupational Performance Analysis
Identify source of information
Questions with bulleted answers What are some of the developmental & occupational performance expectations for a Willow in relation to OT (see areas of occupation below)
2 ½ year old (developmental & occupational performance)? Typical 2.5 year olds
3 to 4 year old (developmental & occupational performance)?
Developmental expectations of a preschooler in the classroom environment.
Areas of Occupation / Co-occupation addressed by the OTPF-3 Table 1 (p. S19-21) ADL: bathing / showering, toileting and toilet hygiene, dressing, swallowing/eating, feeding, functional mobility, personal device care, personal hygiene & grooming, sexual activity. IADL: care of others, care of pets, child rearing, communication management, driving and community mobility, financial management, health management & maintenance, home establishment & management, meal preparation & cleanup, religious and spiritual activities and expression, safety and emergency maintenance, shopping. Rest & Sleep: rest, sleep preparation, sleep participation Education: formal educational participation, informal personal educational needs or interests exploration, informal personal education participation. Work: employment interests & pursuits, employment seeking & acquisition, job performance, retirement preparation & adjustment, volunteer exploration, volunteer participation. Play: play exploration, play participation. Leisure: leisure exploration, leisure participation. Social participation: community, family, peer / friend.Strengths / challenges presented by Willow:
Strengths
Challenges
Relationship with fatherSupport system
Early intervention since 4 months old
Motor skillsADL skillsFine motor skillsPoor hand skillsPlay skills- lower developmental level than peersIncidence of burns to her buttocks and upper thighSensationEmotional status post- injury
Decreased strength
Strengths / challenges presented by her family or caregiver:
Strengths
Challenges
Family is involved and seeks resources Family has support from interdisciplinary team
Financial Caretaker stress Multiple children on the house house including 1 with special needs
Evaluation Process: What assessment(s) might you choose to use with Willow?
Identify source of information
Assessment Tool:
Purpose:
Characteristics:
Peabody Developmental Motor Scales-2 Examiner’s Manual
Peabody Developmental Motor Scales-2
To assess gross and fine motor skills in children
Standardized Cost: ~$450 Non occupation-based For ages birth to 5 Time: 45-60 minutes for entire assessment
Play in Occupational Therapy for Children. (2nd Ed.)
Knox Preschool Play Scale
To assess the child’s play skills in areas such as space management, material management, pretense-symbolic, and participation. In both indoor and outdoor settings.
Formal observation. Cost: $75 Occupation-based For ages birth to 6 Time: 60 minutes total (30 minutes inside, 30 minutes outside)
DAYC-2 Examiner’s Manual
DAYC-2 (Developmental Assessment of Young Children)
To assess the child in five areas, which include cognition, communication, social-emotional development, physical development, and adaptive behavior.
Standardized Cost: ~$363 From birth to 5 years, 11 months. Time: 1 hour, 40 minutes max. 10-20 minutes for each domain.
Kenny, Millie, Stepha* INTERVENTION: Considerations
How would the health care model for Willow’s case differ across the following systems and how will it impact your role as the OT in each practice setting:
Willow’s healthcare model would differ across the systems and would affect the role of an occupational therapist differently in various stages.
Preschool/ head start (ie, role of OT in preschool would emphasize pre-academic skills including motor skills, cognitive skills, social skills…)
The roles of the occupational therapist at this stage would be affected in that he or she would not only focus on willow but other children which could be a challenge in case of a significant number in the preschool. Pendleton & Schultz (2017) explain the roles of an occupational therapist during the preschool stage such as;
Helping willow to development of coordination between the eyes and hands to ensure that they can be able to copy something from the writing board.
Assist in the development of fine motor skills such as grasping and releasing to enhance good handwriting.
Help the child to acquire progressive social skills by practicing how they manage anger and frustrations
Putting the child through sensual programs and accessing play
They should ensure that the child has positional support and the right seating.
They assist the child in developing upper body strength.
