"Okay day today. Ryan was having a tough getting-control-of-his-body day, but we tried a few new things and did a lot of problem solving, which is also useful."
So, what's a "poor body control day"? For Ryan, it looks like this: He has no control over his hand flapping; therefore, it interferes with our programs. He has difficulty holding things and/or putting them in the right places. It often looks like he's throwing things or knocking them down on purpose, but he's not. He has trouble concentrating on the activities because he's so wrapped in dealing with his little muscles going haywire. It's frustrating for both him and us, and eventually, all that uncontrolled muscle activity exhausts him. We've had days like this before, but I didn't really know what to call them. I was calling them "hyper" days. L. explained to me what was going on today with Ryan because he was trying so hard to do the activities, but his body just wouldn't cooperate. That's has to be incredibly difficult and frustrating for him. However, his mood was actually pretty stable today. He only fussed once or twice early on in the morning.
Anyway, we started our day with Ryan being stubborn about moving from the Yellow Room to the Blue Room. We shut off the lights, and started to close the door; he stood up (yay!), but then took about two steps and plopped right down in the doorway, so L. couldn't close it (stinker!). A mixture of me coaxing and enticing, and L. giving him a a few gentle nudges with her foot, eventually got him off his butt and into the Blue Room. He cried a bit when we got in there ("I don't want to work!") until we got him to sit at the table with some Play Doh.
Now, L. hadn't seen him do Play Doh yet, and I was telling her how we'd had no problems: he didn't mind the texture, he was rolling the balls a bit, he wasn't eating it, etc. Anyway, I couldn't find our usual can of purple, so B. found some blue for us. I rolled up the two balls and showed L. how I smoosh one, then Ryan smooshes one with me doing HOH. He did it, she was impressed, and then he started rolling the ball around on the table. She liked that he was showing independent interest in it. However, the next time we did it, Ryan got upset; he tried to pick up one of the smooshed balls to play with, and that didn't work. L. suggested we roll a big ball in a different colour (green) that he could play with immediately (no smooshing) as his reinforcer. That worked out well. Then, Ryan decided to make a liar out of me. Three or four times in a row, he picked up a ball of Play Doh and tried to put it in his mouth! Hey, he didn't do that at all last week. Why now? One time, he was too fast for me and got a good chomp on a ball of Play Doh. We got it all out of his mouth (and into the trash it went), but he had a bit of blue stuck in his teeth. Thank goodness it's non-toxic. LOL
Next, we decided to try and work out the issues of Ryan mixing up all his imitations/signs involving his hands lately. L. suggested that we do high 5/wave hi/clap hands/pat head in trials of, let's say, two at a time, back to back. For example, 2 high 5s followed by 2 clap hands, etc. We noticed when Ryan got the first one confused, and we corrected, then he got the second one right; it was the switching between where he got mixed up. At this point, L. says the only way to get him to differentiate them is keep practicing them like this, back to back, so he eventually gets to know the difference. The other issue is that he's really getting prompt dependent; like, if I block his left arm, he automatically does pat head, and if I hold his right hand, he automatically does clap hands. If I mixed those up (which I did, on accident) he gives the incorrect response. This shows his brain is getting too attached to certain prompts meaning certain actions, and that will make it harder for him to become more independent and generalize later. But that's something to problem-solve another day.
We decided to pick a toy that he could relax with (he enjoys a bit more), so I got out the new pop-up toy, and got L.'s okay for us to exchange it for the old dinos. She agreed, especially once I showed her how the toy was its own reinforcement, and Ryan had some independent skills occasionally showing on it already. He was very excited and pushed down the pop-ups HOH, no problem. He even did a few at the wrist, and one independently. He also popped one up independently and did another with a forearm prompt. Excellent!
Then, we decided to work on some colouring. I got out the markers, Ryan chose yellow, and I showed her how I'm HOH holding it, but he does all the drawing (movement). She had me try fading back (barely holding over his hand), and he did well. However, when I tried to set him up with holding it alone, he kept dropping it. When we put it on the table to see if he'd pick up the marker independently, he kept rolling it off, accidentally. This is where his poor muscle control really came into play.
