case study paeds hukm nadiah
TRANSCRIPT
-
8/6/2019 Case Study Paeds Hukm Nadiah
1/31
SITI NADIAH MD BASRI Page 1
MARA University of Technology
(UiTM)
Diploma in Occupational Therapy
CASE STUDY OCC 376
PAEDIATRIC AREA
NAME: SITI NADIAH BINTI MD BASRI
ID Number: 2007213752
-
8/6/2019 Case Study Paeds Hukm Nadiah
2/31
SITI NADIAH MD BASRI Page 2
1. DEMOGRAPHIC DATA
Name : Adek An
Age : 45 mths / 3 years 9 mths old
Gender : male
Race : Malay
Address : Saujana Impian, Kajang, Selangor.
Sibling : 1st from 3
D.O.B. : 07 November 2006
Diagnosis : Autism Spectrum Disorder with mild ADHD
Refer for : social skills, cognitive function and sensory skills.
2. DEFINITION OF DIAGNOSIS
Autism is one of a group disorders known as autism spectrum disorders (ASDs).
ASDs are developmental disabilities that cause substantial impairments in social
interaction & communication and the presence of unusual behaviors and interest.
Many people with ASDs also have unusual ways of learning, paying attention and
reaction to different sensations.
The thinking and learning abilities of people with ASDs can vary from gifted to
severely challenge.
An ASD begins before the age of 3 and lasts throughout a persons life.
(Centers for Disease Control and Prevention 2007)
-
8/6/2019 Case Study Paeds Hukm Nadiah
3/31
SITI NADIAH MD BASRI Page 3
CHARACTERISTICS OF AUTISM
-
8/6/2019 Case Study Paeds Hukm Nadiah
4/31
SITI NADIAH MD BASRI Page 4
ADHD is Attention-Deficit Hyperactivity Disorder (ADHD or AD/HD or ADD) is a
neurobehavioral developmental disorder. It is primarily characterized by the co-existence
of attention problems and hyperactivity, with each behavior occurring infrequently alone
and symptoms starting before seven years of age.
Subtypes
ADHD has three subtypes:
1. Predominantly hyperactive-impulsive
o Most symptoms (six or more) are in the hyperactivity-impulsivity categories.
o Fewer than six symptoms of inattention are present, although inattention may still
be present to some degree.
2. Predominantly inattentive
o The majority of symptoms (six or more) are in the inattention category and fewer
than six symptoms of hyperactivity-impulsivity are present, although
hyperactivity-impulsivity may still be present to some degree.
o Children with this subtype are less likely to act out or have difficulties getting
along with other children. They may sit quietly, but they are not paying attention
to what they are doing. Therefore, the child may be overlooked, and parents and
teachers may not notice symptoms of ADHD.
3. Combined hyperactive-impulsive and inattentive
o Six or more symptoms of inattention and six or more symptoms of hyperactivity-
impulsivity are present.
o Most children with ADHD have the combined type.
(Wikipedia)
http://en.wiktionary.org/wiki/neurobehavioralhttp://en.wikipedia.org/wiki/Developmental_disorderhttp://en.wikipedia.org/wiki/Hyperactivityhttp://en.wikipedia.org/wiki/ADHD_predominantly_inattentivehttp://en.wikipedia.org/wiki/ADHD_predominantly_inattentivehttp://en.wikipedia.org/wiki/Hyperactivityhttp://en.wikipedia.org/wiki/Developmental_disorderhttp://en.wiktionary.org/wiki/neurobehavioral -
8/6/2019 Case Study Paeds Hukm Nadiah
5/31
SITI NADIAH MD BASRI Page 5
3. FRAME OF REFERENCES
a. Sensory Integration FOR
SI is the process of organizing sensory information in the brain to make
an adaptive response (Ayres,1972)
b. Psychosocial FOR
...with improved sensory processing/ learning strategies to compensate
for deficits, children begin to participate in everyday activities without
difficulty This frame of reference focuses on assessing and helping
children develop play interest, skills, and interpersonal relationship that
are supportive of their mental health (Kramer, P. & Hinojosa, J..)
c. Behavioral FOR
Behavioral theory focuses on reinforcement of childrens performancesthrough specific feedback. (Case-Smith, 2005)
4. HISTORY
SOCIAL HISTORY
o Patient is very close to his father.
o Patient still unable to share with others.
o
Patient able to play with other without talking. MEDICAL HISTORY
o History of present medical illness
Mother noted that patient has patient has problem in sharing things and
social with others.
