1.   Extending light switches with strings.
2.   Using a tiny 'shot glass' for early learning on grasping a cup and bringing it to her mouth to drink.
3.   Booster potty seat with steps and ringed handles to use the toilet independently.
4.   Placed her bowl of food on top of a block so it would be a shorter distance from hand to mouth. (Offered a lot of finger foods)
5.   Made homemade play-doah in different consistencies of density and buried treasures inside which she was required to dig out.
6.   Had a box of dress up clothes to encourage self-dressing.
7.   Placed toys on top of tv trays with legs, to encourage her to raise her arms to play.
8.   Purchased a lg. above-ground pool for water therapy.
9.   Bought velcro shoes and applied on clothing for self-dressing.
10. Range-of-motion exercises with music. (manually with her until 13 mos and then through exercise play independently).
11. Built small steps up to sink and bed.
12. Used special scissors (can be bought in craft stores)that were small and after making a cut, they snapped back to position.
13. Had lots of hands on time with scissors, crayons and paper for practice.
14. Used two-handled cups for drinking.
15. Utensils with long handles.
16. Tooth brushes powered by batteries.
17. Step stool in van to climb into own carseat.
18. Long handled brush for bathtime scrubbing, along with spongy bath accessory that produces lather.
19. Manipulative toys that required hand useage and hand & strengthening muscles in arms.
20. Exchange snaps on pants for buttons or velcro.
21. Removed facet & toilet handles and replaced with easier ones.

One of her greatest achievements has been to become a strong swimmer in deep water. She passed the H.S. Pools swimming test to swim in the deep end at the age of 10 and makes use of the designated laps side of the pool. The water has been excellent therapy for her upper shoulders and back muscles. She is at the 120% in height on the American Girls Growth Charts and at 75% level for her weight. At 9-years-old, she just hits the 5ft. mark for ht and reached 5'7" at age 14. Like many children affected with AMC she has a keen mind. She skipped kindergarten and did so well in the First Grade that she was one of few nominated to attend a full time muti-age level program taught to students with high I.Q.'s at an accelerated rate of learning. She has remained in this program for the past 3 years, and as a 9 year old is in in the 6th grade for her reading level.
She recenly auditioned and had a principle role in a Microsoft advertisement to be used for a worldwide symposium for a Bill Gates conference. The advertisement proclaimed each individuals 'potential'. She aspires to become a writer when she grows up. She has an avid love for words and languages. If she could have one wish, she said, at age 9, she would like to live without Arthrogryposis for 1 day. Now, as a teen, she doesn't believe she should waste a wish or prayer on her disability, but rather on her future potential as a productive member of society.

Age:8 - She has has no surgery done. She's gained function solely through therapy.

Age:8 - She has excellent penmanship. When her hand cramps up
from writing in school, she occassionally uses a slant board.

Age:8 - She keeps a lengthy daily journal on the computer. Her daily use and interest in using
the computer has actually made her a faster one-handed typist than her two-handed classmates.

Age:8 - she started tying her shoes independently.

She began making sandwiches when she was 7

She uses the bicep muscle in her upper rt. arm to hold up her left arm to eat.
Her left hand is more functional for holding things, which is why she eats this way.
One arm's strength, compliments the other's weakness and visa-versa.
She found this technique out in late infancy to get her pacificer to her mouth.

Fine motor is very good for Josepha when she can rest her arms on the table.

She is able to comb her long hair by using a wide-toothed comb.
Styling is still Mom's job.

She is a self-motivated learner. The recorder (flute) was a required class in her elementary school.
She aspires to join the orchestra or band next year when she enters the 5th Grade.

She NEVER rides her scooter without a helmet. Iallowed it for this quick shot.
A pair of night splints designed for her. We have had to think of incentives to
encourage her to keep them on all night.

She sets our table daily. She has become very adept at lifting
the gallon milk carton and carrying full glasses to the table.

Catching and throwing a ball has always been hard for her,
but the lightness and slowness of a beach ball makes it possible
for her and she can enjoy throwing and catching ball like everyone
else with this adaptive measure.

School Orchestra

She began playing the violin at age 10 as a 5th grade student in her school's orchestra. She typically plays the violin wiht her left leg crossed over her right leg and with her left wrist supported on her left knee. After about 30 mins of playing, she experiences left wrist and forearm pain and fatigue.

Finished Product designed by:
Steven Shores, MOT, OTR/L
Assistive Technology Specialists, Children's Therapy Unit at:
stevenshores@goodsamhealth.org

We visited Steve, Chores,an occupational therapist that specializes in adaptive equipment for an evaluation. When she reaches for further fingerboard locations, she appears to be pushing her left wrist into her knee to assist with wrist flexion. This movement appears to be initiated from her shoulder, requires 'fixing' of her forearm and is likely contributing to her fatigue.

a) Increased potential for scoliosis
b) Increased stress to her hand and forearm which can result in contraindicated posture and patterns

Recommendation:
a) Cast a positive mold of Josepha's left forearm and wrist in her functional 'violin playing position'
b) Fabricate a soft forearm and wrist 'trough' (orthoses) from the cast
c) Fabricate a rigid mounting system that would attach to the trough and stabliize it to Josepha's chair.