Obesity and secondary conditions in adolescents with disabilities: addressing the needs of an underserved population

Exploring an Existing Weight Management App for Use With Adolescents and Young Adults With Spina Bifida: Usability Study

BACKGROUND

Adolescents and young adults with spina bifida (AYA-SBs) have unique user needs, given their variable and complex symptom profile. Owing to multiple barriers to prevention and intervention treatments for secondary conditions (eg, obesity), AYA-SBs may benefit from the use of behavioral intervention technologies (BITs). However, as BITs are often designed and tested with typically developing individuals, it is unclear if existing BITs may be usable for AYA-SBs.

OBJECTIVE

This study aimed to evaluate the usability of a high-quality, publicly available, weight management-focused mobile BIT (smartphone app) for AYA-SBs.

METHODS

Overall, 28 AYA-SBs attending a Young Men's Christian Association-based summer camp completed 4 structured usability tasks using a weight management app designed for the general public called My Diet Coach (Bending Spoons). Learnability was measured by (1) time to complete task, (2) number of user errors, and (3) correct entry of data when requested by the app. Satisfaction and general usability were measured via self-reported questionnaires and qualitative feedback following interactions with the app.

RESULTS

The majority of the sample were able to complete the tasks, with increased completion rates and improved times on second attempts of the tasks (Ps<.05). Errors were common, and discrepancies emerged between quantitative and qualitative feedback such that self-reported measures indicated dissatisfaction but qualitative feedback was generally positive. Suggested improvements to the app included (1) tutorials, (2) simplifying the design, (3) more activity options for those who ambulate by wheelchair, and (4) notifications to prompt use.

CONCLUSIONS

AYA-SBs were able to learn how to complete specific tasks independently on a weight management app, but design changes consistent with previously proposed user needs were recommended. Rather than designing entirely new BITs, it may be possible to adapt existing technologies to personalize BITs for specific populations such as AYA-SBs.

Key word signing: Parents' experiences of an unaided form of augmentative and alternative communication (Lámh)

Parents' experiences of using Lámh, a key word signing approach used in Ireland, were captured through in-depth face-to-face interviews with parents of children with a range of intellectual disabilities. It emerged that Lámh provides child users with one of the rudiments of inclusion, that is, a means of engaging with others. A number of factors can potentially influence the engagement achieved, namely ongoing family commitment to the sustainment of Lámh, available communication partners, accessibility, appropriate Lámh training, speech and language therapy support and the existence of a Lámh signing environment external to the home. The child's family, education and community need to commit to Lámh in order to support a child user become an active member of their community.

The Influence of a Developmental Disability on the Child's Weight-Related Behaviors: A Parent's Perspective

PURPOSE

To examine the parent's perspective on how the child's diagnosis of a developmental disability, the weight-management support of the healthcare provider and parental self-care and role modeling influenced the child's weight-related behavior, (i.e. nutrition, physical and sedentary activity).

DESIGN AND METHODS

This qualitative study, guided by Bronfenbrenner's Ecological System's Theory, used a one-on-one semi-structured telephone interview conducted with 15 parents of children 5-16 years of age with spina bifida or Down syndrome. Interviews were professionally transcribed and thematically analyzed. In addition, parents reported height and weight for themselves and their child.

RESULTS

Three overarching themes within the context of how the child's diagnosis influenced the child's weight-related behaviors emerged: 1) Developmental Characteristics or Condition-Related Factors captured qualities of the child's condition and interactions with the healthcare system; 2) Social Consequences encompassed the influence of the diagnosis on relationships of the child and family members; and 3) Parenting Influences and Practices captured three types of responses including parent perceptions of the diagnosis, parenting behaviors, and parental self-care behaviors, each influencing the child's weight-related behaviors.

CONCLUSIONS

Parents illuminated the social and medical challenges that the family encountered due to the child's diagnosis. These challenges directly and indirectly influenced the child's physical and sedentary activity and nutritional intake. Although challenges were present, the strength and determined attitudes of the families became apparent.

PRACTICE IMPLICATIONS

The promotion of self-care and examination and validation of the emotional aspects of parenting a child with a disability may positively influence the child's weight-related behaviors.

Examining risk factors for overweight and obesity in children with disabilities: a commentary on Bronfenbrenner's ecological systems framework

Globally, overweight and obesity (OW/OB) levels are high among children, with rates surpassing the adult population. With such high pediatric OW/OB rates, it is imperative that risk factors are identified and explored. Thus, Davison and Birch developed an adapted framework, based on Bronfenbrenner's Ecological Systems Theory, which identifies and categorizes the factors in a child's life that put them at risk for OW/OB. While a socioecological perspective has been a useful tool for examining risk factors in typically developing pediatric populations, this holistic approach has not yet been applied to populations of children with disabilities, who are at an even higher risk of OW/OB than their typically developing peers. This commentary, therefore, explores Bronfenbrenner's Ecological Framework as applied to OW/OB by Davison and Birch, and critically examines its application to children with disabilities.

To initiate the conversation - Public health nurses' experiences of working with obesity in persons with mobility disability

Aim

Developing a theory explaining how public health nurses accomplish and adapt counselling in lifestyle habits to decrease obesity in people with mobility disability.

Design

Empirical research ‐ qualitative.

Method

Classic grounded theory with face‐to‐face interviews, 2017–2018, using inductive approach to understand public health nurses' intervening experiences with obesity patients.

Results

To initiate the conversation emerged as the main concern meaning having difficulties initiating conversations about obesity with patients. Public health nurses’ facilitators to communicate lifestyle changes emerged as the pattern generating the theory, which consists of the categories; person‐centeredness in the situation, experience and knowledge, strengthening conditions, access to other professionals and prioritization in everyday work.

Conclusions

Public health nurses hesitate to raise topics of obesity in patients with mobility disability. They advocate increased integration with lifestyle changes in everyday work including multi‐professional cooperation. The implication is testing the emerged theory at primary health care centres.

Impact

Obesity is more common in people with mobility disability than in those without. There is a need to understand how public health nurses adapt counselling in lifestyle habits. Public health nurses hesitate to talk about obesity with patients in fear of offending anyone. Public health nurses did not distinguish between patients with or without mobility disability. Several facilitators could be helpful initiating conversation with the patients. Public health nurses need more time and resources to facilitate conversation with patients with mobility disability to counsel lifestyle changes.

Physical, cognitive, psychological and social effects of dance in children with disabilities: systematic review and meta-analysis

AIM

To date it is unclear whether the physical, cognitive, psychological and social benefits of dance extend to children with disabilities.

METHOD

This systematic review synthesised empirical research on the effect of non-therapy dance programs on children with physical and developmental disabilities.

RESULTS

Nineteen studies met inclusion criteria, including 521 participants aged 3-18 years and adapted dance programs with duration ranging from 7-78 hours. Sixteen studies had weak methodology. Most examined physical outcomes with improvements in 17/23 areas and meta-analyses showing significant medium to large effects for balance and jumping skills. Positive effects were also indicated for psychological, cognitive and social domains from the few available studies.

CONCLUSION

Existing literature is heterogeneous and of poor quality but indicates dance may have physical, cognitive and psychosocial benefits for children with disabilities. Implications for rehabilitation To date the benefits of dance for children with disabilities have not been systematically synthesised. Dance may have physical, cognitive and psychosocial benefits for children with disabilities. Further research into psychosocial benefits in particular is warranted.

