Michael’s story: Learning disabilities and speech and language…

Question Answered step-by-step Michael’s story: Learning disabilities and speech and language… Michael’s story: Learning disabilities and speech and language difficulties  Three weeks late, the client was delivered via emergency C-section when doctors discovered the umbilical cord wrapped around his neck following days of labor. Despite his weighing in at a whopping twelve pounds, his APGAR at one minute was only four and his blood oxygen level was dangerously low. The client spent seven nights in the hospital, several in intensive care before his parents could take him home. The client’s mother recalls her son as an “easy baby” who breastfed well for a year and a half. His progression through most of the basic gross motor developmental milestones was on target. His teeth came in very early and the teething period was rough on the entire family.   He was a “mouther,” putting almost everything within his grasp into his mouth. Speech challenges as a youngster prompted extensive speech therapy to help him master nine sounds that he had not been able to produce. The client attended a small private school and worked regularly with tutors. In first grade, the client received additional therapy for the “r” sound at school. He was in a special class that employed Lindamood-Bell techniques, which emphasize the “feel” of sounds as produced by the mouth to promote phonemic awareness. Prior to seeking help from The HANDLE Institute, his family utilized several other therapies to help the client through his challenges. In second grade, the client received vision therapy and also underwent a naturopathic treatment (NAET) to eliminate his many allergies.     Observations: Ten years following his traumatic birth, the client presented with a variety of learning challenges. During the evaluation, the client entered willingly into the spirit of playfulness and competition. An understanding of the root causes of his academic difficulties emerged. Despite vision therapy, the client did not have adequate visual tracking skills. His eyes tended to jump while tracking an object, and he needed a fair amount of help to discern differences on a picture completion task. Additionally, the client had not achieved dependable binocular function; with red/blue glasses on, he saw red and blue halves on white paper indicating that his eyes were not working well together. On a task called finger tapping, where the client copies a simple pattern of touching the thumb to each finger in order, the client first completed the pattern in reverse. When changed to a skip-finger pattern, he had more difficulty with the sequence, and even demonstrated some trouble finding the fingers themselves. On an ear/nose touching task, which involved midline crossing, he also had trouble locating his body parts. Throughout the assessment, the client’s speech was slow and deliberate, as if he needed to consciously conceive the sounds before he spoke them. Repeating a string of nonsense syllables on an auditory task proved very challenging for the client. The client demonstrated a considerable amount of “overflow” movement. That is, when asked to track an object with his eyes, his head moved too. When performing a finger tapping exercise with one hand, the other did not remain still. His whole body moved as he wrote on the chalkboard with both hands at the same time. Multi-tracking, or doing more than one thing at a time, proved difficult for the client. When trying to engage in conversation while performing a task that requires strong connections between the two sides of the brain (interhemispheric integration), he tended to stop either talking or doing the task.   Conclusions: At a foundational level, the client’s learning was compromised by a weak vestibular system (inner ear). Among other things, the vestibular system supports the dynamic use of our eyes and muscle tone. The fine muscle control necessary for the client’s eyes to work together (binocularity) was lacking and his eyes were sensitive to bright light. This, together with poor visual tracking, helps explain why he often skipped small words while reading. Without first strengthening his vestibular system, the client was not able to fully realize the benefits of his previous vision therapy program, and so his reading problems persisted. Sensation of the body in space, called proprioception, is also supported by the vestibular system. Difficulty locating body parts on specific assessments validates proprioceptive irregularities. If the brain does not know where a specific body part is, it cannot move appropriately without monitoring the movement through conscious and cognitive means. Underdeveloped proprioception in the body parts required for articulation can interfere with a person’s inherent ability to enunciate and this difficulty was evident in the client’s speech difficulties. Additionally, reports of thrashing in his sleep, falling out of bed and needing to listen to tapes to fall asleep supported the findings of a weak proprioceptive sense.  Guide Questions:     1. Assess the general situation of Michael. Formulate nursing diagnoses related to the identified problem   2. Formulate a plan of care from your listed nursing diagnoses that will prioritize or will help address the condition of Michael. Health Science Science Nursing Share QuestionEmailCopy link Comments (0)