Monday, November 25, 2013

Parent Teacher Conference


Allie's teachers and I had her semi-annual parent teacher conference today.  The following is the summary of her developmental progress that her teachers wrote.

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SOCIAL/EMOTIONAL (Sense of Self; Responsibility for Self and Others; Prosocial Behavior)
Allie plays well by herself and has recently begun to briefly observe her peers playing before she plays alongside them or joins them in play.  Once she engages in play with her peers she will offer to share what she is playing with to another child.  Allie shows great confidence in meeting her own personal needs despite the weakness of her right side by: climbing playground equipment, grasping and using crayons, scissors, and tweezers.  She is able to follow two or more step directions from her teacher.  For example, after being directed she will wipe her nose, throwing away the tissue, and then wash her hands.  SHe expresses persistence in completing tasks by getting her coat from her cubby, putting a puzzle together, and sipping paper with scissors.

PHYSICAL (Gross Motor; Fine Motor)
Allie is acquiring gross motor skill by swinging a bat and a golf club at a stationary ball and by using a toy hammer to bang plastic nails into a foam surface.  She is able to use her feet to move a tricycle forward or backward but is still developing in using the pedals.  She uses refined wrist and finger movements in her left hand by pouring milk from a cup into a bowl of cereal, squeezing tweezers, and pounding and poking play dough.

COGNITIVE (Learning and Problem Solving; Logical Thinking; Representation and Symbolic Thinking)
Allie is developing in transitioning from one activity and maintaining focus.  She has the ability to continue and complete an activity of her choice without distraction but quickly loses interest during whole group activities.  Allie has begun to show interest in playing matching games and can easily match shapes, colors, and objects.  She is also showing a beginning interest in letters and numbers, being able to count 1 to 4 objects, and recognize that the letter "A" is for her name as well as for the word "apple".

LANGUAGE (Listening and Speaking; Reading and Writing)
Allie has the ability to follow simple two or more requests.  When the teacher announces "It is outside time.  Please go to your cubby and get your coat." She goes to her cubby to get her coat.  She is developing skill in entering into conversation using more than one or two word sentences.

NEXT STEPS AT SCHOOL AND AT HOME:
To continue to enhance development in the following areas:

  • Social-emotional: helping her to become comfortable in engaging in play with peers by coaching her on words to use i.e., "Can I play?" or perhaps having classmate play dates;
  • Physical: Continue to encourage and challenge her to use her right hand.  As well as for parents and teachers to continue sharing learning strategies on ways to enhance and strengthen her physical development especially on the right side of her body.
  • Language: by engaging in conversations with open ended questions.

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Saturday, November 23, 2013

Why we won't be doing Botox again

Playing at a friend's birthday party

Allie is now a month and a half post-Botox and we have seen some good and some bad.  The effects are just starting to wear off a little and this seems like a good time to reflect on what we have seen so far.

The good: Allie's walking is much more symmetric and she doesn't seem to limp as much.  Some of this may return as the Botox continues to wear off but we think she's built a lot of strength and there is a good chance that some of these results will stick.

The bad:  While we were initially encouraged by her right hand loosening, this turned out not to be a good thing.  Allie lost the ability to do a lot of things that she was able to do with Righty and it really crushed her confidence.  The looseness ended up being non-functional for her and, even though she has gained some strength in trying to push through it, it was a net negative experience.

Allie's teacher pulled me aside as I was picking her up yesterday and said that Allie is having a hard time lately.  Instead of playing with her friends like she did pre-Botox, she stands back and watches them play, seemingly unsure if she can play too.  Her teacher also said that since the Botox, Allie has been asking for help with everything and getting really frustrated when they try to get her to use Righty.  Apparently Allie has been asking for help to do simple things like clearing her plate from the table after lunch or throwing things away.  This is all stuff that she was fine with before.

It's a total bummer.  I hate the thought of her not playing with her friends because we hurt her confidence in her ability to do normal things.  Hopefully she'll regain her confidence as her functionality continues to return.

Knowing what we know now, we wouldn't have done the Botox.

Opthalmology Update


Allie had her followup opthalmology appointment last week.  Her last appointment was in September 2012 so we were way overdue for her "6 month checkup".  Oops.  In spite of the delay, it went really well and Allie was very well behaved for it.

After an initial vision exam, the nurse and doctor each loaded Allie up with a stack of stickers.  Her sweater was completely covered and was pretty pleased with it.  The nurse put in the eye dilation drops but Allie was a little pouty in the room afterwards.  I asked what was wrong and she said "No stickers on pants..."  When the nurse came in to check on Allie's eyes, Allie asked "One more sticker, please?  No, two??? Pants!"  We had completely wiped out the room's sticker supply so the nurse had to go hunt around for some more.  Allie really appreciated it.

After an in-depth eye exam, the doctor said that there is no noticeable sign of vision loss or eye damage.  She said it is still possible that Allie has a right visual field cut from the stroke but that she has figured out how to work around it.  With a field cut, the lack of vision never improves but the person gets better at remembering to look in the area where the vision is lacking.  Kind of like how you just remember to look in your blind spot while driving in your car.  Her optic nerve is still fair too but that is not completely indicative of damage.  It could just be because she is a fair skinned kid.

Moral of the story: we'll just have to wait and see what (if any) vision issues she has down the road.  The ophthalmologist told us to follow up in a year, which makes me feel like we didn't drop the ball too badly by putting this followup visit off so long.

Allie and I have started the tradition of getting ice cream together after doctor's appointments.  It kind of makes the whole event feel more fun.  This time, Allie was insistent that she wanted "hot" ice cream.  I'm still not sure what that means but luckily she was fine with her regular cold ice cream.

