Here's a snippet from the Botox assessment. This is what Dr L wrote in his notes about Isla - full of lots of technical stuff, all of which is completely lost on me, but some others may find it useful. I thought I should pop it on here, given that I will no doubt lose the actual piece of paper it's written on. I haven't received a letter like this before, so it's interesting to read all of this, even if I don't understand it ;)

Isla's OT reported that with her Peabody Developmental Motor Scales assessment of her fine motor skills, Isla scored well within normal range. Isla has not yet developed hand preference but prefers to use her right more than her left. There has been a significant decrease in mirroring of her hand movements and there is less tremor.

Michael has also been seeing her privately. He notices internal rotation, particularly of the right leg with the need to circumduct the right leg for clearance of the left. This improved after serial casting to her right leg for 2 weeks in early February 2009. Her mother also agrees that Isla was walking much straighter but the effect of this was not sustained.

Indeed today when Isla walked, she was leading with her right pelvis so the left pelvis was retracted. Her foot progression angles were + 20 degrees on the left and - 40 degrees on the right. Initial contact was with the right forefoot but she did achieve heel contact on the right in mid-stance. At times, she had left forefoot contact initally as well. She had circumduction of the right lef to assist with clearance. Isla was slightly crouched by up to 10 degrees at the knees during mid-stance.

Isla was demonstrating increased tone in the right gracilis. Passive hip abduction in flexion was approximately 45 degrees on the right and 50 degrees on the left, and in extension approximately 25 degrees on the right and 30 degrees on the left. There was internal rotation bias at the hips in extension to approximately 80 degrees on the right and 60 degrees on the left, with external rotation being approximately 30 degrees on the right and 40 degrees on the left. there was no excessive tibial torsion. Foot-thigh angles were + 20 degrees. Gastrocnemius length bilaterally was approximately + 15 degrees with the initial catch at - 15 degrees on the right and - 10 degrees on the left. Soleus length was + 25 degrees with initial catch at +5 degrees on the right and + 10 degrees on the left. There was sustained clonus bilaterally. Popliteal angles were approximately 20 degrees with no catch.

Two weeks ago we had an OT assessment with Mel at the Hospital. It was purely to see where she's at.. Here's the report...

"Isla has been attending Occupational Therapy since November 2006. Her presenting problem related to mirroring of her hand movements. She has attended regular appointments on a monthly basis in which she has been provided activities to decrease the presence of mirroring her hand movements.

A review assessment was conducted today to determine her level of function for her fine motor skills.

Results of Assessment
The assessment conducted was related to her motor skill development. Isla was assessed using the following assessment tools:

* Parent Questionnaire
* Peabody Developmental Motor Scale (2nd Ed)
* Non-standard observations.

Assessment Results
Peabody Developmental Motor Scale (2nd Edition)
The Peabody Developmental Motor Scales-II is comprised of six sub-tests that measure interrelated motor abilities that develop early in life. The assessment measures both gross and fine motor skills, however for the purpose of this assessment, only the fine motor component was utilised. Isla achieved the following results:

Component Standard Score Age equiv.
Grasping 9 34 months
Visual Motor Integration 9 34 months

* Grasping
Isla swapped hands throughout the assessment, Her mother reported that she predominately uses her left hand for feeding and ball skills, however swaps for fine motor activities. She held her pencil with a quadripod grasp (Placed her middle finger on the pencil as opposed to resting it underneath)

* Visual Motor Integration
Isla was able to build a tower of 10 blocks. She also attempted to imitate building structures such as a bridge and a wall, however demonstrated difficulty with copying the structures exacrtly. She was able to copy a vertical and horizontal stroke and a circle, however was unable to copy a cross. She has not yet learnt to grasp scissors with one hand and was unable to snip the edge of the paper. She was able to thread beads onto a string and laced a piece of string onto a lacing card.

Recommendations
1. It is recommended that Isla continue to attend Occupational Therapy to monitor her scissor skills development and hand preference".

So there you have it, Isla is only "delayed" by 2 months with fine motor now which is unreal! We're trying to work out which hand she'll write with. She's always been prone to using her left hand for feeding, throwing etc, and kicks with her left foot too, but has more control and uses an almost proper finger grip when drawing with her right. We need to build her stamina with the one hand, so in effect, stop her from switching hands half way through drawing. We stick a sticker on the hand she uses first and tell her this is her drawing hand, and constantly make sure we keep on her about this.

By the way, the monkey is 12kgs now :)