Occupational Therapy Evaluation

I don't remember what finally made me pick up the phone and make the initial appointment for the OT evaluation, but it wasn't automatic, I think I still didn't understand what difference the therapy would make.  But eventually we got in to a rehab clinic in Maple Grove and met our therapist, whose name also happened to be Katie, and was therefore dubbed  "the Katie-lady". This initial evaluation was in January 2010.

Regarding Kate's behavior during initial evaluation the therapist's reports states "Short attention span.  Constant movement, difficulty to engage in structured activities.  Patient needed movement breaks to sustain attention to tasks."

Regarding motor skills, the report noted that Katie "used compensatory movements to maintain balance" on one foot at a time, indicating "likely poor core/ upper body strength" and that her manual dexterity tested below average. "She is lacking both strength and coordination in her hands and fingers which is limiting her independence with dressing tasks." 

Regarding visual-motor integration, Kate's visual perception tested in only the 6th percentile, and motor control only in the 19th, indicating "Katie demonstrates significant delay in fine motor integration skills.  She is lacking in visual perception as well as motor coordination.  She also appears to have weak hands which would limit her coordination skills."  It was noted that she used a "thumb-wrap" grasp for writing, which "offers more stability and is often used by children with weak hand muscles."

The Sensory Profile questionnaire I filled out indicated a definite difference in Kate's Auditory, Touch and Vestibular processing, as well as in her Emotional/Social responses, the Behavioral outcomes of sensory processing, Emotional Reactivity and Sensory Sensitivity, with most of her scores in these areas only half of the average.  The report states, "These sensory processing issues also affect her ability to get along and play with peers as she has the need to always be in control of her environment so as to limit unexpected noise and touch.  These issues also affect her ability to attend, learn and improve her fine motor skills."

Based on this evaluation, treatment goals were set as follows: 

-Katie would engage in upper extremity strength activities 3 minutes without fatigue

- would demonstrate appropriate tripod grasp on pencil without adaptive equipment

- would demonstrate age appropriate motor control by completing a certain type of maze

- would be able to attend to therapist directed activity at the table for 5 minutes

- would be able to follow directions to complete a 3 step obstacle course, after demonstration

I realize a lot of this specific information may not mean much to many of you readers, but I included it for those of you like me who are curious about such things, for any professionals who may understand such details, and for any parents considering such an evaluation to see one example of what results this type of evaluation will provide.

Split personality

In one journal entry I wrote that Katie sometimes seemed like she had a split personality, being adorable one moment and seemingly possessed by demons the next.  Christmas 2006 was one clear example of this.  Katie was so excited!  She couldn't know what to expect, but she could tell it was exciting.  She stood in the center of the living room and spun around and around in circles, over and over and over.  But within minutes of the family arriving she did a complete 180 and was a major grump for the rest of the day.  I never did get a decent picture of her without the scowl.  (see photo)

Around One Year

Katie loved playing in the water that first summer!  While Melly was leery of any splashing, Katie seemed not to notice getting water in her face, even putting her face in deliberately.  She loved music too, and would get very angry at her musical toys if they did not play.

Oh that temper!  She developed an earsplitting screech that she used constantly to express her displeasure with everything!  In the journal I describe her as stubborn and willful.  She was twisting and fighting with me when I tried to dress or change her.  She began having a hard time going back to sleep after waking in the night, refusing to lay down and self soothe.  Grandma didn't help matters when she snuck down to rock-a-bye her in the middle of the night, inadvertently teaching her to expect to get her way at any hour.

Still loving the swing, she learned to twist herself up (like on a tire swing) and then let go, spinning around and around.  She did the same thing on the floor too, sitting on her bottom and turning herself around and around with her feet.  Katie and Melanie were both devoted pacifier suckers, and around this time Katie started insisting on having one to hold onto as well as the one she sucked.  I had tried to teach Katie the same baby signs Melanie had used so well, but she had only ever used "more" and "all done", and about this time she refused to use even those anymore.

That fall I gave up my job at the day care since it was too far away for us living in the Cities and I needed something closer to full time.  I started working 30 hrs a week and Katie went to a home day care, which she enjoyed, but was always in a hurry to leave when I came to get her and couldn't stand for me to visit with the provider for even a few minutes!

Swinging & Spinning ! Hooray! - June/July 2006

Katelyn absolutely LOVED her Johnny-Jump-Up swing!  (You know, one of those suspended seat swings you hang from a doorway.)  She could not seem to get enough!  But then, quite suddenly, when she'd had enough, she'd really had enough and had to get out of that thing immediately!

Melly and Kate w/Daddy - July 4, 2006

Noisy toys suddenly could not be noisy enough either.  She loved one rattle in particular that was much louder than all the rest, and became very upset at day care if she saw another baby playing with the rattle there that was identical to ours.  She was voicing a lot of frustration with her quick temper and loudly demanded help immediately.  She wasn't babbling much, but would say "Mom!" quite forcefully when angry.  She was slow using her legs and got around just pulling herself by her arms for a long time.  Her first 4th of July she watched the fireworks calmly, while Melanie covered her ears.