Latest Updates
Tampilkan postingan dengan label accessibility. Tampilkan semua postingan
Tampilkan postingan dengan label accessibility. Tampilkan semua postingan

Research neglects alarming obesity rates in disabled children

By Louise Kinross

Children with disabilities are two to four times more likely to be overweight, and two to four times less likely to be physically active, than their peers, according to Dr. James Rimmer, a professor in the School of Health Professions and research chair in Health Promotion and Rehabilitation Sciences at the University of Alabama.

Despite these alarming numbers, the bulk of U.S. government funding goes to research into weight management for typical children, Dr. Rimmer said.

Dr. Rimmer was speaking today at a consensus-building workshop at Holland Bloorview in Toronto bringing together international experts and families to look at research to address weight management in children with disabilities.

Dr. Rimmer shared a number of American studies that showed dramatically higher rates of obesity in children and teens with physical and intellectual disabilities and lower rates of participation in school gym class and recess and extracurricular activities. “There is a tendency to not take these children out for physical education or recess and to involve them in more sedentary activities,” Dr. Rimmer said. In addition, after-school programs and playgrounds in the community may be inaccessible.

We have to teach society that there are ways to adapt programs and include kids with physical and cognitive disabilities,” Dr. Rimmer said.

In addition to being socially isolated, youth with disabilities and obesity are more likely to have a host of secondary conditions such as high cholesterol, asthma, pressure ulcers, fatigue, depression, low self-esteem, high blood pressure and liver and gallbladder disease.

My mission in life has been something called inclusion,” said Dr. Rimmer, noting that he has an adult daughter with autism who has been excluded from preschool and playdates since she was three. “Doctors need to understand that there are many associated consequences of obesity.”

Dr. Rimmer said that some tools that screen for weight issues don't identify problems in kids with certain kinds of disabilities. For example, using body mass index, which is a ratio of height to weight, doesn't work with children with paralysis.

Factors influencing the association between disability and obesity, he said, include: increased dietary intake; less physical activity; decreased fat-free body mass; lower resting metabolic rate, which is the rate at which you expend energy while at rest; and poorer heart function.

Despite the prevalence of obesity in children with disabilities, a disproportionate amount of U.S. government funding goes to research into weight management for children in general, Dr. Rimmer said.

He referenced a 2010 chart from the National Institutes of Health showing 116 federally-funded studies on obesity intervention for the general child population, compared to only eight studies targeted to children with disabilities. Dr. Rimmer noted that research on the general population typically excluded children with chronic medical conditions and genetic syndromes and those who don't walk or take medication. 

Dr. Rimmer said we need to learn from weight management programs that have been effective for the typical child population and adapt them for children with disabilities. “We need a systematic framework for developing guidelines, recommendations and adaptations.”

Dr. Rimmer spoke of a model that included convening an expert panel to assess whether existing guidelines target the disability population and creating focus groups where parents and youth with disabilities evaluate proposed adaptations. “We always find multiple holes in our recommendations after we go through the family focus groups,” he said.

Dr. Rimmer said it's generally not that difficult or costly to adapt programs, and that two common areas that need attention are training instructors on how to work with kids with disability and developing disability-friendly parent education materials.

Overall, adaptations should consider the built environment, such as the need for a ramp or access from a vehicle to a field; appropriate equipment; inclusion of all children in every game, sport or activity in and outside the class; and instruction for staff, for example, in how to communicate with a child with autism.

Dr. Rimmer said obesity is associated with carbohydrates and “our rates of obesity can come down demographically if can get refined carbohydrates, such as high fructose corn syrup, out of our diets.”

Inclusion is a right, he said, not a privilege.

Blogger tracks Toronto's disability-friendly spots

By Louise Kinross

Silvia Guido blogs about Toronto restaurants, bars and music venues that meet her 30-item checklist for accessibility.
The physiotherapist, who launched AccessTO in April 2013, just posted her 122nd review. She's supported by a team of volunteers.
The blog grew out of complaints Silvia heard from patients about the limited number of places they could visit in Toronto.
"I'd talk about going to a new restaurant and my clients would say 'Good for you, but I probably couldn't get in there.' A number of my patients have moved out of Toronto because we have such a long way to go." 
Silvia only writes about Toronto spots that meet her criteria, she says. "It's either accessible to me or it's not. If it's not, I don't want to write about it. I want to keep the blog positive."
Silvia measuresentrance ways, table heights and door widths; checks floor surfaces, turning spaces and how easy the place is to navigate in a chair, scooter or walker; and looksfor automatic door, hand-dryer, sink and toilet features in washrooms.
"Individual washrooms, rather than stalls, are best," she says. "They need to have grab bars, a floating sink and automatic features." She writes about whether they have a fold-out table for changing children, but hasn't yet seen any washrooms equipped with a change table for an adult.
Silvia also writes about nearby accessible subway stations, parking spots or street parking.
The most common barrier she finds is lack of a level entrance way. "We've had restaurants that think they're accessible but they have a six-inch curb in front of the door."
Silvia follows up on recommendations from AccessTO readers and also does walkabouts in neighbourhoods to scout new places. "Right now I can't find anything in St. Clair Ave. W. and it's frustrating," she says. Her blog has categories for 26 Toronto neighbourhoods.
Silvia's volunteers include a friend who uses a wheelchair and some former University of Toronto occupational therapy students. "I'd love to find more volunteers with a variety of disabilities, to make it more personal," she says. You can contact her at info@accessTO.ca.
Silvia generally posts once or twice a week. She'd love to hear about your favourite family-friendly restaurants.

