Steven is a 9-year-old boy who had been diagnosed with ADHD and Dyslexia. He has a past medical history of chronic otitis media in his infant, toddler and preschool years. At the age of three, he had his tonsils and adenoids removed and PE tubes placed in both ears. He currently has no medical issues.
Steven came to Occupational Therapy on 11/20/2013. At that time he was attending 3rd grade at a public school. Last year he failed the FCAT (Florida’s Comprehensive Assessment Test) in both math and reading, therefore he had to repeat the 3rd grade. Steven’s mother was very concerned about his difficulties with written output and processing of information, as these areas were affecting his academic performance. Steven’s mother stated that he could verbally express language or math problems but once he was asked to write them down, he had great difficulty with output of information. With the history of Steven failing the FCAT and his continued difficulty in class, both his mother and teacher were concerned that he may not pass the FCAT again.
During his initial evaluation, Steven demonstrated a large gap between his visual perceptual skills (which were above average range) and motor coordination skills (that were in the low range- more than 1 ½ standard deviations below mean) based in the Beery VMI; his raw score was 27 = 13yrs 5mos. and Motor Coordination; his raw score was 17 = 5yrs 11mos. This will affect processing of information and written expression skills. During the evaluation, Steven was able to write 25 words in 1 minute, 36 seconds. He was able to keep within the space of a regular notebook paper. He did have difficulty with spacing between words, adherence to writing line, and letter formation, all affecting legibility, and efficiency of written output. Steven frequently traced over letters with increased effort and energy output. Finally, Steven demonstrated decreased core strength and postural stability, coordination, and bilateral coordination.
Steven was very willing but nervous about completing the IM assessment. He asked often what would happen if he did not do well enough. He was reassured that all he needed to do was his best, and that was all that was expected. We completed the IM Long Form Assessment but due to his fatigue level and decreased attention we had to complete the assessment over two treatment sessions. On the first day, he completed tasks 1-7 and his total adjusted score was 126 MS; 71.4% of the hits were early and 28.6% were late. On the second day, he completed tasks 8-14 and his total adjusted score was 231 MS; 88.8% of the hits were early and 11.2% were late. As seen in the above results Steven had a much harder time with tasks involving his feet.
When we started the training, many modifications were made to ensure Steven’s success. We sped up the tempo to 70 since most of his hits on the initial Long Form Assessment were early. The difficulty level was also set at 200 so that he would not get discouraged and would feel successful. Steven was motivated by the games on the IM System, and he mostly liked the “Fishin’”, “Monkey” and “Sammich” games. By the 6th visit, we were able to set the difficulty level to 100. On the 8th visit, we added guide sounds. Steven continued to be successful and was able to keep his task average around 60-90. Around this time we started adding more elements to his sessions to increase difficulty. We started having him sit on the therapy ball while performing UE & LE tasks. Sometimes he sat on the bolster swing while completing tasks while watching the other children in the room. By the 11th visit, we started having him complete cognitive motor skills such as naming objects (Lego figures) while clapping. We continued to add to the complexity of each session by having him visually track while completing cognitive motor skills. These activities included having him sit on the therapy ball while looking at the color word chart, first tapping on each word while reading the word, then he had to tap on each word while stating the color the word was written in. Although at times he would get frustrated he always continued to work hard to get the best results possible.
Steven’s mother had not told his teacher about the IM sessions so she could see if the teacher had an unbiased observation of any changes. Within the first 2 weeks of IM training, Steven’s mother came to us and said that Steven’s teachers had inquired as to what has changed with him. His teacher stated that Steven had been more focused, and he was able to complete his classroom assignments in a timelier manner. Steven’s mother also came to us and said that he was completing his homework with less difficulty and his grades in school were improving. She also stated that his attitude towards school in general had improved. In April, 2014 Steven took the 3rd grade FCAT again and this time he passed. The teacher told Steven’s mother that ne not only passed with a grade level score, but he actually passed with and above-average score.
On 3/17/2014, after 3 months of IM training, we re-administered the LFA and Steven’s unadjusted score was 92; 55% of his hits were early and 45% of his hits were late. The LFA was done again on 7/21/2014, after 7 months of IM training Steven’s unadjusted score was 72 (normal range for his age); 59% of his hits were early and 41% of his hits were late. Furthermore, during his re-evaluation on 4-24-2014, the Berry VMI was not re-administered as he was already above the normal range for his age, but the Motor Coordination portion was redone. His raw score was 23 = 8yrs 6mos (3 yrs. 7mos. improvement in 6 months). His ability to complete antigravity prone extension and supine flexion had improved as he was able to hold each position for twice as long as he had on the initial evaluation. He was also able to print a full paragraph neatly and legibly with only occasional prompts needed for capitalizations at the beginning of sentences. The tracing of letters with extreme pressure that was noted on the evaluation had resolved and was not noted on the re-evaluation.
At this time Steven continues to receive OT services, and he will continue IM training to improve his timing even more. His mother now feels hopeful for the 4th grade school year and she says that she knows he will be successful. Steven has also stated that he can see a difference in himself since starting IM training, remarking that he used to get very distracted when his friends in class would talk, but is now able to “tune them out” and focus on the teacher or the work he is doing. He also feels more confident going into his 4th grade school year.
