Benefits of Pilates for Children with Mild Autism

Transcription

1 Benefits of Pilates for Children with Mild Autism Anne York January 14, 2018 Studio 64 Pilates Brisbane, Australia 1

2 Abstract Autism is a neurodevelopmental condition affecting a child s physical and mental development. It is a lifelong condition, with symptom appearing in early childhood. Children with Autism are sticklers for routines, which can affect the way they interact with others, and how they experience the world around them including difficulties with fine and gross motor skills. Parent who added Pilates exercises such as core strength, back strength and vestibular proprioception balance to a child s physical regime reported improved flexibility, balance, and energy in their children. Other symptoms that may be helped through Pilates include loss of balance, changes in posture, movement transitions and environmental transitions; the two biggest challenges these children face. The focus of this paper is on the importance of Pilates as a rehabilitation tool for children with Autism. The goal of my programs for these children is not to get every exercise correct but to help neurons fire to integrate both proprioceptive and vestibular movements to regulate their activity level, emotional regulation and physical strength. Through set routines children learn to develop the necessary and fundamental skills that all children benefit from. 2

3 Table of Contents Abstract Page 2 Table of Contents Page 3 Anatomical Description Figure 3.1 The Autistic Spinal Posture Page 4 Figure 3.2 The Abdominal Muscles Page 5 Figure 3.3 The Erector Spinae Muscles Page 6 Introduction Page 7 Case Study Page 8 Joseph s BASI conditioning program Page 9 Conclusion Page 12 Bibliography Page 12 3

4 Anatomical Description Figure 3.1 The Autistic Spinal Posture The anatomical posture of children with Autism includes hyperextended knees, a pelvis that is anteriorly rotated and mild to severe lordosis. Muscles in the erector spinae, hip flexors and quadriceps are typically shortened and tight which increases the pull on the pelvis forward. The weakened core and stretched abdominal muscles create an imbalance in the child s posture which does not provide adequate assistance in countering the gravitational pull forward of the pelvis. This can result in proprioceptive challenges, balance issues and motor control difficulties for ASD children

5 Figure 3.2 The Abdominal Muscles There are four important abdominal muscle pairs imperative for postural/movement control in children with ASD. These include the Rectus Abdominis (RA), the Internal Obliques IO), the External Obliques (EO), and the Transversus Abdominis (TA). The (RA) muscles are important for flexion, bending and stability. The RA muscles, in conjunction with the IO & EO muscles, are responsible for flexion (including lateral flexion) of the spine. The TA muscle s primary function is postural and protective stabilizing the spine and pelvis before movement of the lower or upper limbs. Children with movement difficulties (joint hypermobility and low muscle tone) benefit from strengthen these core muscles. Movement and standing with a strong upright posture, keeping the head and trunk steady facilitates their ability to move with balance responses, anticipatory postural responses and postural stability. 5

6 Figure 3.3 The Erector Spinae Muscles The Erector Spinae muscles consist of three columns of muscles. The Iliocostalis, Longissimus, and Spinalis, each running parallel on either outer side of the vertebra and extending from the base of the skull to the Pelvis. The Iliocostalis muscle; responsible for extension and lateral flexion of the spine is the farthest from the vertebra extending from the upper thoracic spine (T6) to the base of the cervical spine (C6-4). The Longissimus Dorsi Muscle is the longest of the back, made up of 3 parts, the Capitis, the Cervicis and the Thoracis. The Capitis Muscles hold the head up and rotating toward the same side of the muscle that is contracting. The Cervicis Muscles bend the neck and assist in keeping the cervical spine erect. The Thoracis Muscles assists in the motion of backward and sidewards bending, keeping the spine erect and pulling the ribs downward to help with breathing. 6

7 Introduction: Pilates assists with both movement transitions and environment transitions, which are the two biggest challenges Autistic children face. Pilates enables these children to organize their body movements to execute more coordinated gait-related issues and motor skills. The therapeutic approach to helping children with sensory and attention issues involve the application of strengthening a child s motor coordination and muscle development. Proprioceptive therapies entail stretching and contracting the muscles. The centre of my rehabilitation program is stretching and controlling the muscles. My program focuses on stretching and strengthening the muscles that support the core TA & IO/EO); the spine the extensors, flexors and bilateral coordination and segmental stability. In the pages to follow, I will review my case study and the rehabilitation Pilates program that I designed for my client. Please note, I have been trained in Applied Behavioural Analysis (ABA) and as an Occupational Therapist which is one of the leading methodologies for treating children with ASD; I have the strategies for managing un-healthy behaviours and how to apply a just-right-challenge applicable for my client. The program; behaviours and outcomes are not to be generalized to other children with ASD. 7

8 Case Study Joseph is a 7-year-old boy who is very active and enjoys a variety of indoor/outdoor activities. He is part of a soccer team through school, attends swimming lessons once a week and swims regularly at home. Joseph was diagnosed with a moderate ASD diagnosis when he was 4 years old. For the first 18-months post diagnosis Joseph attended an intensive ABA program to build his communication, social and fine motor skills. Joseph continued to build these skills through his school programs and commenced seeing a physiotherapist for ongoing gross motor development. The physiotherapist worked on lengthening his spinal muscles, supporting active knee flexion/extension through range and core stability work during active movement. Joseph s physiotherapist suggested the incorporation of activities to enhance neuromotor development to improve processing efficiency; which is when his parents came to me for ongoing therapy sessions. Due to Joseph s lack of focus, high stim behaviors and reduced communication I was advised to keep exercises simple and clear but have a well-balanced just-rightchallenge. This meant our sessions needed to include functional breaks and incorporate his preferred activities such as jumping, spinning and rolling. In addition to strengthening the muscles around his spine and core, other goals for our session were to increase the strength of his hips and work on balance. Other than his ASD diagnosis, Joseph presented as a very healthy 7-year-old and was very happy to be trying something new. 8

