06 August 2015

The Summer of Abigail's Improvement, Part I

This is part one in the series; you can read part II here!

When I learned I was pregnant this spring, I decided that summer 2015 would be The Summer Of Abigail's Independence. I wanted to really, really focus on getting her as many new skills as possible before I added a newborn to the mix. Three in diapers, three who can't dress themselves, three who need to sit on a parent's lap at Mass. It would be too much to handle. Throughout the summer, I've been slowly implementing "big girl" changes in the routine and she started at an eating clinic and in equine therapy. Abigail is four now (four years, three months), for reference, but she's the size of the average 2-2.5 year old.

Equine Therapy
Equine therapy is Abigail's new favorite thing in life (not sure how it'll compete with the bus when school starts back up). She asks me every single day about riding. I've heard from many people throughout my life about how amazing horseback riding is for just about every behavioral issue ever, including my mother-in-law, who had Matt in equine therapy when he was a boy, so I was certainly very favorable to the idea. A friend of ours from school has a daughter with cerebral palsy and was talking about a great place nearby, so we checked it out. Coincidently enough, it's run by the same therapist who worked with Matt when he was a boy! I started Abigail up with once-a-week sessions.

Improvements I've noticed so far include:

Her strength and balance - horseback riding strengthens pretty much the entire body, especially the core. The company website states that, "A rider with low tone is stimulated to facilitate muscle response due to the movement of the horse. An increase in weight bearing [...] and increases in functional use of the extremities are all benefits of riding the horse." She rarely falls anymore, either randomly or when bumped. She's a better climber, her running has improved, and she is better with stairs.

Her speech - a strong core provides good support for your diaphragm, which translates into better speech - both in quality and quantity. The therapist's website states that horseback riding promotes an "increase in speech through diaphragm stimulation and increase in respiratory volume." While Abigail has always been chatty and given to long, random monologues at any given time, I have definitely noticed better pronunciation. It's easier to understand her, plus she has better annunciation of the last syllable of a word ("yes" instead of "yeah").

Her confidence - this one is probably kind of obvious, but when you can control a 1,000 pound animal, you tend to feel pretty good about yourself. After Abigail rides, she'll spend the rest of the day randomly saying, "I did it!" with a little smile on her face. When you ask her what she did, she replies, "Horses!" She is less frightened in new or crowded environments and she follows through on tasks much quicker. She responds more appropriately to her emotions, for example, crying when sad and vocalizing happiness. And lastly, she seems to respond with fear to fearful situations. Like, she stands back from the trunk of the car when I move to close it. She hides behind my leg when she doesn't want to approach something or someone.

The therapist rides with Abigail until she's old enough and strong enough to ride on her own. We're specifically working on physical, or gross motor, issues, so that's where she puts in most of the emphasis. Abigail regularly stands on the horse's back while he walks, she kneels, does squats, sits backwards, sits "criss cross applesauce," and stands on one leg. She has to lean forward on the horse and bear weight on her arms to the count of twenty, and ride while doing a puzzle or working a peg board. Abigail has to hold the reigns, she is guided to steer the horse to turn or do a circle around a barrel, and she has to tell the horse to "Go, please!" or "Woah!" The therapist explained that the movement of the horse helps rewire the brain with regard to body movement and teaches it to use each side of the body not in unison, but I forget what she called these two things.

Eating Clinic
I was overjoyed when I found a therapy clinic that specifically worked with kids with eating issues. I've blogged in depth about Abigail's incredible pickiness. I tried the book Food Chaining, and we did have some successes. The problem was that as soon as Abigail would get a cold, she'd eliminate all the new foods. And we'd be back to square one. It was painfully frustrating. So when this clinic specifically mentioned a bunch of unique issues that Abigail has, I was stoked. We met with some of the staff and went over Abigail's medical history and eating habits. Because we've been dealing with this for years, we had already scratched off any medical reasons why she might not be eating (we took care of the reflux and had testing done to be sure there weren't any blockages in her digestive tract). They were confident they could help. And our insurance approved their treatment plan.

The clinic broke down Abigail's issues into three simple categories:
1. Your core supports your jaw. Your jaw supports your tongue. So a weak core means difficulty eating. Abigail's core is weak, so she's having trouble with foods that require extra work. This is probably why she doesn't like meat or peanut butter.

2. Abigail has sensory issues. She's over-sensitive to most things (tactile defensiveness), so she hates loud music, crowded environments, and being touched. But she's under-sensitive in and around her mouth, which means she craves extra feedback from food. So she needs to cram a lot of food in or eat really crunch or really flavorful things in order to process what's going on in her mouth. This is why she hates mac n' cheese, mashed potatoes, and soft bread.

3. Some of it is just behavioral. She's had bad experiences with food in the past, so she's really picky about what she'll tolerate. Plus she's been rejecting new foods for so long, it's kind of just what she does. But because she's not typical, we can't expect results by simply make the pancakes smily faced or say, "Eat this or go hungry."

The equine therapy is really helping with the core strengthening. Then half of our twice-weekly sessions are spent working on mouth awareness and strengthening exercises. The therapist uses vibrating toothbrushes on Abigail's cheeks and tongue and has her do tongue exercises where she has to reach her tongue out to the left, right, and up and tap a spoon with yogurt on it. She's also helping Abigail to take bites off of a larger piece of food,

To help with the sensory issues, the therapist also has us doing the Wilbarger brushing protocol, which is where we brush Abigail's arms and legs with a stiff-but-soft bristled brush in a specific way every two hours.

The regular, constant sensory input is supposed to help rewire her brain to respond appropriately to touch. It's helped immensely! It used to be that when Abigail's hands were messy, she would make a disgusted face and get anxious, but now she can calmly ask me for "help." She also tolerates being touched and having her hair pulled up much better now.

In terms of the behavioral stuff, the therapist has lots of sneaky techniques that have helped more in one month than I had in a solid year of work! At first she just got Abigail to tolerate having strange foods near her (she used to throw them off her tray), then she got her to touch them, then she got her to kiss them! Abigail has kissed and calmly throw away foods that used to cause her serious anxiety! Since starting at the clinic, Abigail's accepted food list has doubled and survived a stomach bug. There is also much less stress and anxiety surrounding dinner time (which used to be the hardest meal). I think part of the success is simply that the therapist is not mommy. She has no frustrating history with the therapist. Sometimes it's easier for kids to learn new things from some else. Abigail is not usually one of those kids, but this therapist really understands her, and she knows it.

The other food-related improvements I've noticed include an increased appetite, a willingness to let different foods be on the same plate, the ability to eat a few bites of this and then a few bites of that (she used to only eat one food at a time and it was the only food allowed to be on her plate, even if she liked both of the foods), decreased anxiety when looking new foods, and she even permits herself to touch new foods. My ultimate goals are to be able to make one dinner and have the whole family eat it and to be able to go to restaurants or playdates or holiday gatherings without having to bring special food just for Abigail.

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