At the barre


































I came across this cool photo by Jamie MacDonald of an accessible ballet class we wrote about last year: Katie's ballet dream comes true.

All are welcome here


Today we have a guest blog from Amy Julia Becker, mom to Penny (above) and William. Amy Julia is a writer and a student at Princeton Theological Seminary in New Jersey. At Thin Places she blogs about "theology, disability, children and parenting, education, and the intersection of grief and hope." Thank you Amy Julia!


All are welcome here
By Amy Julia Becker


“Architecture is evangelism.” I heard it said in the context of church buildings. The speaker was making the point that a ramp at the back of the sanctuary might comply with ADA standards, but it isn’t exactly welcoming to individuals in wheelchairs. I’ve been trying to think of an equally pithy way to state this truth for the rest of the world. “Architecture sends a message” doesn’t have quite the same ring to it, but the point stands. The way our buildings, homes, and public spaces are constructed says everything about which people we want to see in those places.


Last week, my mother and I took my kids to our first Boundless playground, a playground intentionally designed to include children with a variety of strengths and abilities. I noticed the swings first—a few that looked the same as every other playground, and two with full back support and harnesses, big enough to hold an elementary-school aged child. Our daughter Penny, age four, has Down syndrome, and I remember the days when she could only spend 60 seconds in a swing before needing to get down. That low muscle tone made it hard to hold her head up, so the enjoyment of swinging was limited by the design of the swing. At this playground, those bright yellow swings stood out as an invitation for any child to swing with abandon.


And then I noticed that the path up to the slide was quite wide. Wide enough, in fact, for a wheelchair. Along the way up, we discovered “stations”—Braille on one plastic board, a xylophone elsewhere, knobs and different textures lining the walls. Penny and William, our 18-month old son, didn’t seem to notice anything different. They just thought it was fun to slide and swing and seesaw, play peekaboo, run and climb and spin.


A few years ago, it took courage for me to take Penny to a playground. I wondered what questions I might get, particularly, “How old is she?” and then a surprised look when I said “Two,” and they watched her take those tentative early steps, watched her tiny body navigate whatever treacherous structure loomed ahead. I worried about older children knocking her down. I wasn’t even sure she would have fun, since she couldn’t run and jump and climb like other kids her age.


Now, Penny can run and jump and climb. There are still things she can’t do, but she’s old enough now that most playgrounds are pretty fun spots. And if I’m honest about it, even in this inclusive setting, a child in a wheelchair would run into some barriers fairly quickly. She could wheel herself to the xylophone, but she couldn’t get all the way to the highest slide without assistance. She couldn’t get up and ride on the bouncy horse or sit on the giant seesaw by herself. Even a “boundless” playground can’t remove all physical limitations.


So for a moment, the cynic in me kicked in. What’s the point of this place? Penny can have fun on most any playground these days. And it would still be tough for some kids to navigate this one. But the purpose of this space goes beyond physical barriers. It tackles social ones, which is more than half the battle. Because what this playground said to me was, You are welcome here. And so is your daughter, who has glasses and a physical therapist and an individualized education plan. Your daughter, who has by now introduced herself to everyone else on the playground with, “Hi, what’s your name? Want to play?”


Architecture sends a message. In this case, thankfully, the message was: Come on in. Play with us. Stay for a while.

Katie's ballet dream comes true


Like many little girls, five-year-old twins Katie and Emily Suggitt wanted to dance. But until last year, Katie had to watch her sister at the ballet barre because she has cerebral palsy and can’t walk. Determined to see Katie don her own pair of pink slippers and take her place with the other dancers, mom Sarah – working with Emily’s dance school and one of Katie’s therapists – created an accessible class. Ballerina Dreams at Turning Pointe Academy of Dance in Toronto is for girls with physical disabilities. In addition to the traditional tights, leotards and frilly tutus, some dancers wear leg braces, use canes or walkers, and are assisted by high school students rolling around on stools with wheels. In the photo above, Katie waits backstage to perform at a recital with volunteer Julie Gass. I asked Sarah how she got the program up and running.

Me: What motivated you to start a ballet class for children with disabilities?

Sarah Suggitt-Nixon: Emily started ballet when she was three. At Emily’s first recital we were all in the audience, with Katie on my knee. Katie watched the other girls her age up on the stage and kept pointing to herself saying “I want to do it” and at the time I’m in tears thinking, how are we going to make this happen?

Me: How did you create the class?

