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Children with myelodysplasia, also referred to as myelomeningocele and spina bifida, present many challenges to the pediatric physical therapist working in the school setting. The role of the physical therapist includes evaluating and implementing appropriate environmental adaptations and assistive technology for the child in collaboration with the school personnel. The physical therapist will provide intervention services to maximize function and promote optimal positioning to prevent skin breakdown and deformity. The physical therapist must provide information to school personnel concerning the medical and physical issues the student with myelodysplasia presents with, in addition to how these issues can affect the student’s success in the school environment.

Working with students in their natural environment can provide the therapist with an opportunity to be creative in intervention planning and innovative in finding solutions to problems. Ideally, the physical therapist uses a collaborative model in this natural setting and provides the necessary ecological modifications and assistive technology to promote the maximal independence for the student (Palisano, 2006). Along with considerations in the school setting, the impact of the home setting needs to be considered.

The model of collaboration within the natural setting can be challenging. There can be funding issues involved with implementing ecological changes. Assistive technology within the school environment is sometimes dependent on outside resources for the needed modifications. School staff and teacher attitudes concerning independence need to be considered, especially with preschool-age children, because there can be tendencies to foster dependence in areas of daily living. Despite these obstacles, there can be simple solutions to immediate problems that require creativity, innovation, and staff collaboration to accomplish the stated goals.

This case study will focus on the school-based physical therapy provided for Salomon, a 16-year-old boy with myelodysplasia at the thoracolumbar level. He is currently attending a public high school, with regular education classes in a co-taught setting, and receives additional consultative services by an orthopedic impairment (OI) special education teacher. Salomon’s physical therapy will be discussed from 3 years through 16 years of age, with consideration of possible physical therapy needs as he transitions to adulthood.

Examination: Age 3 Years


Salomon was delivered via cesarean section at 33 weeks of gestation and weighed 10 pounds. He was diagnosed with Chiari II malformation and myelodysplasia at the thoracolumbar level and underwent a ventriculoperitoneal shunt placement and myelomeningocele closure following his birth. Hydrocephalus is one of the complications that can occur in children with myelodysplasia, and it often presents as a complication after the surgical closure of the hydrocele (Kahle, Kulkarni, Limbrick, & Warf, 2016). A ventriculoperitoneal shunt is frequently inserted to assist in draining the excess fluid from the brain to the peritoneal space. Children with shunts need to be monitored for possible signs of infection or blockage of the shunt. There are early warning ...

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