It’s that time again. Below is Olivia’s 2-month report card from Occupational Therapy (see here for the one month). It’s thoroughly detailed, as always with Meg.
The short version (from Dad) is that she’s doing well on the sensory side and has hit most of the age appropriate, cognitive milestones. Overall, she’s still pretty weak and doesn’t move her arms and legs against gravity (due to muscle weakness). She is showing some signs of progression, albeit slowly.
Occupational Therapy Report
Name: Olivia Guerrero Age: 60 days
| Developmental Stage | Appropriate Age Range | Current Status | |
| Gross motor | |||
| Fetal position (flexed and midline) | 0 to 2 months | met | |
| Involuntary/reflexive muscle movements | 0 to 2 months | met | |
| In prone head up only | 0 to 3 months | Not yet met | |
| Kicks feet when on back | 0 to 3 months | met | |
| Head steady at shoulder | 1 to 4 months | Not yet met | |
| Will weight bear on legs | 1 to 4 months | Not yet met | |
| In prone head up to chest | 1 to 4 months | Not yet met | |
| In prone head up to forearms | 2 to 5 months | Not yet met | |
| In prone head up with extended arms | 3 to 6 months | Not yet met | |
| Rolling front to back | 3 to 6 months | Not yet met | |
| Bounce in weight bearing | 3 to 6 months | Not yet met | |
| Rolling back to front | 4 to 7 months | Not yet met | |
| Sitting with support | 4 to 7 months | Not yet met | |
| May rock back and forth on hands and knees | 4 to 7 months | Not yet met | |
| Sitting independently | 5 to 9 months | Not yet met | |
| Gross Motor Notes: Olivia is working on increasing her tolerance for play in a variety of positions. Her endurance is improving and allows her to engage in more play. She has increased strength in her arms and legs and has typical movement patterns. She is more consistently able to use her arms and legs age appropriately. She is tolerating sitting up with support and makes some effort to hold her head up. She brings her hands together in sidelying and is active in supine. She settles down for a nap when in prone. | |||
| Fine Motor | |||
| Grasps finger | 0 to 4 months | Met | |
| Brings hands to mouth | 0 to 4 months | met | |
| Hands intermittently open/closed | 0 to 4 months | Met | |
| Plays with feet and brings feet to mouth when on back | 3 to 6 months | Not yet met | |
| Holds toy actively | 3 to 6 months | Progressing towards | |
| Clasp and unclasp hands in finger play | 3 to 6 months | Progressing towards | |
| Bats at objects | 2 to 5 months | Not yet met | |
| Holds objects at midline | 3 to 6 months | Not yet met | |
| Bilateral Reach | 3 to 6 months | Not yet met | |
| Transfers objects | 4 to 7 months | Not yet met | |
| Fine Motor Notes: Olivia is using her hands more and will bring her hands together and to her face. Her hands are more open than closed but she can make a fist. Elbow flexion is easier than extension and wrist extension is easier than flexion. Her arm movements are smooth and coordinated but weak. She rarely looks uncomfortable with ROM anymore; however, she does resist some range of motion at times. | |||
| Cognitive/Emotional | |||
| Makes needs known | 0 to 3 months | met | |
| Sooths when engaged with | 1 to 3 months | met | |
| Social smile | 2 to 3 months | met | |
| Cry when upset to seek comfort | 2 to 6 months | met | |
| Responds to familiar caregivers | 2 to 6 months | met | |
| Show excitement by waving arms & legs | 3 to 6 months | Not yet met | |
| Likes to look at and be near people who are special and significant in their lives | 3 to 6 months | Progressing towards | |
| Smile at herself in the mirror | 3 to 6 months | Not yet met | |
| Pay attention to her own name | 3 to 6 months | Not yet met | |
| Resists end of game | 4 to 6 months | Not yet met | |
| Social/Emotional Notes: Olivia is aware of the world around her. She uses her non-verbal communication to let us know what she likes and does not like. This now involves kicking in addition to crying. She has a variety of facial expressions that she uses to let us know how she feels. She definitely knows her mom and dad and responds differently to them than to others in the room. | |||
| Language | |||
| Cooing | 1 to 4 months | Progressing towards | |
| Laugh | 3 to 6 months | Progressing towards | |
| Turns to voice | 2 to 4 months | met | |
| Razzing | 4 to 8 months | Not yet met | |
| Language Notes: Olivia’s language is all non-verbal at this stage; however, even with the tube in place she is starting to do mouth and facial movements associated with pre-cooing. | |||
| Sensory | |||
| Stares vaguely at surroundings | 0 to 2 months | met | |
| can follow a slowly moving target intermittently to midline | 0 to 2 months | met | |
| learning how to shift their gaze from one object to another without having to move their head | 1 to 4 months | met | |
| Can focus on objects up to 6′ away | 2 to 4 months | met | |
| may follow vertical movements better than horizontal | 1 to 3 months | met | |
| visual searching begins | 2 to 4 months | met | |
| Regards hands | 2 to 5 months | met | |
