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I’ve worked with a range of individuals on the autism spectrum with respect to Physical, Adaptive, and Cognitive functioning.  On the low end of adaptive/behavioral abilities, aggressive or self-injurious behavior can be a concern.  As a fitness professional, or someone who is providing an ongoing adaptive PE, active play, or movement program, the questions becomes; “What do I do to safely eliminate this behavior and how do I modify programming?”

The easy thing to do would be to forego all demands/programming. However this is in nobody’s best interest.  First let’s consider what aggressive/self-injurious behavior actually signifies. ALL behavior has meaning, and all communication attempts to convey something. Typically with fitness programs, the instructor is providing a demand (whatever they want the individual to do), and regardless of how fun I, or any instructor thinks the activity may be, the individual wants no part. This can be activity-specific or simply because we’ve changed up the individual’s typical routine (which may very well have been walking in circles, but is still a routine).  Something new, something that requires effort, may be enough to elicit maladaptive behavior.

Aggression and/or self-injury are usually “escape-maintained” behaviors. Their purpose is to get the individual out of the current situation. Particularly with non-verbal individuals, who lack more appropriate means of expressing needs and wants, this strategy may be met with reinforcement (removal of the demand situation). In the immediate, we want to ensure safety. Given. Absolutely. However the contingency that may form would, from the individual’s perspective, look like this:

He/She wants me to do something I don’t want to do —> I hit/bite/kick myself or them —> I no longer have to do that thing I don’t want to do.

The first proactive step is a behavior modification program, preferably developed by a licensed BCBA or other clinical therapist. It is impossible to eliminate a problematic behavior, particularly one involving communication, without providing at least one (and preferably more) appropriate option. One strategy that has been quite successful is to provide breaks after completing a task.

Suppose Chris is currently able to perform three push throws with a medicine ball and the next goal is four throws. If we are providing secondary reinforcement following the fourth throw (access to a break or preferred activity), we may ALSO provide a break when he asks appropriately (rather than engaging in the aggressive or self-injurious behavior), establishing the contingency between asking/pointing to a picture or using a different mode of communication, and access to the reinfrocer (in this case, a break). This strategy serves two very important purposes; Preempting the maladaptive behavior and providing a more appropriate response in its place.

A high rate of reinforcement to workload/demand may be necessary when first introducing exercise to an individual with low adaptive skills. It may also occur with changes of environment. One of my long-term athletes will become self-injurious when we move our sessions from outdoor in the Spring, Summer, and Fall to indoors during the Winter.  It may be the confined space (he likes to wander around), or that fact that I am now instructing him in his home, but as soon as we move inside the hits to the head and arm biting (his, not mine) commence. So I back off the demands and give him longer breaks between activities. He can ask, appropriately, for a break at any point and it is granted. Eventually, we get some exercise in.

It is always easier to do nothing rather than something, or decide that an individual just “doesn’t want to” or “can’t” participate in an activity, particularly when an extreme behavior is involved. We have to promote more respect and regard for ASD individuals than relegating them to situations that are not challenging or promoting healthy new skills.

None of this is theoretical. Some of the athletes who I now coach through intense, fun sessions, were hitting or biting themselves or me (particularly if I intervened in their self-injurious behavior) when we first began together. Take things at the pace of individual, from all three areas of functioning (Physical, Adaptive, and Cognitive). Remember that something aversive can be made less-so (and even enjoyable), by pairing it with known reinforcers and, just as importantly, with consistency over time.  Becoming familiar with an instructor, program, activities, and new words/association can alleviate anxiety, which may also be contributing to problem behavior.

Everyone deserves an opportunity to move, grow stronger, and become physically healthier. As professionals and providers we sometimes have to strategize a bit more, be willing to change things almost immediately, and keep in mind our priorities. Good information used intelligently leads to positive outcomes.

Live Inspired,

-EC

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Jan
02

Improving Expectations

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Consistency in expectation is a key component of Autism Fitness programming. My athletes know what to expect from me, and I know what they are capable of doing. This is not an immediate situation, but one that develops through building a rapport with an individual. It begins with a basic equation common to Applied Behavior Analysis (ABA):

Antecedent, Behavior, Consequence (ABC)

What comes first? What is the reaction? What is the consequence of that reaction?