Patient also has some unusual sensitivity towards sticky things, and soft
toys.
Doctors at the CDC have diagnosed him as Autism Spectrum Disorder
with Mild ADHD and were sent to OT for assessment and intervention
besides to Speech Therapy for speech delayed problem.
-
8/6/2019 Case Study Paeds Hukm Nadiah
6/31
SITI NADIAH MD BASRI Page 6
o Past medical history
Birth history
Patient is Full Term Normal Delivery baby.
The baby has no jaundice or other medical complication.
Motor development
No obvious delayed in gross motor development.
According to mother, client started to walk at 1 year.
Drug history
Client did not take any medication or dietary supplements.
FAMILY HISTORY
-
8/6/2019 Case Study Paeds Hukm Nadiah
7/31
SITI NADIAH MD BASRI Page 7
5. EVALUATION
Subjective Assessment
(interview mother and observe patient on 20th August 2010)
Patient comes piggyback by his father.
Patient is very active and explores everything when he enters the sensory
integration room. Patient avoids stepping on the stairs in the SI room.
Patient is playful during doing activity.
Patient dislikes soft pet and theraputty.
Mother c/o pt dislikes sticky and soft things.
Patient is cries when therapist asks to do activity.
Client Priority
(Interview mother on 20th August 2010)
Mother c/o patient is very active at home and unable to focus to one task for a
long period.
Patient also unable to focus during play.
Mother is very concern in improving the childs attention span towards activity.
OBJECTIVE ASSESSMENT
-
8/6/2019 Case Study Paeds Hukm Nadiah
8/31
SITI NADIAH MD BASRI Page 8
Pediatric Evaluation of Disability Inventory (PEDI) (assessed on 20th August)
Results:
Composite Scores
Domain Raw
Score
Normative
StandardScore
Standard
Error
Scaled
Score
Standard
Error
Self Care Functional
Skills
48 24.8 2.8 60.5 1.6
Social
Function
Functional
Skills
18
-
8/6/2019 Case Study Paeds Hukm Nadiah
9/31
SITI NADIAH MD BASRI Page 9
Short Sensory Profile (SSP)(assessed on 20th August 2010)
Results:
Interpretation:
Client need more controlled environment in order to be productive. (ex: quieter place to
work)
Child seeks out movement and constantly on the go to seek for sensation.
Child is afraid of high place.
-
8/6/2019 Case Study Paeds Hukm Nadiah
10/31
SITI NADIAH MD BASRI Page 10
6. PROBLEM IDENTIFICATION
I. Occupational Performance Area
Basic Activities of Daily Living (BADL)
Below are the BADL activities that has been highlighted from PEDI where patient
encountered some difficulties/ further explanation need to be given.
BADL PERFORMANCEGrooming & Personal Hygiene Functional Skills:
Patient unable to thoroughlybrushing teeth.
Patient unable to comb his hairappropriately.
Patient unable to care for nose.Bathing Functional Skills:
Patient unable to wash and dries
body thoroughly.Bladder management Functional Skills:
Patient unable to indicate whenwet in diapers or training pants.
Patient unable to indicate need tourinate (daytime).
Bowel management Functional Skills: Patient able to indicate need to be
changed. Patient unable to indicate need to
use toilet.
Patient unable to distinguishesneed for urination and bowelmovements.
Toileting Functional Skills: Patient able to assists with
clothing management before andafter toileting.
Patient did not try to wipe selfafter toileting.
Dressing Functional Skills: Patient able to put on and
removes front-opening shirt notincluding fasteners.
Patient able to put on pants andremoves pants with elastic waist.
Patient unable to zips, unzips,separates and hooks zipper.
Patient able to put on socks.
-
8/6/2019 Case Study Paeds Hukm Nadiah
11/31
SITI NADIAH MD BASRI Page 11
ii. Play (PEDI Social Function Domain)
Functional Skills:
Patient unable to takes turn in simple play when cued for turn.
Patient unable to uses real or substitute object in simple pretend sequences.
Patient unable to puts together materials to make something.
iii. Leisure (PEDI Social Function Domain)
Functional Skills:
Patient likes to watch television commercials.
iv. Social Participation (PEDI Social Function Domain)
Functional Skills:
Patient does not interact with other children and did not play with other children.
