Physical and Sensory Therapy on the Playground

Back in May, Jude had a re-evaluation of his gross & fine motor skills and speech abilities. After numerous phone calls, an incredibly helpful receptionist with a vendetta against the computer system in the records department, several more calls, and an in-person cornering of one of the evaluating therapists, we finally got the report yesterday.

The very excellent news is that he has maintained and built upon all the fine motor skills that we worked so hard to build up two years ago. He and Miss Kathleen met weekly for what we called "Charm School" - they worked on skills used for getting dressed, eating with utensils, and coloring pictures for people. Nine months after his discharge, his Peabody-scaled skills ranged from a 50th percentile/55 mos "age equivalent" grasping skills, and a 63%/65 mos visual motor integration score. Given his chronological age at the eval was 57 months, this is awesome, right? Right.

But that just sets you up for the kill.

Speech -- we expected there to be a delay. It's pretty obvious to anyone who tries to talk to him that this is something he struggles with. His articulation is generally poor, and "intelligibility" scores were 70-80% in known contexts, 50-60% if you didn't know what he was talking about. This seems pretty accurate to me; even being Mom, there are many times I have to say to him, "Honey, I don't understand what you are trying to say." He is being referred for speech services. No big surprise.

What shocked us was how terribly he performed on the gross motor portion of the testing. Doctors have mentioned from time to time that he has some heel cord tightness, but it never has been significant enough to document. It's now documented. However, in a way this makes sense. He has long been a toe-walker, and "true" autism has been excluded as a diagnosis after all of his psychology evals. Toe walking is a classic symptom of tight heels. The Gross Motor Peabody test was also revealing. His overall score quotient was 70, putting him in the bottom 2% for kids his age. (An "average" child will have a raw score of 90-110.)  His overall score puts him at an "average" developmental age of 33 mos (less than 3 years old),  with the individual tests scoring at 30, 32, and 38 mos development (object manipulation, locomotion, and stationary skills, respectively.)  He used to be in PT from about 18 mos of age until last fall and seemed to be fairly caught up. Apparently not. (There was also the thought that peer modeling at school would help him.  Yeah.  Not so much.)  The therapist's assessment was that he is "functional" but unskilled. It makes sense - to look at him, he gets around "fine" but it is obvious when you look at him compared to his peers that he is lagging.

So obviously, he is going to be going back to PT and speech. He was discharged from speech 18 months ago due to behavior issues -- hopefully, we have addressed them enough that maybe it will be less of a struggle.  (We can hope, right?)   They are recommending speech therapy 1-2 times per week, along with weekly physical therapy.  Hopefully, they will also be able to show us how to safely stretch his heels -- the therapist is setting "increase dorsiflexion from 0 to 10 degrees" as a long term goal. I haven't googled enough to figure out what all that means, but it sounds to me like it's a lot to expect if it's considered a long-term goal, lumped in with the seemingly more open-ended/subjective "improve communication and language function to optimal levels."

Obviously, these are definitely not things that will be fixed in a weekly therapy session.  Speech is something we will definitely need to work on all the time with him, by modeling and over-enunciating sounds.  And while a formal PT program is going to be invaluable, the only way to build muscle is to use it, so our homeschool program suddenly is going to add "covert gym classes" to the daily schedule.  The major activity recommended by the therapy team is lots of playground time.

 Concordville Park,pictured here, is one of our favorite places for a "sneaky PT" session.  It is a nearly all-wood playground with lots of opportunities to climb up and down stairs, walk across bridges and balance beams, and over & under climbing. Jude always has a good time on the equipment, but also enjoyed playing Follow-the-Leader. He led Damien and me all over the playground:

Follow me across the bouncy bridge...

This is a new accomplishment for him, because not only is it a wobbly/physical challenge, but from a sensory perspective, it's a whole lot of proprioceptive stress.

Hey! Who put a beam here?  Up and over - use that core!

This beam is easy!

This narrow one, not so much.

 (Makes sense -- putting feet in a direct line position is hard.)

Sideways is a little easier, but he gave up after a few steps. 

Jude's trunk muscles are weak, and that makes even standing in a balanced position difficult. 

His whole body tends to wave like a flag.  But a few steps is better than none!

Stairs are another challenge for him. Balancing on one foot is tough. He is "functional" in that he can get up and down, but he does not properly climb in an age-appropriate alternating step pattern, or even pushing off with his legs - he usually needs a good amount of upper body involvement to propel himself up or lever himself down, or simply climbs up in a toddler-style "bear crawl."

These stairs help with balance, weight shift, eye-foot coordination, perception and muscle strength.Even with all the obstacles ... he's off and running.



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