| Can follow a visual target the size of a finger puppet past midline, and can track horizontally, vertically, and in a circle | 3 to 5 months | Progressing towards | |
| visually aware of the environment | 4 to 6 months | Not yet met | |
| can shift gaze from near to far easily | 4 to 6 months | Not yet met | |
| Convergence is developing | 4 to 6 months | Not yet met | |
| Eye-hand coordination (reach) is achieved | 4 to 6 months | Not yet met | |
| Sensory Notes: Olivia is visually responsive to her environment. She looks between people talking over her bed and watches people move around the room. She will turn her eyes to find a new voice or sound. She is tolerant of touch and movement. | |||
| Feeding | |||
| Suckle pattern on bottle 8-10 sucks | 0 to 1 months | Not yet met | |
| Lip closure on nipple/pacifier | 0 to 2 months | Met | |
| Able to maintain suction on pacifier without external support | 1-2 months | Not yet met | |
| Feedings via nipple | 2 to 5 months | Not yet met | |
| Tongue orientated to midline | 2 to 5 months | Not yet met | |
| Feeding Notes: Olivia’s oral skills are limited by her respiratory support and secretion management. She continues to have a gag, a consistent suck and consistent lip closure. She does not always like oral stimulation but she can do it. She has found that she likes to suck/chew her fingers. She is now able to help bring secretions forward in her mouth though they still pool at times. | |||
| Summary: Olivia is a sweet baby who is working on a variety of age appropriate skills. Her contractures are non-existent in her upper body with her passive range of motion being within normal limits. Her contractures in her lower body are improved as well though she continues have some decreased range of motion in her knees and hips. Her upper body strength is about the same she can now move her fingers, wrist, elbow and some shoulder movements against gravity (when she wants to). Her lower body has gained strength; she has increased strength for flexion and extension her of her knees and flexion of her hips. Her visual and social/emotional skills are on target. Her oral and gross motor skills are limited not only by her neuromuscular condition and by her need for a her ET tube/vent and sensitivity to tube placement. | |||
6/24 – Daily Report
Occupational Therapy
6/24/16 Girl Guerrero was seen today for ROM, positioning, and oral stim
Current Status: no new medical changes
Birth Gestational Age: 38w2d
Corrected gestational age: 46w 6d
Age (d): 60 days
Hospital: LOS: 60 days
COGNITIVE/BEHAVIORAL RESPONSES:
Level of alertness: Alert and responsive, age appropriate interaction
State: Active alert, Quiet alert, drowsy
Able to Achieve Quiet Alert State: Yes
Responds to stimuli: Age appropriate
Signs of stress: Cry, fidget
Able to self sooth: yes
| Area of body | RIGHT- AROM | RIGHT PROM | LEFT AROM | LEFT PROM |
| Overall UE posture | Arms at sides, elbows partially flexed, wrists extended, hands loosely fisted. Fingers active | |||
| Shoulder | 1/4 extension and abduction and flexion | full range | 1/4 extension and abduction and flexion | full range |
| elbow | Full range flexion, 3/4 range extension | full range extension and full range flexion | Full range flexion, 3/4 range extension | full range extension and full range flexion |
| wrist | Extension full and flexion to neutral | Full extension and near full flexion | Extension full and flexion to neutral | Full extension and near full flexion |
| MCP | full flexion/extension except the 5th digit | full flexion/extension except the 5th digit | full flexion/extension except the 5th digit | full flexion/extension except the 5th digit |
| IP | full flexion/extension except the 5th digit. 5th digit remains contracted | full flexion/extension except the 5th digit 5th digit remains contracted |
full flexion/extension except the 5th digit. 5th digit remains contracted | full flexion/extension except the 5th digit 5th digit remains contracted |
| thumb | 1/2 flexion and abduction | Full range | 1/2 flexion and abduction | Full range |
| Overall LE posture | Hips abducted and externally rotated, knees flexed, ankles neutral or dorsiflexed, toes neutral | |||
| hips | full range flexion, 1/2 range abduction/adduction, 1/4 range extension | full range flexion, 1/2 range extension, full abduction and full adduction | full range flexion, 1/2 range abduction/adduction, 1/4 range extension | full range flexion, 1/2 range extension, full abduction and full adduction, |
| knees | full range flexion, 1/4 range extension | full flexion, 1/2 range extension | full range flexion, 1/4 range extension | full flexion, Near full range extension, |
| ankles | 3/4 range | 3/4 range plantar flexion | 3/4 range, | 3/4 range plantar flexion |
| toes | full range | full range | full range | full range |
STRENGTH
Olivia appears to have more strength and activity in her distal muscles (fingers and wrist) compared to proximal muscles (shoulder/hip). Her right arm seems stronger than her left and her left leg seems stronger and more active than her right.
