liz - a case study on a child with down syndrome

Running Head: A CASE STUDY ON DOWN SYNDROME

Liz: A case study on a ci!d "it Do"n synd#o$e E%e!yn &a'a#oudi( )a#ed Hansen( Me!ody *!att( Les!ie Ra$os( )enni+e# To$( and Mice!!e Wi!son Tou#o Tou#o Uni%e#sity Ne%ada Ne%a da

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A CASE STUDY ON DOWN SYNDROME

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Description of Occupational Performance

E%a!uating te c!ient-s .e#+o#$ance ac#oss %a#ious settings is %ita! to identi+ying 'a##ie#s 'et"een tei# +unctiona! ca.a'i!ities and de$ands o+ tei# dai!y !i+e/ Liz( is a 0yea#o!d +e$a!e "it Do"n synd#o$e 2DS3 unde#going ca!!enges "it g#oss and +ine $oto# s4i!!s( acti%ities o+ dai!y !i%ing( .!ay s4i!!s( s4i!!s( and attention to tas4/ Wi!e Liz e5i'its ca!!enges ca!!enges in $u!ti.!e do$ains( an a..#o.#iate inte#%ention can 'e i$.!e$ented to inc#ease o.ti$a! +unction in tese a#eas/ Education

At te age o+ t#ee( Liz attended an ea#!y ci!dood .#og#a$ at a !oca! .u'!ic scoo! "e#e se #ecei%ed s.eec te#a.y in a g#ou. setting( as "e!! as .ysica! te#a.y 26T3 and occu.ationa! te#a.y 2OT3 se#%ices/ Du#ing tis ti$e( te te 6T and OT noted tat Liz ad !o" $usc!e tone( "ic cont#i'uted to "ea4ness in g#oss and +ine +ine $oto# s4i!!s/ Se cu##ent!y attends a .u'!ic scoo! in te C!a#4 County Scoo! Dist#ict and is in a s.ecia! ed ucation .#og#a$ "it .a#t ti$e inc!usion/ Activities of Daily Living

Liz dis.!ays di++icu!ty di++icu!ty "it e# $o#ning #outine/ #outine/ D#essing and g#oo$ing a#e t"o t"o a#eas o+ se!+e!. tat #e7ui#es su..o#t/ He# $ote# e!.s "it +astening te 'uttons on e# .ants and zi..ing u. zi..e#s on e# c!oting/ A!toug se is a'!e to to don and do++ e# soes and soc4s( e# "ea4ness in +ine $oto# s4i!!s ini'its e# a'i!ity to tie e# soe!aces/ Liz is a!so a'!e to '#us e# teet8 o"e%e#( se #e7ui#es assistance assistance "it .#e.a#ation +o# te tas4/ tas4/ Se !ac4s te .#o.e# g#as. .atte#ns and $usc!e st#engt to s7ueeze te toot.aste and a..!y it to te toot'#us/ Wen it co$es to se!++eeding( se is una'!e to $ani.u!ate utensi!s inde.endent!y/ Du#ing $ea!ti$e( Liz atte$.ts to use an a..#o.#iate utensi!( o"e%e#( due to e# di++icu!ty "it utensi! $ani.u!ation( se s"itces to +inge# +eeding/ Due to Liz-s de!ay o+ +ine $oto#


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de%e!o.$ent( se does not uti!ize an age a..#o.#iate g#as. du#ing se!++eeding/ se!++eeding/ Liz-s $ote# #e.o#ts tat se is +#e7uent!y s.i!!ing +ood( due to !ac4 o+ cont#o! o+ te s.oon "en '#inging it to"a#d e# $out/ Instrumental Activities of Daily Living (IADLs)

Liz enoys .a#ta4ing in ouseo!d co#es;in .a#ticu!a#( e!.ing e# $ote# set te dinne# ta'!e/ He# $ote# uses .!astic cu.s( .!ates( and utensi!s( so tat Liz can t#ans+e# te su..!ies to te ta'!e/
Acti%e engage$ent in !eisu#e acti%ities can su..o#t one-s o%e#a!! ea!t and "e!!'eing/ A +e" o+ Liz-s !eisu#e inte#ests a#e singing and !istening to $usic/ Se s.ends $ost o+ e# Sunday $o#nings "atcing Disney singa!ongs singa!ongs "it e# younge# siste#/ siste#/ Tey enoy singing( !auging( and dancing togete# a#ound te !i%ing #oo$/ Social Participation


