Thursday, January 5, 2012

Last, But Certainly Not Least

Our one big goal for occupational therapy:

Jack has never used his left hand. He doesn't have much control over it, and oftentimes, totally ignores it (along with ignoring much of the left side of his body). He is very protective over his left hand and arm and often cradles it and keeps it close to his body. We don't exactly know what is going on with his left-side, but it seems that as opposed to the use of his left leg, Jack is much more guarded when it comes to his hand.

Do any of you use constraint induced therapy? We are going over our options, but one of the main things we hope to do in 2012 is some sort of variation of it. Basically, it is where you restrain the "good" hand or limb thus forcing the use of the neglected side.

We wonder if Jack is a candidate for this. There is an option of doing a 3 week intensive in a another town where Jack's good arm would be fully casted and he would work with an occupational therapist to retrain his brain how to use the other side. We are still figuring out if this is the best avenue, so if any of you are familiar with it, please comment! I imagine this type of therapy would be very frustrating for Jack, but many say it is successful.

Another option is not so intense, but restraining the good arm (with a type brace that can come off and on) for a certain period of time each day to encourage the use of the the other side. This may be what we try first, before doing the intensive. Truthfully, either option makes me worried, especially when I hear those in the occupational therapy field have differing views on it.

Both of these options are working at re-wiring the brain, making new pathways within the damaged areas of the brain to encourage movement. We see how clever Jack has to be with the use of only one hand and this encourages us that with his determination, we may see an increase in what his left hand and arm will one day be able to do.

Jack working with his occupational therapist

come on buddy! use that left hand!

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The Ramsey's said...

Mackenzie has the same issue with not using her left hand much. Although if asked to try with her left hand she will. To your my opinion, yes, restraint therapy works. We did it every day for 30 minutes or longer if she was tolerating it, for 8 weeks. Her OT made a little 'splint' and then we covered that with an ace bandage. During the times we would have special activities/toys that we did during this therapy. Like I said Mackenzie doesn't fight at least trying to use her left hand, but there were definitely times she got frustrated and tried to bite at the ace wrap to pull it off. I would say give it a try and see if it works for Jack...that's all you can do right?!

Cathy said...

There is a blog I read and one of her daughters is doing restraint therapy right now
You can click on her label "constraint induced therapy" to read more of her posts! I am not an OT or PT, but with my experience with the world of therapy for my children I believe in the earlier, the better. It's so hard to get them to do things that are difficult for them, but sometimes something like restraint therapy is a good thing, because it really forces them to do what's hard, when it's for their best interest in the long run. You're doing wonderful things for Jack, keep it up!

Shannon said...

Jessi - Marissa, too, has total left-sided neglect. She spends some time with her right arm in a no-no due to self-injurious behavior and during particularly bad periods we do notice that she will attempt to use her left arm or at least pay more attention to it. So I guess you could say we're accidentally doing some constraint therapy. Check out Jacob and his Mama at they had amazing success with really intensive constraint therapy.

tiffany porter said...

We highly recommend constraint induced therapy. Our son Jack went through the 3 week program and it helped tremendously. He actually said "MOM" for the first time as he was being bittersweet!! Although the other option is less invasive, I think CIT is often a better choice since the child knows you cannot take the cast off. The wrap comes off very easily and was hard for our Jack to leave alone.
Hope this helps! I just read your blog...would love to visit sometime. Although our Jack wasn't a preemie, I can really relate to a lot of what I have read... Blessings, Tiffany

Kristi DeLeurere said...

My friend's little boy had a stroke in utero and was not able to use his right arm at all. They did constraint-induced therapy and had great results. He was actually on the local news if you would like to watch the clip:

Also, I am an OT and have heard only good things about CIT. I am sure that it will be scary and uncomfortable at first, but hopefully it will be worth it in the long run! Good luck!

Deidre Sieck said...

I have been reading about Jack for a while now and I can relate. I have a little guy who is now almost 18mo who was born at 24.6 weeks and is a surviving twin. He had a right sided grade IV bleed and has a left sided hemiplegia. We are working on cruising and walking now so Jack gives me much hope. Finn will use his left arm/hand when he has to for bimanuel tasks but does not initiate tasks with it. We too are looking into adding constraint therapy- hopefully soon.

Keep up the good work Jack- Mommy too!

Julia said...

Hey Jessi! I am actually a PT by profession and u did a research paper on CIT and it most definitely works. Our brains have cortical plasticity ie ability to remodel to a certain extent and Jack being an infant should do superbly! What grade were his bleeds if ou don't mind me asking?

Jessi said...

I don't mind! He had a Grade III/IV... right side with the IV.

Heather L said...

Jessi - Not sure if you've heard of the anat baniel method for helping with CP and other delays. I honestly don't have any experience with it, but have heard some amazing stories from people who have tried it with their own preemies. Just thought I'd throw it into the mix as you figure out how to help Jack learn to love his left arm :)