Last Monday, Maddie's Early Intervention team met for the six month reevaluation. Because Maddie is still delayed despite making amazing progress, she will continue to receive weekly physical therapy. The case manager asked me what my concerns were for Maddie over the next six months. I explained that I feel confident with Maddie's abilities while Heidi, her PT, is working with her. However, during that hour we keep Amelia and James separate because they are so much quicker than Maddie and they frequently steal whatever toy we are trying to entice Maddie with. When Heidi leaves, Maddie is left to fend for herself. The three of them wrestle one another and fight for certain toys (or my cell phone). Maddie is almost always left crying as James or Amelia dominate.
The case manager suggested CBRS. If you are like me and have no clue what that is, here's a quick description from the CDSA:
Community Based Rehabilitative Services (CBRS) is developmental intervention uniquely designed to enhance cognitive, physical, behavioral, self-help, social-emotional, and language skills. This rehabilitative therapy for infants and toddlers is “play with a purpose.” CBRS is one service available to support children and families from birth to age three who have been determined eligible by the Children’s Developmental Services Agency (CDSA) for the North Carolina Infant Toddler Program.
Maddie will now receive an hour of physical therapy every Monday, as well as an hour of play therapy on a different day. I don't really know what to expect, so I'll update after the first session (which will occur within the next three weeks).
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Today I asked Heidi for some more specific ideas to help Maddie strengthen both sides of her trunk. We have stopped making her wear the hiphelpers because they hinder her from pulling up to stand. They worked well to correct her form while crawling, but she now spends more time standing (with support) and cruising than she does crawling.
Heidi's fun suggestion to help build bilateral strength was to make obstacle courses. She explained that anything that Maddie had to climb over would force her to use both sides of her trunk. She encouraged me to let Maddie crawl up the stairs and climb over pillows and couch cushions. We initially set up a course in the open part of the living room, but Maddie just crawled the long way around it. Our next course was narrowly between the couch and the coffee table. We put toys, a pacifier, and a sippy cup in between the pillows so Maddie would climb over them. She grew tired quickly, which is a sign that she's working hard!
After Heidi left I made a large obstacle course using the couch cushions in the hallway. Thank God we did not take the cushions off the couch while Heidi was there. I may have dissolved into a puddle of embarrassment if any other adult had witnessed what all was hiding in between the cushions. I vacuumed while the kids played in the hallway. This provided a lot of entertainment for them!
Once Jackson climbed on a cushion, James, Amelia, and Maddie joined forces!
I let the three climb the staircase to their room. Amelia does this regularly, mostly on accident because she is so fast. Maddie made it to the top all by herself. James refused to go beyond the first two stairs.
It looks like we'll be spending a good bit of time climbing the stairs and pillows this week.