let's try something.
Okay.
Okay.
Is that nice?
You're a stiff boy today?
Okay.
We saw Joey for evaluation
yesterday and found that of
his many problems that one
of the biggest characteristics of his
total patterns of postural tone in movement
was the fact that he is basically a very floppy
boy.
A very hip,
a tonic youngster who has very
very strong patterns of
extension and hyper tennis city
with stimulation and particularly in the
pattern of going into head and
neck.
Neck and shoulder retraction and turning the
head very strongly to the left side.
So that if we were to summarize his basic
basic problems in postural tone and
movement as we typically do after an
evaluation in preparation for setting treatment
goals,
we would say that one of the problems is a basic hype
a tennis city with strong increases in
postural tone with stimulation of many
sorts secondly the problem
of asymmetry.
The problem of turning his head
consistently to one side,
never keeping it in midline and with the head
turning the body itself becoming
somewhat crooked.
Which opens him up in the future for many many
problems with deformities such as scoliosis
subluxation tips and the like as well as
interfering a great deal with learning for function.
Can't get his hands together he can't get hands to
mouth.
You can't roll over he can't do a great great many
things because of this pattern of asymmetry.
Thirdly the strong extensive spasms with a
typical pattern of head and neck retraction.
Neck and shoulder retraction.
Pulling back again,
making it quite impossible for him to get his hands together
or to develop any kind of head control.
A problem of tactile hypersensitivity
primarily of the face and mouth so that as
touch comes to these areas,
he responds by going into his typical
patterns of the neck and shoulder
retraction of the turning of the head to the left side
and becoming quite quite stiff and uncontrolled
and tying in with all of this.
The basic problem of poor head and trunk control.
These then are the most basic things that
Joey has as problems that are going to affect all
aspects of his acquisition of
communication.
Superimposed on top of these are the specific
kinds of problems that we think of
as being pre speech and language requisites,
feeding problems particularly related to the
oil hypersensitivity and to
poor sucking and swallowing
shallow irregular breathing patterns which are rather
poorly coordinated with faux nation.
So that faux nation is of short duration.
It is tight,
it is breathy,
it's not very variable,
a lack of consonants in his sound play and
a very limited repertoire of vowels which he can
produce partially because of the mouth
problems and his whole ability to
coordinate jaw,
tongue and lip position with a
steady stream of vocalization.
He is a very inactive child and probably
very understandably so because when he becomes
active he becomes very stiff he
becomes very uncomfortable.
He becomes very frightened and
along with this he cannot or
does not explore his physical environment in any
way.
And this is something which leads very,
very much to deficits additional
deficits and intelligence,
cognitive development and language or linguistic
development.
And fifth lee this is a youngster
who does have a substantial amount of mental retardation but
he's still a baby and we don't really
know with all of the physical problems and the
sensory problems which he has
what extent this retardation is and how
much of it uh may be
possible to bring him more up to whatever his
particular potential maybe with good
treatment and stimulation.
This then is Joey.
These then are the problems that we're going to be looking at
and trying to solve in a treatment session with
him as we as you
look in on my treatment with him,
I want you to think again about the red
general principles of treatment with Children of this
type.
The fact that the most basic kind of problem is a
problem of postural tone and movement which
affects and influences all of the various
things that the child is able to do in the
communicative area so that this is often where we
start and the underlying theme of the entire
treatment session.
The normalization of postural tone and movement
patterns.
The use of stimulation of trying to get a
more normal response.
That is nice trying to get a more normal
response.
Trying to get better voicing,
trying to get all of the kinds of things that we don't
typically see in the child but that we would like to see.
Uh careful sequencing of
activities so that each one builds on the
last in trying to take the child from a
point where he is at the beginning of the treatment session
to where we ideally we would like him to go.
And then one of the things that I'm going to talk about with
Joey particularly with his being a very young
child are how these kinds of treatment goals
can be incorporated into the natural daily
life of this baby.
The kinds of things that a mother or
award person in a residential
facility can do just in her care of this
child that are going to be therapeutic and are going to
help meet pre speech and language goals to
a greater extent.
What are my specific goals for treatment with Joey
today?
First an inhibition or
reduction in the neck and shoulder retraction,
secondly,
working against the asymmetry with a
development of a midline orientation.
Trying to get both hands together to do some
exploring of the midline of the body.
Thirdly to try to increase the hipaa
Tonia a little bit to the point where some
writing reactions of the head and trunk are possible
where they may be facilitated and thus to
improve head and trunk control during the session.
Fourthly to reduce the tactile
hypersensitivity on the body in the face
and along with this to try to get more tactile
exploration of the hands
and of the face.
And just to use some of the sensory
stimulation uh for
a more natural kind of response
in a young child.
And thirdly or lastly to try to
develop greater lip activity
for better sucking response with him
after hopefully after having prepared him with many of the
other activities.
