amaya at lake

amaya at lake

Tuesday, November 27, 2012

Back to school and back to therapy

   After five weeks off from school (Amaya's school was off-track) Amaya returned to school yesterday. She left her wheelchair at home, took her walker instead and did great all day. She had no pain, walked around the classroom without her walker, and with it outside at recess, to lunch, and back.  She said she even got bumped in the leg a couple of times as she played at recess, but that it didn't hurt at all. Today on the way in to school one of the gliders form the bottom of her walker came off. Josh noticed it was worn all the way down. Later we picked up a temporary pair for two dollars. The ones we got are made for crutches so they don't fit it perfectly so we'll get a pair tomorrow. But these will work for now. The ones she had on earlier came off several times throughout the day. I asked Melissa if certain types worked best, but she said no, any kind would work good.
    Today we had our evaluation appointment with Melissa. We were all excited to go back in and see what Melissa thought of Amaya's progress. Melissa asked Amaya about school, how she maneuvers around, is she walking, or climbing up stairs, how often she walks or uses her walker or wheelchair. I told Melissa about the ways Amaya has adapted her mobility to get places quickly (scooting on her bottom, hopping, jumping shuffling, etc.) that aren't necessarily good for her. Melissa assessed Amaya checking her flexibility, muscle strength, how she walked, climbed on a step, her muscle control, etc. Melissa said its very important to build Amaya's strength so that walking can become easier for her. That seems to be the main thing to work on right now. She's going to see her three times a week then we can drop down to two times per week then to once per week as Amaya improves. She's hoping that we'll only need this one prescription for therapy for Amaya (for eighteen sessions). She said it was important to start strong so that Amaya will respond quickly to treatment and see some results. Melissa suggested spacing the sessions so that Amaya isn't too tired by the end of the week (possibly Monday, Wednesday and Friday). She said the sessions will be tough and Amaya will be in some pain.
    I asked Melissa about Amaya's bedsore. She said it wasn't that bad, but to keep an eye on it. She said it didn't feel blister-like, but more thick and hard with a "ledge" inside. Amaya told her that it hurts more when she wears tennis shoe style shoes because they hug the heel more. Amaya has been wearing some boots which Melissa said was fine to keep doing. I'm going to show it to her pediatrician tomorrow at her check-up to get her opinion.
  After we left Amaya said she was happy she got to go, especially to see Melissa. She also said she's excited to "get better." The work begins tomorrow, we have or first session and four homework assignments to work on. Since we scheduled today we had to take whatever dates and times were available, so we'll have a bit of a hectic schedule again, but we can handle it.
Here's what the glider under her walker looked like. The right one was slightly worn out more than the right so Josh wondered if she's putting more weight on that side. I forgot to ask Melissa. Either way they both needed replacing.
Here's Melissa measuring Amaya's knee in her left leg. She was able to get it to zero degrees (straight) for the first time in a long time (since the fixator was first put on). Amaya's right leg was able to get more than zero, to negative ten degrees. Which reminded Melissa of just how flexible Amaya is. 
Here's Melissa measuring her left knee. It was close to ninety degrees.
Melissa had Amaya gently push her left foot back with her right foot and she easily got to ninety degrees. It was so strange to see her get to ninety degrees so easily and quickly. Almost shocking. On her right leg Amaya was able to bend her knee to 159 degrees. Talk about flexible! I'm not sure if Amaya's left leg will catch up to the right one, or how soon. I'll have to ask Melissa when we see her next.
As Melissa was assessing Amaya she looked at her scars on her pin sites. She noticed how sensitive Amaya was to touch on her scars. Melissa told her that the sensitivity will never go away unless she intensely desensitizes it. She said it would take about one to two weeks of aggressive desensitization. You can see an indentation in the skin. That's where the scar tissue is attached to the muscles. 
Melissa used a towel to rub Amaya's middle pin sites. She said those were the worst, the top ones were the middle and the bottom ones were the best ones. One of the homework assignments Melissa gave Amaya was to rub her scars. She said to do it often with different textures (soft, rough, scarves, towels, socks, etc.), and to include massage. She did warn us not to use a metal scrubbing sponge (apparently she's had two patients do it over the years).
Here's Melissa checking the strength in Amaya's legs. I could see a big difference between her left and right leg. 
Sweet Lidie played zoo with the animals and people. She got back in the swing of things quickly.
Here's another homework assignment. We wrap the yellow band around Amaya's knees and have her pull them apart. Melissa first tried it with the blue band, but it was too hard for her (the blue band has more resistance than the yellow band).
Here's another homework assignment. Amaya is to stand on a step, hold onto a rail and lean her leg back to stretch the muscles behind the knee to help her walk easily. Her last homework assignment is to go from a standing to sitting position slowly while using both legs. 
After all the assessing and work the girls got to jump in the ball pit. They loved it!

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