Cast change

Yesterday, Ella had her cast removed for the first time. It was a very strange experience. One of the co-directors of the clinic came to our apartment to remove the cast as she'll do once a week, and let Ella bathe and play for an hour before putting the cast back on. They'd prepared me for the possibility that Ella's skin would look dry and that she might respond in a confused way to having her cast removed. I'd read in the study that children don't object to having the cast put back on, and that some kids actually ask to have it put on. It's hard to believe until you actually see it.

Dr. DeLuca cut the cast off with scissors while Ella watched with curiosity. It takes two people to pry the cast apart, so Sarah helped with that. Ella seemed confused to see her arm and stared at it, turning it over and moving her fingers as if she were studying an object apart from her body. She grumbled a bit and was generally not enjoying the experience. I bathed her and she played a little in the bath, using her right hand to color with crayons, and more or less neglecting her left, but also not using her right with as much vigor as usual. Her arm looked normal, no dry skin or signs of irritation. We encouraged her to play after the bath but she was so distracted by the sensations coming from her right arm, she wasn't very interested in anything else. She kept wiggling her fingers and moving her arm across surfaces like a windshield wiper. She wasn't crying, but it wasn't the easiest thing to watch.

Soon it was time to put the cast back on, and the moment she realized what was happening, her whole body relaxed. She sat on my lap while they adjusted the cast and re-wrapped it in the color she chose -- "lallow". I put her shirt back on and she was immediately happy again and launched into playing. It was the most bizarre experience.

Some constraint-therapy programs involve taking the cast off every day after the session is over. This seems appealing, to be able to bathe your child without hassle and let them sleep without it. The folks here tend to believe that a method like that causes undue stress because the child never becomes totally accustomed to the cast as part of her body. Ella has completely ignored the cast since the second day. It's part of her life for now, and she is totally focused on learning to do things with her left hand, not waiting for the hour of the day when she suddenly has use of her dominant arm again. Therapy isn't therapy to her, it's just life. It takes place here in her home as a normal part of her day. It's not an event that she learns is difficult and can just wait out. It's every hour of the day when she wants to do something, conditioning her to try with her left, and that's the beauty of it. The reason we're here is because we believe in this therapy when it's executed in a method that makes it blend seamlessly into everyday life. So far, it's having great results.