The Compelling Why

of This Webinar

**********************

To get an introduction to the

safe and therapeutic

management of

Osteoporosis,

the Ticking Time Bomb*

of the world today. *WHO 2004

While waiting for webinar

to begin, get a chair, preferably one

without arms for

S I T - T O - S TA N D - T O - S I T

that, someday in this country and, indeed, around the world, any person, no matter their age, gender, lifestyle, ethnicity,

musculoskeletal condition or any other factor, can go into any environment where exercise and movement are being taught

and be given a program that is

Ideally, it will also be therapeutic. Although there is more awareness now than when I began

teaching in 1998, there is still a lot to be done. By taking this webinar, you will help me fulfill my dream.

As you learn more about movement that is

you can help me take the message of safety and therapeutic intent in movement and exercise into your own life and into

the lives of others. You, too, can become a dreamer!

I AM NOT HERE TO TEACH YOU

I am here to invite you to allow me to establish an environment to take you through a conscious experience of awareness and movement of your own body. You can then take that awareness into your personal life and practice and help those who come before you to develop that awareness of movement so necessary for more true and permanent healing.

On some level, most of what is included in this webinar (and in my seminars) you already know. I am hoping that this webinar will help you recognize and/or awaken that knowledge within you.

A focus on optimal alignment in whatever you are doing and wherever you are can result in greater mental clarity, better physical function and decreased discomfort, pain and anxiety.

And, of course, also promote more specific muscle contraction and weight-bearing forces on bone.

Sara Meeks August 2019

GREAT MINDS THINK ALIKE AND SOMETIMES AT THE SAME TIME

This From Monty Roberts* “Horse Whisperer”

On the same day I thought of the ideas on the last slide.

"I appreciate people who are willing to reach out and learn. In my opinion, there is no such thing as teaching.

There is only learning. I believe it is my obligation to create an environment in which the student can learn, whether human or horse.”

*www.montyroberts.com

A L I G N M E N T

ALIGNMENT

PERCH POSTURE HIP HINGE

S T A N D I N G P O S T U R E

F O O T P R E S S

FUNCTION

FOLLOWS

FORM

IS THE

KEY

SIT-TO-STAND-TO-SIT

The most

FUNCTIONAL MOVEMENT

we do every day

Inability to stand up out of a chair unaided is linked to a

2 fold increase in hip fracture risk Cummings et al 1995

Weakness of lower extremities linked to impending

physical frailty Judge et al 1996 Guralnik et al 1995

Low femoral neck bone mineral density is significantly

associated with a low sit-to-stand performance assessed

by measurement of maximum rising strength in healthy

adult women. Blain et al 2008

Management of

Spinal Pathology

Optimal Alignment for

Osteoporosis/Osteopenia,

Spinal Stenosis, Scoliosis &

Chronic Back Pain

The MEEKS METHOD®

Practical Applications

For Practice

SOME BASIC PRINCIPLES

Focus on Physics for Function

• NEWTON’S 3rd LAW:

For Every Action There’s an

Equal and Opposite Reaction

(Pressing Down Lifts You Up)

• FORCE OF GRAVITY

Assisted, Neutral or Against

• RECIPROCAL INHIBITION

Muscle Activation Creates

Relaxation Response in the Antagonist

• MUSCLE CONTRACTION

WEIGHT-BEARING FORCES

necessary for healthy bones

• Compression, Tensile (Lengthening) and

Shear (Sliding/Gliding) Forces

act on our bones and are necessary for

bone growth and bone health

Bones are

strongest in compression

next in tensile -- weakest in shear

• RANDOM HIGH VELOCITY FORCES BUILD

DENSER, STRONGER BONES*

?How often do you get those kinds of forces

on YOUR bones? Can it be done?

?How can you get these kinds of forces on

your patients’ bones?

*Nikander et al 2009

Non-habitual movement patterns e.g. walking backward & sideward

Bump Bump

©2000 SARA MEEKS SEMINARS

PATTERNS OF POSTURAL CHANGE

Prevent, Arrest or Reverse Function Follows Form

DETERMINING OPTIMAL INTERVENTION

Clinical Condition of the Patient Fracture of Minimal Trauma Hyperkyphosis of Thoracic Spine Loss of Body Height Co-Morbidities e.g. COPD, Fear Patient Preferences-LISTEN to your

patient Where are you meeting this patient?

