Active Learning Study Group 01-21-2016 This video is posted online with the following chapter markers: Chapter 1. Fine Movement Video Chapter 2. Questions about Fine Movement Chapter 3. Gross Movement Video Chapter 4. Questions about Gross Movement Description of graphical content is included between Description Start and Description End. Transcript Start Narrator: Texas School for the Blind & Visually Impaired Outreach Programs present Active Learning Study Group, January 21, 2016. Facilitated by Kate Hurst, Statewide Staff Development Coordinator, hurstk@tsbvi.edu, and Matt Schultz, Deafblind Consultant, shutlzm@tsbvi.edu. Matt Schultz: We will jump right in today to discussing Fine Movement and the Gross Movement sections of Lilli Neilsen's Functional Schemes Assessment. But before we jump in, we're going to take a look at -- or do two polls. [ Slide start: ] Description Start: Title: Poll #1 Content: Which fields have you completed so far? • Gross Movement • Fine Movement • Mouth Movement • Visual Perception • Auditory Perception • Haptic-Tactile Perception • Olfactory & Gustatory Perception • Spatial Perception • Object Perception • Language • Social Perception • Emotional Perception • Perception through Play and Activity • Toilet Skills • Undressing & Dressing Skills • Personal Hygiene Skills • Eating Skills Description End: Poll number 1...asks which field have you completed so far? Lots of people have managed to do the gross and fine motor. I see some folks -- three different people have done the visual perception. Three have done haptic tactile perception. Three on the social, three on the emotional. Wow. That's looking good. It looks like everyone has been busy...in this New Year. So bravo, y'all. In fact, everyone has done the fine motor. And just about everyone has done the gross motor. So, that's wonderful. [ Slide end: ] I think that will set up today's conversation really nicely. So, thanks, good job. [ Slide start: ] Description Start: Title: Poll #2 Content: Were you able to video tape your student? • Yes • No Description End: Let's take a look at poll question 2...which asks, were you able to videotape your student? Yes or no? I know we're asking a lot. But ‑‑ but Kate and I and the team out in Bastrop have been really fortunate to have had some time to take some video and to meet together and, gosh, it is really a wonderful way to get information that you don't see in real‑time. So there we see five folks have been able to videotape, that's great. Two of you that haven't been able to, we sure understand. [ Slide end: ] And hopefully today's conversation, about the video that we see of our case student, Kamryn, can provide you with some motivation as to ‑‑ to the type of conversation and information that you can get out of getting that videotape. And, also today, we have ‑‑ we are very happy, as always, to have our special guest from the Penrickton Center for Blind Children... Patty Obrzut and Jessica Russell. Hopefully Patty and Jessica have... have had a chance to get connected. [ Slide start:] Description Start: Title: Special Guests from Penrickton Center for Blind Children Content: Patty Obrzut Note: This slide will be present whenever Patty Obrzut is speaking during the webinar. Description End: Patty: Hi, it's just Patty today, Jessica is not able to make it. Matt: Okay. Well thanks, Patty for joining us, we sure appreciate it. Patty: No problem. [ Slide end: ] Chapter 1. Fine Movement Video Matt: All right. So let's get started now by taking a look at some video that we took to gain information about our case study student Kamryn's fine motor movement. [ Video start: ] Description Start Audio description provided during the video. Description End [ Slide start: ] Description Start: Title: Fine Movement Video Content: Clips of Kamryn at a Position Board and in a Little Room Description End: Audio Description: You will see three short clips of our student. In the first two clips, she is seated in a wheelchair at a table with a position board in front of her. [ Slide end: ] On the board, from right to left are the following items; A heavy gold chain necklace, a spike key plastic cylinder, a hard plastic whiffle ball with objects that rattle inside, a small set of jingle bells, the plastic letter "P", a small metal model car, a velcro hair curler, a small hand bell and some wooden beads. When the video starts, she's using her left hand which has a bandage on it. This hand is seen as her preferred hand, though she also uses her right hand in the second clip. The final clip shows her in the little room playing with wooden wind chimes, primarily. She used her right hand in this setting, as well. Our student reaches for the hand bell, pulls it down and pops it over the back side of the board. [Singing in the background] Audio Description: Next she tries to grab the letter P, but has trouble getting it. Instead she snags the elastic holding it. Then she grabs the model car and pulls it back. It flips over to the back of the position board. Finally, she grasps the whiffle ball, pulls and flips it over the board. She turns toward the camera and smiles. [ Video end: ] [ Video start: ] Description Start Audio description provided during the video. Description End In the second clip, she is using her right hand. She's not as successful in grasping and pulling with this hand. After pausing for a moment, she rubs her right palm across her stomach, up to her shoulder, then reaches for the jingle bell using a raking motion. She only moves the bell slightly. After a pause, she tries again with a better grasp on the bells, and flips them over the top position on the board. [teacher's voice in background] In the final clip, she's in the little room. She grasps the clapper on the wooden chimes, using a thumb and a forefinger grasp. [clacking sound of chimes] She bangs the clapper in to other items, such as the long wooden spoon, a scrubber with metal measuring spoons, and a link of silk drapery cord. After a time, she pauses and explores the wooden spoons and drapery cords, using her open palm and fingers. She grasps the wind chimes again, but this time by hooking the string through her fingers. She tugs in a sideways motion and then tugs toward her, then sideways again. [ Video end: ] Matt: So there you see an example of great footage that -- that Kamryn's team was able to get. And as -- I think Kate pointed out in that chat... the footage is great to answer questions that the team may have about their ability in that area, but it also sure brings up more questions. To get ‑‑ to look at more videos of Kamryn, you can check out the LiveBinder link to see all of the video that we've