Murray has always struggled with being shy since I met him. He finds a lot of social situations intimidating. Murray will shy away from people and\or not respond at all. Murray will often say he will wait in the car when we arrive places like the mall or the store. However, He is not always interested in staying in the car if he knows or thinks he may be getting something from the respective locations. Murray has experiences some not so pleasant social events in his life and has a bit of anxiety around people he is unsure of. In contrast, if Murray knows someone and\or feels they know him, he will express this very excitedly and often. Helping Murray be a part of his choices when out and in stores, has helped to get him engaged in some social activities. Helping Murray understand who is safe to speak to and who is maybe better to not converse with, could pose a problem. Murrays natural Shy nature could also be a natural line of defence for Murray also, as he would not be inclined to approach or engaged with individuals who may wish to harm him or take advantage. This is a fine line that I believe should be maintained for Murray’s safety, while also helping him differentiate between safe people to speak at the subway counter who are in a service, and possibly unsafe people coming to the door at home who look or act like they are in service.

Helping Murray be involved in social events like ordering or choosing things for himself to buy, like clothes or the design of clothes, could help him feel more included and walk to be more involved in the activities. We have been working on these aspects for the year and Murray now stands and orders his food with me, he does not speak as often about staying in the car if we must enter a place, and he is more aware of the people he can engage in conversation with. Murray has been told a lot of what he should think and do. Letting him be a part of the process or have some choices has made him open up and speak more about his wants and desires when in the community. Including asking me to say hi to people he knows I will see that he feels know him or he feels comfortable with. This shows Murray is remembering them and actively feeling, in regards to his perceived relationship with any individual.

Murray has not had a lot of opportunity to choose and make choices for his own self. Including but not limited to, foods, clothes, events. When Murray is asked if he would like to choose often, he would say” I don’t know surprise me.” When given some options to choose from it is easier for Murray to make a choice, however, when left to his own thinking about what those choices might be, Murray struggles to come up with options. Giving Murray the option to choose should come with suggestions based on things Murray has expressed interest in. when presenting these options, it is easier for Murray to have 3 options, if you give Murray enough time after repeating the options to him. He will come up with an answer he has chosen. While giving the options to Murray, he may repeat the options, or he may exclaim “Yeah that one!” or, Murray will specifically name an activity he wants to do e.g. Tea, bowling. These are all expressions Murray has with different meanings. In my opinion when Murray says “yeah, that one” he does not really understand what the option is but knows he enjoyed some aspects of it. When mimicking the options during the presentation stage, I believe Murray is just processing the options, I do not think he is answering the question and should be given time to come to his own conclusion. If Murray is interrupted and/or feels rushed, he will not focus on the task but rather revert to a stage of concern, answering possibly with the answer he feels will appease the person asking. Or possibly out of embarrassment not wanting to focus to be on him anymore.

To help with communicating and making choices he enjoys we work on giving Murray time and also helping Murray understand the options available. We have worked on talking about why Murray chooses some things and not others. Murray when not wanting to do something will come up with many reasons why we may not be able to go to that activity, or he may say we can do that later or another day. This means he does not want to do the activity. But getting to the why is often a challenge. Giving Murray reassurance he will not be in trouble or he is allowed to express his wants and desires, can help Murray feel comfortable sharing his true desires, and not just what he has been told or feels he should say as response to some things. Explaining to Murray that I also struggle to make choices and sometimes make choices that create more work for myself or emotions I have to work thru. Murray and I have been speaking a lot about emotions and that its okay to feel them. Murray has shared that he speaks to his mom often when he is going to bed and asks her to come back and take care of him. Murray says he is sad sometimes about his situation. Murray is expressing a lot of emotions around his sister also. A lot of emotions come out in the form of perceived views murray may have from close people in his life. He will express in a way that is not common for him and when speaking on some things, which suggests he is mimicking behavior in order to express his emotions. He is a very expressive person and has a hard time with negative emotions. It is evident when Murray feels like he is in trouble, or feels he has done something wrong. Murray will shy away and look down or away, become more quiet and or leave the room. We have worked on expressing and talked many times regarding the importance of expressing our emotions even when they don’t feel so nice. Getting Murray to a point where he feels comfortable with the topic is key. Example Snoring, at home the topic was spoken about often and joked about. However Murray always associated this communication style with negative connotations. Murray would become upset or defensive when the topic was brought up by family. Understanding this behavior cue, I spoke to Murray about snoring, I told him I snore and my dog snores and most people snore sometimes. We talked about the throat and nose and how it works. After some time and learning that I not only snore, but admit it openly and with a smile on my face. I explained its okay to snore and we can help snoring. Now the conversation is lighter he jokes about it and instead of defensive he is respective to the fact that everyone snores. And that’s normal and he is included in that status.

When we started Murray was very against walking and eating healthy foods, going out for him meant treats and he is often looking for ways to find foods that are sugar filled as well as getting out of walking or anything else exercise related. Family reported leaving Murray at home rather that take him out. Areas of interest for maximum exposure to fitness are the pool and bowling.  while I was away during part of the reporting period, Murray changed his stance on swimming and has not wanted to go to the pool. We also had an issue with another participant at bowling, which is driving Murray away from bowling. Statistically speaking bowling can burn from 170 to 300 calories a game, this average of about 1000 steps a game, increases the amount of walking Murray does exponentially. without these two activities, we are limited to what Murray can do.  I have managed to bring bowling back into the picture however family choices on spending restrict the amount of bowling we can do, and with the incident with Special Olympics Bowling, they had opted out of bowing this year.