So let's start out and see what we're going to do
with you.
Mr joe.
Okay as I've been handling him,
I have seen basically the same picture that I saw
last time and you can see a
tendency toward the strong
extension patterns,
the strong asymmetry and the
unhappiness when he goes into this,
he doesn't like it,
it's uncomfortable for him.
And so I'd like to start out
with working with
him a little bit of some of the things that we started
out in the assessment with yesterday
of trying to use a little bit of pressure with my right
hand in the sternal area to inhibit some of
the extension and get a little more flexion to
bring the head a little more forward.
Yes,
we need something interesting here.
Oops Joey also is a
youngster who has seizures and he seems to be
having a little more of them today then
we saw yesterday this is what some of this
jumpiness is.
Please join.
I'm going to use a smaller music box and I'm going to
place it in the middle because he liked
auditory stimulation and this may be a better channel
for him than visual?
Where's the music?
And by getting it in midline,
we're using our stimulation to try to go against
his patterns.
Lookee,
there's joe.
What am I going to do with you?
Okay.
There we go.
We take you further back.
Look at that.
And looking where is Joey?
Where is Joey?
This is very nice.
Easy.
Now I feel in my hands is starting to go
wrong and I come back with what I'm
doing.
I'm bringing this left shoulder more down and forward.
It knocked off.
You used your hand to knock it off.
Okay.
I he seems to
have a little more control of his head.
Yes,
just a minute.
Huh?
I had been doing a little bit of this kind of treatment
prior to our starting the session today.
Okay,
let's go back a little bit.
Huh?
I think you're flopping down.
You're losing you.
I am losing you.
Okay.
All right.
He looked at the show.
Look at Joey.
Look at joe.
That's very nice.
And I would like to be
able to use a little bit of this type of
pressure down to give him some stability
and to try to help him use his head a little more
actively Where the
music did it go off and I
lost it.
Okay,
let's come back.
Huh.
Shall we come back?
You didn't seem to leave as much of the
other?
Where are you going?
Where is Joey?
Would you like the music on again?
Can we turn the music on?
Can we turn it on?
It's right shoulder up.
Uh huh.
Kind of initial startled.
Just from the noise of
the wind er on the music box.
Okay,
let's do this.
Huh?
Where is Joey?
Lucky.
There's you need
lucky.
Oh,
there's joe.
There's Joey.
There is Joey
and that sews leg.
That's my leg.
You find jewelry.
There's Joy's leg.
There's the music.
Do you feel the music?
It's nice,
isn't it?
Is that a nice one?
Is that a nice one.
Look at that big boy.
Easy when we
begin to lose a step,
we take him back,
we take him back to what it was that made it
possible initially.
It's a boy and there's your knee again.
There it is again.
There it is.
Look at that.
Do you know what else we can keep
this up like this.
That's a boy.
Mhm.
It
mm.
That's nice.
Very nice.
Let's bring it in,
huh?
Okay,
bring you up a little bit.
I think we can do this a little more.
Look at you.
Look at Joey.
I'm going to do you like this?
Easy.
We're gonna put you on.
Suse lap can we do this a little
bit,
huh?
Where are you?
Where are you?
Where's joe's head?
Where's Joey?
Where's Joey,
Joey,
Joey,
Joey,
Joey,
Joey,
whoops do we lose you?
You are pulling in deflection.
You are getting very flexed.
There you are.
Hi,
notice that where I am is on his
to him is basically on his right
side.
Because I want my auditory stimulation.
If it comes in on a side to come
in in a way that encourages him
to turn his head in a way that's different what
he does what?
You know what you're face?
You got my face.
Look at that,
Did you get it easy?
Easy boy.
Easy boy.
Easy joe.
Oh my goodness.
I think we're taking you too far too
fast.
It's too far too fast.
That's nice.
Look at your head.
Oh,
is that nice head?
Is that nice head?
He started stiffen when I gave that stimulation with my
mouth.
The noise
and again.
My goodness,
I can feel it in my hands.
Okay,
okay.
Easy.
Where are we gonna go?
We're gonna go,
Huh?
I would like to do is to take you.
Yes.
What can we do?
What can you do,
huh?
Who is going to take you?
Yes.
Let's see where Sue is going to take you.
So can we do some of these same things here,
Can we do it?
Keeping it all
together
all together.
Easy now.
Easy,
Easy,
Easy boy.
Okay,
Okay,
easy.
That's right,
lucky looky.
Oh my goodness!
Oh my goodness!
Oh my goodness.
Where are we going to do this?
Where are we going to do this?
Where is that ball?
Look at that ball!
Okay,
Okay.
Too much.
Too much.
Yeah,
yeah.
What a squeaky old cry.
I think I'm getting a lap full too.
Is that what you're sharing?
Mhm
Okay.