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Dorte Bladt discusses movement and disabilities with exercise physiologist, Anna Campbell.

Intro: Flourishing Families with Dorte Bladt, the Switched-On Kids chiropractor and her passionate friends sharing the secret of inspiring wellness to help your families thrive.

Dorte Bladt: I’d like to welcome Anna Campbell from HealtheCo to our podcast this morning. Anna, tell us a little bit about yourself.

Anna Campbell: Hi Dorte and thank you for having me and thank you, everyone, for listening. I’m an exercise physiologist (EP) and I run a business called HealtheCo who specialises in pediatric disability. Also, we do see clients who have musculoskeletal conditions and other chronic conditions but 99.8% of our portfolio are kids with disabilities.

Dorte Bladt: Excellent. So tell me about – what is an exercise physiologist compared to a personal trainer?

Anna Campbell: We get asked that a lot, actually. Often the question is “what’s the difference between an exercise physiologist as compared to a physio or a personal trainer?” So, there are some similarities but there’s also a vast difference in what we do. Exercise physiologists prescribe specific movements for medicine. So we don’t generally diagnose injuries. We leave that usually up to the physiotherapists and doctors.

You do sometimes find an exercise physiologist out training people in gyms and in football teams and things like that, but most of the time, we spend our time in the middle, working with people with chronic conditions, so for me, I specialise in the disability area but there are lots of exercise physiologists who may specialise in oncology, diabetes, arthritis.

Dorte Bladt: So when you mention those, do you mean exercise physiologists may work for example with someone following surgery for breast cancer who may have trouble moving their arm. Is that what you mean?

Anna Campbell: Absolutely. Yes. So, exercise – the more they study it, the more they realise if it could be put into a pill, every single person on the planet would be taking it and every single doctor would be prescribing it and, basically, the government would be fully subsidising it.  

Dorte Bladt: However, there’s no money in it so…

Anna Campbell: Exactly. So exercise is, fortunately for us, finding its way into so many treatment modalities such as a female who may be suffering from breast cancer. The exercise can not only help with the outcomes of the chemotherapy but it can also help that person feel better throughout the chemotherapy whilst also treating side effects of the chemotherapy such as oedema or swelling, lack of movement through the body, pain in the body, all those types of things.  

Dorte Bladt: So that’s obviously not your chosen field?

Anna Campbell: No. It’s not my specialty. I certainly have an interest in it and follow, I guess, all of the research that’s coming out in those areas but, fortunately, I found myself in a very specific area which keeps me really busy in the paediatrics space.

Dorte Bladt: How did you end up there?

Anna Campbell: Interesting story. So we’re going back to 2002 when I graduated university. I was probably not one of the first exercise physiologists but I was one of the few that came out of the first round of the university degree. I’m showing my age now. Nobody really knew what exercise physiologists were when I first graduated. So I came out and I found myself working – where lots of EPs back then were working, in insurance.  In that space, there’s a lot of people who were suffering from chronic pain and pain-related illnesses, so I got to create a strong foundation on understanding pain, the neurological components of pain and how to use exercise to manage that pain.

I spent eight years or so specialising in that area, then I had my first son, William, and I couldn’t go back to working full time – it just wasn’t going to work for our family, so I started the business HealtheCo. I thought I really want to move into maybe another direction with exercise physiology and one of the biggest areas that I kept getting questions around was postnatal women’s health, so I started educating myself on that area which I found extremely interesting. I started working in women’s health which then led me to meeting a lot of mums, led me to meeting you guys here at Family Chiro, and then I came across a mum who had a little boy with cerebral palsy.  

She basically started asking me a few questions. She said, “could you help out?”  

I thought, “I’m not so sure, but let’s give it a go.”

And I started seeing him four years ago and we haven’t looked back now. My portfolio is full of kids, which is great.

Dorte Bladt: To me that seems like that would be a very different way of doing exercise to a person, but how do you do it?

Anna Campbell: It does, on paper, sound like it would be completely different, but I think that’s maybe why we’ve been so successful in that we actually don’t really treat the kids any differently than I would for an able-bodied child. I want to say I have the same expectations but I don’t have the same expectations in it – I know that all the kids that I see may never be able to run or they may never be able to walk even, but I expect, I guess, the same level of improvements from the kids, you know? We work hard and we play hard in all our therapy sessions and that doesn’t matter whether it’s an able-bodied child or a child with disability. I work across all aspects, so I guess that’s where we find that we’re most effective, I suppose.

Dorte Bladt: What would a session look like for a child that has difficulties learning to walk?

Anna Campbell: Great question. Sessions are all play-based, so our clinic probably looks like you’re going to a daycare centre.

Dorte Bladt: That sounds fun.

Anna Campbell: It’s full of toys, full of mats, and we spend the whole time on the floor.  We use as minimal assistive equipment as I can because I really am trying to help the kids learn where their body is in space – we have a word for that called proprioception, but basically that is helping a child learn where their hands are, where their legs are, where their feet are, and the only way we can do that is having as little equipment or as little assistance as possible and to move their bodies in space.  

Basically, we’ll start a session on the floor. Our warm-ups are usually depending on the child but we might play something like the forest game where we pretend that the child or the mum or me, we take it in turns, have to pick an animal and then we have to pretend to walk or crawl like that animal. So it might be a crab or it might be a giraffe or it might be a bear, depending on the mobility of the child.  

For kids that are at the stage of sitting but are unable to crawl or walk yet, we might pretend to sit up tall like a giraffe or put our hands up tall like a tree, wave our hands around. For the kids that are moving, we may go into a crawl and pretend that we’re puppies. We may wag our tails like puppies, sit down on our backsides like puppies and get up and run around – those type of movements for a warm-up.

Then we get into the more specifics and basically, our exercises or our sessions – I have goals, usually three goals for the session; that might be that we need to work on leg strength; we may work on to allow for standing or coming up to standing. We may be working on upper-body strength to allow that child to pull up to standing and we may be working on balance, for instance.  

So I have those three things in mind and then I usually say to the kids, “okay, what are we going to play today?”

Normally they will lead and they will say, “okay, I want to play drawing on the chalkboard.”  

So, with that in mind, I’ll quickly think on my feet, “okay, great, we’ll start in a kneeling position. We’ll transition into the pull-up phase with the chalkboard, using the chalkboard to pull up, into standing or assist them in standing, and we’ll encourage the child to draw big clouds in the sky”, for instance, so in those, in just that movement we’re working on transitioning from our sitting up to standing and then transitioning to arms up torso. We’re using a core stability proprioception. All that type of thing.

Dorte Bladt: So, what I hear you saying is that you are mimicking the movements that a baby will go through in a normal developmental continuation. So, a normal baby will learn to lift their head up – a normal baby will learn to roll. A normal baby will learn to sit and then they’ll pull to standing and they’ll learn to do whatever.

Anna Campbell: Absolutely.

Dorte Bladt: So, basically you are taking them back to the level they’re at mentally and physically and try to play around that level. Is that what…

Anna Campbell: Absolutely. We all generally have an idea of the milestones that a child is supposed to go through. We go from laying there unable to do too much then we get some head stability and then we start rolling, we start sitting, we start crawling, we start moving. Most parents have that idea. Basically, they’re the milestones that we’re working towards with all the kids.  

Some of the kids have conditions that won’t ever allow them to move through those milestones. However, we will assist them in moving their bodies through those milestones because, as the guys here at Family Chiro will let you know, that’s very important for the neurological development of the brain and the body to move through those milestones and there’s things called primitive reflexes that we need to inhibit sometimes to help the children move through those and that can then assist them with their schooling, their reading, their writing and, eventually, their independence and quality of life down the track. I see it as my job to get the kids basically as independent as possible and our goals of the programs are always working towards that.

Dorte Bladt: Excellent. What if you have a normally-developing child that refuses to learn to crawl? So they bum shuffle or they might do a bear walk or they might insist on commando crawling, so they not necessarily have cerebral palsy or any sort of… not that it’s measurable at this particular time anyway, but it doesn’t look as if they have got any issues. Can you help a child like that? Is it worth looking at?

Anna Campbell: Absolutely. Lots of the kids that I see that would prefer to bum shuffle, usually there is something going on. Not serious necessarily when I say there’s something going on. It might just be a little bit of hyper mobility. The body will always choose the easy way out and it will always use its strongest muscles first. Basically, it’s about looking at that child and seeing why it is that they’re choosing to bum shuffle.  Then individually seeking out opportunities to pop them into the position that we’re trying, such as the crawler crawlies, predominantly the position that most children hate to do because it is so taxing on the body.

