Does anyone know about loose joints?

Discussion in 'General Parenting' started by tiredmommy, Jun 18, 2008.

  1. tiredmommy

    tiredmommy Site Moderator

    Duckie recently had a another Occupational Therapist (OT) evaluation at school because she tires so easily when writing. She doesn't qualify for Occupational Therapist (OT) (barely within normal limits) but has been asked to come to handwriting camp in July to help strengthen her up. The school Occupational Therapist (OT) said Duckie has loose joints. How would that affect her functioning? From what I could see online, it seems to go hand-in-hand with sensory problems.
  2. Sheila

    Sheila Moderator

    Can you tell us more? Is it related to low muscle tone?
  3. tiredmommy

    tiredmommy Site Moderator

    Apparently, yes. I don't have the final evaluation report yet, but the Occupational Therapist (OT) wanted to brief me and give info on the handwriting camp as we need to confirm her place by the time classes end on the 26th. She said she could see that Duckie is struggling, but doesn't meet the criteria for a pullout Occupational Therapist (OT) session planned in the fall. She understands my concern about where Duckie will be as her workload continues to grow. The camp, she said, is the district's answer for those kids at risk to falling behind in these areas but who don't officially qualify for services.
  4. Christy

    Christy New Member

    I've never heard of the term loose joints but I suppose that makes sense. My son has very poor handwriting due to fine motor problems and visual-spatial issues so I just wanted to share a few things that have been helpful.

    A slant board that allows the paper to be clipped at the top to keep it in place, special raised line paper that allows you to feel when the pencil hits the lines, a triangular pencil grip that is molded to the corect finger grip, and keyboarding practice so that he is able to make good use of the word prediction software he has an iep accomadation for.

    Hope Duckie enjoys "Handwritng Camp"!
  5. tiredmommy

    tiredmommy Site Moderator

    Christy, she's already referring to it as "summer school". :rolleyes:
  6. Sheila

    Sheila Moderator

    Anytime you get a "do not qualify" for a service and the next thing out of the mouth is an invitation for tutoring, camp, etc., a red flag needs to go up.

    The school district Occupational Therapist (OT) that did our difficult child's 1st evaluation was excellent. She recognized every problem in her report and gave me tons of stuff for home therapy, guided me on what he needed for his $4,000 gym, etc.

    Think about it. The problem is recognized, difficult child is invited to a camp...but she doesn't need Occupational Therapist (OT)?

    Get Thee a private evaluation via a Pediatric Occupational Therapist (OT) if at all possible. If difficult child tires easily now, imagine what's going to happen as more and more writing is required of her at school?

    PS: I would send her to the camp.
  7. tiredmommy

    tiredmommy Site Moderator

    We're planning on doing the camp and I'm already planning to bring the report to Duckie's well child visit in July to get an Occupational Therapist (OT) referral.
  8. Josie

    Josie Active Member

    Duckie isn't easily fooled! :D
  9. tiredmommy

    tiredmommy Site Moderator

    At least there is a ton of play time built in. The Occupational Therapist (OT) assured me that:

    1. There will be other girls there.
    2. They will get outside on the playground, dependent on the weather.
    3. Duckie will enjoy it and feel lucky to get to go by the end.

    Now to find out if the nurse will be there for the epipen.
  10. Fran

    Fran Former Site Owner

    Does she appear "double jointed?"
  11. tiredmommy

    tiredmommy Site Moderator

    No, she's not double jointed. Personally, I never thought she was all that flexible, lol! But the Occupational Therapist (OT) picked up on it during the evaluation.
  12. witzend

    witzend Well-Known Member

    It can be overstretched tendons. Dancers and gymnasts get it sometimes.
  13. smallworld

    smallworld Moderator

    My daughter A has loose ligaments or hypermobility. It doesn't affect her handwriting, but it causes a lot of sprained ankles during soccer season.

    by the way, my daughter M is a lefty and had difficulty learning cursive in 3rd grade (the teacher didn't understand she had to teach M differently). So I had M work with a private Occupational Therapist (OT) to learn cursive. The program she used is called "Handwriting without Tears," which also covers printing. It was excellent.
  14. tiredmommy

    tiredmommy Site Moderator

    She hasn't complained lately about any "dance injuries", but she did have some growing pains about a month ago. I am concerned that it can later lead to osteoarthritis.
  15. witzend

    witzend Well-Known Member

    Honestly, I would be concerned about OA, as well. I have a friend who went through a brutal year of chemotherapy for OA, only to be told that she had been a dancer and had probably over-stretched her ligaments.

