An adapted walking intervention for a child with Pitt Hopkins syndrome.

PURPOSE: To investigate the effects of a community-based adapted walking intervention on a child with Pitt Hopkins syndrome (PTHS). METHODS: A four-year old boy with PTHS participated in a 12-week intervention comprising five one-hour long walking sessions per week at a local daycare. Walking sessions used the Upsee mobility device (Firefly by Leckey Ltd., Ireland). Outcome measures included Goal Attainment Scaling and the Mobility Ability Participation Assessment. RESULTS: Parental and caregiver goals for social interaction, physical activity and physical health surpassed expectations by post-testing. Gains were not sustained at three months follow-up. The participant's ability and mobility may have increased following the intervention. CONCLUSIONS: Participants with PTHS may benefit from regular physical activity and early intervention. The Upsee mobility device is a feasible and fun way to promote inclusive community-based physical activity and social engagement in a young child with PTHS. Further research into the health benefits of physical activity and the Upsee for children with PTHS may be warranted. Implications for Rehabilitation Physical activity may be beneficial for a child with Pitt Hopkins syndrome, a rare genetic disorder. New design, implementation of mobility intervention for a child with neurodevelopmental disabilities. The Upsee mobility device may offer physical benefits for a child with a neurodevelopmental disability. The Upsee mobility device may offer social benefits for a child with a neurodevelopmental disability.

Bariatric surgery and intellectual disability: Furthering evidence-based practice.

BACKGROUND: Rates of morbid obesity are higher for individuals with intellectual disability (ID). Individuals with ID may find nutritional guidelines difficult to follow and many face personal and environmental barriers for physical activity. Bariatric surgery may reduce obesity related health comorbidities while promoting sustained weight loss in diverse populations. Yet no study has reviewed the feasibility of conducting bariatric surgery on individuals with ID. OBJECTIVES: To conduct a scoping review of literature on bariatric procedures performed on individuals with ID. METHODS: Authors searched electronic database via PubMED, Science Direct, Wiley and Medline (1975-2014). Extracted articles were evaluated independently following scoping reviews guidelines. RESULTS: Reviewers included sixteen studies. Nine surgical interventions were reported on 49 patients with ID. Studies followed either case report or case series design. The most common procedure patients received was biliopancreatic diversion (n = 24) followed by Roux-en-Y Gastric Bypass (n = 12). Degree of weight loss was the primary outcome in each study. Excess weight loss (%EWL) ranged from 12% to 86%. Further benefits included improved quality of life, decreased psychological tension within family and resolution of sleep apnea, hypertension, respiratory distress and type II diabetes. Six studies included a post-operative follow-up period below two years. CONCLUSIONS: Bariatric surgery may be a viable option to treat obesity in individuals with ID but there is no consensus which procedure is preferred and which associated interventions should be in place to warrant long lasting results. Further research featuring randomized control trials may be beneficial.

A therapeutic skating intervention for children with autism spectrum disorder.

PURPOSE: The purpose of this study was to evaluate the effects of a highly structured therapeutic skating intervention on motor outcomes and functional capacity in 2 boys with autism spectrum disorder aged 7 and 10 years. METHODS: This multiple-baseline, single-subject study assigned participants to three 1-hour skating sessions per week for 12 weeks focusing on skill and motor development. Multiple data points assessed (a) fidelity to the intervention and (b) outcomes measures including the Pediatric Balance Scale, Timed Up and Go, floor to stand, Six-Minute Walk Test, goal attainment, and weekly on-ice testing. RESULTS: Improvements were found in balance, motor behavior, and functional capacity by posttest with gains remaining above pretest levels at follow-up. CONCLUSIONS: Therapeutic skating may produce physical benefits for children with autism spectrum disorder and offer a viable, inexpensive community-based alternative to other forms of physical activity.

A comprehensive exercise program for a young adult male with Down syndrome who experienced a stroke.

PURPOSE: Individuals with Down syndrome (DS) may be at heightened risk for stroke due to a combination of physiological conditions and lifestyle choices. There remains a lack of information regarding the effectiveness of exercise training on individuals with DS post-stroke. This case report describes the effects of a comprehensive exercise program on an individual with DS who had sustained a stroke. METHOD: A 20-year-old male with DS recovering from a left hemorrhagic stroke 18 months previous underwent a 12-week land and water-based program 60 minutes/session, 5 sessions/week. Exercise sessions addressed specific limitations, including cardiorespiratory fitness, generalized muscle weakness, balance deficits, and reduced ambulatory ability in terms of speed, gait pattern and walking tolerance. RESULTS: Between the baseline and 6-month follow-up assessments improvements were noted in peak oxygen consumption (VO2peak, 8% increase), one-repetition maximum (51%), community balance and mobility scale (54%), comfortable walking speed (42%), six-minute walk test (28%) and daily step count (21%). CONCLUSION: Improved cardiorespiratory fitness, strength, balance and mobility provide preliminary evidence of the trainability of individuals with both DS and stroke. Future studies are warranted to investigate the role of exercise in risk factor reduction for primary and secondary prevention of stroke in people with DS. Implications for Rehabilitation Individuals with Down syndrome (DS) may be at heightened risk of stroke due to a combination of physiological conditions and lifestyle choices which contribute to reduced exercise capacity, accelerated aging patterns, moyamoya syndrome and physical inactivity as well as high rates of obesity and related conditions. More intensive fitness programs may be particularly important for people with both DS and stroke. Participation in a comprehensive exercise program can be safe and effective in regaining pre-stroke levels of cardiorespiratory fitness, functional mobility and goal attainment. RESULTS suggest that a more intensive physical therapy regimen may be recommendable during out-patient rehabilitation for individuals with DS post-stroke.

