Measuring physical fitness in Persons with Severe/Profound ...

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GMFCS was presented to the investigator, who translated the original version of the GMFCS intoDutch [41] and he concluded that the adaptations did not influence the reliability of the system.The participants were recruited from ‘De Brink’, a residential care facility in the Netherlands, inwhich 200 persons with severe of profound intellectual and sensory disabilities live. Moreover,in 65% they are suffering from motor disabilities as well. We asked the representativesof 92 participants a written permission for the subjects to participate in this study. Eightyrepresentatives gave permission. After informed consent was obtained, we screened theseparticipants based on the examination findings of a physician specialized in mental disabilities andof a behavior scholar and excluded five participants. Another eight participants were excludedbecause they did not live at the centre for people with severe intellectual and sensory disabilitieswhere the tests were performed. Twenty-two participants were excluded because they presentedwith exclusion criteria (see below) at the time the measurements were being performed (Fig. 1).92 subjects80 subjects75 subjects67 subjects45 subjects12 subjects lacked permission of representatives5 subjects excluded for medical or behavioral reasons8 subjects did not live at the examination centre22 subjects excluded because of exhibiting exclusion criteria atthe time of the testFigure 1. Inclusion stepsIn all, 45 participants participated in this study: 17 were female and 28 were male. The mean (SD)age of the men was 38 (11) years and of the women was 44 (10) years. Five participants wereclassified as GMFCS level 0, 21 participants as GMFCS level 1 and 19 participants as GMFCS level 2.Eighty-nine percent (40) of the participants had severe ID and 11% (5) had profound ID, accordingto the classification scheme of the IASSID. Most of the participants also had impaired vision.According to WHO guidelines [42], 55% (25) of the clients were severely partially sighted, 38%(17) were partially sighted and 7% (3) were slightly limited in sight. Most participants had impairedmotor abilities: 64% (29) had orthopaedic defects. In addition, 29% (13) of the participants hadslight hearing problems, 9% (4) had loss of hearing and 4% (2) had severe loss of hearing or werecompletely deaf.Chapter 2 | 25
Study designForty-five participants were measured twice. There was 1 week between the test and the retestand both measurements were conducted at the same time of the day. Food before the test–retest,defecation before the test–retest and the attendant of the test–retest were noted so that we couldcheck if these factors influenced whether the tests could not be reliably performed.Ethical statementThe study was performed in agreement with the guidelines of the Helsinki Declaration as revisedin 1975. Permission to carry out the study was obtained from a institutional ethics committee.Informed consent was obtained from representatives of the participants, because all participantswere unable to give consent. The measurements were performed in accordance with thebehavioral code section entitled ‘Resistance among people with an intellectual disability in theframework of the Act Governing Medical-Scientific Research Involving Humans’ [43]. Consistentdistress or unhappiness was interpreted as a sign of lack of assent and further participation in thestudy was reconsidered.Measures and protocolsAll measurements took place around the swimming pool at the institution. This location waschosen because this was thought to be a relaxing environment for the participants. Three testers,a dietary therapist, a physical therapist and a physical therapy student took the measurementsafter an appropriate training (three times) with two together. Participants were excluded from thestudy if they exhibited any of the following exclusion criteria at the time of the measurements:psychoses, depression, or other severe psychological problems, or somatic diseases, whichwere defined as chronic diseases and/or diseases that do not resolve in the short term (e.g.osteoarthritis, osteoporosis, pneumonia, etc.). Participants were also excluded for the followingreasons: general illness or fever; taking antibiotics; worsening of asthma, epilepsy (recent insult orepileptic fits), fresh wound(s)/bruise(s) or other factors causing pain during movement; or stressdue to the participants’ behaviour just before the measurement date.Body heightThe participant was asked to remove his shoes, to stand with his back against a wall and toplace his feet flat on the ground such that the back of his heels made contact with the wall. Theparticipant had to stand straight and look forward. When the participant was standing correctly,we determined body length by sliding the measuring tape upward from the ground towards theparticipant’s head (Seca height meter 202, accurate at the 0.1 cm level, Hamburg, Germany). Thelength was noted in centimeters (cm). When a participant was unable to stand against the wallproperly, he was asked to lie in a supine position or to lie on one side with stretched legs for bodylength to be measured. To measure a participant in a supine position, we drew two horizontallines – one touching the top of his head and one touching the bottom of his heels – and measuredthe distance between the two lines. To measure a participant lying on his side, we measuredthe following distances: (1) top of head-to-cervical spine; (2) cervical spine-to-os sacrum; and(3) os sacrum-to-bottom of heel. We summed these three distances to obtain the body lengthmeasurement. For both positions, supine and lying on one’s side, it was important to followthe body lines instead of measuring the shortest distance. No protocols from previous studiesmeasuring height in supine position are known. However, our measurer skills are based on 20years dietary and physiotherapeutic experience in handling participants from this target group.26 | Chapter 2
Page 2 and 3: Measuring physical fitnessin person
Page 4: Rijksuniversiteit GroningenMeasurin
