Case Study Evaluation

Intellectual Disabilities 4300

Prepared for Dr. Steven Bell

David Leon

December 3, 2020
Introduction

The development disability that I have been working on is Angelman’s Syndrome. Which

is a genetic disorder that causes problems with speech, balance intellectual disability and

sometimes seizures. Angelman’s syndrome symptom often causes the individual smile and laugh

frequently and have happy and excitable personalities. The individual with this disability was a

7th-grade kid named Suzanne she attended school at Hartvigsen, she also has an unspecified

developmental disability. In this study you should expect to learn more about Suzanne and the

goals and plans we developed for her to improve on her balance and social skills. The purpose of

this study was also to assess Suzanne and help her achieve her goals through a purposeful

intervention and the APIE process providing her therapeutic Recreation.

Client Interview and Assessment

For this Interview assessment, we interviewed Suzanne using pictures since she is non-

verbal. However, we received most of the information from her mom as they interact with her

daily and could express her needs more than Suzanne could. We used pictures to try and

communicate with Suzanne. The answers given by Suzanne are in pink and the ones given by her

mom are in the blue color.

Personal:

What is your name? Suzanne

What is your date of birth/age? 13

What gender do you identify as and what are your preferred pronouns? She/her

What is your race and ethnicity? Caucasian

Do you have a religious affiliation or spiritual beliefs/practice? No

Is there anything else you would like me to know? The daughter loves water. No more personal

Information

Home living:

Who did you grow up with? Mom and Dad

Do you have any cultural traditions you enjoy? no

Do you live with anyone now? If yes, what is their relation to you? Mom and Dad

Are there any barriers to independence at home? Communication, getting around, needs

assistance because of balance difficulties, aggression deters social independence

Is your living situation stable? stable

Do you feel safe at home? yes

Is there anything else you would like me to know? Aggressive with parents, also at school

Life-long learning:

What is your education level? In 7th grade

Did you or do you have an IEP? Yes, with public school she attends

Do you feel you have the support in your learning environment needed to succeed? Does have

support at school but feel like it could improve at home

Are there any areas you would like to develop in? Skills, topics, functions, recreation?

Recreation in water, decrease aggression.

How do you best handle the challenges you face in daily life? Well, but from time to time it is

aggressive

Do you feel you have the resources to achieve your goals? Needs more resources to accomplish

goals

Is there anything else you would like me to know? Enjoys school

Health/Safety:

Do you have any allergies? no

Do you have any dietary restrictions? No, but needs help eating

Do you take any medications? depacon

Do you have any sensitivities? Other people, aggressive responses to others

Do you have any vision or hearing impairments? no

Do you require any support to move around? Yes, walker

Is there anything else you would like me to know? no

Employment:

Are you Retired? No

Are you employed? Parents are employed

Social activities:

What would you say your activity level is low, moderate, high? The activity level is moderate.

Enjoys going on swims.

Developmental and Cognitive Abilities:

How do you like to communicate? Suzanne communicates by pointing or pinching people to get

their attention.

What are your strengths and weaknesses in walking and mobility? She is very determined but

struggles with posture and balance

Do you have sleep difficulties? Yes, struggles with falling and staying asleep.

Are you using any medication or participating in therapy for sleeping disorders? NO

Medical:

Do you have seizures? Yes, not frequent, just from time to time

Are you taking any medications for seizures? depacon

Do you have scoliosis? Does it affect your activities of daily living or physical capabilities? Yes,

mild. Affects posture and physical capabilities. Adds to balance struggles.

Do you have any other medical concerns? Possible other developmental disorder

Goals:

What are your goals? Leisure, improve communication, reduce aggression.

What are your goals for home-life? Less aggressive toward parents

What are your goals socially? Less aggressiveness and improve communication with others

What are your recreation goals? Improve swimming capabilities.

Diagnostic Protocol

My diagnostic protocol differs from the developmental disorder Angelman’s syndrome

since it was switched up in class due to a problem in zoom and we weren’t able to go to the

correct breakout rooms. This Diagnostic protocol is reflective of someone with the

developmental disability ASD more commonly known as Autism Spectrum Disorder.

