Isabel Case Synopsis
Name(s): Milagros Abreu, Stepha Ksionda, Alexa LaGrande, Jen Moore, Omorodion Robinson
Group Assignment
Checklist for the readings:
Readings for Isabel’s Case
1. Porr & Rainville: Children with Traumatic Brain Injury Chap 14 (Angel)
2. Case-Smith & O’Brien, Chap. 26 Hospital and Pediatric Rehabilitation
3. Case-Smith & O’Brien, Chap. 15 Feeding Intervention
4. Case-Smith & O’Brien, Chap 25, Service for Children with Visual or Hearing Impairments (744-765)
I. REFERRAL
Identify if addressed in readings or case discussions Questions with bulleted answers
CBD
Clark & Chandler (Chapter 38) What are the implications of an acquired brain injury on a child?
Physical function (e.g. weakness in upper and lower extremity , poor balance, poor coordination, poor mobility) levels of fatigue (they can become tired out more easily, both mentally and physically) cognitive skills (e.g. problems with attention and concentration, difficulty in planning and organisation)
Clinical Review: Traumatic Brain Injury (2017)
https://www.ebscohost.com/assets-sample-content/RRC_TBI_Gait_Training_CR.pdf
CBD What are some of the precautions / contraindications for an acquired brain injury?
Concurrent injuries
● Fractures with or without external fixators –Ensure that weight-bearing restrictions are being adhered to during examination and treatment
● Ensure that prescribed braces are used properly
Other neurologic compromise (e.g., follow seizure precautions for patients with posttraumatic seizures)
Follow physician’s precautions and contraindications specific to gastrointestinal, genitourinary, dermatologic (e.g., open wounds), and cardiovascular injuries
Respiratory compromise is a precaution
● Ventilator status may contraindicate gait training
Specific Contraindications/precautions to examination and Contraindications/precautions
● Risk for falls; follow facility protocols for fall prevention and post fall-prevention instructions at bedside, if inpatient. Ensure that patients and family/caregivers are aware of the potential for falls and educated about fall-prevention strategies; feeding/swallowing precautions (aspiration problems); Discharge criteria should include independence with fall-prevention strategies
● Clinicians should follow the guidelines of their clinic/hospital and what is ordered by the patient’s physician. The summary presented below is meant to serve as a guide, not to replace orders from a physician or a clinic’s specific protocols
CBD
How does a diagnosis of an acquired brain injury impact occupational performance?
Many if not all areas of occupational performance are affected in a child with TBI
Specific areas that are affected are: ADLs, education, play, social participation and leisure
● Specific problems Isabel and her families may experience are: trouble with feeding, personality changes, self care skills, such as dressing and fine motor and gross motor skills
CBD
The Children Trust for Children with brain injury (2020)
https://www.thechildrenstrust.org.uk/brain-injury-information/info-and-advice/parents-and-carers/looking-after-yourselves
What is the potential impact on the family of a child with a brain injury?
● Different emotions regarding the news
● Families’ needs may change at different stages of the ‘journey’ of ABI.
● Difficulties with their child’s behaviour
● Anxieties about how siblings are coping with the changes
o Denial
o Anger
o Fear
o Guilt
● Stress in relationships
● Stress between family members
● Financial strain.
II. EVALUATION: Occupational Performance Analysis
Identify if addressed in readings or case discussions Questions with bulleted answers
What are some of the developmental & occupational performance expectations for a Isabel in relation to OT (see areas of occupation below)
CBD
Unitypoint (2020):
https://www.unitypoint.org/cedarrapids/filesimages/Services/Physical%20Medicine/Witwer%20OT%20Developmental%20Milestones.pdf
Children’s Hospital of Richmond (2020):
https://www.chrichmond.org/therapy-services/occupational-therapy/developmental-milestones/gross-motor-skills-birth-to-5-years
The therapy spot (2020):
4 year old (developmental & occupational performance)?
● The child should speak fluently in complex sentences with an expanded vocabulary.
● The child is expected to concentrate for longer durations and interact with the environment by virtue of playing with toys.
● Stable running with ability to dodge other objects.
● Ability to color within a line
● Naps regularly
● Cuts out a circle
● Zips jacket
● Copies intersecting lines, diagonal lines, simple shapes some letters and numbers
● Balances on one foot for 10 seconds or longer
● Can run, jump and climb well, is beginning to skip
● Hops proficiently on one foot
● Catches a ball reliably
● Can ride a tricycle
● Begins somersaults
5 years old (developmental & occupational performance)?
● Prints name from memory
● Colors within the lines
● Draws a person with at least 6 or more different parts
● Cuts out a square
● Dynamic tripod grasp (held with thumb, index and middle fingers with ring and pinky curled into palm; movement of writing utensil comes from the fingertips)
● Throws at a target 5 feet away and hits target fairly consistently
● Can skip on alternate feet and jump rope
● Beginning to skate and swim
● Climbing well
● Ties and unties knots
● Dresses unsupervised
● Colors inside the lines
● Folds a paper in half accurately
● Copies a diamond shape
CBD
Guidelines for Educating Students With Traumatic Brain Injury/Concussions (2015)
Developmental & occupational performance demands and expectations in the classroom setting.
Students who have experienced a TBI/concussion may have a diverse range of physical, cognitive, behavioral, and social needs. A team effort is required to effectively address and respond to these needs. The student, the family, school personnel, and service providers must collaborate to ensure that the student receives the support necessary to successfully reenter school.
Occupational performance demands and expectations in the classroom setting.
Attention or Alertness
● Falls asleep in class
● Appears to be daydreaming
● Gets focused on one object or subject; cannot transition
● Loses train of thought when talking
Visual Perception skill
● Omits portions of material when reading or copying
● Cannot find items on a shelf or in text
● Skips words or lines when reading
Memory & New Learning
● Cannot recall events of the day or previous day
● Forgets to do or to hand in assignments
● Loses track of time
Speed of Processing
● Takes excessive time to complete assignments, tasks and tests; overloads easily
● Asks questions about topics already discussed
Verbal Expression
● Can be nonverbal
● Uses vague responses or questions
● Has word finding problems
● Takes long pauses
Written Expression
● Unable to write legibly
● Unable to keep up with note taking
● Makes spelling and grammatical errors
Social
● Jokes inappropriately
● Behaves immaturely
● Interrupts others
Behavior & Emotion
● Has verbal outbursts
● Fights
● Curses
● Demonstrates mood swings
Physical
● May have related pain
● May have impairments in any of the following:
○ Speech
○ Gait
○ Coordination & Dexterity
○ Respiration
○ Feeding
○ Vision
Areas of Occupation / Co-occupation addressed by the OTPF-3 Table 1 (p. S19-21)
ADL: bathing / showering, toileting and toilet hygiene, dressing, swallowing/eating, feeding, functional mobility, personal device care, personal hygiene & grooming, sexual activity.
IADL: care of others, care of pets, child rearing, communication management, driving and community mobility, financial management, health management & maintenance, home establishment & management, meal preparation & cleanup, religious and spiritual activities and expression, safety and emergency maintenance, shopping.
Rest & Sleep: rest, sleep preparation, sleep participation
Education: formal educational participation, informal personal educational needs or interests exploration, informal personal education participation.
Work: employment interests & pursuits, employment seeking & acquisition, job performance, retirement preparation & adjustment, volunteer exploration, volunteer participation.
Play: play exploration, play participation.
Leisure: leisure exploration, leisure participation.
Social participation: community, family, peer / friend.
When filling out this next section consider the strengths / challenges presented by Isabel and those presented by her family or care giver:
III. Occupational Performance Supports & Hindrances (Domains)
Domain Key Supports Key Hindrance
List or Indicate N/A List or Indicate N/A
Client Factors – Table 2 OTPF-3 (p. S 22-24)
Values / beliefs / spirituality
Body functions: mental (specific / global); sensory; neuromuscular & movement-related; muscle functions; movement functions; cardio / hemato / immuno / respir; voice / speech; digest / metab / endocr; genito / repro; skin & related structure functions; body structures
● Early diagnosis at 5years followed with early interventions like treatments and rehabilitation.
● Support system from the mother, family and relatives, school authorities and support groups. ● Limited reference to food, clothing, play activities and social interactions from friends and age-mates.
● Withdrawal of some support groups in the system.
● Unstable support from relatives affects the support offered.
Performance Skills Table 3 OTPF-3 (p. S 25-26)
Motor Skills; process skills; social interaction skills ● Isabel was a typical kindergrander prior to her fall, and was not reported to have any delays or challenges in the areas of motor skills, process skills, or social interaction skills.
● The family has contact with the school to carry over Isabel’s performance skills at home setting after discharge from rehabilitation center. ● Challenge in focused learning for a longer duration of time.
