Submitted by Yogita Bapat, Occupational Therapist
| Before | After |
|---|---|
| Difficulty eating -- would finger-feed and suck rather chew food; could only drink from a sippy cup | Has started to use a fork, holding it appropriately; can now chew small bits of food; and has graduated from a sippy cup to straw bottle |
| Would flap hands and screech when excited or distressed | Decreased hand-flapping, screeching, and humming |
| Only made eye-contact with parents | Now seems to recognize OT; smiles |
| Often seemed spaced out | More engaged with the world |
| Could not help dress himself | Can now help pull off socks and pull shirt down |
| Would not touch anything with texture | Started touching different textures |
| Would not use hands to stabilize himself | Has started activating arms more; using two hands more together to play in the midline |
Click here to see a video showing Gavin's progress.
Gavin is now 38 mos old, with a history of seizures, he has a diagnosis of Lennox Gastau Syndrome, he also has bilateral polymicrodgyria affecting the parietal and occipital lobes. Gavin is followed by a neurologist and an ophthalmologist, he took Epidiolex along with 3 other meds. As an ECI OT, I had been seeing Gavin since he was about 14 months old, at which point mom’s main concern was his crawling. After we got him to crawl, PT and SST services were added to his plan, so that I could address the sensory and self help needs as the OT. He was 31mos (June 2021) months old when I started doing rhythmic movements with him. I was cautious initially due to Gavin’s frequency of seizures, but I had seen that he loves movement, eg. bouncing on the ball really changes his arousal level. Gavin used to also climb on and off of furniture and the little foam play structures in his home. Gavin tolerated the rhythmic movements on his back and tummy well, but did not like them in sidelying. After two weeks of seeing positive responses, I coached mom to do them. I saw Gavin twice a month for an hour each for OT, our treatment sessions included various therapeutic activities including the rhythmic movements. Mom did the rhythmic movements, and joint compressions multiple times a day [from the Brain and Sensory Foundations course], and she said that Gavin liked them.
BEFORE STATUS: (June 2021), before OT introduced rhythmic movements:
Gavin finger fed himself and often ate fast, without really chewing his food. Food was a big motivation, but he would suck on it, rather than chew to turn into a bolus; then swallow when it was softened. When we did work on bringing the fork to his mouth, he would hold the fork where the food was at the distal end, instead of grasping the handle.
Drank juice from a sippy cup, holding the cup with one hand, tilted his head way back. Difficulty drinking from a straw cup, would bite down on the straw cup.
Sat in place with a wide base of support, and stimmed with his hands in front of his face, tilted his head back and hummed or screeched/ to make sounds with his mouth.
Flapped his fingers when he was excited or frustrated.
Mouthed a lot of non food objects (such as straw, shirts, toys etc)
Did not help with undressing and dressing, difficulty pulling off socks, or the shirt off of his head.
Did not play with any toys actively, except for one big cube, he would flip the little flaps on it with his fingers.
Minimal to none eye contact- except with parents. Gavin often seemed spaced out.
Used right arm more than left.
Did not like touching anything that had any kind of a texture.
Decreased protective reactions; on the therapy ball he would stabilize himself with his trunk rather than put his hands down to support himself.
AFTER STATUS: (August 2021) Gavin’s family moved out of our service area. Noticed the following changes as we progressed with the rhythmic movements [from the Brain and Sensory Foundations course] over the 2+ months.
Gavin was picking up his food by holding the proximal end of cocktail skewers, instead of holding where the food was. He was also seen to chew his food more, as seen by eating small pieces of chicken, broccoli etc.
Drinking from straw bottle, holding both hands on it, without hyperextending his head way back.
Decreased flapping of his hands in front of his face, or screeching and humming, decreased spacing out, was more engaged with people and what is happening in his environment.
Decreased mouthing of shirts, decreased drooling.
Pulled the shirt down his forehead, when placed there. Pushed his arms out of the sleeves with physical and verbal cuing, when mom guided his hands into the sleeves. When the socks were half way pulled down below his heel, he would pull them off with max verbal cuing.
Started handling and acknowledging other toys, beyond just the flapping of the parts of the cube.
Gavin started giving the OT more eye contact, like he finally knew who she was after all these months, and smiled, and also expressed dislike of some things he had to do (instead of just moving away from the stimulus).
Started using two hands more together to play in the midline.
Started touching different textures. Mom said he did not fuss, and actually stayed on the beach when they went to visit GM in FL this time.
Still stabilizes with his trunk, but started activating his arms more and placing his hands down on the therapy ball, when his balance was perturbed. Will push the ball with both hands, when the OT pushed the ball down on him gently.
Mom said that Gavin liked mom doing the rhythmic movements with him, he tolerated them well. Mom said that “the rhythmic movements and joint compressions has made a big difference in his activity level and mood. Good and bad, he expresses himself much more.”
[Edited; emphasis added]