May 15, 2011

Occupational Therapy Results

Once again, after a really long break, I say that I'm ready to get back into this. Do I mean it? Only time will tell.  It just seems as if there are so many things to get done during the day, and I never seem to be able to get onto this blog to make a simplepost.  And now, I can't remember where I am in our little history.  I've missed so many important things...I have a lot of backtracking to do!

To help from making a lot of clarifications along the way in regards to other things, let's just get right into our visit to the Occupationl Therapist and what we found out from her.

Upon the request of Jessica Leger, I called the child occupational and physical therapists associated with the Women's & Children's Hospital.  Unfortuantely, they had a waiting list months long.  I did a little investigating online and found a couple other places that sounded promising.  One that I called gave us an online free consultation and asked me to bring Emerson in for a one-on-one evaluation.  They, too, had a months long waiting list, but were willing to at least evaluate him and put us on a cancelled appointment call list while we waited for a permanent standing appointment.

On January 16th (goodness, that was quite a while ago!), Emerson and I went to Pediatric Therapy and Learning Center--Pediatric TLC--for Emerson's evalution.  I had filled out a long questionnaire (and had the daycare provider fill it out as well) about Emerson's medical history, his abilities and any sensory issues.  His evaluation consisted of drawing, tracing, placing pegs, folding papers, picking out shapes, etc for the fine motor activities and climbing, jumping, swinging, crawling, etc for gross motor activities.  Because he took over twice as long on the fine motor activitysection (part of the reasonin being his constant need of redirection and his distractibility to noises coming from the general therapy area), Allison was unable to complete the gross motor activity section.  She got enough of an idea, however, to complete his diagnosis and evaluation.

So, what were the results?  Less than hopeful, but not horrible. All I needed was to hear about more issues with Emerson that we would have to pay heed to and try to wok with, but that's exactly what we got.

Allison's report stated that the test for fine and gross motor skills was incomplete because, during the fine motor section, his distractibility, constant need for redirection, and frequent movement breaks caused the 15-20 minute test to stretch on for just over 40 minutes!  His fine motor precision and integration both tested within average ranges, but his manual dexterity and bilateral coordination were much below average.She did not have time to test his upper limb coordination, balance, running speed and agility, or strength.  She did assess his handwriting abilities where he scored within normal limits for things such as maintaining web space between fingers and arching his hand to hold the pen; he tested within a limited range for the forearm/wrist stabilization and range of motion of digits; and he tested as impaired in areas such as proprioceptive feedback and distal rotation. 

Emerson was also tested in all the sensory areas as well: auditory, visual, vestibular, touch, oral, and multisensory (to see how he responds to a variety of sensory input because, afterall, that's how we all experience the world--thru multiple sensory experiences at the same time).  Just briefly, he tested "typical" in only the visual and oral areas.  Everything else--auditory, touch, vestibular, multisensory--showed a definite difference compared to the average ratings for his age group.

Other sensory areas that were tested showed a definite difference from the average mean in endurance, body position/movement (moving effectively for the task at hand), sensory input negatively affecting emotional responses, and modulation of movement affecting activity level (needing to move constantly).

Overall, the following were Allison's clinical observations:

Proprioceptive System:
Reminder: The proprioceptive system is responsible for our understanding of body position (left, right; up, down).  It also allows us to determine how much force to use for specific tasks (petting the dog vs hammering a nail).  It allows us to perform tasks without vision, such as touching our nose, walking through a dark room, and buttoning the top button of a shirt. 
Emerson exhibited the following deficits in proprioceptive processing--
     *Decreased performance on finger to nose test
     * Poor joint stability in shoulders
     * Poor endurance in unsupported sitting
     * Difficulty following model to fold paper
     * Preferred activities that offered increased crashing and bumping
     * Unable to land on his feet while sliding
     * Decreased balance when vision was occluded
     * Sat on his feet while in the chair