Results of Testing DEXA TBS Lateral Vertebral Assessment X-ray

3 Cardinal Signs

• Determine areas of restriction and weakness

ISOLATE

ACTIVATE

INTEGRATE

• Relieve restriction/strengthen weakness

• Put it all together into functional movement

A musculoskeletal disorder with

compromised bone strength

that predisposes an individual

to increased fracture risk (broken bone)

NIH Consensus Development Panel on Osteoporosis

Prevention, Diagnosis, and Therapy.

JAMA 2001: 285:785-795

•Bone Density (Quantity)

•Bone Quality •Architecture

•Mineralization

•Micro damage accumulation

BONE STRENGTH

PEAK BONE MASS •The amount of bone accumulated as

a young adult (generally age 30-35)

•About 90-98% is

accumulated by age 18-20

Reduction of bone mass,

both quantity AND quality

so that the bones become

fragile and easily fracture

Another Definition

of Low Bone Mass

DETERMINANTS OF

PEAK BONE MASS

•Heredity – up to 75%*

•Physical Activity •Nutrition

•Ethnicity • Hormonal Status

• Lifestyle Factors

http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/bone_mass.asp#a

Accessed October 21, 2011

Bone Health and Osteoporosis

A Report of the Surgeon General October 2004

Vertebral

Column

Bone Density

Report

A/P View

Patient E.W.

Hip Bone Density

Patient R.O.

BONE QUALITY

TRABECULAR BONE SCORE (TBS)

Trabecular Bone Score: A Noninvasive Analytical Method

Based Upon the DXA Image Silva et al Journal of Bone and

Mineral Research Vol 29, No 3 March 2014 pp 518-530

• Complementary to DXA data

• Lower test results in women who have sustained a

fragility fracture in whom DXA indicates normal bone

• Lower values in postmenopausal women and in men

with fragility fractures than in those with no fractures

• Stand-Alone Predictor of Fracture Risk

• Holds promise as an emerging technology that could

well become a valuable clinical tool in the diagnosis of

osteoporosis and fracture risk assessment

Spinomed Online CEU Course July

2011

INSIDE THE

BONES

6

Milner, Colin. Making Bone Health

A Priority. The Journal on Active Aging.

May June 2002.

OSTEOPOROTIC

BONE

NORMAL

BONE

29

F

R

O

N

T

B

A

C

K

B

O

N

E

O

F

T

H

E

T6

T r e a t m e n t

D i l e m m a

BONES • At

• Inside

• Beyond

The Bones

BEYOND THE BONES

ANATOMICAL CONSIDERATIONS

Boney Structure Intervertebral Discs Joints Ligaments Circulation Neurological Muscular Internal Organs

POSITIONING OF

INTERNAL ORGANS

Loss of Body Height Can Affect

Speech Swallowing Breathing

Heart Rhythm Digestion

Elimination Any Internal Organ

Function

OSTEOPOROSIS IS A

PEDIATRIC CONDITION

that manifests in

ADULTHOOD

• Also in childhood--babies are being born with osteoporosis

• Osteoporosis affects all populations—women, men, young adults, the elderly, patients in your clinics and classes, and anyone taking this webinar today

• It knows NO boundaries regarding age, gender, lifestyle, ethnicity or any other factor

• Some people are more at risk than others but no-one is totally immune

• Osteoporosis affects 60% of persons age 60+ (men and women)

• Total of 57 million age 60 + should be very concerned about their bone health

• Total # of people estimated to have low bone mass in the United States—48 million—which means that……………

Osteoporosis is more prevalent than coronary heart disease

(12.5 million), heart attack (1.1 million) & diabetes (17 million)

and more common than

breast, uterine and ovarian cancer combined

PEAK BONE GROWTH

•In Utero •Adolescence

WHEN DOES

PREVENTION

BEGIN ?

BEFORE BIRTH? Evidence that fracture risk might be

programmed during intrauterine life

Maternal smoking, diet (esp. Vit D deficiency)

and physical activity appear to modulate bone

mineral acquisition during intrauterine life

Low birth weight & poor childhood growth are directly

linked to later risk of hip fracture

Optimization of maternal nutrition and intrauterine

growth should also be included within preventive

strategies against osteoporotic fracture

Cooper C et al. Review: developmental origins of osteoporotic fracture

Osteoporosis International 2006

A Timeline

of

Problems

with

Bone

Development

From THE CHAIR

by

Galen Cranz

How infant development is being affected by use of car seats/baby carriers/strollers etc

Oxygen deprivation Delayed development

Skull deformities

Torticollis

Gerd

Sensory deprivation:

Sensory Processing Disorder?

