Case study Reading Profile Do not use or distribute without written permission.

OT Evaluation October 20, 2017 - Age 14-11 Presenting Concerns Frustrated Easily distracted Reading comprehension Slow pace of reading Difficulty reading aloud Spelling Slow processing Sensitive to others talking about her inabilities – not sure how to handle it Do not use or distribute without written permission.

Phase 1: Foundation Findings Generalized sensory sensitivity Listening tested average Significant for ear atypicality though Balance average Do not use or distribute without written permission.

Phase 2: Organization Bilateral Integration Average on BOT Visual Pursuits – jerky over midline Visual Saccades – inconsistent performance Binocularity – right eye leading, delay in achieving convergence, sometimes suppressing left eye at far and near distance Noted physical rigidity during visual spatial infinity walk exercise with some need to look down to her feet Wears glasses for distance vision Developmental Eye movement Test (DEM): impaired vertical and horizontal. Generalized Language Difficulties through TLI including linguistic organization, decoding, attention, social, behavioral Interactive Metronome Timing: severe deficient range with extremely hyper anticipatory responses and extreme deficiency when multisensory stimuli was added Bilateral timing score was in severe deficiency range Do not use or distribute without written permission.

Phase 3: Executive Skills Mixed dominance task specific Legible writing Visual Digit span difficulties during copying tasks BRIEF: impulse control, self-monitoring, set shifting, emotional control and working memory difficulties IVA: Auditory: Response Control - Average Quotient – Severe Deficiency Sustained – Severe Deficiency IVA: Visual: Response Control – Below Average Quotient – Average Sustained – Average Do not use or distribute without written permission.

Social-Emotional Often spends time alone, daydreams, distracted, difficulty with attention, feels unhappy, irritable, down on herself, hopeless Sometimes fidgety, acts as if driven by motor, afraid of new and novel, trouble with friends, difficulty sleeping Always avoids confrontation with others Frequently sensitive to criticism Can make friends easily, but takes time to become close. Self expresses no anxiety socially, but would like to have more vocabulary to socialize with. Does not always express herself clearly Do not use or distribute without written permission.

Intensive 1 – March 5, 2018 12 day program of 2 hours per day during regular work week schedule Tomatis Sound Therapy Yoga interspersed with tactile integration massage High level bilateral activities Learning Breakthrough Program: Bean bags, balance beam, pendulum ball Infinity Walk Intensive was followed by 1x weekly OT for 6 weeks to continue to refine the above. Completed the Forbrain at home with reading aloud exercices Do not use or distribute without written permission.

First Post Consultation: April 25, 2018 Falling asleep easier Going faster down the stairs Improved conversational skills Improved verbal expression Faster uptake on listening – processing No more stammering Increased self awareness Improved frustration tolerance More “even” emotionally More self confident ADL’s and chores faster Feeling calmer to read better Written expression still difficult Attention slight improvement Do not use or distribute without written permission.

Sandtray – April 25, 2018 Improved self motivation Building defense mechanisms Growth evident Improved posture Feeling a threat that she would not maintain this new found “groundedness” she is experiencing due to “failures” in her past Coming to realization of the potential within herself Do not use or distribute without written permission.

2. Intensive 10 day program 2 hours per day (5 days per week) Tomatis Sound Therapy 1 hour Tactile integration massage – yoga poses Bilateral activities Learning Breakthrough Program Infinity walk – adding conversational turntake for cognitive load 1 hour Interactive Metronome with goal to decrease generalized timing skill across all exercises After intensive: 1x hour / week OT and Forbrain Do not use or distribute without written permission.

2.Post Consultation – June 13, 2018 Have been more tired, napping more Body awareness increasing still Volleyball – more aware of surroundings, but could not make her body follow through Handwriting sloppier Stammering a little again, but not much Listening speed “slowed” Increased frustration levels Self confidence maintained Studying for finals was easier Reading “feels” worse, choppier Homework was getting better Still struggling with comprehension Did not comment on written expression Attention feels much easier Do not use or distribute without written permission.

IM Comparison Long Form Results Day 1 Task MS Early Hits Late Hits Both Hands 99 52 2 Right Hand 125 30 1 Left Hand 142 29 Both Toes 130 Right Toe 109 24 Left Toe 202 23 Both Heels 146 31 Right Heel 152 Left Heel 149 Right Hand/Left Toe 144 27 Left Hand/Right Toe 100 21 Bal Right Tap Left Foot 123 28 Bal Left Tap Right Foot 208 Both Hands w/ GS 3 Total Unadjusted 140.9 96.9% 3.1% Day 10 Task MS Early Hits Late Hits Both Hands 36 37 18 Right Hand 49 27 4 Left Hand 51 26 Both Toes 45 30 1 Right Toe 61 29 2 Left Toe 64 Both Heels 67 Right Heel 56 31 Left Heel 94 Right Hand/Left Toe 70 24 7 Left Hand/Right Toe Bal Right Tap Left Foot 68 Bal Left Tap Right Foot Both Hands w/ GS 47 44 11 Total Unadjusted 60.1 88.4% 11.6% Do not use or distribute without written permission.

IM Comparison Averages Day 1 Battery Results, Millisecond Accuracy MS Hands ms avg 127.5 Feet ms Avg 152.4 Both Hands ms avg 121.5 Both Feet ms avg 138 Left Side ms avg 164.3 Right Side ms avg 128.7 Bilateral ms avg 122 Adjusted ms avg 139.9 Highest IAR 2 Total Bursts % within 15 MS 2.6% Attend over time 129 Day 1 Battery Results, Millisecond Accuracy MS Hands ms avg 45.8 Feet ms Avg 65.5 Both Hands ms avg 41.5 Both Feet ms avg 56 Left Side ms avg 69.7 Right Side ms avg 55.3 Bilateral ms avg 67 Adjusted ms avg 55.7 Highest IAR 3 Total Bursts % within 15 MS 12.7% Attend over time 35 Do not use or distribute without written permission.

