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Question: Based on his gestational age at birth, how likely is Ryleigh to have complications? How might her time in the NICU and the specific complications she had affect her outcome today? If you had seen Ryleigh for physical therapy when she was in the NICU, what would have been the focus of your treatment? Additional reading metarial attached on upload files Book need to follow: Physical Therapy for Children, 4th edi. by Suzann K. Campbell PT PhD FAPTA, Robert J. Palisano PT ScD, Margo Orlin PT PhD Case Study: Ryleigh Ryleigh is a 3-year-old female with a history of prematurity, failure to thrive syndrome, and cerebral palsy. Ryleigh was born at 26 weeks of gestation. She spent four months in the Neonatal Intensive care Unit (NICU) and was diagnosed with retinopathy of prematurity (ROP), broncho-pulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and bilateral Grade-III intraventricular hemorrhages (IVHs). For the first year of her life, Ryleigh was diagnosed with Failure to Thrive Syndrome but he has gained weight adequately since a G-tube was inserted when she was 14 months old. Ryleigh seems to have frequent colds and/or upper respiratory tract infections. She requires Albuterol through nebulizer treatments for asthma. Ryleigh's parents took her to a developmental specialist approximately six months ago. At that time, Ryleigh was given a diagnosis of spastic quadriplegic cerebral palsy. During a recent physical therapy examination/evaluation, increased tone in Ryleigh's upper and lower extremities is observed. In supine, Ryeigh tends to arch into extension (also called opisthotonic posturing). While in a supine position, Ryleigh swings at toys hanging from a mobile above her but he does not have the control to reach out and hold a toy at midline. Ryleigh is able to roll from supine to prone using trunk extension, but she has trouble clearing her arm to then prop in prone. In prone Ryleigh is able to push up onto forearms and extended arms (with elbow extension) but her hands remain fisted during this activity. Ryleigh is able to push up into quadruped and occasionally attempts to crawl using a symmetrical pattern (often referred to as "bunny hopping"). When placed in sitting, Ryleigh can maintain the position for brief periods (1 to 2 minutes) but she displays poor protective responses and tends to extend her spine. Ryleigh is able to pull up to stand on furniture but does so primarily with her arms while her knees remain in extension. In standing, Ryleigh pushes up on her toes bilaterally and supports her weight by leaning into the support surface. She is unable to shift her weight in order to cruise along the furniture (cruising is stepping in a lateral direction while holding a support surface). During the examination/evaluation, Ryleigh's mother expresses concern that she would like to join a neighborhood play group, but that she does not know how to include Ryleigh with the other children. Additionally, she confides that she and her husband are having communication problems. She states that he is refusing to accept Ryleigh’s diagnosis of cerebral palsy and will not discuss anything related to this diagnosis for their daughter. Ryleigh’s mother states that the doctor recommended they consider getting Ryleigh a wheelchair as the current stroller they are using is not offering enough postural support. Ryleigh’s mother states that her husband refuses to discuss the matter. On the other hand, she wants to learn as much about cerebral palsy as she can. Ryleigh’s mother shares that she and her husband have not gone out without Ryleigh since her birth and that Ryleigh’s medical needs and daily care giving leave them both exhausted.



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