Case Study 9 – Speech & Motor Development Issues In The Child

Parent’s Experience

Our child was born on October 5^th in 2012. She was born healthy and normal with a birth weight of  3.200 kg. Never once did the word of ASD cross my mind as a possibility for her. No one in my family had ever been diagnosed with autism before. She hit her developmental milestones on time till 2 years, she was a happy baby who was social, loved music, and enjoyed playing with me and with her favorite Barbie dolls. At the age of 2, She suddenly stopped talking with me and became an empty shell of herself. She didn’t respond to her name, and she lost her speech altogether.

I slowed down it off as just a little setback; I never dreamed that there was something wrong with my baby. At 2 and half years she still had not redeemed her lost speech. Six months later, my daughter was officially diagnosed with a ‘Moderate’ case of Autism Spectrum Disorder by one of the top specialists in Trivandrum.

A year later, a friend told me about a clinic she went to in Kottayam. We came to Jewel Autism Centre when she was 4 years 4 months old. At the time of admission, my major concerns were her speech development and motor development delay ( Gross motor and Fine motor skills ) and my child was so frightened even to stand in steps and climb stairs.

Right from the beginning of her treatment at Jewel Autism Centre, we had been getting the service from Occupational Therapist, Ms. Kukku Kurian. She applied accurate interventions to our child. Ms. Kukku made my child do many strengthening and sensory activities. We saw many changes in her.  Now her gross motor and fine motor skills are improved and her sensory issues have been reduced. We are really thankful to Ms. Kukku for all the support and dedication up to our daughter.

Clinical findings of Srithika’s evaluation by the Therapist

She had sensory issues such as toe walking, hand flapping, fear of height (GI and PI), and motor developmental delay. Her muscle strength and stability were very low.

She was in-flight response stage. She avoided movements and she preferred keeping her head up and feet down. She avoided bicycle riding, sliding, and swinging. She was fearful of unstable surfaces, such as sandy beach/climbing playground equipment. She experienced an exaggerated emotional response to antigravity movement. She always preferred to stay lower to the ground and avoided most active physical tasks. She became quite upset when movement is forced on her, especially if it is unexpected. It affects her occupational performance area. There was a marked decrease due to a dislike of activities of daily living such as walking over bumpy ground, climbing stairs, stepping over obstacles, leaning forward, etc. She exhibited limited participation in gross motor play and group play.

What is Gravitational Insecurity (GI)?

GI is described as abnormal anxiety caused by dysfunction in the integration of sensation that arises when the vestibular system is stimulated by head position or movement. The pull of gravity most of us trust and take for granted is perceived by this child as a primal threat to survival. This condition is characterized by over fear of movement, height, or change in head position.

A child with GI has an

• Anxiety when feet leave the ground
• Fear of falling or being moved suddenly
• Dislike being upside down
• Uneasiness when walking on uneven surfaces

What is Postural Insecurity (PI)?

Postural Insecurity is defined as an extreme caution experienced as a result of decreased postural ability when completing physical challenges involving postural strength and stability. Sensory Motor deficits lead to motor coordinative instability leading to postural insecurity. This condition completely lacks the fear response associated with gravitational insecurity.

As a therapist how I helped my child to overcome GI :

Step 1: BUILDING TRUST

What does it mean to build trust?

Building trust is about more than saying “You can rely on me” or “I would never hurt you”.

1. I made myself trust in her
2. I made her feel that she is safe in my hands, which made her empower her trust in herself.
3. My trust made her take the risk of challenging activities.

• • Be protective of them: This helped me much further than stranger danger or made her sure she is safe in my hand. In the beginning, I never forced her to do things that she found scary or painful.
  • Be consistent: I acted in a predictable way. I set some rules.
  • Be reliable: I gave advance warning of changes.
  • Be dependable: Always responded to request for help. Being the one that she can count on to be a source of relief.
  • Be honest: Honesty is one of the corners stone’s of trust, I gave priority to her values

Step 2: Sensory Integration (SI) for GI

I used Sensory Integration Therapy to treat GI  by providing gradual graded vestibular information actively and passively. Sensory experiences are introduced slowly and gradually, to not perceive these experiences negatively. As an Occupational Therapist, I used a multisensory approach to help guide my child to explore her environment through stimulation of her vestibular system. This was accomplished by encouraging my child to climb, swing, jump, roll and crawl –all things which shake her comfort zone a bit. I planned a ‘just right’ challenge for her, it allowed her to gradually begin to participate in activities which she once found terrifying. I never pushed her, I just encouraged her to gain confidence till she succeeded.

Step 3: Muscle strengthening and joint stability for Postural Insecurity

My next goal was to strengthen her major muscle groups which helped her gross motor development. I made her do strengthening activities such as upper extremity weight-bearing, wheelbarrow walking, supine flexion, and prone extension activities. I used neurodevelopment techniques and biomechanical approaches to improve her muscle strength. The result of the intervention showed improvement in walking, jumping, and stair climbing skills in the child.

Kukku Kurian (BOT)

Department of Occupational Therapy