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Playful Strategies to Promote Physical Activityin Children and Adolescents with Special Needs

By Katie Glaser-LeClere, MSPT, PCS

•Allied Health Education and the presenter of this webinar do not have any financial or other associations with the manufacturers of any products or suppliers of commercial services that may be discussed or displayed in this presentation.

•There was no commercial support for this presentation.

•The views expressed in this presentation are the views and opinions of the presenter.

•Participants must use discretion when using the information contained in this presentation.

Provider Disclaimer

BS in Health Studies from Boston University, 1995

MSPT from Boston University in 1997

Maryland Physical Therapy license since 1997

School-Based PT from 1998-2003

Private Practice Owner since 2003

Presenter Bio

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Board-Certified Pediatric Specialist since 2004

Home and Community Setting

Public and Private School Setting

Outpatient Setting

Presenter Bio

Prevention and Wellness Services

Kids on the Block Educational Troupe Puppeteer

Athletics and Fitness Association of America

Primary Group Exercise Instructor

Accessibility and Inclusion Consulting

Presenter Bio

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1. Distinguish between the terms: Physical Activity, Exercise, Fitness, Participation and select the most appropriate measurement tool for the purpose intended.

Course Objectives

2. Describe common barriers and facilitators

that impact exercise, activity, fitness, and

participation in children and adolescents

with disabilities.

Course Objectives

3. Identify age-appropriate resources and

strategies to support children and adolescents

with disabilities and reduce the barriers to exercise, activity, fitness, and participation.

Course Objectives

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World Health Organization (WHO)

The International Classification of Functioning, Disability, and Health (ICF)

The Centers for Disease Control and Prevention

The Maternal and Child Health Bureau

Data Resource Center for Child & Adolescent Health

Introduction

Health Condition (disease, disorder, injury)

Body Function and Structure Impairments

Activity Limitations

Participation Restrictions

Environmental Factors

Risk reduction / Prevention

Health/Wellness/Fitness

Terminology

Physical Activity-(CDC)

Any bodily movement

produced by skeletal

muscle that increases

energy expenditure

above a basal level.

Generally refers to the

subset of physical

activity that enhances health.

Terminology

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Physical Activity-(Ross, et al)

Engagement in a

physically demanding

movement, sport,

game, or recreational

play that results in

energy expenditure

and perceptions of communal involvement.

Terminology

Exercise-

a subset of physical activity that is planned, structured, and

repetitive, and has a

final or intermediate

objective of the

improvement or

maintenance of

physical fitness.

Terminology

Fitness-

A set of attributes that are either health related or skill related (sports or occupational performance). The degree to which people have these attributes can be measured with specific tests.

Terminology

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Health-Related Fitness components:

Cardiorespiratory Endurance

Muscular Endurance

Muscular Strength

Body Composition

Flexibility

Terminology

Fitness (continued)

Skill-related components:

Agility

Balance

Power

Speed

Coordination

Reaction Time

Terminology

Participation-

A person’s involvement in a life situation; represents the societal perspective of functioning;

the connections between

the behavior of individual

people and the structures

of the society in which they live.

Terminology

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Impairment (WHO): A problem in body function or structure

Activity Limitation (WHO): Difficulty in executing a task or action

Participation Restriction (WHO): Problem in life situation involvement

Terminology

Disability (WHO):

An umbrella term including impairments, activity limitations, and participation restrictions

Terminology

SPECIAL HEALTH CARE NEEDS (MCHB) :

Those who have, or are

at increased risk for, a chronic

physical, developmental,

behavioral, or emotional condition

and who also require health and

related services of a type or

amount beyond that required by children generally.

Terminology

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Center for Disease Control Recommendation for

all individuals ages 6-17:

60min/day Physical Activity

Must be age appropriate, enjoyable, and offer variety

3 days per week muscle strengthening

3 days per week bone strengthening

Guidelines

7 days per week, moderate or vigorous aerobic activity (3 days per week vigorous)

Moderate intensity=increase in HR and RR,

5-6/10 rating of perceived exertion

Vigorous intensity=greatly increases HR and RR,

7-8/10

Guidelines

Physical Activity Guidelines for Adults with Disabilities (500 MET minutes):

150 min/week moderate intensity aerobic

(walking) OR

75 min/week vigorous intensity aerobic

(running)

Minimum of 10 minute intervals throughout the week

Guidelines

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Muscle strengthening activities

2 or more days/week

Moderate or high intensity

Involving all major muscle groups

Guidelines

If unable to meet the guidelines, adults with disabilities should avoid inactivity and incorporate as much physical activity as possible.

Adults with disabilities should consult a health care provider for individual guidance regarding appropriate physical activity.

