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Running head: TREATING BABY B.

Treating Baby B.: A Jeune Syndrome Case Study


Dani Goddard, Chris Gutierrez, Lauren Hoppe, Austin Lepper, Natalie Noss & Kerielle Williams
Touro University Nevada

TREATING BABY B.

Description of Occupational Performance


Activities of Daily Living (ADLs)
Baby B. is only 14 months old and requires maximum assistance for bathing and
dressing. He is still currently diapered, has a G-tube in place, and he is unable to feed by
mouth. Although the speech therapist has just begun feeding trials, Baby B. has refused to
swallow. He has limited functional mobility due to environmental factors and due to inadequate
strength and endurance secondary to respiratory and orthopedic issues.
Instrumental Activities of Daily Living (IADLs)
Baby B. is too young to participate in IADLs. For example, Baby B. is not involved in
care of others or pets, financial or health management, or community mobility.
Rest and Sleep
Baby B. wakes up two to three times per night due to constant activity in his room from
the nursing staff and the noise made by his roommates ventilation machine. He does take a one
hour morning nap and a one to two hour nap in the afternoon. He is especially fatigued after
therapy sessions.
Education
Baby B. is only 14 months old and therefore is not receiving any formal/informal
education.
Work
Baby B. does not participate in any work related occupations such as seeking
employment and volunteering.
Play

TREATING BABY B.

Play is Baby B.s primary occupation but is limited due to weakness, low endurance and
environmental limitations causing a decrease in exploration and sensory motor development. He
also requires assistance and supervision while playing which can be limiting. He currently shares
a room with another patient but does have some space within his room to play. Baby B. has
access to age appropriate toys such as a walker, bouncer, rattles and books. He also enjoys
playing with his mom, grandma, and older sister when they come to visit and interacts well with
them. Baby B. especially enjoys playing peek-a-boo.
Leisure
Baby B. does not participate in leisure occupations at this time. He is too young to
identify interests or skills in leisure activities. He also is too young to plan and participate in
leisure activities.
Social Participation
Baby B. loves to wave to people as they walk by. He interacts well with his sister when
she comes to visit and is beginning to initiate parallel play. He does experience some detachment
from his mother and caregivers because there are many different people caring for him. Baby B.
has a tracheotomy and is therefore non-verbal.
Description of Movement, Postural Reactions, and Reflexes
Baby B. is able to sit independently without assistance for brief amounts of time. He is
unable to protectively extend his arms to protect himself or right himself which creates a
problem due to his loss of balance. Baby B. requires assistance from care staff in order to get into
and maintain a standing position. Lack of upper extremity muscle strength makes it hard for
Baby B. to lie in prone-pop or quadruped positions. Baby B. also lacks age appropriate fine

TREATING BABY B.

motor control, gross motor skills and visual motor integration. All primitive reflexes have been
integrated since reaching roughly 12 months of age.
Sensory integration or Self-regulation
Baby B. is hypersensitive in the face and mouth. He does not handle touch and
stimulation well and also refuses to swallow any food. He has chewie tubes which he may
choose to use for self-soothing. He tends to be hypersensitive to touch and is slow to play with
new toys. Baby B.s poor visual motor skills affect his overall self-regulation as well as his fine
and gross motor abilities.
Person-Environment-Occupation-Performance Model
The Person-Environment-Occupation-Performance (PEOP) model focuses on the
interplay between the client and his or her environment and occupations. This model views the
client holistically and takes into account the person's values, interests, skills and abilities. It also
looks at the physical, cultural and social components of the environment and how it can enhance
or hinder occupational performance and addresses meaningful occupations of the client (Boyt
Schell, Gillen, & Scaffa, 2014).
Baby B. is a 14 month old boy with Jeune Syndrome who lives in a skilled nursing
facility (SNF) and has been in and out of the hospital since he was born. His mom works full
time during the swing shift, lives at her mothers house, and has another child, a 3 year old
girl. His mother, grandmother, and sister come to visit Baby B. as much as possible; they
usually average about four visits per week. Baby B. loves his older sister and they enjoy playing
with each other. Baby B.s diagnosis of Jeune Syndrome has caused respiratory issues due to a
narrow rib cage. This causes Baby B. to become easily fatigued during play activities and
therapy sessions. Baby B.s trunk, pelvis, and extremities are also affected by Jeune Syndrome,

