Emily Update

My God where did the past month and a half go? Its been a blur, simple as that. Its been a bunch of ups and downs too (and no Renee, unfortunately none of them were in my marital bed).

On the one hand, I had the blessing to teach the best bunch of students I've ever had, period. Who knew that bringing coffee to class was like winning the golden ticket? Note to self: there is no reason to ever teach non-caffieinated persons again. Conversely, it has been hard dealing with the death of both my grandparents in such a short span of time. There's so much to say about that, but considering this blog is supposed to be about not taking life so seriously, I'm going to skip that subject for the time being to give you all a long overdue update on Emily's therapy progress.

As the days and months have ticked by, Emily has been attending therapy regularly, three sessions per week. Her schedule has changed slightly; she now has speech and OT on Wednesday and group/music/developmental therapy on Thursdays. To say her speech therapy is going well is the understatement of the year. Emily just loves Miss Shelly, and will do anything and everything to please her. Just the mention of Shelly's name leads to smiles and claps, and when Shelly enters the room, Miss Em does somersaults! Its just too much cuteness for one kid, really. Thinking about it makes my smile muscles hurt.

We hardly even need the PECS book anymore; only when Emily is tired (like first thing in the morning) or if she needs something that she doesn't ask for all of the time. I'm still using PECS to teach her new words, although the toilet picture isn't working yet. Nonetheless I think its one of the best things to ever happen to Em. I would highly recommend this type of tool for anyone with a child who has a speech delay.

Her language is really beginning to flourish. Its not uncommon for Emily to use small sentences throughout the day. We have been working on verbs for the past two weeks, and she can say things like, "Shoes off!" and "Swing!" and "Go night-night". She has mastered many animal names and sounds, and can verbally identify the primary and secondary colors. The most exciting thing is the fact she has started using those little language words that make all the difference in the world, things such as "the", "a", and even the pronoun "I". The icing on the cake: she is learning to say "Please". Once she starts talking, I'm going to have another mini-me on my hands!

Occupational therapy is also fantastic. Miss Sue has so many wonderful things for Emily to do. OT is conducted in a gym like environment, so there's swings, a slide, a mini-basketball game, a bike, even a climbing wall! When exposed to a lot of the large, gross motor activities, Emily still has the tendency to freak out and become very disorganized. Sometimes as a parent its really hard to watch, because the disorder in her brain is apparent on her face. However, as the weeks have gone on and she's become familiar with the environment, she is able to better handle the situation. We have also discovered through these sessions that, when placed in an unfamiliar environment, there are a few things that calm Emily down in less than a minute: a silky blanket, a bottle to suck on, tight hugs that imitate swaddling, and (surprisingly) small toys, especially matchbox cars. She loves them! To think I used to kick her out of Nora's room for playing with all of the small toy sets in there, simply because they weren't age appropriate. I was taking away the one thing she needed to feel at peace! Thank goodness for Sue. Otherwise I would still live in tantrum central.

Finally (yes this long post is almost done but geez I have a months worth of stuff to say!), music therapy rocks. Pun intended. Emily is my little singing superstar. Everyday she and Nora sing all of their favorite hits, including the ABC song and Jingle Bells. She also sings the songs with Miss Angie, and when she strums the guitar, she strums in time to the beat. I couldn't be happier for her. Part of the reason she has this group therapy is to help prepare her for school, and I am quite sure she will do well in an academic environment. I also hope when she gets a little older she will be able to take some kind of music or voice lessons. The kid has soul.

Emily's OT Evaluation and Assessment Report

A lot of you have been asking questions about some of the diagnosis information I've received from the occupational therapist. Since most of this is new to me, and foreign in many ways, I thought I would include part of her assessment report for you all to read. Indeed, many of you have a lot more medical background than I, and perhaps you can help me understand some of the things that seem to be going on with my little stinkerbelle.

The following excerpt was taken from the "Early Intervention Evaluation/Assessment Report" dated 2/19/10 and 2/23/10.

"Clinical Observations:

Musculoskeletal: Emily presents with range of motion within normal limits and adequate strength to complete basic gross motor tasks of carrying a toy across the room and pushing a door open. Muscle tone appeared in the low end of a typical range as evidenced by tendency to assume a "w" sit pattern for floor play and palpation.

Fine Motor/Grasping: Emily demonstrated functional ability to manipulate objects with both hands using age appropriate distal prehension... (this continues but it was all normal)

Visual Motor Integration: Emily reportedly loves puzzles and was able to place 3 puzzle pieces correctly in a form board when placed in random order. She was able to build a tower of 6 cubes agter demonstration and minimal assistance to begin (i.e. counting first 2 blocks placed). Emily was unable to imitate vertical or horizontal lines with marker and paper. When asked to snip with sissors, Emily touched the scissors to the paper but was unable to produce cuts.

