Evan is a six year old boy who

.

• Evan is a six year old boy who is
suffering from Muscular
Dystrophy which is an inherited
disorder that results in muscle
weakness or loss of muscle tissue.
The worse part is that it gets worse
over time.
Reference: Case studies
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002172/

Needs of Child: Physical

• Child may require physical therapies
• Need for a wheel chair or other support items like splints or braces depending on the severity of the
Evan’s condition
• Usually wheelchairs are needed when they are around 12 years old but every child’s case is different and
if Evan is facing severe symptoms then he may require a wheelchair
• Medication
• Nutritionist to provide counseling
• Language and speech therapist incase tongue muscle is getting weaker.
• Doctor to do physical check ups
• Psychiatrist incase needed to assist with certain types of medications
• Optometrist to check the development of the eye muscles
• Developmentally appropriate environment free of biases
• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002172/

Needs of Child: Social &Emotional
• Need to speak to a psychologist
• Resource teachers to come and
monitor Evan’s development in
Daycare.
• Consultants or counselors at
school to make time to speak to
Evan when needed.
• Psychiatrists incase medication is
needed to control anxiety or
emotional problems.

Needs of Child: Cognitive
• Special needs teacher who
would give him individual
attention and help Evan
learn at his own pace
• Special needs school in
case Evan’s cognitive
development is extremely
delayed and he requires a
lot of assistance.

Needs of Parents:
• The needs of Evan’s parents is to get
support and be exposed to services
that may benefit Evan’s development
in all areas
• It’s a tough situation for the parents
to be in so they need understanding
from the teacher and their
surroundings
• Need to be referred to counseling
groups
• Social workers or psychologists to
help guide them emotionally and
mentally.
• Relief worker

Muscular Dystrophy
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002172/

• Muscular Dystrophy is a Genetic disease
that weakens the muscles and causes loss
of muscle tissue over time, making it hard
to walk, bend or even stand.
• It could occur in adulthood or childhood
and there are various types of Muscular
Dystrophies. The following video
contains a brief introduction about
Muscular Dystrophy and its most
common type in children:

http://www.youtube.com/watch?
v=AZ0jQZ6aBtk

There are various different types of
Muscular Dystrophies:
• Becker muscular dystrophy
• Duchenne muscular dystrophy
• Emery-Dreifuss muscular dystrophy
• Facioscapulohumeral muscular
dystrophy
• Limb-girdle muscular dystrophy
• Myotonia congenita
• Myotonic dystrophy

• Sometimes it could affect one muscle or involve other muscles at the same time.
Some Muscular Dystrophies could be more severe then others based on what type
it is. Meanwhile, currently there are no cures for this disorder and the most the
doctors could do is control the symptoms as much as possible based on the type
of Muscular Dystrophy.

Some symptoms involve:
• Muscles become week and child might have
difficulty walking or moving around
• Muscle weakness that slowly gets worse
• Difficulty using one or more muscle groups
• They might experience pain in their legs
• Their shoulders and arms might become weak
• Due to weakness they might fall more often
• Strength in their muscles becomes less
• Their gross motor development is delayed and
they will face problems walking
• They will not be able to jump
• They would feel weakness even with their
facial muscles

Ways to meet Evan’s needs in our
childcare setting: physical
environment
• Modify physical layout of
the room and provide
adaptive equipment
• Make a traffic flow in the
room smooth to allow easy
movement with the
wheelchair or other
adaptive equipment

Cont’: modification in physical
(from reading package, unit 2)
Room Area Modification
•Coats at child’s eye level
Cubby •Photo of child and labeled with name
•Space for personal belongings
•Smocks on hooks that are easily accessible
Arts and Crafts •Provide variety in materials and a creative display to
grab their attention
•“locate arts and crafts area near water for use and
clean up purposes”(Reading package, Unit 2)
•Keep the area out of traffic flow to minimize mess
and falls of materials on the floor
•“freestanding easels should be set up in pairs to
promote socialization”(Reading package, Unit 2)

Cont’:
Room Area: Modification:
•Have it close to the block and craft centre to
Sand and Water minimize distractions since these areas could be loud
•Keep area out of traffic flow in the room since they
could be wet and slippery and cause falls
•Have smocks close and easily accessible

•“the table toy area should be enclosed on three sides
Table/Floor Toys using an L shaped shelf to create
boundaries”(Reading Package, Unit 2)
•Labels with pictures for bins would be helpful for
children with special needs and other children
•Grouping of toys will make it easier for children to
understand which toys go where.

