Tuesday, September 22, 2015

Andrew's first walk

Andrew and I took an early trip this morning to get Allie some Fall-appropriate clothes.  She's grown so much over the summer and only had one long sleeve shirt from Spring that remotely fit.  We got there only to realize the store didn't open for another half hour, so we went for a walk around a nearby pond to pass the time.  Andrew loved it.  He walked about a quarter mile by himself and was captivated by the ducks, geese, and fountains. 

It was so nice to spend some one-on-one time with him.  He's starting to understand (and follow!) instructions, which makes outings feel more manageable.  And while we go for long walks almost every day, this was the first time he wasn't in a stroller or a carrier.  I think it was a turning point and I'm looking forward to many more walks to come.

Monday, September 21, 2015

Clemyjontri Park

Yesterday we went to the local Clemyjontri Park, a huge all abilities park with four playgrounds flanking a carousel.  I never thought much about accessibility for parks until we had Allie and she was struggling with stairs.  It's heartbreaking watching a kid want to play on a playground but not be able to.  I'm glad places like Clemyjontri Park exist.

Clemyjontri Park
The kids had a blast exploring the park and testing out the new swings.  Andrew loved that he could get on the play equipment and run around himself and Allie loved the red swings.

There is also a huge maze.  Allie and I teamed up to try to beat Jonathan and Andrew through the maze.  The only problem is that Andrew desperately wanted to follow me, so Allie ended up leading a four person team.  

There were lots of fun things to play on.  Andrew pushed Allie on a springy whale.

We finished up with a couple rides around the carousel.  It was a nice afternoon. 

Friday, September 18, 2015

Night-stretching brace and shoe insert

Allie has grown a lot over the last few months and we're starting to notice some tightness in her right leg again.  It's been over 6 months since she last had Botox in her right leg and we're starting to think about doing it again.  I mentioned the idea to her physical therapist who suggested that we try an adjustable night-stretching brace for a little while first.  I'm all for trying it because I would love to lessen the use of Botox, if possible. 

The brace (shown below) gives a passive stretch overnight, which will hopefully improve her dorsiflexion.  Allie's tone is mostly fine when she's not moving.  She has a good range of motion and her heel is mostly on the ground when she's standing.  However, when she walks she typically puts the ball of her right foot down first followed by the heel.  This gets more pronounced as she runs with her heel rarely touching the ground.

To test the idea of a night splint out, Allie has been wearing her old ankle foot orthosis (AFO), which never really worked during the day.  She was shockingly excited about it because her physical therapist told her if she did a good job with the trial she could pick the colors of the night brace.

Yesterday, after a successful week of the AFO at night trial, Allie was fitted for the brace and picked the rainbow pattern for the long trap, the flag pattern for the body of the brace, and red for the smaller straps.  Allie has been campaigning for us to put a rainbow flag in the front yard and I think this was her way of fulfilling the urge. 

It will still be a few more weeks until she gets the brace but I'm optimistic.  We've been really bad at stretching her every day like we're supposed to so maybe this will help make up for it.  

I forgot to mention it before but a couple months ago Allie started wearing an insert in her right shoe to make up for a half centimeter leg length discrepancy between her right and left leg.  It's called a hot dog (shown below) and just slips in her shoe just like a regular insole.  The improvement in her gait was immediate.  She's much more symmetric and has not tripped once since she started wearing it.  It also promotes more weight bearing through her right leg, which may lessen the chance of her developing a larger leg length discrepancy in the future. It's nice when a quick and easy solution actually makes a difference.

Monday, September 14, 2015

Andrew's first haircut & Allie's new swim class

 I'm happy to announce that the mullet is gone.  My little fuzzy looks like such a big kid.

Last weekend Allie resumed her swim classes after a much longer than expected hiatus.  We took a break last spring ahead of constraint therapy because we didn't want the supposedly waterproof cast getting all mucky and rash-provocking.  Before we knew it, summer was ending and Allie was getting desperate.

Allie did amazingly.  She kicked symmetrically, went under water by himself, and over did really well. She's very proud and so are we.

Wednesday, September 9, 2015

First day of school 2016

Yet another school year is in swing.  It's hard to believe next year Allie will be in kindergarten.

Andrew loved having his photo taken with his big sister but he hated the family shots.

Tuesday, September 8, 2015

Physical Therapy Evaluation

Allie recently had a new physical therapy evaluation and she's making so much progress!  Here it is:

Gross Motor Skills:

  •  Jumping:
  Jumping jacks x5 with cues for foot and arm position. Attempted scissor kicks. Able to complete with handheld support
  • Biking: Able to complete the tricycle outdoors with no tape on her feet and only minimal assist to start and steer
  • Swing: Able to complete the playground swing (sling seat) without assist and with pumping today:

Objective Measures:
The Peabody Developmental Motor Scales - 2nd Edition Standardized Test

The Peabody Developmental Motor Scales, Second Edition (PDMS-2) was utilized to assess Allison's overall motor skill development.

