Monday, June 30, 2014

Field Trip and Sleep Over

Allie has had a fun week.

On Friday, her class went on a field trip to a local park with a train and a carousel.  She had a great time riding the school bus and playing with all her friends.  Since we're only a week out from her baby brother's arrival, I'm really glad that I was able to chaperone the trip.  She was so happy to see me waiting when her bus pulled up to the park that it totally made lugging my 9-month pregnant self around worth it.  Allie kept going up to strangers and telling them "This is my mommy and she has a baby in her belly" as if they couldn't tell.

Holding on with two hands all by herself

Then on Saturday, she had a sleepover with her BFF Abby.  They had a great time.  Allie got to stay up late, eat chocolate ice cream with sprinkles, have her nails painted, and play in the pool.  What more could a girl ask for?  On the drive home the next morning, Allie declared "I'm going to have a sleepover with Abby again soon! I'll eat LOTS of sprinkles!"


It's amazing to me how much Allie is using her right hand without prompting.  She is still so proud to show me whenever she's doing something with Righty, but I love it even more when she just uses Righty and doesn't think anything of it.  We're pretty darn lucky.

Monday, June 23, 2014

Helping Out

Allie has been very helpful lately, especially with getting the house ready for her baby brother who is arriving in 2 short weeks.  We bought a little rolling cart to put next to our rocking chair and Allie was insistent that she be the one to roll it into the room to put it in its final location.  She is loving going through her old toys and deciding which ones baby brother will like---and which ones she should play with again just to see if they still work, of course.  She has been particularly helpful with household chores.  She spent at least an hour mowing grass with Jonathan this weekend.  I came outside to watch and she shouted "I'm helping Daddy with the grass.  It makes Daddy REALLY happy!"  She's a sweetheart.

Wednesday, June 18, 2014

Helping in the kitchen

One of Allie's jobs at home is to help cook dinner.  She usually sits on the counter and plops things in bowls, washes fruits and vegetables, and spins the salad spinner.  Yesterday after she'd finished her salad spinning duties, she started washing some of the dishes that I'd piled in the sink and using Righty to turn the water on and off.

It was just a simple moment where she was using her Righty without really thinking about it, but it was one of those moments that I didn't think would be possible.

Saturday, June 14, 2014

Mommy and Me Weekend

Jonathan is in Minnesota for a dear family friend's funeral this weekend, which means that Allie and I are having a girls weekend.  Since the impending baby is only 3 weeks out, our friends are keeping an eye on me and keeping us busy with fun get togethers.  

Allie and I went to the park this morning and I was completely blown away with how independent she is now.  I think a lot of this is due to her time at KKI.  We were there for about an hour an a half and Allie was running, climbing, jumping, swinging, sliding, and playing with other kids the entire time.  I saw her climb up a three rung ladder without thinking about it and climb a fake rock mound that she's struggled with for a while.  She and a boy about her age climbed the rock mound together and went down the slide attached to it.  She then ran across the playground to me and I told her I was so proud of her.  She said "I climbed it with my friend!  I'll do it again!"  Then, she did.

It was so cool seeing her be so comfortable and independent with all the play equipment.  

Later tonight, we were hanging out in the backyard and she played with her stomp rockets by herself for a half hour while I lounged on the deck and watched.  This is a great toy for her because she needs two hands to get the rocket on and then balance and leg strength to stomp hard on base.  Her goal is to shoot the rockets into trees.  She's not quite there yet but she's getting it higher every day.

Yesterday, we went and visited a PT center that we're considering.  It's a gymnastics and martial arts center that has OTs, PTs, and speech therapists on staff.  Allie had a great time doing the tour and really liked the PT we met with.  However, the PT had some concerns about Allie's leg strength and range of motion and was very vocal about her belief that Allie needs major orthodics on both of her feet and also a brace on her right knee.  I appreciate her concern and I definitely don't want to shoot the messenger, but Allie's other PTs and Physical Medicine doctor haven't ever indicated a strong need for bracing.  I would strongly prefer not to load her up with braces unless they're absolutely needed, but I guess it's something that we should look into.  Time to make a new Physical Medicine appointment.  

Thursday, June 12, 2014

KKI Discharge Evaluation

We got the final discharge paperwork from KKI constraint therapy program in the mail yesterday.  Here are some of the highlights.

She picked up two new grasp patterns.

At admission, Allie could do the following three grasp patterns with her right hand:

  • Raking: extending arm toward a desired object but does not yet have the ability to purposefully grasp it in the hand, may place fingers over top of object but unable to squeeze to grasp it.
  • Gross (or Palmer) Grasp: fingers flex simultaneously around the object in the midsection of the pal. The thumb is adducted and not assisting with grasp.
  • Cylindrical Grasp: the fingers and thumb close and flex around a cylindrical object such as a tube or pencil, which is stabilized against the palm of the hand.