Cont’:
•Locate it in a corner, use furniture or shelves that
Block Center can be moved to create boundaries
•Blocks should be placed at children’s eye level and
traffic flow should be smooth for children with
adaptive devices or wheelchair

•“provide hooks and mini hat racks for children to
Dramatic Play easily access dress up clothes”(Reading Package,
Unit2)
•Put mirrors on the wall for children to see
themselves

•Put this area close to the quiet area of the room
Book Centre •Have books that have information about different
special needs to make children more aware that its ok
to have a special need condition and that we should
treat everyone the same

Cont’:
•Have large space to accommodate all children incase
Outdoors wheelchairs or other devices need to be used.
•“use chalk, tape or small pylons to define high traffic areas
where children ride bicycles or wagons or their
wheelchairs. Use large traffic signs to indicate the flow and
minimize accidents”(Reading Package, Unit 2)

•“sinks and toilets should be mounted low enough for
Washroom children to use independently..”(Reading package, Unit 2)
•Special aid appliances should be added to meet Evan’s
needs incase he needs to hold on to something
•Use bright lights
•Soap and paper towels should be at eye levels of children
for easy access

•Locate besides book center
Quiet Area •Could use see through curtains to isolate the area and give
children their space while being able to see them
•Use natural lighting

Specialized Equipment needed for Evan: part of
modifications in childcare
• Crutches for Evan to be able to walk in the
class since it was indicated in the case study
that he is showing developmental decrease in
all areas.
• Since Muscular Dystrophy causes muscle
weakness, children aren’t able to stand properly
or walk, other mobility aids would be needed to
help them.
• Use of Rolls and Wedges which would help
Evan “develop control of the head, shoulders,
arms and hands”(Reading package, unit 2) This
would be helpful incase Evan is feeling
weakness with his arms or neck aswell.
• Use of visuals during transitions to nap times
or other activities throughout the day to meet
Evan’s cognitive and language needs
• Use of “adaptive toys to provide opportunities
for children with special needs to participate in
play”(Classnotes, week 5)

Teaching strategies:
• Talk to all children in the classroom about
Muscular Dystrophy to increase understanding
amongst the children
• Have books about special needs children and
read it to children to increase awareness and
acceptance and minimize biases
• Teachers should use the 5 steps of prompting
and fading when teaching Evan or other
children a new skill
• Steps to prompting and fading include:
“defining the skill that you want to teach,
identifying suitable prompts, prompts, reinforce
and fade, monitoring results and returning to
stronger prompts when needed.
• Teachers should use prompts less each time
until child fully learns the skill and is able to
perform it independently.
• Allow each child to learn at their own pace.
• Evan has Muscular Dystrophy which will make
it harder for him to work fast with his muscle
weakness but allowing him to work at his own
pace would be helpful

Teaching Strategies: Cont’
(Classnotes, week 7)
• Be positive and give hope to parents
• Observe child’s verbal and non verbal
cues
• Provide reassurance to the child and be
responsive
• Role model social behavior and other
actions
• Provide choices so children become more
independent
• Provide positive reinforcement to help all
children become more independent and
build their self esteem (Connect ability,
week7)
• Actively listen to child’s needs
• Use visual cues for children in different
situations during the day for example
during transitions, trying to communicate
or when teaching new skills.

Teacher’s role:
• Make changes in routines, allow extra time
during transitions throughout the day
• Encourage Evan to use his muscles as much as
possible during activities
• Plan activities that include all children
regardless of special need condition
• Give extra time during activities and clean up
times
• Use positive labels and “assist with researching
information for families and
professionals”(Using Labels handout)
• “work in collaboration with Resource
consultants, specialists, families and
coworkers”(Classnotes, week 5)
• “connect with local organizations that support
families, advertise your commitment to
inclusion”(Classnotes, connectability)

• Incase of Evan, the parents already knew about the fact that he has Muscular
Dystrophy so the teacher was supposed to make some phone calls and get
information to assess the delayed development that was happening in Evan’s all
developmental areas. (Case Studies) The following table has the list the teacher
could give the parents about the people in the community that need to be involved
in Evan’s case to further help him with his condition:

Resource teacher could provide:
Resource: info How could it help
about Evan:
•could gather information about his
Resource condition

Teacher •Guide the staff and parents about
his strengths and weaknesses and
setting goals for working on his
weaknesses.
• “develop appropriate strategies
and service plans to support
inclusion of the child with special
needs”(Classnotes, week 9)
• “interact with related
professionals in the
community”(Classnotes, week 9)