● Decreased safety skills.
● Tiredness, dizziness and lightheadedness when engaged to cumbersome tasks.
● Communication skills
● Socialization with family members and friends.
Performance patterns Tables 4 OTPF-3 (p. S 27)
Person: Habits, routines, rituals, roles.
Group or population : routines, rituals, roles ● Isabel was a typical kindergartener prior to her fall.
● Isabel is supported by her family and has friends that she plays with. ● Lack of play development.
● Irregular patterns of doing things as the brain has not fully developed to coordinate to activities like before the accident.
● Significant difficulties transitioning from one thing to another.
● Avoids vigorous activities due to unpleasant stimuli and pain triggers in the head.
Context & Environment Table 5 OTPF-3 (p. S 28)
Contexts: cultural, personal, temporal, virtual;
Environments: physical and social ● Isabel is cared for by her maternal grandmother and has some experience as a nursing student.
● Isabel’s home was deemed to be organized, accepting, and responsive to her needs according to the HOME assessment.
● Family support helps Isabel to recuperate faster and allow development of skills.
● Parents are involved with helping initiatives and groups willing to help Isabel recover completely.
● The family seeks educational opportunities for Isabel to ensure she keeps up. ● Shelly (Isabel’s mother) is currently away serving in the armed forces.
● Isabel does not have as many books, toys, or music available to her currently to support her
● Isabel does not currently have a lot of interactive play in the home.
Activity & Occupational Demands Table 7 OTPF-3 (p.S 32)
Relevance and importance to client, objects use and their properties, space / social demands, sequence / timing, required actions / performance skills / required body functions / required body structures;
● The family engages Isabel in simple tasks to get the brain to coordinate to different things and improve.
● The family engages her in school programs and school setting programs to get her into developing habits and desires without straining to fit in. ● Some family members may not understand her condition and tend to imitate her slow pace to doing things which in turn triggers negative emotional response in contrast to what is required.
● Required functions impaired by the damage, reducing performance skills.
● Decreased ability to engage in vigorous activities like before, dancing.
IV. EVALUATION PROCESS: What assessment(s) might you choose to use with Isabel?
WeeFIM Measures degree of disability experienced in childr. Six areas are assessed:
– Self-care
– Sphincter control
– Mobility
– Locomotion
– Communication
– Social participation – Completed by healthcare professional observation
– 15 minutes
– Age range: 6 mos.-7 yrs.
Beery-Buktenica Developmental Test of Visual-Motor Integration The Beery VMI helps assess the extent to which individuals can integrate their visual perception and motor coordination abilities. Administration: 10-15 minutes
Age range: 2 years and up
Qualification level: C
The Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT2) The Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT2) delivers the most precise and comprehensive measure of motor skills, both gross and fine.
I. Fine Motor Precision
II. Fine Motor Integration
III. Manual Dexterity
IV. Bilateral Coordination
V. Balance
VI. Running Speed and Agility
VII. Upper-Limb Coordination
VIII. Strength Age range: 4:0-21:11
● Short Form – 15-20 minutes,
● Complete Form – 45-60 minutes,
● Fine Motor Form – 25-30 minutes,
● Gross Motor Form 25-30 minutes
Qualification level: B
Peabody Developmental Motor Scales Second Edition (PDMS-2) Peabody Developmental Motor Scales | Second Edition (PDMS-2) combines in-depth assessment with training or remediation of gross and fine motor skills of children from birth through 5 years.
Age range: Birth through age 5
Administration: 20-30 minutes for each motor-related subtest or 45-60 minutes for entire assessment
Qualification level: B
Behavior Rating Inventory of Executive Function
Use to assess executive function behaviors in the school and home environments Age range: 5 through 18 years for BRIEF
Admin Time: 10 to 15 minutes for BRIEF
Qualification level: C
IX. INTERVENTION: Considerations
1. How would the health care model for Isabel’s case differ across the following systems and how will it impact your role as the OT in each practice setting:
● Hospital setting: Occupational therapists are involved in reviewing medical records, evaluating clinical services and clients outcomes like; ADLs, IADLs, discharge placement, QOL, well being and documentation throughout the hospital setting (Dudgeon, 2020). In the Case-Smith’s textbook the Author Dudgeon (2020) discusses persistent and wide-spread deficits with motor function, cognition, language, behavior and academics among children with acquired brain injury. OTs use occupation centered practice models to address the child’s function, establish interventions, develop goals while collaborating with the child, family and other care providers.
