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

A cybercycling intervention to improve behavioral regulation and classroom functioning among children with behavioral health disorders: Pragmatic randomized trial design for Manville Moves

While positive and clinically meaningful effects of exercise on cognition and behavior in children have been demonstrated in controlled experimental settings, they have rarely been translated and rigorously evaluated in real-world environments. In particular, there is a lack of research on school-based approaches to sustainable physical activity and exercise interventions targeting children with behavioral health disorders. Manville Moves is an exercise intervention designed to improve behavioral regulation and classroom functioning among children with neurodevelopmental and affective disorders within a therapeutic day-school environment. The curriculum is built around virtual-reality exergaming bicycles (cybercycles) and integrated into physical education (PE) classes. Manville Moves was developed using community based participatory research (CBPR) and implemented as a pragmatic trial. In this paper, we describe (a) the background, theoretical framework and intervention setting, (b) the Manville Moves curriculum, (c) the study design and outcome and process measures, and (d) the strategies used to support implementation compliance and intervention uptake by a population with a variety of behavioral challenges. We conclude with a detailed description of the participatory process by which the intervention was developed and integrated into school programming and a review of the program's key innovations and approaches to addressing threats to internal and external validity.

A Cross-sectional Survey of Growth and Nutritional Status in Children With Cerebral Palsy in West China

BACKGROUND

We describe the growth and nutritional status of children with cerebral palsy (2 to 18 years old) in West China and to explore the correlation between the nutritional status and age, gender, and gross and fine motor function.

METHODS

We performed a cross-sectional survey of children registered as having cerebral palsy in the China Disabled Persons' Federation branch in Chengdu. Growth (height and weight) and nutritional (body mass index) status were recorded. Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) were used to determine gross and fine motor function, respectively. The association between nutritional status and age, GMFCS and MACS levels was evaluated.

RESULTS

We enrolled 377 children (53.6% male), among whom 160 (42.4%) were stunting, 48 (12.7%) underweight, 81 (21.5%) thin, and 70 (18.5%) overweight and obese. Thinness was the main nutritional problem in older patients (12 to 18 years), whereas overweight and obesity were the major issues in younger patients (2 to 12 years). Growth deviation and malnutrition were significantly more prevalent in patients with severe motor impairments. A significant negative correlation was found between nutritional status and age, GMFCS and MACS levels, and between growth and GMFCS and MACS levels.

CONCLUSIONS

Growth abnormality is common in children with cerebral palsy. Malnutrition and overnutrition both exist in children with cerebral palsy. Characteristics at different age stages and motor functional levels should be taken into consideration in the management of growth and nutrition in this population.

Examining the social participation of children and adolescents with Intellectual Disabilities and Autism Spectrum Disorder in relation to peers

BACKGROUND

Participation in social and physical activities has a number of benefits for children with or without disabilities. However, individuals with disabilities are often excluded from taking part in social activities. Most of the research on activity participation has focused on adults or youth with milder disabilities. However, children and adolescents with severe and complex needs, including those with autism, are often excluded from this type of research because of their complexities and level of functioning. Thus, we examined the social participation and friendships of children and adolescents with severe developmental disabilities, with and without autism, compared with peers without developmental disabilities.

METHODS

We compared the activity participation and friendships of typically developing children (n = 210), children with an intellectual disability (ID only; n = 186), and children with autism spectrum disorder plus intellectual disability (ID + ASD; n = 232) between the ages of 3 and 19 years. Parents of these children completed a survey, which included questions about their children's participation in six activities, and the number and quality of their children's friendships.

RESULTS

Children and adolescents with ID only and ID + ASD were reported to participate in significantly fewer activities and to participate much less frequently than typically developing peers. Those with ID only and ID + ASD were reported to have fewer friends and poorer quality of friendships. In addition, those with ID + ASD participated even less frequently in some activities and had fewer friends relative to those with ID only.

CONCLUSION

It is important to find ways to increase the social and activity participation of children and adolescents with ID only and ID + ASD. Future research should examine the barriers to such participation and factors that impact social participation in this population.

The nutritional state of children and adolescents with cerebral palsy is associated with oral motor dysfunction and social conditions: a cross sectional study

BACKGROUND

Cerebral palsy (CP) is the main cause of severe physical impairment during childhood and has commonly shown oral motor association. It has been considered as the main cause of the high prevalence of problems in children's nutrition. Respiration, chewing, swallowing, speaking and facial expressionare part of the orofacial motor functions and when affected they can interfere in children's well-being. The aim of this study was to correlate two methods of orofacial motor evaluation, analyze the influence of orofacial motor functional impairment on the nutritional status of children and adolescents with CP, and the association between socioeconomic factors.

METHODS

Seventy children and adolescents with CP were selected, age range 6-16 years and following the exclusion criteria previously determined; 129 normoreactive children (control group), sex and age-matched to patients with CP. For the orofacial motor analysis two evaluation instruments were applied, the "Oral Motor Assessment Scale" (OMAS) and "Nordic Orofacial Test-Screening" (NOT-S). The anthropometric evaluation was based on the World Health Organization (WHO) and followed the criteria recommended by the Brazilian Ministry of Health.

RESULTS

There was statistically significant correlation between the oral motor methods of evaluation (r = -0.439, p < 0.0001). Concerning the nutritional status evaluation, being overweight was associated with dystonic and mixed CP forms variables (p = 0.034), mother with no partnership (p = 0.045) and mild oral motor impairment (p = 0.028).

CONCLUSION

It could be concluded that, the weight's gain by children and adolescents might be favored by a better functional oral motor performance and social factors.

Perspectives on Active Video Gaming as a New Frontier in Accessible Physical Activity for Youth With Physical Disabilities

This perspective article explores the utility of active video gaming as a means of reducing sedentary behavior and increasing physical activity among youth with physical disabilities and limitations in lower extremity function who typically are excluded from mainstream exercise options. Youth with physical disabilities are disproportionately affected by health problems that result from sedentary behavior, lack of physical activity, and low fitness levels. Physical, programmatic, and attitudinal barriers have a synergistic and compounded impact on youths' ability to participate in physical activity. A recent health and wellness task force recommendation from the American Physical Therapy Association's Section on Pediatrics supports analyzing individualized health behaviors and preferences that are designed to improve fitness, physical activity, and participation in pediatric rehabilitation. This recommendation represents an opportunity to explore nontraditional options to maximize effectiveness and sustainability of pediatric rehabilitation techniques for youth with disabilities who could best benefit from customized programming. One new frontier in promoting physical activity and addressing common physical activity barriers for youth with physical disabilities is active video games (AVGs), which have received growing attention as a promising strategy for promoting health and fitness in children with and without disabilities. The purpose of this article is to discuss the potential for AVGs as an accessible option to increase physical activity participation for youth with physical disabilities and limitations in lower extremity function. A conceptual model on the use of AVGs to increase physical activity participation for youth with physical disabilities is introduced, and future research potential is discussed, including a development project for game controller adaptations within the Rehabilitation Engineering Research Center on Interactive Exercise Technologies and Exercise Physiology for People With Disabilities (RERC RecTech) at the University of Alabama at Birmingham (UAB)/Lakeshore Foundation Research Collaborative.

