RE: FOSSELMAN, JOSEPH 3/10/97

This is a follow-up visit for the patient who was last seen formally 1/16/97. In the interim, he has generally been stable. He is accompanied by his father. He appears in the wheelchair quite alert and able to converse. He has been participating in speech therapy, improving speech production with consonant/vowel and consonant/voweVconsonant combinations. Progress is listed in the report. He remains with weakness in the buccal and lingual muscles and will require further treatment. It is clear that he has improved. He has been involved in therapeutic feedings and tolerates 10-20 tsp. of baby food or pudding. He recently ate some ground pork roast, potatoes and carrots. He likes pudding or sherbet. He will undergo a VFSS to assess this further.

He continues in OT and requires moderate to maximal assistance. He is tolerating more positioning and range. He has improved strength for pressure relief to lift his buttocks and do a complete anterior pelvic tilt. He is using the trapeze to pull himself forward. He wears a left upper extremity splint to decrease tone and attempt to improve range. Goals are to improve sitting tolerance and to begin to shave himself with set-up and cues, apply deodorant with minimal PA and begin working on upper extremity dressing, also to bathe the upper body with minimal PA. He will continue to work on trunk and head control and simulated feeding activities.

He is participating in mat activities in PT, and has been working on rolling to the left. He needs to continue progressing with mat activities as well as PROM, AAROM, stretching and PNF.

Although progress will by definition be slow, it is clear that progress continues to be made and is functional in nature. He has a mat at home to work on his therapy in between formal sessions. His wounds are all healed. He did get the mattress purchased by Care Choices.

He saw Star Wars and mimicked the "breathy sound" done by Darth Vader. He smiled afterwards.

He is due for follow up with Dr. Esmaeli in July.

He still drools a fair amount but it is slightly less. He can smile to command. He has good head control in the tilt-in space wheelchair. He is doing well with bowel and bladder. The blood pressure log shows that his blood pressure and heart rate are good. I will try to wean the Inderal. There have been no seizures. He has been on Albuterol tid and Mucomyst bid. As his lungs are clear today, I will make these pm. There has been no nausea or vomiting. He continues on tube feedings of Promote with fiber, 9 cans per day. He is 6'1 ". He still needs his tooth fixed or replaced.

He has a bone scan pending later in the week to assess the HO in the left hip and right shoulder. He does have a lift for his van. There has been evidence of consistent progress in the last two months.

Owen Z. Perlman, M.D.