MaternalMusing

A Personal Adventure Into Parenthood

Occupational Therapy: Step Two – The Diagnosis July 13, 2015

Filed under: Uncategorized — maternalmusing @ 5:34 pm

After our initial visit with all the cutting and drawing we made a follow up appointment with the therapist for the following week so that she’d be able to lay out our treatment plan for V. We wanted to make the most of our summer holidays, while I was still on mat leave, to make up any ground we could before he headed back to the classroom in Sept and I headed back to work!

V absolutely loved this visit…it was all about ‘games’! The therapist explained that all of his exercises needed to be fun, motivational, and most importantly he needed to have a buy in and experience success. Nothing will have a 4 year old checking out faster than if they think it’s boring and they can’t do it.

I won’t get into all the details on the different exercises that we practised during this appointment because I’ll be adding each individual one as it’s own separate blog post; including pictures and a materials list. Keep in mind I am not the Occupational Therapist, I’m only sharing what we’re doing for V on the recommendation of his OT, teachers and doctors.

What we did leave this appointment with was some labels for what the OT thought might be the underlying causes of V’s fine and gross motor delays. I’ll highlight the two big ones here.

Poor Motor Planning:

What this means is that V can watch a teacher, therapist, or peer perform a new, unfamiliar task but he has trouble breaking it down into steps and repeating them himself. He can’t quite translate all that sensory information into a plan on how to get things done. He will often drop things, stumble, trip etc when he’s trying things for the first few times. To help him overcome this we need to take extra time to teach him and repeat more often. For example, when he participates in a song or dance performance at school we should obtain the music and actions from the teacher before hand and help him practice at home.

Poor Motor Planning and rock climbing probably weren't the best mix now that we think on it. He did get about 1/3rd of the way up the wall though!

Poor Motor Planning and rock climbing probably weren’t the best mix now that we think on it. He did get about 1/3rd of the way up the wall though!

Luckily this skill can be taught over time and it will be generalized to different scenarios he’ll come across in school, home, and life!

Low Muscle Tone:

V is a tiny kid. Seriously. He’s almost 5 years old and his favourite pair of swim shorts is a pair of size 18 month trunks. And they fit. Well! He is all skinny arms and long legs at a whopping 29 lbs and 39 inches tall. Not a lot of meat on those bones!

This should have been a good indicator that V hasn’t exactly packed on the muscles and the OT indicated that he does show signs of poor muscle tone. If you watch him do pretty much anything you can see that his joints flex to the point of ‘double-joint’edness and he doesn’t exhibit a lot of stability or stamina. A lot of the exercises that we’ll be doing both for OT and Physio will focus on building muscle tone and control.

Skinny Mr. V trying to work his Nerf water gun! Everything is easier with two hands.

Skinny Mr. V trying to work his Nerf water gun! Everything is easier with two hands.

As a fun FYI this is not the first time we’ve been told that V might have issues with muscle tone. I remember the NICU physiotherapist having some concerns when he was still in the Level 3 NICU. He was a pretty floppy baby but I assumed that issue was behind us when he started to sit, crawl and walk. Guess I shouldn’t have been so hasty on that one!

We left the appointment with several sheets of exercises plus a shopping list for the website of an excellent Canadian sensory tools company (FDMT: Educational Materials and Sensory Tools – FDMT.ca) and the Dollar Store. We are spending at least 15 minutes a day with V on fine motor activities 5-7 days a week. Our goal is for him to be able to control scissors, have a consistent pencil grip and rudimentary pre-writing skills by the start of the school year. I’ll be highlighting our home Occupational Therapy box with it’s individual ‘games’ for V in the next few posts. Feel free to ask any questions you’d like and I’ll try my best to answer them, at least from our experiences and perspective. Wish us luck!

Preview of our 'At Home' Occupational Therapy Kit! Excited? We sure are!

Preview of our ‘At Home’ Occupational Therapy Kit! Excited? We sure are!

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Occupational Therapy: Step One – The Assessment

After requesting an Occupational Therapy consult through our family health team in early June we finally got the call with about two weeks remaining in the school year. I was pretty pumped to get a jump on V’s needs for Senior Kindergarten and the therapist seemed very thorough and kind, even on the phone!

She started by asking me what our concerns were with V and why we’d requested the consult. She listened actively which was a relief, since I originally felt pretty brushed off by our family physician. The therapist immediately recommended that I contact the school and request that V had Physiotherapy set up for Sept, as soon as school starts.

Her reasoning was two-fold:

One – V falls a lot, and since the school is aware that this happens, it is a liability for them if he falls, injures himself and they’ve done nothing to assist him. PT will help his gross motor development and hopefully have him running, jumping and generally keeping up with his peers in the playground/gym class.

