Welcome to the Adapted Page of PELINKS4U!

First of all, we would like to remind our readers to visit the APENS website to apply to take the APENS test this coming JUNE 4th, 2005, to become a nationally Certified Adapted Physical Educator, or CAPE. The deadline is approaching quickly (April 30th!).

Secondly, in keeping with the theme for this month, "Drugs and Alcohol," we have TWO mini-articles. One summarizes the serious consequences (death and disability) from drinking and driving, and thus the need for prevention programs targeted at our public school aged students. The other article, somewhat fitting this theme, is on Acute Lymphocytic Leukemia (as chemotherapeutic drugs play a major role in its treatment, but of course, our main message will be the need for, and the benefit of, adapted games and activities and how to effectively carry out these adaptations).

Finally, we end with an article summarizing a very effective stretching technique, one that is applicable to the young and old, elite athletes, people with disabilities...virtually everyone. Since physical activity is one of our most effective "anti-drugs," we included this feature as this stretching technique is helpful for everyone. ENJOY!

Chris Stopka
Adapted Section Editor

High School and College Age Drinking and Driving: A Significant Cause of Death & Disability - By Travis Broome & Christine Stopka

Motor vehicle injuries and deaths affect thousands of Americans every year. Unfortunately over 40% of the deaths are caused by alcohol-related crashes. In a survey conducted by Caetano & McGrath (2000) it was found that over 20% of male drivers have driven while intoxicated in the past year, and over 11% of female drivers have driven while under the influence of alcohol.

According to Usdan, Schumacher, McNamara and Bellis (2002), drinking and driving causes over 300,000 injuries and 16,000 deaths each year. This issue is disproportionately present in the 15-20 year old age range, thus significantly impacting the college community with statistics as high as 25%-35% of students reporting having driven under the influence of alcohol (Usdan et al., 2002; Wright, Norton, Dake, Pinkston, & Slovis, 1998). Given that injuries can be prevented, the issue of drinking and driving has become particularly pertinent to public health (Borges, Cherpitel, Mondragon, Poznyak, Peden, & Gutierrez, 2004).

Binge drinking, defined as the consumption of five or more drinks on a single occasion in a two-week period, is a major public health issue related to college campuses (Wright, et al., 1998). Recent studies indicate that 44% of college students are binge drinkers and 19% are frequent binge drinkers (Wright, et al., 1998).

What defines someone as being drunk or unable to operate a motor vehicle differs by state. Some states view having a blood alcohol content of over 0.10 as being impaired, while other states, such as Florida, set the legal limit at 0.08 (National Highway Transportation Safety Administration, 2001). The state must prove that a person had blood alcohol content over the legal limit at the time of vehicle operation to charge them with driving under the influence, or driving while intoxicated.

The consumption of alcohol has a significant negative impact on the outcomes of motor-vehicle accidents. Although 4% of alcohol-related crashes in 2002 resulted in death and 42% resulted in injury, only 0.6% of crashes that did not involve alcohol resulted in death and 31% in injury (Hingson & Winter, 2003).

In varying studies drunk driving has been linked to college-aged students ranging in ages from 18-24. Steptoe,Wardle, Bages, Sallis, Sanabria-Ferrand, & Sanchez (2004) conducted a study on drinking and driving primarily because drunk driving has been linked to many traffic accidents, and an increase in automobile mortality rates. In one case, 43% of male students surveyed drove while intoxicated and 28% of females drove while under the influence of alcohol. This is definitely a problem because it showed that over ¼ of college students who drank in the last thirty days, drove home afterwards.

Once again statistics focus on college-aged students, where much of the drinking and driving behavior begins. Hingson, Heeren, Zakocs, Winter, & Wechsler (2003) were intrigued by how many drinking and driving trips were made each year, and the lack of arrests made. They found that there were thousands of fatal accidents that involved college aged students every year. Statistics show that 65% of students who have consumed more than five or more drinks drove afterwards, 48% of students who consumed more than five drinks rode with someone who was either drunk or high, and 10% of those who consumed more than five drinks were seriously injured in an automobile accident (Hingson et al., 2003).

College-aged students are always a target for drunk driving, mainly because college students have always been linked with drinking and risky behavior. There have been 3,674 deaths due to alcohol related motor vehicle crashes associated with people between the ages of 18-24, 31% of those were in college (Hingson, Heeren, Zakocs, Kopstein, & Wechsler, 2002). The number of deaths for students between the ages of 18-24 reached 1,138 out of a survey of over 20, 000 college students (Hingson et al., 2002). The disturbing thing about college-aged students and drinking is that many of them are under the legal drinking age.

In another study, concerns about drinking and driving arose because the researchers felt that college aged students were more at risk for risky behaviors. In a survey of undergraduate students over 27% of females drove while intoxicated during the past 30 days and over 41% of males drove while under the influence (Joly, McDermott, & Westhoff, 2000). This means that from the survey over 25%, or ¼, of the participants drove home while intoxicated during the past 30 days (Joly et al., 2000).

