Name: Gino James A. Limado
Age: 5
Gender: Male
Birthdate: January 29, 2006
Place of Birth: Nunados General Hospital
Address: Brgy. 180, Miramonte Heights Little Baguio Camarin, Caloocan City
Ordinal Position: Eldest
Father’s Name: Mark Anthony Limado
Occupation: OFW
Educational Attainment: Bachelor’s Degree (Business Management)
Mother’s Name: Cielo Jane A. Limado
Occupation: Housewife
Educational Attainment: 2nd Year College (Computer Science)
Sibling: Trixia Joy A. Limado
Ordinal Position: Youngest
Age: 3
B. Joining Process
As I conduct this case study, I sought permission from the mother of Gino James A. Limado (client) who is Cielo Jane A. Limado, to let me ask some questions with regards to their family that will contribute with the completion of the study. I explained the purpose of the study and what are the things they will be expecting. I also asked them if they have any clarifications for the things they may confused them. In doing this, full cooperation of each member is important because I will need some information’s that should be given by them. For the better understanding of this study, time management is essential because I will set dates and time for the activities provided for the child to attain objectives that may develop them.
C. Presenting Problem
As a start of the said interview, with the people involve in this study, they stated all the necessary information’s that expresses the problem of the child (client). I prepare some questions to be answered by them that will serve as background for the study. First, I introduced my self and giving them an explanation with regards to the study in order for me to get their trust and full cooperation. After that, I let the mother to talk freely as she answered the questions about her child’s condition.
Gino James A. Limado a five year old child who was being diagnosed with Cerebral Palsy, in the age of 3, due to some signs and symptoms observed to him. The mother reported that she had an unusual birth delivery. During her 2 months pregnancy, Cielo Jane was so depressed because of the rumors coming around. In the age of 18, she engaged in early pregnancy that leads her to depression. All of the family members were so shocked and feel disappointed especially her father. Cielo Jane and Mark Anthony her boyfriend, were being set apart by their parents because they do believe that, it is not yet the right time for them to build their own family. “In that time all I want is to die because for me I have no reason to stay” quoted by the mother. As she stated this phrase, tears rundown her face and she embraced Gino tightly. Gino looks at her mother and he said,” I- L-o-v-e Y-o-u! Ma-ma.!” In her 28 weeks of gestation, she was being sent to the hospital and she undergo in a serious operation. Since the baby is premature, the mother should go through caesarian section and they also discover that the baby is in breech birth, concerned with the position of the baby inside the mother’s womb, wherein the buttocks appear first followed by the legs and finally the head. It is also called as bottom-down position. The Doctor informed them, that they should be ready for the circumstances that may encountered during the development of the baby. According to the doctor they failed to send the mother to the hospital immediately that caused inadequate oxygen for the baby. The infant must depend entirely on the umbilical cord as a source of oxygen until birth is completed. However the breech birth makes the umbilical cord too short to remain attached while the head is being expelled. As the umbilical cord prolapsed, this complication severely diminishes oxygen flow to the baby and the baby must deliver immediately so that he/she can breathe. If there is a delay in delivery, the brain can be damaged. Regardless of the statement given by the doctor, they think positively and they just ignore the risks that maybe occurred.
Early Development
Gino James growth and Development was observed by the people around him to be different from the normal child. He wasn’t able to attain certain things with regards to psychomotor and language development during the first 2 years, he has problems in terms of sucking, eating, drinking, and controlling his saliva, delayed milestone such as controlling head, rolling over, reaching with one hand, sitting without a support, crawling and walking. Another years passed by, there are no changes on his acts. They also noticed that there is stiffness on his muscles, “it seems like he has no control over the arms and on his legs” the mother said. “In terms of speaking, Gino James finds it hard, he cannot speak normally” added by the mother. The diagnosis showed by Gino James and as they consulted to the specialist, they found out that he has cerebral palsy. This kind of disorder is characterized by disturbance of voluntary motor functions that may include paralysis, extreme weakness, and lack of coordination, involuntary convulsions and other motor disorders. This means that he needs a full support and attention from his guardians because he cannot manage himself independently.
D. Psychosocial History
D.1 Timeline
This timeline indicates some important events that the client has encountered. It shows the existence of the client as he enter into this world and with the use of this timeline, we could determined some factors that affect the behavior of the client in the present as we go back in his past experiences.
