Wednesday, June 23, 2010

Therapy Updates

Whew...what a busy week we have had! We had/have 4 hours of therapies, 1 day of blood work, and 1 new assessment. Everything has gone well so far, so we are pretty happy.
We started with speech therapy last week and have had 2 sessions with our new therapist. She is very nice but I'm still very carefully testing out the waters. We had two main goals with adding speech: lots of oral motor exercises to improve receptive and expressive language as well as acquiring new skills to improve Colin's feeding difficulties. As of right now, I feel that a lot of the sessions have been very similar to the things our developmental therapist works on. I'm also a little concerned because I don't really feel like we are working on our goals specifiically. I'm going to try this out a little longer and then see where we need to go from here.
Developmental Therapy:
Colin has been doing really well with his DI therapy. His receptive language in terms of actions associated with singing songs (itsy bitsy spider, if you're happy and you know it, twinkle twinkle little star) have been improving, he is doing really well with oral motor imitation, his expressive language is coming along (using signs when prompted), and he is able to start putting things into a container (his fishies into their fish bowl). A lot of these things are not completely consistent, but he is making strides!
Physical Therapy:
Colin continues to work really hard. His gross motor skills are coming along slow, but as always, he is making improvements so we know that the bigger skills will come with time. On his tummy he is great with pivoting both ways in a circle on extended arms, he will roll all over the place with intention, on a smooth floor he will push himself backwards, move some inches forward in an army type crawl, and he is trying really hard to lift that tushy off of the ground. I am just waiting for the day that he will be able to combine tushy up with extended arms and get his torso off of the ground. Unfortunately, we are having a really hard time with transitioning from seated to tummy and vice versa, maintaining an all fours position, and weight bearing on his legs. As I've mentioned before, Colin is an observor, so he is content just watching everything from his position (hence why we need to keep pushing him).
We love Miss Kathy because she is great at breaking down the bigger skills into components that will help build strength and get Colin to accomplishing the bigger skill. This picture is Colin this morning on his knees and propped on extended arms. These are the things that we are pretty successful at getting Colin to do (it's just like girl push-ups on your knees vs. guy push-ups the full correct way). Slowly but surely right?

Feeding Therapy Assessment: I have talked many times on here about our concerns with Colin's feeding. Lately, we have gotten to the point where we want to pull our hair out at meal times. However, we can't complain too much because Colin IS improving...albeit slowly. When we got our speech assessment through early intervention, the speech therapist that came to do the assessment told us about the The Children's Specialized Hospital who has a team of therapists that would evaluate him during a feeding session and help us work towards improving meal times.

You better believe the next day I called right away!

We had our appointment today and I am extremely happy with the way that it went. The feeding assessment "team" involved a psychologist (I think that's what she was), dietician, occupational therapist, and speech therapist. They asked a lot of questions to begin regarding Colin's eating habits and our concerns.
Our concerns:
- lack of self feeding (except pretzel rods)
- difficulties with "chunks" and harder textures
- Difficulties controlling liquids through a straw

After they highlighted our concerns, they had us feed Colin all different types of foods that we give him on a regular basis including things he loves, things that he will eat but has trouble with, and things he does not want to eat. They watched for approximately 30 minutes and gave us some tips while we were feeding.

The conclusions:
* Colin's problem is not the chunks/textures themselves, it's the inability to do something with the food. He just doesn't know what to do with anything he can't just swallow like pureed foods. They had us push the food off of the spoon into the sides of his mouth, and they saw hints of "munching" and moving the food.
* He does great overall with the cup, but still struggles with controlling the amount of liquid from a straw.
* There is some clear lack of skill with picking food up and putting it to his mouth.

