Toby- Client Description
Toby has suffered previous physical abuse at the hands of his biological mother. He was allegedly in a motor vehicle accident 8 months ago and has made some recovery. Presently, Toby is living in a foster home with 3 other children. His short-term goal is to return to school and be with children his own age, and his long-term goal is to become a fireman.
Primary Deficits and Therapeutic Value of Sculpting
Balance
Toby has a mild to moderate impairment in balance, but can sit and stand independently. Sculpting will help to increase his sitting and standing balance because he will constantly be shifting his weight to mold the play-doh and to reach for things.
Reduced range of motion and muscle strength
Toby's elbows remain flexed at 85 degrees and his hands rest in a fisted position, his right hand being less involved than his left. He has muscle tightness in his hips and down his right leg.
Changing the height of the table and the location of the sculpture on the table will help Toby increase the range of motion in his elbows through flexion and extension, up to a normal range. To manipulate the play-doh, Toby will have to open and close his hands, eliminating the close-fisted position. This action will improve his hand and forearm muscle strength as well as range of motion, thereby improving his grasp. Toby has yet to show a hand preference, and since his right arm is less involved than his left, he should be encouraged to use both arms and hands equally to prevent disuse of the left. Toby can increase his weakened grasp strength by squeezing the play-doh between his hands as he creates.
Sculpting can be graded to address the issue of Toby's limited ROM in his hips by having him frequently changing his position between sitting and standing. The difficulty of the activity can be increased by using a different medium. By giving Toby papier-mache, he will be encouraged to keep his hands in an open position for the duration of the activity.
Fine motor co-ordination
Toby's fine motor co-ordination is decreased bilaterally and this can be addressed through sculpting. By adding detail to his sculpture, he must concentrate his efforts on smaller movements and how to control them.
By using small instruments to add the detail to his sculpture, this activity will increase in difficulty. Toby will need to control his fine motor activity in order to hold the instruments and also to add detail without disturbing the pattern he is creating.
Hesitant to speak and easily frustrated
Toby responds verbally when prompted, but remains hesitant to speak. He enjoys making new friends and is sociable. However, he becomes easily frustrated.
Sculpture in a group is therapeutic because Toby will be encouraged to interact with others. He can express what he has done and what he would like to do in future sessions with his peers. Allowing Toby to take his time with his sculpture and make what he wants will decrease his frustration. Finishing a project will help him learn how to deal with frustration as he faces the challenges of a project at every step.
A way to grade the activity is the size of the group Toby works in. We will start him out in a small group of his peers, and as he becomes more comfortable with the size of the group, it will be increased. He will be encouraged to interact with an increasing number of his peers, and in this way, we will ready him for his transition to public school. Another way to increase the difficulty is to have Toby involved in a "Show and Tell" group. He will show his finished products to his group, and they will be encouraged to ask him questions. This is a different aspect of interacting with peers that is similar to a school environment.