collected. But -- Kate: Matt, this is Kate. Matt: Yeah. [ Slide start: ] Description Start: Title: Kate Hurst, Statewide Staff Development Coordinator Content: left-side photo: Kate Hust right-side graphic: TSBVI logo Note: This slide will be present whenever Kate Hurst is speaking during the webinar. Description End: Kate: I'm going to jump in here real quick, just to let people know that all of that -- there was tons that the team took, and we just didn't have as much time to show all of the wonderful footage. So, please do go and look at it. [ Slide end: ] Chapter 2. Questions about Fine Movement Matt: So back to Kate's point about how the video has brought up new questions in reference to the assessment; and Patty, we were sure hoping that -- that you could give us your two cents today. We pulled out a list of these items that came up as we sat down to look at the fine movement section. They were just items that we were kind of unsure of exactly what we were looking for. So can we go through the list of these items, Patty, one at a time? And you ‑‑ you shed some light on them for us? Patty: Sure, yes, that's not a problem. [ Slide start: ] Description Start: Title: Questions about Fine Movement Content: Refer to table in handout. Description End: Matt: So the first one, "Performs circular movements with arms." We're not really sure what type of movement that we're looking for here. [ Slide end: ] Patty: I mean typically, when you have someone who is zero to three months old, which is the section that you're in; someone is going to just move their arms in a circular pattern, I don't know how else to describe it. Usually their arms are extended out and they're not reaching toward anything specific, but they're just moving their arms, moving in a little circle. Matt: Am I doing it? Patty: Yeah, kind of like what you are doing, yeah, that works perfect. So, you might not see her do that on the video, because she's passed that, so you might end up saying, no, you don't see her doing it, which is actually not a bad thing. But if you were really looking at a zero to three month old without disabilities, they would engage in what you just did on the video. So... [ Slide start: ] Previous slide; Questions about Fine Movement Matt: Okay. Great, that helps. And so the next one there is F005 in the assessment, it says, "Grasps reflexively." Does this mean ever or only grasp this way? [ Slide end: ] Patty: Typically, the zero to three month old child, again, without disabilities, is going to grasp, first reflexively, and then it becomes purposeful. So you can tell by the video she is trying to grab purposely. So, she's not grasping reflexively -- you give her a no ‑‑ but that, again, is a good thing, because she's developed out of that, as she should. Matt: Okay. So both of those are nos, but they are good things, right. She's moved on. Patty: Correct. [ Slide start: ] Previous slide; Questions about Fine Movement Matt: Okay. The next item, F012, says, "In the little room, learns various ways of grasping." Is this asking about having various ways of grasping, or is it specific to one of the things that she's doing in the little room? [ Slide end: ] Patty: I mean, what I found interesting watching her... trying to grasp things, even with the position board, you notice she's not always grasping the way a typically person would grasp. Sometimes she grasps on to the elastic, which then she's holding the object by holding the elastic, versus the object. So, I take that as, is she experimenting with trying to grasp things, even though it's not a true grasping of an object. Matt: Okay. Patty: So I would say yes, she does that. Matt: You know, we also noticed looking at the video, it seems to me, that she grasped differently with the left hand and the right hand. Her left hand she'll sometimes use like a bunch shape to directly grasp the object. And with her right hand, as her team pointed out, before we did the video, she kind of sweeps it in and with her palm up. And there was discussion among the team that that is likely to ‑‑ to be ‑‑ to be impacted by her vision. That she has some vision on that left side of the body, so the grasp is a little more exact. Whereas on the right side, where she doesn't have that vision, she kind of comes in as a sweeping motion to gain more tactile information. Does that make sense? Patty: Yeah, that makes sense. Yeah, it makes sense to me, and it's very well possible, and you have to take all of those into consideration, because every child is going to be a little bit different. And when you are doing the assessment, too, especially if you have a child who has got...different abilities versus left versus the right, sometimes we give each box an L for left and an R for right. And an L might get a no, where an R gets a yes, and you are actually evaluating them separately. Matt: Okay. Kate: Patty, this is Kate. That's really good to hear, because she does have some of a tendency, she's ‑‑ she's doing more of a ‑‑ sort of a sliding scoop and... once she kind of gets ‑‑ makes contact, she seems to be able to get her hands around it some way, but it's not as nice of a grasp as we are beginning to see on the left hand. We've also noticed with her right leg, it's ‑‑ she's much better using that left leg, than right. And, again, she has no vision on the right‑hand side, and hasn't most of her life. And we're beginning to wonder, if maybe, there's just, sort of this, lack of awareness about the right side of her body. And so our team is trying to think about what we might want to do, in terms of activities and equipment, to see if we can increase her awareness of her ‑‑ the right half of her body. Patty: Well...and I think if you go back to how you had the question on the fine motor, F012, "Learns various ways of grasping." You are making Lilli's point, that kids are going to grasp in different ways, which means they are grasping, but you have to pay attention to that. Do they have to push it first, and accidentally get a finger hooked on it, or do they actually use a gross grasp. Are they, you know -- so are they experimenting with that type of grasping, at a zero to three month old. And then, how does it develop to make sure that you are encouraging a more developed grasp overall. So those are all good points. Matt: Okay. And while we are on the topic of grasp, that next item, F027 states, "Grasps an object, most often by using left hand;." [ Slide start: ] Previous slide; Questions about Fine Movement And that was kind of related to F055 which states, "Grasps using left or right hand without preference." [ Slide end: ] So, when we were filling out the assessment as a team, we were