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Socia!ization is i$.o#tant +o# +aci!itating inte#action inte#action "it .ee#s/ Liz tends to inte#act $o#e +#e7uent!y "it te adu!ts at scoo! suc as( te teace#s and c!ass#oo$ aides( #ate# tan e# .ee#s/ A!toug Liz is $oti%ated to to socia!ize "it e# c!ass$ates( c!ass$ates( tey tend to igno#e e# o# "a!4 a"ay once se initiates contact/ Liz-s $ote# is conce#ned tat se is teased 'y te ote# ci!d#en in e# gene#a!education c!ass/ Wi!e #ecess is Liz-s Liz-s +a%o#ite ti$e ti$e o+ day( e# !ac4 o+ +#iends ini'it e# a'i!ity to +o#$ .#o.e# +#iendsi.s and tus( engage in socia!ization and .!ay/ Play

Liz as te cogniti%e ca.acity to engage in i$agina#y .!ay/ Se and e# younge# siste# a%e a +a%o#ite s.ot in te te ouse +o# .!ayte "a#d#o'e/ "a#d#o'e/ Tey s.end ou#s in tei# $ote#-s $ote#-s "a#d#o'e .!aying d#essu. +#o$ a 'o5 o+ sca#%es( .u#ses( soes( and ats/ Se "i!! d#ess u. an d i$itate e# $ote#/ $ote#/ Du#ing +a$i!y ti$e( se enoys .!aying >Candy Land(? a 'oa#d ga$e "it "it si$.!e #u!es/ Se is a'!e to .a#tici.ate .a#tici.ate in te ga$e( 'ut #e7ui#es HOH assistance to $o%e e# .iece to te co##es.onding .ictu#e o# co!o#/ Se dis.!ays good tu#nta4ing s4i!!s and is a'!e to "ait .atient!y +o# e# tu#n/ Ho"e%e#( at ti$es se se de$onst#ates di++icu!ty "it "it se!+#egu!ation( .a#ticu!a#!y "en !osing/ &e+o#e sta#ting te ga$e( e# $ote# "i!! .#i$e .#i$e e# o+ te #u!es and #e$ind e# tat te .u#.ose o+ te ga$e is to a%e +un/ At scoo!( Liz de$onst#ates an inte#est in .!aying on te .!ayg#ound a..a#atus( o"e%e#( !ac4s te g#oss $oto# s4i!!s #e7ui#ed to uti!ize te e7ui.$ent( suc as s"inging( u$.ing( and c!i$'ing/ Se tends to .!ay 'y e#se!+ a"ay +#o$ te ote# ci!d#en "o a#e .!aying on te .!ayg#ound e7ui.$ent/ Sleep

Liz dis.!ays #egu!a# s!ee.ing .atte#ns/ Se sa#es a 'ed#oo$ "it e# younge# siste#( "ic "ic is nea# e# $ote#-s 'ed#oo$/ Se s!ee.s in e# o"n 'ed and e# $ote# #e.o#ts tat se is a'!e to s!ee. "e!! t#ougout te nigt "itout any issues/


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Description of: Movement Postural !eactions and"or !efle#es

Liz dis.!ays +unctiona! a$'u!ation a$'u!ation and is a'!e to "a!4 inde.endent!y/ inde.endent!y/ Se c!i$'s on and o++ +u#nitu#e8 tis 'ea%io# is s.ecu!ated to 'e due to e# see4ing %esti'u!a# in.ut to co$.ensate +o# te unde##es.onsi%eness unde##es.onsi%eness o+ e# %esti'u!a# syste$/ Liz is a'!e to use $o$entu$ to inc#ease s.eed 'ut !ac4s coo#dination and .ostu#a! cont#o!( as se +#e7uent!y +a!!s "en #unning +u#te# tan ,@ ya#ds/
A study done 'y id!e#( He.'u#n( Man4in( and Roge#s 2,BB@3( +ound( ' y .a#ent#e.o#t( tat ci!d#en "it DS a%e st#engts in socia!ization and "ea4nesses in co$$unication and $oto# s4i!!s/

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#is4s 'y c!i$'ing on +u#nitu#e( and se 'eco$es dist#acted easi!y/ easi!y/ Tis senso#ysee4ing "i!! i$.act e# .a#tici.ation in 'asic ADLs( ADLs( scoo!( and socia! g#ou.s/ He# $ote# stated tat se "ants e# to .a#tici.ate in co$$unity g#ou.s( 'ut is #e!uctant to do so 'ecause se +ea#s tat se "i!! 'e teased 'y .ee#s/ Te OT g#ou. "i!! .#o%ide su..o#t and encou#age Liz-s $ote# to a!!o" e# to .a#ta4e in tese socia! o..o#tunities/ Additiona!!y( se is de$onst#ating tacti!e .e#ce.tion .#o'!e$s due to e# di++icu!ty "it ige# !e%e! +ine $oto# s4i!!s/ <+ not add#essed( uti!izing "#iting and +eeding utensi!s "i!! "i!! 'e +u#te# a++ected/ <+ se is using %ision to co$.ensate +o# .oo# tacti!e disc#i$ination( disc#i$ination( e# eye and coo#dination  "ic is i$.o#tant +o# .!ay and +ine $oto# s4i!!s  "i!! a!so 'e a++ected/ Last!y( it a..ea#s tat e# audito#y syste$ is y.e##es.onsi%e/ y.e##es.onsi%e/ Se is easi!y dist#acted and noises di%e#t e# attention +#o$ te cu##ent tas4 se $a y 'e t#ying to co$.!ete/ Person$Environment$Occupation$Performance Model

