Our granddaughter, Cayley Habelgaarn, sustained a traumatic brain injury after a near drowning incident on 17 December 2013, at the age of 3 years 10 months. Since her injury, she has made great improvement and progress. She has regained significant cognitive functioning and has also progressed with her speech and communication.

 

Cayley is attending Paarl School for children with special needs and she has been attending here since January 2015. At school she has access to group speech therapy sessions once a week and individual physiotherapy input once a week. While this is beneficial, the frequency of treatment is not ideal and we as the grandparents are funding additional private speech therapy, occupational therapy and physiotherapy sessions out of our own pocket. Her mother, Charnay Habelgaarn, is  working at Eros Special Needs School, as a Physiotherapist.

 

Cayley does still need comprehensive and on-going rehabilitation in order to further progress. She is still unable to sit or stand independently and presents with uncontrolled movements. Her speech is also not very clear and difficult to understand. In terms of current mobility aids, Cayley has a wheelchair at school and for when the family go on outings or shopping. She also has a stroller that was bought from Shonaquip.

 

Cayley’s frustration levels are very high due to the fact that her intelligence seems to be unaffected.

 

PRESENTING PROBLEMS: (Click here)

 

• Cayley has underlying low tone which affects her postural control at all levels.

• At present, Cayley is unable to sit upright in a sustained position without support, or else she leans to the left or right sides or “flops down” in the chair which she is sitting in.

• She has poor trunk control which affects her ability to sit upright, get into a kneeling or standing position on her own.

• Cayley is unable to walk.

• She has uncontrolled athetoid movements, which worsen when she tries to reach for a specific target or object, which also affects her fine motor movements.

• Her fine motor control and movements are also further affected by the underlying low tone and poor shoulder girdle stability. As a result Cayley is as yet unable to feed herself or write or draw independently.

• It is not possible to keep her head in the midline, a factor that affects her visual focusing, reaching in space as well as her fine motor function.

   

• When she was evaluated for speech therapy, she was mostly unintelligible to unfamiliar people and approximately 70% intelligible to us her family and our close friends. She presents with poor respiratory support for phonation and imprecise articulation resulting in soft, unclear speech being produced in short bursts.

 

GOALS OF THERAPY: (Click here)

 

Goals of therapy are as follows:

• To improve postural control (i.e. trunk control, neck control, shoulder girdle control) so that Cayley is able to sit and stand on her own independently

• To improve static and dynamic sitting balance

• To improve fine motor control and movement so that Cayley can achieve independence in the areas of personal self-care i.e. washing, dressing and feeding.

• To improve fine motor control so that Cayley can participate independently in school-related activities such as writing, drawing, etc.

• To reduce the frequency and intensity of the athetoid movements so that Cayley can participate more independently in all activities of daily living.

• It is impossible to improve motor function and maintain muscle length as well as joint mobility without regular physiotherapy.

• If Cayley were to continue with weekly speech therapy sessions, she would be able to progress to a level where she would be more familiar with the strategies for intelligible speech and be able to implement them independently in her daily life. Clear communication is incredibly important for Cayley, as she has limited voluntary movement to do things for herself. She needs to be able to communicate her needs and wants to familiar and unfamiliar people at all times.

 

All of these different therapy goals will work toward Cayley’s ultimate goal of walking with no/minimal assistance.

 

ASSISTIVE DEVICES WISH LIST: (Click here)

 

       1. SNOEKIE UPRIGHT WHEELER is recommended for Cayley for the following reasons:

 

• The standing position will promote development of her lower limb, trunk and head and neck muscles

• The Snoekie will give Cayley the additional support that she needs in order to stand in a good position

• Weightbearing through her lower limbs will assist with controlling her movements

• The larger wheels will allow her independent mobility whilst still being in a good supported standing position

   

  2. UPSEE from FIREFLY

   

• Upsee lets children with motor impairment stand and walk with the help of an adult.

• It is a revelation for many kids with neuromuscular disorders.

• Some have been able to stand and hug their little brother or sister for the first time.

• Some have waved at neighbours on their first ever walk along their own street. And some crossed the playground hand-in-hand with their best friend for the very first time.

   

  3. GOTO SEAT from FIREFLY

   

• is a support for children with extra postural needs

   

  4. MEDIUM TRICYCLE

   

• “Riding a tricycle provides both fun and fitness, and is a therapeutic activity that allows children to exercise their lower extremities. As the muscles move through cycling motions, they are flexed, extended and stretched. This range of motion is crucial for children with disabilities, because muscles are incapable of keeping up with bone growth unless fully extended. Disabling contractures are a consequence of immobility.

   

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