wondering, does that mean, Patty, that typically developing children, in this range, use their left hand first? Patty: Well, Lilli did say that. I remember talking to her, she teamed to think that kids used their left hand over their right hand. I will say I have never been able to go and find other research that proves that, but she felt that kids would use their left over their right. I will say, it also is going to depend, though. If you have a child who has spastic cerebral palsy on the left side. Well, then obviously, they are going to probably develop the right over the left. So, when we're doing that assessment, I kind of take that question with, -- you know, definitely do they ‑‑ right or left, sometimes I change it, if I see them -- yes, they're doing it with the right and not the left. But I pay attention to it. She seemed to think that they used the left first. Matt: Okay. How interesting. And I guess, as we've already talked about with Kamryn, it seems like, you know, her vision that she's had her whole life -- with not having vision on that right side, I'm sure would impact the way -- the handedness as that would develop. Which is maybe why we see her use her left hand with more accuracy. [ Slide start: ] Previous slide; Questions about Fine Movement Patty, the next one, we had questions on, was F050, "Grasps and releases own feet." We just weren't sure exactly what we should be looking for... that would indicate that skill. I'm double checking to make sure I'm in the right -- so now you're talking six to nine months. So obviously, you have a child who's literally playing with their feet and grasping, but -- I wanted to make sure, cause when I first looked at this -- do they use their feet to grasp, versus are they grasping their feet with their hands. So, yeah, "Grasps and releases own feet" would be reaching down and actually grasping the feet with the hands and playing kind of with the fingers -- you know the toes and fingers and stuff like that. Matt: Okay. With their own hands. Gotcha. Kate: My question, Patty, this is Kate again. You know, we've seen her grasp her feet, but we don't really see her playing with her feet a lot, and what I'm wondering about is, again -- is this something that maybe she's outgrown? Because I know, you know, young babies do this and then they reach a point and they quit doing it... What can you tell us about that? Patty: Yeah, I think it's absolutely possible that eventually somebody doesn't play with their feet anymore. And it's really going to be up to the person who knows that child really well to say, "I think they're past that, or I don't think they can do it, and they need to do it." So we have a child right now, who is actually at this stage, she balances toys on her feet, you know, she spins them around, plays with them on her feet. So, eventually she might move past that, but I have a lot of kids who cannot even... touch their feet with their hands. And they might ‑‑ nine years old, and I think it's a skill that it would be good to try to encourage...them to do. Kate: Okay. That helps. Matt: Yeah. And it also ‑‑ seems like a reminder for us to... try to include the parent, you know, or the parents, who know the student the most, or the best and the longest. They would really have that information about, "Oh, yes, she used to do that," you know, "x number of years ago, now she doesn't." Patty: Yeah, I would -- Matt, can I make this point about doing the assessments? Matt: Sure. Patty: The hardest thing, I think, about doing this assessment is you have to take each individual child, individually. So, I think Lilli's pointing out all of these steps that kids do, but you have to look at the child you have and say, "Does the blindness affect them?" "Does the spasticity affect that?" and then really look at the question and go, "In that specific child's condition, I think them not being able to do it, is because they're past that skill; or I think of them not being able to do it, because they've never had the opportunity. And that's how you decide whether you should be encouraging those activities, or whether you're past those activities. [ Slide start: ] Previous slide; Questions about Fine Movement Matt: Yeah, great. And the next item builds on that...that F050, and it's F051, that next one that says, "Manipulates own feet." And we were just wondering if there's any particular way that we should be looking, that they manipulate their feet. Is it -- is it -- I mean, the first one is grasp, but beyond grasping, touching, scratching, moving the toes? [ Slide end: ] Can you be more specific there, Patty? Patty: Yes. See, I think it's all of those things. Matt: Okay. Patty: Do they use their feet to explore the surface of a ‑‑ you know, if you put beads under their feet, are they using their feet to make a sound happen by rubbing their feet against it. Do they use their toes to explore the features of a toy? So I think it's all of those things. Matt: Okay. Patty: I think if Lilli had time, she would have actually have, you know, split that one up into maybe, pushing with feet and grasping with feet. But... I don't think she ever got to that point, because I think one leads to -- there could be five different categories just under that one little section. Matt: Okay. And the final item there on fine... fine movement that we had a question, was about F059. [ Slide start: ] Previous slide; Questions about Fine Movement It says, "Uses little room to promote object permanence." The team's question was, "How important is the little room to that item?" Is it just about object permanence, or is it really object permanent in the little room? [ Slide end: ] Patty: I mean, I think her point is...to encourage people to use the little room so that they ‑‑ I mean, you could use the position board to understand object permanence. But is this child actively in a little room, and do they understand that that object is the same object from day‑to‑day. Or do they seem to go in there and just randomly push things. And they know things are there, but they don't quite understand that that's the same object that was there for weeks. So, I take that one as, hey, I put them back in there and they reached for that same toy, or they...you know, that they know that toy is there, they seem to recognize that that's -- yes, that they understand object permanence in the little room, versus I'm just active in the little room. Matt: Okay. That's very helpful. All of those answers, Patty, is very helpful. Thank you. Patty: And I -- I will say, it's my opinion, you know the one thing that Lilli did not do, is leave a definition of all of these things somewhere. So just, in using the