Gino James A. Limado was born on January 29, 2006, and this is a critical period for him and for his mother. According to the mother, He is a premature baby and for 28 weeks of gestation, he needs to be out of his mother’s womb. Gino James is in Breech Birth wherein the buttocks appear first followed by the legs and finally the head, that’s why his mother should undergo on a caesarian section. Everyone was praying that time, they forget all the hatreds in their heart as they informed the family of Mark Anthony, his father and they went to the hospital urgently to support them. It happened because on January 28, late at night, Cielo feel something strange on her stomach, she just ignore it and after a minutes she felt so much pain but then again she didn’t mind it and she just lie on her bed. Accidentally, her parents and the other members of the family we’re all asleep when she is shouting for help because she cannot control the pain anymore and there’s a blood flowing on his legs. It took a long time before they are being informed about the condition of Cielo Jane. As they saw Cielo Jane lying on the floor, they carry her and send her to the hospital. In the hospital, the doctor assists them and urgently prepared for the operation. After waiting with fear on them, the doctor brings good news to everyone and the said operation was successfully done as they are hoping. When Cielo Jane gave birth to her baby boy, the first born baby give hope and brought changes between the 2 parties. Even though there is a threat that their baby may suffer some risks as he grow up, they we’re still happy. Since Gino James is a premature baby, he needs to be on an incubator for 2 months in order for him to be strong and also to meet all of his needs.
In the year 2007, based on their statement, they celebrate 3 important occasions for their son, Cielo Jane and Mark Anthony got married to become legal parents of Gino James. They are bond with the fact that they are already a mother and father that will provide all of the needs of their child. Then they prepare for the baptism of Gino James after that, they also organize a special birthday party for their son. Those three occasions we’re successfully done, all of them were happy as they bond together, its kind a reunion for them, their relatives from different places here in the Philippines are present as they attended, and all of them have their different stories to speak about their lives. In this year also they give all the love and care for Gino.
Another year had passed by for Gino James and that is the year 2008 according to them, in this year they feel embarrassed to what they are being observe to their son. It is quietly different from the other children, in the age of two; Gino James failed to work on some psychomotor activities as discussed in the presenting problem. This includes eating drinking and controlling his saliva, delayed milestones such as controlling head, reaching with one hand, sitting without support and even walking, he has poor balance. From their observations, they think that these things would be the effect of the circumstances they faced during the birth of Gino James. They weren’t able to send Cielo Jane to the hospital for immediate operation because her baby is premature specifically in breech birth and should undergo on a caesarian section. The doctor warned them, that they should be ready for the possible effects of it, a brain damage caused by inadequate oxygen as the umbilical cord prolapses. Cielo Jane was so afraid from the acts of his son, but she needs to face it bravely because in this year also, she gave birth to another member of the family, the birth of her youngest daughter named Trixia Joy A. Limado.
In the year 2009, based on the observer there are other changes that Gino James showed to them; there is stiffness on his muscles that makes him hard to perform a particular task. From this situation they decided to consult to the specialist, for some clarifications on the condition of their son. A confirmation, that makes the whole family feel pity on Gino James, they were so sad that their son couldn’t live in a normal way because according to the doctor this kind of disorder require significant medical and physical care, including physical, occupational and speech therapy but not curable it is just to prevent some seizures, reduce the effects of cerebral palsy and prevent complications.
Because of the diagnosis that his son has a cerebral palsy, the father of the client decided to go to the other country in the year 2010 to work there just to support the needs of his family especially his son.
D.2 Genogram
In this figure, it illustrates the relationship of each member within the family. The straight and broken lines served as an indicator to recognize what kind of relationship they have. Straight lines indicate good relationship and broken lines for bad which concern to misunderstanding. Mark Anthony Limado, the father of the client is the only son of Reymundo and Josefina Limado, his mother quietly upset to what had happened and while his father just accepted the fact that his only son is now preparing for a big responsibility and that is to become a father in his early age. Cielo Jane, Second to the youngest of Emilio and Mercedes Ariola, both of them didn’t expect that Cielo Jane got pregnant in the age of 17; she is in 2nd year college when they discover that their daughter was already 2 months pregnant. Cielo Jane is an intelligent student with the course of Computer Science in a prestigious University, but she was forced to stop because of her condition. Her father was so disappointed and hatred in his heart to Cielo and mark remained. Both sides did not want to have a settlement between them but after the birth of the baby, they planned the marriage for the sake of Gino James. All of the members of the family we’re happy as he exist. After 2 years, another baby was born and that is Trixia Joy A. Limado who felt jealousy to his brother because of too much attention given to him.