    I had way overstretched ligaments as a kid, and as an adult they are still stretched in one way, but shortened in the other. It turns out that for me it was because of the Muscular Dystrophy. But that's a different story. It did lead to torn ligaments in my weaker foot that were really difficult to recover from.

    I hope that you and difficult child will find a good PT or physiatrist that can address this for you.
  16. Marguerite

    Marguerite Active Member

    Witz said earlier, "It can be overstretched tendons. Dancers and gymnasts get it sometimes."

    Dancers & gymnasts sometimes BECOME dancers & gymnasts BECAUSE they are hypermobile and can do things other people can't (such as the splits).

    OK TM, I'll try not to rabbit on for too long. But this is a hot topic in our house, especially in the last few weeks.

    First - we were told it's called hypermobility; it does lead to osteoarthritis at a much younger age; it's due to loose ligaments so strengthening exercises do zilch.

    easy child 2/difficult child 2 & difficult child 3 seem to have it the worst. difficult child 1 comes in close behind.

    easy child 2/difficult child 2 was complaining of joint pain from her early teens. difficult child 3 has been complaining of joint pain for a couple of years now. Both find they do better when the offending joint gets strapped (ankles, wrists). Both had trouble handwriting. difficult child 3 and difficult child 1 have both formally had permission to use a computer/keyboard for writing tasks for school. To get this permission (I think it's similar in the US) they needed an Occupational Therapist (OT) assessment - to determine the extent of the problem; to see if they could type appreciably faster and with less pain than they could write; to see if there was anything else that could be done to make it easier; to see if they would also benefit from extra time in writing tasks and exams.

    The keyboard assigned to them for schoolwork varied. In difficult child 1's day it was initially a school-based computer. Then it was changed to what difficult child 3 uses - an Alphasmart Neo. The one he uses belongs to the state education department. This apparatus is not much more than a keyboard with a small window at the top. It has 8 or 9 memory file possibilities. For an exam, all must be empty. The kid types in what he wants to write and he can check the text by scrolling through it in the little window (which shows about three or four lines of it at a time). difficult child 3 has had some quite long documents in there and could move the cursor freely anywhere in the document.

    The text goes in as text only and downloads via USB cable to either a Mac or a easy child. The computer picks it up as text only, you then format it on the larger computer (often the teacher does this) putting in student name, headings etc.

    The Alphasmart is very robust. When difficult child 3 left mainstream to begin Distance Education he kept the Alphasmart because Distance Ed is still state education. It travels in a briefcase or a document case usually with other schoolwork pages. If we're on the move (on holidays, for example) he can use it in the car to keep a diary, or to write his notes.

    Now, to connections - the three kids of mine with hypermobile joints are also my three Pervasive Developmental Disorder (PDD) kids. And yes, all three have sensory issues, but I think the connection is to Pervasive Developmental Disorder (PDD) rather than sensory. difficult child 3's best friend who is also high-functioning autistic also has hypermobile joints. So does a good friend of difficult child 1's - Aspie, with hypermobile joints.

    I was talking about this to the mother of a drama classmate of difficult child 3's, about two weeks ago while our boys were in class (the parents sit and chat over coffee, in the next room). This woman is also a doctor. We were talking about things our boys have in common and I mentioned how I've noticed that a lot of kids with high-functioning autism and Asperger's also seem to be hypermobile but I haven't found anything about any connections.
    She then mentioned a couple of names (I didn't have a pen to write it down) and said, "Yes, it is being researched; yes, there IS a connection."

