Before I even start:
(a) I’m not a medical professional. None of this advice should be taken as such.
(b) I don’t have formal qualifications to work with dyspraxic individuals (no such qualification exists)
(c) All of this article is based on experience training 4 dyspraxic individuals for a combined 1200hrs (approx) over 6 years, and as such is NOT based on a big enough sample to extrapolate all my methods and findings to *every* dyspraxic individual.
(d) If you’re after proper medical support, contact these people or your GP
Phew. Hopefully the above will stop me getting sued.
I’ve trained four individuals with dyspraxia over the last few years. My very first PT client, who I still train now, has it. That was a baptism of fire for a newly qualified PT!
What is dyspraxia?
I’m going to lift this directly from the Dyspraxia Foundation:
“Developmental Coordination Disorder (DCD), also known as dyspraxia, is a common disorder affecting fine and/or gross motor coordination in children and adults. DCD is formally recognised by international organisations including the World Health Organisation. DCD is distinct from other motor disorders such as cerebral palsy and stroke, and occurs across the range of intellectual abilities. Individuals may vary in how their difficulties present: these may change over time depending on environmental demands and life experiences, and will persist into adulthood.”
In laymans terms, dyspraxia used to be called ‘clumsy child syndrome’ – helpful, eh? Over the years, better understanding has led to dyspraxia sufferers being able to have a less negative label for the condition and be able to seek help for it. Dyspraxia often continues into adulthood, and can present teenagers and young adults with immense problems living a normal life, depending on the severity.
The main manifestations in the clients we’ve helped has been in co-ordination issues – balance, ability to track movement accurately, grip strength and general proprioception (linking where something actually is, with the body’s ability to touch it on the first attempt). Outside of the immediate physical issues, we’ve found that writing skills, following of complicated instructions (not always, but often) and speech are often affected.
Why am I, just a PT, writing about dyspraxia?
Well, we haven’t solved it. Let’s get that straight. But the changes we’ve seen have been *incredible*.
Universally, we’ve seen the confidence of the clients go sky-high. I’m talking about individuals who struggled to make eye-contact and talk about themselves initially, end up joining clubs, taking up sports, start actively socialising. The changes have been mind-blowing and relate in no small part to increased confidence and ability.
What we have found is that there is no real advice on strength training for this group. Recently, we were given access to some physio-type training designed to help, and although well-intentioned, it was awful. There simply wasn’t enough focus on improving the strength levels of the individual. We, right from the beginning, had decided to get the clients *stronger*, training them, with adaptations, exactly the same way as any other client.
This approach has paid dividends. We’ve had two of these clients since assessed by formal physio methods, and they were off the scale in terms of ability. They outperformed every test parameter, and needed to be assessed separately to their peer group.
In one client recently, we’ve even seen an improvement in her vocal ability and speech – we can’t isolate this down to one factor, but we’re thinking that the muscles related to speech have strengthened along with everything else, and her confidence has improved enough to talk more and practice.
It’s simple. More strength makes almost everything easier, for everyone. For dyspraxic clients, getting stronger is *vital*.
So how does that happen? What are we doing?
A dypraxic client is nervous, usually, at the start. Many have been told all their lives that they aren’t good at something – catching, playing a sport, writing, etc. Many will have simply accepted that and given up. It’s hard to defy authority, especially when you’re young and you know that things *are* different for you.
The simple fact is, they CAN do all this stuff. They simply need a lot more practice, patience and understanding than you’ll get from a school PE session or a group gym class. You have to build trust first, like with anyone. But with dyspraxic clients, who have repeatedly been told they “can’t”, that trust is often harder to come by!
Once we’ve addressed basic motor skills and improved those, usually over a period of a couple of weeks, we rapidly start on strength training. Machines and cables work well here, because often the dexterity and motor function to handle weights that can freely move in any direction isn’t there. Often the basic level of strength you’d find in a new, non-dyspraxic client, simply isn’t there and instead needs to be built from the bottom up.
On the non-physical side of training, there is a strong correlation, in some dyspraxic clients, with the autistic spectrum. There seems to be an overlap, to a degree. If you have any experience of training or working with autism, you’ll understand that being able to communicate is vital. For younger clients, you need to find something you have in common with them – so if they like comic books, you’d better learn to like comic books too. It’ll help massively with trust and building a relationship in which they’ll want to help you, to help them.
We’ve outlined a simple plan of how we train a new dyspraxic client below. We won’t outline a more advanced one, simply because with dyspraxia the individualised, tailored aspect of personal training becomes even more unique and we may do more harm than good giving out a ‘standard’ plan.
Basic proprioception and motor skills
– Catch and throw, using larger, weighted balls. Up to 1kg soft balls work well, as they are malleable and a bigger target. The weighted element starts introducing strength work early too.
– Balance – supported one leg standing, graduating to hopping, aiming to land in the same spot each time.
– Straight line walks – as it sounds; aiming to walk without deviating from a line (guided and helped at first)
– Get up get downs – simply starting from a laying position, and allowing the client to get to a standing position however they like, and back down again. These are tiring for anyone, and allow you to spot weaknesses, and areas of strength
Basic Strength Training
– Static lunges, holding on to support if necessary. Progressing on to walking lunges if possible.
– If mobility allows, start working on high box squats
– Very light leg press machine work, including single leg presses
– Hamstring curl machine; again, very light at first.
– Seated cable rows
– Seated overhead dumbbell presses
This is by no means exhaustive, and I’m sure any experienced PT will be able to look at that list and immediately have ideas of ways to use other exercises as well. The trick is to build confidence and make sure the client can DO what you want them to; nothing will turn off a dyspraxic client quicker than re-enforcing the “you can’t” attitude most have faced for years.
I alluded to some results above, but some other things we’ve seen:
– One girl who was too nervous to carry her artwork to college when the weather was windy, because the portfolio was large, she’s only 40kg, and she wasn’t strong enough to not get blown over. Now, no issues. That might seem such a simple thing, but it’s changed her college life completely.
– One lad now does challenges like Tough Mudder routinely. Like two or three times a year. When he started with us, playing Playstation was as active as it got. He can actually do most of the obstacles now too; when we started he couldn’t confidently climb stairs. He also went from 107kg to 67kg over a couple of years…and was capable of 100kg squats and weighted chin ups within 3 years! Not bad for someone ‘clumsy’.
– Another girl actually now plays ball sports (tennis, squash etc)! If you know dyspraxia, you’ll know how cool that is for an achievement. As she says, she’s not very good (!) but the fact she plays, takes part and doesn’t care anymore, and just enjoys it, is amazing.
So, if you’re a PT, and you get a dyspraxic client, just take it slow. You can achieve amazing things together.
If you’re dyspraxic yourself, don’t be put off getting a PT or taking up training in the gym yourself. You can do it, you just need some sensible guidance. You’ll surprise yourself when you add some strength.
If you’re a parent with a dyspraxic child or teenager, please don’t think there’s no help for the physical aspects out there. There is; it’s hard to find (which is why we’ve written this short piece) but there are many of us who can help!
If you think we can help you, your client or your child – get in touch.