In another study by Everett, Lowry, Cohen, & Dellinger (1999), it was found that over 27% of college students drove after drinking alcohol (Joly et al., 1999). Everett's study was focused on college students because college is a time where many people are legally allowed to drink.

Drinking and driving has become a problem that has affected and changed the lives of many. Unfortunately most changes have been because of great loss. Drinking and driving must be looked upon as a serious problem, one that needs to be researched and improved.

Indeed, getting the attention of our public school aged students, before they reach the driving age, is worth the time and energy. Programs resulting in significant reductions of this risky, addictive behavior are sorely needed to prevent the extraordinary frequency of death and disability due to his practice.

References

As a volunteer at Boggy Creek Camp, I have worked with children who have shown incredible strength and unwavering perseverance in the face of terminal illnesses. I have come to realize that these special children often grow up fast dealing with their diseases, but they are still just children. They deserve to have the chance to participate in everyday activities, such as sports. I now believe in using adaptations rather than setting limitations.

I would like to share with you various adaptations that can be used to allow these special children to feel as if they can do anything. I will start with a description of the human blood, acute lymphocytic leukemia (ALL), and side effects of leukemia treatments. I will finish with a generalized description of adaptations possible to assist these children, and guidelines to manipulate adaptations to fit your child’s needs.

BLOOD
Blood is a fluid connective tissue that is pumped by the heart muscle through the vessels of the cardiovascular system. The primary functions of blood include transport of oxygen and nutrients, acid-base regulation through the bicarbonate buffer system to prevent acidosis (low pH) or alkalosis (high pH), thermoregulation, immunity, and hemostasis or clotting (Graaff and Rhees, 1997). Blood is composed of a liquid matrix of blood plasma, as well as red blood cells, white blood cells, and platelets.

Important chemicals are dissolved in the blood including proteins (e.g., globulins), hormones (e.g., thyroid hormone), minerals (e.g., iron), vitamins (e.g., folic acid), and antibodies, including those we develop from our immunizations (The Leukemia and Lymphoma Society, 2004). Red blood cells, which make up half the volume of blood, are filled with hemoglobin. Hemoglobin is the oxygen transporter of the body (Graaff and Rhees, 1997).

Platelets are tiny blood cells released from the marrow that aid in the clotting of blood at a site of injury. White blood cells act as phagocytes (or eating cells), and ingest invading bacteria or fungi to destroy them and help cure infection (Graaff and Rhees, 1997). The main types of phagocytic cells are neutrophils and monocytes.

Blood cells are made in the bone marrow, and leave the marrow to enter the blood when the cells are fully formed (Graaff and Rhees, 1997). Stem cells are a small group of cells that are responsible for making all the blood cells in the marrow. In healthy individuals stem cells produce new blood cells constantly. The presence of stem cells in the blood is important because they can be collected by special techniques and transplanted into a recipient who needs blood to help make more blood cells (The Leukemia and Lymphoma Society, 2004).

ACUTE LYMPHOCYTIC LEUKEMIA
According to the Leukemia and Lymphoma Society, Leukemia kills more children between the ages of 1 and 15 than any other disease. Acute lymphocytic leukemia (ALL) results from a genetic injury to the DNA of a cell in the bone marrow that is acquired, not inherited (Palka, 1987). Due to this genetic injury, immature cells called lymphoblasts replace the normal marrow (Palka, 1987). These lymphoblasts fail to function as normal blood cells and they grow uncontrollably (Sallan, 1981). This uncontrolled growth of the lymphoblasts results in blockage of the production of normal marrow cells (Sallan, 1981). This leads to a shortage of red cells, platelets, and normal white cells such as neutraphils in the blood (Sallan, 1981).

SYMPTOMS OF THE DISEASE
The cause of acute lymphocytic leukemia is unknown in most cases, and acute lymphocytic leukemia is seen most often in the first ten years of life (Wiernik, 2004). Patients may experience a loss of well-being & become easily fatigued (Marcoullis, 2004). If anemia is present the patient will have a pale complexion. Bleeding will occur easily due to a very low platelet count, and bruises may occur for no reason due to internal bleeding (Sallan, 1980).

Petechiae bruises, or red spots under the skin, may appear and the child may bleed extensively from minor cuts (Sallan, 1980). Other signs and symptoms include joint discomfort, fever, enlarged lymph nodes, headache, and vomiting (The Leukemia and Lymphoma Society, 2004).

SYMPTOMS OF THE TREATMENTS
According to facts compiled by the Leukemia and Lymphoma Society, drug treatment has extended the life expectancy for children with this disease, and about 80% are cured. However, the chemotherapy treatment aimed at destroying leukemia cells to permit remission can intensify the symptoms of leukemia (Simone, 1972). This treatment leads to severe decreases in phagocytes, red cells, and platelets causing severe anemia, bleeding, and infection. It may take several weeks to see any benefit from chemotherapy and for the blood count to return to normal (Marcoullis, 2004).

