Tuesday, July 5, 2011

13 Month Assessment

Yesterday Joshua had his assessment with the OT at the Children's Development Team.  His assessment was supposed to be last week with his Physio, but it was cancelled as she was sick and unfortunately still is, so the OT took over to get the report done for his hospital appointment on Friday.

The following is basically cut and paste from the report (except it isn't, because it is a read only PDF and I can't copy and paste... Grrr.. )

Assessment used:

  • Ages and Stages Questionnaire (ASQ-3) 12 Months
  • KIDSCREEN Occupational Therapy Profile 0-18 months
  • General Observation of Play

Presentation during assessment:
Joshua was largely content and he easily occupied himself with the toys available.  He would smile in response to interactions with people, however he was most content playing on his own.

12 months Ages and Stages Questionnaire:
Joshua's development was screened using the 12 month ASQ.
Results are summarised below-
Communication    10/60     Below cut-off
Gross Motor           0/60     Below cut-off
Fine Motor            20/60    Below cut-off
Problem Solving   20/60    Below cut-off
Personal Social      5/60     Below cut-off

Joshua was able to:

  • Sit unsupported and reach for toys close to him- increased muscle tone noted in his right leg, affected his ability to sit and occasionally caused him to lose his balance.  If he fell sideways he was unable to correct and often fell from his sitting position.
  • Commando crawl using both his elbows/forearms bilaterally and simultaneously, as well as his left leg to propel himself.  His right leg remained extended.  
  • Commando crawl position- using his left arm/hand to reach more frequently than the right.
  • Pull into a kneeling position using furniture.  He could remain in this position for approx. 1 min.
  • Once positioned in standing he could stand for short periods supporting himself with his arms.  Increased muscle tone in his right foot/leg made this difficult.
  • Get into a crawling position (hands and knees).  In this position he rocked backwards and forwards, reached for toys using his right hand more than his left and pivoted on his knees using his arms reciprocally to move himself.
  • Transfer toys between both hands
  • Reach and grasp toys with either hand.
  • Hold toys simultaneously in both hands and bang them together.  
  • Use a pincer grasp with his left hand without need for forearm support.
  • Use a raking motion and successfully pick up a small object with his right hand- no pincer grasp yet.
  • Drop an object out of either hand in response to a request "Ta" from an adult.
  • Bring an object to his mouth using either hand or using both hands together.
  • Retrieve a toy which is completely hidden under a cloth (not done previously)
  • Visually search for an object dropped out of sight.
  • Shift attention from one object to another, in the same visual field.
  • Track objects for short periods in all planes however visual attention often shifts from object.
  • Hold and move both eyes equally
  • Converge both eyes equally
  • Play with objects by repeatedly mouthing, banging, shaking or tapping
  • Play with a toy by tapping it away and then moving towards it repeatedly
  • Play by pushing a wheeled toy along the floor and watching how it moves
  • Smile and laugh in response to an adult playing peek a boo with him
  • Shift his attention to another toy easily eg. if one toy taken away
  • Hold his right hand in a fisted position when commando crawling and with some other movements, however when directly weight bearing through his hands either in a crawling position or in supported standing, his right hand was fully extended as was the left.
Joshua is reportedly:
  • Showing more interest in others  eg. watching other Children play
  • Eating a family diet.  He will eat small bits of finger food however is noted to avoid biting on larger bits.  He will eat from a spoon offered by an adult and is beginning to accept using and taking food from a spoon he is holding with assistance.  
  • Sleeping reasonably well.
Joshua was not observed to:
  • Use arms to right himself in sitting if falling laterally.
  • Release an object with control into a container, or onto a surface, or into a person's hand.
  • Imitate routine/social/play actions of others eg. wave good bye.
  • Take turns in a simple game eg rolling a ball
  • Crawl on hands and knees
Other observations:
  • Full passive range of movement in his upper limbs with stiffening at end ranges.
Summary of Findings:
  • Results from the Occupational therapy assessment indicate that Joshua has significant delays across all areas of development, related to his neurological impairment.  He presents with increased tone in his right side, lower limbs greater than upper limbs, causing asymmetry in movement and function.  His play is limited by his motor skills and is largely sensory (self or object focussed), however it is pleasing to see he is beginning to show interest in others.  However, despite this Joshua is progressing and this is largely due to the dedicated and focussed input provided by his parents.
Intervention Goals:
  1. For Joshua to voluntarily release an object from either hand into a container.
  2. For Joshua to imitate social/routine/play actions eg. waving goodbye, playing ball.
  3. For Joshua to sustain tracking a moving object in all visual planes.
  4. For Joshua to sit without falling using balance reactions.
  5. For Joshua to crawl using reciprocal movement in his arms. 
And that is it basically....  We have our appointment at the hospital on Friday and I have to give this report to his Doctor.  I asked her about Ankle-Foot Orthotics (AFOs) as I mentioned in a previous post and she basically told me that she would rather see him crawling for a while before going that direction.  Admittedly, his ankles have not looked as bad while in standing over the past week so perhaps by the time he is crawling well and they would be willing to consider AFOs, he won't need them...  Time will tell I guess...   Although Joshua is SO close to crawling, I am beginning to think it is going to take longer than I first anticipated.  Certainly, I don't think it will happen before his appointment on Friday and I think on Facebook I speculated it would be a month max..  that was a couple of weeks ago, and now I am starting to think it might not happen that soon.  Well, we will see...  Joshua is the boss of these things :)  

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