Communicating about obesity and weight-related topics with children with a physical disability and their families: spina bifida as an example

PURPOSE

The purpose of this study was to explore the experiences of children with spina bifida (SB), their families and healthcare professionals (HCPs) when discussing weight-related topics.

METHOD

In-depth qualitative interviews were conducted with HCPs from Canadian outpatient SB clinics (n = 13), children aged 6-18 years with SB (n = 17) and their parents (n = 20). Data were analyzed using a phenomenological approach within an interpretative paradigm.

RESULTS

Many HCPs were not confident talking about weight, concerned that they would damage relationships with children and families. Parents wanted routine weight surveillance, but were worried about their children's self-esteem if their weight was discussed. They wanted HCPs to acknowledge the challenges of weight management in children with a physical disability and provide specialized solutions. Children wanted a positively framed and tailored approach to weight discussions, although this had generally not been their experience.

CONCLUSIONS

Stakeholders describe therapeutic relationships that are currently disconnected around the issue of weight and obesity. However, children, parents and HCPs all believed that discussing this topic was critical. Positively framed, strengths-based and tailored approaches to weight-related discussions are warranted. Implications for Rehabilitation Rates of overweight and obesity in children and youth with physical disabilities are substantially higher than their typically developing peers. Healthcare professionals, children with physical disabilities and families often find weight-related discussions challenging and disconnected. Weight-related discussions should be tailored to the child and family's circumstances and priorities. Positively framed and strengths-based approaches to weight-related discussions are warranted.

A Call to Action: Setting the Research Agenda for Addressing Obesity and Weight-Related Topics in Children with Physical Disabilities

BACKGROUND

Pediatric obesity is a world-wide challenge. Children with physical disabilities are particularly at risk of obesity, which is worrisome because obesity can result in serious secondary conditions that decrease health status, reduce independence, and increase impact on healthcare systems. However, the determinants of obesity and the health promotion needs of children with physical disabilities are relatively unexplored compared with their typically developing peers.

METHODS

This white paper describes a Canadian multi-stakeholder workshop on the topic of obesity and health in children with physical disabilities and provides recommendations for future research in this understudied area.

RESULTS

Seventy-one knowledge gaps identified by attendees using a modified nominal group technique clustered into six themes: (1) early, sustained engagement of families; (2) rethinking determinants of obesity and health; (3) maximizing impact of research; (4) inclusive integrated interventions; (5) evidence-informed measurement and outcomes; and (6) reducing weight biases. Attendees worked together to develop research plans in more detail for three areas identified through consensus as high priority: "early, sustained engagement of families;" "rethinking determinants of obesity and health;" and "evidence informed measurement and outcomes."

CONCLUSIONS

Using the workshop described here as a call to action, Canadian researchers are now well positioned to work toward a greater understanding of weight-related topics in children with physical disabilities, with the aim of developing evidence-based and salient obesity prevention and treatment approaches.

Association of Obesity, BMI, and Hispanic Ethnicity on Ambulatory Status in Children with Spinal Dysraphism followed near the California-Mexico Border

PURPOSE

Evaluate the relationship between body mass index (BMI), overweight status (OW), or obesity (OB) and ambulatory status in a predominantly Hispanic population of children with spinal dysraphism (SD).

METHODS

Retrospective data were extracted from records of 272 children and youth aged 0-24 years with a diagnosis of SD. Body mass index (BMI) and OW / OB rates were calculated for children 0-3 years, 4-11 years, and adolescents older than 11.

RESULTS

Ethnicity was predominantly Hispanic (65.4%). No difference in mean BMI or OW / OB rate was found between ambulation groups (p = .20; p = .72). Mean BMI and OW / OB rate increased with increasing age in all groups (p < .001; p = .02). Forty-four percent of patients were OW / OB, which was greater among Hispanics (48.2%) compared with non-Hispanics [(35.2%), p = .03]. Female gender was a risk factor for increased BMI among Hispanics (p = .00).

CONCLUSION

Despite no difference in ambulatory status, increasing BMI and OW / OB are associated with Hispanic ethnicity and increasing age.

The extent, context and experience of participation in out-of-school activities among children with disability

BACKGROUND

A growing literature describes the participation of children with disability, but less is known about the effect of disability type, severity and environmental factors on participation.

AIM

To investigate the extent, context, experience and preferences for participation in out-of-school activities among children with disability in Victoria, Australia.

METHODS AND PROCEDURES

Two-hundred and eighty-six children (177 boys, 109 girls; mean age 11.5 years) with physical (n=77), intellectual (n=67), multiple (n=93), and other disabilities (n=49) took part. Data were collected using the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC) questionnaires.

OUTCOMES AND RESULTS

Children with disability participated in 28 out of 55 activities (SD 6 activities), 2-3 times per month, on average. Preference was the most important predictor of participation diversity for all activity types. Disability type was a predictor of participation diversity in active-physical activities only. Severity was a predictor of participation diversity overall, and of participation in formal and informal activities. Age, severity and preference accounted for almost 50% of the variance of diversity of recreational activities.

CONCLUSIONS AND IMPLICATIONS

These results underscore the importance of taking a child's activity preferences into account when implementing interventions to increase participation in out-of-school activities.

The effects of physical activity interventions on preventing weight gain and the effects on body composition in young adults with intellectual disabilities: systematic review and meta-analysis of randomized controlled trials

The aim of this study was to examine the literature on randomized controlled trials examining the efficacy of physical activity interventions to prevent weight gain and the effects on body composition in young adults with intellectual disabilities.A systematic search of Medline, Emabse, CINHAL, PsychINFO, Cochrane library and ERIC was conducted from 1946 to September 2014. Eligibility criteria included; randomized controlled trials of a physical activity intervention: objective measure of body weight and body composition; young adults (age range 16-24 years) with intellectual disabilities. Six studies met the eligibility criteria. The interventions varied in their prescription of physical activity including aerobic and strength-based activities. The mean duration of the interventions was 15.3 (range 10-21 weeks). There was no significant effect of physical activity interventions on body weight (weighted mean difference: -0.17 kg, 95% confidence interval, -1.04 kg to 0.72 kg) and body composition outcomes. The meta-analysis showed that physical activity interventions did not prevent weight gain in young adults with intellectual disabilities. Published studies are inadequate to form firm conclusions. Future longer term studies of interventions specifically designed for this population group are required to elucidate the effects of physical activity interventions on body composition and the prevention of weight gain in young adults with intellectual disabilities.

