Chapter 34 Physical Activity, Exercise, and Sports Overview Benefits of exercise for the child with developmental disabilities Laws regarding inclusion in physical education and community programs How to incorporate physical education adaptations into a child’s IEP based on abilities Community sports and recreation programs available to children with special needs Preparticipation evaluation Types of injuries encountered in athletes with disabilities Chapter 34 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Introduction Physical activity is especially important for children with developmental disabilities because of greater risk for inactivity Benefits: general and cardiovascular health, weight management, development of strong muscles, psychological health Centers for Disease Control and Prevention (2010) recommends 60 minutes a day, three times per week Research suggests many students are not getting enough exercise Greater opportunities for participation and improved understanding of effective strategies needed See the textbook Children with Disabilities, Seventh Edition, for full citation and reference information. Chapter 34 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Health Risks Related to a Lack of Physical Activity Community access and barriers Less opportunity for in- and after-school exercise Inaccessible facilities and playgrounds Attitudes of coaches, physical education instructors, teachers—including emphasis on winning Specific needs of individual children Lack of knowledge about importance of physical activity Need to consider child’s desires and enjoyment These children participate less than typically developing children Risk of adverse health consequences (secondary conditions; loss of functional skills due to lack of physical activity) Parental reluctance Chapter 34 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Considerations for Specific Disabilities Children with disabilities need opportunities to participate, be active and exercise, and enjoy the benefits in terms of physical health and psychological well-being. Autism spectrum disorders Specific concerns: movement difficulties including motor skill and coordination Moderate and vigorous levels of physical activity helpful in reducing undesirable behavior Group program more effective than individual Visual displays for self-monitoring, daily activity logs, social stories, social reinforcement, and behavioral reinforcement useful Chapter 34 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Considerations for Specific Disabilities (continued) Down syndrome and intellectual disabilities Specific concerns: chronotropic incompetence, low strength Structured strengthening improves cardiorespiratory endurance, functional skills, vocational performance, athletic performance Resistance training improves muscle strength and cardiovascular fitness Children with special health care needs Extremely low birth weight: significant motor coordination difficulties Psychiatric disorders: motor impairments, poorer neuromotor and aerobic fitness Clear relationship exists between motor proficiency and participation in physical activity or sedentary behaviors Chapter 34 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Community Programs Parents should consult physician, therapist, or other health professional to decide which activities or programs are best for their children Community sports programs Specialized sports associations Paralympics Little League Baseball’s Challenger Division Disability Sports Alliance Sample program models Special Olympics: sports activities and competitions worldwide Horseback riding therapy (hippotherapy): integrated activities to address specific developmental, therapeutic, and functional skills Chapter 34 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Policies Affecting Participation in Physical Activity School-based physical education requirements vary from state to state Must consider whether IEPs need specific recommendations related to PE and physical activity, including adapted services and levels of access Parents may need to evaluate after-school and weekend activities to achieve recommended physical activity Transition planning begins at age 16 and should take into account that physical activity declines with age Important laws when considering access: Americans with Disabilities Act of 1990 Architectural Barriers Act of 1968 Chapter 34 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Choice and Preparation for Physical Activity, Exercise, or Sports Consider child’s interests, availability of activities, and what would be successful Exercise program for all children should include warm-up, aerobic, balance, strength training, and cool-down activities (total of 60–75 minutes) Preparticipation examinations (PPE) Medical exam prior to sport or exercise participation (junior high or high school) Evaluates athletes with special needs Outcome determines clearance level for participation Chapter 34 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Injury Risk in Children Major reason: repetitive microtrauma (overuse) Training errors (sudden transitions, repetitive demands) Developmental conditions (poor posture, joint limitation or deformity, increased curvature of lower spine, excess knee extensions, flat feet) Major cause: growth Injuries in children with disabilities Minimal information exists, with some studies suggesting lower injury rate and others suggesting higher injury rate Chapter 34 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Disorder-Specific Injuries and Strategies for Prevention Children with the following disabilities may need modifications for training and participation in physical activities Spinal cord injury and spina bifida Risks: may not perceive pain below injury level; soft-tissue damage; autonomic dysreflexia; trunk balance and stability Cerebral palsy Risks: ligament and muscle strains Muscular dystrophy Risks: fatigue from maintaining muscle strength Chapter 34 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Disorder-Specific Injuries and Strategies for Prevention (continued) Down syndrome and intellectual disability Risks: neck injuries, orthopedic conditions that become painful; cardiac problems; seizures Vision or hearing impairments Lower level of physical activity can be increased/improved with modifications Children using assistive technologies Risks: upper extremity injuries for children in wheelchairs Low bone density Risks: fractures Chapter 34 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.

Equipment and Support The use of proper equipment should be mandated and enforced for safety of all children: Activity-appropriate, high-quality, and proper fit Protective padding, headgear, eye protectors, mouth guards Environmental assessment: Well-lit, smooth, and obstacle-free; shock-absorbing surfaces Equipment modification Monitoring of temperature and humidity Proper hydration Proper supervision Chapter 34 slides in Children with Disabilities, Seventh Edition, Online Companion Materials. Copyright © 2013 Paul H. Brookes Publishing Co., Inc. All rights reserved.