Nicholas’ mother, Rose, is a single parent who is only able to work part time at present because she needs to be available for Nicholas’ many therapy and medical appointments. Rose only receives a limited amount of funding for respite and daycare services for Nicholas, and this has further limited her ability to work full-time. Nicholas’ father has not seen Nicholas or Rose since shortly after Nicholas’ first birthday. He has since moved to another province in Canada, and Rose has no interest in attempting to locate him. Rose’s sister and mother are very supportive both in terms of providing caregiver support for Nicholas, and in contributing financially. Rose’s mother has built an accessible addition onto the back of her home for Rose and Nicholas, and they currently reside in this apartment. Rose’s sister and mother live in the original portion of the house.

Nicholas did not attend junior kindergarten, and Rose is very apprehensive about sending Nicholas to school without a family member present. She has never trusted a caregiver who is not a member or friend of their family to care for Nicholas before. Now she has been informed that she will not be able to choose Nicholas’ educational assistant (EA). Instead, Nicholas’ new school will choose an EA without receiving input from her. She is very upset by this, and this has compounded her anxiety about sending Nicholas to school.

Nicholas’ OT, Teresa, has been working with him for the past year to refine his skills with respect to switch use with the goal of preparing him to use his AAC unit. Nicholas has demonstrated his understanding of cause and effect through informal assessments, and he can now reliably operate a switch activated toy using a Big Mac switch. Teresa believes that it is now time to introduce smaller switches. The purpose of this is to assist Nicholas in developing more refined motor skills not only so that he may be able to use a variety of switches, but also so that he may be able to target the keys on his AlphaTalker. Progress has been slow, as Nicholas’ athetoid movements have been interfering with his ability to target small areas. Teresa has also noticed that Nicholas has difficulty with targeting in midline. At this time, Teresa is unsure if he will ever be able to use his AlphaTalker to its fullest potential, and is considering other types of AAC devices that might be easier for Nicholas to use.

Nicholas’ mother is worried that if Nicholas cannot communicate in school, he will not be able to keep up with his classmates academically. It is unknown at this point if Nicholas experiences any cognitive impairment associated with his CP, as this has not yet been assessed. Nicholas’ mother is worried that he will not be included in the classroom setting because of his disabilities.

Rose and Teresa have recently met with Ms. Hamilton, Nicholas’ senior kindergarten teacher, and Nicholas’ EA. They have decided that Nicholas should, and can be integrated in all classroom activities. He will be attending school for 2 full days and 1 half day per week. Ms. Hamilton asked Teresa to perform an environmental assessment of the classroom to facilitate Nicholas’ inclusion. While performing this assessment, Teresa realized that although there was agreement regarding the fact that Nicholas should be integrated fully within the classroom setting, the classroom and school would not be accessible to him. For example, Nicholas’ wheelchair does not comfortably fit at a regular desk, and he does not yet have a computer in the classroom with accessible software. Also, during circle time, Nicholas would be sitting in his wheelchair while the other children would be seated on the floor. The accessible washroom in the school consists of a standard double stall in the main boys’ washroom. Currently, Nicholas’ mother transfers him from his wheelchair to a commode for toileting. Both Teresa and Nicholas’ mother believe that his inclusion in the classroom would be better facilitated if there were some environment controls present to increase Nicholas’ independence.

Disclaimer: This case study has been based on Nicholas, a child featured in the video that accompanies this case study; However, the events described in this case study are entirely fictional, and do not depict actual events. This case study was produced for educational purposes only.