Tag Archives: righty

Neuroplasticity

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.

When 8-month-old Mia started to crawl with her right hand fisted, it was unclear when she’d be able to open that hand consistently and at will, unclear that a month before turning 4-years-old, she’d be able to teach herself to swing like a monkey. But, here she is doing that. I think neuroplasticity can explain it, and all the supports that I have put in place for Mia to continue to learn.

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My own journey with neuroplasticity began more than 20 years ago when I first experienced the Feldenkrais Method® via an Awareness Through Movement® class in La Jolla, California. Moshe Feldenkrais was way ahead of his time, inventing a method to rehabilitate his knee based on his knowledge of physics, judo, and his observations of how babies naturally learn and develop. He soon found applications for all kinds of people of all ages who wanted to improve their functioning. I went to that same class every Thursday at 6 pm for six years all through graduate school and my postdoc. I went initially to help heal a shoulder injury suffered shot putting in high school and exacerbated by playing varsity ice hockey in college. I kept going because the lessons taught me something about myself, about going at a pace that was not my habit. I moved to Ann Arbor, had enough disposable income to seek private Functional Integration® lessons. After a year, I moved to Massachusetts where I still live and once again, I sought out new practitioners. After a few years, I still couldn’t get enough so I entered a professional training program in New York City for four years in the Feldenkrais Method.

It’s as if my apprenticeship in the Feldenkrais Method perfectly prepared me to parent Mia with acute mindfulness about her development and the power of neuroplasticity that modern science is now substantiating in concrete ways.

Through Children’s Hemiplegia and Stroke Association, I am part of a mailing list for families of “Hemi-Kids” – that is children who have impaired use of one side of their bodies. This week, on the Hemi-Kids list, I read of Karen Pape, a neonatologist who has a very progressive approach towards treating children who had early neurological problems. She has a fascinating Ted talk on her site.

Pape’s ideas are completely aligned with those of Moshe Feldenkrais and with how I have been parenting Mia and advocating for her for nearly four years. Habits can get in the way of better functioning and the best way to shake up habits to retrain the brain is to introduce novelty in a challenging situation where some focus is required. In Pape’s Ted talk, she shows a little girl reaching above her head with both arms while standing. She has difficulty doing so fully with her left arm. But, when asked to do jumping jacks, the extension is much more complete and natural. When I saw that, I was immediately reminded of Mia’s monkey bar adventures from last Friday when I captured her extending her right arm beautifully to accomplish her own self-defined goal of mastering the monkey bars.

Zoe is 6 and Mia is nearly 4 and so Zoe has a lot more questions about Mia’s differences than Mia does at this point. In a recent conversation, Zoe stated, “Mia has had two things wrong with her body, her ears and her righty.” As a baby, Mia had recurrent ear infections, ear tubes, and recently a procedure to remove the one tube that didn’t fall out on its own. I reframed for Zoe and for Mia who was in the car too. I offered, “There’s nothing wrong with Mia’s right arm or hand. She had a stroke near birth and that injury in her brain means she needs to work a bit harder and smarter to learn to use righty.”

Pape asserts that baby brains recover better than adult brains in rats and monkeys and she thinks humans too, though not enough research has been done to fully validate the human conclusion. I believe it to be true too since young brains start out as a tabula rasa. Pape’s vision of continual improvement being possible is consistent with my view that the sky is the limit for Mia’s functioning and potential. One of my favorite Feldenkrais quotes goes something like this, “Make the impossible possible, the possible easy, and the easy elegant.”

Occupational Therapy – What’s it mean for infants, toddlers, and kids?

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Before I had Mia, I had no idea what occupational therapy might look like for a child. I had a concept that occupational therapists help people regain the skills of daily living. But, what does that mean if you’re too young to have acquired those skills in the first place?

It turns out, at least in our experience, that the pediatric occupational therapists still focus on tasks of daily living but in a developmentally appropriate way. And, instead of focusing on regaining those skills, they focus on helping the child acquire those skills.

