Explorer Mini: Susanna's Experience
A timeline of Susanna's experience with the Explorer Mini
I do think she has become stronger in her core that she can be more calm in her sitting. I definitely think that this allows her to play.Susanna's Mom
Meet Susanna (nickname Zu)
Personal data at the delivery of the Explorer Mini in May 2020:
Age: 2 years and 6 months
Size: 33” tall, 2T in clothes
Weight: 23.5 Ib
- Family: Susanna lives in a home outside of Nashville, TN with her mother, father, and younger sister.”
- Interests: Susanna really likes being outside. Whenever she’s upset going outside seems to calm her. She also likes water and really enjoys being at the pool. Music and the sound of bells are two of Susanna’s favorite things! When she hears them, she focuses her attention and reaches toward where the sound is coming from.
- Diagnosis: As of March 2020, Susanna did not have a formal medical diagnosis but presents with significant developmental delays. She had surgery in 2019 for a Chiari malformation, which is a structural deficit at the base of the skull that can cause issues with balance. For Susanna, this malformation resulted in muscle weakness, decreased motor skills, difficulty with sleep-wake cycles, and breathing issues.
Explorer Mini Timeline
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Before receiving the Explorer Mini
Presentation of abilities affected by her condition
Prior to receiving the Explorer Mini, Zu had been participating in regular Occupational Therapy and Physical Therapy treatments focused on progressing her developmental milestones. She presented with multiple developmental delays:
Physical Abilities as of May 2020
|Hold head lying on tummy or in sitting||Yes|
|Sit without support||No|
|Stand or bounce through feet||No|
|Take steps with or without support||No|
|Grasp/release a toy or object||No|
|Point to favorite toy/object||Yes|
|Go get desired toy/object independently||No|
Susanna participated in the human factor validation study for the Explorer Mini when she was 1 year old. Mom and dad were interested in the simplicity of the device to get her in an upright posture. They noted the compact size and how it looks "normal", like a toy that any child would use.
"She can move her arms and legs, like she can kick them, but she can't stand up, she doesn't press through her feet to engage those muscles, so we have a standing frame."
- Susanna's Mom
Parents' expectations and hopes before receiving the Explorer Mini
Based on their prior experience in the human factor validation study, mom and dad shared what they anticipated Susanna would experience with the Explorer Mini. They also had experience introducing Zu to her standing frame and gait trainer and were interested to see how she would take to the Explorer Mini. Generally they hoped the Explorer Mini will:
Increase her independence
Allow her to explore and problem solve
Allow her to interact more in an upright position
Allow her to experience her world from a different vantage point
Reinforce cause and effect
Allow Zu to be outside without having to be in her stroller
Allow Zu to be upright for longer periods without having to be strapped in
Increase the number of developmental milestones being worked on at the same time
"It is going to allow her to have more independence, and even if she is only two that is something that we really want, for her to be able to explore and problem solve. I think it [read Explorer Mini] allows us to do all of that."
- Susanna's Mom
Zu’s parents were asked if they had any concerns about trying the Explorer Mini. Based on their past experiences with trying new devices, they expressed the following:
That Susanna will not get comfortable with the device
That she will not want to stay in the device long enough to experience it
Will Zu figure out how to use it?
Concern that little sister Josie will want to play on it
The first week with the Explorer Mini
Susanna’s Explorer Mini was delivered at her house with her OT (Kellie) and Permobil Clinical Education Manager (Tricia Garven) present.
Susanna had a good first trial orienting herself to the feel and function of the device. During the first attempt she tolerated the position well, although was unable to make it go by herself just yet.
A short rest break helped her get used to being in the device again.
The occupational therapist was very encouraged by the interest Susanna was showing and how the Explorer Mini can be part of her therapy.
"My first thoughts are that I am surprised as to how quickly she seems to pick up on needing to touch the joystick to get it to move. She is not super successful at it yet because she is still working on being able to use her arms and hands the way she wants to. But to see her try to reach (the joystick) and have her hand close to it on the tray, she has been able to a few times nudge it on her own. She has not necessarily been able to hold her hand there to keep it going, but I was surprised how quickly that connection happened.”
- Susanna's Mom
The impact on everyday life
We asked the parents to report on the impact the Explorer Mini has had on their day-to-day routines as a family.
- Explorer Mini can be used instantly without any preparation or planning which gives the family more time for other things.
- The Explorer Mini offers flexibility to adapt usage to Zu’s own mood and willingness. It is easy to use the Explorer Mini when it is a good moment for Susanna in terms of her energy levels. This makes the sessions more productive and useful.
- More time to do activities together that are not necessarily focused on therapy. For example be in the kitchen with mom, visit a playground, or participate in doing the laundry. Before the Explorer Mini, Susanna had to lay on a mat while the parents would do the family chores or daily tasks.
Explorer Mini vs. Other Devices
|Device||Get in & Go||Preparation & Strapping Required|
"One thing that sticks out to me is that time when she was in it and she made direct eye contact with me standing across the way. When the Mini moved towards me with her in it - while she was looking at me – I will never forget that part. I can’t tell you a time when that has happened before. She was in it, 10-15 feet apart from where I was standing, and before she started to move, she looked at me and there was movement towards me and the eye contact and the focus. It was amazing to see! It almost felt like a kid taking their first step to a parent where you are holding out your arms - come here, trust, you've got this! I have all of those things with Josie going on right now with starting to walk, those kinds of similar feelings."
