Where is Thumbkin?

According to The Lotus Tree Sensory Integration Center, praxis is the ability by which we figure out how to use our hands and body in skilled tasks like playing with toys, using a pencil or fork, or building a structure. 

Children with praxis problems have a hard time writing, eating with a utensil (often spilling frequently which leads to a preference to use their hands to eat), playing games like rock, paper, scissors or Where is Thumbkin, putting up fingers to show how old they are,  button a shirt, etc.

As a toddler, John would hold 2 fingers (with the opposite hand) when he wanted to show he was 2 years old.  He couldn't fold the other 3 fingers down, while still holding up the 2 to show his age.  He has ALWAYS used his hands while eating and frequently needs to be reminded to use a fork.  He has very little control of it and is considered a "messy eater".    He had problems building towers out of square blocks and during early intervention, they worked with him stacking first 4 blocks, then 5... and then up to 9.    We put a variety of sponges in the bathtub for him to squeeze and release to help him with the muscles in his hand.  The releasing is important because that is the same muscle used to let go of a block with control when it sits on top of another.   In OT, he has been working on buttoning.

More recently, we noticed he couldn't play hand games.  Last week in Kids Crew, the lesson centered around finding "fair" ways to determine who goes first when playing games.  They learned about picking a number from 1-10, eenie-meenie-minee-moe, bubble gum bubble gum, and rock, paper, scissors.  John was unable to make the "scissors" with his two fingers.

Concurrently, he was learning "Where is Thumbkin" at his My Gym Preschool.  He needed to isolate the thumb, the pinkie, and the pointer finger at different points in the song.  At the end, the teacher showed them that if you put all 3 up together, it means "I Love You".  John struggled that day, and the next day had the problems with Rock, Paper, Scissors in Kids Crew.

All week, John has been practicing holding up each finger, singing the Thumbkin song, and attempting to play Rock, Paper, Scissors.  .... AND THERE HAS BEEN SUCCESS!!!   He's got it figured out.  He's able to do it all now and the hang loose sign (like the sticker on the back of Daddy's truck).  I'm so proud of him.  He had to work through some frustration to get there, but he did it all on his own.  Although we've been working on different aspects of praxis since we started early intervention, we concentrated more on achieving the goals that were set for him, like eating with a fork, building the blocks, etc.  He figured out his own goal this week and conquered it before he had to go back to Kids Crew.  This morning he told me, "Mom, I'm going to show my friends in kids crew that I can do it!"  He's proud too! ;)

Eating Problems

Yesterday, John's teachers told me that they fear John could be aspirating when he eats. They recommended I get a swallow test done to check it out.

I thought I'd use today's blog to discuss aspiration. Using NYU Medical Center Online as a resource, here is the information I found.


"Aspiration is the abnormal entry of food or liquid into the windpipe and subsequently into the lungs. Aspiration is important because it may lead to the development of pneumonia and/or long term lung complications. Normally, food and liquid are diverted around the breathing passages and directed into the esophagus. In certain disease processes, however, these mechanisms do not function normally, and aspiration occurs.

Aspiration may be detectable as a cough or gagging associated with food or liquid intake, or it may have no associated symptoms. So-called “silent aspiration” is troublesome, because if is very difficult to detect."

It can cause Aspiration Pneumonia.

About.com defines aspiration Pneumonia as : "Aspiration pneumonia is an inflammation of the lungs and bronchial tubes due to the inhalation of food, drinks or other foreign matter into the lungs. It occurs most often in patients who have difficulty swallowing or controlling their gag reflexes. The gag reflex keeps "foreign" material from entering the lungs and causing infection. "

Symptoms of Aspiration Pneumonia include:

Fever

Cough

Fatigue

Chest Pain

Shortness of Breath

Cyanosis of the skin

Rapid Heart Rate

Wheezing