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

Exploring the complexities of weight management care for children with spina bifida: a qualitative study with children and parents

PURPOSE

1) To explore how children with spina bifida (SB) and their parents understand bodyweight, health and weight management; and 2) To identify what services and supports children with SB and their families feel are most appropriate to help them manage their health and weight.

METHODS

The study used interpretive description within a qualitative design. Participants were children with SB (aged 10-18) attending two Canadian SB clinics and their parents. Data were collected through individual interviews and analyzed using inductive thematic analysis.

RESULTS

Five children and five parents participated in the study. Children and parents had a weight-centric approach to health, which was related to the child's mobility. Weight was considered to be under individual control and mostly through diet. Trusting relationships between healthcare providers, children and families were important to discuss weight in a non-judgemental manner. Children should be involved in setting meaningful and achievable weight management goals.

CONCLUSION

Greater knowledge of how children with SB and their families understand weight and health offers opportunities for non-judgemental discussions about their needs and wishes. Helping families to place more value on health over weight may reduce feelings of stigma, while allowing children to develop some autonomy over health-related decisions.

Participation in Special Olympics reduces the rate for developing diabetes in adults with intellectual and developmental disabilities

AIM

Adults with intellectual and developmental disabilities (IDD) have a significantly higher prevalence of Type 2 diabetes than the general population. Evidence that lifestyle and/or behavioural interventions, such as participation in Special Olympics, decreases the risk of developing diabetes in adults with IDD could help minimize health disparities and promote overall health in this population.

METHODS

This was a 20-year retrospective cohort study of adults with IDD (30-39 years) in the province of Ontario, Canada, that compared hazard rates of diabetes among Special Olympics participants (n = 4145) to non-participants (n = 31,009) using administrative health databases housed at ICES. Using cox proportional hazard models, crude and adjusted hazard ratios were calculated for the association between the primary independent variable (Special Olympics participation status) and the dependent variable (incident diabetes cases).

RESULTS

After controlling for other variables, the hazard ratio comparing rates for developing diabetes between Special Olympics participants and non-participants was 0.85. This represents a 15% reduction in the hazard among Special Olympics participants when followed for up to 20 years. This result was statistically significant and represents a small effect size.

CONCLUSIONS

Special Olympics could be considered a complex intervention that promotes physical activity engagement through sport participation, health screenings, and the promotion of healthy eating habits through educational initiatives. This study provides evidence that Special Olympics participation decreases the rate for developing diabetes.

Location Matters: The Role of the Neighborhood Environment for Incident Cardiometabolic Disease in Adults Aging With Physical Disability

PURPOSE

People aging with disability may be limited in their ability to engage in healthy behaviors to maintain cardiometabolic health. We investigated the role of health promoting features in the neighborhood environment for incident cardiometabolic disease in adults aging with physical disability in the United States.

DESIGN

Retrospective cohort study.

SETTING

Optum's Clinformatics® Data Mart Database (2007-2018) of administrative health claims.

SUBJECTS

ICD-9-CM codes were used to identify 15 467 individuals with a diagnosis of Cerebral Palsy, Spina Bifida, Multiple Sclerosis, or Spinal Cord Injury.

MEASURES

Cardiometabolic disease was identified using ICD-9-CM/ICD-10-CM codes over 3 years of follow-up. Measures of the neighborhood environment came from the National Neighborhood Data Archive and linked to individual residential ZIP codes over time. Covariates included age, sex, and comorbid health conditions.

ANALYSIS

Cox regression models estimated hazard ratios (HR) for incident cardiometabolic disease. Using a 1-year lookback period, individuals with pre-existing cardiometabolic disease were excluded from the analysis.

RESULTS

Net of individual risk factors, residing in neighborhoods with a greater density of broadband Internet connections (HR = .88, 95% CI: .81, .97), public transit stops (HR = .89, 95% CI: .83, .95), recreational establishments (HR = .89, 95% CI: .83, .96), and parks (HR = .88, 95% CI: .82, .94), was associated with reduced risk of 3-year incident cardiometabolic disease.

CONCLUSION

Findings identify health-promoting resources that may mitigate health disparities in adults aging with disability.

Utilizing an Environmental Framework to Explore the Acceptability of a Health Promotion Program for Youth with Disabilities

This study explored the acceptability of Children and Teens in Charge of their Health (CATCH), a program for children with spina bifida or cerebral palsy to enhance their physical activity and diet. Qualitative interviews were conducted with children (n = 6) and their parents (n = 6) who participated in CATCH. Analysis used an environmental systems framework. Microsystem factors impacting acceptability of the program were: Children's motivations for change, their age, and their physical health. Mesosystem factors were: Use of virtual coaching and the relationship between coach and child. Macrosystem factors (e.g. Covid-19), did not impact acceptability, but affected some goal attainment strategies. CATCH was broadly acceptable to children and parents and shows promise as a health promotion program tailored to children with disabilities. An environmental systems framework can potentially help other health promotion programs enhance their acceptability and success.

The Association Between Physical Activity and Health Care Risk Management in Individuals With Disabilities

Despite the increasing economic burden of people with disabilities (PWDs) over time, the impact of physical activity on PWDs in the Republic of Korea (ROK) remains relatively unexplored. Thus, we examined the association between physical activity and disease risk, health care utilization, and expenditures for PWDs in the ROK. We considered gender differences across eight diseases using the National Health Insurance (NHI) panel data from 2013 to 2019. The sample consisted of PWDs who underwent regular medical check-ups and were aged 40 years and above, aligning with the NHI's health screening program targeting beneficiaries in this age range. The final sample included 281 142 healthy PWDs. Among them, 44.1% (n = 124 061) engaged in physical activity, while the remaining 45.9% (n = 157 081) did not participate in any physical activity. The results show a negative association between physical activity and the incidence of various diseases among both genders. Health care utilization exhibited gender and disease-based variations, with men and women demonstrating higher utilization rates in the absence of physical activity. Health care expenditures also differed based on gender and disease, as men and women displayed higher costs in the absence of physical activity. Consequently, public policymakers should establish tailored activity programs for PWDs, adhering to activity guidelines designed for this population.

Diet quality, diet-related factors and disability status among male adults of reproductive age in the USA

OBJECTIVE

To examine diet quality and diet-related factors among male adults of reproductive age with and without disabilities.

DESIGN

Cross-sectional data from the National Health and Nutrition Examination Surveys, 2013-2018.

SETTING

Disability was reported as serious difficulty hearing, seeing, concentrating, walking, dressing and/or running errands due to physical, mental or emotional conditions. Diet quality was assessed by the Healthy Eating Index (HEI)-2015 and diet-related factors included self-rated diet healthfulness, food security and food assistance programmes. Multivariable linear regression estimated differences in HEI-2015 scores. Multivariable Poisson regression estimated adjusted prevalence ratios (aPR) and 95 % CI for diet-related factors.

PARTICIPANTS

In total, 3249 males, 18-44 years; of whom, 441 (13·4 %) reported having disabilities.

RESULTS

Compared with males without disabilities, those with disabilities had a 2·69-point (95 % CI: -4·18, -1·20) lower mean total HEI-2015 score and approximately one-third to half of a point lower HEI-2015 component scores for greens and beans, total protein foods, seafood and plant proteins, fatty acids and added sugars. Males with any disabilities were more likely to have low food security (aPR = 1·57; 95 % CI: 1·28, 2·92); household participation in food assistance programmes (aPR = 1·61; 95 % CI: 1·34, 1·93) and consume fast food meals during the previous week (1-3 meals: aPR = 1·11; 95 % CI: 1·01-1·21 and 4 or more meals: aPR = 1·18; 95 % CI: 1·01-1·38) compared with males with no disabilities.

CONCLUSIONS

Factors affecting diet and other modifiable health behaviours among male adults of reproductive age with disabilities require further investigation. Health promotion strategies that are adaptive to diverse populations within the disability community are needed.

