Hypermobility

The Hypermobility Unit has opened at the St John and St Elizabeth Hospital in London.  This evening I attended a 2 hour Seminar hosted by the Unit and found it profoundly informative.

My background knowledge on Hypermobility Syndrome was sketchy so I was grateful to be invited to this promotional event to enhance it. These are certainly children PhysiFun aims to see benefiting from our great exercise programmes in schools. Exercise is vital in this condition and the role of the Physiotherapist (as part of the Multi-disciplinary Team) was highlighted this evening.

The speakers were Professor Rodney Grahame, Dr Hanna Kazkaz and Dr Alan Hakim. They are all at the forefront of research and treatment of this unique group of patients, it was such a priviledge to be able to hear them expand on all elements of this disorder.

It was fascinating to hear Professor Grahame explain the history of how Hypermobility has been understood by the medical community. From 1967 where it was identified as purely a musculoskeletal problem with pain and instability to today where the full picture is much less straightforward and encompasses both structural and autonomic difficulties in the cardiovascular, gastro intestinal, respiratory and urogenital systems. This condition is a new rheumatological disability and is commonly misunderstood by the greater medical community as symptoms dont seem to match physical findings. Unfortunately children can be misdiagnosed with congenital hypotonia, school phobic, dysfunctional family life (with social service involvement), non-accidental injury and Munchausens Syndrome.
The truth is that when all the symptoms are looked at in the right manner and Hypermobility understood - this 'elephant in the room' can be seen very clearly. Patients typically present with dislocations and injuries in their joints, chronic pain, pelvic floor weakness/prolapse, GI dysmotility, autonomic dysfunction and difficulties with day to day tasks including work. 
However there is a fine line between the benign and serious nature of this condition. On the benign side is someone like Michael Phelps - a hypermobile person who has been able to use these features to his benefit and great advantage in the pool (flexible ankles make great flippers, extra long arms generate more power per stroke and extra range in shoulders makes butterfly an easier pattern of movement). On the serious side is the young adult cut down in their prime, attending a pain clinic in a wheelchair.

The role a physiotherapist plays in this field has been pivotal for many years. From the pioneers  - Anna Edwards-Fowler and Rosemary Keer - to the present day, an evidence base has been established for the hugely beneficial role of exercise for this client group. With programmes focusing on closed kinetic chain exercises eg squat, plie, bridging, wobble board or Wii Fit carried out routinely over a minimum 8 week period, improvement is seen in joint proprioception, balance, muscle strength and quality of life. Those with Hypermobility need to find ways to exercise safely within the full available range of movement to ensure joint strength and stability has the best chance to prevent pain.

For every young adult in a wheelchair I hope that this Hypermobility Unit is the success it sets out to be, and becomes a world class centre as it aspires to be. It is a one-stop shop for everything the patient needs and although private in service base at present it is working towards NHS contracting. There are very few Centres like this in the UK and there are many patients who can benefit! All the best to the team The Hypermobility Unit - St John and St Elizabeth.

If you are concerned about yourself or your child contact 
http://www.orthopaedicunit.org.uk/hypermobility-medicine

References:
Benign Joint Hypermobility Syndrome - MSK manifestations and management, Dr Hanna Kaskaz, Rheumatology Consultant UCH, The Hypermobility Unit of St John and St Elizabeth
What is Joint Hypermobility Syndrome, why is it important and why do we need a Hypermobility Unit?, Professor Rodney Grahame, Hospital of St John and St Elizabeth, UCH
Systemic Complications in Hypermobility Syndromes, Dr Alan Hakim, Honourary Senior Lecturer in Experimental Medicine and Rheumatology, St Barts and The London School of Medicine and Dentistry, Queen Mary University, Chief Medical Advisor and Trustee, The Hypermobility Association
Amelioration of symptoms by enhancement of proprioception in patients with JHS, Ferrell WR et all, Athritis and Rheumatism 2004;50 (10):3323-8
Easily missed? Joint Hypermobility Syndrome, Ross J, Grahame R, BMJ 29 January 2011, Volume 342: 275 - 277

Eagerly awaiting...

Third week back in school and my email account is burning with firing off so many emails! I am eagerly awaiting replies on how PhysiFun is going in our first 10 Surrey schools. It is a very exciting time and it is certainly keeping me out of mischief (and cleaning the house)!