functional scheme over and over again, that's how I interpret it. And if someone else interprets it differently, but uses the assessment consistently in that way, then at least you have an accurate reflection of what you think this child can or can't do. Matt: Sure. And I think...in this experience, with the team that we are working with, it's really reminded me how important it is to use the team approach to go through this, and...and get different people's interpretations, and kind of reminding each other of what area we're looking at. I know we talked about that at the last webinar with you Patty. That any time that you are wondering what a skill means, thinking about what area it's in, can kind of help place it. But the discussion that comes out of -- out of the team looking at the assessment together, sure seems to be helpful, as well as our discussion with you. So thank you. Kate: I just wanted to throw in, Laura mentions in the chat room that her student cannot grasp toes due to hip issues and pain. And I guess my question to Patty, related to that, is, you know, when we have kids that have dislocated hips and ‑‑ and different issues that cause pain and things like that, how ‑‑ how do we take that into consideration? Do we just say, "Okay, we're not going to worry so much about, you know, toes and feet and things like that." Or are we going to ‑‑ how are we going to ‑‑ should we go ahead and be encouraging that in some way? Patty: Well, I think if you are doing the assessment and it was, you know, do they reach for their toes with their fingers, you would NA that assessment. But that wouldn't mean that you wouldn't want to pay attention to them manipulating their own feet to explore an object, because ‑‑ we have tons of kids with dislocated hips, but they still use their feet to explore things that are put down by their feet. So I would be NA-ing the...grasp and releases of their own feet, and not count that in my data, because they're not able to do it. But I definitely would be looking at the next one, manipulates feet and still putting things there, to try to encourage whatever movement they have. Unless it's extremely painful, but hopefully, if it's extremely painful, obviously, hopefully somebody is doing something to correct that pain through surgery or medication or whatever. Kate: Thanks, Patty, that's good feedback. Matt: Yeah. All right. Now, let's look at the Fine Movement Milestones for our student Kamryn. [ Slide start: ] Description Start: Title: Fine Movement Milestones – Our Student Content: Refer to table in handout. Description End: And as you can see, our team checked off the zero to three month milestone; that Kamryn grasps reflexively, she uses the ulnar grip. They also checked yes to the three to six month milestone; she puts her hands together, and grasps, and keeps objects safe. Above that six month level, though, on the milestone sheet, you can see there were all nos. [ Slide end: ] [ Slide start: ] Description Start: Title: Our Student 0-3 months Content: Refer to table in handout. Description End: So, let's move on to the ‑‑ to the fine movement, zero to three months. And you will see there that... the sucked fist, we -- the team said they weren't sure. She puts her hand to her mouth and bites the back of it... But they weren't sure if she was sucking. And then "don't know" on the next one, which I think we've some clarity on today, thanks to Patty and the circular movements with the arms, so... is there anybody on the team that can chime in on that one, now? Have you seen Kamryn move her arms in that circular motion? [Silence] Deanna and... Steven are both typing, so let's see what they say. No, they're saying she's moved beyond that skill. Okay. So that's a -- that's a no -- that's an actually yes, she's moved beyond it. We can see there, that Kamryn has completed the next few skills there; that she reaches for objects without grasping them, that she... pushes objects... that are within reach, and that she grasps reflexively and... I think we've discussed how she's moved beyond that, too, the positive/negative. She has also... checked yes, or the team has checked yes for closes hand around... various objects, the hair -- her hair, the corner or clothes... and the team is checking no for the next one, releases grip without awareness. And the team has checked yes for the last one there on your slide, that she scratches skin, clothes and sheets. And looking at the next slide. We can see that there's a lot of yeses on this next one, we're still in zero to three months. So, "learning has begun" on that first one. "Learning has begun" on another one on this page. We got some clarification on F012... that in the little room, learning various ways of grasping; I think the team has discussed how Kamryn is doing that, and it looks a little differently in the right and the left hand. So, let's go to the next slide. [ Slide end: ] [ Slide start: ] Description Start: Title: Our Student 3-6 months Content: Refer to table in handout. Description End: And here we have the first part of the three to six month area. And you just -- taking a wide look at -- there's still a lot of yeses on this first one, for three to six months. And the team has indicated when "learning has begun" on certain skills... It sure seems like Kamryn -- and we saw that in the video... she's an active explorer of those objects. I think the team has done a wonderful job picking the things that she's interested in exploring, and allowing her time in her day to have that exploration time. And I think the assessment reflects the progress that -- that she's making. Let's go to the next one and start to see ‑‑ We see a few nos, but also a lot of yeses in this three to six month, and we can also see that the learning has begun in a few of these skills for on that page... [ Slide end: ] Patty: Hey, Matt. Matt: Yeah. Patty: Can I interrupt for one second. I think the nicest thing about when you start to look at something like what you have done, you start to see the holes in what you need to provide her for activities. So, if she's not rotating her hands at the wrist, well, now I need to look for objects that would encourage her to rotate her hands at the wrist or if learning has begun, I need to give her more activities. You know, you are kind of laying out exactly the type of curriculum that she needs every day to... grow developmentally. [ Slide end: ] Matt: Yeah. And that came up in our conversation, Patty. That we're identifying gaps of where the instruction -- where we kind of need to fill in, and then you also get an idea of the ceiling of, kind of, where she's at in a general perspective. So that really