Rosati, Springstead; Evaluation of Typically Developing Child PDF

Preview

Summary

professor- kristie konig ...

Description

Running head: EVALUATION OF A TYPICALLY DEVELOPING CHILD

Evaluation of a Typically Developing Child Michele Rosati and Moriah Springstead New York University

1

EVALUATION OF A TYPICALLY DEVELOPING CHILD

2

Background Information, Testing Environment and Behavior Background Information The evaluation was done on an 11-year-old girl named Lily (pseudonym). The child’s birthday is December 22, 2005. She currently attends the seventh grade in Milltown, New Jersey. The evaluation was done on October 7th, 2017. There is no significant medical history provided by the parents. Parents indicated that the child was excited to participate in the evaluation. Testing Environment and Behavior Lily’s evaluation was conducted in the Starbucks eating area within a Barnes and Noble. The environment was conducive to the evaluation. Scheduling the evaluation in the early morning helped avoid distractions from bustling customers to ensure optimal engagement. The area was open with adequate lighting, and minimal noise distractions. The evaluator sat across the table from Lily during tabletop assessment activities. Physical activities were done in a 6ft by 4ft-carpeted area beside the table. Caregiver was not present during assessment. Evaluator provided verbal instruction if needed, as clinical spectator scribed observations throughout activity and scored results. The child was picked up at her house and separated from her caregiver without issue. She was eager to interact with evaluators and partake in the assessment. She communicated efficiently, continuously made eye contact with the evaluators and used physical gestures while speaking. The child was able to attend to tasks and listen to instructions with minimal interruptions. The child concentrated well during the fine motor tasks but expressed slight difficulty in performance and task focus when transitioning to gross motor tasks. The child often giggled during gross motor activity; however, focused when tasks were timed. The child expressed some frustration but mostly laughed at her mistakes during activity trials. Overall, the child appeared engaged, open to evaluators and understanding of her own errors. Tests Administered Table 1 Beery VMI Results Raw Scores

27

Standard Scores

106

Scaled Scores

11

Percentiles

65%

Other Scaling

T Score = 53

Age Equivalency

13:5

The Beery VMI is a developmental test of visual-motor integration. The results report that Lily has the age equivalent visual-motor skills of 13 years and 5 months, indicating she performed at a level more advanced than her age of 11 years and 9 months. Her 65th percentile rank suggests that she performed better than 65% of the other children in the sample that are 11 years and 9 months old. A standard score of 106 shows extremely proficient performance related

3

EVALUATION OF A TYPICALLY DEVELOPING CHILD

to a reference group sample of similar aged children. The standard score of 106 and T score of 53 reveals Lily falls within one standard deviation above the mean. Table 2 BOT2 Short Form Knee Push-Up Total Point Score

74

Standard Score

51

Percentile Rank

54%

Descriptive Category

Average

The Bruininks-Oseretsky Test of Motor Proficiency Short Form assesses fine motor precision, fine motor integration, manual dexterity, bilateral coordination, balance, running speed and agility, upper-limb coordination, and strength. Her 54th percentile rank suggests that she performed better than 54 percent of the other children in the sample that are 11 years and 9 months old. Lily’s standard score of 51 shows proficient performance related to a reference group sample of similar aged children. A 51 standard score reveals that Lily falls within one standard deviation of the mean. A descriptive score of average indicates Lily falls within one standard deviation above the mean. Clinical Observation of Child’s Performance Gross Motor Skills Lily demonstrates gross motor skills typical of a 12-year-old female. She has the postural control needed to complete physical tasks requiring balance and coordination. During closedchain push-ups, Lily was able to hold her head erect and weight-bear in prone using the strength and control she developed at 10 months (Santrock, 2015). Conversely, Lily’s difficulty completing sit-ups suggests weak abdominals and back extensors that usually develop during tummy-time (Park S., Park C., Lee & Cho, 2001). A functional writing posture requires “maintaining an upright position with feet on the floor, fluent movement patterns, and the ability to make postural adjustments when necessary” (Hinojosa & Kramer, 1999, p. 439). Lily demonstrates this posture by sitting close to the table with both feet on the floor and her wrist in slight extension. She often readjusts her seat during tasks requiring fine motor precision. Although Lily exhibits shoulder stability when writing, her tendency to rest her head in her hand and lean her upper trunk on the table for support suggests difficulty stabilizing her trunk and neck in prolonged sitting or a personal technique to increase task focus. (Lane, 2005) Lily demonstrates typical heel-strike, stance and swing patterns when walking and running. Her movements are smooth and coordinated keeping her trunk and head aligned. Lily’s ability to “stabilize her balance on one leg and weight-shift appropriately without falling” during running highlights skills refined at 15 months (Santrock, 2015, p. 119). This agility suggests that with practice Lily has identified “relevant combinations of strength and balance required to improve locomotion skills” (Santrock, 2015, p. 119). Having the balance, postural control, kinesthia, proprioception and visual regard integrated at 5-years-old allowed Lily to successfully

