We help Isla who has Developmental Delay

Isla is five years old and first came to Brainwave's North West Centre in November 2014 for her initial assessment, and has since attended for one reassessment.  When Isla was one year old she was referred to local services following concerns regarding her gross motor skills: Isla walked at 18 months of age but did not roll over.  There were also concerns regarding her speech.  Isla underwent an MRI scan but this was clear, she has been entered into the DDD study.  Isla had grommets fitted in December 2013.  Isla attends school and has a statement of Special Educational Needs, through which she receives 25 hours of support per week.

From a physical perspective Isla has good gross motor skills, she can mobilise and run without difficulties but will trip and fall and can appear clumsy.   Isla is very mobile, she lacks proprioception therefore she struggles to grade her movement.  She trips frequently secondary to her lack of proprioception. Isla’s parents report that she enjoys climbing on furniture, rough and tumble play and jumping on the bed or trampoline.  Isla is not skilful with a ball and is unable to coordinate the movements needed to kick a ball.  Isla has difficulty with reciprocal movements when ascending and descending the stairs.  Isla is unable to manage to ride a bike.  Isla struggles with fine motor tasks, particularly bilateral activities, for example threading.  Isla has difficulty with isolating her index finger and tends to use her whole hand when operating the iPad.

From a sensory perspective Isla shows little awareness of others and would run into another person without adult supervision. Isla has a tendency to touch everything. Isla responded well to the sit and move cushion when placed on the chair for table top activities.  A sit and move cushion, is an air filled cushion, which allows the person sitting on it to move within the chair rather than having to get up and move around.  Isla responds well to tactile input for example weighted items, massage tube and the tactile box, and has a weighted blanket at school. Isla enjoys messy play and enjoys fidget toys.  Isla does not tolerate having her hair towel dried and cannot tolerate the sound of hairdryers.  Isla has some auditory sensitivity to the lawn mower and hand dryers.  Isla will tolerate playground rides providing they are not at any speed.  Isla dislikes escalators and does become car sick.  Isla does not engage within new activities easily, she tends to observe others doing an activity and then try to copy them.  She will also look at others when trying to follow verbal commands. Isla has a high threshold for pain.  If she becomes frustrated Isla will bite her hand, bang her head or hit out towards others.  This would then indicate that Isla has difficulties with sensory processing which impact on her ability to complete gross and fine motor skills, self care skills and it also impacts on her level of concentration.  Isla finds it difficult to attend to adult chosen tasks. Her attention is at a single-channelled level.  She is able to attend to a task of her choosing for a few minutes but finds it difficult to tolerate intervention or direction from an adult. Isla can become distracted by the resources eg musical instruments.

From a communication perspective Isla communicates for a range of functions; she will request, reject, protest and use greetings. She also points to things in her environment to ask an adult to name them.  Isla communicates verbally and through non-verbal language such as facial expression. She will also imitate some signs. Isla uses mostly single words and some two word phrases like “sit down”.  She does not combine words, and her speech is quite unclear. She uses a limited range of sounds in her spontaneous speech.  She is mostly attempting single words and often signals the syllable structure.  However the same sequence of sounds has multiple meaning. The Brainwave programme has started some early imitation of speech sounds. During the sessions at Brainwave Isla was able to imitate (although these were produced without Isla achieving lip closure).  Isla’s mouth at rest tends to have her upper lip retracted and her upper teeth on show.  I was able to briefly examine Isla’s mouth and could not see any structural abnormalities, although she does have a long lower gum going to the back of her mouth.

Isla’s parents report that it has taken her a long time to learn to stick out her tongue and to blow bubbles. She also sucked at food rather than bite it and some loss of saliva was noted from her closed mouth. It took her a long time to learn to chew food.  Isla did not attempt to blow bubbles during the Brainwave sessions.  Exercises to increase awareness of her mouth and use of muscles has been incorporated into the programme.

A developmental graph shows that Isla is functioning behind her peer group in several areas of development. In the area of visual cognition Isla is at a 2 year 8 month level, as she can manage to match 2-3 primary colours and will recognise herself in photos.  In the area of hearing and comprehension Isla is at a 2 year 8 month level with skills emerging for understanding descriptive concepts and later or soon.  In the area of movement Isla is at a 5 year level, the only area of difficulty is with reciprocal stair walking.  In the area of speech, language and communication Isla is at a 22 month level. In the area of hand function Isla is at a 2 year level.  In the area of self-help, Isla is at a 2 year 4 month level, with skills emerging for toilet training and putting shoes on the correct feet. In the area of socialisation and play Isla is at a 2 year level.  We appreciate that our graph does not represent all of Isla’s skills but it gives us a starting point and can be used as a tool to help measure progress.

The goals of the Brainwave program are designed to address the following:

  • Attention and listening skills
  • To improve Isla’s ability to follow 2 word level verbal instructions
  • To develop Isla’s ability to repeat speech sounds in isolation
  • To develop Isla’s syllable awareness
  • To use sensory strategies to improve attention to task
  • To facilitate challenges to improve balance reactions
  • To improve body awareness
  • To improve participation in self-care skills in the areas of bathing and dressing
  • To provide a sensory diet for use at school

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