Effectiveness of wheelchair skills training for improving manual wheelchair mobility in children and adolescents: protocol for a multicenter randomized waitlist-controlled trial

BACKGROUND

Self-directed mobility during childhood can influence development, social participation, and independent living later in life. For children who experience challenges with walking, manual wheelchairs (MWCs) provide a means for self-directed mobility. An effective MWC skills training program exists for adults, but controlled trials have not yet been documented in children and adolescents. This paper outlines the protocol for a multi-centre randomized wait-list controlled trial. The primary objective is to test the hypothesis that children and adolescents who receive MWC skills training will have higher MWC skills capacity compared to children and adolescents in the control group who receive usual care. The secondary objectives are to explore the influence of MWC skills training in children and adolescents (MWC use self-efficacy and satisfaction with participation in meaningful activities), and parents (perceived MWC skills); and to measure retention three months later.

METHODS

A multi-centre, parallel-group, single-blind randomized wait-list controlled trial will be conducted. A sample of 60 children and adolescents who use MWCs will be recruited in rehabilitation centres, specialized schools, and the communities of three Canadian cities. Participants will be randomized (1:1) to the experimental (Wheelchair Skills Training Program [WSTP]) or wait-list control group (usual care). Performance-based and self-report measures will be completed at baseline (T1), three months (post-intervention, T2), and three months post-intervention (T3). The primary outcome will be MWC skills capacity post-intervention. Secondary outcomes will be MWC use self-efficacy and satisfaction with participation of the child/adolescent, and parent-perceived MWC skills. The WSTP will consist of 12 sessions, 45-60 min each, delivered 1-2 times per week by trained personnel with health professions education. Training will be customized according to the child's baseline skills and participation goals that require the use of the MWC. The wait-list control group will receive usual care for 3 months and then receive the WSTP after completing T2 evaluations. Data will be analysed using ANCOVA (controlling for baseline scores).

DISCUSSION

MWC skills training may be one way to improve self-directed mobility and related outcomes for children and adolescents. The results of this multi-centre randomized wait-list controlled trial will allow for the effectiveness of the intervention to be evaluated in a variety of clinical contexts and geographical regions.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05564247, Version October 3, 2022.

Organized physical activity and sedentary behaviors in children and adolescents with autism spectrum disorder, cerebral palsy, and intellectual disability

BACKGROUND

There is little data on physical activity (PA), organized PA (OPA), and sedentary behaviors in autism spectrum disorders (ASD) and other neurodevelopmental disorders in developing countries.

AIM

To examine OPA, non-OPA, and sedentary behaviors and their associated factors in children and adolescents with ASD, cerebral palsy (CP), and intellectual disability (ID).

METHODS

A total of 1020 children and adolescents with ASD, CP, and ID were assessed regarding the child and family information as well as the Children's Leisure Activities Study Survey.

RESULTS

The results showed that the OPA level was significantly lower than non-OPA in all groups. Furthermore, the OPA level was significantly lower in the CP group compared to ASD and ID groups (P < 0.001). Also, moderate (P < 0.001), vigorous (P < 0.05), and total (P < 0.001) physical activity levels were significantly different between all three groups, with the values being higher in the ASD group compared to the other two. The mean of the total sedentary behavior duration in the ASD group (1819.4 min/week, SD: 1680) was significantly lower than in the CP group (2687 min/week, SD: 2673) (P = 0.007) but not ID group (2176 min/week, SD: 2168.9) (P = 0.525).

CONCLUSION

Our findings remark on the participation rate of PA, OPA, and sedentary behaviors of children and adolescents with ASD, CP, and ID in a developing country. In contrast, the need for developing standards of PA/OPA participation in neurodevelopmental disorders is discussed.

GamerFit-ASD beta test: adapting an evidence-based exergaming and telehealth coaching intervention for autistic youth

Background

Health disparities faced by autistic youth are exacerbated by inadequate physical activity (PA) and sleep, whereas healthy PA and sleep may improve mood and function. Adaptive Game Squad (AGS) is an evidence-based telehealth coaching and exergaming intervention to improve PA and sleep for adolescents with diverse neurodevelopmental and psychiatric conditions. This study aimed to adapt AGS for autistic youth ages 10-15 years; beta-test the modified intervention for feasibility, accessibility, and engagement; and further refine the intervention for a larger planned demonstration pilot.

Methods

Interdisciplinary experts adapted AGS to create GamerFit-ASD, a 12-week intervention that included a progressive exergame schedule, Fitbit step-tracking, weekly health coaching, and health tip/exercise videos. For beta testing, the intervention was shortened to a 4-week trial with 5 parent/child dyads. Children completed exit surveys and parents and children were interviewed about intervention feasibility, accessibility, and engagement. Exit survey data were summarized with descriptive statistics. Qualitative data were analyzed using a modified grounded-theory approach.

Results

All participants (n = 5; ages 10-14 years) attended all 4 planned coaching sessions and completed an average of 9 of 12 planned exergame challenges for a weekly average of 50 min. All participants reported enjoying coaching sessions, 4 of 5 reported enjoying exergames, and 3 of 5 reported enjoying on-demand exercise videos. In interviews, children generally reported finding participation feasible, exergaming challenges active and fun, and coaches friendly and helpful. Parents reported high feasibility of supporting their children's involvement and valued child goal-setting and intervention flexibility; however, some found telehealth sessions overly scripted. Several adaptations to coaching scripts, coach training, and parent materials were made for the larger demonstration pilot, including changes to reduce scriptedness of coaching sessions, to provide parents with more information specific to autism, and to make video content more appropriate to children's needs/preferences.

Discussion

A telehealth coaching and exergaming intervention appears feasible, accessible, and engaging for autistic youth aged 10-15. Future studies with larger, more diverse samples, longer study durations and/or follow-up periods, and more rigorous study designs are needed to advance understanding of the appropriateness and effectiveness of this type of intervention for this population.

The Effects of Virtual Zumba ® on Functional Outcomes in Adults with Developmental Disabilities

INTRODUCTION

Few studies have examined the comprehensive impact of adaptive exercise interventions across multiple functional domains (i.e., physical and cognitive health) in adults with developmental disabilities (DD).

METHODS

The present study examined the effects of a 10-wk (2 sessions per week, 1 h per session) adapted Zumba ® intervention on the Six-Minute Walk Test (6MWT), Timed Up and Go (TUG), Clinical Test of Sensory Interaction on Balance, body composition, and executive function in 44 adults with DD age 20.8-69.2 yr. In addition to examining overall differences between control and intervention conditions, the effects of different Zumba ® tempos (normal/low) were examined. A crossover design with a 3-month wash-out period was used such that participants in the intervention also served as controls. The participants were quasi-randomized into one of two Zumba ® conditions: low-tempo Zumba ® (0.75 normal speed; n = 23) and normal-tempo Zumba ® ( n = 21).

RESULTS

A significant condition-time interaction was observed for the 6MWT and TUG; participants in the low and normal-tempo Zumba ® conditions significantly increased the distance walked for the 6MWT and reduced the total time for the TUG. No improvement was observed during the control condition for these measures. There were no significant condition-time interactions for the other outcomes.

CONCLUSIONS

These findings have implications on the efficacy and implementation of virtual Zumba ® programs to increase abilities related to independent performance of activities of daily living in adults with disabilities.

Policy brief: adaptive cycling equipment for individuals with neurodevelopmental disabilities as durable medical equipment

- Durable medical equipment (DME) policies require that the equipment be medically necessary; however, adaptive cycling equipment (bicycles and tricycles) are usually not deemed medically necessary. - Individuals with neurodevelopmental disabilities (NDD) are at high risk for secondary conditions, both physical and mental, that can be mitigated by increasing physical activity. - Significant financial costs are associated with the management of secondary conditions. - Adaptive cycling can provide improved physical health of individuals with NDD potentially reducing costs of comorbidities. - Expanding DME policies to include adaptive cycling equipment for qualifying individuals with NDD can increase access to equipment. - Regulations to ensure eligibility, proper fitting, prescription, and training can optimize health and wellbeing. - Programs for recycling or repurposing of equipment are warranted to optimize resources.

