Rachel Byrne:
Hi, everybody. We are so excited to have you all joining us today. We are so lucky to have Jennifer Jezequel, who is a PT from the Hospital Special Surgery, joining us to talk about everything about movement and activity and things that we can do during these times. Jennifer has a passion for the rehabilitation management of children with cerebral palsy and has a particular interest in gait analysis and orthopedic management. When she's not at HSS, she's also serves as a lab instructor of the program in physical therapy at Columbia University. Jennifer, welcome.
Jennifer Jezequel:
Thank you so much for having me.
Rachel Byrne:
Of course, of course. Today, I think we really want to get into what is activity, what does it mean, what should we all be trying to do during these times, and particularly, we know it's been really difficult for a lot of people because of the pandemic, but what are some of the things that we need to know, just from the outset? Say, for example, I'm a mother of a child with cerebral palsy, what activities should my child be doing? Is there a minimum number? What should we be aiming for each day?
Jennifer Jezequel:
Yeah, sure. No, I think that's a great place to start. When we think about exercise, it is really a form of physical activity. When we think about why we do it, it's to basically improve your physical fitness. There's several different components of fitness. We think about things like muscle strength and muscle endurance and what we think about as aerobic conditioning or capacity.
Jennifer Jezequel:
There's been a lot of research that it's been done within our field, tremendous work really, to help us establish guidelines either as a practitioner or as someone who is guiding someone in terms of either getting started with a program or what to expect. I think from the outset, in general, one good thing to embrace here is that doing something every day is really better than doing nothing at all. I think that's a good place to start.
Jennifer Jezequel:
Also, when you're getting started, I think it depends a little bit on what your initial activity level might be. Of course, that's going to look a little bit different if it's a young child or an adult and what your baseline level up activity might be. I think that's an important considering in terms of thinking about getting started.
Jennifer Jezequel:
In terms of these parameters or guidelines that we have, we embrace this idea of the principles of FITT, so F-I-T-T.
Rachel Byrne:
Okay, I love that. F-I-T-T, everybody, they're things that we're going to remember.
Jennifer Jezequel:
When we break it down, the F is for frequency. That really just pertains to how many times a week you might be engaging in the activity. The I is for intensity. If it's, for example, muscle strengthening, it might be the amount of resistance or the amount of weight you're using, or if it's something aerobic, it might be the zone in which you prefer your heart rate to be as a target. That refers to the intensity. The first T is for time. As it suggests, it's the amount of time that you're going to do it. Then the type is really, again, as it suggests, the activity. It might be something like walking or swimming.
Jennifer Jezequel:
We embrace these principles when we're starting to think about really developing what we consider an exercise prescription. If it's for muscle strengthening, some of the guidelines that exist would suggest that someone's engaging in these activities, let's say as a start, two to three times a week, for a minimum of, let's say, 20 minutes per session. If you're looking to get an effect of improvement, you might need to consider the amount or the dose that you're doing versus if you're just trying to maintain what's already existing. I think those are two important distinctions to make to some regard.
Rachel Byrne:
I think, as adults, we're aware of these different things that we are told, okay, you should all try to do this certain amount of activity two to three times a week, that's harder, but then you should also try to do activity almost every day to remain healthy and active. For children, that same thing does apply as well, it's just potentially what the activity might be different, the activity that they choose to do.
Jennifer Jezequel:
Exactly, yeah. I think that's a great distinction to make. There's a difference between dedicated exercise, where you're looking to achieve a certain number of repetitions for a certain period of time, again, to see a very specific training effect, versus just engaging in physical activity, which would be synonymous with, let's say, getting up out of the chair and walking around or climbing the stairs. I think those two things go hand in hand, but certainly, if you're looking to kind of see an effect over a period of time, it's going to have to be a little bit more programmatic, if you will, than just getting up and moving around.
Rachel Byrne:
Then to individuals with disabilities, there's a thing that a lot of people hear, is that they have to work twice as hard to get the same benefits. Is that true or is that really something that's differing depending on the individual?
Jennifer Jezequel:
Yeah, that's a great question. I think for a long time, a lot of the guidelines that we had available for us, to us rather, were really the same for typically developing individuals. I think we've really seen some of these guidelines emerge, really within the last five or six years, which sounds surprising. I think they borrow a bit from what's expected, but I think the length of time, perhaps, that you might need to engage in this activity to really see a benefit or an effect is going to be a bit longer perhaps than in an individual that doesn't have CP, for example.
