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Gross Motor

Blast Off!

by Mary on September 23, 2009

During the last 2 weeks, the J-man has shifted into high gear. Suddenly, he can do some of the movements to the morning song at school. They’ve been singing this SAME SONG since, well, forever, and something just clicked. Now he is starting to follow along some of the movements with a slight physical cue (touch to his hand) or even a verbal cue (pat your head). He has been playing a game with one of his teachers, Mrs. Cindy. We call it “Pat, pat, pat, pat” at home, because according to what the J-man does at home, it starts with patting the legs 4 times, then clapping 4 times, then patting the legs 4 times, then doing Wonder Twins fists with the other person and bringing both arms up to say Blast Off! He is so proud of himself when he does that, and of course, we are proud of him too.

Think about how much motor planning that little game takes. Patting your thighs: make sure the hands are open, make sure both hands are doing the same thing, actually hitting the thighs but not too hard, and doing it 4 times. Then, SHIFTING to open-hand clapping (the J-man normally claps his fists but not in this game): hands open, arms moving in such a way at the same time to clap them together while SAYING “clap, clap, clap, clap.” Shift again, back to patting thighs. Then, put both fists out to touch the other person’s fists, bringing both arms up at the same time (still touching fists) AND saying “Blast Off” (or the J-man’s approximation of those words).

Now, try to imagine programming a robot to do those things. I know, you’re probably not a programmer, but think about all those steps, and how carefully each would have to be coded. Think about the pages of code that would take. Now imagine that each time something is repeated, you can’t just copy/paste the same code – you have to recreate it, and you don’t have your old code there in front of you, and in fact have trouble even remembering how you came up with that code.

That, I think, is how the J-man has to do it. He has to carefully think through EVERY SINGLE INDIVIDUAL MUSCLE MOVEMENT, big or small. He has to put all those single individual muscle movements together, but because of his motor planning issues, he has to re-think about how exactly one makes that muscle move. For everything. Every time.

I liken his motor planning issues to my inability to dance. I’m not talking about those people who say, “I can’t dance” and then go out and while not the best dancers, can at least do the Clap and Step of every junior high school dance. I mean, I have trouble watching someone do a step, and then repeating that step, because I have to seriously consider what FOOT they started on. Add hands, or any hip shaking whatsoever, and I’m lost. (I was an absolute riot in aerobics class the 2 times I took it.)

So imagine if my whole life was having to dance every day. I could definitely spend an entire year absolutely not getting a dance. I had to learn a dance in the summer before 10th grade, and I still remember it, because it took me having the instructor come over and actually MOVE MY FEET INTO POSITION as she broke down every step. I cried over it, because I was so bad. I can’t imagine doing that every day. It’s been over 20 years, and I still remember how hard that was for me. I wasn’t happy when I learned it enough to stand in the very back and not really let anyone see me, but I was relieved. I wasn’t proud.

And think… my kid does that every day of his life for every move he makes. And he smiles during it. And is incredibly proud of himself.

BLAST OFF indeed.

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Be Our Vest, Be Our Vest! We Love Our Weighted Vests!

by Tim on July 6, 2009

[Personal note: I know I haven't blogged in eons. The chaos of work, the J-Man going on break from school, the serious need to work on some of his behavioral issues, illnesses, and the overall bedlam of baby-parenting have been exhausting. Just wanted to let people know we haven't died or something!]

The adjustment to life as the Flashlight Four has been a challenging one to say the least. Our primary concern has been how all these changes would affect the J-Man as – not surprisingly – even small variations in routine can be difficult for him, and a new baby in the house is decidedly not a small variation in anything.

Things were going along more or less OK, but then we started noticing some significant changes in his behaviors at home. Nothing aggressive or in any way what you might call ‘negative’. It’s that he was so completely overloaded that he would run around screeching, stimming like crazy, spinning in wild circles, and pretty much literally bouncing off the walls. He couldn’t sit still for more than about two seconds for anything, not even for his favorite shows (which is a sure sign something is amiss).

When his teachers said they were noticing similar changes at school and that it was really affecting him there, we knew we needed to concentrate our full attention on finding something to help him get through this.

