Biomedical Engineering Reference
In-Depth Information
appears to lead to inadequacy in terms of confirmatory and definitive evidence for inter-
ventions, this is also an indicator of the wide range of opportunities for concerned indi-
viduals to promote PA among persons with disabilities. Consequently, such variation of
APA programs also leads to a greater potential to engage a range of sectors in the society.
For example, outdoor recreation has been shown to be beneficial for people with dis-
abilities (Loy et al. 2003; McAvoy et al. 2006), and people are motivated to join because the
activity results in social, psychological, and physiological benefits (Manfredo and Driver
1996). Adults with physical disabilities who have been engaged in outdoor recreational
fishing in Germany reported through a questionnaire that participation in this activity
led to benefits in terms of social interaction, self-improvement, experiencing nature and
relaxation, and challenge-related aspects (Freudenberg and Arlinghaus 2010). The par-
ticipant sample consisted mainly of people with mobility-related disabilities; thus, nearly
half reported that engagement in outdoor recreational fishing required the use of special
devices (e.g., wheelchairs) and structural modifications (e.g., ramps) on the fishing sites.
Participants also used fishing techniques that had less demands on physical mobility.
Deliberate exercise consisting of aerobic and resistance training programs may also
constitute an APA program. Implemented among adults with traumatic brain injury,
such program was conducted 3 times per week over eight weeks (Driver and Ede 2009).
Considering the participants' characteristics, individualized treatments were conducted
and heart rates were kept within 50-70% of each individual's maximum heart rate. Results
of this study indicated that the APA program led to a significant decrease of indices of the
participants' tension, depression, anger, fatigue, and confusion. Improvements were also
found in the participants' vigor and friendliness.
APA in the form of deliberate exercise may also consist of flexibility and strengthening
exercises. Such program was implemented among elderly individuals aged 65 years or
older (Benedetti et al. 2008). Postural deformities, flexed posture in particular, are common
impairments associated with aging (Balzini et al. 2003). As such, the APA program con-
sisted of exercises for the trunk that were based on a protocol that focused on propriocep-
tive input (Sinaki et al. 2005). The exercise protocol was adapted by limiting the number
of exercises to suit the elderly participants. Each session lasted for 1 h and was conducted
twice per week for a period of three months. Clinical and instrumental measurements
indicated that the program resulted in significant improvements in postural alignment
and decreased musculoskeletal impairment.
APA in the form of play (e.g., ball games, racket sports, video games) has been imple-
mented in a hospital setting among children with cancer (Speyer et al. 2010). Participants
joined individualized APA sessions for a minimum of 3 times per week during hospi-
talization. Parameters of each session were designed considering each individual child's
choice and capacities, previous physical practices, and phase of the disease. Participation
in APA was shown to lead to higher indices of health-related quality of life, specifically in
terms of physical functioning, social-physical roles, self-esteem, and dimensions of mental
health, behavior, and bodily pain.
Evidence-based recommendations on PA among children have suggested that an adequate
amount of PA may be accumulated in school during physical education classes, along with
recess time, intramural sports, and after-school programs (Strong et al. 2005). Consistent
with this, one of the most prevalent forms of APA is school-based instructional adapted
physical education, which has previously implied the use of classrooms and instructions
that were dedicated to school-aged children with disabilities (Sherrill 2004). The recent years
have seen a shift in the paradigm and attitudes of society toward disabilities (Kudlacek et
al. 2010) such that a growing number of students with disabilities are being included into
