Running head: CASE STUDY 1

Case Study
Mindy Merten
Texas Tech University










CASE STUDY 2
Abstract
This paper investigates the case study of Melissa a seven year old child with multiple
impairments. Melissa attends a public elementary medically fragile life skills classroom in Small
Town ISD. Her Cortical Visual Impairment (CVI) was discovered when she was only a few
months old. Melissas parents are not present in her life, and she currently lives with her
maternal elderly grandparents. She has a history of congenital cytomegalovirus (CMV) which
causes microcephaly, hypertonia, and developmental delays. Melissa wears hearing aids in both
ears and receives Occupational Therapy (OT), Physical Therapy (PT), Visual Impairment (VI),
Orientation and Mobility (O&M), and Audiological Impairment services. She is considered
nonverbal at this time and is tube fed. Melissas case is quite rare and profound.
Keywords: microcephaly, hypertonia, cytomegalovirus, cortical visual impairment







CASE STUDY 3
Case Study
Specific information about Melissa Smith was derived from observations, conversations
with the guardian and teacher, Functional Vision Evaluation (FVE), and the Full and Individual
Evaluation (FIE). The prognosis for Melissa requires attention from several related services
which will hopefully lead to further developmental improvement. Due to the severity of
Melissas condition, it is unlikely for her to regain any of her vision or hearing loss which is
considered permanent.
Information about the student
Melissa Smith is a seven-year-old female diagnosed with congenital cytomegalovirus
(CMV) which causes microcephaly, hypertonia, and developmental delays as well as a cortical
visual impairment (CVI) and hearing loss in both ears. Her pediatric ophthalmologist states that
Melissas mother was infected with CMV while pregnant which caused her lifelong disabilities.
Microcephaly is a rare neurological condition where Melissas head is smaller in size compared
to other children of the same age and sex. Her CVI is due to brain damage caused by CMV. It is
estimated that her visual acuity is 20/400 with nystagmus (rhythmic side-to-side movement).
She wears hearing aids in both ears due to some hearing loss. Due to the severity of her
conditions, Melissa is wheelchair bound and tube fed.
Even though Melissa faces these day to day struggles, she is a very alert and happy child
who loves Barney and smiles constantly when the program is on the television. Currently,
Melissa is in a medically fragile life skills classroom because she must be tube fed every day.
CASE STUDY 4
Her teacher, Mrs. George, does a wonderful job of including Melissa in classroom activities and
states that her favorite activity is to sit in her reclining chair and watch her classmates.
Functional Environment Observation #1
During the first observation, Melissa was observed in her classroom which consisted of
two aides, one teacher, and six students (including Melissa). Lighting for the environment was
provided by the overhead fluorescent lighting with no windows in the classroom. Majority of the
students were eating breakfast and talking/vocalizing. The room was loud and the movement in
the room was quite frequent.
Functional Environment Observation #2
During the second observation, Melissa was observed while playing on the playground
which consisted of eleven children, three aides, and two teachers. The student was seated in her
wheelchair and the aide moved her around the playground to look at different plants. Sounds
from other students could be heard, but these sounds were rather quiet since the student was
further away from her classmates.
Use of Senses
Due to nystagmus, Melissas eyes move from side-to-side quite rapidly. When someone
speaks to Melissa, it appears as though she is looking at the speaker because she will smile and
her eyes will slow down when she focuses her eyes on the subject. She will hold her gaze for a
few seconds before continuing her previous movement.

CASE STUDY 5
Even though Melissa has some hearing loss, the hearing aids seem to assist her quite
well. With this correction, it appears as though she can hear as well as her classmates and
children of her same age. Hand movement is visible when asked to reach for a toy, so it appears
as though her hearing is not as severe as her other impairments. When speaking to Melissa, she
turns her head in the direction of the sound of the speakers voice.
Melissa mostly uses her mouth to feel items placed in front of her. She will place objects
up to her lips and either bite or touch the object with her tongue. The teacher gave Melissa a
small washcloth in which Melissa threw it on the ground. It was indicated that she does not like
certain fabric textures, and this washcloth was made out of one of those textures.
Functions of the Student
Cognitive function development is delayed. Melissas cognitive abilities, as shown on
standardized assessments, are below 50, which is below the average of students her same age.
She can recognize her grandmothers face and smiles during her recognition, but her cognitive
abilities are very limited. Her current level of development is equal to that of a nine to twelve
month old.
Motor development is delayed as well. Melissa experiences severe health difficulties and
uses a wheelchair and stander to aide in her mobility. She wears an ankle-foot orthotic so her
foot does not extend and freeze in addition to a wrist brace which opens her hands. She is fed
through the G-button and eats some foods by mouth and drinks from a bottle sometimes. She is
non-ambulatory and receives injections to loosen her muscles especially in her hip.
CASE STUDY 6
Melissas sociological function is below average as well; however, her grandma describes
her as eager to learn and enjoys interactions with others." When at home she likes to watch TV,
DVDs, and swing in the Wingbo. As a family they enjoy spending time with other family
members and watching movies. Melissa is usually happy and quiet. She does not get upset
unless she is tired, wet, dirty, uncomfortable, or needs something. Discipline used is telling her
"no" if she is screaming because she is being impatient. Her reaction to this is normally more
crying or quieting down.
Melissas communication is delayed and is equal to that of a six to eleven month old
child. She is a nonverbal communicator and most of her communication takes place through
facial expressions, body movement, and vocalizations. She vocalizes vowel sounds and is able
to vary her crying sounds.
Conclusion
Melissa has several impairments which have led to tremendous delays in her cognitive,
social, motor, and communication functions. Hopefully, with the use of her occupational
therapist, physical therapist, teacher of students with visual impairments, teacher of students with
audiological impairments, and orientation and mobility specialist, she can improve her
developmental skills. Since Melissa was considered to be a failure to thrive baby, she has
surpassed the initial expectation of her life expectancy. With the help of her wonderful support
system, she will continue to improve on her developmental skills.