Nutrition, BMI and Motor Competence in Children with Autism Spectrum Disorder

Background and objectives: The purpose of this study was to examine the relationship between motor competence, body mass index (BMI), and nutrition knowledge in children with autism spectrum disorder (ASD). Materials and Methods: Fifty-one children with ASD (five females and 46 males) aged 7-12 participated in the study. The Movement Assessment Battery for Children-2 (MABC-2) was used to examine children's fine and gross motor skill competence; the nutrition knowledge survey assessed children's overall knowledge of food groups and healthful eating; and BMI-for-age determined their weight status. Descriptive analysis and Pearson correlation was used to analyze the relationship between nutrition knowledge, BMI, and motor competence in children with ASD. Results: The majority of children with ASD (82%) showed significant motor delays in MABC-2 assessments. The BMI-for-age percentile data suggested that 20% of participants were obese, 17% were overweight, and 12% were underweight. The nutrition knowledge data indicated that 55% of children scored below 70% on accuracy in the nutrition knowledge survey. Pearson correlation analysis revealed a significant positive relationship between MABC-2 manual dexterity and nutrition knowledge (r = 0.327, p < 0.01), and between MABC-2 balance skills and nutrition knowledge (r = 0.413, p < 0.01). A significant negative relationship was also found between BMI and MABC-2 balance skills (r = -0.325, p < 0.01). Conclusions: The findings of the study suggest that nutrition knowledge and motor competence may be key factors influencing BMI in children with ASD and therefore interventions tackling both sides of the energy balance equation are necessary.

Development of a robotic walker for individuals with cerebral palsy

Objective: This study describes the first use of a robotic walker in youth and young adults with cerebral palsy (CP) Gross Motor Function Classification (GMFCS) IV.Methods: Semi-structured interviews were conducted before and after each robotic walker trial. Interviews were recorded, then transcribed and subjected to thematic analysis.Results: Five participants (4 male, 13-22 years of age) with quadriplegia secondary to CP were recruited. Four individuals with mixed tone quadriplegia GMFCS IV were able to independently walk with the device. One individual with significant dyskinesia was unable to utilize the device. The assessment team included two physiotherapists, an occupational therapist, a physiatrist and three engineers. Major themes related to physical and social impacts were identified. Some physical advantages include the ability to walk hands-free and promotion of physical fitness. Examples of physical barriers include limited harness design and large device size. Social advantages include increased independence and peer engagement. Finally, a social disadvantage identified was limited use on uneven terrains.Discussion: Suggestions for modifications for identified challenges and disadvantages include decreasing the size of the robotic walker, more harness designs, decreasing the force required to take an initial step, adding a joy stick for user control and creating a more versatile base that can be used on different terrains such as ice or baseball fields.Conclusion: Robotics holds great hope for individuals with CP where mobility options are limited. Physical and social advantages are evident. Recommendations for future improvement and studies of use in exercise and participation are provided.IMPLICATIONS FOR REHABILITATIONAs youth and young adults with cerebral palsy age, options for mobilization can become limited with challenges in placing them in a walking device due to size and numerous other physical limitations.A robotic walker with a built-in mechanical lift is available for individuals with cerebral palsy.This study was able to gather important information and recommendations to tailor a new robotic walker prototype specifically for individuals with cerebral palsy.

A school-based mentoring program developing healthy behaviors of adolescents with intellectual and developmental disabilities: A pilot feasibility study

BACKGROUND

Studies have reported that adolescents with intellectual and developmental disabilities (IDD) have a higher prevalence of obesity due to medication intake, poor diet, and physical inactivity. More importantly, they lack awareness and comprehension to prevent weight problems. Thereby, health-promoting practices should be offered in schools for adolescents with IDD.

OBJECTIVE/HYPOTHESIS

This pilot study examined the feasibility of a school-based intervention using the I Can Do It! (ICDI) national health promotion model to promote healthy behaviors of adolescents with IDD.

METHODS

A pretest-posttest design was employed. Fourteen adolescents (9 males, 5 females) aged 12-15 years (mean = 13.4, SD = 0.9) from self-contained classrooms completed a 14-week intervention (60-70 min/session) over 4-month period. Healthy behaviors were evaluated by body composition (waist circumference and BMI z-score), physical activity level and nutrition behaviors.

RESULTS

Body composition did not change as a result of the intervention. The intervention increased the amount of time spent in physical activity, but not the frequency. In contrast, the children's water consumption did significantly increase after the intervention (d = 3.39). The amount of fruit and vegetables also significantly increased after the intervention, where only 7% reported eating these daily before the intervention and afterwards 86% reported eating fruits and vegetables daily (p < .0001).

CONCLUSIONS

The results demonstrate that it is feasible to conduct a goal-driven, mentor-based intervention in school for adolescents with IDD. While preliminary effectiveness results are promising, future research should focus on rigorously testing the effectiveness of the ICDI model and examining the programs long-term sustainability.

Children and Teens in Charge of their Health (CATCH): A protocol for a feasibility randomised controlled trial of solution-focused coaching to foster healthy lifestyles in childhood disability

INTRODUCTION

Children with physical disabilities are rarely included in interventions to promote healthy lifestyles, despite being at higher risk for suboptimal dietary and physical activity behaviours. The Children and Teens in Charge of their Health study explores the feasibility and acceptability of conducting a randomised controlled trial (RCT) of a strengths-based, solution-focused coaching intervention for improving and sustaining physical activity and healthy dietary habits in children and young people with physical disabilities.

METHODS AND ANALYSIS

Thirty children aged 10-18 years with a diagnosis of spina bifida or cerebral palsy who are able to set healthy lifestyle goals will be recruited from two children's rehabilitation hospitals in Ontario, Canada. Participants will be enrolled in the study for twelve months. All participants will receive standard care and printed information about healthy lifestyles. Of the 30 participants, 15 will be randomised to receive a coaching intervention for the first 6 months. Health indicators and psychosocial outcomes will be assessed by blinded assessors four times: at the start of the trial, immediately postintervention (6 months after randomisation), and at 3 and 6 months postintervention (9 and 12 months after randomisation, respectively). Predefined success criteria will be used to assess the feasibility of trial processes such as recruitment, attrition, stratification and intervention fidelity. Acceptability and perceived impact of the intervention will be explored qualitatively.

ETHICS AND DISSEMINATION

The study has been approved by Holland Bloorview Kids Rehabilitation Hospital's Research Ethics Board (Ref: 17-752). A knowledge translation planning template will be used to ensure our findings have maximum reach.

TRIAL REGISTRATION NUMBER

NCT03523806.