Severe infections after chemotherapy can be combated with red cell and platelet transfusions in children (The Leukemia and Lymphoma Society, 2004). Chemotherapy affects tissues with rapidly dividing cells such as the lining of the mouth and intestines, the skin, and the hair follicles. Ulcers, nausea, vomiting, skin rashes, diarrhea, and hair loss are common side effects of chemotherapy (The Leukemia and Lymphoma Society, 2004).

IMPORTANCE OF ADAPTED GAMES
As these children struggle with these side effects, it is important for their emotional well being to allow them to play and have fun like healthy children. Playing a game is much more exciting and beneficial than idly watching a game. Movement games are more pleasurable and much more motivating than working on skills individually.

Adaptations allow special children to feel included rather than left out. It is inspiring to witness the "I did it" look in a child’s eyes when they have accomplished a task they never dreamed they could do. Participation in movement games also has physical benefits due to the increased activity. Games serve as a tool to improve motor coordination in a fun situation. Benefits include improved cardio vascular endurance, body composition, muscular strength and endurance, and flexibility (Kasser, 1995).

Participation games also foster a social sense of belonging within the group participating. Participation also emotionally builds self-esteem regardless of physical ability. Inclusive games teach each person involved to accept other people despite any limitations they may have, and to work in a group (Kasser, 1995).

GUIDELINES FOR ADAPTATIONS
Step 1: Understand your children and their limitations. Major side effects of Leukemia, and its treatment that you may have to address are, as previously stated, fatigue, nausea, joint discomfort, headache, skin rashes, diarrhea, and easy bruising and bleeding. It is important to ask your participants how they are feeling at the moment. Identify the symptoms they are feeling so you know what you must take into consideration when adapting your games. For example a child who is complaining of fatigue, nausea, and diarrhea should not be running in circles, but may be able to play a catching game easily.

Step 2: Understand the activity you are to be performing, and the elements to that activity that may be altered based on the child’s needs.

Equipment: One of the simplest, and yet most effective tricks I have learned, is to change the size and weight of the ball or the target being used. Start playing with a huge ball that everyone could easily hit. This will build confidence and motivate your participants to play hard. As the skill of the group improves the target and ball can get a bit smaller, the net can go a bit higher, etc.

We also want to preserve the challenge for everyone involved. Your game and equipment can, and should, evolve with the skill level of your group. In archery we put up a ton of balloons and the purpose was to touch the balloon with the arrow, not to pop the balloon. When the arrow came close to the balloon we would cheer. We also used a stand for the bow so the children had the added stability and support.

If children have trouble gripping then strap the racquet to their hand in ping-pong, or any other sport. It is important to the children to know that equipment can be adjusted to work for them.

Time: Vary the number of repetitions required, or the time in which the game is played. You are in control, and if you see your participants becoming fatigued and getting frustrated then take a break. In this break you can do an “extra credit” exercise challenge to keep the children’s attention. Keep these exercises low impact and less strenuous than the original game or else you aren’t truly giving the children a break at all. Space:

The boundaries of a game can be adjusted. Utilize less space, or more space, depending on the needs. If you want children to run less, work in a smaller area. If you are having trouble keeping a ball in bounds, increase the boundaries or put up a net to keep the ball in. In archery, bringing a target closer to your participants is a great adaptation. In tennis using half courts instead of whole courts is a good idea.

Force: This is very important for children with Leukemia, because they bruise so easily. Steer clear of contact sports. Substitute stationary tasks for moving ones, and slow the activity down if needed. Remember we are concerned with helping the child and improving their health. Be smart and do your best to keep your child safe in the activities you play.

Rules: Rules are made to be broken. You are in charge of the game. You can change the rules to better suit your group. SIMPLIFY the game, and eliminate rules if it will help. You can also make different rules, for different participants, as long as you explain your reasoning thoroughly as to avoid jealousy. If you have participants in wheel chairs let them use a lower net than children who are standing. ...continued top of next column

...continued from previous column

Acute Lymphocytic Leukemia

Due to decreased hand/eye coordination ping-pong was impossible for one of my participants. We eliminated the rules, and focused on hitting the ball towards a target. This proved to be enough of a challenge and kept her interested without frustrating her.

Leukemia is a horrible disease and, despite the encouraging 80% cure rate for children, we want to make every moment fun and worthwhile. My "buddy" I met at camp, was one of the ones who did not live to see her next birthday, but when she worked with me you could see it in her eyes that she had accomplished something big. It may take a little work and flexibility on your part, but by giving these children a chance to be involved in adapted games you could make their lives happier. Adaptive games foster physical improvements, greater self-esteem and confidence, and pleasure for all involved.

Now, get out there and PLAY WITH KIDS!

References