Week 4-Post 3

Friday 7^th of November 2008

Leah**

Thoughts and feelings in the presenting situation…

Leah is a 5 year old little girl with Tubular Sclerosis, autism and due to this has a delay in her development. Leah also suffers from seizures daily but has a very loving and supportive family to support her all of the way. Leah is a gorgeous, smiley little girl who warms to friendly and familiar voices. This was my fourth home visit with Leah, but today was not a very successful session due to the fact that she had woken when I arrived and had a series of nasty seizures. After these seizures she was extremely fatigued and did not want to have a therapy session. She looked exhausted so I did not push her to the point of exhaustion. The week before we had taken a visit to the centre of cerebral palsy to get her Sir David Brand walker reviewed by two specialist at the CCP. We are finding that Leah is beginning her movement forward through back extension and retraction of her arms and shoulders. She is not independently placing her hands on the bar which is on the tray in front of her. The connection is not there yet. We lowered the padding down on the chest support to help the positioning of her arms. We also put cable ties on her back two wheels to prevent movement backwards or sideways. This will encourage Leah to take steps forward because she cannot get from one place to another anymore unless it is in the forwards direction. It was not a very successful session, but it made mum and I have a chat about Leah in general and her progress so far.

How I managed the patient...

When I had arrived, Leah had just awoken and had just had a series of very bad seizures. I waited until mum had put her AFO’s on and Leah had woken up in her own time. Today I took her for a little walk without the walker with me assisting, she was not initiating many steps and started to get upset from the sheer exhaustion state the recent seizures put her in. I carried her to the walker and we began here. She was resisting a lot with holding her hands over the bar. When she started to get annoyed, I let her recover in her own time. I could only get her walking over to the wall where our next activity was, she was too tired to go any further. I always tried to cheer her up, and used the dummy to initiate a lot of tasks. We did some sit to stands, but she was not holding any of her weight today. I then carried her over to the play area and mat where I did some bouncing on the peanut ball to finish. She was not in an ideal state for therapy, so I cut it short.

What I did well…

I also reassured Leah everything was ok and when we were nearly finished I would make her aware of this. I gave positive reinforcement when she attempted the tasks. I always let her calm down in her own time and I had to allow for plenty of rest time in the session. However, I wouldn’t keep the rests long otherwise she would get too tired and dose off to sleep.

What I could have done better

It was lucky little Leah tolerated anything today. She was exhausted and not motivated to work. To keep Leah more awake during her rests I could sing to her or use toys to keep her mind stimulated.

Forward plan…

I may give mum a call Thursday to check how Leah was during the week. I might bring some more toys in or ask mum for more toys and when Leah is resting I may engage with her and play with her so she doesn’t continue to get sleepy and be tempted to fall asleep during therapy.

Changes for next time…

If the next session is more successful I will focus a lot on her weight bearing and encourage Leah to support more of her weight. Also dad was going to tighten the cable ties, because mum and I both noticed that the walker was moving backwards. This was more than likely due to Leah forcing herself backwards in frustration.

Overall thoughts and feelings of how today has gone…

Today was not a successful therapy session due to seizures. I did however, have a chat to mum about Leah and her progress which is also an essential part of the therapy.

Strategies to improve my performance…

Therapy is also engaging with the patient. When the child is having a rest continue to engage with them by using toys, songs or other verbal communication.

Questions…

I need to ask Jenny about booking in Leah for a visit to Kids are Kids for the upcoming week, to review her and see how she is adapting to the new modified walker.

Name changed**