Measuring body composition in individuals with intellectual disability: a scoping review.

BACKGROUND: Research shows obesity to be more prevalent amongst individuals with intellectual disability (ID) making correct measurement of body composition crucial. This study reviewed the validity and reliability of methods used for assessing body composition in individuals with ID. METHODS: Authors conducted electronic searches through PubMed (1990 to present) and PsycINFO (1990 to present) and assessed relevant articles independently based on scoping review guidelines. Reviewers included primary research related to the validity and reliability of body composition measures on individuals with ID. RESULTS: Searches identified six articles assessing body composition methods used on individuals with ID including body mass index (BMI), skinfold thickness, bioelectrical impedance analysis (BIA), waist circumference, tibia length, and anthropometric girth measurements. BMI and waist circumference appear suitable measures but skinfold thickness measurements may not be advisable due to participants' noncompliance resulting in a lack of precision and inaccurate results. CONCLUSIONS: The current literature contains too few well-conducted studies to determine the precision and validity of body composition measures on individuals with ID. There may be a need to devise further regression equations that apply to individuals with specific types of ID in order to increase the reliability and validity of body composition measurements.

Reduction measures and percent body fat in individuals with intellectual disabilities: a scoping review.

BACKGROUND: Individuals with intellectual disability (ID) may be more obese and extremely obese than individuals without ID. There remains an on-going debate as to the effectiveness of exercise training in decreasing body fat in different populations. OBJECTIVE: This scoping review explored the effects of exercise training interventions on percent body fat in individuals with ID. METHODS: Authors conducted electronic searches through PubMED (1978 to present) and SPORT Discus (1975 to present) and evaluated relevant articles independently based on guidelines for scoping reviews. RESULTS: Few exercise interventions have targeted changes in percent body fat. Based on the 11 articles identified, exercise interventions appear effective at maintaining fat levels but have been largely unsuccessful at reducing body fat following training. Only 18% of exercise alone studies produced positive changes in body fat outcomes among individuals with ID. CONCLUSIONS: Greater focus should be placed on the metabolic health of individuals with ID. Results call into question methods used to date. These findings may be a consequence of the minimal attention paid to nutritional status and also a lack of standardized anthropometric methods and acceptable guidelines for categorizing adiposity based on health risk in this population. Further research is needed to promote more effective and sustainable strategies aimed at combating the elevated levels of body fat.

The effects of swim training on respiratory aspects of speech production in adolescents with down syndrome.

Reduced respiratory muscle strength in individuals with Down syndrome (DS) may affect speech respiratory variables such as maximum phonation duration (MPD), initiation volume, and expired mean airflow. Researchers randomly assigned adolescents with DS (N = 28) to either 12 weeks of swim training (DS-ST) or a control group (DS-NT). Repeated measures MANOVA demonstrated a significant increase in MPD for DS-ST participants from pretest to posttest, t(11) = -3.44, p = 0.006, that was not maintained at follow-up, t(11) = 6.680, p < .001. No significant change was observed for DS-NT participants across time, F(2, 11) = 4.20, p = 0.044. The lack of long-term change in DS-ST participants may be related to the relatively short training period.

Dual-energy x-ray absorptiometry to measure the influence of a 16-week community-based swim training program on body fat in children and adolescents with intellectual disabilities.

OBJECTIVE: To use dual-energy x-ray absorptiometry (DXA) to measure the effects of a 16-week community-based swim training program on percent body fat in children and adolescents with intellectual disability (ID). DESIGN: Convenience sample. SETTING: University sport complex and exercise science laboratory. PARTICIPANTS: Children and adolescents (n=8; mean age +/- SD, 13.1 +/- 3.4 y), 2 girls and 6 boys with ID, of varying fat levels (11%-35%). INTERVENTION: A swim training program lasting for the duration of 16 weeks with three 1-hour sessions held at a 25-m pool each week. MAIN OUTCOME MEASURE: Assessing percent body fat at pretest and posttest through the use of DXA. RESULTS: After the 16-week exercise training program, we observed a 1.2% median increase in body fat percentage with a range from -0.3% to 4.5%. Wilcoxon matched-pairs signed-ranks tests suggest that these results are statistically significant (P=.039; exact). CONCLUSIONS: Exercise training alone proved ineffectual in reducing percent body fat in 8 children and adolescents with ID. Further research should consider implementing a combined diet and exercise program. To gauge the effectiveness of intervention programs, valid methods and complex measurement tools such as DXA should be used to assess changes in percent body fat in such a heterogeneous population.