TREATING BABY B.

which causes his bones and cartilage to develop improperly. The symptoms of Jeune Syndrome
greatly affect daily activities and are an important consideration of everyday life for Baby B.
(Seattle Childrens Hospital, Research and Foundation, 2014).
Since Baby B. has never been allowed to go home due to these health concerns, he has
lived his entire life either in the hospital or in the SNF where he requires one-on-one care from
several different nurses throughout the day and night. He also receives additional services such
as an hour and a half of occupational therapy (OT), two hours of physical therapy (PT), and two
hours of speech therapy (ST) weekly. He is monitored daily by a respiratory therapist. He shares
a room with a 12 year old on a ventilator, but does have his own space within the room to play
and also has a pack and play where he can play with his toys. The limited amount of space for
Baby B. to play in his room has hindered his play exploration.
Baby B.s primary occupation is play, though he struggles in this area because he is
unable to explore on his own due to weakness and easy fatigability. He also requires support to
stand and is not strong enough to move into a propped position in supine or move into a
quadruped position limiting his amount of interaction with the environment. He is beginning to
demonstrate the ability to roll from supine to prone and prone to supine. He does have delayed
fine motor skills, gross motor skills, and visual-motor skills.
Theories and Practice Models
Any OT working with Baby B. has many options when it comes to choosing the most
appropriate model of practice or frame of reference for his case. The dynamic systems practice
model is most likely the best choice for framing Baby B.s performance in terms of the interplay
between his personal characteristics and abilities, his environment, and his expected
developmental tasks. According to the dynamic systems theory, children use several transitional

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stages when learning a new motor task or sequence. These steps include: (1) trying out different
methods of initiating and completing the task; (2) deciding which technique is the most efficient
and reliable; and (3) practicing the chosen technique. All of these steps are influenced
simultaneously by the child, his environment, and the task or challenge. For example, while
Baby B. is learning to stand and later walk independently, he will encounter supports and
constraints at each of these levels (Case-Smith & OBrien, 2010). To assist with intervention
planning, Baby B.s OTs will consider his constraints at each level of skill development. On a
personal level, biomechanically Baby B.s trunk to limb ratio is disproportionate due to his
condition; this will affect his emerging motor skills and may cause difficulty with balance,
coordination, and protective reactions. His limited rib cage expansion also affects respiratory
function and causes Baby B. to fatigue easily during play and motor exploration.
Environmentally, Baby B. is being raised in a SNF and therefore spends much of his day in his
room and/or in his crib and does not have the physical assistance or freedom to practice motor
tasks as much as he might at home or in a more conducive environment that enables more
developmentally appropriate participation in play and motor tasks. On the individual task level,
Baby B. will be challenged to learn and perform novel motor tasks, especially while he is still
working to strengthen component abilities. For example, walking or even independent standing
will be difficult to learn if Baby B. is still struggling to establish effective balance techniques and
is not comfortable with other related tasks such as reaching outside of his base of support (BOS)
while sitting. While motor patterns and emerging motor skills are very important for Baby B.,
plenty of other developmentally appropriate non-motor tasks can also be viewed through the
dynamic systems theory lens. Baby B. will still need to be stimulated and supported in learning