Te 6e#sonEn%i#on$entOccu.ation6e#+o#$ance 26EO63 $ode! is a c!ientcente#ed a..#oac tat +ocuses on inte#%entions tat a++ect te indi%idua!-s cu##ent occu.ationa! .e#+o#$ance/ &ased on te 6EO6 $ode!( occu.ationa! .e#+o#$ance is in+!uenced 'y te inte#de.endent #e!ationsi.s 'et"een te .e#son( en%i#on$ent( and occu.ation 2Co!e  Tu+ano( ,BB3/ Te co$.onents o+ te 6EO6 $ode! .!ay a !a#ge #o!e in Liz-s Liz-s a'i!ity to de%e!o. $aste#y "itin e# en%i#on$ent/

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gene#a! education 4inde#ga#ten c!ass +o# t#ee ou#s and te #e$aining +ou# scoo! ou#s a#e s.ent in a se!+contained s.ecia! s.ecia! education c!ass#oo$/ As $entioned a'o%e( se as $any occu.ations( 'ut e# $ost i$.o#tant occu.ations a#e  e# #o!es as a daugte#( siste#( and student/ Tese a#eas ig!y a++ect e# o%e#a!! .e#+o#$ance in te acti%ities se needs and "ants to do in e# dai!y #outine/ Te .e#+o#$ance a#ea is te $ao# +ocus o+ te 6EO6 $ode!/ Liz is a'!e to "a!4 inde.endent!y and #un so#t distances8 o"e%e#( se is una'!e to #un g#eate# distances o# inc#ease e# s.eed/ Tis is 'ecause o+ e# y.otonia as "e!! as e# .oo# st#engt and y.e#$o'i!ity in te $ao#ity o+ e# oints/ Se dis.!ays .oo# attention "en se is outside( as se +#e7uent!y +a!!s due to te dist#actions +#o$ en%i#on$enta! acti%ity( acti%ity( noises( o# .eo.!e/ Liz as .#o'!e$s "it e# +ine and g#oss $oto# s4i!!s "ic g#eat!y a++ects e# "o#4 as a 4inde#ga#ten student as "e!! a s e# dai!y occu.ations/ An OT can use te 6EO6 $ode! to e!. e# $aste# e# en%i#on$ent and inc#ease e# occu.ationa! .e#+o#$ance in te a#eas $entioned a'o%e/ T#oug use o+ co$.ensato#y co$.ensato#y st#ategies in e# en%i#on$ent( se $ay de%e!o. g#eate# cont#o! o%e# e# occu.ationa! .e#+o#$ance/ o# instance( c!ea#ing te outside en%i#on$ent and c#eating o.en s.ace $ay .#e%ent e# +#o$ +a!!ing/ Te use o+ ada.ti%e e7ui.$ent suc as a .enci! g#i. can g#eat!y i$.#o%e e# +ine $oto# s4i!!s s4i!!s in scoo!/ He# g#oss $oto# s4i!!s s4i!!s can 'e $aste#ed $aste#ed 'y adding $oti%ation to a%e e# "o#4 on st#engt and $o'i!ity inc!uding( .et te#a.y "e#e se can "a!4 a dog !onge# distances/ O%e#a!!( te#e a#e $any as.ects as.ects o+ te .ysica! and socia! socia! en%i#on$ent tat can 'e $ani.u!ated to inc#ease e# o%e#a!! occu.ationa! .e#+o#$ance/

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%rames of !eferences

#a$es o+ #e+e#ences a#e conce.ts o+ 4no"!edge tat e!. in+!uence a te#a.ists .e#ce.tions( decisions( and .#actice $etods/ &ased on e# occu.ationa! .e#+o#$ance( te .sycosocia! co.ing $ode!( $oto# !ea#ning( and neu#ode%e!o.$enta! teo#y +#a$es o+ #e+e#ences "i!! 'e uti!ized to e!. guide Liz-s inte#%entions/ Psyc&osocial: 'oping Model