The solutions:
* Place food in the sides of his mouth so that he has to learn how to do something with it.
* All food should be put in the food processor and made into really small pieces and mixed with a thicker consistency that "goes with" the food. For example, instead of us "hiding" all of the chunky foods in applesauce, we should try to find something that goes better with the vegetables. Broccoli mixed with the water it was steamed it, turkey and gravy, etc.
* Any types of puffs, cereal, etc. that he doesn't do well with should be soaked in milk first and then put into the sides of his mouth to practice doing something with it.
* Something thicker like a smoothie should be sucked up from the straw so that it's slower going into his mouth as he learns to coordinate sucking, moving, and swallowing the liquid.
* Enhance the self feeding that he does do like self feeding with a spoon. Instead of having him grab the spoon with food from our hands, put it on the tray and have him pick it up from the tray.

We will wait to hear what our insurance covers in terms of outpatient feeding services, but in the meantime we have a lot to start with.

Colin was extremely social while we were there waving hi and giving kisses out in the waiting room.
While we were waiting for the team to come back, Colin was having fun entertaining us and making us laugh!
After the assessment, Colin went and hung out with Daddy at work!
Earlier this week, Colin had to get another round of blood work taken to assess the standard year test of lead, and then check on his thryoid function (which was fine the 1st time) and cell counts. Our 1st experience was traumatic, but this time, although they had difficulties getting his vein again, went much smoother and quicker. Colin was such a good boy and did not cry too much! He had to look tough for the 2 young pretty nurses that took care of him!
Healso hung out with me at work a few times this week too!
(Although I don't know how much work you can get accomplished when you have this face looking at you!)
Lots of toys to play with, yet, he tries to dig stuff out of the box that was on the floor!


Kristin said...

It's so interesting to see what other "states" do with therapy. We had an evaluation this week and they said no speech therapy while Max is working on learning to crawl. Only work on one thing at a time. So only PT still for now... and Max is waaaay behind in communication. Good luck.

Kelly said...

Glad to hear that everything went well and you are covering all areas of concern. It's so much easier (and less frustrating) when we identify the isuue and use the correct tools to help fix it!!

We have been working on some of the same tips you got, and it is definitely helping. Good Luck!!

BTW, I wouldn't get much work done either looking at that sweet little "funny" face:) Colin just gets cuter every day!! I hope you're enjoying the summer!!

Rochelle said...

WOW that is one busy week.

Sounds like you got some great tips from the feeding team.

Hopefully your mealtimes soon will be a breeze!

I wouldn't get a thing done with that cute boy making those sweet faces at me all day. But, what a great excuse not to be productive =)

tonya said...

oh it seems like he is doing so well! and i am sure he will only continue to get stronger with each new aspect of life he is working on! :) good luck with therapy! it is so amazing to see all of the people that work so hard to help out our little ones!

amy said...

patience, grasshopper! trust me, colin will amaze you this next year. it's so nutty how just one day it seems to "click!"

Lacey said...

those are some great ideas for feeding! I'll have to remember that if Makayla has problems. I swear he has the best faces ever!

Nana said...

Oh so cute and very busy!! It made me flinch a little to see the bandage on his little arm but he doesn't seem to mind!! Love, Nana

viv said...

Our babys are around the same age (Owens due date was the 27th of April) and their motor skills sound much the same - Owen just recently mastering getting into sitting from lying down. But your Colin seems such a happy little fellow ! Owen is mister grumpy pants and I just know he will be happier once he gets moving

Derek, Kenzee and Gage said...

A busy busy week! But looks like a fun one, and he is doing so great! I don't think I could get much work done with that cute boy around, either! One thing I have started doing with Gage every time he has blood drawn is ask for a heat pack to hold on the inner side of his elbow for a few minutes before they come try to draw. Before we did this, we usually would have at least 5 pokes and end up at the hospital for them to draw blood for his blood checks. But the last 2 times we have used a heat pack and they have gotten it on the first try! So just something to consider since you said they have a hard time getting to Colin's vein!

Melissa M said...

I LOVE reading other people's therapy posts, especially those with kids a little older than Claire. I love seeing what is coming up and all those tips and tricks you pick up from hearing about what everyone else is doing. I love all of his faces too!