Disability and Discussions of Health-Related Behaviors Between Youth and Health Care Providers

PURPOSE

The purpose of this study was to examine the likelihood of discussing health-related behaviors with health care providers (HCPs), comparing youth with and without mobility limitations (MLs).

METHODS

Analyses were conducted using baseline data from the MyPath study. Adolescents and young adults between the ages of 16 and 24 years completed a survey about their health care and health-related experiences. Analyses assessed the relationship between mobility status and discussing health-related behaviors with an HCP. Secondary analyses examined the extent to which adolescents and young adults' engagement in these behaviors was associated with these discussions.

RESULTS

Overall, we found low rates of discussions about the following topics: substance use, sexual and reproductive health, healthy eating, weight, and physical activity. Adolescents and young adults with MLs were less likely to report discussing substance use and sexual and reproductive health, but were more likely to discuss healthy eating, weight, and physical activity than peers without MLs. Those adolescents and young adults who reported substance use had higher odds of discussing this topic and those who reported having sexual intercourse had higher odds of discussing sexual and reproductive health.

CONCLUSIONS

Results suggest mobility status and a young person's engagement in health risk and promoting behaviors are associated with the likelihood of discussing these behaviors with an HCP. It is important that HCPs view adolescents and young adults with MLs as needing the same counseling and guidance about health-related behaviors as any young person presenting him/herself for treatment.

Exploratory Study Examining Clinical Measures of Adiposity Risk for Predicting Obesity in Adolescents with Physical Disabilities

OBJECTIVE

The purposes of this study were to assess the accuracy of clinical measures for predicting adiposity when compared with a criterion standard of body fat percentage measured by dual-energy X-ray absorptiometry and to determine the most appropriate cut points for classifying obesity for each measure in adolescents with physical disability.

DESIGN

Body mass index, triceps skinfolds, and waist, arm, and leg circumferences were collected on 29 adolescents aged 14-17 yrs with spinal cord injury, cerebral palsy, or spina bifida. Percentage of body fat was measured using dual-energy X-ray absorptiometry. Multiple linear regression models were used to assess the ability of measures to predict percentage of body fat. Receiver operating characteristic curves were used to identify optimal cut points for each measure.

RESULTS

Although all clinical measures correlated with body fat as measured by dual-energy X-ray absorptiometry, current cut points are not adequate in this group. Using a body mass index of 20 kg/m (boys) and 19 kg/m (girls) was optimal but still misclassified a significant number of participants as nonobese in this group. Using the optimal cut points for waist circumference, which were 83 cm (boys) and 78 cm (girls), was the best predictor.

CONCLUSIONS

Body mass index, triceps skinfolds, and waist, leg, and arm circumferences are valid measures for estimating obesity in adolescents with physical disability, but further research is needed to validate disability-specific cut points.

Correlates of sport participation in adults with long-standing illness or disability

Background

Little is known about why people with a long-standing illness/disability are less likely to participate in sport than others. This study aimed to identify for the first time sport participation levels and their correlates among Northern Ireland (NI) adults who report a long-standing illness/disability.

Method

Using data collected in the Continuous Household Survey, an annual survey of a random sample of the NI population, during 2007–2011, we examined responses for the total sample, those with a long-term illness/disability and those with no long-term health issues. We conducted univariate binary regression analysis for the whole sample and for those with a long-standing illness or disability, using sport participation as the dependent variable, and then carried significant variables into a multivariate analysis.

Results

The sample included 13 683 adults; 3550 (26%) reported a long-term illness or disability. Multivariate analysis showed that, for the total sample and for those with a long-standing illness or disability, sport participation correlated positively with being male, aged <56 years, having a household car/van, health being ‘fairly good’/‘good’ in the previous year, doing work and living in an urban location. Also, for those with a long-standing illness or disability, being single and less socioeconomically deprived correlated positively with sport participation.

Conclusions

The findings suggest that more focused efforts may promote sport participation for people with a long-standing illness or disability who are female, older, not working, living rurally, married/cohabiting, socioeconomically deprived and report having had poor health in the past year. Our findings should inform public health policy and help in developing initiatives to support sport participation and reduce health inequalities.

Caregivers' hair cortisol: a possible biomarker of chronic stress is associated with obesity measures among children with disabilities

BACKGROUND

The stress of caring for a loved one with chronic illness has been associated with childhood obesity. Hair cortisol has been proposed as a novel biomarker of chronic psychological stress. This study aimed to evaluate the associations between caregivers' chronic stress evaluated by hair cortisol concentrations (HCC) and obesity measures among children with disabilities such as autism.

METHODS

Eighty-five dyads of children with disabilities and their primary caregivers participated in the study between April and July 2013 in the Patagonia Region, Chile. Trained research staff conducted anthropometric measurements of children and caregivers. Cortisol concentrations, extracted from hair samples with methanol, were quantified using liquid chromatography tandem mass spectrometry. Pearson's correlation coefficients and linear regression models were used to examine the associations between caregiver HCC (log-transformed) and child obesity measures with adjustment for covariates.

RESULTS

Caregiver HCC were positively and significantly correlated with child weight (child age- and sex-adjusted r =0.23, P = 0.036), body mass index (BMI) (r = 0.23, P = 0.035), circumferences of neck (r = 0.30, P = 0.006), waist (r = 0.27, P = 0.014), and hip (r = 0.22, P = 0.044). After adjustment for children's age and sex, caregiver HCC were significantly related to child weight (kg) (beta = 4.47, standard error (SE) = 2.09), BMI (kg/m(2)) (beta = 1.52, SE = 0.71), neck circumference (cm) (beta = 1.20, SE = 0.43), waist circumference (cm) (beta = 3.75, SE = 1.50), and hip circumference (cm) (beta = 3.02, SE = 1.48). Caregiver HCC were also positively but not statistically significantly associated with child waist-to-hip ratio (beta = 0.01, SE = 0.01; P = 0.191) or body fat percentage (%) (beta = 2.11, SE = 1.28; P = 0.104). Further adjustment for other covariates including child disability diagnosis and caregiver age, sex, education, current smoking, perceived stress, and caregiver BMI did not change the results substantially.

CONCLUSIONS

Chronic stress of caregivers, evaluated by increased cortisol concentrations in hair, was positively associated with obesity measures among children with disabilities.

The scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities

PURPOSE

The purpose of this report is to discuss the scope of pediatric physical therapy practice in health promotion and fitness for youth with disabilities.

SUMMARY OF KEY POINTS

Evidence is provided that supports integration of health promotion and fitness strategies in physical therapy clinical management. Physical therapists' roles in community-based adapted sports and fitness interventions and reimbursement considerations are discussed.

CONCLUSIONS

Physical therapists are in a unique position to provide expertise in the design and implementation of health promotion and fitness programs for youth with disabilities. These programs are important to promote active, healthy lifestyles and reduce comorbidities associated with sedentary behaviors and unhealthy weight, which are often seen in youth with disabilities.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Pediatric physical therapists should incorporate health promotion and fitness strategies into practice.

