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Adapted Physical Activity and Sport in Rehabilitation

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  • Academic College at Wingate, Netanya, Israel

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Summary This chapter describes the evolution of sport as a means of active training and performance in rehabilitation and its current applications within a comprehensive rehabilitation system. Terminological developments in the past and present are considered first and central issues of adapted physical activity and sport within a rehabilitation framework follow, including: (a) The international classification of function, disability and health as a unified conceptual framework; (b) APA and sport vs. physical therapy in rehabilitation; (c) adaptation theory as the core concept; (d) the inactivity epidemic as a major source for current professional concern; (e) the motivational nature embodied in sport; (f) obligation to self-determination and empowerment as the typical mode of engagement; and (g) classification as a unique instrument for equalizing opportunities in disability.
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International Encyclopedia of Rehabilitation
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Adapted Physical Activity and
Sport in Rehabilitation
Yeshayahu Hutzler
The Zinman College of Physical Education and Sport
Sciences at the Wingate Institute
The Israel Sport Center for the Disabled in Ramat Gan
President, International Federation of Adapted Physical
Activity (IFAPA)
Wingate Institute 42902, Israel
Fax: 972-9-865-0960
Phone: 972-9-863-9222
Email: shayke@wincol.ac.il
Summary
This chapter describes the evolution of sport as a means of active training and
performance in rehabilitation and its current applications within a comprehensive
rehabilitation system. Terminological developments in the past and present are
considered first and central issues of adapted physical activity and sport within a
rehabilitation framework follow, including: (a) The international classification of
function, disability and health as a unified conceptual framework; (b) APA and sport
vs. physical therapy in rehabilitation; (c) adaptation theory as the core concept; (d) the
inactivity epidemic as a major source for current professional concern; (e) the
motivational nature embodied in sport; (f) obligation to self-determination and
empowerment as the typical mode of engagement; and (g) classification as a unique
instrument for equalizing opportunities in disability.
Introduction
The term “sport” has roots in the Middle English term disporten, that comes from Old
French desporter, which means to divert, to carry away. (The American Heritage
2003). Thus, sport can be understood as an active means for recreation, carrying a
person away from every day’s burden. Today, sport has different meanings depending
on culture and history. In the Anglo-American culture it is considered as mostly a
competitive form of organized physical exertion involving skills and regulations,
while in the central European cultures it is typically understood in a broader sense and
means "all forms of physical activity which, through casual or organised participation,
aim at expressing or improving physical fitness and mental well-being, forming social
relationships or obtaining results in competition at all levels." (European Sports
Charter 1992; revised 2001). In the context of rehabilitation, the relationship of sport
and disability are particularly important, because the term to rehabilitate comes from
the medieval Latin "habilitas", meaning "to make able" (Merriam Webster Online
Dictionary 2008) and involves building bridges over disruptions that have occurred
between the past and present, and with regard to control over one’s life (Norman,
Sandvin & Thommesen 2004). Rehabilitation is helping the individual achieve the
highest level of functioning, independence, participation and quality of life possible
(DeLisa 2004). The popular portrayal of sports in disability as “ability not disability
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counts” (e.g., Dallas Mavericks online), suggests that the aim of sport and
rehabilitation are actually similar, only at different ends of the normal distribution
curve. Thus, the methods of training, increasing motivation, and social conduct in
sport may be of particular relevance to rehabilitation efforts and structures.
The inclusion of physical activity and sports into rehabilitation services is associated
with the legacy of the medical rehabilitation specialist Sir Ludwig Guttmann (1976)
who was also known as the founder of the International Stoke Mandeville Games
Federation. Later models of Jocheim (1990); Rimmer (1999) and Schüle and Huber
(2004) suggest physical activity programs within a health promotion delivery system
of rehabilitation from hospital into the community (Figure 1). Today, physical activity
and sports for participants with functional limitations and activity restrictions are
increasingly being referred to within the framework of adapted physical activity
(APA: Sherrill 2004; Steadward et al. 2003; Winnick 2005), Paralympics (Higgs and
Vanlandewijck 2007), Special Olympics (Shapiro 2003; Farrell et al. 2004), health
promotion (Riley et al 2008), and rehabilitation medicine (Røe et al 2008).
Historical roots of adapted physical
activity and sports in rehabilitation
The phrase mens sana in corpore sano (a healthy mind in a healthy body) is a famous
Latin quotation of the Roman poet Juvenal of the first and second century (Satire X,
10.365), construed to mean that a healthy body is needed to produce or sustain a
healthy mind. An editorial entitled with this phrase in the important medical journal
Annals of Internal Medicine, highlights the role of physical activity in protecting brain
structure and function, and the role of exercise in the elderly in reducing the risk for
all-cause dementia and Alzheimer disease (Podewils and Gualler 2006). Physical
activity had an important role in the lives of Ancient cultures including the Greek,
Roman, and Jewish. King Herodikos of Seylembria (5th Century BC) was claimed by
Plato (translated by Lee 1955) of abusing physical activity, apparently due to this
King’s habit of promoting exercise in unsuitable cases (Bakewell 1997). The Roman
physician Galen (129-210 AD) was apparently the earliest source for describing
benefits of exercise by condition and intervention details in his famous work De
Sanitate Tuenda (translated by Green 1951). In the middle ages, Moses Maimonides
(Rambam), the Spanish physician, theologian and philosopher of the 12th century,
who had a major impact on the Jewish and Arabic world at that time, praised exercise
as a protective factor confronting illness (Posner 1998).
