Transcript A Preliminary Investigation of the Effects of Aquatics for

A PRELIMINARY INVESTIGATION OF
THE EFFECTS OF AQUATICS FOR
PEOPLE WITH SEVERE & PROFOUND
INTELLECTUAL DISABILITIES
...some people absolutely amaze
me...what they can do in water...that
they can’t do outside of water...
INTRODUCTION
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Stage 1: Need identified for research of activity
profiles and benefits of activity.
Aquatics.
Stage 2: University Ethics, Guarda Clearance,
Host Organisation’s Ethics.
Stage 3: Manual Handling Training completed
and activity survey delivered to houses.
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Stage 4: Agreement forms sent to next of kin,
Training for Working with Vulnerable Adults
completed and pre-programme questionnaires
completed.
Stage 5: Aquatics programme completed with 4
service users over 8 weeks, post-programme
questionnaires completed and interviews carried
out with frontline staff.
Stage 6: Analyses carried out and research
written up.
LITERATURE FINDINGS:
There is limited research on the profiles and
successful interventions for populations with
SPID (Lin et al., 2010).
 The research available has shown that people
with SPID lead a mostly sedentary lifestyle
which can lead to significant mental and physical
health deficiencies (Cooper et al., 2007; Lancioni
et al., 2004).
 Activity has been shown to have positive effects
on such deficiencies (Lancioni et al., 2005).
 Aquatics is a suitable and feasible activity for
people with SPID to take part in (Grosse, 2010).
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RESEARCH QUESTIONS:
What are the average levels of activity for people
with severe and profound ID in an Irish service?
 What areas of activity are they lacking in?
 What is required to develop an aquatics prog.?
 What are the facilitators and barriers to getting
people with severe and profound ID involved in
aquatics?
 What effects does aquatics have on mental wellbeing of service users?
 What are the experiences of frontline staff
members of implementing aquatics prog.?
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PERCENTAGE TIME IN DIFF. ACTIVITIES
21,050 Mins, 30%
24,630 Mins, 35%
Physical Activity
Sensory Activity
Social Activity
Bus Drives
8,697 Mins, 13%
15,165 Mins, 22%
MEAN VS RECOMMENDED TIME
3.5
120
3
3
100
90
2.66
90.73
2.5
No. Sessions
Time (minutes)
80
60
2
1.5
40
1
20
0.5
0
0
Recommended Mean PA
(Lin et al., 2010)
Actual Mean PA
Recommended Mean PA Actual Mean PA Sessions
Sessions
(Lin et
al., 2010)
THOSE ABOVE & BELOW RECOMMENDED
22, 38%
Below Recommended
Physical Activity
Above Recommended
Physical Activity
36, 62%
28, 48%
30, 52%
Below Recommended
Sessions
Equal to or Above
Recommended Sessions
ELIMINATION PROCESS
58 Service Users
12 Service Users After
Eliminations
7 Participants After Agreement
AQUATICS PROGRAMME
8 Weeks Long
 Offered 12 sessions to each participant to be
timetabled into the daily pool sessions already in
place (from 11.15 – 11.45, 14.45 – 15.15, 15.15 –
15.45)
 Researcher assisted with bringing participants to
the pool and with dressing and undressing.
 Most sessions required a member of the care
staff’s assistance and sometimes two members of
staff were needed.
 Researcher spent 30-40 minutes in pool with
participants.
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AQUATICS PROG. CONTINUED
All sessions fully supervised by pool staff.
 Participants encouraged and assisted to move in
the water, to move their limbs, to walk where
able and to complete as much a range of
movement that they were comfortable with.
 Two participants were given time in the Jacuzzi
for the last 5 minutes of sessions.
 2 participants used life jackets, 1 used arm bands
and floats, 1 did not use any floatation gear.
 Researcher was conscious of maintaining a
positive disposition throughout, interacting and
smiling with participants as much as possible
and encouraging participants to move and be
active for the entirety of the session.
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PARTICIPANTS
Name
Sessions
Completed
Reasons for
Missing Sessions
P1
12
Diarrhoea (1)
P2
12
N/A
P3
11
Drowsy State (1)
P4
8
Illness (2), Started
late (2)
P5
0
Refused (3)...(12)
P6
0
Refused and illness
(1)...(12)
P7
0
Physically Aggressive
(1)...(12)
MEAN ACTIVITY TIME/WEEK FOR PPS.
160
140
120
Time (minutes)
100
80
60
40
20
0
P1
P2
P3
P4
P5
P6
P7
MOOD, INTEREST & PLEASURE
QUALITY OF LIFE
16
14
Mean QOL-PMD Scores
12
10
Before Intervention
8
After Intervention
6
4
2
0
Activities
Phys. WB
Soc. WB
Comm. & Inf
Mat. WB
Dev.
