RETURNING HOME...

Thomas returned home shortly before Christmas after completing ten weeks of therapy, including sixty-five hyperbaric oxygen dives. He is happy to be home with his family and enjoyed attending the holiday gatherings (he now asks to go to “parties” all the time!). He has begun to attend his local therapies and will continue until March, at which time he will return to Ability Camp for more sessions.
Thomas received high marks upon leaving Ability Camp – his progress was summed up as “exceeding expectation”, which is always encouraging to hear. No surprise that staff were most pleased that he overcame his resistance to the program (after several weeks), and ultimately showed high participation and relying on much less guidance. I witnessed this our final week during an observation day, and was surprised at how much he seemed to enjoy himself, answering questions, blurting out “fun” after a song and even completing some of the lyrics. He was definitely one of the more social in the class and seemed to respond well to the routines, maneuvering around on his own during the different exercises.

Throughout Thomas’ therapy, we were most impressed with his added communication skills and interaction with other children and adults. He was and continues to be much more focused on whatever task he is occupied with and is initiating his own activities and goals. He is becoming more of himself, determined to say and do what he wants, despite being limited in his abilities. When he sits on his own, he is frequently reaching for things (within and out of reach) and explores whatever he can – he is not deemed to be still. He is finally able to sit on his own in the bath and when it’s time to leave, he maneuvers to the plug to pull it out. He is slowly coming around with his toilet training and beginning to initiate trips to the potty. He is clearly making his way upwards, and it’s so much more apparent to us when he returns home from Ability Camp. We believe the treatment to be very worthwhile and are committed to continue in 2008.

Completing ten weeks of intensive therapy is never easy to accomplish. It takes months of planning and many sacrifices, not to mention the ultimate physical and mental effort from Thomas. While the rewards continue to motivate us, we recognize that none of this would be possible without the generous financial support of family, friends and community who have allowed Thomas the privilege to participate in this opportunity.

Thank you to all the caring and generous donors who supported Thomas during his trip to Ability Camp!

BEGINNING SESSION 2…


We have now begun session 2, once again a class of 8 children. Three new faces, although 2 repeats (Eva, 7 who was here with us in February and Ilhan, 10) which leaves a single newcomer and the sole US resident, a 5 year old boy Dhevyn from Nevada. We said our goodbyes to Jason, Cameron and Paul (from Trinidad) and the 5 remaining moms hosted a small cocktail party prior to their departure.
At one point, one of the moms piped up and said "we should have done something like this sooner" and about four us looked at each other and replied "we have!” Since I have been here, the TV room is rarely used for watching, TV - there is far too much conversation to be had.

As always, there is one child that stands out to me more than others and this time it is Ilhan (Illy, as she likes to go by). She lives in Toronto and born to a mother from Somali, and is an identical twin. At 3 ½ years, she suffered a stroke and was not breathing for 27 minutes. For over a year, she was in a vegetable state and not given a very good prognosis. Her parents decided to discharge her from Bloorview Kids Rehab because hope was not on her side (Bloorview tends to work with kids with more potential) and did their own therapy at home – which paid off immensely. I really admire her mother's intuition and perseverance, I wonder how many of us would have held out that long, all the while feeling completely devastated at the outcome of such a tragic and shocking incident. I imagine that she must see Illy’s loss through her other child and have such vivid memories of her bubbly little girl, who apparently was so bright and advanced. Illy is one of eight children, and I can’t help wonder how her mother pulls it off…

Back to Thomas, who has thankfully turned a corner and doing extremely well in class. This change really took off during the middle of week 5 and I didn't quite believe it until it continued well into week 6. In between, he and I even drove home for a weekend, which normally would have set him back. If it wasn't obvious in my last blog, I had serious concerns as to whether or not he was going to perform at all. He finally adjusted himself and is now cooperative in all his tasks (some days receiving double stickers, which is awesome) and today used the word “fun” and “class” in the same sentence. He has also stepped up a notch in his toilet training and now wears training pants and frequently initiates trips to the potty. Much to my delight, he has also become quite social with the other children (mostly the girls), playing and sharing baths. Even during oxygen therapy, he has begun to amuse himself and play with other children, from time/time glancing at the TV. I am feeling very optimistic about the remainder of our session and I know staff must be just as relieved. Thomas is an ideal candidate for double sessions - I would have been so crushed to leave after 5 weeks.

Speaking of leaving, Adrienne and I are heading off to the Caribbean on an 8 day cruise, joining my family in a dual celebration – my sister Jayne’s wedding and my parent’s 50th wedding anniversary. Rob will be taking over duties here at Ability Camp and we may even catch an entry of his in the next blog…

For pictures taken during Thomas’ first 5 weeks, cut/paste:
http://www.kodakgallery.com/PhotoView.jsp?collid=36664016506.696338333306.1197492036556&photoid=885168333306&folderid=0&

WINDING DOWN WEEK FOUR…


Our 2nd week began with less chaos, and by week 3 people were really getting to know each other. Evenings especially were becoming much more social than I recalled from previous sessions. We were also becoming familiar with the few visiting spouses (two and one recently separated ex) and siblings (just Adrienne). One grandmother is staying for the entire 5 weeks with her daughter and 2 grandchildren, all under one room. The challenge of co-existing within a large group in a confined area is that privacy becomes limited and you sometimes feel that you are living life in a reality show. On more than one occasion, there have been jokes about who needed to be “voted off the island”. Overall, our group is getting along extremely well…

Weekend trips into Picton are taking place again – the biggest errand of course to the laundry mat. While Thomas makes up for lost time with Dad - mostly in the chamber (2 dives at 90 minutes each), Adrienne and I venture out just the two of us and in between wash cycles we grocery shop and hit our favourites (me, The Coffee Bean - hers, Giant Tiger). Later in the evening, Rob and I spend our time together, heading back into town to our favourite - The Barley Room.

It took us 3 weeks to finally round up a foursome for cards, Angela, a seasoned euchre player and Jo-Lynn who claimed to be really rusty and who Rob decided would be best partnered with me. Unfortunately for Rob, we ended up being a force to be reckoned with and so the weekend challenges have begun…

By the end of week 2, some type of virus had spread through the camp and children were suffering from loss of appetite, nausea and diahria - Thomas included, without the nausea, so he luckily did not lose class time. This did however take a toll on his energy level and he was not in top form for about 5 days. Kids catching and spreading germs is a big issue here and can really spiral out of control. Unfortunately very little can be done in a community type living environment.