Page 10 and 11: Chapter 1IntroductionChapter 1 | 9
Page 12 and 13: overweight [15]. This prevalence is
Page 14 and 15: Theoretical framework of the studyI
Page 16 and 17: Components of physical fitnessThe a
Page 18 and 19: Therefore, a study is put forward w
Page 20 and 21: 2002;40:436-444.19 Temple VA, Frey
Page 22 and 23: Chapter 2Feasibility and reliabilit
Page 24 and 25: IntroductionPhysical fitness and he
Page 28 and 29: Body weightTo determine the body we
Page 30 and 31: Table 1 Results of Wilcoxon rank te
Page 32 and 33: Calculation of heightThe mean (SD)
Page 34 and 35: DiscussionThe results of our study
Page 36 and 37: References1 Bouchard C, Shepard RJ,
Page 38 and 39: 37 Rimmer J, Kelly LE, Rosentswieg
Page 40 and 41: Chapter 3Measuring waist circumfere
Page 42 and 43: IntroductionChildren and adults wit
Page 44 and 45: participants. These calculations as
Page 46 and 47: Data analysisThe data were analyzed
Page 48: Table 2. Simple regression analysis
Page 54 and 55: Chapter 4Feasibility and reliabilit
Page 56 and 57: IntroductionPeople with intellectua
Page 58 and 59: Eighty representatives gave permiss
Page 60 and 61: 3) The measurement procedure: The m
Page 62 and 63: and whether motivation influenced t
Page 64 and 65: Table 3. Mean peak heart rate achie
Page 66 and 67: AcknowledgementsThis research was f
Page 68 and 69: 21 Hopkins WG, Gaeta H, Thomas AC,
Page 70 and 71: Chapter 5Psychometric quality of a
Page 72 and 73: IntroductionIntellectual disability
Page 74 and 75: Exclusion criteria were mental or p
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participant had fulfilled the task.
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Table 2. Descriptive results peak h
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Table 3. Test-retest reliability of
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Table 4. Correlation scored motivat
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preceding GXT results on HR peak. G
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References1 Schalock R, Brown I, Br
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37 Stanish HI, Temple VA, Frey GC.
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Chapter 6Feasibility and reliabilit
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IntroductionLocomotor skills in peo
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this study was to evaluate the feas
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obtained from the legal representat
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Modified Berg Balance Scale scoresI
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Modified Berg Balance Scale scoresT
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References1 Van Erkelens-Zwets JHJ
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39 Dorai-Raj S. Binomial Confidence
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Chapter 7Feasibility, test-retest r
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IntroductionPersons with profound i
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DesignThe muscle tone and spasticit
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Interrater reliabilityFirstly, to d
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Table 3. Summary of the statistical
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Table 6. Summary of the statistical
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RecommendationsThe feasibility of c
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18 Gielen EJJM. Is spasticiteit te
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Chapter 8Heart Rate Pattern as an I
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IntroductionIt is important to gain
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48 persons18 persons lacked permiss
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Furthermore, the mean and the range
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Table 3. Day-to-day outline of the
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Relation between heart rate pattern
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patterns in this study we can concl
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References1 Emerson E. Underweight,
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38 Multilevel Models Project (2004)
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Chapter 9General DiscussionChapter
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on this. To sum up, testing in pers
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for future research it is recommend
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studies. Randomized Controlled Tria
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of these individuals require more?
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19 Lahtinen U, Rintala P, Malin A.
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SummarySummary | 151
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problems in both locomotor skills a
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subjects are to be applied to perso
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may be an indicator of activity lev
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SamenvattingSamenvatting | 159
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InleidingVoldoende bewegen en fithe
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verstandelijk niveau en bepaalde mo
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Hieruit bleek, dat de motivatie van
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Verder is duidelijk geworden dat me
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DankwoordDankwoord | 169
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De leden van de leescommissie, prof
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Judith van der Boom, dank je wel vo
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Dankwoord | 175
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Curriculum vitaeCurriculum vitae |
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Curriculum vitae | 179
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