    So, what do you do?
    First, don't try to strengthen ligaments. It can't be done. But some things can strengthen attached muscles as well as get the child into good habits. But don't expect miracles.
    We enrolled difficult child 3 in piano lessons. This taught him to bring his fingertips inward and not let them bend back.

    We also learned that the problem with handwriting was connected to the difficulty of maintaining control over the pen with fingertips that were 'floppy' and tended to bend backwards instead of pull in and grip firmly. This meant that to maintain a firm enough grip to control the pen, he had to exert more force. This forced his fingertips back a bit more, so he exerted even more force, and so on.
    So anything that increases the effectiveness of the grip is a good thing. For example, pens/pencils with squishy foam or similar that makes grip easier. Or those push-on pencil grips. Just about all the pens we buy now have silicone around the lower half so the fingertips make better contact. But his hand still hurts a lot after only a very short period writing.

    Now to something else we've seen - ring splints.
    On someone else's post I saw a mention of a girl's website which I followed and found this concept - I love it. Never heard of it before, neither had easy child (and as an Occupational Therapist (OT) I thought she would have).
    easy child did say there are ring splints made of plastic but they look very functional, rather than decorative. She thought the silver ones were a great idea. easy child 2/difficult child 2 said she wishes they'd been around when she was at school, she could have used them then. Now she said there's not much point because she uses her laptop computer all the time. I am going to investigate this for difficult child 3.

    Here is the link I found earlier on CD (I had copied it to easy child, which is why I could find it now).

    On this site there is a quote from Tony Attwood in which he claims that there is a link between autism and hypermobility.

    If Duckie is hypermobile, and it is her ligaments, then "handwriting camp" will do nothing to make it better. Hopefully though, they will notice the degree of the problem and the level of fatigue and will be able to make recommendations for her to use a keyboard, if the fatigue is causing too many problems. If part of their brief is to also train her to use a keyboard, then I'd send her. But if the entire aim of the camp is to help her write more neatly, I'd be asking the Occupational Therapist (OT)'s opinion of the value of the camp.

    Instead of going to camp, Duckie may benefit from a referral to a hand specialist for assessment for ring splints or some other option as a specialist determines. I would be nervous if the camp is the school's idea of solving the problem - because it probably won't, if all they do is work on their handwriting. Talk to people about their agenda, their expectations and just how much they can adapt depending on Duckie's specific issues with handwriting.

  17. SRL

    SRL Active Member

    Personally I'd consider any school Occupational Therapist (OT) evaluation as supplemental to a private assessment. difficult child was screened and found only to need consultation and 6 months later he was heading into serious sensory overload.
  18. tiredmommy

    tiredmommy Site Moderator

    Thanks, Ladies. The problem with Duckie is that she is ever-so-close to being out of normal limits. She either does better than expected, has adapted, or just barely behind what's normal. It makes for a very interesting child. I've always felt her myriad of problem (popular but struggling socially, slight gait issues, anxiety issues, literal thinking, even her allergies means she's somewhere at the slightly impaired end of the autistic spectrum. Unfortunately, the pieces don't mesh together to form a full diagnosis but more of a syndrome of issues. I doubt the diagnostic criteria will catch up to her in her childhood. So we do the best we can addressing each issue as it comes it.

    All screenings/evaluations up until now (school & family doctor) have shown no need for further Occupational Therapist (OT). I trust our doctor. I'm sure I will walk out of our July appointment with a referral to an excellent pediatric Occupational Therapist (OT). I'll be asking around for names in private practice. An Occupational Therapist (OT)-related diagnosis would end being only her second diagnosis, the first being ODD.
  19. tiredmommy

    tiredmommy Site Moderator

    I forgot to add: the camp is designed to help strengthen the muscles, not the tendons.
  20. Marguerite

    Marguerite Active Member

    Chances are, the muscles are fine. With hypermobility it's generally the tendons that are loose.