Two – The wait list for Physio is much MUCH shorter than the list for Occupational Therapy in the school system. There are fewer students with gross motor development needs and teachers are less aware that Physio is even an option in their classroom. As adults we typically only consider Physio in the context of injuries and rarely in relation to developmental issues.

V’s teacher is an amazing educator and truly cares for her students. I let her know the Occupational Therapists recommendation and the paperwork for V’s Physio in the fall had been submitted and approved by the end of the week! One thing check off our list for back to school!

The Occupational Therapist then scheduled our first visit so that she was able to evaluate V’s skills in person. She let us know that she would likely need two visits; one to evaluate and one to impart a treatment plan, and they would be about an hour apiece.

We prepped V for the appointment by letting him know we’d be going to see a fun ‘doctor’ who was going to play some games with him. 4 year olds don’t distinguish between different medical professionals and since it was at our dr’s office…they’re all doctors in there! He was excited to go visit.

At the first appointment the therapist did several exercises with V to evaluate his hand strength, coordination and writing abilities. Some of the activities were:

Cutting:

  • Cutting along a straight line (about half a page in length) with basic school scissors. She had him try to hold the paper and cut, and then she held the paper while he cut.
  • Cutting around a right-angled corner with basic school scissors. She held the paper, then had him hold it, then she used coloured markers to mark where each of his fingers should be when holding the paper while he cut.
Scissors worksheet example. Before the exercise.

Scissors worksheet example. Before the exercise.

Trying to coordinate the scissors and his holding hand to cut a straight line.

Trying to coordinate the scissors and his holding hand to cut a straight line. Also note that although he is left handed, he manipulates the scissors with his right hand.

End result of the scissors exercise. You can see that he can't cut a smooth or straight line right now.

End result of the scissors exercise. You can see that he can’t cut a smooth or straight line right now.

Writing:0

  • Tracing between two lines in different shapes using a pencil. He had to trace between two straight lines, two lines with sharp V-like corners, and two wavy lines.
  • Tracing on top of lines using a pencil. Again she had him trace straight, sharp curves and wavy lines.
  • Pre-writing exercise by copying basic shapes: cross, x, square, circle, triangle.
  • Copying the writing of his own name. She had him trace over-top of her writing and then try to copy it by himself.
Line tracing exercise. The large gap between the lines is because we want him to experience success. The width will decrease over time.

Line tracing exercise. The large gap between the lines is because we want him to experience success. The width will decrease over time.

Note the bizarre, fist-type grip he uses because his fingers aren't strong or coordinated enough yet.

Note the bizarre, fist-type grip he uses because his fingers aren’t strong or coordinated enough yet.

End result of the lines exercise. Notice there isn't a lot of movement if he can help it.

End result of the lines exercise. Notice there isn’t a lot of movement if he can help it.

At the end of the exercises she gave us a quick evaluation of what she’d seen. In V’s case she let us know that he has minimal fine motor skills and we’ll need to start right at square one to help him build up to where he needs to be by the time he enters Grade 1.

Pre-writing exercise. V needs to copy the shapes as close as he can in the boxes to the right.

Pre-writing exercise. V needs to copy the shapes as close as he can in the boxes to the right.

Examining his work. This one frustrates him the most.

Examining his work. This one frustrates him the most.

Pre-writing results. Notice that his shapes lack definition and tend to be pretty similar. They will improve as he learns to stabilize and control his pencil.

Pre-writing results. Notice that his shapes lack definition and tend to be pretty similar. They will improve as he learns to stabilize and control his pencil.

V has little to no co-ordination in his hands. He struggles to even open and close the scissors in a cutting motion, let alone have the ability to cut along a line or co-ordinate both hands to hold and cut. V is also left-handed but cuts with his right. The OT told us this is very common in school aged kids because there are rarely, if ever, left-handed scissors consistently available in the classroom. We aren’t going to try to modify this…he’ll be a left-handed writer, and right-handed scissor wielder!

Writing exercise. He needs to trace his name and then try to copy it independently.

Writing exercise. He needs to trace his name and then try to copy it independently.

Funny grip again! He really enjoys trying to write his name though. He's almost got the V down.

Funny grip again! He really enjoys trying to write his name though. He’s almost got the V down.

Writing results. We definitely have a few steps to go before he's able to write legibly.

Writing results. We definitely have a few steps to go before he’s able to write legibly.