| Right Against gravity |
Right Gravity eliminated |
Left Against gravity |
Left Gravity eliminated |
|
| Shoulder | None | Partial flexion and extension abduction and adduction | None | Partial flexion and extension abduction and adduction |
| Elbow | Flexing and partial extension. Stronger than left | Extending | Flexing and partial extension | Extending |
| Wrist | Full extension and partial flexion | Full extension and partial flexion | Full extension and some flexion | Full extension and partial flexion |
| Fingers | Full extension and flexion | Full extension and flexion | Full extension and flexion | Full extension and flexion |
| Thumb | Partial flexion and extension and adduction | More adduction and abduction | Partial flexion and extension and adduction | More adduction and abduction |
| Hip | Full flexion, partial abduction, partial adduction, partial extension | Full flexion, half adduction, half abduction and some extension | Full flexion, partial abduction, partial adduction, partial extension.
Stronger than right |
Full flexion, half adduction, half abduction and nearly full extension |
| Knee | Full extension and flexion | Full extension and flexion | Full extension and flexion | Full extension and flexion |
| Ankle | Full extension and flexion | Full extension and flexion | Full extension and flexion | Full extension and flexion |
| Toes | Full extension and flexion | Full extension and flexion | Full extension and flexion | Full extension and flexion |
FINE MOTOR
Hands: Loosely fisted and grasp/flex is improving, wiggles fingers often. Strong wrist extension and resists flexion.
Arms: Bilateral upper extremities at sides when in supine. When in sidelying, she brings hands to mouth. Resists writer removing hands from mouth or placing them there if she does not want it.
Grasp Pattern: Able to hold a ring for ~30-90 seconds depending on positioning
SENSORY
Eyes: Open throughout the session but will close them when she is tired. They move together and are responsive to light, movement, and visual stimuli
Visual: Demonstrated focus and looking between stimuli. Briefly tracks vertical and horizontal, high contrast toy and looks between faces
Auditory: Responses to sounds in room. Looks to voices
Tactile: Responsive to ROM and repositioning.
GROSS MOTOR
Supine with Zflo support for midline play
Sat up with support. Attempted to contact neck muscles. low tolerance for sitting up (only ~5-8 minutes)
ORAL MOTOR
Secretion management: Mild pooling of secretion in mouth, no pursing lips or pushing secretions forwards when upright
Lips: Mostly closed at rest and with oral stim. Mouth active. No smile
Jaw: closed or relaxed when supine, hangs open in sitting and fasciculation
Tongue: Active in mouth, cupping of tongue with sucking,
Palate: High arch
Suck: Biting and sustained active sucking on own fingers – no brady desat with oral stim today.
Rooting: No rooting noted today – may be outgrowing reflex
Swallow: Observed intermittently during sucking
Gag: Stronger and more consistent
Intervention/treatment: PROM of LE, positional play, sensory stimuli and oral stim, parent education and support
Assessment: Infant has slowly progressing motor skills and low physical activity level for gestational age.
Plan
Frequency: 4-5 times per week
Discharge Recommendations: Early Intervention, carbed, adaptive seating options, HOB and crib adaptations for trach/vent
Multidisciplinary Communication: RN
