Expectations

Since the spring, I've been noticing Obsidian falling farther behind his age matched peers for his gross motor skills.

He has been in PT on and off since he was a year old. More off than on. Last time he was being seen regularly he was 2 or 3. Mostly, I take him in a couple times a year, he gets new AFO's or orthotics for his shoes if he has outgrown his last pair and his PT makes recommendations of things to work on as well as keeping up with all of the activities I do with him.

I was expecting the same. Even though I've been noticing him fall farther behind. And my sister has commented on how he is falling farther behind. And my best friend. So why I was expecting to hear that yes he is still mildly delayed but no need to restart him in formal PT at this time, I couldn't tell you.

And 20 minutes into the session, I realized, that was not going to be the conclusion of the session. Your average parent would not have realized it at that point. Even your average special needs parent. It is a curse and blessing to be an OT. I knew when his PT left the room to get something, that the something was a formal assessment form. The paper she was just writing notes on was not going to cut it. I also know that she knows her stuff well enough, that the only reason she would get a formal standardized assessment out was if Obsidian was not 'passing' it. When she walked back in holding it, I knew. Obsidian is not currently 'mildly' delayed with gross motor skills.

By the end of the session, PT said as much. He now falls into the 'moderately' delayed gross motor skills. For this reason, she is recommending PT every other week until he 'catches up'. 'Catching up' in Obsidian's world is not truly catching up, but returning to the 'mildly' delayed category. At this point, the PT and I diverged, somewhat philosophically. I strongly feel that a good part of Obsidian's gross motor struggles are from vestibular dysfunction. There are multiple causes of vestibular dysfunction in both children and adults. The cause of the dysfunction effects the therapy. The treatment of children with vestibular dysfunction is not the same as adults. Vestibular therapy is a specialized area for both OT and PT. I know a handful of vestibular PTs, but they all are for adults (and they themselves say they would not be comfortable taking on a child because it is different). There are differences on how OT and PT deal with vestibular dysfunction. Obsidian biggest problems, all fall more into the PT realm. His PT feels it is more of a balance and strength issue. She also recommended a formal OT evaluation. I do feel he would qualify for OT because his fine motor skills are starting to fall behind, but this is more of a fine motor control issue and a strength issue. She was thinking more of sensory integration. Obsidian's problem is not a traditional OT sensory integration disorder problem, but a vestibular (which is part of it, but not in what is currently viewed as a "SI disorder"). We got into a bit of a philosophical discussion whether it would be more appropriate for a PT or an OT to address the vestibular issues, or really even try to formally assess his vestibular problems. Neither of us really know of either an OT or a PT that is a pediatric therapist that specializes in vestibular problems. I feel much more strongly that this is the route that really needs to be explored at this point.

I do agree that his gross motor delays do need to be addressed. So in the meantime of me trying to find an appropriate therapist (I would take either an OT or PT if they are a pediatric vestibular therapist), he is back in therapy, every other week. After I got over the shock of it, I wonder why I was shocked in the first place. I took him in because I noticed him falling more behind. It was the hope that I was being an overreactive parent. The hope I was wrong. I knew I wasn't, but I was holding onto hope more than I knew. I am reminded of the blessing it is to Obsidian. I don't wait until he is so far behind it is obvious to anyone. This way, it is harder on me than it is on him. And that is how I like it.