Applying evidence-based guidelines in the clinic is a challenge for many therapists. This case illustrates translating theory into practice. Practical interventions and outcome measures are illustrated for each domain supporting the use of the CPG recommendations in practice.
An infant with HIE was referred aged 8 weeks for plagiocephaly, extremely low shoulder tone, and bilateral hand asymmetry. The team of OT, PT, speech and Mother worked with the infant focusing on motor, CIMT/bimanual therapy, sitting, reaching, play and communication skills. The team added the domain of social-emotional development. OT and PT did monthly visits at home from 7 months to age 3, supporting parents through coaching.
Standardized assessments were used to support earlier Diagnosis: at 4 months (HINE, AIMS) 5 months (MAI), 12 months (GMFM), 11 months DX (CP, GMFMCS II) confirmed by Pediatric Neurologist (Imaging). Outcome measures included: 18 months (BSIDIV); age 3 (GMFM).
Design: Single Case Report
Motor: Early Detection: MAI 19 risk points, HINE 58: AIMS5%; GMFM 22%, Imaging at 9 months resulted in Dx of L hemiplegia Classification II
Milestones (on video): Crawl all 4’s: 14 months, first steps: 21 months. Left upper limb age appropriate; GMFM at age 3: increased from 22% to 89%
Cognitive and communication: BSID IV average range, speech and language age appropriate
Eating/Drinking: Interventions from 7-9 months for asymmetrical tongue use in chew/swallow
Vision: Checked and no concerns
Sleep: Supine positioning to change extreme torsion of head/trunk/ and pelvis during sleep
Managing muscle tone and musculoskeletal health through Hip surveillance (Migration percentage Left decreased from 24 to 14 degrees; Right 14 degrees) and orthotic use
Social-emotional: Education using the Circle of Security
Parent support: Parent comparison to peer function at Preschool at Age 3, Parent satisfaction high
Combining OT, PT, Speech and parent coaching in the home environment addressed intervention for each domain of the CPG plus one, and met this infant’s needs for milestone development, reaching, play, communication, eating/drinking, musculoskeletal issues and parent support. At age three, this case is participating at a typical preschool. Continued parent concerns are fatigue with walking any distance. Future research could use multiple case design to explore additional infant/caregiver dyads and coaching in the domains recommended in this CPG.
This case report adds treatment details which address all nine domains of the CPG plus social emotional development for an infant with CP. Coaching parents in the home environment resulted in satisfactory outcomes at age 3. Practical interventions can be used in any environment.
CPG
Intervention