Liz-s $ote# is esitant to a!!o" e# daugte# to .a#tici.ate "it ote# ci!d#en in co$$unity acti%ities( te#e+o#e( te .sycosocia! co.ing $ode! +#a$e o+ #e+e#ence $ay e!. ease e# tension 'y .#o%iding continued su..o#t in Liz-s socia! at$os.e#e/ He# occu.ationa! .e#+o#$ance can 'e i$.#o%ed t#oug te use o+ te co.ing $ode! in o#de# to de%e!o. socia! s4i!!s and 'ui!d #e!ationsi.s #e!ationsi.s "it e# .ee#s 2Case  S$it( ,B1B3/ No" tat se is 'eginning 'eginning to +a!! 'eind e# t#eeyea#o!d siste# in +ine and g#oss $oto# s4i!!s( se $ay need to !ea#n ne" st#ategies to co.e "it "it st#ess in o#de# o#de# to stay $oti%ated/ Te co.ing $ode! a!!o"s e# to to co.e "it dai!y st#ess .ut on 'y te de$ands o+ e# .ysica! .ysica! and socia! en%i#on$ent/ Se can use inte#na! and e5te#na! co.ing #esou#ces "ene%e# se $ay 'egin to !ose te d#i%e to .a#tici.ate in an acti%ity/

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is .#esent in c!ass/ c!ass/ Tis $ay ease te conce#ns o+ e# $ote# and dec#ease +ea# o+ e# daugte#-s c!ass$ates teasing e# +o# 'eing di++e#ent/ Motor Learning

Te $oto# !ea#ning +#a$e o+ #e+e#ence is an occu.ation'ased a..#oac to !ea#ning $oto# so!utions t#oug an indi%idua!-s inte#action "it te tas4 and en%i#on$ent 2Case  S$it( ,B1B3/ Tis a..#oac "ou!d 'e used to i$.#o%e i$.#o%e Liz-s +ine and g#oss $oto# a'i!ities/ Se as di++icu!ty $ani.u!ating $ani.u!ating e# +inge#s to success+u!!y success+u!!y 'utton and zi. e# c!otes/ c!otes/ &y inco#.o#ating acti%ities tat +ocus on inc#easing e# +ine $oto# s4i!!s( se "i!! !ea#n o" to 'utton and zi. e# c!otes inde.endent!y/ o# instance( se "i!! +i#st !ea#n o" to 'utton 'y st#inging st#inging 'eads onto a .i.e c!eane#/ Tis +ocuses on a ti. .inc g#as. "ic is needed to 'utton c!otes/ Tis +ine $oto# acti%ity $ay 'e di++icu!t at +i#st( 'ut 'y using a #e.etiti%e tas4 $etod ca!!ed blocked se "i!! !ea#n o" 'utton c!otes "it random practice( practice( se "i!! $aste# te action/ E%entua!!y( se practice 'y practice 'y %a#ying di++e#ent sized 'uttons on a +e!t 'o5 to inc#ease s4i!! and a'i!ity/ G#oss $oto# tas4s "i!! 'e add#essed t#oug .!ay acti%ities in e# outside en %i#on$ent/ o# instance( se as a di++icu!t ti$e "a!4ing "a!4ing distances !onge# tan ,@ +eet/ Wa Wa!4ing !4ing is in%o!%ed in $any as.ects o+ e# day( as it is e# $etod o+ t#ans.o#tation a#ound scoo! and o$e/

1B

Te Neu#ode%e!o.$enta! Teo#y 2NDT3 +#a$e o+ #e+e#ence can 'e used to e!. guide gu ide inte#%entions 'ased on +aci!itating +aci!itating $o%e$ents/ Wen identi+ying Liz-s Liz-s a'i!ity to de$onst#ate ADLs( se dis.!ays dis.!ays aty.ica! $o%e$ents $o%e$ents tat !i$it e# a'i!ity to to co$.!ete a tas4/ NDT is used to >+aci!itate .ostu#a! cont#o! and $o%e$ent syne#gies and to ini'it o# const#ain $oto# .atte#ns tat( i+ .#acticed( "ou!d !ead to seconda#y seconda #y de+o#$ities and dys+unction? 2Case  S$it( ,B1B( ./ =93/ An OT "ou!d 'e a'!e to use NDT st#ategies to e!. Liz acie%e 'asic ADLs suc as se!+ +eeding "it $o%e$ents tat a#e ene#gye++icient and agea..#o.#iate/ o# e5a$.!e( se "i!! !ea#n o" to se!++eed se!++eed e#se!+ using age a..#o.#iate utensi!s/ utensi!s/ T#oug te use o+ an ada.ti%e utensi!( se "i!! +i#st !ea#n o" to +unctiona!!y o!d te s.oon an d '#ing it to e# $out/ Se S e "i!! "o#4 on e# +ine $oto# s4i!!s #e7ui#ed +o# se!++eeding t#oug $eaning+u! $o%e$ent/ $o%e$ent/ Acti%ities suc as scoo.ing and sta''ing di++e#ent te5tu#ed +oods "i!! "o#4 on tas4 #e.etition as "e!! as .#og#essi%e!y ca!!enging e# +ine $oto# s4i!!s 'ased on e# .e#+o#$ance/ Tis $o%e$ent can 'e +aci!itated 'y an OT to e!. 4ee. Liz stay $oti%ated t#ougout te acti%ity/ acti%ity/ Appropriate Assessments

