S: D. entered therapy room and stated excitement over beginning to write. D.

also noted his

impatience and frustration at his communication device not recognizing his head switches,
adding extra time before the session could begin.

O: D. was seen for 40 minutes in OT room to address original sentence creation and mechanics
of writing (capitalization, punctuation, and spacing) in order to increase independence and
completion in expression of ideas for schoolwork tasks, as well as increase independence in
daily activities and environmental mobility through ability to recognize and alert others to
safety concerns. During session, D. completed one original 16 word sentence using
communication board hooked to laptop. D. independently identified 3/6 spacing errors in the
sentence, and was independent in selecting a space between words in 1/3 opportunities of
asking what was missing. On all other occasions (pausing to see if selection made
independently), D. required verbal prompts to select a space. D. correctly navigated to home
screen to select icon instead of typing word in 4/6 trials. On selecting capital letters, D. did not
make a selection on any opportunity (0/6). D. required 1 verbal prompt for punctuation at end
of sentence, in 1 trial.

A: D.s performance reflects the need for him to maintain as much independence as possible in
ability to express ideas and accurately communicate as his medical condition has worsened
with age. The goal of the communication board is to allow D. an opportunity to complete school
work in a similar manner as peers and maintain independence even with condition worsening.
D. is encouraged to use icon selection when able to increase speed in communication. D.s
performance in this session displayed his excitement to express ideas through writing, as well
as his abilities to remain engaged in a task, as the sentence writing involved 34 of the 40 total
minutes. Also, performance reflected current condition. As the session continued, D. quickly
fatigued with using head controls, making an increased number of errors and needing extra
time for letter or icon selection.

P: D. will continue to be seen for at least 30 minutes in OT room in order to address writing
mechanics and independence in expression of ideas to allow for completion of school tasks and
interactions with peers. D. will be seen in one week for scheduled session; sessions will
continue as planned until IEP expires, at which time adjustments and alterations to plan of care
can or will be made.