After a good breakfast, I was ready today for a very special patient and my first evaluation. Janine picked me up around 9:45 am and we made our way to a longer session with a 2 year old boy, who does not talk at all yet and has very significant gross motor delay problems. He has very weak muscles that he cannot control at all and might suffer from absence seizures that are not detected yet. A physical therapist, a speech pathologist and Janine as the occupational therapist are currently providing their services. Lucky me, I saw all three of them working one after another and it was very interesting to see where they corresponded in their therapy and with what topic each of them was particularly picky. Since the little boy cannot be mouth fed at the moment, he has a tube leading into his stomach that provides him with enough nutrients to be able to grow. Janine is working with him on getting more used to having textures in his mouth and making oral care easier through this. It is very sad but good at the same time to see this very bright boy being trapped in his body trying so hard to control his movements. He already has made a lot of progress and has come a long way, so that the speech pathologist is working on finding special ways to enable him to communicate. Right now, he is using a keyboard with pictures of actions or wants on it, that he can press to make the keyboard say out loud what he wants. Even pressing these specific buttons though is hard for him, as he still needs a lot of arm support. He will look at the picture he wants, but his arm will go into a completely different direction. Even though the guy is in such a difficult situation, that is very hard for his family, he is very lucky to have a very supporting mom. She has adapted to his situation a lot and has learned how to create or manipulate toys so that he can use them. It was a wonderful experience to see how much a mother’s support can help a child with such difficulties to have a good life and progress so much.
Coming back from this very impressive and powerful session, Janine prepared me for the evaluation we were about to go see and filled me in on the techniques that her company uses to evaluate a child. With that information, Janine and I along with two other therapists went to evaluate a 13 months old baby boy. He had been referred with concerns towards his gross motor development. Even though this was the only area of concern, Janine’s company evaluates every area of development to see if the one delay has any impacts on another area. The area’s looked at are social/emotional skills, communication skills, cognitive/ play development, gross and fine motor skills, self help skills and the sensory processing of the child. Having a chart that says what is age appropriate, the therapist make certain test through playing with the child to determine in what age are his skills fall. Important are also the parent’s answers to question that the therapists asks in order to figure out certain developmental areas like sleeping and eating, that cannot always be looked at during the evaluation. If a child shows 33% of delay in any of these areas, it is considered eligible and services have to be provided within a month. The little boy evaluated today was very cute and fortunately only had some problems with his gross motor skills. Even though he is already standing and walking a little, he does not quite catch himself yet when he falls. It seems like he has weak shoulders. A sign for this is that he never really crawled and only gets around with military crawling. In an evaluation, the therapists go after the wishes and concerns of the parents in order to be able to set up a program that will improve what the parents are worried about but also include the therapist's recommendation. Since the little boy cannot really move himself a lot yet, he depends a lot on his mom, so that her wish was that he could play by himself for at least ten minutes. It was very interesting for me to see an evaluation and go through the process once as I got to see all different areas of development.
Having been with Janine for a little more than a week now, I am starting to understand a lot more myself and find the reason behind it. Especially today in the evaluation, I often knew what Janine was looking for and why she would do certain things.
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