March 29th, 2011

Happy Birthday Kinnick and Carver!!!

Happy 4th Birthday!

It's so hard to believe that Kinnick and Carver will be 4 on Tuesday! We celebrated their birthday this weekend.

My little Prince, Carver

My little Princess, Kinnick

The lights on the cake are way better then eating the cake. Yes, it was a "No Go" for cake again this year.

Carver and his cake

Kinnick with all her packages

Kinnick and her Tag Junior

Clothes from Grandma

Books, books, and more books. A favorite.

All of my gifts. What a lucky girl!

Carver opening his gifts.

Cool new switches

A lantern that lights up

More packages to open

Cool new music ball from Nurse Jane.

The kids had a great Birthday even with their crappy colds.

Happy 4th Birthday Kinnick and Carver! You've come a long way!

Carver's Designated 1:1

I failed to mention one thing about Carver's IEP. Carver will have a specially trained 1:1 to accommodate his needs. This 1:1 will ride the bus to/from school with him and will be with him the entire school day. Here is the designated 1:1's job description.....

The role of the designated, trained one-on-one will be:
-Facilitates access to the environmental information that is usually gained through vision and
hearing, but which is unavailable or incomplete to the student who is deafblind.

-Facilitates the development and/or use of the student's receptive and expressive communication
skills.

-Develops and maintains a trusting, interactive relationship with the student who is deafblind
that promotes social and emotional development and well-being.

-To work one-on-one with the student to implement and facilitate the process of intervention
designed by the teacher and the student's educational team.

-Prepares materials for the deafblind student with whom he/she works in coordination with the
teacher.

-Facilitate the student's connection to others by explaining and modeling the student's
communication system, allowing the student access to the world, and creating a safe and supportive
environment that encourages successful interactions.

-Utilize good observational skills and record progress in daily logs, charts, etc. as directed.

The designated, trained one-on-one will be considered trained when the person:
-Has skills in deafblind intervention including communication methods, environmental access,
sensory loss, deaflblind instructional strategies, and how to create independence rather than
dependence.

-Knows the basic role of the designated, trained one-on-one related to information access,
communication, and social and emotional well-being.

-Is able to provide appropriate deafblind intervention strategies.

-Knows the vision, hearing loss and physical capabilities of the student and understands their
functional implication.

-Is familiar with the student's likes, dislikes, needs, and routines.

All I can say is, Wow! I feel like we have an awesome bunch of therapists and that we are very fortunate. I couldn't ask for anything more.

Carver's IEP Goals

Carver's new IEP Goals:

Goal 1 (PT): Complete the following with 75% accuracy...

A. Tolerate a tailor sitting position with minimum assist for 5-10 min with adequate head control.

B. maintain head neutral position for a minimum of 5 min while in supported sitting and or standing positions.

C. Maintain hip and knee extension to allow weight bearing for a minimum of 5 min with minimal assist/support.

D. Hold a supported quadreped position for 2-3 min, weight bearing through upper and lower extremities with fair form.

E. Tolerate using a gait training device to move forward in an upright standing position for 5-10 feet with appropriate physical prompts/supports and minimum to moderate assist from an adult.

Goal 2 (OT): Demonstrate a functional use of objects in the classroom environment

A. Demonstrate appropriate grasp and release of 3 objects in a container with minimal physical prompting.

B. Reaching for objects in all planes with minimal physical prompting when vibration, song, or light is activated while in a seated position on the floor.

C. Participate in at least 3 different 2 handed tasks in which each hand has the same action.

Goal 3 (SLP): When seated beside the feeder with support and/or equipment...

A. Demonstrate a safe swallow and maintain mobility/movement related to feeding when given a variety of foods (including, but not limited to taste, temperature, smell, and thickness) and utensils (including, but not limited to soon, cup, and straw).

Goal 4 (SLP/HI): Given decreasing facilitation...

A. Demonstrate pragmatic language abilities including but not limited to, initiate, request and refuse during various activities by gesturing/vocally responding using a switch to various educators/team members and peers. Gesturing/vocalizing includes, but is not limited to answering Y/N, "more" by scratching his fingers against a listener's palm, gesture to himself for "my turn", touch a listener to gain his/her attention.

B. Demonstrate the ability to follow verbal directions, including, but not limited to "stop, wait, turn on, off, eat, drink, go, sit up, give me ____, put in" during daily routines and transitions, with no more than 2 verbal prompts.

C. Demonstrate the ability to accurately choose between a variety of objects, preferred vs. non-preferred.

D. Demonstrate the ability to participate in turn taking activities (games, songs) with no more than 1 prompt.

E. Increase joint attention to a task to 5 min.

Goal 5 (HI): Given facilitation...