His OT at school suggested trying out a weighted vest at school and at home. If you’ve never heard of this, it’s worth getting some background information as we’re now total converts to weighted vests as a tool that may help sensory-overwhelmed kids. (BTW – To use one at school here, it has to be ‘prescribed’ and supervised by the OT as otherwise it’s considered a restraint, which is not permitted. Don’t ask; I don’t understand that rule either.)

I found an article (“Weighted Vests for Children with Sensory Issues”) and some additional information on commercial sites at eSpecial Needs and WeightedVest.com. (Note: I’m not endorsing their products as I know nothing about them, nor about anything advertised on these sites. We made our own vests – more below.) Research on the broader effectiveness of weighted vests hasn’t really been conducted to any real degree, so your mileage may vary for sure. All I can say is that our recent experience has made believers out of us.

We tried a weighted vest about a year ago, but the J-Man just walked around like a drunken sailor with it on. His gross motor skills were much less developed then, and the overall experiment was more or less an interesting failure. I think the added year of development and the resulting additional body weight made a big difference toward the success of our recent work. The OT last year did say that before age 3 is early to be trying this out and expecting to see much benefit. We’re very glad we tried it again now.

We borrowed the vest the OT had (I think her mom had made it) and used it both at school and at home for a couple of weeks. He’d wear it for about 20-30 minutes at a time about every two hours. We always tried to do some heavy proprioceptive sensory work while he was wearing it.

(For those still struggling with autism terminology – ‘proprioception’ is basically the sense most of us take for granted that helps us be aware of where our bodies are and what the various parts of ourselves are doing. Example: I’m aware that I’m currently sitting in this chair and that my butt is firmly in contact with the seat of this chair. Now imagine the chair slowly fading out of existence such that you are still in a seated position but you feel it less and less until you don’t feel it at all. Bet you’d seriously flinch and jump to your feet. Know that sensation of falling you sometimes get when you’re in bed and half asleep? Imagine that your kid feels that way all the time, which they very well might.)

At school, they often have him carry heavy objects around (e.g., old encyclopedias) or jump up and down on the mini-trampoline. He loves our little mini-trampoline at home (more accurately, in the kitchen), so he climbs on it and jumps forever. His current record is 13 straight minutes… And he much prefers it if you sing “Supercalifragilisticexpialidocious” and hold his hands while he’s doing it.

The change has been really quite remarkable. One of the teachers said something to the effect of, “We’ve got our old J-Man back!” He really has seemed so much more like himself.

Since commercial weighted vests can be very expensive, we decided to make our own. Or more accurately, we decided to sweet talk Mary’s mom into making them. :-) The basic construction of it is fairly straightforward, but neither of us know how to sew worth anything. Essentially, we (more the ‘royal we’ where we = Mary’s mom) got some heavy denim fabric and some thinner, more decorative fabric to go on top of that, made it into a long vest, and then rolled up the bottom and sewed in pockets to put weights in. Velcro along the back helps fasten it around his body.

Here are some pictures of the J-Man modeling. I thought the chili peppers were an inspired choice.

jman_nemo_vest.jpg

jman_chili_pepper_vest.jpg

For the weights, we took the 1/2-pound inserts out of some adjustable ankle weights (like these) and put one in each pocket. We think these are still too bulky – they make the waist really poof out and hard to velcro closed – but they are still less bulky than the other things we tried such as BBs, sand, pennies, and sinkers (fishing weights). Next things we’re thinking about trying are dense modeling clay and buckshot. (FYI – a digital kitchen scale is a huge help in figuring out the weights and getting them balanced all around the vest, something that’s very important.)

Between the weights and the heavy fabric, the whole thing weighs about 2 1/2 pounds. I’ve heard varying recommendations on how much weight to use, but the consensus of what I’ve been told seems somewhere between 5-10% of the child’s body weight. We’re kind of on the lower end of that right now.

I’d be interested to hear the experiences others have had with weighted vests. If any of this has made you want to try this out, talk to your occupational therapist. You shouldn’t start putting weighted anythings on your child without the supervision of a trained OT who can tell you whether this is appropriate for your child and their needs and what sorts of ‘heavy work’ would be most helpful to them.

As with most things, so much of our learning comes through trial and error, but we definitely feel we have trial and success here!

