It was a Monday morning at breakfast, 10 days into the quarantine, that JoAnna Van Brusselen first noticed the claw.

Her oldest daughter, Iolani Azul, 11, was sitting at the kitchen table in their house in San Francisco, her right hand curled up against her stomach. It reminded Van Brusselen of how her daughter had carried herself when she was an infant, before years of schooling, occupational therapy and guidance from teachers helped her overcome some physical and cognitive challenges resulting from a stroke in utero.

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