Also looking forward to attending some courses over the next couple of months;
Sensory Processing at Sensational Kids Practice in Kingston
Live well Course 
http://www.live-well.org.uk/volunteering/index.xalter
And hoping to attend
Dyspraxia Foundation Conference
http://www.dyspraxiafoundation.org.uk/news/show_news.php?id=100

Will be working at the Gooseberry bush Pamper Evening
http://gooseberrybushcentres.com/category/october

and a few stints at The Portland Hospital and The Harley Street Clinic - keeping myself sharp on all fronts to make PhysiFun the best it can be!

Lots to be done, but looking forward to the hard work and learning!

Slowly but surely...

On the 4th of September I did my first Teachers Inset at Stepgates Primary School in Chertsey. The PhysiFun programme training had already been done by Tracy and this was the general information chat with the whole of the school staff.

Its always a bit nerve racking to stand up in front of a room full of people and speak sense (for me anyway). I find I too easily 'fill space' with rambling and talk too quickly. Fortunately my contact Sarah Billinghurst was very lovely and helped me feel at ease. The talk time seemed to fly past and I really enjoyed seeing faces light up as I was telling them something useful.

Stepgates is doing a great job implementing the programme and I am looking forward to going back out there to observe a class and get feedback from the teachers. It has inspired me to get moving on getting into more schools. There is so much to share to give children with Dyspraxia, Autism, Sensory Processing Disorder and the like, a really positive experience of exercise!

This week I organised a photoshoot with a great photographer to invigorate the website a bit. It was a mad 2 hours as I completely underestimated how much planning and bribery is required to keep 2 four year olds and a 2 year old compliant! In the end the photos look great and I am very excited to get my husband working this weekend on the site.

The next course of PhysiBall starts soon at the Gooseberrybush Centre in Kingston Road. A lot of marketing needed but with the great new images should be a whole lot easier to come up with the words to match. 

PhysiBall

On Wednesday I ran the first PhysiBall class in our local Church Hall. Five 4 year olds and a 2 year old participated in mad bean-bag-parachute-ball fun. Being the first time with new equipment and kids - it was various degrees of mayhem - but I loved every minute! I loved facilitating movement and fun and being challenged to come up with more activities than I had planned for those smiling faces.


It convinced me that I want to be doing this very thing in this very hall or venues like it. Running PhysiBall is the most fun I have had professionally for a very long time! And even though my son was rather the chatterbox and fairly disruptive throughout I was so glad to be providing him with an exercise opportunity - a really positive life skill - and it made me feel like a good parent.


I am so grateful to my friends who came along to support us, Karen and Marzanne with their kids. These things are always difficult to get off the ground and the loyal support of friends is invaluable for encouragement and motivation. Thank you!


I am also grateful to my parents who provided the babysitting of Adam and ball pumping pairs of hands. To have you here in London is such a tremendous blessing and makes things like this possible for me, I cannot thank you enough.


I can't wait for next Wednesday!

Exercise for happiness

My two sons love watching TV and playing games on our phones. I know how easy it is to let hours slip by with them engaged in this way every day. According to a survey children aged six to eleven are thought to watch an average of 28 hours of television, video and computer games a week (four hours a day), with two to five year olds watching an average of 32 hours (Nielsons, 2009 How Teens Use Media - A Nielsen report on the myths and realities of teen media trends). Another survey found that four hours a day was a minimum for six to fourteen-year-olds, but that this often doubled during the weekends and school holidays (Rideout, V.J., Foehr, U.G. & Roberts, D.F. 2010 GENERATION M2 Media in the Lives of 8- to 18-Year-Olds). Parents clearly need encouragement, support and advice on getting their children up and off the couch - myself included.


The long term effects of this level of sedentary behaviour are mammoth and include obesity, delayed speech, aggression, lack of physical and psychological development. Most worryingly is that starting out life like this sets up a really strong pattern for continuing life like this. I certainly don't want my children to struggle with any of the above problems as they grow up. I need to give my children the right example of physical activity and engage them actively every day. For under 5's this needs to be at least 3 hours of a day (not consecutive). We all need to take responsibility in this, parents, schools and government.


