QUEST!

Today Summer and I spent a couple hours at OKP so that she could complete a QUEST. No, we weren’t on a hunt for anything…. QUEST is a Quality of Upper Extremity Skills Test.

With the help of Ann our OT and Andree our PT, Summer was performed tasks that demonstrated her range of motion, fine motor skill, strength and ability to use her right hand and arm.

Summer’s attention span was not stellar, but she was pretty tolerant and we managed to complete all of the required skills at varying levels of function in between her running laps around the room and showing off her jumping and skipping skills.

Some of the skills we looked at were her reaching over head, to the side and out front. She did very well with these except she had about a 5 degree bend in her right elbow – so no points for that… She also had to try to supinate her right hand… no points for that either… but she did very well with picking up blocks and pegs and releasing on a target. She had a tough time with tiny objects too.

Summer will receive another assessment –AHA- Assisted Hand Assessment on Tuesday with our PT in Toronto so we will have a very good idea of her hand and arm function prior to CIT.

Both assessments will be repeated at 6 weeks after the cast is removed.

Summer is slowly becoming aware of the upcoming casting. She is excited that it will be pink and this morning asked me to remind her which hand her cast will be on.

Daycare Routines Assessment - 16 Days Until Casting….

Today we did a routines assessment at Summer’s daycare. The purpose is to identify all the things she does in the day and then assess where she needs help during her three week casting.

It also helps us determine when she will receive 1:1 time with her helper to work on her therapy activities.

We also looked at the environment to see if there are any safety issues.

There are the daily necessities such as:
Eating
 Ann and Marg to look for adaptive utensils that will still promote skill/movement development.
 Consideration for finger foods when appropriate.
Drinking
 Initially to use sippy cup with handles with progression to open cup with small amounts.
Dressing
 Assistance with coat as required.
Toileting
 Assistance with toileting – may require assistance with pants.
 Supervision required for safety
 Step up stool needed
Glasses
 Will require assistance in taking off and putting on glasses.

Wow, we take all these things for granted. Summer has developed all of these skills and does these tasks more or less independently. We’ll be temporarily disrupting her independence and will have to plan for her frustration and needing help.

I've set some goals for us to work on:
1. More frequent automatic inclusion of her right hand in play.
2. Incorporation of her right hand into eating routines.
3. Increase in dexterity and fine motor control in right hand.
4. Consistent ability to get right hand into wrist neutral position.

I know some of the skills she develops will be subtle and maybe I will be the only one to really see the improvement.

Then there is the ‘fun’ stuff - Play and Therapy Activities
 Painting – bulb shaped paintbrushes
 Cutting – training or spring loaded scissors available
 Drawing – larger crayons
 Gluing – use glue sticks
 Sandbox – consideration for keeping the cast as clean as possible.

We have few safety concerns:
 Stairs – Summer will require help with the stairs until we can assess her confidence while casted, as well, on the playground – Summer may not be stable enough for scooter and tricycle play. (Also - the sand box will be awful - but first things first - I'll have to find a cover for the cast to keep the dirt out/off.


Support for Summer:
 One of Summer’s teachers (who we really like – so calm and patient with the kids) will be backfilled for 2 hours per day so that she can spend some 1:1 time with Summer as well as help her when needed.
o She will build up to 1 hour for practicing 1:1 therapy and 1 hour classroom activity assistance.
o We’ll provide her with a daily therapy plan for the 1:1 time – specific activities and tasks to carry out.
o Provide training for the tasks with supporting visual materials.
 Ann– OT support Tuesdays at 09:00am
 Marg– IDP Once a week ad hock 09:00am
 OT assistant – participation to be determined.

General comments:
 Initially the 1:1 therapeutic activity session may be shorter and will lengthen as Summer builds up stamina.
 Summer may have different levels of tolerance from day to day – depending on her fatigue.
 Frustration cues for Summer are usually less emotional in the daycare setting. She is very good at asking for help when needed. She is more a whiner than a cryer when frustrated.

16 days... yikes it is coming up fast!

After school fun in the yard with Daddy

I like to play 'soccer' in the yard after school with Daddy. I am glad the snow is gone. Daddy said tomorrow we will try to navigate the shoreline in our canoe!

Thrilled with her progress

Summer had her block physio assessment yesterday. She sees a OT/PT Assistant weekly and then receives the assessment and treatment plan from her Physio. She reported that Summer was a delight and did very well!

She met her goals for walking up stairs and walking down stairs. She still demonstrates some decreased endurance for her left leg walking up stairs. She put her hands down to the next step walking up the last 4 steps of the long flight of stairs at the Y.

She also assessed line walking (looks at keeping her gait from widening too much) and she did well but steped off the line 2-3 times walking with her brace on and 1-2 times without her brace off.

Hard work is paying off!

Bunny Poop!

This morning was Summer’s first dentist appointment. On the way to town, Summer was struggling in her carseat, so I turned to her and said “do you know who is coming in a couple weeks?” She said “noooooo”, I said he has long ears… she said “noooo”, I said “ and big teeth!” she said noooooo, I said “The Easter Bunny! If you are good (i.e. stop struggling) he will bring you chocolate and maybe a toy. If you are bad, he will poop in your Easter basket! So are you going to be good or bad?” She said in her little voice and mischevious grin “bad!” Laughter ensued…

When we got to the dentist, the assistant seats us down, and she says, “Summer, is the Easter Bunny going to bring you some chocolate?” Summer looks at her, shakes her head and blurts out “Bunny Poop!”

I guess I deserved that one….

Her checkup went well, they managed to count her teeth and there is no visible signs of decay – whew!

What is CIT?

We are hoping that through CIT (constraint induced therapy) Summer can form new pathways in her brain to increase the quality of movement in her right hand and arm. Summer's unaffected hand/arm will be casted on April 12, 2010 and we will commence a 3 week CIT period.

There is much to accomplish before we actually get to casting day and Summer's Physiotherapist Maureen in Toronto at Sunnybrook suggested that we diary our experience. I had planned to start the week of the casting, but we have been busy organizing so many things to coincide with the CIT, that I thought it would be valuable to capture the information for future use.

CIT is a form of therapy that helps stroke and Central Nervous System damage victims regain the use of affected limbs. The focus of CIT lies with forcing the patient to use the affected limb by restraining the unaffected one. The affected limb is then used intensively for either three or six hours a day for at least two weeks. As a result of the patient engaging in repetitive exercises with the affected limb, the brain grows new neural pathways.

CI was developed by Dr. Edward Taub of the University of Alabama at Birmingham. Taub argues that, after a stroke, the patient stops using the affected limb because they are discouraged by the difficulty. As a result, a process that Taub calls "learned non-use" sets in, furthering the deterioration. It is this process that CI seeks to reverse.

Practitioners say that stroke victims disabled for many years have recovered the use of their limbs using CI. The American Stroke Association has written that Taub's therapy is "at the forefront of a revolution" in what is regarded possible in terms of recovery for stroke survivors.

Neuroplasticity (also referred to as brain plasticity, cortical plasticity or cortical re-mapping) is the changing of neurons, the organization of their networks, and their function via new experiences.

We know that the 'years before five last the rest of our lives' and the brain is most 'plastic'during these years. We hope this contributes to a successful CIT period.