Lack of movement –– does this affect bone development too?

Cutting off the airway in cervical-flexed positioning

Reports of babies dying in car seats

CAR BED

RISK FACTORS &

FIRST SIGNS

for

OSTEOPOROSIS

RISK FACTORS

for

FRACTURE

HANDOUT

WITH

WEBINAR

REQUEST HANDOUT AT jharrison2@earthlink.net

Except for some meds, there is no

known cause for

osteoporosis

• Occurs in 1 of 2 women; 1 of 4 men

• Happens every 20 seconds

• Can be immediately life-altering and life-threatening

• Annual Fracture Incidence – Vertebral—700,000

– Hip—300,000

– Wrist—250,000

– Other Sites—300,000

• Cost – >$46 million per day

– By 2020

– >$178 million per day

OSTEOPOROSIS-RELATED

FRACTURE

More fragility fractures occur in women

with normal bone or osteopenia than in

those with osteoporosis Therefore, when prescribing exercise,

it is important to consider bone

health in all populations

Pasco JA, Seeman E, Henry MJ, et al. The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int (2006)17:1404 Sornay-Rendu E, Munoz F, Garnero P, Duboeuf F, Delmas PD.. Identification of osteopenic women at high risk of fracture: the OFELY study. J Bone Miner Res. 2005 Oct;20(10):1813-9. Epub 2005 Jun 20. E. Siris & P. D. Delmas. Assessment of 10-year absolute fracture risk: a new paradigm with worldwide application. Osteoporosis International (2008);19:383-384

•Bones of spine usually first to show signs of osteoporosis

•Primarily trabecular bone •Fractures occur during movement that includes

TRUNK FLEXION

VERTEBRAL BODY

•After one vertebral fracture, the risk for having a 2nd vertebral

fracture increases 5 fold!

•1 woman in 5 will sustain a 2nd vertebral fracture within 1 year •“The risk of death is 2.7 times higher than those with no fracture”1

•Only 20-30% of all compression fractures are symptomatic2

1 Too Fit To Fracture: Exercise recommendations for individuals with

osteoporosis of osteoporotic vertebral fracture 2014

International Osteoporosis Foundation 2005

Report of the Surgeon General on Bone Health Oct 2004 2www.nih.gov accessed November 30, 2011

PRIMARY CONSEQUENCE OF OSTEOPOROSIS IS FRACTURE

PRIMARY OBJECTIVE OF THERAPY AND BRACING

MINIMIZE THE RISK OF THE

NEXT FRACTURE

KUMMELL’S DISEASE delayed post-traumatic osteonecrosis of the spine

• A rarely-reported clinical entity that likely occurs with higher

frequency than recognized

• Treatment decisions are similar to osteoporotic compression

fractures

• Relevant factors include patient comorbidities, level of

disability and pain, degrees of kyphotic deformity and

presence of neurological compromise

• Although early reports were centered on conservative

management, more recent reports favor surgical intervention

Ma, Richard et al. Kummell’s Disease: delayed post-traumatic osteonecrosis

of the vertebral body. Eur Spine J (2010) 19:1065-1070.

THE MEEKS METHOD®

12-POINT

INTERVENTION

FOR

SPINAL PATHOLOGY

PRE-ASSESSMENT (Screening)

ASSESSMENT (Evaluation)

Interactive Screening Form Available Upon

Request Details near end of Webinar

EDUCATION

Patient Advocacy

**** Resources

SITE-SPECIFIC EXERCISE

Target At-Risk Areas--Two Areas with No Muscle Attachments

Start with Fountain-Of-Youth Muscles

(those most important for spinal and hip stability)

Re-Alignment Routine

Focus on Spinal Alignment, Elongation

and Stability **********

Strengthening of the Back Extensors

Strengthen Support Muscles

“Fountain of Youth” Muscles

•Diaphragm & Intercostals •Heart

•Back Extensors •Abdominals •Pelvic Floor

•Gluteus Maximus •Gluteus Medius

CONTRAINDICATED/CAUTIONARY MOVEMENT for PATIENTS with LOW BONE MASS

Movements that Flex

Sidebend and/or Rotate

the Spine

Flexion increases

compression

PRINCIPLES OF THE MEEKS METHOD

DECOMPRESSION

FRONT of the Backbone

T E N S I L E F O R C E Single Best Exercise for Most Back Pain

UN-LOAD the Vertebral Bodies Site-Specific Exercise

QUESTIONS?

