This particular case study was presented in an ITV session on March 31, 2003. You will have the opportunity to view some of these video segments.
As you work your way through the case study, you will come to know MyaGrace and her family. This is a very supportive family with a variety of resources and supports that are built into their lives and available to them within the community.
The purpose of this case study is to demonstrate the clinical reasoning process that professionals use to decide the best course of action for a child and family. In MyaGrace's situation, the therapist considers several conceptual frameworks for understanding her participation challenges and her family's needs.
There is a 10 minute video segment [link to video segment] to allow you to get to know MyaGrace a little better. If your computer system does not support viewing the video you can still to work through this lesson.
This case study contains several components. As the learner, you may choose any or all of the components to guide your learning.
MyaGrace is a little girl who was born on October 18, 2000.
She was born in Bombay, India. She lived in an orphanage for the first two
years of her life. She was diagnosed with failure to thrive within the first
year of her life. She was also diagnosed with mild cerebral palsy which affects
her right arm and leg. She was hospitalized in India for failure to thrive
and gastrointestinal reflux on 2/6/01. There is little additional knowledge
of MyaGrace’s birth and health history.
In November of 2002 she was adopted by an American family and now lives in rural Kansas. She has twin brothers that are 22 months old. Her mom and dad both work outside of the home. MyaGrace and her brothers attend a wonderful in home daycare 5 days a week for about 7-8 hours a day. Her parents do not know how living in an orphanage affected her early development. There are a combined total of 12 children at the day care of varying ages (birth to 5 years old). Her family is very familiar with early intervention services due to mom’s employment. There is a very strong support system for the family and daycare. MyaGrace is receiving infant toddler special services which include developmental pediatrics, occupational therapy, speech language, physical therapy and special instruction.
Since being adopted she has progressed steadily. She frequently
imitates her brothers doing things like climbing into her booster seat for
meals after watching her brothers do this. MyaGrace like to listen to music,
dance and going to daycare. She is extremely social and loves to interact with
familiar adults and children, being the center of attention.
MyaGrace crawls as her primary means for mobility and is beginning to walk
with one hand supported. MyaGrace is a highly motivated little girl. She perseveres
with challenging tasks and does not easily give up.
MyaGrace is reserved and hesitant to interact with unfamiliar people or people who have different physical characteristics such as light skin or light colored hair. MyaGrace also seems to have some separation anxiety. With the exception of going to daycare, MyaGrace is challenged by transitions. Family outings to the grocery store, Walmart or a restaurant are upsetting to her.
MyaGrace’s family and team are concerned about her self-feeding, playing with toys appropriately, throwing toys and food and the use of her right arm and hands. There is a concern about MyaGrace using a ‘w’ sitting position. And they would like information regarding how MyaGrace’s sensory processing patterns may be affecting these concerns.
MyaGrace currently feeds herself using her hands and a primitive, gross, grasp. She often throws food. Plates and bowls appear to be a distraction to her and she seems to do better eating directly from a flat surface such as a table. When feeding herself, MyaGrace is not observed to chew her food. Rather she swallows most things whole. Parent’s and daycare do a great job of giving her small bites of food so that she does not choke. MyaGrace prefers to drink from an open cup but is not yet skilled at doing so. She often spills liquids down the sides of her mouth from a cup when trying to drink and also spills the cup when picking it up and attempting to put it down.
During play, MyaGrace is very active. She likes to move about as long as a familiar adult is in close proximity. Her family is frustrated by her constantly throwing objects. MyaGrace will also use her mouth to access things sometimes rather than her hands or fingers. She prefers to ‘w’ sit and is unstable in a standing position.
MyaGrace has a delayed ability to interact with other children and play with toys. Her hand use is underdeveloped in that she does not yet transfer objects, play with things at midline or use individual finger to activate toys. Additionally, while playing, MyaGrace works hard to maintain her balance in sitting.
Additional information, MyaGrace seems to require little sleep for a child her age (8-10 hours). She does not have any verbal language skills and vocalizes using a single specific guttural vocalization.
MyaGrace’s family is concerned about feeding, playing, fine motor skills, and overall developmental delays. They would like for her to be able to drink from a sippy cup and feed herself independently. They would like her to develop appropriate play skills and social behavior. The would like for MyaGrace to use her right hand, arm and leg more and be able to walk independently. The family would like MyaGrace to be able to communicate using gestures, words or signs to express her needs and wants. They are concerned with her sleeping and throwing objects and food.