o ICU: OT services are initiated in this hospital setting to prevent secondary complications from immobility and restore/maintain homeostasis. The occupations at this stage that OT will focus on will be sleep and rest which is crucial to healing. Interventions in ICU include: prevention of contractures, pressure sores and pain, establishing safety strategies (movement restrictions, protective medical equipment/helmet), monitoring vital signs during interventions, improving ROM/soft tissue mobilization/orthoses/positioning (preparatory methods), collaboration with nursing staff, family and other service providers, facilitate prerequisites to play, promote learning, cognition and early functional mobility and facilitate the caregivers role as the child’s provider. (Sheehan, Sharp & Warnken, 2020, p. 821-824).
o Acute Care: Dudgeon (2020, pp. 823-826) describes interventions in this setting having the ability for the child to begin to interact with their environment. The therapists will continue to use preparatory methods (ROM/soft tissue mobilization/orthoses/positioning), promote homeostasis, prevent secondary outcomes, safety strategies (movement restrictions, protective medical equipment/helmet). The OT will monitor vital signs, body language and facilitate motor function (trunk control), assists the child in transitioning to different positions (upright, edge of bed sitting, bed to wheelchair transfers (vice versa). The ability to resume these functions may take time as it will depend on Isabel’s tolerance to engage in self-care, hygiene and feeding. Assessments related to how Isabel interacts with the environment (localized touch, blink to threat, visually track, visually track, reactions to smells or tastes).
Purposeful activities and occupation based interventions include things like: ability to perceive environmental stimuli (visually tracking, initiating UE movements, reaching for object with gravity eliminated/ lessened, side lying for interventions- grading up to reaching against gravity, increasing distance of object they reach for, practice of trunk control). In this setting neuromuscular re-education is emphasized through active assist arm/hand movement, sensorimotor interventions and supports/adaptations/modifications for restoration of motor functions (Sheehan, Sharp & Warnken, 2020, pp. 824-826).
Continuing to provide information/education on Isabel’s care and rehabilitation will need to be restated in all stages and will depend on caregiver’s readiness to assist in these areas. Focus for education includes the environmental stimuli, child’s level of alertness, ability for child to participate in tasks that are functional as well as education of motor learning through enforcing repetition of the task.
o Inpatient rehabilitation: Children with traumatic brain injury demonstrate improved functional gains most notably with mobility, social abilities and self care (Dudgeon, 2020, p. 684). These improvements are seen among all ages of children who experienced an acquired brain injury. Occupational therapists would work within all these functional areas.
Education, training and demonstration of mobility techniques like transfers, positioning and use of mobility devices as well as safety recommendations and accommodations that will be used with Isabel and her family/caretakers. This area is heavily impacted with Isabel and will take time for the family to develop strategies, adaptations and modifications to help assist them with Isabel in this area. This may require additional support for the family and Isabel to help them cope and accept Isabel’s deficits with mobility.
Social opportunities will be encouraged and supported by occupational therapy. This could include working in groups, among peers who have similar diagnoses, making memory books of friends and family that are of importance to Isabel. Virtual interactions are important for socialization with mom and other family or friends who can not be present for Isabel in this setting. Especially considering the times of covid-19 and the decreased access of social opportunities due to social distancing and CDC recommendations that prevents the spread during this particular pandemic. We can create and promote socialization using assistive technology and build those skills through interventions like a memory book to help Isabel recall and point out her friends and family.
Self care like bathing, dressing, feeding, functional mobility and toileting are heavily emphasized in this setting (Sheehan, Sharp & Warnken, 2020, pp. 825-826). Creating interventions for ADLs that are play based or enjoyable and related to the interests of Isabel. Self care will include education, training and demonstration for Isabel, the grandmother, the mother (virtually) and for the remaining older children in the home who can provide support for Isabel. Safety for self care will be emphasized in this setting and will occur during the education phase of interventions for self-care. The areas of mobility, socialization and self-care will all include aspects of cognition and how to adapt and modify all these areas to address deficits with planning, memory, attention and multitasking (beyond one step commands, although that will happen later in a different rehabilitation setting based on the recovery process).