"Don't sweat it buddy, it's OK": an exploration of the needs of adolescents with disabilities when designing a mobile application for weight management and healthy lifestyles

Purpose: Adolescents with disabilities often demonstrate higher sedentary behaviours, lower physical activity levels, poorer quality diets, and higher rates of overweight and obesity than typically developing youth. This study had two objectives: 1) To understand the needs and priorities of adolescents with disabilities, parents, and the healthcare professionals who work with them around healthy lifestyles and weight management; and 2) To explore whether and how a mobile application could address these needs.Methods: Multiple perspectives were gathered through separate qualitative focus groups with adolescents with disabilities (12-17 years), parents, and rehabilitation healthcare professionals. Data were analysed using descriptive thematic analysis.Results: Parents (n = 6) and healthcare professionals (n = 9) described the complex needs of adolescents with disabilities around weight management and healthy lifestyles, including balancing differing priorities and a lack of appropriate resources. Adolescents (n = 7) endorsed the potential for technology to enhance their health through empowerment and having a virtual support system. All stakeholder groups endorsed taking a holistic, wellness approach.Conclusions: Adolescents with disabilities have a complex lifestyle and weight management needs, but mobile applications have the potential to provide individualized support. It is critical that anyone developing mobile applications engage a range of stakeholders as co-designers.Implications for rehabilitationAdolescents with disabilities have complex support needs and priorities around weight management and healthy lifestyles.Existing resources do not take into account the wide-ranging abilities of adolescents with disabilities.Mobile applications have the potential to empower adolescents and provide tailored support around healthy lifestyles.Including user input when designing technologies is critical.

Fostering positive weight-related conversations between health care professionals, children, and families: Development of a knowledge translation Casebook and evaluation protocol

BACKGROUND

Health care professionals (HCPs) must communicate with children and families about weight management in a sensitive and nonstigmatizing manner. However, HCPs receive little training in weight-related communication and have requested resources, but these are scarce. This article details the development process of a knowledge translation (KT) Casebook and outlines the proposed protocol for its implementation and evaluation.

METHODS

Guided by the knowledge-to-action cycle, a KT Casebook aimed at HCPs integrated findings from a comprehensive scoping review with experiential and contextual evidence gathered through stakeholder workshops to provide guidance to HCPs communicating with children and families around weight-related issues. It was structured around five questions: (a) Who should participate in weight-related discussions? (b) When and how should the topic of weight be broached? (c) What terminology should be used? (d) How can HCPs enhance family engagement in weight-related discussions? (e) What specific communication techniques have been recommended? Checklists, evidence summaries, case studies, sentence starters, simulations, and other resources were clustered under each question. A dissemination strategy was developed using KT best practices and a pilot evaluation protocol designed.

RESULTS

The Casebook was launched in November 2017 and has been presented at pediatric rehabilitation and obesity conferences. A communication strategy targeted multidisciplinary experts and organizations with weight management within their scope of practice. These efforts have resulted in 2,497 downloads across five countries to date.

CONCLUSIONS

A practical and engaging KT Casebook was created to help foster positive weight-related conversations between HCPs, children, and their families. A pilot implementation study examining the impact of the Casebook on clinical practice will provide critical information for embedding the Casebook in a range of health care settings.

Physical and Psychosocial Impact of a University-Based, Volunteer Student-Led Running Program for Children With Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) are frequently excluded from group sports.¹ This accentuates the social isolation inherent in their condition, perpetuates cycles of perceived incompetence in physical activity, and increases susceptibility to weight gain influenced by psychotropic medications.² In a 2015 study of 376 children with ASD, 18.1% of children were overweight and 17% were obese.³ Scarcity of opportunity to participate on athletic teams can contribute to this liability and compound the social isolation inherent in the condition.^4-6 Thus, programs that combine relationship building with physical conditioning present a double opportunity to offset significant hurdles for children with ASD. To address these needs locally, a group of volunteer college student-athletes (led by co-author Annie Marggraff) established a weekly Sunday afternoon program for athletic opportunity for children with ASD in the community. The program, Bear Cubs Running Team, was piloted over 5 successive semesters at Washington University in St. Louis, Missouri to empower children with ASD to set achievable physical conditioning goals, provide a forum to support their families, and increase college students' awareness of barriers against and opportunities to meaningful improvements in health and quality of life.

"It's all about incentive": Social technology as a potential facilitator for self-determined physical activity participation for young people with physical disabilities

PURPOSE

To investigate the perceived role of social technologies in promoting physical activity participation for young people with physical disabilities and to identify design considerations that should be addressed when creating social technologies to promote physical activity.

METHOD

Interactive design workshops for young people with physical disabilities aged 12-18 (n = 8) were held. Data were analyzed using interpretive thematic analysis.

RESULTS

Young people perceived significant benefit for social technologies to promote physical activity as they have the potential to overcome many barriers to physical activity participation. Design features recommended by the participants included (1) options for diverse interests and preferences, (2) provision of informational support, (3) support through equitable technology design, (4) incentive through competition and play, and (5) opportunities to develop community.

CONCLUSIONS

Social technology has potential to provide tailored, equitable opportunities for social engagement and physical activity participation for young people with physical disabilities through needs- and preference-specific design.

Are we making a difference in primary care for adults with intellectual and developmental disabilities?

OBJECTIVES

To examine the impact of the dissemination of guidelines to physicians and of a population-level health communication intervention on the percentage of adults with intellectual and developmental disabilities (IDD) receiving preventive care through primary care.

METHODS

Noninstitutionalized adults with IDD in the province of Ontario, Canada, aged 40 to 64 years were matched to Ontarians without such disabilities each fiscal year (FY) from 2003 to 2016. Health administrative data were used to create a composite measure of receipt of recommended preventive primary care. Age-adjusted rates were used to assess trends, and average two-year rate ratios (RRs) and confidence intervals (CIs) were used to evaluate the effectiveness of the interventions.

RESULTS

The number of adults with IDD identified ranged from 20 030 in FY 2003 to 28 080 in FY 2016. The percentage of adults with IDD receiving recommended preventive primary care ranged from 43.4% in 2003 to 55.7% in 2015. Men with IDD had a 53.7% increase across the 13 years, while women with IDD only had a 30.9% increase. When evaluating the impact of the interventions, men with IDD were 4% more likely (RR: 1.04; 95% CI: 1.02-1.05) to receive recommended primary care in FY 2015 and FY 2016 as compared to FY 2009 and FY 2010; in contrast, women with IDD were 5% less likely (RR: 0.95; 95% CI: 0.93-0.98). A comparable drop was observed among women without IDD.

CONCLUSIONS

Nearly 45% of adults with IDD in Ontario still do not receive recommended preventive care through primary care. Long-term impacts of the interventions introduced in the province may still occur over time, so ongoing monitoring is warranted. Special attention should be given to the preventive care needs of women with IDD.

Park-based physical activity interventions for persons with disabilities: A mixed-methods systematic review

BACKGROUND

Park-based physical activity (PA) interventions improve health in the general population, but it is unknown if the evidence can be translated to persons with disabilities.

OBJECTIVES

To conduct a mixed-methods systematic synthesis of the evidence for park-based physical activity interventions for persons with disabilities and secondarily, to consider the health benefits across the lifespan (children and adolescents, young, middle, and older adults).

METHODS

All major electronic databases were searched from inception until 30^th November 2016. Studies were eligible if the PA intervention was conducted in an urban park environment with people reporting a disability (e.g. physical, psychological and developmental impairments) and health outcomes were evaluated with biopsychosocial measures. Methodological quality was assessed using Crowes Critical Appraisal Tool (CCAT) and key findings extracted.