Hospital
The occupational therapist would be affected by various disorders requiring his or her attention; however, he or she would play a major role in willows’ daily activities such as brushing her teeth, bathing and dressing (Pendleton & Schultz 2017). The occupational therapist would also help in ensuring hand and eye coordination and balance to improve movement while also addressing wound care, soft tissue mobilization and sensory stimulation. Education of diagnosis, precautions and what to expect with the progression of that diagnosis. Education will also include training in the therapeutic equipment needed and how to access them and use them. It is important through these stages of care to also educate the caregivers on how to understand and interpret the standardized assessments administered to Willow. (Sheehan, Sharp and Warnken, 2020)
Home Care
The role of the occupational therapist may be affected in that he or she has to pay special attention to the parents because they know more about their child’s abilities. However, the roles of the occupational therapist remain the coordination between the skills of the patient and their desired activities to fit in the home environment (Pendleton & Schultz 2017). Other aspects of homecare involve adapting and modifying the child’s natural environment to make occupational performance more successful.
2. Implications (of setting) for caretaker/family?
Willow will be seen either at home or in school, frequent visits to the family and school by the occupational therapist may be time-consuming bearing in mind that the practitioner may have other arrangements for the day. Due to familiarity with the school and family, sometimes the occupational therapist may stay longer and forget to focus on the objectives which may affect his or her compensation (Taylor 2017). The family has to apply the skills learned throughout the period in their daily lives, and this may have a long time impact on their schedules and conducts
3. Who would you envision being the OT practitioner delivering OT services to Willow and her family? (OT or OTA)
I would envision an occupational therapist supporting the family. Bearing in mind that the condition of willow is severe, having sustained the burns. She needs someone with expertise to ensure maximum monitoring of her situation and positive progress. Using a family centered approach to intervention planning will ensure that the goals are met within the child’s natural environment with the support of her family. The family will implement the education and training while incorporating the therapists recommendations and also using what they learn to adapt and create other opportunities when they are presented at home with Willow.
4. Which theories or frames of reference would you use to guide your intervention? (You can address this at any stage of the case)
Biomechanical– postural and UE function, gross and fine motor
I would use motor programming theory during the pre-school stage to make sure willow adopts suitable action patterns in circumstances of excellent level motor control, to ensure recovery of crucial activities for efficient movement (Ashby et al. 2017). This frame of reference applies to Willow because in order for her to progress in grasp patterns, she needs to strengthen gross and fine motor skills proximal to distal in order to be successful in all motor development. Proximal strength is needed to build the foundation of support for the
Rehabilitative– environment and adaptive equipment
I would also involve a rehabilitative frame of reference to motivate willow to participate in remediation. I would ensure she centers on the remaining capabilities to accomplish the maximum level of her occupational performance (Ashby et al. 2017). An example of the rehabilitative frame of reference would be for supportive positioning. In order to encourage extension, head control and get pressure off of the affected areas, a prone wedge would be ideal to use during exercises for ADLS or fine motor skills. A supine stander is another example that promotes weight bearing in the lower extremities while strengthening the neck flexors while participating in ADLS or play. This frame of reference supports Willow’s occupational performance and increases her chances of being successful in the performance of ADLs, play. Rehabilitative frame of reference also improves social emotional aspects by adapting her environment to make the activity more inclusive for Willow.
5. List some occupational therapy intervention measures for children with burns?
According to Taylor (2017), some of the intervention measures for children with burns include;
Working toward increasing the range of movement in joints during the scar management program
Providing necessary equipment such as a bed or wheelchair
Devising techniques to make it easier to perform tasks such as dressing
Offering advice on pain management
Assisting in ensuring that the victim returns to education or meaningful occupations
According to Sheehan, Sharp and Warnken (2020) p. 822-825
OT interventions are divided into three main categories
Preparatory methods:
Intensive care- positioning, ROM, custom orthosis fabrication, soft tissue mobilization, wound care, medical consultation regarding medication for pain and arousal
Acute care- positioning, ROM, custom orthosis fabrication, soft tissue mobilization, wound care, sensory stimulation, scar massage, pressure therapy, medical consultations for pain, arousal and spacticity.
Inpatient rehabilitation- positioning, ROM, custom orthosis fabrication, soft tissue mobilization, sensory stimulation, scar massage, pressure therapy, medical consultations for pain, arousal and spacticity.
Purposeful activities and occupation- based interventions. Adapting or modifying routines and habits for ADLS, IADLS, scar management and ROM exercises. Examples include:
Promote– sleep/rest, early functional mobility (postural control/trunk control), learning and cognition (orientation to person/place/time, remembering a game or understanding the cause and effect of the game as demonstrated when they play the game).
Facilitate– games, songs being silly to increase opportunities for child to engage in occupational performance.
