Massage Therapy and Chiropractic Adjustments for Hemiplegic Cerebral Palsy

Now that E is older, we have again broached massage therapy and chiropractic as treatment options for her spasticity.  E had several chiropractic adjustments when she was an infant after her traumatic birth, and we tried myofascial release massage therapy when she was around 3 years old but she HATED it, so we haven’t done either for a number of years now.

E has become very resistant to wearing her TLSO trunk support vest – she is embarrassed by it and complains that it is hot and sweaty (she is currently overweight which contributes to the hot body temperature).  So, this year, I gave her the option of trying massage therapy and chiropractic instead of wearing the TLSO vest.  The massage therapist targets her tight muscles and tries to release built up tension. The chiropractor checks her spinal alignment, arm and leg length discrepancies, and muscle tone.  We have found these both to be very helpful modalities in her overall spasticity/tone maintenance.  Note that the benefit is in controlling muscle pain and tension, which in turn can promote normal growth (preventing bone growth complications, particularly scoliosis).  We have no anticipation that these treatments will assist with functional ability.

Massage Therapy:

E tends to have tightness all along her right (affected) side.  It is in her shoulder girdle, arm, wrist, fingers.  It is along her trunk, trying to pull her spine out of alignment.  It is to a lesser extent in her hamstrings, gluteus, calves, and other ankle/lower leg muscles.  Massage is able to loosen this tension quite significantly.  Unfortunately, the effects only last several days.  Ideally, I would think E should have massage therapy 3+ times a week – but this isn’t in our financial capabilities.  We tried every 3 weeks for about 6 months (1/2 hour session, which was as long as E would tolerate – she watched movies on the iPad during her sessions).

The studies I had read on massage therapy for cerebral palsy had all talked specifically about “myofascial release”.  So initially I had sought out a massage therapist who was trained in “myofascial release massage therapy” (which some advertise).  Our chiropractor has explained to me that the term is kind of a gimmick – ALL massage therapy affects the myofascia and intends to release the tension in it.  So, basically, all therapeutic massage therapy (as opposed to relaxation massage) should work similarly, based on the experience and skill of your practitioner.

Here’s one study, showing benefit in reduced spasticity, but no associated functional improvement:

The effect of deep cross friction massage on spasticity of children with cerebral palsy: A double-blind randomised controlled trial.

RESULTS:  Of the 60 patients, there were 30(50%) in each group. The control group consisted of 14(46.7%) males and 16(53.3%) females compared to 16(53.3%) males and 14(46.7%) females in the experimental group (p=0.72). The overall mean age was 6.03±1.73 years. All patients (100%) were followed up for a period of 6 weeks and there was not a significant (p=0.26) improvement in experimental group compared to control group evident on Modified Ashworth Scale. The experimental group, however, had significant improvement after 6 weeks compared to the baseline values (p<0.001). However, functional level did not improve (p=0.55) by the end of study.

Massage therapy can assist with:

  • promoting relaxation
  • releasing muscle tension
  • decreasing tone in spastic muscles / increasing tone in flaccid muscles
  • encouraging muscle growth
  • improving circulation
  • body awareness

You can ask your practitioner to show you some massage strokes to do at home, going from proximal to distal (truck to tips direction).  It would be most beneficial to your child to do this at home massage on a daily basis, if possible.

It is also helpful to incorporate gentle stretches into your child’s daily routine.  You can consult with a PT, OT, RMT, and Chiropractor for appropriate stretches.  When done consistently, these can make a big difference in your child’s range of motion.

Chiropractic Adjustment:

I found the following information on Chiropractic treatment helpful:

Chiropractic care is technically considered a manipulative and body-based therapeutic method that affects the body systems and structures – bones, joints, soft tissues, and neuromuscular system – that are manipulated beyond their passive range of motion and with appropriate use of force. It is a therapy that uses the manipulation of the spine and joints to relieve pain. The spinal manipulations are made using the chiropractor’s hands, and are referred to as “adjustments.”

Simply explained, the brain communicates with the body through nerves. Chiropractic care is based in improving the way brain control and muscles work together. The neuromuscular system sends messages from the brain, down the spine and into the nerves. If there is interference, the body is not able to function as effectively.