begins to inform that instructional plan... And the nice part about it, as we're doing this as a team, that -- that new instructional plan can start to happen right away as you're having these conversations. Patty: Yeah, and the only other thing that I can ask Kate, or anybody else who did the assessment. Like, sometimes you guys will have checked "learning has begun" and yes at the same time. And I know what we do here is we try to strictly -- if we think learning has begun and they are in the middle of practicing it and don't have it yet -- we try not to do the yes box and learning has begun, because then down the road, three months later, all of a sudden it is a yes, they definitely do it, and then you put that date in the yes box and you can see, hey, three months ago she started doing it, but now she's got it. And you can see that date and that... that development. But you don't have to do it that way, but that's kind of how we do it here. Kate: Patty, this is Kate. I have a question related to that. Because we were trying to get it scoring, and one of the issues that came up for us is... You know, you take the number of items, and then you assign so much value per item, which we did by dividing the number of items into 100. And kind of, you know, getting a rough amount there, and then we figured percentages for the number that were yes. What we ran into problems with, though, is couple of things; is those positive/negatives, and then the other piece was, if we checked learning has begun and we don't check either yes or no, then how do you calculate that. So, can you -- can you give -- give us some ideas on that one? Patty: Sure. I will say, you know, the idea of percentages was something that ‑‑ again, we decided to do here. At no time did Lilli say you have to do a percentage. It just helped us out, with kind of looking at an overall picture. So how we do it is, if I mark it "learning has begun," it's a no, because I only consider it a yes when a child 100% gets it. Because it tells me that I need to work on that area. People have a tendency of saying "Oh, yes they have it, so I've got to move on," when they really should be paying attention that that child needs to... have more practice at that skill. So we consider "learning has begun" a no. We consider ‑‑ if I say grasps reflexively no, but it's a good thing, then I consider that a yes. Does that make sense? I would give them a positive mark. So you really have to look at how many ‑‑ and what I will do, is take like a highlighter -- any time a no is a positive, I might highlight that, so that I can recognize, "Oh, I should count that as a yes." Kate: That... that helps a bunch. Patty: Yeah, so that's why if it's learning has begun, I'm considering it a no. I really need to work at that three to six month old level. Cause, if you say yes, people are going to go, "Oh, she's 90% in the three to six, I've got to work at six to nine," and now you're above where she really is, and you're going to start to stress her out. Kate: Gotcha, gotcha. Matt: That's great information. So really, we want to focus on where that learning has begun, and make sure that we're addressing that in her materials and her activities. Patty: Yeah, it means she needs a lot more of it. Matt: A lot more opportunity before she's ready to move to the next step... That's great information... We can move to the next slide. And there we see ‑‑ we're still getting a lot of yeses in the three to six... area. The nos on this page are grasps objects with both hands. Although, there we seee the team has checked learning has begun, performed in favorable conditions on the 15th of December -- or December of 2015. So, Patty, that's what you are talking about, right, learning has begun and it's a no. Patty: Yeah. And actually, that performs in favorable conditions is also a really scary one. Because that's another one that people will check, because, "If I ask her to do it, she'll do it," or "If I give her -- if I clap afterwards she'll do it" or "If I sing her a song." Now she's only doing it because ‑‑ you know, it could be performed in favorable conditions if you give her the right object she'll do it. So, now I need to pay attention to give her more of those objects. But again, it's not something she does all of the time. So she needs to work at it more. Matt: Okay... great. And let's see, the other no there was grasps a verbal prompt. And there's one more. The last item on that slide, strokes hand over surface, we wrote raking, but not really exploring surfaces with her hands. And the final... portion of the three to six months in fine movement there is ‑‑ we put two yeses, now we have learned... that first one should be moved to a no, learning has begun, for using a thumb while grasping. The team noted that her right thumb does the majority of the time. And a yes for is now best in grasping with the left hand. And, Matt, what I say I consider it a no. Like if learning has begun, I just check that box. Matt: Oh, I see. Patty: You know... what's going to happen over time is you're going to have a child that you see, you know, a year old, and you say no. And then two years later you go, "Oh my gosh, now learning has begun." So on the same assessment, you had a no, let's say December of 2015; now it's June of 2016, and you see learning has begun. Now it's July of 2017 and you have a yes. Now you have a record of... it took that child a year to go from no I can't do it, to now I'm starting to do it, to now I've got it. So I only pick one box, and then as you continue to assess you're going to fill in the other box as things change. Does that help? Matt: That does, yeah. That's really helpful. Because we've talked about how nice it is to create a record of the progress. Deanna and Stephen in our chat are pointing out that -- they think it's really important to keep our notes on what the favorable conditions, and what learning has begun looks like, so that everyone across the team can know that, and that there's a record of that for future team members. Patty: Yeah. And I like the way -- and we do it, too. You guys add little notes into the assessment, kind of recognizing what you see, and sometimes you'll say learning has begun with the left side, not the right side. So, definitely you have to keep notes and add little comments. Matt: Yeah... All right. If we go back to the assessment there, we're at... six to nine months here. [ Slide start: ] Description Start: Title: Our Student 6-9 months Content: Refer to table in handout. Description End: And... we see learning has begun on the first one, that she reaches and grasps successfully. The team pointed out -- or noted she does