-
8/6/2019 Case Study Paeds Hukm Nadiah
12/31
SITI NADIAH MD BASRI Page 12
II. Occupational Performance Component
a) Motor skills (interview using PEC)
a. Patient able to ride bicycle with small wheels.
b. Notice that patient has difficulties to do catching and throwing ball with
correct skills.
c. Pencil Grasp Pattern: Tripod Static Grasp
d. Client has difficulties with threading activity, buttoning and unbuttoning,
copies horizontal, vertical and circular line.
b) Cognitive Skills (observation, PEC)
a. Patient able to fully attends towards an activity for not more than 5
minutes.b. Patient still doesnt know basic concept.
c) Communication Skills (PEDI, observation)
a. Patient unable to uses gestures with clear meaning.
b. Patient shouts to express need.
c. Patient able to understand simple 1 step-command.
7. PROBLEM LIST
a. Patient seeks out movement and constantly on the go.
b. Patient has tactile sensitivity to sticky things and soft toys.
c. Patient is afraid of high place.
d. Patient has lack of attention and concentration in performing task.
e. Patient has poor eye contact towards people and activity.
f. Patient has difficulties with visual-motor integration activity.
g. Patient has behavior problem in giving cooperation to do activity.
h. Patient displays inappropriate play behavior sometimes and did not
interact with peers.
i. Patient still doesnt know basic concept.
j. Patient still dependent in ADL in buttoning, grooming, bathing and toiletingskills.
-
8/6/2019 Case Study Paeds Hukm Nadiah
13/31
SITI NADIAH MD BASRI Page 13
8. PATIENTS ASSETS
a. Patient has no physical limitation.
b. Patient has good family support.
c. Patients mother apply the home programs given and shown improvement
in certain parts.
9. FORMULATING AIMS
SHORT TERM GOALS
a. To decrease patients actively seeking for sensation and constantly on the
go.
b. To decrease patients sensitivity to sticky things and soft toys.
c. To improve patients sensitivity to high place.
d. To improve patients attention and concentration in performing task.
e. To improve eye contact towards activity and people.
f. To improve patients visual-motor integration activity.
g. To improve patients behavior problem in giving cooperation to do activity.
h. To encourage appropriate peer play and interaction with peers.
i. To improve patients basic concept knowledge.
j. To improve patients level of independency in ADL in term of buttoning,
grooming, bathing and toileting skills.
LONG TERM GOALS
LONG TERM GOAL SHORT TERM GOALTo increase patients independency
level in ADL. To improve patients attention and
concentration in performing task. To improve patients buttoning
/unbuttoning and zipping/unzipping. To increase patients level of
independency in grooming. To increase patients level of
independency in bathing. To increase patients level of
independency in bowel and bladdermanagement.
To increase patients level of
independency in toileting skills.To improve patients social skill andappropriate play.
To improve patients behaviorproblem in giving cooperation to doactivity.
To improve and maximize clients motorskills that is vital for preschoolreadiness.
To improve eye contact towardsactivity and people.
To improve patients attention andconcentration in performing task.
-
8/6/2019 Case Study Paeds Hukm Nadiah
14/31
SITI NADIAH MD BASRI Page 14
10. TREATMENT PLAN AND IMPLEMENTATION
GOALS METHODS OFINTERVENTION
PLANNING IMPLEMENT REVIEW
Todecreasepatientsactivelyseeking forsensationandconstantlyon the go.
Jointcompression
Jumptrampoline
Patient
Todecreasepatientssensitivityto stickythings andsoft toys.
Sensorystimulationtechnique.
Patient able toplay with stickythings duringsecond
appointmentd/t exposure tostickythings/soft toysduring firstsession andhomeprograme.
To improvepatientssensitivityto highplace.
SI activitywith ActiveInvolvement.
Patient stillcontinue SIactivity andhome
programme.
To improvepatientsattentionandconcentration inperformingtask.
Table-topactivity
SI activity
Patient able topay attentionfor 5-10minutes duringtable-topactivity buteasilydistracted withsurrounding.
To improve
eye-contacttowardsactivityandpeople.
Eye-level
activity Imitationactivity
-
8/6/2019 Case Study Paeds Hukm Nadiah
15/31
SITI NADIAH MD BASRI Page 15
To improvepatientsvisual-motorintegrationactivity.
