KidsCare Therapist Success Stories
The Definition of Success
Ellen Enright, Physical Therapist
A physical therapist would describe “success” as being able to facilitate improved functional mobility, independence 
and strength through the use of therapeutic innovations. Jason Moreno is a shining example of how physical therapy can make an impact on the activities of daily living.
Jason, age 2, was born prematurely. He and his twin brother were delivered via C-section at 32 weeks because of a complication called twin-to-twin transfusion. One of the twins’ systems (in this case, Jason’s) was doing all of the work for both. To make matters worse, he also had a condition called tricuspid atresia, a problem in which the right ventricle of his heart did not form. Jason’s heart, already weaker than a normal baby’s, was forced to support two babies.
Jason spent the first three months of his life in the hospital before his parents were allowed to bring him home. He underwent his first heart surgery at one and a half months; his second, at six months. His most recent heart surgery, the third, was one month ago—a week after his second birthday. All were considered great successes, but as with any surgery, post-operative care is critical. Because of the vulnerable state of his heart, Jason cannot and should not expend too much energy. In addition, he is very susceptible to infection and he must receive oxygen at all times, which means leaving his house is difficult. Anytime Jason goes anywhere, his oxygen tank and supplies follow.
As if his health problems were not serious enough, the bright lights and constant noise from his time in the NICU created a separate set of sensory issues. He could not tolerate being on his stomach, couldn’t sit up on his own, and had trouble with various textures that prevented him from doing things such as putting his bare feet on the carpet.
All of these complications make Jason a very immobile child. Unfortunately, mobile is just what he and his family must be with the constant schedule of doctors’ appointments. For this reason, they consider themselves very fortunate to be able to receive therapy in the home. Not only does this mean they are not obligated to transport Jason and his equipment to therapy sessions six times a week, but also do not have to expose his fragile system to the shock of the real world as often.
In-home therapy has also given Jason’s therapists a chance to educate the family so that they can better care for Jason. They have been taught exactly how to work with him so that he will continue to progress, even when the therapist is not present. After just a year of therapy, Jason has conquered most of his sensory issues, is standing, and will soon be walking around just like his active twin brother! This is a dream come true for everyone in Jason’s family.
Leaps and Bounds of Improvement
Shannon Smith, M.S., CCC-SLP
Zion has had more medical procedures and hospitalizations in her three years than most people have in a lifetime. She was born prematurely at 24-weeks gestation and spent the first six months of her life in the Neonatal Intensive Care Unit. When I saw her for her initial speech-language evaluation, around the age of 11-months, she had a gastrostomy tube, a tracheostomy tube, required oxygen for most of the day, was unable to vocalize secondary to her trach, and was orally defensive.
Initially, therapy focused on tolerating touch to the face and mouth and increasing basic interaction skills. She received a Passy-Muir valve about six months after I began seeing her, but was unable to use it regularly due to intolerance and various hospitalizations. She also never vocalized with the Passy-Muir valve when wearing it. She was approved, through a video flouroscopic swallow study, to begin oral feeding about a year after she began therapy.
Slowly, goals began to focus more on vocalizing with the Passy-Muir valve, tolerating oral feeding, and increasing interaction skills. Around the fall of 2008, Zion began vocalizing with both a Passy-Muir valve and humidifier that was placed on her tracheostomy tube. She was finally able to have her tracheostomy tube removed in April of 2009.
Today, besides her feeding tube and healing hole where her trach was, you would never guess that Zion was born so early and has come so far. She receives nutrition by mouth and through her gastrostomy tube. She is tolerating all textures, although she is still developing a good chewing pattern. She is using a large vocabulary of words and beginning to use 2-3 word utterances. Now, every time I see her for therapy, she has learned several new words and talks constantly.
Zion is excited when I come for therapy and often runs to the door yelling, in a still weak voice, “Shannon! Shannon!” I know her supportive family and occupational, physical, and speech therapies have helped her tremendously. She still has improvements to make, but has come leaps and bounds in her short three years!
Catching Up
Sue Khammar, Occupation Therapist
Sophia P. was seen for occupational therapy from November of 2009 to April of 2010 for delayed development of overall milestones. She also had expressive language delay. Sophia has a twin sister, and they were born five weeks prematurely. Although her sister is developing on target, Sophia has been delayed along the way. Sophia has a diagnosis of hypothyroidism– at 12 months of age she sustained a subdural hemorrhage due to a fall from balance deficits and underwent a craniotomy. She received physical therapy from ECI, before I joined to provide occupational therapy. Initial testing revealed delayed fine motor skills and ADLs, balance deficits and tactile sensory processing deficits. Sophia did not initiate play or utilize bilateral coordination, nor did she speak.
Sophia’s tactile processing was diminished compared to her peers, so I utilized as variety of techniques, including deep pressure and joint compression input, during therapeutic activities. She was also a bit tactile defensive, so I used the brushing protocol and educated mom on how to perform on Sophia in order to decrease her sensitivity, thereby improving her initiation of play or ADL’s through touch. She had balance deficits, so I utilized a variety of sensorimotor activities including a scooter board, therapy ball and balance board while performing some type of eye/hand coordination task: i.e. bubbles, balloons, etc. Last of all, for her fine motor deficits, she played with a variety of fine motor manipulatives, including craft activities, play dough, peg/board, stringing beads etc. Sophia initially required hand over hand assist, before ultimately working her way to independence of skills for her age.
Her mom was very involved in each treatment session, and often went above and beyond when it came to following through on sensory diet activities and home program. Sophia, twin sister Olivia (both 1 1/2-year-olds) and Joey (3 year-old cousin) were all present during treatment sessions, as Sophia received OT services from “Miss Sue”. Over the five months of “playing”, Sophia made steady gains. She was recently reevaluated and found to be age appropriate in all areas. She had blossomed into a happy girl who could express her own needs, play appropriately with her peers, and had become functionally independent for her age. Sophia was a joy to treat. Although it was often times to me like treating the whole “daycare” with sibling and cousin also present, Sophia was always happy to see me. Sophia was recently discharged. She still requires speech services, but is on a waiting list for that. It was my pleasure to help this sweet little girl!