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OT's are specialist in helping each person achieve balance in their lives, physically and psychologically. When you have a child with ADHD, achieving that balance can be tricky. It impacts their ability to be successful in school, developing friendships, and functioning within the family. Children with ADHD have so much to do and say that the structure of school and home life may frequently run counter to what comes naturally to them. These children are usually brilliant, imaginative, loving, spontaneous, and very much in the moment. They are creative, energetic, and seek challenges. When these gifts are channeled in a productive and creative ways, they will be successful in all areas of their lives. OT's assess each child through a detailed assessment of interviewing parents and teachers to get a picture of how they are handling their school and home responsibilities and what supports are in place. The OT will assess the child's physical, cognitive, and sensory systems to determine what impact these could be having on the child. Continued communication between the parents, teachers, pediatrician, and the therapist will be maintained for a consistent and comprehensive successful plan of care for each child. They will learn how to channel and use their multiple skills and learn new skills for success in school and at home. The OT will work closely with each parent through emails and phone coaching in-between treatment sessions. After each treatment session, a detailed email highlighting any recommendations will be provided to the parents. A dynamic home program is developed and reassessed frequently to determine what changes need to be made. The treatment sessions will tap into the individual child's natural skills and interests, in order to build confidence, insight, and ultimately new skills to handle whatever their challenges may be. As the child develops new coping mechanisms, parents are also instructed on how to improve their own emotional regulation, self care skills, and communication skills to help model behavior for their child. Initially, a child may be seen weekly to practice different strategies, develop sensory skills and coordination, instructed on mindfulness practices, then treatment session may taper off to 1-2 times a month till the child is functioning more successfully in all areas of their lives. As the child grows and develops, new skills will emerge as well as new challenges and after sometime the child may need to be reassessed and a new plan developed for them. ADHD can be a challenging diagnosis to live with but, with understanding, patience, appreciation for all the gifts and talents each child possesses it can be a wonderful journey of discovery! I just had to write about this day with this sweet 3 year old boy, JL! It was close to 100 degrees so water play was the only way to beat the heat! In OT, I am currently focusing on increasing JL's strength, coordination, and confidence to try new activities. Today, we played with various sizes of water balloons. Little did he know, he was building UE and core strength lifting them out of the basket and throwing them at me while I unsuccessfully dodged his throws. He threw over hand, under hand, and twisted his trunk to throw sideways, all while laughing and getting wet. When all the balloons were popped, we played with bubbles. He ran and waved his arms to get the large bubble wand to make bubbles to chase and jump on. As you know, when playing with bubbles, soap goes everywhere so, we got out the hose to clean up. The faucet of the hose was under a large bush and when I asked if he would help me turn on the water he said, "OK." He had to step over rocks and roots to reach the faucet in order to turn on the hose and he did it all without hesitation! Then he began to water the plants, yard, and to chase me around till I was soaked, all the while pulling and holding the hose. JL, in the past has needed assistance with stepping down our front porch steps but not today. When he was on the last step, I said, "Jump!", and he accepted my hands and he jumped! I love that to him it was just pure fun and he had no idea of all the skills and muscles he was developing! I feel so grateful to be able to not only play with this boy but, to be a witness to his physical and emotional development. One of my most favorite days as an OT!