Rachel Byrne:
We'll share after this, just to make sure everyone has it, we'll share the guidelines and all those different things and have it all written out for everybody so that they can go and have a look and go, "All right, well, this is where I'm at. What should I be doing?" Because I think it's really important for everyone to work out, A, what their baseline is, as you mentioned previously, and talk to their provider, talk to their physical therapist to work out what a program could look like, but we can give them some rough guidelines to help start that discussion.
Jennifer Jezequel:
For sure. I think in these cases it's very helpful to have something tangible. I know even for myself, if it's vague, I'm not likely to stick with it. I think having really clear steps as to how to get started and what that might look like over a period of time is really great.
Rachel Byrne:
I think that's a really good way to actually get into this next thing, how to establish activity routines. During these times particularly, it's pretty tricky for all of us. I know some of us have been stuck inside for a long period of time or [inaudible 00:06:41] what we usually would've done. As we think about as children and adolescents transition back into this academic year and they're adjusting to all different schedules that are constantly changing, what are some ways to establish healthy routines to ensure that everyone does remain physically active?
Jennifer Jezequel:
Yeah, no, great question. I think for sure, one thing that's certain is we're all embracing this constant change and flux in terms of what we're needing to do in our lives because of the pandemic, but I think a common thread for sure is that many of us are just having a hard time establishing a routine and might have seen some changes in just how we feel over time because we've had less opportunities to be active.
Jennifer Jezequel:
I think in some cases, because perhaps younger children and adolescents are now doing these virtual learning models, where they're at home, or if you're an adult working from home, I think the lines between work and rest and recreation have blurred a little bit. I think there are a few things that you can try to do to help with this in terms of just establishing a routine here.
Jennifer Jezequel:
I think one is scheduling the physical activity and exercise, just the same way that you would schedule a meeting, you'd schedule the time that you have to arrive to school, the time that you might have therapy. I think you really need to hold yourself to having some type of schedule. It might look a little bit different based on what demands of the day are. You might decide it's best for me to wake up in the morning and get this done in one big burst, or if you're sitting for prolonged periods of time throughout the day, you might decide to intersperse it throughout your day because you're trying to combat some of the effects of just sitting for a long period of time.
Jennifer Jezequel:
I think one of the other things that can be quite helpful, especially if you're doing all these other things in your home environment, and as you said, you can't get to let's say the gym or rec center or what have you, I think also dedicating a very specific part of your home, if at all possible, that you're doing the exercise and physical activity in can go a long way as well. It's perhaps separate from the place that you're logging in and attending school or doing work from home. I think differentiating those two is also very important.
Rachel Byrne:
Yeah, absolutely. Change a scenery, even if it is just a different room, is really good for all of us, particularly when we are thinking about the motivation that it requires around exercise and those different pieces.
Rachel Byrne:
With everyone experiencing less movement throughout the day, I think overall we have probably all become a little bit more sedentary during the pandemic and through these different. Do you have any specific suggestions to promote and incorporate this physical activity during the day? You've just said maybe in a different room in the house, about when it is, but are there any other elements that could help?
Jennifer Jezequel:
Yes, sure. I think if it's a young child, I think you have to, I think, incorporate the fun factor. I think that goes true for adults as well. I think it's something like, again, for a young child, maybe it's making it more of a game activity. Maybe it's musical chairs and the child's allowed to select the music that's played and there's some element of I need to move quickly in order to get to the seat. If it's that you're an adult, maybe again, you're putting on tunes in the background that you enjoy. You have to make it fun, because I think that's going to help you stick with it.
Rachel Byrne:
I love the idea of music, and musical chairs particularly, I've never used that one. I'm a PT myself and so it's always great to hear other people's ideas. But musical chairs as a family, it's usually reserved for children's birthday parties, but I think that is a piece, particularly if there is a goal where transitions are important and you're working on transitions as a goal and thinking about how to work on those and practice those throughout the day. Yeah, musical chairs is a great opportunity.