?

?

? ?

?

?

?

?

?

?

?

? ?

?

?

?

?

?

?

? ?

?

?

?

?

?

?

?

? ?

? ? ?

? ?

?

?

?

?

?

?

?

?

?

?

?

? ?

?

?

?

? ?

?

?

?

? ?

?

?

?

?

? ?

?

?

? ?

?

? ?

? ? ?

? ?

? ?

? ?

? ?

? ?

? ?

? ? ?

? ?

?

?

?

?

?

?

?

?

Decompression Exercise

Shoulder Press

Head Press

Leg Lengthener

Leg Press

Side-Lying Leg Lift- Best For Gluteus Medius Strengthening

Begin by Pressing Bottom Leg Down To Initiate Movement; Lift Top Leg as Tolerated in Alignment

RE-ALIGNMENT ROUTINE PLUS

Squeeze Water Out Of Sponges Under Acromion Processes

Uni- and Bi-Lateral

Single Best Exercise for Most Back Pain

Adjust head position to maintain arch

Positioning Options for Breathing & Back Pain

INDICATED EXERCISE - “CORE”

ABS Isometrics

PELVIC

FLOOR Isometrics

DIAPHRAGM Balloon Breath

BACK

EXTENSORS Re-Alignment

Foot

Press

INTERCOSTALS Segmental Breath

PRONE PELVIC PRESS NOT a Pelvic Tilt

BODY MECHANICS

SAFE MOVEMENT

during ADL’S ****

Golfer’s Reach Hip Hinge

Weightlifter’s Squat Lunge

Assistive Devices

Thanks to Deb Gulbrandson DPT for photos of Lunge and

Weightlifter’s Squat.

Deb is an instructor in The MEEKS METHOD Level 1

POSTURAL

CORRECTION

Visual Imagery Internal Plumb Line

BALANCE STEADI TEST

Feet-Together Semi-Tandem

Tandem Single-Leg

Stance EXPERIENCE

**** Fall-Proofing

the Environment

WEIGHT-BEARING EXERCISE

Not just for lower extremities Weight-Shifting

Assistive Devices Random Forces-Odd Impact

Exercise for the Heart

Gait Training

With Exerstriders

MODALITIES

PAIN CONTROL

Positioning Moist Heat

Ice Ice Massage

Massage Ultrasound

Myofascial Release ***********

Active-Isolated Stretching of muscles of LE’s to

relieve pull on the spine.

For Compression Fractures

Electrical Stimulation along Erector Spinae

at Fracture Level

Bracing is part of

a comprehensive

approach to the

management of

patients

with

osteoporosis

and/or

compression

fracture

BRACING

Purposes of Bracing •Support and Protection

•Control of motion

•Prevent Fracture

•Allow weight-bearing activities

Bracing usually associated with weakening

of body part it is designed to protect

SPINOMED

Spinal Orthosis for Osteoporosis

Spinomed IV

The Spinomed®

Spinal Orthosis for Osteoporosis

Is the only spinal orthosis

designed specifically for the management of osteoporosis and compression fracture and

backed up by a peer-reviewed study that shows it strengthens the body part it is designed to protect—namely, the back

According to The Meeks Method The Spinomed can be used for spinal stenosis, back pain, mild scoliosis, back weakness and

other back pathology

BRACING (with the Spinomed® brace)

– 73% Increase Back Extensor Strength

– 58% Increase Abdominal Strength

– 11% Decrease Thoracic Kyphosis

– 25% Decrease Body Sway

– 7% Increase Vital Capacity

– 38% Decrease in Pain

– 15% Increase in Well-Being

– 27% Decrease in Limitations ADL’s

– Increase in Body Height

Pfeifer, Begerow, and Minne 2004

Best Posture Day 1 – Brace

2 ½ Weeks No Brace

Thanks to Betsey Newcomb OTR/L

BRACING WITH THE SPINOMED Spinal Orthosis for Osteoporosis

“The Spinomed orthosis is the single, most

significant advancement in the conservative

management of osteoporosis and

compression fracture EVER.” Sara M. Meeks, PT, MS, GCS

Use of the Spinomed is part of the

comprehensive approach of

The Meeks Method

Goal of Management is to Minimize the Risk of the Next Fracture

BREATHING Awareness

Diaphragmatic (Balloon/Cell Phone

Breath)

The diaphragm is one of the Fountain of Youth Muscles and should be addressed on first visit.

