Question

Chloe, 6½ years old, had been diagnosed at birth with a lumbar (L1/L2) myelomeningocele and received a shunt for hydrocephalus. Chloe is in a regular first-grade class of 20 students. She gets assistance in school with toileting and with managing her lunch tray. The classroom assistant sits with Chloe while the other children participate in gym and play on the playground.

Chloe has a hip-knee-ankle gait orthosis that only occasionally comes with her to school. She does have a standing frame at school and is transported to and from school in a wheelchair with a pressure-relief cushion. She needs moderate assistance at school for transfers, and maximum assistance for tub transfers at home. Chloe is able to transfer from the chair to the floor, but only does this with much prompting because she is afraid of falling.

Chloe assists with dressing, but continues to have difficulty with zippers, small buttons, and shoelaces. She uses a knife, fork, and spoon during meals, with some spillage. She is unable to peel an orange or banana, and has difficulty opening Tupperware containers and the school milk boxes. Chloe is catheterized and is dependent in bowel and bladder care.

Chloe enjoys school and seems to make friends easily. She has been slow to develop writing skills, and writes with an immature static tripod grasp. At this time she can print her name and only a few additional letters of the alphabet. On standardized testing, Chloe had difficulty with the visual-perceptual skills of visual-spatial relations and visual-sequential memory. Although assured by the first-grade teacher that they would promote Chloe with her class, Chloe’s parents are concerned by her poor writing, reading, and math skills.

Questions/Activities

1. Because Chloe’s parents are concerned about her academic performance, describe some craft and game activities that Chloe could engage in at home and with friends that might help her build the needed fine motor and visual-perceptual skills. Be specific in describing the activities and the specific childhood skills it would encourage.

Answer 1

Chloe is born with a birth defect called lumbar myelomeningocele which is associated with the spinal cord. The children with this disease will have poor academic and visual-perceptual skills but can improve these skills with some craft and game activities. Let us discuss those activities.

Visual perception is the ability of the brain for identifying and sensing of different things while seeing something. These skills can be improved with puzzle games and drawing completion games. Visual perception is associated largely with sensing and memorizing. So hidden picture activities also help them to build visual perception skills.

For improving fine motor skills, we can try tossing and catching a ball game and other self-care activities such as how to put a shirt button, how to find out dress from the wardrobe etc. The most important thing is to ensure the involvement of the child to these activities daily by motivating them.