Chiropractic intervention aims to improve the structural aspects of the body to clear the pathway for the brain to communicate with the nerves. This can result in improved strength, balance, flexibility and coordination skills, especially in the limbs. One intervention doesn’t fix all, rather the intervention chosen and the location of treatment are relative to the symptom being addressed. Since Cerebral Palsy affects people differently, differing chiropractic modalities are used to address specific issues.

There is evidence that the chiropractic care can be helpful to children with Cerebral Palsy. A handful of studies indicates that children that underwent spinal manipulation could sit and stand with more ease. Also, the studies indicated that some children became more active, digested food more efficiently, slept more peacefully, and enjoyed improved coordination after undergoing chiropractic care.

  • Adjustment of the atlanto-occipital subluxations helped with children who had difficulty with sleeping,personality disturbances, and hypertonic musculature.
  • Myofascial release may be used to assist in decreasing the severity of spinal distortion and aid in stabilizing gait patterns in children with spastic Cerebral Palsy who have muscle contractures in the paraspinals, lateral thigh muscles, lower extremity abductors, Achilles tendons, and wrist extensors.

From www.cerebralpalsy.org

In reviewing the literature, there are not many formal studies on the benefits of chiropractic care for hemiplegic cerebral palsy.  However, it is suggested that chiropractic care can assist with:

  • gait patterns
  • hypertonic muscles (spasticity)
  • joint pain or stiffness
  • muscle contractures
  • neck pain and tension
  • scoliosis (curvature of the spine) prevention or treatment
  • sleep difficulties

E started regular chiropractic adjustments about 9 months ago.  At first she was going every 4-6 weeks, but in the last few months we have been taking her every 2-3 weeks.  We have actually stopped massage therapy (appointment overload!) and are just doing the chiropractic for now, and are finding similar benefit.  The best combination would be daily at-home massage therapy, occasional therapeutic massage therapy (unsure ideal timing for E), plus regular chiropractic (every 2 weeks for E is what we have found).  I just haven’t gotten into a routine of trying massage at home yet…

It took several tries to find a good match for a chiropractor.  The one we have found is very proactive and researches things that may help E in between our appointments.  At each appointment, he:

  • Assesses E’s spine for straightness
  • Assesses her muscle tone (spasticity)
  • Provides some myofascial release to high tone muscles
  • Applies vibrational treatment using a vibrocussor (sp?) to spastic muscles
  • Works on loosening her hip flexors and shoulder girdle
  • Sometimes provides adjustments to her ribs or T spine or L/S spine
  • Assigns exercises and stretches he wants her to do at home

We have found that going regularly to the chiropractor has decreased E’s tone in her arm and leg and improves her apparent arm and leg length discrepancies.  Going from 2 to 3 weeks in between appointments we notice a definite increase in tone.  It is also reassuring to me that her spinal alignment is being closely monitored.  Before writing this post, I was not aware that chiropractic can improve sleep – but E’s sleep has improved since having regular adjustments (from never sleeping through the night to sleeping through the night 1-2x a week).

I strongly believe that in this life, nothing happens by accident or coincidence – things aren’t determined by fate or luck (good or bad).  I believe there is an overarching story – a beautiful picture of love, loss, and redemption – and that there is Someone who cares and is in control.  You are already a part of this story, whether you know or believe it or not.  While the end of the story has already been written, your own part lays open before you for you to choose your ultimate destiny.  Maybe all your life has been leading to this one moment: The Bridge to God.

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Childhood Obesity – Our Experience

Our daughter E was born at the 50th centiles for both weight and height.  Around 12-18 months old, she started rapidly falling down both curves, and eventually around age 2-3 she was diagnosed with food allergies (dairy, egg, and soy proteins).  She actually turned out to have FPIES (food protein induced enterocolitis syndrome).  Regardless, the only treatment is strict avoidance of the offending foods.  Even minute quantities of these cause her to have horrible abdominal cramping, nausea, vomiting, and sometimes diarrhea. She became a very picky eater because food often made her feel sick.