Guidelines

. Absolute intensity is the amount of energy expended per minute of activity.

Relative intensity is the level of effort required to perform an activity.

Guidelines

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Physical Activity

Age Group Prevalence of Meeting PA Recommendations

6-11 years 42.5%

12-15 years 7.5%

16-19 years 5.1%

2005-06 NHANES

National Health and Nutrition Examination Survey

(Accelerometry data)

Statistics

Physical Activity

Age Group Prevalence of Meeting PA Recommendations

High School Aged Boys 57.8%

High School Aged Girls 39.1%

2015 YRBSS

Youth Risk Behavior Surveillance System

(Self-report Self-administered Questionnaire)

Statistics

VIGOROUS Physical Activity

Age Group Prevalence of Meeting PA Recommendations

0-17 with no special health care needs

21% failed to meet requirements

0-17 with Functional Limitations

34% failed to meet the requirements

2007 NSCH

National Survey of Children’s Health(Proxy-report Interview Administered Questionnaire)

Statistics

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Individuals with Special Health Care Needs

19.8% of children/adolescents age 0-17 nationwide

National Survey of Children's Health. NSCH 2011/12. Data query from the Child and Adolescent Health Measurement Initiative, DataResource Center for Child and Adolescent Health website. Retrieved from www.childhealthdata.org

Statistics

Physical Activity Disparities

between children with and without specific conditions,

ages 0-17:

Learning Disability: 33% less likely to meet PA guidelines

ADHD: 57% less likely to meet PA guidelines

LD/ADHD: 39% less likely to meet PA guidelines

2007 NSCH

National Survey of Children’s Health(Proxy-report Interview Administered Questionnaire)

Statistics

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1) Indirect calorimetry

2) Self-report measures

3) Proxy-report from parents, caregivers, and teachers

4) Vital Signs

5) Motion Sensors

6) Direct observation/Field tests

Measuring PA

Indirect Calorimetry quantifies energy expenditure based upon gas exchange measurements during rest and steady state exercise.

Basal Metabolism

Dietary Induced Thermogenesis

Physical Activity

Stress Factors associated with disease, injury and pharmacological intervention

Measuring PA

Doubly-labeled water

Direct measure of CO2 production using two stable isotopes of water

One isotope is eliminated as water loss, the other eliminated as water loss and CO2 loss

The difference between the elimination rates is directly proportional to CO2 production or energy expenditure

Measuring PA

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Doubly-labeled water Advantages

Noninvasive

Minimal compliance

Can assess up to

2 week time periods

Measuring PA

Doubly-labeled water Limitations

Expensive

Complex technical analysis

Isotope availability

Doesn’t specify energy expenditure specific to PA

Measuring PA

Respirometry Advantages

Noninvasive

Resting state and/or steady state

Can determine specific activity energy expenditure

Measuring PA

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Respirometry Limitations

Requires a mask to be

worn over the face or in

the mouth

Requires technological

equipment and training

Measuring PA

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Self-Report Measures

Advantages

Simple, inexpensive, useful for a large sample of individuals in a research context

Self-administered, interview-administered, diary

Limitations

Item interpretation, recall accuracy, overestimation of time and intensity

May not be valid or reliable for children under 10

Measuring PA

Proxy-report measures (parent/caregiver)

Advantages

Moderate correlation with activity monitor counts

Limitations

Limited association compared with direct observation

Inconsistent association with heart rate data

Measuring PA

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Children’s Activity, Participation and Enjoyment (CAPE) measure CAPE: 55-item questionnaire examining extracurricular activities

Self-administered AND

interviewer-assisted versions

Appropriate for ages 6-21

with and without disabilities

Preferences for Children's Activities (PAC) measure

55-item questionnaire examining activity preference

Measuring PA

Heart Rate Monitoring-Advantages

Objective indirect assessment of

frequency, intensity, and duration

Inexpensive, unobtrusive

Measuring PA

Heart Rate Monitoring-Disadvantages

Weak relationship with energy expenditure during high and low intensity levels

May be influenced by age, body size, environmental factors, emotional stress, and cardiorespiratory fitness

Delay in heart rate response to movement

Measuring PA

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Accelerometry-Advantages

Small, lightweight, wearable on waist or extremity

Records frequency and magnitude of acceleration in “epochs” to estimate PA intensity or energy expenditure

Strong positive correlation with indirect calorimetry

Variable association with direct observation

Measuring PA

Accelerometry-Limitations

Epoch length may not capture spontaneous bouts of intermittent activity

Lack of standardization of cut-points that define moderate/vigorous PA

Insensitive to certain activities like biking or swimming

Measuring PA

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Pedometry- Advantages

Cost-effective, well tolerated

Moderate to strong validation against direct observation (less at slower walking speeds), accelerometry, O2 uptake, and HR.