Sandtray – June 13, 2018 Worked deeper in the subconscious – very quiet Cozy warm family identity – working on feelings within the family Family connectedness and warmth evident Expressed father’s traditional values in the home Feelings of loyalty and ability to go forward Themes of authority, wisdom and power Do not use or distribute without written permission.

3 and 4. Intensive 1 hour of Tomatis Training Added this time was reading aloud over microphone with calibrated voice as well as ear-and bone conduction 1 hour of Interactive Metronome Adding cognitive load to increase multi-tasking Intensive 4: august 2018 after taking a break after third intensive 15 days of 1 hour daily computerized ReadON program Followed by 10 weekly sessions of SLP services working on reading comprehension and written expression Do not use or distribute without written permission.

Post Consultation – November 21, 2018 More settled, more in control Improved organization in speech, staying on topic, loves to talk now Occasional frustration, but does not give up Self advocates and asks for help when needed – asserting self more Improved eye-hand coordination in Volley Ball / basket ball Using squeezy ball less EF much improved Improved social No concerns with sleep Straight A student! History needs some work, but putting in the extra time Still does not like reading, will use books on tape Using the strategies taught in SLP to keep from “spacing out” No more melt downs Do not use or distribute without written permission.

Client Self report – November 21, 2018 Studying skills improved, taking notes is better Some days more fluent than others Reading comprehension still feels hard, but could not say why Still a little light sensitive Reading speed improved Decoding and fluency has improved Reading better on computer with dimmed screen Not as easily distracted as before Auditory distractions are a non-issue Spelling is still hard Conversation skill is better, though have days still where this is harder Improve body coordination “I feel more confident” Felt that she was glad she came to therapy, it was worth it! Do not use or distribute without written permission.

Interactive Metronome Long Form Comparison Day 1 Task MS Early Hits Late Hits Both Hands 46 50 5 Right Hand 47 28 3 Left Hand 55 29 1 Both Toes 45 26 Right Toe 17 12 Left Toe 42 9 15 Both Heels 56 2 Right Heel 36 22 Left Heel 23 8 Right Hand/Left Toe 48 Left Hand/Right Toe 44 19 10 Bal Right Tap Left Foot 38 Bal Left Tap Right Foot 53 Both Hands w/ GS 31 30 Total Unadjusted 74.8% 25.2% Day 10 Task MS Early Hits Late Hits Both Hands 36 42 13 Right Hand 23 8 Left Hand 39 25 6 Both Toes 27 4 Right Toe 22 20 11 Left Toe 44 21 10 Both Heels 26 3 Right Heel 37 Left Heel 50 Right Hand/Left Toe 34 24 7 Left Hand/Right Toe 18 Bal Right Tap Left Foot 29 2 Bal Left Tap Right Foot 33 Both Hands w/ GS 30 Total Unadjusted 35.4 75.3% 24.7% Do not use or distribute without written permission.

Interactive Metronome Comparison of Averages Day 1 Battery Results, Millisecond Accuracy MS Hands ms avg 44.8 Feet ms Avg 43.1 Both Hands ms avg 38.5 Both Feet ms avg 50.5 Left Side ms avg 47.7 Right Side ms avg 37.3 Bilateral ms avg 46 Adjusted ms avg 43.9 Highest IAR 4 Total Bursts 2 % within 15 MS 21.4% Attend over time 39 Day 10 Battery Results, Millisecond Accuracy MS Hands ms avg 34 Feet ms Avg 38.1 Both Hands ms avg 30.5 Both Feet ms avg 40 Left Side ms avg 44.3 Right Side ms avg 31.7 Bilateral ms avg 27 Adjusted ms avg 36.1 Highest IAR 4 Total Bursts % within 15 MS 26.4% Attend over time 50.6 Do not use or distribute without written permission.

Speech Language Pathology Strong self advocate, expressing needs Vocabulary of new and novel words (multisyllabic words) – impact from years of not decoding, some catching up to do Strategy of “key words’ was replaced with strategy of reading out loud and rephrase the question Strategy of using “post it’s” while completing reading for homework, writing notes and summaries of 3 to 4 lines Strategy of reading shorter passages at a time, then rephrase for herself Auditory comprehension much improved Discussing the material rather than being questioned seemed to be more helpful to her More speech language sessions were recommended Do not use or distribute without written permission.

Finally… Family and Crystal decided to take an indefinite break right now. She felt she had more resources and final strategies to push herself further and wanted to be given this chance. We recommended continued SLP, a more advanced ReadON program and another boost of Interactive Metronome. Truth is though that function is different in everyone’s life. She has made remarkable progress from February through November and she has proven her resilience to herself and like every other typically developing person, she can now drive herself forward. Do we do more therapy to attain a better score? No, we facilitate through therapy the innate drive within the client to want to take the baton and make herself get to the finish line. The door is open, she can come back if there is a glitch in the road, but for now… WELL DONE!!! Do not use or distribute without written permission.

https://maudeleroux.com/ Maude Le Roux, OTR/L, SIPT, IMC Websites https://maudeleroux.com/ www.atotalapproach.com Facebook https://www.facebook.com/ATAMaudeLerouxOT/ LinkedIn https://www.linkedin.com/company/a-total-approach Blog http://www.maude-leroux.com/ Do not use or distribute without written permission.