1. Case study Reading Profile
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2. OT Evaluation October 20, 2017 - Age 14-11 Presenting Concerns
Frustrated
Easily distracted
Reading comprehension
Slow pace of reading
Difficulty reading aloud
Spelling
Slow processing
Sensitive to others talking about her inabilities – not sure how to handle it
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3. Phase 1: Foundation Findings
Generalized sensory sensitivity
Listening tested average
Significant for ear atypicality though
Balance average
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4. Phase 2: Organization Bilateral Integration Average on BOT
Visual Pursuits – jerky over midline
Visual Saccades – inconsistent performance
Binocularity – right eye leading, delay in achieving convergence, sometimes suppressing left eye at far and near distance
Noted physical rigidity during visual spatial infinity walk exercise with some need to look down to her feet
Wears glasses for distance vision
Developmental Eye movement Test (DEM): impaired vertical and horizontal.
Generalized Language Difficulties through TLI including linguistic organization, decoding, attention, social, behavioral
Interactive Metronome Timing: severe deficient range with extremely hyper anticipatory responses and extreme deficiency when multisensory stimuli was added
Bilateral timing score was in severe deficiency range
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5. Phase 3: Executive Skills
Mixed dominance task specific
Legible writing
Visual Digit span difficulties during copying tasks
BRIEF: impulse control, self-monitoring, set shifting, emotional control and working memory difficulties
IVA: Auditory:
Response Control - Average
Quotient – Severe Deficiency
Sustained – Severe Deficiency
IVA: Visual:
Response Control – Below Average
Quotient – Average
Sustained – Average
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6. Social-Emotional
Often spends time alone, daydreams, distracted, difficulty with attention, feels unhappy, irritable, down on herself, hopeless
Sometimes fidgety, acts as if driven by motor, afraid of new and novel, trouble with friends, difficulty sleeping
Always avoids confrontation with others
Frequently sensitive to criticism
Can make friends easily, but takes time to become close.
Self expresses no anxiety socially, but would like to have more vocabulary to socialize with.
Does not always express herself clearly
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7. Intensive 1 – March 5, 2018
12 day program of 2 hours per day during regular work week schedule
Tomatis Sound Therapy
Yoga interspersed with tactile integration massage
High level bilateral activities
Learning Breakthrough Program: Bean bags, balance beam, pendulum ball
Infinity Walk
Intensive was followed by 1x weekly OT for 6 weeks to continue to refine the above.
Completed the Forbrain at home with reading aloud exercices
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8. First Post Consultation: April 25, 2018
Falling asleep easier
Going faster down the stairs
Improved conversational skills
Improved verbal expression
Faster uptake on listening – processing
No more stammering
Increased self awareness
Improved frustration tolerance
More “even” emotionally
More self confident
ADL’s and chores faster
Feeling calmer to read better
Written expression still difficult
Attention slight improvement
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9. Sandtray – April 25, 2018 Improved self motivation
Building defense mechanisms
Growth evident
Improved posture
Feeling a threat that she would not maintain this new found “groundedness” she is experiencing due to “failures” in her past
Coming to realization of the potential within herself
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10. 2. Intensive 10 day program 2 hours per day (5 days per week)
Tomatis Sound Therapy 1 hour
Tactile integration massage – yoga poses
Bilateral activities
Learning Breakthrough Program
Infinity walk – adding conversational turntake for cognitive load
1 hour Interactive Metronome with goal to decrease generalized timing skill across all exercises
After intensive: 1x hour / week OT and Forbrain
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11. 2.Post Consultation – June 13, 2018
Have been more tired, napping more
Body awareness increasing still
Volleyball – more aware of surroundings, but could not make her body follow through
Handwriting sloppier
Stammering a little again, but not much
Listening speed “slowed”
Increased frustration levels
Self confidence maintained
Studying for finals was easier
Reading “feels” worse, choppier
Homework was getting better
Still struggling with comprehension
Did not comment on written expression
Attention feels much easier
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12. IM Comparison Long Form Results
Day 1
Task MS
Early Hits
Late Hits
Both Hands 99 52 2
Right Hand
125 30 1
Left Hand
142 29
Both Toes
130
Right Toe
109 24
Left Toe
202 23
Both Heels
146 31
Right Heel
152
Left Heel
149
Right Hand/Left Toe
144 27
Left Hand/Right Toe
100 21
Bal Right Tap Left Foot
123 28
Bal Left Tap Right Foot
208
Both Hands w/ GS 3
Total Unadjusted
140.9
96.9%
3.1%
Day 10
Task MS
Early Hits
Late Hits
Both Hands 36 37 18
Right Hand 49 27 4
Left Hand 51 26
Both Toes 45 30 1
Right Toe 61 29 2
Left Toe 64
Both Heels 67
Right Heel 56 31
Left Heel 94
Right Hand/Left Toe 70 24 7
Left Hand/Right Toe
Bal Right Tap Left Foot 68
Bal Left Tap Right Foot
Both Hands w/ GS 47 44 11
Total Unadjusted
60.1
88.4%
11.6%
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13. IM Comparison Averages
Day 1
Battery Results, Millisecond Accuracy MS
Hands ms avg
127.5
Feet ms Avg
152.4
Both Hands ms avg
121.5
Both Feet ms avg
138
Left Side ms avg
