PHYSABILITY CONTENTS
Introduction…personal
Introduction …program
R.A.M.P
Disability Specifics
Intellectual Disability
Autism and Autism Spectrum Disorders
Cerebral Palsy
Down Syndrome
Hearing Impairment / Deafness
Brain Injury
Psychological & Mental Illness
Spinal Cord Injury
Blindness & Visual Impairment
Assessment Tool
Task Analysis
Inclusive Coaching
Sporting Organisations
Welcome to PhysAbility and thank you for taking an interest in the wellbeing of others. With many
things in life it’s often a case of not knowing what we don’t know till we find a need to know. For
some that will start a journey of research to find out, others a three pointer in the big too hard
basket and the rest will turn to professionals for information. PhysAbility is a link between people
wanting to know and professionals who have the training around the concept of physical activity
for bodies of all abilities.
Finding myself in the realm of ‘wouldn’t have a clue’ when my youngest son Dane was diagnosed
with Autism Spectrum Disorder at the early age of 20 months, it opened up a whole different world
of parenting and, with my very narrow knowledge base limited to a Rainman (Dunstan Hoffman)
reference, I pursued the internet, books, professionals to increase my knowledge and join the dots
so to speak.
Being a fairly active person (ok the 4 years in the UK doesn’t count) I encouraged both my children
to do the same. Yes Dane took a bit more figuring and as an absconder, activities were inside
under lock and key, trampolining at home, local gymnastics and encouraging his love of water,
lessons at the local swimming pool. Meeting instructors with the patience of saints enabled us as
a family the opportunity of doing things together such as Sawtell Swim Club on a Friday night, a
great way for our local community to meet Dane and vice versa.
All families are different and circumstances vary for those with disabilities as it does with those of
more able bodies but in the following years it became more and more apparent to me a variety of
barriers were in place that were preventing a majority with disabilities from engaging in any form of
physical activity. Children I had the pleasure of teaching swimming during their school years, were
ballooning to near obesity levels in supported living situations, aged parents not having the
physical capacity to assist their grown children participate in social sport, recreational activities and
those whose lifestyle were sedentary and opportunities not passed on to those in their care.
So, the seed of breaking down some barriers through increased awareness was sown and in time
a plan unfolded. I learnt a while ago that if I want others to step out of their comfort zones then I
need to lead by example. So under the banner of Konnecting Kommunities thru Km’s I decided to
run from Tweed Heads to Coffs Harbour via Lismore to raise funds. Why; 1. to put together a living
manual that would assist health, fitness professionals have a broadened understanding of the
barriers preventing people with disabilities from accessing opportunities under the banner of
personal fitness. 2. Information for clubs and supporting groups regarding inclusive practices for all
abilities; 3. Forum for individuals to share their experiences, and 4.Event accreditation by
assistance with course layout for adaptive athletes.
As a triathlete you would think that running wouldn’t be a challenge? As one who firmly believes
that triathlons should be a swim, bike, bike and being a middle aged woman who is a bit round,
running does not come the easiest for me. So with beautiful support from our local community,
fellow runners Jenny and Peter, support crew of Anthony (who ran a big bit more than he
anticipated). We headed up the highway. Unfortunately due to injury Peter didn’t get to start but
the team “soldiered on” and 304km later ran onto Coffs Harbour with one goal satisfied and
another beginning.
PhysAbility is not an exhaustive document but one that hopes to bring professional, sporting clubs,
groups and people with all types of disabilities to a starting point where a common language can
be used to form partnerships that may last a lifetime… a healthy lifetime.
All bodies are designed to move..in their own way.
With thanks, Jo Magill
PhysAbility is based upon the belief that everybody, no matter what our internal and external
wiring may be, enjoys and benefits from voluntary movement.
Are you aware that 4.2 million Australians are estimated to have a disability? That now equates to
1 in 5 people currently living in Australia. The overall population of people with disabilities is
increasing. There are multiple reasons for this, including better identification, increasing levels of
obesity, improved technology that saves and sustains lives and the aging demographics. Many
people with intellectual/developmental disabilities are living much longer and are experiencing the
long term effects of a disability combined with the effects of aging.
Many health disparities observed with people with disabilities aren’t necessarily a direct result of
having a disability and may occur directly or indirectly from a lack of good health promotion
practices. People of all ages with disabilities face substantial health risks associated with a
physically inactive lifestyle. Unfortunately even when individuals with disabilities want to increase
their physical activity levels, they are often confronted with many more barriers than the general
population. This can create a ‘chicken and the egg’ scenario. People with disabilities overall are
often the least active members of the community but need activity most, because of secondary
complications arising from sedentary behaviour. Poor aerobic capacity, poor muscular fitness and
flexibility can often lead to restricted functional independence and increase risk of chronic disease
complications such as coronary artery disease, hypertension and depression. While regular
physical activity has the potential to offset some of the decline in health and function observed in
people with disabilities, barriers to promoting increased physical activities must first be addressed.
Barriers identified include poor accessibility, lack of awareness of fitness facilities, transport, lack
of knowledge of how and where to exercise, perceived discrimination, expense of training, foreign
unfamiliar environmental thought.
Young adults with moderate to severe disability often have great difficulty transitioning from
adolescence to adulthood where programs such as recreation and physical activity were primarily
school based which is no longer part of the individual’s life. Children with disabilities also have
significant lower levels of physical activity compared to their nondisabled peers and by
adolescence inactivity has been reported as 4.5 times higher in comparison. As in the whole
population, higher levels of inactivity during childhood and adolescence are likely to contribute to
increased risk of adverse health conditions alongside rising health costs.
Health and fitness professionals have a unique opportunity to impact a large and substantial
segment of the population (ie people with disabilities) who are underutilising indoor and outdoor
fitness and recreation facilities and programs in their community.
This is where “PhysAbility” can help. As health and fitness professionals, we do not want to tell
you how and why to work with your clients but wish to offer knowledge as to specifics of some
disabilities that may pertain to your potential clients.
While preaching to the converted; did you know:
Resistance training 2-3 times a week for 6-10 weeks will lead to significant improvement in the
strength of persons with Cerebral Palsy plus the added bonus of increased self-perception.
Exercise training generally can produce significant gains in strength in paretic muscles through
increased motor unit recruitment for someone with an incomplete spinal cord injury. With a
complete spinal cord injury, intact muscle groups can be strengthened to be similar to the
respective muscles in the general population.
Randomized studies regarding the effect of exercise and Multiple Sclerosis found significant
improvements in fatigue with exercise.
Significant increases in VO2 peak and in duration, workload, and/of distance were shown in
studies of the effects of exercise in persons with an intellectual disability. One study showed
increased walking speed among older people with an intellectual disability. Apart from the physical
benefits demonstrated, studies also revealed decreased perceived barriers to participation in
exercise, and increased outcome expectations in self-efficacy and life satisfaction.
Endurance and physical work capacity were improvements noted by persons with Down
Syndrome who participated in cardiovascular exercise programs.
And the list could go on……
PhysAbility aims to assist in the following ways:
1. Provision of a manual that can be used on a day to day bases when working with clients
with a disability
2. 6hr workshop that brings PhysAbility to life including
a. Theoretical education regarding disabilities & implications within the fitness and
sporting industry
b. practical application of adaptive practices in a gym setting
c. Case study discussions covering:
i.
ii.
iii.
iv.
Initial thoughts of specific fitness program for an individual client
Challenges that are likely to arise initially and ways to overcome
What would your assessment look like?
Fitness program over 12 weeks including training sessions, goals, number
of sessions, other challenges and
v. Demonstrate to you client that gains in fitness are being made.
3. Adaptive Day for Sporting Clubs
a. A half day workshop to help members of local sporting clubs and organisations
identify ways for inclusive practice for all interested members
4. Event accreditation
a. Assistance with course layout for adaptive athletes and participants
b. Signage signalling PhysAbility friendly
c. Events advertised on PhysAbility web site and FaceBook page
R.A.M.P
Value the no
Value the why
When thinking why you can’t, it becomes clearer as to why
you can
While recognising that many physical activities and sports have an element of inaccessibility for
many with disabilities, a critical feature is to understand the type and nature of the barrier that
many prevent individuals from engaging in physical activities.
Using the acronym of RAMP – Restoring Activity Mobility and Participation, Rimmer and Schiller
developed a model which systematically addresses barriers in the built environment experienced
by people with disabilities. The idea of ramping up to successive levels offers a logical
progression through the domains or rather four components – Access, Participation, Adherence
and Function (Health). Each building on the previous, they reflect the interconnectedness
between the components (levels) in achieving optimal health and well-being. Access is necessary
for participation, and regular participation and adherence are necessary to obtain benefits in health
and function.
RAMP Framework
Access refers to offering an opportunity to experience typical use of the environment or
exercise equipment. The most commonly known access issues for people with disabilities is the
physical access, into a building, full use of the available facilities, access on and off equipment.
The more subtle aspect of access is information on the availability of services, facilities, programs
and equipment. Without at least awareness of the options available, the options are functionally
unavailable. One way to identify people with disabilities is to connect with local organisations who
serve the disabled community. These include special education programs, independent living
centres, developmental disability service providers, rehabilitation facilities, hospitals and long term
care facilities. Meet with professionals in these settings, make them aware of the accessible
physical activities that are available in their community, partner with them on transitioning people
with disabilities into all areas of indoor and outdoor activities. Even commencing activities in a
residential setting is a great way to build rapport and confidence remembering that where you start
isn’t necessarily the final destination.
As health and fitness professionals, sporting group co-ordinators can consider the following when
establishing and upgrading premises and equipment:
1. Consider purchasing equipment using universal design features such as swivel-away
seats;
2. Easy reach weights and easy to change weight on resistance machines;
3. Wide enough spaces between machines for transfer ease
4. Travel paths free of temporary or permanent obstacles
5. Good colour contrasts are good adjustments for users with visual impairments
6. Firm surfaces especially where transfers may occur
7. Adjusted height of benches, lockers etc any items that all members use
8. Sloped entries, slings, hoist etc especially around swimming pools or multi level sites
where stair access is the norm
Participation goes beyond physical access and refers to developing modalities of physical
activity that are both beneficial and satisfactory for people with disabilities. Access is primarily
concerned with availability and opportunities while participation is primarily concerned with
usability or stage of readiness to use available opportunities. The emphasis on the participation
component in the RAMP model is to ensure that the experiences of people with disabilities are not
diminished relative to the experience of other participants. So whilst physical adaptation is
required it is also essential that within the participation component, education and training of
professionals who have little or no background in working with people with disabilities. Many
people with disabilities find that the lack of knowledge about specific disability, poor professional
behaviour and negative attitudes limits their opportunity to participate in a much wider variety of
physical activity programs.
People engage in physical activities for a variety of reasons but above all it’s the enriching
experience that will have people of all abilities returning again and again. Please don’t limit your
search of knowledge to within your own industry but include those who work alongside people with
disabilities in their day to day lives, carers, family members, Occupational therapists, speech
therapist etc..
Adherence presents possible the greatest challenge in securing the health benefits of physical
activities. Full benefits can be and are achieved when individuals participate in moderate physical
activities most days throughout their lifespan. So like most people variety is a spice of life…
Possible strategies for increasing adherence to beneficial recreation and exercise programs
involve varying the types of activities or activity locations and developing social networks that
connect people and make the physical activity part of a socially engaging experience, part of the
local community. Keep sight of a determined goal eg..
If wanting to go sailing but upper body strength and weight are current barriers;
a. Weight program for strength
b. Nutrition program to assist with weight loss
c. Encourage visiting Sailing program, familiarising with equipment,
d. socialising with others who share same interest of sailing
Health and function sits at the top of the RAMP model and equates to achievements in
beneficial health outcomes eg musculoskeletal, cardio respiratory, functional, metabolic and
mental health. The ultimate goal of any health/fitness professional is to improve quality of life and
help lower the risk of various health conditions. Therefore it is important to identify effective
methods for measuring and monitoring physical activities For example, movement of upper
extremities may account for only a small portion of total energy expenditure in the ambulatory
population whereas wheelchair users use their upper body for all activities of daily living and for
exercise such as arm cranking and wheelchair propulsion. Consequently, quantifying upperextremity movement is necessary for an adequate measure of physical activity among wheelchair
users. It is also imperative to avoid an overuse injury resulting from repetitive motions associated
with certain exercises. For someone whose daily activities are confined to self-propulsion in a
wheelchair, continually working the upper body to exhaustion can impede even the most simple of
their daily tasks. Overall, the establishment of good monitoring strategies to ensure the modalities
chosen are safe and effective for the participants.
Disability Specifics
INTELLECTUAL DISABILITY
Individuals with an intellectual / developmental disability have considerable
limitations in intellectual function. They may have difficulty learning & managing
daily living skills. This is because their cognitive (thought-related) processing is
impaired. People with an intellectual disability often learn slowly, but given time, can
adapt to new situations & enjoy many regular life experiences. Intellectual disability
affects around 2-3% of the population in Australia.
Intellectual Disability Characteristics:
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In clinical terms intellectual disability is often defined in terms of the severity of
the condition:
o Mild intellectual disability, IQ = 55 – 70
o Moderate intellectual disability, IQ = 30 – 35
o Severe intellectual disability, IQ = <30
The level of intellectual disability may be stable or can progressively become
more severe. Intellectual Disability may co-exist with other physical
disabilities.
Generally speaking a person with an intellectual disability:
o Learns & processes information more slowly than someone without an
intellectual disability
o Has difficulty with abstract concepts such as money & time
o Has difficulty understanding the subtleties of interpersonal interactions
Medication
It's important to understand the effects that medication have on the body in relation
to exercise. Medication may affect or impair the ability to exercise. It is important to
get a comprehensive list of all medications prior to starting any exercise program.
An intellectual disability cannot be treated with medication. Medication may be used
for the control of other symptoms or illnesses which are affecting an individual, not
the intellectual disability itself.
Exercise Considerations:
Fitness levels of persons with developmental disabilities are generally much lower
than those of the general population. Most individuals with developmental
disabilities get very little physical activity & carry high amounts of body fat,
particularly women. These traits do not develop from their condition, but rather from
their lifestyle. As they grow older, it is likely that a greater number of them will suffer
from secondary disease & disability at an earlier rate than the general population
Fitness levels of children with developmental disabilities are also often very poor,
predisposing them to greater health risks in adulthood.
Issues most related to exercise are:
Issues most related to exercise are:
