case history #3 “t”. background 7 year old male extensive medical history significant cognitive,...
TRANSCRIPT
Background 7 year old male Extensive medical history Significant cognitive, language, and physical
disabilities Attended Kindergarten last year, but now homebound
due to medically fragile condition Communicates primarily with eyes Receives speech therapy twice monthly at home
through Hermantown Public Schools
Medical History Sensory/Physical/Health Status:
Post shaken baby syndrome (occurred at 8 months) Cerebral Palsy Seizure Disorder Developmental Delay Serious Progressive Neuromuscular/Paralytic Scoliosis G-tube for eating Tracheostomy Spastic Quadriplegia Reactive Airway Disease Susceptible to respiratory infection Medically Fragile
Medical History Vision:
Cortical Visual Impairment Large circular movements of eyes when fixating on
object Holds eye gaze when approximately 6 inches from eyes Glare from lighting interferes with ability to visually
attend Requires visual breaks Wears correction Able to maintain eye gaze to identify pictures
Assessment Due to medical conditions, accurate assessment
results were difficult to obtain Intellectual:
Significant cognitive and language disabilities Adaptive behaviors place him below 1st percentile Functioning below 3-6 month level based Adaptive
Behavior Assessment System (ABAS) Behaviors considered stable
Assessment Hearing:
Appears to hear adequately, sometimes moves head slightly in direction of sounds
Assessed next school year by the audiologist
Perceptual: Unable to explore textures Responds to touch
Assessment Social:
Does not respond well to unfamiliar adults Will respond to simple commands when in good health and not
fatigued (e.g., lift your arm) Will initiate crying or facial expression when cold or hurt Will smile and occasionally laugh Seems to enjoy peers Able to differentiate between environments (e.g., home,
doctor’s office)
Assessment Cognition:
Difficult to test Speculate knowledge is higher than checklists indicate Uses eye movement to indicate yes/no Has identified pictures (e.g., familiar objects, body
parts)
Assessment Pre-Academic Skills:
Brigance Diagnostic Inventory (used in part) Results may not be accurate, but indicate potential to learn
academically Areas tested include the following:
Categories of nouns (e.g. food or animals) 6/8 (75%)
Personal Information (e.g., age or gender) 2/4 (50%)
Concepts (e.g., same/different or colors) 10/13 (76%)
Time Concepts (e.g., year or day) 1/3 (33%)
Assessment Daily Living Skills:
Tube fed Completely dependent on caregivers Physical conditions prevent him from assisting with care Strengths: enjoys bath and shows reaction to be wet/soiled Needs frequent humidity Uses manual wheelchair Not able to withstand long periods in sitting position
Uses body jacket brace and leg foot positioning braces
Assessment Communication:
Able to request, protest, greet, show interest, play, seek approval, agree, disagree, indicate that he doesn’t know
Non-verbal Fatigues quickly Attempted right cheek switch and step-by-step communicator, but access was
inconsistent and dependent on health and fatigue Currently uses right eye gaze for yes and left eye gaze for left Needs a more effective, efficient, and formal communication system A good intentional switch access has not been found due to severe physical
limitations “But…appears very ready for an augmentative communication device…”
Additional Comments from IEP No access to computer at home Suggested to video tape classroom lessons for
him to watch at home Able to watch TV mounted near his bed ERICA System evaluation noted as the first step
in an intentional movement evaluation
Treatment Very limited due to medical fragility Surgery not an option because he may not
survive Limited contact with DCD educator and SLP IEP does not state specific goals
Meeting with SLP will help identify goals
AAC Assessment Components: Communication Needs Seating and Positioning Visual Status Motor Control Switch Assessment Cognitive and Language Assessment
Communication Needs Interview (include SLP and foster parents)
Communication partners Communication mode
Strategies Interest in activities (computer use) Family’s feelings on current & potential
communication systems Environmental considerations during evaluation
Seating and Positioning
Device accessed while sitting/or positioned on his back
Able to be mounted on wheelchair
Visual Status
6 inches from eyes and slightly below eye level
Need to find optimum size, color, shape
Need to determine type of “correction” mentioned in IEP
Motor Control Direct selection:
Does he have control over any of these? eye gaze eye blink switch use grunt
Switch Assessment
We want more information about past use and reasons why it failed
Can we use body parts other than cheek to access the switch?
Can we vary body parts used to prolong attending and decrease fatigue?
Is there support for switch use at home?
Cognition and Language Assessment Informal Assessment of Eye gaze
Compare four directions vs. two (e.g., ETran) Maintain eye gaze for period of time Evaluate ability to use eye gaze to answer more than
yes/no questions Evaluate ability to attend before he fatigues Evaluate cause/effect
AAC Options ETran Simple Switch Use
Establish cause and effect
Switch combined with Step-by-Step or other communicator
ERICA System (future goal)
List of Questions for our Meeting today Information about T:
Can he control blink? Eye gaze? Switch? (selection method; what do we have to work with?)
Exactly what does he need to communicate? Humidity? Do we need to accommodate? Can T follow directions enough to direct gaze repeatedly at objects? x/second? Vision portion describes best positioning (at eye level & 6 inches away) what about size? Vision perspective, are any colors preferable? Who is coming on Friday? What position is best for us to interact w/ him? At table? Us on floor? Us on kiddee chair? Hobbies/interests? Doesn’t react well to unfamiliar adults/any suggestions here? How long until fatigues? Why aren’t we assessing him in his home? (consider medically fragile; natural
environment; fear of unfamiliar adults; more info for us; IEP discusses recognition of dr’s office environment, how will he react to our clinic?)
List of Questions for our Meeting today AAC use past/present:
Why are they interested in ERICA? For what activities was the switch used? Is it used at all now? Was it used to teach cause and effect? When did it work; when didn’t it work? How do they see the device being used at home and at school? What types of responses do you want to be able to generate from an educational
standpoint? Same for communication standpoint? Is it important for him to communicate while sitting & lying down? Is it important to
use a system that allows him to communicate from a variety of positions? What are his educational priorities & how do you see an AAC device assisting in this
area? If we do use a switch, is cheek only option? Can we switch cheek to prevent fatigue? Why was step by step communicator abandoned?
Discussion What are your thoughts? What questions would you ask if you were
going to our meeting tonight?
List of Questions for our Meeting today Extra areas to evaluate:
Can T understand cause and effect? What selection method will work? Eye gaze board assessment (ETran) Step by step (or other simple) communicator w/ switch
Ideas: Look in dev psy book for 3-6 month old development review Check CRC for some developmental scale protocols we could
adapt Do most important items at beginning; plan for fatigue