Monday, June 15, 2015

Day one of Floortime with Jake Greenspan

Jenna was a champ today handling new experiences, people and places. When we arrived at the Floortime Center, she sat on my lap holding her "little people" (her dollhouse dolls) and began her usual observing and assessing her surroundings while we waited to meet Jake Greenspan. After a short time, Jake came out, introduced himself and invited us to join him. We started off in one of the therapy rooms that had shelves and shelves of toys to play with. Jenna quickly found a variety of play houses to play with and put her little people in them. As Jason, Marcia (Mimi) and I spoke with Jake, she engaged herself in exploration of the doll houses. I am betting she was quite pleased that she had so many options for her little people to explore. While in this room, she engaged herself with the dolls, dollhouses and with responding to us when requested. While she was content, she was hyper focused on her little people and the moving parts of the doll houses (the doors that opened, which dolls could fit through which doors, etc).

Upon an initial eval of our playtime with Jenna, she engaged with us only when she wanted something or when we "directed" or guided her next step in play with us. As in the Floortime model, our goal is for her to initiate longer exchanges of communication with us and with others. Jenna is a very social person who seeks out relationships, affection, and being with others. However, with her lack of expressive language paired with the fact that she does not know how to put herself out there and be assertive when it comes to interacting with others is the challenge that we are targeting. Social and verbal/language problem solving is an area that she greatly lacks. When she experiences a failed attempt to communicate, she either tries the same approach again and again, gives up, or gets frustrated and reverts to self-calming behaviors such as stemming (other times she taps or hits her head with her fingers or fists, screams, or pushes/hits). Can you imagine knowing what you want to say, knowing what your intention is only for it to be misunderstood? Your thoughts and feelings being locked in your head with no reliable way of sharing them? This is what she faces all day, every day as a curious, vivacious six year old who wants to interact with the world as she watches everyone around her do so "easily".

While in the first room, Jenna interacted with us when we put ourselves in her way but only in a one or two cycle exchange. She remained focused on the little people, the toys, the sounds coming from the other room. While I tried to get her to play WITH me rather than along side me, she humored me but the string of exchanges were short lived and she was easily distracted by her focus of having possession of her little people. There were some near-successes for expanding that number of exchanges but she seemed very content with exploring things and keeping tabs on her little people. She comforted herself by focusing on the small things within close visual proximity. She may have made a fleeting eye contact with Jake once or twice but was focused on things that were in close proximity of her. We then went into a gross-motor room. There was a slide, a playhouse, a swing, mats, and other things that lends to physical play. As soon as she walked in, her face lit up. She expressed excitement and that outgoing personality that always waits in the shadows of her challenges was standing front and center. The one that manages to make appearances when things are lined up just so. The went right over to the "tire with a platform" swing and began to climb in. This part of the session included many smiles, laughs, requests, communication via body language, gestures, words, smiles, and eye contact. She was a different child in the room that provided opportunities to exercise her vestibular system. She was much more willing to put herself out there in order to extend the lines of communication and play. In this room, there were not small objects, no shelves of toys, nothing on the walls, no visual distractions which we clearly saw with her in the first room. She seeks out and responds with opportunities to exercise her vestibular system. When her systems are better aligned, she is able to focus on other things such as other people in the room, making eye contact, expressing herself more effectively, attending to language, seeking out others to play with and sustain interaction with. She quickly "turned on" to Jake's presence and interest in interacting with her. Before we knew it, she was gleaming joy, reaching for his hands, looking him in the eyes and making gestures and verbal requests in order to sustain longer play. This was fantastic feedback in learning that our girl needs movement, she needs help adjusting her vestibular system and bringing it to a regulated state. We've been aware of this but to see the change in her social assertiveness from one situation to the next in a back to back manner, made it even more clear.

Sensory integration will be vital for her in acquiring skills needed that will lead to expressive language acquisition. Jenna experienced damage to her brain in the areas of spoken language, nervous system/sensory, and visual cortex. This does not mean that she cannot or will not gain these needed pathways. It means that they have not followed the typical mapping that one's brain usually undergoes. Our job is to help facilitate the growth of new pathways. Since the brain is an amazing organ, one that has capabilities we do not even yet know, we are fortunate in that we can do things to help Jenna's brain form new pathways. Pathways to build the connections that her mapping does not currently provide. We do have a couple areas that need to be mended and tuned in in order to provide an efficient foundation for this to occur though. Jenna's vestibular system does not function properly. She does not know where her body is in space, her spatial awareness is poor and she does not process incoming sensory information regarding body placement and movement correctly. Imagine you are experiencing one of those days in which you have every intent to complete a difficult task. You are motivated to do so, have a clear goal in how you will attempt but you end up just spinning your wheels. Rather than reach the goal or even make leeway, you find yourself much further behind, exhausted, overwhelmed and frustrated. This feeling is very common with those who experience sensory integrations disorder.

We have to help Jenna's vestibular system move from a system of dysfunction to a system that is regulated. One in which she can depend on and therefore use to help move her closer to appropriately attending to expressive language acquisition.

As my own brain is starting to shut down for the night, Jenna is still trying to regulate herself into a calm state. She has jumped around, back and forth, jumped on the bed, ran from room to room, sang Frozen and Maroon 5 songs, twisted herself into the mummy form with the fitted sheet, jumped on her daddy, tried to eat donuts in the bed, wiggled, waggled and kicked her legs about like a bucking bull. Deep pressure is not enough tonight it seems. And I think my brain just went from fully engaged to hazy stare. Time to close for the night. So much more to say, so little energy to say it right now.

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