|  February's
Adapted section of PELINKS4U is dedicated to a four-step exercise
program for children with Cerebral Palsy, Muscular Dystrophy, and
Spinal Bifida.
This workout program is designed to give instructors the tools
needed to increase mobility, strength, and endurance for students
with disabilities. In addition, suggestions about body characteristics,
stretching ideas, and workout strategies will be presented.
There are four complete workout programs, designed on a continuum
from less able to more able.
Please check these additional resources.
Phillip Conaster,
Ph.D
Adapted Section Editor |
 
As with any exercise program,
intensity, duration, and frequency need to be optimized. To help
ensure the endurance component, students should maintain their
heart rate at 70 to 80% of their max for 35 minutes.
Note: if students are exercising in a wheelchair
or laying horizontal, reduce their maximum heart rate by 20 to
30 beats per minute. For example, a girl 10 years old that uses
a wheelchair, would have a target range of 220 minus 20 or 30
minus her age (10) = 190 or 180 x .7 to .8 = 133 to 152 or 126
to 144 beats per minute. Exercises should be three or more times
a week. Remember, when doing weight lifting, move quickly from
set-to-set or machine-to-machine to maintain heart rate.
Key Things to Remember or Look For
| A. |
The Body |
| |
1. |
Primitive reflexes |
| |
|
a. |
Symmetrical tonic neck reflex: this
will result in an extension of the arms and flexion of legs. |
| |
|
b. |
Mora reflex: loud noises will result in extension
of extremities. |
| |
|
c. |
Cross extension reflex: fluctuation in muscle
and/or movement of one limb reflex affects the other. |
| |
2. |
Tendon reflexes are easily excitable
and stretch reflexes are exaggerated. |
| |
3. |
Agonist muscles strongly flexed;
antagonist muscles usually stretched. |
| |
4. |
Increased muscle tone, primarily
in the antigravity muscles, resulting in abnormalities and
muscle imbalance. |
| |
5. |
Can have contractures in major or
minor joints. |
| |
6. |
Possible problems with spatial awareness,
balance, and kinesthetic sense. |
| |
7. |
Athetoid problems |
| |
|
a. |
Involuntary movement (keep extremities close
to anatomical position; slow controlled movement) |
| |
|
b. |
Too little tone. |
| |
|
c. |
All four limbs affected. |
| B. |
Stretching |
| |
1. |
Generates heat in the muscle due
to the metabolism of contraction and relaxation. |
| |
2. |
Reduces the viscosity of muscular
fluids and synovial fluid. |
| |
3. |
Use active, as well as passive, stretching. |
| |
4. |
Put the lower back on stretch first,
then work out to extremities. |
| |
5. |
Work to maintain symmetry and a mid-line
position. May also be used during the workout. |
| |
6. |
Do not force a stretch by bouncing.
|
| |
7. |
The stretching must be done gradually
(on & off stretch). |
| |
8. |
3 to 10 seconds on stretch, release
and repeat 3 times (1x relax-2x contract-3x relax). |
| |
9. |
5 to 15 minutes on stretch. If you
are trying to stretch aggressively against the tone, release
and repeat 1 time. |
| C. |
The Workout |
| |
1. |
Use your hands to interpret which
muscle is being used to perform a movement. Also, hands can
be placed to maximize the desired motor response. |
| |
|
a. |
Facilitative input to a muscle (tapping
or providing resistance to activate muscle response). |
| |
|
b. |
As a directional control |
| |
|
c. |
Preventing an undesirable movement. Ex: Against
pattern/tone. |
| |
2. |
Do exercises in and out of pattern. |
| |
3. |
Work exercises as a unit and independently. |
| |
4. |
Tone activation
(strength) should be considered to enhance a movement at first;
then, to alleviate tone interference do, (a) put tone on stretch,
(b) hake the muscle, or (c) do movements across midline. |
| |
5. |
Use proper alignment of the spine,
pelvis, and lower and upper extremities (skill specific). |
| |
6. |
Physically help the child perform
a movement through the full range of motion on concentric
contractions. |
| |
7. |
Isometric contraction should be performed
at maximum extension, flexion, abduction, plantar or dorsal
flexion. |
| |
8. |
Eccentric contraction in some cases
is the first way to involve a muscle. |
| |
9. |
While performing an exercise, the
child should, at one time or another, have felt their muscle
contract/relaxed and if possible look at their muscle while
performing the exercises. |
| |
10. |
Small muscle groups 1 to 3, set of
10; large muscle groups, 1 to 3, set of 20. |
| |
11. |
Intensity of workout and accurate
documentation daily is a vital aspect for success. |
| |
12. |
Adaptive PE teachers, class room
teachers, doctors, PTs, OTs, and parents, all need to work
congruently together. |
| |
13. |
This workout program needs to be
approved on an individual basis by the I.E.P. |
|
| Adapted
PE Procedural Guidelines
"Since 1975 children with disabilities have been guaranteed,
by federal and state law, access to appropriate educational programs
that include physical education. By law, children with disabilities
must have the opportunity to participate in any program available
to children without disabilities unless the need for other arrangements
is clearly documented in the child’s Individual Educational
Program (IEP). Further, if a specially designed program is prescribed,
the school district is responsible for the provision of such service."