Fine motoractivity
To improvepatientsbehaviorproblem ingivingcooperation todo activity.
Behaviormodification Play activity.
Patient ableto givecooperationduringsecondappointment.
To encourageappropriatepeer play andinteraction
with peers.
Group play Family
education
To improvepatients basicconceptknowledge.
Multisensoryapproach
To improvepatientsbuttoning
/unbuttoningandzipping/unzipp
ing.
SimulationActivity
Hand on hand Visual/gesture
cues Adaptive
method
Patient ableto unbuttonbut slightlydifficult to dobuttoningafter session.
To increasepatients levelofindependencyin grooming.
Positivereinforcement
Visual cues
To increasepatients levelofindependencyin bathing.
Familyeducation
Visual cues Verbal
prompting.
To increasepatients levelofindependencyin toileting skillincludingbowel andbladder mx.
Toilet trainingprogramMother hasstarted thetoilet trainingprogram butseldom.
-
8/6/2019 Case Study Paeds Hukm Nadiah
16/31
SITI NADIAH MD BASRI Page 16
TREATMENT IMPLEMENTATION
PROBLEM 1 Patient seeks out movement andconstantly on the go. (the childseeking for sensation)
TREATMENT 1. Joint compression2. Jumping on trampoline
TERMINAL BEHAVIOUR Patient will become more calm andable to regulate themselves.
METHOD 1. When patient enter the SI room,therapist gives joint compression topatient. Joint compression on ULstart from shoulders joint, elbow,wrist and finger. Next, pushing onthe shoulder, compress on headand depress above lip)
2. Therapist ask patient to jump ontrampoline on the count of 10.
CRITERIA 5-10 minutes every sessionRATIONAL Pushing down on shoulder, joint
compression, jumping trampoline givethe child extra proprioceptive input tohelp calm and regulate them.
PRECAUTION Guard patient every time pt jumptrampoline to avoid accident.
HOME PROGRAMME Taught mother to give physical activitybefore doing table-top activity.
REFERENCE Occupational Therapy for Children,Jane Case Smith
-
8/6/2019 Case Study Paeds Hukm Nadiah
17/31
SITI NADIAH MD BASRI Page 17
PROBLEM 2 Patient has tactile defensive to sticky things and soft toys.
TREATMENT Sensory stimulation technique.
TERMINAL BEHAVIOUR Patient will decrease tactile defensiveness and be able to dodaily living activity.
METHOD 1. Gives patient soft toys and transfer to other place using hand
on hand technique. Use modeling technique by showing the
patient that it is interesting to play with the toy. After patient has
show less tactile defensive, ask patient to transfer the toy by
himself.
2. Gives patient pink theraputty. Gradually ask the patient to
touch and explore the theraputty
CRITERIA 5 minutes each session until patient able to adapt with the
input.
RATIONAL The emphasis on the innerdrive of the child is another key
characteristic of classical sensory integration therapy (Ayres,
1972b, 1979; Clark et al., 1989; Koomar & Bundy, 2002).
PRECAUTION Do not force patient too much to avoid tense.
HOME PROGRAMME Ask mother to expose patient to different texture.
(ex: bean, cotton, silk, play-dough)REFERENCE Occupational Therapy for Children, Jane Case Smith
-
8/6/2019 Case Study Paeds Hukm Nadiah
18/31
SITI NADIAH MD BASRI Page 18
PROBLEM 3 Patient is afraid of high place.
TREATMENT Sensory Integration Activity with active involvement
TERMINAL BEHAVIOUR Patient will be able to perform daily living skills that involve highplace.
METHOD 1. Patient is ask to ride the swing with therapist.2. Patient climb the stair with his father.3. When patient has improve and feel comfortable,
patient are ask to perform alone.4. The high of swing is increasing every time patient fee
secure with the height.
CRITERIA 5-10 minutes every session.
RATIONAL The emphasis on the inner drive of the child is another keycharacteristic of classical sensory integration therapy (Ayres,1972b, 1979; Clark et al., 1989; Koomar & Bundy, 2002).
PRECAUTION Guide patient during activity to avoid accident.
HOME PROGRAMME Parents are asked to bring the patient to the playground and playwith swing and slide.
REFERENCE Occupational Therapy for Children, Jane Case Smith
-
8/6/2019 Case Study Paeds Hukm Nadiah
19/31
SITI NADIAH MD BASRI Page 19
PROBLEM 4 Patient has short attention span.
