School year-end progress report for Carver

Carver did very well during his 6 weeks in a pre-school setting. He seemed to really enjoy it. He had the best 1:1 that we could ever hope for in addition to his fabulous therapists. They are all just unbelievable.

They made this cute picture for him at school. Very cute.

Carver's Progress (6 weeks in a pre-school environment):

PT:

• Carver is tolerating tailor sitting position with minimum assist for 3-5 minutes with fair head control
• Maintains head neutral position for up to 1 minute while in supported sitting or standing positions
• Maintains hip and knee extension to allow weight bearing for up to 3-4 minutes with moderate assist to complete
• Holds a supported quadruped position for up to 1 minute, weight bearing through upper ad lower extremities with fair form
• Just initiated the gait training device with Carver and he tolerated it well with assisted upright forward position using tactile cues on his lower extremities to keep them on the floor and move forward about 5' with moderate assist

OT:

• Primary emphasis within the classroom setting was to support Carver in his need for appropriate positioning and equipment to support that need. He has recently begun working on reaching for objects in various planes, but there are no significant changes in data at this time.
• Carver has been working on removing his hat, but at this time requires hand-over-hand assistance. He does assist by extending his left arm when donning a coat, 2 of 2 opportunities.
• During snack, he has been given opportunities for tasting, but again, the primary emphasis until recently was to fit him with an appropriate seating device.

VI/OT:

• Carver has become more open to exploring braille books this quarter. This week he was interested in "reading" 7 pages (hand-under-hand) out of a 13 page book! Typically, Carver only explores the braille for 3 pages (hand-under-hand) before it becomes too much to handle.
• Carver independently explores the braille 20% of the time by scratching it. His VI teacher would like to see this move to a side to side motion instead of up and down.
• He is also doing better with turning pages, textures and graphics.
• Carver will grip the page to help turn the page 40% of the time.
• He will independently find/explore the tactile graphics 40% of the time.

VI:

• This quarter Carer has had some changes! It took a while to get into the swing of school, but he has gotten better as the weeks progress. Carver is able to visually attend to objects on the light box 40% of the time. This is a little lower than last quarter, but keep in mind all of the changes.
• He has reached out for objects independently only a couple of times. Once he notices an object he will usually track it for a few seconds if it moves slowly. Carver notices objects best in his lower right field.

SLP:

• Primary emphasis within the classroom setting was to support Carver in his need for appropriate positioning and equipment to support that need. That said, he has been tasting a variety of foods. He loves gravy! Has tried spaghetti and pizza sauce.
• He is learning to close his lips around a straw for 2/10 opportunities.
• He is learning how a cup feels on all of the parts of his mouth.
• Sometimes Carver shakes his head "no" when put in a chair for snack. The moments he shakes his head "no" are now honored, so that he begins to understand that he has power in communicating his wants/needs. He is learning to carry this "no" over to other places and spaces. It should be noted, that Carver has also had some colds, and he has been spitting his food at home. When he does not have a cold, he is much more accepting of oral intake. Success observed for 2/10 opportunities overall.

HI/SLP:

• Carver is learning to adjust to the classroom and various teachers/facilitators/peers, as well as the routine in the classroom. He does not yet reach for a listener.
• He requires verbal/tactile prompts to participate in turn-taking activities. He requires more than 2 verbal prompts to "stop, wait, turn on, off, go, give me ___, and put in. He requires 2 or less prompts to eat, drink, out.
• When he wants more of an activity, he consistently kicks his legs. Now he is learning to vocalize or use his hand to gesture that he wants more.
• Carver consistently indicates that he is finished with a task by pushing the "finish box" away or pushing the item away. He needs help dropping items into the "finish box", but upon hearing it drop, he pushes it away and smiles. In 5 opportunities, he pushed the "finish box" away 5 times.
• He gestures "more" by scratching on his tray, the toy, or into his communication partner's hand (if he is already touching it). During games and songs, he indicates "more" by continuing the activity after is has been stopped.
• He needs tactile cues along with verbal prompts to stop, wait, turn on, off, go and put in.
• He will give his hands before playing games with more than 1 prompt and sometimes a tactile cue.
• He chose between preferred and non-preferred objects when they were dropped onto his tray 2 out of 5 times. He did not choose an object that was offered him (cued with a noise of the toy) from someones hand.
• He participated in turn taking with his chewie 2 out of 4 opportunities. He did not gesture "my turn" when it was his turn, but he reached out toward the sound of the chewie vibrating on the tray to indicate it was his turn. He dropped it on the try when it was someone else's turn.
• When he is doing physical activity (swinging, bouncing on the trampoline, etc.), he indicates "go" by kicking his legs. He kicks his legs faster until his communication partner goes as fast as he wants.
• His joint attention to task varies between 2 seconds to 1 minute and 30 seconds, depending on the task.

HI:

• Carver has responded to the Ling sounds by smiling to the ah, ee, oo, and mm sounds consistently when in a quiet environment. His is inconsistent with the sh and s sounds.
• Carver has been introduced to sounds for new toys and knocking at the door. He smiles when he hears the toys in a quiet environment. He recognizes a turtle toy and puts his hand on the top to turn it on. He recognizes the cloth piano and will put his hand on the appropriate part to turn it on. He is not showing a response to a door knock unless it is with wood on the door.
• He smiles when his name is called, but it is not clear that he understands that it is his name or if he enjoys the sound of the voice talking with him.
• We have not worked on distinguishing the names of objects during a routine.
• He will reach for toys that he hears drop on his tray (if he is interested in them) 1 prompt.

There is so much for Carver to work on. Such small tasks are so big when you can't see or hear. It only complicates matters when your mobility is also hindered due to CP. Carver is making strides with the help of an extraordinary group of therapists/teachers and his 1:1.

Again, we can't wait to see where Carver is when the next school year ends!