STARES 3

SITUATION

A 3 year old boy presented to outpatient physiotherapy department to be treated for gross motor delay. Past medical history included pre-term birth, a liver transplant at 18 months old as well as numerous hospital admissions for respiratory infections, fevers and eczema. On assessment he presented with a significant gross motor delay, not yet creeping, 4 pt kneeling or standing with support. His gross motor abilities seemed to be largely limited by his associated movements or dystonia in his trunk, arms and legs. Mother appeared positive and proactive in helping her son develop.

TASK

For my final placement assessment I was to plan assessment and treatment of this child and then proceed to carry out this plan under the supervision of my clinical tutor.

ACTION

As the child was significantly delayed for a 3 year old, many assessment tools would merely state the obvious. Therefore I deemed it more appropriate to take more qualitative observations of this boy and describe his movements and abilities in detail to best get an idea for areas of improvement. From this assessment I learnt that the next stages in his development were improved sitting balance and reaching beyond his base of support, transitions from sitting to prone and sitting to 2 point kneeling. Using toys and available cushions etc I went through with my treatment ideas.

RESULT

Throughout the session I found it hard to obtain the result I was after as the dystonic movements made it difficult to facilitate movements as well as keep the child’s attention. When placed into a posture, limbs would spontaneously contract or the spine would go rigid, setting the child off balance. At one stage the child knocked his head with a plastic toy. As I had no prior experience with this child or with anyone similar, I was unable to predict this and I was to slow to prevent it. As a result the child spent about 2 minutes crying and had to be settled by the mother. After this however, we were able to resume activities.

EVALUATION

From this session I have developed heightened senses or increased awareness to the environment, actions and risks for each child I am presented with. Personally I feel it was a challenging situation and hard to predict potential risks. On this particular incident I was able to deflate the situation by getting the mother to settle the child. She was also complaisant and understanding, stating that it was a regular occurrence for him to hit himself in the head. From that point on I removed all hard toys and continues with softer balls and teddies.

STRATEGIES

- Start the session with simple, minimally stimulating toys, for example teddies and balls. This also works well with children who have heightened senses.
- Keep a hand close by even when on the floor to prevent accidents or provide facilitation.
- Don’t be afraid to ask the supervising clinician for support or advice.
- Talk through reasoning and ideas to show interest and this is also helpful for the parents as they learn from this also and can occasionally provide input in what they do at home and what works for them.