Finding foods E likes and doesn’t react to has been challenging.  She was able to hold her own, though, and started tracking along the growth curves around 0-1% for height and 5-10% for weight for about 3 years.  She is followed by an endocrinologist for her growth and has been diagnosed with idopathic short stature (initially it was felt she had constitutional growth delay).  [I suspect her stunted growth has to do with the several years it took to diagnose her allergies, when she wasn’t digesting much of the protein in her diet.]

Anyways, about two years ago now, E started to increase in weight proportionately more than height.  This could be because she started enjoying foods more (getting less picky; she had recently outgrown the egg allergy so more foods were now an option as well), so we didn’t worry about it at first. We were actually encouraged that she was eating better.  We thought maybe she was getting ready to have a growth spurt…

Then suddenly we realized that she had gained a lot of weight and never did have a corresponding growth spurt.  She had rolls of extra skin, double chins, and no longer fit any of her clothes (and not because they were too short).  I also noticed that exercise became more difficult for her – she would become winded more frequently and was more resistant to running and active play.  Gross motor skills have always been challenging for her with her hemiplegia and she has always preferred to be sedentary, but this was a noticeable change.  She had also started complaining about her knees hurting.

Since E is followed quite frequently by various health care professionals (including pediatrician, endocrinologist, and others), I was surprised that no one had expressed any concern about this to us.  I did a BMI calculator for children (BMI is calculated differently for kids than adults) online and E was in the 98th centile.  (CDC BMI Percentile Calculator for Child and Teen)

Less than the 5th percentile is considered underweight; between 5-85% is a healthy weight; 85-95% is considered overweight; 95% and higher is obese.

I already was aware that being overweight/obese as a child can have significant health consequences.  These include cardiovascular disease (including increased stroke risk), continued obesity (over 80% likelihood), type 2 diabetes, asthma, sleep apnea, increased cancer risks, and psychological stress.

It is important to discuss this issue with your child’s health care providers so they can provide advice and monitor progress.  Testing for contributing factors is often indicated.  Several health issues can cause rapid or unexplained weight gain, including (but not limited to) thyroid disease.  Because I have a thyroid condition, we had E’s thyroid levels checked (free T4 and TSH).  She also had a CBC and blood glucose screen.  These came back normal.

Dieting in children can have very negative effects on growth and development.  The goal with overweight/obese children is to try to slow or stop the weight gain while height catches up.  (This of course varies with the age and developmental stage of the child).

Instead of “dieting”, we made some long term dietary changes.  We decided to control E’s portions for pasta and grains (which she loves) and allow her unlimited fruits and vegetables (which she doesn’t love).  She doesn’t tend to overeat meat/protein or dairy (almond/coconut) so we kept that the same.  We implemented these changes immediately.  The first few weeks were difficult as E struggled with feeling hungry.  Somehow she had lost that ability to sense when she was full, even though she had been very good at that when younger.  (We had done Baby Led Weaning, which I highly recommend).  However, we explained to her the importance of being healthy so that she feels good and so that her body can develop properly.

After several months, she became quite good at stopping eating when she was full, and wouldn’t feel compelled clear her plate even of things she loves.  I also have to remind myself not to give her so much food – it is better to give too little and have her request seconds, than to give her too much and have her overeat.  So this is a job on my part, to not let my eyes be too big for her stomach!  I do require her to finish her fruit sometimes, as she struggles with constipation.  If she is still hungry after her fruit, I let her have seconds.  But more often than not, she decides she is truly full.

We also deliberately increased her physical activity.  We enrolled her in swimming lessons, Taekwon-do, and dance.  We also started more deliberately walking around the neighborhood and to parks.  I try to incorporate some form of physical activity into every day.

It has been a full year now and although E hasn’t lost any weight, she hasn’t gained any either.  Because she grew, she has gone down from 98% to 95% in her BMI.  Our goal is to get her BMI down under that 85% into the healthy range.