In the context of fitness activities, I ask my athlete to perform a med ball push throw, he does successfully, and earns some break time. While the expectation becomes greater over time (more push throws, push throws + another activity), the sequence remains; The request, the performance, the reinforcement.

Proactivity is damn better than reacttivity when teaching movement stuff. Rather than correct a movement that is too difficult for an athlete to perform, start off simpler. This is where the concept of regression becomes invaluable. With movement andgeneral learning, we are all human beings on different points of the same continuum. We meet our athletes at their current level of ability and progress from that point. Yes, it takes time, and no, it is not always a directly linear process.

Having consistent expectations can help in alleviating anxiety, something quite common to those with autism. Removing the element of uncertainty can have a calming effect. Many individuals with ASD are comfortable, sometimes to a detrimental degree, with repetition and sameness. Introducing new activities can be overwhelming if there is too much too soon. If the goal is to make fitness and active play reinforcing/fun, you have to take your time with establishing first a positive relationship, and second, making sure that you are consistent in your expectations for physical performance. Yes, day-to-day abilities will vary slightly, but understanding what an athlete can and cannot do (yet) on a regular basis will allow a coach/instructor to plan successful programs.

Respect is a word that is tossed around with relation to special needs populations. From my perspective, to respect an individual is to provide appropriate instruction, and make sure that they accomplish something prior to accessing rewards, as the rest of us have to do in society. Developing skills, mastering challenges, and overcoming deficits is not a passive endeavor.

Live Inspired,

-EC

AutismFitness.com 

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One of our we-don’t-want-it-to-be-a-secret secrets in the strength and fitness community is that we ( the learned and practiced strength and fitness community, both professional and enthusiast), have know a lot about gaining and maintaining health for some time (circa early 1900′s). Resistance training for women? Knew it prior to cars being commonly owned. Whole fat foods (milk, butter, avocado, coconut) being heart-healthy? We espoused it the first time handlebar mustaches were hip and when Brooklyn was acres of grass-fed farm land. Kettlebells? Around when bells were the epitome of rocking out. Preventing illness and enhancing physical fitness because it creates a sound constitution and can be a healthy social pursuit? Indubitably.

This recent and well-written article by Dr. Arshya Vahabzadeh in the Huffington Post discusses one of the most frustrating problems with regard to autism and the general issue of healthcare; (yes, I fancily used a semicolon) everything is reactive. Dr. Vahabzadeh discusses both the complications of gaining access to therapeutic treatments and the confusing and seemingly unending hailstorm of information and misinformation (thank you/screw you, Internet) that parents and caregivers of individuals on the spectrum encounter. From the onset of symptoms and diagnosis, nearly every step is reactive. The paragraph that caught me goes like this:

Some people with autism find it difficult to engage in regular exercise, through a combination of a lack of suitable opportunities, their own social difficulties, and stigma against them. Let me jump now to my other truth: As medical professionals we often prescribe medications but “there is no pill that can replicate the health benefits of exercise.” It is not limited to exercise either, what about diet? Many people with autism also find they are particularly picky about the food that they eat, often ending up on a “yellow diet” that includes starchy or fatty foods such as fries, cheese, burgers, and pizza. What are health care systems doing to address these issues? Unfortunately far less than they could be doing. – Arshya Vahabzadeh, M.D.

Each sign-up I get on my email newsletter suggests that some nice person is at least curious about physical activity for the autism population. I’ve likely mentioned it in past posts (or ranted about it during seminars), but when I started Autism Fitness  ten years ago the idea that exercise was highly important for young people with autism wasn’t initially received with fiesta-level enthusiasm. Much as the “weightlifting-will-make-you-bulky-and-turn-you-into-a-goat” dogma, there was a gap between perception of exercise/fitness/active play and it’s benefits. Add to that the near-constant upkeep of educational, vocational, behavioral, and social therapies (and fighting to receive those therapies), and the basics become less than an afterthought.

The basics relate to health; Nutrition, Physical Activity, Sleep, Positive Support, and having Self-time. Ironically, it is all, or most, of these that are pushed away in the pursuit of enhancement. And you just can’t have optimal enhancement without them.

