CSD 823X S10
Reports on Our Visit with Emma F.

Name
Comments
Nicholas Hugh Craft    Michigan State University
Department of Communicative Sciences and Disorders
CSD 823X
Artificial Language Laboratory Visit Report Form


Name of Observer
: Nick Craft

Name of Client:  Emma
F.

Date of Birth:
                        (September 8, 20
05)

Age on Observation Date:
                                           4;7 on April 7,
2010

Diagnosis and Etiol
ogy:
CP secondary to birth complications


Date(s) and time(s) of Observ
ation:

1. Describe Emma's abilities and challenges.
Emma is a wonderful 4-year 7-month old female diagnosed with Cerebral Palsy.  She vocalizes when upset or happy, but has no intelligible speech. Emma is able to move her hand in order to answer questions pressing a yes/no board.  The home environment is well adapted to her needs and a home nurse is available to provide medical care to Emma.  Her strengths include her eye gaze and facial expressions.  Attempts were made to invoke a response from Emma by using computer games and other technology. It was reported that she uses a G-tube and has a hx of aspiration pneumonia and severe dysphagia.  

2.What technology does Emma use?

She uses a variety of augmentative/alternative communication devices; assistance with joystick to operate notebook computer, yes/no communication board.

3. Additional comments:
Emma lives in a caring household and loves to interact with other people when the time is right.  Great learning experience and everyone can learn so much from this young child.
Allison Ann Dery  

Name of Observer: Allison Dery

Name of Client: Emma 

Date of Birth: September 2005
                        (day / month / year)

Age on Observation Date: 4 years; 7 months
                                           

Diagnosis and Etiology: Cerebral Palsy caused by lack of oxygen at birth

Date(s) and time(s) of Observation: Wednesday, April 7th, 2010 at 6:30p.m.

1. What important information was learned during the evaluation? 

Emma is a 4 year and 7 month old female who presents with cerebral palsy. Presently, Emma intentionally vocalizes when upset or happy.  Emma has mobility and control of primarily her right hand and arm and thus uses her hand to push large (approx. 5" diameter) buttons to indicate "yes" and "no" when answering questions. However, Emma has been noted to gaze at the intended button prior to pushing a response. This indicates that she has considerable control of her eyes, which could be utilized in further development of augmentative/alternative communication devices. Emma's mother noted that during speech and language evaluations at school, Emma demonstrated a consistently high accuracy of correct responses when asked a question. Currently, attempts have been made to provide Emma with entertainment (through the use of computer games) and to provide Emma with a means to communicate her intentions. It should also be noted that Emma has limited ability to walk but can move around the room using a Pony Gait Trainer. Emma was also noted to enjoy her "Busy Box", swimming, and attending music camp at Michigan State University. Emma also has a G-tube for receiving nutrition due to dysphagia and history of aspiration pneumonia. 


2. What means were used to obtain this information?

The means for obtaining this information were observation and parent response to questions regarding Emma's past and current condition.  

3. What do you anticipate will be the likely outcome of the evaluation? 
The likely outcome of the evaluation will include modifications to the computer game to correct sound production issues. 

The evaluation has also provided the team with information regarding the future goals of Emma's mother. Emma's mother would like to see an eye gaze device implemented with any further augmentative/alternative communication devices. This could possibly be an option for Emma in the future; however, currently, more evaluations will be needed to determine the most appropriate communication device.  

4. What was the purpose of the evaluation?
The primary purpose of the evaluation was to determine whether Emma would respond positively to her new computer game. The results were mixed due to technical difficulties that disrupted the sound production. However, Emma appeared to be showing some interest in the computer game with the assistance from her mother demonstrating how the device worked. 

5. Additional comments: 

Emma's family owns a beagle and her mother indicated that she enjoys rolling a ball to their dog. A large talking button could be programmed to possibly aid in communication with the beagle. Some example phrases are: "Go get the ball" or "Bring the ball to me". 

Mary Margaret Gebbia-Portice  

 

Michigan State University
Department of Communicative Sciences and Disorders
CSD 823X
Artificial Language Laboratory Visit Report Form


Name of Observer:    Mary M. Gebbia-Portice

Name of Client:  Emma F.