TREATMENT 1. SI activity
2. Table top activity
TERMINAL BEHAVIOUR Patient able to pay attention to the activity for more than 1
minutes
METHOD 1. Patient is instructed to going through SI circuit for 15
minutes. The SI circuit contain of:
Jumping trampoline
Walk through the bridge
Ride on the swing
Climb the stair Walk on the sensory mat
Walk on the Lunar system
Walk through the tunnel
Pick one soft toy and walk through the stepping bucket an
balance beam and throw the soft toys to the basket at the
end of the balance beam.
After finished throw the toy, patient instructed to go throug
the circuit again until 3 rounds.
2. Gives patient drawing activities that involved small
shape only. After pt able to finish it, increase it.
CRITERIA 5 10 minutes per session
-
8/6/2019 Case Study Paeds Hukm Nadiah
20/31
SITI NADIAH MD BASRI Page 20
RATIONAL Visual attention skills are enhanced by activities that are
developmentally appropriate and visually and tactilely
stimulating. Manual activities such as drawing or
manipulating clay encourage the eyes to view the
movements involved(Rogow,1992). In addition, the hand
helps educate the eye about object qualities such as weigh
volume, and texture, and helps direct the eye to the object
(Rogow,1987).
HOME PROGRAMME 1. Suggest mother to provide special table for patient to stud
2. Apply behavior modification at home.
PRECAUTION Do not force patient to do big task before patient able to
finish small task to avoid patient become frustrated.
REFERENCE Occupational Therapy for Children , Jane Case Smith
-
8/6/2019 Case Study Paeds Hukm Nadiah
21/31
SITI NADIAH MD BASRI Page 21
PROBLEM 5 Patient has poor eye contact
TREATMENT 1. Do eye-level activity
2. Provide imitation activities so that referencing skills are
developed (copying noise, banging, singing)
TERMINAL
BEHAVIOUR
Patient will improve in eye contact and be able to follow
instruction accurately.
METHOD 1. Eye level activity.
Using puzzle.
Therapist call patients name to alert him.
Therapist put the puzzle in front of him.
Therapist ask patient to take it and put in the place.
Therapist take out the piece of puzzle and put at patient
eye-sight to attract him. Therapist guides patient hand to take the puzzle.
2. Imitation activity
Using soft toys.
Therapist call patients name to alert him.
Therapist put the soft toys in front of him.
Therapist ask patient to take it and put in the basket.
Therapist imitates sound when patient doesnt want to
look at the toys.
CRITERIA 5 minutes per session.
RATIONAL Visual attention skills are enhanced by activities that are
developmentally appropriate and visually and tactilely
stimulating. Manual activities such as drawing or manipulating
clay encourage the eyes to view the movements
involved(Rogow,1992).
HOME PROGRAMME 1. Ask mother to do eye-level activity at home.
2. Encourage mother to always call patient before ask patient to d
activity.
PRECAUTION Do not do activity with patient more than 5 minutes if patient
have no attention to avoid patient become more stressful.
REFERENCE Incident, Interpretation, Intervention (Rebecca Kildea)
-
8/6/2019 Case Study Paeds Hukm Nadiah
22/31
SITI NADIAH MD BASRI Page 22
PROBLEM 6 Patient has problem in visual motor integration
activity.
TREATMENT 1. Fine motor activity.
TERMINAL BEHAVIOUR Patient able to do visual-motor integration activity.
METHOD 1. Practitioner gives patient fine motor activity such as puzzl
for patient to do.
2. Practitioner breaks down the task.
3. Provide tactile, visual, or auditory cues to help guide
movements.
4. Provide verbal feedback when the child is struggling with
the task.
CRITERIA 5-10 minutes
RATIONAL the hand helps educate the eye about object qualities
such as weight volume, and texture, and helps direct the
eye to the object (Rogow,1987).
HOME PROGRAMME 1. Suggest mother to give patient beading activity.
2. Teach mother the teaching technique to encourage patien
do the activity.
PRECAUTION Do not do activity with patient more than 5 minutes if patient havno attention to avoid patient become more stressful.
REFERENCE Building blocks for learning Occupatiional therapy Approaches (JJenkinson, Tessa Hyde, Saffia Ahmad)
-
8/6/2019 Case Study Paeds Hukm Nadiah
23/31
SITI NADIAH MD BASRI Page 23
PROBLEM 7 Patient has behavior problem in giving cooperation to
do the activity.