Jennifer Jezequel:
Yeah. I think another thing too is just to start to think about reflecting on what you're already doing in the day and thinking about ways that you might be able to alter what you're doing to, again, just get exposure more activity. Maybe it's instead of sitting to do meal prep in the kitchen, maybe you're standing up to do it. Maybe if you live in a building that has flights of stairs and you otherwise would take the elevator, maybe you're choosing to do one flight of stairs to incorporate that activity throughout the day. So just thinking about ways you can incorporate it into what's already happening in your day, I think a little bit goes a long way and cumulatively can just help you break some of these patterns of not having the opportunities to get out and do some of the things that you were probably doing before the pandemic.
Rachel Byrne:
I think one thing that I know I personally benefit for is actually group exercise. I find it really hard to self-motivate when I'm on my own. I think this is really tricky right now, so thinking about that peer interaction and how to do that. Peer-based learning, what's out there right now to help everyone who wants to do things with their friends?
Jennifer Jezequel:
For sure, yeah. That's, I think, a very real thing that many of us are experiencing. I think for younger children, I think we know that, in terms of motor skill acquisition, that such a big part of that being successful is really being able to model what their peers are doing. So yes, the question is what does my child do if they're not in a school setting or a daycare setting where they're around other kids and learning from their peers?
Jennifer Jezequel:
I think for younger children, one suggestion, if it's possible to incorporate if there's younger or older siblings in the home that can, as we mentioned before, whether there's family activities that can be done, I think that can be helpful. I think for young adults, adolescents and adults alike, I think you can consider maybe arranging a virtual session or a date with a friend so that you actually engage in physical activity together. I think this could be motivating and fun, but also a level of accountability. I think if you set up to meet someone at 6:00 PM on a Wednesday, hopefully you can hold each other accountable to that. I think that can go a long way as well.
Jennifer Jezequel:
I do think that seen, certainly there's definitely more resources becoming available because there's such a need for it. Just to name a few, I think that Achilles International has some things on their website that you can either do some components of prerecorded workout sessions or there's some options for live sessions, although I think those are probably not as available, but I do think in time we're going to see more and more of these resources becoming available because there's just going to be a great need for them.
Rachel Byrne:
Absolutely. We've got a list of resources as well. Particularly for young adults, there's some incredible individuals actually who have cerebral palsy who are personal trainers who have created programs that you can now do online. We will make sure that we share all of those with you.
Rachel Byrne:
We've just had Julie. Thank you so much for obviously joining us today. We want to know where everyone else is coming from as well, so please, in the comment section, if you've got any questions or let us know where you're listening in to from today. But if we keep moving on with some of these other questions that we're thinking about, loss of function and actually decreasing skills during this time, is that something to worry about? Is it something to think about, okay, I was able to do this, but now I'm not? How can you decide whether, okay, it's a decrease in skills because I've stopped practicing something and I'm not as active, or there's a decrease in skills, there might be something else going on?
Jennifer Jezequel:
Yeah, that's a great point and sometimes hard to completely know at the outset. I think if you or your child sort of is experiencing a particular change in function, and that could be that there's just, if it's a younger child, who's still in that trajectory of acquiring different motor skills and you see that it seems a little bit paused or maybe a little bit more labor to do some of the activities that they had been doing previously, if there's a change, it may warrant that you're checking in with a specialist, with a physical therapist that can help better tease out what may be going on, because very much of it could be related to the fact that they've just had less opportunities for general practice.
Jennifer Jezequel:
I think for adults, you might be experiencing something a little bit different, where you're noticing that when you do climb the flight of stairs that you're just feeling super fatigued after you've done it. I think, once again, it may be if you're interested in perhaps starting an exercise program, it might be the time that you either resume something that you before that worked or that you're checking in with the PT to get started up with a program to address some of those concerns that you might be having. I think that's a very real and possible thing that you might just need to think about checking in with the PT and delving into what could be going on a bit more there.
Rachel Byrne:
Yeah, no, I think it's so important and that all of us, at times, if you're feeling something that's different, if you're doing an activity that's new, for example, and you're experiencing pain that you hadn't felt before, sometimes that can be put down to just general exercise pain or something like that, but other times, there may be something else going on. It's always good if you're ever starting a new routine or if you're mixing up your routine to make sure that you check in with your healthcare providers.
Jennifer Jezequel:
For sure, yes. Especially-
Rachel Byrne:
[inaudible 00:16:00], if that's who you use as well. I think it doesn't necessarily always have to go through the medical way with exercise, but just making sure that you are checking them in someone if you are feeling that something else is changing or something feels different.