164.3
Right Side ms avg
128.7
Bilateral ms avg
122
Adjusted ms avg
139.9
Highest IAR 2
Total Bursts
% within 15 MS
2.6%
Attend over time
129
Day 1
Battery Results, Millisecond Accuracy MS
Hands ms avg
45.8
Feet ms Avg
65.5
Both Hands ms avg
41.5
Both Feet ms avg 56
Left Side ms avg
69.7
Right Side ms avg
55.3
Bilateral ms avg 67
Adjusted ms avg
55.7
Highest IAR 3
Total Bursts
% within 15 MS
12.7%
Attend over time 35
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14. Sandtray – June 13, 2018
Worked deeper in the subconscious – very quiet
Cozy warm family identity – working on feelings within the family
Family connectedness and warmth evident
Expressed father’s traditional values in the home
Feelings of loyalty and ability to go forward
Themes of authority, wisdom and power
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15. 3 and 4. Intensive 1 hour of Tomatis Training
Added this time was reading aloud over microphone with calibrated voice as well as ear-and bone conduction
1 hour of Interactive Metronome
Adding cognitive load to increase multi-tasking
Intensive 4: august 2018 after taking a break after third intensive
15 days of 1 hour daily computerized ReadON program
Followed by 10 weekly sessions of SLP services working on reading comprehension and written expression
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16. Post Consultation – November 21, 2018
More settled, more in control
Improved organization in speech, staying on topic, loves to talk now
Occasional frustration, but does not give up
Self advocates and asks for help when needed – asserting self more
Improved eye-hand coordination in Volley Ball / basket ball
Using squeezy ball less
EF much improved
Improved social
No concerns with sleep
Straight A student! History needs some work, but putting in the extra time
Still does not like reading, will use books on tape
Using the strategies taught in SLP to keep from “spacing out”
No more melt downs
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17. Client Self report – November 21, 2018
Studying skills improved, taking notes is better
Some days more fluent than others
Reading comprehension still feels hard, but could not say why
Still a little light sensitive
Reading speed improved
Decoding and fluency has improved
Reading better on computer with dimmed screen
Not as easily distracted as before
Auditory distractions are a non-issue
Spelling is still hard
Conversation skill is better, though have days still where this is harder
Improve body coordination
“I feel more confident”
Felt that she was glad she came to therapy, it was worth it!
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18. Interactive Metronome Long Form Comparison
Day 1
Task MS
Early Hits
Late Hits
Both Hands 46 50 5
Right Hand 47 28 3
Left Hand 55 29 1
Both Toes 45 26
Right Toe 17 12
Left Toe 42 9 15
Both Heels 56 2
Right Heel 36 22
Left Heel 23 8
Right Hand/Left Toe 48
Left Hand/Right Toe 44 19 10
Bal Right Tap Left Foot 38
Bal Left Tap Right Foot 53
Both Hands w/ GS 31 30
Total Unadjusted
74.8%
25.2%
Day 10
Task MS
Early Hits
Late Hits
Both Hands 36 42 13
Right Hand 23 8
Left Hand 39 25 6
Both Toes 27 4
Right Toe 22 20 11
Left Toe 44 21 10
Both Heels 26 3
Right Heel 37
Left Heel 50
Right Hand/Left Toe 34 24 7
Left Hand/Right Toe 18
Bal Right Tap Left Foot 29 2
Bal Left Tap Right Foot 33
Both Hands w/ GS 30
Total Unadjusted
35.4
75.3%
24.7%
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19. Interactive Metronome Comparison of Averages
Day 1
Battery Results, Millisecond Accuracy MS
Hands ms avg
44.8
Feet ms Avg
43.1
Both Hands ms avg
38.5
Both Feet ms avg
50.5
Left Side ms avg
47.7
Right Side ms avg
37.3
Bilateral ms avg 46
Adjusted ms avg
43.9
Highest IAR 4
Total Bursts 2
% within 15 MS
21.4%
Attend over time 39
Day 10
Battery Results, Millisecond Accuracy MS
Hands ms avg 34
Feet ms Avg
38.1
Both Hands ms avg
30.5
Both Feet ms avg 40
Left Side ms avg
44.3
Right Side ms avg
31.7
Bilateral ms avg 27
Adjusted ms avg
36.1
Highest IAR 4
Total Bursts
% within 15 MS
26.4%
Attend over time
50.6
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20. Speech Language Pathology
Strong self advocate, expressing needs
Vocabulary of new and novel words (multisyllabic words) – impact from years of not decoding, some catching up to do
Strategy of “key words’ was replaced with strategy of reading out loud and rephrase the question
Strategy of using “post it’s” while completing reading for homework, writing notes and summaries of 3 to 4 lines
Strategy of reading shorter passages at a time, then rephrase for herself
Auditory comprehension much improved
Discussing the material rather than being questioned seemed to be more helpful to her
More speech language sessions were recommended
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21. Finally…
Family and Crystal decided to take an indefinite break right now. She felt she had more resources and final strategies to push herself further and wanted to be given this chance.
We recommended continued SLP, a more advanced ReadON program and another boost of Interactive Metronome.
Truth is though that function is different in everyone’s life. She has made remarkable progress from February through November and she has proven her resilience to herself and like every other typically developing person, she can now drive herself forward.
Do we do more therapy to attain a better score?
No, we facilitate through therapy the innate drive within the client to want to take the baton and make herself get to the finish line.
The door is open, she can come back if there is a glitch in the road, but for now…
WELL DONE!!!
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22. https://maudeleroux.com/
Maude Le Roux, OTR/L, SIPT, IMC
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