Ways to Incorporate Physical Fitness Into the Lives of Individuals Who are Deaf-Blind

Lauren J. Lieberman Ph.D.
SUNY Brockport
Brockport, NY

Jessica Taule M.S.
Technical Assistance Specialist
NTAC, Atlanta, GA

Originally published in Deaf-Blind Perspectives, 5(2) 6-10, Lieberman, L & Taule, J. (1997-98), Ways to incorporate physical fitness into the lives of individuals who are deaf-blind.

This article is reproduced with permission. Any further use requires permission from the copyright holder.

Physical activity is an essential component of a healthy life style. The following anecdote illustrates some of the difficulties that may occur in individuals who have not had an opportunity to develop physical fitness through regular exercise or activity:

Juan, a 17-year-old boy who became deaf and blind from Usher Syndrome, has been placed through vocational training as a horticulture assistant for a mall. His commute to work consists of walking a half mile to the bus stop, a 30-minute bus ride and a five-block walk to the mall. His responsibilities at work include planting, weeding, watering, and repotting. Whereas most 17-year olds could handle this easily, Juan is often too fatigued to complete his work. Physical fitness is limiting him, not only at work, but in all aspects of his life. He could benefit socially and physically by in creasing his current physical activity level.

Justification for Physical Activity

Physical activity is de fined as any bodily movement produced by skeletal muscle, resulting in substantial increase over resting energy expenditure (Bouchard & Shephard, 1994). Increased physical activity can de crease the chances of dying from heart disease, plus the risk of developing diabetes, high blood pressure, dangerous cholesterol levels, and high stress levels (Surgeon General, 1996). Further more, the social and psychological benefits of increased physical activity are tremendous. According to Blessing, McCrimmon, Stovall, and Williford (1993), a regular program of aerobic exercise can improve cardiovascular function and body composition. Many individuals involved in daily exercise report better ability to sleep, improved self-esteem, increased stamina, and decreased stress levels leading to a better attitude about life. Many practitioners also find that when their students are involved in daily physical activity, negative behaviors, as well as self-injurious or self-destructive behaviors, decrease.

Research indicates that children who are blind tend to have more body fat, and less cardiovascular endurance, muscular strength, and muscular endurance than their sighted peers (Lieberman & Carron, 1998; Winnick & Short, 1985). Winnick (1985) has also determined that children who are blind are behind in activities such as throwing, catching, balancing, striking, and body and spatial awareness. Researchers attribute these various de lays not to genetic limitations of performance, but rather to over-protection and discouraging attitudes on the part of the parents or teachers (Nixon, 1988; Winnick, 1985). To date, research on the fitness and motor ability of individuals who are deaf-blind is limited, yet one can logically conclude that children who are deaf-blind, due to their additional communication and mobility needs, will exhibit the same or more severe characteristics.

It is imperative to encourage individuals who are deaf-blind to participate in physical activity in school and in their recreational time. The physical, social, and psychological benefits of physical activity will in crease the likelihood of independence and improve the quality of life for these children.

Fitness Activities

A complete medical examination is recommended prior to beginning a fitness program. Clearance should be granted by an ophthalmologist for activities involving physical exertion if there is a history of detached retina, retinal bleeding, and other tenuous eye conditions. Once medical clearance is obtained, a fitness assessment should be conducted by a certified person such as a health/fitness instructor, exercise specialist, health or physical education teacher, fitness director, exercise test technologist, or personal trainer to determine a starting reference point. Once the preliminary examinations and assessments are completed, an exercise program should be created to include a warm-up phase, an exercise phase, and a cool-down phase. The warm-up and cool-down phases should have a duration of approximately 10 to 15 minutes and should consist of low-intensity cardiovascular exercise (walking, cycling, aerobics, stretching, etc.). It is essential that the individual choose an exercise activity that he or she enjoys.

Many individuals may not at first like the feeling of discomfort that comes with extended periods of physical activity such as bicycling or running; therefore, short distances and times are recommended. It is important to set challenging, yet attainable, goals with each person.