Jennifer Jezequel:
Exactly, yes, especially with pain and different things like that, for sure.
Rachel Byrne:
We've got a question coming in and I think this is a more medical question. Julia, thank you for asking. If the child's [inaudible 00:16:23], should they be tested for COVID, especially by the mother? I think anytime right now, if somebody is experiencing any respiratory illness, please go see your doctor. Go get checked out, it's really important. That's all we will say on that one. I think absolutely go check in with your healthcare provider. If you're concerned about going to do an in-person, a lot of people now are offering telehealth visits, so yes, please check in with them, that's really important.
Rachel Byrne:
If there any other sorts of things that when we are thinking about what's next and what other activities, can you give us some examples? We've talked about some ones, and let's start with kids, let's start with some fun examples that you can do within the home that can really help children stay motivated and have fun as a family.
Jennifer Jezequel:
Sure, yeah. I think one thing that tends to work often with kids, for example, if they just had a session where they're playing and there's things all strewn about the room, making the cleanup time a bit fun. If there's lots of things on the floor, having them have to squat down to bend and pick them up and put them away and reach in different positions could be one way, although maybe not as fun for children, but definitely part of the process of having fun and playing. But I find that that's, again, just something that's very natural in terms of part of the day.
Rachel Byrne:
Sure.
Jennifer Jezequel:
I think getting started with some of these things, I don't think we mentioned this just yet, but I think it's also good to establish some mechanism to motivate with seeing how they change over time. Let's say, for example, it's monitoring progress with something like how many times can I get in and out of a chair in 30 seconds? You do it once and see, okay, I can get up and out of the six times. Then in two weeks, you've worked on some things and you reassess. I think that can go a long way in terms of helping particularly children and adolescents stay on track with monitoring their progress and being really a part of it and seeing some of the changes that can occur by just focusing on a particular activity. I think that's important to mention here as well.
Rachel Byrne:
Sure. What about when it comes to specificity and a crossover of skills. I think when we talk about different goal setting and working out what activity may or may not be best for a certain individual, how do you go through that at home, if you're not having that structured PT intervention?
Jennifer Jezequel:
Yeah, and great question. I think, for sure, you mentioned the buzzword in terms of a goal. I think if you're doing something you have to have a reason for doing it. Again, if it's that you're looking to improve aerobic capacity so that you're not so tired when you're climbing up and down the stairs, for example, I think that the things that you're going to be doing are going to be a little bit different than if you're identifying a goal that's more related to the fact that you're working on more muscle strengthening. I think when we think about general fitness, you have to figure out what it is you're working on in terms of that specificity.
Jennifer Jezequel:
I think physical activity and function, there's definitely some overlap there, but I think if you're looking to improve your strength, those activities are going to look a bit different than those that might be targeting more of your aerobic capacity and fitness in that regard.
Rachel Byrne:
I suppose it's that question, strength training and doing all those things does actually improve your aerobic fitness and all those different things, so you do see a crossover effect. While you might be working on one very particular thing, like I want to get stronger, even if it's a basic thing, like I want to be able to do pushups or be better at pushups and look at actually strengthening my arms and my core, that will help with aerobic capacity and endurance and fitness and all those other things throughout the day as well.
Jennifer Jezequel:
Absolutely. I think especially if you notice that doing the activities that you need to do, whether it's sitting down to participate in what you need to do for school or work, if you're feeling so tired because you've just exerted so much energy and you're less efficient and doing some of those other things, like walking about your home, or as I said, climbing stairs, that can definitely have a big impact on the things then that you need to sit down and focus for. I think certainly there's a lot of carryover between what you're doing, whether it's, as you said, strengthening or working on your aerobic capacity and fitness, for sure.
Jennifer Jezequel:
You mentioned strengthening and it makes me think about just another thing, that for a long time, I think, in individuals with CP, it was thought that doing things like muscle strengthening would actually increase the muscle stiffness and increase the spasticity. More recent research has certainly discounted that belief and we do know that individuals with CP do benefit from engaging in regular strength training activities and that it's not going to necessarily increase the stiffness and spasticity that you're experiencing because of the CP.
