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?
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?
3) Will Lisa benefit more from a Assisted Speaking Device or does she still have a chance to develop her speech at this time?
DECISION POINT :::
ReplyDeleteDo Tim and Yuting have another child? Is the child biological or adopted? Consider Yuting's family history.
Tim and Yuting chose not to have another child. As discussed in a previous blog, they feel that the risk of having another child with a disability is too high. Tim and Yuting know that they would not be able to give a second child as much time and attention as they have with Lisa. They also feel that the financial cost would be too high and that they could not support both children. Tim and Yuting have put a lot of thought into this decision and are comfortable with their choice. They have talked it over with Lisa’s pediatrician as well as family members and feel that their daughter Lisa has provided them with all the love that they need.
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?
An Apgar score is a quick test that is performed on a newborn baby 1-minute and 5-minutes after birth. The reason the test is given both at 1-minute and 5-minutes is because the 1-minute score examines the baby’s health right after the birthing process, and the 5-minute score sees how the baby is doing once it is out of the womb. The test is usually given by a doctor, nurse, or midwife, and the test examines the baby’s complexion, pulse rate, reaction when stimulated, muscle tone, and breathing (Lowry 2010). Each category can be scored with a 0, 1, or 2 . The total score adds up to the most a ten, and the higher the score, the healthier the baby is at birth (Zieve 2011).
It has been found that a low Apgar score at birth is often linked with a later diagnosis of cerebral palsy. A low Apgar score may also indicate that brain impairment occurred during the baby’s delivery or while in utero. According to a study done in Norway, which examined medical birth registries from 1986 to 1995, 11% of the children with an Apgar score less than a 3 at birth were diagnosed with cerebral palsy compared to 0.1% of the children with an Apgar score of 10. In Lisa’s case, she would have most likely scored between 4 or 5 during both the 1-minute and 5-minute Apgar test. This score can vary greatly and due to Lisa’s cognitive delay, it is very likely that Lisa scored very low on the Apgar scale. (Lowry 2010).
In conclusion, the lower the Apgar score, the more crucial it is that immediate medical attention be provided to the baby. A score lower than a 7 indicates the baby is having difficulty adjusting to the environment outside the mother’s womb, which could have multiple causes such as a difficult birth, a c-section, or fluid in the baby’s airway. When a low Apgar score is found, the baby’s airway may need to be cleared out so they can breathe properly, or physical stimulation may be needed to get their heart beat to a healthy rate. This is not to say that a low Apgar score accurately predicts a child’s future health, nor does it signify that they will continue to have long-term health problems as they get older (Zieve 2011).
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?
ReplyDeleteDue to the fact that cerebral palsy often affects the motor skills and muscle coordination throughout one’s entire body, it is very common for individuals with CP to experience difficulties with their speech and communication skills. Some people with CP don’t have the ability to speak, while others may have trouble moving their mouths to articulate sounds because of poor muscle control. There is also a strong chance of hearing loss in those with CP, which can also greatly inhibit language input (About Cerebral Palsy 2005).
It is found that many people that have cerebral palsy also have dysarthria, which is a type of speech related disorder. Dysarthria is a neurologically related speech disorder, which is caused by damage to the frontal lobe of the brain or another location on the brain. The damage affects the motor function in those with cerebral palsy and may cause them to have slurred speech, difficulty swallowing, and additional problems with speaking (About Cerebral Palsy 2005).
It is very likely that Lisa has dysarthria, but the symptoms can manifest differently from person to person. Lisa may exhibit difficulty swallowing and lots of drooling at her young age. As Lisa gets older, she may have inaudible speech, mumbling or rapid speech, hoarseness, and abnormal rhythm or tonality. Although CP is a progressive disorder, dysarthria is not a progressive disorder. Finding the exact location of damage on the brain can help to figure out the best speech therapy approach for the individual (About Cerebral Palsy 2005).
Speech therapy can help those with cp and dysarthria in many ways. The speech therapist can teach the individual, such as Lisa, to control their mouth muscles in a particular manner and also focus on important breathing techniques. One method teaches the person to use pauses between their words and be aware of their overall speaking pace. When the person with cp has no ability to speak, electronic communication devices may be used as an option (About Cerebral Palsy 2005).
From the Wendy Marianna group :::
ReplyDeleteFinancial 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?
There was a study done in 2003 by the CDC that estimated the cost for individuals with developmental disabilities. Among the different disabilities in the study, it was said that for an individual with cerebral palsy, the estimated life span cost was $921,000. For an individual living today this amount will be higher due to inflation in the economy.
