Category Archives: Case Study

Case Study: Ponytails and Folding Socks

Zoe is a great inspiration to Mia. Just this morning, Zoe put her hair in pigtails, and before I knew it, Mia had too. Zoe is seven. Mia will be four years and nine months old tomorrow. Zoe wasn’t even aware of the idea of doing her own ponytail or pigtails until she was in kindergarten last year and saw a classmate doing it. Mia has the good fortune of watching Zoe do everything day after day so she gets the idea that she can too.

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I don’t always see it coming with these new challenges that Mia defines for herself. A couple of weeks ago at bedtime, I noticed that Mia was brushing her hair a ton with leave-in-conditioner and getting frustrated with the tangles. I thought her frustration was related to hairbrushing. It wasn’t until the next morning, when I was sitting on the couch reading to them and Mia was attempting a ponytail and getting frustrated and then going into the extensive brushing routine again that I realized her quest to give herself a ponytail.

Mia is very dominantly left handed and she can do a lot with her right hand, especially in bimanual (two-handed) activities, but learning a new skill behind her head seemed pretty daunting to me as the observer.

So, here’s what I observed in an e-mail I sent to her occupational therapist. “Mia has embarked on teaching herself to do a ponytail on her own hair. She has many of the concepts and steps but not all so is getting frustrated. I am looking for ideas and ways to support her. She puts the elastic on her left hand, uses both hands to gather the hair into her right hand to hold it there. She uses her teeth to get the elastic from her left wrist onto her left hand, and then manages to get it around the bunch of hair somehow but gets frustrated and stuck after that. She then claims her hair is tangled and embarks on a lot of spraying of leave-in-conditioner and brushing with her left hand which migrates her part further to the right. Can you help Mia work on this, break it down, etc?”

Then, I went online and searched for “one-handed ponytail” and posted to ask other families with stroke survivors for their experience with kids learning to do ponytails. One replied that her daughter had learned at age eight. Another told me how ambitious Mia is to be attempting this so young.

I thought about putting out elastics of various size and texture to let Mia experiment. But, life is busy, and I haven’t done much to support her, and still she’s learning, very much on her own initiative and with the ongoing model of Zoe.

At Mia’s weekly occupational therapy, that first week of March, they talked about how frustration comes with learning something challenging. They experimented with doing things in front of Mia so she could see and feel to get the concepts more solid. The therapist even offered that Mia could try on her hair. Instead, they made a bunch of yarn to use for practice. And, in that way, Mia learned the concept of twisting and doubling over the elastic to loop it through a second time.

I’ve seen Mia successfully make a ponytail in her hair once. Even doubled over, the elastic was too loose and fell out after about half an hour. I had no idea she could do pigtails, and since I didn’t see her doing them, I don’t know exactly how she managed, except that she must have reached over around her head to do the major work with lefty.

Since I don’t have good video of her working on this new skill, I thought I’d share another recent clip of a different self-defined fine-motor task. I got the girls new socks and Mia set herself the task of folding them all into balls. Enjoy and look to see how she uses her two hands differently. And, if you listen, you’ll hear Zoe in the background, alternately vying for attention and cheering Mia on as she folds socks. That’s our normal. Zoe said just this morning, “Mia’s learning early with the pigtails and ponytails!” Mia’s persistence, determination and inner drive are all quite remarkable, even more so because she’s not yet five.

Update from March 21, 2014

I managed to capture a video of Mia making a pigtail. Notice how she gives each of her hands different jobs at every stage of the process. And, you can see her moment of pride as she accomplishes what she set out to do. Enjoy!

Preparing for First Hockey Season

My girls think it’s hysterical that my first hockey shin guards were improvised, soccer shin guards paired with foam knee pads. That didn’t hold me back. I played one year with boys, starting when I was eight, and then joined the girls’ league. I went on to play Division I hockey at Brown University, just as the game was shifting to a more competitive level.

Two weeks ago, I signed the girls up for hockey and myself up to coach. The season has already started, but soccer still fills our Saturdays for another couple weeks. After figuring out that their skates still fit, and Zoe had a helmet, but Mia did not, we went shopping. I bought full sets of equipment the first weekend we decided the girls want to play but we hadn’t had time to touch it since. Sunday, they tried it all on, I showed them how to tape their sticks, we labeled it all with their names and color-coded tape (green for Mia, pink for Zoe), and the girls got so excited that they wanted to go to public skating.

October 2013 – Mia 4.25 years old, Zoe 6.75 years old
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It was not crowded, skating was fun and leisurely. Both girls wore their hockey gloves. Mia brought me her right one and asked for help to find spots for each finger. She kept it on easily throughout the hour of skating.

Both girls picked up where they had left off with their skating after a season of lessons last winter. Zoe was too fast to capture well on video in the low light. She progressed a great deal last winter, which was the first year when it was feasible for me to take both girls skating regularly, both to open skate and to weekly lessons for four months.