Dorte Bladt: It’s hard.

Anna Campbell: And it requires so much coordination, so much going on in the brain, so much going on in the body. I can totally understand why kids want to skip that phase because bum shuffling is a hell of a lot easier. So, how do we in the clinic encourage kids to do it? We basically meet them where they’re at. That means that they would prefer to bum shuffle so then we break down the tasks. I won’t go into the details specifically about how many tasks are involved in crawling because it’s a huge number.

Dorte Bladt: You will be there for a while.

Anna Campbell: Yes, but for those that are listening – just know that it’s a lot. Basically, we’ll meet them where they’re at. They’ll be bum shuffling around the clinic and we might say to the child – if they’re a one-year-old child – we might pop toys in front of them and encourage them to put their hands down in front. We call it ‘bunny hands’ or ‘puppy-dog hands’ so they’re getting the feeling of their hands on the floor in front of them, so they could gain that trust that their hands will support them and they have the strength in their upper body because, often, that is a big thing. They don’t trust that they’re strong enough to put their hands in front of them and then we encourage them to start reaching with another hand. So one hand is supporting them then reaching for a toy out in front, or food. Food is always a good one.

Dorte Bladt: Nothing wrong with a bit of bribery.

Anna Campbell: I know. Then encouraging them to come up onto their knees and then it might be that we have to assist them with the movement, with the cross-patterning movement we call it where we do left arm-right leg because the brain actually hasn’t realised that that’s the best way to move in that position. So, I might assist them in that movement by just popping my hands under their tummy and moving their hand to reach and just a little pop of the right leg as a movement. Like, you sort of got to see it done a couple of times so that you can do it at home.  

Generally, the kids will resist and pop straight back onto their bottom because that movement is a little bit scary to start with. Then again, it comes back to that proprioception or awareness of where their body is. I tell parents it’s a little bit like us spinning you around ten times and then back the other way and then telling me where north is. It’s really a bit scary feeling for kids to learn a new movement like that.  

So, it takes a lot of patience and a lot of practice, and that’s what I would say to parents is don’t rush it. A lot of patience, a lot of practice and try and integrate it throughout the day regularly so it becomes a norm. You’ll be amazed that just one day you’ll walk out of the room and you’ll come back and you’ll see them moving around…

Dorte Bladt: Practicing.

Anna Campbell: Yes, practicing because they feel safe in that movement, so it’s about feeling safe in that movement.

Dorte Bladt: A challenge that I feel parents have is that whole thing of, “well, he doesn’t like it.” What’s your advice to parents for, yes, I realise I’m feeling a bit unstable. Shouldn’t we just let him bum shuffle because he will end up walking?

Anna Campbell: I know. Well, he feels he doesn’t like it so there’s reasons why he doesn’t like it. We need to provide the opportunities for him or her to come to like it.  

So, we’re really starving the child of the opportunity to develop and develop those neurological pathways when we don’t spend the time in trying to get them to crawl.  So, it really is important. I don’t want to say that you need to spend half the day with your child screaming and you’re trying to push them into crawling, but certainly a little bit of uncomfortable feelings is where the learning happens.  

Certainly don’t be too afraid to do things that kids don’t like. Of course, we all try and make them fun; we try and encourage them to do them themselves, we meet them where they’re at, all those types of things. But often, in the clinic, we are popping kids into positions that feel scary for them and we just need to reassure them that, “You’re safe. All is okay, darling. Look, we’re going to have a little play in this position for a little while.” The more often you do it, the less resistance there is because that feeling becomes safe.

Dorte Bladt: Because we’re normal and the growth, I think, for all of us in all the areas of our lives is in that uncomfortable zone. If you’re always there in the comfort zone, you are never going to get fitter, you’re never going to get smarter because we always avoid things that are unknown. So, I think it’s very important to provide that safe space and that acknowledgement that you doing something that’s not comfortable will be over here for a short time.

Anna Campbell: Yes, absolutely. The parents often laugh at us in the clinic – before the child gets good at something, we’re often moving to the next thing because I’ll allow them to practice in their own time. My job is to get them into those uncomfortable states to practice it and always be ahead of the next of the current milestones. So, I’m not wanting them to just stay and crawl. Once they’re crawling or almost crawling I’m already looking towards the next milestone. So, my day consists of popping kids into uncomfortable positions.