Se "as .#e%ious!y assessed using te G#oss Moto# unction Measu#e 2GMM3 and te 6ediat#ic E%a!uation o+ Disa'i!ity Disa'i!ity

11

designed to $easu#e ada.ti%e 'ea%io# 'ea% io# o+ indi%idua!s +#o$ ages B to FB/ Te +i%e do$ains inc!ude co$$unication( dai!y !i%ing s4i!!s( socia!ization( $oto# s4i!!s( and $a!ada.ti%e 'ea%io# 2o.tiona!3/ Tese do$ains contain su'do$ains as "e!!/ Sco#es "i!! e!. aid in in inte#%ention .!anning as "e!! as $onito#ing te c!ient-s c!ient-s .#og#ess 2S.a##o"( 2S.a##o"( ,B113/ Te#e a#e t#ee %a#ious +o#$s to coose +#o$ "en ad$iniste#ing te Iine!and<
Te OT tea$ co$.osed +i%e +unctiona! .#o'!e$ state$ents +o# Liz in #ega#ds to .e#+o#$ance in essentia!( +unctiona! acti%ities/ Tese "e#e "#itten to add#ess te $ain a#eas o+ conce#n as identi+ied 'y e# $ote#( and a!so as identi+ied ' y te OT tea$ a+te# 'eco$ing +a$i!ia# "it e# case/ Te +i%e +unctiona! .#o'!e$ state$ents state$ents a#e as +o!!o"s: +o!!o"s: • •

• •

De!ayed +ine $oto# s4i!! de%e!o.$ent !i$it te c!ient-s a'i!ity to engage in se!++eeding/ De!ayed g#oss $oto# s4i!! de%e!o.$ent d e%e!o.$ent !i$it te c!ient-s a'i!ity to acti%e!y .a#tici.ate in +unctiona! .!ay/ De+icits in socia! s4i!!s !i$it te c!ient-s a'i!ity to initiate continued .ee# inte#action/ Li$ited attention to tas4 !i$it te c!ient-s a'i!ity to .a#tici.ate in sa+e( +unctiona!

•

1,

De!ayed +ine $oto# s4i!! de%e!o.$ent !i$it te c!ient-s a'i!ity to .a#tici.ate in inde.endent d#essing/ * %amily"'aregiver"'&ild ,oals

Te a#eas add#essed in te inte#%ention .!an a#e d#i%en 'y te c!ientJ+a$i!y-s se!+ .e#cei%ed needs/ A co!!a'o#ati%e co!!a'o#ati%e a..#oac is used to ensu#e tat te c!ient-s goa!s a#e 'eing $et/ Liz-s $ote# as set +i%e goa!s 'ased on di++icu!ties identi+ied in te #e.o#t and o'se#%ation o+ e# occu.ationa! .e#+o#$ance ac#oss %a#ious do$ains/ He# $ote# "ou!d !i4e to to see Liz 213 de%e!o. coo#dination and st#engt so tat se can uti!ize te .!ayg#ound a..a#atus( 2,3 i$.#o%e inde.endence in ADLs "it e$.asis on 'uttoning and zi..ing e# c!oting( 293 $ani.u!ate eating utensi!s du#ing $ea! ti$e 2=3 engage in socia! inte#action "it .ee#s du#ing #ecess( and 2@3 i$.#o%e e# attention to tas4s to assist e# "it .a#tici.ation in
Witin si5 $onts Liz "i!! "i!! inde.endent!y eat one $ea! using an a..#o.#iate a..#o.#iate 'OAS ,oal 0: Witin utensi!/ O+/ective 0: Se "i!! eat one $ea! "it an ada.ti%e utensi! inde.endent!y "itin t"o

$onts/ Activity 0: Se "i!! scoo. and sta' t#ee di++e#ent 4inds o+ +ood "it te ada.ti%e

utensi! +o# one +eeding session "itin one $ont/ Activity .: Witin Witin one $ont se "i!! inde.endent!y t#ans+e# #ice +#o$ a 'uc4et

to a 'o"! uti!izing a s$a!! so%e! 9 out o+ @ t#ia!s/ Witin +ou# $onts( se "i!! inde.endent!y ta4e +i%e 'ites o+ one $ea! O+/ective . : Witin using an a..#o.#iate utensi!/


19

Activity 0: Se "i!! sta' +i%e di++e#ent ty.es o+ te5tu#ed +ood inde.endent!y "it

an a..#o.#iate +o#4 "itin t"o $onts/ Activity .: Witin Witin one $ont se "i!! $ani.u!ate one 'ite o+ $aca#oni and

ceese in e# $out and s"a!!o" it "itout !etting any +ood +a!! out/ 'OAS ,oal .: Witin si5 $onts se "i!! inde.endent!y d#ess e#se!+ in age a..#o.#iate a.. #o.#iate

c!oting "it 'uttons and zi..e#s/ O+/ective 0: Witin +ou# $onts Liz "i!! inde.endent!y 'utton e# .ants uti!izing a ti.