EVALUATION OF A TYPICALLY DEVELOPING CHILD

4

perform stationary hops without falling. (Rekoutis, 2016) However, her one-foot balance required verbal cues prompting Lily to lift her head, retract her scapula and tighten her abdominals to prevent tipping outside her base of support. In line with her age, Lily’s bilateral coordination allowed her to successfully tap her finger and feet simultaneously (Rekoutis, 2016). These synchronized bilateral movements were expected of Lily at four-years-old (Rekoutis, 2016). Her bilateral catch/release is coordinated; however, she has trouble orienting arm direction and force application when dribbling a ball with alternating hands. After two trials, she corrected her arm movements to prevent the ball from bouncing outside of her reach. She anticipates and prepares to catch the ball; a skill typically seen at age seven (Porter, 2002). Lily performed push-ups from the knee position. While performing knee push-ups, Lily widened her arms and lowered her pelvis indicating arm muscle weakness. A wound on her right knee, revealed post-test, could have impacted her weight-bearing and subsequent positioning during the push-up trial. Fine Motor Skills Lily demonstrated functional fine motor skills equal to age-expectations. Lily’s ability to transfer pennies without hesitation or error suggests advanced manual dexterity skill. She smoothly “moved her wrist, rotated her hands, and coordinated her thumb and forefinger” to efficiently transfer the pennies to the container (Santrock, 2015, p. 122). Utilizing the neat pincer grasp developed at 12 months, the speed at which Lily lifted, transferred between hands and placed pennies, shows skill refinement in bimanual dexterity (Rekoutis, 2016). Demonstrating a dynamic tripod grasp affords better pencil control, steadiness, precision, and optimal pressure gradation. Lily’s pencil movements are isolated to the wrist and intrinsic hand muscles signifying dissociation from the shoulder. She displays complex, rotational in-hand manipulation when orienting her pencil (Hinojosa & Kramer, 1999, p. 442). Her 18-month voluntary release pattern enhances ball and hand manipulation skills (Rekoutsis, 2016). Lily clearly prefers her right hand when initiating tasks. She continuously reached, grasped, caught and dribbled with her right hand. Lily also preferred her right hand when performing fine motor tasks like copying shapes. Since hand preference leads to more frequent use and skilled handedness by the age of six (Kaufman & Zelma, 1978), Lily showed improved strength, coordination and prehensile patterns in her dominant right hand. Visual Regard and Visual Attention to Tasks Lily showed a high level of visual attention during the assessment by performing visual perceptual tasks correctly. She frequently made eye contact while speaking to evaluator and actively engaged with assessment objects. She showed high visual regard when performing the maze activity by staying within maze borders and to fold paper on the black line with clean, even creases. Lily demonstrates adequate visual attention skills as expected since longer attention spans are exhibited from 11-12 years old (Hinojosa & Kramer, 1999, p. 352). Visual Perceptual and Visual Motor Skills Lily demonstrated adequate speed and precision in visuomotor tasks. Her kinesthetic awareness provides the sense of limb position during movement underlying hand-eye coordination tasks (Borstad & Nicols-Larsen, 2016). She reproduced well-formed shapes at an appropriate 11 year level without tactile guidance nor verbal cues. However, she showed

