Wednesday, July 25, 2012

It is representative of me as a person that almost every time Charlotte goes to her grandparents' house for an overnight, I have the should-I or should-I-wait debate with myself about trimming her bangs.  Her bangs are hanging in her face, she's getting a tic from shaking them out of her eyes all the time, and she just looks scraggly.  But cutting them NEVER works out well (at least not since the beginner's luck case of when I initially gave her bangs, back when she was almost three), so there's the risk of sending her to Grammy with blunt, new, crooked bangs.

I used to feel bad about how I could never manage to get her bangs to come out well, but after a while, I realized that none of her hairdressers can either.  So at least that doesn't make me feel inadequate anymore.  I posted on Facebook this morning that I'd rather save the $12 and 20 minutes and cut them myself, since Charlotte's inability to keep still means that her bangs look the same no matter who cuts them.

I went with the trim, because I figured it's best to look like I made the effort, no matter how misguided.  Tell you what, though - the week before school starts her bangs can be someone else's headache.  Because she needs a trim, too, and there's no way our relationship can take that.

Monday, July 23, 2012

Astronaut Training

Bizarrely, tonight was the night I was going to write about Charlotte's new physical therapy program, which is called "Astronaut Training."  It seems kind of weird to write a blog post about astronaut training that has nothing to do with astronauts or Sally Ride, who passed away today.  But, here I go anyway.

It's been weird posting about Charlotte's PT & OT needs.  I'm not sure how much to say, or how much even merits saying.  Right before she turned 3, we noticed (and her grandmother noticed, I better make sure I mention that) that she spent a lot of time walking on her toes.  Like, a LOT of time.  Way more than half.  Almost constantly, actually.  Matt & I dismissed it, thinking she'd probably grow out of it, but her grandmother elicited a promise to have us ask the pediatrician about it at her 3 yr physical.  So Matt did, and the doctor agreed that it was an awful lot of toe-walking, and observed her for a bit.  Then, after testing her range of motion, diagnosed tight heel cords and excessive toe-walking, and referred her to a local physical therapy program.

We got her into physical therapy, with a really great therapist, Arlene, at the tail end of 2010 and beginning of 2011.  Between weather and car troubles, Charlotte got 8 appointments spread out over 4+ months.  After some initial rockiness while we sounded out Arlene and she figured us out, it was a really great fit, and we learned a lot about what was going on with Charlotte.  Namely, some sensory processing issues of the vestibular variety, with attendant physical issues of low tone, poor core strength, and tight heel cords.

Aside - I have a hard time writing about all of this.  Not because I'm ashamed that my kid isn't perfect, or that I fear that I did something wrong and that's why this stuff is going on.  Nothing like that.  More like, I hate to make a fuss, make it seem like this stuff is more important than it is.  Or a bigger deal, I guess, since I do consider it important.  I don't want to be like, OMG, my kid and her therapy, my kid has a disorder, blah blah - nothing like that.  But it is part of Charlotte, and actually, a big part of Charlotte, and we can see how this kind of thing, left unadressed, could snowball as time goes on and in her later school career.

Kids who are hyposensitive to vestibular stimulation, like Charlotte, crave vestibular input.  Spinning, twirling, moving fast, hanging upside down, jumping up and down are all things she loves to do, and these are things that satisfy her craving.  Problems sitting still, issues going down stairs, and easy motion sickness are also signs of vestibular integration disorders.  Kids with vestibular processing issues might also have low muscle town, poor sitting posture (W-sitting) and walk on their toes.  Poor hand-eye coordination & trouble crossing midline visually are additional signs, though I am less sure how that is related.  I do know that it's another thing on the checklist we can tick off, though.

None of these things really bother Charlotte in everyday life as a 3 or 4 year old.  But it was actually really good to have this "diagnosis" (it's not actually a medical ICD-10 diagnosis, this is relevant later) going into her school career.  It's something to talk to with the PT & OT folks in Charlotte's elementary school, as well as her preschool teacher.  It's easy to see how some of Charlotte's behaviors, while fine at home, might be trickier to assimilate in the classroom.  Spinning around in circles in your living room because you need input is fine - doing the same during, say, story time is less acceptable.  Problems sitting still in the proper posture becomes a little disruptive.  And difficulty using scissors and pencils is really not convenient when you are learning to, say, write & cut paper.

