Final Week

Although Lisa had regained happiness throughout her aging years, she had also gained an aging body. As the years passed, Lisa felt the aching presence of her CP more and more. In her mid 40’s, Lisa was still involved with the Special Olympics and community activities, but as she aged her body could not keep up as well. Now in her late 60’s, Lisa struggles through almost more problems than she can handle. Throughout the past ten years Lisa has had to cope with her father’s passing, her retirement from the Special Olympics and community activities, and her deteriorating level of mobility. The only incentive that is helping Lisa to keep her sanity is spending time with her beloved husband, Tray.

As people enter their latter years, deterioration of the body is expected. However, Lisa’s CP has advanced her normal aging process and her mobility has become more limited. As an older adult with CP, Lisa’s “muscles and joints have become very tight,” which has led to an “unsteady gait and loss of coordination” (A.D.A.M., 2012). Along with mobility issues, Lisa also feels an immense amount of pain in her joints and muscles. Lisa’s constant pain and limitations has led her to often feel irritable and helpless. However, Tray has stayed a faithful husband and provides what comfort he can to Lisa. Tray also suggested that Lisa take more proactive steps in regaining her mobility and well-being.

After much deliberation and consulting with a doctor, Lisa decided to finally buy an automatic wheelchair. She hoped this purchase would increase her level of mobility without increasing her level of pain. Just as she hoped, Lisa’s automatic wheelchair provided her with more independence and less pain.

As time progressed and Lisa and Tray reached their late 80’s, they felt it was finally time to hire an in-home senior care assistant. Their self-care needs became too much to manage without the assistance of a health care professional. However, Lisa and Tray were still able to maintain a strong relationship and life with each other. Despite their disabilities, Lisa and Tray lived a fulfilling and happy life until their last days.

Week Thirteen

Lisa just had her 30^th birthday a month ago, and she celebrated it with her closest friends and family.  She is very proud of all she has accomplished in her life thus far.  It has not been an easy path for Lisa given her disability, but she has persevered despite the many obstacles.  Although Tim and Yuting initially protested Lisa and Tray getting married, they ended up seeing the love that Lisa felt for Tray and supported their marriage. 

As they had initially hoped, Tray is able to move into the community apartments designed for individuals with disabilities.  Lisa has no choice but to move out of her smaller apartment into a slightly larger apartment, in order for Tray to be able to live with her.  In the apartment there is a kitchen, one bedroom, one full bath, and a living room.  It is a small apartment for two people but having an apartment this size is easier for Tray to manage his way around in. The community apartments also assist with the maintenance and up keeping of the apartment, which really helps relieve some of Tim and Yuting’s worries.

  It has not been as easy of a transition to the married life as Lisa and Tray had hoped for.  Because of Lisa’s busy schedule working and volunteering, Tray frequently gets upset that Lisa isn’t always there for him.  During the day, Tray goes to the community center for a few hours, but he is unable to keep as busy as Lisa given his blindness.  Lisa understands why Tray gets upset and she proposed to Tray about getting a pet for their apartment.  They spoke to the head of the community, and he informed them that they are unable to have a dog but they can have a cat or any smaller sized pets.  Lisa and Tray decide to get a Tabby cat from the SPCA that they name Fluffy.  Fluffy has been a great addition to their household, and he provides company to Tray when Lisa is not at home.

Lisa is happy to receive a raise to a Disability Mentoring Coordinator who works in the Disability Mentoring program. Her position allows her to bring local children and mentors together. She enjoys this opportunity because she can meet other people from both sides of the program and match the individuals based on her observed compatibility. She began this volunteer job at 36 years old and continues to work as the coordinator at age 46.  Lisa had to stop volunteering with the Special Olympics after she married Tray because she became too busy and wanted to try and spend more time with him.

Lisa decides that she no longer has an interest in medical billing and becomes a guidance counselor’s assistant at an elementary school close by. She began this full time position at age 32. Lisa hasn’t considered another career path after several years of working within the school system. Her salary is now at $20,000 per year. She feels that this is enough for her and Tray to make a happy living considering their housing is already paid for. Tray and Lisa feel that they are able to spend little money in their daily activities.

Like most couples, Lisa and Tray entertained the idea of having children. However, after discussing the matter with Tim and Yuting, the decision to not have children was made, based on financial difficulties that would arise and the current living situation. Even though they decided not to have kids, Lisa still ended up getting pregnant. Unfortunately, however, Lisa suffered a miscarriage and lost the baby. Tray was able to comfort Lisa as much as he could, but Lisa found solace in the company of her mother, which strengthened the already strong bond between them.

