REACH

Our appointment at Reach went really really well. Charles and Consensao are lovely people and seem very compassionate and eager to help Nathan as much as they can. They are kind, knowledgeable people and took the time to answer all of our questions and to give us lots of information about how we can best help Nathan.

Here is a copy of the developmental evaluation and where Nathan is on the chart. There are some areas where his skills are “Functional”, which means that he has them but he has problems. For example, he understands tactile sensation, but his hyporesponsive to touch, meaning he has little feeling in his extremities.

Here are some of the notes from the meeting:

VISION:

* Good pupil dilation
* Good pursuit in every direction
* Convergence: Left convergence strabismus at near point – when light approaches, left eye goes out slightly, right eye continues to follw at close range.
* No apparent strabismus
* Convergence problem is very slight
* Recognition of objects and pictures is very good

HEARING & UNDERSTANDING:

* Startle Reflex is persistent. He continues to react, instead of assimilating to a loud sound.
* Response to threatening sounds is inappropriate, so it is functional. He should’ve been scared when reacting to a loud sound, instead he laughed.

TACTILE ABILITY

* Babinski: Correct response is positive babinksi, big toe goes up & toes spread. As babies grow, the toes should contract. Since Nathan is still reacting by spreading, he has a persistent reflex, meaning this is functional.
* Response to pain: Not responsive to pain. High tolerance, especially in the legs.
* Skin sensation is functional. He is not ticklish, not responsive to a light touch.
* Spatial awareness – knowing where your body is in space – sitting, crawling is where this skill is acquired. He does not have this skill, as he’s not mobile, so he doesn’t know where his body is in space.
* Thirs Dimension: Differences in textures, the difference between paper & table, etc. He does have this recognition.

MOBILITY

* Active movement of limbs – functional – bad head control, tight hand & limbs. Still on level 1 for mobility.

LANGUAGE:

* Expressive sounds – Functional – not full range & tonality, doesn’t babble with a variety of sounds, like mama, dada.

MANUAL ABILITY:

* Grasp reflex: If you put your finger in a baby’s hand, they will grasp your finger without letting go. Later, they will learn to let go. Nathan hasn’t learned to let go, so he is at the level of grasp reflex, and it is functional, as he is tight.

SUMMARY:

Nathan’s sensory skills are very good. He has difficulty expressing information, not receiving information. It is likely that his problems are with mid-brain development, the mesencephalon.

GOAL:

To increase neurological organization.

PROGRAM:

TACTILE:

* Patterning – 6 times a day – 5 minutes
* Brushing – 6 times a day – 1 min.
* Tapping – 6 times a day – 1 min
* Caress – 6 times a day – 1 min
* Hot & Cold – 3 times a day – 1 min
* Tickle – 2 times a day – 1 min.
* Trigeminal massage on the face – 6 times a day – 1min.
* Trigeminal massage inside the mouth – 6 times a day – 1 min.

These exercises are meant to increase his ability to process tactile stimulation. This is related to his mobility problem. If he cannot properly feel his limbs, he will have trouble moving and controlling them. By stimulating the part of the brain that processes tactile sensations, he will gain increased awareness of his limbs and consequently, increased control.

VISUAL STIMULATION

* Read a baby book – 6 times a day – 3 minutes.
* 5 sets of picture/word cards – 4 times a day. Each set will consist of 3 pictures and 3 words corresponding to the picture. They should be related.
* 1 set of dot cards – 4 times a day.

We will show him flash cards 24 times a day in order to stimulate his vision and to teach him to recognize words and objects. The cards will be flashed quickly. New cards will be introduced every day so he’s not seeing the same cards all the time.

AUDITORY STIMULATION

* Sing a song – 6 times a day – 3 minutes

Songs should be accompanied by hands movement, for example, itsy bitsy spider, the hokey pokey, etc.

