Case in Progress
Cole was referred to Pediatric Services in July of 1997. At that time he was 7 months old, or the corrected age of 14 weeks, due to his premature birth at 24 weeks gestation. At the time of referral he weighed 8 pounds 8 ounces.
Cole was born by cesarean section on 1/26/97 at the Neonatal Intensive Care Unit of our local hospital, weighing 1 pound 4 ounces. During the course of his hospitalization he developed respiratory distress syndrome and required the use of oscillator and ventilator for about two months. He underwent numerous surgeries, including a Broviac cathereter and ductus arteriosus. Other medical issues included anemia of prematurity, bilateral grade 2 intraventricular hemorrahage, mild jaundice, osteopenia, and inguinal hernias.
By a few weeks of age, Cole was showing signs of retinopathy of prematurity in both eyes. He underwent laser surgeries on 4/1/97. He eventually required a lensectomy (removal of the lens) and vitrectomy on the left eye and re-attachment of the right retina. He has a cataract in his right eye. He has worn glasses and a contact lens, with intermittent success. Clinically, and legally he is blind. Functionally, he uses his perceptions quite well, although acuity is not good and long term function is unknown at this time.
Cole was finally discharged from the hospital on May 19, 1997, weighing 4 pounds 9 ounces, after approximately 120 days in the neonatal intensive care unit. He lives with his parents and older brother in a rural part of the county. At this time, Cole was waking every 1-2 hours, around the clock, for feedings. He was only able to consume approximate 1½ ounces of Neocal, a 22 cal per ounce formula, at each feeding.
At 7 months, adjusted age of 14 weeks, Cole was referred to Pediatric Services to work with his family on his development. At that time his fine motor, gross motor, and cognitive skills were at 2.5-3 month level. Language development was about 2 - 2.5 months. It was determined that physical therapy, child development and parent education would be provided on a weekly basis.
By the time Cole was 12 month, or 8 months adjusted, his self care skills were at 6-7 months, receptive language at 6-7, and expressive at 6 months, cognitive at 5-7 months, with language based skills slightly ahead of motor skills. Gross and fine motor were at 5-6 months (which was 65-75% of adjusted age), with persistent increased tone was observed throughout. At this time, consultative services with the Braille Institute were added to Cole intervention plan. A bi- monthly support and parent education group, and an evening 8 week couples parenting education class was also begun.
At 18 months, 14 months adjusted, Cole had made some very good progress on his developmental milestones. His learning curve seems to be consistent with the amount of time between assessments, and seems to be adapting to his visual impairments. His range of motions are normal and functional, tone continues to be slightly increased, in his upper extremities more than lower extremities. He is a very active little boy, learning about his environment by getting visually close to his toys and or activities, explore them with his hands and mouth and play with them. When he participated in more of the gross motor activities, he commonly carefully observed, trailed and re-trailed until he was able to successfully complete the activity. It appeared that Cole had developed a good attention span for activities presented and enjoyed exploring and trying out new toys.
At 18 months gross motor skills are at 11 months and scatter to 13 months. He is getting very close to walking independently, enjoys climbing onto furniture. His lack of visual perception has been an impediment to Cole beginning to walk. He was doing very well walking with a push toy, but prefers to crawl.
Fine motor skills are at 10.5 months with skills scattering to 12 months. He has a nice pincer grasp and can remove pegs from a board. He assists in turning pages of a book , although this activity is not reinforcing due to his limited perception.
In the area of personal social skills Cole has skills at 10 months with skills to 12 months. He imitates clapping, is beginning to assist with dressing, gives a toy upon request, and is beginning to play ball cooperatively.
Also at the age of 18 months, language skills were at 7 months, with scattered skills to 12 months. Cole uses a little jargon, pats a named object, follows a simple direction and understands "no" . He says "dada" with meaning, but has no other words. At 21 months of age a speech and language assessment was administered. It was found that he had solid expressive skills through the 9 months level with emerging skills to 12 months and receptive skills solid at 12 months and emerging beyond the 15 month level. Thus, speech and language delays became the most significant area of intervention.
Cole is a wonderful, active, and curious little boy. Due to his premature birth he has had numerous obstacles to overcome. Cole is truly a miracle child and has greatly benefitted from the wonderful and supportive involvement of his parents and family.
Cole will be assessed again in all areas of development when he has his second birthday. At that time, we will be discussing possible inclusion in a center based program as the next step in meeting Coles and his familys needs.
If you have any questions or would like to be in touch with this family, please contact me through this site.
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