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Post Occupational Therapy Exercise Program


Emily Howard

Rowan University

Authors Note

This paper was prepared for Administrations to Health Promotion and Fitness

Management, taught by Professor Fralinger.

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Executive Summary

The mission of the EBS Healthcare Post OT Fitness Program for kids is to provide the

children that attend the schools in the EBS school systems with the opportunity to exercise and

learn to exercise in a fun enjoyable way and to learn to do it at their own pace and skill level. The

goals of this agency are to: 1. Create an exercise program for Special needs kids in OT. 2.

Improve the physical health of OT children in a fun way by playing games and making exercise

fun. 3. Teach the children to Enjoy Exercise and know how to do it on their own. The Mission

and goals of this fitness program are to create a post Occupational Therapy program that helps

the children at the schools have fun after working hard in Therapy while also getting physical

activity for the day. The program would do this by playing games that require energy that way

these kids are still working hard but they are working out as well.

The main objective of the whole program is to show children how to have fun while

exercising. By playing highly active games to show them exercise is fun, they will want to

exercise. This program may also make them want to go to therapy because they will get to look

forward to playing afterwards. This is also a great way for the children to learn exercises that

they can do on their own.

This program is a great way to teach the children fun ways to increase strength,

flexibility, and cardio in a way in which it doesn’t feel like work but actually a game. Children

respond well to games so getting them to exercise will not be a problem if it is presented in a fun

way. Also the program will help reinforce the activities and exercises the children learned in OT

throughout the day.

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Program Rationale

In the United States, one in 68 children are on born with Autism. Children with Autism

benefit highly from Occupational Therapy, they make up a large part of the pediatric OT

population (National Institute of Neurological Disorders and Stroke, 2014). Occupational therapy

is very beneficial for a person with Autism. OT helps autistic children develop the skills they

need in everyday life such as brushing their teeth, or combing their hair. OT also is a good

method of promoting social skills in an Autistic child. Down Syndrome is another disorder that

makes up a large percentage of the pediatric Occupational Therapy population. One in 733

children are born with Down syndrome in the United States (Yamkovenko, 2015). Occupational

Therapist work with children who have Down syndrome to help them master skills so they can

be more independent in their every day lives.

According to Catherine Lord, PhD, children with Autism are best diagnosed between the

ages of 2 and 9 (2006). The treatment for all therapies including Occupational Therapy begins as

soon as the disorder is diagnosed. Autism has an unusual pattern of development that begins in

infancy or toddler years it is defined by reciprocal social interaction, communication, and

restricted and repetitive behaviors (Lord, 2006). Intervention projects such as physical and

occupational therapy have shown extraordinary levels of improvement in young children with

Autism. The earlier it is diagnosed, the sooner treatment can begin and the more likely that child

will be able develop the skills they need to live an independent life.

Down syndrome, unlike autism, can be diagnosed during pregnancy or as soon as

the baby is born, there is no waiting period to see how the child starts to develop. Children with

Down syndrome are also more likely to have other health problems when they are born. They are

more likely to have hearing lose (up to 75% of Down Syndrome), ear infections (between 50-

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70%), eye diseases (up to 60%), and heart disease present at birth (50%) (Centers of Disease

Control and Prevention, 2014). It is proven that services early in life such as occupational

therapy can improve the physical and intellectual abilities of the child that has Down syndrome.

When these children get the help they need early they are much more likely to lead productive

and fulfilling lives well into adulthood, having jobs and living independently (CDC, 2014).

The amount of children born with autism is increasing at an alarming rate. In 1970 the

statistics of a child born with the disorder was one in every 2,000 children and now it is one in

68. This has people very worried, is autism on the rise or do the new statistics just reflecting the

growing awareness of the condition? No matter what the reason for the increase in autistic

children, there must be a way to help them lead productive lives. Many parents are doing what

needs to be done and sending their children to Occupational Therapy to help with their

developmental needs. Down syndrome parents are doing the same thing. These two populations

are increasing and taking up more and more of the occupational therapy population.

