Friday, February 8, 2013

Constraint Therapy Update

Which one is Righty?  Sometimes, it's hard to tell.

Today marked the end of week three of Allie’s constraint therapy at the Kennedy Krieger Institute in Baltimore.  She has been spending an hour there every Tuesday, Thursday, and Friday morning and mostly enjoying it.  She gets to play with lots of fun toys that are only available when she has the cast on and she seems pretty darn proud of her Righty work. 

Outside of our three hours of formal therapy weekly, we try to do at least an hour of home-based therapy with the cast on every day.  This homework is probably more difficult for Jonathan and me than it is for Allie because (as we have re-learned) it requires a good bit of restructuring of her day to fit it in.  On Tuesdays and Thursdays when I’m home with her, we do at least a half hour of blaring music while we dance around and she pops bubbles with Righty.  Something about the music and the dancing makes her less frustrated with an otherwise monotonous activity. 

We’ve also learned that even if Allie refuses to use Righty to play with a toy, she’s willing to use it to clean up.  She is becoming more and more like Jonathan every day.  For example, if she doesn’t want to stack blocks with Righty, I just dump them out and say “OK.  All done.  Clean up time!” and she’ll happily pick up all the blocks and put them back in the container with Righty.  I even got her to push the box of blocks all the way across the room to put them away.  It’s amazing what she’ll do if she thinks that she’s getting out of therapy. 

Our hopes for this round of the constraint therapy are that Allie will:
·         Gain better ranges of motion with her shoulder and elbow, and
·         Improve her ability to open and close her hand for grasping and dropping. 

So far, we have noticed a big improvement in her shoulder.  She seems to have a nearly full range of motion.

Her elbow is improving too.  The motions seem much more fluid and she able to able to functionally use it when it is positions other than fully extended or at a 90 degree angle.  One of her therapists even noted that she seems much more comfortable with engaging her elbow as needed.

Her grasping is getting better too, but not necessarily in the ways that I would hope.  Her ability to open or close her hand is getting easier for her, but she still has a hard time getting her thumb and pointer finger all the way open.  However, she seems to be getting better at working around them, which is good in its own way.

All this being said, I think the best thing that has come out of the therapy so far is that she is much more willing to engage Righty for daily tasks when not casted.  She volunteers Righty to take off her shoes, blow kisses, point to body parts, etc.

She is doing so much cool Righty stuff that it is sometimes hard to fully appreciate all that she is doing.  I was re-filling out a chart that we created for KKI during our first stint last year where we had to rank Allie’s abilities in key areas on a scale of 1 to 10 (1 being not at all functional and 10 being perfect) and also rank our satisfaction with each area.  It was surprising to see the differences in our responses from last year.  Our ranking of her abilities in several areas dropped from last year in spite of her dramatic gains in those areas.  It took me a moment to put myself in my shoes as of a year ago and remember what I then thought was possible.  At the time, I was hoping that Allie would be able to move her arm in some way to eventually be able to, say, carry a lunch tray at school with both hands or dress herself.  Now, I know these things are completely possible and I’m hoping things like to be able to carry a full water bottle in her Right hand and to tie laced shoes with two hands.  The level of functionality and dexterity that I have come to hope for is significantly higher than what I ever would have thought possible a year ago.

Good for her for teaching me never to underestimate her. 

1 comment:

  1. Good work, Allie! You've been amazing since day one. And a good picker upper, too. Love, Gama