.inc g#as./ Activity 0: Se "i!! inde.endent!y 'utton and un'utton a 'utton +e!t 1B ti$es

"itin t"o $onts/ Witin one $ont se "i!! st#ing 1B di++e#ent sized 'eads onto a .i.e Activity .: Witin c!eane# to $a4e a '#ace!et uti!izing a ti. .inc g#as./ O+/ective .: Witin t"o $onts se "i!! inde.endent!y co$.!ete zi..e#s on e# c!oting

uti!izing a !ate#a! .inc g#as./ Activity 0: Witin Witin one $ont se "i!! co$.!ete one ga$e o+ K&ed &ugs- "it e#

younge# siste# using o%e#sized tongs to co!!ect .!astic 'ugs using a !ate#a! .inc g#as./ Activity .: Witin Witin one $ont se "i!! co$.!ete zi..e#s on e# c!oting "it

HOH Assistance Assistance uti!izing a !ate#a! .inc g#as./ 'OAS ,oal -: Liz "i!! ta4e a te#a.y dog on a "a!4 +o# 1B $inutes a#ound e# neig'o#ood

"it adu!t su.e#%ision "itin si5 $onts/ .u.. y .u!!toy +o# +i%e $inutes a#ound te a.a#t$ent O+/ective 0: Se "i!! "a!4 a .u..y cou#tya#d "it adu!t su.e#%ision( "itin t"o $onts/


1=

Activity 0: Se "i!! co$.!ete one ga$e o+ #ed!igtg#een!igt in te out.atient

te#a.y gy$ "it %e#'a! cueing "i!e .u!!ing te .u..y .u!!toy "itin t"o "ee4s/ Activity .: Se "i!! co$.!ete an o'stac!e cou#se "it .ysica! cueing in e#

a.a#t$ent cou#tya#d "i!e "a!4ing a .u.. y .u!!toy "itin one $ont/ O+/ective .: Liz "i!! ta4e a te#a.y dog on a "a!4 +o# +i%e $inutes a#ound e#

neig'o#ood "it HOH Assistance "itin +ou# $onts/ Activity 0: Se "i!! na%igate a sa+e #oute on a "a!4 a#ound e# neig'o#ood

"i!e acco$.anied 'y te#a.ist and te#a.y dog( "it %e#'a! cueing 9 out o+ @ ti$es "itin one $ont/ Activity .: Witin t#ee $onts se "i!! co$.!ete an o'stac!e cou#se "it

.ysica! cueing = out o+ @ t#ia!s in e# a.a#t$ent cou#tya#d "i!e "a!4ing a te#a.y dog/ reatment r eatment Plan

Te t#eat$ent .!an "i!! +ocus on te COAST goa!s tat "e#e c#eated 'ased on te conce#ns tat "e#e identi+ied/ Te OT tea$ "i!! 'e co!!a'o#ating "it Liz an d e# $ote# to ensu#e tat t#eat$ent goa!s a#e 'eing $et( and an d "i!! $odi+y te t#eat$ent .!an as necessa#y to acco$$odate e# needs and .#og#ess/ Environmental Setting

T#eat$ent "i!! ta4e .!ace in an out.atient c!inic and te occu.ationa! te#a.ist "i!! a!so t#a%e! to Liz-s o$e en%i#on$ent to conduct ce#tain t#eat$ent sessions/ Se "i!! #ecei%e OT t#eat$ent sessions t"o to t#ee ti$es a "ee48 sessions +ocusing on +ine $oto# s4i!!s "i!! ta4e


1@

.!ace "itin te out.atient c!inic "i!e sessions +ocusing on g#oss g#oss $oto# and socia!ization goa!s "i!! ta4e .!ace in te o$e en%i#on$ent/ SOAP ote S: Liz stated ><-$ ti#ed? 5 , du#ing te session( and $ote# #e.o#ted Liz "as >u. .ast e#

