April 30, 2011
Dynamic Core for Kids Case Study: 9 year old child with Autism Spectrum Disorder (ASD)
At four years old S was diagnosed with low tone and gross motor delays. Subsequent issues included balance, gross and fine motor delay, increased frequency of muscle sprains, anxiety, sensory processing challenges. Last year at age 9, she was diagnosed with high functioning autism.
Presentation immediately prior to Dynamic Core treatment: S initially presented with decreased strength and endurance issues in her arms, legs and trunk. She had poor sitting posture (see Figure 1) which created difficulty in sitting for more than 15 minutes without low back pain. Her seated posture also limited her ability to look up and down from the blackboard which added to her academic difficulties. In addition, her poor standing (see Figure 2) and walking posture made standing for more than 15 minutes painful and she was unable to walk for more than a few blocks without fatigue. SIndy had additional difficulty standing on one foot, going up or down stairs without holding on to the rail and had difficulties with jumping, skipping and hopping. All of this made joining activities on the playground at school challenging and required modification of home activities.
S also had frequent complaints of headaches and neck/shoulder pain due to poor posture while writing or keyboarding at school. These complaints occurred once or twice per month, requiring the need to leave school so she could be have heat and pain medications at home. She also experienced frequent sprained her ankles on uneven ground bi-monthly, also resulting in the need to leave school for treatment.
S’s primary strategy for creating stability in her trunk was breath holding during movement and prolonged tasks (sitting, writing). It was observed that this breath holding also further contributed to her sensory processing difficulties (as breath holding increases the fright/flight/fight activity of the sympathetic nervous system). This also tended to worsen her anxiety for the same reason.
Intervention: Treatment was provided over a series of 1 hour sessions. The sessions varied from once every 2 weeks to once per month over 4 months. Dynamic Core for Kids is based on creating the best function of the inner core muscles (which stabilize the spine and pelvis before movement begins) in partnership with the outer core muscles (which are responsible for movement). We initially accomplished this for Sindy by teaching proper breathing before she began to move to activate the inner core muscles through diaphragm activation; the phrase “blow before you go” was an important cue. She was able to fully utilize her diaphragm by creating neutral ribcage and pelvis position through the use of pillows in lying and a wedge in sitting.
Results: Treatment resulted in S achieving and maintaining more neutral posture in sitting and standing (Figures 3 and 4). A seating support (wedge or properly positioned office chair) continues to be utilized to maintain proper alignment and build endurance during home and school activities that required the prolonged sitting position.
S has not complained of neck pain or headaches since her posture has improved. Her balance is much better and there have been no ankle sprains since treatment with Dynamic Core. Her Core breathing is now used as a management technique for her anxiety. It is possible for her to take longer walks and she now enjoys swimming as a regular recreational activity. Overall, she is more confident in her movement.
The Dynamic Core for Kids approach was co-created with Julie Wiebe, PT. For more information please refer to previous blogs on HeartSpace Physical Therapy for Children or go to Julie’s website at http://www.interiorfitness.com/ Photographs used with permission.