Feeling fidgety in class? Go stomp, jump or hop down this school’s sensory hallway

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In many Canadian schools, recess and phys-ed class may be the only activity students get in their day, but a school in rural Manitoba is trying to change that.

« This is our Sensory Path, » says Roland School principal Brandy Chevalier, as she points to a colourful activity map on the floor of the school’s main corridor.

« We are very focused on making sure our kids are learning both numeracy and literacy but also being mindful of their whole bodies and wellness, and wellness as a whole being. »

The path instructs them to hop, squat, do pushups and crawl.

They follow the path every morning and after lunch, on their way to class in this community about 100 kilometres southwest of Winnipeg.

Kindergarten student Elizah Wall likes stomping on the bugs. Classmate Everly Semograd likes crawling on the flowers.

« Some parts are challenging, some parts are easy, » says 11-year-old Addison Elias.

If teachers notice students fidgeting, they will send them to the path for a couple of rounds.

Students Ethan Dyck and Caleb Mitchell say it’s making a difference.

 « Really helps me calm down when I’m in a very active position … It’s just helps me burn some energy, » Caleb says, adding his favourite activity is the frog jump.

« Helps me focus, » Ethan ​adds.

Principal Brandy Chevalier and her staff created a Sensory Path for students in the main hallway. She says more schools are developing a strong physical literacy focus. (Trevor Brine/CBC)

Roland School’s Sensory Path is the first of its kind in Manitoba, Chevalier says. It was inspired by an Alberta initiative called Don’t Walk in the Hallway, launched in 2015.

Chevalier says she’s been approached by schools across Canada since her school installed the path in November.

Her students’ comments are music to her ears. 

She explains how this helps the students. « They feel like they burned some energy. They feel ready to sit down and to get down to work. They can focus a little bit better. »

She hopes such exercise can become « a preventative measure for some behaviour issues that might happen by a child who cannot regulate themselves to sit in class. »

The benefits aren’t just academic. Doing exercises like this every day increases physical competence, which boosts confidence, making people more likely to move and be active.

That has health, social, environmental, and economic benefits.

But Canadians are just not moving enough. We got a C– in a recent study of activity levels in 49 countries.

It’s not how much you move. It’s not whether you’re fit or not. It’s do you have the ability to move on land, air, ice, snow, water?– Dean Kriellaars , University of Manitoba

According to Health Canada

  • Just 13 per cent of preschool children and 9.5 per cent of children and teens are meeting Canada’s 24-hour Movement Guidelines.
  • Only eight per cent of Canadian adults are doing 150 minutes of moderate-to-vigorous physical activity per week.
  • Adults over 65 are doing a little better — 14 per cent of them are meeting those guidelines.

« There’s two returns on investment here, » says Dean Kriellaars, with the department of physical therapy at the University of Manitoba. He has practised, researched and taught physical literacy for more than a decade.

« First is the health-related equity that happens if you increase they physical literacy of the population. And then safety and activity levels, you then get dramatic reductions in costs. »

In 2013, the World Health Organization estimated the global cost of physical inactivity was approximately $54 billion US in direct health care, plus another $14 billion in lost productivity.

It accounts for up to three per cent of national health-care costs, and that doesn’t include mental health and disorders such as repetitive strain injury, carpal tunnel syndrome and tendinitis.

More than 40 non-communicable diseases including breast cancer, Type 2 diabetes and strokes can be related to what Kriellaars describes as a global physical inactivity epidemic.

« Our society has to change. Our valuing of movement has to change, in our workplace, in our schools, where movement will be as important as reading and writing, » he says.

« Physical literacy has a physical component, a social component and a psychological component. It’s really about creating that holistic picture of a child and saying we need all three of those working together. »

Exercise physiologist Dean Kriellaars hops in one of his movement labs at the University of Manitoba. He trains athletes of all ability levels, educates health-care professionals, coaches, trainers, and educators about physical literacy and healthy lifestyles. (Trevor Brine/CBC)

Chevalier sees a strong future for mpvement programs in schools. « I think a lot of schools are embracing opportunity for choice in seating in the classrooms, and this just directly complements that concept. »

Her advice for education profesionals?