'edti$e? te nigt 'e+o#e/ occu .ationa! te#a.y t#eat$ent session in te O: Liz "as seen +o# 0B $inute 1:1 s4i!!ed occu.ationa! out.atient setting to inc#ease inde.endence and sa+ety "it g#oss $oto#( +ine $oto# and se!+ca#e s4i!!s/ Liz t#ansitioned to session "it $in %e#'a! cues and 'egan "it a g#oss $oto# c!i$'Js!ide acti%ity +o# %esti'u!a# and .#o.#ioce.ti%e in.ut in .#e. +o# "o#4/ Liz "as noted to s$i!e s$i!e and !aug t#ougout/ T#ansitioned T#ansitioned to a +ine $oto# acti%ity acti%ity to inc#ease inde.endence "it 'uttons/ Liz de$onst#ated te a'i!ity to uti!ize a .ince# g #as. +o# 9J 'uttons "it $od assist( #e7ui#ing $a5 assist +o# te #e$aining =/ Liz ten t#ansitioned to a g#oss $oto# coo#dination( coo#dination( attention and sa+ety a"a#eness acti%ity to to inc#ease sa+ety "it "a!4ing "a!4ing te +a$i!y dog/ Liz de$onst#ated te a'i!ity to $aneu%e# a .u!! toy t#oug an o'stac!e cou#se 9J@ t#ia!s "it $od %e#'a ! cues to attend to te .u!! toy-s !ocation and te o'ects in +#ont o+ e#/
$oto# coo#dination( +ine $oto# and se!+ca#e s4i!!s tat a++ect e# inde.endence in acti%ities o+ dai!y !i%ing/ Tis is de$onst#ated 'y e# a'i!ity to t#ans+e# ce#ea! to e# $out "itout assist ,J@


10

t#ia!s %e#sus BJ@ t#ia!s as seen in .#e%ious sessions( e# a'i!ity to uti!ize an a..#o.#iate .ince# g#as. +o# 9J 'uttons %e#sus 1J 'uttons( and e # a'i!ity to $aneu%e# an o'stac!e cou#se cou #se 9J@ t#ia!s "it $od %e#'a! cues %e#sus $a5 %e#'a! cues +o# @J@ t#ia!s/ Liz "ou!d continue to 'ene+it +#o$ +#o$ OT se#%ices to i$.#o%e de+icits in g#oss $oto# coo#dination( +ine $oto#( sa+ety a"a#eness( attention( and se!+ca#e s4i!!s/ de+icits as .e# 6OC goa!s/ Reco$$ended acti%ities inc!ude eating P: Continue to add#ess a'o%e de+icits utensi! $ani.u!ation acti%ities( .ince#J!ate#a! .inc +ine $oto# acti%ities +o# d#essing( and o'stac!e cou#ses in a 'usy en%i#on$ent to i$.#o%e sa+ety a"a#eness( g#oss $oto# coo#dination and attention to tas4 Post$Disc&arge Plan

Te .ostdisca#ge en%i#on$ents +o# Liz "i!! inc!ude te a.a#t$ent se !i%es in "it e# +a$i!y( and a!so te gene#a! education 4inde#ga#ten c!asses tat se attends at scoo!/ Se "i!! .#actice ADLs( ADLs( .!ay( and co$.!ete o$e"o#4 at o$e( and "i!! .a#tici.ate in .!ay and educationa! acti%ities at scoo! "it e# .ee#s/ Se "i!! continue to de%e!o. s4i!!s s4i!!s in tese natu#a! en%i#on$ents/ Te#e a#e se%e#a! s.eci+ic #eco$$endations tat te OT tea$ "i!! a%e +o# Liz and e# +a$i!y( "ic "i!! e!. e# to continue de%e!o.ing s4i!!s and a!so e5.e#ience a 'ette# 7ua!ity o+ !i+e/

1

A s.eci+ic #eco$$endation "i!! a!so 'e $ade to e# $ote# conce#ning conce#n ing Liz-s a'i!ity to .a#tici.ate in co$$unity .#og#a$s( toug te tea$ ac4no"!edges e# #e!uctance on tis su'ect/ He# $ote# "i!! #ecei%e #ecei%e encou#age$ent and in+o#$ation a'out te 'ene+its o+ Liz .a#tici.ating in co$$unity .#og#a$s( suc as te +act tat it "i!! a!!o" +u#te# de%e!o.$ent o+ socia! inte#action s4i!!s( and "i!! a!so a!!o" e# to de%e!o. in ote# a#eas suc as e# $oto# s4i!!s( de.ending on "at te .#og#a$ $ay entai!/ Te tea$ "i!! .#o%ide Liz-s $ote# "it st#ategies to co.e "it te .ossi'i!ity o+ ote# ci!d#en 'eing insensiti%e to Liz( and $ay a!so e!. e# to identi+y a s.eci+ic .#og#a$ in e# co$$unity tat $a y 'e idea! +o# Liz to .a#tici.ate in/ 1ustification of reatment +ased on !esearc&

