Although we are very proud of our program and think it represents a unique approach to exercise for individuals with severe/profound intellectual disabilities, there are still improvements to be made. During the past year, we have identified cardiac issues requiring the care of a cardiologist. Making referrals to physicians in the community has not always been satisfactory since getting the appropriate evaluation requires several visits over the course of weeks or months. Communication difficulties and the confounding problems of the developmentally disabled, including seizures and atypical psychoses, along with the problems associated with aging, complicate assessments. Physicians need to become familiar with working with individuals with I/DD in order to provide optimal care. For that reason, we actively recruited a cardiologist to work directly in our clinic. We have obtained a stress-testing unit and are in the process of developing a modified stress test procedure that will be performed in our facility. We look forward to incorporating the information obtained from these baseline tests into our protocol to better meet the needs of our participants. We will also, over time, determine how the information may be used to assess changes that have occurred as a result of fitness training. More comprehensive assessments and data collection are being conducted already and will now be expanded so that we can better determine the effects of exercise in this underserved population.

Additionally, we are exploring alternative exercises such as cross-training due to issues with repetitive stress injuries, boredom, and the need for greater variety. Our efforts to find alternatives have not as yet been successful. There are exercise bicycles that, while showing promise, do not yet meet the needs of our participants. They operate on a motor providing passive motion. This does not provide an incentive for participants to exert effort, and we were unable to produce increases in heart rate. As we have more and more individuals enrolled for longer periods of time (several years), this will become an increasingly important goal.

Finally, we are willing to present our program to others who have an interest in learning more about the needs of adults with severe/profound developmental disabilities. Presenting courses and networking with other clinicians would be beneficial in advancing care for all concerned. If you have any feedback, questions, or concerns based on this monograph or on any physical therapy needs involving adults with severe/profound developmental disabilities, please contact:

• Jodi Oren, MA PT
  Program Director and Lecturer
  University of Florida, Dept of Physical Therapy
  Box 100154 HSC
  Gainesville, FL 32610
  Tel: 352/ 955-5884
  Fax: 352/ 955-5792
  E-mail: Joren@phhp.ufl.edu