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?

Week Five

Individual assignments.

Week Four

Lisa has been aided by the development of an IFSP, and she has regular services to aid her with her CP. Now at 2 1/2 years of age, the hard work that everyone has been doing is starting to show some signs of improvement in her basic skills. In spite of all of the challenges, Lisa is a happy child. Tim and Yuting have had to learn her ways of communicating with them since she often seems pretty despondent. Still, they are learning her every day, and they are thankful for her presence in their lives.

Tim and Yuting are very close, to be sure. Nonetheless, they are worried for Lisa in spite of all of the support they have. Yuting states, "I never really expected to have a child with a disability. I mean, in my family, kids were always healthy. It was a surprise that Yuting had CP, but it's OK. We're strong. We're working with her and all of the people around us. It's so hard some days, though. What will she do in life? Will she ever be able to have a job? I guess we really don't know how severe it is, but it seems pretty tough for her a lot of days. She's such a fighter." Tim follows with, "Yeah, it was a surprise. We never really prepared for this - I still remember the day she was born and all of the feelings that went through us both that day. I was just glad that both Lisa and my wife were OK. We really have to think about having another child. I'm not sure we want to risk it."

* Outline typical developmental milestones for a 2 1/2 year old and indicate the extent to which Lisa is progressing in her development. Write 5 goals that would be found in the IFSP at this point. Be sure to include the physical, cognitive, and socio-emotional domains.

* Given your reading with regard to family systems, what are some ways that parents ordinarily respond to circumstances like those of Tim and Yuting? What influence are Ron and Tom likely to have in the family system? Describe Lisa's microsystem, mesosystem, ecosystem, and macrosystem. Be sure to include all of the service providers (pediatrician, social workers, OT, etc.) in your description.

* Depending upon your answer to the first question, does Lisa require assistive devices at this point? What kinds of devices are available for her - given her ability or inability to crawl/walk, what needs does she have for mobility? What about toilet training? What is a reasonable expectation for Lisa in this area?