Here is the latest draft, including what Lougle was so kind to write, and keeping in some parts I had re-written myself. Again, please do comment and criticise as appropriate! I couldn't have done it without the help of you all!
Report Detailing Kerem's Difficulties
Summary:
Medical Needs: Kerem was premature, born at 29+5 weeks. Neonatal haemorrhage leading to diagnosis of Mild-Moderate Cerebral Palsy, with left-sided hemiplegia. Weight below average for age due to feeding difficulties.
Gross Motor Needs: Equinus posturing of left ankle with tight heel cord. AFO splints and heel support provided for both legs. Unstable walker with hobbling gait.
Fine Motor Needs: Left hemiplegia with fisting of left hand. Tendency to rely on right side for fine motor tasks.
Speech and Language: Very unclear speech which is hard to understand even by close family. Expressive speech and Receptive language delay. Uses Makaton.
Personal Care: Difficulties with toileting due to physical impairment. Assistance needed. Full assistance needed with dressing and undressing.
Emotional and Behavioural Needs: Easily frustrated and displays anger when frustrated. Sensitive to emotional upsets of others.
Other Considerations: Currently in receipt of DLA at Middle Rate for care, and High Rate for mobility. Blue Badge Holder.
? Kerem was born at 29+5 gestation by emergency caesarean at xx Hospital, xx, weighing 1.49kgs. He was initially ventilated for just less than 24 hours, followed by CPAP for a further 5 days. He spent a total of 6 weeks in Special Care. He was initially nasogastric tube fed, before moving onto oral feeding. Kerem had an ultrasound scan when he was four days old, showing a small right germinal matrix haemorrhage. A repeat scan a week later showed echogenic flares within the right parenchymal region and sequential scans showed a cystic change in the same region.
? Kerem had a MRI scan of the brain in October 2009 which did not show any overt focal abnormality. He had a diagnosis in July 2009 of mild-moderate cerebral palsy, and displays physical difficulties that are consistent with left-sided hemiplegia. Kerem receives middle-rate care and high rate mobility Disability Living Allowance. He is also part of the Blue Badge Scheme.
? Initial concerns arose when at around 8 months, Kerem was not able to sit unaided, and he had fisting of his left hand. Soon afterwards, it was noted that he developed equinus posturing of his left ankle with a tight heel cord. Throughout the course of the year, Kerem continued to adopt this posture, and it became more prominent especially when he was weight bearing. Physiotherapy and Orthotic Services were involved. He was supplied with AFO splints for both legs. Botulinum Toxin has been discussed more recently and it was felt that he should be given time to adapt to the latest AFO splint and heel support he has been given, with a view of Kerem being referred to the Botox Clinic at his review appointment on 11 November. Kerem learned to sit at 10 months, but did not crawl until he was 15 months old and finally learnt to walk at 2 years and 4 months.
? Kerem tires more easily than other children his age, and despite sleeping soundly at night, he requires a nap of 1-2 hours in the afternoon. Kerem is a faddy eater, and is very reluctant to try foods that he does not recognise. It has been suggested that the occupational therapist introduces messy play with Kerem, to introduce him to various feelings as it is thought he has sensitivity to certain textures. As a consequence, Kerem needs supervision at meal times to ensure he is eating, and that his weight, which is below average, does not fall.
? Kerem is able to walk without the need of physical support. He wears an AFO splint on his left foot, and uses a heel support inside his right shoe. Despite the splint, Kerem still attempts to walk on his tip-toes, causing him to 'hobble' and have difficulties with his balance. Due to the time spent on his feet in nursery, he quite often displays discomfort at the end of the session. Kerem has monthly physiotherapy sessions at home, lasting around 90 minutes each time. This is also parterned with the orthotics clinic who provided him with his heel support, AFO splint, and also a splint that he must wear throughout the night. He is reviewed on a three monthly basis.
? He is unable to run or jump. The nursery which Kerem attends is a busy setting, with children constantly moving around. Kerem will shy away from being mobile as he has awareness that he may be knocked over by another child. He is hindered when trying to navigate his way around as his muscle tone increases when he is active. He cannot participate in games with his peers as he cannot run, cannot climb, or cannot use large apparatus without support. He falls regularly both inside the nursery and outside and as a result has suffered terrible bruising to both legs. He more recently suffered a blow to the head as he used a large abacus to pull himself up from sitting, and this subsequently fell on him, knocking him back onto the floor and banging his head.
