Topic 2- Evidence Based Practice

Situation: A 14 month girl was referred for physio with large undiagnosed developmental delays. Paediatricians, speech pathogists, social workers and more are working with this patient and her family to try to improve her skills. Currently, the patient has had an MRI which was clear, and a series of tests that have all come back with no diagnosis. The patient can sit unsupported with a wide base, can roll with assistance, can prop in prone, and can pull to stand with support. She hardly keeps eye contact, she is not interested in her environment, does not reach for toys and has only just gained righting reactions and equilibrium reactions to stop herself from falling. All this information is making her development about that of a 5 month old. It is also believed that she may have a visual impairment and is reported by the her mother that she had a seizure a couple months ago, but has not had another one since.


Task: My roll with this patient is to work with the my supervisor to facilitate the developmental skills of this patient. Through positioning, play, facilitation techniques and repetition.


Action: The physio and i have been practising different positions such as propping in prone, propping to the side in sitting, four point kneeling and weight-shift in standing. The patient is placed in these positions and left to encourage her to figure out how to move into and out of different positions. Toys are placed in front of her and used as a tactile stimulation however the patient generally wants nothing to do with them. She can pull to stand but does not move once she is in standing. She like to put her fingers in her mouth but nothing else. With facilitation the patient can weight shift and step in standing, which is a large improvement after a month of therapy, however most other progress is slow.

I was facinated but this patient and her lack of diagnosis. So with thinking of evidence based practice and the presentation of the patient, having now done 4 therapy sessions with her, i questioned Autism with my supervisor. My initial question was just regarding the diagnosis of Autism, but as my supervisor did not know the answer, i decided to do some research myself. I looked through a series of Paediatric books in the Physiotherapy department, and discovered how similar the symptoms of Autism where to the presentation of this patient.


Result: The results of my research proved that the patient could possibly have Austism. This is because of her gross motor and speech delays, uninterest in her environment and toys, the vague look she has (no focuse), a lack of motor planning and many other symptoms that match Autism.

I then explained my findings to my supervisor, who then expressed this idea to another member of the multi disciplinary team (MDT), who agreed that Autism definately seems like a part of the patients diagnosis (+/- some other comorbidities).

Evaluation: I was very happy with my research skills and the way i communicated this to my supervisor. I could have possibly done further research into this area, for instance how it will affect the family, support for the child and family, and further treatment suggestions, instead of just being concerned with the diagnosis. I do have to remember that there is no real diagnosis tool for Autism and so this may not be the case or all of this patients problems, even though symptoms are identical. I was happy with my communication and believe i will raise the idea at the next team meeting so it can be discussed further with all members of the MDT.

Strategies: To further my research into this topic i could research journals and talk to doctors and people with experience with this diagnosis, before jumping to conclusions. I need to ensure i have done enough research and have enough evidenced based proof to support my idea before pitching it to the whole MDT. Hopefully all my research may give me further successful treatment ideas and ways to find further support for the family.