Here are some resources on childhood obesity from the American Heart Association:

  • Understanding Childhood Obesity is an American Heart Association sourcebook on child nutrition and physical activity. Both the full and condensed downloadable PDF versions are an update of the 2005 version.
  • AHA Recommendation – Overweight Children – Obese children are more likely to be obese adults. Successfully preventing or treating overweight in childhood may help reduce the risk of heart disease, adult obesity and other complications.
  • AHA Scientific Position – Physical Activity and Children – Physical inactivity is a major risk factor for developing heart disease, stroke, high blood pressure, overweight/obesity, and diabetes. The American Heart Association recommends that children and adolescents participate in at least 60 minutes of moderate to vigorous physical activity every day.
  • AHA Scientific Position – Dietary Recommendations for Healthy Children – The American Heart Association has specific healthy dietary guideline recommendations for all adults and children over the age of 2 years. more.

I strongly believe that in this life, nothing happens by accident or coincidence – things aren’t determined by fate or luck (good or bad).  I believe there is an overarching story – a beautiful picture of love, loss, and redemption – and that there is Someone who cares and is in control.  You are already a part of this story, whether you know or believe it or not.  While the end of the story has already been written, your own part lays open before you for you to choose your ultimate destiny.  Maybe all your life has been leading to this one moment: The Bridge to God.

Taming the Temper – Social and Emotional Struggles in Pediatric Stroke / Hemiplegic Cerebral Palsy

I was deeply moved by reading stories posted by moms on the Hemi-Kids support group about their children having social issues at school.  Unfortunately, it seems, from hearing stories upon stories of pre-teen/teen hemi-kids, that schools can be difficult to navigate physically, emotionally, and socially for some of these more sensitive kids.  Kids with extra challenges can feel overwhelmed, anxious, and embarrassed about their differences.  They often have to work harder to achieve similar results, or maybe can’t achieve them at all.  Studies have found that hemiplegia is unique in that disability isn’t necessarily obvious, and so peers can actually be much harder on these kids than if challenges were more apparent.

Emotional and Behavioral struggles also are more common in kids with brain injuries (stroke, cerebral palsy, etc).  Whether this is due to the actual area of damage or to altered pathways because of the damage varies for each child.  These are the unseen challenges our families face, and can sometimes be more difficult than the visible (physical) hurdles.

E struggles with emotional regulation.  She can get upset easily, and stores up emotions until they burst out.  She still requires a lot of emotional guidance, which I find much more challenging than the physical assistance.  However, I have found that the answer lies in patient empathy.  This is generally well described in the mindsets of “attachment” or “gentle” parenting.  Punishment is not effective, and further isolates E from feelings she cannot control or contain.  E frequently feels overwhelmed, insecure, and overstimulated.  “Typical” things take more work for her to process, practice, and learn.  She is embarrassed by her splints and braces.  I believe her tension and feelings just build up without her knowing.  I am trying to get better at connecting with her to help her release these pent-up frustrations BEFORE they boil over.

E was also very hesitant and “shy”.  We encouraged her in confidence, but rarely “pushed” her to separate or try things before she was ready.  (I did, several times, and regret it).  As far as this goes, she started making great strides in confidence around the age of 5-6.

There is an increased prevalence of emotional and behavioural difficulties compared with the general population and the determinants of such difficulties are similar. I wondered why are emotional and behavioural difficulties more common in children with CP than in the general population? A common view is that the brain damage may have disrupted pathways or networks which regulate emotions and the learning of behaviour and render the brain less adaptive. The present finding that the difficulties are more common in the children with an IQ of less than 70 would support this. But it would also support the view that there may be unrecognized subtle learning difficulties which render many situations more difficult to cope with, leading to the reactive behaviour problems displayed by most children in such circumstances. Another possible cause is that the child may feel self-conscious and embarrassed in aspiring to be like other children and as a result experience emotional symptoms and feelings of isolation. This might explain why children with hemiplegia are more likely to have emotional and behavioural difficulties than children with more severe motor problems. Because the difference between them and the general population is smaller, their peers, parents and teachers, and they themselves may have unrealistic expectations that ‘normality’ can be achieved; peers in particular may be more likely to tease and discriminate. However the current finding of these difficulties being already present in preschool children argues against such an explanation as self-consciousness and discriminatory attitudes from peers are unlikely to be present so soon.