Before catching the bug, Thomas was progressing well, gradually become more cooperative and less vocal during class. His vocabulary was and continues to grow and he was increasing his mobility skills. One day as we were walking back to our room, I observed that he could stand with his walker on his own, quite by accident as I moved an obstacle out of his way. The following day in class, he was expected to use his kaye walker without support at his hips, using a large 2 x 4 board at his feet to prevent criss-crossing. Kriztina, his teacher explained “he can do this now” and I steered him through 3 times with amazement. This is a big leap in terms of his movement towards independence. Unfortunately, his illness struck the very next day and he is only now beginning to reach this level of control, but now a very realistic goal for him.

Another fairly significant incident took place mid-way through the 2nd week. Thomas’ resistance to the classroom reached an all-time high. While a few of the moms entered the classroom to help with individual programming, Thomas realized that I was not one of them and had an inconsolable meltdown. The lead conductor, Tunde, decided to take him outside with his walker and I could hear his screams (closer to a roar) from my bedroom window. At one point, he bit Tunde on the arm. His screams continued into the next segment, (fine motor/speech) and Thomas had to remain in the gym so he would not disturb the others. During his time-out, Larry the husband of one of the stroke patients (who is quite fond of Thomas) spontaneously entered the gym, approached Thomas and asked why he was crying – Thomas replied he “wanted mom”. Larry was immediately asked to leave to which he stated, “Nobody cries like that unless they are being mistreated” then slammed the door. This incident quickly escalated to the owner Kevin’s attention and caused a meeting between all parties including Thomas and I. Kevin took the matter seriously, explaining to Larry the format and objective of the class, the educational process involved with children with high needs and to essentially quash the perception that abuse takes place in any form at Ability Camp. He also spent a fair amount of time describing childrens’ resistance to the program and then moving into behavioural problems associated with children with CP. I listened and sympathized as Kevin protected his staff and business and actually felt bad for Larry, who was visibly uncomfortable and who I knew ultimately reacted out of concern. And although Tunde did at one point highlight that Thomas had made gains with his behaviour, it stuck in my head just how much attention and control Thomas really did command. As we then entered the oxygen chamber I observed how every minute of my time had to be spent on entertaining Thomas or else there was an immediate backlash. Putting him on the potty, he would always call out “done” even though many times he was not – it was just to get me back in the room. During mealtimes, it was almost impossible to finish my meal or clean up afterwards, because he would not be able to sit and wait. It was as if the whole incident made me open my eyes to the fact that on top of every single need Thomas has, he was all of a sudden more challenged with this new behavioural piece, and I suddenly felt as though I had a child with insurmountable needs. By the end of the day, I finally had to concede that I had a more challenged child than I had realized and I took it hard. It was really helpful to be able to discuss this with Deb and Jo-Lynn, who could relate and be supportive and who rationalized the whole emotional dynamics to CP that most people don’t realize. Kevin and I also recapped over the weekend - not only has he seen so many kids over the past 12 years come through his doors, but he also has a 22 yr. old daughter with CP so he always adds a valued and credible perspective. He reinforced that children with physical disabilities are so much more dependent on their parents in general particularly because independence is so much more out of reach and parents end up doing more for them. He stressed that the purpose behind Conductive Education is to move away from that, and push kids to reach and surpass their potential. He also spoke quite highly of Thomas’ progress and while he used Thomas’ behaviour to support his argument with Larry, I think he felt badly that it caused a ripple effect of another kind. Nonetheless I was determined to make Thomas’ behaviour a higher priority and become a lot less tolerant of his screaming/crying. Besides being completely unpleasant, it is a drain on his energy that could otherwise be spent on learning. When I observe the other children in his class, it is heartbreaking to see that some don’t have the ability to swallow, keep their head up, raise their hand or even see. Some are athetoid – their bodies have involuntary movements, so they have to wear arm and leg splints to gain control. I then look at my child who comparatively has so many skills and potential to learn yet chooses to spend his time and energy trying to control the people around him. Somehow I had to make him realize that this is no longer an option for him and so this has become my new focus.

Aside from all that... this past weekend the stroke program winded down and we said good bye to 3 families as well as the two children who were receiving hyperbaric oxygen treatment. A total of 12 people vacated the building so our space has freed up substantially.

The camp also went all out this past Wednesday for Halloween, staff arrived at 7:00 a.m. in costume and decorated the classroom in true theme. During individual programming, the children dressed up and all headed down the dark pumpkin-lit hallways in procession and trick/treated on our bedroom doors. Later that evening Tunde invited everyone back to her home for more trick/treating and made a big batch of her infamous margueritas. Needless to say, it was a memorable Halloween Day for all of us!

WE'RE BACK!

We have now arrived and settled into our 2nd trip to Ability Camp. I could tell right away that we were returning to a good group when a toy truck greeted us on our bed with a note from 5 yr. old Adam Goodwin, welcoming us back...

Adam would be one of 7 returning children, out of a class of 9 (including one from Trinidad!). I was among familiar faces, 2 moms I had met from our prior visit and another man and his wife from Alaska who had been here for the stroke program in January. It was easy to mix with this crowd and despite the busy halls, kitchen and washrooms (40 of us divided into 14 rooms) our individual stories would spill over in the coming days, and despite our differences, we all shared a common goal. Sharing is an added bonus here and I always find it refreshing to learn from others and to appreciate how people overcome such huge obstacles with such determination and optimism.

The children here are overall quite challenged, Thomas is the only one who is verbal (and limited at that) and with exception of Adam who has just learned to take steps independently, the others have little mobility. There is a 3 year old girl named Kamryn here from Thunder Bay who has survived a near-drowning experience -always a difficult story for me to swallow, yet her bright eyes and smile and the huge progress she has made in the past 14 months illustrate her survivor skills and promise for good recovery. I especially loved hearing the success of the fundraising efforts - her community raised over $100,000 in 4 months, including support from one-time resident Paul Shafer and boss David Letterman – very deserving and will take her far.

The session started on Thanksgiving weekend so Rob and Adrienne joined us for the fist day to witness the class. Parents in this age group are only permitted to sit in during first day and then only invited back to assist with individual programming twice weekly and during snack another 2 times.