The modern evolution of physical activity and sports as an active means of
rehabilitation is attributed, among others, to the Swedish scholar Per Henrik Ling
(1776-1839), who established in the 19
th
century a system of medical gymnastics in
the University of Stockholm, Sweden after curing himself from rheumatism and
paralysis through practicing fencing and gymnastics. The term Medical gymnastics
was later transferred to other European and to American institutions of both medical
and educational sciences, but was not accepted. It was transformed in the USA into
corrective gymnastics and later sports for the handicapped (Strafford 1939), Special
Physical Education (Dunn and Leitschuh 2005); adapted physical education (e.g.,
Winnick 2005), and ultimately adapted physical activity (APA: Reid 2003; Sherrill
2004). Following initial generation by French Canadian scholars in the late 1970’s,
the term APA soon became the internationally accepted umbrella for conceptualizing,
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conducting and implementing physical activities suitable for persons with disabilities
(Hutzler and Sherrill 2007). A somewhat different evolvement of terminology
occurred in the German language, where Lorenzen (1961) described terminological
considerations leading him at that time to choose the term Versehrtensport (sport of
the disabled) instead of other terms, including those reestablished during the 1990s:
Gesundheitssport (health sport), and Sporttherapie (sport therapy). The term sport
therapy was preferred in German by scholars referring to specific health benefits,
aimed, specifically designed and pedagogically implemented through sport, play, and
movement (Rieder1977; Schüle and Huber 2004). A more versatile view was
represented by the German teacher, scholar, and Circus Clown E.J. Kiphard (1990).
He identified the evolving field of practice as a meeting point between pedagogical
and therapeutic concepts resulting in four German terms to be related to this field of
inquiry: (a) “Heilpädagogische Leibeserziehung” which applies to remedial,
corrective or adapted physical education, (b) “Behindertensport” (sports for the
disabled), representing the competitive element of sports for persons with a disability,
(c) “Sporttherapie” (sports therapy) referring to physical activity and sports as an
active means of physical rehabilitation, and (d) “Psychomotorische Erziehung /
Therapie” (psychomotor education / therapy) referring to physical activity and sports
as an active means for psycho-social rehabilitation.
Central Issues of Adapted Physical
Activity and Sports in Rehabilitation
ICF as a conceptual framework
Since the 1980's APA is strongly associated with an ecological understanding of the
action system comprising of mutual interrelationships between the person, the
environment and the task (Kiphard 1983; Newell 1986; Reed 1988). Accordingly,
induviduals possess resources enabling them to cope with environmental challenges.
The task is a specific relation between an individual and the environment such as
changing a position from one point in space to another, crossing a distance, or
catching flying objects. The goal of a task may be purposefully determined by the
person, or imposed by environmental stimuli, such as teaching, instruction or
therapeutic treatment. This view is consistent with the major components included in
the International Classification of Functioning, Disability and Health (ICF: WHO
2001) accepted among rehabilitation services worldwide. Defining APA intervention
goals by ICF categories is simple and makes a very clear link to terminology
traditionally used in Sport Sciences and to APA services and practices (Table 1). The
ICF model has been proposed as a framework for conceptualizing physical activity
behavior intervention (e.g., van der Ploeg et al. 2004), classification practices
(Tweedy, 2002) and adaptation modalities (Hutzler & Sherrill 2007). While further
research is warranted, the ICF appears to be a useful common platform for designing,
studying and discussing APA practices together with other rehabilitation professionals
using a common language and concepts, thus gaining tangibility and visibility of
APA.
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Table 1: Description of APA terms and service delivery by ICF and Sport Science
categories (Adapted from Hutzler and Sherrill, 2007).
ICF
Category
Sport Science
Categories
Significance to
participant
Service provider, level;
track accent
Examples of
activity goals
Body
structure
System:
cardiorespiratory
Joints,
neuromuscular,
neurological
Have physical
foundation &
acceptable
appearance
APA specialist; accent
on rehabilitation
(European perspective)
coworking with
therapists
Reduce weight;
align posture;
Increase bone
density; Increase
muscle mass
Body
function
Abilities:
Aerobic and
anaerobic
endurance,
Muscle strength
and endurance,
Joint flexibility,
Psychological traits
Be able to
perform
APA specialist; accent
on rehabilitation
(European perspective).
In USA, this could be a
rehabilitation fitness
instructor coworking
with therapists
Restore range of
motion; increase
muscle strength and
power; increase lung
& cardiovascular
function; increase
energy efficiency
Activity or
task
performance,
related to
physical
activity
Skills:
Fundamental motor
skills,
Sport specific
skills,
Psychological
skills
Doing
meaningful
tasks
APA specialist
coworking with teacher
/ instructor / coach,
each with additional
APA knowledge and or
professional support;
accent on education,
recreation, & sport
Reach for the ball;
finish 10 laps in
swimming; maintain
position; cross the
road; ;enter a bus
Participation
in physical
activity
Tactics and
Strategies ;
Academic learning
time; floor time.
