Left Sided Spastic Hemiplegia | Case Study

Left Sided Spastic Hemiplegia Case StudyIntervention AnalysisBackgroundJane Walters is a five year senescent girl and has a diagnosis of left sided spastic hemiplegia, a form of Cerebral Palsy. Jane has two older sisters who attend one dollar bill travel lessons at their topical anaesthetic st qualifieds. Jane has recently expressed an interest in joining them to her parents. However her parents are worried that because of her diagnosis she will non be able to cargo hold up with her siblings. Jane is very aware of her condition, and has recently lost confidence, asking her parents why she is different from other electric razorren her age.Diagnosis Cerebral Palsy (CP) refers to non-progressive conditions characterised by impaired voluntary causal agency or posture, and resulting from prenatal developmental malformations or postnatal CNS ruin (Reed, 2013, pp. 38-47).According to the National Institute of Neurological Disorders and Stroke (2008), it is highly likely that a ch ild with CP will have other medical disorders such as cognitive impairments, seizures, delayed growth and development. Spastic syndromes such as Janes issue forth in more than 70 percent of CP cases.Spastic hemiplegia is a type of CP that typically needs the body down one side. The spasticity creates a state of opponent against any range 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 afterwards than other children and will tend to walk on their tiptoes because often they will suffer 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 brain has occurred in the right hemisphere. The primary cause of CP is damage to white matter of the brain this is often caused by abnormal brain development. This can 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 burning(prenominal) to consider additional complications related to right sided brain damage to ensure an awareness of Janes level of functional ability be it physically, cognitively or behaviourally. Those that may relate to Janes case are listed below in table one.Table one How damage to the Right Hemisphere can affect function and the occupation 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 lodge pediatric teams (CPT). The team will work closely with the childrens team in social services and primary care. The team will provide a range of judgments and interventions to young people and their families. In Janes MDT team there will be a range of different members such as Physiotherapists, Paed iatricians, occupational Therapists, Social Workers, Speech and Language Therapists and Educational Psychologists (NHS 2012). According to the Disability Act Jane is entitled to an independent discernment of her individual needs. The act is designed to promote the community of people with disabilities in society by supporting the provision of disability specific services (NCSE 2011).A standardised interview was used, this was to allow the OT staff to picture how Jane and her family interact with each other making it easier to obtain randomness, identify abilitys needs and coatings as well as generate an intervention plan and enable end scaling Due to Janes condition she would have already been known to social services and the MDT, as she had already received physiotherapy to aid with pass stiffness and improve core strength. indeed upon the OT department accepting Janes referral, an initial assessment was carried out in her home environment with mother and tyro present (An and Palisano 2013). Collaboration between professional ataff and Janes family is a vital component in family-centred services, this is considered best practice in early intervention and paediatric rehabilitation (An and Palisano 2013). Collaboration between the two parties is essential for setting meaningful and achievable goals for a child. Planning and implementing interventions must be able to fit inwardly the context of family life. (An and Palisano 2013)The following strengths and weaklynesses were identified during the initial assessment.Table two Janes strengths and limitationsDuring the initial assessment Janes mother expressed concerns about 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 dynamic postural control in sitting in children with neuromotor dysfunction (Reid 1 995)This standardised assessment was used to ascertain how Janes CP affects her ability to sit comfortably and concentrate. 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 seance. The SACND measures quality of independent sitting ability across four areas proximal stability, postural tone, postural alignment, and balance (Knox 2002). The assessment revealed that Jane has weak upper trunk control and so will be issued a specially 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 term goal of horse riding and to achieve this long term goal, four short term aims were set to serve as recovery milestones (Duncan 2011).Table three Janes long term aim and short term goals.Occupational th erapists 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 judgment (Asher 2007). Therapists need to reflect on what it is that they particularise to achieve with the assessment, and if this is managed the assessment can be classed as a success. One way of evaluating an assessment is to look at the performance 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 clement 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 (Kielhofner and Forsyth 2011). Riding will help Jane build upon her self-confidence, having that natural organized religioning relationship w ith a horse that shows no judgment and does not understand that she is different (Horseback UK).The major concern that Janes mother presents is the worry that she will not be able to keep up with the physical requirements of riding and that this will dishearten Janes enthusiasm. This concern will be tackled in goal number four. 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 basic understanding of her condition it will be easier for her to set more realistic goals with the OT as she will have a greater awareness of what she is able to do and may struggle with. This will trim the likelihood becoming distressed when trying to achieve goals her agreed goals, this will hopefully reduce mums concerns about the intervention 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 hurting herself or become too t ired. The OT headstrong 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 feeling tired. With this information Janes parents can keep a fatigue diary 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 hence be discussed with Janes parents and the RDA and suitable arrangements can be made regarding fatigue management as to when would be the most appreciate time for Jane to have her riding lesson when she has the most energy.Once a pattern of fatigue can be established the OT staff will develop strategies to manage Janes fatigue. For example Jane should select in an operation that she finds relaxing 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 l esson. If Jane is able to vary her day with relaxing and more strenuous activities, she will be able to conserve energy for the more strenuous activity of riding and hence last the full hour lesson.This form of intervention uses the Compensatory Approach. The principle behind 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 therefore 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 scholarship of Jane by her social circle, thereby mitigating Janes fear about her social circle (Polglase and Treseder 2012). Jane has always 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 treatment 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 evaluate it. military rating a professionals practice is one of the most important elements in occupational therapy without it, the value of their intervention diminishes (Lawcett 2007).Evaluation is important as in theory it enables the OT and the lymph gland to see if intervention is aff ective. However it is vital that the client is willing to be part of the evaluation process, because if they are not this could present an incorrect evaluation of strength of treatment (Lawcett 2007).There are four main was a professional can evaluate their intervention process these areUsing up to determine outcome measures.Using valid and reliable evidence based outcome measures.Evaluate from view point of the service userEvaluate throughout therapy process, at end of intervention(Lawcett 2007).The success of Janes intervention plans can be evaluated by the Goal Attainment Scale(GAS) (Kings College London no date).The GAS is a measurement technique which consist of individualising a persons outcome indicators (Turner-Stokes 2009). In order to evaluate the intervention the professional must first bring to pass a list of thorough and complete outcome measures, which will then be intrustn a numerical value to determine the success of the intervention (Kiresuk and Sherman 1968 Pur kiss et al. 2013).Janes goals were based on a realistic forecast of her progress (May-Benson 2012) Janes performance was scaled into five levels, these reflected her actual performance in coincidence 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 recorded 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 improvement (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).