2. 2
MITCH
According to the Case Study (2014), Mitch is an 18-year-old who has been diagnosed
with spastic quadriplegia CP. He lives with his mother and two older brothers in an apartment
on the first floor. His cognitive skills are at the level of a four- year- old child. He attends school
and is in a special needs classroom with other children who have similar intellectual disabilities.
His teachers are concerned about his ability to indicate his basic needs and choices in the
classroom. Mitch has severe impairments in motor skills, judgment, impulse control and
processing information. He requires one to one assistance from teachers while participating in
classroom activities and is dependent in all self-care tasks. Furthermore, due to high tone in his
bilateral UE’s he can only reach three inches in front of his body. He does have use of his index
finger to point and type while using an iPad or a computer when doing activities in the
classroom. Also he is completely dependent in the wheelchair for mobility but can bear some
weight on his feet to assist with squat pivot transfers from wheelchair to a chair. Lastly, due to
poor cognitive skills and decreased safety awareness, he requires frequent cuing for participating
in activities safely (Case Study, 2014).
According to the Mayo Clinic (2014), Spastic Quadriplegia (CP) means that all four
quadrants of the body are affected, by extensive brain damage or by congenital malformations in
the brain. Many factors, including maternal and fetal infections and exposure to toxins, can cause
the unborn baby’s brain to develop abnormally. However, the damage to the brain can cause
paralysis, spasticity and loss of movement and posture. Therefore, damage to the brain can affect
and impair vision, hearing, and results Intellectual disabilities. Also, damage can cause seizures,
abnormal pain, oral diseases and urinary incontinence. Furthermore, CP can affect sensation,
cognition, communication, perception and motor control of the body (Case Study, 2014).
3. 3
MITCH
According to Baker, Harvey, & Martin, (2014) Children with CP can have primary
impairments as a result of a lesion in the central nervous system (CNS). The damage to the CNS
can happen at birth or after and can cause the child to develop an immature brain which prevents
the progression of development. Furthermore, Children with CP will have hypertonia, muscle
imbalance and poor body alignment which as a result can lead to secondary impairments like
muscle contractures (Case Study, 2014). Children with CP have problems with coordinated
movements of the body which are needed for everyday activities and skills. However, due to
issues with movement patterns with UE and LE it can impact fine motor, gross motor, language
and communication skills. Chau and Leng (2010) indicated that children with spastic
quadriplegic cerebral palsy have decreased use of UE and LE bilateral extremities which make it
difficult to use hands for writing, drawing and other functional activities. However, children can
use facial expression and gestures to communicate their wants and desires. Also children can use
opening and closing of the mouth, protruding the tongue and blinking of the eyes to
communicate (Chau and Leng, 2014).
4. 4
MITCH
References
Case, Study (2014).
Cerebral palsy. (2014). Mayo Clinic. Retrieved from htt://mayoclinic.org.
Leung, B., & Chau, T. (2010). A multiple camera tongue switch for a child with severe spastic
quadriplegic cerebral palsy. Disability & Rehabilitation: Assistive Technology, 5(1), 58-
68. doi:10.3109/17483100903254561
Martin, L., Baker, R., & Harvey, A. (2010). A systematic review of common physiotherapy
interventions in school-aged children with cerebral palsy. Physical & Occupational
Therapy In Pediatrics, 30(4), 294-312. doi:10.3109/01942638.2010.500581
5. 5
MITCH
Strengths
• Age appropriate school environment.
• Appropriate home living environment (ADA).
• He can use his index finger in order to type on key board.
• He can reach up to at least 3 inches in front of his body.
• He can bear weight on his feet to assist with squat transfers.
Deficits
↓ ADL’s
↓ ROM
↓ Memory
↓ Cognitive
↓ Transfers
↓ Strength
↓ Endurance
↓ Postural Alignment
↓Motor Reflexes
↓Perception
6. 6
MITCH
Deficits LTGs
(3)
STGs
(2)
Treatments
(Ex, Preparatory
or purposeful)
Rationales
(Biomechanical or
Developmental)
↓ROM Pt. will
participate in UE
& LE bi-lateral
exercises for 1
hour @ Total
assist in 9 mo.
To educate
family on UE
and LE bi-lateral
movements of all
limbs to ↑ ROM
and prevent joint
deformities.
(Biomechanical)
↓Transfers Pt. will be able
to squat pivot for
wheelchair ↔
chair@ Mod A
in 9 mo.
To educate and
demonstrate to
Pt. family how to
safety perform
transfers from
wheelchair to
chair or
commode & bed.
(Biomechanical)
↓Postural
Alignment
Pt. will be able
to maintain
upright trunk
postural
alignment for 30
min in his
standard desk
chair @ Max A
in 9 mo.
To instruct Pt.
family on proper
positioning and
postural
alignment of
UE’s, LE’s to ↓
joint, bone and
spine
contractures
during sitting or
wheelchair
mobility. (Motor
control)
↓ Cognitive Pt. will
participate in
computer
software games
to↑ memory for
30 min while
sitting in
wheelchair @
Total assist for
UE reach in 9
Therapist will
demonstrate to
Pt. & family on
how to use an
IPad or computer
and different
software.
(Developmental)
