Preschool Updates

This year was a big one for "back to school" around our house - Audrey started Kindergarten and Adam started 3 year old preschool! Of course I intended to post much closer to the start of the school year, but as always time flies and somehow it's almost time for Halloween!

Adam is attending the same preschool as his big sister and couldn't wait to start the year. He was a little hesitant about transitioning to a new daycare earlier in the year, so I wasn't sure what to expect, but he has done just great. He's now in a preschool setting one day a week for daycare and then twice a week at the private preschool. It has been so amazing to see how quickly he's turning into one of the "big kids"!

Physically, Adam continues to do very well. At this point we do very limited "therapy" activities at home, and really just try to encourage symmetry in his every day activities or present play situations that encourage him to use/strengthen his right hand. These days that looks like anything from squeezing clothespins and chip clips, using squirt guns with a lever action to make him use his whole hand, legos, connect four, catching bouncy balls ... the list goes on! He loves helping in the kitchen, so I can almost always get good work in on the right side by letting him help prepare meals, set the table etc. Basically anything he's interested in playing with we just encourage him to use both hands together or to at least try manipulation with his right hand. There are definitely time's he's more agreeable to this than others, but we haven't had to use any CIMT strategies or handsplints to help recently. As for his leg,running around on level surfaces there really isn't any difference left to right. When it comes to climbing or stepping up a big step he still shows a slight preference for using his left leg as his stabilizing or "stepping up" leg, but this doesn't keep him from using stairs using a reciprocal or "every other" pattern, climbing EVERYTHING at the playground and trying to jump on or off anything he can find. He's riding a two wheeler with training wheels and has gotten much better at his little Razor scooter. I definitely have to keep my eye on him because he's absolutely convinced he can hang with the big kids in just about everything!

Adam continues to show good progress related to speech and cognitive development as well. He has age appropriate speech patterns - which means that although he's still working on S-blends, giving us "Fiderman" instead of "Spiderman" for Halloween, most of his words are intelligible to unfamiliar listeners. In fact, Adam has become quite social and often slows me down in the grocery store befriending random ladies in the aisle to tell them about his love of dinosaurs, preschool and brag about pooping in the potty!! It's hysterical and I love every minute. Speaking of which, HE'S POTTY TRAINED! That happened over the summer and although as noted above poop took a little longer, he's doing great now. This means he was able to start school this year and is loving being part of a class. According to his teacher he's doing really well and we see a lot of new skills already at home. He's counting higher (mid-teens consistently), knows his shapes, colors, is interested in letter recognition but not accurate, able to recognize his name/his sister's from a group and is now writing A's, M's, H's and O's ... with both hands!! Although he definitely shows a preference for writing with his left when using pencil or crayons, he often times draws with chalk or colors with his right. We continue to watch his cognitive development closely and as he starts this new stage of preschool to grade school it is definitely on my short list of things that I'm learning more about to be prepared to help support his learning.

Here are a few pics of our little guy in action:

Turning 3 with his excavator cake

Climbing on everything!

Painted his face himself

First day of swim lessons

This boy loves construction equipment

So far Adam throws lefty and bats righty ... guess we'll see!

A little blurry, but my baby picked up his sign with his right hand all on his own. One of those moments that caught me off guard and brought me to tears. So grateful that my little boy is so happy and has the opportunity to experience everything I could hope for him at this age!

Update on Adam's Progress

So after a long break from posting I'm happy to give an update on Adam's progress. He is now 2 1/2 years old and progressing typically in every way. In November he had what will hopefully be his last routine visit with his pediatric neurologist. After a thorough physical exam and extensive questions to rule out any possible seizure activity, the doctor felt that Adam is doing very well, that his physical impairments are very mild and being addressed through therapeutic activity at home. He recommended that Adam did not need to continue routine visits, but that we would consult as needed if there are any future concerns regarding possible seizure activity or higher learning activities in school. We plan for Adam to start regular preschool when he turns 3.

