R. is a girl from mother's first, twin, pregnancy. Mother had a Cesarean section in her 29th week of pregnancy. Apgar score was 3/5, birth weight 949g and 36cm in length. R. had 3rd degree hemorrhage into the left lateral ventricle and spent 69 days in the incubator. She was breastfed only for a short while. She had low muscle tone in her trunk and high muscle tone in her extremities. With physical therapy, she lowered her muscle tone a bit. When in disregulated state, she has a tendency to go into an opisthotonos position. She started sitting by herself at the age of 13/14months, and she started walking at the age of 20 months.
Sensory profile was done in October 2015, exactly a year ago.
R. has proprioceptive modulation problems: she goes from hypo to hyper state very quickly. E.g. she likes jumping on a pilates ball while sitting in her mom's lap, it soothes her but she can easily get overstimulated. These situations used to happen within a minute. After one year of continuous work on her proprioception, she can regulate proprioceptive input a lot better. However, similar reactions happen when introduced to a visual stimulus. E.g. she can get easily disregulated if she sees any door open or balls scattered around the room and not properly placed in the ball pit. These few situations give her a very unpleasant feeling of loss of control.
R. had a period of many different stereotypical movements which were without purpose or a goal. E.g. she used to swirl a ball or any other small object in her hands. If that object fell down, she would lose her regulation instantly. She also stimulated herself with rhythmical movements while laying on the floor on her stomach with her hands straightened and legs under 45 degrees.
R. likes vestibular input, but when you remove that stimulus, she loses her regulation. E.g. she is ok while the car is moving, but as soon as the car slows down or stops, she instantly cries and becomes auto/agressive. She falls asleep by moving her body and head left- right (vestibular) or by cuddling into her mom (proprioceptive – tactile).
Considering the period of time spent in the incubator, it's understandable she is hyposensitive to touch even around the mouth (despite the intubation tubes which usually results in hypersensitivity around the mouth). Pacifier is a good self-soothing means for her, but we recommended to use it only for a certain period of time in a day because she gets overly fixated and we do not have learning experience in those moments.
R. tries to communicate with us within her limits. She gives us smiles, reacts to what we say, rarely she says baba for “grandma” and she used a gesture for “more” once or twice. Other than that, she takes an adult by their hand and takes them to the desired object. Her body schema is not integrated, she does not control her sphincters, but she can cross her midline.
In this period of one year, that R. was in our program, we worked a lot on regulating her and giving her means of self-regulation. We did that mostly through a combination of proprioceptive and tactile stimulation considering her emotional instability and a low body schema integration. Those moments when she had good self regulation, without any stereotypical movements, we used for learning (eye contact, gestures, words like mama, making cause and effect situations like throwing a ball onto a xylophone because she prefers auditive stimuli, going through an obstacle course, introduction of new textures and play with a ball).
Case discussion will be held in croatian language.
Since she has better regulation and less stereotypical activities, we proposed some other skills for our goals: changing her clothes, learning opening – closing of doors and manipulating objects with her hands as well as communications with pictures, gestures accompanied with verbal expression.
Also, it would be good to include in the therapy process one of her parents to be able to multiply activities at home to have better and faster results.