Shortly after the miscarriage, Yuting suffered from a bought of pneumonia. Unfortunately Yuting was not able to pull through this illness and passed away from complications in the hospital. This event in Lisa’s life just added fuel to the fire that was Lisa’s depression. When Lisa miscarried, she started feeling different, very sluggish and just not happy in life. When Yuting passed away, the traumatic event sent Lisa into a downward spiral of depression for the next 2 years. Finally, Tray speaks up about his concerns for Lisa’s health and their relationship. He had been trying hard to help Lisa work through her feelings that were a result of the recent tragedies. Tray made Lisa aware that he was beginning to feel unhappy in their relationship; Lisa was no longer the optimistic fun-loving woman that he knew and loved. The words that Lisa heard coming from the man she loved made her extremely distraught. On one hand, she felt that he was not being supportive of her, and on the other hand, she agreed with Tray when he said something had to change. Since Yuting was no longer there to provide support and advice to Lisa, she and Tray decided to attend couple’s therapy sessions. This allowed the two of them to work on their relationship and strengthen their weak areas. Lisa was able to work towards, and gain, the same trust and support in Tray that she used to have in her mother. Although Tray would never replace the relationship Lisa had with her mother, this helped Lisa work through her depression.

The passing of Yuting proved to be difficult for Tim to deal with as well. In order to help both himself and his daughter cope with the loss of Yuting, Tim frequently visited Lisa and his son in law. This gave him a reason to get out of the house; being there only provided sadness due to the absence of his loving wife. Tim’s visits also provided Tray with more company while Lisa was at work and allowed the two to form a stronger relationship. The presence of her father further helped Lisa in dealing with the death of her mother.

A few years later, Tim ended up being diagnosed with Alzheimer’s Disease and was put in an assisted living community. Lisa struggled with the idea of putting her father in an assisted living community, but after discussing it with Tray and the therapist, she realized that her father would end up needing more care than she and Tray would be able to provide him. This added on to the stress that had building up in Lisa’s life but through continuing therapy, both individual and couple’s therapy, Lisa was able to cope with all that was going on in her life. She made sure to visit her father as much as she could, tray often accompanying her. It was clear that their visits made a world of difference to Time. He was extremely happy and proud to have such a wonderful, loving daughter.

Over the next couple of years, Lisa continued to grow as an individual. She eventually got back to being her happy, fun-loving self. Throughout her therapy sessions, her therapist had suggested that Lisa involve herself in more community affairs since she found so much joy in helping others. She continued to work at the elementary school aiding in the guidance counselors office. She was able to talk to the guidance staff about creating a program within the school that allowed other individuals with disabilities to come together to share their struggles and work together to overcome them. Lisa loved being able to help other children who were experiencing some of the same struggles that she did. She was able to provide a lot of advice as well as inspire many of the children attending the elementary school. Lisa also decided to return to the Special Olympics. When talking about her previous involvement in the program during therapy, Lisa realized how much she enjoyed assisting at the Special Olympics and decided it would be a good thing for her to do again. She was not able to have as much involvement as she did in the past, but she went to as many practices as she could and was always sure to make it to the meets to provide support for the children.

Lisa continued to give back to the community as much as she could. She felt that so many people had helped her along her journey and she wanted to do whatever she could to repay them and give back. She found so much happiness in being able to make a difference in other individual’s life. Her and Tray were able to develop friendships with their surrounding neighbors. Lisa suggested to them that they all start having a group game night. Every Thursday evening, Try and Lisa got together with their neighbors to play different games and just socialize about their lives. They took turns hosting each week.

By 46, Lisa was exactly where she wanted to be. She had experienced a few bumps along the way, but through support from her husband, father, and therapists, she was able to leap over those bumps and regain her happiness. Lisa was able to find comfort and enjoyment in giving back to her community, whether it was through her new developed program at school, the Special Olympics, or participating in different community activities and fundraisers. She turned out to be a very happy and successful individual, despite her disability and the struggles she encountered along the way. She has been an inspiring story to those surrounding her; she has provided hope for those who have disabilities as well as those who don’t!

Week Twelve

Lisa is now a young woman at age 26, and, having just completed her degree at a local community college, she is looking forward to starting out mostly on her own. Lisa has continued to work with Special Olympics, and she even started a club at the community college which continues to thrive - through her organization, individuals from associated fields of study at the college receive credit and training while working to support the annual Special Olympics. Additionally, she started a Disability Mentoring program which brings local children and mentors together. She was recently recognized by the mayor of her town for her contributions to the community.