Date of Birth:
                        (September 8, 2005)

Age on Observation Date:
                                           4; 7 on April 7, 2010

Diagnosis and Etiology:
Cerebral palsy due to perinatal lack of oxygen (approximately 20 minutes).

Date(s) and time(s) of Observation:            April 7, 2010; 6:30pm-7:15pm

1. What important information was learned during the evaluation?
Emma is dependent upon others for all aspects of her care, including the use of a GI feeding tube. Emma is vocal, but speech is unintelligible. She is alert and aware and responds to questions with eye gaze responses and the use of a “yes/no” board. Emma is able to move her hand enough to choose one of two responses on the yes/no board (approximately 4”x10”).
Emma seems smart and perceptive, and displays other age-appropriate characteristics (emotional development and range of interests). The home environment appears to be well-adapted to accommodate Emma’s needs, including many opportunities for Emma to learn through play, as well as a specially designed walker to allow Emma the ability to exercise her legs and explore her environment. The home is also notably clean and hand sanitizer is available throughout the home in order to minimize the possibility of infection for Emma. The family also uses organic food and makes a specially-formulated liquid diet to use in Emma’s GI feeding tube.

2. What means was used to obtain this information?
Direct observation in addition to parental input (mother) and professional caregiver input.

3. What do you anticipate will be the likely outcome of the evaluation?
Our observation team will become more aware and sensitive to the needs of children with cerebral palsy, in addition to becoming aware of the parents’ needs and involvement in the care of the child. Parents are an extremely critical piece of the treatment and therapy puzzle. It is critical to involve and engage them in every aspect of the child’s care.
Another possible outcome will be the improvement of the new software that was tested during the evaluation. The software did not perform as expected and the sound did not work. We expect that the program will be reworked and/or the client’s computer might be adjusted and/or updated in order to help the program function properly.
A third outcome of the evaluation will hopefully be an increased and improved social and care-giving network for Emma and her mother. Emma’s mother suggested that Dr. Eulenberg share her email address with our team in case we have any questions. One team member already offered assistance to the family through a connection at a local school. These types of contacts and communication can only enhance and increase opportunities for improvements to therapy practices and the strengthening of the support network, as well as providing additional learning opportunities for our observation team members.

4. What was the purpose of the evaluation?
The main purpose of the evaluation was to have our team of observers gain experience in interview and observation techniques. This evaluation was different from previous evaluations due to the age of the client. In other cases, we relied on the client directly but in this case, we had two additional sources of information (the mother and the professional in-home care-giver). It is important to learn how to interview all individuals involved in the client’s care and one should never discount their valuable input.
Another purpose of the visit was to test out a new computer game for Emma to see if this new program and pointing device could enhance her therapy program. Unfortunately, there was a malfunction in the software so we were not able to fully assess the potential of this new game.
A third purpose of the visit was to put the client and her family and caregivers in touch with our observation team. By expanding the social and therapeutic network for each client, there is a greater possibility of improvement of therapy techniques for the individual as well as a decreased possibility of isolation and stagnation of progress for the client and family.

5. Additional comments:
The visit to Emma’s house was very enlightening, especially coming from my parental perspective. I was impressed with the dedication of Emma’s mother to her well-being and the lengths she seemed to go to in order to protect Emma from illness and other harm. I did notice, however, that because of Emma’s dependence upon others for all of her care, it seemed easy for her mother to interact with her on what might have been a lower level than Emma might have been capable. One example was what appeared to be a certain level of “baby talk” use to communicate with Emma. Because she is so dependent, Emma might be perceived as younger than the 4 ½ years that she is. It will be important to make sure that this is not what is happening and that the temptation to interact at a lower level does not continue.

Leathia Hodge
 

Name of Observer:

Name of Client:  Emma F.

Date of Birth:
                        (September 8, 2005)

Age on Observation Date:
                                           4;7 on April 7, 2010

Diagnosis and Etiology: Cerebral Palsy caused by Anoxia at Birth

Date(s) and time(s) of Observation: April 7, 2010

1.      Describe Emma's abilities and challenges.

Emma’s abilities include eye gaze, hand movements and she is able to operate her walker.  Some of her challenges include an inability to produce intelligible speech, dysphagia, which results in Emma being susceptible to pneumonia, and severely decreased muscle control.