Being
accepted as
part of a
reference
group
APA specialist co-
working with tehrapist /
teacher / social worker /
psychologist /
important significant
others; accent on
education & recreation
Participate in ball
games; be assertive;
be accepted among
peers; achieve
leadership; compete;
assume
responsibility
Elim
ination
of
barriers to
goal
achievement
Advocacy; Social
support systems
Having no
restrictions,
or opposition
to
participation
(Equity)
APA practitioner
across levels together
with social worker,
volunteer community
activist; accent on
recreation & sport
Change attitudes, set
rules for; use law
and affirmative
action
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APA and Sport in rehabilitation vs. physical therapy
Many professionals and laymen exhibit difficulty in separating APA and sport in
rehabilitation from physical therapy. Surprisingly, most differences suggested in 1961
by Lorenzen are still evident today namely: (a) medical orientation in PT, compared
to pedagogical in APA; (b) intervention goals are mostly referring to the impairment
in PT compared to the whole person and participation in APA; (c) activity is typically
prescribed in PT, compared to self-motivation in APA; (d) participant is passive and
active in PT but only active, mostly in group settings, in APA; (e) the goal in PT is
mostly restricted to specific biological changes, while in APA the goal is promoting
activity across the lifespan; and (f) the intervention is mostly identified as treatment in
PT, compared to self-determined action in APA. Furthermore, a literature analysis
comparing articles in the journal Adapted Physical Activity Quarterly (APAQ) and
the journal Physical Therapy (PT) has shown considerable differences in distribution
of clinical trials between both journals with about third of the articles referring to
participation issues in APAQ, while only about 7% in PT (Hutzler 2006). Figure 1
describes, a service delivery model depicting the specific accents of each profession,
based on rehabilitation phase and goals. Thus, multidisciplinary collaboration and
combination of contextual frameworks is recommended.
Figure 1: Health promotion model of APA in rehabilitation. Adapted from Rimmer
(1999) and Schüle and Huber (2004).
Adaptation theory as a leading paradigm
APA is a generic term that links physical activity with adaptation of various
environmental, social and individual systems. Thus it may be viewed as a practical
application of the Darwinistic concept of adaptive strategies, i.e., a mode of coping
with competition or environmental conditions on an evolutionary time scale (Darwin
1859). Adaptive strategies and adaptive systems are strongly anchored in
contemporary information theory, mathematics and biology, referring to systems that
have the capacity to change and learn from experience (Bar-Yam, 1997). Adaptation
theory (Sherrill 1995; 2004) suggests a philosophy, concepts, models and strategies
applicable not only to physical activity adaptations required for performing under
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disability conditions, but also to age, gender, and heterogeneity-related adaptation
principles. Following experimental work of Burton and associates (Davis and Burton
1991; Burton et al. 1993), Hutzler (2007a; 2007b) suggested a Systematic Ecological
Modification Approach (SEMA) for designing, implementing and analyzing
intervention outcomes, referring to five main modification criteria (task, environment,
equipment, rules and instruction) widely accepted in the literature (e.g. Lieberman and
Houston-Wilson 2002; van Lent 2006). This model links person and environment
factors to the rehabilitation task goals, desired performance criteria as well as limiting
and facilitating factors, adheres to ICF terminology, and provides a useful guide for
practice. A variety of applications for adapted sport activity within the rehabilitation
frame of reference are discussed in the following sections.
Inactivity epidemic
A recent source of concern, contributing to the expansion of sports in rehabilitation is
the trend of sedentary lifestyle and physical inactivity, challenging the “Western”
society, causing serious health problems and increasing costs for health agencies
(CDC 1996; Cavill et al. 2006). Inactivity and its detrimental outcomes are even more
common in individuals with disability (Brown et al. 2005; Rimmer, 1999; 2005;
Rimmer et al. 1996). Data of Brown et al. (2005) based on a survey of 74,900 adults
50 years of age and older, depict a considerable decrease of respondents with
disability being active at the recommended level (28.8 and 43.4%, respectively) and
an increase in inactive respondents with disability (35.5 and 17.5 %, respectively),
compared to peers without disability. According to Boslaugh and Andersen (2006)
only 25% of a representative sample of US adults with disability met the
recommendation for moderate physical activity level. Post-rehabilitation community
sport programs are, therefore, a promising area for APA professional engagement,
study and research. Based on multi site focus group and content analytic research,
Rimmer et al. (2004) have identified a series of barriers and facilitators to
participation in fitness and recreation programs/facilities among persons with
disabilities. Lifetime fitness and adapted physical activity programs are becoming
recognized as a crucial element in the maintenance of health and prevention of
secondary complications for example in stroke survivors (Gordon et al. 2004; Stuart
et al. 2008; Macko et al. 2008; van de Port et al. 2007). Models and programs have
been suggested, focusing on a service delivery from acute through rehabilitation to
post-rehabilitation community-based programs. While in the acute programs medical
supervision dominates, the community-based program warrants psycho-social
interaction and education processes contributing to life long physical activity
(Rimmer 1999; Schüle 2001). Community based educational programs require the
pedagogical expertise of APA practitioners and thus provide a promising field for
innovative design and implementation of health programs.