RESULTS

Six quantitative and four qualitative papers, comprising of 446 participants (age range seven to ninety-one years), were included for qualitative synthesis; five in children/adolescents, none in adults, and five in older adults. There was limited, low level, preliminary evidence for short-term improvements in physical, psychological, and social health outcomes in children and older adults with disabilities as well as improvements in disability-related impairments. When accessible, parks fostered societal inclusion.

CONCLUSIONS

Health benefits from park use in persons with disabilities were identified. Parks may provide an alternative environment for rehabilitation and management of disabilities. Further randomized controlled trials evaluating the long-term effectiveness of park-based interventions is necessary to corroborate our findings. Legislative commitment ensuring urban parks are accessible may mitigate some health disparities in persons with disabilities.

Diagnostic performance of body mass index to identify excess body fat in children with cerebral palsy

AIM

To assess the diagnostic performance of body mass index (BMI) cut-off values according to recommendations of the World Health Organization (WHO), the World Obesity Federation (WOF), and the German Society for Adiposity (DAG) to identify excess body fat in children with cerebral palsy (CP).

METHOD

The present study was a monocentric retrospective analysis of prospectively collected data among children and adolescents with CP participating in a rehabilitation programme. Excess body fat was defined as a body fat percentage above the 85th centile assessed by dual-energy X-ray absorptiometry.

RESULTS

In total, 329 children (181 males, 148 females) with CP were eligible for analysis. The mean age was 12 years 4 months (standard deviation 2y 9mo). The BMI cut-off values for 'overweight' according to the WHO, WOF, and DAG showed the following sensitivities and specificities for the prediction of excess body fat in our population: WHO: sensitivity 0.768 (95% confidence interval [CI] 0.636-0.870), specificity 0.894 (95% CI 0.851-0.928); WOF: sensitivity 0.696 (95% CI 0.559-0.812), specificity 0.934 (95% CI 0.898-0.960); DAG: sensitivity 0.411 (95% CI 0.281-0.550), specificity 0.993 (95% CI 0.974-0.999).

INTERPRETATION

Body mass index showed high specificity, but low sensitivity in children with CP. Thus, 'normal-weight obese' children with CP were overlooked, when assessing excess body fat only using BMI.

WHAT THIS PAPER ADDS

Excess body fat in children with cerebral palsy (CP) is less common than previously reported. Body mass index (BMI) had high specificity but low sensitivity in detecting excess body fat in children with CP. BMI evaluation criteria of the German Society for Adiposity could be improved in children with CP.

Conceptualizing Obesity as a Chronic Disease: An Interview With Dr. Arya Sharma

Dr. Arya M. Sharma challenges the conventional wisdom of relying simply on "lifestyle" approaches involving exercise, diet, and behavioral interventions for managing obesity, suggesting that people living with obesity should receive comprehensive medical interventions similar to the approach taken for other chronic diseases such as Type 2 diabetes or hypertension. He purports that the stigma-inducing focus on self-failing (e.g., coping through food, laziness, lack of self-regulation) does not address biological processes that make obesity a lifelong problem for which there is no easy solution. Interdisciplinary approaches to obesity are advocated, including that of adapted physical activity. Physical activity has multifaceted impacts beyond increasing caloric expenditure, including improved sleep, better mood, increased energy levels, enhanced self-esteem, reduced stress, and an enhanced sense of well-being. The interview with Dr. Sharma, transcribed from a keynote address delivered at the North American Adapted Physical Activity Symposium on September 22, 2016, in Edmonton, AB, Canada, outlines his rationale for approaching obesity as a chronic disease.

The Musculoskeletal Aspects of Obesity in Neuromuscular Conditions

Obesity is a common problem in children and adolescents with neuromuscular disease. The available literature on obesity in cerebral palsy, spina bifida, and Duchenne muscular dystrophy as it relates to orthopedic treatment is reviewed, including the demographics and measurement of obesity as well as the mechanisms of obesity in these individuals. In addition, the effect of obesity on function, patient evaluation, and orthopedic treatment are reviewed.

Physical Activity Interventions for Children with Social, Emotional, and Behavioral Disabilities-A Systematic Review

OBJECTIVE

Perform a systematic review of the available literature regarding the effectiveness of exercise interventions on children with any type of social, emotional, or behavioral disability (SEBD), with attention to a range of physiological, behavioral, and mood outcomes.

METHODS

Six databases were searched using a systematic methodology. References of included studies, as well as relevant reviews, were also examined. The review was limited to studies published since 2000 reporting a quantitative analysis of the effects of a physical activity (PA) intervention on at least 1 behavioral, psychological, or cognitive outcome in children aged 21 and under, diagnosed with a SEBD. Only studies with a control group were included.

RESULTS

We identified 24 eligible studies. Studies varied in design, participant characteristics, and intervention characteristics (single-bout vs repeated exposure, duration, intensity level, mode of exercise). Of the 20 behavioral outcome assessments, there was 1 negative finding, 12 null findings, 5 positive findings, and 2 mixed findings. For the 25 executive functioning outcome assessments, there were 5 null findings, 18 positive findings, and 2 mixed findings. For the remaining outcome domains, 1 of 2 studies looking at academic performance, 3 of 6 studies looking at objective neurological measures, and 1 of 3 studies looking at affect outcomes found positive results. All other results were null or mixed.

CONCLUSION

Although additional research is warranted to further understand the mechanisms by which PA affects behavioral and cognitive outcome measures in children with SEBDs, PA offers a safe and alternative form of treatment for this population.

Adapting the Wii Fit Balance Board to Enable Active Video Game Play by Wheelchair Users: User-Centered Design and Usability Evaluation

Background

Active video game (AVG) playing, also known as “exergaming,” is increasingly employed to promote physical activity across all age groups. The Wii Fit Balance Board is a popular gaming controller for AVGs and is used in a variety of settings. However, the commercial off-the-shelf (OTS) design poses several limitations. It is inaccessible to wheelchair users, does not support the use of stabilization assistive devices, and requires the ability to shift the center of balance (COB) in all directions to fully engage in game play.

Objective

The aim of this study was to design an adapted version of the Wii Fit Balance Board to overcome the identified limitations and to evaluate the usability of the newly designed adapted Wii Fit Balance Board in persons with mobility impairments.

Methods

In a previous study, 16 participants tried the OTS version of the Wii Fit Balance Board. On the basis of observed limitations, a team of engineers developed and adapted the design of the Wii Fit Balance Board, which was then subjected to multiple iterations of user feedback and design tweaks. On design completion, we recruited a new pool of participants with mobility impairments for a larger study. During their first visit, we assessed lower-extremity function using selected mobility tasks from the International Classification of Functioning, Disability and Health. During a subsequent session, participants played 2 sets of games on both the OTS and adapted versions of the Wii Fit Balance Board. Order of controller version played first was randomized. After participants played each version, we administered the System Usability Scale (SUS) to examine the participants’ perceived usability.

