Alo - PT Eval (LONG)

Alo had a PT eval done on the 8th of September, 2008. I got the report in the mail today.. I expected pretty much everything that it said, but I did not expect to see a few things.

Here it is the Bold parts are the different sections of the eval. The quotes are direct quotes and the rest are my comments.


History, Birth History, Medical History - A bunch of stuff here... not really relevant besides him being preemie, hospitalized numerous times and having spina bifida.

Then it goes on to state Social History... Where he lives, his nursing (or lack thereof) and some concerns and needs for him..

Standardized Testing
It explains the type of testing they used to evalutate him. (Peabody Developmental Motor Scales and the Pediatric Evaluation of Disability Inventory)

According to the PDMS He is in the 1 percentile.. I guess the good news about that is that 1% of kids his age are right there along with him.. The bad news of course is that 99% are more skilled than him. Below are the categories and raw scores for PDMS.


Reflexes - 23
Balance - 11
Nonlocomotor - 52
Locomotor - 11
Rec. and Prop. - 0



And the Basal Age Level - 6-7 months
Ceiling Age Level - 10-11 months
Age Equivalence - 7 months
Percent Delay - 82% (Hey, at least he is 18% non-delayed)


Now for the PEDI scores:

Functional skills - 15 - < 10 - NA - 37.1 - 2.4
Caregiver Assistance - 15 - 20.8 - 3.5 - 49.8 - 3.8


Clinical Findings/Observations:

Now for the fun stuff...

Range of Motion

"Aloshua demostrates deficits in PROM in his lower extremities, particularly knee extension and ankle dorsiflexion"

Why yes he does.... He holds his legs very tight.. He has very poor muscle or shall I say lack of muscle along the back of his legs making it very difficult (and painful) for him to straighten his legs out.. Due to nerve damage he is unable to point his ankles. He can flex his feet up but can not point his toes down.

"He also demonstrates decreased trunk and cervical ROM with all movements"

I'm not sure I would go that far, but I guess that is why they are the experts.

Strength

"Aloshua exhibits general decreased strength throughout his trunk, neck and extremities. He is able to perform anti-gravity movements in supine for hip and knee flexion bilaterally (with left increased over right).."

While hs isnt all that strong, he has great strength in his arms and he can kick the crap out of somebody by swinging his legs up. His arms are obviously much stronger than his legs. His neck is extremely strong considering the size of his head. The right side of his lower body was affected more from his spina bifida..

"He is able to maintain his head and trunk upright and in midline while W-sitting for several minutes"

Yeah.. That is the only way he sits. He is a pro at it.

"Formal manual muscle testing was not performed due to Aloshua's young age and inability to tolerate appropriate positioning"

Muscle Tone/Spasticity

"Aloshua demonstrates low muscle tone (hypotonia) through his trunk, neck and extremities. No resistance to rapid movement at major joints or clonus was noted at the time of this evaluation."

Again, Im surprised they say he is weak in the neck... I couldnt imagine them carrying around a head like his and having low tone...

Supine

"Typical Posture: When lying on his back, Aloshua tends to keep both hips abducted and externally rotated, and both arms abducted to each side."

Very common with preemies, though most outgrow it.. I believe this to be due to many reasons.. One being he just prefers it because it feels better.

"Other Observations: In supine, Aloshua is able to turn his head freely to either side."

A feat he reached around 15 months!

"He is also able to bring both arms/hands midline to reach a toy, and is able to cross midline with either arm/hand to reach a toy"

Another that he learned around 18-20 months. He is really good if its food he is reaching for ;)

"He is able to flex both hips and knees through partial range; however his right leg tends to pull into abduction toward the end of his available active range of motion 9AROM)."

Again.. a spina bifida thing for him

Prone

"Typical Posture: When lying on his stomach, Aloshua tends to keep both hips abducted and externally roated, and both arms abducted and slightly retracted."

Again, same reason as above.. Also I believe part of the reason for this (especially on his stomach) is that his trunk is very wide due to a few different things. His extremities are small and it is harder for him to keep his arms under himself as he should.

"He is able to turn his head left and right but tires before fully orienting."

Again... A head issue here. Its just too dang heavy to lift! All of his doctors and specialists think that once his head is more proportionate to his body that he will be able to do many more things. Right now he is just very top heavy.

"Aloshua tends to spend minimal time on his stomach, as he prefers W-sitting."

Cant argue there... He can see the world and come as close to standing as he can by W-sitting.. The therapist hates it.. but its the only way he can sit up.

"Rolling:
prone > R > supine: independently
prone > L > supine: independently"

He is pretty good at rolling. This was how he got around for many months before he figured out the crawling business.