Diagnostic Grouping

Autism Spectrum Disorder is a developmental disability that affects communication and

behavior and is normally diagnosed at an early age. It impacts day to day functions and last

throughout a person’s lifetime

Specific Diagnosis

Autism Spectrum Disorder is a neurological and developmental disability that can severely affect

how you interact with others and behavior. It typically begins in early childhood and can last

through a person's life. Some of the signs and symptoms are, but not limited to:

● Little to no eye contact

● Difficulty with conversation

● Echolalia (word repetition)

● Upset over minor changes

● Obsessive interests

● Unresponsive to their name by 12 months of age

● Avoid and resist physical contact

Etiology

The exact cause of Autism Spectrum Disorder is unknown but there is evidence that genes mixed

with the home environment can have an effect. Some of the risk factors are:

● Having older parents

● Being born with a very low birth weight

● Having siblings with Autism Disorder Syndrome

Comorbidity

Other diagnoses possibly linked to Autism Spectrum Disorder:

● Fragile X- syndrome

● Rett Syndrome

● Down syndrome

● Tuberous Sclerosis

● Tourette syndrome

● Epilepsy

Progression of disorder

1. The most common initial symptom recognized by parents is delayed speech development,

with lesser recognized symptoms being social and nonverbal communicative delays.

These differences are more reliably present and consistently found in the second year of

life, known as an early onset pattern.

2. With the second pattern of onset, known as regressive autism onset pattern, children

appear to be developing typically for the first year or two but in the second year, they lose

skills they had previously acquired with an onset of autistic symptoms.

 3. There are three levels of support for the progression of autism the fist one being some

support, the second substantial support and the third being very substantial support.

Related Factors

Characteristics or symptoms of Autism Spectrum Disorder may be:

● Underreact to pain

● Overreact to sounds

● Normal development of gross motor skills but weak fine motor skills

● Flap their hands, rock their body, or spin in circles

● Get upset by minor changes

● Delayed speech/language skills

● Repetition of words or phrases

● Prefers to play alone

● Problems with sleep

Identify Problems

In the treatment of individuals with Autism Spectrum Disorder, Recreational Therapists must

assess:

● Obsessive behavior

● Conversation skills

● Interaction with others

● Aggression

● Temper tantrums

● Attention span
 ● Social skills

Signature and Date

D.Leon Student 12/012020

(B.Ramirez Student 9/29/20,L.Spackman Student 9/30/20 they helped with the diagnostic

protocol)

Plan

Our client is Suzanne, she is 13 years old and goes by the pronouns she/her/hers. She is

Caucasian and does not practice any spiritual beliefs. She lives at home with her mom and dad

and her living conditions are stable. Suzanne has Angelman’s Syndrome and an undiagnosed

development condition; she attends school at Hartvigsen and is in the seventh grade. Due to

Suzanne having Angelman’s Syndrome her communication skills and balance are not as up to

par as she’d like. Suzanne would like to better her balance skills and try to be less aggressive

toward others. Our goal with Suzanne is that after 60 sessions of aquatic recreation sessions she

will be able to perform 1 full lap of pool walking showing that her balanced skills have improved

by doing it by herself. This is to be performed by the end of this year.

For Suzanne’s intervention, we will do pool walking. We will assist her in wading around

a shallow pool. This will cater to her personal interests in swimming. Walking in water will be a

slightly easier environment to practice her walking skills and improve her balance. We will

gradually have her participate in more and more social interaction with other people in the pool

and reinforce positive social skills. We will pause and correct any aggressive behaviors. This will

help teach her not to be aggressive, and it will motivate her to practice good social behaviors.

Necessary equipment will include her walker for the first few sessions until her balance
improves. We will also use the shallow pool at our facility. Suzanne would need a swimming

suit, nose plug and maybe a paddle board. We will also need the pictures that we will be using to

communicate with her. The specific actions of this activity will include many types of walking

and movement. We will start off by walking her around the pool in her walker. We will practice

walking forwards, backwards, sideways, and turning. We will then work towards doing all those

motions without the walker but with the assistance of the therapist. Finally, we will work

towards doing all of those motions on her own.

