Multidisciplinary screening clinic assessment report - 31.08.06


Background: Medical History: Isla was born via an elective caesarean for placenta praevia at 35 weeks gestation. Her Apgar scores were 9(1) and 9(5) and her birth-weight was 2585g. Her mother experienced multiple (12 in total) haemorrhages during her pregnancy, with the onset being at 22 weeks. There were no complications during the delivery.


Isla began sitting (“w” sitting) at 11 months and crawling at 12 months. Her paediatrician is Dr F. She has been seeing Dr L, rehab specialist for Botox and Dr A, neurologist.


She has been diagnosed with spastic diplegia. She is an only child.


ASSESSMENT Isla’s was assessed using the Bayley Scales of Infant and Toddler Development 3rd Ed. This test looks at different areas of development, and gives a picture of the child’s skills at one point in time, providing information to guide intervention. Repeat assessment at a later age gives further information about the rate of development.


1. Cognitive skills (Occupational therapy) The cognitive scale looks at how your child think, reacts and learns about the world around him/her. Tasks measure interest in new things, attention to familiar and unfamiliar objects and play with toys, problem solving, puzzle skills, pretend play and pre-academic skills.


Isla performed at a 16-18 month level which was on the 25th percentile for her corrected age, and within the normal range. Isla was able to place pegs in a pegboard, blocks in a cup, and place a single puzzle piece. She enjoyed listening to a story , and demonstrated relational play on herself. She had some difficulty with finding hidden toys, and was not able to complete puzzles.


2. Speech and language skills (speech Pathology) The language scale has two parts. Receptive Communication looks at how well your child recognises sounds and how much your child understands spoken words and directions.


Expressive Communication looks at how well your child communicates using sounds, gestures or words. Overall Isla displayed skills on the 8th percentile representing average development. Today Isla presented as a bubbly little girl, who was very communicative with the therapists. She readily performed for social attention and had engaging interaction skills.


Receptive Communication (Understanding): Isla performed at a 10-12 month level. Today Isla showed that she could understand the meaning of “no!” and respond to simple social requests (eg “blow a kiss”). Isla did not identify any of tour toys (eg ‘ball…cup…doll”) , but she did identify familiar people/things (eg “where’s your Mum?”). Isla is not yet able to identify pictures in books when named by an adult, although at home Isla is beginning to find familiar pictures (eg “cat”) in her favourite book.


Expressive communication (talking): Isla performed at a 16-18 month level. Today Isla used single-word approximations (eg “tuh-dah”), babbled in play (eg “ba-ba” and readily imitated babble and words. Isla said 3 words for us today (ie “Mum”, “ta”) and at home she has a reported vocabulary of approximately 15 words. She shakes her head and says ‘no!” to protest. Isla combines gesture and words to communicate her needs (eg puts hands upwards and says “Mum” to be picked up). Isla did not name any of our toys/pictures today. She was unable to answer “yes/no” questions correctly.


Feeding: Isla eats a variety of textured family foods and can drink from a sipper cup/pop top. She is also learning (open) cup drinking, which is a fantastic skill for building tongue-tip strength. Today Isla was observed to drool saliva more form the right side of her lips, because she is teething.


3. Motor (Occupational therapy & Physiotherapy) The motor scale has two parts. The fine motor part looks at how well your child can use his/her hands and fingers to make things happen. Tasks include reaching, grasping, block building and drawing. The gross motor part looks at how well your child can move his/her body. Skills include rolling, sitting walking, climbing, balance and ball skills.


Overall Isla displays skills on the 5th percentile representing low average development. This is a combination score reflecting average fine motor development, and delayed gross motor development.


Fine Motor (Occupational therapy) 17-19 month level. Isla demonstrated a mild increase in tone in her upper limbs, presenting as a stiff quality, and clumsiness rather than abnormal patterns of movement. Currently she is managing age appropriate activities, but may have difficulty as the requirements for precise control increase. Isla is able to hold a pencil in her palm, and scribble spontaneously, she can copy a stroke but not with direction. Isla is able to isolate her index fingers to point, and use a pincer to place pellets into a container, and post coins into a money box. She does not have the motor control to stack blocks on top of each other.


