Adapted PE
Category: Profound/Severe Disabilities

I am a preschool adapted physical education teacher. I have a new student for ape who has been diagnosed with Arnold Chiari Syndrome (Type II). She has significant gross motor delays and tires in her legs very easily. Can you suggest some activities or exercises/stretches to do with her? I have been to the Arnold Chiari websites and understand what it is, but not exactly sure how to get the most of ape for this particular girl.

Arnold Chiari malformation is a very rare occurrence, in individuals with myelomeningocele, their hydrocephalus is often caused by the Chiari II.

For your question, clearly, physician clearance is needed along with any special indications and contraindications. In general, these folks need to work on balance as well as motor memory tasks (cerebellar functions). So, learning to ride a bike (something that takes balance, and, becomes automatic with most of us, does not become so easily automatic with this syndrome, thus more practice should be expected).

Ataxia is also common (again, due to the cerebellar involvement). So age appropriate, but safe activities, that address this, along with the gross motor skills mentioned below, are needed. Limit intensities regarding any high resistances, endurance, duration, any straining. I would limit unnecessary impact activities (eg., instead of sprinting on concrete; a nice smooth treadmill walk, and at an incline, but still walking, when fitness levels increase, makes more sense). I would certainly avoid collision activities.

To sum up: Clear things with a physician; limit contact/collision activities (anything that could risk cranial concussion [shaking] or impact [contusions]); build up to higher intensities (resistances, reps, duration, etc.,) slowly and cautiously; listen and look for any signs/symptoms of stress; and relax and have some fun!

I'd agree that your student's physician be involved in recommending activities (areas that can be worked on) as well as contraindicated activities. Gradually work on gross motor skills to build some endurance, though doing too much should be avoided as I've read symptoms can worsen with exhaustion. Activities that put stress on the head and neck should also be avoided, though log rolling could be okay - I guess it would also really depend on what symptoms (dizziness/nausea) may be present. Using music and doing a variety of activities that are of low and high intensity would be helpful. Simple dances done seated and while moving could work well. Water activities may work well too. Water provides a great medium to decrease any impact. Parachute activities for upper body strength may work though motions should be kept gentle; no jerking it up and down. I think with her physician's support you may be able to do many things with this student that you do with your other students - it just may be that you modify for her condition, to not tire her out too much, limit impact activities, and work on gradually improving her endurance.

Last modified date: 9/14/2010

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