PALAESTRA
- forum of sport, physical education & recreation for those
with disabilities |
|
 |
| What
workout
suggestions do you have for developing physical fitness
when working with students who have special abilities? Please
add your suggestions to the forum. |
|
Workout for very physically
challenged individuals
Warm-up:
The warm-up will need to be individualized, and contain some type
of movement for 8 to 10 minutes. Suggestions include, rubbing/massaging
the muscle, vestibular movements, weight-bear a muscle group, or
you physically manipulate a particular gross motor movement activating
primitive reflexes with physical prompting (this form of stimulating
muscle contraction is only for people that have no active range
of motion). 
| Stretches - active or passive |
| 1. |
|
Calf
stretch |
| 2. |
|
Knee to
chest |
| 3. |
|
1/2 back
roll |
| 4. |
|
Ham stretch |
| 5. |
|
Quad stretch |
| 6. |
|
Sit and
reach |
| 7. |
|
Half-mat
hurdle stretch |
| 8. |
|
Butterfly
stretch |
| 9. |
|
Spinal twist
|
| 10. |
|
Shoulder
stretch (subscapula tilt, maximum rotation on dislocates and
inlocates) |
| 11. |
|
Neck rotation |
| 12. |
|
Arm and
hand stretch (supinate arm, fingers to neutral position then
work thumb out) |
| 13. |
|
7-13 can
be facilitated in 2 person sitting position. |
| Suggestions for workout: |
| 1. |
|
Use
simple key words to describe how the exercise might feel or
relate to. Example: For leg curls say "pool" or for
leg extensions say "kick." |
| 2. |
|
Use your
hands to direct, stabilize, or stimulate muscle movement. |
| 3. |
|
When assisting
with an exercise, try to encourage them to do most of the work. |
| 4. |
|
Encourage
any and all active range of motion/dynamic movements. |
| 5. |
|
Some weights
might be involved, but gravity and/or you will provide the resistance. |
| 6. |
|
Refer to
the stretching section above. |
| Workout for Monday,
Wednesday, Friday (1 set): |
| 1. |
|
Log
roll (front to back and back to front) |
| 2. |
|
Creeping |
| 3. |
|
Combed crawling |
| 4. |
|
Head control
exercises |
| 5. |
|
Sit-ups
(Assisted) |
| 6. |
|
Pull-ups
(floor) |
| 7. |
|
Arm lifts
(front, side, and front circle (clockwise and counterclockwise) |
| 8. |
|
Butterflies |
| 9. |
|
Arm curls |
| 10. |
|
Forearm
and finger grip exercises |
| 11. |
|
Bench press
|
| 12. |
|
Pulls |
| 13. |
|
Diaphragm
exercises |
| 14. |
|
Lat pulls
(rubberband) |
| 15. |
|
Upright
rows (one arm or both at a time, rubberband) |
| 16. |
|
Any active
range of motion/dynamic movement isolates and strengthens. |
| Workout for Tuesday,
Thursday, Saturday (1 set) |
| 1. |
|
Plantar
and dorsal flexion |
| 2. |
|
Bent knee
side to side |
| 3. |
|
Front leg
lifts |
| 4. |
|
Leg curls
|
| 5. |
|
Leg extensions
|
| 6. |
|
Squats (possible
concentric "+" contractions only) |
| 7. |
|
Knee walking
and supine position walking. |
| 8. |
|
Knee or
standing balance |
| 9. |
|
Back arches |
| 10. |
|
Any active
range of motion/dynamic movement isolates and strengthens. |
| Equipment: |
| 1. |
|
Mat |
| 2. |
|
Ankle or
arm weights |
| 3. |
|
Squeezable
object |
| Activities for Tuesday
& Thursday |
| 1. |
|
Numbers
2, 3, and 11 repeat |
| 2. |
|
Numbers
13 to 15 can be done on this day |
| 3. |
|
Adaptive
bike or tricycle 5 to 8 minutes |
| 4. |
|
Walking
with assistance (goal 130 yards) Note: Walk on different surfaces |
| 5. |
|
Independent
walking (goal 8 to 10 feet) Note: Walk with smooth surface |
| 6. |
|
Walking
with arm supports (goal 70 yards) Note: Walk with smooth surface |
|
| Warm-up:
Choose a particular exercise that will involve as many muscles
as possible for 3 to 5 minutes (walking, etc.).
