Tuesday, January 19, 2010

Adam's first RDFP appointment

I still have some other information to catch up from last week but I thought I would do a quick lunchtime post to provide an update on Adam's first RDFP appointment. This is the Easter Seals developmental program that we have been anxiously awaiting since we learned of his Grade 3 brain bleed in the NICU. He will be evaluated by their program at his corrected age of 6 months, 12, 18, 24, and 36 (or when he is actually 9 months, 15, 21, 27, and 39). It is similar to other developmental assessments we have had done in the home through the Early Intervention Program.

The visit began with a weight check, length measurement, and head circumference measurement. Weight today with clothes on and a full diaper was 16lb 12oz. Length of 27.5".

Then we spent some time with Ellen, the physical therapist. He smiled at her right away and was good for most of the assessment until he had performance anxiety at the end and started to cry. She took off her shoes and got right down on the floor with us. Adam sat in front of her on a play mat and she put a little wooden table in front of him. Right away he put his hands on top of the table, wondering what we were going to do.

The first tests Ellen performed were to assess Adam's fine motor skills. Those are grabbing things with his hands and how he handles toys. She got out a little wooden block and put it on the table. He immediately reached for it and picked it up. Of course then it went in his mouth. She put another block on the table. He seemed a little shy. I'm sure it's hard when you are in a new place with a new person and new toys with everyone looking at you. So a third block went on the table and he picked that one up in his free hand. Maybe he just liked that color better. She asked if he was banging toys together with both hands yet. No, not yet. But she was happy to see him using both hands at the same time.

She got out another bright colored toy with a string attached. He reached right for the string and grabbed it, which is an advanced maneuver.

The next test was a wooden board with pegs sticking out of holes. She showed him that the peg pulled out of the hole and went back in. He was watching her so intently. He put his little hand around the peg and pulled and pulled. The only problem was that he wasn't pulling straight up but more of an angle. After much trying, he decided he would just take his mouth to the peg and work around the problem!

Now Ellen pulled out a bowl of Cheerios to watch how his pincher grasp was developing. This is much improved over a few weeks ago because he reached and grabbed it with his thumb and forefinger and...tried to put it in his mouth.

She moved on to assessing his gross motor skills, which is the large muscle groups that are used to roll over, stand, sit, and crawl. Ellen began by seeing if Adam could sit up. She moved his legs so his knees were bent in front of him for stability, almost like a cross-legged sit. He held that for just a little bit and then stretched them out straight, which made him lose balance. She laid him on his back on the floor and watched him roll over right away. Then Ellen put some toys around him to see how he would move to get them. This is when he started getting a little anxious. At home, he would be all over the place twisting and turning in circles to get the toys on the blanket. But he just propped up on his arms and looked at all of us.

While he was laying there she took off his socks and rolled up his pants so she could see his legs and feet. She rotated his ankles around and moved his legs. Then she had him stand.

Ellen's portion of the assessment was over. She said Adam is very advanced with his fine motor skills and rates him at 8 1/2 months - just one month behind his actual age. Excellent news! However, she sees some tone issues in his legs and rates him at 6 months with gross motor skills. This surprised me. If you are around Adam, you would see that he rolls over, stands, and gets up on his knees like he is almost crawling. Ellen told us most babies when they sit up, naturally hold their legs in front of them with their knees bent for stability. Adam doesn't hold that position and by straightening his legs, that is an example of tone or stiffness. Another example is that when he stands, he has a tendency to stand on his tip toes rather than flat footed. This can cause balance issues as he is learning to walk.

When Ellen was working with his ankles and feet, she also noticed they seem a little stiff. She gave us some exercises that we can do 3-4 times a day to stretch that muscle that runs from the bottom of your foot, up your calf, around your knee, and into your thigh. While he loves his time in the exersaucer and jumperoo she would like us to not have him in it at all or limit his time to no more than 10 minutes per day. The way the seat is positioned it has a tendency to force them to lean back and put their weight on their toes rather than stand upright, flat footed.

Because we don't have another appointment with RDFP for 6 months, she would like us to start our communication with Early Intervention again. She is going to call the physical therapist and ask if she can assess Adam once or twice a month for the next 6 months. This timeframe is a very key time to keep a close eye on him and make sure he continues to move forward with development and not regress with his gross motor skills. Obviously we are willing to do any exercises she recommends and attack these minor issues early on. We feel thankful that we can be part of a valuable program, especially at no charge to us!

With that portion of the assessment over, we moved to another room to get examined by Dr. Corralis. She was actually Adam's doctor on June 1 and handled his discharge from the NICU. The first thing she said when she walked in the room was that he looked yellow - is he always this yellow? I don't know. He is typically more pale and Sara has pink rosy cheeks. She wrote a script for a blood test to check his levels - maybe he has jaundice, anemia, or possibly an iron deficiency. Dr. did a short physical exam and then pulled out some toys of her own to rate him on some things. He picked up both blocks again, actually got the peg out of the board this time, pulled on the string, looked at himself in the mirror and touched it, and flailed his hands out wide as a sign of protection/catching himself when he felt like she was dropping him face down. Thankfully, no spit up! We put him on the floor sitting up and he bent forward in a crawl position - hadn't seen that one yet. And she stood him up to look at the tone herself. She didn't feel it was as bad as Ellen because while he started on his tiptoes, he did relax and settle into being flat footed eventually. Dr. Corralis agreed that he rated 8 1/2 months on the fine motor skills. She was very proud of him.

Since we still had a little time before needing to relieve Dawn watching Sara, we thought we would try to get his blood test done at the hospital. What an ordeal! Dr. Corralis didn't write a diagnosis on the script so they couldn't fill it without it. Quite a few phone calls and 40 minutes of waiting, we finally got what we needed. The lab was quite helpful in moving us through quickly once the paperwork was in order. Adam thought the prick in his heel was no big deal. It was the lady squeezing his foot to get blood out that made him really mad. Sorry for the tears, my boy! Results will be sent to Dr. Neese, the pediatrician, and we will see if that skin color is just normal for him or if something needs attention.

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