Training/ demonstration– adaptive equipment for ADLs, strengthening using ADL participation and self care (self feeding, hygiene and mobility).
Education- on positioning, moisturizing the affected area, ROM exercises, ADL management, social emotional aspects, compression garment dressing, wound care, backward chaining for the caregivers, soft tissue management and home programing.
-Making note of education on safety precautions, monitoring vitals, monitoring skin integretity
Intervention: Goals /Approaches/Types (Kenny)
Identify source of information
Goal or outcome
Approach Table 8 OTPF-3 (p. S 33)*
Types Table 6 OTPF-3 (p. S 29-31)/Methods/ Activities
Example: Willow will transfer from chair to multiple surfaces with minimal assistance of one staff member or care-giver.
Example: establish and restore….. Modify….
Example: occupational-based intervention….. using sliding board to transfer from chair to floor for circle time…..
Reading (Clark & Chandler Chap 2, p.13-15) Clark & Chandler Chap 23: Best Practices in Transition Planning for Preschoolers
Willow will improve her fine motor skills
Establish fine motor activities that willow can complete at school and home.
Occupational based intervention: Willow will learn and practice how to write her name using blocks or coins to shape the letter of her name; Willow participant in reading time and she will be encouraged to turn the book pages; Additional activities: Educational coloring with mall crayons that fit her little hands Educate Willow’s father on how to practice activities at home to promote carry-over.
Reading (Clark & Chandler Chap 2, p.13-15) Clark & Chandler Chap 23: Best Practices in Transition Planning for Preschoolers
Willow will improve her gross motor skills
Establish gross motor activities that willow can complete both at school and home.
Occupational based intervention: Willow willpractice using proper body mechanics and techniques when getting in and out of her chair, or her stroller Move like an animal activity: Willow will play how to move like an animal -ex she will move like a snake (wiggle on tummies on the floor) while learning about different animals Alphabet yoga: Willow will engage in alphabet yoga -For ex: A – Airplane (hold still and move arms to the side) Educate Willow’s father on safety precaution and proper use of body mechanics during gross motor activities; Educate Willow’s father on ways they can play with large objects to help with her gross motor skills
Reading (Clark & Chandler Chap 2, p.13-15) Clark & Chandler Chap 23: Best Practices in Transition Planning for Preschoolers
Willow will improve her postural stability
Establish postural activities that Willow can complete both at school and home with her father.
Occupational based intervention: (with appropriate assist) Willow will complete clean-up activities while standing such as washing of hands; cleaning her table after use. Yoga poses; incorporate small weight shift activities (move from side to side in upright sitting position)—for ex: reaching to grab an object Practice proper use of body mechanics when sitting and standing school activities–incorporate and practice the (90-90-90 sitting position rule) Educate Willow’s father on safety precaution and proper use of body mechanics during sitting and standing activities; Educate Willow’s father on ways him can play with her that encourage progression in postural control and development
Reading (Clark & Chandler Chap 2, p.13-15) Clark & Chandler Chap 23: Best Practices in Transition Planning for Preschoolers
Willow will improve her functional mobility
Establish functional mobility activities that Willow can complete both at school and home with her father.
Occupational based intervention: Willow will practice proper body mechanics when walking to the library, or other various areas within the school using her forearm crutches. OT will gradually increase walking distance over time to improve her strength and endurance. Based on Willow’s needs, the OT may consider additional AE such as custom wheelchair; Orthotics (lower extremity and trunk). Educate Willow’s father on safety precautions and proper use of body mechanics during functional mobility walking
Reading (Clark & Chandler Chap 2, p.13-15) Clark & Chandler Chap 23: Best Practices in Transition Planning for Preschoolers
Willow will improve her ability to transfer- stand pivots (she currently transfers with maximum assistance).
Establish transfers- stand pivots activities that Willow can complete both at school and home with her father
;p]Occupational based intervention: Willow will practice proper body mechanics during transfers- stand pivots; and ADLs with forearm crutches (getting clothes to get dressed;); gradually increase duration over time to work on strength and endurance. Educate Willow’s father on safety precautions and proper use of body mechanics during Transfers-stand pivots activities.