The motivational nature of physical activity and sports
Physical activity has very tangible outcomes. When mastery and success are
accomplished through learning a new motor skill, such as swimming, riding, cycling,
batting, etc., or through increasing the strength needed to push the body away from
the floor, thus initiating different modes of locomotion, individuals of all ages and
abilities gain confidence in their body and consequently their life. As proposed by
Lorenzen (1961), APA is mostly accomplished in group settings, thus further
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providing a social motivational factor based on model learning. The advantage of
motivating activities such as virtual reality in rehabilitation has been summarized
elsewhere (Weiss et al. 2004). The motivational effects of APA in a health and
rehabilitation context have been linked not only to initiating a desired exercise
behavior, but mainly for maintaining it, thus increasing the probability of life-long
adherence (Rieder 1996). Evidence supporting the motivational effect of sport in
rehabilitation is mostly qualitative and anecdotal (Hutzler and Sherrill 1999), with few
exceptions, one of which comes from psychiatric rehabilitation, where based on 180
respondents, Huber (1999) determined five factors, including (a) perceived self-
efficacy and control, (b) increased performance in activities of daily living (ADL), (c)
social support, (d) improved body-image and control, and (e) endured health
competence. A model for studying and implementing physical activity in
rehabilitation based on the ICF terminology and motivational theories has recently
been introduced (van der Ploeg et al.2004), acknowledging self-efficacy, intention
and attitude as important personal attributes and transportation, accessibility,
assistance, adapted equipment and supports as environmental factors.
Self-determination and Empowerment as Community Related
Rehabilitation Outcomes
The principal aims of Rehabilitation Medicine are to optimize social participation and
quality of life. This normally involves helping to empower the individual to decide
upon and to achieve the levels and pattern of autonomy and independence that they
wish to have, including participation in vocational, social and recreational activity
(White paper 2007)
APA calls for increasing choice, empowerment and responsible decision making of
the rehabilitation client, leading to counseling initiatives providing alternatives for
participation in sport activities in the community. Randomized comparative
interventions consisting of personalized tailored counseling with regard to (a) sport
stimulation and (b) daily physical activity promotion programs revealed, however,
that only a combined intervention of sport and exercise had increased
sports
participation and daily physical activity behavior nine
weeks and one year after the
end of inpatient or outpatient rehabilitation, in contrast to sport only and exercise only
during the corresponding rehabilitation programs
(van der Ploeg et al. 2006; 2007).
Further initiatives based on the Salutogenesis model (Antonovsky 1987), have
acknowledged the impact of sports as a protective factor (Hamsen et al. 2004; Schűle
and Huber, 2004). These factors are very much in common with the personal and
environmental facilitators postulated in the ICF model. Attributes such as increased
physical fitness can be recognized as protective factors in a variety of senses: (a)
buffering the detrimental effect of environmental hazards (e.g., stress;) on
psychological function (e.g., depression); (b) mediating a sense of perceived physical
self-efficacy and thus facilitation motivation toward performing recreational and
vocational activities, and (c) increasing the actual capacity of accomplishing tasks in
daily life and leisure time, such as gardening, crossing a busy road fast enough,
enjoying the environment through hiking etc.). Evidence supporting this approach is
yet to be disclosed.
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Classification as an activity enhancing and human rights agent
One of the major agents enhancing the participation of individuals with disability in
sport programs has been the classification principle. In sports of participants with
disabilities the classification system is aimed at increasing participation of all
individuals including those with severe disabilities across the life span (Strohkendl
1991). Therefore, ranges of functional limitations are identified, forming competitive
categories enabling relatively equal but also broad enough competition. The
Classification systems in sports for persons with disabilities are aimed to provide an
equitable starting point based on functional ability, i.e. performance should depend
upon training, talent, motivation and skill rather than on belonging to a favored or
disadvantaged group based on functional capacity (Richter 1993; Vanlandewijck and
Chappel 1996). By means of the classification systems both able-bodied and relatively
severely impaired participants can be included and enjoy participation for example in
reverse integrated wheelchair basketball (Brasile 1990; Tweedy 2003; Vanlandewisck
et al. 2004). Thus, the continuous establishment of classification systems in sports
would increase the likelihood of equal status participation, conforming to the UN
Convention on human rights of persons with disability (Article 30 of the United
Nations Commission for Equal Rights of People with Disabilities).
Conclusions and recommendations
APA and sport as service in rehabilitation
1. It is strongly recommended that intervention research be enhanced to establish
evidence based practice. All levels of evidence, but particularly those with
randomized recruitment of participants and multi-site samples are still needed
in a variety of populations.
2. The motivational aspects incorporated in physical activity, such as task
mastery and group modeling, should be increasingly tested for their
effectiveness and recommended as a low-cost service relative to other health
services.
3. The coupling of APA professionals with emerging technological devices such
as VR and tele-rehabilitation as well as other health professionals is warranted
within a service delivery team approach in order to provide for linking
utilization of competencies achieved at an early level of rehabilitation to later
stages in a community setting.
4. All aspects of article 30 of the convention on human rights for persons with a
disability are to be explored and lines of action developed for their
implementation and monitoring their utilization.
APA as a profession in rehabilitation
1. It is recommended that a gradual education system be developed that allows
for teaching knowledge bases of APA to a variety of other professionals,
particularly those at the lower end of the wage structure such as home personal
aids, teacher assistants, etc.
