Physiatrist Appointment

Sammy had his appointment with Dr. Klava his physiatrist. Here are some issues that were discussed.

SMO-
Sammy is doing really well with the SMO. We LOVE the SMO. The thing that I love the most about the SMO, is that he has full range of motion with his ankle. Meaning, he can go up on his tippy toes while wearing the SMO. I also love that he can wear it all the time, it is not restictive at all. HOWEVER, because he has full range of motion with his ankle, he can stay in slight pronation. All these fancy terms you learn! You can see what pronation does for slippers. I have NEVER before had a child get a hole in their socks or slippers until Sammy. The doctor told us that the articulating AFO would be a solution for this. His ankle is slightly tight, but he softens up immediately and has full range of motion. The doctor said as long as his ankle stayed like this we could stay with the SMO. I appriciate that Dr. Klava will let us decide what is best for Sammy. He says he is very content with the SMO for Sammy but if we are concerned with the toe walking we can discuss other options. We did ask if toe walking/leading gets worse with age. Dr. Klava said sometimes just depends on the child. I hate that he is already picking up bad habits. They are going to make some modifications to the SMO due to his recent growth spurt. They are going to file down the existing toe plate and put in a new foam toe plate.

Leg Length Difference-
I think I have mentioned this before. Leg length difference is really common in hemi kids. I was expecting this to a degree. You kind of hope that your kid will miss some of the things you read about. But not this one for Sammy. Daniel and I laughed today because we don't know if his leg length difference is due to the hemiparesis or is genetic. Daniel's dad has one leg that is longer then the other one. So it could just be genetic!!! Sammy has about a centimeter difference right now. The doctor said that putting a lift on the SMO will help with this and will probably help with the toe walking too. We will see. He still has his UCB insert for the right side, they are going to file that down as far as they can to help with the evenness on the two sides. Dr. Klava said that he doesn't want to give the full centimeter because hopefully his left leg will catch up. Karen, our PT said that sometimes hemi kids have a growth spurt and it takes their affected side longer to catch up. We have been so impressed with the orthotics at our hospital, they are just great to work with. We can pick up the braces tomorrow morning. Just great service.

SHOES-
Sammy has been wearing his boots all the time. They fit over his SMO and he loves them. I didn't think to bring his athletic shoes to the appoinement. WHOOPS! I guess he really isn't supposed to be wearing slippers or boots with his SMO. The orthotics guy did say a couple of times what is best and what is practical. So I think they understand, but I still felt kind of silly. In our defense, and Daniel pointed this out nicely in the appointment. IT IS HARD TO FIND SHOES! Our main problem with Sammy's shoes, is that you have to buy them big to fit over the brace so they end up slipping off and seem clunky. After we pick up the braces tomorrow, we will have to figure out some sort of supportive athletic TIE shoes that work. I was getting excited thinking crocs for the summer......maybe it will still be fine when "they" aren't looking.

CIMT-
Yesterday, at therapy there was talk that since Dr. Klava likes to be present for the constraint casting, we should be prepared to cast TODAY. However, when we got there, he didn't have time to do the casting, so we will be waiting till he comes in March to cast. We are ready to do this. Yesterday, during OT Stephanie said that Sammy really is at a plateau of sorts right now. I couldn't agree more. While he is doing so well with his left hand as a supporter hand. He does not have any individual finger isolation, while he still has full range of motion in his supinators he really struggles with supination and his left hand is weak. Last week, I noticed him sitting on the stairs looking at his left hand moving each finger. Honestly, when we got the diagnosis, I didn't expect him to have individual use of his fingers, but after witnessing this episode it was a wake up call for me, and we really should set HIGH goals for Sammy.....the sky is the limit. I know that his left hand will never be "normal". I have come to terms with that, but I really want him to have an active pincher grasp and be able to point with his left pointer finger. Supination, from the start OT Stephanie has told me that is one of the last skills for hemi kids to master, it is tough, but another goal to work on. I often notice him doing things with his left hand that would be so much easier if he could only supinate. Next is building strength in that hand/arm. These are the things that we are hopeful will improve with constraint induced movement therapy. It has been fantastic researching this. I was so skeptical before of this but Daniel and I decided that we need to try everything. We don't want to regret not doing it. Though, I do think we are going into it with cautious optimism. I will blog the whole program in the next couple of weeks.

All in all a really good appointment. Daniel and I couldn't be more pleased with Sammy's progress thus far. I often look back to old videos and it really is amazing how much difference one year can make.