Results

The adapted version of the Wii Fit Balance Board resulting from the user-centered design approach met the needs of a variety of users. The adapted controller (1) allowed manual wheelchair users to engage in game play, which was previously not possible; (2) included Americans with Disabilities Act-compliant handrails as part of the controller, enabling stable and safe game play; and (3) included a sensitivity control feature, allowing users to fine-tune the controller to match the users’ range of COB motion. More than half the sample could not use the OTS version of the Wii Fit Balance Board, while all participants were able to use the adapted version. All participants rated the adapted Wii Fit Balance Board at a minimum as “good,” while those who could not use the OTS Wii Fit Balance Board rated the adapted Wii Fit Balance Board as “excellent.” We found a significant negative correlation between lower-extremity function and differences between OTS and adapted SUS scores, indicating that as lower-extremity function decreased, participants perceived the adapted Wii Fit Balance Board as more usable.

Conclusions

This study demonstrated a successful adaptation of a widely used AVG controller. The adapted controller’s potential to increase physical activity levels among people with mobility impairments will be evaluated in a subsequent trial.

Trial Registration

ClinicalTrials.gov NCT02994199; https://clinicaltrials.gov/ct2/show/NCT02994199 (Archived by WebCite at http://www.webcitation.org/6xWTyiJWf)

Motor skills intervention research of children with disabilities

BACKGROUND

Physical inactivity and obesity among children with physical and cognitive disabilities is an emerging public health issue. Children's motor skill development is a determinant of lifelong physical activity and obesity.

AIMS

The purpose of this article is to critically evaluate motor skill intervention literature among children with physical and cognitive disabilities.

METHODS AND PROCEDURES

Electronic searches were completed to identity research articles published from 1984 to 2014. Major findings were categorized among subtopics including characteristics of intervention studies, research designs, diagnostic method, motor skill interventions and motor skill outcome.

OUTCOMES AND RESULTS

21 studies were found and included participants with developmental delay (42.8%), autism (19.0%), cross-disability (19.0%), intellectual disability (4.8%), cerebral palsy (4.8%), developmental coordination disorder (4.8%), and learning disabilities (4.8%). Only one study was a randomized controlled trial.

CONCLUSIONS

and implications: The current literature on motor skill intervention research is broad in scope and has limited generalizability within and across disability groups. Future research is needed to develop cross-disability intervention methods adaptable to disability and function-specific needs, including the utilization of rapidly developing technology. Researchers are encouraged to utilize sound methodology with robust theoretical foundations. Family and community engagement is encouraged in intervention delivery.

Health promotion for young people with profound and multiple learning disabilities

Research confirms that children and young people with severe learning disabilities do not have the same level of access to high-quality care, health education and health promotion activities as children and young people without disabilities. This article discusses a quality improvement, action research project to investigate alternative approaches to health promotion that enhance the health and well-being of children and young people with complex neurodisabilities. The project involved assessment of school records and completion by staff of an eight-question survey. It found that the proactive approach of school nurses in raising awareness and understanding through questioning was positively received, and reinforced how meaningful and relevant information could be delivered to these young people. The project also had unexpected benefits, including more integrated team working, increased knowledge, greater awareness and understanding of the importance of health promotion participation, and student satisfaction.

A feasibility study using solution-focused coaching for health promotion in children and young people with Duchenne muscular dystrophy

PURPOSE

To evaluate the feasibility and acceptability of a coaching intervention (Solution-Focused Coaching in pediatric rehabilitation [SFC-Peds]) related to physical activity and diet in males with Duchenne muscular dystrophy.

METHODS

A pre-post design was employed. Participants had five coaching sessions over 8 weeks. The first session was face-to-face, followed by four virtual sessions. Feasibility criteria included recruitment rates, attrition, and intervention fidelity. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were employed to look at outcome trends. The acceptability was assessed using a survey.

RESULTS

Five males (11-19 years) participated. All feasibility criteria were met. Clinically significant increases were observed for GAS and COPM scores. Participants reported SFC-Peds to be acceptable. Broad barriers and facilitators to coaching success were identified.

CONCLUSIONS

A SFC-Peds intervention for health promotion is feasible and acceptable in children with DMD and their families. A rigorous efficacy study assessing SFC-Peds intervention is warranted.

A community-based exercise program to increase participation in physical activities among youth with disability: a feasibility study

PURPOSE

To evaluate the feasibility of a student-mentored community-based exercise program for youth with disability.

METHOD

Nineteen youth (nine female; mean age 18 years) with disability (seven cerebral palsy, six Down syndrome, three spina bifida, two autism spectrum disorder, one spinal cord injury) were recruited. Each participant was matched with a student mentor and exercised twice a week for 12 weeks at their local gymnasium. Five domains of feasibility were assessed: demand, implementation, practicality, limited efficacy testing, and acceptability.

RESULTS

Demand comprised 55 expressions of interest. Demonstrating evidence of implementation, 91% of scheduled sessions were attended and training fidelity (comparing training load in weeks 1 and 12) showed exercise intensity significantly increased for strength and aerobic exercises. The program was practical with no major and 17 minor adverse events (e.g., muscle soreness). Limited efficacy testing was demonstrated by increased arm (4 kg, 95% CI: 1-7) and leg strength (43 kg, 95% CI: 24-62), walking endurance (80 m, 95% CI: 24-137), and improvement in three dimensions of health-related quality of life (autonomy, physical, and psychological well-being). The program was accepted very positively by participants.

CONCLUSIONS

A student-mentored community-based exercise program feasibly engages youth with disability in community-based exercise. Implications for Rehabilitation A 12-week community-based student-mentored exercise program for youth with disability is feasible. Exercising in a real-world setting with a student mentor has a positive effect on physical and psychological well-being of youth with disability.

"I've Had Bad Experiences With Team Sport": Sport Participation, Peer Need-Thwarting, and Need-Supporting Behaviors Among Youth Identifying With Physical Disability

This study was guided by self-determination theory to explore the sport experiences of youth with a physical disability and the role of peers within this context. Interviews were conducted with eight youths using a relational mapping technique and analyzed using a deductive thematic approach. Sport peers were broadly defined by the youth as individuals from a large age range and of all abilities. Youth perceived their sport peers to have dynamic roles throughout their participation in sport. The perceived roles of these sport peers included supporting and thwarting basic psychological needs, and influencing the youths' processing of sport internalization. Findings focus on the complexity of peer need-thwarting and need-supporting interactions in sport for youth with physical disabilities. Overall, peers have a multifaceted role in the sport experiences of youth identifying with a physical disability and may, in some cases, thwart youths' basic psychological needs.

Comparison of three interactive video games for youth with visual impairments

There is a current trend toward using innovative interventions, such as active video gaming to increase physical activity levels among youth with visual impairments. Therefore, the purpose of this study was to compare three video games (Dance, Dance, Revolution [DDR]; EyeToy Kinetic; and Wii Boxing) in allowing youth with visual impairments to achieve time (seconds spent during a 10-min bout) in moderate-to-vigorous physical activity (MVPA). Participants with complete data were youth ( N = 5) with visual impairments aged 10–16 years who played three games for 10-min bouts. Heart rate monitors measured physical activity intensity. A Friedman’s analysis of variance (ANOVA) was used to determine differences between the three interactive video games. Most players were able to achieve time in MVPA in all three games and there was a significant difference in time spent in MVPA, χ2(2) = 7.4, p = .024, with the most time in MVPA from playing EyeToy Kinetic. This study demonstrated that EyeToy Kinetic, Wii Boxing, and DDR are capable of helping youth with visual impairments accrue time in MVPA.

