Where Do We Go From Here?

The DAFO (not the greatest pictures, I know)

Here is the evaluation:

Patient Name	Anna Watson
DX	764.0 IUGR, 343.9 Cerebral Palsy NOS, 348.0 Cerebral cyst, 160.10 Auditory tubes

Subjective	Anna Watson, DOB 12/03/2007, was evaluated on 04/01/2009 for occupational therapy services. Anna’s prior medical history, as reported by mom, includes intrauterine growth restriction, cerebral palsy/static encephalopathy, bilateral Eustachian tubes in Nov of 2008, speech delay and history of chronic ear infections, immature mylenation and small cyst after cerebral MRI. Mom reports that Anna does not appear to feel pain, has irregular sleep patterns, appear clumsy and uncoordinated and is on a modified diet. Anna has had Early Intervention therapy, however, parents feel that more can be done for Anna.
Objective	The following assessments were completed with Anna: The Peabody Developmental Motor Scales 2nd edition Anna’s age is 15 months. Her record of scores is: Reflexes Raw Score 11 Age Equivalence 7 months Stationary Raw Score 37 Age Equivalence 14 months Percentile 50 Locomotion Raw Score 78 Age Equivalence 15 months Percentile 50 Object Manipulation Raw Score 5 Age Equivalence 13 months Percentile 25 Grasping Raw Score 40 Age Equivalence 14 months Percentile 37 Visual- Motor Integration Raw Score 64 Age Equivalence 12 months Percentile 16 Gross Motor Quotient 96 Percentile 39 Fine Motor Quotient 88 Percentile 21 Total Motor Quotient 92 Percentile 30 The Infant and Toddler Sensory Profile was completed by Mom. Anna scores Definite Difference More that Others for Low Registration Quadrant and Probable Difference More that Others for Sensation Avoiding and Low Threshold. Anna scores Definite Difference More than Others for Sensory Processing Section of Vestibular Processing and Probable Difference More than Others for Auditory Processing.
Assessment	Anna is a pleasant 15 month old girl. She was a bit apprehensive but warmed up quickly and was very clear in what she was willing to participate in. She does not speak audibly. She grunted, pointed and garbled to let her needs and wants know. She demonstrated residual reflexes which are typically integrated by 6 months of age, specifically asymmetrical tonic neck reflex and she did not display protective extension backwards or sidewards. When tracking an item, Anna follows with her entire head and does not track sole with her eyes. Because of her decrease functional vision and lack of protective reactions, she is at a safety risk for bumping and falling. Anna presents with decreased visual motor integration skills (VMI) and auditory and vestibular processing issues. Her balance deficit was very apparent after completing a forward swing motion in that she walked 3 steps and fell down and required min assist to stand. Anna does not demonstrate a significant delay in any one area however when the VMI, auditory and vestibular differences are looked at as a group in functional skills the slight gap difference will only become wider if not addressed.
Plan	Anna would benefit from occupational therapy to address her balance, visual motor integration and her hypertonia so that Anna can complete age appropriate functional tasks. It is recommended that Anna participate in our intensive treatment of 12 consecutive days in our clinic followed by an 18 day home program. At the completion of the home program she will return for a follow up, it will be determined at that time further course of treatment.

Kenneth and I are trying to decide whether to do the intensive program or not. I have many reasons for and against it. We see Neuro on May 5 and I am hoping his input will help us decide one way or the other. She didn't do too badly but it is sad to not see her above the 50th percentile in anything. She is so bright and I fear that may someday be overshadowed by her body's inability to do some things. If I ever hear anyone refer to her as retarded I will lose my mind. She is smart and funny and I do not want her physical limitations to become what people see in her. I love her because she is Anna. I am having a rough time with all of this again. I am torn about what to do. I am so afraid I will miss something.