Em runs the track: Em is a young man in his 20s with significant visual impairments. He uses a cane on the streets. At home, he knows his way around. He is studying to become a teacher of the blind. He gets clearance from his doctor to exercise, with the advice to exercise in uncluttered places and without traffic. Em likes to run on the treadmill, but would love to run outdoors. He speaks with an adaptive PE instructor at his school. The instructor suggests starting by walking a track. Em's runner friend helps him get to the track. Initially, they walk. Over time, they jog. Em is thrilled. He would like to run full out. He decides to count steps on the straight away. He continues walking the curves. He does this over many practice sessions. Soon, he can run the straight part of the track alone. He continues walking the curve. Next, he jogs counting steps on the curve. Gradually, he increases his speed. He gets so familiar with the track that he hardly has to count. His friend can barely keep up with him.

Jay plays kickball: Jay is a vivacious 9-year-old boy with quadriplegic cerebral palsy. He uses a power wheelchair for distances. In the classroom and at home, he uses a reverse walker with large all-terrain wheels. Jay's older sister is on a recreational kick ball team. Jay loves the games and cheers her on. But, what he wants to do is play kick ball too. Before the practices, Jay starts walking the bases with his walker. Mom or Dad walks next to him.

When Jay gets around the bases reliably, Jay's dad speaks to the coach. The coach says he worked with kids with disabilities in college. Jay gets in the lineup. On Jay's turn, someone else kicks the ball. Jay scurries to first base with his walker and dad, mom, or coach at his side. The other kids applaud. The coach signals to the team on the field not to tag Jay out. The next player kicks the ball and Jay goes to second base. Eventually, Jay arrives at home plate to a wildly cheering crowd.

Everyone Can Get Moving 

These cases involved fairly complex modifications. There are easier ones. Whether seated, standing with an assistive device, or having something to grab, modified tai chi, yoga, or karate are options. Many people with motor, cognitive, or perceptual impairments enjoy making up karate moves or doing free-form dance. Just turn on their favorite music. The most important principles of adapting exercise are:

• Ensure the activity is safe. Consult a physician and a movement professional.
• Be creative with activities and individualize them when possible.
• Ensure success. Boost self-confidence by starting with easier versions. Build up slowly.
• Recognize even small accomplishments with enthusiasm.
• Where the athlete is self-conscious, try to make the modifications inconspicuous. Give other players similar modifications.
• Most importantly, the activity should be enjoyable or, even better, FUN! •

ABOUT THE AUTHOR:

Aviva Gans, PT MS is a NJ based Pediatric Physical Therapist. Aviva worked as a school-based physical therapist for 30 years and has taught at the university level. She serves as the Chair of the Pediatrics Special Interest Group of the American Physical Therapy Association of New Jersey. She is also involved with the APTA's Academy of Pediatric Physical Therapy. Her primary interests are teaching motor skills to children with learning disabilities, gross motor development, motor learning, and advocating for children, especially children with disINTERNATIONAL PARALYMPICS COMMITTEE paralympic.org abilities. Aviva mentors early career physical therapists, and is available to consult, or speak, with teachers, parents, and parent groups.

References

1. Center for Disease Control Division of Nutrition PAO. Benefits of Physical Exercise. Published June 16, 2022. Accessed June 18, 2023. cdc.gov/physicalactivity/basics/pa-health/index.htm
2. World Health Organization. Global Recommendations for Physical Activity. (World Health Organization, ed.).; 2010. NATIONAL CENTER ON HEALTH, PHYSICAL ACTIVITY AND DISABILITY (NCHPAD) nchpad.org
3. Smith PJ, Merwin RM. The Role of Exercise in Management of Mental Health Disorders: An Integrative Review. Annu Rev Med. 2021;72(1):45-62. doi:10.1146/annurev-med-060619-022943
4. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd SPECIAL OLYMPICS specialolympics.org Edition. 2018. Accessed June 18, 2023. health.gov/sites/default/files/2019- 09/Physical_Activity_Guidelines_2nd_edition.pdf
5. Liou TH, Pi-Sunyer FX, Laferrè B. Lead Review Article Physical Disability and Obesity. Published online 2005. doi:10.1301/nr.2005.oct.321-331
6. National Center on Health PA and D (NCHAD). Best Practice of Inclusive Services: The Value of Inclusion. National Center on Health, Physical Activity, and Disability (NCHAD). Accessed June 18, 2023. nchpad.org/341/1999/Best~Practice~of~Inclusive~Services~~The~Value~of~Inclusion
7. Hollis NTD, Zhang QC, Cyrus AC, Courtney-Long E, Watson K, Carroll DD. Physical activity types among US adults with mobility disability, Behavioral Risk Factor Surveillance System, 2017. Disabil Health J. 2020;13(3):100888. doi:10.1016/J.DHJO.2020.100888
8. MacEachern S, Forkert ND, Lemay JF, Dewey D. Physical Activity Participation and Barriers for US DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Surgeon General, Washington, DC. Step it up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities. cdc.gov/physicalactivity/walking/call-to-action/index.htm. Children and Adolescents with Disabilities. Intl J Disabil Dev Educ. 2022;69(1):204-216. doi:10.1080/1034912X.2021.1952939
9. Tomlinson C, Campbell A, Hurley A, Fenton E, Heron N. Sport Preparticipation Screening for Asymptomatic Atlantoaxial Instability in Patients With Down Syndrome. Clinical Journal of Sport Medicine. 2020;30(4):293-295. doi:10.1097/JSM.0000000000000642
10. Meyerber M, Fraisse B, Dhalluin T, Ryckewaert A, Violas P. Trampoline injuries compared with other child activities. Archives de Pédiatrie. 2019;26(5):282-284. doi:10.1016/j.arcped.2019.05.008
11. Wulf G, Lewthwaite R. Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning. Psychon Bull Rev. 2016;23(5). doi:10.3758/s13423-0150999-9

WORKING IT OUT : RESOURCES

CENTERS FOR DISEASE CONTROL

Division of Nutrition, Physical Activity, and Obesity (2022, June 16). Benefits of Physical Exercise. cdc.gov/physicalactivity/basics/pa-health/index.htm

(22 C.E., January 4). Physical Activity for People with Disabilities.

cdc.gov/ncbddd/disabilityandhealth/features/physical-activity-for-all.html

INTERNATIONAL PARALYMPICS COMMITTEE 

www.paralympic.org

NATIONAL CENTER ON HEALTH, PHYSICAL ACTIVITY AND DISABILITY (NCHPAD) nchpad.org

SPECIAL OLYMPICS www.specialolympics.org

US DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Surgeon General, Washington, DC. Step it up! The Surgeon General's Call to Action to Promote Walking and Walkable Communities. cdc.gov/physicalactivity/walking/call-to-action/index.htm.