Jake was born 3½ months prematurely, in a small rural hospital. The delivering obstetrician was concerned about possible oxygen deprivation at the time of his birth, although Jake was put in an incubator shortly after he was born. Because of their son’s prematurity, Jake’s parents were counseled to expect developmental delays. They reported that he was irritable and seemed to have difficulty ingesting milk. At 4 months of age, his pediatrician expressed concern because of the continued presence of some reflexive behaviors such as the whole- body response to startle and lack of eye–hand coordination. She referred Jake to a developmental team in a large urban hospital. The multidisciplinary team consisted of a pediatrician, a neurologist, a physical therapist, an occupational therapist, and a speech- language pathologist. They determined that Jake had cognitive and motor delays, as well as moderate dyskinesia. He was given a diagnosis of athetoid cerebral palsy. Following the evaluation, it was recommended that Jake participate in home- based early intervention services, provided by the multidisciplinary team’s rehabilitation specialists (i.e., physical therapist, occupational therapist, SLP), with periodic follow-up assessments at the hospital. The diagnosis of CP was very disheartening and painful for Jake’s parents. Therefore, the team also recommended that the parents receive counseling and participate in a parental support group as part of their son’s treatment plan. By age 3, Jake was able to feed himself finger foods, but he still had some difficulty. Dressing was limited to pulling down a shirt that had been fitted over his arms and head. He could walk but not without significant difficulties, as he needed support to steady himself. His speech consisted of a few words and phrases that were often unintelligible to people other UIBO IJT GBNJMZ 0O UIF BEWJDF PG UIF 4-1 BU UIF TQFDJBM needs preschool Jake attends, he began training on an AAC device. At first this involved pointing to pictures on a communication board. Although his pointing response was somewhat imprecise, Jake continued to use the communication board until he entered elementary school. In first grade, he began using a computer with specialized communication software. Pictures evolved into words and then into individual letters. Now in third grade, Jake is communicating using a combination of his own speech and selection of pictures, words, and simple spelling on his computer. He takes his computer everywhere and can even order his favorite foods at restaurants independently
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