Wednesday, June 22, 2011

In-Home Services!

Today began with a trip to a different part of Nairobi for Kaizora's first in-home session ever!!!  Addressing this need has been a challenge in the past, as staffing and transportation have not made this possible.  However, it is clear that there are more and more families asking for such services, so this is a gap Kaizora would love to fill.  This particular case is a 4 year old kiddo from the Phillipines who just moved here with his family.  Given his location relative to Kaizora, the family was unable to come daily, despite their desire for him to receive daily ABA.  As a sort of pilot opportunity, Kaizora has agreed to provide in-home services 2x/week.

When taking into account the advantages, this could be a good opportunity for generalization of skills taught in the center, an opportunity to include self-help and toilet training programs, and provide the father, who cares for the boy at home during the day, with some modeling and coaching, as this is an area he felt as if he wasn't as skilled in.  This session consisted primarily of observing him in the home, getting a feel for his routine, and getting him comfortable with trainers being in his environment.  Things went really well, and what is clear is that the boy seems eager to learn, and the father is very receptive to feedback.  I became inspired that things could work well when the boy grabbed his father's hand and led him into the kitchen towards the fridge, we prompted the father to ask the boy to say "open please", which he did, and when the father did so, the boy grabbed a bottle of coke and handed it to his father.  The father said "no coke" and closed the door.  The boy instantly tantrummed, throwing himself on the floor screaming and crying.  The father tried to redirect the behavior by looking at the boy and saying "it's ok, come on, let's leave, it's ok, it's ok, it's ok".  I asked the father "what would happen if he just walked out of the kitchen?", and the father said he had never tried it before.  I said "let's try and see?".  He walked out of the kitchen, and approximately 1 minute later the boy came out of the kitchen, plopped on the floor, looked around, walked to a roll of paper towels, ripped one off, wiped his own tears, threw the paper towel in the trash, and climbed on the chair and got his cup of water and had a few sips.  We of course gave the father lots of praise and he seemed content.  The father is apprehensive about his English skills, especially given we have talked to the family about only using one language to facilitate language acquisition.  Nonetheless, the father seemed content with the day's session, and after leaving the team from Kaizora was thrilled about the prospects of subsequent sessions.

Upon returning to Kaizora, we met with a family from Zimbabwe who has a 6 year old son with Cerebral Palsy with severe physical limitations on the left side of his body.  His leg has virtually no muscle structure, and his mother is taking him to South Africa in a month to receive a botox injection in his leg.  There was a lot of clinical problem solving around how to increase functioning on the left side of his body, including me contacting a Doctorate-level Physical Therapist in the United States with extensive background in working with children.  She offered many helpful suggestions based on the most current research in Physical Therapy with regard to complete vs. incomplete hemiplegia, motor planning abilities and spastic vs. flaccid CP.  She informed us of a growing body of evidence in support of "constraint-induced therapy", which basically entails putting the unaffected side of the body into a position to essentially make it non-functional, and incorporating fun activities into tasks such as pulling a rope, pouring water back and forth between cups, riding a bike with straps to keep his foot on the pedal, stacking blocks and pushing magnets all over a wall.  Hopefully as the kiddo is able to make more use out of the left side of his body, he will be able to participate in more activities with his peers, and subsequently gain more self confidence.  A program will be put in place incorporating ABA tasks and programs and prompting more use out of the left side of his body.  Ultimately, of course, the parents would like to see him go to a mainstream school with the rest of his peers, while still being able to receive the most out of his schooling environment.  We also agreed to meet with the school teachers and his aya (aide) in order to replicate tasks like those at school in the center so the goal can continue to be mainstream placement.  We were able to run many sessions with this kiddo later as a team, and what was also evident is the desire for him to compensate the best he can given restrictions on his left side.  We ran Precision Teaching sessions, and prompted lots of motor imitation in the context of his preferred activities, such as peek-a-boo, high fives, raising arms above the head and cheering and manipulating objects with his hands.  His left side upper body is much more functional than his left leg, and his mother indicated that when he had botox previously on his leg, his stance and walk was much better.  The team is excited to see how this round of botox affects his muscles in his legs.

Overall the day was very good, and there was lots of opportunities for in situ clinical problem solving and development.  We had the chance to record some sessions so we can review later and provide feedback later and review with Molly back in New York on Skype.  Pooja was hard at work trying to ascertain a large selection of reinforcers for the kiddos, and pairing these reinforcers with pictures she made on cards so they can have some meaning as we implement "First, Then" boards.  Way to go team!!
- Emily

1 comment:

gaurav said...

This session consisted primarily of observing him in the home, getting a feel for his routine, and getting him comfortable with trainers being in his environment. doral real estate