9 Joseph s BASI conditioning program Over the course of 6 months, Joseph joined me for Pilates sessions two times a week, and I rotated what equipment he used from session to session. Below are two examples of programs that I implemented with him. Sometimes not all of the blocks were met due to times constrains or behaviour challenges. Occasionally parts of one program were switched with the corresponding block exercises in the other program due to flow or how Joseph was feeling that day. His program focused on building core strength, hip flexor strength, balance and stretching while working with his physical and mental limitations; most importantly, continuing to work with his behaviour needs. The warm-up included some of the BASI fundamental warm-up but was modified based on his attention span and stim-behaviours on the day of session. Starting with the fundamental warm up reminded Joseph of the importance of focusing and stabilizing his body for movement. This foundation work facilitated his understanding of initiating movement, then using breath through movement. It was a good way for him to start our sessions to maximize benefit throughout each exercise. Footwork was completed on the Cadillac. This allowed Joseph to focus his attention on the feet, hips and knees. As he gained strength in his lower body (without hyperextension of the knees) we could increase his resistance. His mother and I agreed to do all footwork on the Cadillac as Joseph would get distracted and hyperactive when on the reformer. The combination of the push/pull of the springs and the bed travelling was a sensoristiumulating activity. During sessions when Joseph needed a break or was demonstrating inappropriate stim behaviour (such as flapping, jumping, or clenching of his body) we would work through a jump-board routine on the reformer. 9

10 Abdominals: Majority of our abdominals were completed on the Reformer; through level one/two options. The movement of the carriage supported his vestibular needs, and speed regulation. Hip Work: The Cadillac is beneficial when performing hip work as it promotes a feeling of stability. As each leg uses a separate spring, it is possible to individually address the muscular imbalances. Spinal Articulation: Roll-downs on the Cadillac facilitated stretching and anatomical posture with minimal distraction. Full Body Integration: Reverse knee stretch works the body bilaterally. Scooter builds on this by working the body unilaterally, further strengthening the weaker side by including more repetitions Arm Work: Standing Cadillac / Ped-a-Pull Leg Work: The jump board helped to provide a linear combination of vestibular and proprioceptive input. Lateral Flexion: Side Stretch works each side independently. The focus will be on strengthening the weaker side more and stretching the stronger side more. 10

11 Block Program #1 Program #2 Warm Up (on mat) Roll Downs, Pelvic Tilt, Pelvic Curl, chest lift with rotation, Single Leg Lift Roll Downs, Pelvic Tilt, Pelvic Curl, chest lift with rotation. Supine Spine Twist was added once he has sufficient oblique Footwork (on Cadillac) Abdominals Hip Work Parallel heals, Parallel toes,v-position toes, Wide v heals, Wide v toes, Calf raises, Prances, Single leg heals, Single leg toes On Mat: Single leg lifts/leg changes, hundred prep Double Leg Frog, Double Leg Hip Circles, Double Leg Walking, Double Leg Bicycles, strength after 4 weeks) Foot work on Cadillac to open up hamstrings, calves and hips as well as work on pelviclumbar stabilization and hamstring ex tensor strength. Reformer: Chest Lift 1 / 2, Obliques, Scissors, 100 s. Tower: Single Leg Frog, Single Leg Circles, Single Leg Hip Extension, Single Leg Bicycle Spinal Articulation Cadillac: Monkey Stretches Standing Lunge Only Standing Lunge Only Full Body Integration Scooter Reverse Knee Stretch Arm Work Standing PAP; Chest Expansion, Biceps, Rhomboids, Hug A Tree, Salute Standing Cadillac Chest Expansion, Biceps, Rhomboids, Hug A Tree, Salute Full Body Integration Elephant Reformer Elephant Reformer Leg Work Wunda Chair- Hamstring Curl, Single Leg Step ups, Hip Opener Side Stretch (Wanda Chair) Reformer Jump Board, Single Leg Skating, Leg Press Standing Side Stretch (Wanda Chair) Lateral Flexion/Rotation Back Extension Wunda Chair Swan on Floor, Swan Basic (proceeding with Back Extension Single Arm) Rest Position 11

12 Conclusion At the end of the 6-months, Joseph s progress was evaluated through the same assessments completed at the beginning of the program. These measurements ncluded range of motion assessments at the shoulder, knees, hips and lateral flexion as well as muscle strength testings and endurance (ie. Planks). Joseph demonstrated improvement in all areas of assessments with the greatest success in endurance. Furthermore. Feedback from his mother concluded Joseph was able to maintain focus better throughout his daily activities, with prompting he could work through some fundamental mat exercises at home when he was stimming. Through observations and the program developed within his personalized Pilates program, a child with mild autism can work through a structured program to increase core stability/strength and have a positive outcome. While it is not an easy issue to deal with and can be extremely frustrating, taking the time and energy needed to work on the behaviour management as well as the physical morbidity, outcomes can be extremely beneficial. As previously discussed, it is critical to strengthen the muscles of TA & IO/EO); the spine the extensors, flexors and bilateral coordination and segmental stability. By strengthening these muscles you are allowing for greater participation in daily activity and management of un-healthy behaviours. 12

13 Bibliography Biel, Andrew, Trail Guide to the Body Clippinger, Karen. Spine Anatomy & Core Basics Online Workshop #2801. January 13, Garland, T. (2014). Self-regulation interventions and strategies keeping the body, mind and emotions on task in children with Autism, ADHD or sensory disorders. Eau Claire, WI: Pesi Publishing & Media. Isacowitz, Rael and Karen Clippinger. Pilates Anatomy. Champaign, Illinois: Human Kinetics Print. Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International,