In New Jersey, Autism rates are higher than the rest of the country, they are one in every

45 children are autistic (autism New Jersey, 2015). Therefore, making OT a very important

resource here in New Jersey. The rate of autism is steadily increasing in New Jersey with each

passing year. After researching the different ways these children get OT I found that New Jersey

has 104 after school programs made specifically for autism and Down syndrome children.

During the day many of these children have their Occupational Therapy done, they work with

OT and PTs during the school days. I want to implement an after school program dedicated to

exercise in a fun way for these children. If we implement games into the after school programs

that have an active premise behind them, these children will have more fun exercising. During

the day they do a lot of classroom work with their therapist but not much physical activity. By

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implementing a work out program these children will learn how to exercise in a fun way that will

benefit them throughout their lives. Plus this will help them look forward to there after school

program and increase their overall health.

I did my research at a Bancroft school in Haddonfield New jersey, at this school they

provide on sight speech, occupational, and physical therapies. The reason I want to implement an

after school exercise program is because after school activities don’t start until the middle school

age group, but I feel as though children under that age should start getting involved in active

exercise activities. Bancroft serves 1500 individuals each year and of that 1500 approximately

800 are under the middle school age group. I plan to implement a fun way to exercise for all of

the children who aren’t getting the opportunity to play in organized sports yet.

Needs Assessment

When conducting my needs assessment, I began by collecting survey data from the

occupational therapists of EBS Health Care, which is a health care facility that has a variety of

therapists that work with children between the ages of infancy to 21. First, I determined the

types of children this facility is working with and what their disabilities consist of. Next, I

analyzed the data I collected. Then, I tried to figure out what would help benefit this program.

Finally, I validated the prioritized needs of the target population of this community.

When first determining the types of children in my current population and what

disabilities they consist of I used the PRECEDE framework that entails the following: Social

diagnosis, Epidemiological diagnosis, Environmental/ Behavioral diagnosis,

Educational/Organizational diagnosis, and Administrative diagnosis. For the current target

population of EBS health care, with the social diagnosis I looked at the quality of life of the

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patients. I distributed surveys to find out what types of home lives they had and how much

activity they are apart of outside of occupation therapy. I also talked to the occupational

therapists to find out more about what the students they work with are like and what they do for

fun.

Next, I determined the types of needs of the children getting OT in the epidemiological

diagnosis. In this part I found out how many students have each type of disability and which ones

have become more common or less common in passing years. I found this out through both

program and school records.

Then I found out the environmental/behavioral diagnosis by going back to my original

survey and looking at what other activities the students are involved in. This would help me to

determine what type of program would be good for them but isn’t something they all ready have

done.

After, while referring to the organizational/educational diagnosis, I needed to determine

predisposing factors (provides motivation/rationale such as knowledge, attitudes, and beliefs),

enabling factors (enable motivation to be realized; availability of resources, health care

facilities), and reinforcing factors (subsequent to behavior; provides rewards for continuum of

behavior). These types of questions were also apart of the original survey I gave out to find out

more about the students. Through this I found out what motivates them to work harder and do

better, I also saw the factors that would make them want to do better in their programs such as

rewards and reinforcement.

Finally, with administrative diagnosis, I determined what resources the program already

has and what it would need by talking with the OTs.

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Once all of the information was collected I reviewed it and did an analysis of the data to

find out what types of disabilities deem most prevalent in this program and how I can help to

improve these children’s quality of life in a fun active way.

When prioritizing needs, I determined the strength of importance in attending to the

concern due to the amount of resources provided. Once this was determined, an appropriate

intervention could be implemented.

Finally, in validating the prioritized need, I went back through my needs assessment to

make sure the program I want to implement is actually in fact a need in the community.