We were going to stop the colouring, but when I tried to present his reinforcement, he kept grabbing the pencil I use to take data. L. said, "Let's just see what he does with it." So, I did HOH with the pencil, and Ryan really enjoyed scribbling. He got very excited. But again, his jerky muscles kept making him fumble the pencil or roll it off the table when he was trying to grab it. L. thought of a way to keep the pencil from rolling so easily; she borrowed a monkey pencil-topper from a STEPS child, got a thicker pencil, and taped the two together. This did work to help Ryan keep it on the table, but his muscles were going too wacky for him to hold it on his own. He wanted to, though. He kept grabbing it. Then, L. though of another idea. She did some shaping; she held the pencil point down, with her fingers only on the very end. If Ryan moved his hand at the pencil, she drew a little. If he touched the pencil or grabbed it, she drew a lot. Ryan was fascinated. He kept going back for more. So, we got a clean sheet of paper. L. started to draw a bit of a circle, and then stopped. She held the pencil straight up with the tip on the paper again, and let Ryan push it. He caught on really quickly, and would grab the pencil and make it move, to write on the sheet! I don't know how long this went on for, but it seemed like ages. His engagement in and attention to this activity was astounding. Who knew? He loves pencils! Here is a picture of his "pencil art" from today.
Um, the only catch is that we're supposed to be focusing on skills that he'll need for J.K., so colouring has to come before writing with a pencil. So, we'll still be doing colouring as our main program, but offer him pencil drawing as a reinforcement for after, if he shows interest again.He was really upset/tired when he was done with the pencil, so we tried to give him a break while we discussed what to do next. We've noticed a trend: Ryan gets tired much more easily after a period of intense concentration/effort. We didn't push him to do all that pencil work; it had been his choice, but it still wore him out. I eventually got out the ball ramp just to give him something easy and fun to do. I coaxed him to sit on the floor, and after a few trials, we got lots of smiles and good independent attempts at putting the ball into the holes. However, Ryan's wild motor control meant I was chasing balls around the room a lot, too!
Next I set up "push a train" with the smooth plastic tracks, and that went excellent. His motor control had calmed a bit, plus with the plastic tracks, he had great success. In fact, he did one push without me even asking (!), then several with only a verbal prompt. L. says we'll have to up the ante on this one soon: probably using more trains, or pushing it in one direction and then the other, or something like that.
Then we went back up to the table to do matching, and geez, this one jut seems to keep heading downhill. Of course, Ryan's poor body control made matching a nightmare today; he kept dropping the items, missing the bowls, hitting the bowls and shifting them around, and dropping things on the floor. He also did a lot of mouthing of/playing with the matching items, instead of matching them. I was so busy blocking him that I was having trouble taking my data and keeping the program running smoothly. He also seemed totally disinterested in all the things we offered as reinforcement. It was frustrating. So, L. made these recommendations, which we (hopefully) can try tomorrow:
- Get something "super cool" for reinforcement.
- Get something "BORING" for matching, and make sure to get things that don't roll.
- Tape the bowls down, or use a non-slip material underneath, to prevent them from sliding.
Then it was circle time. We did it in the Yellow Room because the new university/college students were in the meeting room today. Ryan did the usual; he was pretty prompt dependent, and needed a few reminders to sit up nicely (not lay down on the floor/put his head on the floor), but he did some good matching in circle and actions to songs. We had to overlook his motor control a bit as he was flinging things back at L., but I don't think that was intentional.
During snack he was lacking motor control, too. He was doing a lot of dropping and flinging his spoon, but some of that was intentional. He's gotten into a strange routine of taking a bite of yogurt, then putting his spoon on the table, then waiting for me to put it back in the yogurt cup. Sometimes he dumps his spoonful right on the table, and doesn't even attempt to go for the mouth. L. said maybe I should try putting his yogurt in a bigger bowl instead of leaving it in the yogurt cup. I guess that's a bigger target area to work with. (?)
After snack, we did the shape sorter, and Ryan did great. He was calmer, and his control was better. We did all three shapes successfully (circle, triangle, square) at a wrist prompt, and he even tried to do a few independently. There are several pieces in the shape sorter, and he did all of them correctly! L. said that would be a high point to leave on, so we took her up on that invitation to go home.
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