Reliable at R/L hip and umbilicus

Limitations-

Counts ambulatory movements only

Measuring PA

Direct Observation-Advantages

Objective measure including context, social factors Provides info about type and intensity

Can be used in a variety of settings

May be computer analyzed

Limitations

Time-intensive for the purposes of observer training and data coding

Measuring PA

Direct Observation

Children’s Activity Rating Scale (CARS)Validated against respirometry

Rates PA intensity level from sedentary to vigorous on a scale of 1 to 5

Evaluates young individuals, age 2 up to age 6

Frequently used to validate and calibrate the ActiGraph accelerometer

Measuring PA

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Direct Observation

SOPLAY (System for Observing Play and Leisure Activity in Youth)

Appropriate for measuring PA in groups of children; ie; school environment

Uses momentary time-sampling techniques

Number, gender, activity level, type of activity including equipment

Coded Sedentary, Walking, or Very Active

Measuring PA

Child and Adolescent Scale of Participation

*Proxy report measuring perceived impact of problems experienced with physical, social and attitudinal environment features of the child’s home, school and community*Developed for monitoring needs and outcomes of children and adolescents with traumatic or acquired brain injuries

*Useful for individual intervention planning, program evaluation, and population-based research

*Moderate correlation with PEDI functional activity scores

Measuring Participation

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Participation and Environment Measure for Children and Youth

*Measures participation in home, school, and community settings

* Examines participation frequency, extent of involvement, and desire for change

*Used for children and adolescents between 5-17 years old with or without disabilities

* Reliable and validated for population-level studies

Measuring Participation

The Compendium of Energy Expenditures for Youth

Lists the MET expenditure for 26 pages worth of activities, from texting while lying down to windsurfing.

Differentiates between light, moderate, and hard effort for most activities

Not intended for use with children and adolescents who have disabilities that would significantly alter their movement patterns, mechanical efficiency and energy cost of activity.

Measurement

25% of U.S. children and youth, ages 6-15 met the guidelines for 60 minutes of MVPA per day

U.S. Report Card

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53.5% of U.S. children and youth, ages 6-11 met the guidelines for <2 hours screen time per day

U.S. Report Card

12.7% of U.S. children and youth, ages 5-14 who walked or biked to school

U.S. Report Card

58.4% of U.S. high school students participated in 1 school or community organized sport team

U.S. Report Card

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MVPA during spontaneous unorganized free play activities was 55% higher than in structured activities

U.S. Report Card

Insufficient National Data to grade health-related fitness components including cardiorespiratory, metabolic, morphological, motor, and muscular fitness.

U.S. Report Card

Family and peer support is another aspect considered in the National report card; again, there was not enough nationally representative data to grade this item.

U.S. Report Card

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Schools received a grade of C- based upon 51.8% of U.S. high school students attending at least one PE class per week.

U.S. Report Card

Community and Built Environment received a grade of B-, with 84.6% of children and youth living in a neighborhood with at least 1 park or playground.

U.S. Report Card

There is insufficient data to grade the effect of government strategies and investments on increasing physical activity levels. Some initiatives have included:

2008 PA Guidelines for Americans

2012 PA Guidelines Midcourse Report

Community Transformation Grant Program (No longer funded)

Federal Safe Routes to School Program (No longer funded)

Let’s Move (Discontinued)NHANES National Youth Fitness Survey

President’s Council on Fitness, Sports, and Nutrition

U.S. Report Card

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Demographic barriers to Active Transport:

Girls

Younger children

Children with higher socioeconomic status

Children in households with increased car ownership

are less likely to walk or bicycle to and from school

Barriers to PA

Active Transport

Barriers to PA

Intrapersonal Interpersonal Institutional Environmental

parental fears for safety

time management

motivation

schedule conflicts

social norms

low peer/parent support

parental time constraints

related to work

convenience of driving or

bus riding

greater support for

sedentary transport

safe equipment storage

(bike racks, etc)

logistical coordination of

car/bus/walkers

early school start times

lack of crossing guards

school material burden

travel distance

road infrastructure

hilly terrain

traffic dangers

crime danger

inclement weather

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Demographic Barriers to Structured and Unstructured PA

