Josh is a 13 year old student who is in 7th grade. He has a medical diagnosis of hypotonia along with an educational diagnosis of orthopedically impaired. The hypotonia primarily effects hand functions, making it difficult for Josh to write legibly even for short periods of time.

On the WISC-R, Josh received a verbal IQ of 153 and a performance IQ of 108 yielding a full scale of 135. He is enrolled in accelerated classes, however the staff has discussed a change of placement to a less demanding class because of concerns over written productivity. Due to his medical condition, Josh fatigues easily which makes it difficult for him to keep up with the class as far as writing is concerned. His teachers report that Josh is able to produce 50% of the written work that the other students produce.

The school Josh attends is a two story building. It is arranged in subject area wings to facilitate collaboration among teachers who teach like subjects. While most classrooms are on the first floor, the Science and Computer labs are on the second floor. With the exception of the English, Computer and Science labs, most classrooms do not have computers. Each Science lab has a computer that students utilize to maintain a data base of information obtained during experiments. In English, students have access to two computers per room for word processing.

Josh is involved in several projects for the semester, he is concerned about getting all of the work done. In science, the class is developing an essay that compares and contrasts scientific accuracy as portrayed in the television shows ER and Chicago Hope. The seventh grade English class is reading The Secret Garden in English and must complete an analytical book report by the end of the semester. In social studies, Josh is involved in a cooperative learning group which is considering the factors that influence the migration of wildebeests on the plains of Africa.

In order to maintain a heavy class load, Josh saves his work for the evenings and completes assignments on his computer at home. He works approximately 3 hours each evening and turns in completed work the following morning.

Josh receives occupational therapy at school for 1/2 hour a week which focuses on upper extremity strengthening, fine motor strengthening, and endurance for hand work. Presently Josh receives OT services in the resource room where he does hand exercises and practices typing on a manual typewriter. The OT feels he can concentrate better and is not a disruption to the other students when his therapy is provided in a separate classroom.

SETT Framework