Laura has come in today saying that she noticed her son Elijah is acting differently than the other kids in the neighbourhood. Elijah is 18 months old now. He was born at just 33 weeks into pregnancy, which means that he was 6 weeks premature. As far as the parents knew, even though Elijah was a preemie, he was a healthy baby based on the tests taken after birth. It’s only until recently, when Elijah started to walk, that Laura and her Husband Brian have noticed that his posture just doesn’t look right. He doesn’t stand up straight like the other kids and isn’t able to keep his balance up for too long. Brian believed that his balance issues were typical for a child that’s just learning how to walk. But Laura, disagreed. Laura has not only seen typical balance problems with her son, she’s also noticed that his legs look almost stiff, so much so that he isn’t able to keep himself up for long enough. She also has knowledge of one of her uncles having a problem with his legs while growing up. She doesn’t know the type of condition it was and she’s never even considered the possibility of her own child getting it while her and her husband were trying to get pregnant. Brian did notice that it’s been a lot harder to feed Elijah, as he keeps spitting it out or moving around a lot. He moves so quickly it’s close to impossible to be able to get any spoon-fed foods. They have tried using bottles of pablum instead so he gets the nutrients he needs.For Elijah, I would recommend a cranial ultrasound. A cranial ultrasound uses reflected sound waves to make pictures of the brain and its inner fluid chambers (ventricles) where cerebrospinal fluid flows. This test is most commonly done on children up to 18 months old. It checks for problems from premature birth. It may be used to check problems in the brain and ventricles as well. The ultrasound waves are not able to pass through bone. So, since Elijah is still quite young, this means that his cranial bones are not yet completely formed. With the bones not formed, it will be much easier to see an image of his brain to see what’s going on (webmd.com, 2018). For further testing, I am also going to recommend that he gets an x-ray computed tomography (CT) scan. This scan is able to obtain images of Elijah’s brain through x-rays. This will give us an excellent view of the cross-sections of this brain. With these types of images, it can help us detect more complex abnormalities in the brain (cerebralpalsy.org, 2018).Patient Name: Laura and Brian May with their Son: Elijah MayDate: August 26th, 2016Time: 1:30 p.m.Visit #: 2The test results are in, and it is most likely that Laura and Brian’s son has Spastic Cerebral Palsy. This is the most common type of cerebral palsy, and because Elijah was a premature baby, it is more likely for him to develop this condition in his life. Cerebral Palsy is just the basic term for developmental movement disorders caused by brain injury. Each type is caused by damage to a specific part of the brain. Spastic Cerebral Palsy is a developmental disorder caused by damage to the brain rather before birth, during delivery or within the first few years of life. It prevents his motor function from developing properly. There are 4 types of Spastic cerebral palsy. Based on the current test results, Elijah, unfortunately, has spastic quadriplegia. This specific type of Spastic Cerebral Palsy involves damage to the motor cortex in the brain. It is located in the cerebral cortex. This is the largest part of the brain. It contains many parts that are responsible for sending signals to other parts of the brain to control body movement. The most important part of the motor cortex is how it’s able to regulate voluntary movement (cerebralpalsyguide.com, 2018). Elijah has damage to this part of the brain, so it makes his voluntary movement very hard to control and a lot less fluid or “spastic” than normal. This type of Cerebral Palsy with affect all four of Elijah’s limbs, as well as his torso and face. This type of cerebral palsy will often make just the simplest tasks of life a lot more challenging, such as walking or picking up a small object. It is a possibility that Elijah can also develop other disorders over time along with this one as the brain continues to develop. Some of these disorders may include epilepsy or attention deficit hyperactivity disorder (ADHD) (cerebralpalsyguide.org, 2018).For further testing on Elijah’s development, I will refer them to Dr. Janice Obi. She is Cambridge’s best pediatrician. All a is pediatrician is a child’s doctor (Umm.edu., 2018). They work specifically with children and are trained to do multiple in-depth tests to really see what Elijah has. She will be able to do a physical examination and health assessment to observe Elijah’s overall health. I will send over all of the information that I know, she will know what types of things to test for. For example, Laura mentioned that Elijah has been having trouble walking on his own. This will give Janice a basic idea to do multiple tests on his legs and balance. She will also take multiple tests to check his cholesterol, blood pressure, and blood sugar levels. You will have to meet up with her regularly to make sure he meets the proper milestones in growth, behaviour and skills. (Umm.edu., 2018)Patient Name: Laura May and Son: Elijah MayDate: September 8th, 2018Time: 2:00 p.m.Visit #: 3For Elijah, I strongly recommend getting him into physical therapy as soon as possible. It will be one of the best ongoing treatments. Since he has developed Spastic Cerebral Palsy, muscle training and exercises will help Elijah’s strength, balance, motor development and mobility. This will also allow him to have independence. The physical therapist that I will refer them to works specifically with young children that have cerebral palsy. She uses various types of range of motion (ROM) and stretching exercises that will help improve his ability to move his joints. She also is big on using age-appropriate toys and games that will make the therapy enjoyable for him. This type of therapy can help improve overall motor function and help prevent any future complications. There is a certain medication that can help Elijah’s