. . Ak (CL Center Morris County Society for ‘he © wT forthe Handicapped — Crippled Children and Adults id 260 Route $3, Morris Plains, NJ. 07950, TAARGERY OPPENNENICI (201) 538-5636 Enecune Buecior Physical Therapy Evaluation Thomas McBride 22 Fleetwood brive Rockaway, NJ 07866 9/25/87 Right Hemiplegia Thomas is 4 i: year old who attends a preschool handicapped program in svckaway and was referred by the Child Study Team for a Physical Therapy Evaluation. He receives Occupational and Speech ‘iierapy at school. He has been seen by Dr. Wight, Pediatric Neurologist, who diagnosed Thomas as having mild right hemiplegia. Social/Emot Little is known of Thomas’ birth history or early development as he and his twin sister, Amanda, were adopted by the McBrides at 3 years ot age. At that time they were severely malnourished, weighing only 12 lbs. each (Birthweight - 1.8 kg.) and very developmentaily delayed in all areas especially speech and gross motor. Amanua is also enrolled in the preschool handicapped class. Her sother reports that Amanda has some difficulty with speech and the length of her attention span. Thomas was cucompanied to the Physical Therapy department by his mother, He was very cooperative and tolerated handling well, He attempted all tasks and took pride in those he could accomplish. Cognitive/S)cech Thomas is speaking in full sentences and his articulation is fair. He teids to speak softly at first then as he adjusts to a new situation he becomes louder. His mother reports no feeding prolilems and although he seems small for his chronological age he appecis well-nourished. Thomas was able to follow 2-step motor directions, only occasionally having to be shown visually first. He can name several colors and count to 10. He knows simple body parts. Fine Motor Thomas was vvserved to use his right hand for fine motor tasks. He was able to imitate a circle and cross after being shown. He drew a person with arms, legs, hair, and facial features. His drawing was somewhat light. Thomas‘ right arm coordination and strength appears to be relatively unaffected until he is Accredited by tne Commission on Accreditation of Rehabilitation Facilities ‘A Member of the United Way of Morris County— Cemer sls County Sociely for RCL forth dicapped Crippled Children and Adults WARGERY OPPENREINILII (201) 639-5696 Enecutie Director 260 Rove 53. Morns Plains, NJ 07950 Thomas McBi . PT Eval. - 4/25/87 Page 2 asked to pe:torm a difficult gross motor task. Then he reverts to a stabili ing pattern. He will hold his arm in shoulder retraction ...1 >stension with elbow and wrist flexion. Muscle Tone Mild dynamic hypertonia in the right lower extremity distal greater than proximal, Range of Motion Upper extrenities - Within normal limits. Trunk - mild tightness into left trunk rotation and left lateral flexion. Left lower extremity - Within normal limits. Right lower extremity - Hip flexion with knee extension 0° - 70° Hip abduction 0° - 30° Hip external rotation 0° - 70° Ankle dorsiflexion in prone 0° Ankle dorsiflexion in standing 0° - 5° Gross Motor ‘hills Thomas can cumplete all of the 36 month skills but right upper extremity fixing for stability as described above is seen when he stands on one foot (right) or walks a line on the floor. These skills require greater trunk/pelvis/hip stability and Thomas must resort to a more primative pattern in the upper body to compensate for this lack of stability. He can accomjlish the following 48 month skills: Walks a circular line, throw a 2" ball 10', and climb ladders on the playground. He is unable to stand on one foot 5 seconds (2-3 seconds only), hop on one toot, 2 hops, heel-toe forward, skip on one foot (left foot forward only}, catch a 2" ball with arms bent (tends to hold his right arm higher than the left and not get a good enough grip tv hold on to the ball as the reaction time in the right arm is slow), or ascend/descend stairs alternating feet (up only). His gross motor level is approximately 36 months with compromises for quality in the right extremities and trunk. His gait pattern includes a toe first pattern on the right, Accreaited by the Commission on Accraaitation of Rehabihtation Facies 'A Member of the United Way of Mortis Countyi Cemer Moris County Society for CL forthe Handicapped — Crippled Children and Adults TAARGERY OPPENMEINEIL (201) 539-5635, Execute vector 260 Route $3, Mots Plains, NJ 07850, Thomas McBr- PT Eval. - 9125/87 Page 3 with slight external rotation and circumduction form the hip. Very mild recurvatum is also noted. When Thomas runs his re- curvatum is more pronounced as is the planter flexion in his foot. His scher reports that he still occasionally falls but this was not .bserved during the evaluation. Reflexes No clonus o: iabinski on right. Equilibrium and protective reactions a:. mildly delayed on the right. Equipment None Summary Thomas is a + year old who is functioning at a gross motor level of 33:5. In addition, the quality of movements on the right side ¢: his body are compromised. His upper extremity seems less zitected as he is emerging as right side dominate for fine mot.: tasks. He has some decreases in range of motion especially :1. his ankle. His gait pattern reflects these range and