Dorte Bladt: I love you, Anna.

Anna Campbell: Please, just know that those kids love and trust me and still, to this day, even though they come and see me every week, twice a week and often are getting into positions that they are resistive of, but they know that they trust me as they would trust their parent.

Dorte Bladt: You mentioned the primitive reflexes. I read a study about normal adults and the amount of reflexes that were actually present in normal adults. I guess I’m going back to that whole thing of skipping the crawling phase or skipping the rolling phase and we often think it’s no big deal. He’ll walk anyway, but we don’t necessarily understand the long-term neurological repercussions. I’m not saying that these adults don’t have the reflexes weren’t functioning well. I’m just saying that it is more common that these people like that that we know and that it means that there is a weak link somewhere in the brain.

Anna Campbell: Absolutely. You do see it. I’ve got a couple of friends actually who I interviewed because they were fully functioning, very successful people, but they reported to me that they never crawled so I found that quite interesting in the work that I was doing. So I thought, well, do I need to be ensuring that these kids definitely crawl when they are resisting the crawling phase?  

So I really started chatting with them, digging around what were you like as a child?  Did you find it easy to read at school? Things like that that research tells us that if you have some of the reflexes still there that it makes it difficult in lots of areas, sports, reading and things like that at school. Often it came up that they found anything that where you’re moving across the body, so for instance your hand going across to the other side of the body, from right-to-left for instance, they found things difficult.  

So I would say, “Did you enjoy a sport?”  

“Not so much. I was particularly bad at tennis.”

Dorte Bladt: That was the one I was thinking of. Squash.

Anna Campbell: They can’t for the life of them hit a tennis ball or a squash ball. As an adult now they find that quite funny, but as a child who has to do tennis for sport, I would imagine that would have been quite frustrating and quite embarrassing and those types of things. As I say, it’s not the end of the world because they’ve grown up as very capable adults but there are things that they are particularly not good at.  They’re not good at understanding where their body is. So if you spun them around or if they’re in a city that they’re not aware of, they find it very hard to find their way back. Things like that. Both of these people that I interviewed there were very strong similarities between them.

Dorte Bladt: Interesting.

Anna Campbell: Yes. So as a kid, they’re all things that we would prefer for them to have developed. Certainly it’s not the end of the world but it’s at least a very important part of our development.

Dorte Bladt: And it’s never too late to pick up and say, “okay, well, I didn’t crawl so I will now,” so you’re still creating the neurological pathways even though you are eight years old or 48 years old.

Anna Campbell: That’s right. So, as an adult, physically… I assessed them both physically as well, these adults have very poor core stability generally, because they didn’t spend all those hours in the crawling position, which is in quadrupedal or all fours which is very important for a stabilising our core. So, therefore, they do tend to end up with a lot of cervical injuries or pain due to poor posture because their core is not nice and strong.  

We can go into numerous things as to what they have going on but, as an adult, you certainly can work on being in quadruped, as silly as it sounds, crawling around on the floor, doing bear crawls, regular quadruped crawls, doing what they call “Supermans” where one arm, left arm is out in front, right leg is out in the back while in quadruped – those type of things. Anything that you see a baby doing in crawling position we need to do with adults, too – assist in that primitive reflex and gaining the strength that they didn’t gain in those early years.  

Dorte Bladt: My brain is going all over. It’s just so exciting. When I recently did my course, I did a certificate in neurobehavioral disorders with a PhD in America, so he works with kids that have all sorts of learning challenges and you’re saying – it’s really interesting – the push that we have to help kids that are maybe overweight and just spend too much time on their iPads or iPods, or whatever they’re doing and to push them to start walking. Whatever you do, just start walking. What he was saying was that it’s actually totally, totally, totally wrong, because we start too high in the hierarchy of neurological development. He was saying we need to go back to – not necessarily rolling, but going back to the core stability, because if you don’t have the core stability you don’t get the proper walk and then you’re really just setting yourself up for injury.