Parent-child interactional styles may also contribute to the higher prevalence. Parents of children with CP experience more stress than parents of children in the general population; and parental stress is known to be associated with emotional and behavioural difficulties in all children. But maybe even more important is whether parents of a disabled child manage and set boundaries differently for a disabled child. I highly recommend the article by Woolfson which reviews the literature on how societal views and parent preconceptions may mix with feelings of guilt and sadness to alter fundamentally how parents deal with a child with CP. Certainly the finding that emotional and behavioural difficulties are already present in the preschool years when parent-child interactional styles are set is consistent with the hypothesis that a disabled child may be managed differently.

(From: Why are Children with Cerebral Palsy More Likely to Have Emotional and Behavioral Difficulties, by Allan Colver)

Some resources I have found helpful:

Helping Your Child Manage Her Emotions – Aha! Parenting – I find this a very helpful website for learning how to guide E’s emotional and social development.  It doesn’t come naturally to me (I didn’t learn a lot of emotional intelligence as a kid, negative emotions were repressed).  I also find her e-newsletter helpful.

Emotional Intelligence – Helping Your Child’s Emotional Health

Peaceful Parent, Happy Kids: How to Stop Yelling and Start Connecting – Dr. Laura Markham.  If I only had one parenting book, this one would be it.  It develops the emotional and social intelligence themes and gives you understanding and strategies to guide your child into learning to appropriately express (instead of repress) her feelings.

Raising an Emotionally Intelligent Child – John Gottman

Helping Your Anxious Child – A Step-by-Step Guide for Parents

Anxious Kids, Anxious Parents

Playful Parenting

I strongly believe that in this life, nothing happens by accident or coincidence – things aren’t determined by fate or luck (good or bad).  I believe there is an overarching story – a beautiful picture of love, loss, and redemption – and that there is Someone who cares and is in control.  You are already a part of this story, whether you know or believe it or not.  While the end of the story has already been written, your own part lays open before you for you to choose your ultimate destiny.  Maybe all your life has been leading to this one moment: The Bridge to God.

Our Orthoses and Therapies Age 4-5 – SPIO, McKie, Bamboo, Ottobock

As E gets older, her orthotic and therapy needs change as well.  This is very individual, but I will update with what is working (or hasn’t worked) for us!

I have found that at times, when I focused on therapy and outcomes, I began to view E’s physical challenges as obstacles to overcome.  Since I am a problem solver, these obstacles became “problems”, to which I needed to find “solutions” – such as CIMT, ABM, MNRI.  This played out most clearly in our last trip to California for ABM/MNRI, where I pushed to follow the therapy plan with (as I see it now) disregard for E as a person.  She was sick, she was a toddler, and it was way too much for her.  Desiring to please me, she mostly cooperated – but did end up shutting down.  As a result, we didn’t see much improvement from that therapy trip.  Therapy only works if your child is engaged and reasonably happy – an upset brain doesn’t lend itself to learning.

Since then, I have learned to SLOW DOWN.  Yes, therapy is important.  But not at the sacrifice of personhood.  E is so much more than a “tricky” arm and leg.  I would love to maximize her abilities and prevent future complications, but what is even more important to me is her heart.  Wise advice from those further down the road than us – Recovery is a marathon, not a sprint.  You don’t have to do it all today. 🙂

Slowdown

Upper Limb:

Thumb Splint – E still typically keeps her thumb postured in her palm unless consciously opening it.  We have found two options useful to us – one is the SPIO wrist/thumb sleeve.  It probably works better than the McKie for keeping the thumb joint out and stable, but it is kind of tight on E’s arm and didn’t fit very long (she has chubby arms); we didn’t find it helped with the wrist.  Cost is around $31 and it can be ordered online (http://www.spioworks.com/category/31/wrist-and-hand).  Our mainstay for the thumb has been the McKie thumb splint.  Measuring is easy and we have had no issues ordering online – cost is around $25. (http://www.mckiesplints.com/features.htm).  The palmar surface is nice and open with this splint.

Wrist Splint – E’s wrist tends to bend downwards quite often throughout the day.  She is able to elevate it with effort since our Alabama CIMT camp.  To maintain range of motion, we find the Ottobock cock-up wrist splint very effective.  It also doesn’t cover the whole palm and is less bulky than a Benik.  There is an adjustable metal stay in the wrist area.  We layer the Ottobock over the McKie.