Something else that I believe is overlooked in this dilemma is our children's general happiness and their ability to be happy throughout their life. Mihaly Csikszentmihalyi, a hungarian professor, is the architect of the concept of 'flow' - a state of concentration or complete absorption with the activity at hand and the situation. It is a state in which people are so involved in an activity that nothing else seems to matter. (Csikszentmihalyi,1990). He developed this concept from his work in trying to understand human happiness and studying the creative processes of artists and the like. When in the flow we are also at our happiest. When in a state of apathy we are at our unhappiest but don't necessarily understand why. Activities that induce apathy are typically ones where we are not challenged nor require any skill - eg watching TV. The more time we spend doing them, the stronger the pathways of apathy we create in our psyche and the more we diminish our interest and ability to engage in activities requiring challenge and skill thereby denying ourselves the joy that comes from being in the flow.

Lets be mindful of the effect of our choices today on our children's and our own future happiness!


http://www.bhfactive.org.uk/userfiles/Documents/guidelineswalkers.pdf
http://www.boysdevelopmentproject.org.uk/downloads/reports/BDP_A4Factsheet(refs)%20copy.pdf
http://www.ted.com/talks/lang/en/mihaly_csikszentmihalyi_on_flow.html

How do we encourage children to do sport and exercise?

I am so excited to have Michelle Burns as part of the Physifun team. We are both so passionate about Physifun's goals and I know that Michelle will take Physifun UK from strength to strength.  I believe that Physifun offers a cost-effective and evidence based approach to helping children with motor skill difficulties and that intervening at an early age with Physifun will give these children the confidence and self-esteem to adopt a healthy lifestyle that includes sport and exercise. 


An article in the Canadian Medical Association Journal (Vol 182, number 11, 2010) showed that children with possible Developmental Coordination Disorder were at a greater risk of obesity and being overweight, than children without the disorder. Surely, research like this should make governments question where they should be spending their money? Governments should give funding priority to those exercise programmes which help the children who have exercise and motor difficulties. These children need to be taught the skills in a therapeutic way so that they can reach a standard baseline of activity. All children need to be able to hop, skip, jump and catch a ball. These are the fundamental skills of sport and exercise. A child who cannot do these things will not be interested in exercise because (as we all know), no-one wants to do something that they feel they cannot do. So, what happens? The fit and able get fitter and more able and the less fit, less able, less co-ordinated get less fit, less able and (according to the Canadian researchers), more likely of being overweight. 


Governments of the world: spend your money on helping these children develop a life-long interest in sport by giving focus and priority to teaching ALL children the basic skills and then... I foresee a healthier society.

The beginning

PhysiFun has been developed by Tracy Prowse, a Chartered Physiotherapist, in response to the increasing incidence of poor posture and gross motor skills of both adults and school children, back pain prevalence in the general population, but more worryingly, adolescents, and the increasing occurrence of Dyspraxia, ADHD and other learning, motor & behavioural difficulties in mainstream children. Tracy Prowse completed her Masters Degree in Sports Physiotherapy in 2002 and has been working as a Chartered Physiotherapist for 14 years. Her experience as a physiotherapist has led her to developing the PhysiFun exercise programmes. 


At PhysiFun we are passionate about giving everyone the tools to ensuring they have a balanced healthy body, free from the aches and pains of everyday life and we are passionate about making postural and core muscle exercises fun. We believe all children need access to regular exercise programmes to develop their gross motor skills, self esteem and confidence and that unlocking physical capability is a key component to ensuring their future success as confident individuals.


It has been shown that up to 50% of 14 year olds have now experienced back pain, and there is a growing trend towards sedentary, unfit teenagers. However, research shows that aerobic exercise and physical activity benefits brain function, is proportional to cognitive ability, prevents disease and reduces back pain. Reduce the incidence of back pain; improve both your own, and your child's, sense of wellbeing, health and confidence. Give yourself and your children healthy habits that will last a lifetime. Teach your children what the scientists have proven: exercise, good posture and healthy lifestyles can change their future. PhysiFun raises the awareness of adults, pupils, staff and parents about the importance of looking after their backs, bodies & posture and the benefits of movement, exercise and diet - all essential strategies of optimising one's health and learning environment and preventing back pain now and in the later years.


We aim to help everyone get fit and have fun!