Running head: CASE STUDY

Said: A Case Study

Marissa Elder, Lauren Hawkins, Kelsey Puliafico, Sara Silverberg, Marissa Stendel, and
Jesse Vallera
Touro University Nevada

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Occupational Performance

Occupations within the realm of occupational therapy, refer to meaningful and purposeful
activities individuals complete (American Occupational Therapy Association [AOTA], 2014). The
Occupational Therapy Practice Framework (OTPF) separates occupations into eight categories to
assist occupational therapists as they consider all aspects of their clients life. This becomes
pertinent when developing an occupational profile. Said is a 6-year-old boy recovering from a
traumatic brain injury (TBI) endured during a vehicle accident 8 months ago. Because of this
incident, it is important to review what occupations he will need when rehabilitating.
The first occupational area is Activities of Daily Living (ADLs), which are the occupations
related to self-care (AOTA, 2014). ADL activities impacted by Saids injury include toileting,
swallowing/eating, and functional mobility. Since his injury, Said has not regained bowel or
bladder control. Additionally, he is unable to receive proper nutrition via oral feeding and drinking,
leading to a percutaneous endoscopic gastrostomy (PEG) tube being inserted to the abdominal
area. Lastly, Saids mobility has been limited. Currently, he is able to stand for 30 seconds and
uses a posterior walker to support himself while walking 100 meters. Throughout the course of his
recovery, Said has gained strength and muscle tone, which shows potential for his prognosis. Upon
discharged, Said will be given a wheelchair to help him maneuver in the community. Said will
need to practice maneuvering a wheelchair in the indoor environment of the rehabilitation facility,
so that he is better able to manage his wheelchair when he returns to school.
The next occupational area is Instrumental Activities of Daily Living (IADLs). These
occupations are more complex than ADLs and help support an individuals life at home and in the
community (AOTA, 2014). Due to Saids age, his role in most IADLs are limited and are often
performed by his family. However, Said will soon be expected to take some responsibility for

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safety and emergency maintenance. It will be important for Said to learn emergency telephone
numbers and recognize unsafe situations. In order to perform ADLs and IADLs, Said will need
rest and sleep.
Rest and sleep are important occupations for a growing young child with many factors
contributing to sleep preparation (AOTA, 2014). At 6 years old, Said should be able to change into
pajamas and brush his teeth prior to going to bed each night with supervision. Since his accident,
Saids low cognitive level and muscular endurance prevent him from completing these activities
independently. These factors also influence his education.
Education is an important occupational area for Said as he recently started first grade. Said
participates in the formal aspect of education by attending public school in the town near his home.
His father reported that Said is a good pupil at school, [and] has just acquired reading and writing
skills. Said has also established right-hand dominance, which will be important to keep in mind
when planning interventions for Said to rebuild upper extremity strength. Being a student is Saids
primary work occupation due to his young age. Also, at 6 years old, play is Saids main priority.
Play is one of the most significant occupations in Saids life. Saids father also indicated
that Said is a typically developing young boyenjoys playing outside with his friends, especially
ball games. Said will have difficulty participating in play activities outside with his friends after
leaving the rehabilitation facility due to his limited mobility and hypotonia in his limbs and trunk.
A main focus of occupational therapy intervention should be in the area of play. The occupational
therapist will help Said develop adapted ways to engage in play.
Saids leisure time is directly related to play. He is not yet at an age where he is able to
explore leisure options on his own. For example, he cannot venture out into the community to
search for new hobbies to participate in, he is limited to where his parents take him and supervise

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him. Many of the leisure activities he participates in are at home with his family. Living with a
large family, there are many opportunities for engaging in leisure.
Said is an active member in social participation at home and in the community. Because
he lives in a home with many family members, social occupations are common. He enjoys
spending time with his family and is very close to his siblings. As a young elementary school aged
boy, Said enjoys attending family gatherings, going to church and playing video-games with his
siblings and friends.
Movement, Postural Reactions, and Reflexes
Over the course of his eight months in rehabilitation, Saids condition has greatly
improved. Although Said is still hypotonic, his muscle tone has increased to an Ashworth scale
score of 1, indicating a slight increase in muscle tone with minimal resistance applied. Saids
manual muscle testing (MMT) results (4/5 for upper extremity and knee strength) indicate that
Said should be able to participate in upper extremity ADLs, such as upper body dressing and
dental hygiene. Said can also stand for 30 seconds, but is only able to keep his eyes closed for 3
seconds during that time. This could illustrate that Saids postural sway has increased due to his
brain injury and is causing him to have poor balance when his vision is occluded. In his current
state, Said is only able to maintain a kneeling position and can walk short distances with support.
The farthest he has walked is 100 meters with a posterior walker and constant supervision.
Because he is unable to maintain a standing position for longer than 30 seconds, Saids
equilibrium reactions may not be strong. If Saids equilibrium were disturbed, he would be
unable to recover from a fall. It is important for the occupational therapist to consider the
improvements Said has made in muscular strength and to continue assisting him with getting
stronger.