Goals and Objectives

Pediatric Occupational Therapy

Mission: To create an exercise program for Special needs kids in OT

Goal: To improve the physical health of OT children in a fun way by playing games and

making exercise fun. (Process)

Objective: To create a post Occupational Therapy program to help the children

there have fun after working hard in Therapy while also getting physical activity

for the day. I would do this by playing games that require energy that way these

kids are still working hard but they are working out as well.

Goal: To Enjoy Exercise and know how to do it on their own (Outcome)

Objective: The main objective of the whole program is to show children how to

have fun while exercising. By playing highly active games to show them exercise

is fun, they will want to exercise. This program may also make them want to go to

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therapy because they will get to look forward to playing afterwards. This is also a

great way for the children to learn exercises that they can do on their own.

Theoretical Basis and Conceptual Model

The constructs of Social Cognitive Theory will guide program development. SCT is a

combination of Stimulus Response Theory and cognitive theories. This means that with those

two types of theories together that reinforcement becomes a very important component of SCT.

This theory is best for this particular group of people because the program is a group exercise

meaning socialization is a very important part of being successful, also exercise is a state of mind

no matter what age group is being worked with therefore cognitive reinforcement will be

necessary in order to convince these children that exercise is in fact fun.

The constructs being used to reinforce Social Cognitive Theory are: Behavior capability,

expectations, expectancies, self-control/self regulation, self-efficacy, emotional-control response,

reciprocal determinism, and locus of control. The ones that will be used as most beneficial for

this program will be: behavior capability, self-control, self-efficacy, and locus of control.

Behavior capability is very important for this program because we are working with a

special needs population therefore what they can and cannot do is very specific. We must figure

out what works best for each child and modify our games and exercises to meet their specific

capabilities. This also leads to why self-control is an important construct to the development of

our program. Throughout our program we are going to try to make these children like exercise

and get more of it each day but we are also going to help them gain more self-control. By doing

these exercises and strengthens muscles, some children may develop better self-control over their

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own bodies. So as we plan the program we must also find out where each child is at on a control

of its own body basis.

Lastly, Self-efficacy and Locus of Control somewhat go hand in hand. In order to have an

internal locus of control you must have a good self-efficacy there for believing you control the

outcome of a situation. By playing games, doing exercises, and having fun with other students,

these children will hopefully raise their self- efficacy and they’re for locus of control. This

program is manly an exercise program but if it goes as planned it will be a great way for these

children to have fun.

Also, the model being followed for the program is the Transtheoretical Model. This is a

framework to understand how the population in the program is progressing toward adapting and

maintaining a behavior change. The five constructs being followed are: Stages of Change,

Decisional Balance, Self-efficacy, Processes of change, and Temptation.

The following is the model of the program:

Intervention Behavioral Determinants Behavioral outcomes Ultimate Outcome

Education Behavioral capability Increase knowledge of

Exercise

Group Exercise Self Control Increased

Self Efficacy enjoyment of

Games Exercise

Locus of Control Increased Self Esteem

Visualization

Booklet

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Program Plan/Intervention

Lecture

Before the program begins there will be a small introductory lecture it will last no more

than thirty minutes and this will only be at the first and last session of the program. The program

is an hour session that meets 3 days a week after regular schooling hours. The sessions with

lectures will be an hour and a half. During the lecture the participants will be informed on what

they will be doing through out the program and what to look forward to. The will be told about

the different types of exercise and how it will presented in game form.

Stretching

Each session will begin with a warm up to get the body ready to exercise but first the

participants will stretch for 10 minutes. They will work on their flexibility while also getting

their bodies ready to be active and work to prevent injury.

Warm up game

The warm up game will be different each session. It will be a game that gets the kids

moving. Some days it will be picked from our cardio games, some days from flexibility or

strength or some days it will be an extra long dance party session. The warm up game will be

played for about 10 minutes before moving onto the exercise portion.

Dance party

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The dance party is a 5 minute short little spurt of energy release that is fun and relaxed.

Dancing is a great way for not only children but for everyone to express himself or herself. I feel

as though this should be incorporated in all of our sessions because one of our goals is to help

improve the children’s self esteem and give them time to let all their sillies out that built up

during school.

