Transcript Chapter 14 - Delmar

Chapter 14
Resistance-Training Strategies for
Individuals with Intellectual
Disabilities
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Developmental Disabilities
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Mental retardation
Cerebral palsy
Autism
Spina bifida
Vision or hearing impairment
Other delays
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Mental Retardation (MR)
• Intellectual and developmental disorder
• Characterized by substandard intelligence
quotient (IQ) and need of support
• Most common developmental disorder in
industrialized society
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MR
• Previous classification system based on IQ
scores:
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Mild
Moderate
Severe
Profound
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New Classification System by
AAIDD
• American Association on Intellectual and
Developmental Disabilities (AAIDD)
• Defines MR as being manifested by
significantly subaverage intellectual
functioning
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New Classification System by
AAIDD
• Exists concurrently with related limitations
in two or more adaptive skills areas
• Must be evident before age 18
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Individuals with Disabilities
Education Act (IDEA)
• Adds schooling to other criteria for MR
• Individuals with MR usually have IQ below
70
– Plus several deficits in adaptive skills
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Two Classification Levels of MR
• Mild and severe
• Classification based on:
– How well individual functions in adaptive skill areas
– Level of support required due to deficit
• More support required, less functional the
individual
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Four Levels of Support
1. Intermittent
– Support on as-needed basis
– Either high or low intensity
2. Limited
– Support needed consistently over time
– Lesser intensity
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Four Levels of Support
3. Extensive
– Regular support
4. Pervasive
– Constant care
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Prevalence of MR
• In industrialized society, 3 percent of total
population
• Approximately 9 million in US
• More than 90 percent of all individuals with
MR classified as mild
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Prevalence of MR
• Less than 10 percent of all individuals with
MR classified as severe
• Severe MR
– IQ levels below 50
• Often below 35
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Economic Impact of MR
• Most live either independently, with family,
in group homes, or in assisted living
facilities
• De-institutionalization movement in
progress for last 30 to 40 years
• Most fully/partially integrated in society
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Mortality Rates
• One and one-half to four times higher than
average population
• Linked to:
– Low IQ
– Poor self-care skills
– Physical inactivity
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Mortality Rates
• Most common medical problems include
cardiovascular and pulmonary disorders
– Except Down syndrome (DS)
• More susceptible to infections, leukemia, and early onset
Alzheimer’s disease
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Etiology of MR
• Specific cause usually unknown
• Leading cause:
– Fetal alcohol syndrome
• Second leading cause:
– Maternal drug abuse
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Etiology of MR
• Other causes:
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Birth-related trauma
Infectious diseases
Maternal disorders
Genetic disorders
Chromosomal abnormalities
• E.g., DS
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Other Causes of MR
• Poverty
• Malnutrition
• Infections during pregnancy
– E.g., rubella, herpes
• Severe stimulus deprivation
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Other Causes of MR
• Perinatal factors
– E.g., prematurity
• Postnatal factors
– E.g., lead poisoning
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DS
• Most common manifestation of MR
• Occurs in approximately 1 per 800 to 1 per
1000 births
• Risks increase with maternal age
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Physical Characteristics of DS
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Short stature
Short arms and legs
Foot and toe malformations
Visual impairments
Joint laxity related to atlanto-axial
instability
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Physical Characteristics of DS
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Skeletal muscle hypotonia
Pulmonary hypoplasia
Congenital heart disease
Reduced immune function
Higher risks for developing leukemia and
Alzheimer’s disease
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Benefits of Resistance Training
• Likely plays important role in developing
and maintaining independent living
• Increases muscle strength
• Increases quality of life, independence, and
(potentially) vocational productivity
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Comparative Levels of Muscle
Strength
• Individuals with MR have very low levels
of strength
– 30 to 50 percent lower than nondisabled peers
• Individuals with DS have even lower levels
of strength
– 30 to 40 percent lower than MR peers
– Less than 50 percent of nondisabled peers
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Comparative Levels of Muscle
Strength
• Persistent problem from childhood into
adulthood
• Even very active MR individuals still 25
percent below normal strength values
• Few existing studies have found lower body
strength to be low
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Leg and Back Strength from
Childhood to Early Adulthood
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Implications of Low Muscle
Strength
• Limits recreational activities
• Limits vocational productivity
• Hinders aerobic capacity and endurance
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Research Supports Resistance
Training
• Improvements shown in muscle endurance
• Beneficial effects reflect type of training
conducted
• Self-motivated individuals with mild MR
can maintain strength gains independently
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Research Supports Resistance
Training
• For individuals with DS, studies show
changes in strength with variety of training
approaches
• Refer to Table 14.1
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Program Design Considerations
• Level of understanding
• Attention span
• Level of fitness
– Prior exercise experience
• Age
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Program Design Considerations
• Potential physical impairments
– Significant coordination problems
• Individualization of program
• Reason for program
– Individual’s goals
• Medications
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Health Screening
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Cardiovascular disease
Diabetes
Cancer
Lung disease
Infectious diseases
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Health Screening
• Includes:
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Neurological conditions
Orthopedic conditions
Medications
Exercise and lifestyle history
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Exercise Testing Considerations
• Conduct thorough health history screening
• Involve parent/guardian
• Screen individuals with DS for:
– Congenital heart and related conditions
– Atlanto-axial instability
– Lax ligaments
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Exercise Testing Considerations
• Obtain physician clearance when individual
has serious medical complication
• Include familiarization process to increase
individual’s comfort level and
understanding of process
– Ongoing
• Use weight machines for testing
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Exercise Testing Considerations
• Use either standard 1 RM testing protocols
or submaximal loads estimating 1 RM
• Perform 10- to 12-repetition set to fatigue
• Fatigue may be hard to ascertain
– Repeat test, as needed
• Test eight to 12 exercises using major
muscle groups
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Program Components
• Ensure individual can perform exercise
using proper form
• Teach proper breathing techniques to avoid
Valsalva maneuver
• Teach lower weights during two- to threeweek initial period at intensity of 40 to 50
percent of 1 RM
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Program Components
• Begin with warm-up of five to seven
minutes
• Follow with “easy” set
– E.g., 40 to 50 percent of 1 RM
• Follow with normal set
• Include flexibility training before/after
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Program Components
• After first few weeks, follow ACSM
guidelines for resistance training programs
for healthy adults
• Re-test frequently
• Gauge signs of muscular fatigue to assess
intensity
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Program Components
• Exercises should stress all major muscle
groups
• Modify exercises based on individual’s
physical limitations
– Refer to Table 14.2
• Spotting required
• See sample 24-Week Program
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