The occupational therapists will contribute to the discharge process at the inpatient setting when Isabel is ready to transition home and to the pediatric outpatient rehabilitation setting.
o Outpatient rehabilitation: Authors Sheehan, Sharp & Warnken (2020, pp. 830-834) in the Case-Smith’s text discusses this stage of rehabilitation addressing Isabel and her family’s needs once they have returned to the child’s natural environment (home and community). Assessments will be conducted to determine baseline functions for the purpose of developing outcomes for outpatient rehabilitation. These measurements will be re-administered regularly to assess efficacy of interventions, her progress and to update methods for her intervention plan. The therapist will continue to use the preparatory methods as listed in other settings.
Purposeful activities and occupation based interventions are used to address neuromuscular re-education (such as constraint induced therapy/strengthening) while facilitating age appropriate participation of self care tasks at home, school or leisure activities. The OT will collaborate with the family to develop client centered goals for short and long term objectives. Cognitive retraining to restore process planning/memory or to develop cognitive compensatory strategies. School re-entry is also a focus in outpatient rehabilitation. This could include using in home instruction, communicating with the school about the challenges or strengths of the child post injury, collaborating with the school to develop accomodations for the child to perform optimally and promote a consistent approach to the needs or expectations of the child in the school setting.
● Home Care services: Home care services provide access and integration for Isabel within her home and community. Home care also explains how and when the child engages in ADLs, play, work and participate in tasks based on their preferred routines and habits in their natural environment. It is crucial for OTs to transition Isabel from the hospital setting to home and then to school. Without exceptional transition plans the child may experience low expectations and outcomes. Safety in the home setting will include Isabel and all members of the household including virtual sessions for the mother who is deployed. Education and training for ADLs, performance skills, positioning, motor function, mobility and cognitive retraining within the home setting will provide stronger carry over in other settings like at school and other community settings (Cleary & Persch, 2020, p. 664).
● School-based services: Author Galvin in Best Practices for Occupational Therapy in Schools (2019, pp. 314-318) describes school based services for children with acquired brain injuries. Services typically begin when the child is still in the hospital setting and requires communication between teams at both the hospital and school. Once in the school setting the school OT will evaluate to identify strengths and needs, assess academic performance, assess occupation-based performance, assess participation and performance skills, provide effective interventions for performance skills, develop occupation based and school based interventions while incorporating task modifications.
The initial focus will be on Isabel’s ability to interact with peers and manage routines of the classroom and school then progress to academic engagement. Due to Isabel’s motor and mobility impairments there will need to be planning that involves accommodations for her to access the environment before she returns to school. The school OT will help provide analysis of the school environment that Isabel’s hospital and school teams should prepare for. Due to the cognitive challenges the school OT will consider times and places that Isabel can rest and get away from the noise and overstimulation of the classroom setting. The school OT will also address loss of concentration, increased distractibility, impaired processing of information and emotional/behavioral responses that can impact Isabel’s ability to participate in the school and classroom setting.
2. Implications these settings have for practice? (i.e. time frame, reimbursement, focus, team interactions etc): (Dudgeon, 2020, p. 684)
Reimbursement is supplied by private insurance or a combination of Medicaid, state programs or in some instances Medicare. OT is a skilled service that is reimbursed at inpatient hospitals, medical rehabilitation units, home health care and outpatient services. Medicaid coverage is different from state to state and some areas may be free of charge but depend on local and national service options. Home based services are reimbursed through Home and Community Based Services Final Settings Rule (HCBS) that determines Medicaid funds with the goal of fully integrating the disabled child within their local community.
Third party payers and other agencies attempt to control costs through limiting length of stay, transferring to skilled nursing facilities, home care, outpatient services and school-based services. A case manager will work with Isabel’s family to determine funding rules, regulations to coordinate care and services available. Billing is based on the Healthcare Common Procedure Coding System (HCPCS) using American Medical Association’s Current Procedural Terminology (CPT codes). OT’s should be informed and cautious of payment limitations when providing interventions and treatment plans.
Length of stay at the children’s hospital can vary between a few days, to a few weeks and sometimes as long as a few months.
3. How would you envision the OT/OTA partnership in the delivery of OT services to Isabel?
When in the hospital setting, the OT/OTA parenship will consist of evaluations and goals completed by the OT. The OTA can offer some insight when creating goals for Isabel, but ultimately the goals are formulated by the OT. The interventions can be carried out by either the OT or OTA. In Isabel’s case, she is being treated in the hospital setting by an OTA named Jamel, who is administering the intervention sessions. Lastly, the OT is responsible for the discharge process for OT services from the hospital setting.