Physical fitness and overweight in Israeli children with and without developmental coordination disorder: gender differences

Physical fitness and overweight among children has become paramount in the general population and more so in children with developmental coordination disorder (DCD). The purpose of the current study was to examine the association between physical fitness and overweight in a sample of Israeli children in comparison to typical children, and to examine gender differences. DCD was identified through total scores on the movement assessment battery for children 2 (MABC-2) equal to or less than the 16th percentile as well as parents' report that the child's deficits in motor skills interfered with at least two daily life activities. The sample included a group of children with DCD (n=22, M age=8.70 [SD=1.36], 16 boys [73%]) and a control group of typical children (n=47, M age=8.90 [SD=1.52], 34 boys [72%]). Measures included the strength subtest of the Bruininks-Oseretsky test of motor proficiency (BOT-2), the six minutes' walk test (6MWT) with heart rate measure, BMI and the percentage of body fat. Significant differences between DCD and typical children were found on all variables of physical fitness and weight. A two-way analysis of variance (ANOVA) analysis (group/gender) also revealed significant interactions for the percentage of body fat (F=8.51, p<.005) and BMI (F=4.50, p<.038) meaning that less fit children are more obese. The current study supports previous findings that children with DCD are less physically fit and more overweight compared to typically developing children. Moreover, in comparing between the genders, the girls in the study sample weighed more and had a significantly higher percentage of body fat than boys, it is essential to further our understanding of the relationships between obesity, physical fitness and gender among children with and without DCD.

Availability of state-based obesity surveillance data on high school students with disabilities in the United States

The aim of this study was to assess the availability of public health surveillance data on obesity among American children with disabilities in state-based surveillance programs. We reviewed annual cross-sectional datasets in state-level surveillance programs for high school students, implemented 2001-2011, for the inclusion of weight and height and disability screening questions. When datasets included a disability screen, its content and consistency of use across years were examined. We identified 54 surveillance programs with 261 annual datasets containing obesity data. Twelve surveillance programs in 11 states included a disability screening question that could be used to extract obesity data for high school students with disabilities, leaving the other 39 states with no state-level obesity data for students with disabilities. A total of 43 annual datasets, 16.5 % of the available datasets, could be used to estimate the obesity status of students with disabilities. The frequency of use of disability questions varied across states, and the content of the questions often changed across years and within a state. We concluded that state surveillance programs rarely contained questions that could be used to identify high school students with disabilities. This limits the availability of data that can be used to monitor obesity and related health statuses among this population in the majority of states.

Overweight and obesity in youth with developmental disabilities: a call to action

Elevated weight status has become a leading problem for adults and children around the world, regardless of the presence or lack of disability. Youth with intellectual and developmental disabilities are more vulnerable than the typical population to overweight in recent decades, and these individuals often experience overweight and obesity at higher rates than their typically developing peers. Young people with disabilities have many circumstances, beyond those of typically developing children, which increase their risk for greater body mass. These include greater medication use, having syndromes with obesity as an associated symptom, and possessing altered eating habits related to their disability. We discuss obesity-related health risks, possible weight management options, recommendations for weight maintenance or loss, and future research. Although most professionals who work with youth having developmental disabilities do not have great expertise in nutrition and weight management, we must collectively recognise the importance of weight issues for quality of life of these individuals and work with them in maintaining healthy lifestyles. Intervention options, both for caregivers and for health professionals, are discussed.

Disparities in access to health care among adults with physical disabilities: analysis of a representative national sample for a ten-year period

BACKGROUND

People with physical disabilities are the largest underserved subpopulation in the U.S. However, disparities in access to health care and how these have changed over time have not been fully explored.

OBJECTIVE

To examine national trends in disparities in access to health care and to identify the impact of physical disability and the personal factors that are associated with unmet health care needs, defined as self-reported ability to get medical care, dental care or prescription medications, among working age adults within the United States.

METHODS

Logistic regression analysis of a nationally representative sample of adults ages 25-64 (n = 163,220) with and without physical disabilities, using pooled data from the 2002-2011 Medical Expenditure Panel Survey.

RESULTS

Individuals with physical disabilities have 75% (p < 0.0001), 57% (p < 0.0001), and 85% (p < 0.000) higher odds of having unmet medical, dental, and prescription medication needs, respectively. Sociodemographic and health factors were related to unmet needs in all three measures of access to care. In particular, being female, living at or near the poverty level, and lacking health insurance increased the odds of unmet health care needs. Predicted probabilities of unmet health care needs from 2002 to 2011 show persistent gaps between individuals with and without physical disabilities, with a growing gap in unmet dental care (p = 0.004).

CONCLUSION

Having physical disabilities increase the odds of unmet health care needs. This study has important policy and community program implications. The Affordable Care Act could significantly reduce unmet health care needs, especially among individuals with physical disabilities.

Heart age differentials and general cardiovascular risk profiles for persons with varying disabilities: NHANES 2001-2010

BACKGROUND

Persons with disabilities are at risk for secondary conditions, including allostatic load contributing to cardiovascular disease. The General Cardiovascular Risk Profile (GCRP) estimates cardiovascular disease risk for individuals. The GCRP variables are present in the National Health and Nutrition Examination Survey (NHANES) for the Healthy People 2010 decade.

OBJECTIVE/HYPOTHESIS

The objective of this study was to compare persons with varying disabilities versus persons without disabilities on GCRP cardiovascular disease risk estimates across the Healthy People 2010 decade.

METHODS

Weighted cross-sectional one-way Analyses of Variance (ANOVA) and non-parametric Kruskal-Wallis analyses compared persons with each of eight disability types versus persons without disabilities for point estimate GCRP heart vascular age differential and Cox regression model ten-year risk estimate in each NHANES survey year for 2001-2010.

RESULTS

Persons with mobility or vision disabilities had significantly (p < .025) greater ten-year percent risks for cardiovascular disease and negative heart vascular age differentials (with respect to actual age, therefore "older" hearts) than persons without disabilities. The GCRP dual models conflict for certain disabilities (e.g., hearing, physical/mental/emotional) but are consistently reliable measures of GCRP for persons with mobility limitations and vision disabilities.

CONCLUSIONS

With higher CVD risk among persons with disabilities, there is a clear need for increased interventions to benefit the health of persons with disabilities. The GCRP represents a valuable, simple measurement that uses routinely collected examination data. Physicians and nurses can use the GCRP to make immediate CVD assessments and to provide point-of-contact counseling to patients with and without disabilities.

