End of Constraint...

Annabelle ended up doing so well with the cast on that we left it on for a week and a half. Our limiting factor was not wanting to send her to daycare without a functioning arm/ hand and my ability to take time off from work. We saw huge improvements in her ability to supinate her arm and once we got the cast off her spontaneous use of lefty helping righty has been much improved. Generally you see some back-sliding of skills once the constraint is over (just hopefully not enough to put you back where you started so that you are at least a little bit more ahead). As far as her arm goes we have continued (now 2mos later) to see her spontaneously use lefty more on its own and to help righty, improved supination and reaching out to grab. Her motor planning also continued to improve throughout the week... in the video she got REALLY fast at grabbing objects and handing them over, even across midline. I don't think this is still as good as it had been with the cast on but overall it has remained improved.

Her walking and going upstairs (so basically lefty leg) took a hit. I think it was a combination of focusing on her arm and a growth spurt.  Her gait is pretty terrible and she struggled to walk up the stairs again for a while after the cast was off (we were allowing her to crawl up with the cast on).  Her leg did not respond as well as her arm, or as well as it has in the past, with this round of botox. Bummer.  We are 2 mos out from our next round of injections and the poor kid is already getting mad at stretching her hamstring. She has also lost a few degrees off her popliteal angle (at the knee) according to the rehab doc at follow up. Despite that we are totally planning on doing the constraint casting for her again.  Rehab and OT actually suggested that we do it with our next botox round in June but given work we are planning on doing it with every other, so we are shooting for October at this point.


A hit to lefty leg still doesn't slow
this girl down!

We also have our regular eye follow up coming in another month which I am happy for because her left eye is hardly focusing at all. I told the ophthalmologist it was getting worse last time but he liked the way she looked in the office so we didn't do anything. Now it's not just when she's tired but frequently throughout the day, she focuses on you with her right eye while the left one is just sliiiightly off and kinda glazed over.  With her birthday coming up we also have our regular meeting with her pedi. I'll be interested to see how she feels about Annabelle's verbal skills, I think her vocabulary is great but her pronunciation and grammar are a bit behind, maybe ~6mos is all.  And of course with an upcoming birthday comes visitors and planning for a celebration! No real party this year but Annabelle has informed me that she would like Minnie and Mickey cupcakes that are strawberry just like her daddy's were... Does this girl know what she wants or what?

Still such a typical toddler

 

 



Restraint Week, Day 2-4

Annabelle kept doing GREAT throughout the week! As we went on we did a few more structured activities to allow lefty to get a lot of active use. Mealtimes still seemed to be the best and most intensive "therapy" but there was still no fighting, which was really nice, meals just took forever!

We did a bit more baking, because Annabelle loves to cook (eat) and it takes so much grasping and rotating her arm it was one of the best activities we found. We played the Elefun game multiple times and she improved throughout the week in her accuracy and speed in picking up the butterflies and with holding onto her net.  Too bad she still didn't actually want to catch any of the butterflies. We also played the "Frog Game" where you pick up lilly pads, rotate them to see the animal on the other side and match 2 together. Then once you have a match you get to stomp on the "button" to make the frog fly into the air (Oh hey left leg therapy, we didn't forget about you this week!).  This game was a lot more difficult and she needed a lot of help as she had to isolate her thumb to get it under the lilly pad to pick it up and then rotate her wrist but it was still helpful.

We of course painted with lefty because Annabelle absolutely loves to get paint everywhere, the projects didn't last nearly as long as normal but lefty did get to get a bit goopy and I have a lovely lefty painting sitting on my desk now. We also did a lot of play-doh with lefty. Lucky for us Aunt Kris had sent some new play-doh toys for Valentine's day so that kept us very entertained. We have a few rollers and blocks with shapes to push into the play-doh which was good for lefty to open/roll, grab and push. Part of our new set let us make play-doh turtles which Annabelle really liked but when she wanted something new made out of the play-doh lefty had to grab the turtle and "smush" it so lefty also got a lot of squeezing/ strengthening practice.


It is also starting to get nicer out around here, finally. So we took her new bike from Xmas out for a spin. I couldn't get her off the thing! It was difficult to learn the steering concept since she couldn't even hold on with righty, she was concentrating very hard on grasping with lefty aaaaand I was kind of mean about the peddling and made her legs do a lot of  the work, which is still very difficult for her (again, hey lefty leg I totally didn't leave you out!). She got so worn out the first time we took it out she put her head down on the handle bars and told me "night night".  We took the bike out a few times and each time her lefty grabbing and steering skills improved and her peddling strength got a little bit better!

Looking pretty exhausted after an hour of bike riding

There are a few more things that we did throughout the week, I will post about those later. I have some good videos and really don't want to over do it in a single post!

Restraint week, day 1

There really was not much going on for the past few months.... Really busy with visitors and the holidays. Our therapists wanted to give Annabelle a break so we weren't really going there or working specifically with lefty for awhile.

Well bring on the new year and another round of Botox! This time we decided to cast righty arm afterwards to force Annabelle to use lefty. No planned intensive therapy but I took some time off of work (no way was she going to day care without a functioning hand) and did some activities at home that promoted some serious lefty work...

Day 1 and she was already doing well. The cast didn't bother her at all, she thought it was funny and kept telling righty "not today righty, it's a lefty day!" The first day we kept things pretty simple and mostly focused on getting lefty to help during meals. Our pronation/supination was a huge area to work on so eating was good practice. We also made pink cookies for valentines day, she had to grasp the measuring cups and then pour them into the bowl, which worked out great. She didn't think of it much as work as there was chocolate chip cookie dough and cookies when we were all done!


Struggling a bit at first, but much improved just a few bites later!

I LOVE this picture, the rotation of her wrist looks so "normal"!


We also played some games that specifically made her reach out and grab things. She loves the Elefun game, not that she tries to catch the butterflies with her net but she holds the net, laughs at the butterflies flying and then will pick them up in order to do it again... It's a riveting game for mommy and daddy ;-)

We are already seeing progress from lefty arm and she's still in a good mood with regard to the cast. It is really exciting to see. More activities and progress to follow!