For more information on basic fitness principles for individuals with sensory impairments see Lieberman (1996) in the Winter issue of Deaf-Blind Perspectives. The following are success fully tested strategies to adapt fitness activities for individuals who are deaf-blind. Remember that activities should be chosen based on the individual’s strengths and weaknesses. In addition, these activities need be adapted to each person to increase the chances of reaching his or her potential.

Bicycling

Independently: Individuals who have some usable vision may be able to ride a bicycle in dependently in a quiet park or around a track. Going with sighted companions will help ensure safety.
Tandem bicycles: Tandem bikes al low the sighted participant to peddle in the front of the bike while the participant who is deaf-blind peddles in the back. The person in front is responsible for steering and stopping. Tandem bikes can be purchased through most bicycle stores and range from $400 to $2,000. To find riding partners, contact your local bicycling club, university, or deaf club. Develop specific signals for turning, stopping, or emergencies.
Surrey or duo bikes: These bikes enable the participants to ride side-by-side, making conversation easier. The sighted participant is responsible for steering and stopping. A local bike store can usually supply a catalogue for these bikes.
Stationary bicycles: Any one who has some functional use of the legs can use one of these. Many stationary bikes will log the distance traveled and amount of time ridden. They can be purchased for $100 to $1,000 in most sporting goods stores.
Bicycle stand: Bicycle stands can turn an ordinary 10-speed into a stationary bike. These work like stationary bicycles and can be purchased for under $100 from any sporting goods stores.

Jogging

Sighted guide: The runner grasps the guide’s elbow, shoulder, or hand depending upon what is most comfortable for the runner and guide.
Tether: The runner and guide grasp a tether which is a short string, towel, or shoe lace. This allows the runner full range of motion of the arms, while remaining in close proximity to the sighted runner.
Sound source: The guide rings bells or shakes a noisemaker for the runner to hear while they run side-by-side. This works best in areas with limited back ground noise and for runners with enough residual hearing.
Guidewire: This allows the runner to run in dependently. A guide wire, set up permanently or temporarily, is a rope or wire pulled tightly across a gymnasium or track. The runner holds onto a sliding device such as a rope loop, metal ring, or metal handle, which prevents rope burn and allows for optimal performance.
Sound source from a distance: The runner runs to a sound source such as a clap or a bell. This can be done as a one-time sprint or continued for a distance run.
Sighted guide shirt: The runner with partial vision runs behind a guide with an easily recognizable shirt. This must be done in relatively uncrowded areas.
Independently around a track: Runners with low vision can follow white lines on a dark track when the track is relatively empty.
Treadmill: Running on a tread mill provides a controlled and safe environment. Tread mills, which can be purchased at most sporting good stores, cost any where from $200 to $1,000. The best tread mill will include a safety feature for quick stops. Many come with timers or mileage readers.
Wheelchair racing: An individual in a chair can use any of the above adaptations if necessary and appropriate around a track, through the neighborhood, or on a paved path with assistance.

Circuit Training

The safest way to train for muscular strength and endurance is with a circuit of stationary machines. The machines may consist of bench press or leg flexion extension machines, a sit-up board, or a universal machine. The following strategies will help ensure success:

Enough time: Al low time for tactile and/or visual exploration when introducing an individual to a machine.
Demonstration: The instructor should demonstrate the movement and link the movement to language, including the name of the exercise and muscle involved.
Option to perform: The individual is encouraged to try everything, yet it is important that they understand that they can decline. The following adaptations may be made:
Pictorials/braille instructions: Al low time for the person to look at performance pictorials and/or the opportunity to read about it.
Visual or tactual perimeter: For safety, mark the perimeter of the exercise machines with rope or contrasting colored tape on the floor.
Adaptations to equipment: Use large print, Hi-Mark and braille to mark on/off switches. Vibrating timers can be worn around the neck or in the pocket.
Number stations: Use large print, Hi-Mark, and braille to mark each piece of equipment with a designated number. A rope, tape, or tactile guide can lead from one piece of equipment to the next one.

