Down's Syndrome: Case Question

Jennifer Posts

DEAR ERI COMMUNITY: I am a new pediatric occupational therapist and I can’t wait to hear some suggestions. A fellow physical therapist and I have been struggling with a patient: 16 month old female, Dx with Down’s syndrome. I have been seeing this pt. for around 5 months. The physical therapist and I whom are working with this little one feel as if we have hit a wall for about the last month. The patient was making excellent progress, including independence with sitting balance and improvement with functional transitions. The patient now begins to cry the second she leaves her Mother’s arms. We have tried having the mother observe unseen through a one way mirror, using the mother as a distracter, and even utilizing Mom for much of the handling. The other therapist and I have begun testing a variety of sensory strategies along with private rooms, large treatment gym, natural lighting, low lighting, music, etc. We have backed off with handling and tried moving off of the floor to platform swings, swiss ball, & even mother’s lap to no avail. The patient immediately closes her eyes, throws herself into extension, begins to cry, and is unable to be calmed by Mom or therapist. The patient has been cleared by her MD for GI, cardiac, and any other factors we could think of. Mom and Dad report the Pt does not demonstrate any difficulties at home. Any suggestions would be greatly appreciated!

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Evidence Based Practice and Osteoarthritis

In honor of May being Arthritis Awareness Month we wanted to alert you to a promising study looking at which subgroup of patients with OA benefits from physical therapy.

Few studies have investigated or identified common clinical tests and measures as being associated with progression of hip osteoarthritis (OA); fewer still are longitudinal studies exploring prognostic variables associated with long-term outcome following physical therapy treatment.

The focus of this study: http://www.hookedonevidence.org/searchresults.cfm?process=1&ReviewID=15375 (APTA members will need to log in to read the article) was the identification of factors to identify those who responded to physical therapy interventions. The authors report their results are the first step in the development of a preliminary cluster of baseline variables that identify patients with hip osteoarthritis as positive responders to physical therapy interventions. This study showed that selected combinations of unilateral hip pain, age of < 58 years, pain of > 6/10 on the NPRS, a 40-m SPWT value of <25.9 seconds, and a duration of symptoms of <1 year were associated with a favorable response to physical therapy treatment in patients with hip osteoarthritis. 

Share your thoughts with how consistent your clinical experience is with these findings.

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Feeding Dilemma – 5 month old

Jennifer Martin Posts:

DEAR ERI COMMUNITY:  I am an SLP working with a 5-month old, full-term baby, who was born with a duplication of chromosome 7. She is feeding using a Habermann feeder right now. She is not able to use a regular bottle, as she does not use suction, but only compression to express the formula. When using a pacifier for non-nutritive sucking, she is able to hold it in her mouth for less than a minute by herself. When checking her sucking ability with my finger, she is not wrapping the sides of her tongue, but only using compression to feed. One of the symptoms of this duplication is low muscle tone, and she mainly demonstrates this with all muscles from the waist up.

Does anyone have suggestions on how to improve her sucking ability? Also, when she is able to transition to a regular bottle again, what are some suggestions for bottle brands/types? Thank you!

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SOS Approach to Feeding Disorders

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Kay Toomey and Erin Ross two of our esteemed instructors recently published a description of their SOS Approach to Feeding Disorders in:Perspectives on Swallowing and Swallowing Disorders (Dysphagia) October 2011 vol. 20 no. 3 82-87. 

This highly successful transdisciplinary approach starts with addressing the reasons why a child is struggling to eat. It uses a whole child perspective, integrating sensory, motor, oral-motor, behavioral/learning, medical, and nutritional factors for both assessment and intervention, resulting in strategies to comprehensively evaluate and manage children with feeding/growth problems.

What are the goals of this program?

Success is determined by
(a) intrinsically motivated and sustained interest in trying new foods
(b) enjoyment in and appropriate skills for eating and drinking a wide range of age-appropriate foods and fluids
(c) consumption of sufficient calories for optimal growth along a child’s own percentile line on a growth curve
(d) improved family understanding and functioning during mealtimes for the development of healthy relationships with food and each other.

[caption id="attachment_259" align="alignleft" width="150" caption="Erin Ross"][/caption]

Clinicians: please share your experiences with this approach!

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Enter to win a free CEU course by blogging with ERI

We are offering you the opportunity to be entered into a drawing for a free CEU course. All you need to do is submit a blog entry which can be:
1. a clinical issue that you are seeking opinions about.
2. a case problem that you are struggling with.
3. a therapy tip that you would like to share.

The post can be of any length (up to 500 words) and photos and videos are great, as long as you have obtained written permission.

We will enter the first 50 blogs in a drawing for a free ERI course.
Deadline for entry is June 15th 2012 – winner to be announced before the end of June

Please post your blog in the comments section below…… you will then see your entry posted as a separate blog

We look forward to hearing your thoughts and sharing them with our ERI community.

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