Age and socioeconomic status:

adolescents have more homework and part-time job requirements;

youth were impacted by cost, distance, safety, and condition of facilities

Barriers to PA

Structured and Unstructured PA

Barriers to PA

Intrapersonal Interpersonal Institutional Environmental

embarrassment

Fear of injury

Weight criticism

Lack of

interest/time/skill/

motivation/equipment

Other priorities

Sedentary or No Peers

Low peer/parent support

Family obligations

Low priority

Negative experiences

Coaching problems

Staff discouragement

Heavy workload

Competitiveness

Facility unavailability

Job responsibilities

Undesirable choices

Transportation

Expense/cost

Inaccessibility

Lack of opportunity

Physical safety

Inclement weather

School-Based Physical Activity

Barriers to PA

Intrapersonal/Interpersonal Institutional Policy

Negative perceptions of PE

Lack of activity choices in PE

Lack of instructor support

Lack of confidence in front of peers

Girls feel dominated and discouraged

by boys

Lack of interest/priority

Uniforms

Negative experiences

Inappropriate class size

Inadequate time for

changing/showering

Lack of funding/equipment/facility

space

Inconsistent national

standards for PE

Inconsistent recess

policies

Withholding recess

punitively

Facility availability for

after-school use

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Active Transport

New construction: site plans

conducive to walking

Existing sites: crossing guards,

walking school bus

Solutions

Structured and Unstructured PA-Community Level

Develop community-level coalitions and programs to promote PA

Youth service agencies offer a variety of PA programs with flexible scheduling, transportation, and financial assistance

Comprehensive PA programs that include individual and team sports, activity lessons, and exercise classes

Solutions

Structured and Unstructured PA-Home Level

Time limits on sedentary entertainment

Encourage outdoor play

Provide equipment

(balls, bikes, etc.)

Parental support

(transport, monetary, attendance)

Parental activity alongside the children

Solutions

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Structured and Unstructured PA-School Based

PE provided by certified/licensed teachers

150min/wk elementary

225min/wk middle/high

Incorporate PA throughout the school day, with special events and activity clubs

Solutions

Compounded in children who have special needs

Lack of knowledge and skill

Child’s preferencesFear/Frustration/Loss of confidence

Negative Attitudes toward disability

Inadequate facilities

Lack of transportation

Lack of programs

Lack of staff capacity

Cost

Barriers to PA

Specific to children who have special needs

Child’s desire to be fit and activeSkills practice

Involvement of peers

Opportunities sensitive to the issues of children with special needs

Skilled staff and information dissemination

1:1 instruction

Positive encouragement

Flexible payment schemes

Subsidized programs

Access to modified equipment

Inclusive policies

Facilitators to PA

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Individual level

Incorporate practical instructor training

Invite families to express their activity choices

Introduce flexible/subsidized payment options

Encourage participation from early childhood

Strategies

Social level

Lessen the burden on parents through financial/social support or incentives

Invite families to express their activity choices

Introduce flexible/subsidized payment options

Encourage participation from early childhood

Strategies

Policy level

Develop partnerships in sport and disability sectors, local government, and schools

Encourage positive societal attitudes to disability

-learn how to value people who have disabilities, not condescend

Strategies

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Access to modified equipment

Bad Choice.mov

Case Examples

1:1 instruction

Sandra’s Samba.mov

Case Examples

Inviting families to express their activity choices

The Climb.mov

Case Examples

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Child’s desire to be active

Video: Donnie’s Dubstep.mov

Case Examples

Mentoring-examples of 1:1 instruction

The Physical Activity Mentoring Program for Persons with Disabilities (https://www.uwlax.edu/physical-activity-mentoring)

Sponsored by the Center on Disability Health and Adapted Physical Activity at the University of Wisconsin-La Crosse.

Goals: increase physical activity, improve nutrition habits, and enhance community-based physical activity experiences

Resources

Mentoring-examples of peer involvement

Unified Sports (http://www.specialolympics.org/unified-sports.aspx)

A Special Olympics program that promotes social inclusion through sports.

Over 4500 teams nationwide in elementary, middle, and high schools

Unified PE

A Special Olympics program structured around the national physical education standards and grade-level outcomes

Designed as a high-school level course

Resources

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Access to modified equipment examples

Maryland Technology Assistance Program (http://mdod.maryland.gov/mdtap/Pages/MDTAP-Home.aspx)

V-LINC (http://www.v-linc.org/)

Professionals working with high school or college students to provide custom solutions to barriers using assistive technology and adaptive equipment

iCanShine.org (Bike, Swim, Dance)

National program using modified equipment to teach bike riding to people with special needs

Resources

Inclusive policy-examples

National Center on Health, Physical Activity and Disability (http://www.nchpad.org)

Special Education State Advisory Committee (http://marylandpublicschools.org/programs/Pages/Special-Education/sesac/index.aspx)

Special Education Citizens Advisory Committee

Resources

Q & A

pt@bodybenders.com