Gross Motor (Physiotherapy): Isla is a charming little girl who is using crawling as her main form of mobility. She crawls with an increased lumbar lordosis and with her legs abducted and externally rotated. When she sits she tends to “w” sit and is unable to sit with her legs out in long sitting or with her legs crossed . She occasionally walks up on her knees. Isla can pull herself up to stand but not yet through ½ kneeling. She was previously up on her toes when she stood or cruised but it was difficult to assess today as Isla was in bilateral short leg casts. She did however, display a tendency to incline forwards in an attempt to stand up on her toes. She has two more weeks of serial casting at PAHU and then is scheduled for a review with Dr Lowe (paediatric rehab specialist) in Botox clinic. She has increased extensor tone with the lower limbs having more tone than the upper limbs and her right side is slightly more then the left. Her deep tendon reflexes are brisk. She is currently receiving Physiotherapy with Michael in Campbelltown. Isla would benefit from ongoing physiotherapy to improve her gross motor skills as well as continue to monitor her tone.


4. Social - Emotional (occupational therapy): Isla is a delightful little girl who was a little unwell and irritable today. She tries to feed herself with a spoon and fork, and can drink small amounts from a cup. Isla assists with dressing, enjoys her bath, but W-sits for stability. She attends Family Day Care 2 days a week.


Summary and recommendations: 1. Discussion with Michael , treating Physiotherapist, regarding ongoing Physiotherapy management. Attend Botox Clinic at PAHU on the 20.09006 and AFO Clinic on 26.09.06 2. Isla will be offered Occupational therapy and Speech Pathology intervention through Campbelltown PAHU. She will be placed on our waiting list as high priority

Tuesday, June 06, 2006


Neurologist appointment


Our appointment was for 3.15pm - yet we didn't get in to see Dr Andrews until almost 5pm Isla was getting a tad cranky and I was bored out of my mind - couldn't even watch Big Brother on my mobile because I'd run out of battery!!


Once we finally got in to see him, he studied Isla quite meticulously, he is indeed a very 'unique' man. He'd be asking me questions and interrupt himself by commenting on how cute Isla was!!


He said that in his opinion she was/is a "textbook diplegic" but he wants to prove this hypothesis (his words!) he's a bit of a crack up. Basically, he said that he *thinks* Isla has CP but there is a very slight chance that it is something else (hereditary) - but what that is he didn't elaborate. He said that in order to prove his theory, he'd need to do an MRI. He said that because Ian and I are so young (both 24) and that we're both healthy/no family history, it is probably more a case of 'bad luck' that Isla has CP.


He helped me understand what role my Placenta Praevia played in the CP. He said that the part of the babies brains that control movement develop most during 25-32weeks. I suffered 12 bleeds from 22-35 weeks. He asked when I first felt movement while pregnant, and commented how 15 weeks was early and then asked if Isla was active throughout the pregnancy, which she definitely was - even when I was bleeding she would tumble & jive He said that because Isla was so active, she would require more blood from the placenta to keep up with her, and that because I was loosing blood, the part that became compromised was her brain - and as the brain cells don't regenerate she was left with CP. He also said that the Placenta Praevia was also a case of 'bad luck'.


He said that he wants to definitely confirm it is CP so that Ian and I can go on TTC#2 without any worry - which is reassuring to me. He is going to book us in for an MRI at the Sydney Children's Hospital at Randwick sometime in October - which isn't too long to wait.
Overall, Im pretty pleased with how today went. He said that the majority of Diplegic children have no intellectual impairment, and he commented that she was very very bright


We see him again in November.


One thing he did that I thought was VERY weird, while he was asking me q's about Isla, he said, "Does she look like Dad?" and I said, "yes, she's Ian all over" and he wrote in his notes, "looks like Dad" what the???