Aerobics

The term aerobics means literally "with oxygen" or the "steady state transport of oxygen to the working muscles" (Shephard, 1990, p. 5). Thus, aerobics involves sustained physical activity to a point at which the body is utilizing oxygen or reaching 60%-80% of maxi mum heart rate over a period of time. To determine an individual’s working heart rate, subtract his or her age from 220, then multiply that number by .60, .70, or .80 depending upon how hard he or she wants to work (American College of Sports Medicine, 1991). For example, Nancy, who is 32 wants to work at 60% of her maximum heart rate. She would calculate 220 – 32 = 188 x .60 = 112.8. This means that Nancy’s working heart rate would be 110-120 beats per minute. To see if Nancy is working up to this level, she would sustain an activity such as aerobic dancing, cycling, or jogging in place for 5-10 minutes. While continuing this activity, she would take her pulse for 6 seconds, then add a 0 to her pulse score and compare that to 120. If her 6-second pulse was 14, that translates to 140 heart beats per minute and she should slow down a little. A pulse count of 10 translates to 100 beats per minute and she needs to step up the pace a little to maintain her desired heart rate. The working heart rate should be sustained for over 15 minutes, and preferably 30 minutes. It’s important to start out slowly. Some examples of aerobic activities include the following:

Step aerobics: This is sustained stepping on and off a 4-, 6-, or 8- inch platform at varying tempos and in different directions. This type of activity is adaptable to any level of ability. If an individual cannot step onto a platform, he or she can do the same activities without it.
Low-impact aerobics: This is sustained activity keeping one foot on the ground at all times. This includes marching with high knees, kicks to the front, bringing knee up and clapping under leg, marching in place and bringing arms up and down, toe touches to the front, right, and left, or just walking briskly around the room. As long as the individual is moving and keeping his or her heart rate up, this activity can be executed successfully by any one who is ambulatory.
High impact aero bics: This is sustained activity with both feet leaving the floor at some point during the movement. This includes jumping jacks, kicks to the front, jogging in place, bringing knee up and clapping under leg with a jump with the other leg, pendulum leg swings out to the sides, side jumps and front jumps in alternating directions. Doing these for any length of time requires good physical condition.
Wheelchair aerobics: While sit ting in a wheel-chair, the individual moves his or her arms up in the air, out to the sides, punches down, or twists at the hips for eight counts or more to elevate the heart rate. If possible, the individual can move his or her legs at the same time.
Physical assistance and/or brailling (Lieberman & Cow art, 1996): When the individual does not have enough vision and/or hearing to understand the details of a movement, the instructor can simplify all the moves to one touch cue or a sign cue that the participant will understand. For example, if the instructor wants the participant to march in place, the instructor would make the sign for soldier or tap the individual’s knee to signal marching. Since this has been previously explained, the participant will know what to do until a new cue is given. Routines that are consistent in their content will allow the instructor to gradually fade out cues and will lead to more independence.
Others: Any activity that raises the heart rate for a sustained period of time is considered an aerobic activity. Cycling, running, swimming, or walking can also accomplish this.

All these activities can be enjoyed with or without music. It is much easier to practice them without music first, then add that variable later.

Aquatics

Swimming is one of the best activities for individuals who are deaf-blind. There are few barriers, and the swimmer can move freely with out worrying too much about obstacles. Water can aid in range of motion, balance, stability, locomotion, and socialization. Adaptations for aquatics include the following:

Flotation devices: A variety of flotation devices is available, and an individual can still receive an aerobic workout while using a flotation device. Kick boards are especially helpful since the board hits the side of the pool be fore your head does!
Trailing: Use the wall and lane lines as guides for lap swimming the length of the pool.
Counter devices: Use flip cards, counters, or rings to assist in understanding of distance traveled or number of laps.
Hand-over-hand teaching and brailling: for beginners (Lieberman & Cowart, 1996).
Tread water: As an alternative to swimming laps, treading water provides a good aerobic workout.