Charlotte had those 8 appointments last year, but that was all our insurance would cover.  Since "vestibular integration disorder" is not an accepted medical diagnosis, the only thing that we could bill for was "tight heel cords", and only 8 appointments a year was deemed acceptable.  I learned a lot from Arlene in those 8 visits, and we made some goals to work towards until we could be covered again.  Last year, the big concern was working on Charlotte's muscle tone and core strength, since that would help her feel more secure in her balance, and maybe offset some of the toe-walking & spinning.  A year later, at Charlotte's 4 yr old physical, we had the doctor observe Charlotte's toe-walking again, and got another referral to get back into the PT program.  Amazingly, a space with Arlene opened up, and, a little over a year after her last appointment, Charlotte got back into a PT schedule with Arlene.  Arlene was really pleased with the work that we had done, both at home and at school (where Charlotte had started a PT evaluation process, and had a few 20 minute sessions before the end of the school year), and decided to get down to the nitty-gritty of vestibular integration therapy.

This brings us to the titular Astronaut Training.  It's a vestibular/auditory/visual series of exercises developed by an OT.  They gave it a theme of "astronaut training" to get the kids interested in the exercises.  They are described using space words, and with a space theme, and even the background music on the accompanying CD is kind of "space-y" sounding.  This is the program Charlotte & I are doing for the two weeks while Arlene is on vacation, and we are missing our PT appointments.  So far, it seems to be good stuff, and Charlotte really loves doing it, which is the important part.  Part of it involves laying on a spinning board (checked out from the PT department) with her eyes closed while I spin her - this is pretty much her favorite thing in the world.

All in all, I'm happy this is something we're working on.  Learning why Charlotte does what she does, and learning that some of her more disruptive behaviors are actually related to something going on with her physically, not just a sign of stubbornness, was enlightening.  And having this fore-knowledge made some of her preschool transition issues a little easier.  It also made our decision to keep her in another year of preschool, instead of fighting to get her into kindergarten this year, a no-brainer.  For a kid who still has trouble sitting still and holding a pencil, it makes sense to do another year of preschool - and almost more importantly, physical therapy - rather than fighting with the school district to let Charlotte start kindergarten 3 weeks before she turns 5.

Here's some links to both Sensory Processing Disorder (SPD) and the specific vestibular stuff:

* Astronaut Training
* The Vestibular System and SPD
* really good article by an Australian SPD organization on vestibular processing
* Vestibular Dysfunction
* What is Vestibular Disorder?
* wikipedia definition of Sensory Processing Disorder

I'll post more about the occupational therapy side of things, the fine-motor stuff we've been working on, and some of my favorite resources.  It's kind of funny, funny weird, that this would come up with Charlotte.  Back in 1998, when I worked in a day care, one of my kids, I'll call him Sam, had some major sensory processing struggles.  The teacher recongized it for what it was, not a stubbornness or behavior issue, but a processing one.  Her son had similar issues when he was a toddler, so she had a feeling there was more to Sam's behavior than just acting out.  Because of her, I learned about what was then called Sensory Integrative Disorder, SID, and I was intensely interested.  I did some research, and even wrote papers for one of my child development classes.  This interest never went away, and stood me in good stead when I related to some other kids in my life who definitely had some processing issues.  So by the time Charlotte came along, and I watched her spinning and running in circles for ten minutes at a time at the end of the day, I was able to say to myself, "You know what?  This behavior looks really familiar."  It was good to start the conversation with at least some knowledge of what Arlene was talking about.  To have her say, "I think what we're dealing with here goes beyond heel cords," and to have me say back, "I've been wondering if there's some sensory processing stuff going on," was just a good way to begin all this.

So here we are.  Almost five years old, and deeply involved in astronaut training.

(edited to correct a PT/OT slip-up!)

QOTD: Ambitious

C:  I think I could be a brilliant artist when I grow up.

Mama:  I think that's a great idea.

C:  Because you always like my art.

Mama:  I really do.

C:  And my art could be in a picture museum and I could be the richest girl in the world.

Mama:  What does that mean, richest girl in the world?

C:  It means everyone knows I am brilliant.

Tuesday, July 3, 2012

cell phone pictures from swim lessons

ready to go, day 1!

first day of lessons, it rained, but they swam anyway

day two of lessons looked completely different

after a dip

warm water!

Daddy said, "She is NOT Dr. Doolittle."

Today Charlotte:

1. got her first ever bee sting.

2.  's pet snail Ben died.

3.  got scratched by the cat.

She's doing okay with the death of Ben.  She goes between crying about it, to pragmatically discussing the life cycle, to asking when she can get a new snail.  And then cries because he's dead and she doesn't want anything to die.  Like, can we get a new snail tonight?  Or do we have to wait until tomorrow?  Typical four year old stuff.