4. Which theories or frames of reference would you use to guide your intervention? (Consider the setting of practice; home, hospital or school)
When working with Isabel in the hospital setting, the following frames of reference may be applied: rehabilitative/biomechanical, and sensory integration.
When working with Isabel in the home or school setting, the following frames of reference may be applied: rehabilitative/biomechanical, cognitive, sensory integration, behavioral, cognitive-behavioral.
5. Are there distinguishing characteristics between the prognosis of a child or an adult with ABI?
Distinguishing characteristics include deficits that primarily impact mobility, self care activities, strength, ROM, vision/visual motor, social and cognitive abilities. These deficits will require education, training, safety strategies and demonstration of tasks that may include modifications and adaptations. The prognosis of an ABI for child or adult can vary but overall depends on the specific contexts of the individual, their environment and support. Although the impairments for Isabel are extensive the focus of interventions should include the above recommendations in all settings, to promote the best outcomes for her prognosis.
Intervention: Goals /Approaches/Types
Goal or outcome Approach Table 8 OTPF-3 (p. S 33)* Types Table 6 OTPF-3 (p. S 29-31)/Methods/ Activities
Isabel will improve transitioning skills when transitioning between activities or tasks. Establish A visual schedule (with picture cards) can be used to help Isabel to be aware of her daily activities, and to know what activity or task will come next. To actively engage her in using the visual schedule, she can add the activity pictures to her schedule, and then remove a picture of the activity from the schedule once she has completed it.
Isabel will tolerate 10 minutes of an activity with verbal cues for attention. Restore Isabel will increase ability to tend to tasks over time by chunking tasks and completing one part at a time and slowly increasing load. Eventually, we want Isabel to be able to work on a task for ten minutes even with verbal cues.
Isabel will improve sequencing during self care activities such as feeding, dressing, and grooming with the use of visual cues and supports. Modify Visual cues such as color coding, picture cards, and stickers can be used to help Isabel with tasks that require multiple steps. A sign in the bathroom with pictures and step-by-step directions (easy to understand) can help improve routines like teeth brushing, washing face, bathing, toileting, etc.
Isabel will improve visual motor skills Restore There are several areas that encompass visual motor skills. When working with Isabel, we may work on visual motor skills such as scanning. An intervention we might use to help improve visual scanning skill could be playing a card matching game with simple pictures. This intervention would not only work on scanning, but it would also work on memory skills, such as short-term memory and recall. To add another element to this intervention, we could also be able to identify the image on each card she picks up, which would also work on her memory recall skills.
Isabel will improve memory skills Restore As previously mentioned above, a card matching game can help to develop memory skills. Another intervention we can use to help increase Isabel’s memory skills is the magic cup game. We can use 3 different colored cups and put a small object under one of the cups. Isabel will be asked to remember which cup the object was placed under. This activity will help to work on short-term memory. This activity will also work on some visual skills such as tracking.
*Table 8 Create/promote, establish/ restore, maintain, modify, prevent.
*Table 6 Occupations and activities, preparatory methods, education and training, advocacy, group interventions.
6. TRANSITIONS / DISCHARGE / OUTCOMES
1. What transitions do you see Isabel experiencing over the next year?
Isabel will have improved her skills to attend school and extracurricular activities. She will have gathered her confidence and overcome the incident.
2. What do you think will be the goals / emphasis of OT for Isabel:
. . . during elementary school?
❏ To communicate needs effectively to peers and adults
❏ To be able to self-regulate
❏ To be able to continue working on fine and gross motor skills.
❏ To master fine motor skills like cutting with scissors and printing
❏ Independent in self-care skills such as toileting, dressing and eating
❏ To participate in classroom routine independently or with assistance from classroom aid
❏ To participate in extracurricular activities
❏ To engage in group cooperative play
❏ To work with the teacher for training and to establish modifications or adaptations
❏ To maintain safety with the use of adaptive equipment
❏ Strengths based
. . . during junior high?
❏ To maintain safety with the use of adaptive equipment
❏ To develop time management and organization skills
❏ To develop social relationships with peers
❏ To develop self-care skills related to menstruation
❏ To work with the parent to establish a home program regimen
❏ Community participation: access and utilization of public transportation, interacting with volunteers, volunteering, health and wellness promotion
. . . during high school?
