Measuring physical fitness in Persons with Severe/Profound ...
Measuring physical fitness in Persons with Severe/Profound ...
Measuring physical fitness in Persons with Severe/Profound ...
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As this thesis is comprised of multiple studies related to psychometric characteristics ofmeasurements concepts when test<strong>in</strong>g for a multiple disabled target group, a solid overview ofthe results and their relations is a necessary and natural last step. This discussion is roughlydivided <strong>in</strong>to four parts. The first part touches upon general f<strong>in</strong>d<strong>in</strong>gs, which deal <strong>with</strong> classification,test sett<strong>in</strong>g and adjustments <strong>in</strong> formulas. Then, this discussion goes <strong>in</strong>to more detail discuss<strong>in</strong>gresults grouped per studied concept: body composition, functional exercise and aerobic capacity,balance, flexibility and <strong>physical</strong> activity respectively. Additionally, the third part deals <strong>with</strong> themethodological issues encountered dur<strong>in</strong>g research; lack of standards and cutt-off scores, smallsample size and heterogeneity of the study population. The f<strong>in</strong>al part of this discussion seeks togive an overview of the implications of the different studies comprised <strong>in</strong> this thesis, as well as to<strong>in</strong>dicate recommended areas of further research.General F<strong>in</strong>d<strong>in</strong>gsClassification and Test Sett<strong>in</strong>gThe subjects of this thesis have severe or profound <strong>in</strong>tellectual as well as visual disabilities andthe study population is thus referred to as persons <strong>with</strong> severe or profound <strong>in</strong>tellectual andmultiple disabilities (SPIMD). The term ‘multiple’ <strong>in</strong>cludes locomotor disabilities, neurologicalproblems, sensory disabilities, and/or problems <strong>with</strong> food <strong>in</strong>gestion.An important topic that came up dur<strong>in</strong>g the studies of this thesis [all chapters] is the importanceof comb<strong>in</strong><strong>in</strong>g both severity of <strong>in</strong>tellectual disabilities as locomotor levels (GMFCS) to classify theabilities of persons <strong>with</strong> severe or profound <strong>in</strong>tellectual disabilities. Only if both classificationsare used, the appropriate <strong>physical</strong> <strong>fitness</strong> tests can be <strong>in</strong>dividually selected. Contrary to commonassumptions, persons <strong>with</strong> profound <strong>in</strong>tellectual disabilities do not automatically have lowlocomotor levels. The ability to walk varies considerably <strong>in</strong> persons <strong>with</strong> severe <strong>in</strong>tellectualdisabilities as well as <strong>in</strong> those <strong>with</strong> profound <strong>in</strong>tellectual disabilities. Specifically, 75 % of thesubjects <strong>with</strong> severe <strong>in</strong>tellectual disabilities were able to walk, leav<strong>in</strong>g 25 % which were not ableto walk. In contrast, 56 % of the subjects <strong>with</strong> profound <strong>in</strong>tellectual disabilities is able to walk,whereas 44 % is not able to walk [1, 2]. Not test<strong>in</strong>g for GMFCS levels thus means ignor<strong>in</strong>g a bigpotential for both research as improvement of <strong>in</strong>dividiual <strong>physical</strong> <strong>fitness</strong>.Also, contrary to common beliefs, persons <strong>with</strong> SPIMD can become accustomed to test andmeasurement situations despite their severe or profound <strong>in</strong>tellectual and multiple disabilities,if optimal test environment and conditions are created. Test<strong>in</strong>g <strong>in</strong> persons <strong>with</strong> SPIMD <strong>in</strong> afeasible, valid and reliable way is possible –albeit challeng<strong>in</strong>g due to the limitations <strong>in</strong> <strong>in</strong>tellectualfunction<strong>in</strong>g, adaptive behaviour [3] visual impairment [4], low motivation and adherent stress [5,6].This thesis made use of environmental cues to counter these limitations. Environmental cues<strong>in</strong>cluded adaptations of exist<strong>in</strong>g test protocols, perform<strong>in</strong>g practice sessions <strong>with</strong> a familiarizationprotocol, test<strong>in</strong>g at the regular <strong>physical</strong> activity hours <strong>in</strong> the regular sports hall accompanied byfamiliar gymnastic <strong>in</strong>structors, who were used to motivate the participants. In addition, the useof a treadmill to assess cardiorespiratory <strong>fitness</strong> is shown to be an effective environmental cue.Follow<strong>in</strong>g theories about perception-action coupl<strong>in</strong>g [7, 8], these environmental cues may havefacilitated the performance of the subjects by both reduc<strong>in</strong>g stress as enhanc<strong>in</strong>g motivation.Technology could be used to develop other environmental cues such as auditive or other sensorystimuli, which may even further ameliorate the test<strong>in</strong>g situation. Future research should focus140 | Chapter 9