Emma seems to really enjoy her at-home therapy sessions and can often be seen smiling, but I think she especially loves OT (occupational therapy) and getting to bounce on the peanut ball. Lisa does the bouncing for fun, but she will also hold Emma by the hips so she has to control her core and keep herself sitting upright. Other times she will lean her from side to side or roll her front to back - on her butt as well as on her tummy. Emma loves all of these variations. This could also be seen as a type of physical therapy, but all three (occupational, physical & speech) are connected and they sometimes work on similar things. We really like her having all three, and getting the full two hours per week total with licensed professionals, especially since she will "age out" of the program in 7 months. All of the kids "graduate" from Early Steps when the clock strikes midnight at age three.
These pictures are from October and November.
Another big part of OT is motor skills and using her hands for new things, including holding objects for several seconds, instead of just throwing them across the room the moment she has a grasp, although Emma thinks doing so is super hilarious. Lisa will hold Emma's hands around her rattle weights and count while shaking them to see how long Emma will hold on.
While helping Emma hold the "pen" to draw on the board, Lisa sings a song while moving Emma's hand in different directions. "Up and down, across and around. Up and down, across and around." I have made Emma "write" on cards before, especially when I was sending out thank you cards after her birthday. I'll most likely do the same after Christmas. Even if I have to hold the colored Sharpies in her hand, her arm is doing the motions and I move the card to make sure she's marking on the paper. Back in December 2017 when Emma was less than six months old I was able to get a sort of rainbow drawing out of her. It was great and I have kept it up in her display area of the dining room. I was probably holding her hand then too, and assumed by now she would be able to hold the pen on her own, but I guess she doesn't understand the reasoning and throws the pen the second I let go. And then gives a big visual laugh.
Lisa also has Emma play with a zoo animal pop up toy. Hers has five different buttons and knobs that have to be pushed or moved in different ways for the animals (giraffe, elephant, lion, monkey, and panda) to pop up. Emma does okay with some of them and I love how Lisa will repeat in sentences the animal that it is and make sounds and gestures for each animal, trying to get Emma to copy her. In these two pictures Lisa is doing the giraffe sign (I don't think that's the official ASL sign because according to Google that's more of a hand and neck motion), but I like how Emma is holding Lisa's hands while she does the sign (like hooves) for better understanding, like a sighted baby Helen Keller.
^^ In this photo above Lisa is using our pop up toy that Michael bought. It's a little different with four boxes instead of five, and the one he picked out has smiling fruits and veggies instead of animals. We have been practicing with Emma for her to close the boxes and she will flap her arms and laugh in accomplishment as we clap and cheer and tell her, "Good job". Michael loves to pop another one open the instant Emma closes one- a never ending game! In this photo you can see tiny wrist weights on her arms. She had just closed the red strawberry when I got the picture.
Lisa also brings a princess board that plays music and lights up when the different parts of the pictures are pressed. Emma seemed a little confused by this one, but still had fun. Lastly, they play ball which Emma also really enjoys. Its like throwing but keeping it on the ground. The first time they rolled the ball back and forth, Lisa said to me, "You must do this a lot with her!" I admitted that we had not and that I was impressed as well. She does not have her own ball yet- maybe for Christmas! Sometimes the ball gets caught at her toes so she will give it a little kick since she can't reach forward that far yet.
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For physical therapy, Emma can continually be seen doing her push ups and sit ups, from leaning forward. One night I got a video of her on the couch and she kept leaning forward with her arms out so her hands would catch her six inch fall, then she would push herself back into a sitting position by using the armrest. She did this over and over, about ten times. When she does her push ups from laying on her stomach, her back has seemed to reach a higher angle and she holds her head up higher now.
She has not worn her leg braces in a few months since her legs can bend forward at a 40-45 degree angle, as they should. The braces only bend at maybe a 30 degree angle and she was able to kick them off too easily. And with her spending a lot of time sitting up, she can't wear her braces in that position, so we stopped putting them on her. Her legs are almost never seen bent in his position on her own, and she loves to flop them back "the wrong way" (although it's normal for her since that how she was born and she doesn't have knee caps). Her legs are usually only bent forward 45 degrees when we or the physical therapist, Trish, do the leg exercises. On Friday we are picking up her AFOs (ankle/foot braces), but that doesn't work much with the knee. I'll talk more about those next month.
In the picture below you can see Trish working with Emma this past Monday, having her sit on a stool and Emma's ankles are gently pressed between the stool and Trish's leg to put the knee joints in a bent position while distracting her with other toys. This exercise was also about grabbing, holding, and dropping (not throwing) - similar to OT, but mixing in PT as well with the leg movements.
Trish has her own set of pop up toys and will get Emma to try to press the buttons or push the pieces down while supporting her weight in her arms. This way she has to hold herself up with one arm while lifting her other arm to press the button. It's not easy, but it's good exercise and practice!
The big, blue pool noodle is used a lot during PT (physical therapy) as well. Similar to the peanut ball, but without the bouncing. Since this is closer to the ground, Trish makes Emma bend her knees and hold her foot flat on the ground in the way it is supposed to be. Emma will need to get used to this soon in order to use her AFOs properly!
Some other things that Trish wants us to work on with Emma is her being able to move herself while in a sitting position, so Michael has been doing this during trach care. This is done by moving one leg out in the direction that she will be turned, then move the other leg towards it and so on until she has turned 90 to 180 degrees. She also says Emma needs more practice with reaching across her body and turning her torso to reach things. She showed me examples such as placing something on the ground on the outside of her left leg and then making her reach it with her right arm. This will usually require her to lean and support herself with her left arm on the ground next to her in order for her right arm to be able to reach the object. Trish said this may be harder for Emma because, although she has a strong core from all her sit ups (when she holds our fingers and pulls herself into a sitting position from laying on her back), she doesn't get the stretching movements that a toddler body normally gets from crawling. Emma does not know how to crawl, but seems to find it easier to scoot herself around while on her back. She's got a lot more to learn over the next 7 months!! :)
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