EVALUATION OF A TYPICALLY DEVELOPING CHILD

5

frustration copying complex figures involving figure-ground and visual discrimination of 3-D and overlapping line images that children 12 years 8 months can complete fluently (Beery & Beery, 2010). Her frustration is evidenced by her desire to erase and verbal expression. Her advanced visual perception manifests as attention to spatial relationships, direction orientation, visuospatial encoding, mental image formation motor planning and sequencing (Lane, 2005). She has coordinated her 12-month-old understanding of spatial relations (closure, proximity, succession, openness and separation) and the four to eight-year-old recognition of perceptual space to perform visuomotor tasks (Lane, 2005). Especially during balance and UE movement activities, she demonstrates clear understanding of her position in space related to objects and “awareness of one’s body concepts such as right/left, up/down, and front/back” (Hinojosa & Kramer, 1999, p. 368). Lily’s ability to perform smooth pursuits to track maze direction and voluntary saccades to alternate fixation from the picture model to her drawing space contribute to her drawing execution. Although Lily demonstrated adequate depth perception when obtaining and transferring pennies from a start to end point, a discrepancy in distance awareness is seen during dribbling and catching a bounced ball. Perhaps her forceful dribbling is an indication of a depth issue that causes her to misjudge the hand placement necessary to bounce the ball effectively. Results/Summary Whole Picture of Child Lily is a high-energy 11-year-old motivated to participate and succeed in evaluation tasks. Her task focus, perceptual abilities and motor skills allow her to fulfill her academic role as a seventh grader. Throughout testing, Lily actively asked questions, smiled and laughed. She was able to recognize task transitions as light-hearted moments, but also demonstrated impulse control by returning to the assessment when directed. Lily shows attention to detail and ability to self-correct by recognizing and asking to erase errors. At times she expressed low confidence to emotionally guard herself in case of poor performance. However, clinical observation determined that Lily was extremely capable of performing all gross-motor, fine motor, visuomotor and strength activities with only arm and trunk strength needing minor improvement to reach age expectations. Lily appears through both standardized testing and clinical observations to be functioning at an adequate level for her age. In addition, Lily demonstrated adequate listening, relatedness, attention, and social skills throughout the evaluation. Overall, Lily is functioning at an adequate age-level in all areas. Strengths Standardized testing results indicate Lily fell within the 65th percentile for the Beery VMI and the 54th percentile for the BOT-2. However, Lily’s high raw score on BOT-2 fine motor integration, fine motor precision, balance, and bilateral coordination subtests indicates areas of strength despite her low raw score in the muscle strength subtest. In addition, a higher percentile score in the Beery VMI indicates her fine motor skills were a strength when not combined with gross motor skills. During the assessment, Lily demonstrates precise fine motor skills with a mature grasp of her handwriting tool. Lily’s determination to perform well throughout the activities contributes to her successful performance outcome because she was more engaged and intrinsically motivated to complete the task at hand. Her ability to recognize mistakes and desire to self-correct were indications of this. Lily cooperated with the evaluators by always paying

