“Sunshine @ AIC”: An Occupation-based Physical

Activity Program for Adults with

Intellectual and Developmental Disabilities

Allison SullivanTemple University

Occupation-based Theory and Participation Spring 2013

Some people I know

Obesity: a national health crisis

According to the Centers for Disease Control and Prevention (CDC), obesity is “common, serious, and costly” over one-third of adult Americans

meet the body mass index (BMI) criteria for obesity

Heart disease, stroke, diabetes, and some cancers are obesity-related conditions that the CDC considers some of the leading causes of preventable deaths

U. S. Department of Health and Human Services, 2001

Sedentary lifestyle is one of the most significant risk factors for obesity

The Best Practices Statement for promoting physical activity (PA) developed by a coalition of national organizations led by The American College of Sports Medicine include the following recommendations:

Individually tailored PA programs and interventions that include principles of behavior change.

Emphasize the need to increase PA in

underserved populations primarily because these groups are at higher risk of poor health and have lower levels of PA than their counterparts

Stewart, et al.,2006

Adults with intellectual and developmental disabilities face multiple challenges in addressing the health-related risks of sedentary lifestyle :

They are more likely to:

Be people with low socioeconomic status Require assistance with everyday life skills Have poor dietary habits, low physical activity,

and weight disturbances Have more chronic disease conditions than

that of the general population Elinder, et al, 2010

Although a significant amount of research exists on obesity & interventions designed to promote weight loss, very little research has been conducted to date to identify those interventions that most effectively promote weight loss in this population

Context: Sunshine Village

A private, nonprofit organization located in Western Massachusetts serving people with developmental disabilities.

Staff of more than 150 people. Over 350 adults attend its day habilitation & employment services operations in 6 locations.

The day habilitation development training includes IADL, ADL, social, communication support & health care services. It is accredited by CARF

Sunshine Village offers speech, physical, and occupational therapies, as well as behavioral counseling for consumers in its day program.

The organization’s programs are licensed by Massachusetts Department of Developmental Disabilities.

Theoretical context: MOHO and CDM

Kielhofner’s Model of Human Occupation MOHO as a model for individual intervention

within a public health care setting is a compatible and consistent approach to treatment because both MOHO and the public health model are grounded in open systems theory

MOHO-based constructs of client volition and habituation via expansion of occupational roles and choices are key features of this program that differentiate it from traditional exercise and health-education interventions

Evidence-based support for MOHO-grounded interventions

Braveman & Suarez-Balcazar’s study “Social Justice and Resource Utilization In a Community-Based Organization: A Case Illustration of the Role of the Occupational Therapist” (2009). “Through the application of occupational

therapy processes, occupational therapy personnel are positioned to guide organizations to support people to achieve self-sufficiency and self-determination, concurrently establishing reasonable expectations for people to contribute to this process”

Allen’s Cognitive Disabilities Model

Allen Cognitive Levels and Modes identify problem solving skills in the program participants facilitates clinicians’ ability to:▪ anticipate safety issues ▪develop specific interventions and environmental and communication supports to maximize positive outcomes.

Evidenced-based support forAllen’s Cognitive Disabilities

Model A study by Mary Ann Mayer (1988)

provides convincing support that Allen's model “can be useful in guiding occupational therapy planning when expected outcomes depend on the patient's learning potential”.

Mayer, M., A, (1988). Analysis of information processing and cognitive disability theory. American Journal of Occupational Therapy. 42, 176-183. doi: 10.5014/ajot.42.3.176

Sunshine@AIC Program Components

Use of a college gymnasium twice a week for two hours Provide a safe and accessible environment

conducive to physical activity for adults with significant developmental disabilities from Sunshine Village Identification of a facility that is safe and

appropriate for the purpose of creating an opportunity for adults with significant developmental disabilities to get physical activity is a key factor in being able to successfully address the occupational deprivation caused by the effects of sedentary lifestyle.