Elbow Brace – We continue to like the Bamboo Brace for elbow posturing.  It comes with 5 or 6 different strengths of stays that you can use interchangeably.  The bamboo has been helpful for keeping the elbow straight when learning to hold handlebars (tricycle, bicycle).  We also use it when E is eating as that is another time her elbow postures.  It is also a pretty cheap investment at around $50 online. (http://www.amazon.com/The-Bamboo-Brace-Infant-Toddler/dp/B0051747D8)

CIMT Constraint – We have had an orthotist fashion a constraint cast out of thermoplastic material for E’s left arm when we practice CIMT.  This has been much less bulky, cooler, and cheaper than a cast.

We haven’t found a need to night brace, as E is typically loose and relaxed when asleep.

Lower Limb:

AFO/UCBL –  We ended up going to see Dr. Paul Jordan in New York for specialized orthotics.  He felt that E did not need SPML surgery as her range of motion videos we sent were within acceptable limits.  He did an assessment and impressions of her legs and feet on a Tuesday, they fashioned the orthotics on Wednesday, and we went in for our fitting on Thursday.  E got a modified AFO for her affected side and a modified UCBL for her unaffected side, which was doing some abnormal compensating.  How were they different from more standard AFO’s and UCBL’s?  Dr. Jordan demonstrated to us how applying “arch support” did not actually accomplish an ideal foot position, but just moved the fat/skin.  This is going to be difficult to explain properly, but there was a point on the bottom of E’s feet where, when pressed, her ankle would give way and roll.  By placing the support under that point (instead of the “arch”), he was able to correct her foot position.  I may have said that completely wrong, but whatever he did, it corrected her gait quite substantially.  Perfect, no.  (but much better than the conventional offerings).  Note: Dr. Jordan has adjusted the orthotics via mail based on videos we have sent and markings we make on them.  They are supposed to last 2 years or so!  *Highly* recommend him.

Trunk Support:

SPIO – We currently have the shorts and the TLSO vest.   The shorts don’t seem to make any difference to E’s posture or gait, and so we didn’t reorder them.  The vest does improve E’s seated posture, and I would recommend it for that as a cheaper alternative than the DMO and it is easier to apply than Theratogs.  It is hot in summer, though, so we mostly just wear it in the fall, winter, and spring.  Each of these fit about a year or so before we have to size up.  The TLSO is quite adjustable and forgiving if you get it a bit on the larger side.  We also order these directly online. (http://www.spioworks.com/product/26/classic-tlso)

Therapies:

Although we have been using orthoses somewhat regularly as above, we haven’t been doing much targeted therapy for the last year+.  I feel like we did a huge push her first 3-4 years with therapies, and while we made some wonderful gains, she definitely started to plateau in her abilities.  What started to become more important was “regular kid stuff”, so this has become our new “therapy”:

  • playground confidence – going to various playgrounds and gaining increased skill and confidence on the structures
  • scooters – practicing on 3-wheeled scooters
  • tricycle – practicing pedaling and steering
  • balance/strider bicycle – practice steering and balance
  • swimming – gaining water confidence
  • gymnastics – with parental assistance, basic level
  • obstacle courses

This has also helped our lives to feel more “normal”!

I won’t lie, E’s activities have been limited by her stroke.  Although she is musical, she hasn’t been able to pursue music lessons past the introductory levels because of fine motor challenges.  She is hesitant and needs assistance on playground equipment and at her gymnastics classes.  She is still working at getting steering and pedaling coordinated on a tricycle and never did get the hang of gliding on a balance bike.  E has noticeable gait issues in both walking and running.  She has difficulty with dressing and undressing.  She uses her affected hand mostly as an assist, and the arm often moves as one unit to stabilize objects more than to functionally participate.  I say this all matter-of-factly, because although it is part of who she is, it doesn’t define her.  We all have different strengths and challenges.  Part of life is learning to embrace all the bumpy bits in ourselves and others, for we are none of us without flaw.