"Transitions Floor > Sit: Aloshua requires assistance to transition to sitting as he prefers to W-sit. He maintains unsupported sitting less than one minute"

Well if they arent considering W-sitting to be "unsupported sitting" then yes, he can not sit up on his own. W-sitting is the only way he can sit up.. It gives him a wider bottom to sit on.. If he sits with his legs out in front of him we run into that head issue again. (He is like an upside down weeble.. as soon as you let it go, it tips back over)

Moves us right along to Sitting

"Typical Posture: Aloshua prefers W-sitting and is able to maintain this position independently while playing with toys and exploring his environment. He is not able to transition independently into tall kneeling from W-sitting or quadruped."

Well Im not so sure about that... While he can not tall kneel as tall as they want him to I do believe that he can transition into quadruped (of course he is froggied, but at least its quadruped)

"He currently requires assistance to transition to sitting with his legs and feet in front of him"

And if he is let go then he topples over. Sitting like this is uncomfortable for him. His legs are very tight in the back and this forces him to stretch them much more than he is comfortable with. And yet again, the head issue

"He was able to tolerate unsupported sitting for 30-45 seconds before tiring and supported sitting up to 5 minutes during testing before tiring"

He tires very easily with everything.. Mostly due to lung/airway issues.. Its the reason he is so small.

"He was able to maintain his head upright and in midline well during supported sitting He was able to track to either side, but would lose his balance with any attempts to look behind his shoulder"

At least he got part of it right...

"Transitions up from Sitting: Aloshua transitions from sitting to W-sitting or quadruped in order to creep"

Ok.. Creep, different from crawling, though I would call what he does crawling. So.. this means he DOES get into quadruped..

"He is not ambulatory nor does he attempt to pull to stand at surfaces without facilitation"

First off, he IS ambulatory.. He doesnt walk; true, but he crawls (or creep as they say) and by gosh he gets to where he needs to go... He is not ambulatory outside. Regarding the pulling to stand; I wouldnt say he did it with facilitation either.. He bears no weight and has no interest in it.

Orthotics/Adaptive Equipment/Assistice Devices

"Aloshua currently utilizes a tumbleforms feeder seat that was donated to him for supported upright sitting time."

He received this chair after much hassle with medicaid when he was younger so he could sit up. He had other chairs but they positioned him funny and he was unable to breathe. This was pre-trach.

"He has a standing frame, but has not used it."

Well, it is being used as a makeshift end table!! He does not like to use the stander.. It is uncomfortable with him, but hopefully as PT works with him more he will be able to tolerate it.

"Aloshua's mother reports he "stands" in a baby walker to eat, but requires assistance to propel the walker in order to explore his environment."

I wouldnt really say he explores his environment, but I guess we all chose different words... While sitting in his baby walker (we call it his "chair") he will attempt to put some weight onto his feet and push himself backwards while doing so. He is unable to move himself forwards.

"His mother utilizes a standard double stroller for outing to transport Aloshua and his respiratory equipment, and he uses a standard card seat for transportation"

This eval was done before he got the wheelchair but it would be nice if that fancy wheelchair we just got could be used now instead of the stroller!! The stroller is big and bulky and when loaded down with his stuff makes it very hard to get to things (like his vent if its beeping).. Re the carseat, his is currently in a Scenera which is FF or RF dependig on who is driving the car. I prefer to keep him RF for safety but thats not possible if Courtney (the Giant) is driving.

"Aloshua's mother has been given a prescription for bilateral AFO's through the spina bifida clinic at ACH; however, he had not been evaluated at Snell at the time of this evaluation."

PT will be working with Snell (the orthotic place) to get him the AFO's.. They want him to use the AFO's for weight baring activities (like the stander).

Strengths
"- loving and devoted network of family and caregivers
- very playful personality and enjoys interacting with others
- able to creep reciprocally to explore environment"

Sometimes he is a little TOO playful and doesnt want to do his work. He would rather play.. For many months during Speech Therapy he would only play peek-a-boo instead of doing his work.. Cute, but not what they want of him :) I still find it crappy that they say "creep" instead of crawl!! Does this mean we need to work on crawling still??

Concerns

"- hypotonia
- decreased strength
- decreased AROM
- dependence for transfers
- delayed mobility skills"

I think he quite likes to be carried around.. Like today the little bugger wanted me to carry him ALL.DAY.LONG! .... And he has great strength.. Just piss him off or try to suction him when he is mad.. He will demonstrate it then.

Lastly it says the Informed Clinical Opinion and Recommendations which basically say that Alo is delayed and needs therapy and the therapist thinks that Alo would benefit from therapy.

And the Physical Therapy Goals

Im not going to list them all but pretty much things to try and get him to a 10-11 month level... Bearing weight on his feet, sitting, quadrupred, tolerating activities, and lifting his head more while prone