Two Months: OT Report Card

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

4 Comments

  1. Thanks Luke, whew, what a read.bGlad to see that she is making great progress in many areas. She is working so hard!! We think of you all and love you all so much. 💘💞💙

  2. That was a great report. She is. blessed to have a great OT, Meg ! So good to see your progress ms Olivia! Praying for you every day. Sending something fun for you very soon. Love you all.

  3. So many goals for babies to meet. Never knew this. Thanks for the up date, Luke! Looks like she’s making progress. Keep up the good work,Sweet Olivia! We’re all pulling for you and sending love and strength to you and Mom and Dad 😍💛☀️

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