Assessment

We did this before, during and after the last treatment.

Awareness - was getting upset at end of elmo grouchland but stopped after just one week, likes facial expressions in movies, still gets upset if adult acts upset, thinks sadness (pretend crying) is funny though, PECS helps him anticipate choice
Mood- not so good, doesn't love to be alone, but will laugh for no reason- seems to self entertain sometimes with no toys, some say they can't do anything with him, grumpy, difficult to entertain
Social - likes his brother, will smile at all people, likes to watch other kids play around him
Stiffening - not as bad as in the past, still a hinderance, will use this as a physical response for "no" or when he dislikes something
Leans to his right
ATNR - moderate and present when he's not angry
Startle - comes and goes but doesn't last more than a day or two- is always present first thing in the morning, walking instead of being carried helps
Likes- counting to 123, anticipation, other daredevilish type things
Self-entertain- will for AF and no one else
Excited by elmo, parents, swimming, Pecs, food, dad's funny voices, tickle anticipation, anticipation in general, books, funny faces
Swimming best form of therapy now- increased range of motion in legs
Eyes - open more with glasses, seems to see better, better focused, not as glazed over, sometimes favors his left eye more, crossing isn't quite as noticeable, n says it is the same, hard to say if one crosses more than other
Eating- 75% by mouth, as of 3 weeks ago, skills have improved, can eat for various people, consistency has to be thick, still bad with liquids, enjoys varieties, tongue moving better according to ST, will sometimes incorporate hands into eating process
Speech- playing around with sounds on occasion, did a shriek of delight similar to Rew's, is louder, tries to get attention with a noise, definite yes noise, sort of fading in importance with the use of pecs, has to be promopted to make  yes noise sometimes, no repetition of noise from request, doesn't copy, not yet moving sounds towards words - PECS - understands it and choices most of the time, accuracy is spotty but more accurate than previously thought
Walk- likes it but not so good at it - flops toward ground- leans etc
Arms - decent range of motion, very stiff, very limited voluntary motion, almost no bending at the elbow unless in ATNR posture, moves slowly, some gross motor skills, no fine motor skills, limited grasp
Hands- open and relaxed 30-40% of the time, rarely trying to grasp objects, accuracy still bad when grasping
Hips/Rolling- lost interest in rolling, decent roll over right arm, not rolling over left although has in past - and will end up on floor in room - having had to go over his left (?), hips somewhat flexible at all times, slow roll and infrequent
Legs - tight in hamstrings/hips, knees and ankles, walking with only minor crossing, frequent curling of toes while standing or sitting, slight inward turn of feet, difficulty with voluntary and controlled motino, good movement in the pool
Sitting - bad
Sleep - through the night, bedtime around 8, wakes 5:30 to 6, might wake once in middle of night but not fed, will play a whole lot more at nap and bedtimes
Nap- within 4 hours of waking lasting 2 plus hours- sometimes taking more than an hour to fall asleep as he plays
Valium- just moved to twice daily at .75 am and then 8 hrs later
prevacd - one solutab daily - no signs of reflux - occasional gag when stomach is empty (rare)
Crawl- doesn't try much lately