Alarming low physical activity levels in Chilean adults with disabilities during COVID-19 pandemic: a representative national survey analysis

Background

People with disabilities usually face barriers to regularly engaging in physical activities. Estimating physical activity patterns are necessary to elaborate policies and strategies to facilitate active lifestyles, considering the particular access difficulties experienced by this population.

Purpose

This study aimed (i) to describe the prevalence of physical activity levels and (ii) to examine the associations of physical activity levels with socio-demographic variables and type of disability in the 2020 Chilean National Physical Activity and Sports Habits in Populations with Disabilities (CNPASHPwD) survey during the coronavirus disease 19 (COVID-19) pandemic.

Methods

Cross-sectional data from 3,150 adults (18-99 years old), 59.8% female, were analyzed from November to December 2020. Self-reported age, gender, type of disability (i.e., physical, visual, hearing, intellectual, or mixed), socio-economic status, area and zone of residence, and physical activity levels (0 min/week, < 150 min/week, ≥ 150 min/week) were obtained.

Results

11.9% of the participants were classified as active (≥ 150 min/week), and 62.6% declared no involvement in physical activity. A larger proportion of females (61.7%) did not meet the current guidelines (≥ 150 min/week of physical activity) in comparison with males (p < 0.001). Participants with visual and hearing disabilities were more likely to be active than those with other types of disabilities. Those living in the central and southern regions of Chile were more likely to be physically active than those from the northern region. Also, older participants, women, and those from lower socio-economic statuses were less likely to meet the physical activity guidelines.

Conclusion

Alarmingly, nine out of ten participants were categorized as physically inactive, particularly women, older adults, and those with a low socioeconomic status. If the pandemic context moderated, the considerable prevalence of reduced physical activity levels deserves future exploration. Health promotion initiatives should consider these aspects, emphasizing inclusive environments and increasing opportunities to favor healthy behaviors, countering the COVID-19 effects.

'Our time is precious': An exploration of parental feeding behaviours for boys with Duchenne muscular dystrophy

INTRODUCTION

Due to the increased risk of obesity for boys with Duchenne muscular dystrophy (DMD), recent guidelines recommend that dietary intake is carefully managed. Parents play an important role in the development of their child's eating behaviours and patterns. However, despite what is known about the increased risk of obesity for children with DMD, little is known about parental feeding behaviours in this population. The objective of this study was to qualitatively explore the experiences of parents of children with DMD around their child's weight management and understand what influences their feeding behaviours.

METHODS

This paper reports a secondary data analysis. Semi-structured, individual interviews were conducted and analysed using qualitative description.

RESULTS

Thirteen parents were interviewed for the study. Three themes were developed: (1) parent responses to healthcare provider interactions, (2) mixed emotions contributing to feeding approach and (3) variable parenting feeding styles. Within the third theme, two subthemes arose including (1) control and preoccupation and (2) striking a balance.

CONCLUSION

Given the potential impact of higher weights on the progression of DMD, it is important that healthcare providers explore feeding behaviours with families. However, it is essential that healthcare providers consider the impact of these conversations on parents, as well as the broader issues that may place additional pressure on the lives of families.

Brassicaceae Fungi and Chromista Diseases: Molecular Detection and Host–Plant Interaction

Brassicaceae plants cover a large number of species with great economic and nutritional importance around the world. The production of Brassica spp. is limited due to phytopathogenic fungal species causing enormous yield losses. In this scenario, precise and rapid detection and identification of plant-infecting fungi are essential to facilitate the effective management of diseases. DNA-based molecular methods have become popular methods for accurate plant disease diagnostics and have been used to detect Brassicaceae fungal pathogens. Polymerase chain reaction (PCR) assays including nested, multiplex, quantitative post, and isothermal amplification methods represent a powerful weapon for early detection of fungal pathogens and preventively counteract diseases on brassicas with the aim to drastically reduce the fungicides as inputs. It is noteworthy also that Brassicaceae plants can establish a wide variety of relationships with fungi, ranging from harmful interactions with pathogens to beneficial associations with endophytic fungi. Thus, understanding host and pathogen interaction in brassica crops prompts better disease management. The present review reports the main fungal diseases of Brassicaceae, molecular methods used for their detection, review studies on the interaction between fungi and brassicas plants, and the various mechanisms involved including the application of omics technologies.

Accommodation and disability-specific differences in nutritional status of children with disabilities in Kathmandu, Nepal: A cross-sectional study

BACKGROUND

Worldwide, more than 150 million children < 18 years live with disabilities. These children are more vulnerable to malnutrition regardless of institutional care that they receive, such as daycare or residential care. In Nepal, little is known about the status of malnutrition and factors associated with malnutrition among children with disabilities. This study was conducted to investigate the factors associated with malnutrition based on the types of disability and accommodation.

METHODS

This institution-based, cross-sectional study was conducted in 22 institutions in the Kathmandu Valley, Nepal. From these institutions, parents/guardians of all children with disabilities were recruited who were present there on the day of data collection. They were interviewed using a structured questionnaire. The questionnaire included questions on demographic characteristics, disability type and severity, accommodation place, feeding practices, and dietary patterns. The outcome variables, stunting, underweight, and obesity were measured using height-for-age, weight-for-age, and body mass index-for-age, respectively. A generalized linear model was used to investigate the factors associated with stunting and underweight, and multinomial logistic regression was used to identify the factors associated with overweight and obesity.

RESULTS

Among the 345 children with disabilities, 45% were stunted, 33% were underweight, 19% were thin, and 12% were overweight. Children with physical disabilities (relative risk ratio = 1.88, 95% confidence interval [CI] = 1.26-2.81) were more likely to be stunted than those with sensory disabilities. Children with autism (adjusted odds ratio [aOR] = 5.56, 95% CI: 1.23-25.23) and intellectual disabilities (aOR = 5.84, 95% CI: 1.59-21.51) were more likely to be overweight and obese than those with sensory disabilities. No evidence was found regarding an association between accommodation type and malnutrition.

CONCLUSION

Children with disabilities are vulnerable to malnutrition in several ways. Different types of disabilities are associated with different forms of malnutrition. Considering the types of disabilities, tailor-made approaches should be adopted to improve malnutrition status.

The delivery of healthy lifestyle interventions for people with disability living in supported accommodation: a scoping review of intervention efficacy and consumer involvement

BACKGROUND

People with disability living in supported accommodation experience health disparities that may be partly attributed to sedentary lifestyle behaviors and poor dietary quality. Healthy lifestyle interventions have been suggested as a method of health promotion for this population; however, a synthesis of their efficacy has not yet been conducted.

OBJECTIVE

The primary aims were to (1) identify healthy lifestyle interventions delivered to people with disability living in supported accommodation and (2) examine their efficacy in supporting health and well-being. A secondary aim was to explore whether people with disability have been involved in the codesign of these interventions.

METHODS

A scoping review was conducted following the Joanna Briggs Institute's guidance for conducting scoping reviews, and six databases were searched from January 2011 to November 2021.

RESULTS

Thirty-two studies were included. Identified intervention types included training and education, exercise programs, and multicomponent interventions. A broad range of outcomes were examined; however, findings regarding efficacy were overall mixed and limited due to significant heterogeneity and the underreporting of consistently measured outcomes. The codesign of interventions in consultation with people with disability was underexplored.

CONCLUSIONS

Health promotion training for staff and tailored education for people with disability hold promise in creating a care environment that supports a healthy lifestyle. The paucity of interventions developed in consultation with people with disability is concerning and highlights the importance of meaningful co-design. The development of a theoretically informed intervention that is codesigned and addresses the broader social determinants that influence health behavior is recommended.

A randomized, cross-over trial comparing the effect of innovative robotic gait training and functional clinical therapy in children with cerebral palsy; a protocol to test feasibility

PURPOSE

Robotic gait training is relatively new in the world of pediatric rehabilitation. Preliminary feasibility studies and case reports include stationary robot-assisted treadmill training. Mobile robotic gait trainers hold greater promise for intensive practice-based therapy within hospitals, schools, rehabilitation centers, and at-home therapy as they enable participation and social integration while practicing high-quality gait patterns.