As for writing he has no consistent pencil grip. He alternates from a fist, to a modified three-point grasp, to a bizarre grasp stabilized by his middle finger along the length of the pencil. This stems from the fact that he can’t coordinate his fingers so that the far fingers are stabilizing his hand and the inner fingers and thumb manipulate the pencil. His whole hand works as one whole grasp. We’ll need to help him learn to co-ordinate his fingers and find a proper grasp before we can even move into tracing and pre-writing. The goal is to have him writing his name at the end of the year. There is no rushing this type of thing. We want him to learn consistency and co-ordination, not shortcuts to create the appearance of him learning.

 

A Short PSA On Parking Lots: Don’t be a Jerk! July 12, 2015

Filed under: Uncategorized — maternalmusing @ 4:03 pm
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Over the past 4, almost 5, years I’ve witnessed some pretty blatant disregard for pregnant women and families with young children in parking lots across our fair province. For the sake of this blog, let’s review; most parking lots in Ontario, and I think many in North America, now offer three types of spots.

  1. ‘Regular’ parking spots: take up the majority of the lot, evenly spaced, clearly marked with yellow/white lines that encourage people to park their cars in an orderly fashion.
  2. ‘Handicap’ parking spaces: typically close to the entrances and wide enough to accommodate assisted mobility devices. They are clearly marked with both a bright blue sign and blue marking on the pavement. These are available to those with disabilities who have acquired the appropriate pass, displayed clearly on their dash.
One of many signs to indicate a 'Handicapped' parking spot.

One of many signs to indicate a ‘Handicapped’ parking spot.

Now we also have one more type of parking space that is starting to make an appearance in our local lots:

  1. The ‘Expectant Mothers/Young families’ parking spots. These are typically next to the ‘Handicap’ spots, close to the door, slightly wider and marked with cute signs sporting strollers or storks.
Pregnant and Small Family Spot sign. Please become familiar with and respect this sign!

Pregnant and Small Family Spot sign. Please become familiar with and respect this sign!

As a parent with two kids, I appreciate the fact that retailers understand that leaving the house with kids and all of their accessories is a daunting task. It’s hard when the only available spot is at the far end of a parking lot and you have to work your way to the doors through insane, careless drivers, while holding the hands of a curious toddler jumping his way along and toting 20 lbs of baby in an infant seat which is doing it’s best to pull your shoulder from it’s socket with every step. Having a shorter trek to the shopping carts, where you can corral your offspring, makes the trip infinitely more pleasant and I’m always pleased when we manage to snag one of those coveted spaces! It’s definitely a letdown when you see them all full up but we can’t be winners every time!

Now, my annoyance is this, child-free people who cut you off like it’s the last lap in Mario Kart in order to grab the spot for themselves! It makes me bust out into an internal monologue of ‘REALLY?!?’ a la SNL Weekend Update. I know that it’s raining outside, or hot, or you’re in a hurry but let me tell you, it’s much easier for you to drag your lazy butt the 10 extra feet from the next available spot, than it is for me, my husband and two kids to do it.

It really took the cake when people would use the short-term, 10 min max, ‘Labour and Delivery’ drop off spots in front of the hospital to wait for various friends and family. I observed many vehicles there for half an hour or more last summer and rarely saw any pregnant women exit any of the cars. Women who have delivered…just take a minute to let that one sink in. Can you imagine walking from the next lot over while experiencing contractions? Good times right?!? No.

Personally, A and I only park in those spots if all 4 of us are going into the store. If we’re shopping without the boys, that spot is not for us. Honestly even if we just bring V we’ll walk from the next available parking space because we KNOW someone else needs it more.

Topping my personal list of ‘worst offenders’ is a lady who almost sideswiped us to swing into the spot ahead of us. This was in ankle deep snow, with a tiny 4 year old and infant in his carrier, all while I was still sporting my nephrostomy tube. Oh you just needed to grab some dip for that dinner party you’re headed to? That’s fine…I don’t mind carrying two kids while slogging through slush and snow, trying not to catch my medical tubing on the infant car seat. We’re cool. I seriously debated hunting that woman down in the store and giving her a piece of my mind but managed to (grudgingly) let it go.

It is probably my number one pet peeve when we’re in a lot these days, when I see people who clearly have no kids, grabbing the spots because they don’t feel like walking the extra few feet. Sadly I think it’s just a sign of the times that people just don’t care about anyone other than themselves. I don’t believe people take the spots to be malicious…it’s just that they can’t see beyond their own wants at the time. I’d love to carry passive aggressive ‘spot shaming’ cards on me to leave on windshields but let’s be honest…that type of person probably wouldn’t care anyways.

So as a public service announcement please be courteous when you park! There may be no-one lined up behind you for the spot at the time but who knows what will happen 5 minutes down the line. Think of the worn-out moms and dads who just want to get in and get out with their overtired kids before you snake a spot just so your hair won’t get frizzy in the rain.