let's try something.

Okay.

Okay.

Is that nice?

You're a stiff boy today?

Okay.

We saw Joey for evaluation 

yesterday and found that of 

his many problems that one 

of the biggest characteristics of his 

total patterns of postural tone in movement 

was the fact that he is basically a very floppy 

boy.

A very hip,

a tonic youngster who has very 

very strong patterns of 

extension and hyper tennis city 

with stimulation and particularly in the 

pattern of going into head and 

neck.

Neck and shoulder retraction and turning the 

head very strongly to the left side.

So that if we were to summarize his basic 

basic problems in postural tone and 

movement as we typically do after an 

evaluation in preparation for setting treatment 

goals,

we would say that one of the problems is a basic hype 

a tennis city with strong increases in 

postural tone with stimulation of many 

sorts secondly the problem 

of asymmetry.

The problem of turning his head 

consistently to one side,

never keeping it in midline and with the head 

turning the body itself becoming 

somewhat crooked.

Which opens him up in the future for many many 

problems with deformities such as scoliosis 

subluxation tips and the like as well as 

interfering a great deal with learning for function.

Can't get his hands together he can't get hands to 

mouth.

You can't roll over he can't do a great great many 

things because of this pattern of asymmetry.

Thirdly the strong extensive spasms with a 

typical pattern of head and neck retraction.

Neck and shoulder retraction.

Pulling back again,

making it quite impossible for him to get his hands together 

or to develop any kind of head control.

A problem of tactile hypersensitivity 

primarily of the face and mouth so that as 

touch comes to these areas,

he responds by going into his typical 

patterns of the neck and shoulder 

retraction of the turning of the head to the left side 

and becoming quite quite stiff and uncontrolled 

and tying in with all of this.

The basic problem of poor head and trunk control.

These then are the most basic things that 

Joey has as problems that are going to affect all 

aspects of his acquisition of 

communication.

Superimposed on top of these are the specific 

kinds of problems that we think of 

as being pre speech and language requisites,

feeding problems particularly related to the 

oil hypersensitivity and to 

poor sucking and swallowing 

shallow irregular breathing patterns which are rather 

poorly coordinated with faux nation.

So that faux nation is of short duration.

It is tight,

it is breathy,

it's not very variable,

a lack of consonants in his sound play and 

a very limited repertoire of vowels which he can 

produce partially because of the mouth 

problems and his whole ability to 

coordinate jaw,

tongue and lip position with a 

steady stream of vocalization.

He is a very inactive child and probably 

very understandably so because when he becomes 

active he becomes very stiff he 

becomes very uncomfortable.

He becomes very frightened and 

along with this he cannot or 

does not explore his physical environment in any 

way.

And this is something which leads very,

very much to deficits additional 

deficits and intelligence,

cognitive development and language or linguistic 

development.

And fifth lee this is a youngster 

who does have a substantial amount of mental retardation but 

he's still a baby and we don't really 

know with all of the physical problems and the 

sensory problems which he has 

what extent this retardation is and how 

much of it uh may be 

possible to bring him more up to whatever his 

particular potential maybe with good 

treatment and stimulation.

This then is Joey.

These then are the problems that we're going to be looking at 

and trying to solve in a treatment session with 

him as we as you 

look in on my treatment with him,

I want you to think again about the red 

general principles of treatment with Children of this 

type.

The fact that the most basic kind of problem is a 

problem of postural tone and movement which 

affects and influences all of the various 

things that the child is able to do in the 

communicative area so that this is often where we 

start and the underlying theme of the entire 

treatment session.

The normalization of postural tone and movement 

patterns.

The use of stimulation of trying to get a 

more normal response.

That is nice trying to get a more normal 

response.

Trying to get better voicing,

trying to get all of the kinds of things that we don't 

typically see in the child but that we would like to see.

Uh careful sequencing of 

activities so that each one builds on the 

last in trying to take the child from a 

point where he is at the beginning of the treatment session 

to where we ideally we would like him to go.

And then one of the things that I'm going to talk about with 

Joey particularly with his being a very young 

child are how these kinds of treatment goals 

can be incorporated into the natural daily 

life of this baby.

The kinds of things that a mother or 

award person in a residential 

facility can do just in her care of this 

child that are going to be therapeutic and are going to 

help meet pre speech and language goals to 

a greater extent.

What are my specific goals for treatment with Joey 

today?

First an inhibition or 

reduction in the neck and shoulder retraction,

secondly,

working against the asymmetry with a 

development of a midline orientation.

Trying to get both hands together to do some 

exploring of the midline of the body.

Thirdly to try to increase the hipaa 

Tonia a little bit to the point where some 

writing reactions of the head and trunk are possible 

where they may be facilitated and thus to 

improve head and trunk control during the session.

Fourthly to reduce the tactile 

hypersensitivity on the body in the face 

and along with this to try to get more tactile 

exploration of the hands 

and of the face.

And just to use some of the sensory 

stimulation uh for 

a more natural kind of response 

in a young child.