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appropriate cognitive, social, and emotional tasks as he grows; this development may be
hindered by his physical challenges, health status, and environmental constraints.
Two other practice models will be appropriate to consider while teaching Baby B. new
motor tasks: neurodevelopmental training and motor learning. Neurodevelopmental training
(NDT) is a therapist-guided intervention that helps the patient learn and execute motor patterns
based on proper and consecutive musculoskeletal movements, energy conservation techniques,
and developmentally-appropriate tasks. Baby B.s OTs will use NDT techniques to physically
assist him in learning and practicing these motor patterns until they become inherent (CaseSmith & OBrien, 2010). Motor patterns supported by NDT handling include rolling,
unsupported sitting with proper postural form, transitioning between positions, standing, and
walking. Baby B.s OTs can also teach other caregiverssuch as his mother, grandmother, and
the SNF staffbasic NDT techniques to use outside of formal therapy time to continue
supporting his emerging skills. Motor learning is another technique that will assist Baby B. in
learning novel motor tasks. According to motor learning theory, new tasks should be taught in a
way that makes them transferrable or generalizable to different settings (i.e. from the SNF to the
community or home settings) and makes learning fun, attainable, and as naturalistic as possible.
Motor learning focuses on sequencing and grading activities appropriately by breaking down
component parts as needed; however, therapists using motor learning techniques should also
focus on using whole practice, completing the motor pattern as much as possible in the natural
and continuous way it is usually performed. According to motor learning theory, OTs should
teach tasks using modeling, demonstration, and appropriate cues and feedback. As Baby B. ages,
his therapists can also utilize mental practice and rehearsal to help him further internalize more
complex motor patterns (Case-Smith & OBrien, 2010).

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Applicable Pediatric Assessments

Baby Bs therapists have many choices when it comes to formally assessing patients
developmental levels as well as their strengths, weakness, and occupational intervention needs.
For Baby B, the most effective, developmentally appropriate, and comprehensive assessments
his therapists can use include the Transdisciplinary Play-Based Assessment, 2nd edition (TPBA2),
and the Pediatric Evaluation of Disability Inventory (PEDI). The TPBA2 was created to utilize a
team-based assessment approach for evaluating children under the age of six. It recognizes play
as the natural context for childrens development and learning and includes caregivers in every
aspect of the evaluation process. The TPBA2 assesses structured and unstructured play, peer
interaction, caregiver interaction, and motor play under four functional categories: cognitive,
communication and language, social-emotional, and sensorimotor. It identifies preferred play
activities, level of assistance needed, supports or adaptations needed, and specific abilities or
disabilities within a play context. It also lays out sequential treatment options based on
developmental play milestones and essentially provides an easy-to-follow plan for specific playbased activities and guidelines (Linder, 1993). The PEDI is another assessment created for
children ages six months to seven years. It can be used to assess the severity of Baby Bs
disability in terms of its effect on his functional abilities (age-appropriate self-care, mobility, and
social function). The PEDI measures the childs function independently, with the assistance of a
caregiver, and with modifications. It can be completed in its entirety or partially depending on
the therapists goals and the abilities he or she wishes to measure. The PEDI assessment will
allow Baby Bs treating therapists to determine intervention strategies needed in order to ensure
completion of occupational areas (ADLs, IADLs, play) while managing his energy conservation
and fatigue (Haley et al., 1998).

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Functional Problem Statements

1. Tracheostomy and G-tube dependence results in the inability to tolerate eating by mouth.
2. Poor postural stability, lack of equilibrium reactions and protective reflexes results in limited
independent seated balance to sit at play.
3. Limiting contextual factors results in restriction to social participation with family and peers.
4. Restrictive environmental arrangement (in pediatric skilled nursing facility) results in limited
sensory exploration through play.
5. Visual motor delays result in deficits in completing age appropriate fine motor tasks.
Family/Caregiver/Child Goals
1. Baby B.s mother will bring his sister to sessions at least once a month to be included in his
treatment plan to motivate endurance of play with Baby B.
2. Baby B. will increase endurance, strength and balance in order to participate in play-based
gross motor functions.
3. Baby B.s mother will continue to meet/work with the facility social worker on exploring and
acquiring a safe, healthy, smoke-free living environment for the family.
4. Facility staff (i.e. direct care staff, nurses) and family will increase opportunities for Baby B.
to interact with similarly-aged peers in and out of the facility (i.e. nearby park or community
library) as safely and medically appropriate for all parties.
5. Baby B.s mother will continue to provide developmentally-appropriate and visually
stimulating toys for Baby B. to have available in facility, as well as check in with occupational
therapist for toy recommendations appropriate for Baby B.s development.
Occupational Therapy Goals

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Long-term Goal 1: Baby B. will be able to independently sit while participating in an


age appropriate play activity for at least 5 minutes within an 8 week time period.
o

Short-term Goal: Baby B. will be able to sit independently and use protective
extension as necessary for a 3 minute time frame by the end of a 4 week period.

