A Case Study on Cerebral Palsy

Reference:

Adapted from a case study developed by students at Program in Occupational Therapy at Washington University in Saint Louis

http://enablemob.wustl.edu/CaseStudies/case_studies.htm

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

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.

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

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

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.

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.

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

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