Strength exercise game

This is a 25-minute portion of the day. It will only be once a week, Strength, Cardio, and

Flexibility games will not be done every day, only one will be done during each session.

Strength games will be focused on building muscle strength. They will involve heavy balls and

obstacles that use a variety of muscles. Obstacle courses, weighted ball toss, and relay races that

involve muscle strength are all good options for this category.

Flexibility exercise game

This is also 25 minutes and will be done once a week. Flexibility games will be calmer.

They will be done through yoga and relaxation technique type of games. These games will help

the students improve flexibility and overall range of motion. This will help them have better

body control, which is another one of the programs goals.

Cardio game

Cardio games will be 25 minutes and these include a wide variety of everyday fun games

that the children will already be familiar with. This includes tag, jump rope, kickball, man hunt,

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relay races, obstacle courses and many more. Any type of came that involve moderate to high

intensity movement will fall into the cardio games category.

Cool down/ meditation

The last 10 minutes of each session will be spent doing a cool down and some

meditation. Meditation is proven to help people deal with stresses of everyday life, by ending

each session with meditation the students will go home calm and centered. This is a great way to

end a full exercise and the students will enjoy this part especially after working hard and playing

energy burning games for an hour.

Marketing Plan

I plan to use my flyer to post around the school and have sent home to the parents of the

school. I also would like to keep it open to any other special needs kids in the area who would

like to attend so I will post it around town and make the program well known. This flyer will

help people know about the program and by giving it out through the school word of mouth will

also spread about my program.

I would like to use this program to help these children enjoy exercise therefore I feel as

though the parents will sign them up for this program without even thinking twice about it. This

program will benefit these children to a great extent and this flyer is a great way to show people

how beneficial the program will be and how to sign them up.

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Budget Table

SAMPLE BUDGET SHEET

Revenue

Donations from participants ______________________________

Gifts ______________________________

Grants ______________________________

Fundraiser _____________________________

Total Income_________________________

Expenditures

Curriculum Materials _______________________________

Marketing _______________________________

Flyers _______________________________

Personnel _______________________________

Planning _______________________________

Facilitators _______________________________

Space _______________________________

Supplies _______________________________

Travel _______________________________

Total Expenses_______________________

Balance ________________________

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Budget Explanation

Personnel for this project will include one exercise specialist and high school and college

volunteers to supervise and rum the program. The exercise specialist will have to be paid 500

dollars for her services and commitment to the program over the course of the year. The

volunteers will gain experience with these types of children in an exercise setting and will not be

paid throughout the course of the program. The facility being used in the gym in the building the

children already attend school and since this program runs during operating hours of the school

the gym will not cost any money to uses.

A booklet will be given out to the parents of the children explaining the exercise the

children will be going though and what they will do and learn through out the program. It will

also contain some exercises the children can do at home on their own time and when the program

is complete. This booklet will contain about 30-40 pages each costing about 10 cents a copy will

lead the booklets to cost around 300 dollars in total to make, copy and distribute to the parent of

the children in the program.

There will be no necessary equipment that the school does not already have accessible

such as balls and other game paraphernalia.

Donations will be taken from participants and a fundraiser will be done to raise some

money for the small cost of this program since it will be free to participants. Total cost of

program is $800.00.

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Timeline

Study Timeline 2016

September October November December January February March April May June

------

make booklets

(September 1-23)

first class

(October 5)

Break period

(December 23-January 4)

strength evaluation

(March 21)

Cardio evaluation

(April 20)

Flexibility Evaluation

(May 27)

Field week

(outdoor and water activities)

(June 6-10)

Program concludes

(June 10)

