Toby saw a physical therapist this week. She explained to me that muscle problems can present as either high tone or low tone. Low tone is the better problem to deal with and that is what Toby has. It explains his extra flexibility. She plans to equip us with some strength building exercises.

Yesterday, Toby visited the U of M again for his MRI. We got out of there faster than expected. I think they wanted some peace and quiet. Toby was miserable in recovery and persistent in his communication. He calmed down quickly when we left, so the trauma was evidently more emotional than physical. Results are expected next week.

First Steps

Toby has been working hard this week. He has been very intent on walking along the furniture at every opportunity and creating opportunity where there is none. He has also been standing on my bed (where he knows it's a soft landing) and practicing his release. "Look, no hands!" Today, he put it all together and walked a few steps to his sisters and father.
(Insert clapping and cheering here. Toby likes applause and will cue us if he thinks we're slacking.)

I'm not sure what this means for the physical therapy the doctor thought might be needed. He is scheduled to meet with a therapist on Monday. Maybe this will be enough to reassure the doctors that, even though he is "behind schedule", he is making proper progress.

Developmental Clinic

Today was Toby's first visit to the developmental clinic at the U of M. It is for NICU graduates, similar to the Special Care Clinic in Toledo which he visited a few times. A special team headed by a neonatologist follows up with the babies after discharge to screen for and deal with the problems for which they have an increased risk.

A brief summary of today's judgements might read as follows:
(I will have to do this from memory since I do not have my copy yet)

Toby is 20 months old. His adjusted age is 16 months. His growth (height, weight, head circumference) are in the proper curve and trajectory for an extremely low birthweight child when adjusted for his gestational age.

Development levels:

gross motor skills: 10 months (He has just begun walking while holding on to furniture but does not yet stand or walk alone. )

fine motor skills: 17 months

receptive language skills: 11 months

expressive language skills: 14 months (Scoring higher here because of his sign language skills. Does not vocalize at as high a level.)


Recommendations:

Hearing test. Toby passed one before he left the NICU, but they would like to be sure this is not a factor in the speech delays.

MRI- You may remember that God mercifully spared Toby from brain bleeds during his early days after birth. But his continued pulmonary problems place him in a high risk group for neurological problems. This would look for possible reasons for the gross motor delays.

Physical therapy twice a week.

Speech therapy once a week.

A more extensive assessment in December or January.

Toby was fairly cooperative during today's assessment despite his understandable apprehension of medical people. He was not very impressed with agenda. It seemed to consist of engaging him with a toy or activity for a brief moment and then snatching it away. I do think they made a fairly accurate assessment of his developmental progress, excepting perhaps his receptive language skills. Sometimes I thought he understood but just didn't want to do what they asked.

The MRI has been scheduled for the 24th. We will be working on getting the rest of the stuff set up. I would like to see if it is possible to get therapy closer to home since twice a week to Ann Arbor would be logistically difficult.

The session both began and ended with reminders that Toby is a "miracle" child whose health and progress have been truly blessed by God. The doctor said he is living up to the meaning of his name- "The Lord is Good". So despite some of the news not being what we would like to hear, today is a good day for thanksgiving and praise.