Anna Campbell: Absolutely. So, so important. I always say to the families that are worried about their child not meeting the milestone as quickly as other parents should or the parents sort of gloating that their child walked, “didn’t even bother to crawl, just went straight to walking and then running, isn’t that great?” I often find myself saying to the parents whose child is supposedly, in inverted commas, “behind”, those kids are the smart kids. They’re the ones spending huge amounts of time on the floor strengthening their bodies, doing the hard work. So when they’re older they will not end up with all these injuries that are caused through not strengthening the body in the way it should be, before the body is up on two limbs and compressed by gravity and running. So absolutely, for the parents out there worried that your child still isn’t walking in 15 months, just keep them crawling. They will get up. They’re just doing the hard work in their early years.

Dorte Bladt: That’s good. Do you have any advice for – not necessarily the kids with delays, but just something that you can tell to the parents of the kids that we see at Family Chiropractic, something you’d say this is what I would focus on?

Anna Campbell: First and foremost, any type of activity is better than none. So don’t think that you need to enrol your child in a particular type of sport. Of course, unless they really enjoy being involved in sport, and they’re probably not the parents who would be necessarily listening or need to worry about or have that thought, “ah, my child’s not doing enough activity. They prefer to sit and watch the TV or their iPad and everyone tells me they’re watching too much screen time,” really worried. So for those parents out there who want to get their kids more active I would say that – first and foremost, being over-scheduled as a parent yourself and being in a hurry and not having time to play with the kids is probably the worst case scenario because kids they want to do things with you, they want you to be involved with them – and I’m talking kids that are 12 and under. Of course, once they start getting older than that they prefer to do things with their friends, I guess, but for those kids that are younger they want to hang out with you, they want you to be involved in things that they’re interested in.  

So meet them where they’re at. Look – maybe it’s about finding something on their iPad that they’re interested in. I actually don’t know what’s cool on iPads these days, but maybe there’s a game on there that you can play with them in real life. So maybe they’re watching Paw Patrol or Superman or things like that, so maybe it’s about, “how about you turn that off and we’ll act out these in real life?”

Then if it’s Superman it’s, “let’s go to the park and swing from the bars and let’s roll”  and maybe mum may not be fit or well enough to be rolling, doing tumbles at the park, but you can certainly jump and move and pretend that you’re the baddie and shoot spider webs and all those type of things. So, the first thing is find out what they’re interested in and see if you can mimic that in real life through movement.  

And again think, I guess, going back to the start where I have those three goals in mind about what I want to do, so if you find that in your child probably could do with a little bit extra upper body strength, for instance, because they’re slumping in their chairs or having trouble holding their pen writing, maybe the swing from the bars would be an excellent thing to do as Superman or maybe it’s like, “how many push-ups can you do, Superman?” 

Just think on your feet and just become involved in the play. Let them lead the play but have the goals in mind about what you’re trying to achieve out of it.  

Dorte Bladt: That’s excellent advice. I love that involvement of parents because it’s easier just to delegate but…

Anna Campbell: Absolutely.  

Dorte Bladt: We have kids for a reason. We want to have fun with them.

Anna Campbell: Absolutely. Be involved. They will keep you fit and kids will always mimic what they see. If all else is lost, get up and start doing a few exercises yourself and things like that and talk about how well it makes you feel and how great you feel.

Dorte Bladt: So don’t be irritated that they’re jumping on you but use that opportunity to play.

Anna Campbell: Play with them, yes. Absolutely, because they mimic everything you do and everything that you do they take it in.  

Dorte Bladt: That’s great. So tell us again: who are you, where can people find you?

Anna Campbell: Sure. So our business name is HealtheCo. We’re in Lake Macquarie.  You can find us at www.healtheco.com.au and all the contact details are on there. You can also click on there and follow us on Facebook, which is great. You can see what we call the HealtheCo Kids are up to. We’ve got some quite funny little snippets of what they’re doing in all the sessions on there and all their progress, so jump on and check it out and become part of the little community we’ve got going on.

Dorte Bladt: Sounds wonderful. Thank you so much for coming in this morning, Anna.

Anna Campbell:  No worries. Thank you.  

Outro: The opinions expressed in this podcast are those of the guest and do not necessarily reflect the opinion of Family Chiropractic or the host. Brought to you by Family Chiropractic Centre Charlestown, serving the families in Newcastle, Lake Macquarie and Charlestown.