condition. They are called antispastics. This is the best type of medication for Elijah’s type of cerebral palsy because they are meant to relax contracted, overactive or stiff muscles in the body. They are non-invasive and very easy to use. There are many benefits that are obtained from taking antispastic medications. Such as controlling muscle contractions, increasing his range of motion and relaxing his tight muscles so it will make it easier for him to move and interact with other children and objects. But, of course, alongside those benefits, there are many side effects as well. Some of them may include flu-like symptoms like drowsiness, headache or nausea. One of the best things about these types of medication are that they are known to be very fast acting, and work really well at reducing and controlling the little spasms he has as well. There are a variety of options of how this medication can be administered. This type of medication is available in tablet form, to be taken orally, by injection directly into the muscles themselves or by an intrathecal baclofen pump. An intrathecal baclofen pump is surgically implanted in the abdomen. It delivers the medication directly to the cerebral spinal fluid. (cerebralpalsy.org, 2018) Since Elijah’s condition is just starting and isn’t as severe, I wouldn’t recommend this option quite yet. I believe that the better option for him would be through tablets. I recommend these over the injection because the oral medications are usually prescribed for overall spasticity, while the injections just target a specific muscle. The benefits of oral medications and injections are usually short-term, requiring refills or further injections. But, I believe this will be a good for me to keep track of Elijah’s condition to really see if it has improved. With the pump, on the other hand, it provides steady doses of medication on a long-term basis. Since Elijah is still very young, there is a possibility that he is able to grow out of this condition, or at least improve that it is less and less severe. The pump must be maintained and refilled so as not to run the risk of abrupt withdrawals, or possibly death. This will make not only his childhood life, but the life of the people around him much more difficult than it already is. (cerebralpalsy.org, 2018)Patient Name: Laura and Brian May with Son: Elijah MayDate: October 9th, 2016Time: 2:30 p.m.Visit #: 4Some other options that I recommend for Elijah to start in the next few years are occupational and speech therapy. Occupational therapy will improve his ability to do daily tasks and activities independently. Occupational therapists perform various exercises that specifically target the muscles in the wrist, forearm, thumb and upper body. This type of therapy will be beneficial for Elijah’s cerebral palsy because it not only focuses on his motor control, it also focuses on his hand-eye coordination and upper body strength. They will help prepare Elijah for Kindergarten by helping learn how to properly use various types of writing utensils and scissors. I believe that speech therapy will be very beneficial for Elijah since the specific type of cerebral palsy he has, is known to affect his face. Speech therapy overtime will not only strengthen the muscles that are used for speech, it will also help with clarity and coordination. Some children with Elijah’s type of cerebral palsy also tend to drool or have difficulties swallowing. This form of therapy helps make chewing, breathing and swallowing less difficult, allowing for normal growth and development for Elijah. Speech therapy will also provide the tools him to be able to clearly communicate their thoughts and socialize with others. I recommend starting these therapies when Elijah is closer to 3 years of age. That is the age children start to talk and interact with various things. Starting from an earlier stage in development is very beneficial for him. There are many other natural alternatives that Elijah’s parents can try to help with his symptoms as well. One includes acupuncture, this may be difficult to do at this age, but it is definitely something to consider for his future. Having this kind of treatment done can be a very effective way to reduce inflammation on the body and promote blood flow. Some other benefits are that it improves the development of muscles, pain relief and is even able to help with the development of some parts of the brain. Another natural alternative is including fish oil or ginger into his diet. Fish oil is very high in omega-3’s. Patient Name: Laura and Brian May with Son: Elijah MayDate: November 8th, 2016Time: 1:30 p.m.Visit #: 5The prognosis is, is that every child that was diagnosed with cerebral palsy is different. There are a whole bunch of possible outcomes for Elijah. I would suggest for the parents to have a general plan for him, I don’t suggest letting his condition get in the way of many of his developmental milestones. Based on the results of his tests, it is very possible that Elijah will have for the most part, a very normal life. Although there haven’t been any general studies of the true life expectancy of a person with cerebral palsy, it is possible for them to live anywhere between 30 and 70 years of age (birthinjuryguide.org, 2018). This all depends on how severe the condition is, and in Elijah’s case, I have a really good feeling because in general, a child with a mild case of cerebral palsy like Elijah usually lives longer than a child with severe mobility and academic restrictions. One thing is, that Elijah’s type of condition affects his movement quite a bit, so this makes driving a vehicle very difficult, but not impossible. It really all depends on how much he has improved over the years. Usually the actual brain injury or problem that causes cerebral palsy doesn’t get worse over time. But, it is very likely that new symptoms may appear, change or possibly become worse as Elijah gets older. This may include an increase in spasms, increase in muscle contractures or multiple joint problems. For example, it is a possibility that he will lose the ability to use his legs to walk properly. This means that he could end up needing crutches or even a wheelchair.