<snip>

Ally took a deep breath and looked at Jon. They had agreed she would present it and he would field any questions that Derek and Pilar would have. Since there could be a lot Ally was happy that section would be directed to Jonathan. Sliding a PaDD over to them, there were three files marked.

https://imgur.com/OANAvWB
https://imgur.com/UMy04a3
https://imgur.com/gOtqtyu

The report was self-explanatory so Ally just hit the highlights. “Otana presented with a mild traumatic brain injury to her Frontal and Temporal lobes. The Frontal lobe lesion is what is impacting her communication, executive functions, memory and attention/impulsivity. The Temporal lobe lesions is affecting her auditory processing and the ability to control her emotions. As you know both of these injuries are permanent and can not be repaired. The good side is due to Otana’s age and the plasticity of her brain, with enough therapy and specialized education, she has the possibility of regaining most if not all of the function back. It will be a long road but we do have options. Otana’s traumatic brain injuries will impact her daily living skills. Applied Behavioral Analysis or ABA therapy is recommended to work on her ability to complete tasks and improve scholastic performance. ABA will increase her ability to process language and increase her communication skills. Academically skills should be broken down to smaller steps with teach-reteach sessions as warranted until her skills are independently achieved. Home and school should employ the use of visual supports such as times and visual displays to ease the anxiety associated with transitions and increase Otana’s ability to predict changing events in her environment.” Ally’s tone was neutral and matter of fact. She was relaying information and not to the point of interpreting it.

Taking a deep breath after flooding them with facts she changed wheels and tried to gauge how well the couple was following it. Looking up Ally took a moment to judge the parent’s eyes for comprehension. Some parents had a glassy look that meant their brain was being overwhelmed by the sheer amount of information. Other parents had a blank look that meant the report could have been in Romulan for as much as they understood of it. A few parents over the years broke down crying devastated that their world was now torn in half and never able to be reassembled. Starfleet medical trained people to be stoic and detached when the need called for it but when it touched your loved ones. When the news was about the only people in the universe one cared for, an individual’s reaction was unpredictable. Ally was happy Jonathan was here to help her friends through this if they needed to. There was one last piece of information Ally could share. “Pilar I can’t imagine what is going on in your mind right now but know that you are not alone okay,” Ally reached out her hand towards Pilar. “Otana’s rate of learning may be impacted but it is difficult to predict how the injury will present during her formative years. I am not going to give up on her. Jonathan is not giving up on her. No one is giving up on here,” Ally said firmly and waited for the parents to reply.

Lt. Ally Scott medical

Pilar looked at Ally taking the information in and digesting it. She looked at Derrick to judge his reaction, he looked just as calm as she was “Okay. I understand everything that you have said and we knew that there was something going on.” She said as Derrick took her hand, Pilar was hard to read, she had learned to hide her emotions “What do we need to do? I am okay with the medications.” She stated as Derrick nodded in agreement and then spoke “What kind of supports can we give her in school?” He asked.

Head Nurse

“We can work with a program on that, she would come see me for one on one sessions as well. We will be here every step of the way.” Reez chimed in.

Reez, CoP

“I think we should start on a token exchange system,” Ally asked giving Reez a side glance as she paused for a second before continuing He was the expert on behavioral analysis. Jon was also never shy about stating his opinion. Since he hadn’t voiced his opinion so far Ally continued mainly for Derek’s behalf. “A token exchange system is basically doing something for a reward. The reward doesn’t have to be huge just something highly desirable. In the past, I have seen it work with earning an edible or special toy. Whatever is her reinforcer or reward, Otana has to complete a series of tasks in order to get the reward. We will want to go with continuous reinforcement at the start so that she understands if I do A I get B. When this connection is made, and it should not take long, we start to extend to periods between when she is given the reinforcer. My gut is that we start with a familiar task but one that she is not thrilled with such as cleaning up her toys. We show Otana that while she might be unhappy or frustrated with a task how to control an outburst because after you do a less preferred activity you can do a more preferred on.” Ally hoped she was not going too simplistic in her descriptions however it was not uncommon for people to hear that white noise rush when trying to process news like Derek and Pilar were. Ally paused for a second and looked at Jon again hoping he was on the same page as her.

Lt. Ally Scott medical

bump

“Is there anything you guys want us to focus on?” Jonathan asked, they had their plan but they needed to know what roles the parents saw. It was ultimately their child and their choice.

Reez, CoP

Derek spoke up “Mostly her outbursts. They are becoming more frequent and violent.” He said “We do some of the token rewards at home. It works most of the time. There are other times that it doesn’t.” Pilar nodded “We will follow your lead on this. I am willing to work with her on whatever we need to.” She said

O’Keefe (Head Nurse)

“What if we start slow? Maybe the holodeck? We could sabotage her, watch how she handles things, and then go from there?” Ally knew Jon and Pilar understood but she had to keep in the back of her mind Derek. So many times people walked into her office and Ally she treated their illness but as a doctor you always needed to treat their souls.

“Sabotage is when we set her up to fail at a task so that we can help her learn from it. It’s a classic behavioral technique. It allows her to learn to work through her frustration but in a safe and controlled environment where things won’t escalate. Any ideas of what she loves and would struggle at,” Ally asked

Lt Allison Scott. Pediatric

“She seems from last time had issues with sharing, coming place to start but might be something to try if you think she could use lessons there.”

Reez, CoP

Derek looked between the three medical officers, he knew his wife was struggling with this and was holding her emotions in check so he spoke for both of them “Let’s start with the sabotage and see what happens. She definitely needs to learn to share but if we can work that in as well.” He said “When do we start?”

Derek O’Keefe

“Tomorrow after school,” Ally suggested. “If you can come up with a setting for the holodeck which Otana loves but also can stress her out some so we can work through it that would be perfect ,”.

Lt. Ally Scott. Medical

Derek nodded “When we go we often run a scenario where she has to complete a series of increasingly difficult tasks for a specific reward, we have based it on academic things such as vocabulary, math and science. She often gets frustrated and will shut down, but she loves the program because it’s interactive and fun.”

O’Keefe’s

“Perfect, let Ally and I work on this, and we will get the best program for her.” Jonathan said as he smiled softly at the two parents. He understood the fear, his kids were three and growing by the minute and he feared every moment for them.

Reez, CoP

bump

Pilar nodded and looked at her daughter, her anger for the Cardassians rising again. She took a deep breath and looked at Derek “We should get home, so she can get her bath and dinner.” She said standing “Let us know when you’re ready for the program to begin.” She said, her face devoid of any emotion, if she was upset with the diagnosis, neither Jon nor Ally were able to see it.

O’Keefe Head Nurse