Activity 1: Dynamic sitting balance will be encouraged on a peanut


therapy ball while reaching for a preferred toy in order to help strengthen
Baby B.s postural control and stability as well as help him learn to reach
out of his BOS safely. The therapist will provide moderate assistance to
support Baby B. with points of control at the hips to encourage him to
balance on a therapy ball through weight shifting. The therapist will hold
out a toy ring chain (or other preferred toy item) in front of Baby B. to
encourage reaching. Distance between toys and Baby B. will increase as
stability increases. This activity will be modified if dynamic sitting is too
challenging by having Baby B. only hold toy in front or on lap while on
therapy ball instead of reaching arms out for toys as needed. This activity
can be graded up by allowing Baby B. to complete activities in prone.

Activity 2: Baby B. will sit on a mat while supported by his therapist for
stability while completing a fine motor task. The therapist will actively
support Baby B. at the hips in order for him to maintain stability to flex
trunk forward to engage in play. The therapist will lessen the contact as
Baby B. increases stability. Baby B. will play with a noise making toy by
exploring the buttons which do not require high level grasps (can be
activated using palmar pressing). As Baby B. increases stability, the

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activities will be graded to include playing with a toy piano and/or


completing a simple 3-5 piece peg puzzle which would require a pincer
grasp, object manipulation, and visual-motor integration. This activity can
also be graded up by testing sitting balance on a sit-n-spin or by
completing play activities in prone to build additional core and postural
strength.
o

Short-term Goal: Baby B. will be able to demonstrate a radial digital or pincer


grasp while picking up and placing objects by the end of a 2 week period.

Activity 3: Baby B. will retrieve small objects hidden in Theraputty.


Therapist will playfully ask for the items by describing the colors and
shapes while directing Baby B. to pick up the items. The items will
include multicolored blocks and other figures; the therapist will use hand
over hand (HOH) cues to promote pincer grasp and other appropriate
object prehension patterns. This activity will begin with the lightest
resistance Theraputty as Baby B.s grasping strength is weak; item size
will decrease and Theraputty resistance will increase to modify for a justright challenge as appropriate. The therapist may modify Baby B.s
position to either be seated in a cube chair or eventually supported in a
standing position.

Activity 4: Baby B. will place shapes into the shape sorter while using a
radial digital grasp. The therapist will encourage Baby B. by providing
verbal, gestural and physical prompts to grasp shapes and release them in
the appropriate opening of the shape sorter. Baby B. will require physical

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and verbal prompts to rotate items properly to fit into openings at his
current age. Baby B. will be seated supported by a cube chair or therapist
for this activity. This activity can be graded by types of cues, limiting or
increasing the number of shapes and/or trials, and by promoting higher
level prehension patterns such as a pincer grasp. Puzzles can also be used
to encourage similar functional goals.

Long-term Goal 2: Baby B. will be able to tolerate various oral sensory stimulation
(tastes, textures, and temperatures) in at least 1 out of 3 trials by the end of an 8 week
time period.
o

Short-term Goal: Baby B. will be able to orally tolerate various textured nonfood items on 3 out of 5 trials by the end of a 3 week period.

Activity 5: Baby B. will spend time tolerating various textured chewies as


presented through a Simon Says type song by therapist. The therapist
will play music in the background and sing as skilled introduction of the
chewies is monitored closely. This can be modified by first beginning with
smooth chewies, then moving on to studded chewies; resistance of
chewies can be modified as well. The culmination of the song signals the
end of the activity and/or a break from the chewie. Time modifications can
also be made by allowing Baby B. to utilize the chewie for longer time
periods as his tolerance and oral strength increase. Introducing Baby B. to
various chewies will help build his oral strength and endurance as well as
provide sensory input which will all hopefully encourage him to feed by
mouth in the future.