Lisa continued to keep in touch with her friend Tray over the few years that she was focusing on her studies. While she had thought that she would be able to do medical billing, she was able to gain a degree to supervise the process. She and Tray stayed in touch, and, more recently, have started to date one another. She still gets a little nervous thinking about the two of them, but things are going well - who knew that the boy she met way back then would be the man she might just marry?

Lisa lives close to her parents in her own apartment. It seems that a forward-looking entrepreneur in the community received a grant to build apartments designed for people with disabilities. Lisa was able to qualify to live there, and she loves it. There is a community garden and a community center where people gather regularly. Each month, there is a speaker on an issue of importance to people living in the community. It is a little like a commune and a little like a neighborhood. It is interdependent yet private at the same time. Lisa couldn't be happier in her surroundings. She is worried that, if she and Tray get married, they may have to move out. She figures that she will cross that bridge when she needs to, though.

* How is Lisa's CP likely to affect the possibility of her having biological children?

* Do innovative housing programs exist anywhere in the US for people with disabilities? Where? Briefly describe the program(s).

* Cite relevant statistics with regard to people who have CP attending college. How unique is Lisa's path?

DECISION POINT ::: Do Tray and Lisa marry?

Week Eleven

Lisa’s participation in Special Olympics has been an incredible opportunity for her, and, at age 16, she has come to love and to rely on her experience with the organization. In fact, she was asked last year to take on a peer leadership role, and she has grown tremendously from the experience. Through her middle school years, in fact, her focus became less on school and more on her increasing interest in Special Olympics. Not that she didn’t do well in school – she did – but the environment was different than elementary school, and she started to develop relationships outside of the confines of school.

Lisa has developed some wonderful friendships with boys and girls alike. Her friend Tray was really special to her, and she felt a certain something for him – she thought of him often and got a little nervous when they were together. She couldn’t imagine ever going on a date with him, and she wasn’t really sure how that might happen. She also wasn’t sure what her mom and dad would say. Still, she could scarcely stop think about him some days, and she kept wondering what to do next. Should she tell him? No WAY! Should she tell another friend who would tell him? Should she try to find out if he felt the same way? She just wasn’t sure – he was, after all, a little older. They really understood each other because he also struggled with a lifelong disabling condition too – he was visually impaired. She really felt like she might be in love.   

* In your group’s opinion, what circumstances led to Yuting and Tim’s resilience in the face of the challenges Lisa has presented as a child with CP? Describe the factors that likely led to such resilience – be sure to consider what you can ascertain of Yuting and Tim’s general level of functioning including what you perceive to be their overall psychological well-being.

* From the standpoint of the school and the IEP, what is transition? Describe at least 3 transition goals for Lisa. When would the IEP team have started to consider and include these?

* Describe the cognitive developmental changes that take place during puberty, and hypothesize how these apply to Lisa based on this week’s installment.

* Describe how Lisa would likely have experienced the physical changes associated with puberty.

* Write 3 goals (include 2-3 objectives for each goal) that might be found in Lisa’s IEP at age 16 given her learning disability. Assume that her disability was identified as indicated in the previous week’s post, and posit her approximate academic growth given the disability from age 8-16. Write your goals at age 16 with that in mind.

* What happens when Lisa turns 18? For which services will she still be eligible? What kind of public assistance can she receive? Will she support herself? If so, how? Be sure to look into SSI and disability – is she eligible when she turns 18? Is she eligible now, at 16?   

Week Ten

Week Ten is courtesy of the Thomas Mahoney group.

Lisa has continued to attend public schools and is now 12 years old. Lisa has experienced many changes within the past year in her life due to the transition into middle school. Since she has CP, this transition has been even more difficult for her. Her teachers in elementary school were wonderful and more than her parents could've asked for. However, since transitioning into middle school, they have not been as lucky. The teachers seem to be stressed out and are more worried about getting through each day then truly helping the child learn and develop. Tim and Yuting have considered pulling Lisa out of the middle school and placing her into a different school.

Lisa has progressed from the use of the walker to forearm crutches which has given her much more freedom and independency. The assistants help her with her gait. She continues to go to occupational therapy which has helped her tremendously along with speech therapy. She is able to communicate with her peers effectively and express her needs to others. Her parents have had to pay out of pocket for her occupational therapy, which has caused tremendous stress and burden on both of them. However, after Ron passed away, they received a generous amount of money which will help cover the costs.