This, as are all big problems, is one of those pesky multi-faceted things. It is not cured by a change in one area (Electro-conducive ionized wheat grass reverse osmosis water baths), but a meaningful and practical synergy of all participants, meaning parents and professionals begin to share information across disciplines and practitioner guidelines, Federal and State mandates, and social expectations and behaviors change as a result.  This is called progress and depending on the issue, can happen in one large sweep or gradually. I would argue that a national movement towards a more proactive approach to autism wellness will be on the gradual side. It’s not really an “add Vitamin C to Cheeze Curlz” type of fix.

I’ve developed an, as titled, overly generalized visual chart for establishing a more fitness-forward autism community. You can see it by clicking the link below

http://prezi.com/dwuqgplj4ncy/?utm_campaign=share&utm_medium=copy

* (Thanks to one of my closest friends and colleagues Dr. Kwame Brown for introducing me to Prezi)

In our vocational capacities, we tend to view things through a rather narrow set of contingencies. I think everything from goldfish dandruff to nuclear disarmament can be cured through squats and monkey bars. Financial advisers cannot fathom how families do not have weekly budget meetings to alleviate social anxiety, and Dietitians know that cucumbers and kale will raise  social reciprocity. We’re all kind of right when things have proper balance.

I’m proposing, as I suspect Dr. Vahabzadeh (whose name I deeply hope I’ve spelled consistently correct in this post), would agree that in addition to access to services, the appropriate services are offered. Ignoring the practices of a healthy lifestyle has been an interesting social experiment and I think we can surmise that it has failed spectacularly. Our generation of young people with autism deserve a little more of what we (should) already know, that a healthier, more active foundation will lead to greater outcomes. Simple, bold declaration. Now all we have to do is make large, sweeping changes…one brush stroke at a time.

Live Inspired,

-EC

IMG_2599

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Autism Fitness sessions with my athletes typically last about an hour. Therapists, fitness professionals, we typically work on either a 45 minute to 1 hour session time frame. Some of us even get fancy and do a “professional” hour, which translates to 50 minutes. But does the 1 hour block make sense each and every time?

Depends on how you break up the hour.

For some of my athletes, that hour winds up being an 80/20 split between breaks or reinforcing activities (i.e., anything other than exercise) and actual exercise and physical activity. Ironically, if you really pay attention to youth sports, most are an 80/20 split for the majority of participants, but that is another issue/article entirely. Unless the athlete is highly motivated, you’re going to end up somewhere in this time exchange, with a high rate of reinforcement/free time/break time to actual instructional activity, which is fine in the beginning.

The goal with individuals who are lower in their adaptive functioning is to “thin” the schedule between access to reinforcement time and structured activity time. Those with lower adaptive functioning are the kids/teens who will wander away from the target activity, begin doing something else during the target activity, or, in the most delightful cases, have a meltdown (to varying intensities) during the target activity. Incidentally, when you work with an athlete/client long enough you begin to pick up on some of the precursory behaviors that happen prior to an actual tantrum/meltdown/aggressive episode.  During a Discovery Channel Shark Week years ago there was footage of a blue shark arching its back and swimming in small circles in a defensive posture prior to attack. I think of this a lot during my more challenging sessions.

Physical functioning is going to have different time variable than adaptive functioning, provided you have a highly motivated (or at least very compliant) athlete. Depending on his/her level of physical functioning , We may perform anywhere from 1 to 5 activities prior to a break.  This can be a set of 6-8 medicine ball push throws or a circuit of exercise activities (Sandbell slams, ropes swings, cone touches, overhead walks, etc.). It can also be time-based, which works well for those ASD individuals who are very adamant about knowing how much time is left before they get access to a break/reinforcer. You can do both at the same time, setting a timer for anywhere from 1-3 minutes and having the athlete perform the single or multiple activities until the timer goes off.

HERE’S THE THING. As a fitness professional and one of those fitness professionals who is very particular about technique, I cut instructional time when form in a particular exercise begins to break down. I want to reinforce proper mechanics and movement patterns, when an athlete is fatigued that does not happen. I’ve had plenty of parents give me “the look” or suggest that “break time” should be finished, but when an athlete needs recuperation time, they need recuperation time.

I understand you’re paying good money for this hour, but we’re not going to jam pack every possible exercise I know of into this hour simply because we have an entire 60 minutes. Fitness doesn’t work that way, time-space continuum be damned. You just have to learn to be patient and/or ask about the physical attributes and appropriate work-to-rest ratios for specific age ranges (and account for gross motor and strength deficits). I’m not being snarky. Really. Ask.