Rachel Byrne:
Yeah, no, I think that's such a really important point to emphasize. We've got a comment coming through from Chris who's like, "Nerf footballs was good for me." Absolutely. In your comment section, put the stuff that you love to do and all those activities that you might have been doing during this time, because I think we can all learn from each other and work out, "Oh, wow. That activity? I never thought of that before." Please put them in the comment sections, we'd love to hear from you.
Rachel Byrne:
Jennifer, if we keep going on, and I will just look at any other questions and things that have come in, but going back to thinking about what we are doing at home. What are some common household items or objects that can be used to perform or replicate therapeutic activities at home? I'd love to hear your list of fun ways of getting these things done.
Jennifer Jezequel:
Sure, yeah. I think to your point, sharing amongst one another I think goes a long way. I think this is certainly a community effort to share resources and ideas of what works and what doesn't work, so I think definitely a big fan of sharing those ideas.
Jennifer Jezequel:
But definitely things that are in the house that you could use to replicate what you might have otherwise used in, let's say, a gym setting or even a therapy setting. Let's say, for example, you're working on something like a step up and a step down and you don't have stairs where you live or a single step to do it. You could think about using either a very large sturdy book or a sturdy container or a step stool. There's some ways that you can kind of mimic the activity of stepping up and stepping down, either front or sideways. Of course, you always want to be mindful about positioning these items when you're using them for their not intended purpose, to be sure that you're doing it safely.
Jennifer Jezequel:
But also things like stepping over, for example, an obstacle much like you might step over a hurdle. You could use something like the long end of a broom or a mop or even a long umbrella to elevate it on something so that you can step over the activity that you'd otherwise do, let's say, with a hurdle. Other things that I think have been pretty creative, using socks that are rolled up into a ball and standing up and throwing them into, let's say, a laundry basket.
Jennifer Jezequel:
Then you'd be surprised what you can find in your pantry to use as weights, because I think that's kind of a common feedback at this point is, well, listen, I want to get started with a workout routine, but I'm in my home and I don't really have any equipment, so can I get it done? I think you could use, let's say for example, holding water bottles in each of your hands as you're performing an activity where you're going from sitting to standing. Some modifications that might need to be in order here, let's say, for example, it's hard for you to grip the object, you can certainly put it in a bag and then hold the bag, so you're still getting some of the resistance as you move through whatever the activity might be.
Jennifer Jezequel:
I think the story is you have to be creative and I think you certainly be willing to have to adapt it to what the needs that you might have.
Rachel Byrne:
We've actually got quite a few different questions that have come in now. Chris Myers is asking, "Are sitting tricycles or general tricycles good for exercise?" I think the answer to that is yes.
Jennifer Jezequel:
Yes, yes, yes, yes, and yes. I think sometimes with cycling, it's good to also think about ways that you might need to modify, modify either the way that someone's sitting on the tricycle or the adaptive cycle, if that's what it might be, things like having to strap your foot to the pedal if it's hard to keep it in a position that's ideal to be able to pedal. But I think there's both benefits from the aerobic perspective, but also just even coordination and moving your legs in that reciprocal pattern. I think if that's an option, that would be a wonderful activity to do.
Rachel Byrne:
Yeah, absolutely. We've got another question that's just come from Brad. He's curious about your opinion on maintaining interaction with your PT/OT provider via telehealth, for example, previously held in clinic one-and-a-half hours, twice a week. Would you recommend the same frequency for telehealth? I think that's a great question, and I think it depends on what you're out of it from your provider, but what's happening in your clinic right now? What's the norm?
Jennifer Jezequel:
Yeah. At the outset of all of this, I think I was a bit leery of how this would go in terms of trying to conduct telehealth with all different ages. I have to say I've been really surprised with a lot of the advantages that we're unexpected. I think one of the nice things about providing telehealth services is that you really get to see an individual in their natural environment. So many times in the clinic, we're really doing so much to replicate and mimic what otherwise happens in a natural setting. I think with telehealth, we've had an opportunity, a window into what strategies might need to be implemented in the home environment. I think that's been really great.
Jennifer Jezequel:
In regards to that specific question, in terms of the frequency, we've definitely had individuals that have done a hybrid model and it just depends what the goals are and what the needs might be. They a benefit from coming in, for example, one time a week for an onsite visit when you're working on some things that would otherwise be more difficult to execute through a virtual setting, and then maybe connecting on a virtual setting to work on some things that the individual might be able to more easily do on their own. I think we have to be open to it, circumstances are certainly different for everyone and the comfort level of what that might look like.
