Case Study of Carlos: First, read/review the case study of Carlos (see below), textbook -Chapter 17, the pdf chapter by Campbell et al. on Down Syndrome, and the monograph on lower-leg orthoses (Uploaded on attached file). View one of the video clips for a child with hypotonia on the Cascade-DAFO website (link is provided below). Points of your Discussion Posting

Questions for the Case Study of Carlos: First, read/review the case study of Carlos (see below), textbook -Chapter 17, the pdf chapter by Campbell et al. on Down Syndrome, and the monograph on lower-leg orthoses (Uploaded on attached file). View one of the video clips for a child with hypotonia on the Cascade-DAFO website (link is provided below). Points of your Discussion Posting: 1. Identify and discuss the factors you would want to examine/evaluate to determine if an orthoses is needed for Carlos. 2. Based on the information in the orthoses monograph, discuss at least two different types of orthoses that you would consider for Carlos. 3. With consideration of Carlos’ current physical status and his developmental level, identify and describe two therapeutic activities you would include in therapy sessions to help Carlos improve his functional and play skills. During these therapeutic activities, identify any special considerations for Carlos’ cognitive level and his abilities to initially learn and retain what he has learned for the performance of new functional and play skills. Case Study-Carlos: Carlos is a 30-month-old boy with a diagnosis of Down syndrome. His family’s primary language is Spanish. Carlos lives with his mother, father, and two older sisters, Anna (age 6 yrs.) and Cristina (age 4 yrs.). Carlos was born full term via vaginal delivery with no complications. Carlos had surgery at 5 months of age to correct a ventriculoseptal defect. His mother reports that although Carlos has not had any severe cardiac complications since his surgery, he does tend to fatigue after 30 minutes of play. Carlos continues to require two naps each day (a one-hour morning nap and a two-hour afternoon nap). Carlos has frequent ear infections (otitis media) and is scheduled to have tubes inserted in his ears next month. Carlos’ overall development has been delayed. His mother reports that he first rolled at 9 months, sat independently at 14 months and crawled at 22 months. Carlos is able to feed himself with his fingers and is working on feeding with a spoon. His mother reports that he usually wakes up 2-3 times each night but is able to fall back asleep on his own. In addition to weekly physical therapy, Carlos receives one hour of occupational therapy a week and attends a toddler program through the local social services agency one time per week. His parents’ goals are for Carlos to walk and run with his peers. Carlos is currently able to roll, sit, and crawl independently. He typically pushes up to sitting from prone by widely abducting his legs and pushing straight back into sitting. In sitting, Carlos usually assumes a wide-based position with his hips abducted and knees extended. He demonstrates very little trunk rotation in this position. Carlos transitions to quadruped from sitting by coming straight forward and then bringing his legs together behind him. He is able to crawl reciprocally without difficulty. Carlos pulls to stand on furniture, but does so using primarily his upper extremities while his hips are widely abducted. In standing, Carlos bears weight on the medial border of his feet and significant midfoot pronation is noted. Additionally, he has a 30o angle of toe-out of his right foot (left foot alignment/ toe out appears to be within normal limits). Carlos is able to cruise along furniture for short periods of time, however, he does not demonstrate adequate weight shifting during this task and weight is never shifted onto the lateral border of his feet. He is not yet able to stand without support. Carlos tolerates 10 to 15 minute periods of standing and cruising. Carlos is generally a very happy toddler. Unfortunately, he has periods of irritability during times when he has ear infections. Although Carlos enjoys playing with toys, his form of playing is usually banging the toys on the floor or throwing the toys. Carlos’ parents and therapists work on showing Carlos more functional activities with some of his toys such as placing wooden shapes (cubes, spheres, cylinders) into a container rather than just throwing or banging the wooden shapes. Assignment Resources Link: •  Patient Case Study From the Cascade DAFO website homepage, then from left menu select “Practitioner”, then under the heading, “Education”, select “Watch Videos”. •  Recommended Cascade DAFO Video Clips to view: 1) Scroll down the list of patient video clips to the video clip for “Ellen: Low Tone Pronation”. Ellen is a 2.5 year old female diagnosed with Down Syndrome. (This is video clip #36 on the list.) Video link- http://cascadedafo.com/library/videos/case-study-3-yr.-old-girl-excess-dorsiflexion-crouching-dafo-turbo-softy Text Book- Campbell, S. K., Palisano, R. J., & Orlin, M. N. (Eds.). (2012). Physical therapy for children (4th ed.). st Louis, MO. Elsevier/ Saunders. (Chapter 17