Who is home?

Mom, Dad, David, Exchange Student

Why was Amy referred for early intervention?
- Amy has Hydrocephaly (water on the brain- Has brain stem, cerebellum, cerebrum-
occipital and temporal lobe)- Given a BP shunt to drain fluid.
- Seizures started at 4 months- takes medicine and mostly under control, hasn’t had a big
one in over a year.
- Couldn’t eat at 4 months, couldn’t suck or swallow. (seizures destroy it or did we lose
that part of the brain?) –Failure to thrive (G-tube)
- Reflux- Easy to throw up/gag. Acids come up to her throat.
- Cortical Visual Impairment- Eyes function, brain doesn’t have the capacity to function
the eyes.
- Hearing- Same type of thing, ears work but brain doesn’t have the capacity... no formal
diagnosis in that
- Quadriplegic cerebral palsy- can’t control her muscles- very tight. Spastic and hypertonic
muscles. (range of motion exercises daily) Cut the muscles in the thigh area to help
stretch muscles once. Now they use Botox as a muscle relaxer to help her move (every
three weeks) Dorsal rhizotomy- went into back bone, pulled out nerve system and
tested all the nerves to see what they were connected to then trimmed them. Puts her
in a stander to help muscles and bones grow- best place to work with her.

Main Concerns:
- She has so many needs, takes a lot of people to meet them
- OT, PT, Music therapy
- Not a lot of time to develop cognitive (School is short)
- Wants to give extra opportunities to allow Amy to learn and grow

Routine:
7:00- Turn off the overnight pump for extra fluids, Start daily medicine (seizure)
(Does not have a regular sleep pattern… if she is awake, start getting her dressed,
change diaper etc.)
8:30- Breakfast- G-tube (Doesn’t have to be awake for this)- usually laying down
11:15-20- bus picks her up- Get her ready, in wheelchair, get on bus.
- Para rides with Amy and tells mom how school went (new para starting Mon 22)
- Medicine and lunch at school
2:30- Returns home on bus
After school- 5:00 Therapy (2 hrs. OT 2 hrs. PT 45min PT (30 min each at school)
-MWTH (TH- aqua therapy T- activity days F- music therapy (in home))
Nurse comes in (TWTHF nights)- feeds Amy, chest percussions, breathing activities, getting
ready for bed, nightly medicines (7:30).
9:00-10:00- Start bedtime routing (10:00 Melatonin)- Different time asleep every night.
10:30- last feeding
12:00- last medicine
12:30 Turn on nightly fluid pump
 - If she knows the routine, she will be more alert. Make the routines familiar. 3 rd time
should understand more.
- “Amy’s brain is like a floppy disk, she is on for one thing and off for another”
- The more engaging and interactive the nurses are, the more she will respond to them
- Longer possessing time than usual “Do you want more” “Raise your hand if you want
more” touch hand then say, “Raise your hand if you want more.
- If you have a familiar thing you do every time she sees you, she will know you

Happy with routine?

- Would like more communication with the school.

Goals:
- Make activities fun and exciting- socialization

Ideas to work on:

- Sensory
- Pushing buttons with hands or feet
- Making facial expressions
- Cause and effect
- Problem solving