The session I wished to reflect on was with MA, an 11-year-old male with global developmental delay secondary to mental retardation/autism spectrum disorder, to consider fronto-parietal atrophy. His schedule is a co-treatment session between physical and speech therapy interns. However, during this session, no speech therapy intern was present.
Gross assessment of the child shows no marked physical therapy therapy problems on the impairment level such as deficits in strength, range of motion and balance. On the other hand, the following therapy problems on the "activity limitation" level were identified:
1. difficulty in stair negotiation, manifested by refusal to do activity
2. level ambulation, manifested by assumption of cross-sitting >50% of the time
Basically, what his mother sees as problematic was the frequent and sudden sitting of the child when they are walking in public. During these events, the mother sings "Twinkle, twinkle star" and the English alphabet, songs used by the interdisciplinary care team (group of physical, occupational and speech therapy interns) who previously handled the child. These songs serve as a cue for the patient to stand up.
Because I did not identify any physical therapy impairment, I focused on these two activity limitations and addressed them through the functional training organized by the said team.
The main difficulty was making him follow my instructions. I utilized what the occupational therapy interns called the Therapeutic Use of Self [TUS], namely, active friendliness and kind firmness but with no success. When instructing him to stand without success, my last resort was to pull the child into standing with my grip on the guard belt. The child then immediately flung his arms to me upwards so I had to move my face away to continue pulling without letting myself get hurt
I learn to muster more patience every time I see this child. Back then, i gave the child an ample time (random duration between >1 to 4 minutes) to respond before forcing him to stand. I chose not to force him to stand right away so he would learn how to even without anyone forcing him to do so.
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