« You need to do your homework. You need to sit down with your occupational therapist. You need to sit down with your experts in the building from phys-ed background and really chat about what your students need, » she says.

Students travel the Sensory Path at Roland School. (Brett Purdy/CBC)

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One solution to hallway medicine: outpatient hip-replacements

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Kaori Noguchi recalls being taken aback when her surgeon’s office called to book her hip replacement surgery.

She was told she could have the operation as an outpatient, meaning she would be in and out of hospital the same day.

Thirty years ago, this procedure would have required a hospital stay of up to seven days, and more recently it’s taken an average of three days.

“Initially I was a bit freaked out,” Noguchi said, explaining that she was concerned she would be in too much pain and not mobile enough to leave the hospital so soon.

But on Monday she did just that. The 47-year-old Toronto resident left Women’s College Hospital just after 4 p.m. — only four hours after being wheeled out of the operating room and eight hours after arriving at the hospital.

Women’s College is the only fully ambulatory hospital in Ontario, meaning it has no overnight beds. It describes itself as “a hospital designed to keep people out of hospital.”

Part of its mission is to help improve the broader health system. One way it’s trying to do that is by spreading the word about the advantages of ambulatory, or outpatient, surgery.

Surgeon-in-chief Dr. David Urbach said doing more joint-replacements this way could take significant pressure off the entire hospital system.

“This approach, applied throughout the province, has the potential to save a huge amount of money and free up many beds in the Ontario hospital system,” he said.

According to data from the hospital, approximately 50,000 hip and knee replacements are done annually in Ontario. The average hospital stay is three days.

Health reporter Theresa Boyle shares her experience witnessing a hip surgery | Story Behind the Story

If 50 per cent were done on an outpatient basis, that would free up 75,000 days of hospital beds annually. That would be the equivalent of opening up a new 200-bed hospital.

10:30 A.M. Kaori Noguchi's leg is held up while the medical team prepare for surgery.
10:30 A.M. Kaori Noguchi’s leg is held up while the medical team prepare for surgery.  (Steve Russell)

The savings would amount to more than $100 million annually.

“What we are advocating is to transform up to half of all total joint operations into same-day discharge ambulatory procedures, without patients entering a hospital ward at all,” Urbach said.

Women’s College rolled out a similar program for knee replacements earlier this year.

Anthony Dale, president of the Ontario Hospital Association, said solutions like this are needed to address hospital overcrowding.

“This work at Women’s College Hospital is a great example of the kind of innovation that’s needed to end hallway health care,” he said, referring to the phenomenon of hospitals being so crowded that patients are cared for in corridors.

11:48 A.M. Anesthesia assistant Angela Chan begins to wake patient Kaori Noguchi after the surgery.
11:48 A.M. Anesthesia assistant Angela Chan begins to wake patient Kaori Noguchi after the surgery.  (Steve Russell)

Though Women’s College is not the first hospital in Ontario to do ambulatory hip-replacements, this kind of surgery is “not widespread at all,” Dale noted. “The fact you can have it done in a single day … that’s pretty powerful.”

Urbach estimates fewer than 100 total joint replacements, without overnight hospital admissions, were done in the province prior to this year.

Ambulatory hip-replacement surgery was pioneered in Chicago in the early 2000s, explained Dr. John Antoniou, president of the Canadian Orthopaedic Association, adding today it is done with much more regularity south of the border.

He acknowledged some patients might be uncomfortable with the idea of leaving the hospital so soon and said initiatives such as the one at Women’s College “help make it more socially acceptable.”

Noguchi said she came around to being OK with the idea of ambulatory surgery after her doctors explained how it worked and shared with her media stories about others getting it.

She is the fourth patient at Women’s College to undergo outpatient hip replacement surgery in the last month.

Noguchi has hip dysplasia, a condition that has resulted in painful arthritis and causes her to limp.

