Case Specifc

Question 1

What antenatal CP risk factors are present in Jared’s Case?

Answer 1

• Prematurity
• Low Birth weight (<2.5kg)
• Pregnancy complications

Question 2

Jared rolled at 12mths. What is the normal? Is this a red flag?

Answer 2

Normal 3-4 mths
Red flag: 6 mths (yes)

Question 3

Jared sat at 10mths. What is the normal? Is this a red flag?

Answer 3

Normal: 6 mths
Red flag: 9mths (yes)

Question 4

Jared began cruising at 20mths. What is the normal?

Answer 4

10-11 mths

Question 5

Jared began walking at 24mths. What is the normal? Is this a red flag?

Answer 5

Normal: 12-18mths
Red flag: 18 mths (not attempting to walk without support)

Question 6

Jared is unable to run. What is the normal? Is this a red flag?

Answer 6

Normal: 18mths
Red flag: 2 years

Question 7

Jared is unable to go up/down stairs without significant support. What is the normal? Is this a red flag?

Answer 7

Normal: 24mths
Red flag: 2 years (holding on) or.3 years (independently)

Question 8

What exercise is giving for retained babinski

Answer 8

Brushing integration

Question 9

How would a retained babinski present?

Answer 9

Toe walking
Altered gait
Difficulty with balance

Question 10

What exercise is given for a retained grasp/palmar reflex?

Answer 10

Pincer grip rubber band exercises

Question 11

How would a retained grasp/palmar reflex present?

Answer 11

A weak grasp
Poor fine motor skills
Poor handwriting

Question 12

What exercise given for a retained moro/startle reflex?

Answer 12

Starfish exercise

Question 13

How would a retained moro/startle present?

Answer 13

• Hypersensitive or undersensitive to sensory stimuli

Question 14

What exercise is given for a retained galant reflex?

Answer 14

Snow angel

Question 15

How would a retained galant reflex present?

Answer 15

Delayed bladder control
Intolerance of food textures
Scoliosis
Poor concentration/inability to sit still

Question 16

What exercise is given for a retained rooting reflex?

Answer 16

Brushing integration

Question 17

How would a retained rooting reflex present?

Answer 17

Picky eater ie resistance to some textures
Issues with speech articulation
Thumb sucking

Question 18

What exercise is given for a retained ATNR?

Answer 18

Bear walking while holding a toy between neck and shoulder
Opp fencing posture

Question 19

How would a retained ATNR reflex present?

Answer 19

Abnormal gait
Ear/eye/foot/hand dominance
Poor balance
Difficulty rolling

Question 20

What exercise is given for a retained STNR?

Answer 20

Bear walking on hands and feet instead of crawling on hands and knees.

Question 21

Why prescribe stretching for Jared?

Answer 21

To prevent spasticity and contractures

Question 22

What is the purpose of modular seating?

Answer 22

Support growth of Jared spine’s
Prevent hip dislocation
Provide stability & support to the head/neck which will make swallowing easier and reduce tantrums around mealtime

Question 23

What education will you provide to Jared’s mother?

Answer 23

• Encourage self reliance ie Jared should do as much as possible on his own
• Supportive home environment –> safe spaces for practice eg stable furniture he can use to practice cruising/standing. Toys within reach for independent exploration.
• Ensure he is reviewed periodically so his intervention and goals can be adjusted as needed
• Encourage trial and error + repetitive practice
• Parent support and education groups that may be able to provide additional advice regarding navigating daily challenges
• NDIS funding for adaptive equipment and home modifications
• Environmental modifications eg installing handrails on stairs and steps, using non-slip mats to prevent falls, stools and stable chairs to help with his ADL’s, minimise obstacles that may make it challenging for him to navigate the home

Question 24

What are the assessment tools that can be used for Jared?

Answer 24

Gross motor function measure (every 3-6mths)

Manual ability classification system (6-12 mths). Functional use of hands (grasping, manipulating and coordination)

Communication function classification system. Designed to assess how well children communicate in everyday situations (send, receive and understand messages)

Observation of walking/mobility/self care

ROM and lower limb strength

Tone: tone can fluctuate so its important to reassess how its affecting Jareds mobility

Question 25

Please list 3 SMART Goals for Jared (walking, stair preparation and balance)

Answer 25

All within 3 mths:

Walk independently on a flat surface for 10m with fewer than 2 stumbles to improve walking stability and confidence

Ascend and descend a 10cm step using alternating legs with minimal assistance from a handrail

Jared will stand on one foot with minimal support for atleast 2 seconds to promote balance and prepare for more dynamic activities

Question 26

Please list 3 SMART goals for Jared (run, stairs and ADLs)

Answer 26

Within 9-12 mths for each of the following:

Independently run a distance of 5m with controlled speed to facilitate engagement in playgroups and social activities with peers

Ascend and descend a staircase with one hand support on a railing

Independently remove and put on simple clothing items (eg shoes, jacket) to support independence in ADLS

Question 27

What is GMFCS II

Answer 27

Can walk in most settings but may need support on uneven surfaces and use handrails on stairs. They experience some difficulty with stability, speed and coordination.