Saturday, January 05, 2008

Allie's Physical Therapy Update

Allie had a recent evaluation that I thought I'd share with those of you who are interested. I know that many of you are praying for us. I need you to keep it up. We attribute the success Allie has experienced to your fervent prayers. By the way, Michelle and Rena, Allie's therapists, are awesome. Their love for their work and this little girl are incredibly evident.

Dates of Evaluation: December 17 & 24, 2007

Diagnosis: Status post nonaccidental head injury, cortical visual impairment, optic atrophy.
Treating Diagnosis: Quadriplegia

Parent Concerns: Allie's grandfather is pleased with her progress. He would like to see her use her hands more effectively and be able to roll.

Functional Skills:
Mobility:
Allie is dependent in mobility. She is able to roll occasionally from prone to supine but does not yet roll consecutively for mobility. She is usually carried by her grandparents. For distances, Ali uses a jogging stroller.

Transfers: Allie is dependent in all transfers as she is unable to push up into sitting or pull to stand.

Muscle Tone: Allie has markedly increased tone especially around her hips, hamstrings, and shoulders.

Balance/Gross Motor Skills: Allie is able to roll prone to supine with moderate (sometimes minimal) assistance. She is not able to push up into quadruped or prop on her elbows in prone but is able to maintain quadruped with assistance when placed. She is not able to pull into knee stand or standing. She is able to stand with support but not balance in standing, and when held in standing, feet are plantar flexed to about 60 degrees bilaterally and her hips are flexed 30 degrees.

Allie can step reflexively when held in standing, with excess ankle plantar flexion, hip adduction.

Allie has fair head control and can usually hold her head up in supported sitting. She has inconsistent head righting which is better on the left compared to the right. Allie is not able to sit by herself but is able to sit with moderate support. She is able to balance momentarily when placed in sitting but lacks equilibrium and protective responses to sit without falling.

Progress: Allie met her goals of being able to tolerate side-lying in preparation for rolling, the ability to flex her neck forward and laterally against gravity when held with support as well as rolling from side-lying to supine from prone. New goals were set in September 2007 for mobility - scooting and rolling two feet towards toys with assistance - she has not met this goal.

She met her goal of sitting with moderate assistance, but not transferring in and out of sitting with moderate assistance. She is making progress towards these goals but has not yet attained them.

Summary: Allie is an 18 month-old girl with a diagnosis of spastic quadriplegia secondary to nonaccidental head injury. She also has significant visual impairment. She has made progress in Physical Therapy in the past six months as she is now much more tolerant of being handled/moved, and has demonstrated better head control, is able to be positioned in sitting with support, and is able to roll prone to supine inconsistently. She continues to have significantly increased tone, particularly in her hips and shoulders. She has significant contractures of her hip adductors and flexors, and slight hamstring tightness bilaterally. Her grandparents are excellent at following through with suggestions for activities and exercises given by this therapist and are consistent in attending Allie's therapy appointments.

Goals:

Improve transfers - Allie will be able to

  1. sit independently when propped for one minute when placed
  2. push up from side-lying to sitting with moderate assistance
  3. support self in quadrupled for thirty seconds when placed in preparation for creeping and moving in/out of sitting

Improve mobility - Allie will be able to

  1. scoot or roll two feet to obtain a toy

Recommendations:

  1. Continue Physical Therapy twice weekly
  2. Obtain AFOs (ankle-foot orthosis) for lower extremity positioning in sitting and standing

4 comments:

Vicki Small said...

Thanks for this update, Bryon. I'll post the link on my blog.

Lots to continue praying about, but it is about progress, and not perfection.

Bryon Mondok said...

thanks, vicki...

MWest said...

Gotcha in prayer. What a lesson in patience. 1 day at a time.

Michele P said...

Thanks for the update. I can't wait to see her meet these new goals. I am confident that, with continued prayer, she will meet them soon! How exciting to see how far she's come.