Sunday, November 10, 2013

Fun at the park


There is a park near our house that Allie loves and we bring her there for some good therapeutic play whenever we can.  There are several sets of equipment for all different levels of kids.  The first time we went there, I was so impressed because it is largely handicapped accessible with subtle ramps so kids with disabilities can play right along with typical kids.  I remember thinking to myself, 'how did I never think about accessible playgrounds?'  Allie has changed my perspectives in many ways.  

At the park, there is is a big hill down to a stream.  It is really steep. Before Botox, she had a hard time walking up it because her right ankle couldn't flex enough and the more she tried the stiffer her leg got.  It was very frustrating for her.  We walk up the hill now every time we go to the park and, while she still doesn't love it, she seems to be getting more confident.  Plus, the stream at the bottom of the hill is enough of a pull to get her down and then the playground on top is enough to get her back up.  I love it.

I woke up this morning to these great photos from Jonathan.  


Allie also found a big pile of leaves.  Look at her playing with both hands! 


Saturday, November 9, 2013

"B is for Beer"

Allie has been working hard on her ABCs.  She wants to read her alphabet book first thing in the morning and last thing at night.  She sings the ABC song to any song that is on the radio.  I think she thinks that is the only song people sing.  She sings it while she washes her hands, while she walks down the street, and while she rides in the car.  She still drops some letters occasionally but she's getting pretty good.



Her alphabet book is fun because she gets to slide a little window to show an animal that starts with each letter.  A is for alligator, B is for bear, C is for camel, etc. She is also getting good at identifying the different animals and learning to say all their names.  She has a little trouble with the B animal, however.

We were at her OT appointment last week and since Allie is so in love with doing the alphabet, the OT got out a wooden letter puzzle for Allie to try to do with Righty.  She had a little trouble maneuvering the pieces, as expected, but picked up a B and proudly declared "B is for BEER!"  The two OTs in the room gasped and looked at me like I was the worst parent ever.  I burst out laughing, turned bright red, and said "She's saying 'bear'.  I promise."  I'm not sure they believed me.

On the note of awkward pronunciations, her speech therapist is really concerned with Allie's word articulation.  During her annual assessment, she scored well on her receptive language (what she understands) and expressive language (putting together words), but scored at a less than 2 year old range for articulation even though she was 2 years and 10 months old at the time.

Allie has some strange word substitutions, such as "das" for "sky", "bite" for "bike", and "max n cheese" for "mac and cheese", but Jonathan and I don't believe that Allie is as behind as the test indicates.  When she's at school, she seems pretty on par with most of the kids in her class.  Her speech therapist is recommending that she transition to a speech-impaired preschool, which would be 2 days per week for 2.5 hours a day and would only include kids who have difficulty communicating.  Then she would get carted to her regular preschool by Jonathan or me.  This all seems like an awful idea to us.

I brought the idea of the specialty preschool up with Allie's teacher, whom we love, and she said that she never would have considered Allie to be delayed and that she seems to communicate fine with the other kids and the teachers.  I know she's not a speech specialist but she has spent the last 15 years or so with 2 year olds and that should count for something.

We pushed back on the preschool idea and instead increased the frequency of her current home-based speech therapy to once a week with alternating weeks at home and at school.  We also got her in the queue for outpatient speech therapy at the Children's Hospital where we currently do outpatient OT.  I look forward to having the Children's speech pathologist weigh in on the articulation.  It bothers me that she scored so low and, even though I think it's wrong, I don't want to just stick my head in the sand and ignore it if there really is a problem.

I'm currently in Japan for work and Jonathan is at home taking great care of Allie.  Here are some of the recent photos that he sent:

"Oh, hello Mama!"
Friends at last

I talked to her on the phone before she went to bed tonight and she informed me that I'm in "Jaaa-PAN" and that she had "1... 2... 3... 4... 5... 6... 7... 8... 9... 10 (slices of) pizza" for dinner.  Jonathan contests that it was only 7 of the 4 square inch pizza slices but Allie held firm.  Maybe she snuck some home in her pockets for later.

Sunday, November 3, 2013

Fall-filled Week

Allie has had a wonderful week, filled with Fall activities.

Last Sunday, Allie and I watched her BFF Abby run the Marine Corp marathon.  She loved watching everyone run by and got really good at cheering and clapping for the runners.


On Monday, her class went to a local orchard to visit a pumpkin patch.  All the kids rode the school bus and Allie really loved it.


Once the kids were unloaded, we took a hayride up the hill to the pumpkin patch.


Allie was a little overwhelmed by all her pumpkin options but she was up for the challenge.


She eventually found a pumpkin she liked that was "not too heavy."  She then went around and pumpkin "cheers-ed" all the other kids' pumpkins.


After a hayride back, she got to check out the animals.  I think the chickens were her favorite.


All the kids lined up on a hay pile for a class photo before getting back on the "cool bus" as Allie calls it.

On Thursday, Allie's school had a Halloween parade and she was very proud of her princess outfit.  Whenever she thought nobody was looking, she would twirl and twirl, admiring her dress.


Trick-or-treating at home was fun too, although she was incredibly shy and refused to say anything to the neighbors when she got to her door.  

On Friday, Allie and I brought Jonathan to the airport for his weekend trip to MN.  She was a really good sport about getting up at 4am to drive him.

On Saturday, Allie and I went to a local farm with our friends Chris, Shara, and their 1 year old Jake ("baby" as Allie calls him) that had themed kids areas and a petting zoo.  She liked exploring all the different areas.


And feeding the goats and sheep was awesome.



After the farm, we all went out for a great lunch and then home for a long nap.



This afternoon, Allie and I will be going to a musical at a kids theater nearby.  I hope she likes it!