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Motor Feeding Skills: Oral phase was judged to be disordered due to poor lip closure, reduced tongue mobility, reduced anterior posterior lingual movement, tongue thrust, increased oral transit time, uncontrolled bolus, and oral hypersensitivity. Pharyngeal phase was judged to disordered due to delayed pharyngeal swallow, vallecular pooling, pyriform sinus pooling, reduced laryngeal closure, transglottic aspiration during the swallow, and poor sensitivity to aspiration no cough ; . Recommendations: Patient to continue to receive speech and language therapy to develop and improve receptive and expressive language skills, as well as oral-motor therapy to normalize sensitivity. Interventions should consist of 90 minutes weekly. Language emphasis should be placed on establishing joint attention, encouraging babbling, imitation, and turn-taking, stimulating independent vocalizations, increasing variety in phonetic repertoire, stimulating babbling and use of jargon, developing use of communicative gestures, developing receptive and expressive vocabulary, developing functional play with objects, fostering imitative and independent verbalizations, and developing response to cued directions. Oral-motor interventions should include direct oral-motor stimulation exercises to normalize sensitivity to tactile stimulation and to facilitate tooth brushing and oral swabbing. Patient should receive hearing screening and tympanogram to determine her present level of auditory function. 6 12 02 Splint Medical Plaza, Las Vegas, AR., Consultation referred by Dr. M.S. Instance to Dr. Adam C. Gold. Procedure: Two-view chest. Impression: Bilateral consolidation. Infiltrate seen anteriorly over heart. Possible left lower lobe pneumonia. A bubble of gas seen above diaphragm may represent a hiatal hernia. 7 02 Splint Medical Plaza, Forth Smith, AR., Consultation referred by Dr. M.S. Instance to Dr. David G. Albers. Procedure: AP and lateral radiographs of right lower extremity. Impression: Fracture of distal femur. This involves distal femoral metaphyseal region and its junction with femoral shaft. There is impaction at fracture site. No other fractures noted. 07 19 02 The Gregory Kistler Treatment Center for Children, Inc., Forth Smith, AR., Physical Therapy Re-Evaluation performed by Rose C. Stevens, P.T. Tests administered were Gross Motor Function Measure GMFM ; , the Pediatric Evaluation of Disability Inventory PEDI ; and clinical observations. Patient's abilities prior to her fracture were taken into consideration in regards to these tests. Patient scored as follows: GMFM ; - a ; lying and rolling 82% Dimension percent score, b ; sitting 57%, c ; crawling and kneeling 12%, d ; standing 0%, e ; walking, running, and jumping 0%. Total 30%, Goal Total Score: 17%. PEDI ; : Mobility Functional Skills Normative Std. Score: below 10, Mobility Caregiver Assistance Normative Std. Score: below 10. Normative standard scores below 10 indicate significant motor delays. Inspection Posture: Patient has lateral C curve convex ; to right of thoracic spine. Patient sits with posterior pelvic tilt, decreased spinal curves, and forward head. Patient can stand with forearms resting on stable object and knees hyperextended for three minutes. She cruises with her trunk leaning heaving against a support surface with maximal assistance. Muscle Tone: Patient presents with fluctuating muscle tone and underlying low muscle tone. Range of Motion Strength: Overall passive range of motion is within normal limits. 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