Tactile System
Reminder: The tactile system serves as part of our protective system, specifically to light touch.  Some individuals exhibit an intense reaction to irrelevant light touch inputs, resulting in a protective reaction that is often seen in "flight, fright or fight" reaction.  When individuals respond to irrelevant stimuli as "threatening", they often resort to more protective reactions, such as biting or hitting, fleeing the experience; or shutting down.
Emerson was reported to have increased sensitivities to touch. They are as follows--
     * Dislikes being touched unless he initiates
     * Apprehensive about being barefoot, especially outsde in grass
     * Prefers to keep his socks on
     * Increased mouthing of inedible objects (clothes, rocks, writing utensils, toys)
Another aspect of the tactile system is to discriminate and localize touch. These abilities, in combination with the proprioceptive system, allows us to perform fine motor and self care skills with little to no visual input, resulting in more automatic performance.
Emerson exhibited the following--
     * Decreased localization of tactile stimuli on the arms
     * Decreased awareness of tactile input as noted by increased touching of objects, increased mouthing of inedible objects, doesn't notice when face is messy
     * Decreased graphesthesia (the ability to feel writing on the skin purely by the sensation of touch)
     * Decreased finger identification (when finger is touched and there is no visual stimuli)
     * Decreased supine flexion (lying on back with knees flexed into stomach while keeping head off of the floor)

Vestibular System
Reminder: The vestibular system is responsible for discriminating movement in space with input from our inner ear. It provides us with information about the position and motion of our heads in relation to gravity for the development of equilibrium reactions. This system works simultaneously with the proprioceptive system to regulate muscle tone, develop postural control and balance, and provide a foundation for skill development in bilateral and eye-hand coordination.
Emerson exhibited the following deficits in regards to vestibular processing--
     * Decreased postural control
     * Increased fidgeting at the table
     * Leaning on thetable during fine motor activities
     * Standing up at the table during testing or in-between subtest items
     * Decreased bilateral coordination
     * Decreased trunk flexion while jumping on the trampoline

So, out of all this, what was the assessent and recommendations made by Pediatric TLC?

Emerson appears to exhibit significant deficits in vestibular, proprioceptive and tactile processing, which is leading to symptoms of dyspraxia.  Praxis is the ability to plan and carry out a novel activity.  In dyspraxia, a child has great difficulty planning how to approach and carry out new activities.  A child with dyspraxia has difficulty knowing what to "do" with toys or games; instead, the child may resort to lining up toys or simply pushing them around.  (On a side note:  I was reminded of this explanation of dyspraxia just this past week when I took out 2 pails of building blocks for the boys to play with for a while.  Emerson set to work building me a castle, but--unable to "see" how the blocks could work together--he simply stood a bunch of them up on their ends, pushed them close together and declared his castle complete.  Even when we show him how to build towers and walls, he has to be directed where to put each block because he just can't figure it out on his own. His brain doesn't work that way.)

     * Occupational therapy intervention 2-3 times a week for 60 minute sessions, wth re-evaluation at six months
     * Home program to address decreased fine motor skills
     * Home program/sensory diet to address decreased regulation and/or decreased motor planning
     * Therapeutic Listening two times a y for 30 minutes per session

Of course, Allison also listed our goals for Emerson at the time of his 6 month assessment.  They called us every once in a while to see if we wanted to take a cancellation spot, and they finally had one permanent spot open for us on Thursday mornings with a wonderful OT named Lauren. Emerson just loves her tpo pieces!  But we're still waiting for a second standing appointment.  Right now, however, once a week is better than nothing at all.  They haven't given us a specific sensory diet to do at home, but we try to do some of the same things at home that they do at therapy.  I have to stay in the waiting area during sessions--so as to not distract him--but Lauren lets me know what they did that day and ask about modifications we can do at home. 

I think that's enough for today.  I'll fill in blanks as to what they do at therapy and what we do at home to help; and I'll define Dyspraxia as I have SPD and Autism. (Did I write a blog about how they switched his diagnosis from Autism to Asperger's?  Really no difference as far as anything goes except the school district and our insurance are less likely to consider a diagnosis of Asperger's as seriously as they would a diagnosis of Autism.  In the future, Asperger's will be grouped into the Autism umbrella and no distinction will be made. It seems to be hurting us now, though, and I wish they would have just left the original diagnosis alone.  They changed it because Eerson did not have any verbal of the main differences that marks an Aspie.)

Oh, and a special thanks to Melisa who gave me the gentle nudge I needed last week to get me back writing on this blog.  Thanks, chica!