Author: Darlene K. Sekerak, PT, PhD
Kevin is 2 years old and lives with his family (mother, father, and older sister) in a rural community. His dad is a contractor and his mother is a full time homemaker. They live in a sprawling ranch style house in a small community subdivision that includes many families with young children. Kevin?s maternal grandparents live close by and are an important part of family life.
Kevin has cerebral palsy and profound mental retardation. He is alert and responds with smiles and focused attention. His mother is confident that she can tell the difference between a yes or no response but they are unclear to other family members or care givers. Kevin has minimal head control and although actively swipes at toys, is usually unsuccessful at grasping and holding a toy. He requires tube feedings for nutrition and adapted equipment for sitting upright.
A physical therapist has been providing early intervention services in the home for Kevin for the past six months with consultation from a speech pathologist and nutritionist as needed. Medically, Kevin is being followed at a tertiary care center 50 miles away. Therapy has focused on maintaining range of motion to prevent deformities, engaging Kevin in developmentally appropriate activities, and incorporating intervention into daily family routines.
It is apparent that Kevin?s mother is very loving and caring, however, the therapist suspects that very few of the therapist?s suggestions are being followed between visits. Although Kevin?s mother seems to go along with acquiring recommended adapted equipment and is attentive during therapy visits, there is no evidence that the equipment is being used or that the mother has tried suggested activities. This concerns the therapist as she is eager to meet the needs of both Kevin and his family relative to his care.
In an attempt to better understand, the therapist talks with Kevin?s mother about Kevin?s development and what might help him. Kevin?s mother shares her belief that Kevin?s condition is a mystery of God and that only God will make him better. She is clear that she loves Kevin and will do anything necessary to care for him but believes that therapeutic activities directed at improving his development are useless.
Gaining insight into the mother?s perspective was very helpful to the physical therapist for working with this family and planning future intervention visits. The therapist made no effort to change the mother?s beliefs or to suggest that it was the mother?s responsibility to ?help? God help her child. Instead, the therapist began to focus energies on activities that Kevin particularly enjoyed, as a way of encouraging his mother to play with Kevin, rather than emphasizing the therapeutic value of the activities. She also increased her efforts to assess the daily care challenges faced by Kevin?s mother. She worked with the mother to make Kevin?s care easier while still incorporating strategies and positioning that might also prevent deformities and encourage development. Gradually over the next month the therapist realized that Kevin?s mother was beginning to use the special chair that had been purchased for Kevin and she was asking more questions about toys the therapist thought Kevin might enjoy during play.
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