Mia qualified for Early Intervention services when she was just one month old. Her diagnosis (stroke) meant that she was eligible until she turned 3 and aged out of the Early Intervention program. Early on, we worked with a developmental specialist and a physical therapist. But, as Mia’s gross motor skills emerged very much on track for age, the physical therapist started to increasingly do more occupational therapy things with Mia to focus on developing functional use of her right arm and hand. Through the Early Intervention program, we switched to weekly sessions with an occupational therapist who continued to help Mia work on her grasp and release and finger dexterity in the context of play, using toys that required one hand or two. Bimanual activities and toys are particularly motivating.

All the while, I was constantly vigilant to make sense of the therapy she was receiving in the context of my own Feldenkrais training and approach to learning which is rather different from conventional approaches. More on that later in a post focused on Feldenkrais.

The Early Intervention program in our area is wonderful. The therapists made house calls or met us at Mia’s daycare. They really got to know us and when we had to switch from one to another, they took great care with the transitions.

Mia also saw an outpatient occupational therapist who specialized in constraint therapy from when she was one until she was about two-and-a-half. We saw that therapist every few months for ideas related to constraint therapy, which is yet another post. The picture that leads this post is from our first experiments with constraint therapy. I wrapped Mia’s lefty all her waking hours that week of vacation and let her spontaneously discover more of her world with righty.

Last spring, we went through a formal “Turning Three” process of graduating from Early Intervention and so now Mia receives services through the public schools. Our town has a public preschool and while Mia doesn’t go there for school, she goes once a week for a 30 minute occupational therapy session. Since September, her regular time slot has been 8-8:30 am on Friday mornings. We all go together, Zoe, Mia, myself, and our au pair in two cars so I can go to work afterwards and the au pair can take the girls to their respective schools. Zoe and I get to have some 1-on-1 time while Mia is in her session.

Just yesterday, I spoke with the therapist about what she plans to recommend for Mia as her annual IEP (Individualized Education Program) meeting is coming up in a couple weeks. Last year, I was very nervous about the first such meeting. Mia barely qualified for services because she’s so strong functionally. So, I thought the therapist might say that she would end services at the end of this school year. She honestly said she goes back and forth about what to recommend but she thinks that she plans to recommend continuing services at a half hour per week for the next year. She and I both see benefits. Mia likes going there most of the time. Once Mia enters Kindergarten, it’ll be a new set of decisions. Even if she’s deemed eligible, I’ll have to decide if it’s more worthwhile for her to stay in her classroom or be pulled out for therapy. I expect that as she gets older, sports and other activities of her choosing will take the place of these weekly OT sessions but for now, I’m glad to hear they’ll likely continue.

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.

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.

Preschool Brunch Tradition

Mia goes to a preschool (that Zoe also attended for the past 3 years) where they celebrate seasons but not holidays. One of the highlights of the year is when each preschool class hosts a brunch. Each child gets to invite one special guest. They go all out to prepare decorations and food and to welcome their special guests.

Here’s Mia this morning, all ready for starting her brunch day.

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I was honored to be Mia’s special guest.

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Just to include a little stroke-related observation, here’s Mia eating her yogurt parfait. Note how she is using the spoon with lefty and keeping the cup from tipping over with righty in her own style. It’s challenging for her to open her right hand wide enough to hold a cup of that size so she sort of braces her thumb and other fingers to keep it from tipping over. I read a really interesting essay today on Adaptation versus Innovation by a college student who is a stroke survivor.  It’s on the Children’s Hemiplegia and Stroke Association blog. Last summer when Mia would eat ice cream from a cup, she would get her right hand really messy before she had refined this strategy she is using in the picture below. I suggested that she switch hands and use righty to hold the spoon while holding the cup with lefty. That was much tidier and she has enough control to use righty to scoop ice cream and eat it. But, recently when I suggested the same strategy, she had an emphatic, “No, mommy. I don’t want to do it that way.” After reading the essay on Adaptation versus Innovation, I’m more inclined to let her continue to figure out what works for her as she’s the expert on how it feels. And, so what if we have messy clothes for a few more months or years while she sorts it out.

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For historical reference, here are shots of Zoe from her brunches in May of 2010, 2011, and 2012.

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This post is part of my streak of posts in the month of May to spread awareness about pediatric stroke. If you’re able, please consider donating to support Children’s Hemiplegia and Stroke Association.