MOBILITY

* Floor time on his belly – 18 times a day – 15 seconds (the duration will increase over time, and the frequency will decrease)
* Incline Plane – 6 times a day – 3 minutes

This will teach him to move his arms and limbs in a purposeful manner, which should result in army crawling on a flat surface. Initially, we will use the incline plane (gravity) to teach him that if he moves his limbs, he can move forward. The incline plane will be gradually lowered as he becomes more and more effective at moving.

NUTRITION

* Diet should be natural. Avoid processed foods, including flavorings, coloring, additives, preservatives, chemicals, etc.
* Feed him fresh foods, nothing canned
* Fresh is better, then frozen, last is canned
* Whole foods are better than refined, for example, whole wheat bread instead of white bread.
* Feed him slow sugars instead of fast sugars. Slow sugars are fruits, vegetables and whole grains. Fast sugars are the ones we take in juices, candy, sodas, etc. This way he will have more sustainable energy, which he will need for the program.
* Organic food is ideal.
* Omega 3 fatty acids – very helpful. It can be found in fish from cold water (salmon), cod fish, and sardines. The problem with these is mercury. Flax seed oil is a good, natural, healthy replacement.
* Vitamin C is good for him. Powdered, buffered, vitamin C, 3 times a day.
* Acidophilus for healthy digestion.

This is what a session of this program would look like:

Exercise Duration
brushing 1 min
patterning 5 mins
tapping 1 min
song 3 min
incline plane 3 min
visual stim 1 group
arm & leg swing 2 mins
read book 3 min’s
floor 15 sec’s
soft texture stim 1 min
visual stim 1 group
upside down swing 30 secs
floor 15 sec’s
visual stim 1 group
rocking 1 min
visual stim 1 group
hot & cold stim 1 min
floor 15 sec’s
trigeminal face 1 min
trigeminal mouth 1 min

This series of exercises will create a session, and should take about 30 minutes. We will do this 6 times every day.

The paradigms that are being used is that of brain plasticity, neurological organization, and stages of development. Their theory is based on the idea that the brain is capable of changing and adjusting constantly. The more information that the brain receives, the more information it is able to process. The brain also changes structurally to reflect the feedback it is receiving. Function determines structure. So if there is a need for a certain function, the brian will adapt and change it’s physical size and geographic parameters to adjust for the functional needs. As the brain becomes more and more sophisticated (more neural pathways, improved connectivity, etc), the brain goes through a process of neurological organization. The more organized the brain is, the more effective it will be in processing data. If a part of the brain is damaged or malformed, there is an area of disorganization that prevents the brain from developing higher, more sophisticated functions. If neurologic organization is enhanced, and the brain is “fed” with exericses that will allow it to adapt to the damage or malformation, it will then maximize what is currently there while creating different pathways to process information. Also, structural changes will occur that will allow other parts of the brain to take over and process data that the damaged parts can’t.

Having read “The Brain that Changes Itself” by Norma Doidge, I totally believe all this is true. The only question is whether these particular exercises will allow Nathan’s brain to change structurally so that other parts will take over for the malformed parts. Charlie and Consensao believe this can happen, as Nathan’s brain has already shown it is able to adapt. He is missing his occipital cortex, yet he is able to process vision almost perfectly. If vision has already been compensated for, why not motor skills?

We feel really hopeful that that this program will help Nathan. We know for a fact it can’t hurt, and we hope that we will satisfy his insatiable intellectual curiosity. This is a child that is hungry for information. I wish I had filmed him at Rutgers during the neurocognitive assesment. He was so interested in all of the studies, eager to be presented with more stimuli, to show that he understood. The timing was amazing, as we learned that not only is Nathan very smart, but that he is very curious and desperately WANTS to learn. So at the very least, this program will keep him physically and intellectually stimulated. At the most, maybe we will have an army crawling baby soon!

We are gathering all of our materials for the program and will be starting on Monday.

I will post videos of each part of the session so everyone can see!

Sorry for such a long post, but I thought other parents of kids with special needs would benefit from the level of details.

And finally, here’s a quick pic for ya: