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An 11-year-old girl with L4/L5 spina bifida (myelomeningocele) is enrolled in a regular sixth grade class at the local elementary school and uses a manual wheelchair for school and community ambulation. She has always been quite social and verbal and has many friends at school. Immediately after birth, she had surgery to close the myelomeningocele in her lower back and she had a ventriculoperitoneal cerebrospinal fluid (CSF) shunt placed to prevent hydrocephalus. Since then, she has had two shunt revisions due to infection and she also has frequent urinary tract infections. She rolled at 8 months and sat independently at 11 months. She belly crawled at 16 months, and has been using a manual wheelchair since she was 3 years old. She has received physical therapy services regularly since she was a baby. She is now independent in intermittent catheterization during her school day. The school physical therapist has been working with her to maximize her endurance with a walking program using her long leg braces. However, she is only able to ambulate up to 30 ft with her crutches at home and in the classroom, and she is much slower than her peers. She will be going to junior high school next year, which is on a larger campus with hilly terrain, and she will need to change classrooms throughout the day. She is also starting to mature and has gained weight, which has made walking and pushing her wheelchair more difficult. The physical therapist is consulting with the school district and her family to make recommendations for her transfer to junior high and to help establish goals for adaptive physical education.

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Identify her functional limitations and assets.

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How would this child's contextual factors influence or change your patient/client management?

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What are the most appropriate examination tests?

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What are the examination priorities?

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  • INDIVIDUALIZED EDUCATION PLAN (IEP): Plan mandated under federal law called the Individuals with Disabilities Education Act (IDEA) and 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 primary and secondary impairments and the functional and activity limitations affecting children with spina bifida.

  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.

  5. Discuss assistive/adaptive devices and equipment recommendations for a child with spina bifida.

  6. Describe attainable age-appropriate goals for a preteen with spina bifida.

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PT considerations during management of the child with mobility, activity, and ...

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