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Sensory Integration

Sensory integration is the process of receiving, integrating and responding to sensory

information from the environment and demonstrating an adaptive response to that input (Ayers,
1972). The bodys ability to integrate and modulate sensory input and appropriately respond is
essential for cognitive and social development and self-regulation (Galvin, Elspeth & Imms,
2009). Self-regulation relates to observable behaviors demonstrated by the client in response to
stimuli. Inability to properly modulate or self-regulate ones behavior impacts an individuals
ability to participate in daily occupations (Galvin et al., 2009).
It is common for children with a TBI to express a variety of somatosensory impairments
(Cronin, 2001). Commonly reported difficulties include impaired postural awareness and
orientation, sensation impairments and difficulty grading muscle force. Said demonstrated
postural deficits due to limited vestibular and proprioceptive processing. While he has regained
the ability to stand unsupported with both feet on the floor, he was unable to do so for more than
30 seconds and required assistance turning 360 degrees. Ataxia of Saids limbs and trunk are also
making grading of muscle forces difficult. Standing, walking and transferring have become
increasingly difficult as Said does not have the ability to properly coordinate his extremities.
Said also has difficulty controlling the power and speed utilized in movement.
Additionally, children may display impaired motor planning, tactile sensory dysfunction
and spatial disorientation, which influences cognition. Cognitive impairments include deficits in
attention, concentration, judgment and impulse control (Cronin, 2001). Saids cognitive
impairments prevent him from properly utilizing his working memory, which is important when
accessing learned information. This directly affects his ability to plan and organize. Saids
difficulty accessing learned information may present as trouble remembering, following and

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completing multi-step instructions. Said demonstrated these deficits when he was unable to lead
the way to and from his daily activities and relay the sequence of his daily routine. A study
conducted in 1997 by Ewing-Cobb et al. found that young children are especially vulnerable to
long term cognitive impairment as their executive systems are still undergoing rapid change.
They also state that while a childs cognitive functioning may improve in the first six months
post injury, the subsequent 18 months may present persistent deficits in the childs ability to
acquire new skills.
Said is also demonstrating poor modulation. Saids father reports that he has become
increasingly aggressive, restless, and he startles easily to loud noises. During Saids last home
visit, his father noticed Said covering his ears when the entire family was in the room.
Additionally, it has been noted that Said is increasingly unable to focus when presented with
excessive visual stimulation.
Theories and Practice Models
Determining what models and frames of reference to use when working with a client is
important in finding how the client can be successful in their own right. Saids case is very
unique, thus a multitude of models and frames of reference can be identified in order to help Said
overcome his injuries and live a meaningful life. Using the following models will help further
goals for the client and help with implementation of interventions and/ or treatment plans.
PEOP Model
The Person Environment Occupation Performance (PEOP) model focuses on the clients
concerns and views of their occupational performance. PEOP is a model where participation
within occupation is a result of the persons willingness to act in that occupation (Brown, 2014).
The interaction of the person and the environment create the occupational performance. Because