Jennifer Jezequel:
I think the reality with it is I always would say, even if someone was coming in for formal physical therapy every day of the week, there's so much time outside of that window of PT where you're still continuing to learn, practice and benefit from whatever it is you might be doing. I think that's a good thing to bear in mind, regardless of what the delivery model might be at this point.
Rachel Byrne:
Yeah. I think for me, it would be if you are using those one-and-a-half hours twice a week as your core time to do some really focused exercise, if you are still able to do that without having a telehealth visit, then that's probably okay, as long as you're then checking in to make sure that you're increasing it as you need, but if you are not doing it at all then outside of it, then you're going to get probably a decrease in different pieces. I think to your point, it probably is a hybrid model that's the most effective, but if you're needing that one-and-a-half hours twice a week for the motivational component and you're needing it to really make sure that it gets done, then if your provider does it through telehealth, I don't see that there would be a disadvantage to that at all.
Jennifer Jezequel:
Same, yeah, I agree.
Rachel Byrne:
Then the other comment is from Troy. Troy is doing Tai Chi, Yang style might be very beneficial. Absolutely, I think any of the martial arts can be very beneficial for looking at motor control and body awareness and also strength and fitness.
Jennifer Jezequel:
Absolutely. Yeah, I agree, the postural control piece, the balance piece, the coordination and bringing all those things together, I think definitely you hit a few things all at once with that activity, for sure.
Rachel Byrne:
What about some other martial arts pieces? I know there's a lot of different ones going on. Is there anything that people need to be concerned or aware of if they're going to start any of those at activities?
Jennifer Jezequel:
Yeah. I think if it's something that you've never done before, you do want to probably do a bit of research to see what supports might be available for you and what ways you might need to modify the activity to both enjoy it and be successful with it. I think with anything, it's best to start slow, especially if you've been particularly less active and more sedentary in the last few months. It's good to realize that anytime you're picking up something new, even in this setting, your body might just respond a little bit differently than had you had been active all along. I think that's important to respect, start slow, see how your body responding before you jump in and do a lot all at once.
Rachel Byrne:
Yeah, absolutely, because you want to make sure that actually safety is a consideration and make sure that you don't get injured, because once you get injured, then it's actually really hard to then not only are you trying to strengthen, but then you're also rehabilitating at the same time. It makes things a lot more complicated and a lot more complex.
Jennifer Jezequel:
For sure. I think that leads into also the importance of if you're doing particularly an exercise program for strengthening or for aerobic fitness that you incorporate a warm up and cool down so that you can avoid some of these, as you said, musculoskeletal injuries, because you don't want to suddenly then be excited about starting to be active and then have to sideline it because you're nurturing something else that happened as a consequence, so to speak.
Rachel Byrne:
Absolutely. I think that's important though to also note, that if you do feel like you've interview yourself, please reach out it to a healthcare provider because it may be that you have, it's not just your typical, as we say, that exercise soreness that you get, there could be something else going on.
Rachel Byrne:
We've got a question from Julia, and I know we're getting a little bit short on time, but Julia would like, what will benefit a child with quadriplegic cerebral palsy? What are some different things to be able to focus on if a child is experiencing that?
Jennifer Jezequel:
Yeah. I think similar types of principles in terms of thinking about what type of position your child might be spending a better part of the day and figuring out how you might be able to incorporate, I think in that case, lots of different positional changes. Getting out of perhaps a wheelchair and being in a position, if it's tolerated, to be either a little bit flatter on the back or on the stomach to, let's say, get out of the position that you're in when you're sitting in a chair, just to combat some of those muscles that are more prone to getting stiff because you're sitting, for example, in a wheelchair. I think changing the routine of what positions you might be spending a better part of the day in.
Jennifer Jezequel:
I think also being creative in thinking about if there's an activity that you'd like to have your child being engaged in and just being willing to be creative and modify it. Whether it's helping them do yoga type positions to get physical fitness and stretching in that capacity. I think, for me, I'd say pick what it is and let's figure out how we can modify it and get it done.
Rachel Byrne:
Absolutely. Yeah, I think that's so important because we really don't want to underestimate anybody's abilities or anybody's desire to put participate in any particular activity. I think that's really important to encourage, particularly as children are growing up, to find that piece that they really enjoy and to try and create these lifelong activity and healthy habits.