| Stretches: |
| 1. |
|
1/2
back roll |
| 2. |
|
Knee to
chest |
| 3. |
|
Right
hand, left toe |
| 4. |
|
Spinal
twist |
| 5. |
|
Butterfly |
| 6. |
|
Quad stretch |
| 7. |
|
Half-mat
hurdle stretch |
| 8. |
|
Sit and
reach |
| 9. |
|
Neck rotation |
| 10. |
|
Shoulder
stretch |
| 11. |
|
Arm and
hand stretch, (supinate arm, fingers to neutral position then
work thumb out) |
| 12. |
|
Calf stretch |
| 13. |
|
Ham stretch |
| Workout for Monday,
Wednesday, Friday (2 sets): |
| 1. |
|
Knee
or standing balance |
| 2. |
|
Knee walking
and supine position walking |
| 3. |
|
Squats;
Hint: do not allow knees to adduct |
| 4. |
|
1/2 squats |
| 5. |
|
Leg extensions
(supine and sitting; legs together and independent) |
| 6. |
|
Leg curls
(in and out of pattern, standing or prone) |
| 7. |
|
Hip flexor
(prone and bent knee or doggy position) |
| 8. |
|
Front
leg lifts |
| 9. |
|
Bent knee
side to side |
| 10. |
|
Plantar
and dorsal flexion (sitting, bent knee or standing) |
| 11. |
|
Sit-ups
(knee bent at different heights) |
| 12. |
|
Outer
thigh |
| 13. |
|
Push-ups |
| 14. |
|
Forearm
and finger grips |
| 15. |
|
Arm lifts
(front, side, and around to pocket) |
| Workout for Tuesday,
Thursday, Saturday (1 set) |
| 1. |
|
Numbers
2, 3, and 11 repeat |
| 2. |
|
Numbers
13 to 15 can be done on this day |
| 3. |
|
Adaptive
bike or tricycle 5 to 8 minutes |
| 4. |
|
Walking
with assistance (goal 130 yards) Note: Walk with different
surfaces |
| 5. |
|
Independent
walking (goal 8 to 10 feet) Note: Walk with smooth surface |
| 6. |
|
Walking
with arm supports (goal 70 yards) Note: Walk with smooth surface |
| Consulting: |
| 1. |
|
Walker
all time (school, home, etc.) |
| Equipment: |
| 1. |
|
Walker
|
| 2. |
|
Bike |
| 3. |
|
Mats |
| 4. |
|
Ankle
and arm weights |
| 5. |
|
Squeeze
ball |
| Possible Braces: |
| 1. |
|
AFO,
KAFO, HKAFO |
|
|
|
Warm-up:
Walk with arm supports for 3 to 5 minutes.