We will make several adaptations for Suzanne during this activity. She will need her

walker for the beginning sessions. We will clean the bottom of the pool thoroughly beforehand

so that her walker doesn’t slip. Because of Suzanne’s communication disability, we will use

pictures to help communicate to her what we will be doing in each session. There are no specific

rules for the walking part of the activity, so the rules will pertain mainly to social behaviors. Any

time she demonstrates aggressive behaviors, we will immediately pause and explain to her that

that is not acceptable. We will take a brief time out to help her cool down from the excitement or

frustration that caused the behavior. Every time she has a social interaction with no aggression,

we will enthusiastically celebrate and encourage those behaviors to strongly reinforce them.

We hope that with this activity being performed 3 times a week for the following 2

months Suzanne will be able to improve her balance and have less aggressive social interactions.

We hope that Suzanne is able to make her hour-long sessions for 3 times a week. In practicing

water walking, her leg musculature will increase causing a better balance which later on transfers

to outside the water. We hope to later work with her in being able to walk without a walker

outside of water. By increasing the social interactions that Suzanne gets with peers and

reinforcing good behavior, her aggressive tendencies will be reduced. We want these learned
behaviors to carry on to her household and improve her interpersonal skills. Overall, this will

increase her mobility, independence, and relationship with her parents and others around her.

Critical Reading Form

How would you use aquatic therapy to provide an intervention for Suzanne?

Suzanne is a 13-year-old girl who has Angelman’s syndrome and an undiagnosed

developmental disability. She struggles with balance and interpersonal skills. We know she

enjoys swimming so we chose an aquatic intervention to best help with her balance and

interpersonal skills. We found a research article called “Aquatic Interventions and Disability:

A Recreational Therapy Perspective” which aligned with the intervention that we wanted to

provide for Suzanne. Some of the key terms in the article were recreational therapy, aquatic

intervention, physical activity, and swimming. These key terms were important to us as we

want to provide a purposeful intervention through recreational therapy to help with

Suzanne’s intellectual disability. We decided to do so by doing an aquatic intervention that is

a physical activity such as swimming, and we want to get a positive outcome that will help

her balance and social skills.

What is the purpose of this study?

The purpose of this research study is well stated at the beginning of this article, and it is

that they want to show the positive benefits of therapeutic recreation that occur through the

use of aquatic therapy. It mentions that recreational therapy through aquatic therapy provides

a wide array of health benefits such as increasing the overall health of individuals and

increasing the quality of life of these individuals by improving motor skills, social skills,
 increasing strength, decreased pain, bone loss prevention, improved pulmonary function and

decreased anxiety. The article did a good job of mentioning that before anything we have to

make sure our client is safe and to make sure we are aware of the potential risks that our

client might experience with the conditions that they have. We did this for Suzanne by first

interviewing her and her mom to find out more about her condition and any possible

knowledge that we could get by doing a clinical rotation, client interview, and assessment.

We then planned out our intervention and all the needed materials that Suzanne would need

due to her capabilities and strengths to make sure she is safe during the sessions.

How can aquatic therapy create a therapeutic environment?

This article described many of the benefits of a water environment, especially a warm

water environment. Walking in a pool versus on land is beneficial because it puts a lot less

pressure and impact on your joints and muscles. This will decrease any pain or difficulty

normally experienced while walking on land. Suzanne is non-verbal, so communication

challenges could be a source of stress for her. The authors point out that one-on-one aquatic

activities generally require less verbal communication skills. This often removes a layer of stress

for clients with communication disabilities, increasing enjoyment and motivation. This may be

why Suzanne enjoyed swimming so much in the first place.  We can start off very easy with little

verbal interaction with others and work our way into communication slowly to avoid distress for

Suzanne.  

How can aquatic therapy improve balance and physical skills?