grasp and release her own feet, and -- but we don't see a lot of the manipulations of the feet. And I think even with your clarification today, team do you all agree that's not what we are seeing? We are not seeing her explore a lot with her feet. [ Slide end: ] Give you a chance to chime in. Yeah, Deanna and Stephen say yes. Say no manipulation or exploration with feet. And Liz agrees... So looking back at the assessment... The team does not see her uses fist to bang toys on table tops. The team is not seeing her bang one hand on an object that is held in the other hand. She does do some voluntary releasing. And the next slide ‑‑ is six to nine months, and we see nos for the first two items there, grasp using left to right hand without preference. She prefers the left... No on transfers an object from hand‑to‑hand. A few yeses on banging an object on the table top and pushing objects. And then we've got kind of a run of nos here. No banging two objects against each other. No on picking up small objects using index finger and thumb No on grasping objects pushing them back and forth. No on explores the characteristics of objects... Then a yes, she does perform shake and rattle movements. And then a no on picking up two objects, holding on ‑‑ one in each hand. So Patty, would you agree, that seems to be where she's plateaued there? Patty: Yeah, what's fun, is I don't even know this child, but I got a huge picture just by your assessment. Like, if she were to come to Penrickton, I would know exactly where to start... which is great. Matt: That is great. Chapter 3. Gross Movement Video Bravo to all of you folks in Bastrop that have been working hard there. All right, guys, let's move to our Gross Movement video. [ Video start: ] Description Start Audio description provided during the video Description End [ Slide start: ] Description Start: Title: Kamryn Gross Movement Content: Nov. 2015 and Jan. 2016 Description End: >> Audio Description: We will see a number of short clips illustrating Kamryn's gross movement skills. The first two clips were taken in November of 2015, and the remainder taken in January of 2016. [ Slide end: ] [ Slide start: ] Description Start: Title: Nov. 2015 Content: Rolling over on Resonance Board Description End: In the first clip, Kamryn is prone on the resonance board and independently rolls to her left onto her stomach. [ Slide end: ] [chain rattling] [ Slide start: ] Description Start: Title: Nov. 2015 Content: Playing with legs Description End: In the second clip, she is lying on her back on the resonance board, with her head on her teacher's leg. [ Slide end: ] The teacher has put bells on her shoes. She puts each arm around each of her calves and brings her feet up toward her face, and looks at them smiling. [bells ringing softly] She moves her feet back and forth. When her teacher touches the bells on her feet, she moves the soles of her feet back up to her face and brings them together. In the next... three segments, we will see... [ Slide start: ] Description Start: Title: Jan. 2016 Content: With PT traveling to her trike Description End: Kamryn with her PT traveling from a seated position on the floor... with legs Indian style. [ Slide end: ] The PT lifts her from under the arms to her feet. [staff voices in background] She prompts Kamryn to move her feet by nudging them and then lifting her ‑‑ Kamryn's right foot with her own foot. Kamryn attempts to move her left leg but needs a little prompt. Once again, she nudges her right foot, and helps her to move it forward. And Kamryn attempts on her own to move her left foot forward. She tries to pick her up right foot, then makes a good left step. Then she picks up her right a little bit... and then her left. [ Slide start: ] Description Start: Title: Getting on her trike Description End: Okay. Now we're going to see Kamryn getting on her trike. [ Slide end: ] [staff voices in background] Kamryn requires complete assistance for this task. However, once she's on the trike, she is able to maintain a... a good, seated posture. She cannot lift either her right or left foot to place them on the pedals, but requires full assistance from her PT. [staff voices in background] [ Slide start: ] Description Start: Title: Pedaling to see the Principal Description End: In this next clip we will see Kamryn... pressing the pedals on the trike, [ Slide end: ] as she's encouraged to travel towards her principal, who is speaking to her. Kamryn is able to press her legs down. Though... she is better with her left leg than with her right. [staff voices in background] [ Slide start: ] Description Start: Title: Standing Description End: In the final clip, Kamryn is standing with her hands on a table for support. [ Slide end: ] Her PT provides some support initially... by supporting her back, but Kamryn is able to stand unsupported, except for holding on to the table for about 15 seconds or so... finally. During this activity, she becomes tired very quickly and then begins to fuss. [ Video end: ] Chapter 4. Questions about Gross Movement Matt: Man, that girl is working hard! So... the team had some questions on the gross movement area, too, Patty. And you'll see we have a slide here. [ Slide start: ] Description Start: Title: Questions about Gross Movement Content: Refer to table in handout. Description End: We're hoping that you can add some insight to these. The first one there is G064, practices to balance. [ Slide end: ] What the team was talking about was, we think this means, like when she's trying to stand in space and maybe -- maybe has her hands on some support and moves away from it, is that practicing to balance? Patty: I mean, I would ‑‑ you are down in the six to nine month old, so I would be saying practice to balance way down in sitting. You know, if you have someone in sitting, they don't ‑‑ if you have protective extensions, you go to push somebody over and they catch themselves. A lot of times you will take a kid, sit them up and they kind of move their body around and practice that shifting their weight and sitting, but they still might fall over. So ‑‑ you know, just on the video, I'm not sure that I would say watching her in standing that she's practicing to balance. I would be really looking is she even practicing to balance in sitting, at a six to nine month old level. Because, really, you're not going to balance yourself in standing, until you are way into the 12 month... Matt: 12 months. Okay. Patty: ...typically. Yeah. Matt: All right. Patty: And you could split it up, and you could say that she practiced the balance in standing and does she practice the balance in sitting. But typically someone who can't stand, is