If the athlete is highly motivated AND capable of performing most of the day’s exercises independently, breaks and recovery time are appropriate. I seldom go more than 4-5 minutes of straight activity without a break. This relates to 1-to-1 situations. With groups it can vary, considering that with circuit stations and activities in which turns are taken there is more rest time. Nonetheless I’ve found that after about 5-6 minutes groups need some downtime as well, which is an ideal opportunity for speech and language development (“what did you just do?” “Who did you exercise with?” “What did you do first, second, third, last?” and, my favorite, prepositions including in, on, under, over, right, left, etc.), socialization, and relaxation.

Your 45 minutes-to-an-hour is not about how much you can get done so much as how well it can be done and the careful balancing act between instruction time, free time, and play time (where the skills being developed are used as per the independent engagement of the athlete).  Have specific and measurable goals, remember that every day is going to be a little different, and if your athlete starts doing something new, creative, or just keeps going with a particular activity, LET THEM. Independence  and creativity are the most sought-after adaptations/skills with the autism population.

In closing with key points:

- An hour session does not have to be sixty minutes of straight activity

- In fact it shouldn’t be

- But you can use the down time to develop other skills (speech, socialization, memory)

- IF it is appropriate

- For adaptively lower functioning individuals, your reinforcement-to-structure ratio will be higher. The goal is to “thin” it out and get more instructional time in

- This will take time and a lot of reinforcement + good coaching

- Have goals for each session and allow for a little bit of chaos

- When independent movement (play) happens, allow it

 

Live Inspired,

-EC

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Nov
03

Objects vs. Objectives Revisited

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One of the central concepts in Autism Fitness programming is Objects vs. Objectives. Recently I overheard a discussion between two parents regarding use and access to a treadmill for one of their teens on the spectrum. Now why a treadmill? Because of the current overwhelmingly bad information and programming our gym/fitness culture provides, several fallacies exist:

1) Running in and of itself, is a great fitness activity

2) Treadmills, because they exist, must be valuable pieces of equipment

3) Because running is “cardiovascular” exercise, it is ideal for individuals who are sedentary and/or do not participate in other fitness activities

4) Because many other people do it, running is a great way to get fit

 

The reality is that running is a very specific fitness activity which, for a good number of participants, causes as much or more harm than it does good. Running (distance), requires a certain amount of baseline strength, technique, and ability. Since many individuals on the autism spectrum already have deficit levels of strength and often gross motor issues, I would argue that running is a really poor choice as a singular fitness activity.

Good fitness programming addresses individual goals. Developing a greater level of strength in the major muscle groups and movement patterns should be the basis of just about every program. Why? Because developing general strength provides both the foundation to perform other activities (daily living and otherwise) and serves as injury preventative as well.  Developing healthy levels of strength as a foundation for other endeavors just makes sense, and it does not work the other way around, meaning general strength (pushing, pulling, squatting) is not enhanced by highly specified movement (running, riding a bike, etc.) The only time highly specific activities will build strength is when little-t0-no activity was performed prior. Suppose a 14-year-old has never done any physical activity and is started on a treadmill program with a goal of jogging for 5 minutes. He/she may eventually reach that goal, having increased their capacity to jog for up to 5 minutes. This accumulation of skill, however, is going to have minimal carryover or generalization to any other activity or task.

In addition to being outright boring for most, running or “treadmilling” does not address the low levels of low body strength and hip flexibility found in the majority of our population and, simply by default (and the fact that there is a high rate of sedentary lifestyle), the autism and special needs population. You can do all the treadmill programming you want, you’re not going to develop hip flexibility and probably exacerbate existing issues.

So why do all these treadmills and cardio machines take such precedence in gyms? Isn’t it because that’s what will get us fit and what we’re supposed to be doing? Gym are businesses, designed to turn a profit. Cardio machines require no explanation from a knowledgeable/reputable coach or trainer, can be placed in row after row, and, compared to free weights, medicine balls, and other more effective equipment, have a relatively low intimidation factor. Now a good medicine ball runs about $60. A treadmill works out to about $1k. The difference is that with the medicine ball you have to know a little bit about fitness programming and movement.  The treadmill is easy, it dictates what you’re supposed to do with little to no thought on the part of the trainee. The medicine ball, Sandbells, fitness ropes? Better choices absolutely; more fun, versatile, effective, and able to be used towards individualized objectives, but again, you have to educate yourself a little bit about what goals should be and how to use these objects effectively.