This article cited many different studies showing aquatic therapy to increase motor skills,

strength, endurance, fitness, and range of motion. All of these skills can help directly with

Suzanne’s goal of improving her balance. They will also help her develop many skills to increase
her independence at home. As mentioned before, the low impact and weightless qualities of a

water environment have many physical benefits. Walking on land is a challenge for Suzanne, and

it may be difficult and frustrating for her to continue developing those muscles and motions in

such a challenging situation. The water will decrease the challenge so that she is more likely to

achieve a state of flow and see real improvement. The article discusses the evidence that aquatic

therapy has increased the range of motion for people with cerebral palsy. It has increased energy

and movement among those with multiple sclerosis. It has increased strength and balance in

patients with osteoarthritis. 

How can aquatic therapy improve social skills and decrease negative social behaviors?

Another intriguing benefit of aquatic therapy has been demonstrated most clearly among

people with autism spectrum disorder. Studies have shown that aquatic therapy helps people with

autism improve many social skills such as their ability to respect the boundaries of others’, eye

contact, interpretation, and impulsivity. The aquatic activities decrease social demands, so people

can start with low social interaction and work into it slowly in a happy and lower stress

environment. These benefits can help Suzanne work toward her social goals. She wants to

decrease her pinching behavior, and these studies show that aquatic therapy has a good chance of

helping her with that. 

Key Quote

“RTs have been providing aquatic interventions for a number of years and findings have

indicated the therapeutic benefits of warm water interventions, aquatic therapy interventions and

aquatic exercise individuals with disabilities.”(Scott, J, 2020)

Conclusion

Suzanne’s main goals are to improve her balance and improve her social skills by

decreasing pinching behaviors. This article discusses evidence from several studies indicating
that aquatic therapy will help Suzanne achieve these goals in a couple ways. Aquatic therapy has

been shown to improve balance by increasing strength and mobility in people with disabilities. It

has been shown to increase social skills in many areas in people with social challenges, including

maintaining others’ boundaries socially. It also creates a therapeutic environment that will reach

her at her level and help her improve more quickly. Based on the evidence, aquatic therapy

would be a good treatment for Suzanne.

Outcome Evaluation

After 2 months of 3 sessions a week of aquatic pool walking of therapeutic recreation, we

have seen great progress from Suzanne in some of the goals that she wanted. Aquatic pool

walking has definitely benefited her balance with her almost being able to complete her goal of

being able to complete one lap of aquatic pool walking by herself with no help. Her social skills

have not improved as much as we’d like as she does still have aggressive tendencies, but she is

interacting more with other people.

In the future I would like to work more with Suzanne and focus more on her aggressive

tendencies to try and improve her interpersonal skills. I suggest that Suzanne keeps attending her

therapeutic therapy sessions to keep improving her balance and walking abilities. It has shown

positive result with her and I believe she can benefit from it more by strengthening her motors

skills and balance.

I hope to still be able to work with Suzanne and her family in her goals to help Suzanne

improve her balance and social skills. Which will later facilitate her day to day activities to the

point where she no longer needs a therapeutic therapist. From the sessions we have had she has

had great progress and her balance has increased tremendously almost being able to complete a
full lap of pool walking by herself. I believe Suzanne should continue with her therapy and we

will see results that will soon transfer to outside the water pool.

References

Autism Spectrum Disorder. (2020). Retrieved September 27, 2020, from

https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml

Risk Factors for Autism Spectrum Disorders. (2019, August 16). Retrieved September 29, 2020,
from https://www.winchesterhospital.org/health-library/article?id=19127

Signs and Symptoms of Autism Spectrum Disorders. (2019, August 27). Retrieved September
27, 2020, from https://www.cdc.gov/ncbddd/autism/signs.html

The Onset of Autism: Patterns of Symptom Emergence in the First Years of Life. (2008).
Retrieved September 30, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2857525/
Scott, J., Wozencroft, A., Nocera, V., Webb, K., Anderson, J., Blankenburg, A., . . . Lowe, S. (2020). Aquatic
Therapy Interventions and Disability: A Recreational Therapy Perspective. Retrieved November 25, 2020,
from https://scholarworks.bgsu.edu/ijare/vol12/iss3/5/