Murray eats and drinks a lot of sugar, his choices for food and drink are left solely up to him at home. getting Murray to drink water any chance we get is key to flushing his system of the sugar overload. saturating our body in sugar will cause medical issues, if we can reduce the amounts of sugar in Murray’s diet, we will see major changes in his health. introducing Murray to healthy choices is key to finding ways to cut out the junk food intake. at home Murray drinks soda and concentrated juice full of sugar, he adds sugar to his tea and uses it on some foods. Murray likes to eat a lot foods that are unhealthy and often expects to have treats when he sees them. one way the family has curved this is by leaving Murray out of shopping and trips to other stores. this cuts down on his exposure to exercise again and possibly could be adjusted to assist Murray.

Murray has very poor mouth hygiene and does not know how to brush his teeth properly, this condition may cause problems with, eating, sleeping, balance, mood, and mental functions of choice and understanding to name a few. getting Murry accustom to a morning routine would be wise.  considering the mouth, foods can taste, off or bad when the mouth health is not well. finding ways for Murray to comfortably change some habits over time would include having proper mouth care. getting Murray into routines where he can see and know how the proper way to do things are and why, may help in both health and fitness. Some estimates that brushing the teeth for 2 min (recommended time) can burn up to 6 calories each brush. this amount may seem small for sure considering it takes 3300 calories to drop 1 lbs. combine all the activities of daily living we do in a day, and on a regular basis in a routine, estimated at roughly 1800 calories a day just from activities we normally would not consider substantial. increasing the areas, we can without seemingly adding exercise could help increase Murray's health.

Working forward we have implemented several new routines into our visits. Walking farther by parking farther away from destinations. for instance, if we go for Tea, or to the movies, or out to the shop or store. I will intentionally park farther away, if the there is a safe walking path to our destination. I wear a watch and speak often with Murray about getting my steps in. Murray has a very good ability to mimic or assimilate behavior's he is shown or sees from people he respects or is fond of. this is key for helping Murray understand what we want to achieve. Murray now uses these terms when he speaks of going to the mail box, or taking the garbage out. "Tony, I got my steps in" usually followed by "Just for YOU". I feel Murray is expressing his desire to be part of the fitness I do and also to participate in the discussion and praise for the work put in. these small "steps" will equal major results over time and with enough small changes like these ones, Mostly Murray will be experiencing life from his views enjoying the activities with the people he enjoys, not really knowing its exercise, in my opinion. In regards to foods and eating, I have introduced Murray to the idea that we do not need to eat burgers everyday, that possibly trying new foods would be nice and he may enjoy them. We have worked on this by choosing to go to subway instead of burgers. Murray will eat subway and he will order his own vegetables. Murray will try to go sit down right away but we have been able to use subway for a few different learning opportunities. not only healthy choices which we talk about during the meal at subway, how subway is better than burgers and how good it tastes. but also, in getting Murray to stand for longer and be a part of the process.

Murray complains of pains in his feet and knees, he speaks of difficulty getting up out of chairs and walking up and down paths and stairs. This is a direct result of several factors, including but not limited to in my opinion, weight, age, lack of activity most of the day. Murray enjoys activities that don't include moving. I believe that with some small changes Murray will find less pain in his body and be more inclined to walk. Murray needs to have supportive shoes, without the proper support for his body, he may be experiencing increased pain due to lack of proper supports in shoes.

Today we are walking more often and doing more active talking about fitness. We do not eat burgers every time we go out and we do not go out for food every time we meet. We have adjusted our intake of calories and increased our walking and discussion of walking. We go to healthier places to eat and find ways to include Murray in the processes of everyday activities and community life. Murray speaks more positively about health and exercise now than he has ever done in the past with me. Parking farther away and choosing some places, where walking a little farther is required, within safety parameters. Positive talk about activities is also important. Murray has a lot of expression he says but I feel a lot of them are from what he hears and not actually personal opinion.

1. Positive talk and active participation in Walking and steps
2. Group visits via zoom at the office with other staff and individual
3. Choice making based on NEW information assimilated during the year eg. Food, walking, Social events etc.
4. Arts and Crafts projects that are displayed in his room, including trips to hockey games for pictures that were incorporated into the projects.
5. Meeting hockey players from local teams.
6. Trips to Duncan for bowling and lunch with his favorite waitress at the local restaurant.
7. Social freedom from Covid

There are several areas that Murray could see improvements including but not limited to; Health, fitness, skill development.

Health would benefit from a large decrease in the sugar consumption Murray intakes on a daily basis, despite using stevia, in his tea, Murray eats and drinks a lot of sugar in his regular caloric intake. Finding alternative options for Murray would be key in changing this. We have switched fast food from burgers to subway occasionally, and he is able to make better choices and does enjoy some other foods if prepared in specific ways. Decreasing Murrays sugar and increasing his steps per day will massively increase his quality of life and health.

Fitness

We have implemented walking by parking farther and making regular events part of our visits that include walking, also positive talk about steps has been beneficial to Murray and he has now started talking more about getting his steps. Also, I am working on getting him back into the pool and bowling which as mentioned I feel will increase the chances of Murray becoming more healthy. Murrays current weight is 248lbs he is 58 years old, these factors alone increase risk of health, Fitness will be key, helping Murray do activities like bowling and swimming combined with positive talk, will increase Murray’s quality of life and health.

Skill development

Developing skill in the house and in the community that include work with the body such as walking or bending or squatting, will increase Murray’s success in health and fitness. Starting with common activities and moving to more complex movements could bring Murray to a better understanding of his health and motivate him to be more inclined to move his body. Building skills in chores and helping with daily activities including shopping and helping with carrying things. In a safe manor Murray is able to assist much more than he has had opportunity to do. Developing skills will bring many benefits including but not limited to; social confidence, knowledge, and confidence in small tasks both why and what we are doing. Murray learns well with repetition and is able to retain knowledge with some assistance form his environment. Eventually resulting in permanent memory storage of said information.