Here's a run down of where Adam is at with regards to his development:

Walking/Gross motor/Play - Adam started taking steps at 11 months and really started walking on his actual birthday. Although we initially noticed more posturing in his right arm while he adjusted to walking this lessened overtime and rarely happens now. We are relieved that there was no difference in his legs or feet as he has learned to walk, run, climb stairs and jump. Adam can now ride a 3 wheel scooter (pushing with his right leg!) and although he CAN pedal a tricycle a little bit he finds it much faster to scoot along with his feet. He climbs ladders, slides and on top of tables easily; jumps on/off and over things and has good balance/coordination in all of his play activities.

Fine Motor - Once Adam got the hang of walking we started an intensive program of constraint induced movement therapy. We consulted with our pediatric OT (often through use of video and less frequently in person) to develop and modify our program. Adam wore a mitt on his left hand 4-6 hours a day on most days to help him develop his motor skills on the right side as well as address an ever increasing preference for using his left hand. It was truly amazing to see how the quality of his movement in the right arm, grasping skills and frequency of initiating use of the right arm improved with the constraint induced program. After about 3-4 months we began to wean time in the mitt and emphasized skills that required him to use both hands together. We saw a significant improvement in the frequency with which he would spontaneously choose to use his right hand for a task such as playing or eating but he then required cues to start to use both hand together to complete the more complex tasks required of a toddler. After discontinuing use of the mitt for about 3 months we began to introduce it again on a limited basis to emphasize new skills such as drawing and in-hand object manipulation. We also briefly utilized a custom hand splint during these activities to help improve Adam's finger position during grasping. Specifically it allowed him to strengthen his lumbrical grasp, essentially allowing him to better use his whole hand during activities.            

 Just to give you a picture of where Adam is at now, if you watched him play not knowing that he had a stroke you would probably not notice anything atypical about the way he uses his right arm/hand. If you watched very closely you would see that he still demonstrates a preference for use of the left side and that his movements are smoother/more coordinated with that hand. Despite this Adam can pick up a grain of rice with his right hand, he will sometimes use a spoon with his right hand instead of his left and if a task is difficult for him to do with his left hand he will then try it with his right - something I wasn't sure we would ever see! He loves to color using both hands, cuts using scissors with his right and is able to put caps on/off markers using both sides. He can manipulate puzzle pieces, legos and shape sorters using his right hand, turns pages in books, drives his cars all over the house and will use both hands for dressing (taking socks/hats off, jackets etc). These days we spend much less time on specific therapy activities and try to focus his play activities on tasks that will encourage use of both hands together (playdough, building blocks/legos, stringing beads etc) or specific strengthening/fine motor control on the right (helping with cooking by placing all the ingredients to the right/overhead/strategically placing bowls/utensils, cutting with scissors, coloring, squirt guns/squeeze toys etc).

Adam enjoying his Elmo cake on his 2nd birthday

Adam using his hand splint while coloring

Speech/Cognitive - Adam's language development has always stayed right on track. We have touched base often with my co-worker who is a pediatric speech therapist and although he has never needed speech therapy she has been a great resource on strategies to encourage typical language development. He is now using full sentences with a vocabulary that seems to be expanding by the day. I am often amazed at the detail and thought behind what comes out of his mouth these days! He loves to describe what he sees going on, tell us about events in his day and is now recalling more of what has happened in the past. He has good articulation and people generally understand him well even outside our friends and family. He loves to "read" books on his own and listen to stories read to him. He can now not just identify what is on the page, but will tell you what characters are feeling and why or start to predict what might happen next. He can consistently count objects up to 10 well and is starting to count out loud to 20 ... with a lot of number skipping :).

Following the diagnosis of stroke there is so much uncertainty. I can't express how grateful we were for stories that parents shared about their children's growth and success. Knowing that there was a possibility for Adam to have functional use of his right hand ... to run, walk and play with his peers ... to learn, grow and lead a healthy, happy life ... this is what we clung to. It was motivation even on the difficult days to seek out new therapy strategies, to practice our home exercise program activities (even the boring ones...even with the tantrums!) and to adapt Adam's daily routine to give him the best opportunity for development. We still have a lot of work ahead of us, but it felt important to share Adam's story so that others headed down this same road may find the same comfort and hope that we did.