We’ve taken much of the “E” out of “PE.” The trend of using team sports or cardio equipment as the basis for Adaptive PE is a simply-because-it-exists and mostly thoughtless approach. Neither develops foundational levels of strength or movement patterns, nor do they lend towards individual goals.  Keep in mind also that fun and enjoyment of physical activity should be programming goals, and using cardio machines “just because they’re available” lends nothing towards creative and individualized ways to help make moving fun for young people with autism.

Of course then I’ll have the occasional response of “Shawn loves to run. He’ll go and go and doesn’t want to stop.” Great. Build it into his programming. It should not be the sole source of movement activity in his programming.

“But it’s hard to introduce new things”

Yes, it can be, as it can be to achieve anything worthwhile. Which is why knowing the How’s and Why’s of programming is essential and why I created several informational products on the subject.

Remember that just because it exists does not make it inherently good or bad. Having a basic working knowledge of fitness and movement will make choices regarding equipment, programming, and goals much more clear.

Live Inspired,

-EC

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As my 10-year-old athlete “Nick” dashes through a circuit of Sandbell overhead presses, overhead walks, squats to a Dynamax ball, and jumping rope swings, I hear the grand old sound of sport-specific coaching for children.

About a hundred yards away from our playground fitness empire, the basketball court is rife with 8-year-olds whose basketball aspirations, I can only assume, are being replaced by a silent and passionate plea for Coach to just shut up and let them play basketball. Even with my poor distance vision, I can see, or maybe sense their eyes glaze over as Coach provides three-to-five set instructions on specific drills and movement patterns. Everbody knows an 8-year-old boy’s favorite thing is to stand and listen to multiple instructions while the siren song of actually playing lingers just out of reach. The best part is that each one of those little fellows will likely retain exactly none of what Coach is saying.

Coach is an assssssssss.

And Coach is not just an ass because he isn’t doing things the way I like to do things, but because he clearly, clearly has no understanding of childhood development or how an 8-year-old brain works.  I do not want to assume here, but all available evidence made it seem likely he was of the “I don’t need to know about brain stuff, we’re here to learn basketball” ilk. So yes, if that is the case as I believe it to be, Coach is an ass.

For motivated 8-year-olds, particularly with sport-specific activities (which, as you may already know, I think suck anyway), one or two practical pieces of coaching input per lesson is about right. Something about dribbling and something about passing. And that’s it. That’s it because no matter how well you phrase it, how good the analogy, or even how positive the reinforcement, the 8-year-old brain is not going to retain a great deal of information about the nuances of basketball technique. Nor are many children physically capable of performing sport-specific movements over and over without some type of overuse injury or imbalance occurring.  I highly recommend Marky Hyman’s book Until It Hurts on this matter.

Now that September is here, adapted PE classes around the country will start doing units of team sport activities, and notes will go home stating that Craig or Lisa or Tim or Jordan is “doing really well with soccer or football skills.”  Hell, Nick got a football award the other day from his phys ed class and he can hardly hold his body in position when performing an overhead throw.

It must be me. It is apparent that I don’t have the magic wand that these  adaptive PE coaches wield. Or maybe I’m just not a liar.

Sometimes it’s difficult to write a note home saying “Chris is working on standing for 3 seconds on a pair of spot markers” or “Jillian is working on raising her arms over her head and extending them fully 3 times,” because we think these are skills that young people, even those with autism or related special needs already have. And I do get emails from coaches and professionals saying “That’s not how we do it, we actually focus on developing movement patterns, etc.” That’s great. Congratulations. You’re the minority. If you were the majority, we wouldn’t be facing a lifestyle-related disease/disorder problem among the young autism population. But we are.