MATERIALS AND METHODS

This paper (clinical trials registry number: NCT05378243) provides a detailed description of a mixed-method cross-over trial design with a broad set of outcome measures. Ultimately the goal is to establish the feasibility of this design which includes the collection of qualitative data regarding patient, family, and therapist experience and quantitative data regarding gait efficiency and quality, impact on tone, individualized goal achievement and bone strength.

"WOT" Do We Know and Do About Physical Activity of Children and Adolescents With Disabilities? A SWOT-Oriented Synthesis of Para Report Cards

The purpose was to synthesize information gathered from the interpretation and conclusion sections of the Global Matrix of Para Report Cards on the physical activity of children and adolescents with disabilities. The synthesis was based on the strengths, weaknesses, opportunities, and threats framework. The procedure consisted of three stages: (a) the application of the International Classification of Functioning, Disability and Health as the theoretical framework; (b) identifying and aligning Global Matrix indicators and benchmarks with the International Classification of Functioning, Disability and Health components through a Delphi approach; and (c) using content analysis to identify themes from specific report cards. Outcomes reveal that further attention toward including children and adolescents with disabilities in fitness assessments is needed as well as adapted assessment methods. Program availability, equipment and facilities, and professional training emerged as strengths but need further development to overcome weaknesses. Paralympic inspiration was an opportunity, whereas extreme weather conditions presented potential threats to physical activity participation among children and adolescents with disabilities.

Opportunities for Participation: A Mapping Review of Inclusive Physical Activity for Youth With Disabilities

INTRODUCTION

The purpose of this review is to map the literature regarding group-based inclusive and adapted physical activity opportunities for youth with disabilities, and to identify gaps in that literature.

METHODS

A comprehensive search was completed across 5 electronic databases. Inclusion criteria were for any study type with youth ages 3 to 21 years who participated in any adapted group-based physical activity program, or their caregivers.

RESULTS

A total of 30 studies were included from 13 countries, consisting of more than 15 types of physical activity. Levels of evidence ranged from 2b to 4 as per the Oxford Centre for Evidence-Based Medicine Levels of Evidence system.

CONCLUSIONS

A small but growing body of evidence exists regarding group-based inclusive and adapted physical activity. A dearth of evidence exists for rurally residing programs and programs that include children with severe disabilities.

A qualitative exploration of the priorities and experiences of children with Duchenne muscular dystrophy, their parents, and healthcare professionals around weight management

PURPOSE

The quality and length of life for boys with Duchenne muscular dystrophy (DMD) has improved due to medical advancements, but obesity has emerged as and may pose a risk to their physical health. Clinical guidelines recommend attention to weight management, but healthcare professionals (HCPs) find implementing them in clinical care challenging. Little information is available about the perspectives of children with DMD and their families around weight management. This study explored the key priorities of children with DMD, their parents, and HCPs who treat them, around weight management.

METHODS

Qualitative, individual, semi-structured interviews were conducted and analyzed using a qualitative descriptive approach.

RESULTS

Participants included parents of children with DMD (n = 13), children with DMD (n = 10), and HCPs (n = 14). Theme one: "Competing priorities between healthcare providers, parents, and boys" contained two sub-themes: (i) Body mechanics and function; and (ii) Psychosocial well-being. Theme two: "The realities of living with Duchenne's Muscular Dystrophy," with subthemes: (i) Striving for normality; (ii) The trajectory of DMD; (iii) The labour associated with DMD.

CONCLUSION

HCPs, parents, and boys have diverging worldviews around weight management, highlighting the importance of integrating the priorities of families into care, even when not aligned with guideline recommendations.IMPLICATIONS FOR REHABILITATIONHCPs must understand the competing priorities in the lives of children with DMD and their families when discussing weight, weight management, and lifestyle changes.Quality of life and living a "normal" life are prioritized by children and families over the surveillance and time demands of lifestyle routines recommended by clinicians for weight management.Weight management recommendations should be based upon the individual needs and priorities of the family.

Metabolic Syndrome in Children With Myelomeningocele and the Role of Physical Activity: A Narrative Review of the Literature

Objectives

The purpose of this review is to describe the current scientific literature on the prevalence of metabolic syndrome in children with myelomeningocele and to gain insight into the baseline levels of aerobic fitness, endurance, and strength in this population in order to identify gaps in knowledge, suggest potential primary prevention strategies, and provide recommendations for future studies.

Methods

A literature review of articles published in English and French between 1990 and April 2020 was conducted.

Results

Obese adolescents with myelomeningocele have an increased prevalence of components of the metabolic syndrome. Children and adolescents with myelomeningocele have decreased aerobic fitness and muscular strength, decreased lean mass, and increased fat mass, all of which, when combined with higher levels of physical inactivity, put them at higher risk of developing metabolic syndrome and cardiovascular diseases.

Conclusion

Until more research is conducted, addressing weight-related challenges and promoting healthy habits (such as optimal activity levels) could be easily integrated into yearly myelomeningocele clinics. An actionable suggestion might be to systematically weigh and measure children in these clinics and utilize the results and trends as a talking point with the parents and children. The follow-up appointments could also be used to develop physical activity goals and monitor progress. We recommend that the health care practitioner tasked with this intervention (physician, nurse, etc.) should be aware of locally available accessible sports platforms and have knowledge of motivational interviewing to facilitate removal of perceived barriers to physical activity.

A comparison of the physical fitness of individuals with intellectually disabilities autism spectrum disorders and Down syndrome diagnosis

Introduction: This article reports the physical abilities and physical wellness of three groups of children with different neurodevelopmental disabilities: Autism, Down Syndrome and Intellectual Disability. Methods: The causal-comparative research method was implemented in this study. The participants comprised 32 students with moderate intellectual disabilities, 18 with autism spectrum disorder, and 22 with down syndrome. The body mass index (BMI), flexibility, standing long jump, sitting height, stroke length, and medicine ball throwing levels were measured for physical fitness, and the groups were compared afterward. The Kruskal Wallis-H Test and Mann-Whitney U Test were applied to determine the differences between the groups' physical fitness averages for the statistical analysis. Results: Statistically significant differences were obtained in BMI, standing long jump, stroke length, and medicine ball throwing variables (p < 0.05). However, no statistically significant difference was discovered for the flexibility and sitting height variables (p > 0.05). The BMI, sitting height, and stroke length levels for the group with autism spectrum disorder were higher than the other groups, as the flexibility levels of the group with down syndrome were higher than the other groups. Students with intellectual disabilities were demonstrated to have better values than other groups regarding standing long jump and medicine ball throwing performances. Conclusions: Objective information about the physical fitness of individuals with children with different neurodevelopmental disabilities was obtained. In addition, the data obtained with these children will contribute to future plans for movement training as well as the content and frequency of the interventions, and will guide the development of new strategies to develop physical abilities and physical wellness.

Older people and nature: the benefits of outdoors, parks and nature in light of COVID-19 and beyond- where to from here?

The COVID-19 pandemic has taken a significant toll on people's health and wellbeing globally. In the pandemic, parks, gardens and other local green spaces have been recognised as vital to people's physical and mental health. Emerging global evidence shows increased access to local parks and recreational activities and a new appreciation of the natural surroundings. Various movements and organisations globally have called for actions to embrace recent trends and changes in relation to the planning of public spaces and urban built environments to enable better access to parks and nature. The crisis, however, has exposed the inequities around access to green space where vulnerable populations such as older people and those in low socioeconomic areas are particularly affected. The crisis presents an opportunity to positively impact on society, and an opportunity to consolidate new emerging trends to better integrate nature into the architecture, infrastructure, and public spaces of urban areas.

Team Approach: The Management of Adolescents and Adults with Scoliosis and Spina Bifida

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Globally, the prevalence of myelomeningocele, the most common subtype of spina bifida, is 0.2 to 6.5 per 1,000 live births. In the U.S., adults account for >67% of the overall population with spina bifida.