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When the Only Thing Routine is the Lack of Routine

by Tim on June 2, 2009

It’s hard to comprehend that Little E is four weeks old today!?!? Time flies! Perhaps it particularly flies when you’re too tired to understand the concept of time anymore. :-)

We do seem to be getting some aspects of the baby’s sleep to a better place, so we are starting to get a bit more sleep at night, and sometimes even in our own bed too. The nursing/recliner sleeping thing has certainly been rough on Mary. I think we’d both forgotten how much the sleep depravation babies bring with them can turn even the best of us into drooling, narcoleptic idiots.

The J-Man is struggling more than before in his adjustment to everything. Weekdays when he’s at school much of the day, he does fairly well overall. We haven’t seen any major, ongoing issues at school, which we think has been a real achievement for him. He certainly has been ‘off’, with his teacher and OT noticing what we have been at home – he’s hard to calm down and get to focus and generally keep still in one place for any length of time. It’s clear the lack of structure in our chaotic house right now is really causing him some stress.

A couple of hours after he gets home from school, he gets more and more into his “running rebel yell” mode, where he runs aimlessly around the downstairs hollering. He’s not upset or angry or anything – as a matter of fact, he’s generally smiling and even laughing while he’s doing it – but it’s like he’s turned into pure, nearly uncontrollable, kinetic energy. Eventually he can get so overloaded that he starts coming unraveled. This has been really bad over the weekends where he doesn’t get the structure of school and losing him to his frenetic running and hollering is almost a given.

We’re been doing some serious therapeutic brushing and joint compressions lately [a real basic overview here - just don't go doing it on your own without a trained OT], which do help, but when he’s heading toward full freak-out, the calming effects of them last little more than a few minutes. Even staying ahead of the freak-out, the brushing and compressions only seem to partially forestall the inevitable. Right now, we can’t really have much structure around the house, so it’s clear we need some more serious sensory intervention.

The OT at school is starting him on an experiment with a weighted vest. [a decent overview here] We tried this about a year ago. He was kinda young for it then, and even the little bit of extra weight threw his then more fragile gross motor skills and balance off so much that he couldn’t even walk in a straight line. Reports from Day 1 of this latest experiment with it was mixed and inconclusive, but it takes a few days to discern much about whether it’s helping or not.

On the personal side of things, to be honest, I’ve been having a very rough time of things the last several days. Prolonged lack of decent sleep is usually a one-way ticket to a bad place for me regardless of anything else. Most days, I’m a walking, finely-tuned chemistry set. With our daily – particularly nighttime – schedules being what they are right now and all the new and exciting and stressful and sometimes confusing changes in our lives, I haven’t found a way to rebalance that equation.

Physically, my body is feeling a lot older the past couple of weeks, too, to the point where it’s often hard to bend over to do much and even walking anything more than a couple of lengths of the house feels like running a couple of miles. I’ve seen more of my chiropractor than usual, and I’m going for more therapeutic work tomorrow to see whether she can get my back and knee to move. Even simple things like bending over to change a diaper or walking the baby around are getting harder.

Trying to coax a non-sleeping baby through the night and a stressed, unfocused, whirling dervish of an autistic toddler – along with his crying brother – through the day has some weekends felt like a bridge too far for me. I think it’s the need to divide time between them that’s been the hardest for me. I haven’t reached any sort of peace with that yet. I know it’ll come someday. Right now, it’s just hard.

I had forgotten how tiring and emotionally and physically challenging these first weeks with a new baby can be, even without all the other stuff in our lives. I just hope we soon get to the point where we get just enough sleep to restore just enough brain cells to really enjoy and appreciate how good things really are. It’s hard to keep perspective when your main objective is simply to make sure everyone is wearing the correct clothes and you don’t drool on yourself in public… at least not much.

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What’s Your Autistic Toddler Like Now? (Part 3)

by Tim on March 2, 2009

And welcome finally to Part 3! This is the continuation of our series “What’s Your Autistic Toddler Like Now?”, a journey through what’s happening these days in the life of our autistic 3 1/2-year-old son and sequel to our very popular original article, “What’s Your Autistic Toddler Like?”. I meant to write this sooner, but illness has swept through the Flashlight household and rendered us all pretty useless this week.

If you haven’t already, go back and read Part 1 and Part 2.

I’m calling this group “Moderately Present” as these things are generally more common than not around here, but not as prevalent as the “Significantly Present” group from before. As with the previous posts, some of these are challenges for us and others are just things that are part of our day-to-day life. None of these are meant to be value judgments, just information about what one autistic toddler is like so you can perhaps see similarities in your own children or learn more about how these things are part of another family’s life.