D.3 Sociograph
In the Family and Community;
The data shows different people connected with the client and it is interpreted on how they are being connected to him. This figure is being recognized through like and dislikes of the client and the people around him.
In the family there are top 3 people being like most by the client, including his father (Mark), mother (Cielo), and his grandmother (Mercedes). Trixia, Miliscent and Rhea we’re being listed on the client’s dislike, they are the people that the client thinks who hates him. Trixia, his younger sister, who used to shout her mother caused by too much attention given to the client, she got jealous. Miliscent, younger sister of Cielo, who got irritated every time his mother will please her to take care of him based on the client. She likes Trixia. Lastly Rhea, who likes his Tita Miliscent, cousin of the client, who used to teased him “Lampa” as she always saying.
In the community, based on the gathered information’s, the client received the most number of choices. He likes by Rem, Michael, Betty, and Michelle, they are about 6 years of age. They form a special friendship as what we call as “barkada”. They always visiting the client to make him laugh and used to play with him. The other children dislike by the client because of their bad attitudes. Betty likes Elvin and Lizzy. Elvin also likes Betty and Michelle. Alvin likes Michael, and Michael likes Mica.
D.4 Self-Mastery
Since Gino James (client) has a cerebral Palsy there are limitations with regards to self mastery. According to the observer there are things that he can and cannot do. Based on his performances they can easily distinguish what are the strength and weaknesses of the child. On his age, as they said he wasn’t able to attain certain skills particularly language and psychomotor skills. Gino James can speak even if it is not normally; there is a delay in every word he is going to express. In terms of psychomotor skills, he cannot walk on his own “I just carry him, wherever I am,” the mother said. “Before I used to feed him because he cannot hold the spoon with just one hand and he finds a hard time to chew,” added by her. According to the mother, through determination he can now eat on his own, but still with his assistance. Based on the family members, he can write his whole name with the use of two hands. He can count numbers 1-10, but not fluently, sometimes it is being rumbled. He can distinguish colors. He was able to recognize big from small and short from long. He can response with the questions being asked to him but there is an instances that stuttering occur when he speaks. The client also fun of watching T.V and he was able to remember the characters especially in cartoon shows. The client’s mother also providing him coloring books and he is enjoying coloring it even if it is not neat and clear. He can also respond with the music by moving his hands and feet.
D.5 Relationship
Having a good relationship with other people is very important particularly to the family members. Based on the statement of the client there are some people who used to laughs at him and they sometimes hurt him physically and emotionally. Despite of this people according to him, the other family members we’re very supportive and who loves him very much especially his father and mother. As they said, the client is friendly; he used to make friends with the other children, sharing his toys to them as his mother invites them to their home, since the client cannot walk alone. The client is also sweet, when some of their relatives visited them; he preferred to give them a warm smile, hugs and kisses. Based on the people I interview, the client has no problem with regards to relationship with others, except for those people who didn’t show a care for him just because of his condition. They said that Gino is a good boy and having a positive relationship with others.
D.6 Action
Based on the gathered information’s, Gino James wasn’t able to perform lots of activities, because of his condition. He does most of his task, through the help of them. As mention earlier, he cannot work independently. When He is asking for food, He will tap his 2 hands on his lap and saying “ka-en a-k-o”. The same action as he is demanding that he need to go to the comfort room and saying “pu-pu, or wi-wi.” According to the mother, she is the one who bathe Gino and dressed him up. After taking a bath, Gino used to comb his hair, using 2 hands. He cannot brush his teeth alone or with just one hand.
E. Theoretical Framework
Development in utero covers about thirty-eight weeks or 280 days or nine months of gestation or growth in the mother’s womb. In the case of Cielo Jane, the client’s mother, she just took 28 weeks of gestation approximately 7 months. At 7 months, the fetus is seventeen inches long and weighs about 3 pounds. Still the baby is at risk, because he is a premature and the mother should also undergo on a caesarian section due to the reason that the baby is in Breech Birth. The normal and desirable position of the fetus when labor begins is with the head toward the cervix. In Breech Birth, the buttocks presents first instead of the head posses substantial danger. In the principles of normal development, when there are problems in pre-natal and birth, deviations from the normal developmental milestones in infancy and early childhood can be expected. Inadequate supply of oxygen as the umbilical cord prolapsed, the primary source due to the delay of delivery and as a result of breech birth, brain damaged occur that later on, they discover as a disorder called Cerebral Palsy. Cerebral palsy characterized by disturbance of voluntary motor functions that may include extreme weakness, lack of coordination and other motor disorders.