❏ To maintain safety with the use of adaptive equipment
❏ To master self-care skills related to menstruation
❏ To improve time management and organizational skills
❏ To develop meaningful relationships
❏ Learn a vocational trade; To find productive work
❏ Prepare for work
❏ IADL independence; Community integration: organization of personal, social, vocational competencies to successfully live in the community
3. What would be your anticipated outcomes of your intervention? Use components from Table 9 OTPF-3 listed below
● Improvement of occupational performance in ADLs, specifically self-care, education, social participation, play, rest and sleep
● Prevention of future injury
● Improvement of physical, mental, social emotional and overall health and wellness
● Overall improvement of quality of life
● Improvement in participation in school occupations and activities
● Improvement in role competency as a daughter, student, peer
● Improved overall well-being
● Occupational Justice will be ensured through various opportunities and supports placed in home environment as well as classroom
4. Recommended referrals for follow up:
a. Child Life Specialist
b. Support group for Isabel’s mother, grandmother and family
References
American Occupational Therapy Association, (2014). Occupational therapy practice framework: Domain & process, 3rd ed. American Journal of Occupational Therapy, 68, S 1- S 51.
Cleary, D., Persch, A., (2020) Transition Services. In J.C. O’Brien & H. Kuhaneck (Eds.), Case-Smith’s Occupational Therapy for Children & Adolescents (pp. 659-679). Saint Louis, MO: Mosby/Elsevier.
Dudgeon, B.J., (2020) Hospital and pediatric rehabilitation services. In J.C. O’Brien & H. Kuhaneck (Eds.), Case-Smith’s Occupational Therapy for Children & Adolescents (pp. 680-701). Saint Louis, MO: Mosby/Elsevier.
Galvin, J., (2019) Best practices in supporting students traumatic brain injury. Clark, G.F., Rioux, J.E., Chandler B.E. (Eds), Best Practice for Occupational Therapy in Schools (pp. 313-319) Bethesda, MD : AOTA Press/The American Occupational Therapy Association, Inc.
Palmer, E., & VanderKool, S. (2018, January 5). Traumatic Brain Injury: Gait Training. Retrieved from https://www.ebscohost.com/assets-sample-content/RRC_TBI_Gait_Training_CR.pdf
Sheehan, A., Sharp, P., Warnken, E., (2020) Trauma-induced conditions. In J.C. O’Brien & H. Kuhaneck (Eds.), Case-Smith’s Occupational Therapy for Children & Adolescents (pp. 814-839). Saint Louis, MO: Mosby/Elsevier.
Thechildrenstrust. (n.d.). Looking after yourselves. Retrieved November 01, 2020, from https://www.thechildrenstrust.org.uk/brain-injury-information/info-and-advice/parents-and-carers/looking-after-yourselves
Texas Education Agency Education Service Center, R. (2015, August). Guidelines for Education Students With Traumatic Brain Injury (TBI)/ Concussions. Retrieved from Witwer Children’s Therapy. (n.d.). Occupational Therapy Developmental Milestones. Retrieved November 01, 2020, from https://www.unitypoint.org/cedarrapids/filesimages/Services/Physical%20Medicine/Witwer%20OT%20Developmental%20Milestones.pdf
Witwer Children’s Therapy. (n.d.). Occupational Therapy Developmental Milestones. Retrieved November 01, 2020, from https://www.unitypoint.org/cedarrapids/filesimages/Services/Physical%20Medicine/Witwer%20OT%20Developmental%20Milestones.pdf
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Our customer support team is available 24/7 to provide you with any necessary assistance when you need it. You can contact us at any time, day or night, via email or through the live chat button.
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How it works?
Follow these simple steps to get your paper done
Place your order
Fill in the order form and provide all details of your assignment.
Proceed with the payment
Choose the payment system that suits you most.
Receive the final file
Once your paper is ready, we will email it to you.
Our Services
We provide our customers with the best experience in the academic and business writing field.
Pricing
We provide the best quality of service at affordable prices. We also allow our clients to make partial payments for their orders. You can also contact our customer support team in case you need to discuss a different payment plan.
Communication
Admission help & Client-Writer Contact
We realize that sometimes clarification is necessary to ensure that quality work is done. Therefore, we provide a button for clients and writers to communicate in case some clarification is needed.
Deadlines
Paper Submission
We ensure that we submit all papers ahead of their respective deadlines. This allows you to go through the documents and request any revision, corrections, or polishing before the paper is due.
Reviews
Customer Feedback
We encourage customer feedback, positive or negative. We can identify the various areas that we need to improve to provide even better services through your feedback. Please feel free to give us feedback.