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.