PEDIATRIC CASE STUDY (TOBY)
PRIMARY DEFICIT AREAS OF TOBY
Toby is a seven year old boy who has physical impairments resulting from a car accident. His physical impairments are: bilateral flexure of the elbows with decreased hand function involving grip and fine motor coordination, difficulties with standing and sitting balance, and muscle tightness at his hips and down his right leg. Due to these physical impairments Toby would have difficulty with productivity such as schoolwork and play (productivity and leisure). For example writing or sitting on a chair in school would be very difficult with fine motor and balance impairments. Also, most play activities such as baseball would be very difficult, since it would be hard to hold the bat with a weakened grasp, or even to run with balance problems. The client would not be able to do some self care activities such as buttoning a shirt, due to his decreased fine motor coordination. In addition to physical impairment, the client is somewhat socially withdrawn, and becomes easily frustrated since the car accident. This could be due to an underlying confidence problem possibly from not being just like his peers, or from an abusive childhood. From the latter, trust would also be a primary issue of treatment. Lack of patience and little confidence would be a disadvantage in the rehabilitation process since some activities such as dressing, would take much longer to do with his physical difficulties.
POTTERY AS A THERAPEUTIC ACTIVITY FOR TOBY
For an activity to be therapeutic for Toby it would have to be relatively simple (few steps to make a project), due to his lack of patience, and be possible without full range of motion of the arms and decreased function of the hands. Furthermore the activity would have to be like play for the client, to keep him motivated. Pottery fits this criteria since it can be quite simple, and for making basic shapes full range of motion of the arms and full function of the hands is not necessary. Also pottery could be thought of as a playful activity since the client would be able to make anything he wanted, such as a turtle or a dinosaur. Modifications that could be made to this activity for the client are many. A child sized chair with a high back and arms could be used to help with his balance. If this was not adequate wedges could be inserted on the sides of the chair to enhance his sitting balance. As the client improved his balance the wedges could be taken away, and a chair offering less support could be used, for example, a chair with a lower back. Possibly he will be able to progress to doing pottery while standing, thus helping rehabilitate the clients balance and also his muscle tightness. The projects Toby could undertake are limitless, and easily gradable, since they could be simple to complex. Initially the client may just form basic shapes (eg. snake) using gross motor movements such as using the base of his hand to form. Once Toby gained strength in the intrinsic and extrinsic muscles of the hand more complex shapes could be made. For adding fine detail the client could use wide handled tools (eg. wide handled scorer) until his hand function increased, then smaller handled tools could be used. Working with clay should increase the strength of his hands due to the constant moulding of the clay, and the more complex the project the more hand strength involved. Additionally the greater the complexity of shape the more time to do the task, and thus more muscle endurance will be required. It should also increase his fine motor coordination and range of motion of his arms due to the detailing of the intricate shapes. Working with the client, the OT would have to take the relationship one step at a time to try and build the clients trust. With encouragement and some help (when required) from the OT, the client should build confidence quickly. Once this occurs he could be put into a group setting to get him back into a social atmosphere, like that of public school. At first he could be in a group where each participant worked on their own project. Then he could work in a group where they worked on one project together. Toby could even teach his siblings the activity.
Through this therapeutic activity Toby should have increased range of motion in his arms and increased function in his hands, as well as independent balance. Toby will be well on his way to becoming independent in all areas of occupational performance, as a seven year old should be. Additionally, with increased confidence, and trust in other individuals he should be able to become more socially active thus enabling his participation in occupational performance.
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[Description of Pottery]
[Betty]
[Jane]
[Summary]
[References]
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