Week 5 STARES - TCCP

Situation
Over a 3 week period I was required to assess a 6 year old boy from Indonesia who had never been to the centre before and in fact had not had a clear diagnosis made up to this point. He travelled to Perth with his mother & grandparents seeking advice and guidance as to the best management for this child. To date he had been through many services & facilities in Indonesia to treat his condition.
The family noticed at the age of 2 he was not developing as well as other children and did not start walking until the age of 4. He is not able to speak and communication is very difficult, especially in English. Nothing motivates him to do anything and to date we have not been able to request him to perform any activity or action. This is despite the fact that he is able to perform most functional tasks but very irregularly and only when he wants to which is most likely a response to him being over-cared for and not needing to develop any independence.
He is able to walk with a wide base of support but his gait pattern is very unstable and he uses his hands in high guard to stabilise himself. He was not witnessed performing any functional floor movements or transfers between different postures although his family mentioned they have seen him sit to stand and roll on the floor. His favoured resting position is cross legged with his head resting on the floor in front.

Task
To carry out a thorough assessment & determine what the child’s main impairments are. Also to determine what the family’s main goals are and in what areas they would best like to see their child improve

Action
Initially a full subjective history was taken to gain a full understanding of the situation and determine what the family’s main concerns were. After this the objective assessment began which involved measuring his ROM and functional ability where possible. The child was hypermobile at the majority of joints and was unresponsive to all requests to perform any functional tasks. I then attempted to determine exactly what the child could do by simply observing him in a relaxed environment just going about his normal activities. I was able to observe his balance and mobility. At all times I continually guided the family as to what I was doing at what the aim of physiotherapy at the centre was.

Result
The patient was hypermobile and his strength was unable to be determined but as he could sit and stand it was assumed that he had the necessary strength and stability to be able to achieve most functional activities. The only movement I saw the child performing was lowering himself against a wall into a sitting position, walking and sit to stand only twice. The family was very keen to assist in anyway and were eager to understand as much as they could.
Evaluation
The child was very difficult to contend with but I managed to get a baseline understand of what his main impairments were and where our energies needed to be focused. I felt I communicated with the family effectively and even though I did not have the knowledge of some of the staff I still felt that I was able assist them with understanding the situation. Knowing what to do in terms of intervention was a struggle and I needed some guidance with regards to treatment ideas.

Strategies
Continual involvement of the family and analysing the situation thoroughly should have been the focus of my treatment. The child could do many of the movement but building the foundations of having him understand that he can do them and not require someone else’s assistance would be the focus. My knowledge of facilitation techniques for children needs improvement.