Maya
Example of anIndividual Program
Let's Meet Maya.............
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Maya 21 year old
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Dual Diagnosis Down syndrome, Autism, SPD & PDA
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Congenital Heart Disease
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Mild Intellectual Disability
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Verbally Communicates
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Low Proprioceptive Awareness
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Poor Balance
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Hyper Mobile- Hips,Knees,Elbows, Shoulders
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Low Muscle Tone
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Minimal Movement in Ankles and Wrists
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Poor Grip Strength
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Short Digits & Limbs
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Over Weight
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Flat Feet & Fallen Arches
Maya's Main Goals For Attending Sessions....
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Wanting to Walk Better
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Feel Comfortable in Her Body
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Walk Without Hurting
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Loose Some Weight
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Be Able to Wipe Herself Without Assistance
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Stop Some Pain in Body (shoulders,lower back & knees)
What to provide in Maya's 45 minute Program.....
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Strength and Stability: Focus on exercises that strengthen muscle around the joints
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Proprioceptive Feedback: Movement that provides Proprioceptive Feedback (deep pressure) Using exercises and postures that provide pressure to help with body awareness (weighted Props & Balls)
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Weight Bearing: Weight baring exercise for core strength. Mat based exercise.
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Support for Hyper-Extension: Props and Supports to prevent Hyper-Extension, over extension of joints. Using blocks, balls, bolsters etc...
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Encourage Softness in Joints: Avoid locking knees and elbows during weight-Bearing exercise.
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Avoid Over Stretching: Modify Postures/Exercises to prevent over stretching & props used, remembering Maya has shorter reach.
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Rest Breaks: Allow rest periods through session, drink breaks, regulation breaks.
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Offer Choices: Use a task board with 3 to 5 options.
Maya's Feet.......
Maya has extremely flat feet with dropped arches, as we see from her foot scan, the red spots are where her foot lands on the ground as she walks. Maya shuffles as she walks. feet turned out often toes on the right side don't touch the ground. Maya has pain in her ankles and the tops of her feet. Due to sensory issues she won't wear shoes very often and definitely does not like her orthotics.
Every session we start with Maya's feet:
Picking up pompoms and placing them in the bowl one at time.
Sitting in the hammock and rolling several different textured balls under her feet.(selection is good for sensory preferences)
Standing holding the hammock in a basic grip/back wrap - heel raises, also using angled yoga block.
Maya's Program....
Working alongside Maya's Physiotherapist at HT Health we came up with a similar program for the Hammock and the Gym.
SQUATS AND MARCHING
Modification: Maya needed to find away to hold the fabric that was comfortable for her.
Block placed between her feet to assist keeping toes to the front.
Same grip used for marching with heavy sandbags floor on the outside of feet to
keep feet facing straight ahead.
1.Squats - with blocks X 8
2.High Marching - X 20 stop and hold for a count of 3 each 5.
3.Option 2 - High Marching using the wall for support, opposite hand to opposite knee X 20 stop and hold for 3 each 5.
Lateral Flexion...
Several options to explore..
1. Block placed between the thighs encouraged Maya to keep legs and feet closer together, also toes to be forward to front of mat. X 8
2. Balanced board used as an option, star shapes on board to keep toes to the front.
3. Flipping fabric to front with soft knees, gentle twisting from left to right, blocks & added weighted bags in the end as feet started to drift outward. X 8
Seated forward folds & twists...
1. Gentle movements moving forward & back.
2. Twisting left & right
3.Rocking motion to staring the pot (rotation)
Maya tended to roll her knees and feet out to the sides and drop her head down. I assisted sitting in front of her and gently holding her feet to bring legs into a better position.
Focusing on breathing with movement allowed her to bring her head into a better position taking strain off neck and shoulders.
Singing songs was also useful here.
4. Double ankle trap on back, yoga strap used to keep knees together. Arms shoulder height palms down. X 8 each side.
Following on from previous Forward Fold & Twisting, we worked on using balls to add a little Proprioceptive Awareness.
Beginning on the mat sitting opposite Maya, feet touching, legs apart using my feet to limit Maya, (as she is very Hyper Flexible through the hips).
Rolling textured pilates sized ball down each leg with some pressure, returning and rolling up body and lifting ball up over head. X 8 each side.
We then transfer to the hammock in Straddle Wrap.
Rolling ball up the front pillar of hammock first then pressing down and rolling the ball with pressure down each leg toward the toes. (being cautious of Hyper Flexibility) We ended up in a low hammock with bolsters placed either side to remind her of safe spaces. X 8 each side
In this position we introduce some ball squeezing to strengthen hands, wrists and fingers. (grip strength) X 8 also incorporating deep breathing.
Placing a larger textured ball between the thighs, squeezing and releasing building strength through the hips, glutes, pelvic floor and thighs.
Maya's Progression.......
It took 8 weeks before Maya was comfortable enough to try coming onto her tummy.
Using a peanut ball for a beautiful pressure made her feel a little more comfortable as there was still a feeling of being connected to the ground beneath her. Often I would assist her to roll onto her back and gently rock her back and forth across the peanut ball, she found this very regulating and often finished the class in this way.
Maya has become increasingly comfortable on her tummy in the hammock.
Building up strength
Boxing with several different sized balls
Sorting balls into boxes
Shooting Hoops with the chi balls and even a little art work.
Mum's the Word.....
Maya's Mum commented...
Maya has been going on small walks with her & support staff
Feeling more comfortable in her body
The Podiatrist managed to get her into a supportive pair of shoes.
Still struggling with twisting, Mum thinks it is more to do with weight, we will continue to work on this.