There are many costs that go into the life span cost that was estimated earlier. The main group of costs for an individual with cerebral palsy is the medical expenses, which can include surgery, rehabilitation, counseling, medications, and assistive devices (Cost of Cerebral Palsy, 2005). There are also non-medical costs that the family or individual must pay, which include modifications to the home and vehicle and special education programs (Cost of Cerebral Palsy, 2005). While these previous costs that were discussed were expenses that the individual or family pay from money they have earned, there is also a cost that is “paid” by individuals and families of individuals with cerebral palsy. That cost is the indirect cost, which includes loss of wages, loss of earning potential, pain and suffering, and the inability to provide for or contribute to their own life financially (Cost of Cerebral Palsy, 2005).
For a family living with an individual with CP, cost can be a scary idea. There are times when the family will have to pay out of pocket for services while there are other times that the federal or state government is responsible for paying for services (cerebralpalsycost.com). For example, there are schools that are open just for individuals with disabilities, and it is the responsibility of the public school the individual would normally attend to pay the bill. This is not the case with all special needs schools, but there are several that will do this for an individual.
Do you think it is likely that Lisa will grow up having learning disabilities because of her CP? Why or why not?
There is the possibility that Lisa will grow up having a learning disability. This possibility is not only because she has cerebral palsy, but also because her mother, Yuting, has a learning disability as well. Learning disabilities in individuals can vary based on the severity of cerebral palsy the individual has. Learning disabilities also very between individuals in general, they can range from being mild to being severe. An individual with a mild learning disability might have trouble in a couple of subjects, while an individual with mental retardation and cerebral palsy will have a slower time learning and will need special educational help.
While this is being said, it is not necessary that Lisa will grow up with a learning disability. The chances that it will happen, however, are great because of Yuting’s evident learning disability. Areas that Lisa might struggle in because of her cerebral palsy include motor skills, reading skills, writing skills, math skills (memorizing math facts), as well as auditory processing skills (Cerebral Palsy and Learning Disabilities, 2012).
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?
ReplyDeleteAs answered in our decision point, Tim and Yuting decide not to have another child. If they were to have another child with a handicap they feel the expenses would be too much for them to handle. They also think that they would not be able to give a second child the attention and care that they have provided to Lisa. There is nothing that Tim and Yuting can do to prevent having another child with cerebral palsy. However, Lisa should maintain a healthy diet while pregnant and should not consume carcinogens.
From the Ahmad Nassar group :::
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?
As it stated in the video we watched last week, successful relationships are the key to happiness. It is important that an individual is able to create and maintain successful, positive relationships in their lives to avoid feeling lonely or unhappy. With that being said, by developing a positive relationship with her grandparents, Lisa is creating more happiness in her life. Not only will this help with the happiness in her life, but it will help with the happiness in Ron and Tom’s life as well. A positive relationship between Lisa and her grandparents will create another strong familial bond for Lisa; it is another source of attachment that will be formed that will help with Lisa’s development and help her with forming future relationships. It gives Lisa an additional outlet of support other than that of her parents.
Not only is the relationship between Lisa and her grandparents an additional outlet of support for Lisa, but a positive relationship between parents and grandparents also creates that additional support. With all the Tim and Yuting have taken on, and have yet to take on, a strong support system is crucial in getting through everything. They have faced some tough situations and are sure to face more in the future with Lisa and her CP, and the more support they have from friends and family, the easier the situation gets. It is important that when we are faced with struggles, our friends, family, and loved ones are by our side to help us and support us rather than running in the opposite direction in fear.
Will Lisa benefit more from a Assisted Speaking Device or does she still have a chance to develop her speech at this time?
ReplyDeleteAlthough an AAC, Augmentative and Alternative Communication, device would be of benefit to Lisa, it is not something that she should have to rely on in order to speak for the rest of her life. At the age of 4, Lisa has shown improvement in her speech abilities and although they are much slower than that of a typical developing child, they are still developing and still coming along. With the intense therapy and care given to Lisa by her parents and therapists, she should be able to develop the ability to speak. Her speech, however, may not be as easily understood by others as the speech of a typically developing child. With this being the case, having an AAC device with her at all times, or close by, could benefit Lisa until she has mastered the ability to speak on her own. This will help her get her message across if she is not being understood or is unable to produce a certain word or speech sound.
Aside from Lisa showing progress in her ability to produce speech, there are also scientific findings that state that Lisa should be able to learn and produce speech. Lisa is only 4 years old at this point; the ability to learn is much higher when a child is younger than when they are older. If someone is constantly working with Lisa on her speech, she has the capacity within her brain, and the ability, to learn how to speak. It is a matter of practicing once she has learned that will enable her to master speaking. Although it may happen a little later than it does for typically developing children, and take the help of therapists and AAC devices along the way, Lisa should be able to develop and produce speech eventually without single handedly relying on an assistive device.