Here’s a moment when Zoe wanted to skate with Mia. For me, it was so lovely to be on the ice with them both. They needed much less help from me than last year, or any prior year, and I can glimpse ahead that in a few years, they’ll be skating circles around me. Zoe told me that she feels lucky that I know all about the equipment and about hockey. She has noticed that most of the soccer coaches are men and it already makes a difference to her to have me there on the ice with her.

In this tiny clip, I captured Mia falling and getting up quickly and easily. Anyone familiar with hockey knows this is the first and most important skill. The notable moment of this video for me is that to stand up, Mia first stands her right foot. Last winter, she used her left foot exclusively. Her right side is the side affected by her stroke. I’m so happy to see her using both sides now to fall and get up. And, I was also happy that she was able to manage her glove on her right hand.

The girls wanted to stay to watch the Zamboni clear the ice but there had been so few skaters that they didn’t need the Zamboni. I promised many more opportunities to watch the Zamboni.

Just to show our history of attempting to skate each winter, here’s a photo log. We missed one winter when Mia was an infant.

January 2008 – Zoe, 1 year old
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January 2009 – Zoe, 2 years old, with Mara (pregnant with Mia)
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January 2011 – Mara helping Mia get her skates on
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January 2011 – Mia, 18 months, with Mara
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January 2011 – Mia, 18 months
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January 2011 – Zoe, 4 years old
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Thanksgiving 2011 – Zoe, almost 5 years old, with cousin Alex
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Thanksgiving 2011 – Mia, 2-and-a-half
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Thanksgiving 2012 – Mia, 3-and-a-half
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Thanksgiving 2012 – Zoe, almost 6 years old
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October 2013 – Mia 4.25 years old, Zoe 6.75 years old
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Case Study: Skin-the-Cat

Mia taught herself to do skin-the-cat the weekend of her birthday party, days before turning four. This is one of many seemingly amazing milestones she’s hit this spring and summer. I’ve been celebrating them along with her and Zoe. In fact, the first time she did it I was not watching and Zoe helped her. Mia came to tell me and repeatedly told me, “I’m so proud of myself!” And, she was, she owned her new accomplishment.

Here she is, the morning of her birthday party in full action.

I have a series of posts in mind that I’d like to write over time to show and tell how I think it’s been possible for Mia to master so much. I happen to have a lot of photos and videos of her development. This is the first such post. Mia is incredibly determined and courageous and always has been. I’m quite attuned to her needs and goals and have focused a lot of attention on providing an environment where she can continue to thrive and learn, sometimes in surprising ways. Mia has been pretty persistent at mastering her world since infancy and that continues. Her repeated practice in different settings allows her many “successive approximations” until she masters a new skill. This notion of “successive approximations” is one that Feldenkrais wrote and spoke of often.

At four years old, Mia definitely owns her “I can” attitude. She has many experiences of watching her older sister, Zoe, master one thing after another. And, Mia comes along finding her own way to do many of the same things in her own time. Just this week, she surprised me in the lake where we swim. She’s swimming farther each day than the last without assistance or floatation and now she’s asking to dive under my legs, just like Zoe. And, she surfaces with rocks in her clenched fists asking me to guess which one has the rock and which one has just sand.

This story goes way back to when Zoe was an infant and some friends lent us this baby hammock for her to sleep in. Zoe was so mobile that she only lasted a couple of months in this hammock because I was afraid she’d end up on her belly in the soft hammock and obstruct her breathing.

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Those friends needed it to lend to another family so we gave it back but I asked to borrow it again when I was expecting my second child. I had it set up days before Mia was born, and Zoe discovered that it worked pretty well as a place to swing like a monkey. Zoe was nearly 2.5 at the time.

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Mia did sleep in it too for a few months. By the time she was done with it as a sleeping hammock, Zoe’s habit of swinging from it was so established that I put the hammock away and left the frame in my bedroom for daily gymnastics practice.

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Mia started to swing from it a couple months after turning two.

Zoe taught herself to do skin-the-cat on the hammock frame when she was 4 years, 8 months.

When Mia was nearly 3, she could swing from rings like these. Soon after this picture, we got our own set for our outdoor playset.

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At Zoe’s, sixth birthday party, when Mia was 3.5, Mia was able to support herself well on the bar and pull her knees to her chest.

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So, Mia’s seemingly sudden mastery of skin-the-cat on the triple trapeze swing featured at the top of this post really can be traced all the way back to Zoe discovering what a wonderful piece of equipment that baby hammock could be, without the hammock of course.

The frame remains in my bedroom. I’ll close with a video clip of Mia working and working to get her feet on the frame of it. She had done it several times before I started trying to capture it on video so by this time she was tired. But, you can still see her determination, intense persistent efforts and  good attitude. Note how she experiments with placing her hands in many different spots to see how that feels and works. Allowing all of these attempts is what ultimately helps Mia build strength to master these skills and many others. And, she can transfer the same skills to doing the monkey bars.