Acco#ding to Wuang et a!/ 2,B113( te $ost e++ecti%e t#aditiona! OT a..#oaces used +o# ci!d#en "it DS inc!ude senso#y integ#ation 2S<3( neu#ode%e!o.$enta! t#eat$ent 2NDT3( and .e#ce.tua!$oto# a..#oac 26M3/ Wi!e eac a..#oac a!one as its o"n +ocus and st#engts( a co$'ination a..#oac( using $u!ti.!e a..#oaces o# a %a#iety o+ tese +#a$e"o#4s( can 'e de%e!o.ed and uti!ized to #eac te goa!s o+ te ci!d/ Acco#ding to Ande#son( Ande#son( Hinoosa( and St#auc 21F3( >A te#a.ist $ay e%en use $o#e tan one +#a$e o+ #e+e#ence du#ing a t#eat$ent session eite# si$u!taneous!y si$u!taneous!y o# se7uentia!!y? 2./ =,=3/ Wen using any o+ tese a..#oaces it is 'ot i$.o#tant to inco#.o#ate( as $uc as .ossi'!e( te natu#a! en%i#on$ent and conte5t o+ te ci!d( "i!e +ocusing on +eeding( +ine $oto# s4i!!s( and g#oss $oto# s4i!!s( and inc!uding .!ay into te inte#%ention/ eeding di++icu!ties "e#e +ound to 'e a co$$on issue +o# indi%idua!s "it Do"n synd#o$e( 'eing +ound in a'out 10 o+ indi%idua!s 26a!isano( ,BB13/ Do!%a( Coste#( and Li!a 2,BB=3( !in4ed se!+ca#e tas4s( suc as +eeding( and +ine $oto# s4i!!s "en tey said tat >.oo# +ine $oto# s4i!!s $ay 'e disa'!ing in tis .o.u!ation( +o# e5a$.!e( 'y a++ecting .e#+o#$ance o+


1

co$.!e5 se!+ca#e tas4s tat in%o!%e +ine $oto# s4i!!s? s4i!!s? 2./0,3/ So$e co$$on inte#%entions +o# tose "it +eeding di++icu!ties inc!ude +aci!itating o#a!$oto# s4i!!s( i$.#o%ing +oot .!ace$ent( and +aci!itating and +unction 2Ed"a#ds( 2Ed"a#ds( 1FFB3/ Many +eeding di++icu!ties can 'e add#essed 'y +ocusing on +ine and g#oss $oto# $i!estones 2Ed"a#ds( 2Ed"a#ds( 1FFB3/ As a te#a.ist #e$e$'e#s #e$e$'e#s to inco#.o#ate .!ay( +ine and g#oss $oto# $i!estones and +eeding goa!s can 'e $et/ &y inco#.o#ating te use o+ .!ay in de%e!o.ing g#oss $oto# s4i!!s( Liz "i!! a%e te added 'ene+it o+ inc#easing e# socia! inte#action( and e# .e#ce.tua! $oto# s4i!!s/ 6a!isano et a!/ 2,BB13 o'se#%ed tat in ci!d#en "it DS te#e "as a de!ay in $oto# de%e!o.$ent tat inc#eased "it age/ Tey +u#te# noted tat $any ci!d#en ci!d#en "it DS >$ay success+u!!y acie%e $oto# goa!s t#oug .!ay and st#uctu#ed de%e!o.$enta! acti%ities? a cti%ities? "i!e ote#s $ay not acie%e $oto# de%e!o.$ent goa!s "itout te#a.y inte#%ention 2./ =FF3/ One e5a$.!e o+ o" to inc!ude .!ay in e# inte#%ention .#og#a$ is to inco#.o#ate te use o+ a .u!! toy/ toy/ id!e# et a!/ 2,BB@3 o'se#%ed tat >Ci!d#en "it Do"n synd#o$e synd#o$e a!so ad di++icu!ty di++icu!ty "it +u!!'ody tas4s/ tas4s/ On te .u!! toy tas4( ,/ 2 o+ 113 o+ ci!d#en "it Do"n synd#o$e cou!d not coo#dinate "a!4ing $u!ti.!e ste.s and "atcing te toy in in a s$oot +asion/ Most ci!d#en "e#e a'!e to $o%e te toy t#oug !oco$otion( 'ut did not si$u!taneous!y $o%e +o#"a#d "i!e "atcing te toy( o# did not sustain tis $o%e$ent 'eyond a +e" ste.s? 2./ 19=3/ &y inco#.o#ating te use o+ a .u!! toy( g#oss $oto# s4i!!s can 'e acie%ed "itin te conte5t o+ .!ay "i!e +ocusing on #eacing #eac ing Liz-s goa!s/


1F

Re+e#ences Ande#son( )/( Hinoosa( )/(  St#auc( C/ 21F3/
Co!e( M/ &/  Tu+ano( R/ 2,BB3/ Applied 2,BB3/ Applied theories in occupational therapy/ therapy/ To#o+a#e( N): S!ac4
A CASE STUDY ON DOWN SYNDROME S.a##o"( S/ S/ 2,B113/ Iine!and Ada.ti%e Ada.ti%e &ea%io# Sca!es/
,B

liz - a case study on a child with down syndrome

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