Children with disabilities arguably represent one of this country's most vulnerable populations, facing far more mental and physical health issues than children without disabilities. Children with disabilities are approximately two times more likely than children without disabilities to suffer maltreatment, including physical abuse, sexual abuse and emotional and physical neglect from their families or guardians (Gaebler-Spira & Thornton, 2002). In this vein, exercise staff may need to communicate closely with social workers and therapists to monitor the mental health of their charges. According to Ayyangar (2002), the physical health management of children with disabilities requires the careful monitoring of several conditions, such as contracture development due to muscle imbalance from myopathies or neuromuscular diseases. Spasticity is a health issue for many children with disabilities, especially those with cerebral palsy [CP], brain injury [BI], spinal cord injury [SCI] and stroke. Spinal problems encompass a range of health issues. Children with Down syndrome, in particular, are at risk for atlanto-axial instability. Children with BI, CP, SCI, spina bifida [SB] or Duchenne muscular dystrophy [DMD], need to be monitored for scoliosis or lateral curvature of the spine. Osteopenia and resultant fractures from immobility, or stress fractures from transfers or normal activities, are an added health concern, often as a result of poor eating habits and medication side effects. Finally, pressure ulcers should be avoided at all costs and are more likely to occur in children whose sensation is impaired, such as those with SCI and SB (Ayyangar, 2002).