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Activity 6: Baby B. will be able to accept a variety of spoons of different


shapes, sizes, and textures orally. The therapist will adapt to Baby B.s
sensitivity with textures by slowly introducing smooth spoons that do not
require as much effort to explore (i.e. fewer tongue movements to move
over spoon); the activity will be gradually graded to include studded
spoons, spoons with ridges, and various shapes and sizes as tolerated. This
activity will help familiarize Baby B. with utensils for potential future oral
feeding.

Short-term Goal: Baby B. will allow oral introduction of a variety of foods,


flavors, and temperatures on 3 out of 5 trials by the end of a 4 week period
(without being expected to swallow any substances).

Activity 7: Baby B. will tolerate oral introduction of a bolus bag with a


variety of food items. The bolus bag can be constructed using non-dyed
polyester organza or cheesecloth. Food tastes can be varied and different
textures can be used to grade the activity. A natural food texture
progression to use in conjunction with a bolus bag may include the
following (from softest to most chewy): various pureed baby foods,
applesauce, hummus, yogurt, peanut butter, soft cheeses, tender proteins
such as stew meats, and chewier proteins such as boiled chicken. Baby B.
will need to be directly monitored in case any attempt to swallow results
in coughing, gagging, or aspiration as evidenced by food particles
appearing during tracheostomy suctioning. Helping Baby B. to become
familiar with various food tastes and textures will help him become less

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orally defensive toward potential future feeding and will build chewing
strength and tongue coordination.

Activity 8: Baby B. will orally accept a wash cloth and gum massage of
varying temperatures (chilled, warm). Providing Baby B. with a variety of
temperatures will help familiarize him with sensory experiences inherent
in oral feeding. By providing him with cold (or frozen) and warm
washcloths, the therapist can help Baby B. become familiar with oral
temperature stimulation without directly having to introduce food
substances. This activity can be graded to allow Baby B. to independently
explore the temperatures and textures of the cloths or by providing him
with a gentle gum massage which will help organize and focus his sensory
experience. This activity can be further modified by providing other
temperature-variant objects such as a frozen teething ring or a chewie that
has been soaked in warm water.

Long-term Goal 3: Baby B. will begin peer interaction by engaging in parallel or


interactive play with mom and sister, as well as participating in community-based
playgroups in order to prepare for discharge by the end of a 16 week time period.
o

Short-term Goal: Baby B. will increase social interaction within the skilled
nursing facility with family members as well as the staff within a 3 week period.

Activity 9: Baby B. will participate in catching a small, light ball as it is


rolled to him while interacting with his mother and sister. The therapist
will encourage mother and sister to model appropriate manipulation of the
ball for Baby B. to see while the therapist will be seated behind Baby B. to

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support him in ring sit if needed. Mother and sister will communicate
using facial and verbal expressions while playing with Baby B. The
therapist will modify the activity by decreasing distances to roll the ball
and through the use of physical cues for Baby B. (i.e. helping him stop the
ball with both hands and roll it back during play). This activity can also be
modified by using balls of different sizes or textures, by playing on
various surfaces, or by having Baby B. play with both his mother and
sister at the same time.

Activity 10: Baby B. will be able to play patty-cake with direct caregivers.
Baby B. will sit either supported by his therapist on a mat or in a cube
chair at the level of his mother, sister, or grandma. The therapist will
facilitate play as needed to ensure playfulness during the interaction.
Support from his therapist will also provide Baby B. with assistance with
bilateral arm coordination needed to play Patty-cake.

Short-term Goal: Baby B. will experience social interaction within the


community 1 time per week over a 4 week period.

Activity 11: Baby B. will attend a story time group at the local library. He
will sit on the mat with other children attending story time with seated
support provided by his therapist, mother, or grandma as needed. This
activity can be modified by varying the time spent at the story time group
or by lessening the physical support offered so Baby B. can actively
engage postural control independently during the mostly passive activity
of listening.