Communication: Emily demonstrated inconsistent eye contact with the therapist which may have been related to high level of visual distractions in the therapy room. Once acclimated, Emily several times took the therapist hand, leading to a toy she wanted and pointed and looked, verbalizing "this this". When given additional processing time, Emily on several occasions would repeat back a word when modeled by the therapist, i.e.; "ball, green, clean up, swing, down, up". She had difficulty initially expressing what she wanted without modeling and would try to use other means to express i.e. pointing, gesturing, leading the therapist, etc. but would become quickly frustrated if she did not get what she wanted.

Sensory Processing: Sensory processing refers to the way an individual registers, modulates, and uses incoming sensory information for appropriate use (adaptive/functional responses). Adaptive responses are seen in how an individual reacts to stimuli (i.e. Movement, visual, touch, etc.), events (i.e. transitions, open spaces, room or schedule changes), and toys or utensils (desire, avoidance, preference, etc). Organization of sensory information is needed to adapt to, deal with, or respond adequately to environmental demands.

Emily has significant difficulty transitioning out of desired activities, waiting for a desired activity or toy. She often results with creaming, tantrums or aggression towards her mother. Her mother reports that they currently use time outs in her room for 2 minutes with her door closed. They have begun to incorporate transition songs learned from her musical therapist Angie for goodbye with success. When extremely upset, she will reportedly use her silky blanket for soothing and suck her thumb.

Auditory: The auditory system receives, organizes, and utilizes auditory information to facilitate communication and cognition. Integration of the auditory system with the vestibular system and proprioceptive system has affects on the central nervous system functions that include arousal, attention, motor functions, spatial awareness, and motor responses.

Significant difficulties noted in this area both in the understanding of more than 1 step directives, and ability to prioritize sounds in her environment. Per the sensory profile, Emily's family frequently has to speak loudly to gain her attention or touch her; she frequently takes a long time to respond, even to familiar voices, and frequently appears to be ignoring her mother when she is talking. It was also reported that this has improved a little since beginning therapy over a month ago. She seldom startles to sounds and seldom appears affect by busy or noisy environments.

Visual: Per the sensory profile, Emily almost always enjoys looking at moving or spinning objects and almost always prefers fast-paced brightly colored TV shows. Her mother reported they have removed all TV's from their home because she will persevere on watching and will become hyper-focused and not engage with others with the TV is in the house.

Vestibular: The vestibular sense responds to and provides information related to the changes in head position, gravity, and movement. Vestibular input plays a role in the integration of an individuals's balance, extensor muscle tone, and equilibrium responses. It affects the ability to use both sides of the body together, and coordination of head, neck and eyes moving together. It also has an affect on the processing of auditory-language information, and behaviors related to the arousal system.

Per the profile, Emily almost always enjoys physical and rhythmical activities (i.e. being bounced, swinging, rocking or car rides), almost always becomes upset when placed on back for diaper changes and almost always resists having head tipped back during bathing. In the evaluation, Emily frequently jumped from activity to activity and did not engage for very long with trampoline jumping or swinging, especially when movement was imposed by the therapist.

Proprioceptive: Proprioception allows awareness of the position of muscles and joints. Proprioceptive input provides us with information as how far to reach, with how much pressure, timing, etc. It also provides us with feedback as to where we are in space and our relationship to things outside of ourselves.

Emily reportedly takes risks in play without regard for personal safety inclduing climbing on things, etc. She was reported by her development therapist to often engage in proprioceptive seeking activities.

Results/Implications: Emily's strengths include a supportive family and mother who appears interested in the therapy process and in helping her daughter, age equivalent grasping skills, good strength, functional mobility and interest in engaging with adults if motivated by activity and clear expectations are set. Her challenges include atypical sensory processing which impacts her ability to prioritize sensory information and respond appropriately to it, specifically proprioceptive, tactile and auditory. Emily appears to have trouble modulating her responses to input and either under-responds (not noticing) or over responds. Her over responses pose a safety risk for herself and others and limit her ability to problem solve situations adequately. In addition, Emily present with visual motor skills below age level which may be impacted by her difficulty following adult directed tasks and processing verbal instructions.

Emily presents with signs indicative of mixed responsiveness to sensory input and atypical modulation of responses. These significantly impact her ability to engage appropriately in home and community tasks with her family and peers. In addition, she resorts to non-functional behavior within her activities of daily living including toileting issues and food intolerances. Emily's visual motor integration skills are recommended to be re-assessed as her sensory process is addressed to determine accuracy of age equivalency."