Cont’

Resource: info How could it
about help Evan:
•Performs the diagnosis of the
Family Doctor condition
•Could refer the parents to
specialists that would further
be able to help in dealing with
Evan’s condition
•Prescribe medication

Cont’
about Evan:

•Addresses physical aspect of child’s
Physiotherapist condition that involves moving around,
muscles strength etc. This is critical in
Evan’s case because his development is
decreasing in all areas and physiotherapy
would certainly help him physically.
•Would work with families to help child
strengthen his physical development

Cont’
Resource: info about How could it help
Evan:
•Would help Evan become more independent
Occupational in his daily life

Therapist •OT would do home visits and work with
families and the child and help the child
become more independent in areas of
dressing, bathing, feeding, play and school
activities.(Classnotes, week 9)
•This is necessary in Evan’s case because due
to muscle weakness he will have a lot of
problems independently doing his regular
routine chores. However, exercising these
skill would still help him to some extent until
his condition becomes extremely severe.

Cont’:
about Evan:
•Would be able to monitor Evan’s
Behavioral behavior and make suggestions about
things parents and teachers could do to
Consultant help him during certain negative
behaviors.

•With Muscular Dystrophy, most of the
Speech and times the muscle of tongue is effected
causing delays in speech or language
Language •Speech and Language Therapist would
Therapist “work with children and their families
to develop the child’s verbal and non-
verbal communication skills, their
understanding of language and their
swallowing and feeding
skills”(Classnotes, Week 9)

Cont’:

Resources: info How could it help
about Evan:
•Would be able to give parents information
Social Worker about the types of services available in the
community which would be able to help them
deal with Evan’s condition more
appropriately.

Cont’:
Resources: info How could it help Evan:
about
•During this time parents and the child require a lot of
Psychologist reassurance and someone to guide them through this emotional
journey and psychologist provide this support.
•“offer diagnosis and can address concerns about a child’s
learning abilities or behavior as well as provide family centered
treatment and support”(Classnotes, week 9)

Cont’:
Resources: How could it help
info about Evan:
•This condition could cause Evan to
Psychiatrist have mood swings or feel emotional or
anxious. Psychiatrist could provide
medication
•Therefore, for certain cases a
psychiatrist is needed to provide proper
medication to control the emotions,
anxiety and stress and this medication
can’t always be prescribed by a regular
doctor.

Cont’:

Resources: info about How could it help Evan:
•Eye muscles could also be affected at times with
Optometrist Muscular Dystrophy cases
•So in Evan’s condition it would help him get a
diagnosis about his eyes through the eye examination
and precautions or steps could be taken based on the
diagnosis of the Optometrist that would be useful for
parent’s awareness and Evan’s condition.

Cont’:

Resources: info about How could it help Evan:
•Muscular Dystrophy cases also involve the special
Dentists needs child having certain dental problems with
proper tooth structure formation, decreasing muscle
function, production of too much plaque and more
tarter which needs to be kept in control with regular
dental visits.
•Although there isn’t specific mention of this in the
case study, having problems with teeth and bones
inside the mouth are common in muscular Dystrophy
cases.

Cont’:
Resources: How could it
info about help Evan:
•“Works with the child with
Relief special needs within the home to
allow relief for the
Worker: parents”(Classnotes, week9)
•This support could be very
helpful because for parents all the
running around and taking care of
Evan could lead to a lot of stress
and at times they do need a relief
worker who would be able to give
them some time for themselves.

Cont’:
Resources: info How could it
about help Evan:
•“observes, participates in
Early creating and implementing
IPP’s, make adaptations in the
Childhood environment, supports families,
links with other professionals
Educator and more”(Classnotes, week 9)
•Daycares are where children
spend more then half of their
day and it is vital to have a
good ECE who would be
resourceful and understanding
in meeting the child and
family’s needs.