At discharge, she could do the following two new grasp patterns:

  • Lateral Pincer: object being secured between the adducted thumb and radial side of the flexed index finger. The thumb is not opposed, but slides over in a pattern of adduction to trap an object against the side of the index finger. Web space is closed.
  • Inferior Pincer: thumb adduction and emerging opposition to secure the object against the extended index finger.  The object is held proximal to the pad of the finger.

Here are the grasp patterns that we're still working on:

  • Hook Grasp: transverse metacarpal arch is flat, fingers are adducted with flexion at the IP joints, flexion or extension at MCO joints.
  • Disc Grasp: finger abduction graded according to the size of the object held, hyperextension of the MCP joints and flexion of IP joints.  For larger objects pad of fingers may be all that is in contact with objet. Example: grasped used on the lid of a jar to open it.
  • Spherical Grasp:  the fingers and thumb close and flex around a round object such as a tennis ball, which is stabilized against the palm of the hand.

  • Tripod Pincer:  thumb opposition to the digits 2 and 3.  The object is held proximal to the pads of the fingers with space visible between the object and the palm.  The ring and little finger are flexed. 

  • Superior Pincer:  this grasp is characterized by thumb opposition to the index and middle fingers.  The object is held at the pads of the index and middle fingers, as well as the pad of the thumb.  The OP joints of the index and middle fingers range from extended to slightly flexed, with flexion of the MCP joints. 

She improved her bilateral hand skills.

The Assisting Hand Assessment (AHA) measures how effectively children with unilateral upper limb impairment use their affected hand/arm (assisting hand) in play requiring bimanual performance.

Initial score: 48 (39% of the possible score)

OT's initial assessment comments: "There is a slight delay in initiating use of her RUE (Right Upper Extremity) during play.  Her LUE (Left Upper Extremity) often touches the objects first, grasps it and then she brings her right hand to the toy.  Allison primarily uses her RUE as a stabilizer or to support/hold objects.  She stabilizes objects with some difficulty and effort.  Stabilization is not always reliable for all objects, especially those that are larger in diameter or heavier.  She seldom uses varied positions of the upper arm/shoulder but when she does she has a large ROM (range of motion).  She moves her R fingers with some difficulty and does not always abduct her thumb.  She has some difficulty coordinating movements between her right and left hands.  Tasks are performed with reduced precision, slowly or with external stabilization on her trunk or table top surface.  She reaches for objects on the table primarily with her LUE and has limited reaching range of motion with her RUE.  She does not release objects in her right hand directly to the table but rather pulls them out of it with her left hand of opens her hand with delay or effort.  To reach for objects on her right side, she crosses midline with her LUE.  She uses the same gross grasp for all tasks; she does not have a variety of grasp patterns in her RUE."

Discharge score: 61 (59% of the possible score)

OT's final assessment comments: "At discharge Allison is not reaching to her right side with her right hand more often.  She releases toys and objects to her right side more often and with verbal cues.  She picks up some items from the table spontaneously such as paper, wood, and metal cymbals.  She is also releasing these items directly to the table with a fully open hand.  For other items she released them from her right hand to her left hand quickly and without delay.  Release is now active with full opening of her hand with improved efficiency instead of pulling them from her right hand.  When reaching for objects she has a completely open hand and actively abducts her thumb during reach and grasp.  She is using right gross grasp but on a variety of objets but can grasp a greater variety of items with  that grasp pattern.  She stabilizes objects both on the table top with her whole body weight and with grip.  She has overall improved coordinating when manipulating objects with 2 hands.  She supinates to midway actively."

She improved her overall right arm use.

The Quality of Upper Extremity Skills Test is used to evaluate quality of upper extremity function in the following four domains:

  • Dissociated Movement
    • Admission score: 71.88
    • Discharge score: 75
  • Grasps
    • Admission score: 44.44
    • Discharge score: 85.18
  • Protective Extension
    • Admission score: 50
    • Discharge score: 41.66
    • Comments: At initial testing Allison was more cooperative with protective extension testing.  At discharge a number of items were not tested due to decreased cooperation despite multiple attempts. 
  • Weight bearing
    • Admission score: 74
    • Discharge score: 98 

She met most of the OT goals set for the program.

Here are the 6 goals that we set at the beginning of the program.
  1. Allie will open age appropriate containers of various sizes 75% of the time with no more than 2 verbal cues for strategy.
    • Admission status: total assistance required 
    • Discharge status: ongoing/emerging, 90% met.  She can open Ziploc bags with verbal cues but has difficulty with larger containers such as PlayDoh containers and needs assistance to open markers.
  2. With supervision Allie will doff her pants from hips to ankles using both hands.
    • Admission status: with increased time, doffs pants with dominant hand only.
    • Discharge status: met.
  3. Allie will doff a t-shirt with moderate assistance.
    • Admission status: total assistance required.
    • Discharge status: met.
  4. Allie will don a t-shirt with maximum assistance.
    • Admission status: total assistance required.
    • Discharge status: met.
  5. Allie will advance her pants from knees to ankles with 2 hands and supervision. 
    • Admission status: total assistance required.
    • Discharge status: met.
  6. When grasping toys at eye level or below, Allie will reach grasp with thumb abducted 75% of trials.
    • Admission status: reaches with thumb adducted 90% of trials; self-initiates strategy of stretching thumb prior to trying to grasp.
    • Discharge status: met.