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2. Counseling and marketing competencies should be incorporated in the
professional profile of the APA specialist, since he or she is expected to
interact with a variety of professionals and compete in providing their services
with other similarly efficient professions.
3. Professional identity of APA specialists is to be enhanced by means of
consensus statements and clear tangible guidelines of practice. The theory and
criteria of adaptation appears promising as a unique body of knowledge that
can provide some aspects of this goal.
4. A common language with other rehabilitation professions should be
guaranteed by spreading the use of the ICF terminology, thus increasing
visibility and comprehensibility of APA among other professionals.
5. Service providers in the wellness and health industry need to be encouraged to
increase their application of APA services and approaches to a growing
(elderly and movement impaired) client population that may benefit from
utilizing these services.
6. The adaptive principles of APA should gain particular importance in 3rd
world countries and in rehabilitation of victims in post-disaster and war zones
(Chew 2008).
APA as a field of study
1. It is recommended to enhance the range of populations attracting research in
APA. Aging individuals with disability is one area that still lacks research.
Also, the effectiveness of exercise and training regimens adapted for specific
individual need to be studied.
2. The effectiveness of adaptations used while providing APA should
increasingly be identified and become a research priority, thus enhancing both
evidence-based practice and professional identity.
References
Antonovsky A. 1987. Unraveling the mystery of health. San Francisco: Jossey-Bass.
Bar-Yam, Y. 1997. Dynamics of complex systems. Reading (MA): Addison Wesley.
Boslaugh SE, Andersen EM. 2006. Correlates of Physical Activity for Adults With
Disability. Preventing Chronic Diseases July 3(3):A78. Published online 2006
June 15.
Brasile FM. 1990. Wheelchair sports: A new perspective on integration. Adapted
Physical Activity Quarterly 7(1):3-11.
Brown DR, Yore MM, Ham SA, Macera CA. 2005. Physical activity among adults
>or=50 yr with and without disabilities, BRFSS 2001. Medicine and Science
in Sports and Exercise 37:620-629.
-9-
Burton AW, Greer NL, Wiese-Bjornstal DM. 1993. Variations in grasping and
throwing patterns as a function of ball size. Pediatric Exercise Science
5(1):25-41.
Cavill N, Kahlmeier S, Rocioppi F. 2006. Physical activity and health in Europe:
Evidence for action. Copenhagen: World Health Organization, Europe
Regional Office.
Centers for Disease Control and Prevention (CDC). 1996. Physical activity and
health: A report of the Surgeon General. Atlanta (GA). U.S. Department of
Health and Human Services.
Chew V. 2008. Sport in Post-Disaster Intervention, Germany [Abstract]. In: 3rd
Annual International Forum. Apr 20-22. Qatar, Doha.
Dallas Mavericks. Wheelchair Basketball: Mission Statement. Available on-line at
http://wheelmavs.org/philosophy.htm
Darwin, C. 1859. On the origin of species. London: John Murray.
Davis WE, Broadhead J. 2007. Ecological perspectives on movement. Champaign
(IL): Human Kinetics.
Davis WE, Burton AW. 1991. Ecological task analysis: translating movement
behavior theory into practice. Adapted Physical Activity Quarterly 8(2):154-
177.
DeLisa J. Editor. 2004. Physical Medicine and Rehabilitation: Principles and Practice.
4th ed. New York: Lippincott Williams & Wilkins.
Dishman RK. 1988. Exercise adherence. Champaign (IL): Human Kinetics.
Dunn JM, Leitschuh C. 2005. Special physical education. 8th
ed. Dubuque (IA):
Kendall/Hunt.
Farrell RJ, Crocker PRE, McDonough MH, Sedgwick WA. 2004. The driving force:
Motivation in Special Olympians. Adapted Physical Activity Quarterly
21(2):153–166.
Frontera WR. 2006. Research and the survival of physical medicine and
rehabilitation. American Journal of Physical Medicine and Rehabilitation Dec
85(12):939-44.
Galen, Hygiene. 1951. De Sanitate Tuenda. Green RM, translator. Springfield (IL):
Charles C. Thomas.
Gordon NF, Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, Shephard T.
2004. Physical activity and exercise recommendations for stroke survivors: An
American Heart Association Scientific Statement from the Council on Clinical
Cardiology, Subcommittee on Exercise, Cardiac Rehabilitation and
Prevention; the Council on Cardiovascular Nursing; the Council on Nutrition,
-10-
Physical Activity, and Metabolism; and the Stroke Council. Circulation
109:2031-2041.
Gutenbrunner C, Ward AB, Chamberlain MA. 2007. White book on Physical and
Rehabilitation Medicine in Europe. Journal of Rehabilitation Medicine 45
Suppl:1- 48.
Guttmann L. 1976. Textbook of sport for the disabled. Aylesbury (UK): HM&M.
Hamsen R, Beudels W, Hölter G. 2004. Aufmerksamkeitsdefizit- und
Hyperaktivitätsstörungen (ADHD) im Kindesalter. Zur Entwicklung
bewegungsorientierter Interventionsmodelle [On development of movement
oriented intervention models]. Zeitschrift für Sportpsychologie 11(3):91-102.