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Program Evaluation

Process evaluation deals with evaluation of the program during implementation to see if

the program is being implemented as planned and to make modifications if necessary. When

performing a process evaluation for this program, the instructors and the material of the program

will be observed by the head of the program during both the education and exercise portions of

the program to see if they are properly teaching the skills that need to be learned throughout the

program. The program will also be evaluated on how well it is being implemented and if the

students are gaining any benefit throughout the program. Toward the end of the program both the

parents and the students will be surveyed on how well they liked the program. They will be

asked questions to see what they learned and how they plan to implement it into their life or their

child’s lives. Therefore, process variables would include proper class instruction techniques,

organized session times, effectiveness of the program/instructors (for example: effectiveness of

observational learning techniques, reinforcement, and reciprocal determinism). Some examples

of types of survey questions would be as follows: for the parents: how did your child like the

program? Do you feel as though your child benefited from this program? Do you plan to

continue these types of exercises with your child when the program ends? I also plan to ask them

questions on a rating scale such as: how much did you like this program? Would you have your

child take it again? For the children I would ask more lower scale questions and I would do it as

a group. So rather than handing out surveys and tailoring them to each child’s level of

comprehension I will do a group survey and while they are all together I can ask questions and

have them raise there hands to see how they felt about the program.

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Impact Evaluation

Impact evaluation deals with the immediate effects of the program and is done right after

the program ends. Impact evaluation in this program could be done posting surveys for them to

fill out and by doing self-efficacy and behavioral capability exams. The results would be

compared to retest data gathered during the education portion done in the beginning of the

program when the participants and their parents are learning about the program and how it can be

used after they are done with the program. It will teach them how to be nutritious and how to

exercise daily and make it fun so this is a perfect way to later assess how the program has

changed their view of exercise. Self-efficacy and behavioral capability with regard to

implementation of exercise techniques learned during the program would be assessed

immediately after the program concludes. This means that there will be a test at the start and end

to see what the clients have learned. There will also be a parent test at the end to see what they

think their child learned and if they feel it was beneficial.

Both self-efficacy and behavioral capability will be assessed through survey

administration on a 5-point rating scale. For self-efficacy I will ask oral questions to the children

participants about how they believe they have improved throughout this program and how if they

are now more confident in their ability to exercise.

Outcome Evaluation

Outcome evaluation deals with whether the program met its stated long-term goals.

Outcome evaluation could be done with a one-year follow- up measurement of program

implementation among organizations/services that took part in the program. Specific variables

that are important to the outcome of the program are self-efficacy and behavioral capability.

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After waiting a decent amount of time (6 months to a year) I will send out a second round of

questionnaires to see if the participants of the program have used any of the skills they have

learned to continue their own exercise program. After finding out the outcome I will be able to

change the program or keep aspects of it the same depending on what was successful and what

was not.

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References

Centers of Disease Control and Prevention (CDC) (2014). Facts about Down syndrome. Birth

Defects. CDC. Retrieved from

http://www.cdc.gov/ncbddd/birthdefects/DownSyndrome.html

Yamkovenko, S. (2015) The Role of OT with Persons with Down syndrome. Children And

Youth. The American Occupational Therapy Association, Inc. Retrieved from

http://www.aota.org/about-occupational-therapy/professionals/cy/articles/down.aspx

Lord, C. (2006). Autism From 2 to 9 Years of Age. Volume 63, Number 6. JAMA Psychiatry.

Retrieved from

http://archpsyc.jamanetwork.com/article.aspx?articleid=209669

Autism New Jersey. (2015) Understanding Autsim. Retrieved from

http://www.autismnj.org/prevalence-rates

National Institute of Neurological Disorders and Stroke (2014). Autism Fact Sheet. Autism.

NINDS. Retrieved from

http://www.ninds.nih.gov/disorders/autism/detail_autism.htm

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http://www.ninds.nih.gov/disorders/autism/detail_autism.htm

http://www.autismnj.org/prevalence-rates

http://archpsyc.jamanetwork.com/article.aspx?articleid=209669

http://www.aota.org/about-occupational-therapy/professionals/cy/articles/down.aspx

http://www.cdc.gov/ncbddd/birthdefects/DownSyndrome.html

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