Stationary (posture, strength, balance, etc.)
Now: 75th percentile
December 2014: 63rd percentile
August 2014: 25th percentile

Locomotion (running, jumping, climbing, etc.)
Now: 63rd percentile
December 2014: 37th percentile
August 2014: 25th percentile

Object Manipulation  
Now: 50th percentile
December 2014: 25th percentile
August 2014: 25th percentile

Gross Motor Skills

Stationary Skills

On the Peabody Developmental Motor Scales (PDMS-2) subtest of Stationary skills, Allison's scores placed her in the 75th percentile for her chronological age. This subtest measures a child's ability to sustain control of her body within its center of gravity and retain equilibrium. Allie has improved in this area from a raw score of 50 and percentile of 63%. She was able to stand on her LLE [Left Lower Extremity; her left leg] for 10 seconds and her RLE [Right Lower Extremity; her right leg] for 4-5 seconds. She can stand on her tip toes for 8 seconds without moving. She is also able to imitate movements with her arms. Allie completed 7 sit ups in 30 seconds. She was not able to complete a push up on her knees.

Locomotion Skills
On the PDMS-2 subtest of Locomotion Skills, Allison scored with the 63rd percentile for her chronological age. This subtest measures a child's ability to move, including running, hopping and jumping forward. In December Allie scored a raw score of 152 and was in the 37th percentile. She is now able to:

  • Stairs: Allie is able to complete a reciprocal pattern ascending and descending without the rail. She is not confident descending but can complete this technique when asked.
  • Jumping: Allie is able to jump down from an 18" surface and land on two feet with symmetry. She is able to jump forward 30.5 inches and over a 6 and 9 inch hurdle (no hesitation today). She can jump on her L foot forward 10 inches. She attempted to jump on her R LE but was unable to leave the ground. This is a huge improvement that she is attempting to jump on the RLE without assist. She requires assistance to hop on her L and R foot forward. She can complete a turning jump and a lateral jump
  •  Running: Allie is able to run 45 feet in 5.59 seconds. She demonstrates decreased arm swing on the R. She is able to stop within two steps when asked. Running 10 feet forward and back Allie was able to complete this in 4.88 seconds.
  • Balance: Allie was able to walk on her tip toes across the room and on a line. She is able to walk on a balance beam forwards and is progressing with a heel toe pattern. She can walk on the beam backwards as well without heels touching toes.
  •  Other: Allie can complete a forward roll. She is able to gallop. Skipping is progressing but not coordinated and smooth.

Object Manipulation
On the PDMS-2 subtest of Object Manipulation, Allison scored within the 50th percentile for her chronological age. This subtest measures a child's ability to coordinate arm and leg movements in order to manipulate balls (catching, throwing, kicking). Allie has progressed from a raw score of 33 and the 25th percentile in December. She is able to kick a ball across the room and in the air. She is able to throw a ball over and underhand across the room. She is able to catch an 8" ball 2/3 reps hugging the ball to her body. She can hit a target from 5 feet away 2/3 reps throwing underhand and 3/3 reps overhand throwing. From 12 feet away she hit the target 1/3 times overhand. Allie can bounce a ball and hit the wall one time. She can catch a tennis ball with her hands 1/3 reps. She could catch a bounced ball 1/3 reps.

Shuttle run: This test measures how fast a child can run 30 feet, pick up a block, return to starting line and repeat. (120 feet total).
Current: 23.33 seconds (8-18-15) [Average time for a 5-6 year old is 15.1 seconds]

Timed floor to stand:
This test measures the time it takes for the child to get up from the floor (from seated in a crossed-leg position), walk as quickly as possible for 3 meters, turn around, walk back to starting line, and return to sitting on the floor.
Current: 6.81 seconds (8-18-15) [Average time for a 5-6 year old is 7.5 seconds with a standard deviation of 1.5 seconds]

Allie has improved greatly on the Peabody since December especially with jumping, single limb stance and ball skills. She is much more stable with attempts to stand on her RLE alone. Continue to work on hopping, skipping and higher level balance activities.