Dance

Dancing gives an opportunity for free movement and exercise as well as a chance to be involved in a crowd, bumping bodies, moving, holding hands, and socializing (Smith, 1994). Pay attention to the following:

Decibels: Play music very loud and turn up the bass. Be sure to in form those with hearing aids before you turn the music up so they can adjust the setting if necessary.
Beats of music: Strobe lights can reflect the beat of the music or participants can hold a balloon which will pick up the vibrations from the music (Smith, 1994).
Wooden floor: Dancing on a wooden floor produces vibrations and tactile cues.
Peer tutors: Peer tutors can model and give physical assistance (Houston- Wilson, Lieberman, Horton, & Kasser, 1997; Lieberman & Cowart, 1996).

Deaf peer tutors are also excellent role models!

Summary

The benefits of physical activity have been well documented, yet many children who are deaf-blind are excluded from participation. Even when included, success or failure depends upon the attitude of the physical educator, teacher, parent, support staff, and the individual him/her self (Downs & Williams, 1994; Rizzo & Kirkendall, 1995). It is hoped that the above suggestions will foster creative ways to adapt attitudes, equipment, and the environment so the person who is deaf-blind may achieve his or her highest possible level of physical fitness. This will in turn lead to greater independence-the key to good job performance and a better quality of life.

References

American College of Sports Medicine (1991). Guidelines for exercise testing and prescription (4th ed.). Philadelphia, PA: Lea & Febiger.

Blessing, D.L., McCrimmon, D., Stovall, J., & Williford, H.N. (1993, February). The effects of regular exercise programs for visually impaired and sighted school children. Journal of Visual Impairment and Blindness, 50- 52.

Bouchard, C., & Shephard, R.J. (1994). Physical activity, fitness, and health: The model and key concepts. In C. Bouchard, R.J. Shephard, & T. Stephens (Eds.), Physical activity, fitness and health international proceedings and consensus statement (pp. 77- 86). Champaign, IL: Human Kinetics.

Downs, P., & Williams, T.(1994). Student attitudes toward integration of people with disabilities in activity settings. Adapted Physical Activity Quarterly, 11, 32- 43.

Houston-Wilson, C., Lieberman, L.J., Horton, M., & Kasser, S. (1997). Peer tutoring: A plan for instructing students of all abilities. Journal of Physical Education, Recreation, & Dance, 6, 39- 44.

Lieberman, L. J., & Carron, M.F. (1998). The health related fitness status of children with visual impairments. Presented at the Research Poster Session for AAHPERD in Reno, Nevada.

Lieberman, L.J., & Cowart, J.F. (1996). Games for people with sensory impairments. Champaign, IL: Human Kinetics.

Lieberman, L.J. (1996). Adapting games, sports and recreation for children and adults who are Deaf-Blind. Deaf-Blind Perspectives, 3, 5-8.

Nixon, H.L. (1988). Get ting over the worry hurdle: Parental encouragement and sports involvement of visually impaired children and youth. Adapted Physical Activity Quarterly, 5, 29- 43.

Rizzo, T.L., & Kirkendall, D.R. (1995). Teaching students with mild disabilities: What affects attitudes of future physical educators? Adapted Physical Activity Quarterly, 12, 205- 216.

Shephard, R.J. (1990). Fitness in special populations. Champaign, IL: Human Kinetics.

Smith, T.B. (1994). Guidelines: Practical tips for working and socializing with deaf-blind people. Burtonsville, MD: Sign Media Inc.

U.S. Department of Health and Human Services (1996). Physical activity and health (Report of the Surgeon General). Washington, DC: U.S. Government Printing Office.

Winnick, J.P. (1985). Performance of visually impaired youngsters in physical education activities: Implications for main streaming. Adapted Physical Activity Quarterly, 3, 58- 66.

Winnick, J.P., & Short, F.X. (1985). Physical fitness testing for the disabled: Project UNIQUE. Champaign, IL: Human Kinetics.

Lieberman, L. & Taule, J. (1997-98). Ways to incorporate physical fitness into the lives of individuals who are deaf-blind. Deaf-Blind Perspectives, 5(2) -10. http://www.tr.wou.edu/tr/dbp/pdf/dec97.pdf