Joan's physio

Sorry for the late update, everyone. I started writing this last night, but Joan woke up, and one thing led to another, and it got put off.

Yesterday was Joan's physio day. It was, in a word, awesome! What a cool little facility! It's an entire little building devoted to kids with problems like Joan's, filled with therapists who specialize in babies and kids. It was very, very cool.



We met her little team for a two hour assessment. (Man, was I glad John had a sitter for that!) She has a physio student, a physiotherapist, and an occupational therapist. They asked a lot of questions, took a lot of notes, talked to each other in physio-ese, which I didn't understand, and sent us on our way with a few more appointment dates, and a bunch of things to do with her in the meantime.



It was very neat watching them work. It looked to me like they were just goofing around and playing with her, but they were actually testing for very specific things. At one point, the physio guy was swinging her back and forth, singing her a song, and I thought he was just trying to cheer her up, because she was getting tired and crabby. But then he "sang" to his student to make note of a certain thing one of her legs was doing as he swung her. As they went, they pointed things out to me. Some of it was quite technical. I got a bit of a crash course in anatomy, and how muscles and ligaments work together - all well beyond the scope of my OAC biology - but they dumbed it down fairly well for me.



So, what did they say? In a nutshell, she's going to be OK. She's way, way more mobile than most kids they see with this condition. They said most never open their fists, and can't physically move their arms - they just keep them clamped up to their sides. So it's like we're starting with a huge head start, which is very good news. They said she has good range, and good function- they just need to get it to the next level. The goal isn't to make her right-handed, because that isn't realistic or necessary, but to make her right hand a useful supporting hand. And they said by watching her, that's entirely possible. Physio guy said he sees great things in her future, and thinks that with therapy, she'll be able to lead a completely normal life.



The stroke DID affect her right leg, but less dramatically than her arm. It displays "toning" I think they called it, which is caused by a stroke - when her good side is working hard, she tenses her bad side - she curls her toes and balls her fist. It's one of the things they have to work on. That's where the hand brace comes into play.



In terms of time, we're looking at years. They said it's about goals - both our goals for her and her own goals for herself, as she gets older. Right now, the goal is to get her using her right arm, and get her to bear weight on it, to build up the muscle. Then, the goal will be to get her mobile - she'll probably need extra help learning how to walk. Maybe climbing will be another goal. Later down the road, maybe it will be writing, or sports. She'll keep running into limitations as she grows, and her body is expected to accomplish more, so as those expectations crop up, she may need more therapy. They said it's slow, and often frustrating, especially at this age, when they don't understand the end goal. But they were all confident she'll get where she needs to be.



They said mentally, she's a "smart cookie." And they said she has a great attitude and temperament - she's happy and easy going, and they were impressed by her drive - that she tries so hard to accomplish, even though it's hard for her. They were very impressed that she's progressed from having a gimpy hand flopping behind her to being able to get up on all fours, all by herself.





This was just an assessment - her first actual appointment isn't for a couple more weeks, then we go every couple weeks as long as we can. That's when they get into the nitty gritty of specific games and exercises. But because we're all eager to get a jump start, they gave me a few things to concentrate on in the meantime. They suggested little games, like putting a sock on her left hand - it forces her to try to get it off with her right hand. He said sometimes, pediatric stroke patients adapt by using their mouths as their second hand, so to make sure she's not pulling it off with her teeth instead. Putting toys in hard-to-reach places is another fun game. She really, REALLY doesn't like that one, but it forces her to stretch her muscles out, and it will force her to bear weight on her right arm, or else she'll fall. She needs to do lots of stretching out, or else the muscles will shorten, and therapy will become even harder. And I'm supposed to position her in such a way that she's forced to support herself with her left hand, so that she has to reach for a toy with her right - that's another exercise. They also told me to keep her from turning her wrists a certain way that she does, because that also lets her muscles shorten. And it's important to turn off all of my mommy instincts to do these things, they said, because she's really not going to like it. They said she's found a happy place - she can sit up and play with stuff, and she does that very well. The stretching is going to be challenging for her, but I can't let her wimp out. She's going to get mad and frustrated. But she needs to get through this to progress to the next step, which is the all-important goal of mobility - she needs to be able to bear weight on her arm to get up off the floor. Sigh. But they also suggested I bring the Jolly Jumper back out, so she'll like that.

I asked if she'll have her good arm put in a sling, like people have been telling me will happen. They said it's actually a splint, and perhaps down the road a ways, but not anytime soon - she's too young and too early in the process for that. And the goal is to have her hands work together like a team, each with its own purpose, so it's a form of therapy they use sparingly, if it's even needed at all.

There were several interesting things she did there that I'd never noticed. She's a good spinner - she can pivot around both on her bum and on her belly. But they discovered she can only spin counter-clockwise. They put toys on her right side, to try to get her to pivot clockwise; she couldn't do it, so she actually spun all the way around to get to the toys. Also, she can't actually change positions, which is something I'd never even really thought about. If she's sitting, she can't get down on her belly - I have to put her there. She's almost able to sit up from belly, but not 100 per cent. Helping her get down on her belly is one of their goals with the stretching exercises - eventually she'll be able to stretch far enough that she'll flop right over.

I told them that she seems to have abandoned crawling altogether - even when she is on her belly, she doesn't even try anymore. Physio guy said that's totally normal. She wants to walk now, so she's concentrating on that. She'll definitely need help, though. If I prop her against furniture, she tries to cruise, but can't get her legs to do their thing yet. I think the Jolly Jumper is supposed to help with that.

That's about it, in a nutshell. It was very informative, and they were very positive and uplifting, and despite a few frustrating games, Joan had a great time playing. It was a very active two hours for her. She was pooped when we left - she fell asleep in her stroller even before we got to the edge of the parking lot!

Other than that, things are chugging along. John is back in school today. I wish he'd gotten more rest yesterday. He stayed home from school, but the sitter was with him for four hours in the afternoon, and she took him from his cozy blanket in front of the TV, and made him walk around the neighbourhood, and go for a drink at a restaurant, and then rake leaves, and play with the neighbours. By the time I got home, he was completely toast, even though I asked her to take it easy on him, because he's just getting over a bad flu. I felt bad dropping him off at school today. He looked pale, and still has a bad cough. But I'm not allowed to miss three days in a row without a doctor's note, because it's a taxpayer funded program, and he's not sick enough to warrant a trip to the doc. So off he went, hacking and spluttering away.

Speaking of John, it's time to head out to pick him up. I'll try to keep you all updated as things go. The next few days are going to be busy, with Jer moving out. I'm stopping by the paper on Friday for a visit, too. That should be an exciting field trip. There's a Steel City Safari event I want to take the kids to this weekend, as well. It looks like a lot of fun - lions and tigers and snakes and things. I think John would enjoy that a lot! I'll take the camera!