The brain and nervous system control our perceptions, thoughts and voluntary actions, and also the most of body’s internal processes. Brain is divided into three parts: hindbrain, midbrain, and forebrain. These three divisions separate functions in the most primitive vertebrates; the hindbrain for balance and coordination movement, the midbrain for vision, and the forebrain for smell. The hindbrain and the midbrain together make up the brain system. Scattered through the brain stem is an intricate, network of cells known collectively as the reticular information. These cells receive inputs from several sensory systems: they send outputs upward to the forebrain. The forebrain is composed of 2 parts: the diencephalons and the cerebrum (telencephalon). The diencephalons contain the thalamus, a fairly large bilobed area at the midline of the brain; an important way of station for receiving information from the various sense organs and relaying it to the cortex. The other part of diencephalons is the hypothalamus, located below the thalamus. This is an extremely important part of the brain because of its role in maintaining balance in many of the body’s systems. Hanging from the thalamus like an apple from a tree is the pituitary gland. Although this organ is an endocrine gland and not really part of the nervous system, it receives neural and hormonal mechanisms in the brain. Another part of the forebrain, is the cerebrum the brains largest division, consisting of 2 cerebral hemispheres and their enveloping layer of cerebral cortex. It includes neocortex, wherein neuroanatomists divide each hemisphere into four region lobes: these lobes are separated from one another by landmarks such as central fissure (which goes over the top of the head, cutting across both hemispheres) and the lateral fissure (on the side of each hemisphere). The human neocortex, like that of other mammals, is partly taken up by sensory and motor functions. Two areas that have been extensively mapped are the somatosensory and the motor areas. From the given concept, we could say that that this is the part of the brain, responsible for motor functioning that was being damaged to the client’s difficulties. As the client grew up, he wasn’t able to develop certain skills specifically language and psychomotor skills that results failures in performing some task that on his age can do. In line with this, the client wasn’t able to explore and manipulate his environment and his concept further explained in the “psychosocial theory” proposed by Erik Erickson wherein he mentioned 8 stages of development. The second stage in Early Childhood is about 18 months and to 3-4 years old. The task is to achieve a degree of autonomy while minimizing shame and doubt. In the case of the client, he wasn’t able to take an opportunity to experienced being a child. With regards to this situation, the client developed shame and doubt, to feel deeply ashamed and to doubt his abilities. The client’s mother noticed that her son is always lonely; he preferred not to talk and always want to be alone. Someone suggested him that she might give him a chance to be treated as normal. The client’s mother refused how she will do it, because of the client’s actions being showed to them, she was afraid to what will happen. From this encouragement the client attained development. In the age of 5, through prayers and hard work in training him, the client can now do simple things without any doubt compared before that he cannot do, such as holding the spoon, combing his hair, playing his toys, writing his names, coloring books all of these tasks with the use of two hands. He is also encouraged to talk freely to express what he feels by teaching him specific words that he can use. All of those things can achieve by the client with the assistance of the mother and with the other adults. This scenario explained by the most significant basis of social constructivist theory that was laid down by Lev Vygotsky, which is “Zone of Proximal Development.” The difference between what the child can perform and what she can accomplish with the guidance of another is what Vygotsky referred to as zone of proximal development. The zone represents a learning opportunity where a knowledgeable adult such as parent or a more advanced peer can assist child development. The support or assistance that let’s the child accomplish a task independently is called scaffolding. Before the client do a particular task, the mother assist him and giving him instruction how we will perform it.