As a therapist, it is my job to never give up on believing in a person's potential. If a spirit is willing, the body can get stronger and develop new skills. Andrew is an incredible example of determination! Last week, he began to pedal the recumbent bike on his own! His left leg has increased in strength over the year using e-stim, weightbearing exercises, and ROM exercises. After figuring out the best way to position him in the bike and patterning him using the arm levers, Andrew began to be able to relax the tone in his right leg in order to bend his knee and push the pedal with his left leg. He has been reaching up with his right hand to hold onto the hand lever to push and pull. He is fully aware of what he is doing and gives us a big smile when he does a few repetitions on his own! After two sets of 10 minutes on the bike, we get him into the Riftan (special walker that takes up his body weight) to walk. He consistently is taking steps with his right leg and is able to initiate his left leg during ambulation in the Riftan! Andrew has increased in his ability to tolerate activity and his treatment sessions quickly pass the 1 1/2 hour mark! His increased alertness, ability to follow directions, and never giving up is proof that he will be able to do anything! An amazing treatment session with Andrew! Since his accident, Andrew's left side has been slowing increasing in tone and trace muscle strength and today he surprised us all when he kicked a ball with his left foot while he sat on the edge of his mat. I burst into happy tears! I have believed in his full recovery and visualized it clearly in my mind and to see proof of it is such a thrill! After much cheering on our part, he did it again! We set him up in the Riftan walker, which helps support his trunk and weight so he can attempt to walk. Usually, it takes one person to operate the walker and two more people assisting him with moving his legs in a walking pattern. Just last week he began moving his right leg forward without assistance 7 times in a row. Today, he independently moved his right leg with every step across the room! More happy tears! His speech has been progressing to the point of being able to say a few words when cued to. Today, he said loud and clear, "No more, please!" when we asked if he wanted to sit or walk more. We quickly sat him down the mat, with hugs, cheers, and more tears of joy! I can clearly visualize Andrew walking, doing his daily activities independently, and enjoying his life! I feel so honored to witness his recovery! Hip Hip Hooray, Andrew! This link is to a video of Andrew back in January just beginning to move his right leg independently. https://www.youtube.com/watch?v=njUA_pnKyhg&feature=youtu.be Yesterday, I had the opportunity to accompany this young man all the way into the operating room to witness the surgery performed on his hand. One year ago, his hand was crushed, resulting in median nerve damage, soft tissue damage resulting in contractures of his thumb and MCP joints in 30 degrees of flexion. He started therapy with me about 3 months after his injury. He was so compliant with all the different treatment strategies, from sensory desensitization, fluid massage, joint mobilization, and soft tissue mobilization all to attempt to decrease the excruciating nerve pain and increases his active range of motion of his hand. We used splinting, serial casting, and other methods to correct his contractures. Although, his thumb motion was improving and his pain was decreasing, after 3 months, he and his doctor decided on 2 surgeries, one to correct his thumb contracture and the second to correct the tightness in his MCP joints. After the first surgery, it took over 6 weeks of wearing a thumb spica cast for the bone to begin to heal. Once healed, he quickly scheduled the next surgery to correct his inability to straighten his fingers. I requested to be able to watch the surgery so I could learn exactly what was done with his hand to provide appropriate therapeutic interventions. At the John's Hopkins Out Patient Center, his doctor and staff graciously allowed me to watch his surgery. They ended up releasing the intrinsic muscles, the joint capsules of all the digit MCP joints, release of the volar plate tightness, and removal of scar tissue in order to allow for full digit extension and hopefully, in time, a functional hand. I am so touched that he felt comfortable for me to be there for the surgery. Now, we wait for 10 days till this cast comes off and start therapy again. The operation was deemed a success and now its up to us to get him back to having his right hand back. He is a strong and determined man that will be able to accomplish anything!
