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Dynamic Core for Kids
Shelley Mannell, BScPT, Julie Wiebe, BSc, MPT
The following is a summary of a more formal case study (submitted for a future publication) of the response of a 12-year-old boy, Michael (name changed for privacy), had to the Dynamic Core for Kids approach. Co-created with Shelley Mannell, this pediatric application of the core program I developed for adults, integrates the pelvic floor and diaphragm into core rehabilitation and fitness programs. These photos actually capture his progress better than our words! His response was exciting and we are seeing a similar response in kids and adults with a variety of diagnoses.
Case Study of a 12 year old male with Cerebral Palsy:
Initial Presentation:
Michael had a stroke at birth that primarily impacted his right arm and leg, causing them to be weak and tight (spastic). His trunk was very weak and he experienced compensatory left-sided arm and leg deficits as well. The resulting postural weakness (see photos below) made it difficult for him to sit still for longer than 10 minutes. In addition, he had trouble keeping his eyes at the horizon resulting in an elevated gaze. This made social eye contact, and visual demands of reading the chalkboard at school challenging. Michael had difficulty maintaining balance when moving from sitting to standing and had falls due to poor balance in walking. His primary resource for creating stability at his center for seated and standing postures and to help with movements was to hold his breath.
Intervention:
We utilized a holistic approach to restore his core function. The adult physical therapy literature has demonstrated that the components of the inner core (Diaphragm, Transversus Abdominis, Pelvic Floor, and Multifidus) all become more active automatically in a neutral alignment of the pelvis and the ribcage. Thus, we initially focused on creating a core-optimizing alignment through the use of pillows, wedges and towels. In these core-optimizing positions, we helped Michael access his inner-core components through the use of blow toys to stimulate his diaphragm. The diaphragm has been shown to elicit a response for the other 3 elements of the core. Michael was encouraged to use the mantra “Blow before you go” to elicit core support for his posture before each repetition of his therapeutic activities, each transitional movement, and as he participated in play. Following this training approach, his core strengthened and began to hold his alignment without the need of additional propping from seating aides. The improved alignment improved the activation of his core during daily activity, school work, and play. (Michael does use a wedge at school to improve his tolerance for full day activity).
Results:
As seen in the series of seated photos, Michael made a significant improvement in maintaining a more neutral postural alignment both with and without seating support. Michael now sits independently for school work without time limitations. Improved posture also resulted in a significant change in his eye gaze positioning, which has the potential to positively impact both social interaction and school work success. His seated alignment facilitates his ability to rise from sitting to standing without using his arms. Similar development is evident in the standing photos. His parents noted that Michael displayed improved standing balance.
