March 15, 2023 "Neuropsychological Evaluation Findings"

Neuropsychology evaluation 3/9/23 Dr. Hannah Allen

Rather than discussing every score, the following is a synopsis of the most important findings.

Compared to the same aged peers, Rayden's general neuro-cognitive functioning is developing at a slower rate globally. Rayden's intelligence is in the borderline impaired range, with stronger verbal than visual skills. Language functioning and emerging executive functioning was borderline to mildly impaired for age. 

Rayden's academic skills are generally within expectations based on his demonstrated cognitive skills, with the exception of math computation. Reading and conceptual math skills were consistent with intelligence; however, he is making slower progress with computation, which is more abstract and requires written responses.

Rayden learns best when information is presented verbally, but without extraneous language. He demonstrated better rote memory than story memory, suggesting he may get overwhelmed with too much language. Succinct instructions and explanations that can be repeated easily if needed are likely most efficient in helping him learn. Rayden also has a brief attention span so that new learning sessions should be direct and brief with a break before returning to cognitive demands. 

From parent ratings and interview, symptoms of anxiety as well as ongoing ADHD are impacting his functioning. The level of worry fell in the 99th percentile range for his age. 

Areas of significant strength include motor reduced adaptive skills, behavioral compliance, and social skills. Rayden presented with generally well understood developmental needs. His presentation is consistent with a Major Neuro-Cognitive Disorder due to Spina Bifida, as well as Generalized Anxiety Disorder. His profile on testing is notable for stronger language than visual spatial processing, well documented as an expected pattern for children with Spina Bifida. 

Notable results include his unique memory profile – that Rayden learns best verbally with rote, repeated information. He can become overwhelmed easily with too much content and will learn best when mastering smaller chunks of information. Tasks that require coordination of different cognitive skills, like generating a word and writing it, are more difficult for Rayden.  He requires specific adjustments to his educational environment to learn. Additionally, symptoms of inattention, hyperactivity and anxiety are also likely impacting his ability to learn at his best level. Rayden has strong social and adaptive skills, as well as parental and educational support. With some additions to educational and community support, he is expected to make ongoing progress.

Educational Recommendations:

Continue to participate in the formation of an Individualized Educational Program and collaborate with his teachers to support his educational goal progress. For Rayden to meet his full potential in terms of academic achievement, he requires the following:

• Please provide a learning environment with decreased distractions (visual and auditory). Rayden is very susceptible to extraneous noise visually and auditorily in his space, which will decrease his attention to task and impact learning.
• New learning occurs best in with mastery of small increments and help generalizing those mastered principals to other areas.
• Very careful progress monitoring is recommended so that new strategies are trialed if he is not making progress with current methods. Progress may be checked monthly to ensure he is responding to interventions.
• Incorporation of all recommendations from VI specialists
• Decrease fine motor demands in learning. For example, he can choose letter forms or say them verbally in place of writing letters. Requiring him to write numbers and letters will greatly decrease his available attention to talk.

With this information, we decided to request a one-on-one para-professional for Rayden at school.

March 20, 2023 "Visual Therapy"

Vision Therapy 

Rayden was seen at Triangle Visions Optometry in Cary on December 27 & 30, 2022. He had a range of visual efficiency and processing evaluations. The purpose of the evaluations was to determine if problems with visual information acquisition and processing skills may be interfering with Rayden's ability to achieve his full potential for learning within the academic setting and overall development. Rayden's visual acuity is below expected both in near and distance. Dr. Brett Miller recommended wearing glasses to promote the best clarity of vision possible at school. Rayden continues to demonstrate a mild-moderate degree of intermittent esotropia in the left eye. The testing indicates that he does not see double, but he suppresses vision received by the left eye when the eye deviates. He seemed to have inaccurate eye movements when isolating targets used in a non-reading task. His fixation was poor and he had some difficulty moving the left eye into left gaze. Most of vision takes place in the brain. While the eyes collect visual information, the brain processes that information and makes it meaningful to us. The brain is then able to drive motor movement, make decisions, and coordinate vision with our other senses. Rayden's visual perceptual skills and visual memory scored at/or below that of a 4 year old, therefore she recommended visual therapy once a week for 45 min. per session. Vision therapy is an optometric specialty designed to stimulate the sensorimotor connections between the eyes, brain, and body. It is individualized to fit the visual needs of each patient. We have been waiting for 3 months for our insurance to approve it. He finally began today. 💗

To my knowledge, there are only three places in NC that offer Pediatric Visual Therapy; Raleigh/Cary, Wilmington, and Charlotte. Even though we will have to drive an hour there and an hour back once a week, I am willing to do WHATEVER it takes to help Rayden achieve his potential. 

March 9, 2023 "Post-op at UNC"

 Our day began at 6:30am with a long drive to UNC for multiple appointments. 1-Neuropsychological Evaluation with Dr. Hannah Allen. This took two hours. (Results will be discussed next week.) Rayden enjoyed riding the shuttle from the ACC building to UNC Children's Hospital. He had 2-X-ray shunt series, and 3-Rapid sequence MRI. Rayden didn't even need Momma during any of these exams. He knew exactly what to do and wasn't scared at all. He is growing up so fast. We also went upstairs to the 7th floor to visit his nurses and get the Beads of Courage he has earned from 4-Child Life. We rode the shuttle back to the ACC building for 5-Neurosurgery post-op appointment. Dr. Elton said his shunt looks great. He went over Rayden's symptoms and explained how lucky we were to be that close to a Children't Hospital with a Neurosurgeon. He even spoke about how children with Spina Bifida have always scared him with shunt failure. The headache and vomiting is one thing, but SB kids have brain stem issues that can quickly become critical. He said the CSF can build up so fast that it puts pressure on the brain stem and they stop breathing, which is what Rayden was doing. This can also happen to people without SB, but it is so far down the symptom line that you are already getting treatment before this happens. The time-line is accelerated in SB kids. He said we were one step away from fatality! He told me that Rayden's shunt failure will progress the same way each time, so we do not need to wait if he begins showing any symptoms. He has to go back for follow-up in two months. Rayden was exhausted and slept the majority of the way home. We arrived home around 7:00pm. 

They were able to download the MRI scans from Orlando to Rayden's chart. These comparison photos are before surgery in Orlando (2-14-23) and after surgery in NC (3-9-23).