Monday, May 23, 2016

Andrew's first zoo field trip

Andrew's class had its first field trip to the zoo on Friday.  It was a beautiful day and Andrew could not have been more excited.  Note the green vest he and his classmates had to wear as it was the recurring villain of the trip.  He really did not want to wear it and kept taking it off when he thought we weren't looking.

The first stop was the farm petting zoo where Andrew got to visit close up with a cow.  I think Andrew would have climbed into the pen if he could have just made it over that top board. 

We then went to see the tigers and the vest struck again.  After a strong escape attempt, I had to tie the vest tighter so he couldn't weasel out.  It's hard to see in the photo but there is a tiger walking along the edge of the water immediately above Andrew's left hand.  The tiger was going to play with a big ball floating in the water.  Andrew strongly objected to this plan.  He started yelling "NO BALL!!!! NO BALL!!!  NOOOOOOOOOOOO!!!!!" as soon as the tiger touched it.  I guess Andrew wanted to play with it instead?

He refused to look at the lions over the recurring vest feud and we instead made our way to the monkeys.  He really liked them, especially the little baby.  Note his classmate won her anti-vest battle...

After lunch, we headed back on the bus.  He got the vest off (finally!) and was cracking himself up the whole ride.  I couldn't even make eye contact without him laughing.  We played a prolonged game of hard to get, where he dramatically turned away from me and declared "No kiss!"  I would then kiss his cheek and he would belly laugh.  It was a delightful trip.

Tuesday, May 17, 2016

New Evaluation

Allie had a new evaluation a couple weeks ago and things are going well.  It's a different test than before so we can't compare the percentiles but here is her breakdown:

Fine Motor Control - 84th percentile
Manual Control - 58th percentile 
Body Coordination - 79th percentile 
Strength and Agility - 84th percentile 


Standardized Tests

The Bruininks-Oseretsky Test of Motor Proficiency (BOTMP), Second Edition (BOT-2), was used to assess Allison's motor skill development.

Fine Manual Control
The Fine Manual Control composite is comprised of the subtests of Fine Motor Precision and Fine Motor Integration. Allison's score placed her at the 84th percentile, Above Average for the entire Fine Manual Control composite, when compared to other children her age.

The Fine Motor Precision subtest consists of activities that require precise control of finger and hand movements. It has five drawing items, one paper-folding item, and one cutting item. The object of each task is to draw, cut or fold within a specified boundary and performance is evaluated based on how well the child remains within the boundary.

Allie did very well coloring in the circle and star. She was able to draw a line in the path without moving outside the lines. She connected the dots well. Allie was able to fold the paper but not on the line. She also cut out the circle well with her L hand but it was >1/4 inch outside the line

The Fine Motor Integration subtest requires the child to reproduce drawings of various geometric shapes that range in complexity from a simple circle to overlapping pencils, and measures the child's ability to integrate visual stimuli with motor control.

Allie did well copying the other shapes. Some of them were smaller than the picture. She also missed one point on the star. She did well not overlapping lines and making the edges even. The pencils did not overlap but did look like pencils

Manual Coordination
The Manual Coordination composite is comprised of the subtests of Manual Dexterity and Upper-Limb Coordination. Allison's score placed her at the 58th percentile, Average for the entire Manual Coordination composite, when compared to other children her age.

On the Manual Dexterity subtest, Allison scored within the Below Average range when compared to her same-age peers. This subtest uses activities that involve reaching, grasping, and bimanual coordination with small objects. Emphasis is placed on accuracy, but the items are timed and the child is told to perform the tasks as quickly as possible to assess level of dexterity. Testing items include making dots in circles, transferring pennies, placing pegs, sorting cards and stringing blocks.

Allie was able to draw 11 dots in circles in 15 seconds. SHe was able to transfer 4 pennies from one hand to another in 15 seconds. She was able to do 6 pegs in the peg board while timed. She sorted 10 cards into two piles and was able to string 2 blocks on a string

On the Upper-Limb Coordination subtest, Allison scored within the Above Average range when compared to her same-age peers. This subtest consists of activities designed to measure visual tracking with coordinated arm and hand movement. Tasks include catching, dribbling and throwing a tennis ball.

Allie was able to catch a tennis ball with multiple trials 5 times. She was able to capture it with her L arm against her body. She caught one ball tossed to her. She was able to drop and catch a ball with her L hand trapping the ball against her body 5 times. She did try and dribble a ball with one hand (again a tennis ball) and completed it 4x with L hand and 2x with L and R. She did better throwing a ball at a target underhand vs overhand

Body Coordination
The Body Coordination composite is comprised of the subtests of Bilateral Coordination and Balance. Allison received a score which placed her at the 79th percentile, Average, when compared to other children her age.

On the Bilateral Coordination subtest Allison scored within the Above Average range when compared to her same-age peers. This subtest measures the motor skills involved in playing sports and many recreational games. The tasks require body control, and sequential and simultaneous coordination of the upper and lower limbs.

This involves touching your nose with your index fingers with eyes closed, jumping jacks, scissor kicks, thumb and fingers pivoting and tapping fingers and feet. more challenged with the scissor kicks, which were new.

On the Balance subtest Allison scored with the Average range when compared to her same-age peers. This subtest evaluates motor control skills that are integral for maintaining posture (stability of the trunk) when standing, walking or performing other common activities.

Tandem on a line for 10 seconds with eyes open and 6 seconds with eyes closed. Able to walk heel toe on a line without stepping off. Able to stand on one foot on the line for 10 seconds and then 5 seconds with eyes closed. Able to stand on the balance beam on one leg for 10 seconds and with eyes closed 4 seconds.

