1. www.cddft.nhs.uk Referral History Tom is a 10 year old boy with Cerebral Palsy. He has spastic quadriplegia, which affects the control of movement throughout his body. His legs are much more severely affected than his arms and hands and he uses a wheelchair to move around outside of the house. Tom’s speech is also affected and he uses an Augmentative Communication Device (Dynavox). Tom has had ongoing contact with the Occupational Therapy Team throughout his life, since his original referral at the age of 3 years. Tom has been maintained within the mainstream school setting and is due to transition to secondary school in September. The occupational therapist has been asked to review his needs as part of the transition process. Assessment Process The first part of the assessment process was conducted at home to allow the therapist, child and parents to discuss their views on the key issues highlighted in the referral. This approach also provides an opportunity to assess Tom’s functional abilities in his home environment as part of a holistic assessment approach. A school visit then allowed the therapist to meet with the teaching staff and observe Tom working within the school environment. Discussions highlighted concerns that the school are having currently as well as plans for the forthcoming move to secondary school. A visit to the secondary school was also arranged – to assess the actual environments in which Tom would be working. A number of key issues were highlighted during the assessment phase, forming the basis of planned intervention: Child and family Mobility Issues Seating & Positioning Equipment for independence Communication Skills Health & Safety Special Educational Needs Multi-agency collaboration Care Pathway for a child with a physical disability – Tom’s Story Children’s Occupational Therapy Service Multi-Agency Approach The multi-disciplinary team has been extremely active with this young man and his family and close information sharing has been vital. The family have had many personal challenges, resulting in a lot of difficulty managing Tom’s needs. The multi-agency “Safeguarding process” was initiated and this has brought services together and helped the family to develop their ability to look after their son more successfully. Measuring Outcomes Tom’s occupational therapist identified SMART objectives to guide her therapy plan. These objectives were based on areas of everyday function such as “being able to sit in a supported manner to take part in school lessons” These objectives were reviewed after an agreed period of time to measure their success – fully achieved / partially achieved / not achieved Discharge Process Like most children with complex physical disabilities, Tom’s functional needs are constantly changing and new issues will continue to present. For this reason he is likely to be on the occupational therapists caseload as a longer term client. It is likely that this will continue until his growth and development has reached a plateau. Once Tom’s main needs are addressed, he will be discharged from the active caseload with ongoing advice to home and school on maintenance of his skills. Specialist equipment will continue to be checked every 6 months – giving an opportunity for the occupational therapist to review his situation and take any action that is required. Although Tom will be able to access Health services until he is 19 years old, he will be transferred to adult social services for any ongoing adaptation and specialist equipment needs at the age of 18. Intervention Physical Needs Tom’s physical skills are affected by increased tone (spasticity) and weakness. The occupational therapy intervention aims to improve function by reducing the impact of physical deformity and promoting normal development of skills. This required: Improved seating position to reduce postural deformity and encourage independent hand function. This comprised assessment and recommendation of specialist seating for school. Consideration of night time positioning to promote symmetry and reduce deformity Assessment for Dynamic Lycra Splinting to reduce spasticity and promote normal patterns of movement Cognitive and Learning Needs Tom’s cerebral palsy also impacts upon his level of understanding and ability to learn as quickly as other children. The OT was able to assess Tom’s visual-perceptual function and advise on how this might impact upon his learning needs. This advice, and associated strategies to help support Tom’s skills are now incorporated into his IEP (Individual Education Plan). Equipment for Independence Tom required additional equipment to help support his developing independence. As well as specialist seating and night time positioning Tom’s home was assessed and further adaptations to the home were advised. The OT worked with the local housing team to provide ramped access to the property and adapted showering facilities. A ceiling track hoist was also provided in Tom’s bedroom to reduce manual handling risks. Small items of equipment were also provided – adapted cutlery and scissors enabled Tom to be much more independent and less reliant on his family for assistance. Health & Safety The key issues were of particular consideration in school setting. This included the reduction of manual handling risks to support staff, and advice on how Tom could fully participate in practical aspects of the school curriculum. Together with LEA staff, the OT identified ways of enabling Tom to take part in practical activities such as Design Technology etc. Mobility Issues The OT collaborated with the local wheelchair therapists on provision of suitable mobility equipment so that Tom could get around the school more independently – resulting in the provision of an electric wheelchair. The OT linked closely with the LEA Access and Inclusion Service to plan how Tom could move around the school building especially for his transition to comprehensive school – giving input on relocating classrooms, adapting his timetable, etc Communication Skills The Occupational Therapist works closely with the Speech and Language Therapist in assessing and reviewing Tom’s use of his communication aid in order to promote his independence. The Occupational Therapist can give particular advice on positioning and hand function as part of the multi-disciplinary team. 429 children 228 children 114 children 192 children Current active occupational therapy caseload - by diagnostic group – December 2011 (SystemOne)