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A 5-year-old girl was referred to the school district physical therapist for an evaluation before she enrolls in kindergarten. Her medical and physical therapy records document a diagnosis of cerebral palsy—spastic diplegia. She has received Early Intervention (EI) services (physical, occupational, and speech therapy) at home for 3 years. The child wears an articulating lightweight ankle-foot orthosis (AFO) and ambulates at a very slow speed with a handheld posterior walker for distances of up to 30 ft. She is able to sit in a chair for activities, but her postural control is only fair. She requires extra time to move from a chair to standing in the walker, and has difficulty negotiating her walker around obstacles. The physical therapist is asked to evaluate the child and develop the physical therapy plan for achieving functional mobility outcomes in the school setting in consultation with her family and teachers. The report will be part of the Individualized Education Plan (IEP). Along with the IEP team, the physical therapist will determine what level of physical therapy services she will receive as part of her educational plan.

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What are possible secondary impairments for children with cerebral palsy?

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What are the most appropriate physical therapy outcome measures for functional mobility for children with spastic diplegia cerebral palsy in the school setting?

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What are the examination priorities?

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Based on her health condition, what do you anticipate will be the contributors to activity limitations?

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  • CEREBRAL PALSY (CP): Group of permanent activity-limiting disorders of movement and posture development that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain; motor disorders are often accompanied by disturbances of sensation, cognition, communication, perception, behavior, and/or by epilepsy, and by secondary musculoskeletal problems
  • INDIVIDUALIZED EDUCATION PLAN (IEP): Plan mandated under federal law called the Individuals with Disabilities Education Act (IDEA); developed annually by the family, school personnel and occupational, physical, and speech therapists, as indicated by the child's level of functioning; plan may include provision of physical therapy in the school setting, if the team determines it is needed to help the child achieve his/her educational goals1

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  1. Describe the impairments and functional and activity limitations affecting children with cerebral palsy.

  2. Identify key questions to determine the priorities of the child and family in the physical therapy plan of care.

  3. Identify reliable and valid outcome tools to measure a child's mobility and level of functioning in school.

  4. Discuss appropriate components of the examination for the child with cerebral palsy.

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PT considerations during management of the child with mobility, activity, and participation limitations in the school setting due to cerebral palsy—spastic diplegia:

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  • General physical therapy plan of care/goals: Assess gait and mobility in the school setting including transitions to and from classroom seating, bathroom/toileting, and meal/snack ...

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