11:04 A.M. Surgeons Dr. Paul Kuzyk uses a tool to prepare the hip socket as Dr. Oleg Safir, right, looks on.
11:04 A.M. Surgeons Dr. Paul Kuzyk uses a tool to prepare the hip socket as Dr. Oleg Safir, right, looks on.  (Steve Russell)

In recent years, the pain has become so bad it interrupts her sleep. It has also forced her to switch to a desk job in her field of event and catering management. It hurts when she is on her feet for too long.

The way the actual surgery is done is no different for outpatients than for those with longer hospital stays. What is different is the anesthesia and aftercare.

“What we have done is develop a virtual care pathway that makes same-day total joint replacement routine for many patients,” Urbach explained.

Ultra short-acting spinal and regional anesthesia is used instead of general anesthesia. That shortens recovery time and allows patients to walk comfortably immediately after surgery.

“We add additional resources to replicate the in-hospital post-op care experience,” Urbach added.

Surgeon Dr. Paul Kuzyk prepares to move the adductor muscle.
Surgeon Dr. Paul Kuzyk prepares to move the adductor muscle.  (Steve Russell)

That includes a virtual care app, developed by the hospital, which allows patients to keep in touch with their care teams.

“The app replicates the experience you would have as a surgeon seeing your patient in hospital. You can look at them face to face, you can answer questions, you can see if they are in pain, you can see how they are doing,” he said.

As well, remote monitoring devices are used, including step counters.

“Many patients probably have enhanced exposure to their care team,” Urbach said. “Doctors and nurses can connect with them using mobile devices instead of rushing to see them in hospital wards.”

Dr. Paul Kuzyk, one of two orthopedic surgeons who operated on Noguchi, explained that not all patients who need hip replacements are candidates for day surgery. It works best on those who are otherwise healthy, highly motivated and have loved ones at home to help them recover.

2:30 P.M. Patient Kaori Noguchi walks with physiotherapist Hari Nair.
2:30 P.M. Patient Kaori Noguchi walks with physiotherapist Hari Nair.  (Steve Russell)

The surgery itself took less than two hours. Noguchi was out of it for the most part, awakening only briefly to the noise generated by orthopedic surgery tools.

She was oblivious to what was happening below the surgical drape and assured the anesthesia assistant she was comfortable.

After Kuzyk removed the femoral head — the “ball” part of the ball-and-socket hip joint — he pointed out where it had been damaged by arthritis. Cartilage was visibly worn away from the surface.

Kuzyk and fellow surgeon, Dr. Oleg Safir, replaced Noguchi’s hip with ceramic, plastic and titanium parts. Their work was physically demanding.

11:23 A.M. The ceramic ball is ready to be placed onto the metal femoral stem.
11:23 A.M. The ceramic ball is ready to be placed onto the metal femoral stem.  (Steve Russell)

Safir explained stays were longer in the past because hospitals wanted to ensure patients did not suffer from post-surgical complications.

As stays have shortened, complication rates have been closely monitored. They have not increased, Safir said.

Urbach said outcomes are excellent and patients recover just as well with ambulatory surgery.

“Being able to discharge a patient on the day of surgery means the patient has to be completely comfortable, mobile, stable and confident,” he said. “We ensure patients feel so good after surgery that they are not afraid of going home.”

Patients benefit by recovering in the comfort and familiarity of their own homes, Urbach noted. Shorter stays reduce the risk of picking up a hospital-acquired infection or developing hospital-acquired delirium, he added.

Less than three hours after her surgery, Noguchi was on her feet. She tested out her new hip, walking down the hospital corridor with the aid of a walker.

Physiotherapist Hari Nair then guided her as she climbed a staircase, using a cane.

Noguchi said she was in no discomfort. She was on painkillers and given a prescription so she could continue taking them at home.

“It’s pretty amazing how they can do this operation as and in-and-out surgery,” she exclaimed. “I’m feeling good. I’m ready to go.”

Theresa Boyle is a Toronto-based reporter covering health. Follow her on Twitter: @theresaboyle

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