And thirdly or lastly to try to 

develop greater lip activity 

for better sucking response with him 

after hopefully after having prepared him with many of the 

other activities.

So let's start out and see what we're going to do 

with you.

Mr joe.

Okay as I've been handling him,

I have seen basically the same picture that I saw 

last time and you can see a 

tendency toward the strong 

extension patterns,

the strong asymmetry and the 

unhappiness when he goes into this,

he doesn't like it,

it's uncomfortable for him.

And so I'd like to start out 

with working with 

him a little bit of some of the things that we started 

out in the assessment with yesterday 

of trying to use a little bit of pressure with my right 

hand in the sternal area to inhibit some of 

the extension and get a little more flexion to 

bring the head a little more forward.

Yes,

we need something interesting here.

Oops Joey also is a 

youngster who has seizures and he seems to be 

having a little more of them today then 

we saw yesterday this is what some of this 

jumpiness is.

Please join.

I'm going to use a smaller music box and I'm going to 

place it in the middle because he liked 

auditory stimulation and this may be a better channel 

for him than visual?

Where's the music?

And by getting it in midline,

we're using our stimulation to try to go against 

his patterns.

Lookee,

there's joe.

What am I going to do with you?

Okay.

There we go.

We take you further back.

Look at that.

And looking where is Joey?

Where is Joey?

This is very nice.

Easy.

Now I feel in my hands is starting to go 

wrong and I come back with what I'm 

doing.

I'm bringing this left shoulder more down and forward.

It knocked off.

You used your hand to knock it off.

Okay.

I he seems to 

have a little more control of his head.

Yes,

just a minute.

Huh?

I had been doing a little bit of this kind of treatment 

prior to our starting the session today.

Okay,

let's go back a little bit.

Huh?

I think you're flopping down.

You're losing you.

I am losing you.

Okay.

All right.

He looked at the show.

Look at Joey.

Look at joe.

That's very nice.

And I would like to be 

able to use a little bit of this type of 

pressure down to give him some stability 

and to try to help him use his head a little more 

actively Where the 

music did it go off and I 

lost it.

Okay,

let's come back.

Huh.

Shall we come back?

You didn't seem to leave as much of the 

other?

Where are you going?

Where is Joey?

Would you like the music on again?

Can we turn the music on?

Can we turn it on?

It's right shoulder up.

Uh huh.

Kind of initial startled.

Just from the noise of 

the wind er on the music box.

Okay,

let's do this.

Huh?

Where is Joey?

Lucky.

There's you need 

lucky.

Oh,

there's joe.

There's Joey.

There is Joey 

and that sews leg.

That's my leg.

You find jewelry.

There's Joy's leg.

There's the music.

Do you feel the music?

It's nice,

isn't it?

Is that a nice one?

Is that a nice one.

Look at that big boy.

Easy when we 

begin to lose a step,

we take him back,

we take him back to what it was that made it 

possible initially.

It's a boy and there's your knee again.

There it is again.

There it is.

Look at that.

Do you know what else we can keep 

this up like this.

That's a boy.

Mhm.

It 

mm.

That's nice.

Very nice.

Let's bring it in,

huh?

Okay,

bring you up a little bit.

I think we can do this a little more.

Look at you.

Look at Joey.

I'm going to do you like this?

Easy.

We're gonna put you on.

Suse lap can we do this a little 

bit,

huh?

Where are you?

Where are you?

Where's joe's head?

Where's Joey?

Where's Joey,

Joey,

Joey,

Joey,

Joey,

Joey,

whoops do we lose you?

You are pulling in deflection.

You are getting very flexed.

There you are.

Hi,

notice that where I am is on his 

to him is basically on his right 

side.

Because I want my auditory stimulation.

If it comes in on a side to come 

in in a way that encourages him 

to turn his head in a way that's different what 

he does what?

You know what you're face?

You got my face.

Look at that,

Did you get it easy?

Easy boy.

Easy boy.

Easy joe.

Oh my goodness.

I think we're taking you too far too 

fast.

It's too far too fast.

That's nice.

Look at your head.

Oh,

is that nice head?

Is that nice head?

He started stiffen when I gave that stimulation with my 

mouth.

The noise 

and again.

My goodness,

I can feel it in my hands.

Okay,

okay.

Easy.

Where are we gonna go?

We're gonna go,

Huh?

I would like to do is to take you.

Yes.

What can we do?

What can you do,

huh?

Who is going to take you?

Yes.

Let's see where Sue is going to take you.

So can we do some of these same things here,

Can we do it?

Keeping it all 

together 

all together.

Easy now.

Easy,

Easy,

Easy boy.

Okay,

Okay,

easy.

That's right,

lucky looky.

Oh my goodness!

Oh my goodness!

Oh my goodness.

Where are we going to do this?

Where are we going to do this?

Where is that ball?

Look at that ball!

Okay,

Okay.

Too much.

Too much.

Yeah,

yeah.

What a squeaky old cry.

I think I'm getting a lap full too.

Is that what you're sharing?

Mhm 

Okay.