1. A Case Study on Cerebral Palsy

2. Reference:  Adapted from a case study developed by students at Program in Occupational Therapy at Washington University in Saint Louis http://enablemob.wustl.edu/CaseSt udies/case_studies.htm

3.  7 years old  Diagnosis of spastic, quadriplegic cerebral palsy  Drools excessively  Non-verbal, but understands simple conversation  Cognitive functioning at about 4-year-old level  Dad uninvolved, Mom works full time  Lives in group home with visits from Mom  Attends general elementary school in a rural area; has one-on-one aide

4.  Spastic tone in all extremities  Has voluntary and involuntary UE movement  Cannot weight bear or ambulate  S-curve scoliosis  Windswept hips, pelvic obliquity, and pelvic rotation  Severe wrist contractures  Current services: ◦ A physical therapist (PT) travels to his school two days a week to work with him. ◦ No occupational therapy (OT) services ◦ Teacher nor aide are trained in movement therapy. ◦ He is placed in a positioner each day for a set time. ◦ His aide works with him on stretching each day.

5.  Lives in a group home during week ◦ Lights and TV are inaccessible to Josh ◦ No accommodations for toys (blocks)  Visits with Mom during week and outings with Mom on weekends  Mom’s house/car currently inaccessible to chair ◦ Bathroom has narrow doorway ◦ 3 steps to enter house ◦ Mom can’t lift chair into trunk  Unable to feed self at home ◦ Totally dependent on mom and group home workers for feeding ◦ No specialized utensils

6.  Attends general elementary school in district ◦ Strongly dependent on aide and teacher ◦ Many items in classroom out of reach ◦ Tables to low for wheelchair to fit under; sits apart from classmates ◦ Uses same basic materials as other students (pencils, crayons, paper, etc.) ◦ No specialized toys  Unable to feed self at school ◦ Totally dependent on aide/teacher for feeding ◦ No specialized utensils

7.  Current wheelchair: ◦ Sunrise Medical power wheelchair.  Has specially designed joystick to accommodate for Josh’s wrist contractures.  Is 5 years old and has no more available growth. ◦ Backup manual wheelchair.  Has one year of growth left.  Is too heavy for Mom to put in car.  Cannot access Mom’s house due to steps.  Older school grounds inaccessible in wheelchair ◦ Uneven surfaces on playground  Most field trips and outings inaccessible in current chair ◦ Zoo, shopping, etc.

8.  Non-verbal, but understands simple conversation  Areas of communication ◦ To teacher, aide ◦ To parents ◦ To peers  Current accommodations ◦ Keyboard: Josh types slowly with one finger. ◦ Picture Board: Simple communication board with pictures that Josh points to in order to indicate what he wants or needs.

9.  Watching TV  Watching videos about construction or building  “Helping” (watching) other kids at group home and school build with blocks  Learning about animals  Doing art at school  Going to the zoo with friends at group home  Going shopping with Mom

10.  Physical ◦ No structured plan for positioning and movement ◦ Limited access to PT/OT specialists  Environment ◦ Group home ◦ Mom’s house ◦ School classroom/grounds ◦ Toys inaccessible (i.e. blocks)  Mobility ◦ Has almost outgrown power wheelchair ◦ Backup chair is not motorized  Communication ◦ Lack of typing skills ◦ Limited by available pictures on board