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Activity 12: Baby B. will attend a community based-playgroup to


facilitate peer social interaction. Baby B. will be in close proximity to
peers to experience their verbal and nonverbal communication and to
allow for opportunities to reciprocate the interaction. Age-appropriate toys
available at the playgroup may include balls, musical instruments, and ball
pits to promote play within the group. Baby B.s therapist, mother, or
grandma will be nearby to facilitate and intervene as needed.
Treatment Plan

The majority of occupational therapy treatment will take place at the SNF, with the
exception of occasional community based playgroups. The participants of the treatment plan
include the OT, PT, ST, nurses, as well as the clients mother and sister. These individuals will
work cooperatively with one another as well as any other care providers in order to best meet the
needs of Baby B. The structure of the treatment plan will address the major deficits affecting
Baby B.s everyday life. Transitions between goal directed activities as well as duration of the
activities will be directed by Baby B.s interests and fatigability as interpreted by his therapists
and team.
Environmental setting
The environment of the skilled nursing facility limits the extent of the treatment for Baby
B. The environment consists of Baby B.s room that he shares with a roommate. Baby B.s room
consists of age appropriate toys, a hospital crib, a Pack-N-Play, a baby walker, and a bouncer. In
addition, Baby B.s room includes many different manipulatives in hopes to increase his fine
motor as well as visual motor skills.
SOAP Note

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S: Baby B. was compliant and content throughout most of the therapy session. Baby B. was very
social during the session, waving to visitors and staff as they walked by his room. Baby B.
seemed to have some fatigue towards the end of the session.
O: Baby B. participated in a 30-minute OT session at a SNF focusing on improving fine motor
skills, gross motor skills, and social interaction in order to increase overall functionality and
independence.
Fine Motor Skills: Baby B. displayed lack of upper extremity strength and weak muscles. Baby
B. was unable to retrieve all of the items from the Theraputty without showing signs of fatigue.
Gross Motor Skills: Baby B. was able to sit independently without assistance for a period of 45
seconds. Baby B. was unable to protectively extend his arms to protect himself or right himself
to correct his balance while playing with a toy piano. Baby B. was able to complete 2 out of the 5
piece puzzle while sitting on the mat table with support at both hips.
Social Interaction Skills: Baby B. enjoyed participating in a game of Peek-a-Boo as well as
interacting with the numerous visitors that walked by his room throughout the session. Baby B.
showed interest in learning Patty-cake when it was presented to him as a new activity.
A: Baby B.s waving to others and acknowledgement of others implies that he has age
appropriate social interaction skills. Baby B.s weak muscle tone impedes his functional ability
to transition from prone to supine as well as supine to prone. Baby B. requires assistance for
nearly all of his transitional mobility movements, which hinders his ability to function
completely during age appropriate activities. Baby B.s ability to independently stay in ring sit
for very brief amounts of time shows potential for increased tolerance for independent sitting.
Baby B.s weak muscle tone interferes with his ability to independently sit while engaged in a
play activity for longer periods of time. Baby B. would benefit from continued skilled OT

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intervention to increase fine motor, gross motor, social interaction skills, as well as visual motor
skills needed to participate in age appropriate activities and developmental milestones.
P: Baby B. will continue to attend OT for 30 minutes 3x per week for 6 months to improve his
fine motor, gross motor, visual motor skills, and social interaction skills needed in order to
participate in functional age appropriate activities. His OTs plan to implement functional motor
activities while participating in social interaction as well as encouraging age appropriate
communication. Further evaluation should be done at the completion of the 6 month time period.
Specific Recommendations and Post Discharge Environment
Baby B. is a great candidate for continued skilled occupational therapy intervention.
Baby B.s strong desire to socialize and interact with others shows his interest in play time
activities. Baby B. continues to show delays in gross motor, fine motor and visual motor
functions. It is recommended that Baby B. will continue to receive skilled occupational therapy
3/week for 30 minute sessions until next re-evaluation.
Baby B.s family is working towards sustaining a living situation outside of the SNF
which would be most conducive to Baby B.s development. Baby B.s mother will continue to
work with the facilitys social sorker per previously stated goal in order to find the resources
available to her. The home environment must be smoke-free and cleanliness must be maintained
in order to provide minimal impact on Baby B.s delicate respiratory system. Child friendly play
furniture should be available for Baby B. to promote support needed to pull to stand, cruise, and
further explore his environment. Breathable clothing and diapers should be chosen continuing
into the future to help comfort Baby B. when sweating due to rapid breathing and fatigue.
Justification of Treatment based on Research

