Wednesday, April 3, 2019
Left Sided Spastic Hemiplegia | Case Study
Left Sided convulsive Hemiplegia Case Study hinderance AnalysisBackgroundJane Walters is a five year old girlfriend and has a diagnosis of left sided competentful hemiplegia, a form of intellectual Palsy. Jane has ii older sisters who attend horse travel lessons at their local anesthetic st equal to(p)s. Jane has recently expressed an interest in joining them to her p arents. However her parents are worried that be give of her diagnosis she pass on not be open to bear on up with her siblings. Jane is very aware of her condition, and has recently lost confidence, asking her parents why she is different from some early(a) chelaren her age.Diagnosis Cerebral Palsy (CP) refers to non-progressive conditions characterised by impaired voluntary movement or posture, and resulting from prenatal waxmental malformations or postnatal CNS modify (Reed, 2013, pp. 38-47).According to the National Institute of neurological Dis crops and box (2008), it is highly the likes ofly that a child with CP will have other medical dis sound outs such as cognitive impairments, seizures, delayed growth and development. Spastic syndromes such as Janes occur in more(prenominal) than 70 percent of CP cases.Spastic hemiplegia is a type of CP that typically affects the ashes down adept side. The spasticity creates a state of resistance against any grip of motion this resistance ultimately increases with increasing speed of that movement (Reed, 2013, pp. 38-47). Children like Jane with spastic hemiplegia will generally walk later than other children and will tend to walk on their tiptoes because often they will contract from high heel tendons. Often the arm and leg on the childs affected side are shorter and thinner (National Institute of Neurological Disorders and Stroke 2008).Impact of Right Hemisphere Brain Damage- Jane has left sided spastic hemiplegia, indicating that damage to the wag has occurred in the castigate hemisphere. The primary cause of CP is damage to whi te matter of the brain this is often caused by abnormal brain development. This stick out be caused by a bleed on the brain, or by a lack of oxygen to the brain, generally caused by a difficult birth (NINDS 2008).It was important to consider additional complications related to right sided brain damage to ensure an awareness of Janes level of running(a) ability be it physically, cognitively or behaviourally. Those that may relate to Janes case are listed below in t equal one. dodge one How damage to the Right Hemisphere whoremonger affect function and the line of descent of horse riding.Janes diagnosis would mean that she would need input from a Multi-Disciplinary Team (MDT). Given her age this would come from a community pediatric teams (CPT). The team will work closely with the childrens team in companionable services and primary care. The team will provide a range of discernments and preventatives to young people and their families. In Janes MDT team at that place will b e a range of different members such as Physiotherapists, Paediatricians, employmental Therapists, Social Workers, Speech and Language Therapists and Educational Psychologists (NHS 2012). According to the deterrent Act Jane is entitled to an independent assessment of her individual needs. The act is intentional to promote the objet darticipation of people with disabilities in society by musical accompaniment the provision of disability specialised services (NCSE 2011).A standardised reference was used, this was to concede the OT staff to observe how Jane and her family interact with each other do it easier to obtain information, identify strengths needs and final stages as well as engender an hindrance plan and en competent goal scaling Due to Janes condition she would have already been known to brotherly services and the MDT, as she had already received physiotherapy to aid with muscle stiffness and advance core strength.Therefore upon the OT department accepting Janes referral, an initial assessment was carried out in her home environment with mother and father bear witness (An and Palisano 2013). Collaboration between professional ataff and Janes family is a vital fixings in family-centred services, this is considered best practice in early intervention and pediatric rehabilitation (An and Palisano 2013). Collaboration between the two parties is essential for setting pregnant and achiev subject goals for a child. Planning and implementing interventions must be able to fit within the context of family life. (An and Palisano 2013)The following strengths and weaknesses were identified during the initial assessment.Table two Janes strengths and limitationsDuring the initial assessment Janes mother expressed concerns to the highest degree her core strength and whether this would affect Janes ability to ride. In order to address these concerns a Sitting Assessment for Children with Neuromotor Dysfunction (SACND) assessment was completed this is a clinical instrument to assess static and combat-ready postural control in postureting in children with neuromotor dysfunction (Reid 1995)This standardised assessment was used to ascertain how Janes CP affects her ability to sit easily and undertake. This skill will be essential if Jane wants to be able to sit upon a horse comfortably and be able to concentrate for the entire session. The SACND measures quality of independent sitting ability across iv areas proximal stability, postural tone, postural alignment, and balance (Knox 2002). The assessment revealed that Jane has weak f flake trunk control and so will be issued a especially adapted chair which will enable her to sit more comfortably and for longer periods of time compared to standard chair.After both assessments were completed an intervention plan was made with input from Jane, her family and the occupational therapist. Jane identified her long barrier goal of horse riding and to achieve this long edge goal, 4 short term aims were set to serve as recovery milestones (Duncan 2011).Table three Janes long term aim and short term goals.Occupational therapists are not required to use a specific functional outcome assessment tool in the selection of their assessments. When a professional is selecting an assessment, they must rely on their clinical and professional psyche (Asher 2007). Therapists need to reflect on what it is that they intend to achieve with the assessment, and