After over four weeks in the ICU, my patient with MS is finally home! It was a very difficult hospitalization for him and his family. The first two weeks in the ICU he was confused and on the ventilator due to pneumonia. Around the third week he was beginning to breathe on his own but, not still not strong enough, requiring a tracheotomy. Before his hospitalization, he was independent operating his electric standing wheelchair, able to use both of his arms for self feeding, grooming, and working full time from home on his computer. I have been seeing him for about a year to decrease his upper extremity tone, increase his arm strength and range of motion in order to make his movement easier and more coordinated. He always wore a smile, gave 100% to each therapy session and never complained. He did everything he could to hold the tide of his MS back, using multiple supplements, ice cold showers, pure clean eating, meditation, yoga, massage therapy, and staying active with family, friends, and work. His illness appeared to come out of nowhere! When he left the hospital on Friday, he was able to speak softly, rotate his neck, and was clear minded. I was so thrilled on Tuesday to see him sitting up in bed with his familiar warm smile and strong sounding, "Hello". He had traces of movement in his right shoulder and was able to initiate movement in his left arm with assistance and even able to provide some resistance! When his wife came in I asked when the last time she had held his hand and she immediately came over to hold his left hand. "It's a miracle!", she cried, as she felt him squeeze her hand back! Their love for each other filled the room! I was so thrilled to see the hope in their faces that he will be strong enough to use his wheelchair again, move his arms again, and return to his previous level of independence. I have no doubts about that happening for him. He is blessed with a loving wife, two grown children, two dedicated caregivers, loving friends and family who are all supporting this wonderful man. I feel honored to be one of his therapist! Andrew, a 27 year old, who is awakening from being in a minimally conscious state from a traumatic brain injury, had another great treatment session Friday! He was maintaining eye contact, smiling, and attempting to talk saying, "Hi, Diane." and "I want to get up." He is very aware of his left arm now, which was initially paralyzed and now he is able to perform some shoulder and elbow movements when assisted. He is initiating more with sitting up and rolling and is able to tolerate being on his stomach for weight bearing through his arms and lifting his head and trunk. I was curious about his ability to read. His Dad wrote "Thumbs up" on a board and showed Andrew and without any hesitation at all, he gave us a thumbs up! I was over come with emotion! With further experimentation we will determine what size letters and amount of words Andrew can see and understand. Eventually, he will be able to read magazines, books, computer screens, and make more choices and communicate by choosing the word(s) for what he wants! Andrew communicated he wanted to walk by lifting his right leg several times so we set him up in the Riftan walker. He is assisting more with lifting his right arm to place on the pad and pushing through his legs as the walker lifts him off the mat. He immediately began swinging his right leg back and forth as if warming up, and then began to take a step. We need to assist him with his left leg but he initiates the step. As soon as the left foot makes the step he immediately steps with his right. Due to his high tone in his right leg, it tends to cross and get caught on his left but, today, he was able to lift his right leg placing it forward! Each session he is taking more steps with more of a regular pattern and less assistance for his right leg. We have music in the background and found Walk This Way, by Aerosmith, is fun for him to walk to. He is an incredibly patient and hard working young man! His positive attitude and easy smile amazes me considering how difficult and frustrating therapy can be at times. I can't wait to discover how his ability to read will enrich his days and help us provide him with more control over his life. I am so grateful for the opportunity to be a part of his recovery!
A few blogs ago, titled State of Grace, I wrote about a woman living with grace as her neurological disease took control of her body. I had been fortunate to be able to spend time with her each Sunday giving her therapeutic massage and Reiki. Over time she had completely lost her ability to speak, to open her eyes, and to move her body. Occasionally, she could raise an eyebrow, furrow her brow, cry, and made sounds to communicate her feelings. She was never alone, always with a sister or daughter, husband or multiple grandchildren. One day, as her son-n-law was leaving her bedside for us to start her session, he lovingly whispered in her ear and hugged her so tenderly, then kissed her tear stained cheek. Her daughter kissed her other cheek and lightly let her fingers linger and trace lightly along her arm and down her leg to my hand with a peaceful smile, as if to say, "It's your time with her now." I began doing more Reiki than massage because touch was beginning to be too painful. I'd slowly move my hands along her arm and if she so much as twinged, I'd stop, hold the area lightly and send Reiki. During our last session, I was feeling such gratitude for being with her. I felt gratitude for all the love she has from and for her family, all the lives she and her family have touched with their kindness and love. I prayed for guidance to be quiet or to speak my heart. Throughout the treatment session, I told her how beautiful she is, filled with God's radiant golden loving light, how much she is loved, and I thanked her for letting me be with her. I told her that I only wanted to give her love and peace. I found myself whispering to her, "You will always be, as you are now, and forever." I thanked her again as I left, lightly hugging her, telling her I loved her. She is in heaven now. |
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AuthorDiane Gubisch, PhD, OTRlL Archives
June 2022
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