- Susanna's Mom
After one month with the Explorer Mini
I was thinking there would be more hardware and more things that we would need to know about or be more savvy in certain areas, but the simplicity of it has exceeded my expectations. The simplicity of getting in and out of it, moving it, understanding what needs to be done to effectively use it.Susanna's Mom
Susanna had a difficult month due to sleeping issues related to her condition. However, the parents found it easy to place her in the Explorer Mini during the day, even if for only 5-10 minutes. Although Zu is not actively driving the Explorer Mini consistently yet, her parents and therapists have noted a significant impact on her skills development as a result of using the Explorer Mini.
Response to possible challenges or concerns:
All of the initial possible concerns expressed by the parents are no longer an issue. Susanna has taken to the device and actually seems relaxed in it. Her parents are always close by her side and simply provide her with rest breaks when she’s fatigued. Although she is not consistently driving the device, she is making intentional efforts to reach and grasp, bringing her hands to midline. This is a significant improvement for her based on her therapy reports. Her sister Josie has adapted to Susanna being in the device and knows that it can move. She no longer tries to climb on it when Zu is in the Explorer Mini.
Occupational therapist's impressions
Although Susanna is not using the device to move yet, there are multiple benefits to using the Explorer Mini. Zu’s time in the device has propelled her progress towards OT goals that they have been working on for a long time.
- Susanna is more relaxed and stable in the Explorer Mini (less extension and posturing) than her other devices such as her highchair and standing frame
- Improved visual tracking and attention, especially towards midline
- Improved open hand reaching
- Improved bringing hands together toward midline
"Honestly, I was surprised on that reaching for midline because we have been working on that for long, long time, over a year now. I have seen a big improvement just bringing her hands together and seeing how relaxed she is with her arms. Just bringing them down on the table is huge, because we have been working on that for a while, I think that is the biggest improvement. I was worried about the joystick because we have been working hard at that. I thought it was going to be so much harder for her, but I must say she is doing really well with that."
- Occupational Therapist
Susanna struggled the first month with sleeping issues related to her condition. Despite the challenges lately, they feel that the Explorer Mini has had a significant impact on some of the skills that Susanna has been working on for a long time before she got the Explorer Mini.
- Bringing her hands to midline together and let them just be and resting together
- Bringing her arms together
- Reaching and opening hands at the correct time
- Intentional reaching
“I think bringing her hands to midline together is the biggest thing. She might bring one if we are trying to do stuff with toys, but for her to bring them together and let them just be and resting together, that has definitely been a product of her being in the Explorer Mini. We cannot really replicate that anywhere else. So her bringing her arms together, it has helped with that skill for sure."
- Susanna's Mom
After three months with the Explorer Mini
The parents continue to like the ease of use of the Explorer Mini. They even trained their in-home childcare provider on how to supervise her in the Explorer Mini. They continue to use the Explorer Mini daily, often twice a day, and she is alert and active for longer periods of time, up to 30-45 minutes.
Physical therapist's impressions
In the beginning, the PT thought the Explorer Mini would impact more OT and Speech, but was surprised at what she observed:
- Susanna's increased level of alertness
- Spending time in midline with improved head control and upper thoracic control
- Increased weight-bearing through her forearms with anterior weight shift
- Increased daily participation with Explorer Mini due to ease of use
- Increased upright exploration
- Increased opportunity for weight-bearing with hips in good alignment due to saddle seat
“For me, I think it has really helped with like the use of her hands and intentionally trying to reach for things. That is probably what has stood out to me - that once she gets it, that the joystick moves. But also that she is figuring out how to use her hands better, and I think definitely that the Explorer Mini has helped with that.”
- Susanna's Mom
Zu tolerates the Explorer Mini more than other devices and it has been easy to use on a daily basis. The parents have noted several benefits from Susanna spending more time in an upright position.
Zu is more alert and content and her personality is coming out more
“We also see more of her personality than we do in the Gait Trainer or the standing frame…she is not having to concentrate so much on holding herself up or stabilizing herself like she does in the other devices so she can show more personality, explore more things and react to things a little bit more.”
- Susanna's Mom
Increased level of purposeful looking and vocalizing from visual stimulation
"If I go get her up after her nap and I pick her up, I will go like 'Hi Susu!' And she will turn her head to me, things like that she would not necessarily do before, so her visual focus has definitely improved in the past couple of months a lot.”
- Susanna's Mom
Ease of use brings peace of mind
"From my side, during the day when we do have the nanny here, knowing that she does not have to go through some big training manual and I feel comfortable letting her put Zu in the Explorer Mini…I feel very comfortable about anyone being able to use it with our daughter and I do not feel that way with any other device we have. That peace of mind part, that is really important.”
- Susanna's Mom
She is reaching goals not only IN the Explorer Mini but also OUTSIDE the device
“I feel that since we have the Explorer Mini that Zu is a lot more comfortable propped up on her forearms, like even to where she has her weight on one hand and moves this other hand. She is definitely more comfortable with that positioning and supporting herself on one forearm and using her other hand to kind of explore. I do think she has become stronger in her core that she can be more calm in her sitting and I definitely think that this allows her to play plus improved balance.”
- Susanna's Mom
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