Early intervention services is a state program to assist in identifying and treating developmental delays and disabilities for children ages 0-5. Liam began with Northampton County Early Intervention at just a few months old to evaluate his muscle tone. To qualify for services in Early Intervention at least one of the following criteria needs to be met:
· At the evaluation a score of 1.5 standard deviation or a 25% developmental delay in one or more of the areas listed above or,
· A child must have a physical or mental condition/diagnosis that has a high probability for a developmental delay or,
· An Informed Clinical opinion can be used to determination that a child requires supports and services even though they might not have a developmental delay according to the score of the evaluation.
We have been very grateful that this program is set up in such a way that Liam will qualify for services even though he doesn't necessarily have a 25% developmental delay... Liam qualifies for services based on the fact that he has a diagnosis of Hypoxic Ischemic Encephalopathy, a traumatic brain injury which occurred during birth. Unfortunately this diagnosis will stay with him for the rest of his life. Early Intervention has been consistently evaluating, monitoring, and treating Liam for the following conditions: torticollis;evaluating/monitoring for equal and adequate muscle tone; delayed speech; aspiration of thin liquids, and most recently low muscle tone and foot pronation. We have worked with the following: physical therapy, occupational therapy, speech therapy and feeding therapy. We have the highest hopes for our little man that any issues that have arrived or arrive in the future can be quickly identified and treated. With a diagnosis of HIE, it may be hard to identify something abnormal that is occurring with the infant/child, even if there are 6 or 8 doctors involved in their care. This is partly due to doctors appointments running 15-20 minutes and most of the time we are told there are no large issues and we should be happy with how "high functioning" Liam is. Every doctor that has ever seen Liam has been overly supportive of EI services because they monitor/treat children in one hour intervals which is so important in identifying potential issues before they snowball into something larger. We have been very satisfied with the care we have received and continue to receive, as they are such an integral support system for us first time parents attempting to navigate this diagnosis.
In the latest news, we are so proud to say that Liam has been discharged from speech therapy. Liam was noted to have a minor speech delay at about 13 months. Immediately after this was discovered, we learned that Liam was aspirating thin fluids, which was causing his chronic ear infections, and what we now believe may have caused his asthma and multiple respiratory infections throughout his first year. Since we have been treating the aspiration by thickening fluids, Liam's ears and lungs have cleared up and his vocabulary "took off" with some extra assistance with speech therapy. Liam has been discharged as he now has the ability to speak and communicate at a more advanced rate that some other children his age. There are times I am absolutely blown away by the things Liam says, remembers and communicates to me. He can now tell us his first, middle, and last name!
Liam has been involved with feeding therapy for the better part of a year, which has assisted us in identifying that Liam may have some low tone/sensory issues in his mouth/throat. These issues were often previously leading to stuffing, and pocketing of food. Liam also had a tendency to "chug" fluids which we recently learned predisposes him to more aspiration even if fluids are thickened. Feeding therapy assists us in rerouting these behaviors, and they have drastically decreased with time. At this point we have our feeding therapy sessions once monthly just to have someone overseeing Liam's progress in the home, while we continue with NMES treatments at Good Shepard to hopefully treat Liam's aspiration/delayed swallow.
Liam was previously discharged from physical therapy as no issues were noted at the age of 12 months. I recently requested another evaluation after the Lehigh Valley Hospital therapist picked up that Liam has some pronation of his ankles, which may be caused by low tone. Unfortunately...this session identified some abnormal behaviors and possible underlying tone issues.
We identified that Liam is still pronating his feet, left more than right. Basically, this looks like this:
Our game plan with this issue is to assist Liam in developing a "natural" arch by challenging him physically with several different surfaces in bare feet. This is one of the large reasons we will be taking Liam to The Little Gym! If this issue does not resolve by age of 3, Liam may need supports placed in his shoe to prevent any complications or injuries. In addition, we have also found during our evaluation with physical therapy that when Liam jumps, he lands on straight legs. (I have thought that this seems odd!) Our therapist has explained to us that Liam has some low tone in his hips and knees, as he should definitely be landing on bent knees. If this continues Liam is at risk for hyperextension and possible injury, which we of course want to avoid! We also noticed that Liam does not like to come down the steps using both feet. Liam only comes down with left foot leading unless we really work with him to do otherwise. After this last therapy session, it has been decided that Liam is experiencing some weak eccentric contractions in his legs, which I will try to show you below:
We have been assured that these muscles can be strengthened, and have been given exercises to do. We are excited to get Liam a mini trampoline to help him strengthen these muscles! Liam has found such a brilliant way of compensating for these weaknesses that he is not having a hard time keeping up with other kids his age. We are very confident that Liam will strengthen these muscles and continue to amaze us! I have set up an evaluation at Good Shepard's physical therapy gym, just for an extra opinion since they are so wonderful. As a mom, it cannot hurt to have more information! I will keep you posted on our journey!
That's all for now! We are very excited for the upcoming holidays with our little miracle! We hope everyone has a joyous holiday season, Love to all <3
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