Goals: Patient will continue to work on the following short term goals next session:

  1. Allison will gain >5 degrees of R ankle DF to help prevent tripping and optimize gait pattern. Time Frame: 2 months. Goal Progressing

  2. Allison will be able to perform single limb stance on each LE x3-5 seconds demonstrating improved balance. Time Frame: 2 months. Goal Met on 10/14/14

  3. Allison will be able to step onto uneven surfaces without falling 3/5 reps demonstrating improved balance. Time Frame: 2 months. Goal Met on 10/14/14

  4. Allison will be able to jump over a 6" hurdle with a two foot take off and symmetrical landing. Time Frame: 2 months. Goal Met on 01/13/15

  5. Allie will perform single limb stance x20 seconds BLE without additional support for balance or grounding. Time Frame: 3 months. Goal Progressing: Progressing on both LE, working on endurance with the LLE. Able to stand on the RLE for 4-5 seconds. Working for more stability. 8-18-15
  6. Allison will be able to hop on one leg 10 reps each without support. Time Frame: 5 months. Goal Progressing: Currently about to complete several hops on the L with assist and on the R with assist. 8-18-15
  7. Allie will be able to walk across a 4.5" balance beam in tandem with a 3 second pause without stepping off. Time Frame: 4 months. Goal Progressing: Able to walk across and is starting to attempt tandem 8-18-15

Patient will continue to work on the following long term goals:

  1.  Allison will ride a tricycle without LE stabilization x10 feet. Time Frame: 4 months. : Goal met- Allie is able to ride a tricycle without LE support now.

  2.  Allison will be able to consistently complete a reciprocal pattern ascending and descending the steps with one rail or less. Time Frame: 4 months. Goal Progressing: Allie has improved with the stairs. Working on consistency and confidence descending the stairs 8-18-15
  3.  Allison will be able to catch a >5" ball with 2 hands 3/5 reps. Time Frame: 4 months. Goal met 10/14/14
  4. Allie will be able to gallop with a smooth pattern x15 feet. Time Frame: 2 months. Goal met 8-18-15
5. : Allie will walk with a consistent heel strike or heel contact without catching her toes >75% of the time. Time Frame: 3 months. Goal Progressing

Sunday, September 6, 2015

California Girls' Trip

I had three days of work meeting in northern California so Allie and I turned it into a girls' trip and used the opportunity to visit some of my family. It was awesome.

Allie had never ridden in a cab before and she was so excited that she camped out front a half hour before the driver was set to arrive.  Note the blue pillowcase.  Allie and I went to the fabric store a few days before and she spotted this great blue fabric with Thomas the Train and some of his friends on it.  She fell in love so we bought a yard and turned it into a pillow case minutes before she took it outside so the impending cab driver could see it.

The cab ride was everything she had hoped for.

We had some extra time at the airport so we played an epic game of tag that spanned two terminals.  It was fun running all over the place but we needed to stop occasionally for photos with giant chocolate things...

and to check in on our plane...

Finally, it was time to get on the plane.  Allie tested out her new headphones and they worked great the whole flight.

 When we finally made to our hotel, grandma met us and got big hugs.

The next morning Allie and I woke up on East Coast time and spent a few hours cuddling in bed watching Thomas.  There weren't any good cartoons on tv at 4am so she declared the tv broken.

After breakfast we went over to Allie's great grandma's house for a tea party in the back yard.  Allie made Great Grandma a big cup of dirt tea.  Yum.

Allie, Grandma, and I then drove out to Santa Cruz so Allie could see the boardwalk.  She preferred the beach.

We rented a house in Santa Cruz for the night.  Allie called the house the "Bubble Shack" because we let her set up a bubble maker in the living room.  She loved it.

The next day we went to a railroad line to do a train ride through the redwoods to celebrate Great Grandma's birthday.  It was beautiful and Allie declared it the best part of our whole trip.

That evening Allie, Grandma, and I drove down to Monterey.  My first day of work meetings was there the following day and luckily she had a lot to keep her entertained, including the beach...

The Monterey Bay Aquarium...

And of course Grandma...

Later that night, Allie and I parted ways with Grandma and the two of us drove up to Palo Alto for the day.  She and I fell right asleep at our new hotel and were strangely awoken by an unscheduled front desk wake up call.  It took me a moment to realize that the person on the phone was actually Great Grandma who had driven out with my Uncle Mike to spend the day with Allie.  Mike had to go to work for a while but Allie and Great Grandma spent the day at a kid's museum and a playground.

Allie was exhausted by this point as we made our way to the East Bay for the evening.  Luckily our hotel that evening had a surprise for Allie: a whole gift bag full of toys!  It made her night.  We had dinner with Grandma and went to sleep early.

Grandma came over bright and early the next morning and Allie slept in until 10am, which is unthinkably late for our 6am riser.  I went off to my meetings and Allie had a fun day of hanging out with Grandma, going to Pump it Up, and relaxing.

That evening we drove to the airport and had a relaxing dinner while we waited to board our red eye flight home.

I was very nervous about this flight because 4 year olds and overnight flights don't seem like a great combination for me.  However, Allie was asleep within minutes of takeoff and we both slept almost the entire flight.

We had another fun cab ride home and finally got to see Jonathan and Andrew.  It was  a great reunion.

What made it even sweeter was that the three of us then took a 3-hour long family nap time.  It's good to be home.