quality differences. The dynamic muscle tone in the right lower extremiiy is mildly hypertonic. His equilibrium and pro- tective reactions are slightly delayed on the right. Recommendat ius Weekly Physical Therapy for 45 minutes supplemented by a home program. Cci.sultation with the classroom and Physical Education teachers. [cssible fabrication of a hinged BKO to improve gait pattern when range of motion is gained in the right foot/ankle. Proper seati:g in the classroom to ensure feet are flat on the floor. Submitted bj: Coden \y Bout OT. tte! ance or Accreoited by the Commission on Accreitalion of Rehabilitation Faciities 'A Member of the United Way of Morris County, ROCKAWAY TOWNSHIP PUBLIC SCHOOLS Project Step-Up Name: Thomas McBride Date of Visit: 2/ 768 22 Fleetwood Dr. D.O.B.: 4/22/83 Rockaway, N.J. Social Worker: J. Kopacsi Thomas 1s currently classified as Preschool Handicapped and is being re-evaluated because he is in his transitional year. Previous Social assessment was completed on 5/155/86. 11. Observation: Thomas was observed at home with his mother and twin sister Amanda. Amanda is also currently classified as Preschool Handicapped). During most of my interview with Mrs. McBride, Thomas was in an ajacent room watching T.V. and playing with toys. His interactions with his mother, sister and with me were appropriate, frieandly and "serious". He answered my questions easily and demonstrated the workings of several of his toys. 111. Family Constellation and Dynamics: There have been no changes in the family constellation. Mrs. McBride’s mother stayed with the family recently for a month and Thomas enjoyed being with his grandmother. Thomas and Amanda have many pieces of play equipment as well as alot of toys to play with in the house. Both parents are attentive to the needs of their children. They provide as much stimulation as they can for their child. In general, Thomas listen to his parents directions and there is little need for formal discipline. If Thomas does have to be disciplined for something he will have to “sit In the corner" or not watche T.V. for several minutes. Both children get over their angry very quickly and no one in the McBride’s family stays angry for a long period. Thomas is close to his sister and their relationship is described as good. Mrs. McBride is currently enployed outside of the home. She works 3 days a week as a dental hygienist and would like to cut back to 1 day per week shortly. IV. Health History: Thomas is in good general health. He has cight hemiplegia and is receiving physical therapy once a week. He 15 just now getting over a cold and had a temperature around 103-104. In December 1987 Thomas Slippea on some ice and broke his arm. It healed properly. No eating oc sieep problems were reported.Mebriae, Thomas How Chila Functions: ‘According to parent) Thomas 1s described as being sensitive towards others. He is a caring and easy going youngster. He appears to be “other directea” ana does not generally personalize his experiences. He likes to color and enjoys learning. Thomas is inquisitive and likes to know how things work. He will often try to "prompt" his sister when she is working with her parents (on identifying colors for example? and may even "stop learning" so Amanda can catch up to him. Peer relationships are described as good. There are no children in the neighborhood for Thomas to play with but Mrs. McBride has made arrangements for the children from Community Day Nursery to come over to the house to play. Thomas shares his toys with others easily and finas it difficult to understand why at times other children do not share as freely as he does. Thomas enjoys athletic type activities and he enjoys helping his father with chores, although he relates equally well with both parents. Other than nursery school, Thomas is not Involved in any community activities. The Vineland Adaptive Behavior Scales were administered with Mrs. McBride as the respondent. Thomas chronological age was 4-9. The results are listed below. Standard National Adaptive Age Domain Score %ile Rank Stanine Level Equivalent Communication 92 30 4 Adeq. 4-2 Daily Living 83 13 3 Mo Lo 3-9 Socialization 90 25 4 Adeq. 4-0 Motor Skills 69 2 1 Low 3-8 Adaptive Bahavior Composite 78 4 . Mo Lo 3-11 Thomas overall adaptive functioning 1s moderately low. He had adequate scores in the Communication and Socialization domains. His daily living skills were mogerately low, about a year below his age level. His weakest area was in the area of motor skills with gross motor skills being lower than fine motor. His composite score suggests a delay of approximately 10 months.Mebrice, Thomas VI. Summary: Thomas 18 a 4-9 year old youngster who continues to live with his Parents and twin sister Amanda. He is in good general health. Thomas 48 ceceiving physical therapy because he has right hemiplegia. Family ang sibling relationships are satisfactory. The McBride's provice a secure and nurturing environment for Thomas. Peer relationships are Satisfactory and Thomas is sensitive to the needs and feelings of other. His overall adaptive functioning as measured by the Vineland Adaptive Behavior Scales 1s moderately low. 4 Hepa Joséph Képacs: Social Worker Project Step-Up