if this is managed the assessment can be classed as a victor. One way of evaluating an assessment is to heart at the mathematical process of patients on an individual assessment task (Steultjens 2005). And will be able to question how well did the assessment relate to the goal setting and objectives for the patient (Duncan 2011).As part of the Model of Human Occupation horse riding will play a central part in Janes habituation. Not only will this establish a routine, it can be something that Jane can take pride in (Ki elhofner and Forsyth 2011). ride will help Jane build upon her self-confidence, having that natural effronterying relationship with a horse that shows no judgment and does not understand that she is different (Horseback UK).The major(ip) concern that Janes mother acts is the worry that she will not be able to keep up with the physical requirements of riding and that this will confuse Janes enthusiasm. This concern will be tackled in goal number quad. Once Jane and her family have a better understanding of hemiplegic cerebral palsy, the OT can begin discussing, through the use of pictures how this may affect her. If Jane has a canonic understanding of her condition it will be easier for her to set more living goals with the OT as she will have a greater awareness of what she is able to do and may struggle with. This will chastend the likelihood adequate distressed when trying to achieve goals her agreed goals, this will hope abundanty reduce mums concerns about the intervent ion plan.Jane feels her parents do not allow her to do as much as she would like to be able to do for fear of ache herself or become too tired. The OT mulish to make to make Jane aware of what fatigue is and may feel like. This would hopefully encourage Jane to let her mum or dad know when she is hint tired. With this information Janes parents can keep a fatigue journal with Ellie.This will provide the OT with some information regarding when Jane feels most tired and how this impacts on her occupations. This can indeed be discussed with Janes parents and the RDA and suitable arrangements can be made regarding fatigue management as to when would be the most give notice time for Jane to have her riding lesson when she has the most energy.Once a principle of fatigue can be established the OT staff will develop strategies to manage Janes fatigue. For example Jane should engage in an activity that she finds reposeful such as reading, colouring or watching television. This can be done after more strenuous activity or in the morning if Jane is known to have a busy afternoon full of physical activities such as a riding lesson. If Jane is able to start out her day with relaxing and more strenuous activities, she will be able to conserve energy for the more strenuous activity of riding and whence last the full hour lesson.This form of intervention uses the Compensatory Approach. The principle tail this approach is adapting to and compensating for a dysfunction rather than just treating the cause of the problem. Which in this is Janes cerebral palsy and her left sided weakness there is more of an emphasis on treating the symptoms (Feaver and Edmans 2006). Additionally, the Compensatory Approach may allow Jane to be able to regain a degree of her independence by compensating where the main cause cannot be treated. In Janes case this is managing and compensating on her weakness and fatigue, and then allowing her to conserve energy in order to complete a riding lesson (Addy 2006).The social approach recognises Jane as a social being who is easily influenced by the people around her. Therefore by using Janes whole family in her therapy and fatigue management, the professionals are integrating Janes social environment into her therapy (Polglase and Treseder 2012).Both interventions also reveal the perception of Jane by her social circle, thereby mitigating Janes fear about her social circle (Polglase and Treseder 2012). Jane has unendingly said that Jane feels her parents do not allow her to do as much as she would like to be able to do for fear of hurting herself or become too tired. The intervention will require Jane to trust her parents and tell them when she is tired instead of retreating from her social circle (Martin 1998).In order to determine if Janes intervention has been a success we first tax it. Evaluation a professionals practice is one of the most important elements in occupational therapy without it, the value of their int ervention diminishes (Lawcett 2007).Evaluation is important as in theory it enables the OT and the customer to see if intervention is affective. However it is vital that the client is willing to be part of the evaluation wait on, because if they are not this could present an incorrect evaluation of effectiveness of treatment (Lawcett 2007).There are four main was a professional can evaluate their intervention process these areUsing up to date outcome measures.Using binding and reliable evidence based outcome measures.Evaluate from view vizor of the service userEvaluate throughout therapy process, at end of intervention(Lawcett 2007).The success of Janes intervention plans can be evaluated by the cultivation Attainment Scale( gasoline) (Kings College London no date).The shove along is a meter technique which consist of individualising a persons outcome indicators (Turner-Stokes 2009). In order to evaluate the intervention the professional must first relieve oneself a list of thorough and complete outcome measures, which will then be given a quantitative value to determine the success of the intervention (Kiresuk and Sherman 1968 Purkiss et al. 2013).Janes goals were based on a realistic visualise of her progress (May-Benson 2012) Janes performance was scaled into five levels, these reflected her actual performance in comparison to her expected outcomes (Kiresuk et al. 1994).Table four Example of GAS goals used from Janes second RDA lesson.A score like this was record for each weekly session over the course of a month and a total was tallied at the end, scoring the intervention with a numerical value. The professional knew it would be vital to give Jane and her control in her treatment in order to motivate an rise (Turner-Stokes 2009), hence it was decided that the GAS goals would be discussed at the end of the session, showing a level of improvement (King et al. 1999) instead of recording it as s pass, fail assessment (Turner-Stokes 2009).