A. Show recognition of Ling sounds (ah, ee, oo, sh, s, and mm) when the sounds are presented 1 foot away.

B. Will learn 10 new sounds.

C. Will show a response of attendance to the listener (smile, lifting head, tuning head) when his name is called.

D. Will listen for the sounds of objects and retrieve the objects when the object is 2-3' away from him.

E. During a routine, Carer will be presented with the name of 2 objects (1 syllable word vs. 2 syllable word) and he will choose the correct object.

Goal 6 (VI): Develop visual efficiency

A. Carver will attend to an object on a lightbox.

B. Carver will track on object on a lightbox.

C. Carver will physically locate an object on a lightbox.

Goal 7 (VI): Given a book...

A. Carver will locate tactile graphic 50% of the time.

B. Carver will locate braille 50% of the time.

C. Carver will turn pages independently with 75% accuracy

Goal 8 (SLP/OT): Improve self-help independence within the classroom environment

A. Bring a cup to his mouth with verbal and visual cues only

B. Utilize a spoon for self feeding with minimal assistance

C. Demonstrate the ability to remove his own hat

The "Finish Box"

Since Carver is Blind/Deaf, it's important that we teach him that things don't just disappear when they are no longer in your hands. So, we keep a tin cake pan next to his chair. We call this the "finish box". He is able to use his Cochlear implant to hear when something falls into the tin cake pan. Then, if he wants something to play with, he knows where he can find it. He is supposed to put things in the tin pan when he is finished playing with them.

I'd say he's getting pretty good at using the "finish box".

That's a big pile of finished toys.

Kinnick loves music. Her newest thing is to beg for everyones I-Phone, so she can listen to the music. Bob's I-Phone quit keeping a charge, so now it's Kinnick's. Here's where we found her today - listening to music on her I-Phone...

Auditory Conditioning / Operant Audiometry

I asked Kat to explain the Auditory Conditioning System that we are trying with Carver, and this is how she explained it...

We are teaching Carver to discriminate both the absence and presence of 4 combined tones. Once he learns to press the switch to indicate he hears a tone and does not press the switch when there is silence. The end goal is to get him to press the switch to at least 4 different tones at 65 dB presented individually, so that we can then take the switch to the audiologists so that they can get a behavioral audiogram, and hopefully, have more information with which to map the implants/ or a hearing aid. We are hearing more and more how many children with multiple needs cannot simply hold up their hand or drop a block in a bucket when they hear. At first, Carver wanted to press the switch to get the reinforcer, but he didn't do that this week...we were impressed that he did smile sometimes when he heard the tone and put his hand back to the place on the tray. However, he waited to be prompted. Melinda and Tara will see if we need to position his hand differently to encourage him to hit the switch. We might need an adaptive elbow holder so it is simplified. The following parameters are factors for individualizing for any child.

1. Determining a strong, consistent contingencies or multiple positive contingencies.
2. Determining the best body positioning and type of response for each child.
3. Determining the best environment (no one talking, lights down for better visual or more contract for some children).
4. Developing a program so that the tones can be presented consistently (sound meter and downloading apps).
5. Determining the easiest motor response for the individual child.
6. Determining the timing features and types of prompts to be used.
7. Developing an interrupter so that the child does not get the contingencies without a tone first & delaying the tone as long as the child is activating the switch.
8. Securing the switch on a tray so the child does not try to mouth or pick up the switch...and being able to connect the interrupter switch so it can't be pulled.
9. Collect and analyze data on prompted and unprompted responses.

10. Giving the child a consistent program across time so that they can learn the task.

We will look at the data to determine if the program needs to be changed. We go by the philosophy that it isn't a child learning or not, but if the program is working or not. We will discuss how it can be made more simple if we don't see Carver responding without prompts...so, I am not sure how long it might take.

Fun on the AmTryke

Kinnick riding the AmTryke...

Kinnick backing up on the AmTryke...

Kinnick cruising down the driveway....

I'm still trying to figure out everything to order for Carver's seat. I can't wait to get a seat that will allow him to ride on the AmTryke.

A new AmTryke - Donated to Kinnick and Carver

I received a call from one of my Case Managers yesterday (MRDD). She had a lady donate their child's AmTryke. This is a special needs tricycle. She asked if we would like to have it. Of course I said, yes! I was wanting one for the kids, but they were so expensive. It cleaned up wonderfully! Kinnick has spent all evening trying to figure it out. She is able to push with her feet (on the floor) and turn the handles to go. We're going to work on pushing - using the pedals.

Carver isn't able to use the AmTryke as-is. So, I'm going to order a snappy seat, and an H harness. This will give him the security he needs to ride of the tricycle. The picture below doesn't show the H harness. It comes separately.

The AmTryke is made by Kettler. So, I sent an email to see if we can get the tandem insert. This will allow Kinnick and Carver to ride together. I'm hoping they say the insert will work on the AmTryke. Just looking at pictures, it looks like they use the same base frame. I'm excited to hear if it will work.