RELAXATION

Conscious “Time-Out”

Contract-Relax

Doing “Fun” Things

Breathing

ADVANCED EXERCISE

Seated Classes Fitness Center Yoga -- Pilates

& More

Yoga Bone Camp with Sara Meeks, PT, MS, GCS, KYT

A narrowing of the spinal and/or foraminal canal

One of the most disabling pathologies in the elderly population

Occurs most frequently in lumbar spine but can occur in cervical area

Congenital or acquired

Commonly caused by disc dehydration and degenerative changes in the discs and facet joints which may lead to vertebral displacement and spondylolisthesis

Changes can cause neural compression which can present as varying degrees of back and leg pain, weakness and numbness, as well as gait deterioration.

Patients often find that adopting a flexed

spinal position relieves pain.

Because a flexed position relieves pain, flexion

exercises are prescribed.

However, if the patient also has osteoporosis,

we are faced with a dilemma

Spinal stenosis is often silent and……….

May also may occur with osteoporosis and

other back pathology

Because many spinal pathologies are silent

and may have conflicting exercise indications and contra-indications, we need to re-think the types of exercise we prescribe, especially, but not limited to, older populations

• Positioning in Pain-Free Alignment

• Re-Alignment Routine as Tolerated

• Advance to Prone Positioning with Support Under Pelvis (Hip Crease Area) as Needed

• Isometric Pelvic Press Exercise

• Advance Meeks Method Exercises as Possible minimizing Lumbar Extension using Pelvic Press for stabilization—stay with Isometric Muscle Contraction

• Check for Hip and Lower Extremity Tightness and Weakness and……………….

• Design a Program to Address these Findings

• Advance to Standing Postural Correction, Balance, Gait Training and ADL’s (functional movement) as possible

GUIDELINES FOR BEGINNING

MANAGEMENT OF SPINAL STENOSIS

Before +1 ½ Hour +1 month

Fred SPINAL

STENOSIS

with

surgery

scheduled

************

Cancelled

surgery

Back to

doing

what he

likes to do

The US Scoliosis Research Society defines idiopathic scoliosis as a Cobb angle >100 which increases the displacement and curvature of the spine in the left and right sagittal planes

Patients with idiopathic scoliosis have a 3-dimensional deformation with lateral curvature and rotation of the vertebral body—may have flexion, side-bending and rotation forces all at the same time in different directions in different areas of the vertebral column during movement

There are different “kinds” of scoliosis including idiopathic and acquired/destructive (acquired later in life) secondary to spinal pathology such as degenerative disc disease, facet joint issues, repetitive use injuries, vertebral compression for which the spine compensates

• Non-habitual Movement – FIRST VISIT

• Exercises for Spinal Elongation and Strengthening of Back Extensors and Other Core Musculature—begin with Re-Alignment Routine

• Check for Hip and Lower Extremity Tightness and Weakness and……………….

• Design a Program to Address these Findings

(e.g., tightness of hip flexors and external rotators is common)

• ACTIVE Spinal Rotation in Prone (i.e., into extension)

• More Site-Specific Exercise if Therapist has

X-ray reports and pictures of the spine outlining

Cobb Angles, direction of rotation etc.

• Use of partial inversion if possible

GUIDELINES FOR BEGINNING

MANAGEMENT OF SCOLIOSIS

Mastercare Back-A-Traction

It is the most common health problem that results in pain and disability among older adults

Up to 80% of older residents in long-term care

facilities experience substantial musculo-skeletal pain with about 1/3 of them being LBP

However, back pain cases in older adults are frequently underreported and inadequately treated

Potential Causes: Non-specific or mechanical low back pain Radiculopathy Osteoporotic compression fractures Degenerative spinal stenosis Tumors/Cancers Spinal Infection Visceral diseases Cauda Equina syndrome

• Positioning in Pain-Free Alignment

• Re-Alignment Routine as Tolerated

• Advance to Prone Positioning with Support Under Pelvis (Hip Crease Area) as Needed

• Isometric Pelvic Press Exercise

• Advance Meeks Method Exercises as Possible--Emphasize Isometric Muscle Contraction for Stability

• Check for Hip and Lower Extremity Tightness and Weakness and……………….

