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NCHPAD - Building Healthy Inclusive Communities

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Case Study


A 12-year old girl with spina bifida (L2) has been referred to the physical therapist for a fitness program. The child uses a wheelchair to ambulate but is unable to go long distances without becoming short of breath.

The Target Aerobic Movement Test was performed in an indoor gymnasium. The child was unable to maintain a minimal target heart rate of 130 bpm for 15 minutes and therefore failed the test. Body composition was assessed using the triceps and subscapular skinfolds. Her summed pretest score was 50 mm (30 on triceps and 20 on subscapular), which is high for her age group. In addition, height and weight were recorded to compute BMI. Her BMI was 28 which put her into the >95th percentile for her age and classified her as overweight.

Muscular strength and endurance was performed using a hand grip dynamometer and a 10-RM bench press. Baseline scores indicated that strength levels fell into a normal range for her age and sex.

On the Backsaver Sit and Reach Test, the child achieved a score of 9 in. with the right leg and 4 in. with the left leg. That criterion passing score for the test was 8 in. (Winnick and Short), which indicates that she did not pass the test with her left leg. On the Modified Apley Test the child received a "3" (passing score) with both her right and left arms.

The parents were contacted and invited to a meeting where they were told that their child's excess weight was obstructing her ability to ambulate. The parents informed the therapist that their child had just gone through puberty and gained 20 pounds within the last 12 months. The parents were very interested in a weight reduction program. The therapist referred them to a registered dietitian to obtain a comprehensive weight reduction plan. Goals were established to allow a weight reduction of two pounds a month for the next year.

The primary goals of the fitness program were to reduce body fat and improve cardiovascular endurance. A secondary goal was flexibility in her left leg. The physical therapist provided the family with specific suggestions for improving cardiovascular fitness. The child was enrolled in a fitness program after school (Monday, Wednesday, Friday) where she was asked to perform a 10-minute warm up consisting of various stretching activities, 5 minutes of the routine focusing on hamstring flexibility in the left leg. A goal of 20 minutes of cardiovascular exercise using an arm cycle ergometer was set. Interval training techniques were employed for the first four to six weeks of the program (1:1 - one min. exercise/one min rest gradually increasing exercise time and decreasing rest interval).

A fitness instructor from the exercise facility was assigned to the student and assisted her in correctly using the equipment and monitoring the early stages of the exercise program. RPE and heart rate were used to gauge the exercise intensity. RPE was set between 10 to 12. Heart rate was checked every 5 min. and was set between 50 to 60% of her target heart rate. A resistance of 15 to 20 watts was used to keep her heart rate in the training zone and was gradually increased to 25 watts after the first four weeks of conditioning. Resistance was adjusted accordingly to maintain heart rate intensity between 60 to 75% of target heart rate.

After completing the 20-minute regimen, the student went to the walking track inside the exercise facility where she wheeled for 5 to 10 minutes during the first four weeks of the program, which was gradually increased to 20 minutes after six weeks of training. On weekends, the parents took the child for a 30 minute walk/wheel (pushing the child when she became fatigued or stopping to rest every few minutes), and purchased a wheelchair exercise video that the child performed on Saturday and Sunday mornings.


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