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.
ReplyDeleteThe stress of having a child with a disability is immense on a family. At this age, when children should already be walking, talking, and becoming self-sufficient, a child with cerebral palsy is not capable of doing those things. Lisa has to use a walking-device to assist her in getting around. The stress from this can be anything from having to get remodeling on the house for the walker to fit through doors to making sure she does not go close to stair cases. She must always be watched so she does not fall. If Lisa is in school at this time, for any periods throughout the day, there is a chance that she is getting therapy in school, which could alleviate some of the stress put on Tim and Yuting. Therapy equipment might be placed in their home so she has do therapy while she is at home as well (A Mom’s Perspective, n.d.). Another stressful topic is the fact that Lisa probably cannot be self-sufficient when it comes to feeding herself. Children with cerebral palsy often have trouble drinking from straws, so this might be a problem for Lisa as well. This could make meal time difficult in the house. Another stressor that might be present is the idea of money and who is working in the house. It has not been specified if Tim or Yuting are working, but it is implied that one or both would be working in order to bring money in the house, because assistive technologies and medical bills are expensive. But never the less, the stress of having a job would not only put stress on the parent who is working, but also the parent who stays at home and has to help Lisa alone.
A typical day in the life of Tim and Yuting with Lisa would be as follows. Every step of the day Lisa will need help with. When Lisa wakes up, she will need help getting out of bed and into her walking device. This she cannot do on her own, so Yuting or Tim will have to help her. Then comes the typical morning routine of brushing her teeth and hair and using the restroom. All of these things Lisa will need help doing, so Tim or Yuting will have to assist her. Then, assuming that they have located Lisa’s room on the first floor of the house, Lisa will most likely be able to use her walking device to get to the kitchen for breakfast. Tim or Yuting will then have to prepare breakfast for Lisa and help her eat. Because children with cerebral palsy have deficiencies with gross and fine motor skills, Lisa will need the help eating (My Child with Cerebral Palsy, 2011). After breakfast, Tim and Yuting might do some therapy with Lisa. If Lisa is enrolled in any type of school program, she will most likely go to that before lunch. Getting Lisa in the car will mean Tim or Yuting having to carry her, unless they had a ramp put in for her to be able to get out of the house and make it to the car. The same process goes with getting into the car, if they had a ramp or assistive technology added to the car, Lisa should be able to get into the car by herself using her walking device. If not, Tim or Yuting will have to help her in. The same process then goes with getting out of the car at school. If the school doesn’t have ramps for wheelchair accessibility, Tim and Yuting will have to find a way to get her inside. Most likely, if the school did not already have it, Tim and Yuting will have said something and the school will have to put one in. Once in school, Lisa will do as much in the classroom as she can. She will most likely have assistive technologies in the classroom, and hopefully she will have an aid to help her through her day. When lunch time arrives she will need help eating, and this help will either be given by an aid or by a therapist. Lisa will probably go through hours of therapy during her school day, which will ultimately help her in the long run (A Mom’s Perspective, n.d.). Once school is over, Tim or Yuting will pick Lisa up from school and take her home. There is a chance that Lisa would be able to ride the bus to school, if the school was within the distance a bus would travel and if the bus had assistive technologies for Lisa to be able to get on and off. When Lisa gets home, Tim and Yuting then have the opportunity to do more therapy with Lisa, which could be anything from physical therapy with equipment provided by the school to just playing with toys to progress her motor skills (A Mom’s Perspective, n.d.). Feeding time at dinner is the same obstacle as breakfast. Tim or Yuting need to help Lisa eat, maybe allowing her to try and feed herself before helping. Then is some down time, which could be used to relax or for more therapy. Then comes the bed time routine, similar to the morning routine, brush teeth and hair, and use the restroom. The idea of using the restroom is optimistic, because it is not known to us if Lisa is still in diapers because she does not have the motor skills to make it to the restroom when she needs to go. At night is most likely when Lisa will be bathed as well, which she will also need help doing unless she has assistive technology to do so. Then it will be bedtime. One could hope that Tim and Yuting read to Lisa at night before bed. Then after a full night’s sleep, the Yoo family wakes up and starts again.
ReplyDeleteWorks Cited:
ReplyDeleteA Mom’s Perspective. (n.d.) Early Elementary Years. Retrieved February 26, 2012 from http://www.thecpchild.com/early-elementary-school-years
My Child with Cerebral Palsy. (2011). Signs and Symptoms of Cerebral Palsy. Retrieved February 26, 2012 from http://cerebralpalsy.org/about-cerebral-palsy/symptoms/