This particular case study was presented in an ITV session in the spring of 2004.
As you work your way through the case study, you will come to know Sam and his family. This is a very supportive family with resources and supports built into their family structure and 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 Sam’s case, the team considers several conceptual frameworks for understanding his participation challenges and his family’s priorities and needs.
This case study contains several components. As the learner, you may choose any or all of the components to guide your learning.
Sam
is a 16 month old boy who lives with his parents and 2 sisters. The family lives
in a small, close knit community, and many extended family and friends are available
to support Sam’s family. Sam and his family are also receiving Early Intervention
services, which provide additional professional supports (Occupational therapy,
physical therapy, speech therapy and early childhood educator).
His parents and grandparents indicate that Sam is a very happy and contented child. Sometimes he notices people and toys around him, and plays with toys that are within his reach. At other times, Sam doesn’t seem to notice or be interested in what is around him, and does not make efforts to interact with objects farther than he can reach.
Sam does not move around. He seems happy when he sits on the floor to play
and has good stability when seated upright, but doesn’t seem interested
in moving from the spot where family members place him. As the therapist observes
him, she wonders what the reasons might be for his immobility. He has normal
reflex integration, so this does not seem to be part of the reason. He is just
beginning to bring his hands together. He is not moving out of sitting or supine,
is not bearing weight on his arms or legs, and dislikes being on his stomach.
Lately, sometimes, he does get frustrated when he can’t get his body to
do what he wants it to. His sisters and other family members are very attentive
to Sam’s needs, and bring toys to him when he is sitting on the floor.
His parents want him to move around more when playing and to explore his environment.
Sam eats a narrow range of foods at meals. His mom reports that he does not
like textured foods, and prefers to use the bottle for feeding. He will eat
some foods from the spoon; typically, mom feeds him, and Sam takes food from
mom, and she tells us that Sam will hold the spoon. He only puts his fingers
in his mouth, and does not chew on toys or other objects. His parents want him
to eat a wider variety of foods. They also notice that Sam does not like having
his face or mouth wiped off; his parents want him to be more cooperative with
face washing as well.
He was born 4 weeks prematurely and had low fluid levels resulting in early delivery possibly due to Sjogren’s Syndrome. Sam has been diagnosed with hydronephrosis; at 2 months of age, he had surgery to reimplant his ureter. His parents want to know if there is a reason for his small stature, and if there are things they should be doing related to his size; because of concerns about his size, the parents are taking him to get genetic testing.
The parents described Sam’s day. Sam cooperates with family members when getting dressed, bathing and eating. He gets up at 8, drinks a bottle and eats a jar of food. He rides in the car to take siblings to school, and this takes some time, since the family lives in a rural community. Sam likes riding in the car. He takes a nap every day; Sam has to have his pacifier to go to sleep, although hi is a good sleeper both at nap and nighttime.
At home, Sam likes to play. He watches short movies, and will play with toys that his sisters and parents put in his lap or very near him. His sisters play near by. He is also in a play group at church and in the neighborhood (children come over to Sam’s house to play). HE is not talking. Sam also spends time with grandparents and with other extended family; the parents feel they have a lot of family and friend support networks in their community.