Obesity and children with special healthcare needs: special considerations for a special population

PURPOSE OF REVIEW

The high prevalence of childhood obesity continues to persist, especially in children and youth with special healthcare needs (CYSHCN). The International Classification of Functioning, Disability, and Health model and the American Academy of Pediatrics recommendations are appropriate frameworks related to increasing physical activity and healthy eating habits among CYSHCN. This review aims to provide pediatric providers with recommendations in the assessment, treatment, and management of obesity in CYSHCN.

RECENT FINDINGS

Personal, environmental, and parental factors contribute to participation of CYSHCN in physical activity and consumption of healthy foods. Findings demonstrate that physical activity among CYSHCN is possible with proper guidance and supervision from families, healthcare providers, and community recreation staff. Proper direction from parents can help CYSHCN with food restrictions consume healthier food options. Creative solutions for promoting physical activity and healthy foods are vital for this special population.

SUMMARY

Promoting healthy weight and addressing health behaviors can contribute to favorable health outcomes and quality of life in CYSHCN. Pediatricians are encouraged to assess risks contributing to obesity in collaboration with families and interdisciplinary teams (specialists, psychologists, primary care providers, mental health professionals, social workers, physical therapists, and dieticians), providing their patients (CYSHCN) with essential skills and resources to prevent and manage obesity.

The influence of condition parameters and internalizing symptoms on social outcomes in youth with spina bifida

OBJECTIVE

To test a model of social competence in youth with spina bifida (SB). Involvement in social activities was expected to mediate associations between SB-related condition parameters (pain, body mass index, and motor function) and social competence. Internalizing symptoms were predicted to amplify the negative impact of condition parameters on social activity involvement.

METHODS

108 youth with SB, their caregivers, peers, and teachers participated in a multimethod study that included cognitive testing, questionnaires, and observational interaction tasks.

RESULTS

Social activity involvement partially mediated the relation between pain and lower social competence. Internalizing symptoms had a significant indirect effect on social competence via decreased involvement in social activities.

CONCLUSIONS

Pain and internalizing symptoms interfere with social activity involvement, which is, in turn, important for social competence development in youth with SB. Assessing and treating these condition parameters and activity factors may be important areas of focus in clinical practice and research with these youth.

Current perspectives on physical activity and exercise recommendations for children and adolescents with autism spectrum disorders

Recent evidence suggests that childhood obesity is increasing in children who are developing typically as well as in children with developmental disabilities such as autism spectrum disorders (ASDs). Impairments specific to autism as well as general environmental factors could lead to an imbalance between the intake and expenditure of energy, leading to obesity. In this article, we describe the mechanisms by which autism-specific impairments contribute to obesity. The evidence on exercise interventions to improve physical fitness, address obesity, and reduce autism-specific impairments in children and adolescents with ASDs is discussed. Limited evidence is currently available for exercise interventions in individuals with ASDs. Therefore, literature on other pediatric developmental disabilities and children who are developing typically was reviewed to provide recommendations for clinicians to assess physical activity levels, to promote physical fitness, and to reduce obesity in children and adolescents with ASDs. There is a clear need for further systematic research to develop sensitive assessment tools and holistic multisystem and multifactorial obesity interventions that accommodate the social communication, motor, and behavioral impairments of individuals with ASDs.

Impacts of mobility disability and high and increasing body mass index on health-related quality of life and participation in society: a population-based cohort study from Sweden

BACKGROUND

Increasing obesity in adults with mobility disability has become a considerable health problem, similar to the increasing trend of obesity in the general population. The aims of this study were to investigate the association of mobility disability with overweight status and obesity in a large population-based Swedish cohort of adults, and to investigate whether mobility disability, high body mass index (BMI), and increasing BMI over time are predictors of health-related quality of life and participation in society after 8 years of follow-up.

METHODS

The study cohort included 13,549 individuals aged 18-64 years who answered questions about mobility disability, weight, height, health-related quality of life and participation in society in the Stockholm Public Health Survey 2002 and 2010. The cohort was randomly selected from the population of Stockholm County, and divided into six subgroups based on data for mobility disability and overweight status. Multiple binary logistic regression analyses were performed to assess the likelihood for low health-related quality of life and lack of participation.

RESULTS

Respondents with mobility disability had a higher mean BMI than those without mobility disability. Respondents both with and without mobility disability increased in BMI, but with no significant difference in the longitudinal changes (mean difference: 0.078; 95% CI: -0.16 - 0.32). Presence of mobility disability increased the risk of low health-related quality of life and lack of participation in 2010, irrespective of low health-related quality of life and lack of participation in 2002. The risk of pain and low general health (parts of health-related quality of life) increased for every 5 units of higher BMI reported in 2010. In respondents without low general health at baseline, the risk of obtaining low general health increased for every 5 units of higher BMI in 2010 (OR:1.60; CI: 1.47 - 1.74).

CONCLUSIONS

The greatest risk of low general health after 8 years was observed for respondents with both mobility disability and high BMI. These results indicate the importance of working preventively with persons with mobility disability and overweight status or obesity based on the risk of further weight gain.

Obesity and overweight in intellectual and non-intellectually disabled children

BACKGROUND

Few studies have compared overweight and obesity in intellectually disabled (ID) and non-intellectually disabled (N-ID) children. This research compared the prevalence of overweight and obesity between a sample of 218 ID and 229 N-ID school pupils in Northern Ireland (NI). Comparison of the physical activity and dietary behaviour of the two groups of school pupils were also undertaken.

METHODS

Each pupil completed (assisted if required) a food intake and physical activity questionnaire. Following this body mass index (BMI) and waist circumference were measured and recorded.

RESULTS

Significantly more ID pupils (72, 33%) were overweight/obese compared with 55 (24%) of the N-ID pupils in accordance with their BMI. ID pupils also had significantly higher waist circumferences. Over a quarter of foods consumed by the pupils were fatty and sugary foods and close to 30% of these foods were eaten by the ID children. Pupils spent most of their time engaging in low levels of activity such as reading, watching TV, on games consoles and listening to music. Pupils with an ID spent fewer hours on moderate and high levels of activities compared with those children with N-ID.

CONCLUSIONS

Results of this study found higher levels of overweight and obesity in this sample than in international published research. Additionally significantly higher numbers of ID pupils were overweight and obese indicating the need for future research and public health to focus on this issue.

Obesity trends of 8-18 year old Special Olympians: 2005-2010

Obesity is a worldwide health problem. Individuals with intellectual disabilities (ID) experience health disparities, including higher rates of obesity than their peers with typical development; however, there has been no tracking of the obesity rates of children and youth with ID over time. The objective of this study was to compare the BMI of children and youth (8-<19 years of age) with and without ID in the USA, measured overtime; and determine differences between the two groups. This study is a secondary analysis of BMI derived from the Special Olympics International (SOI) Healthy Athletes database. Data were available for 2541 (1527 male) American SOI participants. Using BMI cut-offs from the CDC growth curves the BMI data were stratified into two age bands: 8-11 years (n=429) and 12-<19 years (n=2112), and comparisons were made between SOI participants' BMI data and published NHANES data from the years 2005-2006, 2007-2008, and 2009-2010. SOI participants (12-<19 years) had significantly higher levels of obesity than the national average in 2007-2008 and 2009-2010; there were no differences in the children (8-11 years). Males in the 8-11 years age group were more likely to be obese than females in the same age group (OR=1.62, p=.035). These results highlight that an obesity disparity exists in the USA for children and youth with ID, particularly as they get older and there is a need for further physical activity and healthy eating interventions and overall health promotion activities targeted at this population.