I strongly believe that in this life, nothing happens by accident or coincidence – things aren’t determined by fate or luck (good or bad).  I believe there is an overarching story – a beautiful picture of love, loss, and redemption – and that there is Someone who cares and is in control.  You are already a part of this story, whether you know or believe it or not.  While the end of the story has already been written, your own part lays open before you for you to choose your ultimate destiny.  Perhaps our coinciding struggles have been finely orchestrated to lead you to this one moment: The Bridge to God.

 

Homeschooling Our Stroke Survivor – Academic Challenges

We didn’t set out planning to homeschool.  It just kind of evolved from the situations we found ourselves in.  We had been advised to hold E back for a year before starting Kindergarten as she also has constitutional growth delay in addition to her gross motor delays (balance, coordination, physical skills).  She didn’t qualify for an aide (being “too functional” to qualify for access to the limited pot of funding), but was unable to independently potty or dress and has difficulty navigating in crowded situations.  So instead, I homeschooled her so that she wouldn’t fall behind.  The further we get into this adventure, the more I appreciate it!  We have also started homeschooling our younger child.

The process here is that we join a school board and notify them of our intent to homeschool (starting in Grade 1; Kindergarten is optional).  We then choose Aligned (teacher directed), Traditional (parent directed), or some combination of the two.  Last year we did Aligned, this year we did Traditional.  Either way, E has a teacher who comes to our house several times a year to view her portfolio and progress.  We just save up all her crafts, workbooks, writing samples, and pictures of projects and field trips.  I have an IEP in place for E just like in public school, which allows her to dictate answers to me to reduce some of the fine motor burden of writing.  We also have other fine and gross motor goals for her specified.

We have completed 3 years of homeschooling now, and have discovered that E does have some learning challenges.  This was unexpected since her stroke was sub-cortical.  I am wondering if it’s because her brain has had to do so much rewiring that her neurological connections may not be very streamlined, or that maybe because her brain has to work so much harder at typical tasks that it doesn’t have the energy for academics?  Whatever the reason, it has guided me into a much more relaxed approach to learning.  I started out very excited in Preschool / Kindergarten and set out with charts and workbooks and learning resources.  E struggled with all the workbooks, hated school, and resisted all formal learning.  Since the early years are supposed to be FUN, I had to re-evaluate what our goals are.  Learning is vitally important to me – I am a lifelong learner who has a passion for study.  However, for E, I have cut everything back to the basics of reading, writing, and math for now.  We watch The Magic School Bus and Dr. Binocs for science, and do experiments.  We talk about abilities, disabilities, social issues, and health as situations present.  Everything else is about life – practical, everyday things.

Here are some wonderful resources for this approach:

The Hurried Child – I really love this book and it has given me much-needed perspective

Article on The Hurried Child

Better Late Than Early  / School Can Wait – I haven’t read these but they came recommended to me

Homeschooling approaches that work best with learning challenges:

Charlotte Mason / Unit Studies

Unschooling

Learning Disabilities Online

E’s academic struggles (early elementary):

Writing:  She finds the fine motor skill of writing difficult, and it takes her a long time and a lot of concentration to form letters. Not surprisingly, she doesn’t enjoy it at all.  I try not to pressure her too much, so we try to do just a little bit of writing a day (Handwriting Without Tears workbooks/copywork).  Since her stroke has forced her to be left-handed, I feel it’s probably kind of like all those left-handed kids that were forced in school to be right-handed back in the day.  It doesn’t come naturally, it’s strained, and sloppier than if she would have been able to be right-handed.

Reading: E has been read to extensively since birth, and has always enjoyed stories.  We do notice that her expressive language is challenging for her (she struggles to put things into words).  Reading also has been coming slowly for E.  She is making wonderful progress, but it hasn’t come quickly or easily.  We have been reinforcing the basics with a variety of phonics programs (www.readingeggs.com; Hooked on Phonics; BOB books; various phonics books).

Math:  E struggles with the relationships between numbers.  Again, we have been trying to lay a solid foundation on the basics of adding and subtracting.  She *really* dislikes workbooks and worksheets so I am trying not to panic but we are taking things slowly.  We started out with Math-U-See, which has manipulatives and DVD teacher presentations, and will continue with this in the future.  However currently we are using http://www.mathseeds.com.