2.What technology does Emma use?
           

            On the visit, Dr. Eulenberg attempted to fit Emma with a switch that would be attaches to her wrist/hand, but the device was malfunctioning.  Emma uses a yes/no board as well for communication.  For mobility, Emma uses a walker, and for nutrition she uses a feeding tube and pump.


3. Additional comments:

 

Emma and her mother appear to have a very close bond, and the mother is very much in tune with her needs.  The home environment appears to be structured in a manner that provides Emma the maximum opportunity to thrive. Emma also has a nurse that seems to be equally bonded and knowledgeable in regards to Emma’s challenges.  Emma was tired, and therefore a little bit cranky throughout our visit which made more careful observations difficult.

Jessica Marie Kaman  

Michigan State University
Department of Communicative Sciences and Disorders
CSD 823X
Artificial Language Laboratory Observation Form

Name of Observer: Jessica Kaman 

Name of Client: Emma Feig

Date of Birth: 2005
(day / month / year)

Age on Observation Date: four years
years ; months

Diagnosis and Etiology: Cerebral Palsy

Date(s) and time(s) of Observation: 4/7/2010 @ 6:30 pm

1. What important information was learned during the evaluation? 

When we traveled to the Feig house, I learned more about Emma?s cerebral palsy and every day life. She was without oxygen when she was born, which caused the condition she has. This brave four year old has an excellent support system. Her mom makes a nutrient enriched formula for Emma. I think her skin and overall health is at the maximum that it could be due to this healthy diet. Also, there are many accommodations in Emma?s house to help her. She has a walker that helps her to exercise her muscles. It takes about a half hour for her to get from one side of the house to the other, but it is well worth it. Also, there is a really awesome playset made by Emma?s Speech Therapist. She can lie on her back in this ?box? that has about twenty toys dangling down and choose what she wants to play with. This is one of the few activities that she can do without any assistance from others. Another aid for Emma is her dog. I feel like the connection Emma has with her dog is very beneficial.  It helps with therapy and for her to connect with a living being. One other aspect I learned about was her augmentative alternative communication that she used. Emma used aac which allowed her to say ?yes? or ?no.? Also, Dr. Eulengberg was trying out a game that used aac, but the sound wasn?t working well and Emma it was not a good time of day for Emma. If these two factors were changed, then I think it would be a very good activity for her.

2. What means was used to obtain this information?

Most of this information was given by Emma?s mother and her nurse. Also, some of the information I was able to obtain by observing her house.

 

3. What do you anticipate will be the likely outcome of the evaluation?


I think it will be a very positive experience. The home is very welcoming. It was so generous for her mom to give us delicious food. Also, Emma is a very beautiful little girl, and she is so lucky to have a great family support system.

4. What was the purpose of the evaluation?

The purpose of the evaluation is to observe Emma in her house, learn more about cerebral palsy, and to see the augmentative alternative communication she uses.

5. Additional comments:

I had a great experience going to visit Emma. I know it was not a very good time of the day for her. Her mom referred to it as her power hour of crying. However, I learned a lot and still got to see her wonderful personality.


Andrea Marie Kujawa  

Michigan State University
Department of Communicative Sciences and Disorders
CSD 823X
Artificial Language Laboratory Visit Report Form


Name of Observer: Andrea Kujawa

Name of Client:  Emma F.

Date of Birth:
                        (September 8, 2005)

Age on Observation Date:
                                           4;7 on April 7, 2010

Diagnosis and Etiology: Cerebral Palsy due to birth complications

Date(s) and time(s) of Observation: 4/15/2010

1. Describe Emma's abilities and challenges.
Emma is able to communicate through cries, laughs, other sounds and some movements.  It seems that eye gaze is one of her largest strengths.  When we visited Emma, it was during a time of the day when she is generally tired.  She also seemed somewhat overwhelmed by the number of people visiting her. 