so worried about just not falling over, that it's not like they practice balancing in standing. Does that make sense? Matt: Absolutely. Absolutely... Deanna and Stephen are writing when she is Taylor sitting she is able to sustain an upright position of torso... and that she cannot stand without weight bearing both arms on the table. Patty: And if you think about it, if she's Taylor sitting, she's using her legs to maintain the seated position, so she doesn't fall over, which is different than able to sit without falling over. So those kind of... little details are important, because it tells you she still needs to practice -- to learn to balance in sitting, because she doesn't have that yet. Matt: Okay. Excellent. Deanna and Stephen also add, she cannot stand without weight bearing both arms on the table, she cannot sit with her legs outstretched before her. And Liz adds that her lower half is much stronger than her upper. [ Slide start: ] Previous slide; Questions about Gross Movement So the next item that we had questions on was the G080, sitting: moves from one place to another. Can you kind of describe what that might look like, Patty? [ Slide end: ] Patty: I mean, it really is kind of scooting on your butt... Matt: Okay. Patty: ...to get from one place to the other without, you know ‑‑ and kids move differently, they can move backwards, they can move forwards, they can move sideways, but they're staying and sitting, but they're moving around the room in a sitting position. Matt: Okay. Now the big question here... is that sailing on your bottom if you are scooting on your bottom? Patty: I definitely ‑‑ sails on the bottom, to us, is scooting on your bottom... Matt: Okay. Patty: But moving from one place to the other and sitting is different than sailing, in that you could move yourself a really small distance in sitting and you are moving in a seated position. Where there are kids who scoot their butt, and they go across the room in two seconds. Matt: Okay. Patty: And to me that's really sailing, or crawling, and going somewhere, versus moving in a sitting position. Matt: Gotcha. That's very helpful... And then on the item G092, balances while sitting. [ Slide start: ] Previous slide; Questions about Gross Movement Does that mean she maintains her balance, [ Slide end: ] or what you were talking about earlier, she plays with the balance and tries to find it? Patty: See, those to me -- that's the two differences. In 080, sorry, in 64, which is a much lower level, you're down, I think it's six to nine months, that's -- you're in sitting, but you are kind of shifting your weight, and trying to stay upright, and someone might be helping you. Where in 092 ‑‑ you're up in the... 9-2 is -- nine to 12 months. Now you have somebody who maintains their balance in sitting. You kind of give them a little push and they -- they can stay upright. So, that's the little nuance... between the two. Matt: Okay. All right. Thank you. Again that clarification is ‑‑ is wonderful. So if we move forward a slide, we will see the Gross Movement Milestones. [ Slide start: ] Description Start: Title: Gross Movement Milestones - Our Student Content: Refer to table in handout. Description End: And we can see, already, that it's a little higher here in gross matter than we were at in fine... movement. So the team checked yes that Kamryn can... control her head movements, yes to turn from prone to supine positions, yes to turn in supine to prone, and yes to sit unsupported, which is a skill that we typically see in kids at the nine to 12 month range. And everything above 12 months on the milestone... form is checked no. [ Slide end: ] [ Slide start: ] Description Start: Title: Our Student 0-3 months Content: Refer to table in handout Description End: So let's move forward and look at gross movement, zero to three. You will see all yeses there... she thrusts her heels against the mattress, she moves her legs about in the supine position, moves her arms and legs in that position. [ Slide end: ] [ Slide start: ] Description Start: Title: Our Student 0-3 months Content: Refer to table in handout Description End: Let's go on to the next one. And we'll see all yeses. Although the team wasn't sure about using a support bench with a head support to facilitate the control of the head, arm and leg movements, and they weren't sure about using a support bench without a head support to facilitate the control with the head, arm and leg movements. And... Kate: Matt. [ Slide end: ] Matt: Go ahead. Kate: I'm going to jump in here, cause this is one of those other points for ‑‑ for her, they are using a support bench... but have just started using it, and are not using it all that many times... with her. And what they said is, is that, if she's on the support bench... her head is going to droop. But if they put an iPad up at a higher level, she will raise her head up and look at that. So I... felt like we didn't ‑‑ I kind of feel like that she can support her head without the ‑‑ the head rest, but it's not going to be up all the time. It's going to be one of those things where she's kind of practicing bringing that head up. And I'm wondering what you might have to share about that, Patty. Patty: I mean, the reason why she's got the two sections, is you have to make a decision which one are you going to use. And definitely with her, I would not be using a head rest... because she should be practicing lifting her head. That's what I would want her to do, and anybody who's going to have their head hanging down... a lot of times, and then you want to see them lift their head up. So, I would be... NAing the whole using the head rest -- that isn't even considered, and I would just be using the one without the head rest. Kate: Okay. That's good information for us to have. I need to -- also while I've got the mic -- Laura mentioned that... if a student is unable to support themselves in a standing position -- and again she says this is about a hip and pain issue -- he had surgery last year and needs another. He is, however, able to move his body to reach objects on the floor near him, and grabs them and puts them in the lap. He also pushes himself in his wheelchair and can maintain his balance. Everything is in a seated position. No standing, unless in a stander, and he does not walk. If they cannot do these things, does it mean that he will not move out of the six to nine month range? Patty, what do you say to that? Patty: I mean, if you have ‑‑ if you have a child who is never going to be able to stand or bear their weight, then they are never going to go past 12 months old in gross motor, because that's what someone does. However, you