Tuesday, January 15, 2013

Developmental Evaluation and PattiBobs

The new year is off to a good start.  Warning, this post has A LOT of bragging.

Developmental Pediatrician 

Allie had a checkup with her new developmental pediatrician today.  Our insurance got this doctor as part of the HMO and cut off our referral to the Children's developmental psychologist that we have been seeing for the past year.  Unlike the neurologist switch that didn't go so well, this developmental pediatrician is amazing and replaced the crotchety Children's doctor who was always so pessimistic about what Allie was capable of.  The new doctor was very mellow, very sweet, and both Allie and I loved him.  

We got the our 3pm appointment at about 2:45, checked in, and we took a seat in the somewhat kid-friendly part of the waiting room, which is shared with a pharmacy.  This is the first time we had been to this building and I was thrilled to find out that it is less than 2 miles from our house!  Allie had boycotted her daily nap and I was nervous that she was going to be a pain during the appointment.  Much to my surprise, Allie had more energy than ever and she was running circles around the waiting room and darting into the other specialty offices whenever she could.  I would grab her and carry her back to our sanctioned corner and she would kick and scream the whole way.  Then we would repeat.  After a few visits to the radiology wing, the receptionist started saying "Hi Allie!" as she barreled in.

During one of her frantic laps, she tripped on the transition between carpet and tile and faceplanted onto the tile.  Her mouth filled with blood and she burst out crying.  No more than two minutes later, the bleeding had stopped and she was back to her rounds, even showing the radiologist receptionist her wound.  

Come 3:30pm, the doctor came out to the waiting room and apologized for the delay.  Allie liked him right from the start.  We went into the exam room and she was thrilled to see all the bins of toys to play with.  She happily pilfered while I gave the doctor all her history.  He was impressed by all the therapies that Allie gets.  Then, it was Allie's turn to play.  He brought out a peg board that Allie had trouble with during her last appointment with the Children's doctor.  Allie dominated it, put all the pegs in, and asked for more.  The doctor got out another peg board with square pegs, and Allie quickly beat that one too.  He said that completing the square peg is about a 22 month skill, so it was good that Allie found it so easy.

Then it was time for the shape sorter.  Allie skillfully put the circle in the circle spot, the square in the square, and the triangle with the triangle.  The doctor then put it in all different orientations and Allie did them all.  Once again, he was pleased.

He moved on to the receptive language test where Allie had to point to the object that he named.  She got 7 of 10 correct, which the doctor said puts her at about the 2.5 year range.  

The next test was coloring/drawing lines and circles.  The doctor drew a horizontal line and Allie copied it.  He drew a vertical line and so did Allie.  He drew a circle and she drew a circle.  Dot... dot.  Once again, he was thrilled.  He said that she held her marker better than kids her age typically do.  

He got out a baby doll and Allie shouted "My Baby!"  He wanted to see how she pretend played with toys.  He handed her a little cup and asked her to give the baby a drink.  She held the little tiny cup up to the baby's mouth, gave the doll a sip, and said "Aahhhhhhhh...." as if the water was really refreshing.    The doctor couldn't help but laugh.  He then gave her a piece of a tissue and asked her to wipe the baby's nose.  Allie wiped the doll's and her nose.  Another chuckle.  Then he asked her to give the baby a hug and Allie tucked the baby under her right arm and hugged and rocked the baby for a few seconds.

Lastly, he got out some little blocks, lined them up in a row to make the train, and pushed his pretend train around the floor in hopes that Allie would follow suit.  Allie copied and shouted "go! go! go!" as she pushed her block train along.  Test, passed.  He then asked her to stack the blocks and she got 6 high until she stood up and dramatically kicked them over and laughed.  He said that he was hoping for 3 blocks high so Allie clearly excelled on that one as well.

There were then some gross motor tests of walking and trying to engage her right hand more.  

Come 5:30pm, we were finally getting ready to leave.  His summary remarks: Allie is scoring at or above age level on all cognitive and language tests.  Her fine motor is lacking but only in her right hand.  He said "when you read the records for a kid with a stroke and infantile spasms, you expect to see a certain kind of kid.  Allie is not that kid.  She is astounding.  This is no guarantee about her future success but, as far as I'm concerned, things could not be going better.  Keep up with everything you're doing."  

Freaking amazing appointment.  


At Allie's last Physical Medicine and Rehabilitation appointment (discussed here), the physiatrist suggested that we get Allie a foot and ankle orthotic called an SMO to help her right foot from turning out when she walked.  Allie's physical therapist strongly objected (discussed here) and pushed us to wait and decide after Allie had been a strong walker for a couple months.  That time finally came and the physical therapist recommended starting off with these intense arch support in-shoe orthotic called a PattiBob (shown to the right).  These are sold over the counter and just need a shoe-fitter.

On Sunday, the three of us went to a local store that our PT recommended.  This place was a mad house.  There was a 30-45 minute wait but they gave us a buzzer and we got to go next door to the toy store to pass the time.  Allie had a lot of fun and even managed to get in a fight with a little girl over a rubber ducky.  Finally it was our turn at the shoe store and Allie got fitted right away.  The PattiBobs were $71!  I was kind of shocked.  Then we had to buy extra-wide shoes too.  

While the shoe guy was in the back looking for Allie's size, Jonathan and I were balking at how surprisingly expensive the PattiBobs are while Allie played at the train table with the other kid (shown below).  Jonathan and I were chatting when Jonathan looks up and says "Ummm... She's gone."  Allie had disappeared!  After a couple seconds of panic, we found Allie wandering into the back room.  We still have to get used to having a walking child.

The shoe guy came back and during the fitting, we mentioned that Allie had a stroke which is why her therapist wants the PattiBobs.  He looked genuinely shocked and said "I've been doing this for 41 years and I never would have known if you didn't tell me.  So many kids with her diagnosis are wheel-chair bound and she's walking around so well.  I never would have known.  You are so lucky!"

We really are.

The PattiBobs are great and we noticed a clear improvement in her gait with just a little extra arch support.  I'm excited for her therapist to see her on Thursday.
Shoe store chaos 

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