Hello,

Thank you for including me in your information search for Cianna.  She is really a joy to work with, and has made great progress in the past year.  In her outpatient occupational therapy we are currently working on:

• buttoning and unbuttoning medium sized buttons (currently Minimum assistance)
• zippers (Mod A)
• tracing shapes with corners & "L" using Handwriting Without Tears worksheets, while maintaining a left emerging static tripod grasp.  Sometimes she can set herself up with the pencil (we use "The Pencil Grip" to facilitate grasp,) but most often she needs set-up A.
• copying a criss-cross.  She has mastered copying vertical lines, horizontal lines, and circles.
• oral motor work using the Beckman protocol to encourage tongue lateralization, tongue tip elevation, and mouth closure to decrease drooling (also using kinesiotaping and cueing to swallow and wipe mouth.)  
• Problem solving, visual scanning, and fine motor skills with matching and puzzle activities.
• Hand-eye coordination games (fishing)
• Gross motor work; not so much lately, but jumping and balance on targeted stepping mats.  Just started abdominal work on therapy ball and hanging from hands on trapeze swing.
• Arts & crafts activities (in spurts) with coloring, cutting, and glueing.

I hope that this is helpful, and please don't hesitate to call or email me for more information.  I will be out of town Feb 8-18th, so if you contact me in that time period, I will get back to you when I return.  Have fun with Cianna!

Thanks,

Heather Browne, MS OTR/L

206-240-8313

• Bears and hibernation

• Lots of spontaneous speech
• Lots of description: what she is doing. what people in cards are doing. "bridge is lying down"
• Red rover and yoga stories.
• Finding hard to stay focused

CCC 2/5/2008

Trapeze: swing and let go, land on bean bag
Crawling practice Ab exercises
Exercise ball (height: sit on ball, knees at 90 degrees)
- balance (and bounce) on ball
- Shift hips to one side. (Cianna counterbalances)
- avoid cianna tipping completely
- get Cianna to right herself
Lip strengthening (straw)
Tongue rotation of fruit (twice from left to right side of mouth) Fine motor cube: velcro, buttons, zipper.
Fishing game

• Play crashing game
• Play on ground with Cianna. Encourage crawling. (develop core muscles, hips, hamstrings)
• Massage feet in morning and evening (strongly, not lightly)
• Climbing game: Shift hip weight towards left leg. Hop up on bed left leg first. (15 times left, 5 times right)
• Crawl & lie on back -> then roll to right
• Allow to eat sometimes with fingers
• Play in water as much as possible
• Play with face using high pressure (vibrating toothbrush / toy around mouth).

• Balance command attention from brain - unable to listen.
• Eyes are 20% balance, Cianna's eyes more towards balance
• Attention issues are not ADD/ADHD -> Related to balance commanding brain attention

• Auditory processing -> related to muscle tone
• Muscle and balance interfere with attention. because of slower response / time needed to muscle and balance
• Issue is not attention span -> time to process
• System takes pattern that have been used recently. (e.g. responding to question with last choice in question: Is this red or yellow? yellow.)
• Muscle, balance and symmetry is important: helps auditory processing

• Use picture clues
• Use singing voice to get attention
• have to trick Cianna at times: reasoning doesn't always work

• Clarify hand dominance
• Listen, Follow directions
• Increase comprehension of language (fatigues quickly - take a break and then repeat later)
• Increase pronunciation and speech
• Decrease Pain Threshhold (strong physical pressure around mouth, cheeck. honey and yogurt on face)
• Attention span and focus

• Cianna tends to withdraw from task, and be charming: Avoids issue and distract you. This prevents her from learning.
• Don't make work cognitive task. Make it a game.
• Cianna can't walk/perform activity and talk/listen effectively
• Half  help with task. Cianna finishes. Ask who did it? Me! (Self esteem)
• Expect failure for new/hard tasks. Don't get upset.
• Cianna senses parental frustration.
• Try to decrease frustration (Parent and child)