know, like we have kids all the time in the HOPSA dress who have dislocated hips, and they do -- you know, they trail furniture, and they move around the room, moving those dislocated hips and legs to get around a room. So they do a lot of skills. But when I take them out of the HOPSA, they are not at a one‑year‑old level. Do you know what I am saying? So... you know, there are certain things that you can't fix. So, then you understand, well, that child can't do that. It doesn't mean I still don't do the activities using a HOPSA dress. Because maybe one day, they will sit up better, or they will bear a little weight more. But there is a reality to -- I mean, I work with certain kids who I know are never going to walk, which means gross motor wise they will never be above 12 months. But tat doesn't mean socially and emotionally they can't go higher in other areas. I don't know. Does that answer your question, Kate? Kate: Laura, what do you say? Typing right now... I think that's important, because, you know, we sort of say "Oh, well kids have got to keep going in every level, every level," but sometimes, physically, they really cannot go beyond a certain level, but we don't give up on all of the other levels. And Laura says "Yes, that answers it, thank you." Matt: Awesome. Patty: Well, and I do see, though, that you can then focus to somebody and say, "Look this child is at a six to nine month old level. We have to keep giving him activities at a six to nine month level, or else they're going to lose those physical skills that they have." They've got to be able to keep moving those legs, they have to keep sitting and balancing... they have to keep wanting to roll over. Because if you don't use those skills, now you're going to have somebody who's going to fall down to a three month old level, you don't want that because their body is bigger or harder to move. Kate: That's real important, Patty. I'm glad that you added that last little bit. Because I think sometimes our tendency is to be, "Oh, we're just not going to worry about that," especially when time can be... hard to come by. You know, we just say "Oh, we're going to give up on that." But what you are saying is, "No!" You want to at least keep them at the level that they are at, by continuing to give them those kinds of activities. Patty: Yeah. And I will just tell you a quick story. I had one of our kids came back in on Tuesday, -- he's been out of our program for a year and a half, and not using a HOPSA dress, because they don't have one, won't provide it. And there's a distinct difference in his ability to walk with someone holding his hands. He's now pulling his feet up and walking on his tiptoes; whereas when he was here, he was flatfooted. And I truly believe it's because, for a year and a half, he has not been in that -- that HOPSA dress every day, where he can -- he's... he's sitting more in a wheelchair and they're... they're not walking him as much. [ Slide end: ] So, now he's starting to lose some of those skills that he's completely cable of. Kate: Patty, and while we're on the HOPSA dress, I'm going to ask another question... With our student, again, not necessarily holding her head up all of the time, although she's able to hold it up a lot -- I -- you know, there's been a concern about her being in the HOPSA dress with [indiscernible] all the time. And I am thinking that's actually what she needs to be doing, is being in situations where she's got to bring that head up, and we have got to find motivators to get her to bring that head up. Patty: Well, and I would also emphasize lifting your head is a zero to three month old level. And you know, just me watching her videos, yes, she can -- you know, someone can hold her up in a standing position, and yes, she can sit on a bike. But boy does she need practice at the zero to three month old level. She needs to be prone and lifting her head. And she needs to be pushing up on her elbows and prone. I didn't -- you know, she might be able to do that, I didn't see that. But she needs more practice at that. Just because someone is successful, doesn't mean, you know ‑‑ Kate: Move on. Patty: If you want her to stand, she's got to have head control. She doesn't have head control yet. So, in a HOPSA dress, practicing head control; on a support bench, practicing head control. That's what she really needs. Kate: Thanks a lot, that helps. [ Slide start: ] Description Start: Title: Our Student 6-9 months Content: Refer to table in handout Description End: Matt: Can we go back to the last slide on the fine motor -- I'm sorry -- the gross motor assessment. And I know we had a brief discussion earlier about... the scoring. Did... did we get our questions answered there? [ Slide end: ] Kate: I think we actually got most of our questions answered, and that will help me to go back, with the team, and revise some of our scoring on here... I ‑‑ I think that, you know, it's just tricky to figure this out ,and so you've helped a whole lot, Patty, sharing that information. Patty: Well, and I -- the only other suggestion that I would have, too, is go back and look at your gross motor. Because I know -- I didn't look at them really quickly. If they are all yeses, go back and look, and say, "Is it yes in a favorable condition, or is it still learning has begun, not a definite yes." Because -- just because somebody can do it, yes she lifts her head, but she doesn't lift her head all of the time. So, I would be saying maybe that's a learning -- it's still happening. Kate: Okay. Patty: Or it could be a yes but you've just got to remember to still focus on those activities. Kate: Right. Thanks. Matt: All right guys. That was a great discussion. Patty, thanks for joining us. Everyone that ‑‑ that was in on today's discussion, thank you so much, and thank you for -- for being such good Study Group participants. The poll data that we got is great. You guys are using the assessment, and you are using videotape to get some more information from your students. So that's wonderful. Kate: and Matt, I'm going to jump in here and say, also, those of you that aren't registered for the Active Learning Conference, you know, Patty's going to be here at the end of February, and we can have lots of her time in that event. So I want to encourage people to get registered. Matt: Yes. Wouldn't it be nice to have all of these discussions around a table, without the technology? And I will remind everyone our next Active Learning Study Group session is on the 29th of March. So if ‑‑ hopefully we will see you at the conference, first, and then back hear on the web. Kate: Thanks to all of you guys, this has been terrific. Transcript end