A Three Day Cycle

It Takes About Three Days...................

We have entered a stage of continued growth but it is more subtle and internal for Maddi. We spent so many days wanting her to walk and talk. With her doing both of those things it would be easy to overlook the other things we need to work on. One of the two goals have been met for the most part in physicality and the second needs better tone and volume for this stage in the mechanics of talking. The physical stuff is the easy part. Maddi is walking very well, she still needs work on balance and stamina mainly. As for talking, that is where another long journey begins. All of that must be accessed internally through Maddi and like everything else in the brain it is as individual as each person.

Being a data driven teacher I tend to take note of little things like how many times she needs to try things before she begins to generalize the skill, how often she repeats the skills and how long it takes to master it. Maddi's pattern is about three days after introduction of the skill. That is where I get the "It Takes About Three Days".

Working with her body if she is shown what is wanted and you stimulated the correct muscles and make her do it first, she could then learn to activate that skill. It would take her three days of working on it until she could do it independently. That was the easy part. All of the other cognitive things you can't actually reach out and stimulate the muscle to create a response. It is much like entering a labyrinth and hoping you find the right pathways to follow. It is not an exact science.

In terms of Speech and Language, Maddi's work is two fold, the mechanics, and the cognition. She needs to work on the mechanics of speech to increase her volume and to lose the whisper sound that she has. Part of her whisper is rooted in the abdominal muscles needed for volume so PT is working on that with Maddi. It seems that she hasn't found those muscles yet but there is still the chance that there is actually some paralysis or damage from the breathing tube (intubation). It is too early to tell right now but it is definitely on the top of the watch and wait list.

As far as the cognition part she is doing pretty well but there is still the rate and appropriateness of speech. Right now she has no filter, meaning if she thinks it she says it. Teaching that filter is a high priority but must take an understudy role until she can slow her speech down and gain better understandability. Her brain is going so much faster than her body that the synchronization is off.

I kind of compare it to watching a YouTube video that hasn't buffered right. The sound is coming out good but the mouth is in a delay cycle. It isn't the same but she thinks it but by the time she gets it out her brain has moved on to the new topic. It makes her talk super fast and she drops words that she is thinking but hasn't spoken yet. It will come but it is a skill that she needs to work on.

We have been told so many times that Maddi's recovery is classified as miraculous. Maddi's memory and recall is pretty amazing. Her retention of previous skills and rate of recovery are remarkable That being said there is still some questions about some areas of cognition. I hate to even write about any of those deficits in question because we are too early in the recovery to really make that call.

Here is what my gut says on those skills that are lagging behind. She has really advanced skills for this early in the recovery so we want or expect to see all the connecting skills come at the same rate. I know that there is a direct correlation between skills and how they emerge but nothing Maddi has done followed an "average" trajectory so we can't assume that she will do anything by the book. So, I believe that perhaps those skills are just emerging at an average or less than average rate rather than the advanced one. I have no proof but I am also not one to solidify a deficit during a rapid growth cycle either.

We have two variables, time and injury. What we know about her injuries makes absolutely no sense in the context of what she is currently doing. So setting expectations and plans based solely on the specifics of the injury doesn't seem helpful. Time allows us to watch what Maddi IS doing and adjust the plan of care based on that. So right now time is on our side.

That is not to say that Maddi won't have deficits because I am sure there will be some however I don't think they will be insurmountable. Perhaps the cascading effect of emerging skills will follow a surprisingly different pathway. Maybe it is hopeful thinking but maybe not.

The brain is an amazing thing. The more you study it the more you understand how little you know. Based her injuries, scans and such she shouldn't be able to do most of what she is doing. I always knew she was brilliant but watching her relearn is fascinating.

As for new things is all about the subtly of the task, attention and impulse control. These are all a huge aspect of her recovery right now. She can read and comprehend but if you give her a test she will verbally answer correctly but mark something completely different. It really isn't that different from where first graders begin. She is able to count money and give change but over time becomes tired and starts making simple mistakes. Her ability to fight the impulses of just marking or answering the first thing to pop into her brain is so difficult. First graders often do that too but over time and persistence they can learn to control it and so will Maddi.

We are so hopeful but realistic about where we have been and where we are going. She describes her brain like this.

"Inside my brain feels the same but my body won't answer. My body needs to catch up."

That being said somethings may take longer than "Three Days" but as I always say in teaching. It takes as long and it takes and rushing it doesn't better the situation.

It is all about TIME and PRACTICE.