Thomas showed his resistance to the class and continued to scream and cry until Friday, when he finally realized that this was not going away and possibly could be enjoyable(?). The first day on his own, I greeted him during snack with a tray of his favourites (cookies from grandma) and his swollen eyes let out another burst of tears. Each day, he would cry less and participate more – including pointing and asking for his walker and to his art on the wall.

He is very popular with the seniors here for the stroke program (3 couples) who greet him in the hallway and during meals and he often points to the oxygen chamber and says “kawa” for Kevin. The chamber is still not a favourite for him and now that he has more words, he points to his hood during dives and constantly requests “off”. Thankfully he has learned to yawn on command, which helps to clear his ears.

All in all it was a rough week for him, lots of change and due to scheduling of the dives, he had to discard his nap. I am however noticing his speech is much clearer already and he is much more forthcoming with conversation. He now sleeps in a single bed and enjoying the added space. On a couple of occasions I have walked in and noticed him wresting with his pillow and ending up at different ends of the bed throughout the night. Our room is small and esp. crowded on weekends but I placed mats in the middle so that he can engage in daily floor play, which helps keep him active. He is initiating more trips to the potty and placing his feet flat on command. Still showing high muscle tone in his legs, and after speaking to parents who have employed this with their kids with success, I am now considering Botox as a treatment when we return home (which up to now I had been closed to).

The weather is still warm and dry so when possible we are getting out to the playground at the back, and some of the siblings join us (there are four). It’s busy yet at times quite fun and Thomas seems to not be missing home, yet.

HUGS AND THANKS FROM THOMAS

Thomas returned home March 7th after spending 10 weeks at Ability Camp. The experience was lengthy and exhausting yet rewarding and definitely worthwhile. The knowledge and skills that he gained are applicable to his life back home and he is much more settled and happy.
Thomas is now using a Kaye walker with assistance, is able to sit with less support, can transition from a prone position to a crawl and responds to instructions that allow him to maneuver with greater skill. His communication has improved significantly (he now says his name!) and he is becoming a social little boy.

Overall he is more functional which is critical to his independent future.

We would like to express our heartfelt thanks to all the family, friends and community who provided the financial support to allow Thomas to participate in this life-changing experience. Together, you allowed us to realize a dream to bring change and hope to Thomas’ challenging world.



DONORS TO THE HOPE FOR THOMAS FUND (2006)

Anonymous
Air-Time Express
Bali International
Christine Bourke and Paul Lewis
David and Cindy Bourke
Stellina Bourke
Cynthia Boyne
Canadian Centre for Occupational Health and Safety (Employees)
Don and Ann Canning
Elaine Canning
Jayne Canning
Jennifer Canning
Paul and Brenda Canning
Classic Care Pharmacy
Ian Clyne
Julia Dilullo
Dophes Ltd.
Echlin Investment Management
Ex-Kirkland Lake Goldtimers Hockey Team
Keven and Suzanne Fischer
Peter Gnish
Patrick and Leslie Gorman
Macsan Air Cargo
Marina Pharmacy
Mulvihill Drug Mart
PLASP
RC Design
Runnymede United Church Congregation

FUTURE TREATMENT

Thomas will be returning to Ability Camp October 2007 to attend ten weeks of intensive therapy – therapy proven to successfully improve the many symptoms caused by cerebral palsy. The cost for this treatment is expensive ($18,000 each visit) yet effective, and particularly beneficial when applied during early years when intervention is critical to teach the brain new pathways.

We look forward to sharing the outcome of this experience with you.

EIGHT AND A HALF WEEKS

There has been a lot less motivation to write since I am now so restricted from Thomas’ therapy, with a lot less to observe (and maybe just getting a little lazy). Thomas is learning to get by without me for up to 4 hours - this is proving to be a learning curve in itself and one that he struggles with less, but still struggles esp. during separation and the beginning of the program. I have discovered that leaving the kitchen area (which is situated outside of his classroom) is the best coping strategy. By the time I visit Thomas during individual programming or at times not until lunchtime, he is very much at ease, and very social to be with. He knows all the children’s names and attempts to say them, he points to his artwork on the wall and to the progress charts. The progress charts are really well done, they are themed differently each week and chart each child’s progress in terms of performance and cooperation. Last week, the theme was transportation and there were different sceneries on Bristol boards (i.e. boats in water, trucks on road) where each child’s name was attached to a vehicle and placed along the route accordingly. I was surprised to find Thomas consistently in 3rd place.

During this session, we received visits from Jayne and Greg (who were briefly passing through on their way home from Ottawa) and our first overnight guests Suzanne, Keven and Alexandria. We booked an apartment at the Picton Harbour Inn and while it snowed and snowed, we spent a whole lot of time indoors playing cards. Adrienne also appreciated her cousin’s company. It was great to have a little escape from camp and spend some quality time with family. The following weekend, Cynthia treated Rob and I to dinner in town - lobster at Currah’s which was delicious!

Even after almost four weeks, it continues to be very easy living with the other parents. We all continue to get along well – there is a good ratio of vehicles, so more comings/goings and less congestiveness. Thankfully the mom with four kids (Helene) has learned to adjust probably as much as we have had to adjust to living with her kids. The food cupboards are all safety locked as well everyone locks their bedroom doors (on a couple of occasions, with keys inside). One morning while Thomas was still sleeping her son Marcelle snuck into our room and crawled into his crib - about twenty minutes later, he climbed onto a chair and put his face right into our omelet. He needs to be watched constantly and I had to remind Helene of that. I don’t envy her being here with 4 kids, it would require me to be constantly on top of them, which she seems to struggle with a lot. Aside from that, there is lots of socialization within the camp… Kelly from Oklahoma does a lot of “home” cooking and has invited us to sample her specialties like deep fried pickles and homemade enchiladas. Last weekend she also baked a humongous butternut pecan cake for the entire camp. One of the grandmothers arrived (her daughter had to return to work) and she happens to be a fitness instructor and has motivated me to finally devote some time to exercise. She also enjoys drinking red wine, so we are spending even more time together. Robin’s husband Chris is here for a week, so we now have two men who are still largely outnumbered but manage to hold their own (and add a lot of levity to the atmosphere). Today, we are holding a potluck dinner which is turning into a small feast…

I am also spending a lot more time in the TV room and really appreciate the depth of conversations, which probably comes from being with an older crowd and just having the wisdom of parenting kids with special needs over a longer haul. There is a mom here who filed a human rights complaint against the government of Yukon, based on a wide discrepancy in funding awarded for early intervention to kids with autism vs. kids with CP. I remember learning about the new funding on the news (somewhere up to $60K per year, per child up to age 6) and feeling completely outraged that nothing even close was in place for kids with CP. I have now been inspired to take some action of my own – advocacy is an important piece to the management of a child’s disability. Unfortunately there is still a lot of ground to cover, yet the challenge is finding time within your day which is so consumed in your child’s care – which is why early intervention if so critical!

I am now in full downsizing mode, trying to hang on to as little as possible to prepare for my drive home. I cannot wait - eight and a half weeks has been a long time to be away from home and family, especially for Thomas. He is continuing to increase his walks up and down the hallways and stops at most doors to say hello - when he passes the TV room he is reminded of his dad’s departures and announces “Hommmme”. It has now become his favourite and most commonly used word. It will be difficult to challenge Thomas to walk the distance he has worked up to given our household layout and I know that a move is imminent, esp. if we want him to use his walker. News arrived this week that Thomas’ new plinth table, grasping bar, stool and walking ladder are now complete - thanks to Uncle Paul, and Uncle Keven has begun to build chairs and a foot stool. Thoughts of all the changes to implement at home are consuming my mind. It is definitely time to prepare to shift gears…

SESSION TWO

Our second session began with a sense of déjà vu… the arrival and settling in of new families. We drove back to camp through the tail end of a major snow storm - luckily familiar with the surroundings as all signs were covered with snow. We did however have the added anxiety of an existing crack in the windshield which began to spread from one side to the other. Adrienne was extremely nervous about that and another mental note that I needed a new car!

When we finally did arrive, the camp was unfortunately completely locked up, so we had to sit in the storm for another 45 minutes. A van immediately pulled up next to us – it was a family who had driven up from Oklahoma, and spent several days getting here. This would be their daughter’s sixth session. Shortly thereafter, the camp designated cab driver (Dot) appeared with another mom/son from California (welcome to Canada!). Dot was anxious to drive back to the airport to pick up another family from Edmonton – a mom and her 4 children! When the doors did open up, it was a hussle/bussle of activity and lots of snow in the hallways. Rob was anxious to get back to Toronto, thankfully the 401 was now completely opened.

It was easy to tell apart the returning families from the newcomers and it made a big difference in settling in. Including Thomas and I, there were four families who had attended the camp previously (the other 3 having undergone 4 and 5 earlier sessions). The first difference that struck me to being amongst 3-6 year olds, was their mobility (half of them were walking independently with walkers or canes) and their ability to speak (about half again). There were nine children in total; 4 boys, all happening to be on the younger end - age four, and five girls - who all happened to be six.

This time around, Thomas and I were assigned (at our request) one of the larger rooms which happened to be at the end of the hallway, farthest away from the kitchen and the noise. Thomas and I (and Rob/Adrienne on weekends) would have to get used to sharing a room, but a good trade-off for location and noise control. By dinnertime I could tell that we had a very different group, not just because we had repeated families, but because the parents in general were much more mature and more cohesive together. I was told that our earlier session had been the worst group, so we had an immediate advantage. I sat with Robin who lives in London, Ontario and we swapped stories. She too, had her share of experiences with groups who didn’t mesh too well. While we were chatting, a dad from the outskirts of Sudbury arrived around 7:00 p.m. (there seems to be always be one token dad) with his son Alex. They had left their home at 10:30 a.m. and for him to say “this is really in the middle of nowhere” pretty much summed up the location of the camp!

Later that night, I tried unsuccessfully to use my computer and unpack while Thomas was asleep. After waking him up for the third time, I decided that if I couldn’t beat him, I may was well join him and gain a lot of extra sleep in the process. Another big difference with this group is that lights are out and bedroom doors closed between 7:30-8:00 p.m.

By 10:30, the family from Edmonton must’ve arrived because one of the boys opened our bedroom door and came inside to say hello and to play. I immediate shushed him out and locked the door. The following day, I would find Thomas’ stroller halfway down the hallway. This would be an early indication that the kids – in particular the 4 year old boy Marcelle, would be a little too invasive for everyone’s comfort level. They unfortunately became very quickly, very unpopular among the camp.

The following day we gathered for therapy and the parents went through the entire program with the conductors. Thomas was more unsettled than the previous week and I was a little worried. Kristina noted that he was not as bad as the first week of the earlier session (she always looks on the bright side). At the end of the lunch, Tunde (the leading conductor) announced that the following day parents would not participate in the class at all except to make periodic appearances during snack time and individual programming. I was surprised that this was happening so quickly and thought very ambitious, but was reminded that they’ve done this many times and I did trust their experience, I just worried about how Thomas would cope. I offered to help with Thomas’ therapy more often than twice a week but was turned down. I knew that he would have difficulty, as well, I kept me plugged in. There were a couple of other moms who had concerns and one ended up accompanying her child one more day. Crystal (from California) was especially having difficulty settling in and was having several meltdowns throughout the day. I tried to encourage her and throughout our dialogue began to wonder whether this type of therapy might be for everyone? At one point while she was commiserating about all the changes/challenges, she blurted out “and then I was getting groceries and people were trying to steer their shopping carts in the snow!!!” I knew she just had to give it more time…

The following day, Thomas let the whole camp know that he was not amused about being on his own. When he wasn’t moaning “mom” he was screaming at the top of his lungs. This carried on until 10 a.m. and was only reduced to a lower and more sporadic level after that. A few of us tried to keep a watchful eye on the classroom but our peering efforts were quickly caught on to and the doors were locked. I, in particular was scolded for talking too loud in the kitchen because it was making Thomas upset. The Hungarians run a tight ship around here!

I had to redirect myself to a whole new agenda – ME TIME, which was somewhat difficult to do. I immediately focused on settling into the new room, updating this blog (just not posting it) and doing something that is a true luxury – having a morning shower and actually washing my hair! I kept checking the time to make sure I wasn’t running late and was so surprised with how much time I had at my disposal! I found myself doing new things like having coffee with other parents, chatting with staff, planning ahead and just getting things organized. This took the entire week to get used to and many times I would find myself not knowing what to do with myself.

I decided to give the chamber a pass on the first day, it was running into the dinner hour and I wanted to get Thomas outside. Had we not just completed 40 hours, I might not have been so lenient, but I wanted him to settle into his new routine. He was not as relaxed in the chamber and this carried on throughout the week; I had to really work on keeping him entertained. By Saturday, he and another child Kiera were sick and unable to keep any food or water down so we kept him out another 3 sessions. Illness unfortunately is difficult to control in the camp - another girl Eva had come down with tonsillitis on the 2nd day and had to miss 3 days of therapy.

If there is one child that stands out in my mind in this session (besides Marcelle) it would have to be Mackenzie from Ohio. I noticed her right away being carried in by her father. A big 6 year old who also didn’t speak and have use of her hands. She was very pretty and didn’t have any of the classic facial expressions of CP that would otherwise accompany that many motor restrictions – rather, she appeared monotone with a focused gaze. I waited a few days for the information to be shared and I was shocked when I learned that she had been a victim of a drowning incident just 2 years earlier. I was suspicious when I overheard her mother speak about how precautious she was, using words like Cornocopia at age 4, so I finally enquired. Her drowning accident happened during daycare at a local Y while her mother was doing civilian work in for the US army in Baghdad. For days, I was having trouble trying to grasp how anyone could cope with the trauma of that accident, and just feeling for her and her family. They all had vivid memories of her as a healthy child and it had been taken away from her so drastically. I felt devastated for her, and while tragedies are known to us throughout media etc. it is very different to see the effects of it up close. Mackenzie would be the one that I would hope and pray for the most for some type of miracle and I kept watching her for some spark to ignite.

Thomas survived his first week of session 2, a little weary from being sick and from screaming and crying so much. From repeated exercises, he now knows his left from his right side. He is able to walk with his walker down the hall to our new room, which is approximately 140 feet from the kitchen (although sometimes he resists because he is exhausted). Speaking of which, his bedtime is now closer to 7:30. His stretching is being done both at night and first thing in the morning and his tone is becoming better and better.

Pictures of Session Two to follow…

WEEK FIVE

We ended our first session a bit worn out but with lots of progress to show for. On Wednesday there was no class, rather there were exiting interviews and “home plans” to communicate to all parents but me, since Thomas and I were staying on. During the free morning, we drove into town for a scheduled chiropractor appointment. We came back to meet with Christina and exchanged feedback – mostly on the receiving end. A summary of Thomas’ accomplishments include:

∙ Added flexibility
∙ Improved head/trunk control
∙ Improved attention span
∙ Acceptance to following instruction
∙ Learning to sit on a stool, supported with his arms by side
∙ Improvement in manipulation of activities (this is actually a big gains)
∙ Improvement in separating legs and putting heels down while walking
∙ Learning to use a Kaye walker with assistance at hips
∙ Improvement in advanced walking tasks (ie side stepping, parallel bars, stairs etc)
∙ More vocal in classroom (and not just screaming!)
∙ Improvement in use of potty
∙ Development in social skills

All in all a pretty accurate and lengthy list and definitely reason to carry on. Our next day ended with a graduation where Kevin handed out certificates and medals. We were then treated to a homemade Hungarian goulash lunch, which was delicious.

The final day was a shortened class with no hyperbaric oxygen since families had to leave and the camp needed to undergo a thorough clean-up for the next session beginning on Monday. Unfortunately the 401 was closed due to a severe accident and it created chaos for everyone. We were so thankful that we decided to stay in town for the weekend, esp. since the next two days we had a major snow storm. Despite staying on, I still had to pack up our belongings, only to unpack again on Sunday (not to mention the packing/unpacking in the apartment) so lots of work for me but so nice to finally be in our own devoted space. I was literally exhausted and coming down with what felt like flu, so most of the weekend I rested. Thomas surprised and delighted us when he refused the hotel’s pack and play and instead pointed toward the single bed – he was clearly telling us that he was ready to graduate to a big boy’s bed – a definite sign that he was growing up! Luckily I had packed a bedrail and he managed very well for naps and nighttime sleep, despite Daddy’s apprehensiveness and tower of pillows at every gap of open space (which I kept removing!)

To be honest, I returned to camp with mixed feelings about starting another session. I didn’t know if I had the same amount of energy/drive and questioned whether or not Thomas would continue to progress. Mostly, I think I just wanted to go home! I knew I was doing the right thing, just had to muster up the stamina that was spent during the previous session. On her way out, Adrienne hugged me and said “you are really tough mommy” and Rob reminded me that Thomas was lucky to have a mom who cared so much. I think I am the lucky one to have my family with me each weekend - they keep me going more than they know.

WEEK FOUR

The most noticeable change during week four is the emphasis on winding down and preparing to leave. Makeup sessions were being booked for missed hyperbaric therapy, exiting interviews and “after videos” scheduled, notification of the goodbye party and many logistics sorted out for people departing. Courtney (Denton’s mom) and I volunteered to design and complete the “poster” which would be presented to the camp and displayed in the hallway. We decided on an underwater theme showing Kevin as a deep sea diver next to his hyperbaric tank and our kids as a “school” of fish. This week we also said our first goodbyes to the stroke therapy families. Even though we were staying on, Thomas and I had to make plans to leave during next weekend to allow the camp to clean-up and reorganize the rooms. We ended up settling on a spacious and reasonably priced 3 bedroom furnished apartment in Picton…

Thomas almost seemed to set back during this week, - he was continuously resisting his therapy, and showing other signs of being off like tuning out (esp. in the hyperbaric chamber) and seemed a bit tighter and out of balance – this was especially surprising given his prior week, in which he seemed to excel. I discussed this during lunch on Wednesday and another parent Jennifer agreed that her Phillip wasn’t doing as well and thought that maybe they were just exhausted. Another parent hinted at toxicity – something that happens with excessive amounts of oxygen. I was even starting to consider the possibility that Thomas’ chiropractic adjustment had gone wrong. When I explored this with Kevin he thought it mostly sounded like Thomas was fighting off an illness esp. since so many kids (six out of the eight) had been sick the previous week/end. Many had been taken to the hospital for care and oddly enough, no two children seemed to have the same symptoms – there was a mix of ear infections, colds, tonsillitis and a viral cough. Thomas and Denton were the only two to escape it and Thomas was probably still fighting it/them off. Over the next couple of days, Thomas seemed to have shaken it, and by the weekend was going to bed at 7:30.

Our weekend was again very full… Rob’s sister Christine and husband Paul came to visit us on the Saturday – they left their house at 6:00 a.m. so that they could join Thomas during his 10:30 morning dive - they also brought us a homemade hot lunch! Thomas seemed happy to show them his different walking strategies and they remarked on how content and settled he seemed as well noticed added dexterity. I also noted this week that Thomas’ attention span seems to be increasing, a skill that is worked on in the classroom. I also learned this week that rhythm is something we will need to teach our kids and were shown exercises on how to develop this.

This being the final group weekend, Rob and I fixed dinner for euchre opponents Courtney and Steve, and still made it to the Barley Room for our weekly date.
Hard to believe that next weekend we will be meeting a whole new crew and starting over again…

WEEK THREE

This week the group met to review the Conductive Education Therapy and how it addresses CP. Hand outs were distributed prior to which listed every type of delay, learning and behavioral problem and physical impairment associated with CP. And it was lengthy. My first reaction was “this is depressing” to which the conductor replied: “you need to know because many things can be prevented or minimized”. The talk ended up being really productive and focused largely on developing a mind-set of raising your child like an age appropriate child who, despite their physical limitations, needs to adapt to their environment and cannot be held back because they are “sick”. They really hammered home that many barriers end up not being overcome because parents don’t think their child can do things like be toilet trained (guilty) maneuver a knife/fork (guilty), walk, communicate etc. so they end up doing too many things for them and the child grows up expecting not to try or succeed. And while it is definitely more challenging to teach/learn, the pay-back is huge because every dependency that is removed is an opportunity for accomplishment and success in the child’s life. They also really pushed the idea that therapy doesn’t end with “traditional” sessions - rather it is woven into everyday things to reduce as many dependencies as possible and to train the child to “walk” to the door rather than be carried etc. Almost every point they made they would reference a child they had encountered, with very extreme and preventable outcomes. It was a discussion worth hearing and I left with lots to think about.

Following the meeting, I stayed back and spoke with Kevin (owner) and Kristina (Thomas’ teacher) to discuss the possibility of extending Thomas’ therapy into the next session. Kristina needed to assess Thomas’ readiness to determine if he would be able to participate in an older group (3-6 years) which meant that he would spend a large portion of that time without me in the room. Surprisingly, Kristina thought that Thomas would be ready – he was making progress settling in and wasn’t resisting as much (still had some work to do), but believed he could manage. As well, he was responsive to the program. Coincidently he had just completed his two best days yet - just that day he used his walker up a set of shallow stairs and then down a ramp! He was beaming and another mom Amanda noticed and said “you must be so proud” and I was! I knew too, that Thomas was in good hands to respond to this next challenge, they knew him really well and he respected their authority and also liked them. It also made a lot of sense to extend the time while he had already settled rather than go through the initial shock again.

Later that day,(still reeling from the news that we were staying on till March 9th!) Thomas attended his first chiropractor appointment. He was assessed the previous day and were told that three areas along his spinal cord needed to be adjusted. At first I was worried about adding something else to the mix (our days were already so full) but I had a feeling that he might need this addressed – an X-ray on his spine done a year ago showed a slight curve that we were told was insignificant but Thomas’ alignment is really important in the overall picture.

Of course the big build-up to the week was Thomas’ 3rd birthday. He received an early celebration during Friday’s class; his teachers presented him with a cake and sang Happy Birthday. The following day, we hosted a pizza lunch (rather than dinner), since we now had 5 confirmed out of town visitors – Cynthia and the girls, Leslie/Patrick and Suzanne. It was great to receive family and show them around and to tap into outside news (a bit isolated here). Adrienne of course loved spending time with her cousins. It was a busy and fun day – and Rob and I actually made it to the Barley Room later that night (but had to stop at the Laundromat on our way!). Thomas of course enjoyed the pizza, cake and throwing balls/bean bags to “Pat” in the hyperbaric oxygen tank.

The one highlight that particularly stands out in my mind this week was seeing Thomas intentionally open and shut his eyes. I first noticed it when I washed his hair and asked him to close his eyes, but I thought it might’ve been instinct. Then I noticed another time (again, in the bath) he had this look on his face, kind of a slight grin and his eyes closed very lightly and then opened. I continued to ask him to do it without success, even tried to develop a turn-taking game of closing eyes – he wouldn’t budge (although he enjoyed the game). He has successfully done it about 8 times and it’s getting easier for him each time. I think it’s one of many things that requires a concentrated amount of coordination so I’m always excited for him when he has the ability to overcome that. As long as he is learning to accomplish new things, he is enlarging his world and giving himself confidence that things are possible. Speaking of which, his potty training is coming along (people have been asking!), and he is averaging 3 hits each day and when this happens, he lets me know with a reassuring “yeah!”

This week our group passed the halfway mark to the session and I am so relieved that we are staying on. For the first time since Thomas’ diagnosis I feel like we are really concentrating on his needs and he is responding in all areas. I really believe that this is where we need to be.

WEEK TWO

This week there was a number of comings/goings amongst the residents, but mostly comings. The adult stroke therapy session got underway and two men - one from Alaska, the other from Chicago, arrived with their spouses and sons. They would join us in the chamber only and surprisingly it wasn’t too crowded. Also, Ken (father of Holly) left on Sunday and his mother and mother in law filled in until Wednesday. Of course weekend dads (Rob and Daniel) also departed. I have to say that despite having extra bodies here, the older adults give the camp a much better balance. With exception to Kim and me, the other parents are in their early-mid 20s, with one only 18!

The biggest change to the therapy was a new "block" devoted to individual programming. Following the group stretching, standing, stepping exercises, every child now follows a separate program, according to their individual goals. Each day this changes, so it provides a variety to the routine, as well, it focuses more on Thomas’ needs. Thomas mostly spent this time working on his walking and balance. Everyday he used a Kaye walker, which is a low-end support walker that doesn’t hold him in at all, he controls his core balance 100%. Although I hold him from behind at the hips, this is the type of walker I have always hoped Thomas would strive for – the other ones we had been trialing really locked him and didn’t give him enough control or challenge. In the Kaye walker, he held himself very nicely, controlled his gait with few corrections and pushed the walker forward while stepping. This was a great exercise and we would practice after dinner, walking down the long corridor. He also had to walk outside of a large 2 x 4 type board to help control criss-crossing, as well use parallel bars to side-step in/out of a horizontal ladder. I wish I had a gym like this at home to use! Another day he spent 10 minutes riding a rocking horse, then stood holding onto two bars at his sides, while kicking a ball.

The last part of the day always ends with the group sitting down at a table, working on fine motor skills. I was surprised when the conductor placed a wooden puzzle in front of Thomas and he was able to pick up the small pieces with the finest tips, including his left weaker hand. They sing more songs during this period with kids participating with different hand movements like shaking a rattle or raising a bar up/down and using a ring as a steering wheel to sing “wheels on the bus”. They also focus on fingers and thumbs and I noticed that Thomas still has difficulty isolating each one. As well, they do speech exercises like blowing a bubble off the wand, placing a straw between their lips or trying to lick off jam from above their upper lip. The kids take a final break for lunch and we receive tips on eating skills. All in all, a very well rounded program - you feel like you are addressing the whole person - and all the different challenges.

On Wednesday, Thomas was being very disruptive and uncooperative, so I pulled him out a bit early. I knew that he needed a break and we ate lunch on our own then went outside for some fresh air. I placed him on a swing and he thoroughly enjoyed it. At one point, he had this very concentrated look on his face and bent and extended his legs like he was trying to self-push. He usually just lets his legs hang so this was good to see. Later that day in the chamber, we were throwing bean bags back/forth and Thomas reached for one while lifting his leg up at the same time - another new maneuver. I keep noticing more vocalization and that he carries his voice better (not just with loud screams and cries) using words – he bellows back “nah” for no and “yea” for yes, and calls out to me “mum”.

The sage bath routine is now in full swing and taking on a life of its own. With the preparation, steeping, then 20 mins soak, followed by the stretching, this takes anywhere from 60-90 minutes in duration. I pretty much have to start right after dinner, following a quick lap down the hall in the walker. During baths, Thomas is becoming less reliant on using his left hand to stake his balance and uses both hands to do things like putting the facecloth right over his face and over his head. Although it is time-consuming to engage in these nightly rituals, I have noticed that Thomas’ tone is much looser when he wakes up- it used to be quite regularly tight.

This week Phillip, a 2 ½ year old boy from Texas, suffered a seizure in the middle of the night. It lasted 4 mins and 59 seconds and his mother Jennifer was extremely worried – anything over 5 mins could result in a coma. Although Phillip takes anti-seizure medication, oxygen is known to flush impurities out of your body and in some cases, make medication less effective. The following night, she noticed that he was moaning in bed and rushed him to the hospital – luckily, it was only an ear infection (also common with oxygen chamber) so he had to take a break from it for 3 days. Phillip unfortunately has one of the more severe cases among the group. He does not have CP, rather he was born with a brain malformation that severely limits his muscular movement as well as his ability to digest food. He is a fairly big boy (about Thomas’ size) and quite observant as he scopes his surroundings and can make eye contact with you from across the room. It is often heartbreaking to watch him, he seems to have had so many challenges and so little quality of life. On top of that, Jennifer is a single mom who also has a 1 ½ year old daughter and although we clashed a bit during the first week, I have come to admire her relentless strength and dedication to her kids.

The week ended with Rob and Adrienne’s visit, which many people now seems to look forward to. Friday night we joined the group and played some euchre - Rob and I finally became partners and lost 2/3 games. We now owe another couple a cooked dinner (thanks Rob). On Saturday night, we went into town (while Adrienne babysat) and discovered a pub that has live music, which we decided would be a good regular spot. Today Adrienne and I got busy planning and distributing invites to Thomas’ birthday party next weekend and are looking forward to receiving our first visitor – my sister Cynthia from Ottawa.

I would say that we are definitely starting to settle in…

WEEK ONE

There was so much build up to our trip to Ability Camp; the drive up seemed like the final bit of anticipation. Navigating through the Prince Edward County, passing over that bridge south of the lake, seemed like our final frontier. The blue signs marked Ability Camp signaled that we had finally made it. Adrienne and I approached the building, somewhat disappointed...it appeared to be an oversized, dated portable-type building, not the type of facility we imagined would bring us all those expected results. We were met at the door by Kaitlyn, the 20 year old daughter of the owner, the person who inspired Ability Camp. She walked us through the facility which housed mostly lodging and a large kitchen, gym and of course hyperbaric chamber. It was clean and tidy and smelled of fresh paint, they had just renovated the bedrooms. Our room had a small double bed and crib. We immediately got down to solving our first problem - space. Luckily there were a couple of rooms not being used and they offered an extra one to us. Now we had a separate room for the adults and the kids - much better I thought...
Adrienne and I unpacked (Rob and Thomas would venture out after naptime) and chatted with a couple from Sutton -they brought their 18month old son Denton who appeared to be quite healthy, but we learned had many motor delays including not being able to roll over yet. We later met another couple from Quebec, whose 2 1/2 son Malik was very involved, could hardly lift his head and required a feeding tube. This would be their 2nd trip to Ability Camp, their first session (only last Nov) involved only hyperbaric and they were extremely impressed with results they witnessed by children who did both oxygen and therapy, so decided to come back.
It would be 8 o’clock before the other 3 families arrived from the US - Florida, Texas and Ohio, they all brought boys in their 2nd year, 2 of the 3 with severe cases of CP. We all gathered for orientation around 9ish and Thomas didn’t get to bed til 10. Therapy would begin the next day at 9...

Thomas woke up at his usual time, not as rested as he could have been, but quite good natured - until of course someone tried to speak to him! I noticed that he favoured the dads; of course the dads also paid more attention to him. Adrienne was enjoying the American groceries (lots of junk food) by 8 a.m. she was offered a package of sour skittles, hot chocolate and a cocoa puff cereal bar! More distressing was the abundance of peanut butter jars! I had to let people know right away about Thomas' allergy and hope for the best. We made it to our 1st session and went through the routine. There was plenty of stretching and transitioning from laying on backs/fronts to standing holding onto these wooden ladder-type chairs. Thomas unfortunately did not want to cooperate and let everyone know it. His screams/cries overpowered the room. I was struggling to keep up and getting frustrated with him. Not to mention, the conductors (therapists) had heavy Hungarian accents, which made it difficult to follow. Part of the day also consisted of potty training - each child had their own designated potty which was brought out approx. 3 times throughout each session. During snack, Thomas sat in a regular chair with a foot rest. They fastened a bar to the table which he held onto for support. It was the first time he has sat at table in a chair with so little support and he looked good. It was upsetting seeing many of the other kids struggling with their food, although the conductors insisted on moving everyone up to some degree of independence. Thomas would need to eat with a fork and mostly need to be able to control himself when I had to leave the room. Throughout the entire week, there were frequent breaks in the routine involving discussions, assessments, filling out forms, fittings for shoes etc. During these times, Thomas would enjoy crawling around and doing his own thing, even approaching different children and stealing their socks. He seemed to be unusually at ease in his new environment, only when he had to perform would he resist (and of course when I had to leave). This has always been a huge setback in his therapy - I stated this as his first goal to overcome on my list, as well as improvement to balance, ability to stand, crawl and speak with more ease. Following lunch Thomas was exhausted and I opted not to participate in the first hyperbaric session - there would be two each day and I figured he'd cope best after his nap.
The hyperbaric chamber didn't end up getting underway until 5p.m. Thomas was well rested and cooperated reasonably well all things considered. Two of the 4 kids did not do so well and screamed most of the hour. I entertained Thomas with books, beads and balls and sang for him. He was kept entertained and only cried when the plastic transparent hood was put on his head and when the oxygen pressure was rising and hurt his ears.
We didn't exit until close to 7 and it was time to prepare dinner. The day was already gone and it felt exhausting. Following dinner, we walked around and Thomas spent time on the floor crawling and exploring his new space.
Later that evening, Adrienne and I sat in front of the TV with some popcorn and were interrupted by two little girls ages 18 months 2 ½ who had plugged up the toilet of a bathroom under renovation. There was water all over the place and at 10:30 the Shopvac could be heard throughout the building. Needless to say, Thomas woke up and I was quite disturbed by the whole incident. Very young children were still awake and there was a whole lot commotion going on. These types of things were added adjustments to make…

The next day and going forward, therapy would begin at 8:30. It was a bit challenging to get to on time. Thomas did better with his exercises - I liked the stretching that took place, Thomas needs that to relieve tightness. He was still quite resistant and screamed blue murder each time a conductor tried to demonstrate on him. They lent us a pair of orthopedic shoes they believe are effective for tone and we walked with him pushing the back of the chair into the snack room. After snack and on the 3rd try, Thomas peed on the potty!
Following lunch, we did his favourite thing - 1-2-3-Go on the bed (he kept asking for it during therapy), then put Thomas down for his nap, which he again was more than ready for. It worked out nicely too because during that time the first hyperbaric "dive" takes place which means peace/quiet. I had to wake Thomas for his turn in the chamber. He didn't resist too much, however getting ready, he continually blew raspberries at Kevin (the owner and operator of the chamber) to show that he was not a huge fan. He kept busy watching one of his videos, his picture book and bean bags. I listened to Kim (the parent who owns a chamber) tell me about the benefits she experienced with her son and discovered that another child Devon has similar symptoms that Thomas has. As long as Thomas is content, the hour flies by with lots of chit/chat amongst parents. It was 6 o’clock by the time we exited; it was time for dinner and to wind down the day. The days were filling up quickly. That night at 10 p.m. a new parent arrived from Milton - a 27 yr. old dad with daughter Holly who just turned 1 a few weeks ago - she is now the youngest attendee by far. The common room (situated right next to my room) was busy with people talking over a loud TV. Finally at 12:30 I went out to close the door. A baby woke me up crying at 5:45 - sleep was going to be a huge challenge, which I couldn't really afford to miss. Just about every morning I would be so thankful and relieved to have brought the cappuccino maker...

On Thursday Holly joined the class and was placed next to Thomas. She screamed and cried throughout most of the session. It was heartbreaking because not only is she so young, but also blind and incredibly stiff and I imagined how terrified she must've felt. Surprisingly, she peed on the potty just about every time she was placed there – yet her sorrowful cries were esp. difficult to witness. At times, I would look around the class and be overwhelmed with the volume of suffering and frustration these kids had to endure to overcome so many obstacles most people wouldn’t think twice about. Later that night, I got up close with Jason - a two and half year old boy who was born 4 months premature, under a pound to a schizophrenic mother who was in prison. He and his twin sister (who has CP that is barely detectable) were adopted by Kim, who at 40 had three children already. Although Jason has so few abilities (i.e. can’t swallow, see at distance, hold his head, use of arms/legs) I placed my face next to his and sang and he turned and with some effort was able to focus and give me this broad smile. He was a beautiful child and I could see so clearly beyond his disabilities.

Earlier that day, Thomas completed his "before” video. An "after" would be done before we leave. At the close of the session, the conductors held a meeting with us to go over "issues" I think we were all experiencing. Things were not meshing so well and they wanted better participation from us and more patience. Not to mention, there were a couple of parents who were trying to be challenging and they basically had to say - "Trust us; we know what we're doing!" The next day, a huge improvement, including starting on time. We were also given big bags of the spice sage to bath our kids in! Apparently, this has been used for centuries as a natural muscle relaxant and when followed by the stretching exercises can reduce tightness, which Thomas does have. A new bath time ritual began that night. Also that night, Rob arrived for the weekend, it was exciting to hear someone call out "Linda, your husband is here!" Thomas played shy for a couple of seconds then decided to give in to a big bear hug and the two were practically inseparable most of the weekend, including 4 trips to the hyperbaric chamber - a nice break for me and a chance to finally organize my room, drive into town and do laundry and groceries and spend more time with Adrienne. The four of us also ventured out for dinner - although very small, Picton has a pretty good selection of restaurants. Rob and I put Adrienne on notice that we would need her to babysit so that we could go out just the two of us for a late dinner. Getting out is absolutely necessary - some days we wouldn't even set foot outside because the days are so full. As well, spending so much time with the other guests can be a bit much.

I think we had a productive first week and covered a lot of ground, including Thomas completing 8 hours of oxygen therapy (40 is considered a typical block). While I don't absolutely love staying here, I do have confidence in the program and the expertise of the staff. I think the first four days of therapy were more of an orientation and settling in period, so am expecting to see it ramp up more in the following weeks. I notice that Thomas is making gains - he is happy for the most part and learning to relax. He is communicating more and sounds are coming much easier and faster to him - he tries to jump in during song and twice this weekend I heard him say Adrienne’s name and it sounded very close. Yesterday I peeked into the oxygen chamber and waved to him and Rob and he waved back with an open/closed hand gesture- that is new. Tonight I was washing his hair and he voluntarily put both hands on his head and tried to wash – also a first. He is transitioning himself around better and while I tried to complete his stretching exercises in a lying down position, he pulled himself up to interrupt it. These are all indicators that new skills are developing. It is still early days and it feels like we have just completed the warm-up exercises to the therapy...