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With an estimated prevalence of up to 50%, scoliosis is one of the most common and severe orthopaedic conditions in patients with myelomeningocele.

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The variable effects that scoliosis can have on an individual, the comorbidities associated with progressive scoliosis, and the risks associated with spine surgery call for a strong partnership and care coordination between medical and surgical teams to deliver a patient-centered approach.

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A coordinated, structured, planned, and incremental team approach can help individuals achieve the overall goals of functionality and independence, as well as successful transition to adulthood.

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Teams should consider a patient's social determinants of health (e.g., poverty or language barriers) and the effect of scoliosis on quality of life before proceeding with spinal deformity correction.

Exploring Direct and Indirect Associations of Exercise and Sport Participation with Employment among Individuals with Disabilities: A Scoping Review

Purpose Exercise and sports have many positive benefits for persons with or without a disability. Despite this, the contribution of exercise and sport participation to employment is less documented. The purpose of this scoping review was to provide insight into the direct and indirect associations of exercise and sport participation with employment among persons with disabilities. Methods Six databases were searched (MEDLINE, Embase, Scopus, PsychINFO, CINAHL, and HealthStar) from their inception date to March 20, 2020. Peer-reviewed English and French articles were included if at least one outcome measure on employment or work-related outcomes as a result of participation in, or benefits of exercise and sport participation was the focus of the study. Results The research identified 2796 hits. Of which, 23 published between 1992 and 2019 met eligibility criteria. Seven studies identified a direct association between exercise and sport participation with employment and full-time positions. Sixteen studies reported on improved health/work-related outcomes such as occupational performance (i.e., self-care, functional independence), physical fitness (i.e., upper extremity strength, endurance) and psychological well-being (i.e., self-efficacy). Conclusions This scoping review highlights that exercise and sport participation have associations with employment and work-related outcomes. Benefits of exercise and sports may be considered to a greater extent, than in the past, in programs that facilitate employment for persons with disabilities. Additional research using longitudinal design should be conducted to further understand the strength of these associations and evaluate whether exercise and sport participation should be incorporated more intensely in vocational programs.

Barriers and Facilitators of Physical Activity Participation among Children and Adolescents with Intellectual Disabilities: A Scoping Review

Background: Children and adolescents with intellectual disabilities (ID) have low levels of physical activity (PA). Understanding factors influencing the PA participation of this population is essential to the design of effective interventions. The purposes of this study were to identify and map the barriers and facilitators of PA participation among children and adolescents with ID. Methods: A scoping review was conducted in accordance with established methodology. Articles were evaluated for relevance using predetermined inclusion criteria in eight databases. Extracted barriers and facilitators were classified using the social ecological model as individual, interpersonal, or environmental factors. Results: Thirty-two studies published between 1992 and 2020 were included (24 quantitative, 6 qualitative, and 2 mixed-method). Thirty-four factors were identified. The most commonly reported barriers included disability-specific factors, low self-efficacy, lack of parental support, inadequate or inaccessible facilities, and lack of appropriate programs. The most commonly reported facilitators included high self-efficacy, enjoyment of PA, sufficient parental support, social interaction with peers, attending school physical education (PE) classes, and adapted PA programs. Conclusions: Continued exploration of factors influencing PA participation is required among children and adolescents with ID. Future interventions should involve families, schools, and wider support network in promoting their PA participation together.

A-ONE - an accessible online nutrition & exercise program for youth with physical disabilities

BACKGROUND

Pediatric disability prevalence has increased to 17.8% in recent years. This youth population faces a range of individual, social, and environmental level barriers to a healthy lifestyle. This is particularly concerning because this population is at a higher risk of obesity and lifestyle-related morbidity and mortality. Therefore, A-ONE: An Accessible and Online Nutrition & Exercise Program was designed to provide a comprehensive and holistic online program for youth with physical disabilities.

METHODS

A-ONE will offer two individualized fitness workouts and one accessible cooking session per week for 16-weeks. In addition, A-ONE will offer one social-mentoring session per week. All programming (4 sessions per week) will occur during after-school hours. The program will be offered 6 times during the 2-year grant period, enrolling 10 youth per cohort, for a total of 60 youth with physical disabilities. Outcomes to be examined include physical activity, fruit and vegetable consumption, independent meal preparation, quality of life, and self-efficacy. They will be assessed pre, post, and 4-weeks following the end of the program. Program fidelity and feasibility will also be assessed.

CONCLUSION

While children with physical disabilities benefit from opportunities to engage in physical activity and nutrition, accessible programming is unavailable. Despite decades of disability rights legislation mandating access to equal education, there is still a lack of system level solutions to improve the health inequity for youth experiencing disabilities. This program represents a sustainable and scalable way to remove barriers and improve the trajectories of health among youth with a physical disability.

Quality of Dietary Intake in Children With Developmental Disabilities: A Pilot Study

BACKGROUND

Children with developmental disabilities have a high prevalence of overweight and obesity. The role and contribution of their diet to weight status is poorly understood.

OBJECTIVES

This pilot study describes the dietary quality of children with spina bifida and Down syndrome compared with typically developing peers.

METHODS

Dietary intakes of 8 children with spina bifida or Down syndrome and 4 children without developmental disabilities, aged 8 to 18 years, were collected using six 24-hour dietary recalls through Facetime. Dietary quality was assessed by application of the Healthy Eating Index (HEI).

RESULTS

Children with spina bifida and Down syndrome had higher HEI scores when compared to typically developing peers (48.3, 52.9, and 46.2, respectively) and vegetable consumption (1.9, 2.6, and 1.4, respectively). All groups had undesirable intakes of saturated fat, added sugar, and sodium. Within this small sample, children with spina bifida and Down Syndrome had similar diet quality to their typically developing peers.

CONCLUSIONS

Further investigation in a larger sample is recommended to support the development of methods to optimize weight management in children with developmental disabilities.

Physical activity levels, lifestyle behaviour and musculoskeletal health profiles among seated video gamers during COVID-19

OBJECTIVES

The aim of this research study was to determine the physical activity levels of non-active video gamers, and to determine how much other time was spent with sedentary behaviours, both in recreational and occupational domains.

METHODS

The study used the International Physical Activity Questionnaire, and investigated physical activity levels and health data of seated gamers. Typical weekly gaming habits, self-reported musculoskeletal pain and physical activity levels experienced by participants while gaming was also obtained.

RESULTS

Out of a total of 102 participants, 69.6% stated that they game for 3 hours or more on a typical weekday. Most participants video game seated or reclined (96.1%, p=0.01), with only four participants engaging in some form of active video gaming. In relation to physical activity levels, despite the high frequency and duration of gameplay, 87.3% of participants stated they engaged in moderate-intensity physical activity (p=0.02). There was an association with video gaming and musculoskeletal pain, with over half of the participants stating they experienced pain while gaming. There was also a link between seated video gaming and musculoskeletal pain among participants.

CONCLUSION

Findings from this study show that the high frequency and duration of video gaming among gamers does not affect physical activity for moderate and vigorous intensities, but does affect musculoskeletal pain. Further research is required to determine whether video gaming has a significant effect on lifestyle, sedentary habits and musculoskeletal health, especially in the context of the COVID-19 pandemic where sedentary behaviour has likely increased.

Physical and psychological health outcomes of a sitting light volleyball intervention program on adults with physical disabilities: a non-randomized controlled pre-post study

BACKGROUND

People with physical disabilities (PWPD) have limited opportunities to participate in sport activities. Sitting light volleyball (SLVB) is an adapted sport that combines light volleyball and paralympic sitting volleyball. This study examined the effectiveness of an SLVB intervention program to improve the physical and psychological health outcomes of PWPD in Hong Kong, China.