Higgs C, Vanlandewijck Y. 2007. Perspectives Volume 7: Sports for Persons with a
Disability. Berlin: International Council of Sport Science and Physical
Education (ICSSPE).
Huber G. 1999. Evaluation of health related movement programs [Evaluation
gesundheitsorientierter Bewegungsprogramme]. Waldenburg (Germany):
Sport-Consult Verlag.
Hutzler Y, Sherrill C. 1999. Disability, physical activity, psychological well-being
and empowerment: A life span perspective. In: Lidor R, Bar-Eli M, editors.
Sport psychology: Linking theory and practice. Morgantown (WV): Fitness
Information Technology. p 281-300.
Hutzler Y, Sherrill C. 2007. Defining adapted physical activity: International
perspectives. Adapted Physical Activity Quarterly 24(1):1-20.
Hutzler Y. 2006. Evidence based practice and research in adapted physical activity:
Theoretical and data-based considerations. Revista da SOBAMA 11(1):13-24.
Hutzler Y. 2007a. A systematic ecological modification approach to skill acquisition
in Adapted Physical Activity. In: Davis WE, Broadhead J, editors. Ecological
perspectives on movement. Champaign (IL): Human Kinetics. p 179-195.
Hutzler Y. 2007b. A systematic ecological modification approach to skill acquisition
in adapted physical activity. In: Davis W, Broadhead J, editors. Ecological
task analysis perspectives on movement. Champaign (IL): Human Kinetics. p
179-195.
Jochheim KA. 1990. Adapted physical activity—An interdisciplinary approach:
Premises, methods, and procedures. In: Doll-Tepper G, Dahms C, Doll B, v.
Selzam H, editors. Adapted physical activity: An interdisciplinary approach
Berlin: Springer-Verlag. p 15-22.
Kiphard EJ. 1983. Adapted physical education in Germany. In: Eason RL, Smith TL,
Caron F, editors. Adapted physical activity: From theory to application:
Proceedings of the 3rd ISAPA. Champaign (IL): Human Kinetics. p 25-32.
-11-
Kiphard EJ. 1990. Comments on adapted physical activity – Terminology and
concepts. In: Doll-Tepper G, Dahms C, Doll B, v.Selzam H, editors. Adapted
physical activity: An interdisciplinary approach. Proceedings of the 7th
ISAPA, 1989 Berlin: Springer-Verlag. p 11-14.
Kizony R, Raz L, Katz N, Weingarden H, Weiss PL. 2005. Video-capture virtual
reality system for patients with paraplegic spinal cord injury. Journal of
Rehabilitation Research and Development 42(5):595-608.
Lieberman LJ, Houston-Wilson C. 2002. Strategies for Inclusion: A handbook for
physical educators. Champaign (IL): Human Kinetics.
Lorenzen H. 1961. Lehrbuch des Versehrtensport [Textbook of disabled sports]
Stuttgart (Germany): Enke Verlag.
Macko RF, Benvenuti F, Stanhope S, Macellari V, Taviani A, Nesi B, Weinrich M,
Stuart M. 2008. Adaptive physical activity improves mobility function and
quality of life in chronic hemiparesis. Journal of Rehabilitation Research and
Development 45(2):323-328.
Merriam-Webster Online Dictionary. 2008. "rehabilitate". Retrieved June 15, 2008,
from http://www.merriam-webster.com/dictionary/rehabilitate
Norman T, Sandvin JT, Thommesen H. 2004. A holistic approach to rehabilitation.
Oslo: Kommuneforl.
Plato. 1955. The Republic. Lee HDP, translator. Harmondsworth (UK): Penguin.
Podewils LJ, Guallar E. 2006. Editorial: Mens Sana in Corpore Sano. Annals of
Internal Medicine 144:135-136.
Posner F. 1998. The medical legacy of Moses Maimonides. Hoboken (NJ): KATV
Publishing.
Reid G, Stanish H. 2003. Professional and disciplinary status of adapted physical
activity. Adapted Physical Activity Quarterly 20(3):213-229.
Reid G. 2003. Defining adapted physical activity. In: Steadward RD, Wheeler GD,
Watkinson EJ, editors. Adapted physical activity. Edmonton (Canada):
University of Alberta Press. p 11-25.
Richter KJ. 1993. Integrated classification: an analysis. In: Steadward RD, Nelson
ER, Wheeler GD, editors. Vista ’93 – The outlook: Proceedings of the
international conference on high performance sport for athletes with
disabilities. Edmonton (Canada): Rick Hansen Centre. p 255-259.
Rieder H, Huber G, Werle J, editors. 1996. Sport with special groups: A textbook
[Sport mit Sondergruppen: Ein Handbuch]. Schorndorf (Germany): Hoffman
Verlag.
Rieder H. 1977. Sport als Therapie [Sport as therapy]. Berlin (Germany): Limpert
Verlag.
-12-
Rieder H. 1996. Adapted physical activity. In: Rieder H, Huber G, Werle J, editors.
Sport with special groups: A textbook. [Sport mit Sondergruppen: Ein
Handbuch]. Schorndorf (Germany): Hoffman Verlag. p 81-85.
Riley BB, Rimmer JH, Wang E, Schiller WJ. 2008. A conceptual framework for
improving the accessibility of fitness and recreation facilities for people with
disabilities. Journal of Physical Activity & Health Jan 5(1):158-168.