Jennifer Jezequel:
Exactly.
Rachel Byrne:
Chris has asked, "Where would I find an adaptive tricycle?" Chris, we will make sure that we post those different links to different places, so make sure that you have that. Now, I just want to follow up, does anyone have any ... Oh, there is one more final question. Okay, Maria is asking, "My daughter is age nine and she has cerebral palsy and is having backaches. Is there a good stretch for her?"
Rachel Byrne:
This I'd love to actually dive into a little bit deeper because it comes to that idea of stretching and thinking about the purpose of stretching and why someone might be doing stretching. Stretching won't necessarily change spasticity in a muscle, but there are other benefits to stretching that are really important to consider.
Jennifer Jezequel:
Yeah. I think, just at the start, if it's a new onset of back pain you want to be particularly cautious, just monitor that and see if it really warrants different attention, but to start to figure out, is there something that's changed throughout the last couple weeks, days, months perhaps? It could be very well that your child might just be spending a lot more time sitting and is experiencing some of these effects of not moving around as much.
Jennifer Jezequel:
With regard to your question, Rachel, about stretching, I think yes, we know for sure if you're just holding a stretch for a short period of time it may not in fact have a huge benefit on changing your overall movement. You've got to perform the stretch and then, as best as possible, encourage active movement afterward to do those two in combination and not just to passively stretch a muscle and expect that the length is going to be changed because you've stretched it.
Jennifer Jezequel:
But I also think changing perhaps the position that your child might be sitting in for the day that they might be. For example, at home doing virtual learning, maybe it's a modification of the chair or the position of the height of the desk that they're using. Just thinking about the environmental components that could be contributing to some of that as well, I think can be quite helpful.
Rachel Byrne:
Absolutely. I think when it comes to stretching as well, just the benefits sometimes you get just from the mobility and it actually can make you relax and feel just that little bit better as well. A lot of people can use it as a meditation piece or particularly a relaxation component. I think it's important.
Rachel Byrne:
All right, we've got one last question.
Jennifer Jezequel:
These are great.
Rachel Byrne:
Okay. This is the last one, but any recommendations for a nutrition plan for kids while maintaining an exercise routine? I think this is important when we're thinking about any sort of increase in physical activity and then the demands that would put on somebody's nutrition. This is when having a multidisciplinary team is going to be really important.
Jennifer Jezequel:
Yeah. I would completely agree and not wanting to overstep my boundaries of not being able to provide specific nutritional counsel, but I think that goes in both directions, because I think some families have even identified concerns about their child from being on the other end of the spectrum perhaps not as active and is there a concern that because of it they're going to have weight gain as a result of just being less active. But if you're ramping up your activity and doing something very different than you had been, and certainly some of these exercise programs for a short period of time, you would be quite more active, and it depends if your child's growing, might feel a little bit more hungry. I think that's definitely, to your point, Rachel, really important to think about the multidisciplinary component of thinking about all those things, because we can't just think about one piece and not expect that there might be changes needed in other domains as well.
Rachel Byrne:
Yeah, absolutely. I think when we are thinking about building muscle or any strength training, protein is that an important thing, for example. Speaking to a nutritionist or a dietician and having them as part of your team to work out that program is going to be really important.
Rachel Byrne:
I think I just want to say thank you so much, Jennifer, obviously, for spending so much time with us today and answering everybody's questions. It's so wonderful to be able to on and for people to have this feedback. Is there any final thing that you would like to say? But otherwise, I think we will ... Oh, just to remind everyone, yes, we will be sending out the links. We'll also be sending out all different resources, both from Jennifer at HSS and the ones that we have at the foundation. Look out for those in the coming days.
Jennifer Jezequel:
Yeah, no, just I want to thank you so much for letting me have this opportunity. Like I said, I hope it's just the beginning of getting everyone thinking a little bit more about this and being a little bit more creative about how it needs to happen because of what's going on around us. But yeah, I hope it's gotten you thinking about how you might be able to change some of your habits and that we're in a community together, so keep sharing resources with one another because I think that goes a long way.
Rachel Byrne:
Absolutely. All right, well, wonderful. Thank you again for joining us and thank you everybody else for tuning in. We will see you again next week. All right, bye everybody.