 Previous exposure to activity & exercise may be very limited
 There is often low motivation for exercise & lack of comprehension about the
benefits of exercise
 Exercise will need to focus on activities which the client finds enjoyable &
meaningful & in which they can achieve some success, which will assist with
engagement & long term program adherence & success
 Factors such as limited cognitive understanding as well as limited physical
capacity need to be considered
Implications for Trainers:
There are many ways to make positive lifestyle changes in persons with
developmental disabilities using behavioral strategies that in many respects are no
different from the general population. These may include:
 Develop a reward system that reinforces small accomplishments in the
exercise program. Repeat this regularly
 Offer a ‘buddy’ system that will allow the person to exercise with a friend or
someone they enjoy being around
 Keep visual wall charts to record progress. Many adults with developmental
disabilities will enjoy seeing their names on the board & following their
progress as they increase their physical activity levels
 Work with carers to incorporate activity into daily scheduling, such as shooting
hoops, walking to shops, running around park for fun
General Exercise Guidelines for Individuals with intellectual
Disability:
People with developmental disabilities have the same essential needs as the general
population in terms of improving their health & fitness. An exercise program should
include the three common elements: cardiovascular endurance, strength & flexibility.
If there is not enough time, energy or concentration to complete everything in one
session, break it up into two or three shorter sessions.
Be conservative. Start the program at very low levels (e.g., 10-minute walk, 5
minutes on a stationary bike) & work toward higher levels once adherence is
established. The highest dropout rate will usually occur in the first six months of the
program.
One very important strategy for increasing exercise compliance among persons with
developmental disabilities is to motivate staff & caregivers. It will be extremely
difficult to change the lifestyle patterns of persons with developmental disabilities if
staff or family members are not proactive in encouraging physical activity
participation.
A fitness program should include as much variety as possible.
Cardiovascular Exercise:
One of the most challenging aspects of a physical fitness program for persons with developmental
disabilities is improving cardiovascular fitness. Aerobic condition may initially be quite poor but
progression is only limited by other coexisting conditions.
Getting some adults with developmental disabilities to exercise at a sufficient intensity level for 20
to 30 minutes to attain these physiological changes may be difficult. It is best to start off slowly &
gradually increase the workload. Start off at a lower intensity (45% to 55% MHR) & gradually
increase the intensity as the person's fitness & motivation levels improve. Effective activities
include those that are rhythmical, repetitive & simple in nature. Walking is a very simple & effective
activity. Dancing is also a great cardiovascular activity that many adults with developmental
disabilities enjoy.
There are many other activities that can be used to improve cardiovascular fitness, including
jogging, swimming, hiking, bicycling, arm cycling, stair-climbing, rowing & skating.
Strength Training:
The strength levels of adults with developmental disabilities are generally inferior to adults without
developmental disabilities, but gains are only limited by lack of other coexisting conditions.
Muscular strength & endurance is related to improved performance in daily activities including
lifting & carrying things, walking up a flight of stairs, maintaining good posture & performing workrelated tasks (e.g., pushing carts, stocking shelves).
Some recommendations for a strength-training program include:
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Do activities that the person enjoys
The program should be progressive in nature & highly individualized
The first few weight training sessions will require a great deal of supervision.
Practice using the equipment for several sessions to ensure that the person
understands how to properly lift the weight
Emphasize the development of the arms, legs, stomach & back
Provide adequate rest between exercises
Teach persons to track & record their own progress. Simplified forms can be
developed to teach persons with developmental disabilities how to record their
results
Provide clear feedback reinforce form & safety instructions frequently.
Flexibility:
Flexibility levels are only limited by other coexisting conditions & it should be given as
much emphasis as it would in a program with any other population.
Communication & Teaching Style:
Effective communication is a cornerstone to success when working with clients with
developmental disabilities. You may need to liaise with another professional such a
speech therapist to develop effective communication strategies, or to understand
what strategies work best for your client.
Some points to consider:
 Clients may have difficulty communicating with you or understanding
exercises & instructions, particularly verbal instructions. You may need to
repeat instructions, in a variety of different ways to ensure full understanding.
Sometimes demonstrations, pictures or diagrams can be useful.
 Allow additional time for an individual to mentally process an instruction or
desired movement
 Sometimes memory may be problematic & instructions & demonstrations
previously given to an individual may need to be repeated at each session. It
may take a very large number of repetitions before a client becomes proficient
or comfortable with an exercise or activity
 It is important that there is an element of success. Provide a lot of
encouragement & motivation. Progress pictures, charts or goals may also
provide motivation. Monitor the program on a regular basis
 The client may not be able to generalise a particular movement or activity to
another piece of equipment, another place or another time. You may need to
go over an activity each time a variable is changed
Tips that may help you when communicating with someone who has a
developmental disability include:
 Make sure you have the person’s full attention. User their name, gain eye
contact or touch their arm to get their attention
 Speak clearly. Don’t rush. Allow the person time to listen, process your
words & respond
 Use simple language, but start by assuming the individual can understand
you, then adjust your level of communication as needed according to their
response
 Ask the person how they prefer to communicate if they do not use speech.
This can include gestures, communication aids or devices, sign language,
facial gestures, head or hand movements. If you are not able to understand
the person, you may need to ask their carer to assist
 Use appropriate language for the person & the situation – for example,
simple, clear words & short, uncomplicated sentences. If the person is an
adult, do not speak as though they are a child.
 Use visual aids such as pictures, diagrams signs, objects, gestures or miming
to improve understanding
 Use respectful tone & volume. Try a different method rather than raising your
voice
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Check their level of understanding by asking them to rephrase what you have
said in their own words
If you don’t think you have been understood, try repeating your message
more slowly or using different words or methods
If you don’t understand the person do not pretend that you have understood.
Be honest & ask them to tell you again.
Safety:
There will need to be a lot of supervision, especially at the initial stages & when
using machines or equipment for the first time. Also be aware that even if you are
using the same machine, but in a different manner this will often seem like a totally
new experience for the client so spend the time & explain, show & ensure that they
can do the activity & use the equipment safely
Resources & Further information:
NSW Council for Intellectual Disability
Australasian Society for Intellectual Disability
http://www.nswcid.org.au/
https://www.asid.asn.au/
AUTISM & AUTISM SPECTRUM DISORDERS
Autism Spectrum Disorder (ASD) is a developmental disability that affects affect a
person’s communication, social skills & behaviour. It is typically diagnosed in childhood &
often lasts throughout a person's lifetime. The most well-known types of Autism
Spectrum Disorders are Autism & Aspergers syndrome.
The word 'spectrum' describes the range of difficulties that people with ASD may
experience & the degree to which they may be affected. The severity of its effects on each
person can vary greatly. No one person is affected the same as another, & even one
individual may not have the same consistent effects day to day. Some people may be
able to live relatively normal lives, while others may have an accompanying learning
disability & require continued specialist support.
ASD Characteristics:
The word autism means ‘absorbed in self’. Individuals with ASD might show a range of
characteristics, & these characteristics vary between individuals. They can also change
depending on the person’s age & stage of development. Many of the characteristics
displayed by people with autism include:
 Impaired ability to communicate & relate to others socially
 Obsessive or repetitive behaviour – pre-occupation with certain objects or topics or
wanting to do something over & over again. Displaying repetitive patterns of
behaviour, such as body rocking, spinning, head-nodding, hand flapping, objecttapping, & light gazing
 Resistance to change, both in daily schedule as well as environment
 Unusual sensory interests such as sniffing objects or staring intently at moving
objects
 Sensory sensitivities including avoiding everyday sounds & textures such as hair
dryers, vacuum cleaners & sand
 Intellectual impairment or learning difficulties
 Co-ordination difficulties, often appearing awkward or clumsy. Tripping over or
bumping into objects
 Hyperactive behaviour – hard to sit still & are always on the go
 Tics –uncontrolled jerky movements, such as blinking, twitching their faces, or jerky
movements of the arm or shoulder
 Aggressive & highly emotional behaviour
 Difficulty understanding what you say & tendency to take things literally
 Secondary challenges including:
o Anxiety & depression
o Sleeping & eating disturbances
o Attention issues
o Temper tantrums, aggression or self-injury
o Seizures
Exercise is an effective therapy for children, adolescents, & adults with autism. It can
reduce the severity of negative behaviours as well as improve social skills.
Medication
It's important to understand the effects that medication can have on the body in relation to
exercise. Medication may affect or impair the ability to exercise. It is important to get a
comprehensive list of all medications prior to starting any exercise program.
There is no medication that has been proven to address the core characteristics children
with ASD show in the areas of communication & social relations. But medication can help
ease challenging behaviours associated with ASD.
Some of the most common medications prescribed may include Ritalin, Selective
serotonin re-uptake inhibitors (SSRIs), Antipsychotics & Anti-epileptic medication. Side
effects of each drug can vary greatly but may include:
 lower appetite
 tics & more repetitive behaviours
 Increased anxiety& hyperactive behaviour.
 irritable or nervous feelings
 gaining weight
 feeling tired or sleepy
 drop in blood pressure or heart rate
Exercise Considerations:
Exercise provides so many positive outcomes for children with autism, but the most
important part is that the child is comfortable & is having fun. If the child can pick the
activity / exercise themselves they can retain a sense of control.
A lot of children with ASD are either overweight or at risk. Whilst decreased physical
activity may be the primary reason for the increased rate of weight gain in children with
autism, unusual dietary patterns & the use of antipsychotic prescription drugs can also
lead to weight gain.
Participation in physical activity may be challenging for individuals with autism for various
reasons such as limited motor functioning, low motivation, difficulty in planning, & difficulty
in self-monitoring. Increased auditory, visual, & tactile stimuli may too prove challenging.
Physical activity involving social interaction such as team sports can present a difficult
situation for someone with autism. However, if implemented appropriately, the addition of
physical activity to an autism intervention program can help overcome many of these
challenges & improve one’s overall quality of life.
Aerobic exercise can significantly decrease the frequency of negative, self-stimulating
behaviours. Exercise can also discourage aggressive & self-injurious behavior while
improving attention span. One theory behind these findings is that the highly structured
routines or repetitive behaviors (such as those involved with running or swimming) may be
similar to & or distract from those self-stimulating, repetitive behaviors associated with
autism.
Physical activity can promote self-esteem, increase general levels of happiness, & can
lead to positive social outcomes. For those with autism who are able to participate in
team sports, this presents an opportunity to develop social relationships among
teammates & learn how to recognize the social cues required for successful performance
on the sporting field.
Implications for Trainers:
It is crucial for trainers to prepare for challenging behaviour by being aware of each child’s
sensory sensitivity & providing a private / quiet space for the child to calm down.
Individuals with ASD prefer to follow very specific routines. It is important to make any
transitions or changes to the routine gradual & consistently.
Avoid activities that the individual does not like or is fearful of. For example if a child has a
fear of water, exercise in a pool may not be as beneficial as another activity that they
would enjoy, such as dancing, running or horse riding.
The exercise program needs to be individualised for each person, their own interests,
hobbies & goals. The more fun it is & the more engaged the client is the greater the
adherence & success.
Some of the issues for people with ASD are:
 coordination difficulties - difficulty linking movements into a sequence or more
complicated activity or difficulty learning new physical tasks.
 Difficulty with gross & fine motor skills.
 May tire more easily.
 Difficulty with understanding what you are asking them to do, especially if the
activity is new to them or there is more than one step to it.
General Exercise Guidelines for Individuals with Autism
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Vigorous exercise can have a positive impact on decreasing stereotypic behaviours
Exercise can be used most effectively when it mimics the feedback that the child
would receive from the self-stimulatory behaviour
Cardiovascular Exercise:
To maintain cardiorespiratory fitness, & also reduce disruptive behaviour, is around 6090% of the heart rate maximum for a minimum 20 minutes of exercise. Any form of
vigorous aerobic exercise can be utilized to control non-functional behaviours associated
with autism, allowing individuals to function more easily in the workplace, social &
academic settings, & beyond.
Some simple activities for individuals with ASD include:
 Running, dancing, swimming
 Pool - dog paddle, kicking with kickboard (no flippers)
Water based exercise can also provide added benefits for children with autism. The
weightlessness of the water allows for greater range of motion & fluidity, & ease of
movements. The sensory signals that the child receives from being surrounded &
supported by the water also help to calm & steady the child. It also assists the child in
knowing where their body, arms & legs are in space (proprioception). Many children with
an Autism Spectrum Disorder enjoy the feel & the physical support that the water
provides.
Children with an Autism Spectrum Disorder can find learning to swim in a group
environment challenging due to the noise, splashing & unpredictable movements &
playing of other children. One on one sessions, in a quieter time of the day & area of the
pool can be more effective.
If doing pool based activities be aware that children with an Autism Spectrum Disorder,
often they do not like the ‘feel’ of the flippers on their feet.
Strength Training:
Stabilising & core activities are often required & need to be focused on before further
progression of the program can occur. Some simple activities for individuals with ASD
include:
 push ups
 sit ups
 swimming strokes & kicking - for developing core stability
Flexibility:
Specific muscle stretches are generally not indicated with ASD
Coordination:
Some simple activities for individuals with ASD include:
 climbing activities
 pool – freestyle, backstroke
 walking along a balance beam
Communication & Teaching Style:
Individuals with ASD may demonstrate various communication difficulties including:
 difficulty with eye contact & other nonverbal body language such as gestures &
facial expression
 difficulty telling you what they want or need
 difficulty making conversation
 being awkward & ill at ease in a social situation
 unusual or challenging behaviours in response to their confusion & stress
Important strategies for creating a supportive environment for children with autism to be
able to actively participate in include:
 Establishing a routine, with clear structure to activities & visual cues
 Have a clear beginning & end to the session
 Use positive reinforcement
 Communicate in a way that the individual child responds well to
 Teach new skills by breaking them down into smaller, organized tasks & then
rewarding them for successful achievement
 Avoid loud noisy places with increased distractibility
 Use clear, simple instructions
 Practising movement again & again. The individual with ASD will need more time
than most of their peers to learn a skill. Practise for short periods of time,
frequently (rather than a large chunk for an extended period)
 Break down a skill or activity into much smaller parts. You may only teach part of a
skill or activity in one session. Practice the parts separately, then gradually link the
parts together, in sequence until the whole skill is achieved
To further assist with learning & developing motor skills & movement components, it is
important to use all of the senses. Simple learning methods can include:
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Physical demonstration of a specific movement or activity
Use picture cards or DVD’s / YouTube of people doing the movement/skill you are
trying to teach
Use picture cards which break down the movement or activity into its component
parts. Place the cards in a row in the correct order to complete the correct