F. Prognosis
As I first met the client, before the interview, I’ve already noticed some problems pertaining to his movements. There are some difficulties on his actions; he cannot move his hands orderly. There is a stuttering when he speaks. The client cannot walk and just sitting on the lap of his mother. In this case, I formulated that the client’s problem has something to do with his growth and development. There will be factors or risks that were being contributed to his condition. It maybe occurs during the pregnancy of the client’s mother or in the period of birth process. As I gathered information’s with the people involve, I found out that the client was being diagnosed with cerebral palsy as an effect of the problems occurs during the birth process. As a result, the client wasn’t able to work on, as a normal child. Since his brain is being damaged, he cannot control most of his movements. In this case, the child developed the feeling of being ashamed and to doubt his abilities. The people around him who used to teased him and degrade his capabilities are the factors that makes it worst. There is also a possibility that a child could develop the feeling of inferiority, thinking that he has no purpose, to feel down, and this may discourage him to do a particular task. He doesn’t have enough confidence to face the reality and feel pity on himself. These are the reasons why, he preferred not to talk and always want to be alone. In line with this condition, a proper care and full attention should establish by the people around him. Since this kind of disorder is not curable and the medications provided for them are just the prevention of seizures and some involuntary convulsions, they should focused with the client by giving him an opportunity to feel accepted despite of his condition.
G. Therapeutic Plan
In order for the client to equip with knowledge, skills and attitude therapeutic plan includes activities which are concerned in building these concepts.
G.1 Knowledge Building
At the end of the case study the client child should be able to build the following knowledge:
The concept of seriation and numbering
G.2 Skills Building
At the end of the case study the client child should be able to build the following skills.
Dance with the rhythm
Drawing
Reading
G.2 Attitude Building
At the end of the case study the client child should be able to build the following:
Nurturing imagination
Dramatic Play
K. Summary, Conclusion, Recommendation
In conducting this case study, the client child who was being diagnosed with cerebral palsy, possessing the characteristics for having this kind of disorder as mentioned that will served as a proof and it is also further discussed sequentially as how the client child come up to this, including all the factors that affect the condition of the client child. It also involves the theories and concepts that will explain cerebral palsy, its cause, how does it occur and the effects on his present life. The client child was also given an opportunity to experienced thing which they think as his limitations, it was being achieved through establishing training and providing an activities that could help him. In a given data, we could say that the activities are effective.
As the client child performed the activities, with some interventions, I therefore conclude that the client child’s condition could be improve and make some changes. It also contributes, the training provided with the parents that served as a step for the better improvement of the client child. A continuous training could be the way, to live the client child normally despite of his condition.
Children learn through play, using their senses, being motivated through praises, interacting with peers and having positive environment. Based on the information’s given by the members of the family, the client child don’t have enough mastery because of his condition and there are limitations on his acts but as they established some training and with the activities using interventions given to him, the child come up to some improvements. There are some ways to enhance and gain improvements with regards to their knowledge, skills and attitude. Therefore, I recommend that parents and other concern adult inside the client child environment should provide proper assistance and guidance to the child. They should also pay more attention to the client child’s difficulties and training could be a big help.
L. Implications
In studying this case, we could realized that it is important to know what are the possible causes of the client child’s behavior in order for us to be aware why he/she is acting like that. To know more about this we are relating some concepts and theories for further discussion. We are being informed that a loner child has something to do with his condition and preferred environment. Since the client child has a cerebral palsy, having difficulties, and just because of this he rather choose to be alone. In line with this, he developed shame and doubt, proposed and explained by Erik Erickson on his Psychosocial stages of development, wherein in the age 2-3, children are abut to develop between autonomy and shame. Starting to help the child to be independent, if they were contrasted it maybe developed shame and doubt. The client child named Gino has limitations on his act that’s why he developed this behavior, because the adult concerned to him is the one who works for him. As they noticed it, they think of a way that they can resolve it, and try to help the client child to experienced simple things which are easy to performed as it stated on the self- mastery, actions and in therapeutic plan provided activities for the client child to enhance his capabilities with full attention and guidance of the adult concerned. This concept explained by lev vygotsky, the difference between what the child can perform and what he/she can accomplish with the guidance of another is what Vygotsky referred to as zone of proximal development. The zone represents a learning opportunity where a knowledgeable adult such as parent or a more advanced peer can assist child development. The support or assistance that let’s the child accomplish a task independently is called scaffolding. A proper training provided for those children who also suffering from this kind of disorder is recommended. Helping them to achieve set goals could develop their self-esteem to do a particular task. An activities and a set of interventions served as an assessment for these children. They are about to build certain concepts with regards to knowledge, skills and attitude. These things will contribute to their difficulties and expecting for the positive outcome, if not think of another objectives or strategies in order for the client child to attain it.
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