Sally Case Study
General Background Information
Sally is a 13-year-old, eighth grade student. She has been present 55 days out of 68 days from the first day of school, August 9, 2020 through November 16, 2017. Sally is currently receiving special education services in a self-contained class serving students with multiple disabilities (MD). Her current primary eligibility category is multiple disability with severe sensory impairment (MDSSI) with additional eligibility categories of visual impairment (VI), severe intellectual disability (SID) and hearing impairment (HI). Sally is categorized as a deaf-blind student and has complex medical needs. Sally is hypoglycemic. Her blood was drawn three times at school before her feedings last year, but due to lack of insurance coverage of testing strips, nurses are currently checking her blood glucose levels twice a day at school. Her current feeding schedule is a bolus feed at 9:00 a.m., 12:00 p.m., and 3:00 p.m. Blood glucose levels are currently checked before 12:00 p.m. and 3:00 p.m. bolus feeds.
Sally requires a significant level of assistance and modifications and/or adaptations for communication, motor and cognitive skills as well as daily living skills activities. Sally is generally a very happy student as demonstrated through laughing and smiling. She enjoys a standing embrace and will rock from one side to the other while being embraced; hence the nickname “Rocky.” She does, however, show a pattern of distress when she is on her menstrual cycle as demonstrated through crying with tears, balling up into a fetal position when on the floor/mat, and refusing to be touched. Nurses, with parental consent, will administer Tylenol or Motrin during these episodes. Sally is also prone to extreme diaper rashes. When these rashes occur, her mother is contacted, and the trained staff apply the prescribed ointment to affected areas until rash subsides. Nurses have advised against using baby powder in diaper as it promotes the skin break down.
Sally maintains the ability to crawl. Sally has a habit of taking her finger and poking her right eye. Often, she goes so deep as to cause herself pain as demonstrated with loud crying, tearing eyes, and rapidly waving her hands in the air. It is unknown why she persists on poking her finger in her eye.
She has also been observed choking herself. She seems to do this to clear her throat when she has excessive amounts of drainage/mucus, which is somehow dislodged during the process and she is able to clear her throat as demonstrated with large, thick, ropelike mucus draining out of her nose and mouth. Her mother had also noticed her behavior and had her seen by her doctor. Upon receiving a new allergy medication, she has not demonstrated the choking behavior.
Sally can sustain her school day and enjoys interaction with her non-disabled peers and other adults. Her general education teacher reports that Sally continues to do well in PE, and she is usually in a good mood during the class. She attempts to walk holding hands with an
assistant. She expresses her desires through facial expressions and benefits from the social experience and physical activity provided during PE.
Sally requires specialized instruction and access to a modified curriculum in order to be
successful as well as an adapted curriculum, smaller class size, therapy-based activities, and related services.
Present Level of Performance Areas Based on Sally’s Individualized Education Program
Sally has a visual diagnosis of cortical visual impairment. When presented with objects in front of her or people, Sally does not visually fixate or focus her visual attention on them. She will turn her head in the direction of sounds. The light box is pleasing to Sally and she enjoys looking at the light. It is important to use movement and sound to gain Sally’s visual attention during some learning activities. Sally shows more interest in materials that are placed on her light box.
Reading
Due to significant physical and cognitive delays, Sally does not participate in traditional reading.
Sally receives all her reading instruction through the ULS (Unique Learning System) curriculum. Sally requires full physical assistance to participate in all reading activities.
Writing
Due to significant physical and cognitive delays, Sally does not participate in traditional writing activities. Sally participates in writing activities through the use of the ULS curriculum. Sally requires a full physical assistance to participate in all reading activities.
Math
Due to significant physical and cognitive delays, Sally does not participate in traditional math activities. Sally participates in all math activities through the use of the ULS curriculum. Sally requires full physical assistance to participate in all reading activities.
Social Emotional and Behavior:
Sally comes to school typically in a good mood. Sally enjoys interaction with adults as well as utilizing a vibrating toy, light box, etc. Sally can familiarize herself with her surroundings when she is on the floor exploring. Sally can participate in daily activities with the help of adult assistance.
Physical Development
Sally is seen by the physical therapist on a direct and consultative basis. Sally comes to school in a stroller style wheelchair propelled by an adult. Most of her campus mobility is in her stroller. Sally demonstrates the ability to roll, sit, crawl, and pull to stand independently, but is not always safe doing so due to visual impairment. She will cruise along furniture and familiar objects for short distances, but will go back into a crawling position when in unfamiliar areas. She can walk with her hands held for short distances with moderate assistance. Her medical status greatly affects how much she is able/willing to do during her classroom day.
Occupational therapy (OT) will continue to provide consultative support to monitor her progress in the classroom setting and support the staff with adaptations as appropriate. Sally is encouraged to participate in all classroom tasks and continues to require adult assistance for fine motor tasks and messy tasks, due to her limited vision, attention span, and her tendency to put everything into her mouth as a means of sensory exploration.
Communication
Sally is a nonverbal, deaf/blind student. Sally communicates through crying and laughing.
Sally expresses when she is done with an activity by pushing object away or dropping it on the floor. Sally expresses her pleasure with adult interaction and cuddling with giggles and smiles.
Sally continues to demonstrate significant communication impairments secondary to her primary disability and cognitive impairments. She should continue to be exposed to tactile experiences throughout her school day to provide a concrete representation of language, and to provide a model of how to use the symbols to increase her expressive communication. Her communication needs are met within the classroom setting, which provides a variety of language rich activities and alternative communication modalities.