Rimmer JH, Riley B, Wang E, Rauworth A, Jurkowski J. 2004. Physical activity
participation among persons with disabilities: barriers and facilitators.
American Journal of Preventive Medicine 26(5):419–425.
Rimmer JH. 1999. Health promotion for people with disabilities: the emerging
paradigm shift from disability prevention to prevention of secondary
conditions. Physical Therapy 79(5):495-502.
Rimmer JH. 2005. Exercise and physical activity in persons aging with a physical
disability. Physical Medicine and Rehabilitation Clinics of North Amerirca,
16:41-56.
Røe C, Dalen H, Lein M, Bautz-Holter E. 2008. Comprehensive rehabilitation at
Beitostølen Healthsports Centre: influence on mental and physical
functioning. Journal of Rehabilitation Medicine Jun 40(6):410-417.
Schűle K, Huber G. 2004. Essentials of sport therapy [Grundlagen der Sporttherapie].
2nd ed. Munich: Elsevier: Urban, & Fischer.
Shapiro DR. 2003. Participation motives of Special Olympics athletes. Adapted
Physical Activity Quarterly 20(2):150–166.
Steadward RD, WheelerGD, Watkinson EJ, editors. 2003. Adapted Physical Activity.
Edmonton (Canada): University of Alberta Press.
Strohkendl H. 1991. The relevance of understanding sportspecific functional
classification in wheelchair sports and its future development. Proceedings of
the Kevin Betts Symposium on functional classification, International Stoke
Mandeville Wheelchair Sports Federation: Stoke Mandevill July 1991.
Stuart MS, Card S, Roettger S. 2008. Exercise for chronic stroke survivors: A policy
perspective. Journal of Rehabilitation Research and Development 45(2):329-
336.
The American Heritage® 2003. Dictionary of the English Language 4
th
edition.
Wilmington (MA): Houghton Mifflin Company. On-line edition retrieved Jan
2008.
Tweedy SM. 2002. Taxonomic theory and the ICF: Foundations for a unified
disability athletics classification. Adapted Physical Activity Quarterly 19:220-
237.
-13-
-14-
Tweedy SM. 2003. Biomechanical consequences of impairment: A taxonomically
valid basis for classification in a unified disability athletics system. Research
Quarterly for Exercise and Sport 74:9-16.
United Nations Commission for Equal Rights of People with Disabilities. Convention
on the Rights of Persons with Disabilities. Online
http://www.un.org/disabilities/default.asp?id=259 retrieved June 20, 2008.
Van de Port I, Wood-Dauphinee S, Lindeman E, Kwakkel G. 2007. American Journal
of Physical Medicine and Rehabilitation 86(11):935-951.
van der Ploeg HP, Streppel KRM, van der Beek AJ, van der Woude LHV,
Vollenbroek-Hutten MMR, van Harten MD WH, van Mechelen M. 2007.
Successfully Improving Physical Activity Behavior After Rehabilitation.
American Journal of Health Promotion 21:153-159.
van der Ploeg HP, Streppel KRM, van der Beek AJ, van der Woude LHV,
Vollenbroek-Hutten MMR, van Harten WH, van Mechelen W. 2006.
Counseling increases physical activity behaviour nine weeks after
rehabilitation. British Journal of Sports Medicine 40(3):223-229.
van der Ploeg HP, van der Beek AJ, van der Woude LHV, van Mechelen W. 2004.
Physical activity for people with a disability: A conceptual model. Sports
Medicine 34:639-649.
van Lent M editor. 2006. Count me in: A guide to inclusive physical activity, sport
and leisure for children with a disability. Leuven (Belgium): Acco.
Vanlandewijck YC, Chappel R. 1996. Integration and classification issues in
competitive sport for athletes with disabilities. Sport Science Review 5(1):65-
88.
Vanlandewijck YC, Evaggelinou C, Daly DJ, Verellen J, Van Houtte S, Aspeslagh V,
Hendrickx R, Piessens T, Zwakhoven B. 2004. The relationship between
functional potential and field performance in elite female wheelchair
basketball players. Journal of Sports Sciences Jul 22(7):668-675.
Weiss PL, Rand D, Katz N, Kizony R. 2004. Video capture virtual reality as a flexible
and effective rehabilitation tool. Journal of NeuroEngineering and
Rehabilitation 1:12.
Winnick JP, editor. 2005. Adapted physical education and sport. 4th ed. Champaign
(IL): Human Kinetics.
World Health Organization [WHO] 2001. International classification of functioning,
disability and health (ICF). Geneva, Switzerland: Author [On-line]. Available:
http://www3.who.int/icf/icftem
plate.cfm.
... Nonetheless, when interpreting Hutzler's study outcomes, it should be taken into account that APA and physical therapy have distinct philosophies and practices (Lorenzen, 1961;Perreault, & Vallerand, 2007;Rossow-Kimball, & Goodwin, 2009). APA is based on a pedagogical and self-deterministic perspective, while physical therapy follows a rather medical prescriptive model of exercise (see Hutzler 2007Hutzler , 2008 for further discussion of the differences between these fields of study and practice). ...