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Said is a 6-year-old child and in a vulnerable place, it is important to focus on what the client and
his family or parents believe to be optimal for his occupational performance. Prior to the
accident, Said lived in an underprivileged neighborhood in a crowded home. He attended school
and engaged in age appropriate play with peers. Saids performance has diminished
tremendously by his occupations and daily routines. By utilizing the PEOP model, Saids
occupational therapist can identify these factors through his occupational history and implement
for the clients new needs through occupation.
Additional Theories and Models
Another model that can be used by the occupational therapy practitioner is Occupational
Adaptation. This model views the clients deficits on a continuum of change and how it
reorganizes over time, which is important for Saids continual progress (Schultz, 2014). Under
this model, Saids optimal functioning will occur where there is a desire for mastery or
involvement in the environment. In order to achieve this, it is important to implement play
throughout Saids rehabilitation treatment sessions. As Saids condition changes, the
circumstances surrounding his situation shift as well therefore leading to adaptation. The goal of
this model is to not help the client adapt but to increase the clients ability to adapt, which can be
achieved through occupational readiness and occupational activities (Schultz, 2014).
Lastly, the Sensorimotor frame of reference (FOR) can be used to focus on the planning
of Saids movement and coordination within functional activities. This FOR finds that movement
is a product of specific motor responses initiated by sensory stimulation and promotes the use of
sensory input to change muscle tone and muscle contraction (OBrien & Hussey, 2012). One of
the occupational therapy goals for Said is for him to gain access to the community through
mobility. Creating the appropriate movements with his wheelchair, standing, and kneeling will

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help Said to ultimately achieve community mobility. Combining sensorimotor strategies with
play activities, such as Wii Fit balance games and playing with Legos while kneeling, will
ultimately help Said to improve his motor skills through the exploration of his sensory system.
Assessments
Said has been evaluated, and will be re-evaluated, with three assessment tools focusing
on gross motor, fine motor, self-care, mobility and social function. These three assessments, the
Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT-2), Gross Motor Function
Measure (GMFM) and The Pediatric Evaluation of Disability Inventory (PEDI), are dependable
tools. The GMFM and the PEDI have been used previously to assess Said. The BOT-2 was the
only assessment not to have been conducted previously. However, this tool would be beneficial
to gage Saids specific motor subtests (fine motor precision, fine motor integration, manual
dexterity, bilateral coordination, balance, running speed and agility, upper-limb coordination and
strength) (Bruininks & Bruininks, 2005).
The GMFM will help measure Saids improvements in the 8 months of recovery and his
ability to progress in the future. In the 2-month and 5-month interval of Saids treatment, the
lying and rolling section of the GMFM revealed initiation of movement in supine but no
initiation in any prone dimensions. The collected scores of the 8-month interval indicated that he
could complete the lying and the sitting sections. Upon discharge, the GMFM will be
administered again in order to gain more clarity on Saids standing and walking. Because the
familys greatest wish is to have Said ambulate again, this tool is excellent to assess domains for
static and dynamic gross motor activities associated with ambulation (Russell, Rosenbaum,
Avery & Lane, 2002). Lastly, Saids level of independence will be evaluated in self-help,
mobility and social play with the use of the PEDI assessment. Said improved every interval on

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the PEDI score in all domains, indicating that potential changes may be seen if this trend
continues upon final discharge.
Functional Problem Statements
1) Child is unable to stand with his eyes closed for three seconds due to a weakened sense of
vestibular and proprioceptive input.
2) The clients TBI contributes to toileting dysfunction due to bowel and bladder incontinence.
3) Client requires constant supervision in walking 100 meters with a posterior walk due to
bilateral hypotonia in his lower extremities, which impacts his functional mobility.
4) Client struggles to complete ADLs, such as dressing, due to difficulty sequencing tasks
involved with his daily routine.
5) Client has difficulty engaging in tasks requiring structural stability due to limited ROM in
both ankles, hypotonia in all four limbs and weakened base of support.
Family/Caregiver/Child Goals
1) The family will learn strategies to encourage appropriate toileting through the use of
behavioral interventions.
2) Said will utilize coping mechanisms to aid in his modulation.
3) Saids family would like him to increase his capacity to participate in functional mobility.
4) Said will be able to communicate using the picture exchange communication system
(PECS).
5) The family would like Said to be able to complete his daily routine with supervision.
Occupational Therapy Goals, Activities and Application
1) LTG: Said will be able to complete his morning routine using a visual schedule with
supervision upon discharge from the hospital.