Utilizing health records to characterize obesity, comorbidities, and health-care services in one human service agency in the United States

US surveys report higher prevalence of obesity in adults with intellectual disability. Health records of 40 adults with intellectual disability were retrospectively reviewed for data on health status, problem lists with International Classification of Diseases, Ninth Revision codes, medication lists, and health encounters over 18 months. Mean age was 49.5 years, 53% were males. Prevalence of overweight, obese, and morbidly obese was 28%, 58%, and 23%, respectively. Primary diagnosis was intellectual disability (50% mild, 33% moderate, 10% severe, and 8% profound), 85% had mental health disorders (67.5% with affective or mood and 42.5% had anxiety disorders). On average, residents consumed 2.63 psychotropic medications daily with additional 5.75 medications for axis 3 diagnoses and made 39.2 health visits over past 18 months. Our analysis supports increased prevalence of overweight/obesity, higher comorbidities, dual psychiatric diagnosis, substantial medication consumption, and higher utilization of health-care services in adults with intellectual disabilities. Targeted health interventions are therefore essential to improve their health and quality of life.

Influence of full mouth rehabilitation on oral health-related quality of life among disabled children

The efficacy of full mouth rehabilitation (FMR) on oral health-related quality of life of physically disabled children was assessed. This prospective study was performed at Dental Department of Sultan Bin Abdulaziz Humanitarian City, Riyadh, and King Abdulaziz University Hospital, Jeddah, Saudi Arabia, during May 2012 to September 2014. A total of 186 physically disabled children aged 11-14 years were assigned to a test group (n = 97) or a control group (n = 89). FMR was applied for test group children at baseline and 3 months' visits, whereas those in the control group did not receive FMR. Both group children received dental kits and oral hygiene instructions. Children were asked to complete the Child Perceptions Questionnaire, whereas Parental-Caregiver Perceptions Questionnaire and Family Distress Domain questionnaire were completed by the parents/caregivers at baseline and 6 months' visits. Children in both groups showed positive trends in oral symptoms at 6 months compared with those at baseline. However, when they were compared to control, significant improvement in oral symptoms was observed in the test group at 6 months' visit (p < .05). Also when they were compared to control, significant improvements were observed in the functional limitation, emotional, and social well-being subscales of the Child Perceptions Questionnaire and on the Parental-Caregiver Perceptions Questionnaire scales at the end of the study (p < .05). Compared to the parents/caregivers of the control children, the parents/caregivers of the test-group children reported insignificant but positive trends in Family Distress Domain at the end of the study (p < .05). FMR in children reduced oral-related problems subsequently to a better oral health-related quality of life.

The role of physical activity in improving physical fitness in children with intellectual and developmental disabilities

BACKGROUND

One in three children in North America are considered overweight or obese. Children with intellectual and developmental disabilities (IDD) are at an increased risk for obesity than their typically developing peers. Decreased physical activity (PA) and low physical fitness may be contributing factors to this rise in obesity.

AIM

Because children with IDD are at an increased risk of diseases related to inactivity, it is important to improve health-related physical fitness to complete activities of daily living and improve health.

METHODS AND PROCEDURES

The focus of this research is on improving the performance of physical fitness components through physical activity programming among a group of children with IDD, ages 7-12 years. The Brockport Physical Fitness Test was used assess levels of physical fitness of 35 children with IDD (25 boys, 10 girls) before and after participation in a 10-week program.

OUTCOMES AND RESULTS

The results of paired sampled t-tests showed participation in 15-h PA program can significantly increase aerobic capacity and muscular strength and endurance in children with IDD.

CONCLUSIONS AND IMPLICATIONS

This study is aimed at understanding the role of PA in helping children with IDD to develop the fitness capacities essential to participation in a wide variety of activities.

Evidence for increasing physical activity in children with physical disabilities: a systematic review

AIM

To summarize the best evidence of interventions for increasing physical activity in children with physical disabilities.

METHOD

A systematic review was conducted using an electronic search executed in Academic Search Elite, Academic Search Premier, CINAHL, Embase, MEDLINE, PEDro, PsychINFO, and SPORTDiscus up to February 2016. The selection of articles was performed independently by two researchers according to predetermined eligibility criteria. Data extraction, methodological quality, and levels of evidence were independently assessed by two researchers using a data-collection form from the Cochrane Collaboration and according to the guidelines of the American Academy for Cerebral Palsy and Developmental Medicine.

RESULTS

Seven studies were included. Five randomized controlled trials ranged from strong level I to weak level II studies, and two pre-post design studies were classified as level IV. There is level I evidence for no effect of physical training on objectively measured physical activity, conflicting level II evidence for interventions with a behavioural component on the increase of objectively measured physical activity directly after the intervention, and level II evidence for no effect during follow-up. Results are limited to children with cerebral palsy as no other diagnoses were included.

INTERPRETATION

Increasing physical activity in children with physical disabilities is very complex and demands further development and research.

Accessibility and usability of parks and playgrounds

BACKGROUND

Public parks and playgrounds are an environment for leisure activity, which all generations can enjoy at low or no financial cost. Evaluating the accessibility and usability of parks and playgrounds is crucial because their design, environment (natural and built) and safety could restrict participation of persons with disabilities.

OBJECTIVE

To evaluate the accessibility and usability of 21 public parks and playgrounds in three metropolitan cities of New Zealand. Secondary aims were to compare the accessibility and usability by park type (destination or neighborhood) and deprivation level (high and low).

METHODS

Twenty-one parks were evaluated. A stratified random sampling was used to select 18 parks (six from each city). Three additional parks were purposely selected (one from each city) at the request of each respective city council. The parks and playgrounds were evaluated using a customized tool. Data were analyzed using descriptive statistics.

RESULTS

None of the parks we evaluated met the national standards and/or international guidelines for park and playground design. We identified potential accessibility and usability issues with car parking spaces, path surfaces and play equipment as well as lack of lighting and fencing. The presence of amenities (e.g. toilets and drinking fountains) was more common in destination parks. Fewer parks in areas of higher deprivation had accessible car parking spaces and main paths wider than 1.5 m.

CONCLUSION

Our evaluation identified potential design, environmental and safety barriers to park and playground based participation for persons with disabilities across the lifespan. A larger, more comprehensive evaluation of parks and playgrounds is required.

From Disease to Health: Physical Therapy Health Promotion Practices for Secondary Prevention in Adult and Pediatric Neurologic Populations

BACKGROUND AND PURPOSE

Over the last decade there has been a substantial increase in efforts to better understand how targeted physical activity and exercise interventions can be used to minimize secondary consequences arising from neurological damage in both adult and pediatric populations. This article offers an overview of contemporary research that addresses mediators of functional and neuroplastic adaptations associated with physical activity and exercise. We emphasize the important role that physical therapists can play to increase participation and improve well-being in adults and children with neurological disorders. We further highlight potential strategies to foster translation of evidence-based findings for use by clinicians and consumers.

SUMMARY OF KEY POINTS

Engagement in physical activity can serve as a powerful promoter of health and well-being in adults and youth with neurologic disease, and has the potential to alter the course of disease processes. Physical therapists can play a key role in promoting fitness and wellness by encouraging active living, providing early diagnosis of disease and prescribing targeted activity interventions to improve fitness and participation, and helping individuals overcome personal and environmental barriers to an active lifestyle.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Physical therapists must adopt a model of rehabilitation that emphasizes secondary prevention in adults and youth with neurologic diseases. Physical therapists have a unique role in developing forward-thinking approaches in using innovative health and wellness strategies to promote positive changes in activity and exercise behaviors.

