Queena's Progress May 2012

Dear family and friends,

Over 4 years Queena has been working very hard everyday from inside out to get her life back. I am her mom, proud to say she has greatly remarkable improvements her ability and made even more progress.

We want to glory all that to God and praise God of miracle. Thanks for Your healing, thanks give Queena strength and watching her health closely (she lightly sick about 2 times over 4 years).
Thank Father for Your love and thanks to show us how to love and share with each other, in Jesus name.

Thank you so very much to family and friends for your loving, supporting and prayer for our family. Especially to all friends we just made from the last few fundraisers, I am proud to call you "family".

Please take few moments to read newest report from Queena's therapist. Enjoy and God bless!

In God loves,

Vanna



Dear Vanna,
 
As Queena has just completed an episode of care at South Bay Hospital Outpatient Center, I wanted to provide you some updates regarding her progress.  We treated Queena from 03/07/12 to 06/01/12 during this course of treatment and she was discharged for a summer break. I have been reviewing old records from 2010 and 2011 and I am truly amazed at the progress that she has exhibited in the past two years! I will break down her progress into categories and highlight some of her achievements.
 
Head and trunk control: Queena has continued to build up her tolerance for controlling her head, holding up her head for the entire session. She does have intermittent moments where she “rests” her head, extending head and neck; however, she is able to follow commands to tuck her chin and correct.
Queena has greater opportunity to improve control with turning head side to side but she is able when given extra time and cues. This year, we’ve noted that Queena is much more capable of lifting up not only her head but her shoulders and chest while in a prone position. Whereas before she was dependent upon others to help her initiate propping up head/shoulders in prone, she is now able to purposefully raise her head up and look up without assistance. She raises her shoulders high and gets her chest up off of the mat table. This is fatiguing but she can hold for over 30 seconds by herself.  This increased control strength has allowed her to interact more w/ her surroundings, improve her swallowing potential, improve sitting and standing posture and progress with enjoyable and therapeutic activities such as the tricycle. Also to note, she has greatly improved her ability to initiate rolling! She can turn from deep sidelying to supine without assistance and initiates supine to prone with less assist than before. Last year at this time she could not turn without maximum to total assistance. A good goal is for Queena to be able to turn  self from prone to supine and supine to prone.
 
Sitting balance: Last year, Queena had little ability to right herself in sitting. She had made progress and was sitting up w/ use of PVC pipe and moderate assistance of others, an improvement since 2010. However, this year, she has made even more progress! She can sit up for over 15 minutes with her head up and trunk with a good posture with just minimal assistance of the therapist. Usually, the therapist would just need to hold on to her hands or one hand to help her balance. Queena’s postural support muscles have definitely become stronger! Queena was responding to cues to “lean back” or “come forward” and she was exhibiting ability to follow those cues to help right self to midline. She was trialed unsupported and held 15 seconds at one point before losing balance and requiring assistance. The goal is to continue to improve so that she will be able to eventually support herself in sitting without assistance.
 
 
Standing balance:Two years ago, standing was not a possible goal. She was not physically able to even attempt that feat.  At that time, in 2010,  we were simply trying to help Queena with building up her trunk strength and neck control so that she could try to sit up with a lot of assistance... Upon review of 2011 records, she had built up her postural tone and trunk/neck strength to be able to stand up with maximum assist of two persons up to 10 minutes. Max assist and blocking of the ankles and knees was essential at that time, requiring x 3-4 people to safely perform (AFO’s/shoes used).  Here in 2012, she has been able to consistently arise sit-stand with moderate-minimal assist and stand erect for multiple sessions of 5-10 minutes with only minimal assistance x 2 and without blocking of the knees or ankles. (AFO’s/shoes on). She can typically stand for 3 sessions of 5 minutes or one long session of 10 minutes, again requiring no manual blocking of the ankles or knees. She does begin to buckle with left knee but responds very well to verbal cueing or light tactile cueing to “straighten left knee.” As she fatigues, she does tend to have extensor posturing with head/neck and trunk but responds well to cueing to “tuck your chin” or “squeeze your butt.” Queena seems to know exactly what the cues mean and responds without delay.  We have also begun working on weight shifting from right to left for neuromuscular re-education to the pelvic girdle and lower extremities. With 3 people, we began simulating ambulation with manually assisting Queena’s legs/feet forward  x 3 feet and backwards 3 feet. While Queena needs manual assist for legs, she is responding to cueing to lock knees or “stand tall.” The goal is to continue to improve standing tolerance and continue with pre-gait activities and reciprocal leg activities to re-establish gait patterns.
 
Mental status: Two years ago, records indicated that Queena  was not able to consistently follow commands  more than 10% of the time and was not able to effectively express herself or communicate with therapists. Delay was significant. I could not be sure that she was comprehending commands..In 2010, she was noted to have made significant improvements in this regard, being quite interactive and using non-verbal expressions (facial expressions, raising her arm or using her tone to move her body). She was laughing at appropriate instances, often catching subtle humor. In 2011, she was proven to be able to follow verbal commands to kick her legs or raise her arms intermittently but still inconsistent (less than 50% and with significant delay) …However, from 2011 to 2012, we have noted even more remarkable improvements. Her ability to comprehend instructions and produce a motorical response without delay may be the most amazing of her feats thus far! She has been consistently following verbal cues to “tuck chin,” “straighten left leg,” “squeeze your butt,” “kick your legs (right and left),” “push (tricycle pedal),” and so much more. In a recent session, Queena was doing some stretches designed to inhibit extensor posturing. Ten times in a row, I would softly say “push back” and she would rise, without delay, to follow the command. Ten out of ten times she responded. She did the same with right leg kicks five out of five times and left leg two out of two times. She does have greater difficulty w/ motor control on the left leg so she required extra time on those. She needed no more than soft-spoken cueing. I can honestly say that I believe she comprehends simple and, likely, complex cues. I believe that she is in a rapid state of learning. She is much more capable of expressing herself to communicate now. Smiling, laughing or grimacing and raising her hand or leg help us to know how she is doing. She works very hard on each exercise, often exhaling w/ relief or giving a little laugh and smile after she is done. Goals include even more effective communication from Queena’s perspective so that the therapist can know more of what she wants/thinks/feels.
 
Tone: Undoubtedly, Queena has significant tone in which she has extensor posturing in lower extremities, trunk and head/neck and flexor tone in the upper extremities.  Continual neuromuscular re-education is essential. The tricycle has been wonderful as Queena is able to consistently reciprocate left and right legs in a fluid motion without tone for over 40 minutes on this newly acquired vehicle. Queena has also been able to stretch her arms to reach the handle bars, putting her in a very therapeutic position (arms extended, head and neck upright, trunk upright and lower extremities reciprocating fluidly). We have definitely noted increased motor control. We have been working on Queena’s ability to relax her muscles after she kicks for instance. She did a great job with that the last few sessions and I can see her comprehending the difference between contracting the muscles and relaxing the muscles. i.e. She kicked 5 times and was able to relax the muscles and lessen the extensor tone before completing the next repetition on command of therapist. Future goals include being able to have command over inhibiting her tone even more consistently and efficiently!
 
Our team at South Bay is so very proud of Queena! She is truly an amazing young lady!! Have a great summer break and we will look forward to seeing you again in the fall! I know she is going to have Thera-Suit training in August so that should be great!
 
Thank you Vanna for your confidence in our team at South Bay.  Queena is a remarkable young lady and is truly an inspiration to all of us!!
 
Sincerely,
 
Heather
 
Heather L. Smith, PT
Rehab Supervisor
South Bay Hospital



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