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STG A: Using a visual schedule, Said will effectively learn to sequence steps associated
with dressing with moderate assistance within two weeks.
o Activity 1: Said will practice the sequencing of dressing on a teddy bear.
Application: This activity will help Said work on task-sequencing
associated with dressing within the context of play. Said will put on four
clothing items: underwear, a shirt, pants, and shoes. Said will put on the
underwear before the pants, and the shirt last. The activity should take 1015 minutes. Said may need some assistance, including scaffolding during
difficult parts of the activity (i.e. pulling up the bears pants).
o Activity 2: Using a visual schedule, Said will practice donning and doffing his
shirt.
Application: This activity will not only help Said with his ability to
sequence but also with his ability to perform the ADL of UE dressing.
Said will practice with a t-shirt for easy application and removal. He will
don the shirt three times and doff the shirt 3 times. This activity will take
about 15 minutes. Said will need moderate assistance with tactile cueing
and verbal prompting.

STG B: Said will be able to complete three-step tasks with supervision within two weeks.
o Activity 1: Said will complete a sequential puzzle with three pieces that depict
steps of tasks associated with his morning routine.
Application:The puzzle will help Said work on task sequencing and fine
motor control. Said will practice the puzzle until he completes it correctly
one time and without tactile cueing or physical assistance. Verbal cueing
and set-up should be provided. The activity should take approximately 510 minutes to complete.
o Activity 2: Said will practice taking turns playing a board game.
Application: The board game will provide Said with the opportunity to
practice the sequencing skills he has been learning throughout therapy
while also reinforcing proper social conduct. Said will also benefit from
UE use by moving his game piece across the board. The activity should be
completed with another patient during therapy. The game will be played
until it is completed or 15 minutes have passed. Said may need physical
assistance to move his game piece and verbal cueing to assist in his ability
to sequence.

2) LTG: Said will be able to toilet on a schedule after each meal with moderate assistance upon
discharge from the hospital.

STG A: Said will be able to manage his clothing and basic hygiene needs when using the
restroom with moderate physical assistance within two weeks.
o Activity 1: Said will use a Theraband to practice LE dressing.
Application: The Theraband activity will allow Said to be a more active
participant in the ADL of LE dressing. It will also provide Said with
sensory input that will guide him while dressing. Said will don and doff
sweatpants 1-2 consecutive times. Said will need moderate physical

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assistance as well as verbal cueing. The activity should take about 15

minutes.
o Activity 2: Said will practice hand washing associated with a token system.
Application: This activity will address Saids ability to practice skills
associated with toilet management as well as general hygiene. Said will
navigate his wheelchair to the sink with minimal assistance. He will then
practice all steps associated with hand washing for asepsis. This activity
should take approximately 5 to 10 minutes. Minimal assistance may need
to be provided through the hand washing process. Said will then receive a
sticker for completing the task. Once Said has earned 3 stickers, he will be
able to pick a toy from a treasure box.

STG B: Said will be able to communicate using a Personal Exchange Communication

System (PECS) his need to use the restroom after meals with supervision within two
weeks.
o Activity 1: Said will play Bingo using PECS with therapists.
Application: The bingo game will allow Said to practice communication
using PECS as well as help him recognize what each picture signifies. The
Bingo board will consist of pictures from Saids PECS and will run like a
regular Bingo game. The practitioner will need the Bingo board and chips
to cover each picture once it is called. The activity should take about 15
minutes. Said may need verbal prompting to stay on task as well as some
physical assistance when placing chips on the board.
o Activity 2: Said will play Simon Says utilizing the PECS.
Application: This activity will help Said understand the meaning of his
PECs pictures within the context of play. The practitioner will play Simon
Says and ask Said to point to different tasks on his PECS chart. The
activity should last about 5-10 minutes. Said may need verbal prompting
to locate the right picture on the PECS.

3) Said will be able to maneuver his wheelchair in an indoor environment with minimal
assistance upon discharge from the hospital.

STG A: Said will be able to balance while standing with a posterior walker for 60
seconds and balance while high kneeling for 30 seconds with moderate assistance
within two weeks while engaging in play activities.
o Activity 1: Said will build a small tower out of Legos while high kneeling.
Application: By high kneeling during play, Said will gain postural
stability and strength needed for mobility. The Legos will provide Said
with motivation and make the treatment more occupation-based. Said
will build a tower utilizing ten blocks while high kneeling and then
rest for one minute. He will complete this sequence 3x with a 10
minute rest between each attempt. This should take 5 to minutes. Said
will most likely need physical support while maintaining a high
kneeling position. He may need verbal cueing to build the tower.
o Activity 2: Said will participate in one Wii Fit activity.