Bicycling

This post on bicycling is part of my streak in the month of May to spread awareness about pediatric stroke. Please consider donating to support Children’s Hemiplegia and Stroke Association, an organization that has helped our family tremendously with support and information.

Both my girls started riding balance bikes (2 wheels, no pedals) when they were two years old.

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In late March, Zoe asked me to go to the bike store to look at bikes. She’d been outgrowing her 16″ bike which she rides well. I had raised the seat but then the handlebars were too low. Of course, Mia also chimed in with, “I want a new bike too!” That wasn’t part of my original plan. She was on track to stay on the balance bike a while longer and then get Zoe’s 16″ hand-me-down.

For historical reference, Zoe could ride her Skuut balance bike the mile to their daycare before I got her the 16″ “pedal bike” which was in the spring after she turned 4. We skipped training wheels. The 16″ bike was a little too big. She could pedal right away and balance and steer but it took her a while to be able to start and stop with confidence and she went back and forth between the balance bike and the pedal bike for more than a year before things clicked on the pedal bike.

On that shopping day, I ended up getting Zoe a 20″ bike with hand brakes and gears. It seems like she is a really big kid all of a sudden. She can ride it well and independently. I even let her go up and down the street by herself. She’s good about going to the side of the road when a car is coming.

Mia fell in love with a little red 12″ pedal bike so I indulged her too. Mia could pedal, balance, and steer on day 1. She still needed help to get started over and over again, but she mastered her 12″ 2-wheeler faster than Zoe did the 16″ just because it’s more her size. Bicycling is an excellent skill and activity for Mia with her right-side challenges as it requires that she use her whole self in a balanced way. The grip on the handlebars and the pressure up through the arms is good for her. On her first day, she seemed to need to look at her feet to make sure they are on the pedals and some of that could be that she’s learning but some could be that she uses her eyes on the right foot particularly since her sensation is less developed there. I kept reminding her to look up at Zoe who was off in front most of the time.

Here’s Mia after just three weeks on her new pedal bike. She can pedal, steer, turn around to come back, and stop in a controlled way. You may notice that she does let go first with her right hand when stopping at the end of this video. Since that video, she has taught herself how to start on her own, all before turning 4 in June!

My lessons from this experiment in supporting two children in learning to ride bicycles:

  • Balance bikes are awesome! Kids learn to balance and steer and go fast without also dealing with pedals.
  • It’s possible and faster to skip training wheels.
  • The right size bike makes learning much easier. I don’t mind that Mia will outgrow her 12″ bike after a season if she has used that season to master the skills.

Monkey Mia

There is a place on the west coast of Australia called Monkey Mia. It’s famous for the dolphins that come ashore. I was there in about 1995 after a research cruise that ended in Perth. But, we never saw any dolphins.

“Monkey Mia” is a good nickname for my Mia now who seems utterly determined to master the monkey bars as soon as she can.

This evening, we went to the park. Zoe is a pro at the monkey bars, so fast that I couldn’t get any pictures of her on them. I was also trying to help spot Mia. Little did I know that Mia had moved on and no longer wanted my help.

Zoe is trying to master her next challenge with climbing trees  with branches that are kind of hard to reach.

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So, here’s Mia in a series of action shots. Her focus and motor planning are palpable. She makes the riskier big reach with lefty as she knows that’s safer for her and then she’s able to reach and extend her fingers to grasp with righty.

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Every occupational therapist who has worked with Mia has focused on helping her extend her right arm, hand, and wrist. This shot below is an incredibly clear view of how well she has to do that to succeed in her goal of mastering the monkey bars.

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And, here’s a video of Mia putting it all together on the monkey bars.

Earlier this week, Mia figured out how to get started on her bike on her own. She’s been riding it well for a few weeks but still needed a tiny push to get going. No longer. It’s almost as if each new motor skill she masters drives her to find the next challenge. In the last picture above, she’s reaching for the fifth bar. There are only two or three after that. And, she wants to go back to the park to practice so she can go all the way across. She did the monkey bars so many times this evening, dropping to the ground each time her arms gave out. She’d get up and say, “I need to try again.” I started to worry that her determination was so intense she might keep trying past the point of fatigue and injure herself. I gave my 5 minute warning and we biked home for bedtime snack.

This post is part of my streak of posts in the month of May to spread awareness about pediatric stroke. Please consider donating to support Children’s Hemiplegia and Stroke Association, an organization that has helped our family with support and information.

Update on September 3, 2013

Here’s Mia yesterday at 4 years 2 months old (four months after her early forays shown above) showing me that she has been practicing and can go all the way across the monkey bars. Note how confident and nonchalant she is. She just knows she can do it and she does. You might also notice that she consistently reaches first with her left arm (unaffected) and then with her right arm (affected by stroke). She does this for every one of the seven bars, reaching first with lefty, then with righty. She happens to be wearing the same lucky butterfly shirt she wore in May when I first captured her learning to swing on the monkey bars in the still and video images above.