Small successes

My posts that can be labeled under 'inspiration' have been pretty lacking, which is probably an outlook thing. But here are 3 great small successes from pediatric land this week, plus a small SNF story thrown in. And though they are small victories, it's more than we often get.

Little Miss X is someone I've known for awhile. She is about 8, has autism, and has recently started ABA therapy at home, also on a new special diet, and they're making some great changes at school. I cotreat w/ PT and we have recently had some success with using patterns for different actions. This has really helped her with doff/donning shoes, she really loved the "monster under the bed" toy and really understood how to retrieve the object and then reinsert it under the pillow. We have worked on throw & catch for months upon months, and yet miss S would become distracted, just flip the ball out of her hands instead of throwing it accurately. I don't know what it was about Tuesday, because we have used the "ready, set, go (throw whether ready or not)" method with her before, but this time it really worked. Even when she wouldn't put out 'catching hands' ahead of time, she would bring her hands together in time to catch the ball. We worked up to 10 rapid catch/throws with no drops and accurate throws.

Little Miss Y has also been a long term client. She is 10, has CP, and has just restarted therapy recently due to an orthopedic surgery. Her mom has more focused goals now relating to her ADL performance and overall function. Her RUE is often held in elbow extension, extreme pronation, wrist flexion, and finger flexion. This has been a challenge for me in the past when trying to help her stretch or get in a more normalized position for an activity. But at this point, I just want her to use the RUE in a semi-functional assistive fashion. So we have worked on pushing objects across a table or holding them using the dorsal side of hand & wrist. We have also started a very very modified CIMT program where a thick sock is applied to the LUE, which she hasn't actually started to hate yet. At any rate, this week, when she was pushing these oversized jacks, I noticed that her thumb was more separated from the rest of her fingers for a change. So with a lot of coaching, she was able to basically drive her hand over the jack and manage to get one stick beside her thumb, and then get enough thumb adduction to actually pick up the jack independently! Previously, the only way I could get her to hold an object w/ RUE only was after placement, but she picked up 6 jacks and transported them across midline. Only assist was for wrist flexion to stimulate release.

Little Mr. Z is the third of the long-time peds clients. We are working on developmental skill progression. We have tried a lot of BUE activity, grasp & release, purposeful use of UEs. He's nonverbal, so we anytime we can get a smile basically makes a great day. This Monday, we were working on BUE coordinated use of toys using this accordion that I found in our closet. With PT on one arm and me on the other, we pushed and pulled and made the accordion make funny little sounds and Z just laughed and laughed.

I love the little smile moments, I love having something to tell the parent how wonderful their child did. Sometimes it's hard to feel that progress is happening, especially when therapy has been continually ongoing. Heck, my BKA pt. on the SNF floor couldn't even see her own progress over the past 2 weeks when she used to be a DEP Ax3 for supine to sit and now is SBA. She was also able to don pants in bed using semi-SCI method, and transferred to a chair for the first time using a sliding board and 2-3 person assist. At any rate, we all need to feel and share the successes when we can, since the lack of progress can be so disappointing. Parents, therapists, patients... we all need an uplifting moment to get through the day.

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