Sarah Suggitt-Nixon:
Katie was having a therapy session with Barb MacDonald, her occupational therapist, and I asked her “What do you think of this idea of starting a ballet class for kids like Katie?” She said “I think it’s great to find activities that are useful from a therapy perspective, but the kids don’t think it’s therapy.” She offered to volunteer her time. We found a book called Ballerina Dreams about a class in New York for children with cerebral palsy, but in talking to the staff, it sounded like an expensive program to start. It seemed to me that we should try to find a school in Toronto that was already established and would entertain a class for these girls, so I called the director of Emily’s school at Turning Pointe. She said: “Wow, I love that idea. I’d like to figure out how to make it happen.”

Me: How does the class work?

Sarah Suggitt-Nixon: There are about six girls, aged five and six. The ballet teacher took the typical program she does and adapted it a little. Turning Pointe helped us find high-school student volunteers to be one-on-one helpers with each child. The volunteers have stools on wheels and in Katie’s case one holds her waist to help her stand up. They do a lot of coaching to remind her to reach her arms straight up over her head, or not to cross her feet or to lift her foot up. They work at the barre and work with colourful scarves to do the arm movements. Katie doesn’t use her voice device in the class, but Barb printed off some sheets so she could pick colours for different games they do in a circle. They use the same moves and music that they use in the classes for typically-developing children.

Me: How did they know how to adapt the program for each child?

Sarah Suggitt-Nixon: The occupational therapist put together a two-pager for parents to fill out to give a picture of their diagnosis and relevant information on how their little dancer moves and she met them on the first day and worked with the student volunteers. We didn’t do a lot of preparation as far as meeting with the dancers or volunteers up front. We told them “If you want to come and be a dancer, come, and if you want to come and be a volunteer, great,” and then we figured it out from there.

Me: What impact has the class had on Katie?

Sarah Suggitt-Nixon: She loves it. Saturday mornings in our house are ballet. Emily goes at 9:15 and Katie goes at 11:15. For all the girls, the biggest highlight at the beginning was putting on the outfit. Katie gets to be like every other girl. At their first recital, the director did an amazing job of not making the Ballerina Dreams class any different. She didn’t give a preamble to the class. It was just: “next up is Ballerina Dreams” and out they came in their walkers or with their volunteer. There wasn’t a dry eye in the house. After the recital they had a waiting list of high school students wanting to volunteer.

Me: What have you heard from parents of other kids in the class?

Sarah Suggitt-Nixon: “I can’t believe my little girl with special needs is doing a ballet class like her sisters or friends.” One mom told me she had been looking for this kind of program for two years. One of the girls who started in November is now taking steps, where she wasn’t before ballet. They’re ordering her a walker to use in addition to her wheelchair.

Me: How have other parents and dancers responded?

Sarah Suggitt-Nixon: You can peek through the window at the class and a lot of people stop by to watch. I heard one teenager say to her mom: “This is the class I was telling you about that I want to volunteer in. When they get more dancers, I’m next on the list to volunteer.” For many of the student volunteers it’s the first time they’ve been involved with kids with special needs and it normalizes these kids for them. They’re not different or weird. One mother said her daughter who’s going to university is now interested in looking into occupational or physical therapy as a career after working with these kids. There haven’t been any negative reactions.

Me:
What was the greatest challenge in starting the class?

Sarah Suggitt-Nixon: You know what, there wasn’t a big challenge! The studio is accessible and there are no stairs. I let families in the Bloorview School know about it, so we had dancers lined up and ready to go. Turning Pointe needed to schedule the time slot and teacher and get the volunteers. But I was very pleased at how receptive everyone was.

Ballerina Dreams was profiled in this Toronto Star article last weekend. Check out the online video. Photo above by Jamie MacDonald.

This and that


This post is a mixed bag.

Saturday was the first night we went trick-or-treating with Ben in a wheelchair. We used to pull him around in a wagon (because he’s tiny), and he would hobble up the stairs to people’s doors or we would carry him on our backs.

But this year it made sense to use his new wheelchair, which he now uses whenever he’s out.

It was an eye-opener to realize how many homes were inaccessible, with two to three steps up to the path, and then numerous steps up to the door. Our house is probably the worst: we live on a steep hill and have about 30 steps up to our house (we bought the house when I was pregnant with Ben).

Most people didn’t come out of their homes to hand out candy. They waited until the kids got up to the door and knocked. So there were at least a couple of streets where we were forced to roll by every single house, without stopping, because we couldn’t make it to the door.

I’ve always thought of our neighbourhood as being welcoming and friendly. But it’s not from a wheelchair.

Check out this new web site about Fragile X, developed by a non-profit group of parents and professionals called the Fragile X Research Foundation of Canada. The group says this most common cause of inherited developmental disability lacks awareness and research funding. I hope we can interview one of the parents in the future.

And this new collection of stories by parents of children with disabilities looks promising: My baby rides the short bus: The unabashedly human experience of raising children with disabilities. It includes a piece by our guest blogger Elizabeth Aquino.