Reading (Clark & Chandler Chap 2, p.13-15) Clark & Chandler Chap 23: Best Practices in Transition Planning for Preschoolers
Willow will improve her hand skills: Reach, Grasp; Carry; Voluntary release; In-hand manipulation; Bilateral hand use
Establish hand skills activities that Willow can complete both at school and home with her father
Willow will be encouraged to participate in various activities such as: Place a stack of coins or block within reach in a table: Reach: Willow will reach for the coins or block- using the coin or block she will practice spelling her name using those objects. – this will also work on Grasp (holding the object -ex: pincer grasp); Carry (Pick up the object/ moving and lifting); Voluntary release (picking and dropping of the object); In-hand manipulation (use fingers and thumb to position the object); Bilateral hand use (use of one hand to support and stable the body position while the other hand perform the activity) Practice activities that promote hand skills development through the use of play: Cutting paper with scissors task; Looking for different colored beads in a bowl (to learn colors); Finding letters in noodles and spelling words Educate Willow’s father on hand skills development activities and ways to encourage her progress in hand function.
Reading (Clark & Chandler Chap 2, p.13-15) Clark & Chandler Chap 23: Best Practices in Transition Planning for Preschoolers
Willow will improve her psychosocial status
Establish a coping mechanisms or technique to improve overall well-being both at school and home Promote positive interaction both at home and school
Educate Willow on emotional intelligence and coping technique. Encourage her to always express her emotions by using a letter to identify her feelings whenever she’s upset (M for I am mad); Practice using educational “play” to promote coping mechanisms whenever emotionally upset. Ex: willow will learn to name animals alphabetically (alligator, bear, cow, dog) when she is emotionally upset; Willow will squeeze Something (play dough); Willow will rate her emotions/feelings at the beginning of every class using 1-10 scale (1=mad; 10=happy); Educate Willow’s father on the importance of re-establishing his relationship with his daughter. Encourage him to engage in play activities with Willow at home such as using a play doll to practice ADL’s activities with Willow (this will help practice her dressing and bathing)
Reading (Clark & Chandler Chap 2, p.13-15) Clark & Chandler Chap 23: Best Practices in Transition Planning for Preschoolers
Willow will improve her perform in ADL’s
Establish ADL’s activities that Willow can complete both at school and home with her father Create effective daily routine for ADLs Modify and compensate for lack of grabs or fine motor by using AE at home and school
Practice ADL’s activities at school: Set a play stations with a doll and perform bathing, dressing and feeding Ex: Willow will practice dressing tasks on a baby doll such as bottoming or zipping); Practice using adaptive utensils based on her needs during feeding. Educate Willow’s father on safety precaution during ADL’s (bathing, dressing etc.); Educate Willow’s father on the use of AE that can help promote Willow’s self-care in feeding, bathing and dressing- such as otter bath chair tub; Long-handled bath Kit; adaptive utensils; dressing aids Educate Willow’s father on ways to help in daily activities at their home. Ex: using modeling/simulating technique, Willow and her father will practice feeding after brushing teeth
Key:
*Table 8 topics: Create/promote, establish/ restore, maintain, modify, prevent.
*Table 6 Items: Occupations and activities, preparatory methods, education and training, advocacy, group interventions.
TRANSITIONS/DISCHARGE/OUTCOMES
Describe best practice in the transition from early intervention to preschool.
How would you assist in the transition process as the occupational therapist finishing up in EI process or receiving Willow in the preschool program?
What do you think will be the goals / emphasis of OT for the Willow:
. . . during her preschool years?
. . . during elementary school?
What would be your anticipated outcomes of your intervention Use components from Table 9 OTPF-3 listed below
Occupational performance;
Prevention;
Health and Wellness;
Quality of Life;
Participation;
Role Competence;
Well-being;
Occupational Justice;
(Recommended referrals or follow up), What recommendations would you make to the family of services that are not currently received?
References
Taylor, R. R. (2017). Kielhofner’s research in occupational therapy: Methods of inquiry for enhancing practice. FA Davis.
Pendleton, H. M., & Schultz-Krohn, W. (2017). Pedretti’s Occupational therapy-e-book: Practice skills for physical dysfunction. Elsevier Health Sciences.
Ashby, S., Gray, M., Ryan, S., & James, C. (2017). An exploratory study into the application of psychological theories and therapies in Australian mental health occupational therapy practice: Challenges to occupation‐based practice. Australian Occupational Therapy Journal, 64(1), 24-32.
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