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Application: The Wii Fit Sport game will provide Said with the
opportunity to work on muscle strength and endurance. Said will play
the game while standing and utilizing his posterior walker for support.
Sitting breaks and resting should be provided as needed. The activity
should be played for about 15 minutes. Said will need to be carefully
watched in case he loses his balance and support while standing may
be provided. Verbal cueing and general set-up will be applied as
needed by the practitioner.

STG B: Said will be able to navigate his wheelchair throughout the hospital with
supervision within three weeks.
o Activity 1: Said will navigate his wheelchair through a simple cone obstacle
course in the therapy room.
Application: Said will be provided with a simple cone obstacle course
so he can notice objects and perceive his environment while engaging
in indoor mobility. This obstacle course is motivating, fun and serves
to increase his mobility as an ADL. Said will accomplish the course in
2 minutes and he will decrease his time when he will be more familiar
with the course to increase his confidence. Said may need physical
assistance pushing his wheelchair and verbal cueing may be needed for
him to navigate through the cones.
o Activity 2: Said will navigate his wheelchair through the cafeteria and gift
shop within the hospital.
Application: In order to navigate his wheelchair, Said will
require mental functioning to orient himself and other locations. Said
needs to interact with his environment to recognize obstacles and/or
people to execute his DME successfully. He will also become aware
with sensory stimuli that he will interact with. Said will visit both the
cafeteria and gift shop before returning to his room. If Said becomes
agitated or appears to lack endurance, the practitioner may need to take
him back to his room before completing the excursion. Rest breaks
should be provided as needed. This activity should take approximately
30-45 minutes. Verbal and tactile cueing may be needed to help Said
attend to and complete tasks associated with this activity.
Treatment Plan

Environmental Setting
Saids therapy sessions will occur in a rehabilitation center, which has benefits as well as
drawbacks. The rehabilitation center is good for Saids treatment because it is a safe place with
professionals knowledgeable about Saids condition. Because of the access to equipment and
safe-patient handling protocol, the center will be well equipped to work with Said in a manner

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that is low risk to him. Professionals at the rehabilitation center also understand his abilities and
limitations better than the average person, making it easier for them to work with Said. One
drawback to therapy occurring within a rehabilitation center is that the skills Said learns may not
be generalizable because it is not his natural environment. Professionals working with Said have
a restricted view of his occupational performance as they have not seen his home environment or
its impact on Saids role performance.
Recommendations
One of the most important aspects of Saids treatment will be continued collaboration
between his doctors and parents as he experiences changes in his condition. One key to any
continued care plan is to modify the difficulty of the tasks to challenge the client appropriately.
The team associated with Saids treatment can do this by increasing the difficulty of some of the
tasks he practices at home. For example, as Said continues to complete puzzles associated with
his daily schedule, the therapist and the family can collaborate to increase the puzzles difficulty
level by adding more pieces, schedule components, or adjusting levels of assistance. Once Said
has mastered these tasks, the next step will be to implement more activities associated with his
morning routine. This will involve a series of tasks to be performed sequentially as part of his
routine, reinforcing his ability to sequence tasks as well as perform the motor requirements
associated with ADLs such as toileting. A visual schedule will give Said an amount of cueing
that provides a just right challenge. The schedule will also be a great way for his family and
caregivers to be involved with his progression.
Post Discharge Environment
Upon discharge, Said will return to living with his parents, four siblings, his
grandmother, and four uncles in a four bedroom apartment in an underprivileged neighborhood.

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There is no restroom in his familys apartment, which is problematic because Said currently has
limited mobility and will need a wheelchair after therapy is completed. Because of this, the
therapist will request that he be given a bedside commode to take home with him. The therapist
will also instruct Saids caregivers on how to properly assist Said when he needs to use the
restroom once he is able to utilize the visual schedule to help sequence the associated tasks. The
therapist will make modifications in Saids small apartment in order to make it more conducive
to wheelchair mobility. This will include suggestions on how to arrange furniture as well as
ensuring the hallways are wide enough for Saids wheelchair.
SOAP Note
S - Client was lethargic and appeared to be confused during the tx session. Client responded
minimally to yes and no questions but displayed excitement during child board game as
evidenced by his increased participation in the tx at that time.
O - Client participated in 60-minute OT session at the inpatient rehabilitation center focusing on
improving his ability to sequence, increase fine motor skills and engage in self-care activities
through functional play. Client demonstrated poor selective attention and frustration during
puzzle activity as evidenced by his lack of eye contact and refusal to participate. Client
completed the sequence puzzle with mod A and some HOH scaffolding. Attention and focus
improved with child board game. Client followed 3-4 word command sentences, responded by
participating in particular task associated with game and engaged in some Yes or No reciprocal
communication. Client demonstrated fluency in fine motor activities as evidenced by moving
the game piece across the board. Client was able to perform tasks sequentially and discriminate
between different colors. Client was able to remember to put toothpaste on toothbrush and was
able to brush his teeth with max A.

