Monday, August 29, 2011

New Therapy and W-Sitting

As I have mentioned previously, we finished up with the Children's Development Team a few weeks ago, which is where we have been receiving Therapy since Joshua was 5 months old.  After Joshua's official Cerebral Palsy diagnosis, the Doctor wanted him to be referred to Carpentaria Disability Services, which is an early intervention service for children that have higher support needs than those that are catered for with the Children's Development Team.
Last week, we had our initial assessment done with the Pyschologist.  I am still waiting on the results.  He initially told me he'd call me with them on Friday, but he didn't call on Friday.  He called today and said he will have the report ready in the next few days, definitely by the end of the week.  I am a bit impatient for the results, but I don't have much choice but to wait!  His assessment was done using the Griffith's Scale, which is the first time we've had this particular assessment.  (All previous assessments were done using the ASQ).  The report from the Griffith's Scale is apparently much more detailed and will give the age level that he is functioning at for each of the developmental areas.  I am looking forward to seeing it.  When you have a child with developmental delays, a common question is "How delayed is he?" and until now, I haven't really had an official answer for that.  Of course, given my own knowledge of child development, I can make my own approximation, but I am keen to see what this assessment says and how it compares with what I am thinking in my head.
Carpentaria also have a visiting Physiotherapist that comes up from Adelaide every 3 months.  Apparently she is a very well respected Paediatric Physio, and she is coming to Darwin this week.  She is going to come and see Joshua on Friday, so that should also be interesting.
Today, we had our first therapy session with our new therapist from Carpentaria.  Her name is Andy and she is an Occupational Therapist.  She will be Joshua's primary therapist as part of a multidisciplinary approach to Therapy.  They believe it is best for each child to form a good relationship with one particular therapist rather than see many different people each week, however, other therapists will be called in as needed.  Andy was very nice and interacted well with Joshua.  It almost amuses me to say that, since the model of therapy they use is called DIR/Floortime.  And they also use something else called the Circle of Security.  If you ask me, these are just fancy names for saying that they base their therapy on theories of Child development.  Which seems kind of obvious.  LOL.  Mostly though, they are interested in attachment theory and the fact that children learn best when they have a secure base to explore from, so they focus largely on establishing positive relationships with the child and supporting such relationships between the parent and the child and using those relationships and interactions to build on the child's development.
If anybody is interested, I found an article a few weeks ago about DIR/Floortime, it is not a bad read.
DIR/Floortime - What is is and isn't.
Basically, they focus on development from a holistic point of view, which is quite interesting (yet logical!).
So, I discussed with Andy about getting AFO's for Joshua (braces for his legs), and she also asked me if we'd ever had input from a Speech Therapist.  I told her No, that we had been placed on the waiting list at CDT when he was 10 months old, and were not seen in the time we were there.  So she is going to arrange for the CDS Speech Therapist to come and see Joshua and give some input and also to do a feeding assessment to check if he is having any feeding issues that might need to be worked on.
I also talked to her about W-sitting.  This is a type of sitting that is often favoured by children with Cerebral Palsy as it is a much more stable way of sitting.  Unfortunately, it is also quite bad for the hips and many people treat W-sitting as though it is the devil and should be avoided at all costs because your child will damage themselves.
This is an example of Joshua W-sitting.  Basically the legs form the shape of a W.
I asked some other HIE parents about it, and basically the replies were a resounding NO WAY.  That they were told to never ever ever let their child sit like that and if they did, they should correct them right away.  This was not actually the response I wanted.  Why?  Well because at 15 months of age, Joshua is still unable to get himself into a sitting position independently.  That is, a real sitting position, on his bottom.   I don't think there is any real physical reason to why he can't...  I think he should be able to, given the other things he is doing.  But he doesn't.  We've been trying to show him/help him for months and months, and he still doesn't do it.  He does however, get up on hands and knees and push back into a W-Sit.  This has opened up a whole new world of play for Joshua.  Because he can get into this position independently and can use it to play with toys upright, rather than having to play from his tummy or wait for me to sit him up.    So, you see, it doesn't sit too well with me to have to prevent him from doing something that gives him so much independence.  I wanted somebody to tell me it was ok to let him sit like that.  And I didn't really want to bring it up with one of his therapists and have them tell me under no uncertain terms that I had to stop him from doing it, because then I would just feel guilty when I don't.  Let's face it...  I have 4 other kids to look after 4 days a week..  I really don't have time to be following Joshua around and stopping him from W-sitting every time he does it...
So, I talked to Tahnee, the physio at the Children's Development Team on our last day there..  she told me that if he was only sitting like that to transition between positions then it was ok, but if he was sitting like that for long periods then it would be best to encourage a different position, even if it was just by bringing one leg to the front. Today, I spoke to his new therapist Andy, about the W-sitting.  She was not too concerned.  He does sit and play like that..  but he is 1 years old.  And he has the attention span of a..  well.   of a 1 year old!  Which really isn't that long.  So he really only sits like that for a few minutes before he is off again doing something else.  Plus, she noted that he isn't just sitting there like that, but he also gets up into high kneeling while doing something and then sits back down in a W-sit again to play a bit more and then he is off again and moving.  He is a busy boy.  So yeah.  Joshua W-sits.  And I don't make him stop.  And I don't feel bad!
So that is it from me, hopefully I will be updating again soon about the results of his assessment and how things go on Friday with the physio!

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