METHODS

Thirty-two PWPD [13 women; SLVB group, n = 18; control group (CG), n = 14] with an average age of 48.89 years (SD = 14.42 years) participated in a 16-week intervention consisting of basic SLVB skills, and they also received instructions on the required posture, team tactics, and SLVB rules. Physical (i.e., muscular strength, muscular endurance, body composition, flexibility, and aerobic endurance) and psychological (i.e., physical activity enjoyment and quality of life) health outcomes were measured before and after the intervention.

RESULTS

Individuals in the SLVB group exhibited statistically significant improvements in cardiovascular endurance [F(1,29) = 4.23, p = .049], body composition [F(1,23) = 6.67, p = .017], and physical activity enjoyment [F(1,29) = 16.94, p = .001] compared with adults in the CG.

CONCLUSIONS

Participating in SLVB has physical and psychological benefits for adults with physical disabilities in this study. Registration number of trial registry: The trial is registered at chictr.org.cn, number ChiCTR2000032971 on 17/05/2020.

Prevalence of overweight and obesity in children and adolescents with intellectual disabilities in China

BACKGROUND

Overweight and obesity in children and adolescents has become a worldwide epidemic. There are several studies that have concentrated on the prevalence rate of children and adolescents with intellectual disabilities (ID), whereas data on such a population on the mainland of China remain unclear. The purpose of this study was to investigate the prevalence rate of overweight and obesity among school-aged children and adolescents with ID on China's mainland.

METHODS

This study employed a cross-sectional design to examine the body weight status of 1873 children and adolescents (ages 6-18 years old) with ID in 35 special education schools. Body mass index was calculated, and the concepts of overweight and obesity were defined according to the standard of the Working Group for Obesity in China.

RESULTS

Data indicated that 18.2% (95% CI: 16.5%-20.0%) of children and adolescents with ID were overweight and 14.4% (95% CI: 12.8%-16.0%) were obese. Boys with ID were more likely to be overweight than girls with ID (OR = 1.48[95% CI: 1.13-1.94], P < 0.05). Children and adolescents with Down syndrome or autism spectrum disorder had a trend to be classified as overweight (OR = 1.76[95% CI: 1.22-2.54], P < 0.05; OR = 1.57[95% CI: 1.17-2.09], P < 0.05, respectively) or obesity (OR = 1.82[95% CI: 1.23-2.69], P < 0.05; OR = 1.40 [95% CI: 1.02-1.93], P < 0.05, respectively) compared with those with ID without these conditions. Moreover, children and teenagers with ID living in urban areas had a predisposition to be overweight (OR = 2.16[95% CI: 1.14-4.09], P < 0.05) or obese (OR = 3.25[95% CI: 1.41-7.50], P < 0.05) relative to those who lived in rural areas.

CONCLUSION

Results indicated that in China, the prevalence rate of overweight and obesity among school-aged children and adolescents with ID was remarkably high. Therefore, future research should make every effort to focus on reducing and preventing overweight and obesity of this population in China.

Physical Activity and Accomplishment of Recommendations in University Students with Disabilities: A Longitudinal Study

University settings are socio-environmental contexts that can reduce health disparities in students with disabilities. Therefore, the aim of this study was twofold: (a) to examine the longitudinal physical activity (PA) changes of Spanish university students with disabilities during a three-year period; and (b) to identify the accomplishment of the World Health Organization’s PA recommendations in this period. A three-year follow-up cohort study was conducted on 355 university students with disabilities (172 men, 183 women). The participants completed an electronic survey on PA after which a descriptive analysis, longitudinal (Wilcoxon tests) and cross-sectional pairwise comparisons (Mann–Whitney U and Kruskal–Wallis tests) were performed on non-normal data. The results show no significant PA changes during the three-year period. The cross-sectional comparisons between the waves presented a reduction in vigorous PA according to sex and similar values by age, origin of disability, and socioeconomic status. A global reduction of 0.6% was found in achieving the recommendations between the waves. We also found an increase of 5.3% in the participants classified as overweight–obese during this period. The findings offered in this study have important implications for university disability care services and sports services. University policies should focus on rethinking PA and sports programs for students with disabilities.

The Adaptive GameSquad Xbox-Based Physical Activity and Health Coaching Intervention for Youth With Neurodevelopmental and Psychiatric Diagnoses: Pilot Feasibility Study

Background

The prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences.

Objective

This pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs.

Methods

Participants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA.

Results

Of the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67%) reported intention to continue, and 8 (89%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (−58.8 min; P=.04) but not for the intervention group (−5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames.

Conclusions

AGS shows promise in delivering a health behavior intervention remotely to youth with NPDs, but a full-scale efficacy trial with a larger sample size is needed to confirm this finding. On the basis of feedback from beta testers and intervention participants, the next steps should include reduced technology burden and increased exergame choice before efficacy testing.

Trial Registration

ClinicalTrials.gov NCT03665415; https://clinicaltrials.gov/ct2/show/NCT03665415.

The delivery of obesity interventions to children and adolescents with physical disabilities: a systematic review

BACKGROUND

To examine the process and mechanisms of delivering obesity interventions to physically disabled children/adolescents.

METHODS

PubMed, Medline, CINAHL Plus, Embase, Cochrane Library, Google Scholar, ClinicalTrials.gov, Science Direct were systematically and manually searched for studies conducted in physically disabled children/adolescents (0-18 years). Included interventions were physical activity, diet and obesity prevention education. Included outcomes were body mass index (BMI)/weight and obesity prevention knowledge. The Mixed Methods Appraisal Tool aided methodological quality assessments. Data were extracted and delivery models were synthesized and narratively summarized using the social ecological model.

RESULTS

Seven studies of low (n = 4) and moderate (n = 3) scoring on methodological quality were eligible for inclusion. Study duration was 5 months or less (n = 5), 8 months (n = 1) and 2 years (n = 1). Interventions were delivered at home, school, hospital and rehabilitation centre through the internet, face-to-face and parents. No intervention was delivered at three or more levels of individual, interpersonal, institutional or community levels. No study reported significant outcomes on reduction in BMI/weight, or increase in obesity prevention knowledge.

CONCLUSIONS

Evidence reviewed in this study shows that obesity interventions for physically disabled children/adolescents lack both in delivery and design. Gaps revealed should be considered when developing interventions for this special population.

Accuracy of body mass index in categorizing weight status in children with intellectual and developmental disabilities

PURPOSE

To identify the accuracy of Body Mass Index (BMI) to categorize body weight in a sample of children with spina bifida and Down syndrome as compared to typically developing peers.

METHODS

A secondary analysis of 32 children with spina bifida, Down syndrome or no chronic illness. A calculated BMI was plotted on the Centers for Disease Control and Prevention age- and sex-specific BMI growth charts to determine each child's weight status. Percentage of body fat, obtained by labeled water, was plotted on two different body fat percentile reference curves, one derived from a whole body measure (DXA) of body fat and one by skin-fold measure. Differences in weight categories between calculated BMI and body fat percentile curves were reported.

RESULTS

The calculated BMI for children with a disability had significant misclassifications as a screening tool for body fat when compared to children without a disability. Misclassifications were increased with the body fat percentile reference curve derived from skin-fold measures and for children who primarily used a wheelchair.

CONCLUSION

The current recommendation to use BMI to categorize weight status is not useful for many children with disabilities. Further research to identify an alternative pragmatic strategy is necessary.

Physical Activity Levels, Enjoyment, and Perceptions of Barriers to Physical Activity of Adolescents with Visual Impairments in Turkey

Purpose:

The purpose of this study is to determine the physical activity (PA) status of adolescents with visual impairment, their enjoyment of the PA, and their perception of barriers to PA.

Design and Methods:

This descriptive study was conducted with 110 adolescents with visual impairment. The data collection tools consisted of the (ALP-R2)-Physical Activity Subscale, the Physical Activity Enjoyment Scale (PAES), Barriers to Physical Activity Questionnaires, and an Observation Form. The data were analyzed using frequencies, correlation, and Kappa tests.