Program Components Continued

The college provides the facilities, basketballs for consumer use during that time, and a device for playing music in the gym The low level of demand placed on college

employees and materials makes the program very appealing to The College▪ College can promote its role as a good

community partner▪ Also promotes disability awareness in the

college community ▪ Provides an opportunity for student fieldwork

Program Components

Sunshine Village provides: Up to 50 consumers each visit who are

identified as candidates for the program from all 6 locations

Staff supervision of program participants as designated by attendees’ staffing protocol

Transportation of program participants and their staff to and from the college

Occupational therapist to supervise the program

Program Components Continued

Features of the college gymnasium that promote successful intervention for this population: Large size accommodates the free movement of many

people at one time. No furniture or environmental hazards such as rugs or

small objects in the gymnasium that can be safety issues for consumers (some consumers have pica).

The facility is completely handicapped accessible, including its restrooms and water fountain.

The parking lot is fenced in, which is a significant safety feature, due to the fact that some individuals who attend the program have decreased safety and environmental awareness and can behave unpredictably during transition times.

Specific physical activities that are offered at the program

Walking around the gym to music Shooting basketballs into baskets

around the gym perimeter Kicking soccer balls at designated

targets.

The activities selected are appropriate for participants functioning within the Allen Cognitive Levels 3-4.and promote physical activity.

CDM Rationale for Activity Choices

Based on Allen’s CDM, skills of individuals functioning in the Cognitive Level 3-4 range include: the ability to manipulate objects be engaged in activities of interest follow simple commands when appropriate

communication techniques are learned complete steps of familiar tasks complete familiar activities that don’t

require precision socialize demonstrate improved performance in

familiar tasks involving structure and routine

Other intervention components Water cooler breaks Donning and doffing outer garments Toileting and toilet hygiene

Spectating/observing Dancing Van to gym transition Socializing with staff, peers and

studentsTasks that are not essentially “physical” are crucial to consider within the overall structure of the program when establishing the MOHO-based constructs of volition and habituation

MOHO Rationale: Volition Influences Performance & Adaptation

Emphasis on clients’ ability to exercise personal choice within program activities is a key feature of this intervention

Participants choose what they want to do in terms of the activities offered, how long they want to do it for, and with whom they do it

People may move freely from one activity to the next or remain with one choice for the duration of their visit

“Me time” is Key Time!

MOHO-based Consideration of the Impact of Environment on Occupational Performance

Kielhofner and Barret describe the “contribution of the environment to occupational adaptation”

Severely circumscribed environmental constraints by the day program setting diminishes people’s natural human potential- work and play occupations are limited by lack of choices. Motivation for occupation is diminished as occupational role

choices are sparse, not necessarily client-centered Volition, habituation and performance subsystems are

negatively affected by a lack of opportunities to grow or change.

The addition of a new environment that offers opportunities to increase individuals’ occupational choices is an ideal way to influence change at the systems level and in that way influence health of individuals in the system positively.

External Factors to Consider Based on ICF Domains

Include items identified within the Activities and Participation and Environmental Factor Domains

In particular, attention should be directed to to those items identified in the following subheadings:

Learning and Apply Knowledge, General Tasks and Demands, Communicating, Mobility, Self-Care, Interpersonal Interactions and Relationships, Community, Social and Civic Life (specific items)

Program Evaluation

Voluntary Participation indicates huge success as a choice-based avenue for participation

Success as a Falls Prevention Program Weight Management Program for obese participants MOHOST Pretest and posttest Likert scales for rating health

status Instrumental and Activities of Daily Living Scales

completed by a guardian Pre and posttest self-report measures including the

Cognitive-Emotional Barriers to Exercise Scale, Exercise Perception Scale, a non-standardized measure of self-efficacy, Life Satisfaction Scale, and an adapted Children’s Depression Inventory (Heller, et. al, 2004).

Conclusions

Adults with intellectual disabilities are an under-studied group of individuals in our population.

A paucity of evidence indicates that there is still much to be learned about the usefulness and best methods for this type of intervention with this population.

Doing nothing almost guarantees negative health outcomes in this vulnerable population

clinicians seeking to implement physical activity interventions to address health risks related to sedentary lifestyle with this population are encouraged to seek alternative environments such as local college gymnasiums to develop these interventions, given the occupational deprivation that is a frequent consequence of the day program setting

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