Assessments

So many interesting things happened this week that I feel like I could write forever! But I will try to keep it short and will talk about the most exciting thing for me: the assessments. In my opinion the re-evaluations are the best part of the job as you get to see all the hard work paying off. This week we did many assessments on new children as well as re-evaluated several people and modified their treatment plans. The assessment tool used here at Toñito for many of the children is the Milani-Comparetti tool developed in 1967. What I like about the assessment is that it is simple to administer, quick, objective, and the results are clearly mapped out on a chart where progress can be clearly identified.

If a child cannot lift its head then all the exercises in the treatment plan focus on this goal. If they cannot sit or stand independently, then all exercises focus on developing these skills. It makes prescribing a treatment plan simple when using this method. I am dying to know if the Milani-Comparetti Assessment is used in Canada. It is very old, however many theories used today are based on research from long ago.

One girl we assessed had progressed significantly since her last test and I have noticed significant changes in my short time here. She could not walk independently when I arrived and had severe “atetosis” (uncontrolled movements), but now she can walk independently, count out loud, and her atetosis have diminished by a lot making it easier for her to develop more precise and planned movements. Not all the cases we evaluated were as progressed as this, but it definitely makes for a great reward!

Language Barrier

This week I got to talking with my husband about the fact that, for the most part, Peruvians don’t tend to question authority such as the word of doctors, therpists, or other authority figures. I see this presented in therapy at Toñito where the parents and caregivers seem to take the therapists word for gospel. No one ever questions the exercises. At times when kids are screaming and crying uncontrollably, no one ever seems to question why and what is worse, in my opinion, is that no one ever bothers to ask if another treatment should be sought out. After 7 years of University I have been trained to ask questions and think critically so it is difficult to accept this way of thinking. This is something that is uncommon in Canada where parents often question exercises and challenge those who care for their children to the point that it is almost excessive and counterproductive to therapy for the children. I suppose that as with most things, the grass is always greener on the other side of the fence.

My lack of Spanish has left me frustrated this week more so than usual as I wish to have answers and explanations about many things. For example the therapist was explaining that every child at Toñito has to do arrastre, an exercise where the client drags themselves on the ground with their elbows (it looks like a soldier or warrior in battle). I asked the therapist why each kids does the same exercise if every child is different and has different needs. He said that every child needs to be stimulated by feeling the ground or carpet as it rubs against their body. I confirmed by saying (with doubt) “but do ALL children needs this stimulation?” and he said yes. This is when I wish I had the words to say that there are possibly other ways to achieve each patient’s goals (not that they have actual goals) or improve each patient’s physical ability and that this one exercise might not fit each person’s needs. I don’t want to express my thoughts unless they are clear and they don’t come off as condescending or rude, and I just don’t have the vocabulary yet to do so. There is also a girl that works with a couple of the children who gets a kick out of purposely saying something extremely quickly to me and then laughing about it after because I don’t understand her, which adds to my frustration.

On another note, my favorite little girl is now able to crawl on her own!!