Last month, we switched Nate’s private physical therapy (PT) services to Yale-New Haven Hospital, which has a special pediatric wing that provides PT, occupational therapy, and speech-language pathology services. The best part about this change is that they provide parent training, so I can learn exercises to carry over into the home environment. The worst part about this change is the cost. At our old place, the out-of-pocket expense for one hour of PT was $90; at Yale, it’s $190 per half-hour. Our insurance provides us with fifty (combined) PT, OT, and/or speech visits annually so, with these new rates, we’re doing our best to stay within the 50 annual visit limit.
Nate had a physical therapy evaluation in late November. To Nate, physical therapy is a giant playground. Lots of jumping, stair climbing, ball throwing — he’s got no clue how hard he’s working. His new PT Kelly feels that Nate’s really strong and doesn’t need too much therapy at this point but he does still require his SMOs to help stabilize his body and train his feet/legs on the right way to stand. We’re starting with sessions every two weeks, shifting to every month in the new year. With this schedule, it opens up the opportunity for Nate to have private speech therapy!
Yale’s a pretty popular place and it was more than a two-month wait for Nate to get a physical therapy evaluation, which is necessary prior to being accepted into their practice. After our PT session last week, I inquired about the availability of a speech evaluation. Lo and behold, they had a cancellation and it was in just one week’s time! So yesterday, on the most bizarre snow day ever (Nate’s school had a 2.5 hour delay AND early dismissal, meaning the kids were basically going to school for lunch) I kept Nate at home to keep him happy before his evaluation. Around 1, we loaded up the four-wheel drive sleigh, went to Yale, and met Ms. Aimee.
All evaluations are basically the same: there’s a parent interview first, followed by an evaluation of your child, followed by a recommendation of services for said tot. The parent interview portion varies, though. Sometimes it’s questions; sometimes it’s a formal answers to a test. With Aimee, we talked for a bit and then I took a test on Nate’s behalf. I don’t remember the name of it (there are hundreds of them, it seems) but this one measured milestones for children nine months to three years of age. As a general rule, I don’t look at milestone lists. For Nate, those lists don’t measure his abilities and only highlight his inabilities at the moment. However, when I have to go through these very extensive lists, I am reminded of how very far we have to go to meet these milestones. I easily answered no to 75% of those questions and/or had a significant qualifier to my answer. Questions included: Does Nate respond to his name? (No…but he just mastered his IEP goal of looking at someone calling his name from two feet away 80% of the time….) Can Nate follow one-step directions? (The only one he follows is “sit down.”) Does Nate know his body parts…or any body parts? (No. That’s been a goal since Birth to Three…) And as I kept answering, “No,” I kept hoping that Nate, who was hanging out under a table eating Goldfish crackers, would get a chance to shine.
About twenty minutes of the session was dedicated to one-on-one work with Nate. Ms. Aimee had a flip book with pictures and she asked Nate to show her the item she named. Sometimes, maybe fifteen percent of the time, Nate did it right. Often, Nate used his finger to count the items (in his head) instead of point to the scissors or ball or sock. The book progressed in the number of objects on each page. We noticed that, as the field got smaller, Nate’s interest waned. The page that had five items held Nate’s attention and he performed best here — but Nate completely tuned out on the page with two items (50% chance of getting the correct answer); he actually wouldn’t participate on that page. Nate imitated sounds very nicely for Ms. Aimee and showed off his hard work with Ms. Mollie a bit. In speech therapy at school, they’re working on consonant-vowel-consonant (or CVC) sounds like ball, bat, cat. So Aimee probed Nate a bit on those types of sounds, too.
Because speech-language pathology focuses on all types of communication, the Proloquo2Go app on Nate’s iPad is also part of therapy. When we switched over to P2G, Nate shined like the brightest Christmas tree in the world! Ms. Aimee asked Nate to request shape-sorter items by color. Our boy hero ably typed I-want-blue! or I-want-green! and got the request right each time, matching the color of the item in Aimee’s hand to the color on his iPad. Aimee was floored at how quickly Nate navigated screens, folders, and icons and couldn’t believe that he was already making four-word sentences. (At school, he identifies animals with sentences like I-see-a-cow.) All of the no’s of the developmental milestone survey melted away as Ms. Aimee proclaimed Nate’s abilities with speaking through the iPad was easily in the top 1% of kids in his age bracket. Easily. I could barely contain myself and almost asked if there was a trophy for that.
Aimee was very happy to add Nate to her roster of clients and he’ll have speech therapy weekly on Monday mornings. Mondays were our leisurely days with just a half-day of school (12-3) and suddenly they’re packed. Nate will have speech in the mornings, followed by school, followed by our rehearsal at the dentist’s office. I feel like a shuttle bus sometimes but it’s all in the name of great help that’s very needed in our household. And we’re grateful for it.