movement sequence
Vary the volume & tone of your voice
Physically guide & move the child’s arm/leg/body movements. However note that
some children with an Autism Spectrum Disorder can be exaggerated in their
reaction to your hands-on guidance. They may seek out your touch or they may not
like the sensation & avoid your physical assistance. If their reaction to the sensory
input of your guidance distracts them from their learning, focus on visual learning
strategies instead
Be precise - if you move the child’s body/arms/legs in an awkward movement
pattern, that is the movement they will learn
The key things to remember in developing any physical activity program with individuals
with ASD are:
 make sure it is fun
 make sure it is achievable
 make sure it is not too easy, not too hard
 select a variety of activities
 do little bits & often
 work out the best way they learn. Tailor the way you teach to the way the individual
best learns. Try visual teaching methods first.
Safety:
Resources & Further information:
Autism Fitness
www.AutismFitness.com
Autism Awareness
http://www.autismawareness.com.au/
Autism Spectrum Australia http://www.autismspectrum.org.au/
CEREBRAL PALSY
Cerebral Palsy (CP) is a non-progressive disease that affects both fine & gross motor
control. CP is a condition caused by injury to the parts of the brain that control our ability
to use our muscles & bodies. Cerebral = brain. Palsy = weakness or problems with using
the muscles.
While there are many obstacles associated with CP, it is still possible to have an active
lifestyle. There are different types of CP, but all have similar characteristics. CP can be
mild, moderate, or severe, which ranges from being clumsy to being wheelchair bound.
CP doesn’t get worse over time, & most people with CP have a normal life span.
CP Characteristics:
The signs of cerebral palsy can vary greatly from person to person & may change over
time. General signs of cerebral palsy may include the following:
 child is slow to reach developmental milestones such as learning to roll over, sit up,
crawl, smile, or walk
 weakness in one (hemiplegia) or more limbs
 standing & walking on tiptoe
 difficulty with fine motor tasks
 clumsiness or difficulty maintaining balance
 walking with an abnormal gait, with one foot or leg dragging or a scissored gait
 involuntary & uncontrolled body movements
 excessive drooling
 lack of muscle coordination when performing voluntary movements (ataxia)
 rigidity, stiff, tight or contracted muscles & exaggerated reflexes (spasticity)
 learning problems
 difficulty with speech, hearing or seeing
 behavioral or emotional challenges
 muscle tone that is either too stiff or too "floppy"
Medication
It's important to understand the effects that medication have on the body in relation to
exercise. Medication may affect or impair the ability to exercise. It is important to get a
comprehensive list of all medications prior to starting any exercise program.
People with CP may be prescribed anti-seizure & antispasmodic medications & these may
decrease the intensity of aerobic exercise that they can do.
Exercise Considerations:
There are a variety of health & social benefits associated with exercise in this population,
including:
 increased participation in individual & community activities
 improved sense of well-being & a reduction in anxiety
 increased lung & heart efficiency
 increased strength, flexibility, mobility, & coordination
 improved bone health
 weight control
 reduction of chronic diseases & secondary conditions (eg: osteoporosis)
Implications for Trainers:
The benefits of exercises for people with cerebral palsy are great but each individual has
their limitations. As with everything else in life, moderation is the key. Know the client’s
limits & understand that they will build stamina over time. An appropriate exercise program
should not aggravate conditions that accompany cerebral palsy or other neuromuscular
disorders.
Individuals with cerebral palsy (CP) have challenges with movement, function & mobility
that last a lifetime. The disability is non-progressive, with the physical challenges faced by
this population stabilising once they reach adulthood. However, while the condition is not
progressive, the level of independence & mobility may actually deteriorate as the person
ages.
Because of the dangers of inactivity, innovative forms of physical activity & exercise for
persons with mobility impairment need to be developed & implemented. Many clients with
CP may be wheelchair bound & or experience frequent seizures throughout their body.
Individuals with CP are also more susceptible to overuse injuries because of inactivity &
other associated conditions, such as contractures & joint pain.
Good positioning of the head, trunk, & proximal joints of extremities is advised. This may
include strapping of the hands or feet to the pedals when using the arm or leg cycle
ergometer, or strapping of the individual’s pelvis in the wheelchair for proper positioning,
as well as thighs to prevent adduction of the hips, or of the feet on the footrest to prevent
slipping.
Other simple adaptive items to consider include:
 The use of gloves during wheelchair exercise
 Velcro gloves can be used to attach the hands to equipment (if the client has
trouble with gripping).
 For swimming programs, the use of flotation devices should be considered.
 For cycling, the use of a tricycle, tandem bike or pedal straps may be helpful.
General Exercise Guidelines for Individuals with Cerebral Palsy
Even though the design of the exercise training program should be similar to the principles
for the general population, modifications to the training protocol may have to be made
based on the person's functional mobility level, number & type of associated conditions, &
degree of involvement of each limb.
Persons with CP fatigue easily therefore, it is important to tailor the activity, intensity, &
duration to your client. The use of short intervals & relaxation & stretching sessions
throughout the training sessions can help to decrease fatigue. In general, 20-30 minutes
per session is the minimum goal. However, during the first few weeks, several short
sessions (e.g.: 5-10 minutes) per day can be better than a longer period. It is particularly
important to increase the duration, intensity, & frequency of the exercise activity gradually.
Duration should be increased progressively before increasing intensity.
Aerobic exercise programs should start with frequent, but short bouts of moderateintensity (40-50% HRR). Once the client is comfortable, you can progress the exercise
intensity to reach 50% to 85% HRR), gradually increasing the duration of each session as
endurance improves.
Reducing muscle spasticity may be an important goal of treatment. This can improve
comfort & function & help prevent future musculoskeletal complications such as
contractures (permanent tightening of the muscle). Early prevention of contractures may
reduce the need for corrective surgery.
Cardiovascular Exercise:
Endurance training is best done with shorter duration of efforts (ie: 5-15 minutes), 2-3
times per week (or more often) if possible.
If the condition is localized in the arms or the client is wheelchair dependent, arm cycling /
ergometer cab be a great option, to increase cardiovascular fitness, muscular strength &
flexibility.
Walking can help improve the mobility of the leg & hip muscles, & can result in increased
flexibility & better balance. Ensure a thorough assessment is conducted first so that there
is minimal risk of losing balance & falling.
Wheeling involves propulsion of a wheelchair by the arms or legs over an extended
distance. Vigorous wheeling can be done inside or outside. It can be done using a
conventional wheelchair or a specialized sport wheelchair, with or without a wheelchair
roller. If wheeling outside, precautions should be taken for street traffic. Hills or gradients
are also great for increasing intensity of wheeling (just be mindful of the downhill descent
afterwards)!
Strength Training:
Resistance training for persons with cerebral palsy is vitally important. These exercises
should be designed to target weak muscle groups that oppose hypertonic muscle groups,
improve the strength of the weak muscle group, & normalize the tone in the opposing
hypertonic muscle group through reciprocal inhibition. It is also recommended to have
your client perform slow, dynamic strengthening exercises over the full range of motion.
Muscle strengthening exercises are most effective when they are focused primarily on the
muscle group opposite the tight muscle group. For example, biceps are tight, stretch &
strengthen the triceps. For people with severe contractures or weakness, extra caution is
advised to minimize muscle strain. Doing any type of stomach & back strengthening
exercises will help counteract a lot of the typical postural problems associated with CP.
The exercise program should change consistently with changes in muscle tone.
Loads should not be at a maximum. Weights should not be allowed to dangle on the limb.
Free weights (e.g. bar bells) should be used with caution by persons with athetosis
(involuntary body movement.) Weights are not advisable for persons who cannot control
the weights. If using free weights, it is recommended to have a partner or spotter.
The strong pull of the hip adductors seen in many persons with cerebral palsy will require
a resistance training program that places greater emphasis on strengthening the hip
abductors. This does not necessarily mean that the hip adductors do not need to be
strengthened. While the adductor muscles are often very tight due to spasticity, they may
also be very weak. Therefore, both sets of muscle groups must be strengthened even
though the abductors might have to receive a greater amount of work. Make sure that
clients have not had a hip dislocation prior to working these muscle groups. Seek medical
advice if your client has had a previous dislocation.
A common type of cerebral palsy that results in weakness or paralysis to the right or left
side of the body is spastic hemiplegia (a similar condition occurs in persons with stroke).
Developing strength on the weaker side of the body will greatly assist with this condition.
Since balance is often impaired in ambulatory persons with cerebral palsy, it is important
to protect clients from injury by developing safe resistance training programs that do not
expose them to a high risk of injury. Some clients will be able to work on strength
exercises in a standing position with physical assistance from the instructor, while others
will have to perform the exercise routines from a chair. Asses the client's balance before
developing a resistance program to determine if standing exercises are safe.
Certain individuals with cerebral palsy have a condition known as athetosis. This
condition results in involuntary movements that occur in one or more of the person's limbs.
The movements are uncontrollable & are often referred to as slow & 'writhing.' Facial
muscles are also involved, which make the person appear to be laughing or crying. Since
the movement of muscle groups is involuntary, use of free weights may not be possible
because the hand may open reflexively during the weight routine. Elastic bands may also
be a problem since the resistance may be difficult to control & may result in the band
snapping back too quickly. Cuff weights & machines are the most appropriate modalities.
Active-assistive exercise may be needed to perform the motion smoothly.
Flexibility:
Flexibility training is a very important part of the exercise prescription for persons with
cerebral palsy because of the high level of spasticity. Stretching will help relax & repair
muscle tendons from the constant tightness & contractions seen with these types of CP.
It is important to include a proper warm-up & cool-down, as well as a stretching session to
help maintain muscle length & flexibility. Ballistic stretching should be avoided.
Yoga can be ideal for persons with CP, especially for those suffering from Spastic or
Rigidity.
Swimming & water based exercises are other great options. Because of water's natural
buoyancy & resistance, it makes it easier for people to perform at optimal range of motion
(ROM) without feeling the effects of gravity or extra stress on joints. Aqua therapy
provides deep, intense exercise within a soothing & comforting environment. If in a
heated pool the warm water therapy provides a massage effect on muscles, joints &
ligaments. It is important to note that cold water can increase muscle tone, but warm
water often has a relaxing effect & can help reduce muscle tone. Locate a pool / ocean
with the water temperature that is best suited for your client’s tone.
Coordination:
Yoga, Tai Chi & Balance style classes are great for improving balance, mobility &
coordination.
Communication & Teaching Style:
Cerebral palsy can affect a person’s ability to finely coordinate the muscles around the
mouth & tongue that are needed for speech. Some adults with cerebral palsy may not be
able to produce any sounds, others may be able to produce sounds but have difficulty
controlling their movement enough to produce speech that is clear & understood by
others. Some people may not speak at all, but they may have good understanding of
what is said to them.
Work with the person to establish ways in which they can show you whether or not they
are receiving what you say & understanding it. Really listen to the person when they
speak. While many people with CP have problems with speech, you can usually learn to
understand their verbal communication over time. Various tips to assist with
communicating with someone with CP can include the following:
 Go to a quiet place & so that you are completely focused on listening
 Show the person you are listening to that you want to understand. Lean forward,
ask questions of clarification if you need to. Be an active listener
 Give them time to say what they want to say (a lot of people with CP have very
slow speech). Don’t interrupt, don’t finish sentences for them or cut them off with
statements like ‘OK. Don’t worry. I know what you mean’ & don’t speak for them.
 Tune in. Remember that the speech rhythms & voice pitch of someone who has
vocal impairment are often very different from those of someone who does not.
Once you become familiar with these differences, comprehending the person’s
speech will be much easier.
 Be technology knowledgeable. It is important to understand the technological aids
a person with CP might use.
 Communicating electronically. If you are ‘talking’ with a person through an
electronic communication form, learn how they use language & how to respond in
the same way – it will be easier for both of you. Sometimes reading the message
aloud makes it easier to follow.
Safety:
Even very severely involved individuals with CP can enjoy physical activity & exercise, but
they may need more supervision. In certain cases, cognition may be a limiting factor, as it
may affect their ability to understand the use of equipment.
Weight bearing & joint flexing exercises must be done with caution, especially if the client
has contractures &/or loss of bone density.
Special safety considerations include strapping of the hands or feet to the pedals when
using the arm ergometer or cycling & strapping of the individual’s pelvis in the wheelchair
for proper positioning. The use of gloves during resistance & wheelchair exercises is also
recommended.
For swimming programs, the use of flotation devices should be considered.
Resources & Further information:
Cerebral Palsy Australia
Cerebral Palsy Support Network
Cerebral Palsy Alliance
The Centre for Cerebral Palsy
https://cpaustralia.com.au/
http://www.cpsn.org.au/
https://www.cerebralpalsy.org.au
http://www.tccp.com.au/
DOWN SYNDROME
Down syndrome, also known as trisomy 21, is a genetic disorder caused by the
presence of an extra chromosome (chromosome 21). It is a condition that impairs
cognitive ability & physical growth. People with Down syndrome can have numerous
medical conditions & like the general population, some are very fit & healthy, while others
experience a range of issues.
There is no cure, but exercise can enrich the lives of people with Down syndrome by
improving health, longevity & productivity. Most types of exercise can be performed with
minor difficulty. However, special precautions are required to ensure safety.
Down Syndrome Characteristics:
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short stature
a particular set of facial characteristics
shortened limbs & fingers
low muscle tone
minor physical limitations often affecting gait
varying degrees of intellectual disability
often difficulty with speech & social interaction
some health & medical challenges
o bowel issues
o congenital heart conditions
o increased incidence of leukemia
o higher incidence of Alzheimer's disease
Medication
It's important to understand the effects that medication have on the body in relation to
exercise. Medication isn't used to treat Down syndrome itself, however medication is
often prescribed to treat other health issues associated with Down syndrome. Medication
may affect or impair the ability to exercise. It is important to get a comprehensive list of all
medications prior to starting any exercise program.
Exercise Considerations:
An individual with Down syndrome can participate in most forms of exercise. Overall, this is a
healthy population that enjoys the social aspects of physical activity.
The inclusion of physical activity daily life will improve overall health. For individuals with Down
syndrome, physical activity has important implications positively impacting on health, longevity, &
productivity
Issues most related to exercise are:
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Muscle hypotonicity (muscles have the ability to be stretched far beyond normal
limits), joint hypermobility & ligament laxity (increased flexibility in their joints
associated with increased susceptibility to subluxation & dislocation). It is important
to note that hypotonicity & hypermobility are often associated with lordosis,
dislocated hips, kyphosis, flat pronated feet, forward head, & atlantoaxial instability
(AAI)
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Atlantoaxial Instability is a severe cervical disorder that occurs in approximately
17% of the population with Down syndrome & is characterized by increased laxity
between the first & second cervical vertebrae. This makes spinal cord injuries much
more likely. Medical clearance is highly recommended & strict monitoring is
important to avoid injury to the spinal cord & other areas of the body
mild to moderate obesity in adulthood (greater amongst women than men)
an underdeveloped respiratory & cardiovascular system, resulting in reduced
cardiovascular capacity
poor balance & perceptual difficulties
some health & medical challenges
o bowel issues
o congenital heart conditions
o increased incidence of leukemia
o higher incidence of Alzheimer's disease
lowered general immunity compared to the general population
