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ANNUAL REVIEW Classroom, Speech, & OT |
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Student: Dorina Vital Date: Age: 7 years Dorina
is a 7-year-old student enrolled in the Therapist works with
Dorina to prompt learning and independence throughout her day. At present,
Dorina receives occupational therapy 2x30 minutes per week with an
occupational therapist from In the area of Communication, Dorina has achieved several of her objectives this year. Dorina currently taps a person's shoulder and says "excuse me" when attempting to get their attention. She currently receptively identifies 250 photographs containing objects, community helpers, or actions and expressively identifies 261 photographs containing objects, community helpers, or actions. Dorina is able to answer 17 simple social questions (e.g., "What is your name?"), but is unable to consistently reciprocate this information a social context. Dorina identifies many of the people in her environment with whom she regularly interacts. At this time, Dorina is unable to identify gender, emotions, use possessive pronouns, state the function or category for an object, or use simple sentences to comment on her environment (e.g., "I see (x)."). In the area of Classroom Readiness, Dorina made progress on each of her objectives. She currently uses a two-tier token system to increase the length of time that she is working with her therapist in her cubby. This year, Dorina increased the amount of time that she appropriately waited for an item to 60s. Additionally, Dorina responds to her name being called by establishing eye contact with the speaker across her school day. She is currently working on responding to her name being called from 5-7 feet away by walking over to the speaker and saying "What?". Dorina is also able to independently ask for help when necessary and is currently working on raising her hand before asking for help. In the area of Academics, Dorina made progress on her objective. This year, Dorina used flashcards to complete simple additions problems. Additionally, Dorina is able to perform 1: 1 correspondence with 1-5 objects and is currently working on performing 1: 1 correspondence with 6-10 objects. At this time, Dorina has not been evaluated on quantity to numeral matching. In the area of Decreasing Maladaptive Behavior, Dorina has made progress on her objectives throughout this year. Dorina currently engages in an average of 0.2 pinches per day, an average of 5 aggressions to others per day, an average of 0.5 aggressions to the environment per day, an average of 0.7 crying/laughing/screaming episodes per day, and an average of .13 instances of PICA per day as summarized across the last 15 data points (9/7-9/28). Data was collected on Dorina's non-contextual speech paired with self-injurious behaviors (SIB) or aggressions, major SIB, and minor SIB using a 15minute partial interval time sampling method across her day. Dorina engages in noncontextual speech paired with SIB or aggressions in an average of 4% of 15-minute intervals per day as summarized across the last 15 data points (9/7-9/28). She engages in major SIB in an average of 4.9% of 15-minute intervals per day and minor SIB in an average of 59.7% of 15-minute intervals per day as summarized across the last 15 data points (9/7-9/28). It is important to continue to target these aberrant behaviors in the coming year. In the area of Daily Living Skills, Dorina has made progress on her objectives. Currently, Dorina completes 2 activities (i.e., Mr. Potato Head toy and styling Barbie's hair) independently with appropriate play behavior. Dorina is currently working on completing the steps of a picture activity schedule to increase independent play skills. Currently, Dorina will respond to the instruction to "stop". At this time, Dorina has not been evaluated on parallel or associative play skills. Dorina has made progress over the past academic year. It is appropriate for her to remain in the ABA Program Sub-Separate Classroom for the next academic year. In addition to expanding skills in the areas she is currently making progress, it is recommended that additional target skills include increasing spontaneous and functional language; increasing peer interaction skills; and increasing opportunities for inclusion and reversed inclusion. Speech and Language Review Name: Dorina Vital Date: Age: 7 years Background: Dorina is a 7 year old
student enrolled in the Currently: Dorina is able to spontaneously elicit most of the stimulus words on the Goldman Fristoe Test of Articulation 2. She had difficulty with the beginning sound /th/ as she substitutes this with the /f/ sound as in (fum/thumb). And the medial /th/ she also substitutes with Id/ as in (federl feather). She was able to correctly produce most of the blends with the exception of /fl/ she produced as /fw/, (fwoer/flower). Dorina also presents with final consonant deletion as she would leave endings off of words with plurals, /ing/ , /t/, and /l/. Multisyllabic words are correctly produced by tapping or clapping out each syllable. Currently, Dorina's length of utterance is approximately two to three words in length. Increasing her length of utterance is being addressed through modeling "I want -" and the item, and through the use of sentence strips. Additionally, she is practicing appropriately gaining someone's attention by tapping the adult on the shoulder and saying "excuse me". A word list has been comprised for carry-over of specific words she would say during class activities. For example days of the week, counting numbers, polite words such as please, thank you, excuse me, and classmates names. Recommendations: It is recommended that Dorina receive direct speech and language therapy one time weekly to improve articulation skills and speech intelligibility. Areas to be addressed are: Final consonant deletion Multisyllabic words Intelligibility at the phrase and sentence levels Occupational Therapy Annual Review NAME: Dorina Vital AGE: 7 years 1 month Annual reviews are designed to monitor a child's progress in specific skill areas addressed in occupational therapy as outlined in his/her Individualized Educational Program (IEP). BACKGROUND INFORMATION:
Dorina is a 7 year old girl who is currently attends the sub-separate INTERPRETATION OF PROGRESS BASED ON CLINICAL OBSERVATIONS POSTURAL AND PROXIMAL STABILITY / POSTURAL CONTROL This is an area of development, which encompasses muscles of the neck, trunk, shoulders and hips. This musculature gives a child stability for movement and provides the foundation for fine motor manipulation, loco motor skills as well as attending abilities. In the progression of development, one develops proximally (i.e. from the spine) then outward, distally toward the fingertips. Therefore, if this musculature is not adequately developed refined hand skills, overall gross motor coordination and attending abilities may be negatively impacted. As a result, inadequate postural and proximal stability can negatively influence the acquisition of readiness skills needed for academic success. This foundational skill is not specifically addressed by occupational therapy in her current IEP but based on clinical observations Dorina appear to demonstrate proficient fundamental skills in this area. She demonstrates an adequate ability to maintain upright unsupported sitting for extended periods of time at the desk and demonstrates good endurance when participating in therapy. Overall this appears to be an area of strength for Dorina. Continued participation in gross motor activities at home is suggested to promote good overall health, strength, and coordination as well as to provide appropriate sensory activities (swimming, climbing, jumping, running, ball games, and swinging to provide a few examples). BILATERAL MOTOR INTEGRATION As we know, the brain is divided into two hemispheres and bilateral motor integration develops as a result of communication between the two hemispheres. This permits the brain to function as a whole rather than as two separate halves. As communication develops, the hemispheres take on specialized functions (i.e. left - language and logical thinking; right-spatial relationships and music). In addition, specialization is necessary for the development of hand and eye dominance along with adequate coordination of both sides of the body. If a delay in bilateral motor integration exists, a child may exhibit poor reflex integration, diminished eye and hand dominance, decreased fine and gross motor coordination, may be resistant in crossing the midline of one's body and exhibit difficulties in tasks that require the use of both sides of the body. Therefore, inadequate bilateral motor integration can adversely effect overall motor coordination as well as cognitive development thus negatively impacting academic performance. Dorina demonstrates improvement in bilateral motor control At this time, she uses her right hand as dominant and needs verbal cues to use her "helper" (left) hand to stabilize the paper when writing. Dorina is now crossing the midline of her body more consistently (approximately 80% of the time verse last year at 58% of the time). She is now able to perform a few of the higher level bilateral coordination tasks (i.e. galloping). On the other hand she continues to have difficulties "discriminating” right and left on herself and objects. She also continues to have difficulty with higher level bilateral and eye hand coordination tasks that requires using both sides of her body to work together (i.e. skipping, jumping jacks and thumb/index finger pivot). OCULAR MOTOR FUNCTIONING: This is the ability of one's eyes to work together in a smooth coordinated fashion in the areas of visual tracking, attending, convergence and teaming. Adequate ocular motor skills are essential for laying the foundation in the acquisition of basic academic skills such as reading, writing and copying material. If inadequacies with ocular motor coordination exist, one may experience difficulties with visual perceptual skills, visual motor integration, and overall fine and gross motor coordination. This area was informally assessed through a simple screening. Based on clinical observations, Dorina demonstrating nice improvement in this area, she is able to demonstrate independent eye from head movements when visually tracking a moving object of interest in all visual fields. She seemed to exhibit competent eye teaming abilities along with sufficient convergence skills. However, Dorina continues to have difficulty sustaining eye contact. Verbal and visual prompts are provided to increase visual attention and eye contact. SENSORY MOTOR FUNCTIONING: This involves the organization and awareness of one's body as it relates to space around it, through the sense of touch (tactile system), joint perception (proprioceptive system) along with movement and balance in relationship to gravity (vestibular system). The combination of these three systems (Le. tactile, proprioceptive and vestibular), when working efficiently provides one with sensory information which is internalized, resulting in the formation of a body map (i.e. where one's body begins and where it ends). With the development of good body awareness comes efficient motor planning abilities, proficient visual perceptual skills and competent attending abilities. If one lacks the ability to efficiently discriminate sensory input, inefficiencies in the previously mentioned areas will or may be observable. The first four years of Dorina's life were marked with severe environmental deprivation, which has in turn caused her central nervous system to process sensory information in a faulty way. Dorina has made some really nice gains in the area of sensory processing over the last year. She appears to