I’ll be dividing this group into two parts. So we’ll finish this up in Part 4 soon.

Note: Wherever you see “DSM-IV” below, this means that attribute is part of the diagnostic criteria for autism spectrum disorders in the Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition or DSM-IV. In medical terms, a specific combination of those DSM-IV criteria is what brings about a diagnosis of autism.

Same obvious disclaimer as before: We are not advising you on how to evaluate your child. Go get them evaluated by professionals with extensive experience with autism. Don’t just rely on some random people on the Internet – namely, people like us.

And here we go!

Characteristics That Are Moderately Present

Fixation or attachment to a particular object or parts of objects (DSM-IV; hard one to nail down for us) – For some, this manifests itself as obsessive-looking hoarding and organizing of objects. You might also see this as what seems like excessive fascination about a particular object (looking at a particular train for a long time or staring at a ceiling fan) or part of an object (a spinning wheel on a car).

The J-Man is all over the map on this one. It has gotten more noticeable over time, but I wouldn’t call anything he does here a major issue. The object(s)-of-the-day rotate regularly through an array of toys. For the longest time it was wooden blocks. Then it went to pieces of his farm animals puzzle, and then on to flash cards, and then wooden numbers, and then stuffed animals (which was cause for much rejoicing actually!), and then plastic food, and then randomly back through the order, occasionally mixing in some other things.

[click to continue…]

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I’m not wearing pants!

by Mary on August 12, 2008

Because the J-man has recently gone to wearing 2-piece pajamas (I’m telling you, we tried to keep him in sleepers for as long as possible!), we have had some issues.

Some of it is good: the J-man is learning more about self-care. He is very good at putting his arms through shirt sleeves, and working hard at stepping into shorts. He definitely knows that his socks go on his feet, but will just lay them over a foot because he can’t figure out how to open the top.

Also good: J-man is learning to help take his shorts off. He can already rip his socks off – mostly through effort because he likes to be barefoot whenever possible. He doesn’t like taking his shirt off though, and will fight that.

However… Saturday morning when Tim got up with J-man, Tim walked into the nursery, and the J-man was there with a shirt on. No pants. No overnight pull-up. Lots of pee (crib, sheets, remaining part of the bumper pad). Saturday night, when I put the J-man down, he stayed awake for a while. I joked to Tim that I should check on J-man to make sure he was still wearing clothes. I JOKED! And then I walked in. Little man lying there sound asleep… wearing a soaked shirt, with soaked sheets, and the pants and pull-up on the floor. Bare ass shining brightly. Picking up a wet, sound asleep toddler, trying to get him clean and into new pajamas, stripping the bed and putting on clean sheets, all while trying not to wake him? Awesome.

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Apparently Vomiting Improves Gross Motor Skills

by Tim on June 19, 2008

Well, probably not… Though I could probably poll some former college friends and they might provide some corroborating evidence for this.

J-Man literally put the ‘gross’ in ‘gross motor skills’ tonight. After hurling up his entire dinner intake and probably parts of previous meals, he proceeded to walk up the dozen steps to our upstairs all by himself for the first time, holding on to the bannister and nothing else, and much of it with just one hand. Go him! Stairs have really been hard for him to deal with.

He also struggles with stepping into clothes, and stepping into his big boy diapers (pull-up types) after his bath is very difficult. He could knock over a two-ton grizzly bear with one hand but standing and holding up his foot a fraction without holding on to something for support is very hard for him. But he managed his best ever at it tonight – I guess with some nebulous benefit from blowing chunks. I suppose lightening the load a little helped his coordination.

So he’ll either wake up starving at about 3AM or spew off the side of his bed tonight just our luck, but maybe not. Who knows what brought this on. Sometimes it happens.

To provide some symmetry to the whole thing, one of the cats coughed up a fur ball on the blanket on our bed. There is no indication it improved the gross motor skills of whichever one did it as they are both conked out in their respective sleeping spots at the moment.

Well, sometimes eventful is a good thing.

On a better note, we’ve just about finished the home classroom and figuring out what kind of home therapy program we’re going to do in complement to his school and regular therapies. That’ll require either many posts or separate pages, but I’m working on it. So better programming with less gastrointestinal content is coming soon!

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