Strength and Agility
The Strength and Agility composite is comprised of the subtests of Running Speed and Agility, and Strength. Allison received a score which places her at the 84th percentile, Above Average, when compared to other children her age.

On the Running Speed and Agility subtest Allison scored within the Average when compared to her same age peers. Testing activities included a shuttle run, hopping on one or both feet, and stepping over a balance beam. These were all timed tasks.

Completed a shuttle run outside in 14 seconds. Able to sideways step over the balance beam 23 times. Hopping on her L foot 24 times. Hopping on one foot side to side 2x and with both feet 12 times

On the Strength subtest Allison scored within the Above Average range when compared to her same-age peers. This subtest measured trunk and upper/lower body strength. Testing activities include standing long jump, push-ups, sit-ups, wall-sit and v-up.
Long jump of 41.5 inches. Completed knee push ups x13 with cues for form. Sit ups x12 in 30 seconds. Wall sit for 17 seconds and a superman of 29 seconds

Completed the BOT2 today. Allie did very well. Most challenging was manual coordination which includes manual dexterity and upper limb coordination. Most of the activities she was average for her age or above average with the exception being manual dexterity which is challenging because of her hemiplegic R hand. Continue to progress scissor kicks, ball skills with a small ball and strength in general.

Continued physical therapy will address:

Body Functions and Structure
·      Balance
·      Endurance
·      Range of Motion
·      Strength
·      Hypertonia
·      Flexibility
·      Gait
·      Coordination

Activity Limitations
·      Unilateral stance
·      Walking on uneven surfaces

Short Term Goals:
·      Allison will gain >5 degrees of R ankle DF to help prevent tripping and optimize gait pattern. Time Frame: 2 months. Goal Progressing
·      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
·      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
·      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
·      Allie will perform single limb stance x20 seconds BLE without additional support for balance or grounding. Time Frame: 3 months. Goal Progressing: 2-4-16 able to stand on her LLE almost 20 seconds. R is more stable at ~4-5 seconds. Continue to progress stability.
·      Allison will be able to hop on one leg 10 reps each without support. Time Frame: 5 months. Goal Progressing: 2-4-16 Able to hop on her LLE 8 times and R 1-2 reps. Will continue to work on RLE hopping
·      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 Met on 02/25/16 

Long Term Goals:
·      Allison will ride a tricycle without LE stabilization x10 feet. Time Frame: 4 months. Goal Progressing: Goal met- Allie is able to ride a tricycle without LE support now.
·      Allison will be able to catch a >5" ball with 2 hands 3/5 reps. Time Frame: 4 months. Goal Progressing: Goal met 10/14/14
·      Allie will be able to gallop with a smooth pattern x15 feet. Time Frame: 2 months. Goal ProgressingGoal met 8-18-15
·      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 

·      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 Met 2-4-16. Able to complete much more comfortably down the steps now without the rail
·      Allie will be able to skip smoothly >10 feet without stopping or LOB (2-4-16)

Monday, May 2, 2016

Day Out with Thomas, Round 2

We took the kids to do a Day Out with Thomas this weekend.  Allie and I did it last year and she loved it, so we were excited to try it with Andrew now that he was older and very interested in Thomas.

Andrew somehow missed the gigantic Thomas train when we walked in but ran over to the model tracks to watch the characters zoom by.  He shouted their names as they chuffed past.

Then we got in line for the ride and he spotted the big Thomas.  He and Allie both went absolutely nuts. 

 We got on the train and kids played with my glasses and each other until we left the station.

Andrew narrated the whole ride for us, shouting "CAR!!!" or "TREE!!!" or "DOG!!!" the whole time.  When Thomas blew his whistle, both kids cheered.

After the ride, they went on the carousel.  They were very excited until Allie realized she accidentally picked a horse that didn't go up and down.  She was devastated.  

To make up for her carousel disappointment, the kids went on a train wheel ride where they go up and down a few feet in a circle.  Andrew thought he would like it when he was close to the ground but he quickly changed his mind when they went up.  He spent the whole ride yelling "DOWN! DOWN!"

 I think his terror added to Allie's enjoyment.

Andrew's big boy bed

Our little boy is getting bigger by the day.  Last week he moved out of his crib and into a big boy toddler bed.  He's very proud and has slept shockingly well.

He picked out his comforter all by himself and loves to point out the cars and airplanes in the patterns. 

He also loves that we all pile in his not-quite-big-enough bed to cuddle and read stories.

Sunday, May 1, 2016

A new EEG and a new plan

A few weeks ago we noticed that Allie was having trouble remembering some words.  She brought her "teddy bear" to school for show and share and couldn't remember the word "teddy".  She got a new squirt gun and asked me dozens of times what kind of gun it was because she couldn't remember the word "squirt".  I alerted her neurologist and she wanted to get an EEG right away to see if Allie was having any seizure activity. 

Allie was a trooper.  She has to fall asleep during the EEG so she got a hefty dose of Benadryl before the appointment.  She really dislikes the goo in her hair but stayed relatively still while the technician put everything on.  There were only a few tears and a couple "I don't like you when you're doing that" directed at the poor woman.

Two hours later she was done and we could go get ice cream (shown above).

The neurologist called a couple days later with the results.  Unfortunately, Allie has been having abnormal brainwaves while she's sleeping, which could impair her concentration and memory.  We're almost doubling her twice daily medication over the next couple weeks.  So far she's tolerating it well.

She'll be getting another EEG toward the end of summer to see if the additional medicine has made a difference. Finger crossed.