be able to process sound information in a more effective way. She does not appear to have any adverse effect to loud sounds. She appears to still have an under responsiveness to touch or deep pressure as evident by her self-injurious behaviors, however, these behaviors have decreased significantly. Dorina continues to seek out sensory input but is now appearing to be able to register the sensory input. In reference to body awareness, Dorina now able to independently scan the therapy room and remove any objects within 4 feet of a desired piece of equipment. She is able to identify over 20 body parts as well as draw a recognizable self portrait with minimal cues (with a head, eyes, Dose, and a mouth). Dorina continues to have difficulty motor planning new activities. She continues to require that simple and multi step tasks be broken down with increased amounts of verbal and visual prompts provided. She seems to continue to learn new tasks better when given verbal, visual and physical prompts. Therefore, it is felt that Dorina would benefit from utilizing a multi sensory teaching approach within the classroom. FINE MOTOR COORDINATION: Fine motor coordination refers to one's ability to handle and manipulate small objects in a coordinated and purposeful fashion. The development of efficient fine motor coordination is achieved through the agile hands of the developing child by exploring, forever piling and building, picking up and putting down, reaching, shaking, turning, and fitting things together. In the area of fine motor coordination, Dorina is demonstrating improvements evident in her ability to write her name. During paper pencil tasks, Dorina is noted to grasp the pencil with her right hand utilizing a modified tripod prehension pattern. When manipulating the pencil, overall pencil control is elicited via wrist and arm movements verse the desired wrist and isolated fine finger movements. She demonstrates a slow but steady improvement in speed and dexterity of her fingers, which has helped improve her writing, cutting, and coloring. She is now able to translate small objects into the palm of her hand, yet continues to have difficulties with translating small objects out the palm of her hand. She is also able to manipulate buttons and continues to be able to snap/unsnap five snaps. Dorina is able to cut a straight line on a 1/4" wide by 6" long, and a curved line 1" wide by 6" long given verbal prompts. On the other hand, Dorina continues to have difficulties when requested to engage in more demanding fine motor tasks (i.e. skillfully cutting with scissors) secondary to her decreased attention, and decrease eye hand coordination. VISUAL MOTOR INTEGRATION This is an area of development which combines visual perceptual skills as well as eye hand coordination was reassessed by the Developmental Test of Visual Motor Integration (VMI). A test that examines one's ability to visually perceive geometric figures and then motorically reproduce those figures utilizing paper and pencil. Figures to be copied are arranged in developmental order, from simple to more complex. Visual motor integration is the process in which information is taken in through the eyes, processed, organized and then transferred into a motor response. For example, copying off the board a student sees the word, recognizes it, and then is able to reproduce that word by holding a pencil and writing it on paper. Recent testing indicates that Dorina has mastered 5 out of 9 developmental strokes necessary for quality penmanship and achieved a score of 4 years, 3 months on the standardized test for these skills (Beery Test of Visual Motor Integration). This assessment was given with verbal cues to increase attention to detail, decrease impulsivity, and offer encouragement. The quality of Dorina's work during this assessment was compromised as a result of her impulsivity. She seemed to work fast and she was Dot paying attention to details, which is needed to copy the more complex geometric figures. However, functionally Dorina has showed improvement in the quality of her writing. Given verbal prompts, Dorina is able to write her name on a line with correct formation in the therapy room. SUMMARY OF PROGRESS AND RECOMMENDATIONS: In examining the results presented in this annual review Dorina seems to have made some nice gains in all areas addressed in occupational therapy. At this point in time Dorina presents with strengths and weaknesses regarding the development and acquisition of foundational and functional skills needed for academic success. Relative strengths seem to be reflected in the area of postural and proximal stability, and ocular motor control. Weaknesses seem to be evident in the areas of bilateral motor integration, sensory processing abilities, fine motor coordination, and visual motor integration. . Based On these findings
it is felt that Dorina would continue to benefit from occupational therapy
services two times weekly for 30 minutes. Therapy will focus on utilizing a
sensory integrative model, aiming in the promotion and acquisition of the
delayed foundational skills noted in this annual review. In addition, it is
recommended that a team approach comprised of consultative services provided
to the parent(s), classroom teacher and supportive educational services be
implemented to facilitate and enhance academic progress. One should also note
that, although the acquisition of readiness skills along with academic
success is dependent OD foundational development, it is also interdependent
on cognition. ID the event that cognitive delays should exist, the cognitive
delays may negatively impact the overall gains that can be made via
occupational therapy intervention. With this in mind, the determination of
the effectiveness of occupational therapy intervention and the continuation
of OT services will be based on the amount of progress Dorina makes within
the next IEP school year. |