iLs Case Summary Report
Subject: 4.5-year-old with Developmental Delays
Therapy: Speech, OT, iLs combined
Associates’ Names: Cindy Dawkins, OTR/L; Shannon Norris, OTR/L; and Andrea W. Pointer, M.S., CCC-SLP
Name of Organization: Kids Kount Therapy Services
Presenting Problem: Developmental Delays (speech-language, fine motor, and gross motor skills); auditory processing weaknesses; and pragmatic language problems (i.e. delayed social skills development)
Background Information: “Matthew” was born at 36 weeks gestation with the following complications: respiratory distress syndrome with ventilatory support for three days, followed by onset of pneumonia on day five; ventricular septal heart defect; grade I intracranial right hemispheric hemorrhage; separation from mother for initial five days post birth. Matthew did not crawl until 14 months of age and walked at 16 months. First words were spoken after his second birthday. Matthew did not show affection until approximately 2-3 years of age. Matthew was diagnosed with a developmental delay and possible Asperger’s syndrome. Matthew had received prior speech-language and occupational therapy services from 2 ½ years of age prior to services at Kids Kount.
Matthew was evaluated at the age of four years, five months. The Test of Auditory Processing Skills-3 revealed weaknesses in phonological blending, phonological segmentation, and auditory comprehension. Expressive and receptive language scores were within normal limits for concept knowledge. However, Matthew was unable to complete greater than three circles of communication without diverting attention to a task or distractor in the room in attempts to avoid further reciprocal exchange. Eye/facial contact during communicative acts was less than a second and occurred less than 20% of reciprocal exchanges without prompting. He was unable to describe or talk about events of the day and described objects and pictures with less than 50% accuracy. Difficulty was also present with following two-step directions (67% accuracy).
Goals for Occupational Therapy focused on organizing his sensory system; improving balance, core strength, and motor planning skills; improving visual attention, tracking, and memory skills; and improving simple design copy and letter recognition/formation. Speech-Language Therapy addressed production of error sounds/phonemes; pre-literacy skills for rhyming, blending phonemes, and segmenting phonemes; sound/symbol letter awareness; recalling and describing daily events; describing objects and pictures; discriminating words in presence of background noise; completing auditory memory tasks for words and directives; and addressing weaknesses in social skills with regards to reciprocal exchanges/circles of communication.
iLs Program Used:
Matthew completed a customized program of 80-minute Occupational Therapy sessions and 70-minute Speech-Language Therapy sessions utilizing the iLs Pro System simultaneously. Occupational Therapy sessions averaged two times per week for 10 sessions, and Speech-Language Therapy sessions averaged three times per week for 10 sessions. Matthew was given a break in therapy for a period of four months and then resumed with a 15-session program of Speech-Language Therapy, which included utilization of the iLs Pro System with sessions occurring 70 minutes in duration three times a week.
Other Interventions Used:
Matthew participated in Speech-Language and Occupational Therapy integrated with use of the iLs Pro System. No additional interventions were utilized. He was enrolled in a Pre-K4 program in which the teacher was educated regarding learning weaknesses and educational needs.
Summary of Changes:
The Test of Auditory Processing Skills-3 was administered for follow-up testing. All subtest and index/overall scores were within or above normal limits post therapy utilizing iLs. (Average range for subtest scores is 7-13, and average range for overall scores is 85-115.) Significant changes in areas of weakness are as follows:
Regarding articulation errors, Matthew progressed from an imitation word level at 30% accuracy to producing all phonemes at a cued phrase/sentence level with 90% accuracy or greater. Reciprocal interactions improved from a maximum of three circles of communication during an interaction to greater than 25 circles of communication during an interaction. Eye gaze increased from less than one second (at a 20% occurrence) to an average of 4 seconds (at a 75% occurrence). Rhyming skills improved from 0% to 80% at time of reassessment and following two-step commands increased from 67% to 90% accuracy. All of these changes occurred based on 25 targeted sessions of Speech-Language Therapy paired with iLs.
Alphabet memory progressed from less than 30% to 80% accuracy. Matthew progressed from copying simple designs with 25% accuracy to writing letters with 71% accuracy. Motor planning for three-step actions progressed from 50% to 95% accuracy. Problem-solving, organizational skills, directionality, and following directions with puzzles improved from 40% accuracy to 50% accuracy. The changes noted in these areas were based on ten targeted sessions of Occupational Therapy paired with iLs.
Parental reports included improvement in the following areas:
- awareness with sensory stimuli (smells, noisy crowded places)
- ease with transitions
- understanding of others’ tone of voice
- functional processing of directions in presence of background noise
- interactions with other children in his peer group
- eye contact with less prompts needed
- coloring, drawing, and writing as well as a desire to please his teacher with his work
- recognition of numbers and letters as well as associated sounds
Matthew’s grandmother also reported he has been in therapy for many years, but progress with iLs has been faster and more consistent.
Conclusions and Recommendations: Matthew made significant gains in all areas as evidenced by standardized testing, parental report, and successful completion of a Pre-K4 academic program. Teacher and parental reports indicated social skills are age-appropriate with peers. He functioned in the academic setting in areas of literacy and cognitive-linguistics without difficulty. Auditory processing skills were also within functional limits within the classroom setting. Matthew does continue to present with mild delays in the areas of visual processing, visual tracking, motor praxis, and fine motor skills. As Occupational Therapy only consisted of 10 sessions paired with iLs, Matthew will be enrolled in Occupational Therapy paired with iLs for a summer intensive program; upon completion, Matthew will begin Kindergarten.