Summary of Skills

Allie has has mastered or greatly improved the following skills:
  • Supinating to midline 
  • Active thumb abduction 
  • Pushing pants down with 2 hands
  • Wrist extension
  • Releasing items in her right hand directly to the table instead of passing them to her left hand
  • Carrying items with her thumb in abduction 
  • Carrying items like a tray with forearm supinated 
  • Carrying item in right hand, while using left hand to open drawer/cabinet
  • Squatting to floor to retrieve things
  • Opening eye level drawers/cabinets with thumb abducted/in cylindrical grasp 
  • Carrying a large ball/bin with two hands 
  • Carry up to 1 lb object in right hand
  • Weight bearing through right hand while playing using her left hand 
  • Going up the stairs with an alternating pattern 
  • Peddling a tricycle

Emerging skills:
  • Pulling pants up with 2 hands 
  • Taking off and putting on a shirt 
  • Carrying items with 2 hands and maintaining proper item orientation 
  • Right forearm supination in combination with almost full elbow extension 
  • Jumping with both feet evenly 
  • Catching a ball
  • Going down the stairs with an alternating foot pattern 
  • Steering a tricycle 

Tuesday, June 10, 2014

No more speech therapy

Allie has been discharged from her county speech therapy.  Hooray!

Her speech therapist is going to continue seeing her once a month for an academic check-in just to make sure that she continues to thrive in her preschool.  This academic monitoring is particularly important because our county-run occupational and physical therapy would get dropped if Allie isn't being followed by someone interested in her cognitive development.  It's a great compromise for us.

In other news, Allie figured out how to jump off a step today.  It was pretty cool to see because I remember her physical therapist talking to us years ago about how hard that kind of jumping can be.  This isn't something that we've really been working on during physical therapy so it's nice to see her just pick this stuff up somehow.

Monday, June 2, 2014

Parent Teacher Conference

Before I get to our parent teacher conference, check out Allie climbing up the playground rope ladder all by herself!  She has been obsessed with this rope ladder for years and she's had some success climbing it with assistance or with a hovering teacher, but this is the first time that I saw her do it all by herself without anyone hovering over her.

I'm so proud!

OK, now to the parent teacher conference.  Here is the summary that we got from the teachers (here is the summary of our last conference for comparison).


Social/Emotional (Sense of Self; Responsibility for Self and Others; Prosocial Behavior)
Allie understands and follows classroom routines with limited guidance.  She demonstrates self-care skills by using the bathroom, dressing, and washing her hands.  She has personal initiative showing interest in many different activities.  She, with guidance, has the ability to name the feels she is experiencing.  She interacts with peers, takes turns during play, participates in imaginary and dramatic play, and works with others to solve problems with guidance being prompted by her teachers on words and phrases such as "Can I have a turn?", "Can I play?", "You want to play?", or "You can play when I am finished."

Cognitive (Learning and Problem Solving; Logical Thinking; Representation and Symbolic Thinking)
Allie uses mathematical thinking when counting out two packs of crackers from the snack bag when it is passed to her.  She also demonstrates this skill by filling a scale with rocks until one side goes down and playing a variety of matching games.  She explores social learning by pretending to be a cook preparing and serving food to peers and her teachers; when working with a friend pulling chairs together to make a train; and when following the instruction of her teacher when she says, "Everyone who has a purple shirt you may go to the table."

Physical (Gross Motor; Fine Motor)
Allie demonstrates find-motor skill using the same hand to hold writing tools, scissors, tweezers, droppers, etc.  She demonstrates body awareness by using a sufficient amount of pressure when holding objects and writing tools.  She is acquiring skill in bilateral motor coordination by making the effort to use two hands when playing rhythm sticks and using drumsticks.  She demonstrates visual motor control using visual cues when looking at hands to reach for and grasp objects, i.e. getting puzzle pieces to complete a puzzle.  She continues to acquire gross-motor coordination by using her large muscle groups to maintain posture in the sitting position in a chair and the floor, and also, in galloping and hopping on two feet.

Language (Listening and Speaking; Reading and Writing)
Allie demonstrates skill in listening and understanding being able to get her eating supplies when directed; listens more easily in a one-on-one conversation than in a group setting; being able to name and point to many body parts; and beginning to use some positional and directional words such as around, backward, next to, and behind.  She is using plurals, pronouns, and possessive words such as "my" and "her".  She shows interest in entering into conversations by: singing songs or chanting rhymes; telling what she did in the past, present, and future; and repeating what a peer has asked.

Next Steps at School and at Home 

  • Continue to help develop social-emotional skill through coaching and modeling behavior; and 
  • Language skill by inviting her to engage in many conversations, pulling her into the conversations by asking "why", "what if", and other questions, and talking about the past, present, and future events.