2.What technology does Emma use?
Emma's mother is the most in tune with Emma's ability to communicate, mostly through eye gaze.  Her mother seems to be very insightful and aware as to what her daughter's needs are from moment to moment.  We brought a device that Emma could use when attached to her arm.  She could use the device (computer chip controlled) to move the dot on the computer screen in order to hit the target and make a noise.  Unfortunately for this meeting, the sound system was not working properly.  In addition Emma appeared somewhat overwhelmed and tired, so it was difficult to observe her full ability to communicate.  In the play area, her mother created a wonderful set up with a variety of toys hanging above Emma.  Perhaps at another time of the day we would have seen a different side of Emma and how she communicates.

3. Additional comments:

I was moved by the love that Emma's mother had for her.  One of the most interesting things was the whole foods that she blended for Emma every day, rather than processed liquid nutrients.  It was very kind of her to allow us into her home to ask questions and to provide dinner for us as well. 
 

Chelsea Rebecca Adler Marks  

Michigan State University


Department of Communicative Sciences and Disorders


CSD 823X


Artificial Language Laboratory Visit Report Form

 

Name of Observer: Chelsea Marks

Name of Client: Emma Feig

Date of Birth: September 8 2005

Age on Observation Date: 4 years 7 months

Diagnosis and Etiology: Cerebral Palsy caused by lack of oxygen at birth

(approx. 20min)

 

1.     What important information was learned during the evaluation?

a.     Visiting Emma’s house was a great learning experience. From the visit I was able to observe the lifestyle of a young girl with cerebral palsy and the types of complications there can be with the lack of communication. It was nice to see that her mother was still able to indicate her different emotions but it was obvious that the family still finds it difficult that she is unable to verbally express herself. I found that she is very lucky to have such great support in her life. Her mother clearly loves her and cares a lot about Emma’s support system. Emma’s diet is clearly effective to her well being, although it doesn’t look the most appetizing it has all the proper nutrients she needs in order to stay strong and lively.

2.     What means were used to obtain this information?

a.     Direct observation

b.     Parental input

c.      Professional caregiver input

3.     What do you anticipate will be the likely outcome of the evaluation?

a.     Finding key aspects about Emma’s life that will help towards shaping an AAC device that will be most effective for her to communicate. The information gathered from her mother and caregiver will indicate what devices they think might best fit Emma and her needs as a communicator.

4.     What was the purpose of the evaluation?

a.     The purpose of the evaluation was to observe Emma’s and her behaviors within her home setting.  During this visit it was also important for us to observe how a child with cerebral palsy is supposed to use an AAC device.

5.     Additional comments:

a.     It was nice to finally meet Emma I heard so much about her and it was nice to get to see a little about how she lives and some of the things she likes. Her mother stated that she really enjoys having their dog Toby around and I feel that her preference for her dog could be used in a therapeutic exercise as a motivator.

Amanda Marie Vanhuysse  

Name of Observer: Amanda VanHuysse

Name of Client: Emma F.

Date of Birth: September 2005
(day / month / year)

Age on Observation Date: 4 years; 7 months
             

Diagnosis and Etiology: Cerebral Palsy caused by lack of oxygen at birth

Date(s) and time(s) of Observation: Wednesday, April 7th, 2010 at 6:30p.m.

1.     What important information was learned during the evaluation? 

Emma is a young girl who is able to let caregivers know her feelings through her vocalizations and facial expressions. She has a device with two large buttons for her to answer yes/no questions regarding choices. Her home is a very stimulating environment including a "busy box" with lots of toys to play with. She lives with her mom and dad and has a caregiver. Emma receives her nutrition through a feeding tube in her stomach. She attends Heartwood school and receives Speech, PT and OT there.

2.     What means were used to obtain this information

Interview with Emma's mother

3.     What do you anticipate will be the likely outcome of the evaluation? 

Dr. Eulenberg is currently looking for a better way for Emma to communicate



4.     What was the purpose of the evaluation?

To inform the class on Emma's condition and modes of communication, and ideas on how to improve her communication We were also looking at whether Emma would respond positively to her new computer game. There were some difficulties with the technology, but she seemed to be interested in it.

5.     Additional comments: 

I think Emma has a lot of potential to be a good communicator. Her parents seem to care about her progression very much and they are a big part of Emma's support and growth. I believe with the right tool, Emma can participate more in school and social settings