TREATMENT 1. Play activity.
2. Behavior modification. (negative reinforcement)
TERMINAL BEHAVIOUR Patient will be able to give cooperation to the activity.
METHOD 1. Invite patient to play with activity that he likes.
(Unstructured play).
2. Gives patient time to get comfortable with the environmen
3. Ask patient to involve with the SI activity when patient look
comfortable with the place.
4. Tells patient that he will not be able to do his favorite
activity if he did not do the activity given. (during tabletop
activity)
CRITERIA 5 10 minutes
RATIONAL Play is the multidimensional system to adapt to the environmentand that the exploratory drive of curiosity underlies play behavior(Reilly,1974)
REFERENCE Occupational Therapy for Children, (Jane Case Smith)
-
8/6/2019 Case Study Paeds Hukm Nadiah
24/31
SITI NADIAH MD BASRI Page 24
PROBLEM 8 Patient has inappropriate peer play and interaction w
peers.
TREATMENT 1. Group play
2. Family education
TERMINAL BEHAVIOUR Patient will be able to play and interact with peers
appropriately.
METHOD 1. Group Play
Let the patient to have free play with few peers with
the guidance of the therapist.
Cues will be given when inappropriate behavior lik
did not follow turn are displayed.
2. Game play
Patient are given rules to play with peers.3. Family Education
Ask mother to encourage patient to play with his
cousin and brothers.
Teach mother to give cues when patient display
inappropriate behavior.
CRITERIA 10 15 minutes each session
RATIONAL Games with rules teach children to take turns and to
initiate, maintain, and end social interactions. (Johnson,Christie, and Yawkey, 1999)
PRECAUTION Observe patient during play to avoid accident.
REFERENCE Occupational Therapy for Children, Jane Case Smith.
-
8/6/2019 Case Study Paeds Hukm Nadiah
25/31
SITI NADIAH MD BASRI Page 25
PROBLEM 9 Patient has problem in recognize basic concept due t
patient still not recognize colors, numbers and shape
TREATMENT Taught patient shape using multisensory approach and
gradually.
TERMINAL BEHAVIOUR Patient will be able to recognize shape.
METHOD 1. Therapist chooses the first shape patient needs to learn.
2. Therapist tells the patient the name of the shape.
3. Therapist take patients hand and ask patient to touch the
shape.
CRITERIA 5 10 minutes per session
RATIONAL Sensory input is the sensory nourishment for the brain, ju
as food is the nourishment for the body. (Ayres ,1979)
HOME PROGRAMME Educate mother to teach patient one colour first. Mother
start with red colour until patient able to recognize the
colour.
PRECAUTION 1. Use same instruction and method every time therapist wa
to teach pt to avoid patient confuse. (ex: if teach patient
circle as circle, do not change circle as bulat)
2. Teach patient one shape first until patient able to master,
then change to second shape.
REFERENCE Occupational Therapy for Children, (Jane Case Smith)
-
8/6/2019 Case Study Paeds Hukm Nadiah
26/31
SITI NADIAH MD BASRI Page 26
PROBLEM 10 Patient has problem in buttoning /unbuttoning and
zipping/unzipping activity.
TREATMENT 1. Simulation buttoning activity
2. Hand on hand guide
3. Visual/gesture cues
4. Adaptive method on buttoning activity.
TERMINAL BEHAVIOUR Patient will be able to do buttoning/unbuttoning and
zipping/unzipping activity.
METHOD 1. Simulation act.
Gives patient buttoning kit activity.
Demonstrate to patient and ask patient to follow. Gives hand on hand guide during patient doing the
activity.
2. Adaptive method.
Teach patient to button from bottom. (easier to see
and align )
CRITERIA 10 minutes per session
RATIONAL because clothing manufacturers recognize the value o
universal design, many of these adaptation are availablecommercially. (Schwartz,2000)
PRECAUTION Use same method every time want to teach patient.
The practitioner must respect the childs and family
preferences in hair style, cosmetics, and routines.
REFERENCE Occupational Therapy for Children, Jane Case Smith
-
8/6/2019 Case Study Paeds Hukm Nadiah
27/31
SITI NADIAH MD BASRI Page 27
PROBLEM 11 Patient has problem in grooming activity. (brush
teeth)
TREATMENT 1. Adaptative method
2. Hand on hand
TERMINAL
BEHAVIOUR
Patient will be able to do grooming activity independently.
