The learning journey of Eemaan - a child with Down Syndrome

In November 2017 I met Eemaan, a sparkly bright four-year-old with a diagnosis of Downs Syndrome, for the very first time. She was invited for an assessment at the Bal-A-Vis-X training event as her mum was undertaking the two-day training we organised with Integrated Brain. Since this time we have been working with Eemaan on a weekly basis.

At the very start

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At the start she would sit and smile, communicate non-verbally for the best part of the session, occasionally saying single words and point. Eemaan’s balance was not sufficient to stand on the balance board. Her attention was scattered, and her ability to hold the small sand filled bag (like a bean bag) used during the Bal-A-Vis-X exercise, was inadequate. We would do face-to-face exercises. She would have an assistant seated behind taking her tiny hands and guiding them as to how to move the object. Eemaan’s hand was guided to move the sand-filled bag from her right hand to my left, I then passed it to my right hand and into her left hand. My assistant again helped her make the transfer from left to right hand crossing the midline. The whole exercise repeated many times each time the assistant guided Eemaan.

Progress with Bal-A-Vis-X

Fast-forward two months and eight sessions later and she was able to cross the midline in front of her body holding the sandbag by herself no assistants required. Moving it behind her body from the left to the right was more difficult than the right to the left. Nevertheless, at this point, we noticed a marked difference in her engagement and her joint attention had clearly improved. The next noticeably change her improved pen grip, from holding the pen in her fist to more of a tripod grip. Each session I asked her to draw on the whiteboard and on occasion she scribbled and said, "smiley face” and “Eemaan." Each week we practise tracing circles and creating smiley faces.

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Nine months from our first meeting Eemaan is now using sentences, and her vocabulary is growing daily. She is also able to count to ten and beyond. She can stand on the board unaided but only with assistance and for a limited time of twenty to thirty seconds. Thirty seconds may not sound like a long time, but the additional exercises we do that loosen the pelvis, as well as leaning forward when moving the sandbag around her back, has improved her gait. What’s more, her initial fear of climbing onto the balance board is no longer an issue. She attempts the aeroplane pose of extended arms but then habitually sits down on the board instead of remaining in the standing position beyond 30 seconds...this is work in progress!

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By using a trapping method for catching the ball, used for those unable to catch, she can catch the ball seven to eight times. She has developed a habit of folding her arms in to trap the ball when I bounce to her waist level. It is clear she is not tracking with her eyes but listening to the sound and traps the ball after she hears the cue of it bouncing on the floor. The work is not always consistent and keeping her motivated is an ongoing challenge. However, we have persevered with the routine both at home and in the therapy session, and her mum says Eemaan looks forward to her weekly sessions.

Each child is different

Eemaan loves to wear pretty clothes, have different hairstyles and carry her own backpack, which she knows is her possession. Every time she works well she claps in recognition of her 'excellent' work. We in return reward her with a bead to thread onto her very own necklace. Each week she takes home a new necklace of up to ten beads all earned through the hard work on her part. She selects the colour herself and is very patient when pushing the bead onto the plastic needle. We also do patter cake songs, so she can build her rhythmic timing and continue to cross the midline during the therapy breaks.

She loves it when we change the names of the characters in the song to ‘Eemaan’ and as she laughs with joy at this her little eyes sparkle even more. In our therapy-breaks we also race little wind-up toys – she is so motivated following the toys racing across the room. It’s all part of the fun to engage her and help her participate in joint attention, motivate language and interaction.

Since September 2018 Eemaan joined a mainstream school. She has an assistant, but her mum (a PhD holder from UCL) insists she does not have the assistant for the entire duration of the day. Integrating is gradual and at her own pace. Eemaan listens to her mum when things have gone wrong and repeats the information verbatim so to remind herself of what not to do, such as touching the hair of other children. She says to me ‘Eemaan is not touching my hair, only her own.’ You can see from this engagement alone that her understanding is not so different from her peers, and the positive reinforcement with verbalisation shows her language and social behaviour developing.

The next goals are to improve fine-motor coordination, getting her to stand unaided on the board as well as having more clarity in speech. We are currently working with more action nursery rhythms to motivate her to move and sing. There is a long journey ahead, but this is the first part of many tiny steps forward.

The learning journey of Eemaan - a child with Down Syndrome will be a continuous feature on this blog.

With thanks to Dr K Osman for allowing Raviv Practice to share this story of her daughter’s progress and we thank Eemaan for being a motivated student who brings joy to our Thursday afternoons whilst she come to be taught we feel we are on a beautiful journey of learning from her.

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