Information about agencies:
: Cont’
What population they serve:

Cost:

Referral process:

Muscular Dystrophy Canada:
(non-profit organization)
Mandate and Mission:
• to find cure to the different types of
Muscular Dystrophies, they provide
resources and support on an on going
basis to families who have members that
have this condition.
• They help families get support by
providing them with the proper education
about this condition, information,
Advocacy and equipments such as
Wheelchairs, scooters, orthotics, hospital
beds and other equipments.
• They also provide emotional support to
families and children during the process

http://www.muscle.ca/ontario-nunavut/services/register-to-receive-services/

Muscular Dystrophy Canada
Cont’:
Population they serve:
• With the group of volunteers that work across
Canada, they collect donations to help the lives
of children and families who have this
condition.
• They provide them resources and ongoing
support.
Cost:
• They try to lower parent’s financial burden by
covering the costs to the needed adaptive
equipments needed for this condition.
• Their cost is covered by the donations they
collect from across Canada
• They provide financial assistance plans for
basic medical equipments


Muscular Dystrophy Canada
Referral Process:
• Staff give referrals to families on
the local clinics, agencies and
other community resources to help
guide them during this process
Availability:
• You have to register in order to
access these services
• Services are available to anyone
who is diagnosed with Muscular
Dystrophy, must be a Canadian
Citizen, Landed immigrant or
refugee in Canada

Holland Bloorview- Kids
rehabilitation hospital:
What do they do?
• Provide treatments,
therapies, technologies
and programs to allow
children with special
needs to participate in
daily life

http://www.hollandbloorview.ca/

What population they serve?
• They serve about 7000
children per year
• “With about 600 inpatient
admissions and 58,000
outpatient visits”(website)
Cost: not specified and
depends on the condition
and the amount of things
the patient needs


Referral Process and availability:
• Services are available through referrals of
doctors and approval process of the hospital
• Referrals are reviewed Monday to Friday and
they respond within 72 hrs
• Admissions Facilitator: (416) 753-6022 for
more information on the process
• Medical referral from physician is required
• Must complete the form of the hospital itself
• Complete medical summary must be submitted
• Once the referral is approved then patients and
their families are encouraged to get a tour of
the facilities and services offered


Overall References:
• http://www.hollandbloorview.ca/
• http://www.muscle.ca/
• http://www.muscle.ca/ontario-nunavut/services/register-to-receive-services/
• http://www.youtube.com/watch?v=AZ0jQZ6aBtk
• Reading Package, Unit 1, 2, 3
• Classnotes- weeks 4-9
• Case Study from class notes
Images:
• http://kidshealth.org/teen/diseases_conditions/bones/headers_86797/T_MuscularDystrophy1.jpg
http://orthoinfo.aaos.org/figures/A00384F01.jpg

• http://www.oumedicine.com/images/ad-neurology/parke-
childneuro.jpg?sfvrsn=2

• http://www.cookchildrens.org/SiteCollectionImages/Neur
• http://www.anmolarora.com/wp-content/uploads/2008/09/
• http://i.dailymail.co.uk/i/pix/2012/06/11/article-2157820-1
• http://healthmedcare.com/wp-
content/uploads/2011/05/muscular-dystrophy-
types.jpg

• http://www.prosensa.eu/img/timeline-DMD-patient.png
• http://www.muscular-dystrophy.org/assets/0003/6347/134
• http://image.made-in-china.com/2f0j00SvptcnTlfKqj/Chil
• http://www.ucdmc.ucdavis.edu/news/images/one
%20time%20use/Rutt-Jake.jpg

• http://blogs.slj.com/bowllansblog/files/2012/01/Xavier-BDay-028.jpg
• http://www.specialeducationadvisor.com/wp-content/uploads/2010/09/teacher.jp
• http://www.kotb.com/kob2.htg/mdcast.jpg
• http://www.asianscientist.com/wp-content/uploads/2011/11/Health-Supplement-L
• https://www.ynhh.org/vSiteManager/Upload/Images/childrens/muscular_
dystrophy_hdr_image.jpg
• http://news.brown.edu/files/article_images/Fallon1_0.jpg

• http://www.ward11.roh.nhs.uk/app/webroot/fi
les/image/physio.jpg
• http://www.crc.ie/images/services_4.jpg
• http://www.orange.mu/bollywood/xml/4%20t
hings%20to%20know%20about%20Speech
%20Therapy.jpg
• http://rcssocialwork.webs.com/hands.jpg

• http://www.collive.com/pics/s_nf_7228_27656.jpg
• http://www.online-nursing-dot.com/images/muscular.jpg
• http://www.childrendentists.com/web/graphic/Child-Dentist-
1.jpg
• http://www.muscle.ca/typo3temp/pics/4a5b9ddc4a.png
• http://www.muscle.ca/typo3temp/pics/3b58dfcee3.png
• http://www.beltina.org/pics/muscle_relaxant_medications.jpg

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Evan is a six year old boy who