other medical factors to consider in relation to exercise capacity are: thyroid
hormonal deficiencies, abnormal energy expenditure & substrate utilization,
impaired sympathetic response to exercise, & anemia
Implications for Trainers:
It is extremely important to confirm if a client with Down syndrome has AAI (instability of
the joints in the neck) before participation in physical activity. Contact sport & heavy
resistance activities are contraindicated when AAI is present.
Encouraging the client to have regular health checks, & obtain medical approval for the
exercise program, particularly if it will be a physically demanding one.
Ongoing education on maintaining a healthy weight & living a healthy lifestyle is important.
There can be a tendency for both children & adults with Down syndrome to become
overweight.
The effects of aerobic training on individuals with Down syndrome can have a positive
training effect but this is usually after a long training program.
Down syndrome clients will have difficulty generating resistance & their hyper-flexible
joints make them more susceptible to injury during movements requiring higher degrees of
coordination (e.g., power exercises, plyometrics, agility). Exercise intensity for Down
syndrome clients should proceed gradually. Machine based resistance training & aerobic
training is encouraged at the start of an exercise program because of its low level of
difficulty.
Reduced cognitive ability & hormone imbalances can result in decreased memory
retention, decreased motivation to exercise, & other issues. It is important to make Down
syndrome clients feel comfortable with exercise. The trainer needs to focus on gradual
progressions, have patience & provide adequate supervision.
A combination of aerobic & resistance exercise program may have a larger impact on
physical fitness than aerobic exercise alone in people with Down syndrome
Training can be linked to increased performance in activities of daily living (ADL) tasks, as
well as work & leisure activities. Training could include teaching skills for particular sports
or activities they are having difficulties with or wish to participate in. This may include task
analysis & breaking down the activity into component parts so that training can focus on
increasing skills for these component tasks. By linking training goals to the client’s life
goals & activities makes them more meaningful & will result in a greater adherence rate,
ie: improve cardiovascular fitness so the client can actively participate in a game of tennis
with their friends.
For children, the training program needs to extend beyond the development of motor skills
& can include specific programs, advice & education for families so they can support their
children to develop active play & sporting skills.
There may be a need to raise expectations of what young people with Down syndrome
can achieve among parents, professionals & the wider community. All motor activity only
improves with the opportunity to learn & practice. The younger a client starts with a
focused training program the greater improvement they will have over time & the more
profound effect this will have on their life.
It is also important to remember, when programming, that it is not necessary to aim at
excellence or competence in particular sports. A more important goal is to find ways to
keep children & adults with Down syndrome active rather than sedentary, ideally finding
ways that are fun & can be enjoyed by other members of the family so that this can be
reinforced regularly, become a regular part of the family ritual.
General Exercise Guidelines for Individuals with Down Syndrome
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obtaining medical consent, particularly if AIA or any secondary issues are present
understanding the effects of any specific medications on the body in relation to
exercise
providing increased supervision
Incorporating behavioral therapy & motivational techniques (i.e., token reward
system) to improve adherence. This is a system of social reinforcement with
primary & secondary reinforcement. An effective technique is recording progress
on a wall chart once they reach their goal.
Starting the program with light activity that is enjoyable & pain-free.
Cardiovascular Exercise:
The goal of an aerobic training program for individuals with Down syndrome is to increase
cardiovascular fitness. Recommended modalities include: walking, jogging, stationary
cycling, & aerobic dance. It is important to monitor heart rate & blood pressure whenever
possible to determine the intensity level of the activity & to avoid early-onset fatigue.
The general recommended protocol is training at an intensity of 60-80% of an individual's
maximal heart rate (MHR), 3-5 days a week, for 20-60 minutes per session. A suggested
starting protocol can be 5-10 minute continuous activity, 1-2 days a week, gradually
increasing over time. It is likely to take longer than with the general population to see a
training effect.
Strength Training:
Children with Down syndrome often have a much harder time learning to walk, primarily
because of their characteristic low muscle tone. Building muscle is critical to helping
children with Down syndrome combat low muscle tone & reach development milestones.
One of the most effective & easiest exercises to strengthen muscles for walking is
climbing stairs.
The goal of resistance training is to maximize strength in the large muscle groups.
Training intensity should be 70-80% 1-RM for 3 sets of 8-12 repetitions. A training effect is
typically seen 10-12 weeks into the program. Circuit training is appropriate for individuals
with Down syndrome. A simple circuit program can include 2-minute stations with 30-60
second rest intervals between each station.
Flexibility:
Due to hypermobility & joint laxity that is associated with Down syndrome, excessive
flexibility training is not recommended for this population. With any stretching the focus
will need to be on correct technique & joint alignment in order to reduce stress on weak &
instable joints.
Communication & Teaching Style:
Most people with Down syndrome are great communicators. It is quite common however,
for children & adults with Down syndrome to demonstrate speech difficulties. People with
Down syndrome often have much better receptive language than expressive language that is, they can often understand a lot more than they can tell us.
People with Down syndrome respond more to visual cues than verbal cues. Relying on
nonverbal skills such as gestures & body language can also be an effective way of
communicating, especially if dealing with a younger person who may have a specific
difficulty with learning grammar & developing clear speech.
Tips to ensure optimal communication include:
 Use visual supports – eg: photos or pictures on written program
 labeling machines with pictures of what the machine is used for & how it works
 Providing both verbal & non-verbal encouragement
 providing more visual instruction than verbal instruction
 Teaching clients to record their own information to improve long-term adherence &
empowerment.
 Use technology – eg: programs online or emailed to client
 If client is having difficulty getting their message across then ask them to
physically show you what they are talking about
 Use face-to-face methods to communicate, ensuring eye contact
 Give instructions one at a time.
 Allow client time to respond (& process what you have just said)
Safety:
Constant supervision is integral for people with Down syndrome, especially if the exercise
involves complex movements, physical contact or heavy weights
Resources & Further information:
Down Syndrome Australia
Down Syndrome NSW
http://www.downsyndrome.org.au/
http://www.downsyndromensw.org.au/
HEARING IMPAIRMENT / DEAFNESS
There are different terms to categorise a hearing impairment. The most common ones
include Deaf, hearing impairment or hard of hearing. Because there is such a vast range
of sounds to be interpreted, there will be a wide variation between individuals & what
sounds they are able to hear & interpret.
Deafness & hearing impairment can be hereditary or due to a range of factors such as
traumatic accident, injury, disease, medication, prolonged exposure to noise or ageing
process.
Hearing Impairment Characteristics:
People with a hearing loss can be divided into distinct groups:
 Deaf. People who are born deaf or became deaf at an early age (before language
acquisition) use the term Deaf (with a capital “D”). Deaf people identify themselves
as part of a Deaf Culture & Community & are likely to use Auslan (Australian Sign
Language) as a first or preferred language. These iindividuals have complete
hearing loss & are unable to use residual hearing for processing information or
communicative purposes, even with the use of amplification devices. People who
are Deaf often see themselves as a language & cultural minority, not as a disability
group
 deaf. The term deaf (with lower case letter “d”) is used more generally when
referring to people with a condition that has led to them acquiring a hearing loss to
whatever degree regardless whether signing or oral methods of communication are
used
 Hard of Hearing / Hearing Impairment. Generally this term is used to describe
people who have experienced varying degrees of hearing loss after the acquisition
of speech & still use speech as a primary means of communication
Medication
Most people with Deafness or a hearing impairment do not require any specific medication
to manage this condition. As with all populations it is imperative to be aware of any
medication they may be taking & the impact this may have on their safety & exercise
performance.
Exercise Considerations:
Generally there are no physical limitations directly associated with hearing impairments.
Most individuals can take part at a high intensity of exercise or sport without any special
considerations. While people with hearing impairments do not differ radically from the
general population with respect to exercise. However both children & adults who are hard
of hearing or Deaf tend to have a higher incidence of overweight & obesity when
compared to the general population.
Balance & spatial awareness concerns may be evident, depending upon the specific type
of hearing impairment the person has. This can have an effect on motor performance,
especially in dynamic & competitive sport situations. However, deficits in balance should
not prevent involvement in physical activity programs. Incorporating balance activities
into the fitness program can improve performance & decrease the risk of falls, especially
in older adults.
Effective communication & understanding are important considerations when working with
someone who has a hearing impairment. A client with profound hearing loss may not be
able to hear music at an acceptable level for participation; however, they may feel the
vibrations either through the floor or by holding a vibration-transmitting object while
completing exercise movements. Spoken communication is also a concern for people with
severe to profound hearing loss. This can lead to fewer social opportunities, lower selfconcept, decreased self-esteem, lack of self-confidence, & isolation.
Implications for Trainers:
There are four different types of hearing loss: conductive, sensorineural, mixed, & central
hearing loss. Some of these types may affect dynamic balance & spatial orientation specifically sensorineural. This may in turn affect the clients' cardiorespiratory efficiency in
exercises or activities requiring high levels of balance.
General Exercise Guidelines for Individuals with Hearing Impairment
If there are no other limiting factors or secondary conditions, the rules for exercise
prescription intensity can be the same as the general population
Balance & Flexibility:
Various balance activities that can assist with improving balance for Deaf clients include:
 Tumbling & gymnastics
 Practice of basic body movements – including Tai Chi, Yoga & Body Balance
classes
 Dance
 Martial arts
Gym based equipment / Environmental modifications
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Avoid loud, constant background noise as this may cause headaches (from echoes
or vibration) or reduce the effective use of hearing aids. This can be especially
problematic in a gym environment
Ensure adequate lighting
Facilities can be equipped with strobe or visual fire alarms or other alerting devices
or strategies. Alerting devices or strategies include use of the buddy or tapping
system, very loud sounds, vibrations, colorful flags, or flashing lights.
Communication & Teaching Style:
Around 10% of Australians have a hearing loss. Generally, the more hearing a person
has, the more they will speak & rely on lip reading. The less hearing they have, the more
likely they will use Sign Language. Each individual has a particular communication
preference which is often related to family upbringing & the schools they have attended.
Hearing aids can help some people, but they only amplify whatever sounds can be heard.
Unclear sounds remain unclear; they are just louder.
Auslan is recognised by the Australian Government as an Australian Community
Language. Auslan is a visual language that includes; sign vocabulary, complex
grammatical rules, facial expression, body language & finger-spelling. It is not the same
as English.
Even the most experienced speech readers are able to pick up only about 30% of spoken
language. Strategies that can enhance communication effectiveness include:
 Always face the person so that he or she can see your face, lips, eyes, & body.
Stay close enough to the client so they can see your mouth & facial features
 Identify yourself - don't assume the person will recognise you by your voice
 Speak at normal speed, but avoid speaking too fast
 Maintain eye contact & speak directly to the person, not to the interpreter if one is
present
 Use facial expression, body language, gestures, & common signs or cues, such as
thumbs up or down to communicate emotions & meanings
 Avoid chewing gum or food, covering the mouth, or having an untrimmed mustache
 Use normal enunciation & loudness, regardless of whether the person is deaf or
hard of hearing or uses a hearing aid, cochlear implant, or no assistive listening
device
 Demonstrate exactly what is required from start to finish, as many people who are
deaf or hard of hearing are very visual learners
 Some basic cue or feedback signs, for words such as "ready," "start," "faster," "ok,"
"stop," or whatever words are necessary for activity should be established & used
consistently
 Use accurate & specific language when giving directions. For example, "the door is
on your left", rather than "the door is over there".
 Avoid situations where there is loud or competing noise
 Visual & tactile cues should be used to enhance understanding, including having a
notepad on hand if needing to write words down. Present instructions in writing or
picture form via signing, or on a video with closed captioning
 Allowing the person to describe or demonstrate the test protocol before the task
begins
 If an individual's speech is unclear or difficult to understand, the listener should not
pretend that he or she understands, but rather ask for clarification
 In a group situation, introduce the other people present
 Never leave a conversation with a person without saying so
Safety:
The individual should be orientated to all aspects of the facility, & environment with special
attention to emergency aspects, such as exits & fire evacuation procedures. Having an
OHS procedure listing how to ensure all members are aware of any alarms (especially if
only auditory in nature) further improves safety.
Hearing aids & external cochlear implant devices should be removed before participation
in activities involving contact & in water activities.
Resources & Further information:
Deaf Society of NSW
http://deafsocietynsw.org.au/
Vision Australia
http://www.visionaustralia.org
Royal Institute for Deaf & Blind Children http://www.ridbc.org.au/deafness
Australian Sign Language
http://www.auslan.org.au/
BRAIN INJURY
Acquired brain injury (ABI) refers to an injury to the brain that results in the deterioration in
level of functioning. This can occur traumatically as the result of extreme force exerted on
brain tissue (such as a fall, car crash, near drowning or blow to the head), or from internal
causes (such as a stroke, brain aneurysm, infection or tumour) when the brain does not
get enough blood or oxygen.
An ABI can occur at any age, to anyone, but certain groups are more likely to experience
a brain injury. Children under the age of 4 are at risk of injury from falls & child abuse.
Adolescents aged 15-19 are at an increased risk due to sports & car crashes. People
aged 75 years & older are at risk from falls.
Many people with an ABI adopt a sedentary lifestyle. The role of increased physical
activity is necessary as a preventative measure against chronic disease, cognitive
challenges, & depression in people recovering from ABI.
Acquired Brain Injury Characteristics:
Because the brain controls our ability to move, think, sense, & socialize, the symptoms
that result from ABI can vary widely. They may include:
 Physical symptoms. Weakness or difficulty moving the arms, legs, body, & head.
The person may have difficulty sitting, standing, balancing or walking. Fatigue,
decreased range of motion, & poor endurance can also be affected, as well as
bladder & bowel problems.
 Cognitive symptoms. Difficulty remembering, paying attention, planning, goal
setting or solving problems. The individual may also display learning & attention
deficits. They may have a reduced awareness of these difficulties, which can
cause safety concerns.
 Sensory symptoms. Changes in vision, hearing, or the sense of touch. Balance
senses that are aided by the inner ear may also be impaired.
 Emotional & behavioral symptoms. Difficulty in controlling emotions, or even a
change in personality. Behavioral changes may also include onset of depression &
anxiety, disruptive or combative behavior, lack of inhibition, self-abuse, irritability &
detachment from reality. If cognitive deficits are significant, the person's inability to
understand what has happened may result in significant emotional agitation.
Unlike individuals with developmental disabilities, people with brain injuries are often
acutely aware of these limitations. They are still able to remember their abilities prior to the
incident & can experience significant loss
Medication
It's important to understand the effects that medication have on the body in relation to
exercise. Medication may affect or impair the ability to exercise. It is important to get a
comprehensive list of all medications prior to starting any exercise program.
Exercise Considerations:
Most therapy interventions after ABI focus on specific impairments such as spasticity,
flexibility, muscle strength, balance, gait mechanics, improving physical work capacity,
endurance & functional skills.
Benefits of exercise for people with ABI include:

Reduced physical, emotional & cognitive complaints & symptoms, such as sleep
problems, irritability, forgetting, & being disorganized.

Improved cognitive & memory
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Reduced depression & higher levels of self esteem

Improved engagement in school or work & community integration

Decreased risk of developing secondary health problems
Targeted exercise can also assist with improving:

Alertness levels & following commands

Muscle & joint flexibility

General mobility, balance, coordination & postural control

Strength & energy, reducing any feelings of fatigue that occur from inactivity or the
injury to the brain itself

A return to sports, fitness & work activities
Issues most related to exercise are:
People with brain injuries generally have a greater propensity towards poor health habits
as well as having poor health profiles. As in other special needs populations, the benefits
of a proper exercise program can be helpful in the avoidance of secondary health
problems. People with ABI also have a greater risk of developing circulatory problems,
including heart disease & stroke. Trainers need to be aware of the importance of the
prevention strategies to reduce the cardiovascular disease & illness in a client with ABI.
Implications for Trainers:
Many people with TBA may have difficulties with agility, dynamic balance & coordination.
These may only be subtle but could easily prevent the client from being able to safely
participate in high level mobility type activities, such as sports & contact activities.
Individuals with little physical impairment may have barriers to participation because of
cognitive, behavioral & executive impairments. These individuals will need to receive the
proper supervision & education throughout their training programs.
Structured exercise programs with regular routines will help with attendance, adherence &
progression with exercise program.
Fatigue levels can be significantly impacted following an ABI. Trainers may need to
schedule shorter sessions, or time the sessions for when the client is at their optimal
energy level
General Exercise Guidelines for Individuals with traumatic Brain Injury
For some clients with an ABI, something as simple as walking down out the front door
may be taxing. Before starting a fitness program, consult with their doctor or therapist
regarding any physical challenges, balance problems or other issues that may affect the
client’s safety.
Participating in a regular fitness program not only improves fitness outcomes, but the skills
required to execute & maintain a program may also help improve cognitive function after
injury. Although the needs of an individual with a brain injury are the same as those of a
non-injured person with regards to physical fitness, steps must be taken with each
individual to ensure that the specific functional disabilities are addressed to ensure the
success of the program. Each person has different needs & approaches to motivation,
communication, & the individual's capacity to understand & follow a fitness program must
be individualized.
Cardiovascular Exercise:
A sedentary lifestyle & lack of endurance are common characteristics of individuals with
ABI. In general people with ABI will often have reduced peak aerobic capacity of 65-70%
of the general population. This may mean that intensity & duration of the session needs to
be lower (ie: 60-70% Max HR, with sessions between 20 – 40 minutes duration). For
home based exercises sessions may be better broken down into 10 minute bouts
throughout the day, or shorter if needed.
Increased physical activity & exercise training improves cardiorespiratory fitness in many
populations with physical & cognitive impairments. Therefore, increasing the endurance &
cardiorespiratory fitness of persons with ABI would seem to have important health
implications.
Strength Training:
Depending upon the residual physical limitations strength training may need to focus on
improving range of movement, co-ordination & function rather than pure strength
improvement. Range of motion exercises can help maintain strength as well as flexibility
of the joint. Such exercises as simply extending & flexing the forearm or the lower leg can
significantly help to maintain muscle tone & functioning ligaments & tendons that enable
the client to gradually regain strength or function of the limb over time.
Testing via the form of ROM & functional activities can be a better way to track success
rather than via number of reps / weight achieved in the gym, particularly in the earlier
stages post injury. It is much easier for an individual to progress with strength training
(compared with cardiovascular training), which can provide powerful motivation for a
participant who demands immediate gratification.
Circuit training may be particularly useful because the variety of exercises performed. This
can assist with alleviating the monotony for clients who are difficult to motivate & easily
bored with one type of exercise.
Flexibility:
Many individuals with an ABI will suffer from ataxia, reduced range of motion, spasticity &
reduced coordination. For some of these participants, stretching may be a tremendously
grueling experience, even at its most basic approach.
Stretching should be performed every day & as often as possible. Slow static stretching
or PNF stretches will often be the most effective.
Communication & Teaching Style:
People with ABI may be lacking in motivation to exercise & various techniques may have
to be utilised in order to get regular attendance & participation in the program.
 Ensure that the client understands exactly what you are asking of them. Get then
to repeat it back to you or show you what you have requested. You may need to
repeat yourself several times, or in different ways in order to correctly understood.
Utilising all the senses is a good way to assist with cementing the learning
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Keep your voice tone low & unhurried. Give the client the opportunity to speak &
allow them time to process what you have just said
Speak clearly, use shorter & direct sentences
Physically demonstrate as well as verbally explaining what is being requested.
Because of common short-term memory problems, all aspects of the fitness
program should be methodical & repetitive
To assist with memory difficulties ensure appointments are written down in a
calendar / phone as a reminder of when the next session is
Using index cards that contain specific steps to follow for each set of exercises.
These cards reduce the number of times the client may need to ask for help &
ensures that they are doing the exercise correctly, especially if requiring to do this
independently
Provide regular & frequent breaks to accommodate fatigue
Use wall charts & photographs to track progress & provide motivation
Neurobics are mental exercises that can enhance the brain's performance. These
can be incorporated into the training sessions, which help create & develop neural
cells & pathways in the brain. Instead of lifting a weight from the rack with the
dominant hand, ask the client to switch to using their non-dominant hand. Other
examples include using a different route to get to a destination, reversing the order
that you do the training session, learning a new dance / aerobics routine, closing
eyes whilst performing simple exercises
Safety:
Specific issues with regards to safety include:
 Difficulties with balance & coordination. Consideration with regards to the type of
exercise & amount of supervision – ie: highly choreographed aerobics classes or
bike riding may not be appropriate, but tandem cycling, Pump or spin classes could
be a better option
 Cognitive, behavioral & executive impairments. These individuals will need to
receive the proper supervision & education throughout their training programs
Resources & Further information:
Brain Injury Association of NSW
http://biansw.org.au
Mid North Coast Brain Injury Rehabilitation Service
Ph: 6652 2856
PSYCHOLOGICAL & MENTAL ILLNESS
A mental illness is a health problem that significantly affects how a person feels, thinks,
behaves, & interacts with other people. It results from complex interactions between the
mind, body & environment. Factors which can contribute to mental illness are:
 long-term & acute stress
 biological factors such as genetics, chemistry & hormones
 use of alcohol, drugs & other substances
 cognitive patterns such as constant negative thoughts & low self esteem
 social factors such as isolation, financial problems, family breakdown or violence
Approximately 1 in 5 Australians will suffer from a mental illness at some point in their
lives, with anxiety & depression being the most commonly diagnosed mental illness.
Mental illness may fall into two distinct categories – psychotic & non-psychotic.
Diagnoses vary significantly with symptoms & degrees of severity. Some of the major
types are:

anxiety

depression

schizophrenia (psychotic)

bipolar (psychotic)

mood disorder

personality disorders

eating disorders
Mental Illness Characteristics:
While most people may experience strong feelings of tension, fear, or sadness at times, a
mental illness is present when these feelings become so disturbing & overwhelming that
people have great difficulty coping with day-to-day activities, such as work, enjoying
leisure time, & maintaining relationships. At their most extreme, people with a depressive
disorder may not be able to get out of bed or care for themselves physically. People with
certain types of anxiety disorder may not be able to leave the house, or may have
compulsive rituals to help them alleviate their fears. People with Mental Illness often have
high rates of physical illness, much of which goes undetected.
Some common symptoms of mental illness include:
 Fatigue
 Lack of energy
 Hopelessness
 Reduced Psychomotor skills
 Lack of interest or motivation
 Fear & low self-worth
 Lost touch with reality (psychotic illness)
Medication
It's important to understand the effects that medication have on the body in relation to
exercise. Medication may affect or impair the ability to exercise. It is important to get a
comprehensive list of all medications prior to starting any exercise program.
Individuals with depression are typically prescribed antidepressant medication. Side
effects can vary from medication to medication. They include:
 Headache
 Nausea
 Dry mouth
 Constipation
 Sexual problems
 Drowsiness
 Blurred vision
Additional common side effects of anti-psychotic medication can include:
 Blurred vision
 Dry mouth
 Drowsiness
 Weight gain
 Muscle spasm or tremors
 Loss of menstrual periods in women
 Low blood pressure & dizziness
 Sexual difficulties
 Nausea or constipation
These side effects are particularly prevalent when individuals are first taking the
medications, & may subside after a period of time.
Exercise Considerations:
On average, depressed people only exercise about half as much as people who aren’t
depressed. This lack of cardiovascular fitness puts a depressed person at an increased
risk of heart disease. It also believed that depression & exercise influence each other – a
sedentary lifestyle increases the risk of depression & depression increases the likelihood
of a sedentary lifestyle. Exercise improves mental health by reducing anxiety, depression
& negative mood & by improving self-esteem, cognitive function & feelings of wellbeing
Exercise is especially important in patients with schizophrenia since these patients are
already vulnerable to obesity, associated with antipsychotic treatment.
Regular exercise can be an effective way to prevent or manage mild anxiety & depression
& it has been shown that physical activity can be as effective as antidepressants or
psychological treatments like cognitive behavioural therapy (CBT).
Monitoring fitness gains & exercise performance throughout an exercise programme may
provide positive feedback & encourage further participation for your client. It is also
important to monitor their depression levels throughout exercise programmes to make
sure the workload is manageable & helpful in managing the client’s mental illness.
Simple strategies to assist & effectively manage some of the barriers that arise with clients
with mental illness can include:
 Schedule exercise sessions for earlier in the day as opposed to evening after a full
day of work has occurred
 Find a form of physical activity that is enjoyable to the individual
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Find a picture or word that is motivational to the client & hang it in a visible place
Encourage the individual to share their physical activity plans with a friend or family
member who can help with motivation, or train in a small group whereby motivation
& accountability can be pursued with others in the group
Vary physical activity & keep it fun to prevent boredom
Create a training log & get the individual to complete this each week & return to you
Work together to create realistic goals & write them down, along with a rewards
system for achievement
Implications for Trainers:
A single session of exercise can result in reasonably large mood benefits, including:
 Increases in positive mood states
 Decreases in negative mood states
 Positive well-being
 Vigor, more refreshed, elation, feeling upbeat, happy or enthusiastic
 Peaceful, calm or relaxed
To reap the psychological benefits of exercise, there are some key points to remember:
 To feel better after exercise a 10-15 minute walk is sufficient
 To feel better during activity, exercise for longer periods. It is better to walk for 45minutes (even at a lower intensity) than for 20 minutes
 The largest improvements are often made on the days that the individual feels least
positive prior to exercising
General Exercise Guidelines for Individuals with Mental Illness
Many different forms of physical activity have proven effective with reducing the symptoms
of mental illness.
The physical activity programme undertaken by a client suffering from mental illness,
should be tailored to their individual preferences. It is recommended that the person
undertake a full pre-exercise questionnaire & testing before commencing any training,
particularly if there is a possibility of other co-morbidities.
One of the most important considerations when building the exercise program for this
population is to make it fun & interesting for the client whilst keeping all activities & goals
achievable. It may also be beneficial to introduce new exercise settings to encourage &
motivate the client as well. Successful exercise programmes give the client a sense of
achievement, mastery & build confidence.
The program needs to be flexible in order to encourage & challenge the participant
through normal exercise adaptions.
Cardiovascular Exercise:
With regards to reduction in symptoms, evidence is strongest for aerobic activities such as
walking, running, cycling, swimming, & exercise classes – rather than anaerobic activities
(such as weight training). Although a 10-15 minute walk can result in mood
improvements, most mood improvements aren’t detectable until 25-40 minutes of physical
exertion, where people will feel less tense, more clearheaded, more elated – less
depressed, & more energetic.
Strength Training & Flexibility:
Whilst evidence is strongest for cardiovascular exercise with regards to reduction of
symptoms associated with mental illness it is important to develop a well-rounded exercise
program for your client, including strength & resistance training & flexibility if appropriate.
Communication & Teaching Style:
Be respectful to the person. When someone feels respected & heard, they are more likely
to return respect & consider what you have to say.
If they are experiencing events like hallucinations, be aware that the hallucinations or the
delusions they experience are their reality. You will not be able to talk them out of their
reality. They experience the hallucinations or delusional thoughts as real & are motivated
by them. Communicate that you understand that they experience those events. Do not
pretend that you experience them.
Some people with paranoia may be frightened, so be aware that they may need more
body space than you. Do not assume that they are not smart & will believe anything you
tell them. Mental illness has nothing to do with the person's intelligence level. Do not lie to
them, as it will usually break any rapport you might want to establish.
If needed, set limits with the person as you would others. For example, "I only have five
minutes to talk to you" or "If you scream, I will not be able to talk to you." Call for help
(police, security, or colleagues) if you feel physically threatened or need help deescalating the person.
Safety:
Tailor exercises to account for possible drug side effects (eg: if experiencing blurred
vision, do activity indoors or exercise outside with supervision or in low traffic areas).
If you think the client is in crisis & you have concerns about their safety, call emergency
services (triple zero – 000), contact their doctor or local mental health service. Do not
leave the person alone, unless you are concerned for your own safety.
Resources & Further information:
Beyond Blue
Lifeline
Kids Helpline
Headspace
http://www.beyondblue.org.au/
https://www.lifeline.org.au/
Ph: 13 11 14
http://www.kidshelp.com.au/
http://www.headspace.org.au/
Ph: 1800 55 1800
SPINAL CORD INJURY
Spinal cord injury (SCI) is damage to the spinal cord that results in a loss of function such
as mobility or feeling. It’s a permanent and irreversible injury. The extent of dysfunction
depends on the location of the injury.
 Quadriplegia (also referred to as tetraplagia) is loss of function below the neck
(paralysis of the four limbs & trunk musculature)