Results:

It was observed that 60% of the participants stated that they did not engage in PA, 58.2% said they did not engage in PA to the extent of breaking out in a sweat and increasing their heartbeat, and 48.2% indicated that they never did PA 3 times a week for 20 minutes or more. The PAES mean score was 55.1 ± 5.5; the Physical Activity Subscale mean score was 12.5 ± 4.1 ( r = 0.42; p < 0.01).

Discussion:

Our findings were consistent with the results of other studies in that the changeable external factors and parental attitudes perceived as obstacles were similar.

Implications for practitioners:

Most of the participants wanted to be more active. Most of the adolescents’ answers to the questions about the perceived barriers to PA were contrary to what had been expected. Although the adolescents said they did not engage in PA, the number of adolescents who perceived changeable factors such as the environment and parents’ attitudes as barriers was not negligible.

Identifying characteristics and outcomes in youth with obesity and developmental disabilities

BACKGROUND

Youth with developmental disability are at increased risk of obesity; literature focusing on the two is rare.

OBJECTIVE

To identify characteristics and outcomes of youth presenting for obesity care having a disability as compared to without.

METHODS

A medical record review of youth aged 2-18 years initiating obesity care 2013-2015 at a tertiary care obesity management program. Youth were grouped by disability status to identify differences in presenting characteristics and factors associated with a reduction in body mass index (BMI) percent of the 95th BMI percentile (BMIp95) over 12 months. Logistic regression (LR) models examined associations with BMIp95 drop (<5-points versus ≥5-points) for each disability group.

RESULTS

Of 887 subjects, 253 (28.5%) had a disability. At presentation, youth with disability were more often (p < 0.01) male (58.5% versus 47.9%), had birth weight <2500 g (14.1% versus 8.4%), had a father who was not obese (61.6% versus 47.4%), and were on weight influencing medications. Overall, 182 subjects (20.5%) completed 12-month follow-up. At follow-up, the with disability group (n = 63) had mean -2.3 (SD 10.7) BMIp95 change (p = 0.679); youth having a motor disability less often had ≥5-point BMIp95 drop (odds ratio 0.15, 95% confidence interval 0.04-0.59). At follow-up, the no disability group (n = 119) had mean -2.9 (SD 8.5) BMIp95 change; youth identified as having initial severe obesity status and not having a parent with diabetes more often had ≥5-point BMIp95 drop.

CONCLUSION

Youth with developmental disabilities were as successful in obesity care as those without disabilities. Predictors of success differed between the groups.

A cross-sectional examination of the 24-hour movement behaviours in Canadian youth with physical and sensory disabilities

BACKGROUND

Canada's 24-Hour Movement Guidelines for Children and Youth provide daily recommendations for physical activity (PA), screen time, and sleep for optimal health. The appropriateness of such guidelines for youth with disabilities remains unknown.

OBJECTIVE

To cross-sectionally examine the 24-h movement behaviours and guideline adherence in youth (ages 12-21 years) with physical and sensory disabilities.

METHODS

54 youth with physical and sensory disabilities completed two, 24-h recalls to assess PA, sedentary behaviour, and sleep. Descriptive statistics were used to analyze behavioural patterns and guideline adherence. Gender and age differences were tested using analyses of variance and logistic regressions.

RESULTS

55.5%, 13.0%, and 53.7% of the sample met the individual guidelines for PA, sedentary behaviour, and sleep, respectively. 3.7% of the sample met all three movement guidelines. No significant gender or age differences in guideline achievement were found. Over a 24-h period, youth spent 77 (59) minutes engaging in moderate to vigorous PA, 252 (120) minutes engaging in sedentary activity, and 546 (90) minutes sleeping. Boys reported significantly more time (adjusted M_difference = 11 min) playing passive video games than girls.

CONCLUSION

Overall, our sample of youth with physical and sensory disabilities falls far short of meeting the Canadian 24-Hour Movement Guidelines for Children and Youth. The low proportion of youths' time spent engaging in sport and active play is concerning, highlighting the importance of creating access to these types of PA experiences for this population. Future population-based research is needed among children and youth with all types of disabilities to build an evidence-base of their movement behaviours.

Analysis of health habits, vices and interpersonal relationships of Spanish adolescents, using SEM statistical model

The objective of this article is to know the state of health of a sample of adolescents and how it relates to toxic habits and personal relationships. Likewise, it is presented how can influence eating habits, sports practice and interpersonal relationships in their general health status. The research has carried out through a survey of 56 questions to 470 adolescents, between 13 and 18 years old, of both sexes, of different schools in the province of Cordoba, Spain. These results have been subjected to a statistical model widely used in health and social sciences in general, called Structural Equations Model (SEM), through the SPSS program, v. 23 and AMOS. SEM is widely used in the social sciences to estimate regression models (usually multi-equational). The estimated model shows a significant global acceptability based on the usual statistical tests and goodness-of-fit measures. In this regard, these results are: CMIN = 17.554 with 33 degrees of freedom (DF) and a probability level, p = 0.987, which is higher than any reasonable level of significance (α = 0.05, 0.10, even 0.20). Likewise, FMIN = 0.038, CFI = 1.000 and RMSEA = 0.000. The main recommendation of this research aimed at improving good eating and healthy habits, and to avoid toxic habits of adolescents, is to begin the education in the family, in coordination with their school and high school.

Social Participation Among Adults Aging With Long-Term Physical Disability: The Role of Socioenvironmental Factors

Objective: This study examined the environmental barriers and facilitators that hinder or promote participation among adults aging with physical disabilities. Method: Data come from an ongoing study of 1,331 individuals aging with long-term physical disability (M = 65 years). Linear regression examined the association between individual and socioenvironmental factors and participation restrictions in work, leisure, and social activities. Results: Pain, fatigue, and physical functional limitations were significant barriers to participation for individuals aging with physical disability. Barriers in the built environment also reduced participation, net of health and functioning. Poor access to buildings was especially problematic for participation among individuals not using any mobility aid to get around. But for those using wheel or walking aids, environmental barriers had no adverse effect on participation. Discussion: These findings highlight the importance of disentangling the role of different environmental factors by distinguishing between assistive technology for mobility and the physical built environment, including their interactive effects.

The Effect of Vibration Therapy on Walking Endurance in Children and Young People With Cerebral Palsy: Do Age and Gross Motor Function Classification System Matter?

Objective

To investigate the effect of age and Gross Motor Function Classification System (GMFCS) level on walking endurance after 20 weeks of vibration therapy in children and young people with cerebral palsy (CP).

Design

The study was a clinical trial without control group comparing baseline and postintervention outcomes within participants.

Setting

Vibration therapy was performed at school or at home. Assessments took place in a clinical research unit.

Participants

Children and young people (N=59) with CP, aged 5-20 years, GMFCS level II, III, or IV, recruited through schools, physiotherapy services, and District Health Board clinics, Auckland, New Zealand.

Interventions

Participants performed side-alternating whole-body vibration therapy (WBVT) at 20 Hz and 3-mm amplitude, 9 minutes per day, 4 times per week for 20 weeks.

Main Outcome Measures

Distance walked in the 6-minute walk test (6MWT) was recorded before and after the intervention.

Results

Participants baseline results for the 6MWT were lower, independent of age or GMFCS, when compared to non-CP literature. On average, participants walked 12% further in the 6MWT after the intervention (P<.001). There was significant improvement in 6MWT distance in all age groups (5-10y: 16%, P<.001; 11-15y: 10%, P=.001; 16-20y: 13%, P<.001) and all GMFCS levels (level II: 10%, P<.001, level III: 40%, P=.013, level IV: 57%, P=.007). There was a greater percentage improvement in the distance walked in those with GMFCS level III and level IV than level II (P=.049 and P<.001, respectively).

Conclusions

WBVT had a beneficial effect on walking endurance in children and young people with CP, independent of age and GMFCS.

