Physical fitness and activity in persons

with

severe/profound intellectual and

visual disabilities

Dr. A (Aly) Waninge

Physical therapist and Lector Participation and health in persons

with severe/profound intellectual and visual disabilities

Koninklijke Visio & Hanzehogeschool Groningen

De Brink Applied Science in Health Care

and Nursing

Content

Definition and features ID

Target population ID

Overview research

Target population ID and visual disability (4)

Adapted tests physical fitness

GMFCS

Tests and measures (3)

Questions

Results (5)

In practice (2)

Lectoraat Transparante

Zorgverlening22-3-

2015

Definition and featuresIntellectual Disability

(ID))

Inleiding Mensen met een

verstandelijke beperking.

Significant limitations in intellectualfunctioning and adaptive behavior

Social and practical skills

Ability to make choices

Inclusion* Schalock et al, 2002

IQ<70

>2 (adaptive) behavior problems

Handicap discovered before 18 years old

Prevalence: Europe 1 %, NL 160.000* Ras et al, 2010

Lectoraat Transparante

Zorgverlening22-3-

2015

Target populationID 1

Inleiding Mensen met een

verstandelijke beperking.

Four levels IQ

- Mild ID 50-69

- Moderate ID 35-49

- Severe ID 20-35

- Profound ID <20

Lectoraat Transparante

Zorgverlening22-3-

2015

Foto´s Doelgroep Verstandelijke Beperking

(VB)

Inleiding Mensen met een

verstandelijke beperking.

11-12-2014 Lectoraat Transparante

Zorgverlening

Overview research

Health Participation

Healthproblems in persons withProfound Intellectual and Multiple Disabilities (Dinette vanTimmeren)

Concept participation in persons with severe/profound intellectualand visual disability (GinekeHanzen)

Active Ageing of persons withIntellectual Disabilities (Rianne Steenbergen, Marie José Ahlers)

ADL independence, strength andbalance in persons withsevere/profound intellectual andvisual disability (Annemarie Dijkhuizen)

Care for Participation: Rehabilitation in persons withsevere/profound intellectual andvisual disability (Gineke Hanzen)

Target population

1

Persons with Intellectual disabilities Visual impairments

Opportunities for compensation decrease

Disabilities increase(Kiestra, 2005)

IQ < 35; 75% loco motor disabilities(Nakken & Vlaskamp, 2007)

Target population

2

Prevalence visual impairment

(according to WHO)

In persons with intellectual disabilities

- 19% (Splunder et al, 2003)

In persons with severe intellectual disability

- 67% (Nagtzaam/Evenhuis, 2002)

In persons with severe or profound intellectual

disability - 92% (Van den Broek, 2004)

People

With

SIVD

Target population

3

Target population

4Motor disabilities

Slower

Less coordination

Less variation

Less explorative

Adapted tests

Physical Fitness 1

http://www.visio.org/nl-nl/bewegen-is-

gezond

Related to demands set by his or her

environment

Components related to sports, speed,

reaction time..

In case of poor motor skills…

Adaptation tests cardio respiratory fitness

Practice (with heart rate monitor)

Environment and structure

Professional guidance

Parcource

Contra-indications

Validity less, if feasibility is insufficient?

Difficulties in determining validity of tests and measures?

Adapted tests

Physical Fitness 2

GMFCS

(Palisano et al,1997; Gorter, 2001 NL)

*Gross Motor Functioning Classification System

I Walking without disabilities

II Walking with little support; walking outside

III Walking with support, distance decreases

IV Active moving

V Hardly active moving

Measuring

physical fitness

Body composition: BMI, waist circumference

Cardiorespiratory fitness:

- 6 Minutes Walking Distance (6 MWD)

- adapted Shuttleruntest (aSRT)

Balance:

- modified Berg Balance Scale

Muscle tonus:

- Modified Ashworth Scale

Muscle strength

- No feasible tests available

[Waninge et al, 2010]

Questions?

?

Question 1

What is true for persons with severe/profound

intellectual and visual disabilities?

1. Less overweight than in persons without

disabilities

2. More overweight than in persons with mild or

moderate intellectual disabilities.

3. More overweight than in persons without

disabilities

Results 1BMI 2007-2010!

p>0.05

p>0.05

n=45

Question 2

What is true for persons with severe/profound

intellectual and visual disabilities?

1. Cardiorespiratory fitness similar to healthy

elderly

2. Cardiorespiratory fitness worse than healthy

elderly

3. Cardiorespiratory fitness better than persons

with heart failure

0

100

200

300

400

500

600

700

Heart failure ChronicPulmonalDisease

Healthy Elderly Persons withSIVD

Dis

tan

ce in

met

ers

Results 26 Minutes Walking Distance

Results 3

6 MWT

Results 4

aSRT

P=0.135

22-3-2015 Titel presentatie aanpassen 22 Research and

Innovation Group in

Health Care and

0

5

10

15

20

25

30

35

40

2008 2011

p

o

i

n

t

s

mBBS niv 1 n=15

mBBS niv 2 n=11

p < 0.05

p = 0.168

Results 5modified Berg Balance Scale

Right/wrong?

People with intellectual disabilities perform

sufficient healthy physical activity

Influence direct support persons on life style

is important

Physical fitness of all persons with intellectual

disabilities can be reliably and validly

measured

Lectoraat Transparante Zorgverlening

In practice

1

Measurements weight monthly; Body

height once a year

Tests once a year

- Follow up individuals

- A movement plan voor every one,

integrated in daily program;

- Attention for healthy diet

In practice

2

New ways to move

Special weeks to promote physical activity,

sports and healthy diet

Motivation of clients and caregivers

increases

Moving is fun!

Thanks for your attention!