You’ve heard it time & time again – EARLY INTERVENTION IS KEY. This is proving to be true the deeper we get into Kara’s therapy sessions.
There is definitely a developmental gap between her and some of her peers, but that doesn’t mean that she’s failing. In fact – she’s doing AMAZING things & we love to watch how she grows.
I’ve been writing about these details on Kara since her birth. You can check out previous updates under the Health & Therapy category ((HERE)).
As of 22-Months old, this is where we’re at with her therapy goals.
Click below to jump to each section.
Physical Therapy (gross motor)
Occupational Therapy (fine motor)
To say we have some sort of routine with this little one is almost laughable, but we do try our best! Jacob & I are both extremely involved in her schedule.
This is what a typical week looks like for us:
Monday
We have Kara’s individual therapy sessions. After breakfast, we’re packed in the car for back-to-back Occupational Therapy, Speech Therapy & Physical Therapy. She has been working so very hard to meet her goals and I love watching her progress. We do more celebrating than not!
Tuesday/Wednesday
Reserved for doctors appointments and social calls.
Thursday
Every other week we get an early morning visit from Kara’s Speech-Language Pathologist provided through the county. This is where Kara gets the bulk of her support in her oral-motor development. We have all learned an incredible amount from these visits.
Friday
Normally, you’d think Friday is the end game – the weekend is here!
For parents, there is no such thing. For our family, it means our alarm is set earlier to make it to group therapy in time. Kara enjoys her friends during music, PT, snack, OT & speech. She loves it so much that the exhaustion doesn’t set in until after we’ve waved goodbye & she cat naps all the way home.
THERAPY
{Physical Therapy}
:::GROSS MOTOR:::
Kara works HARD in PT. Her struggles with low-muscle tone are seen the most in this area while she tries to achieve gross motor milestones. Gross motor are the BIG muscle movements – think walking, standing, crawling, etc. Right now our main focus is on her core. There is so much riding on a strong core that it simply can’t be ignored.
Where she’s at now
Climbing on/up/down from anything and everything. She’s also getting better at crawling, but we’re still working on getting on all fours. She boogies around either on her bottom by doing a sort of spider crawl or inching along in an army crawl. CORE is the key here. We’d like to see her strengthen that middle so she’s able to support herself better.
Our Regimen
We help her by giving her opportunities to kneel, climb, and shuffle her knees. We have a big cushion in the middle of our living room that we encourage her to crawl up to. She will reach out, plant her hands on the cushion, and then turn to shuffle her little knees up to meet it. It’s also helpful to guide her on the stairs. If there’s a toy within view, she is motivated to climb up to get it. Climbing the stairs (with our hands behind her at all times) is great for working her core.
Goals
Strengthening her core is the main goal here – once that happens, we will see her crawl on all fours, pull herself up on the furniture (more than she’s already doing) and will be that much closer to taking unassisted steps.
*Kara LOVES walking when we help her, but she’s very dependent on us for balance. Every step takes a ton of core work that she’s just not ready for yet.
{Occupational Therapy}
:::FINE MOTOR:::
Kara has a love/hate relationship with OT. Low muscle tone affects every bit of her body so she still works hard to do the things she does, but in general she enjoys it a bit more & shows more motivation. Fine motor are the SMALL muscle movements – think pointing, wiggling toes, grasping/releasing.
Where she’s at now
Even though fine motor skills come a little easier for Kara, it is still hard work. She likes to practice using utensils at every meal and she LOVES to put things in/together be it a wooden puzzle, stacking rings, or nesting cups. She’s also gotten good at other achieving other goals like hold a container with one hand and take an object in/out of it with the other.
Our Regimen
There are lots of ways we incorporate OT into our day. These are good activities for Kara’s skill-level:
1. Offering utensils at every meal & helping guide her hands from the plate to her mouth so she develops the right motor plan for coordination.
2. Having her practice turning the lights on/off when passing through a doorway.
3. Having her put hot glue sticks through the holes of an empty Parmesan container. We’ve even challenged her with putting toothpicks through an empty seasoning container! *Always supervised*
4. Helping her use a shape sorter by covering all but two options: the circle & square.
5. Stacking/nesting empty containers – think Tupperware or plastic cups. We like to use these empty, mini Pringles containers leftover from my husband’s lunches!
6. Incorporating a sticker chart with potty-training where she has to place a sticker on paper.
Goals
The big goal here is to continue seeing progress. We encourage Kara to alternate using both hands (which she’s awesome at). We’d like to see her have more control over a crayon/marker as well as her spoons and forks. These skills are very important to development so we’re excited to watch her hit her goals!
