Posted: September 28th, 2016

Chanel is 14 months old and has a diagnosis of cerebral palsy. She has a twin sister, Destiny who has a congenital respiratory condition.

Social History:
Chanel is 14 months old and has a diagnosis of cerebral palsy. She has a twin sister, Destiny who has a congenital respiratory condition. She lives with her two older brothers, Anthony (12) and Bashir (9) and their mother Dolly. They live in their family home that is owned by the department of housing. The living arrangements are not ideal with issues around accessibility. Dolly’s mother Lidia is very supportive towards the family and provides assistance where possible. Chanel’s father (Ata) and Dolly separated and Ata does not live with the family.

Birth History
Chanel is a twin who was born 29 weeks gestation via an emergency caesarean section. Chanel weighed 1.44kgs at birth and initially required mechanical ventilation. Chanel spent 2 weeks in intensive care unit along with her twin sister, Density. Chanel was discharged home after 2 months but Destiny remained in hospital for 3 months before being discharged home. After medical staff completed scans of Chanel’s brain results indicated periventricular encephalomalacic changes in the parietal and frontal white matter as well as the thinning of the corpus callosum. After receiving these scans, Chanel was diagnosed at 5 months with Cerebral Palsy.

Development History:
Gross Motor
Chanel is able to roll from her stomach to her back but not from her back to her stomach. Chanel could not sit for a long period of time on the floor but after physiotherapy intervention Chanel is now able to sit on the floor unsupported for 16-30 seconds without losing her balance. She has adequate head control, but leans to her right side. When held in supported standing Chanel’s legs have a tendency to cross and she remains on her toes. Chanel can bring her hands to her mouth but finds these activities challenging. She experiences increased spasticity in her right hand compared to her left that prevents from feeding herself independently.

Fine Motor
Chanel experiences difficulty with grasping toys due to her adduction of her thumbs. The occupational therapist has provided Chanel with thumb spica splints this has improved her ability to grasp toys but still requires further interventions within this area.

Self care
Dolly reports putting on a nappy on Chanel is difficult as getting her legs to separate is a challenge because of her increased spasticity in these muscle groups. This is also a problem with bathing Chanel. The current method is Dolly holding her over the bath, which is physically demanding on Dolly. Dolly finds it difficult to dress Chanel’s upper limb due to increased spasticity.

Sleep
Chanel sleeps in the same bed as Dolly. Destiny sleeps in her own cot. Dolly reports Chanel to be a very light sleeper. She has 2 small sleeps during the day. She will only get to sleep when Dolly holds her to settle her. However, in the car both Destiny and Chanel sleep well.

Family Concerns
The family are experiencing some major changes to their lives as they come to terms with Chanel’s diagnosis. For Chanel’s family the major concerns are around establishing a routine to enable for family members to participate in social activities and access the local community. The social worker is working closely with the family to develop a routine. Dolly is anxious about Chanel and whether she will ever be able to walk. Her brothers have indicated that they are concerned about Chanel’s future and how people will treat her when she’s older.

However, the major occupational therapy concerns that were expressed by Dolly were developing a better bathing technique that will not place as much physical stress on Dolly, accessing the community to participate in social activities and Chanel not being able to sit in her high chair independently to be able to feed herself.

Assessment
Assessments were completed in Chanel’s family home and in the clinic with allied health professionals. There were four assessments that were conducted these included Gross motor function measures (GMFM), Modified Tardieu Scale (MTS), Range of motion measure, Australian spasticity assessment Scale (ASAS) and Paediatric Evaluation of disability inventory. The MTS indicated there was spasticity in Chanel’s upper limbs including elbow flexors, elbow extensors, thumb abductors and should flexors. Spasticity was also found in her lower limbs including plantar flexors, knee flexors and hip adductors.

The physiotherapist conducted the GMFM whereby Chanel received a level 4 this is used to help clinicians predict the degree of motor function that a child with cerebral palsy may achieve. Whilst this is not used as a sole indicator to reflect her motor function the physiotherapist will reassess using this same outcome measure in 6-months time.