Chloe, 6½ years old, had been diagnosed at birth with a lumbar (L1/L2) myelomeningocele and received a shunt for hydrocephalus. Chloe is in a regular first-grade class of 20 students. She gets assistance in school with toileting and with managing her lunch tray. The classroom assistant sits with Chloe while the other children participate in gym and play on the playground.Chloe has a hip-knee-ankle gait orthosisthat only occasionally comes with her to school. She does have a standing frame at school and is transported to and from school in a wheelchair with a pressure-relief cushion. She needs moderate assistance at school for transfers, and maximum assistance for tub transfers at home. Chloe is able to transfer from the chair to the floor, but only does this with much prompting because she is afraid of falling.Chloe assists with dressing, but continues to have difficulty with zippers, small buttons, and shoelaces. She uses a knife, fork, and spoon during meals, with some spillage. She is unable to peel an orange or banana, and has difficulty opening Tupperware containers and the school milk boxes. Chloe is catheterized and is dependent in bowel and bladder care. Chloe enjoys school and seems to make friends easily. She has been slow to develop writing skills, and writes with an immature static tripod grasp. At this time she can print her name and only a few additional letters of the alphabet. On standardized testing, Chloe had difficulty with the visual-perceptual skills of visual-spatial relations and visual-sequential memory. Although assured by the first-grade teacher that they would promote Chloe with her class, Chloe’s parents are concerned by her poor writing, reading, and math skills.Questions/Activities1. Using examples from Chloe’s case, explain how her lack of independent mobility and her fear of position changes might impact the development of skills needed in the classroom and the community.2. Because Chloe’s parents are concerned about her academic performance, describe some craft and game activities that Chloe could engage in at home and with friends that might help her build the needed fine motor and visual-perceptual skills. Be specific in describing the activities and the specific childhood skills it would encourage.

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