? Increased muscle tone has also been noted in his left arm when he is active or excited. He shows difficulty in playing with basic equipment such as using a rolling pin to play with play-doh. Although he can achieve simple tasks like throwing, pointing and holding a pen, the effort required is much more than that of other children his age
? Kerem lacks the ability to complete many basic personal tasks that should be expected of him at this age. Due to the stiffness in his left arm and hand, he cannot put on his own shoes, fasten his own coat, or get dressed without support. Kerem is not potty trained as he is unable to pull down his trousers in time in order to prevent an accident.
? Kerem's speech and language skills are significantly delayed in comparison to other children of his age. SALT have been involved since Kerem was around 15 months old. He uses both Makaton and words in order to communicate, but his speech is very unclear and often cannot be understood by people who do not know him well. He only uses around 15-20 words and cannot initiate conversation. He also cannot structure questions. Close family members have difficulty understanding what Kerem is saying, and so it is a big concern that in a setting where Kerem is still new, he is not able to express his needs. He only understands key words in a question or instruction and therefore has to guess what is expected of him. Kerem often relies on gestures to aid his understanding, which means that he require direct visual contact with the person giving instructions.
? Kerem has delayed development of social skills. He shies away from adults that he does not know, often showing embarrassment when they try to communicate with him. He knows a few children out of nursery of a similar age, and can find it difficult to engage in play as he cannot communicate well enough to initiate a game or role play situation. He will play alongside other children, but does not tend to play with other children.
? This is emotionally challenging for Kerem and upsetting when he is unable to be understood by others. Most importantly, he is unable to form friendships. He does not have one-to-one help in which someone can get to know Kerem well enough to ensure that his needs are met. He has monthly speech and language appointments, lasting 90 minutes each time.
? He is a sensitive child, and becomes emotional if he takes a fall or sees somebody else upset. He requires reassurance and assistance to understand that everything is OK, so that he can resume activities. He becomes frustrated when he can?t make his feelings understood through speech, and can display this through anger. He is also very anxious when in new surroundings or situations. Although he hasn?t had any 1:1 assistance at nursery, he has been starting the session later than the other children so that the atmosphere would be calm and settled when he arrived and the staff could focus on him whilst the other children started activities.
? Kerem?s cerebral palsy will need careful management to ensure that he is given opportunities to catch up developmentally to the abilities of children his age.Help is currently available through the health professionals involved with Kerem, but the support needs to be present at nursery, and subsequently school, once he starts in September 2011.
? Kerem is at a significant disadvantage to the other children in the nursery setting. I have been called in twice to change Kerem?s nappy when he has soiled himself as the nursery does not have the provision of staff to change him themselves. It is distressing for him to be left in a soiled nappy for any amount of time until I am able to reach the nursery, and this shouldn?t been expected of him. He requires a high level of support to prevent accidents and to help him with his confidence in this area, as well as his dignity.
? He is unable to interact with his peers as he cannot initiate conversation and cannot make himself clear to others. This means he is singled out as an individual as there is nobody present who can spend time with Kerem to improve his communication skills on a 1:1 basis. He is therefore unable to develop his social skills- something that is paramount in an education setting.
? Kerem?s physical difficulties present a health and safety concern as he is at risk from daily falls, trips and stumbles. As other children grow and develop, they get faster and more agile, and will expect Kerem to be able to avoid them. He is unable to move faster, and will therefore simply become an obstacle. He is at significant risk of injury in a playground without additional supervision, because he is not able to react fast enough to approaching children. He has already injured himself by using furniture to pull himself up from a sitting position and an accident report has been completed regarding a fall he suffered in the playground, from falling over whilst simply pushing along a pram. This could have been avoided, had the right supervision been in place.
? I believe that Kerem needs the help of a classroom assistant who would work with him on a daily basis. This person would be able to learn the way that Kerem communicates and understand his needs and emotions. Kerem needs support with the most basic of tasks such as dressing and help when using the toilet. He would most certainly struggle when in primary school without this help. He would be unable to dress and undress himself for P.E. and be unable to participate due to his physical disabilities. As Kerem uses both Makaton and speech, he needs 1:1 interaction with somebody who can learn what he is trying to contribute to the class.
? Without additional support from an early age, Kerem will simply fall further and further behind. If he is to have any hope of a future without extensive additional support, he needs the benefit of dedicated, targeted input now. His physical difficulties are wide-ranging and affect all activities of daily functioning within a classroom environment.
? On a whole-class level, I am confident that without the support of the Local Authority, other children will suffer the detrimental impact of Kerem?s needs as the whole-class support of the Teaching Assistant is diverted to meet his needs. He simply cannot function without additional support. A Statement of Educational Needs for Kerem would not only provide him with the provision he requires to be successful at school, but also reduce the impact of his disability on the rest of his class.