| Stretches: |
| 1. |
|
1/2
back roll |
| 2. |
|
Knee to
chest |
| 3. |
|
Right hand,
left toe |
| 4. |
|
Spinal twist |
| 5. |
|
Butterfly |
| 6. |
|
Quad stretch |
| 7. |
|
Half-mat
hurdle stretch |
| 8. |
|
Sit and
reach |
| 9. |
|
Neck rotation |
| 10. |
|
Shoulder
stretch |
| 11. |
|
Arm and
hand stretch, (supinate arm, fingers to neutral position then
work thumb out) |
| 12. |
|
Calf stretch |
| 13. |
|
Ham stretch |
| Workout Monday, Wednesday,
Friday (3 sets): |
| 1. |
|
Standing
balance (1 minute) |
| 2. |
|
Standing,
locked knees (1 minute) |
| 3. |
|
Squats (1
set) Hint: do not allow knees to adduct |
| 4. |
|
1/2 squats
(4 sets) *If possible with arm supports |
| 5. |
|
Leg extensions
(sitting; legs together and independent) |
| 6. |
|
Plantar
and dorsal flexion (sitting, bent knee or standing) |
| 7. |
|
Leg curls
(in and out of pattern, standing or prone) |
| 8. |
|
Front leg
lefts |
| 9. |
|
Back arches |
| 10. |
|
Bent knee
side-to-side |
| 11. |
|
Hip flexor
(prone and bent knee) |
| 12. |
|
Sit-ups
(knees bent) |
| 13. |
|
Outer thigh |
| 14. |
|
Push-ups |
| 15. |
|
Forearm
and finger grips |
| 16. |
|
Arm lifts
(front, side, around to pocket) |
| Activities for Tuesday
& Thursday |
| 1. |
|
Numbers
1 to 5, repeat 1 set |
| 2. |
|
Walking
with arm supports (goal 130 yards under 10 minutes) Note: Be
attune to form, speed, safety. |
| 3. |
|
Cruising,
with 10 steps between objects. Note: Walk with smooth surface. |
| 4. |
|
Independent
walking (goal 20 feet) Note: Walk with smooth surface. |
| Consulting: |
| 1. |
|
Arm
supports all the time |
| 2. |
|
Walker only
when necessary |
| 3. |
|
Cruising
sometimes (desk to desk, home, very short distances) |
| Equipment: |
| 1. |
|
Arm
supports |
| 2. |
|
Walker |
| 3. |
|
Mats |
| 4. |
|
Ankle and
arm weights |
| 5. |
|
Squeeze
ball |
| Possible Braces: |
| 1. |
|
Short
AFO, KAFO, HKAFO, part time or none, Loftstand crutches, Forearm
Platform crutches, sticks |
|
| Warm-up:
Cruising for 3 to 5 minutes
| Stretches: |
| 1. |
|
1/2
back roll |
| 2. |
|
Knee to
chest |
| 3. |
|
Right hand,
left toe |
| 4. |
|
Spinal twist |
| 5. |
|
Butterfly |
| 6. |
|
Quad stretch |
| 7. |
|
Half-mat
hurdle stretch |
| 8. |
|
Sit and
reach |
| 9. |
|
Neck rotation |
| 10. |
|
Shoulder
stretch |
| 11. |
|
Arm and
hand stretch, (supinate arm, fingers to neutral position then
work thumb out) |
| 12. |
|
Calf stretch |
| 13. |
|
Ham stretch |
| Workout Monday, Wednesday,
Friday (3 sets): |
| 1. |
|
Standing
balance with locked knees (goal 3 minutes or more) |
| 2. |
|
1/2 squats
(4 sets) |
| 3. |
|
Leg extension
(sitting; legs together and independent) |
| 4. |
|
Plantar
and dorsal flexion (sitting, bent knee or standing) |
| 5. |
|
Leg curls
(out of pattern, standing) |
| 6. |
|
Front leg
lifts |
| 7. |
|
Bent knee
side-to-side |
| 8. |
|
Hip flexor
(prone, 4 sets) |
| 9. |
|
Sit-ups |
| 10. |
|
Outer and
inner thigh |
| 11. |
|
Push-ups |
| 12. |
|
Forearm
and finger grips |
| 13. |
|
Arm lifts
(front, side, around to pocket) |
| Activities for Tuesday
& Thursday |
| 1. |
|
Numbers
1, 2, and 3 repeat 2 set |
| 2. |
|
Cruising
(goal 130 yards) Note: Walk with smooth surface. |
| 3. |
|
Independent
walking (goal 60 yards) Note: Walk with different surfaces. |
| Consulting: |
| 1. |
|
Cruising
- independent walking all the time |
| 2. |
|
Walking
with arm supports only when necessary |
| Equipment: |
| 1. |
|
Mats |
| 2. |
|
Arm supports |
| 3. |
|
Ankle and
arm weights |
| 4. |
|
Squeeze
ball |
| Possible Braces: |
| 1. |
|
Short
AFO, part time or none |
|
| These articles,
by Mike Ross, present some advice for integrating all people into
your aerobics classes, regardless of ability or disability.
|
| If you have ideas, comments, letters to share, or
questions about particular topics, please email one of the following
Adapted PE Section Editors: |
|