Characterizing socially supportive environments relating to physical activity participation for young people with physical disabilities

PURPOSE

To explore the experiences of young people with physical disabilities relating to social inclusion and physical activity, in order to describe the characteristics of social environments that support participation in physical activity.

METHOD

An iterative, qualitative design employed in-depth, semi-structured interviews with young people with physical disabilities aged 12-18 (n = 11). Data were analyzed using interpretive thematic analysis.

RESULTS

Young people described several ways that their social environments help motivate and support them in their physical activity participation. These include providing: fair and equitable participation beyond physical accommodations; belonging through teamwork; and socially supported independence.

CONCLUSIONS

Supportive social environments characterized by equitable participation, a sense of belonging, and opportunities for interdependence, play a critical role in promoting the health and well-being of young people with physical disabilities. These characteristics are important to consider in the design of both integrated and dedicated physical activity programs.

Children with Physical Disabilities at School and Home: Physical Activity and Contextual Characteristics

The purpose of this study was to assess the physical activity (PA) of children with physical disabilities (PD) in school and home settings and to simultaneously examine selected contextual characteristics in relation to PA in those settings. Children with PD (N = 35; Mean age = 15.67 ± 4.30 years; 26 boys) were systematically observed using BEACHES (Behaviors of Eating and Activity for Children’s Health: Evaluation System) at school (before school, recess, lunch break, after class) and at home (before dinner) during four normal school days. The children spent most of their time in all five settings being physically inactive, but had slightly more PA during recess and lunch break periods. Hierarchical multiple regression revealed that selected contextual characteristics explained 18.9–56.0% (p < 0.01) of the variance predicting moderate-to-vigorous physical activity (MVPA) after controlling for demographic variables. Prompts to be active were positively associated with MVPA at school and the presence of fathers and fathers being motivators at home. This study highlights how little PA that children with PD receive and identifies the importance of the provision of prompts for PA at both school and home with this special population.

The Importance of Inclusion for Cardiovascular Health Promotion Programs in Delaware

Individuals with disabilities experience greater rates of cardiovascular disease than individuals without disabilities. This increase can be attributed to decreased levels of physical activity, poor eating habits, and increased levels of diabetes, smoking, and obesity. Individuals with disabilities are often excluded from surveillance, treatment, and prevention efforts. Consequently, there is little known about their participation rates in health promotion and disease prevention programs. The aims of this investigation are (1) to examine time trends in cardiovascular disease and risk factors over a 10-year period by disability status and (2) to assess the inclusiveness of health promotion programs in Delaware. The percentage of individuals with disabilities increased from 18% in 2001 to 28% in 2011. Individuals with disabilities had higher rates of cardiovascular disease (t = 80.45; degrees of freedom [df] = 198; p < .0001) and obesity (body mass index > 30 kg/m2) than individuals without disabilities (t = 33.0; df = 198; p < .0001). They also reported less physical activity (t = 44.21; df = 198; p < .0001) and worse diet quality (t = 4.70; df = 198; p < .0001). There was a consistent lack of information about inclusion and participation of individuals with disabilities in health promotion programs. Making adaptations within cardiovascular disease prevention programs in Delaware is imperative to improving the health of individuals with disabilities. Ensuring cardiovascular disease programs are accessible and provide disability-specific trained staff will reduce barriers to participation so that all individuals can benefit.

Obesity Prevention for Individuals with Spina Bifida

PURPOSE OF REVIEW

Obesity is a common comorbidity in individuals with spina bifida. Carrying excess weight exacerbates the inherent health challenges associated with spina bifida, impedes the individual's ability to self-manage their condition, and creates further challenges for family members and caregivers. This manuscript provides a narrative review of key issues for understanding and prevention of obesity in persons with spina bifida within the context of the social ecological model.

RECENT FINDINGS

Specific variables related to obesity and spina bifida include individual factors (i.e., body composition and measurement issues, energy needs, eating patterns, physical activity, and sedentary activity) family factors (i.e., parenting/family, peers), community factors (i.e., culture, built environment, healthcare and healthcare providers, and school), and societal factors (i.e., policy issues). Due to the complex etiology of obesity and its increased prevalence in individuals with spina bifida, it is critical to initiate prevention efforts early with a multifactorial approach for this at-risk population. Increased research is warranted to support these efforts.

Impact of enjoyment on physical activity and health among children with disabilities in schools

BACKGROUND

Enjoyment in school-based physical activity (PA) programs, such as recess or physical education may be important for promoting children's health, but there is a lack of evidence explaining how enjoyment affects health in children with disabilities.

HYPOTHESES

Enjoyment in school-based PA programs will positively influence general health through participating in more daily PA, and this relationship will vary between younger and older children with disabilities.

METHODS

We conducted secondary analysis of data from the 2012 National Youth Fitness Survey. The sample included 241 children with disabilities (age 5-15 years; 129 boys and 112 girls) identified using three criteria: (a) having an impairment, health problem and mobility limitations; (b) needing special equipment; or (c) receiving special education services. Variables extracted were the number of days per week participating for at least 60 min in PA a day; general perceived health; enjoyment in school recess (for ages 5-11 y) or physical education (for ages 12-15 y). Mediation analysis was conducted to test the research hypotheses.

RESULTS

Daily PA participation significantly mediated the relationship between enjoyment in physical education/recess and general health. Children who enjoyed physical education or recess more participated in PA, and those who spent more days being physical active were healthier than their counterparts. However, this mediating relationship, when divided by age groups, was shown for only older group (ages 12-15 y) that received physical education.

CONCLUSIONS

Physical educators should provide enjoyable PA opportunities during physical education classes for students with disabilities for promoting their health.

Treatment of Obesity Among Youth With Intellectual and Developmental Disabilities: An Emerging Role for Telenursing

Childhood obesity is a serious health issue, associated with medical comorbidity and psychosocial impairment that can persist into adulthood. In the United States, youth with intellectual and developmental disabilities are more likely to be obese than youth without disabilities. A large body of evidence supports the efficacy of family-based treatment of childhood obesity, including diet, physical activity, and behavior modification, but few interventions have been developed and evaluated specifically for this population. We highlight studies on treatment of obesity among youth with intellectual and developmental disabilities, including both residential/educational settings as well as outpatient/hospital settings. All interventions were delivered in-person, and further development of promising approaches and delivery via telenursing may increase access by youth and families. Nursing scientists can assume an important role in overcoming barriers to care for this vulnerable and underserved population.

An exploration of the bone health of older adults with an intellectual disability in Ireland

BACKGROUND

Many risk factors have been confirmed for poor bone health among the general population including age, gender and corticosteroid use. There is a paucity of investigation among people with intellectual disability; however, research points to differing risks namely anti-epileptic medication use, Down syndrome and poor behaviour lifestyle.

METHODS

Data was extracted from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing in Ireland. In total, 753 participants took part, and data was gathered on participants' health status, behavioural health, health screenings and activities of daily living. The prevalence of osteoporosis and related risk factors were specifically examined.