Park-based afterschool program to improve cardiovascular health and physical fitness in children with disabilities

BACKGROUND

Children with disabilities are more likely to be overweight or obese and less likely to engage in physical activities versus their peers without disabilities.

OBJECTIVE

The effect of a structured afterschool program housed in a large county parks system on several obesity-related health outcomes among children with disabilities was examined.

METHODS

Children/adolescents with a developmental and/or intellectual disability ages 6-22 (N = 52, mean age 13.7 years) who participated in an afterschool (either 2010-2011 or 2011-2012 school year) health and wellness program called Fit-2-Play™ were assessed. Pre-post comparison of outcome variables (mean height, weight, waist/hip/midarm circumference, fitness tests, and a 9-item health and wellness knowledge assessment) via general linear mixed models analysis was conducted to evaluate the effectiveness of the program for normal and overweight/obese participants.

RESULTS

Normal weight participants significantly improved pre-post mean number of push-ups (9.69-14.23, p = 0.01) and laps on the PACER test (8.54-11.38, p < 0.01) and the overweight/obese group significantly improved the number of sit ups (7.51-9.84, p < 0.01) and push ups (4.77-9.89, p < 0.001). Pre-post mean health and wellness knowledge composite scores significantly improved for all participants (p < 0.01).

CONCLUSIONS

Parks-based afterschool programs can be effective community resources for instilling physical health in both normal weight and overweight/obese children with disabilities. More studies are needed to ascertain whether community-based afterschool health and wellness programs can be implemented and sustained across this population.

Is participation among children with intellectual disabilities in outside school activities similar to their typically developing peers? A systematic review

OBJECTIVE

To compare the extent, context and experience of participation in outside school activities of children with intellectual disability (ID) and their peers with typical development (TD).

METHODS

A systematic review was completed. Nine databases were searched and citation tracking performed. Included studies were in English, published in a peer-reviewed journal, used a quantitative study design and compared children with ID to children with TD. Studies were assessed for quality using 15 items from the Downs and Black quality checklist.

RESULTS

Four papers were included. Participants were reported to have similar participation in leisure activities. Children with ID were reported to participate in fewer community-based social activities, recreational, family-enrichment and formal activities than children with TD.

CONCLUSION

Key differences in participation between the groups were identified. Given their methodological limitations and that most studies were published prior to the International Classification of Functioning, Disability and Health, further research is required.

Combining self-help and professional help to minimize barriers to physical activity in persons with multiple sclerosis: a trial of the "Blue Prescription" approach in New Zealand

BACKGROUND AND PURPOSE

Increasing participation in physical activity is a goal for many health care providers working with persons with disability. In order to reduce the physical and social barriers to participation, there is a need to develop approaches that integrate self-help with professional help for autonomous yet supported health promotion. This study reports on an innovative program, entitled the "Blue Prescription approach", in which physical therapists work collaboratively with persons with a disability to promote community-based physical activity participation.

METHODS

We trialed this collaborative approach with two physical therapists and 27 participants with multiple sclerosis (MS) over a three month period. We gathered qualitative data from four sources: (i) individual interviews with our participants, (ii) individual interviews with the physical therapists, (iii) clinical notes, and (iv) Advisory Group meeting notes. We then analyzed these data for categories to inform the content and resources required for delivery of the approach.

RESULTS

For most participants, the Blue Prescription approach facilitated regular engagement in the physical activity of their choice. The Advisory Group provided advice to help solve individual contexts that presented as challenges to participants. Based on review of interview transcripts, we identified four strategies or issues to inform the further development of Blue Prescription.

DISCUSSION AND CONCLUSIONS

Evidence indicated that the Blue Prescription approach can provide a collaborative and flexible way for physical therapists to work with individuals with MS, to increase participation in community-based physical activity. To further develop the approach, there is a need to address issues related to the use of standardized measures and develop strategies to train physical therapists in collaborative approaches for promotion of physical activity.The integration of self-help and professional help provided by the Blue Prescription approach appeared to result in successful promotion of physical activity in persons with MS. Additional testing is required to examine its efficacy in other health care systems, in conditions beyond MS, and in terms of its economic impact.Video Abstract available (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A46) for more insights from the authors.

Reducing Obesity Among People With Disabilities

Achieving healthy weight for people with disabilities in the United States is a challenge. Obesity rates for adults and children with disabilities are significantly higher than for those without disabilities, with differences remaining even when controlling for other factors. Reasons for this disparity include lack of healthy food options for many people with disabilities living in restrictive environments, difficulty with chewing or swallowing food, medication use contributing to changes in appetite, physical limitations that can reduce a person's ability to exercise, constant pain, energy imbalance, lack of accessible environments in which to exercise or fully participate in other activities, and resource scarcity among many segments of the disability population. In order for there to be a coordinated national effort to address this issue, a framework needs to be developed from which research, policy, and practice can emerge. This paper reviews existing literature and presents a conceptual model that can be used to inform such a framework, provides examples of promising practices, and discusses challenges and opportunities moving forward.

Participation of children with intellectual disability compared with typically developing children

We compared participation in out-of-school activities between children with intellectual disability and children with typical development using the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children questionnaires. Thirty-eight pairs of children were matched for age (mean age 12.3 ± 2.7 years), sex (17 female, 21 male), location (32 metropolitan, 6 regional) and socioeconomic background (mean SEIFA score 1021 ± 70 and 1024 ± 66). When compared to their typically developing peers, children with intellectual disability participated in fewer Active-Physical and Skill-Based activities and in more Recreational activities. Children with intellectual disability participated less frequently in Skilled-Based activities, had a higher preference for Recreational and Self-Improvement activities, enjoyed Self-Improvement activities more, and participated in a higher proportion of Social activities at home and in a lower proportion of Recreational, Active-Physical, Skill-Based, and Self-Improvement activities alone. These differences may be due to reduced physical, cognitive and social skills in children with intellectual disability, or a lack of supportive environments.

A multi-tiered approach to addressing the mental health issues surrounding obesity in children and youth

Obesity in children and youth is a major public health concern known to have a significant impact on physical and mental health. Although traditional approaches to obesity have emphasized diet and exercise at the individual level, broader attention to the mental health consequences of obesity is crucial. Individuals who are obese live in a world where they are often less accepted resulting in social exclusion and discrimination. A public health multi-tiered approach to obesity focusing on mental health promotion, prevention, and individualized intervention is presented.

