Gustavo is an energetic four-year-old who was diagnosed with other lack of expected normal physiological development in childhood and Microcephaly. Gustavo was initially unable to stand, walk, and sustain short sitting position without dependent assist to prevent loss of balance and risk of injury. Gustavo’s primary mode of transportation was to sit and scoot all around the house. Additionally, while maintaining eye contact with the floor to prevent loss of balance while sitting, he was unable to hold his head in a neutral position. The family’s goals for Gustavo were to ultimately walk without a gait trainer and stand without support to play with family members.

Gustavo was making progress with Physical Therapy services by beginning to stand with less assistance and stepping with hand hold assist when his mother reported the family would be moving to Michigan for family reasons. Gustavo did not progress after stopping services and eventually the family moved back to San Antonio to continue physical therapy with Therapy 2000. Gustavo was then able to progress with ability to stand with encouragement from family and increased his desire to explore his environment. Gustavo demonstrated decreased core strength and sitting balance but was able to improve with weight shifting in sitting position while playing with toys and attempting to eat at the table. He was also able to attempt to ambulate with hand hold assist and hip support in the forward direction to follow and play with siblings.

Gustavo has progressed with ability to step up and down steps in front of the house with rail support in either direction with stand by assist. He currently can ambulate without support as the primary mode of transportation in the house, over the uneven terrain in the front yard with head in midline position as well as the ability to visually track in all directions without loss of balance. He can currently stand without support to engage with peers and play with toys. Gustavo also has improved with his ability to jump, run, and perform standing and squat positions. He has improved with core strength and ability to sustain sitting without support at the table to eat and play with toys without loss of balance. His mother now feels comfortable sending Gustavo to school due to gross motor function gains made in physical therapy.

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