Shelley Mannell, BScPT, Julie Wiebe, BSc, MPT

The following is a summary of a more formal case study (submitted for 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 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 elements of the inner 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.

Treatment was provided over a series of weekly 1 hour sessions for 2 months to address sitting posture.

September 2009                   November 2009                November 2009

Treatment was subsequently provided for another series of weekly 1 hour sessions for 2 months to address standing posture.

September 2009        Treatment Jan- March 2010

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Conclusion:

This case illustrates the possibilities for improved postural control and movement capacity in a child with CP using the Dynamic Core for Kids approach.

For more detailed description of the study please see Shelley Mannell’s blog at www.heartspacept.com. For more information on the clinical approach please see http://interiorfitness.com/services/for-pros/ . Photographs used with permission.

Bibliography

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Hodges PW, Butler JE, McKenzie DK, and Gandevia SC. 1997. “Contraction of the human diaphragm during rapid postural adjustments.” The Journal Of Physiology 505 (Pt 2): 539-548.

Hodges PW and Gandevia SC. 2000. “Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm.” The Journal of Applied Physiology 89: 967-976.

Hodges PW, Sapsford R, and Pengel LH. 2007. “Postural and respiratory functions of the pelvic floor muscles.” Neurourology And Urodynamics 26, no. 3: 362-37

Liu WY, Zaino CA, McCoy SW. 2007.  Anticipatory postural adjustments in children with cerebral palsy and children with typical development.  Pediatric  Physical Therapy 19(3): 188-95.

Sapsford RR, Richardson CA, Maher CF, and Hodges PW. 2008. “Pelvic floor muscle activity in different sitting postures in continent and incontinent women.” Archives of Physical Medicine & Rehabilitation 89, no. 9: 1741-1747.

Van der Heide JC, Begeer C, Otten B et all. 2004.  Postural control during reaching in preterm children with cerebral palsy.  Developmental Medicine and Child Neurology 46: 253 – 266.