Physical activity in children and adolescents with autism assessed by triaxial accelerometry

OBJECTIVE

This study aimed to examine physical activity (PA) patterns in children with autism spectrum disorder (ASD) as well as to address PA determinant factors by employing triaxial accelerometry.

METHODS

In a school-based cross-sectional study of 80 children and adolescents with ASD (mean = 9.6, standard deviation = 1.8), we investigated demographics, children's behavioural and clinical profile, and their PA data as objectively measured using an Actigraph GT3X on the right hip for seven consecutive days. All activity measures were expressed as counts per minute (c.p.m.).

RESULTS

There was a substantial reduction in activity across the adolescent years in ASD. Girls were significantly less active than boys with ASD. Participants were remarkably less active in school compared to after-school, and there was a PA decline during weekdays compared to weekends, which was not significant. Household structure, sedentary pursuits, comorbidities and obesity were identified as other determinants of PA in children with ASD.

CONCLUSIONS

Given the limited objective assessment of PA in children with ASD, our findings stressed the need for improving PA programmes, particularly for girls and older children with ASD. This study also provided important information for counselling clinicians, families and school policy-makers about health issues in ASD.

Physical activity, dietary habits and overall health in overweight and obese children and youth with intellectual disability or autism

In children and youth with disability, the risk of obesity is higher and is associated with lower levels of physical activity, inappropriate eating behaviors, and chronic health conditions. We determined the effectiveness of a program in managing weight, through changes in physical activity and nutrition behaviors in overweight and obese New Zealand children and youth with intellectual disability or autism. Twenty-two children and youth 14±4 y (mean±SD) and their families participated in a 10-week school-based program. The program consisted of 18 sessions focusing on physical activity and nutrition. Changes were measured immediately after completion of the program (post 1) and at 24 weeks (follow up). Fitness was assessed with the six-minute walk-test (6MWT) and body fatness via waist circumference and BMI. Physical activity and nutrition changes were measured by means of proxy reporting and interviews with parents. Individual interviews were conducted with school teachers and program leaders at 24 weeks to gain feedback regarding the program. Most quantitative outcomes were either unclear or trivial. The only possible change was observed in the six-minute walk-test where 24 weeks post program where participants walked 51 m further. There was however, a substantial reduction in the consumption of confectionery and chocolate at the two measurement points. Parents commented that during the program there were less hospital visits and absences from school related to illness. The program assisted in the development of a supportive community network and participants' abilities to partake in family and community activities. This the first study to report on the results of a physical activity and nutrition program targeted in children and youth with intellectual disability and autism. The results of this study may support and inform future developments of an integrated weight management and prevention program to enhance the health and well being in children and youth with disabilities.

The assessment of weight status in children and young people attending a spina bifida outpatient clinic: a retrospective medical record review

PURPOSE

Children with disabilities are two to three times more likely to become overweight or obese than typically developing children. Children with spina bifida (SB) are at particular risk, yet obesity prevalence and weight management with this population are under-researched. This retrospective chart review explored how weight is assessed and discussed in a children's SB outpatient clinic.

METHOD

Height/weight data were extracted from records of children aged 2-18 with a diagnosis of SB attending an outpatient clinic at least once between June 2009-2011. Body mass index was calculated and classified using Centers for Disease Control and Prevention cut-offs. Notes around weight, diet and physical/sedentary activities were transcribed verbatim and analysed using descriptive thematic analysis.

RESULTS

Of 180 eligible patients identified, only 63 records had sufficient data to calculate BMI; 15 patients were overweight (23.81%) and 11 obese (17.46%). Weight and physical activity discussions were typically related to function (e.g. mobility, pain). Diet discussions focused on bowel and bladder function and dietary challenges.

CONCLUSIONS

Anthropometrics were infrequently recorded, leaving an incomplete picture of weight status in children with SB and suggesting that weight is not prioritised. Bowel/bladder function was highlighted over other benefits of a healthy body weight, indicating that health promotion opportunities are being missed. Implications for Rehabilitation It is important to assess, categorise and record anthropometric data for children and youth with spina bifida as they may be at particular risk of excess weight. Information around weight categorisation should be discussed openly and non-judgmentally with children and their families. Health promotion opportunities may be missed by focusing solely on symptom management or function. Healthcare professionals should emphasise the broad benefits of healthy eating and physical activity, offering strategies to enable the child to incorporate healthy lifestyle behaviours appropriate to their level of ability.

Cross-sectional changes in patterns of allostatic load among persons with varying disabilities, NHANES: 2001-2010

BACKGROUND

Allostatic Load (AL) is a measure of physiological stress that correlates with morbidity and mortality.

OBJECTIVE

The purpose of this study was to evaluate patterns of AL among persons with each of eight categories of disability versus persons with no disabilities over the 10-year Healthy People 2010 examination period.

METHODS

The study examined measures of AL from the 2001-2010 National Health and Nutrition Examination Survey (NHANES). The independent variable was Disability Status (hearing, vision, memory, physical-mental-emotional, walking up 10 steps, bending or kneeling, lifting or carrying, assistive devices, no disability). Eight laboratory and one social AL dependent variables included blood pressure, body mass index (BMI), HDL cholesterol, number of friends, and neutrophil percentages. Weighted statistical analyses included one-way ANCOVA with age as the covariate and chi-square tests.

RESULTS

Among respondents, 2.3% had hearing disabilities; 14.0% vision disabilities, 4.6% memory disabilities; 1.5% physical, mental, emotional disabilities; 1.3%, 5.9%, and 3.5% various mobility disabilities; and 5.3% used assistive devices. Persons with disabilities had significantly higher BMI, lower HDL cholesterol, higher C-reactive protein, and higher neutrophil levels than persons without disabilities. Systolic and diastolic blood pressures decreased during the decade, but BMI increased. A range of 36.2-61.0% of persons with non-hearing disabilities exceeded BMI obesity thresholds during 2009, and 13.8-29.9% had fewer than three friends during 2009.

CONCLUSIONS

These findings support previous research linking risks for secondary conditions/morbidity and allostatic load while demonstrating associations between disabilities and AL, especially for persons with mobility disabilities.

Association of physical activity and body mass index with metabolic syndrome among U.S. adolescents with disabilities

BACKGROUND

Adolescents with disabilities (A-With-D) have shown to be less physically active and more obese compared to adolescents without disabilities (A-Without-D); however, little is known in regards to the impact of physical activity (PA) and body mass index (BMI) on metabolic syndrome (MetS) among A-with-D.

OBJECTIVE

The purpose of this study was to compare the prevalence of MetS, PA levels and BMI percentile between A-With-D and A-Without-D, and to examine the influence of PA and BMI on MetS among A-With-D.