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Intervention strategies implemented to address Long-term Goal 1 include improving


postural control in either dynamic or static conditions. For example, either seated or on therapy
ball and the therapists will respond to Baby B. by providing light cues to help him correct his
posture in order to increase control which will then lead to increased stability needed for further
play positions. Similar strategies and promising findings were recognized in a randomized
longitudinal study in 2010 by Harbourne, Willett, Kyvelidou, Deffeyes & Stergiou. The study
compared two groups of children who were analyzed as they participated in either a perceptualmotor intervention group or home-based intervention group. The participants were considered atrisk in terms of placing more than 1.5 standard deviations from the mean of their Gross Motor
Quotient (GMQ) of the Peabody Developmental Motor Scales assessment (PDMS). The
dynamic and variable perceptual-motor intervention group was found to yield greater increases
to postural control in the participants. The intervention strategies implemented in the perceptualmotor intervention include the therapist using light touch to guide the infant to activate leg
support and to adjust base of support as needed when addressing coming in and out of sitting
position as well as maintaining a stable seated position (Harbourne, Willett, Kyvelidou, Deffeyes
& Stergiou, 2010).
Intervention strategies implemented to address Long-term Goal 2 were adapted through a
study conducted by Fucile, Gisek and Lau in 2012. The study recruited 75 infants born between
26 and 32 weeks gestational age with a primary diagnosis of prematurity. Each child was
randomly placed in a non-nutritive oral motor therapy, infant massage therapy, combined
interventions or no intervention groups. The non-nutritive oral motor therapy consisted of
stroking the cheeks, lips, gums, and tongue for 12 minutes concluding with a 3 minute active
sucking on a pacifier. The infant massage therapy consisted of 10 minutes of stroking the head,

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neck, back, arms and legs and was then followed with 5 minutes of passive range of motion to
the limbs. The study showed that the children who had received either non-nutritive oral motor
therapy or infant massage therapy were able to independently oral feed sooner than those who
received no treatment. The participants who received a combination of the two therapies started
to self-feed sooner than the children in the other categories. The therapists will use these
findings to support intervention strategies to increase tolerance with oral sensory stimulations. A
warm soft wash cloth will be used to massage Baby B.s cheeks, lips, gums and tongue in order
to decrease sensory sensitivity in these areas and increase tolerance for food in or around his
mouth (Fucile et al., 2012).
Long-term Goal 3 states that the therapists will work to improve family participation
within therapy sessions to increase Baby B.s social participation and help to improve the bond
between the family members. A study by Haslam & Harris (2011) discussed the perceptions and
attitudes of play therapists incorporating family members during therapy. The study recruited
play therapists that were used to understand how integrating the child into family therapy
through using play therapy was effective. The study found that families who participated in the
study stated it was important to them to be involved in play-based participation within therapy.
About two-thirds of the participants believed that play therapy was effective. Based on these
findings the therapists will incorporate Baby B. in more play-based activities with his mother,
grandmother and sister in the community in order to help facilitate social participation that is
limited in his current living arrangement (Haslam & Harris, 2011).

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References

Boyt Schell, B. A., Gillen, G., & Scaffa, M. E. (2014). Willard & Spackmans occupational
therapy (12th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Case-Smith, J., & OBrien, J. C. (2010). Occupational therapy for children (6th ed.). Maryland
Heights, MO: Mosby Elsevier.
Fucile, S., Gisel, E.G., & Lau, C. (2012). Impact of nonutritive oral motor stimulation and infant
massage therapy on oral feeding skills of preterm infants. Journal of Neonatal-Perinatal
Medicine, 5, 311-317.
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