{Speech Therapy}
:::ORAL MOTOR:::
Speech is an area that Kara truly enjoys, BUT is also a major struggle. Her lack of speech is due to her weak core and (you guessed it) low muscle tone. You need a strong core and diaphragm to be able to expel sounds on command. You need good control of your lips, cheeks and tongue to manipulate those sounds meaningfully.
For me, personally, speech is a top priority. It always has been. It has been my main focus with her since she started early intervention at 6 weeks old. It has been a very loooong and frustrating journey, and some days it seems like she hasn’t gotten anywhere, but she HAS!
I view Kara’s speech development routine as three different parts:
- Spoken words
- Sign language
- Oral motor muscle development.
Where she’s at now
Right now, Kara communicates by using baby sign language. She knows over 70 signs & is fantastic at using them correctly. Her spoken words, however, are very minimal. She says “mama” and “dada”, but doesn’t use them very often unless she’s prompted. Also on command, she’ll tell you what a dog, cow, pig, and sheep say – It’s very muted, but so very adorable.
Recently, she has made us and her speech pathologist. VERY proud by being able to rest her tongue at the top of her mouth. For someone with regular muscle tone, this is something that comes naturally, but for someone like Kara, it has taken months of training.
She is also using signs to communicate in sentences. We get a lot of “help, milk, please” or “want, more, Moana, please”
Our Regimen
To help Kara speak, we help her by practicing with her constantly. When she makes a sound, we mimic it back to her and try to change up the consonant. For example, if she starts babbling “bababa” we’ll jump in with “bababa…mamama…dadada…” and wait for her to play. She’s gotten really good at the “lalala” sound.
Signing is something that Kara excels at. Right now, we’re working on signing in sentences and pushing her to use them unprompted (as opposed to us telling her to sign a word.) Our main regimen here is practice.practice.practice. We use every opportunity to speak and sign a word – like “Go get that big, green ball you can play with!”
Oral motor development has been a fascinating struggle. I’ve learned that straws go hand-in-hand with proper oral motor development. We use straws day in and day out. NO sippy cups for this girl. When she was just 6 months old, she started using the Honeybear (this was all under the guidance of our very knowledgeable & perceptive SLP). We finally graduated from the Honeybear and moved onto different kinds of silly straws. These straws varied in length and width and we never move on until she’s mastered each one. She is currently on a level 5 straw.
Alongside the straws, we use food to help strengthen her jaw muscles. This is our main focus right now. We use veggie straws as a tool in a “slow feed” technique that will help her to disassociate her facial muscles and make her work the ones in her jaw.
Goals
Strengthening her core will help her in this area, but we’re also working to strengthen her jaw. We focused so long on keeping her tongue retracted that it feels nice to check that off the list and move on! Once her jaw is nice and strong, we will see more mouth closure and will hear more articulate sounds!
{Potty Training}
::: POTTY TRAINING :::
Kara started potty training for two specific reasons:
1) She hates a wet diaper
2) She has a great way to communicate (sign language) & is excellent at it.
We jumped into potty training when she was 17-months old while giving her little expectations and lots of support.
Where she’s at now
Kara will use her potty about 50-60% of the time. She will either wait until our structured potty times, sign “potty” when she has to go, or she’ll just put her diaper to use.
Our Regimen
Kara is taken to the potty whenever she wakes up, after every meal, and right before bedtime. You can bet that she’ll go almost every time. Right now, we’re using a sticker system where she gets to pick out sticker and place it in her “potty notebook” (this is also great OT practice). Otherwise, we give her lots & lots of positive attention and stay in tune to how she reacts. She actually gets more joy from flushing the potty, washing her hands and turning out the light than she does from us cheering her on.
*You can find the training potty we use HERE – Kara has really taken to it & recognizes that it matches the bigger one.
Goals
The goals we have for Kara in this area are very lax. We started training very early so we are just taking her lead. Her PT and OT suggested pushing her potty up next to the bathtub so that she’s able to practice getting on and off the potty without any assistance, even though she’s not walking yet.
A couple weeks ago, I took diapers out of our daily routine to see if we’d be able to eliminate the times she goes in her diaper, but she didn’t really respond to the change. We stepped back after two days in training undies (which were ADORABLE – find them HERE) and decided to keep things going the way they were. I’ll hold onto the sprinkle-themed undies for when she’s ready for them 😉
Got questions? Feel free to ask! Go to my contact page and send me a message – I am not a therapist, but I can answer anything about our experiences. If I cannot answer you, I will always point you in the right direction.
Also make sure to follow us on social media – I share lots of pictures and videos of our day-to-day therapy routines & sessions!
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Amber, I always enjoy your appetite for more knowledge and information on ways to help Kara to reach her full potential. Her progress is a pure reflection of your willingness to grow and learn along side of her. Such a wonderful family to work with!
We are so grateful to have such a great influence! You have taught all of us so much. 💛