THE CASE OF ELISA

Diagnosis and compromised functions

Elisa is a 21 year old female affected by a cerebral palsy with
congenital diplegia (ICD-9-CM diagnosis 343.0) therefore she
cannot control the movement of her lower limbs. She also presents
a medium difficulty with the control of her upper limbs. We have
observed a moderate dystonia at a muscular level, which gives her
difficulties to a full postural control of the torso and the head.
The language area is compromised: Elisa expresses herself with
guttural sounds and her own expressivity, particularly through her
eyes and her facial mime. Elisa can control only in part the
movement of her upper right limb, while she finds more difficult
than the use of her left upper limb, particularly more difficult than
the performance of tasks of final motility.
Activities and participation
Elisa is capable of moving on an electric wheelchair for mediumto-long distances. She is also able to support herself and move
from the chair to the bad and vice versa with the supervision of an
operator and his minimum physical strengthening.
She is a sociable girl by nature, balanced and motivated to
improve her quality-life. She is cognitively complete and she is
able to understand simple and more difficult expressions both of
the concrete dimension and the abstract of reality. Elisa
communicates through the use of two augmentative and
alternative communicative-tools, which she always brings with
her in the side pocket of her wheelchair. In addition she uses a
laptop (with an adapted keyboard and mouse), which is in her
room and allows her to express (through writing) her own needs
and moods in a more detailed form. She also has a program of
vocal synthesis of what she writes, which allows her an even more
immediate communication with other people. At the high school
she attended (a high school in her hometown) these alternative

communication-strategies have already been used successfully.

Her formal learning has given good results in terms of how she
applies her formerly acquired knowledge. Elisa shows good
results in Mathematics and Italian, however she is able to write on
computers by using only her right hand, but she shows a slight
difficulty due to the slow movement due to the dystonia already
described and observed. There are no problems in her reading. In
the dimension of the personal care, Elisa needs to be assisted in
the hygiene of her body and the clothing aspect, even though she
shows a cooperative attitude and she takes part in it with the
operator. Elisa can wash her hands and face but also brush her
teeth. Concerning food and nutrition, she uses a special tool (a
spoon with an adapted handle) to take meals even though she
needs help from an assistant to cut the food.
Everyday life
Elisa has been living for about five years in a Health Center for
people with disabilities, which offers her the services and the
support she needs for the main activity of her daily routine. For
one year she has chosen to start study-lessons at a Law University.
Elisa loves to spend her free time with other people, watching
movies or participating in planned outings.
Atmosphere and Environment
Elisa has a drug-therapy schedule administrated daily, which is
aimed at limiting the issues of her movement caused by the
dystronia. In relation to her university career, Elisa is now able to
follow the classes through electronic devices and soon she could
handle her second exam. Despite the difficulties that took away
time and energy, Elisa seems now strongly motivated to complete
in short-terms her university studies. To study she uses a computer
and an electronic device (CD) on which she uploads her university
study program. She also receives help from an acquaintance who
supports her with a fortnightly frequency to verify her level of

education. Concerning the social environment; there is an assistant

administrator who is available to fulfill the practical needs of
Elisa. This important figure personally provided the laptop that
Elisa has in her room and he is also involved in her university
career (in terms of communication with teachers). In addition, the
assistant administrator is understanding together with the Social
Services how to make an easier and more punctual deposit of the
invalidity pension for Elisa, although at the moment this problem
remains. The administrator, in collaboration with the staff of the
centre, is finally seeking special assistance advices for her
education in terms of detailed software to facilitate the reading
skills and the learning skills of Elisa whilst she studies for exams.
There is also a large network of volunteers who help to improve
the relational needs of Elisa, by involving her in outgoings from
the Health Center and also in leisure activities that interests her,
particularly every Sunday night a group of volunteers take Elisa
and other guests out of this Center to the movie theater with a bus
arranged by the Center itself. Elisa has a close friendship with her
roommate: with her she expresses often her emotional crisis of
sentimental nature. In this regard she would express interests to
some gentlemen of the Center, but in the end her feeling is not
returned. Such situation makes her sometimes irritable which
causes episodes of psychical sufferance expressed through the act
of crying. The intimate family is composed of only one brother.
After her parents death her brother needed to decide with Elisa
his choice to locate her in a long-term care structure where she
could have lived. This decision has been offered for both of them
but because of her brothers work and personal issues (he lives in
a one-room flat), he could not have taken care of his sister as their
parents did previously. Her brother comes to visit her periodically,
approximately once a month. The extended family sees the figure
of the paternal aunt as an important reference point from the
emotional point of view for Elisa. She visits her niece weekly and

organizes a homecoming at her own house for Christmas and

Easter holidays.