Paraplegia is loss of function below the chest (usually resulting paralysis of the legs
& hips & in some cases the trunk)
Spinal cord injuries may be caused by trauma (eg: motor vehicle accidents, falls, highimpact sports injuries & diving accidents) or disease (eg: polio, spina bifida, multiple
sclerosis).
Fitness plays a vital role in helping the spinal cord patient live a fairly functional existence.
Spinal Cord Injury Characteristics:
No two spinal cord injuries are the same & what happens with one person does not
necessarily happen with another. Some general characteristics include:
 Movement may be lost below the level of the injury
 Sensation may be lost below the level of injury
 Blood pressure & circulation may be altered
 Breathing dysfunction especially in those with cervical or thoracic injuries.
 Temperature control may be affected, including sweating & shivering
 Bladder & bowel function dysfunction
 There may be spasms or involuntary movement below the level of injury
 Sexual dysfunction
 Fertility may be affected
Other medical issues can include:
 Osteoporosis & Fractures may occur due to lack of use, particularly in the legs
 Changes in blood pressure. Hypotension (low blood pressure) usually occurs when the
patient changes his body position too quickly
 Autonomic dysreflexia – a reflexive response to a distended bladder, fecal mass, pain
or heat & resulting in pounding headaches, anxiety, sweating, chills, hypertension &
the like. This is a medical emergency & life threatening.
Medication
It's important to understand the effects that medication have on the body in relation to
exercise. Medication may affect or impair the ability to exercise. It is important to get a
comprehensive list of all medications prior to starting any exercise program.
Exercise Considerations:
Individuals with spinal cord injuries can experience numerous benefits from regular
exercise, which may include:
 Prevention of secondary conditions such as cardiovascular disease, diabetes,
pressure sores, carpal tunnel syndrome, chronic obstructive pulmonary disease,
hypertension, urinary tract infections, & respiratory disease
 Prevention of deconditioning & obesity

Psychological &/or recreational benefits
Issues most related to exercise are:
 Incontinence - Individuals with lesions above the sacral level experience a loss of
control with their bowel or bladder
o Ensure the client has an empty bowel & bladder before starting exercise.
 Spasticity - This condition is characterized by high muscle tone & hyperactive
stretch reflexes. It typically occurs in the muscles below the site of injury & is
exacerbated by exposure to cold air, urinary tract infections & physical exercise.
o The spastic muscle groups will need to be stretched often
 Autonomic Dysreflexia - A sudden rise in blood pressure resulting from an
exaggerated autonomic nervous system response to noxious stimuli below the level
of injury, usually due to bladder/bowel overdistension or blocked catheter.
Symptoms include profuse sweating, sudden elevation in blood pressure, flushing,
shivering, headache, & nausea
o Medical attention may be needed if this occurs.
 Orthostatic hypotension - A drop in blood pressure (greater than 20 mmHg for
systolic blood pressure & greater than 10 mmHg for diastolic blood pressure). It
occurs in upright postures, especially moving from supine to upright
sitting/standing/head-up tilt. Symptoms include nausea, dizziness & lightheadedness
o blood pressure might need to be monitored throughout exercise
o avoid quick movements
o maintain proper hydration
o use compression stockings & an abdominal binder
o If orthostatic hypotension occurs, lie in a supine position with feet elevated
 Thermoregulation - Irregular body temperatures are often experienced by
individuals with SCI.
o ensure appropriate clothing worn
o drink plenty of fluids
o in warm environments a fan & water spray can aid in cooling
o in cold environments, ensure extra layers worn
 Pressure sores - Damage to the skin or underlying tissue caused by prolonged
sitting, using old wheelchair cushions, sitting on hard surfaces, shear forces or as a
result of a fall
o perform wheelchair push-ups or pressure releases often
 Transfers
o Be sure to follow appropriate guidelines
 Balance
o Use straps or other physical assistance to hold the trunk in position during
upright exercise.
Implications for Trainers:
The trainer should be aware of the level of lesion & any side effects or medical issues the
client may have. Also be aware of how to transfer the client appropriately – you may need
to get assistance / training from their carer initially to ensure you can do this competently
& effectively.
As the majority of SCI clients are wheelchair bound sessions will need to be wheelchair
accessible. If training outdoors ensure the client brings the appropriate wheelchair. There
are also chairs that are suitable for going on the beach or rough surfaces.
General Exercise Guidelines for Individuals with a Spinal Cord Injury
Some exercises provide greater benefit for persons with SCI than others. These include:
 Aerobic exercise to maintain cardiovascular health & prevent secondary conditions
 Strength training to maintain & improve the ability to perform activities of daily living
& mobility, to aid in transfers, & to prevent injury through muscular balance
 Flexibility training to improve range of motion & reduce spasticity
Cardiovascular Exercise:
Quadriplegia MHR typically does not exceed 100 to 125 bpm, & training intensity should
be between 50% & 70% maximal heart rate. Arm ergometry is often a preferred type of
exercise training for individuals with quadriplegia.
Be sure the wheelchair is locked, the hands are secured to the equipment (straps can be
used for stability & balance) & the ergometer is in a fixed position. Other forms of aerobic
exercise may include pushing their chair or a track chair & hand cycling.
The MHR of individuals with paraplegia is also suppressed, however, for lesions below T6,
the MHR is closer to the age-predicted maximum. Training intensity should not go above
70%. Types of cardiovascular training that benefit individuals with paraplegia are
wheelchair ergometry, upper-body calisthenics, rowing machine, recumbent steppers,
handcyling, sports such as basketball, track, swimming, quad rugby, & functional electrical
stimulation-leg cycle ergometer.
Strength Training:
Training sessions should be held regularly. Refrain from training the same muscle groups
on consecutive days. Upper-body pushing & pressing exercises (bench press, overhead
press) will help transfers & wheeling, while pulling/rowing exercises will help prevent
shoulder overuse injuries & improve sitting posture. Wheelchair push-ups are great to
assist with transfers.
Use straps or a partner for stabilization & balance. Vary exercises to reduce over-use
injuries & emphasize muscle groups that are still functional. Types of strength training that
benefit individuals with SCI are free weights, weight machines, medicine ball, wall pulley,
cable columns, & theraband.
Flexibility:
Flexibility training is important to prevent contractures (permanently shortened muscles),
particularly in the hip area. Paralyzed muscles should be passively stretched, specifically,
the hamstrings, adductors, hip flexors, plantar flexors, & lumbar extensors. Types of
flexibility training are: Passive & active resistance Theraband Standing in a standing frame
(if not medically contraindicated)
Standing may also help to maintain muscle bulk & may help with reducing loss in one
density in your lower limbs. Equipment such as tilt tables can help standing safely with
support.
Communication & Teaching Style:
Most individuals with SCI do not have any difficulty with communication nor do they have
any intellectual or leaning difficulties.
Safety:
If the individual is starting physical activity, it is important to check with their GP to
determine if there are any activities they should avoid. If it has been a long time since they
last stood, they may require a bone density test to determine if it is safe to do so.
Regularly monitor blood pressure, heart rate, RPE, & symptoms. Stop exercising if the
individual feels pain or discomfort. Don't exercise if they are ill (i.e., cold, flu, bladder
infection, pressure ulcer, unusual spasticity). Check medications & their effect on exercise
tolerance.
Often a client with SCI is self-sufficient with their wheelchair mobility, but ensure that the
brakes are locked on wheelchair & ensure adequate safety measures if training outside,
particularly in high traffic areas or on sloped surfaces.
Resources & Further information:
ParaQuad
Spinal Cord Injuries Australia
www.paraquad.org.au
https://scia.org.au/
Spinal Cord Injury Network
http://www.spinalnetwork.org.au/
Spinal Injuries Australia
http://www.spinal.com.au/
BLINDNESS & VISUAL IMPAIRMENT
Blindness & low vision can occur as a result of a number of different diseases, conditions
or accidents. Some eye conditions are congenital, others are caused by a disease or
infection & others can be caused by accidents or through over-exposure to UV light or
chemicals. Many of the most common eye conditions have no known cause.
Visual Impairment Characteristics:
The range of vision impairment can vary greatly from loss of near / colour vision, difficulty
seeing in dim lit situations to total blindness.
Medication
Most people with vision impairment do not require any specific medication to manage this
condition. As with all populations it is imperative to be aware of any medication they may
be taking & the impact this may have on their safety & exercise performance.
Exercise Considerations:
People with visual impairment may be prone to lower levels of fitness compared to their
sighted peers.
Issues most related to exercise are:
 Inaccessible exercise equipment & programs
 Decreased safety with navigating their way around a gym or using equipment
safely
 Lighting – may need to conduct sessions in brightly lit gym or during sunny daylight
hours outdoors
Implications for Trainers:
The first step in exercise for the blind, like exercise for the general population, is to assess
the individual needs of the person. A person who is totally blind & cannot relate to visual
descriptions needs to be taught exercise activities differently from someone who has
some useful vision. For example, an aerobics instructor may have to use touch to
demonstrate a movement. Visually impaired persons with even a little useful vision may
be able to grasp at least some visual concepts, but this should not be assumed. Safety is
a big issue that will need to be taken into consideration in each & every session.
General Exercise Guidelines for Individuals with Vision Impairment
If there are no other limiting factors or secondary diagnoses, the rules for exercise
prescription intensity can be the same as the general population
Cardiovascular Exercise:
Walking & Running:
There are several strategies commonly employed to provide guidance to people with
Vision Impairment.
Running outdoors:
 Sighted guides are commonly used. The visually impaired runner holds the elbow
of the guide, who should be the faster of the two.
 A guide rope may be used. Ropes can be placed around a track, gym floor or even
a backyard. This frees the blind person from dependence on a guide for exercise.
Running on a treadmill:
 Any person with or without a visual impairment can run on a treadmill. It is
recommended that the individual start out slowly to get a feel for the motion & use
the handrails.
Cycling:
Stationary Cycling:
 A stationary bike may be used & requires no modification & little instruction.
Independent Cycling:
 Individuals who have some usable vision may be able to ride a bicycle
independently in a quiet park or around a track. It is always safer if there are peers
or individuals with sight close by to ensure safety.
Tandem Bicycles:
 Tandem bikes allow the sighted participant to ride in the front of the bike, while the
participant who is visually impaired or blind rides in the back. The person in front is
responsible for steering & stopping. When riding be sure to develop specific
signals for turning, stopping, or emergencies.
Bicycle stand / wind trainer:
 Bicycle stands can turn an ordinary road bike into a stationary bike.
Swimming:
Swimming is one of the best activities for individuals who are visually impaired or blind.
There are few barriers, & the swimmer can move freely without worrying too much about
obstacles.
 Instructors will need to demonstrate techniques via touch. For example, an
instructor may use her own body to demonstrate a stroke while a blind student
follows the arm motion with his fingers. Students also have to learn to use lane
dividers & pool walls to stay oriented.
 If swimming in open water, a tether / guide rope attached to another person or a
stronger swimmer staying nearby will be required
General Sports:
Exercise for a blind person need not be limited to basic workouts. Once a visually
impaired individual has achieved a good level of physical fitness, a wide range of
competitive sports is available.
Aerobics:
Many visually impaired people participate safely in aerobics classes.
 The initial routine may have to be taught or described by a helper, but after that the
participant can participate independently. The participant can include an 8 count or
a 4 count routine & combine different moves.
Flexibility:
Yoga:
The life of an individual with a visual impairment can often be very stressful. Yoga has
many advantages including weight loss, muscular strength, flexibility, & most importantly,
relaxation. Once yoga moves are learned the participant can train in the home or yard
alone or with friends & family.
Balance:
People with visual impairment have a higher risk of falling compared to people without
visual impairment. Since balance programs have been demonstrated to reduce fall risk it
is essential to incorporate a balance component into the exercise program. Balance may
be improved by working on lower extremity strength, such as squats, lunges, hip flexion, &
knee flexion/extension. Flexibility on lower extremities should also be performed to
ensure adequate walking-mechanics to avoid obstacles & everyday situations. Such
flexibility exercises may include working on toes or heels. Stance positions are a great
way to challenge the different sensory mechanisms incorporated with balance (vision,
proprioception, & vestibular function). Stances that can be performed include: single leg,
tandem, wide, narrow, & stagger stance.
Gym based equipment / Environmental modifications
Pictorials/Braille instructions:
Allow time for the person to look at performance pictorials &/or the opportunity to read
about it.
Use large print
Braille on/off switches.
Visual perimeter:
For safety, mark the perimeter of the exercise machines with rope or contrasting colored
tape on the floor.
Record performance: The participant should have some way of recording number of
repetitions & weight on each exercise
Vibrating timers can be worn around the neck or in the pocket.
Cardiovascular Machines
Issues:
 The display screens often have poor contrast or reflective plastic coverings that
cause a significant amount of glare
 The flat panel controls are also often labelled in small fonts & poorly contrasting
colours &, like the visual displays, are covered in highly reflective plastic
 A green Start button & a red Stop button are common on many exercise machines;
although colour indicators such as these are helpful to people with low vision, the
ability to start & stop the machines does not create accessibility
Modifications:
 Handheld magnifier or reading control labels & visual displays
 Placing braille or other tactile markings on the various controls on the flat panel
 Using spin bikes with mechanical knobs to increase or decrease the resistance of
the bikes' pedals, not having to use visual display screens
 Ensure well lit gym areas
Weightlifting Machines
Issues:
 Unable to read weights on plates
 Unable to determine weight of free weights
 Tripping over weights left lying on floor
Modifications:
 Marking plates / weights with braille
 Teaching the client the weight of each plate & showing them how to manually count
down the plates to the correct weight they require
 Using pneumatic system
 Ensuring free weights are placed into a specific order according to weight
 Educating clientele on putting weights / equipment away when finished &
monitoring that this occurs
 When purchasing new equipment consider equipment with markings / adaptations
for people with disabilities / vision loss (ie: tactile discernable control, larger labels
on controls & higher-contrast colours on pedals, handgrips, larger-font, easier-toread visual displays)
 Ensure well lit gym areas
Communication & Teaching Style:





A person with a visual impairment is unable to pick up on many non-verbal
communication cues. Make sure you describe to them what is happening
throughout the session
Avoid standing near windows or spaces with glare, as this will impede their ability to
see you
When introducing an individual to a new machine, allow time for tactile &/or visual
exploration.
The instructor should demonstrate the movement & link the movement to language,
including the name of the exercise & muscle involved.
Provide any written material in larger fonts & if printing in colour choose colours that
contrast strongly with each other
Safety:
A lot of strategies to ensure safety of clients with vision impairments have been addressed
above. Fall-risk is the highest safely concern, particularly in older adults with a visual
impairment.
Ensure the environment is safe for the person with visual impairment. Guide them around
the gym / workout area. Remove any clutter & have the area set up the same way each
session so the client can familiarise themselves with the layout
Ensure adequate supervision, especially in the early stages until the client is comfortable
with the exercises & familiar with the environment
Resources & Further information:
Vision Australia
http://www.visionaustralia.org/
Royal Institute for Deaf & Blind Children http://www.ridbc.org.au/blindness
ADAPATIVE
EQUIPMENT
AND
ASSESSMENT
TOOLS
ADAPTIVE EQUIPMENT & ACCESSIBILITY
One of the major barriers to access for people with disabilities is inaccessible exercise
equipment. Gyms often have obstacles, such as stairs preventing disabled members from
reaching parts of the club, and others lack equipment that could be used by people with
disabilities or staff members who are willing to help such members.
There are various simple ways to ensure that the gym environment is accessible &
numerous different types of adaptive equipment & aids that can assist with people with
disabilities. Some of these solutions are commercially manufactured; others are very
simple & require a slight adaptation or different way of thinking when using a standard
piece of equipment.
Access:
 Access routes free from obstacles
 Wheelchair accessibility – including lift access if needed
 Routes clearly marked, including Braille
 Large turning circle for moving and transferring next to equipment
 Large turning space between rows of equipment
Gym Environment & Equipment
 Minimise trip hazards & put away all equipment after use
 Provide space for mobility objects and service animals next to machines
 Handles and grips for transfer/ support
 Removable and adjustable seats to help with people who use wheelchairs


Keep equipment and objects in the same place
Machine may need to be labelled with pictures, braille & large print words

Large green start button & a red stop button on exercise machines



Bright / adequate lighting, including access to darkened cycle rooms
Use of technology (applications for I Pads and I Phones)
Marking the perimeter of the exercise machines or designated area with contrasting
colored tape on the floor
Change rooms / showers
 Provide space for mobility devices and service animals
 Accessible shower, toilet, locker, changing area, sink, and water dispenser
 Entrance doors and stall doors have low knobs or handles, or are automatic
Assistance Animals
A Guide Dog or Service Dog is a vital means of independence for many people living with
a disability. It is illegal to discriminate against or refuse entry to a person with an
Assistance Dog and anyone who does so can be prosecuted.
SPECIALISED EQUIPMENT:
People with disabilities will often require specialised equipment or modifications to
standard equipment in order to allow them to safely & effectively use it.
Cuffs, Velcro Straps & Gripping Gloves
 Useful for quadriplegics, paraplegics, and individuals with compromised grip and
cerebral palsy
 Velcro gloves can be used to attach the hands to equipment
 Use with bats, racquets, mits etc
Wheelchair gloves
 Great for propelling wheelchair, allowing speed & quick movements whilst
decreasing risk of injury to hands
Cuff weights
 Can add resistance to movements & allow people with reduced grip be able to
safely perform resistance exercises
Auditory / noise balls

Allows participant to hear rather than see ball
Arm Cycle
 Large free standing machines
 Smaller table top models
 Great for warm ups, loosening shoulder joints, improving circulation & upper body
fitness
Pedal Straps
 For bikes to keep feet attached to pedals
Flotation Devices
 To improve buoyancy in water
 Kickboards, water running / floatation belts, buoyancy vests
Theraband
 Resistance varies according to colour
Medicine Balls
 With or without handles
 Can use with gripping gloves if hand function is limited
Heavy bag / speed ball with stand
 Able to use these whilst seated in a wheelchair
 Lower / raise speed ball to various heights to allow for different styles of boxing
 Can do a very similar boxing workout to able bodied participants, with the ability to
incorporate a wheelchair bound participant into a mainstream class
Gym Equipment
Pro Gym CT - all in one system allows for paraplegic, quadriplegic, and able bodied
athletes to get a total body workout.
Cybex - various cardiovascular and strength training equipment for people with disabilities
(PWD). The Arc Trainer allows for a cardiovascular workout for PWD’s
Funding
There is often government & non-government funding & support available for both
individuals with disabilities with disabilities, or organsiations who are wanting to make
changes to allow access & integration of people with disabilities.
The Aids and Equipment Program is a NSW Government initiative to assist eligible
residents of NSW, who have a life-long or long-term disability, to live and participate within
their community by providing appropriate equipment, aids and appliances.
http://www.enable.health.nsw.gov.au/aep
Resources & Further information:
Independent Living Centre
http://ilcaustralia.org.au
Technical Aid to the Disabled
http://www.tadaustralia.org.au
Australian Institute of Sport (Inclusive Coaching)
http://www.ausport.gov.au/participating/coaches/tools/coaching_specific_groups/Inclusive
D-Ability
http://www.d-ability.org
Able Data
www.abledata.com
Physiotherapy Exercises
https://www.physiotherapyexercises.com
(A free tool to create exercise booklets for people with disabilities)
Opening Doors
http://www.ausport.gov.au/__data/assets/pdf_file/0004/448645/Opening_Doors.pdf
Online equipment suppliers
Achievable Concepts
Adaptive Sports Equipment
FAS Therapeutic Equipment
Active Hands
Infinitec
The Hand Cycle Store
http://www.achievableconcepts.com.au
http://www.adaptivesportsequipment.com
http://www.fasequipment.com
www.activehands.co.uk
http://www.infinitec.org
http://bike-on.com
ASSESSMENT TOOLS
Assessing physical fitness with a person with a disability can pose various challenges,
including:



inability to complete usual fitness tests due to restrictions
difficulty with comparing results to normative data
impact of various medications on results
Goals:
Often exercise based goals for people with disabilities can be quite different than their
able bodied counterparts. They may be more functional & less aesthetic, such as:
 Improve co-ordination & general function
 Be able to complete a specific task or activity (eg: able to get self in & out of bed,
catch a wave with a boogie board)
 Used as a social outing & community participation
 Freedom of movement (eg: when in water)
 Feeling like a ‘normal’ person & doing what they do
Questions…..
What is the goal of the client?
What is the goal of your training program?
How are you going to achieve this?
Considerations when assessing & designing a program
 Look at client’s functional abilities (outside of gym), as well as fitness based tasks
 Look at activity preferences, family engagement in social & recreational activities, &
family activity preferences
 Determine what modifications will need to be made to ensure effective delivery &
outcome of program, including:
o Communication, language & literacy skills
o Physical limitations – access, modification to exercises
o Psychological considerations – best time to attend gym, cancellation policy
o Medical – is clearance required
Assessment
 A person with a disability should undergo a thorough physical fitness assessment
prior to commencing a fitness program. This should include the same core
components that their able bodied companions would complete. Adaptations to the
standard assessment format will need to be undertaken to ensure a holistic
assessment & functional results.
 Assessment of physical activity & fitness can be determined using a variety of
strategies, including direct observation, self-report measures, electronic monitoring
& physiological measures
 Liaison with treating doctor, therapist, family members & carer is invaluable
 The assessment tool should be valid, reliable & objective




Less likely to be able to score against general population norms
o Various norms available for people with disabilities
o Data also used for baseline information & comparison at each re-test
Include health status, secondary health issues, medication as often this will change
before ‘fitness’ levels
May need several sessions & observations to get a good overall assessment
Task Analysis – break down activities to work out core issues / areas that need to
be focused on for greatest improvement
MODIFICATIONS TO STANDARD FITNESS TESTING
Traditional Assessments
Modifications & Considerations
Health Screen
- Questionnaire
- Resting Heart Rate
- Blood Pressure
- Medication
 Provide questionnaire to client prior to appointment
to get filled out before session & include authority to
talk with doctor / therapist etc if needed
 Talk with carer & get a history of medication &
recent BP & HR recordings
 Talk with doctor & see if any long standing issues
Nutrition & Lifestyle
- Food diary
 Talk with carer / family member
Body Composition
- Skin folds
- BMI
- Height & Weight
 Skinfolds
- Measurements should not be taken at sites with
scar tissue, at sites where injections have been
received repeatedly, or on limbs that have
muscular atrophy.
- In some instances, it may not be possible to
attain skinfold measurements at a site
- often difficult to measure in people who are
obese due to the difficulty in finding the
landmarks, & due to callipers not able to record
large numbers. Consider additional girth
measurements until accurately able to measure
skinfolds
 Height
- individual who wears prosthetic devices or
braces should be measured whilst they wear the
items
- Clients who are unable to support their body
weight in a standing position can lie on a mat
while body length is measured with a tape
measure.
- Liaise with doctor or carer to obtain height
 Weight
- If wearing a prosthetic device or brace, weight is
taken with the items removed or by subtracting
the weight of the item.
- In in a wheelchair, weight can be determined
either by taking the individual out of the
wheelchair or by weighing the individual in the
wheelchair & then subtracting the weight of the
wheelchair
Aerobic Capacity
 Blind – run with a partner, guide rope or wire
-
Timed walk /run
Beep test
Step test
 Intellectual - take additional time to explain & check
understanding
 Hearing Impaired – visual cue (flashing light) to
indicate timing / pacing
 Wheelchair – find a big hill!
 Use flight of stairs with handrails for safety &
balance
 Allow practice sessions, including listening to any
audio, to ensure comfort & minimise stress
 If unable to walk / run change to a swim, cycle or
hand ergometer test
 Use modified standardised tests (see below)
Muscular strength
- Bench Press
- Military Press
- Push Ups
 Intellectual – check understanding on how to
perform the test. Take whatever time is necessary
for the participant to learn the test
 Participants can be held or secured as necessary &
appropriate for stability
 Stay within the client’s range of motion. If complete
elbow extension is not possible due to impairment,
record a successful lift each time the participant lifts
the weight with his or her maximal elbow range of
motion
 Choose machines / exercises that the client can
safely use & use these for testing each & every time.
To measure leg strength you may wish to perform
a 1RM seated leg press, & for upper body strength a
wall push up test or repetition max bench press may
be suitable
 Use a grip dynamometer to assess & record grip
strength
• Visual - Considerable time is required to teach the
test to individuals with visual disability if they have
not already learned how to perform a push-up.
Provide tactual or kinesthetic cues to help
participants know correct arm positions & recognize
a straight back during the push-up
 To help participants learn the exercises, (eg: pushup) have them watch themselves in a mirror
 Seated push up in chair
Core
- Curl ups
- Plank
 Use a pressure biofeedback unit
 Modified plank position
 Supine single leg lift
STANDARDISED TESTS:
Wheelchair Aerobic Test
 Aerobic fitness test for wheelchair users
 400m running track, recording distance over 12 minutes
Rockport Walk Test
 Aerobic fitness test for those of low fitness level, calculates rough VO2max
 Time taken to complete 1 mile. Recording of heart rate upon completion
2 Minute Step in Place Test

Alternative to the 6 minute walk test for people who use walking aids or who have
difficulty balancing.
 Client marches in place, next to wall, raising knee to pre-determined height. Can
hold onto wall for support
6 Minute Walk Test
 Aim is to walk as quickly as possible for six minutes to cover as much ground as
possible. Can walk outside or on treadmill
Astrand-Rhyming Cycle Ergometer Test
 Submaximal cycle ergometer aerobic fitness test
 Uses cycle ergometer, with client pedalling at a constant workload for 7 minutes.
Heart rate is measured every minute, & the steady state heart rate is determined.
Variations of the Beep Test
There are many variations of the standard 20 metre beep test

Multistage Field Test (MFT) for wheelchair users
o Wheelchair version of the beep test
o 15 m x 15 m square, with each corner modified to create a long turning zone,
avoiding necessity to make a sharp 90 degree turn

Williams Swimming Beep Test
o The test is based on a 1500m swim. The 1500 is broken down into 15 x 100,
each 100 is then broken down into 8 x 12.5m swims.

