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Chapter 14

Chapter 14. Resistance-Training Strategies for Individuals with Intellectual Disabilities. Developmental Disabilities. Mental retardation Cerebral palsy Autism Spina bifida Vision or hearing impairment Other delays. Mental Retardation (MR). Intellectual and developmental disorder

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Chapter 14

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  1. Chapter 14 Resistance-Training Strategies for Individuals with Intellectual Disabilities

  2. Developmental Disabilities • Mental retardation • Cerebral palsy • Autism • Spina bifida • Vision or hearing impairment • Other delays

  3. Mental Retardation (MR) • Intellectual and developmental disorder • Characterized by substandard intelligence quotient (IQ) and need of support • Most common developmental disorder in industrialized society

  4. MR • Previous classification system based on IQ scores: • Mild • Moderate • Severe • Profound

  5. New Classification System by AAIDD • American Association on Intellectual and Developmental Disabilities (AAIDD) • Defines MR as being manifested by significantly subaverage intellectual functioning

  6. New Classification System by AAIDD • Exists concurrently with related limitations in two or more adaptive skills areas • Must be evident before age 18

  7. 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

  8. 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

  9. Four Levels of Support • Intermittent • Support on as-needed basis • Either high or low intensity • Limited • Support needed consistently over time • Lesser intensity

  10. Four Levels of Support • Extensive • Regular support • Pervasive • Constant care

  11. 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

  12. Prevalence of MR • Less than 10 percent of all individuals with MR classified as severe • Severe MR • IQ levels below 50 • Often below 35

  13. 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

  14. Mortality Rates • One and one-half to four times higher than average population • Linked to: • Low IQ • Poor self-care skills • Physical inactivity

  15. 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

  16. Etiology of MR • Specific cause usually unknown • Leading cause: • Fetal alcohol syndrome • Second leading cause: • Maternal drug abuse

  17. Etiology of MR • Other causes: • Birth-related trauma • Infectious diseases • Maternal disorders • Genetic disorders • Chromosomal abnormalities • E.g., DS

  18. Other Causes of MR • Poverty • Malnutrition • Infections during pregnancy • E.g., rubella, herpes • Severe stimulus deprivation

  19. Other Causes of MR • Perinatal factors • E.g., prematurity • Postnatal factors • E.g., lead poisoning

  20. DS • Most common manifestation of MR • Occurs in approximately 1 per 800 to 1 per 1000 births • Risks increase with maternal age

  21. Physical Characteristics of DS • Short stature • Short arms and legs • Foot and toe malformations • Visual impairments • Joint laxity related to atlanto-axial instability

  22. Physical Characteristics of DS • Skeletal muscle hypotonia • Pulmonary hypoplasia • Congenital heart disease • Reduced immune function • Higher risks for developing leukemia and Alzheimer’s disease

  23. 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

  24. 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

  25. 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

  26. Leg and Back Strength from Childhood to Early Adulthood

  27. Implications of Low Muscle Strength • Limits recreational activities • Limits vocational productivity • Hinders aerobic capacity and endurance

  28. 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

  29. Research Supports Resistance Training • For individuals with DS, studies show changes in strength with variety of training approaches • Refer to Table 14.1

  30. Program Design Considerations • Level of understanding • Attention span • Level of fitness • Prior exercise experience • Age

  31. Program Design Considerations • Potential physical impairments • Significant coordination problems • Individualization of program • Reason for program • Individual’s goals • Medications

  32. Health Screening • Includes: • Cardiovascular disease • Diabetes • Cancer • Lung disease • Infectious diseases

  33. Health Screening • Includes: • Neurological conditions • Orthopedic conditions • Medications • Exercise and lifestyle history

  34. 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

  35. 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

  36. 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

  37. Program Components • Ensure individual can perform exercise using proper form • Teach proper breathing techniques to avoid Valsalva maneuver • Teach lower weights during two- to three-week initial period at intensity of 40 to 50 percent of 1 RM

  38. 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

  39. 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

  40. 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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