child with schizencephaly... I need treatment ideas

[Hayden123]

Hello. I am in a rural area that supplies variety of physical therapy needs. Main patient case load is middle age to older orthopedic, neuro patients. we recently have a patient that has come to us that is 7 months old and dx with schizencephaly. area in the brain on the Right side that causes ventricular system to go through brain tissue to edge of cerebral tissue. here is my question? patient has no protective reactions any of the ways. I need some treatment ideas to gain reactions. Also is this something that patient will be able to do or learn? I have tried sitting on lap and drop leg and extending arm, roll on bolster, etc. Also he has decrease use of his L side mainly L UE . He keeps thumb in his fist and doesnt open or use L arm much. (OT is helping with UE but treatment ideas for getting him to use arm would be great.) Patient sitting for approx 5-10 sec with good head control. pt can prop up UEs on legs and support self but if he turn to look to far left or right or behind he falls over mainly to the L (weaker side) but sometimes he just falls back without warning. Standing: originally patient would not put his L leg down with standing but now he places both feet flat and stand 20-30 seconds with trunk support without LEs giving way. Rolling: can roll side to side and onto stomach but he cant get L arm out without assistance. patient can lay on stomach prone on elbows and occasionally shift to R side but not left side. Any suggestions for other treatment ideas would be great. Thank you !!!!

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[estherderu]

Have a look at Pams site, for some wonderful ideas how to handle young children.
www.skillsforaction.com

[PamVersfeld]

Hello

From your description it sounds like this infant is quite a challenge.

I would suggest you take a task/context based approach to intervention. The basic principle is that you start with what the infant can do - and then find ways to engage the child in goal directed actions so that she increases her ability to do things by exploring different ways to achieve the goal. In this way you slowly but surely build the infant's capacity for action.

One of the earliest postural skills an infant learns is to keep the head steady so that she can look around and visually explore the environment, either in lying when being supported by a care. Visual reach and search requires a steady head - and this early looking action is a major stimulus for the development of head control and stability.

When the infant is being held by a carer, what does she do? Is she interested in looking at things? Hpw much support does she need in order to keep her head steady so that she can look. What does she like looking at?

How old is the infant now? This makes a difference to what task you can expect her to do. At seven months I would mostly be looking at what she does when lying on the floor and how she responds to the challenges of sitting on an adults lap and being picked up and carried around.

Esther suggested you look at my site for ideas on task based approaches - just to mention that it has moved to Home | SfA Webmanual

Pam

[Hayden123]

thank you so much for your response... I am so sorry it took a little while to respond. i have been seeing the infant for a month now and have seen hugh gains. patient is now rolling all around. patient is now able to pull arm out from underneath body when he rolls over onto stomach. Prior to today he would always need assistance with positioning L arm because he did not have enough strength to pull his arm out from under him.

You asked about his head control. he has great head control. Day one he was looking all around almost to much . Just meaning some times he turns his head so far around or leans back he automatically loses balance in sitting. He still has difficulty with decrease protective responses. He is gaining some with R UE and did place hand L and R down when lying over roll to reach for toy. He suppport himself for the first time today. it was wonderful. You should hear us cheering. Last week we constrained the R arm by putting his jacket on and keeping left arm out . He actually is putting thumb and fingers to mouth. He also grasped a rattle and with several tries took to mouth.

I have a new concern now. The mother was the main one that got her pediatrician to send patient to therapy. She was seeing neuro MD at a bigger city but no scheduled appt with either for another 2-3 months. The OT and I have noticed a few instances that we feel he may be having seizure activity but cant pinpoint for sure. He the other day did something where he leaned his head to the side like laying on his shoulder 3-4 x mother had never seen this either but he looked to be looking at his daddy but then would straighten head and smile. He also has had a few times that he will have his L hand in a fist so tight it is hard to pry his fingers open but other times he can slowly open and close hand and grasp without trouble. i dont want to alarm the mother but he doesnt have a MD appt for quite some time. There are also times he seems to get upset for no reason. Although i feel like it may be due to him coming out of a seizure where he is staring. Do you think any of this sounds like seizure activity. The OT and I both wanted to do another session or so to see if these continue and then will probably recommend a check up but I am afraid that the regular pediatrician may dismiss it since he didnt see much deficiet with normal check up but it was the mother who pressed the issue of him not using his left side. Like I mentioned before we are rural and deal more with middle to older adults with CVA, orthopeadic etc. Is this seizure activity or do you have some info on what things to look for? I have looked on Utube a various videos of infant spasms and seizures but none exactly like his.

thanks