The entire foundation of adapted PE requires complete upheaval and reconstruction. Here’s what we need:

- Programming that focuses on the foundations of human movement (pushing, pulling, bending, locomotion, rotation)

- Programming that assesses baseline skills and creates individualized goals based on Physical, Adaptive, and Cognitive abilities (Ahem, PACProfile.com )

- Programming that supports the development of active play skills (creativity and exploration of movement) in all ages

- Programming that introduces and/or facilitates social interaction during movement, and not just (or not at all) with competitive games

- Programming that builds strength, stability, coordination, speed, and motor planning in a variety of different activities

Here is an example of an exercise circuit I would use in an APE class:

Station 1: Hurdle Step-overs

Hurdle 7

 

 

 

 

 

 

 

 

Station 2: Sandbell Overhead Presses

One day he'll thank me for teaching him to slam stuff. His mom, however...

One day he’ll thank me for teaching him to slam stuff. His mom, however…

 

 

 

 

 

 

 

Station 3: Rope Swings

Eric and Don

 

 

 

 

 

 

Station 4: Squats to Dynamax Ball

Squat to ball

 

 

 

 

 

 

 

 

I like to use a time-based approach for these stations. Each athlete, or pair of athletes, is at the station for 1-2 minutes and then moves on to the next one. The activities can be made simpler (regressed) or more challenging (progressed) based on the individual at each station at any given time. Try that with a competitive activity. If you have two or more athletes at a station, they can practice taking turns, working on social skills, or completing the activity together (cooperation). Each station can be run through 3-5 times or more. Or run it forwards (stations 1, 2, 3, 4) three times and then backwards (stations 4,3,2,1). This provides some variety while giving the athletes enough time to learn and become more proficient with each activity.

The new Autism Fitness E-book details all of these exercises and more plus programming tips and the concepts necessary to make programming successful.

Autfit E-book

 

 

 

 

 

 

Live Inspired,

-EC

AutismFitness.com

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After a longer-than-expected editing proAutfit E-bookcess, the new Autism Fitness E-books are finally available. Both The Autism Fitness E-Book and Bike to the Future  feature:

 

- New exercises with full color pictures

- Programming ideas

- Detailed, easy-to-understand plans for implementing fitness programs

- Behavior support concepts

- Movement progressions and regressions

…and MUCH more

 

To get your downloadable copy, visit AutismFitness.com 

Bike to the Future Cover

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On Sunday I had my regularly scheduled AM park session with 9-year-old “Jack,” who has a PDD diagnosis.  We set up a fitness rope, Sandbells, small hurdles, spot markers, and a medicine ball on the blacktop. Typically, some other children wander over to our spot (children CANNOT resist heavy, brightly colored, and oddly shaped objects that are throw-able), and as long as they are supervised (because we live in current, overly fearful times), I let them toss or slam the Sandbells, swing the ropes, and…play. It is a pretty good social opportunity for Jack and the onlooking parents seem to thing it’s damn cool. So is this therapy? Is it play? Is it therapeutic for one kid and play for the neurotypical one?

Is Autism Fitness a therapeutic thing or…not? I often get labeled as a “therapy” practice (my original company name, Theraplay-NY does NOT help and that is entirely MY fault), but the assumption, I think, is as follows:

Autism Fitness provides some type of activity for the autism population, therefore, it is therapeutic. Now, “therapy” can have both broad and specific/clinical definitions, however most people do not immediately associate the fitness profession with therapy, they associate it with, typically, health and wellness, strength, conditioning, and athletics, and/or aesthetic enhancement.  Because the autism (and a generally younger) population is involved here, there is confusion between Fitness/Active Play and Physical Therapy.

Many young people with autism have physical therapy to enhance poor strength, coordination, stability, and general gross motor skills. There are plenty of good studies, some cited in this article  demonstrating that the ASD population has a higher incidence of gross motor delays/deficits than the neurotypical pop. The difference between physical therapy and a fitness/active play approach is the latter, my area, is more robust. There are a good number, I’m sure, of PTs who know what they are doing, and an equal if not greater number who simply apply what they learned in PT school with no conscious or ongoing thought of what, exactly, they are trying to accomplish and whether or not what they are doing is actually accomplishing the goal (I’ve met both kinds).  Some PTs can be singularly-focused, with one specific goal for one area of the body or movement pattern meaning they have to focus on a specific gross motor issue whereas I, and other fitness professionals, are not limited to a shoulder or hip.

