Biomedical Engineering Reference
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hypermetropia. She was born at 41 weeks, distocical birth, and vacuum was applied to
assist with delivery. ZA was born with serious medical complications and an Apgar score
of 1; she was reanimated, incubated, and moved to the pediatric intensive care unit, where
she received neurorehabilitative care for 40 days. She was discharged home to parents,
and therapy services continued through an early childhood intervention (ECI) service pro-
gram. She has received occupational, physical, and speech therapy services through the
ECI program since birth.
11.5.1.2 Current Status
This case will discuss the role of occupational therapy in the delivery of AT for ZA through
the ECI program. The early intervention team's evaluation of ZA's current level of perfor-
mance was discussed with her parents at their annual review plan meeting. The team
used the ICF-CY model to assess her performance; her scores are as follows:
Psychosocial/emotional skills: ZA is an attentive female toddler and motivated to
learn. She has a very supportive family and a good relationship with the health
professionals she has worked with. She is engaged in therapy sessions and appears
to try her best even when she is frustrated. She enjoys social interactions with her
siblings and peers. The speech-language pathologist (SLP) and OT have looked
into various augmentive and alternative communication (AAC) devices and have
tried some basic devices with switch selection. ZA is just learning to make choices
among three items using visual scan.
Cognitive: ZA is able to sustain attention and learns best through visual model/
representation versus kinetic learning because of her physical impairments. She
understands cause and effect and seems to understand basic concepts with use of
adapted toys during play and exploration. She is able to attend to task and sustain
attention.
Visual-perceptual: ZA has hypermetropia (but within physiological age-level) and a
symmetric corneal reflex. She has a sporadic convergence and a latency delay with
visual processing/fixating on target. She currently uses her visual system to scan
items for communication.
Physical: ZA has paralysis in both her upper and lower extremities (complete
motor impairment ICF-CY: S-730-4, 750-4) and relies on primitive reflexes to elicit
motor movement. She has increased tone (hypertonia) and still displays primitive
reflexes. She is able to sit supported in her manual wheelchair with an adapted
seating system and headrest, and the therapists have been working on increasing
her head control. She does use an asymmetrical tonic neck reflex (ATNR) pattern
to reach toward an item, but she is unable to grasp the item because of decreased
functional hand use. She wears resting hand splints at night to facilitate a neu-
tral hand position and decrease contractures. ZA also wears bilateral ankle-foot
orthotics (AFOs) to decrease tone and maintain position to prevent contractures.
She has been able to hit a wheelchair-mounted switch using her ATNR to activate
her adapted toys with a wobble switch. She has decreased head control, but she
does keep her head up when supported with an adapted headrest. The OT and PT
have placed a head switch on her headrest, and she has been successful with using
this to access her toys and computer. She is able to maintain visual fixation when
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