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A - Clients poor selective attention and frustration during tx session limits ability to engage in
age-appropriate play activities and self-care activities. Low tone, limited trunk strength, and
cognitive dysfunction interferes with client reaching cognitive and fine motor goals. Client
demonstrates progress in 3-step task sequencing with repetitive verbal and tactile cueing.
Clients ability to differentiate colors and ability to respond to 3-4 word commands improved
during child board game. Client has the potential to improve ability to follow a morning routine
with the help of a visual schedule and other sequencing activities. Client will benefit from
continued intervention to increase sequencing, and fine motor needed to improve occupational
performance and engagement in play.
P - Continue to treat client in two 60-minute sessions 6x/wk for 1 month to address problems
with sequencing, fine motor skills, and mobility. Plan to address toileting and community
mobility along with fine motor task during next treatment session.
Research
Virtual Realities for Balance Rehabilitation
Virtual reality (VR) describes a range of interactive technologies that present artificially
generated sensory information (Cheung, Maron, Tatla, & Jarus, 2013, p. 207). VR has become
popular in electronics and interactive gaming systems. These games are interactive in that the
user senses a virtually created environment, primarily through visual experiences, and can
kinesthetically control events on a monitor through manipulation of a device or motion detection
through video capture (Cheung et al., 2013, p. 207). They have been used in rehabilitation
settings for a variety of diagnoses including brain injury. A recent study was done to examine the
effects of VR gaming systems on balance in children with brain injuries. Systems such as the
Xbox Kinect and Nintendo Wii have been shown to improve static and dynamic balance, as well

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as motivation to participate in therapy (Cheung et al., 2013). Based on previous research on the
effects of VR gaming for rehabilitation with brain injury patients, Said could benefit from
participating in such activities to help improve his strength and balance prior to being discharged
from the hospital.
Sequencing with Visual Prompts
Visual supports are commonly employed with individuals with intellectual disability to
aid in maintenance of attention, sequence events, organize environments and/or increase
independent task performance. Pictorial prompts have proven efficacious in increasing
independence with multi-step tasks, sequencing through a schedule, initiating and participating
in an activity, and decreasing adult dependence (Mechling, 2007). Visual schedules are utilized
to depict the sequential order of tasks necessary to complete a broader activity. Visual schedules
have been found to increase understanding of routines and expectations, promote activity
transitions and provide opportunity to make choices (Mechling, 2007). In a study conducted by
Copeland and Hughes (2000), pictorial cues enabled severely disabled students to initiate and
complete job tasks. Agran, Fodor-Davis, Moore and Martella (1992) found participants unable to
respond to peer verbal instructions until visual cues were incorporated in to the task. Pierce and
Schriebbman (1994) studied three children with autism and found they were able to self-manage
their behaviors to complete daily living skills, generalize these skills across settings and tasks,
and maintain this behavior for two months when presented with pictorial prompts.
Sensorimotor Intervention
Treatment specifically focusing on Saids sensorimotor function will help him achieve
his various goals. Particularly, implementing activities where he can work on his core strength,
postural alignment and balance will be the most beneficial. A suggested form of therapy to work

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on his sensorimotor function is structured sensorimotor therapy. Structured sensorimotor therapy,

according to DeGangi, Wietlisbach, Goodin, and Scheiner (1993) teaches specific skills, is adult
directed, and has a predetermined sequence. Though, in comparison, play therapy is beneficial,
sessions with more structure may help Said to reach his goals of balance, walking, and general
body strength, according to DeGangi and colleagues (1993). Having Said utilize the Wii Fit for
balance, gross motor, and bilateral coordination, while keeping the structured therapy format,
should produce optimal results for Saids sensorimotor issues, similar to those found by the
researchers.

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