When Lisa was 8 years old, she was diagnosed with having a mild learning disability. English is the subject that Lisa has the most trouble with and her language comprehension skills are delayed due to the late onset of speech.

The grandparent, Ron, died when Lisa was 10 years old and was a major presence in her life. She would take Lisa to many activities and they shared a special bond so this was a devastating event for Lisa and she still struggles to cope. In order to help Lisa cope, her parents have actively engaged her in a supportive group which was Special Olympics. Lisa began to partake in the Special Olympics in her community and has excelled in bowling. She has gained a lot of friendships through this and looks forward to going to the practices each week.

Week Nine

Tim and Yuting are content in their decision not to have another child, and the years with Lisa have been both joyous and exhausting. At age 7, Lisa has come a long way - she can now speak relatively well and can communicate her basic needs. Tim and Yuting have worked with her, and she has had ongoing speech therapy and occupational therapy. Additionally, Lisa visits regularly with a doctor who specializes in working with children with CP.

Lisa goes to the local public school, and she has a wonderful teacher who cares deeply for Lisa. For most of the day, Lisa is in a self-contained classroom, but the school she attends is rather progressive in its insistence that students with disabilities be integrated as much as possible into typical activities with other children. As a result, Lisa has many people at school that she considers friends, and her peers treat her with kindness and seem to forget Lisa's limitations and challenges. Tim and Yuting could not be happier with the school and the hard work that all have done to provide care and education for Lisa.

Describe some of the goals and objectives that are likely to be found on Lisa's IEP.

Find research that looks at the nature of peer relationships for children with CP.

What is the relationship between general intelligence and CP?

How is it that Lisa's therapeutic needs are met? In other words, what is the likely intensity of speech services and occupational therapy services? Are there any services that come into the home?

Week Eight

Spring Break

Week Seven

Individual assignments

Week Six

Lisa and her parents are getting along. Tim and Yuting continue to deal with Lisa's needs, and they have moved into a place of acceptance of Lisa's diagnosis. It has meant that Lisa did not walk until she was 3 1/2, and that was with the help of a walker-type device that aids her with balance. Lisa is a fighter, though, and she seems to relish the challenge that each day brings. Tim and Yuting were overjoyed when she was finally able to say "mama" and "dada." At age 4, Lisa's speech is developing much more slowly than is typical, but it is coming along.

Tim and Yuting, in spite of their exhaustion, are considering having another child. They aren't sure, still, what created the circumstance that brought Lisa into the world much earlier than expected. Still, they think they would like a bigger family    

* Describe the ongoing stress on the family given Lisa's diagnosis. Outline a typical day for Tim and Yuting with Lisa as a 4 year old child with CP. 

DECISION POINT :::

Do Tim and Yuting have another child? Is the child biological or adopted? Consider Yuting's family history. 

In addition to the questions above, please also answer the following questions posed to you by the other groups (not all questions are included from all groups) :::

From the Terrance Singh group :::

1) It is understood that Lisa’s premature birth is responsible for her CP. What is an APGAR score, and what would likely be Lisa’s APGAR score at the 1 minute and the 5 minute recording? With regard to her CP, was the APGAR score she received a possible indicator of her later diagnosis? Finally, what are the common risks and outcomes associated with low APGAR scores?

2) What are the different ranges that children with CP can have in regards to their speech and language skills (non-verbalà verbal), and what is most common? Lisa has shown considerable delays in her Speech and Language milestones. Children with CP often have dysarthria; could this be what Lisa has? What is dysarthria, along with its common symptoms, and signs that could be shown at an early age? With therapy is it possible for children with Dysarthria and CP to become intelligible speakers? 

From the Wendy Marianna group :::

1) Financial support for children with disabilities has been controversial for many years. Is there an average cost projected throughout the lifespan?What are the most prominent costs related to CP? And do the costs for services change as more or less are needed? Is the government, or Lisa's parents, or both responsible for the cost?

2) Do you think it is likely that Lisa will grow up having learning disabilities because of her CP? Why or why not?

3) Tim and Yuting are not sure whether or not to have another child in fear of risk of the child having CP as well as Lisa. What are the outcomes of having another child with CP? Are there any preventable measures the couple can take to prevent another child with CP? If so, what are they? 

From the Ahmad Nassar group :::

1) What are the benefits to the child of having a positive relationship with her grandparents Ron and Tom? What are the benefits for the entire family?

3) Will Lisa benefit more from a Assisted Speaking Device or does she still have a chance to develop her speech at this time?