RESULTS

Overall, 8.1% reported a doctor's diagnosis of osteoporosis with over 20% reporting history of fracture. Risk identified included older age (P < 0.0001), female gender (P < 0.0001), difficulty walking (P < 0.0001) with older age and being female the stronger predictors for osteoporosis, odds ratio = 6.53; 95% confidence interval 2.82-15.11 and odds ratio = 4.58; 95% confidence interval 2.29-9.17, respectively. There was no gender difference regarding the level of fractures; however, epilepsy and anti-epileptic medication were strong predictors. Overall, 11.1% attended for bone screening diagnostics.

CONCLUSION

Despite low levels of reported doctor's diagnosis of osteoporosis risk factor prevalence was high. Considering the insidious nature of osteoporosis and the low levels of diagnostic screening, prevalence could be possibly higher.

Parent perceptions of health promotion for school-age children with spina bifida

PURPOSE

To gain insight into how parents develop their beliefs of health promotion for their children with spina bifida (SB) and how they develop and promote health promotion practices for their children.

DESIGN

Qualitative, exploratory design with semi-structured interviews of parents of children between 6 and 12 years of age diagnosed with SB was used for this study.

RESULTS

Perceptions of health promotion were maintaining healthy bowel function and managing SB care. Good bowel function and SB management is health promotion and adequate bowel function is viewed as a marker of health. Maintaining healthy bowel function was identified by parents as the key marker of health for their children with SB. Further, the term health promotion brought up plans, concerns, and goals more related to their child's physiologic functioning and health care needs rather than promoting health and avoiding preventable disease.

PRACTICE IMPLICATIONS

Nurses and healthcare providers are in unique and powerful positions for strategizing with parents on how to integrate health promotion into the lives of children with SB. Team-based, whole-person, holistic assessment and teaching inclusive of promoting healthy lifestyle behaviors in addition to providing excellent care related to their physiologic systems affected by SB can improve how we promote health for these children.

The Participation Patterns of Youth with Down Syndrome

PURPOSE

The purpose of this paper was to investigate the participation patterns of children with Down syndrome (DS) using the construct of participation as defined by the International Classification of Functioning Disability and Health (ICF).

METHODS

Sixty-two children with DS were recruited between the ages of 9 and 17 years. All participants were given an interview-administered version of the Children's Assessment of Participation and Enjoyment (CAPE) to measure participation (1).

RESULTS

Children with DS participated the most often, based on frequency, in recreational activities (p < 0.001); social activity types represented the greatest extension into the community based on with whom the children participated with (p < 0.05); finally, physical and social activities represented the greatest extension into the community geographically (p < 0.001). In addition, children with DS are significantly more active in activities that are informal in nature.

CONCLUSION

Children with DS participate in a number of activities; however, the extent of their participation within these activities differs depending on the participation pattern examined. Implications for educational and community-based programs are discussed.

Promoting Health, Well-Being, and Quality of Life for Children Who Are Overweight or Obese and Their Families

Obesity is a complex, multidimensional challenge that compromises occupational participation for children and families. Children who are overweight or obese are at serious risk for being stigmatized, bullied, or marginalized, and they often are medically compromised. They cope daily with occupational participation issues at home, in school, on playgrounds, and in their communities. Prevention and health promotion assessment and intervention in occupational therapy are imperative for the profession to make a significant and sustainable difference in the lives of these children and families. Innovative client- and occupation-centered programming promotes health, well-being, and quality of life for this population. It is incumbent upon occupational therapy practitioners to prevent occupational marginalization, deprivation, and alienation while promoting occupational justice for children who are overweight or obese.

Health-Promoting Physical Activity of Children Who Use Assistive Mobility Devices: A Scoping Review

Children with physical disabilities who use assistive mobility devices (AMDs) are at risk for obesity and other secondary health conditions. Habitual physical activity is one lifestyle factor that may prevent obesity and contribute to overall health, and an active lifestyle in childhood improves prospects for lifelong healthy behaviors. Child, family, and environmental facilitators and barriers influence health-promoting physical activity (HPPA) for children without disabilities, but comparable models and levels of understanding for children who use AMDs are lacking. In this scoping review, we identified a similar set of child, family, and environmental facilitators and barriers relevant to HPPA participation among children who use AMDs. Noted gaps in the literature included limited reporting of AMD use, inconsistent HPPA definitions, and inadequate measurement tools for children who are nonambulatory. The identified child, family, and environmental factors provide a framework for occupational therapy practitioners and interprofessional teams to develop HPPA opportunities and interventions for an underserved population.

Health-Related Physical Fitness among Young Goalball Players with Visual Impairments

Introduction

The purpose of our study was to determine the passing rates on health-related physical fitness tests of young goalball players. More specifically, we compared their passing rates according to gender and visual impairment classification.

Methods

Participants included 40 Brazilian goalball players with visual impairments (20 female [B1 = 7, B2 = 8, B3 = 5]; 20 male [B1 = 6, B2 = 4, B3 = 10]), with a mean age 17.3 (SD = 1.6). The Brockport Physical Fitness Test, a health-related, criterion-referenced protocol, was employed to evaluate percentage of body fat, shoulder stretch, back-saver sit and reach, trunk lift, curl-ups, push-ups, and the one-mile run or walk.

Results

A significant difference was found in passing rates between genders only in the one-mile run or walk. More than half the participants were able to pass in at least four out of the seven tests. No significant differences were found between groups regarding the proportion of athletes who reached the protocol standards.

Discussion

Irrespective of gender or visual impairment classification, the participants of this study had high passing rates on most tests. Nonetheless, athletes had low passing rates on specific areas (cardiovascular and muscular strength), which need to be acknowledged. Future studies with a bigger sample could seek to determine the effects of specific training regimens not only on youths, but also on adult groups.

Implications for practitioners

As a Paralympic sport likely to be of interest to visually impaired children and adolescents, goalball seems to be a feasible game to support the achievement of ideal physical activity levels in this population, leading to higher levels of health-related physical fitness.

Prevalence of overweight and obesity among children and adolescents with intellectual disabilities: a systematic review and meta-analysis

Although there have been numerous studies examining the prevalence of overweight and obesity among children and adolescents with intellectual disabilities, they have not yet been integrated and synthesized through a systematic quantitative review process. The purpose of this systematic review and meta-analysis was to determine: (i) the prevalence of overweight/obesity among children and adolescents with intellectual disabilities; (ii) the sources of heterogeneity in studies reporting the prevalence of overweight/obesity in this population; and (iii) the risk of overweight/obesity in this population compared with their typically developing peers. A systematic literature search was performed and 16 studies, published between 1985 and 2015, met the inclusion criteria. The resulting pooled prevalence estimates for overweight, overweight-obesity and obesity were respectively: (i) 15%, 30%, and 13%, in children; and (ii) 18%, 33%, and 15% in adolescents. Subgroup analyses showed significant variations in the pooled prevalence estimates as a function of geographical region, recruitment setting, additional diagnoses, and norms used to define overweight or obesity. The findings also showed adolescents with intellectual disabilities to be respectively 1.54 and 1.80 times more at risk of overweight-obesity and obesity than typically developing adolescents. Unfortunately, no such comparison is available for children. © 2016 World Obesity.