• Design a Program to Address these Findings

• Advance to Standing Postural Correction, Balance, Gait Training and ADL’s as possible

GUIDELINES FOR BEGINNING

MANAGEMENT OF LOW BACK PAIN

“Non-Compliant”

Patients

STAGES OF GRIEF (modified from work of Elizabeth Kubler-Ross)

DENIAL

"No way - can't be!" “They’ve got my report mixed up with someone else’s”

ANGER

"Darn! I am so angry: I did everything right and I get

OSTEOPOROSIS anyway?!??!!!“

NEGOTIATING/BARGAINING

"So ... it's not so bad (osteopenia, borderline) .. and, if I elongate

A LOT, I can still do those forward bends, side bends and twists right?

Maybe just breathe and move more gently?“

DEPRESSION

"I am so down about this ... I have this condition for the rest of my life. I

just won't move at all cause I could break a bone“

ACCEPTANCE

"Ok, I have osteoporosis. Sucks. But I'm going to find a way to do yoga

and exercise because I love it ...

Just have to find a way to do it safely"

o Health care workers may benefit from an individual approach

o Face-to-Face delivery more effective o Take time to explain benefits of physical activity o Give clear & personalized advice o Message from providers should be more consistent o Educate older patients that it takes time to adapt to

new physical activity (I usually say “give it 6-8 wks”)

o Involve relatives, friends and important peers o Check regularly to see that older patients

understand what you are asking them to do

Baeert V et al. Motivators and barriers for physical activity in older adults with osteoporosis. J Ger Phys Ther. Vol 38. Number 3. July –Sept 2015. PP105-114.

o Personalize your approach – consider clinical condition of the patient

o LISTEN to your patient o Engage your patient as a partner in their therapy o Give your patient something they CAN do and which

will make a difference right away and they will be more likely TO do it

o Keep instructions simple & modified for each patient o Err on the side of caution o When in doubt, don’t

In the end—minimizing risk of injury is the “bottom line”

Habitual Posture Best Posture Best Posture–1 Hour Later

JAMES Thoracic Kyphosis

The World’s

Osteoporosis

is

Ticking

Chan et al. Bulletin of the World Health Organization 2003, 81 (11)

!! TAKE ACTION NOW !!

Best way to diffuse the world’s

OSTEOPOROSIS TIME BOMB

is to

THINK

BONE

WHEN YOUR PATIENT

FIRST COMES THROUGH

THE DOOR

“BOTTOM LINE”

MINIMIZE

THE RISK OF THE

NEXT FRACTURE

WHAT IS

YOUR

NEXT STEP?

OSTEOPOROSIS Does Not Occur Alone

Spinomed Orthosis for Osteoporosis

spinomed@mediusa.com

or contact me at

jharrison2@earthlink.net

Exerstrider Walking Poles

walkingpoles.com

Partial Inversion Table

Back-A-Traction

http://www.mastercare.se/

For PDF’s of

The Re-Alignment Routine+

Pre-Assessment (Screening) Form

Risk Factors/First Signs

PowerPoint (color) Presentation

Slides on Compression Fracture Management

Kishikawa study

send email to

sara@sarameekspt.com

Check website www.sarameekspt.com for

more education by

Sara Meeks PT MS GCS KYT

For

seminars, webinars, books, DVDs

and other products

designed to enhance practice

please visit

www.sarameekspt.com

3rd Edition In The Works

DISCLAIMER

Sara Meeks receives no commission on sales of any products presented or mentioned in this webinar

She recommends only products that enhance practice.

SEE

YOU

at

Level 1

Sara Frank & Deb

Raven

Alandra

MIKKI

Elysia

Rose

DELIGHTFUL by

Andrew DeVries ww.andrewdevries.com

Every person can

become an artist in

their own field of

expertise – one needs

a certain amount of

technique but it’s the

• INSPIRATION

• CREATIVITY

• HARD WORK AND

• LETTING GO that brings one into

the realm of artistry.

and Remember…………

WAITING FOR ME TO FEED THEM

A

R

C

H

I

E

M

O

S

E

S

BOBBSEY

JUGHEAD

QUESTIONS?

?

?

? ?

?

?

?

?

?

?

?

? ?

?

?

?

?

?

?

? ?

?

?

?

?

?

?

?

? ?

? ? ?

? ?

?

?

?

?

?

?

?

?

?

?

?

? ?

?

?

?

? ?

?

?

?

? ?

?

?

?

?

? ?

?

?

? ?

?

? ?

? ? ?

? ?

? ?

? ?

? ?

? ?

? ?

? ? ?

? ?

?

?

?

?

?

?

?

?