Homeschooling Benefits:

  • Is an excellent way to bond with your children
  • Instead of losing them to “peer orientation”, you are able to pass down your values and worldview.
  • Homeschoolers generally perform better in all aspects of academia and social skills than their public schooled counterparts [see this Fraser Institute Paper on Canadian Homeschooling]
  • The child-to-teacher ratio is very low, individual attention is high
  • Children get MUCH more time to play and explore their interests
  • Busywork can be eliminated, focusing on what you and the child deem important to learn instead
  • Nothing “falls through the cracks” – you know exactly what your child’s strengths and weakness are and can tailor learning and help appropriately
  • You get to learn along with your child
  • You have lots more time for therapy, appointments, and can properly apply and monitor orthoses

I encourage you to consider this option for your child, if you think you might be able to make it work!  There are many resources and supports for homeschooling these days – try finding a facebook homeschooling group in your area!

Here might be some places to start:

Our Family’s Educational Philosophy

Each child is a unique person, with different interests, strengths, and challenges.  Each child is capable of becoming a responsible citizen, developing good character, and making wise choices.  Progression will be at each child’s own pace; encouraging areas of strength and allowing extra assistance in areas of weakness.

Throughout our child’s education we will endeavor to develop:

  • The desire and skill for life-long learning
  • Excellence in reading, and oral and written communication
  • Excellence in mathematical ability and spacial/abstract thinking
  • Critical thinking, problem solving, and decision making skills
  • Curiosity and imagination
  • Exploration and understanding of the world using the scientific method
  • Resilience and instill confidence in own abilities, strengths, and uniqueness
  • An evaluation of the past and present of humanity, utilizing biographies and “living books”
  • An understanding of social issues, and a discussion of root causes
  • An understanding of and respect for political, cultural, and religious diversity around the world
  • Introspection and reflection for self-evaluation
  • A healthy, active lifestyle
  • Well-informed choices and habits that contribute to the well-being of self and others
  • An appreciation for excellence in literature, art, and music
  • A foundation of good citizenship – rights and responsibilities, service to others
  • A priority for relationships and empathic thinking
  • Practical life skills, including: budgeting & work, cleanliness, communication, community, food & nutrition, hygiene & personal habits, survival skills
  • Strength of character – raising moral, responsible, authentic people of integrity, including: courage (bravery, persistence, integrity, vitality, personal initiative, truthfulness, fortitude), decency and propriety (cleanliness, neatness, order, regularity, diligence, self-discipline, hard work, obedience, self-control, self-regulation, even temper), humanity (love, kindness, peace, patience, goodness, gentleness, courtesy, forgiveness, good manners, generosity, faithfulness, usefulness, mercy), justice (citizenship, responsibility, loyalty, teamwork, fairness, leadership), temperance (humility, modesty, prudence, self-restraint), transcendence (appreciation of beauty and excellence, gratitude, hope, joyfulness, humor, meditation, reverence, outdoor appreciation, thanksgiving, spirituality), wisdom and knowledge (creativity, curiosity, open-mindedness, love of learning, perspective, attention, imagining, observation, remembering, thinking)
  • Social IQ – the ability to negotiate a variety of social situations with grace and skill
  • Emotional IQ – the ability to manage the range of human emotions with dignity
  • Biblical discernment and worldview, including an understanding of place and purpose

We will endeavor to provide a practical, living education that maximizes each child’s potential.  Our approach is eclectic – a blend of Charlotte Mason’s unit studies and “living books”, Classical Education’s guidance through the three stages of learning: Knowledge, Understanding, and Wisdom, and Unschooling’s holistic child-directed learning and lack of rote memorization of isolated facts.

I strongly believe that in this life, nothing happens by accident or coincidence – things aren’t determined by fate or luck (good or bad).  I believe there is an overarching story – a beautiful picture of love, loss, and redemption – and that there is Someone who cares and is in control.  You are already a part of this story, whether you know or believe it or not.  While the end of the story has already been written, your own part lays open before you for you to choose your ultimate destiny.  Maybe all your life has been leading to this one moment: The Bridge to God.