... Results indicated more successful passes (activity criteria) and more active time (participation criteria) in children with and without disabilities during the adapted compared with the nonadapted game. Thus, this study, although in an educational and not a rehabilitation setting, complied with ICF criteria that have been recommended as a common ground for EBR in medically oriented literature (e.g., Simensson et al., 2003), as well as that of APA literature (Hutzler, 2007(Hutzler, , 2008. ...
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... De igual forma, potencia a la persona que lo practica y transforma la manera en que la sociedad observa al individuo por medio de un cambio de foco en la habilidad y no la discapacidad (ONGs, 2015). Los beneficios de la práctica del ejercicio físico en la salud y bienestar de los seres humanos han sido descritos desde tiempos antiguos, donde además su práctica ha tenido un rol vital en culturas antiguas como las civilizaciones Romanas, Griegas y Judías (Hutzler, 2010). Para la población con discapacidad, estos beneficios son aún mayores, teniendo en cuenta el impacto que tiene la práctica de ejercicios en la salud física, psicológica y en los componentes sociales que permiten favorecer la inclusión social. ...
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... O esporte praticado por pessoas com deficiência (PCDs) teve seu início após a Segunda Guerra Mundial, embora já se promovessem atividades esportivas para PCDs antes da década de 40 1 . O Esporte Adaptado ou Paradesporto é compreendido como prática que oportuniza às PCDs o alcance de novos horizontes e perspectivas de vida por meio de vivências motoras, psicológicas e sociais diversificadas 2,3 . A terminologia "Esporte Adaptado" é utilizado apenas no Brasil e consiste na possibilidade de prática esportiva para PCDs com modificações relacionadas às regras da modalidade ou a maneira como a modalidade se desenvolve 1,4 . ...
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... In the context of rehabilitation, the connection between sport and Physical disability is important as it serves as a bridge beyond the physical limitations with which disabled individuals must grapple in their lives. Nonetheless, the term "sport" has many definitions depending on the culture and history (Hutzler, 2012). In order to help people with intellectual http: //dx.doi.org/10.15405/epsbs.2016//dx.doi.org/10.15405/epsbs. ...
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The gold-standard physical medicine and rehabilitation text is now in its Fourth Edition—with thoroughly updated content and a more clinical focus. More than 150 expert contributors—most of them new to this edition—address the full range of issues in contemporary physical medicine and rehabilitation and present state-of-the-art patient management strategies, emphasizing evidence-based recommendations. This edition has two separate volumes on Physical Medicine and Rehabilitation Medicine. Each volume has sections on principles of evaluation and management, management methods, major problems, and specific disorders. Treatment algorithms and boxed lists of key clinical facts have been added to many chapters.
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This study examined the effect of ball size on the movement patterns used by children and adults to grasp a ball and then to throw it as hard as possible. A total of 104 kindergarten, second-grade, fourth-grade, eighth-grade, and young adult males and females were asked to pick up six styrofoam balls of different diameters (from 4.8 to 29.5 cm) four times each as they were presented in random order, and then throw them as hard as possible at a wall 6.7 m away. Transitions from one- to two-hand grasps were made as ball diameters increased, with older subjects switching at significantly larger diameters than younger subjects (p<.0001); however, when ball size was scaled to hand size, older subjects switched at significantly smaller relative diameters than younger subjects (p<.Ol), indicating that hand size may be a critical factor in determining grasp form. Transitions from one- to two-hand throws were made by less than 25% of the subjects (mostly kindergartners and females), demonstrating a strong preferen...
Chapter
As progress in scientific medicine has led to considerable improvement in the outcome of formerly fatal diseases and injuries, rehabilitation has gained an important position in the overall system of health care. The need for such services, however, varies greatly for various age groups. Only some 10% of the disabled population have incurred disabilty in childhood or adolescence. Over 30% have become disabled in the middle years of their life, and more than 50% have acquired the disability beyond the age of 65 (Fig. 1).
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Adapted physical activity has debated its professional and disciplinary status, but agreement has not been achieved. As a means of objectively evaluating the field for evidence of discipline status, the contents of APAQ (all issues between 1984-2000) and Clinical Kinesiology (1991-2000) were reviewed and compared against four criteria of a discipline: unique knowledge base, methodology, theoretical framework, and terminology. The review indicated that adapted physical activity has a distinct knowledge base but borrows considerable terminology, research methodology, and theory from allied fields. This is likely a reflection of our history, which has been tied to medicine, kinesiology, physical and special education, and some therapies. We conclude that adapted physical activity is a professional field of study with a crossdisciplinary knowledge base, rather than a discipline in its own right.
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Special Olympics programs provide competitive sport opportunities for athletes with intellectual disabilities. This study investigated athletes' perceptions of motivation in Special Olympics. Using Self-Determination Theory (SDT) as a guiding framework to explore athletes' experiences, 38 Special Olympians (21 males and 17 females) from British Columbia, Canada were interviewed. The data suggested that factors that enhanced autonomy, competence, and relatedness were linked to the participants' motivation in Special Olympics programs. These factors included positive feedback, choice, learning skills, demonstrating ability, friendships, social approval, and fun. Social support from significant others was a key factor related to participation motivation. There was also evidence for the motivating aspects of extrinsic rewards. Motivation was undermined primarily by conflicts with coaches and teammates.