METHOD Tooth brushing actually difficult for child with oral
sensitivity.
The child should use his or her preferred brushing
methods until tolerance improves and he or she can
improve more thorough cleaning.
When the childs gums are tender, the caregiver may
substitute a soft, sponge-tipped toothette for a brush. A hand over hand technique helps a child learn how to
direct the toothbrush in the mouth and to reach all teeth.
CRITERIA 10 minutes per session
RATIONAL Adaptation, therapeutic use of self-purposeful and
meaningful activities, consultation, and education are
methods use to help others learn ADL occupation.
PRECAUTION Make sure the toilet environment is not scary.
REFERENCE Occupational Therapy for Children, Jane Case Smith
-
8/6/2019 Case Study Paeds Hukm Nadiah
28/31
SITI NADIAH MD BASRI Page 28
PROBLEM 12 Patient unable to bath independently.
TREATMENT 1. Family education
2. Visual cues
3. Verbal prompt
TERMINAL
BEHAVIOUR
Patient will be able to do bathing activity with
independently.
METHOD 1. Family Education
Educate mother that patient should be able to bath
with supervised at his age.
2. Visual cues.
Make picture sequences to tell patient on bathing
step.
3. Verbal promptMother supervised patient during bath and gives verbal
prompt during the activity.
CRITERIA 10 minutes per session
RATIONAL Adaptation, therapeutic use of self-purposeful and
meaningful activities, consultation, and education are
methods use to help others learn ADL occupation.
PRECAUTION Do not left patient alone in the bathroom to avoid anyaccident.
REFERENCE Occupational Therapy for Children, Jane Case Smith
-
8/6/2019 Case Study Paeds Hukm Nadiah
29/31
SITI NADIAH MD BASRI Page 29
PROBLEM 13 Patient still not independent in toileting (mx of bowel
and bladder). Patient unable to indicate wet dryper.
TREATMENT Educate mother to do toilet training program
TERMINAL
BEHAVIOUR
Patient will be able to indicate PU and BO and pt able to
manage himself after BO or PU.
METHOD 1. Introduce wet and dry concept to pt.
2. Introduce child with the toilet environment.
3. Simulated play: use doll to demo the act.
4. Establish a routine that becomes habitual and easy for
the child.
5. Make task smaller or larger, depend on the child abilities.6. Use habit training if no pattern is evidence: go at the
same time every day.
7. Have child dress in easy to manipulate clothing.
8. Child does not sit: use timer and instruct child to stay
seated until timer rings.
CRITERIA everyday
RATIONAL Adaptation, therapeutic use of self-purposeful and
meaningful activities, consultation, and education are
methods use to help others learn ADL occupation.
PRECAUTION Make sure the toilet environment is not scary.
REFERENCE Occupational Therapy for Children, Jane Case Smith
-
8/6/2019 Case Study Paeds Hukm Nadiah
30/31
SITI NADIAH MD BASRI Page 30
11. REASSESSMENT (done on 23rd August 2010)
Patient comes with his parent piggyback by his father.
Patient refuses to do activity asked by student initially.
Patient looks interested when student show some demonstration and play with
him. Show better cooperation than first session.
Patient likes to do scribbling in his book.
Patient has shown improvement in tactile sensitivity. He able to play with sticky
things and soft toys. According to mother, patient is given play dough and play
with it every day.
The next appointment was on 27th September 2010. The re-assessment for ADL
and social are scheduled to be done on 6 months after first assessment due to
mother just started the home programs given.
12. FUTURE PLAN
a. To improve patients social problem gradually and prepare patient for
school.
b. To help patient in improving ADL and become totally independent in ADL.
13. PROGNOSIS
Rehabilitation good
a. Patient has improved in behaviour and show interest in doing activity
during treatment session.
b. Patients mother is very compliance to appointment and cooperative in
doing home programme.
-
8/6/2019 Case Study Paeds Hukm Nadiah
31/31
REFERENCES
1. Occupational Therapy for Children (Jane Case Smith).
2. Building Block for Learning: Occupational Therapy Approaches (John Wiley and
Sons).
3. http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder 4. Incident, interpretation, intervention. A practical guide. (Rebecca Kildea)
http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorderhttp://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder