{Karlton Bontrager}

This meeting was called to renew Karlton’s plan for therapies. Such meetings occur every three to four months.

The director of the adult program began the meeting. She stated that Karlton has evidence of growth, insight, and direction during the period of the latest plan (that is, since 12/18/03).

The occupational therapist (OT) reported that one goal of the plan had not been met—that of documenting and carrying out a regimented exercise program three times per week. Karlton has recently acquired a Day Timer, a personal organizer as per her suggestion. The OT plans to work with Karlton in using the Day Timer to accomplish the exercise and practice goals. The OT noted gains in other areas. One of those was increased fluidity of movement as well as stability of the proximal muscles in the shoulder. She commented on Karlton’s social interactions in the group that eats in restaurants on Fridays. She stated that his appropriateness in that context “has skyrocketed.” To a question about the benefits of repetitious exercise, she responded that Karlton would not benefit from passive exercise. He needs to initiate action—not be acted upon. She further stated that there is no concern about awakening muscles within a limited amount of time. All of Karlton’s muscles and muscle responses are there. He just needs to learn to use them in new ways from how he did before.

The speech and language therapist (SLT) stated that Karlton is becoming more self-aware. She cautioned that crises such as depression can result. This self-awareness is in sharp contrast to his former apathy. Karlton is now doing more on his own. He initiates requests for help in certain areas. At the community college, for instance, he took the initiative in arranging for one-on-one tutoring in his coursework. The SLT sees as goals his continuing to work on initiating, planning, time management, and directing behavior toward what he should do versus what he would like to.

It was with the SLT’s assistance that Karlton organized his Day Planner. Together they have been focusing on plotting his time on Mondays and Wednesday, the days that Karlton attends the community college. His Mondays are long because class time is followed by work in the laboratory. The SLT recommended doing grounding activities such as range of motion exercises when he returns home. Those activities contrast with the focusing and cognitive work he does at the college.

Time management has been a principal concern in speech and language training. A goal is for Karlton to get to bed earlier. He often overlooks the goal and time itself when he is on the computer. He has begun using a kitchen timer to limit his computer time to one hour. Occasionally Choy-Lang, his mother, has had to lock the door to the room where the computer is stored because Karlton has not been able to discipline himself. Yet he is becoming more responsible in this area.

Money management is another area for attention. At the moment, Choy-Lang controls his check book and credit card. The SLT stated that with so many other changes going on, now is not the time to institute a focus on money management.

The physical therapist did not attend the meeting. She filed a written report that had high praise for Karlton’s “brain to feet reprogramming,” as she referred to it. She described Karlton’s gait has having greater symmetry, trunk rotation, and fluidity. He can balance on his left foot for about 15 seconds at a time. She has had him hopping and running in place on a trampoline. Hopping is a precursor to running, and Karlton has succeeded in hopping when he is on solid ground as well.

The case worker from the Office of Rehabilitation Services has made Karlton aware of the field of medical interpretation. The next training for that area will begin in January. In the meantime, he encouraged Karlton to consider taking Spanish courses at the community college or through an extension program. A course in medical terms for Spanish speakers might be ideal.

The meeting ended on a very positive note. Karlton continues to make significant progress even though the rate of progress has slowed. I feel most encouraged by his change in attitudes in terms of initiation, social appropriateness, and budgeting his time.