10m Shuttle Test
o Aerobic fitness test designed for children with cerebral palsy (CP). Variation of
the 20m beep test

10m Incremental Shuttle Walk Test (ISWT)
o Aerobic fitness test designed to assess functional capacity of patients with
COPD. This test is a variation of the 20m beep test

Groningen Walking Test
o Adapted in order to suit an elderly population. Modified to eliminate the sharp
turns at both ends of the 20m shuttle may strain the knees & joints of the
elderly participants.
HOLISTIC ASSESSMENT & TRACKING
Area of testing
General observations & feedback
Medical & Health
Energy levels
Sleep patterns
Health complaints
Medication
Weight
Foods eaten
Self Care
Performance of ADL’s
Assistance Required
Mobility & Balance
Gait pattern
Use of mobility aids
Need for physical assistance
Ability to transfer
Walking up stairs, hills, uneven ground
Social outings
Trips or falls sustained
Strength
Performance of tasks at home
Cardiovascular
Energy levels
Naps / rests required during the day
Flexibility
Functional tasks – can reach to shoulder but not
overhead (can’t reach top shelf in cupboard)
Sport Specific
Throwing, catching & bouncing ball
Running & jumping
Forward, backward, lateral movement
Fitness, endurance & speed
Psychological
Attendance / cancellation of sessions
Behaviour
Emotional upsets
Mood swings
Change in medication
Resources & further information:
Brockport Physical Fitness Test (BPFT)
 A criterion-referenced health-related test of physical fitness, appropriate for use
with young people with disabilities
Physical Activity Scale for Individuals with Physical Disability (PASIPD)
Top End Sports
http://www.topendsports.com/testing/specific-groups.htm#
Physiotherapy Exercises https://www.physiotherapyexercises.com
(A free tool to create exercise booklets for people with disabilities)
Australian Institute of Sport (Inclusive Coaching)
http://www.ausport.gov.au/participating/coaches/tools/coaching_specific_groups/Inclusive
TASK
ANALYSIS
How to write a Task Analysis
1. Write down steps
2. Have someone perform it
3. Watch others and research
4. Do the task
5. Watch your client perform the task
6. Adjust analysis to include missing steps
TASK ANALYSIS
TASK
Participate in Deep Sea Fishing
LEARNING
CONSIDERATIONS
Intellectual Disability
PREREQUISITE SKILLS
OBJECTIVE
1. Able to tread water for 10 mins in life jacket
and clothes unaided
2. Cast a rod while standing
Safely participate in deep sea fishing excursion
RELATABLE SKILLS
1. Comfortable in deep water
2. Knowledge of fishing equipment and their
use gained from beach fishing
3. Experience of open water from Harbour
ferry trip in Sydney
BARRIERS
1. Cannot tread water for extended period of
time
ADAPTIONS / SOLUTIONS
1. Build on existing water skills with time in
water, initially local swimming pool then
open ocean in The Jetty area.
2. Engage a swimming instructor to assist with
water skills and to increase confidence
around open water
3. When beach fishing, practice casting rod
while standing instead of using current
preferred method of sitting
4. Time on fishing boat in a moored situation
5. Spending time at Deep Sea Fishing Club
on fishing mornings to become familiar with
routines prior to first outing
EQUIPMENT
COMMUNITY
ENGAGEMENT
Life jacket
1. Deep Sea Fishing Club member to assist
with familiarisation of boat, club activities
and provide life jacket or information to
enable purchase of a jacket
2. Swimming Instructor from local swimming
pool
3. Personal trainer from local gym to assist
with overall fitness eg increase in cardio
capacity and upper body strength
INCLUSIVE
COACHING
INCLUSIVE COACHING
Good coaches adapt and modify aspects of their coaching to create an environment that caters for individual needs, allowing
everyone to take part and experience success within the activity. The onus of inclusion rests with the coach.
Many people think that you need special skills or knowledge to coach participants with a disability. This is not the case. The basic
skills of good coaching, when applied with an inclusive philosophy, will ensure that all participants including people with disability
can participate.
Qualities and skills of an inclusive coach
Qualities
Attributes
Patience
Recognising some participants will take longer to develop skills or make progress than others
Respect
Acknowledging difference and treating all participants as individuals
Adaptability
Having a flexible approach to coaching and communication that recognises individual differences
Skills
Attributes
Organisation
Recognising the importance of preparation and planning
Safe practices Ensuring every session, whether with groups or individuals, is carried out with the participants’ safety in mind
Knowledge
Utilising knowledge of training activities and how to modify them in order to maximise the potential of every participant
Planning for inclusion
When preparing a coaching program, examine what, if anything, needs to be adapted or modified. Two strategies coaches can use
when planning and conducting activities are TREE and CHANGE IT. By modifying the factors listed, coaches can meet the individual
needs of the participants.
TREE
T
Teaching / Coaching Style
R
Rules / Regulations
E
Environment
E
Equipment
CHANGE IT
Example
C
Coaching Style
Demonstrations, use of questions, role models, verbal instructions
H
How to Score
Rules
A
Area
Size, shape or surface of the playing environment
N
Numbers
Number of participants involved in the activity
G
Game Rules
Number of bounces or passes
E
Equipment
Softer or larger balls, or lighter, smaller bats/racquets
I
Inclusion
Everyone has to touch the ball before the team can score
T
Time
‘How many … in 30 seconds?’
Sports CONNECT
Coaches looking at furthering their knowledge in inclusive coaching can contact their sport or attend Inclusive
Coaching workshops as part of Sports CONNECT Education. For more
information visit: ausport.gov.au/disability
Tips for coaches working with participants with disability
• The basic principles of coaching apply when coaching participants with disability.
• Accept each participant as an individual.
• Ask the participant what they are able to do; the needs, strengths and weaknesses of
individuals will differ.
• Assess each participant’s aspirations, needs and ability and plan a training program accordingly.
• Understand how the impairment (disability) affects the participant’s performance; it is not
necessary to acquire extensive knowledge of the disability.
• Set realistic and challenging goals as you would for all participants
• Be aware of the risks associated with all participants in your care, and be prepared to deal with
emergencies should they arise.
ausport.gov.au/coach
© Australian Sports Commission 2010
FACT SHEET
INCLUSION IN SPORT
Inclusion of people with disability is about providing a wide range of options
Being inclusive is about providing a range of options to cater for people of all ages, abilities and backgrounds, in the most
appropriate manner possible. Inclusion encompasses a broad range of options in many different settings.
The inclusion spectrum
A common misconception about inclusion is that it is solely about including people with disability in regular sport activities
without any modification. Inclusion encompasses many different options in different settings. Inclusion in sport can be
viewed in terms of a spectrum. Each section of the spectrum is as important as the next, and ideally there would be
programs for people with disability available in all sections to choose from.
Examples of the inclusion spectrum
• No modifications: an athlete with an intellectual disability may train and compete with athletes without intellectual disability at a local
swimming club
• Minor modifications: a vision impaired tenpin bowler using a rail for support
• Major modifications: a seated shot-putter competing under separate rules using modified equipment against other athletes with disability
in an integrated track and field competition
• Primarily for people with disability: athletes with disability and their able-bodied peers combine to form teams for the purpose of developing a
wheelchair basketball competition
• Only for people with disability: goalball players participating in a competition exclusively for people with vision impairments
• Non-playing role: people with disability can be officials, coaches, club presidents, volunteers and spectators. The following factors will
influence the section/s of the spectrum an individual chooses to participate in:
• their functional ability
• the sport in which they are participating
• the opportunities within their local environment
• their personal preferences.
The inclusion spectrum allows games and activities to be delivered in different ways, with more options. The aim is to encourage higher quality
participation by people with disability, both with or away from their able-bodied peers. Clubs can provide a range of options by adapting and
modifying their sport in different environments.
ausport.gov.au/disability
INCLUSION TIPS: ADAPTION & MODIFYING
The effective teaching of skills and techniques are equally important for bowlers with a
disability. People with a disability do not generally need to be treated differently to anyone
else who participates in bowling. As a coach, leader or teacher you are in a great position to
ensure that you take an inclusive approach. To do this you can use the TREE principle. The
TREE principle can be used as a guide to modifying your activities and sessions so that
you can be inclusive of not only people with a disability but people of all abilities.
Teaching or Coaching Style:

What can I modify about the way I am teaching / coaching?

Think about how your methods can make the most of the abilities within the group.
Rules and Regulations:

What can I modify in the rules or regulations?

Rules and regulations can be modified to ensure someone can participate.
Equipment:

What can I modify about the equipment used in the
session ?

Equipment can include things such as bumpers, guide rails,
ramps, ball handles etc.

Changing or including equipment in a session may allow a
bowler to make the most of their abilities
Environment:

What can I modify about the environment to ensure no one is left out?

Think about where your bowlers are positioned on the lanes or how easy is it to move around the
approach.
More information on the TREE principle can be found on the following web pages:

Australian Sports Commission: www.ausport.gov.au/disability

VicSport: www.vicsport.asn.au
SPORTING
ORGANISATIONS
SPORTING ORGANISATIONS CATERING TO PEOPLE WITH
DISABILITIES
Australian Sports Commission http://www.ausport.gov.au
http://www.ausport.gov.au/__data/assets/pdf_file/0004/448645/Opening_Doors.pdf
Developed or supported national sporting organisations, state departments of sport and recreation and
Sporting Wheelies and Disabled Association to develop programs and resources to assist sporting
organisations and schools to create safe, fun and inclusive sport environments.
Burn Rubber
http://www.pcycnsw.org/prime_sparts_burn_rubber
A health and fitness program developed for individuals with a physical disability. Operates
within the PCYC across metropolitan Sydney.
Community Care Options
http://cco.net.au/community/connectable/community -directory
Links to the list of partners in the ConnectABLE project. These clubs & groups have expressed their
commitment to social inclusion and being accessible to everyone in the community.
Disability Sports Australia http://www.sports.org.au/index.php
Australia's peak national body representing athletes with a physical disability. Provide opportunities for
development of athletes at a national level and supporting pathways from grassroots to national level.
Administer the Wheelchair Rugby and Wheelchair Basketball National Leagues, and the Lawn Bowls
Multi-Disability National Championships
Disabled Surfers Association of Australia http://disabledsurfers.org
The DSA is setting the world’s best practice for the sport of Disabled Surfing. Caters for all disabilities.
Currently 15 branches across Australia and New Zealand.
Disabled Wintersport Australia
http://www.disabledwintersport.com.au
DWA is an organisation with a national perspective taking responsibility for development of disability
winter sport in Australia. The organisation has assisted thousands of individuals with disabilities to
participate in winter sports annually. The organisations members range from recreational skiers to
Australia’s Winter Paralympians.
Gymbaroo
http://www.gymbaroo.com.au
Group exercise classes for young children based on sensory and movement experiences required for
healthy brain development.
NICAN
http://nican.com.au
Information on recreation, tourism, sport & the arts for people with disabilities. Funded by the Australian
Government.
Rainbow Club
Providing swimming lessons for children with a disability. Located throughout NSW.
Reclink
http://www.reclink.org
Reclink is a non profit organisation whose mission is to provide and promote sport and art programs for
people experiencing disadvantage
Riding for the Disabled (NSW)
http://www.rdansw.org.au
Provides supervised access to horse riding for people with disabilities at 38 centres throughout NSW.
Sailability
http://www.yachting.org.au/participation/sailability
http://www.sailabilitynsw.org
An entry level program for people of all-abilities to get into sailing and activities at clubs.
Special Olympics
http://www.specialolympics.com.au
Special Olympics provide sports opportunities for all people with an intellectual disability regardless of
their skills, every week in communities right across Australia.
While some Special Olympics athletes strive to win medals, others enjoy the chance to get active, have
fun, make friends and be part of a family. Whatever their motivation, we cater for them by providing
meaningful sports programs delivered within a supportive environment where people with an intellectual
disability are accepted and can feel proud.
People with an intellectual disability are often ridiculed, misunderstood, isolated or simply ignored. Yet,
with the understanding and support of Special Olympics they discover the skills that allow them to
improve their health, develop self-confidence and bring joy to themselves, their families and their
community.
Sporting Wheelies & Disabled Association http://www.sportingwheelies.org.au
Queensland’s peak body for sport, recreation and fitness for people with a physical disability or vision
impairment.
Surf Life Saving http://sls.com.au/who-we-are/community-programs/inclusion/sportconnect
Offers a range of activities regardless of ability or disability. SLS is part of the Sports Connect program
through the Australian Sports Commission, aiming to enhance the opportunities for people with
disabilities to access sport.
Swimming NSW http://nsw.swimming.org.au
Offers Multi Class swimming, which is a form of competition designed specifically for swimmers with
disability. These events are normal swimming events with some minor modifications to the rules and
regulations.
Tennis Australia: http://www.tennis.com.au
Provides a tennis program for people with disabilities
Ten Pin Bowling http://www.tenpin.org.au
Works closely with local centres and state associations to provide inclusive environments in all
registered bowling centres. The sport is easily adaptable & can be done by using various adapted
equipment & techniques. Provides information on inclusion & adapting the sport.
Wheelchair Sports NSW
http://wsnsw.org.au
Provides a range of sporting programs, wheelchairs, facilities, financial assistance and support across a
variety of sports. Programs are specifically designed to cater for people with disabilities & are delivered
throughout regional and metropolitan NSW.
Wheelchair Sports Group (Coffs Harbour) http://cco.net.au/suppclub/wheelchair-sports-group/
Offers inclusive games of balloon soccer, wheelchair basketball, wheelchair hockey or bocci. A range
of activities to suit individual interests & abilities. Fully accessible venue (Sportz Central). Wheelchairs
provided.