Nathan Dorje Andrew is an 11 month old male with severe semi-lobar
holoprosencephaly and spastic quadriplegic cerebral palsy. He presents with high
muscle tone in the four extremities, and low tone in the trunk and neck. Nathan
is at risk of developing contractures as well as varoius orthopedic and muscular
problems as a result of muscle tone problems. He presents with serious global
developmental delays.
I have prescribed the following treatment:
 Medical
o Gastroenterologist: Monthly checkups, and when necessary
 Medications: Prevacid once / day
o Orthopedist: Every two months
o Immunologist: quarterly
 Medications: Folic Acid, Vitamin C, multi vitamins
o ENT: quarterly
o Opthalmologist: every two months
o Neurologist: quarterly
o Neurosurgeon: with any complications, as well as every 2 months
o Audiologist: when necessary
o Additionally, I have asked Nathan’s parents to bring him to see me
with any sign of a cold, fever, projectile vomiting, lethargy, as these
are symptons of potential shunt infections or malfunctions.
 Physical Therapy
o Physical therapist: twice per week, 1 hour sessions
o Aquatic therapy: once per week, 1 hour session
o Partial Weight Bearing Therapy:
 Clinical setting: once per week, 1 hour session
 Home setting: Daily, 30 min’s per day
o Exercises by the parents:
 Passive range of motion to all joints: Daily, at least 10
repetitions per joint, at least 3 times per day, or when
diapering
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 Stretching every joint of the body, shoulder, elbow,
hands, to prevent contractures
 PNF patterns (diagonal patterns for legs and arms)
 Adductors
 Hamstrings
 Calf
Age appropriate strengthening exercises: Daily, at least 30
minutes of intensive therapy
 Abdominals
 Back extensors
 Extremities
 Pectoralis
 Biceps
 Triceps
 Rhomboids
 Hamstrings
 Quad
 Rectus abdominus
Standing program: Daily, 10 minutes 3 times per day
 Prone stander
Positioning: Reccommended 1 hour per day on different
positions or devices
 Hold by pelvis to control trunk
 Sitting
 Kneeling
 Stander
 Corner chair
 Upright head
 Prop sitting
Therapeutic ball: Daily, 3-5 10 minute sessions
 Strengthening
o Trunk
o Abdominals
o Back
 Side sitting
 Postural Control: Daily, 15 minutes per day
 Elicit balance reactions
 Transitioning for mobility: Daily, 45 minutes per day
throughout the day
 Rolling from back to stomach, and stomack to back
 Prone to go up to his hands
 Rolling to the sides to come up into side sitting
 Kneeling
 Quadruped position (hands and knees)
 Occupational Therapy
 Oral motor exercises: Daily ,5-10 repetitions, whenever
possible
 Gum massage
 Lip stretching
 Tongue lateralization exercises
 Tongue tip elevation exercises
 Mid-blade elevation exercises
 Jaw control exercise
 Fine motor coordination: Daily, 3 30 minute sessions
 Reaching activities
 Grasping activities
 Bimanual and bilateral activities
 Proprioceptive activities: Daily, 1 hour per day
 Vestibular stimulation such as swinging
 Rotary stimulation
 Weight bearing on arms
 Joint compressions
 Deep pressure
 Tactile stimulation
 Auditory Stimulation (sensory processing): Daily, 3 10 minute
sessions
 Self-regulation
 Attention stimulation
 Adaptive Devices: Daily, 1 15 minute session
 Playing with switch activated toys
 Child development therapy:
o Cognition: Daily, 1 hour per day
 Look from one object to another; held 1 foot from his chest,
objects 6-8 inches apart, he will glance several times to look
directly at each object
 Find a partially hidden object
 Continue a familiar activity by initiating movements
 Reach for a nearby object consistently
 Anticipate visually a slowly moving object; look to the other
side for it to reappear
o Language: Daily, 30 minutes per day
 Maintain focus and watch speaker’s eyes and mouth when
spoken to
 Use eye gaze, body movements to initiate and maintain
interaction with a person or object
 Wave or respond to bye-bye
 Respond to a simple request with a gesture, “Give
mommy/daddy a kiss
o Social: Daily, 1 hour per day
 Inspect his own hands
 Respond playfully to a mirror (smiles, laughs, pats, reaches
toward his image)
 Enjoy songs; clapping his hands upon hearing a familiar song
as, “pat-a-cake”
 Play “peek-a-boo” and remove a cloth from his face
 Vision Therapy
o Tracking objects: Daily, 10 repetitions
o Identifying colors and shapes on flash cards: Daily, 15 minutes
 Massage Therapy: Daily, 20 min’s in the morning, 20 min’s in the evening
o Massage thighs, groin area, and feet to avoid contractures of muscles
o Massage arms and hands
This is an intensive program for a child so young but I see potential in him and
with effort and stimulation his potential will be maximized.