My two goals for Autism Fitness athletes are: 1) Get them moving better and 2) Eventually find some aspect of movement that is reinforcing for the athlete. The idea is not “success at the enhancement of poor upper body muscle tone,” rather “Establish fitness and the seeking of movement/active play as part of daily living.”  While my athletes often do have some motor issues, the programming will include exercises both for that particular deficit and beyond (with other, unrelated movement activities).

The point to all this, I suppose, is that fitness and active play can be therapeutic, but they are separate (and more general) than therapy. Ironically, effective PT programming looks a lot like fitness and active play.

Live Inspired,

-EC

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Autism Fitness Tutorial Tolerance and Motivation June 2013 from Eric Chessen on Vimeo.

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Jun
30

Definition: Muscular and Otherwise

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My park sessions with Nick rule. I have him perform some combination of Sandbell presses, Overhead walks, Rope swings, Squats to a Dynamax ball, Jumping Push throws, and hanging off the monkey bars. His reinforcer/break consists of playing on the playground or on the swings for a couple of minutes. It is a most ideal session. He’s moving the entire time, in both structured and chaos/play situations. It flows like a London Philharmonic Orchestra concert. Seamless. Seamless, I tell you! Nick also self-regulates to a capital degree. You tell him his break is over in two minutes, and he’s back, ready to move, in two minutes.

Nick’s goals are to increase general strength, particularly with regard to upper body, though we do a good amount of squatting because 1) He needs it and 2) Everyone needs it. We are also working on movement sequencing, a fancypants way of saying motor planning, a fancypants way of saying going from one action (ex: squatting to a ball) to another (ex: jumping forward) with little time between the movements (in some circles referred to as “flow”). With Nick, motor planning is not always at platinum level. Cognitively, he can follow a 2-step direction pretty well. Physically, from a coordination perspective, things are, professionally speaking, a bit off. In order to have optimal coordination, you need: 1) The strength to perform the movement correctly and 2) The stability to control the movement effectively. This may be the single best reason why sports-based activities are a poor choice for serving as the foundation of PE programs, but that statement leads to its own book. With pictures.

When we get back to his house, Mom informs me that according to his PT, Nick has achieved his/their goal of “performing jumping jacks.” There is no way whatsoever that Nick can perform jumping jacks at this point. Here are my immediate possible conclusions:

1) Nick’s PT has a magic wand, and can summon powers that allow him to perform proper jumping jacks in, and only in, his/her presence
2) Nick’s PT just likes putting down whatever he/she damn well pleases, and figures Mom will say “Oh, that’s nice,” and not give it second regard
3) Nick’s PT has a vastly different idea of what a jumping jack involves, and, evidently, he has performed that version/approximation to his/her satisfaction

I’m not going to badmouth/slander Nick’s PT without some more information (provided the proper information I’d be happy to badmouth, justifiably), but what we need here are definitions, specifically, Operational Definitions.  Nick’s PT may have a criteria for jumping jacks that is different from my, or anyone else’s interpretation. If he/she is using an approximation, meaning a jumping jack that is not quite a jumping jack but as good as Nick can do right now, fine. But you have to let other people know that. Yes it is tedious to write down every little nuance. Sure, it can be slightly time-consuming to provide details. One of my ABA mentors shared this delightfully macabre notion with me:

Your programs should be written to such extent that if you were hit by a bus tomorrow, another professional could pick it up and continue to run them.”

I always look both ways AND I’m a good sprinter, but my programs are still written out in case of large vehicle-related occurrences upon me.

The value of skill development programs and protocols is that they can be built upon and progressed, so that deficits are eradicated and other abilities optimized on a fairly linear continuum. Saying that Nick has “achieved his goal” of performing jumping jacks does not help anybody, particularly Nick. Where does the next step start? How come he cannot perform them anymore (likely because he never could in the first place)?

Work by the mantra “Pull the sheet tight.” The wrinkles in the sheet are the questions, unclear parts, and assumptions about the goals, steps, and current abilities. Pulling the sheets tight leads to not only transparency, but really, really knowing what an individual can do, and where the next progression needs to occur.

Meanwhile, Nick continues to progress with his overhead presses (4lb. Sandbell for up to 10 repetitions), Squats to a 10″ diameter Dynamax ball (up to 6 reps while holding a 2lb. Sandbell), and monkey bar holds (up to 7 seconds, assisted via holding his torso). I don’t plan on being hit by a bus, but I keep it in mind.

Live Inspired,

-EC

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