School

School of Health Sciences and Human Performance

Department

Physical Therapy

ICC Theme

Other

Date

2-4-2019 12:10 PM

Abstract

Background: Selective Mutism is a childhood anxiety disorder characterized by the individual’s inability to speak or communicate in certain settings.1 Selective Mutism is typically identified in the early school years when the child is between 6 and 8 years old, although parents often report the presence of symptoms as early as 3 years of age.2 Prevalence rates vary between 0.3 and 7.1 per 1000 children,2 although accurate population estimates are difficult to ascertain due to differences in sampled populations and variations in diagnostic procedures.1 Selective Mutism is 4 times more prevalent in immigrant populations than native populations and is more common in females than males.1 Although extensive research on identification and treatment of Selective Mutism in relation to psychology and speech-language pathology (SLP) has been completed, the literature discussing physical characteristics of Selective Mutism is limited. The purpose of this case series is to describe the physical presentation of two children with Selective Mutism in school-based physical therapy and how this impacted their functional abilities.

Methods: Two students, a 15-year-old Caucasian female and a 6-year-old Caucasian female, with a diagnosis of Selective Mutism were seen in school-based physical therapy for impairments related to muscle tone, strength, range of motion, balance, coordination, motor planning, and posture. The episode of care for both cases took place over an 8-week period. Each 30-minute treatment session consisted of flexibility and aerobic exercises followed by balance and strengthening interventions. Posture, range of motion (ROM), muscle strength, Bruininks-Oseretsky Test of Motor Proficiency – 2nd edition (BOT-2) scores, and observation of the individual in the academic environment were used to evaluate the individual’s impairments and compare the presentation of the two students.

Results: Both students presented with similar impairments. They shared a common posture which included protracted scapulae, internally rotated shoulders, forward head posture, increased thoracic kyphosis, and decreased lumbar lordosis. Limitations in range of motion were likely related to this posture and both students presented with increased internal rotation at the shoulder and hip compared to external rotation. The students demonstrated similar compensations when attempting to extend the spine and neither exhibited observable lumbar motion. It is important to note, that the younger student was able to adjust her posture with cuing from the therapist and maintain the appropriate position for short periods of time, while the older student had difficulty adjusting her posture, despite cuing from the therapist. This may suggest that addressing impairments at a younger age may have a better prognosis for improvement. Both students had decreased strength, which was seen during functional movement, and decreased muscle tone throughout the body. The students also had impaired endurance, balance, coordination, and motor planning, which were observed during the BOT-2 and during observation within the academic environment. These impairments impacted the students’ ability to navigate the school. The older student had adapted well to the educational setting and was able to move safely, while the younger student had difficulty maintaining her balance in busy environments, and refused to participate in playground activities with other children.

Discussion and Conclusions: The presentation of students with Selective Mutism at different ages allowed for the comparison of physical impairments at two points in the life span. The similarities found suggest that there may be a common physical manifestation related to Selective Mutism, which impacts the success of these children in the academic setting, which reaches beyond their inability to communicate. Physical therapists should evaluate students with Selective Mutism for gross motor impairments, as this may be an underserved population. This case series demonstrates that Selective Mutism may be related to a common physical manifestation, which impacts functional activities in the school environment and may warrant school-based physical therapy services

Document Type

Poster

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Apr 2nd, 12:10 PM

Physical Manifestations of Selective Mutism in School-Aged Children: A Case Series

Background: Selective Mutism is a childhood anxiety disorder characterized by the individual’s inability to speak or communicate in certain settings.1 Selective Mutism is typically identified in the early school years when the child is between 6 and 8 years old, although parents often report the presence of symptoms as early as 3 years of age.2 Prevalence rates vary between 0.3 and 7.1 per 1000 children,2 although accurate population estimates are difficult to ascertain due to differences in sampled populations and variations in diagnostic procedures.1 Selective Mutism is 4 times more prevalent in immigrant populations than native populations and is more common in females than males.1 Although extensive research on identification and treatment of Selective Mutism in relation to psychology and speech-language pathology (SLP) has been completed, the literature discussing physical characteristics of Selective Mutism is limited. The purpose of this case series is to describe the physical presentation of two children with Selective Mutism in school-based physical therapy and how this impacted their functional abilities.

Methods: Two students, a 15-year-old Caucasian female and a 6-year-old Caucasian female, with a diagnosis of Selective Mutism were seen in school-based physical therapy for impairments related to muscle tone, strength, range of motion, balance, coordination, motor planning, and posture. The episode of care for both cases took place over an 8-week period. Each 30-minute treatment session consisted of flexibility and aerobic exercises followed by balance and strengthening interventions. Posture, range of motion (ROM), muscle strength, Bruininks-Oseretsky Test of Motor Proficiency – 2nd edition (BOT-2) scores, and observation of the individual in the academic environment were used to evaluate the individual’s impairments and compare the presentation of the two students.

Results: Both students presented with similar impairments. They shared a common posture which included protracted scapulae, internally rotated shoulders, forward head posture, increased thoracic kyphosis, and decreased lumbar lordosis. Limitations in range of motion were likely related to this posture and both students presented with increased internal rotation at the shoulder and hip compared to external rotation. The students demonstrated similar compensations when attempting to extend the spine and neither exhibited observable lumbar motion. It is important to note, that the younger student was able to adjust her posture with cuing from the therapist and maintain the appropriate position for short periods of time, while the older student had difficulty adjusting her posture, despite cuing from the therapist. This may suggest that addressing impairments at a younger age may have a better prognosis for improvement. Both students had decreased strength, which was seen during functional movement, and decreased muscle tone throughout the body. The students also had impaired endurance, balance, coordination, and motor planning, which were observed during the BOT-2 and during observation within the academic environment. These impairments impacted the students’ ability to navigate the school. The older student had adapted well to the educational setting and was able to move safely, while the younger student had difficulty maintaining her balance in busy environments, and refused to participate in playground activities with other children.

Discussion and Conclusions: The presentation of students with Selective Mutism at different ages allowed for the comparison of physical impairments at two points in the life span. The similarities found suggest that there may be a common physical manifestation related to Selective Mutism, which impacts the success of these children in the academic setting, which reaches beyond their inability to communicate. Physical therapists should evaluate students with Selective Mutism for gross motor impairments, as this may be an underserved population. This case series demonstrates that Selective Mutism may be related to a common physical manifestation, which impacts functional activities in the school environment and may warrant school-based physical therapy services

 

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