METHODS

Data from the National Health and Nutrition Examination Survey 1999-2010 was used in this study. Inclusion criteria for the study consisted of those who indicated, in the survey, that they had received special education or early intervention service (n = 278). PA level was assessed subjectively by asking the amount of leisure time PA. BMI percentile was obtained using BMI growth charts by age and sex. The continuous MetS (cMetS) score was computed using age and sex standardized residual for mean arterial blood pressure, triglyceride, glucose, waist circumference, and high-density lipoprotein cholesterol.

RESULTS

A-With-D were more likely to be obese and less likely to be engaged in PA compared to A-Without-D. A-With-D were less favorable to MetS with significantly higher cMetS scores than A-Without-D. Lower levels of PA and higher percentile of BMI were significantly associated with higher levels of cMetS scores among A-With-D.

CONCLUSION

This study provided empirical evidence for the importance of promoting a healthy lifestyle (i.e., increasing the level of PA and decreasing the BMI percentile) among A-With-D in order to reduce the risk of MetS.

Measuring physical activity in children and youth living with intellectual disabilities: a systematic review

Accurate assessment of physical activity is necessary in determining levels of physical activity in children living with intellectual disability (ID) and assessing effectiveness of intervention programmes. A systematic review of measures of physical activity in children with ID was undertaken using the PRISMA guidelines. MEDLINE-PubMed, Scopus, CINAHL Plus with Full Text and SPORT Discus (up to May 2012) databases were searched and articles were identified. The following inclusion criteria were used; articles in English which reported original research and measured physical activity levels in children with ID, and participants of school age (5-18 years). Searches were limited to articles from peer-reviewed journals and those available in full text. The search identified 5087 titles. Seventy-eight articles were retained for full review and 30 met the inclusion criteria. The review identified a clear deficiency in the number of validity and reliability studies of tools used to quantify physical activity in children with ID. Objective measurement of physical activity provided consistent results. Despite the differences in study design and methodological quality, there was agreement among studies that children with ID were significantly less active compared to children without disabilities. Refusal to wear instruments, movement limitations in children with ID, and positioning of devices were common issues. Future studies should focus on determining the validity and reliability of tools used to assess physical activity in children with ID.

Effectiveness of an upper extremity exercise device and text message reminders to exercise in adults with spina bifida: a pilot study

Obesity, deconditioning, cognitive impairment, and poor exercise tolerance are health issues concerning adults with spina bifida (SB). Our aim is to describe exercise participation and identify motivating tactics and exercise devices that increase participation. In a quasi-experimental randomized crossover design, the GameCycle was compared to a Saratoga Silver I arm ergometer. Personalized free or low-cost text/voice message reminders to exercise were sent. Nineteen young adults with SB were assigned to either the GameCycle or Saratoga exercise group. Within each group, participants were randomized to receive reminders to exercise, or no reminders, then crossed over to the opposite message group after eight weeks. Before and after a 16-week exercise program anthropometric, metabolic, exercise testing and questionnaire data, and recorded participation were collected. Miles traveled by the GameCycle group were significantly higher than the Saratoga exercise groups. No significant differences were found in participation between the message reminder groups. Low participation rates were seen overall. Those using the GameCycle traveled more miles. Barriers to exercise participation may have superseded ability to motivate adults with SB to exercise even with electronic reminders. Support from therapists to combat deconditioning and develop coping skills may be needed.

[Importance of secondary conditions in rehabilitation medicine]

The author interprets disability on the basis of the "International Classification of Functioning, Disability and Health (ICF)". In this review the applied method is a purpose oriented, restricted survey of continuously increasing articles published during the last two decades. Definition and interpretation of secondary conditions are based on the cited international classification. It is noted that secondary conditions frequently develop during acute care and usually require rehabilitation. Significance of secondary conditions in rehabilitation is highlighted by selected examples of traumatic spinal cord injury, stroke, lower limb amputation and intellectual disabilities. The author states that there is an insufficiency of presently available knowledge and raises the need for the use of the International Classification of Functioning, Disability and Health as foundation of future research.

International BMI comparison of children and youth with intellectual disabilities participating in Special Olympics

The purpose of this study was to describe the BMI status of children and youth with intellectual disabilities by world region, gender and age. A total of 9678 children and youth records were available from the Special Olympics International Health Promotion database after data cleaning (6084 boys and 3594 girls). Children were defined as 8-11 year olds (n=2035), and youth were defined as 12-18 year olds (n=7643). BMI prevalence rates were computed using the International Obesity Task Force (IOTF) cut-points, and logistic regression was used to determine if either age or gender was associated with being overweight or obese. Approximately 30% of the sample was overweight or obese; however, the prevalence rates in North America were much higher, particularly among girls. Fifty-four percent of girls (95% confidence interval [CI], 51.4-57.2%) were overweight or obese. Logistic regression revealed that both age and gender were significant predictors in North America; however this pattern was not consistent throughout the world regions. BMI status is a significant indicator of health, and these findings suggest that overweight and obesity are significant health concerns for children and youth with intellectual disabilities around the world. Obesity rates in this population are particularly high in North America, and the odds of becoming overweight or obese increased with age in North America. It is critical that health professionals increase Health Promotion efforts, including physical activity and healthy eating behaviors for children and youth with intellectual disabilities.

Weight-based nutritional diagnosis of Mexican children and adolescents with neuromotor disabilities

BACKGROUND

Nutrition related problems are increasing worldwide but they have scarcely been evaluated in people with neuromotor disabilities, particularly in developing countries. In this study our aim was to describe the weight-based nutritional diagnoses of children and adolescents with neuromotor disabilities who attended a private rehabilitation center in Mexico City.

METHODS

Data from the first visit's clinical records of 410 patients who attended the Nutrition department at the Teleton Center for Children Rehabilitation, between 1999 and 2008, were analyzed. Sex, age, weight and height, length or segmental length data were collected and used to obtain the nutritional diagnosis based on international growth charts, as well as disability-specific charts. Weight for height was considered the main indicator.

RESULTS

Cerebral palsy was the most frequent diagnosis, followed by spina bifida, muscular dystrophy, and Down's syndrome. Children with cerebral palsy showed a higher risk of presenting low weight/undernutrition (LW/UN) than children with other disabilities, which was three times higher in females. In contrast, children with spina bifida, particularly males, were more likely to be overweight/obese (OW/OB), especially after the age of 6 and even more after 11. Patients with muscular dystrophy showed a significantly lower risk of LW/UN than patients with other disabilities. In patients with Down's syndrome neither LW/UN nor OW/OB were different between age and sex.

CONCLUSIONS

This is the first study that provides evidence of the nutritional situation of children and adolescents with neuromotor disabilities in Mexico, based on their weight status. Low weight and obesity affect a large number of these patients due to their disability, age and sex. Early nutritional diagnosis must be considered an essential component in the treatment of these patients to prevent obesity and malnutrition, and improve their quality of life.