Tuesday, January 3, 2012

Constraint Therapy Evaluation

Allie had her evaluation for the constraint therapy program today and everything went perfectly. Allie liked her therapist, Jordan, and was mostly fine doing all the tests that she asked of her. All of Allie's evaluation was filmed. At the end of the program, the same evaluation will be repeated so that we can see a before and after of the skills that Allie will learn. We are very excited!

The best news we got today was that there was a scheduling miscommunication and Allie will be getting therapy Tuesdays, Thursdays, and Fridays instead of Monday through Friday. This could not be better for our work schedules. I don't usually work on Tuesdays and Thursdays anyway so I can take her on those days and Jonathan is working from home of Fridays and will be able to take her on those days. It really could not have worked out better.

We will have a total of 30 1-hour therapy sessions (spanning 11 weeks) where Allie will have a resting hand splint (like what is shown to the right) put on her left hand. The splint will be covered with a stocking all in the hopes of encouraging her to use her right hand. Allie will have a similar splint made for Righty to wear at night when Allie is sleeping. The Righty splint will help to help stretch her thumb muscle, which is the tightest and most obvious part of her cerebral palsy.

Jordan said repeatedly that Allie is a lot more capable than she was expecting. In addition to the Kennedy Kreiger Institute where Allie will be having her therapy, she also works with kids in an early intervention program similar to the Infants and Toddlers program that Allie is in. Allie was also very chatty with Jordan and wanted to tell her all about her daddy.

Allie: "Da da daadaddadd DA!"
Jordan: "Really, Allie? Tell me more!"

Allie: "DADADADDDAAADD Daa Daa!"

Here are some of the mini-goals that Jordan has in mind for Righty. Keep in mind that she made these goals without having ever met Allie.

1. Grasping a toy for 5 seconds. (She currently has a hard time independently grabbing an object but once she has it, she can hold on to it for a long time.)

2. Grasping a toy with finger extension and abduction---basically going from a fist to a fully stretched right hand, comparable to how you would hold your fingers out to tell someone you want 5 of something. (She is just starting to try to abduct Righty and are really hopeful that therapy will help push her along.)

3. Shoulder flexion of at least 100 degrees. (She has pretty good shoulder flexion but it takes a lot of thought. We hope this movement becomes a little more natural with the therapy.)
4. Consistently reaching to toys placed at midline of body. (Allie currently doesn't do this at all.)

5. Sustaining grasp on toy and successfully bringing toy to mouth. (She can hold an object and bring it to her mouth with Righty, but she does move her head around to help shorten the distance between hand and mouth.)

6. Protective extension forward to quick weightshift---see below how the girl's arms both go in front when her therapist pushes her forward. (Allie is inconsistent at best on this. She will put her left arm out but usually not her right.)
For the next few months, this is Allie's therapy schedule:

Mon: free!
Tues: Constraint Therapy (CT) in the morning, Physical Therapy (PT) at the Children's Hospital in the afternoon
Wed: free!
Thurs: CT in the morning, Speech Instruction at our home in the afternoon
Fri: CT in the morning, PT at daycare in the afternoon
Sat: Swim class in the morning
Sun: free!

We are putting both of Allie's other occupational therapies on hold until we figure out what her schedule will be like. The constraint therapy counts as occupation therapy so we didn't want to push Allie too much with OT. We are also considering an additional PT session starting soon. We really want her to crawl!

The program officially starts on Thursday and Allie will be fitted for the resting hand splints. Jonathan and I both left today feeling very encouraged by the revised weekly schedule, the positive way that Allie responded to the therapist, the ease at which we were able to travel to and from Baltimore, and the plan for the whole modified therapy. Jordan warned that not all progress is permanent, meaning that even after the program, Allie may not voluntarily do things with Righty that she has shown she is capable of doing during therapy. That's OK. We just want to make sure that she has all the opportunities possible. The more she can learn that she is capable of now, the easier things will be in the long run.

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