EVALUATION OF A TYPICALLY DEVELOPING CHILD

6

attention to their directions and speaking to them with eye contact; a social skill often abandoned in this generation’s children. Functional Concerns Lily’s possible weakened postural control can affect her handwriting stamina and lead to early fatigue during academic tasks like copying the blackboard (Erhardt & Meade, 2005). Over time, compensatory strategies to combat trunk and neck extensor weakness can cause malalignment, muscle shortening, strained musculature and pain (Tabary et.al, 1972). These effects can deter functional engagement in meaningful activities. In addition, her weakened core and arms may impact her involvement and performance in the team sports Lily plays. Her strength and endurance will hinder performance and team acceptance. Becoming a good player and team member will impact Lily’s social environment which is especially important in pre-teen years. With that said, Lily’s overall muscle strength is not so weak that it drastically impedes the completion of the everyday activities Lily wants to engage in. Personal Reflection of Evaluation Process Michele Lily is a precocious 11-year-old girl. She is motivated to complete tasks to the best of her ability. She openly accepts constructive criticism, laughs off errors and quickly self-corrects. When facing challenge, Lily problem solves without asking for help prematurely. I enjoyed working with Lily because her lighthearted energy and will to excel was refreshing. Simulating the evaluation also provided insight on my evaluation skills. Lily’s questions caused me to reflect on my therapeutic sense of self and diction when providing verbal cues. A challenge to administering was sticking to the script and refraining from offering additional instruction when Lily wasn’t choosing the optimal way to complete the task. It was frustrating to know a more efficient way to complete the activity wi t h o u tbeing able helping her problem solve. Next time, I aim to understand the developmental milestones prior to administering the evaluation to be more aware of the skills underlying different movement patterns. This can help me attune to detail without disengaging with the client to reference the manual. Moriah Lily is a intelligent motivated eleven-year-old girl with supportive parents who encourage Lily to always strive to do her best. Her mother’s excitement for Lily to participate in the evaluation provided relief and less anxiety on the evaluators. Lily appeared to enjoy herself throughout the evaluation, which made the experience pleasant. Furthermore, I appreciated the balance Lily demonstrated to laugh of errors yet still attempt to correct herself without showing signs of defeat. I enjoyed the experience of performing an evaluation on a child in order to receive insight on how pediatric assessments may run. In addition, I enjoyed working with both Lily and Michele because they each demonstrated a desire to learn yet were both engaged and lively throughout the entire assessment. A challenge to administering the assessment was the desire to offer additional assistance and too much verbal encouragement. While performing the BOT-2, I found it difficult to withhold strategies for the physical activities. Next time I will choose a better evaluation setting. Although Barnes and Noble wasn’t crowded, a more secluded area is a more appropriate testing setting.

EVALUATION OF A TYPICALLY DEVELOPING CHILD

7

References Beery, K. E., & Beery, N. A. (2010). Beery VMI.: The Beery-Buktenica Developmental Test of Visual-motor Integration with Supplemental Developmental Tests of Visual Perception and Motor Coordination: And, Stepping Stones Age Norms from Birth to Age Six. Administration, Scoring, and Teaching Manual. Psych Corp. Borstad, A., & Nichols-Larsen, D. S. (2016). The Brief Kinesthesia test is feasible and sensitive: a study in stroke. Brazilian journal of physical therapy, 20(1), 81-86. Erhardt, R. P. and Meade, V. (2005), Improving handwriting without teaching handwriting: The consultative clinical reasoning process. Australian Occupational Therapy Journal, 52: 199–210. doi:10.1111/j.1440-1630.2005.00505.x Kaufman, A. S., Zalma, R., & Kaufman, N. L. (1978). The relationship of hand dominance to the motor coordination, mental ability, and right-left awareness of young normal children. Child Development, 885-888. Kramer, P., & Hinojosa, J. (2010). Frames of reference for pediatric occupational therapy (3rd ed.). Baltimore: Lippincott Williams & Wilkins. Lane, K. A. (2005). Developing ocular motor and visual perceptual skills: An activity workbook. Slack Incorporated. Park, E. S., Park, C. I., Lee, H. J., & Cho, Y. S. (2001). The effect of electrical stimulation on the trunk control in young children with spastic diplegic cerebral palsy. Journal of Korean medical science, 16(3), 347-350. Porter, L. (2002). Educating young children with special needs. SAGE. Rekoutiss, P. (2016, September 21). Gross Motor Development & Fine Motor Development P.1 [PDF Document]. Retrieved on (2017, October 30) from Lecture Notes Online Web site: https://newclasses.nyu.edu/access/content/group/cefb52af-6a43-4cf6-93aa1ce94864a9b3/Lecture%20Notes%209.7%20%2010.19.2016/Gross%20Motor %20Development%20_%20Fine%20Motor%20Skills% 20part%20I%20%209.21.2016.pptx Santrock, J. (2017). Life-span development. New York, NY: McGraw-Hill Higher Education. Tabary, J. C., Tabary, C., Tardieu, C., Tardieu, G., & Goldspink, G. (1972). Physiological and structural changes in the cat's soleus muscle due to immobilization at different lengths by plaster casts. The Journal of physiology, 224(1), 231-244. Von Hofsten, C., & Rosander, K. (1997). Development of smooth pursuit tracking in young infants. Vision research, 37(13), 1799-1810....