Comparisons of Speech Parameterisation Techniques for Classification of Intellectual Disability Using Machine Learning

Classification of intellectually disabled children through manual assessment of speech at an early age is inconsistent, subjective, time-consuming and prone to error. This study attempts to classify the children with intellectual disabilities using two speech feature extraction techniques: Linear Predictive Coding (LPC) based cepstral parameters, and Mel-frequency cepstral coefficients (MFCC). Four different classification models: k-nearest neighbour (k-NN), support vector machine (SVM), linear discriminant analysis (LDA) and radial basis function neural network (RBFNN) are employed for classification purposes. 48 speech samples of each group are taken for analysis, from subjects with a similar age and socio-economic background. The effect of the different frame length with the number of filterbanks in the MFCC and different frame length with the order in the LPC is also examined for better accuracy. The experimental outcomes show that the projected technique can be used to help speech pathologists in estimating intellectual disability at early ages.

Growth assessment and weight management in paediatric neuromuscular clinics: a cross-sectional survey across Canada

PURPOSE

To identify current practices related to the assessment, monitoring and discussion of bodyweight, growth and obesity in neuromuscular clinics for children with Duchenne muscular dystrophy (DMD).

METHODS

A cross-sectional, online survey was distributed using snowball sampling to healthcare providers working with children with DMD across Canadian neuromuscular clinics. Summary and descriptive statistics were calculated. Content analysis was performed on open text responses.

RESULTS

Thirty-seven responses were received, representing a range of healthcare disciplines. Height and weight were routinely assessed by 32/37 (87%) respondents, although only 21/37 (57%) responses reported having a clinic standard for measuring height and 23/37 (62%) for weight. While 32/36 (89%) reported discussing weight during consultations, only 13/37 (35%) felt confident doing so. Dietitians were considered the most appropriate person to discuss and manage weight with children and families, although only 17/37 (46%) reported having a dietitian involved in their clinic.

CONCLUSIONS

Neuromuscular clinics could benefit from implementing consistent and recommended growth assessment practices. The development of evidence-based tools, training and protocols tailored to Duchenne muscular dystrophy should be a priority.IMPLICATIONS FOR REHABILITATIONGrowth and weight monitoring approaches vary within and between neuromuscular clinics.Additional training on discussing and managing weight are warranted across disciplines.Advocacy is required to ensure access to dietetic expertise within neuromuscular clinics.

Lessons learned from a blended telephone/e-health platform for caregivers in promoting physical activity and nutrition in children with a mobility disability

BACKGROUND

Children with physical disabilities report higher rates of sedentary lifestyle and unhealthy dietary patterns than non-disabled peers. These behaviors can increase comorbidities, caregiver burden, and healthcare costs. Innovative interventions are needed to assist caregivers of children with physical disabilities improve health behaviors.

OBJECTIVE

/Hypothesis: The purpose of this pilot study was to test the usability and preliminary efficacy of an e-health and telecoaching intervention compared to telecoaching alone.

METHODS

Parent/child dyads (n = 65) were randomized into either the e-health and telephone group (e-HT) or the telephone only group (TO). All participants received regular calls from a telecoach, and the e-HT group received access to a website with personalized weekly goals for diet and physical activity, and access to resources to meet these goals. At the conclusion of the intervention, participants in the e-HT group were asked to complete a semi-structured interview to discuss the usability of the e-health platform.

RESULTS

Fifty of the 65 randomized dyads (77%) completed all baseline measures and had at least one intervention call. Forty families (80% of those that started the intervention) completed the study (50% spina bifida, 24% mobility limitation, diagnosis not reported). Age of the children ranged from 6 to 17 years old. Both groups had high adherence to scheduled phone calls (e-HT (n = 17): 81%, TO (n = 23): 86%); however no significant differences in dietary intake or physical activity were seen within or between groups. Primary themes to emerge from qualitative interviewers were: the platform should target children rather than parents, parents valued the calls more than the website, and schools need to be involved in interventions.

CONCLUSIONS

E-health interventions are a promising way to promote healthy behaviors in children with physical disability, but technology must be balanced with ease of use for parents while also engaging the child.

Nutrition, metabolic syndrome, and obesity: Guidelines for the care of people with spina bifida

Nutritional challenges and a lack of activity can lead to health problems across the lifespan for people with spina bifida. Children and adults with spina bifida are also at greater risk of being classified as overweight or obese compared to their peers without the condition. Therefore, early recognition of nutrition problems, weight management counseling, and timely referrals for evaluation and management of diet and activity can help those with spina bifida and their families achieve a healthy lifestyle. This article details the development of the Nutrition, Metabolic Syndrome and Obesity Guidelines, which are part of the 2018 Spina Bifida Association's Fourth Edition of the Guidelines for the Care of People with Spina Bifida. It discusses the identification and management of poor nutrition and prevention of obesity for children, adolescents, and adults with spina bifida and highlights areas requiring further research.

I Work Out, Who Cares if I'm Bigger: What Matters to Youth with ASD regarding Weight and Their Bodies?

Background: Childhood overweight and obesity, in addition to weight stigma, can result in numerous physical and psychosocial conditions. Children with Autism Spectrum Disorder (ASD) are at a higher risk of developing overweight/obesity than their typically developing peers, yet we know little about what matters to them with regards to weight and their bodies.Methods: Eight semi-structured interviews were conducted with youth with ASD. Interviews were transcribed and analyzed using a phenomenological approach within an interpretive paradigm.Results: Participants mostly showed little concern about their weight. Participants highly valued moving their bodies and reported feeling good about their bodies.Discussion: Findings suggest that children with ASD may be more engaged in healthcare discussions focusing on growth and health rather than size and weight. This approach can also reduce stigmatizing discussions.

The perspectives of parents of youth with disabilities toward physical activity: A systematic review

BACKGROUND

Parents' perceptions of physical activity (PA), in particular, are critically important because children with disabilities are often dependent on their families to be able to engage in physical activities. Thus, adapted physical activity scholars have acknowledged the need for research addressing the perceptions of parents of youth with disabilities regarding their child's PA engagement.

PURPOSE

The purpose of this review was to examine published research literature pertaining to parents' perspectives toward physical activity of youth with disabilities by describing study characteristics and major findings.

METHODS

Electronic database searches were conducted to identify relevant articles published between January 2007 and January 2018.

RESULTS

Thirty-two articles met all inclusion criteria, and relevant data such as participant characteristics, theories, measurements, and dependent variables were extracted from them. Of the 32 studies, 26 were descriptive, and six were correlational. Seventeen studies explicitly stated a theoretical or conceptual framework.

CONCLUSIONS

Major findings suggest that parents have reported multiple motives to engage their children with disabilities in physical activity. However, numerous barriers (e.g., lack of program, lack of time, children's disability) were reported that negatively impact physical activity participation. As such, parents are calling for the need for training provided by qualified professionals to enhance participation for their children with disabilities.

The International Spinal Cord Injury Pediatric Activity and Participation Basic Data Set

Study design

International focus groups.

Objectives

The objective of this project was to develop the International Spinal Cord Injury (SCI) Pediatric Activity and Participation (A&P) Basic Data Set.

Methods

A focus group of experts in pediatric and adult SCI, and contributors of the existing adult International SCI Adult A&P Basic Data Set convened to develop an initial draft of the data set, which was iteratively refined over a 12 month period based on relevant literature and existing outcome measures that evaluate pediatric activity and participation. The draft was reviewed and approved by the larger project working group and then distributed to the International Spinal Cord Society (ISCoS), American Spinal Injury Association (ASIA), and relevant expert groups for review. Feedback received was considered before the final data set was approved.

Results

The International SCI Pediatric A&P Basic Data Set is comprised of 13 variables: administration date, mobility, dressing, feeding, toileting, communication, family outings, spending time with friends, being out with friends, participating in team or club activity, paid work, dating, and physical activity. It is intended for children between 6 and 17 years of age, who have been discharged from initial rehabilitation/hospitalization for a minimum of 3 months.

Conclusion

The International SCI Pediatric A&P Basic Data Set was developed to standardize the recording of a minimal amount of information about activities and participation in children with SCI. Further work on reliability and cultural validation is needed.

Sponsorship

This study was funded by the Rick Hansen Institute, Research Award #G2015-27 (Mulcahey, PI).