ENJOYMENT
ALERTNESS
4.5
4
3.5
Mean Alertness Scores
3
2.5
2
1.5
1
0.5
0
P1
P2
P3
P4
REFLECTIVE PIECE: P1
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Began hesitantly but easier to encourage as time
went on.
For example, carried in fully for 1st session but
actively engaged in getting in independently by
final session.
Fearful in the beginning but by the end was
kicking about, interacting and walking by
himself with aid of side railing.
Enjoyed the Jacuzzi very much.
REFLECTIVE PIECE: P2
Began programme with untrusting demeanour.
 Held side rails at all time and avoided eye
contact.
 By the end of the programme, independently
walked from one side of the pool to the other,
prompted researcher to jump with him and
smiled regularly with eye contact.
 Also enjoyed Jacuzzi.
 Did not like accessories (balls, floats etc.) nor did
he like lying on his back independently.
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REFLECTIVE PIECE: P3
Enjoyed sessions from the beginning.
 He was held from behind for first sessions to help
him kick etc.
 By the end of the programme was spending much
of the session on feet, walking with aid of
researcher.
 Increase in smiles and verbalisations over time.
 Enjoyed throwing ball, kicking legs and making
eye contact.
• Least interactive for sessions after seizure
activity but still completed sessions, particularly
did not like getting water in his eyes.
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REFLECTIVE PIECE: P4
Seemed to enjoy sessions from first day in
programme.
 Actively interacted and verbalised.
 Kicked legs for the majority of session.
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Missed some sessions due to lack of sleep or
illness.
Maintained positive demeanour for full
programme and it seemed to be one of the only
forms of exercise he could participate in given
considerable physical disabilities.
STAFF INTERVIEWS
6
staff members interviewed
 4 key workers/service managers
 1 member of management team
 1 member of gym team
 Thematic
Analysis of interviews
THEME 1
Effects
Mental state and
physical state
Water has a distinct
effect
Knock-on effect of
programme
Possible effects for
‘others’
EFFECTS ON MENTAL & PHYSICAL
 “In
the beginning he was
exhausted...but P3 goes through periods
of being really tired anyway
and...unmotivated...It seemed to have
helped him, absolutely helped him
enormously because I’ve noticed in the
last two weeks in particular...He’s
really become alert and just generally
more motivated, generally more alert.”
WATER EFFECTS
 “He’s
supposed to have a walk everyday
around the bungalow...There are days
when you can’t do that, even with two
people because he just is falling...he’s
dropping his legs. He’s just not able to
stand, he won’t weight-bear, he can’t
weight bear...So at least in the pool it
was automatic wasn’t it really?”
THEME 2
Facilitators
Support and resources
Organisation’s position
on activity
Staff attitude
Individual
characteristics
Enjoyment levels
RESOURCES
“We have very good access here, we have hoists, we
have...everything really needed to get into the
pool, we have hoists in the dressing rooms and so
on so really from an access point of view I think
we’re really set up well.”
 “They employ...their own personal support for
some hours during the week and...we use that
then to kind of up...their...level of interactions so
we’re pursuing that more and more now because
we feel that may help us in some way to increase
their levels of activity.”
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HOST ORGANISATION’S POSITION ON
ACTIVITY
 “We’ll
try and organise other activities
kind of that’ll benefit him.”
 “...We try to get them to the pool as often
as we can...”
 “Every opportunity that...that comes
along we try to avail of it.”
STAFF ATTITUDE
 “We
would attempt to push....to facilitate
what they want and that can prove to be
difficult but we would try to find ways
around that.”
 “It
can be tried maybe again...you can’t
ever rule anything out completely because
sometimes they can change and get to like
something.”
THEME 3
Barriers
Time constraints
Support and resources
Health
Challenging population
Individual
Characteristics
TIME CONSTRAINTS
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“Here in the morning we’d have the lads all up,
it’s probably 11 o’clock before they’re finished
breakfast and then our break starts at 12. So you
have that hour from 11 to 12 and we’ve 9 clients
and...ideally it’d be lovely to get em all out for a
walk or to get them out for a bus drive but being
realistic there’s so much office duty and things
like that, it doesn’t happen.”
SUPPORT AND RESOURCES
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“I suppose our biggest barrier really...is staffing
and not having people...to take them to places.”
HEALTH
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“Well I suppose there are medical issues...that
some people you know...are not able to come...for
different reasons, some people have very bad ear
infections and ear problems and some have severe
epilepsy.”
CHALLENGING POPULATION
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“It’s very poor actually (level of activity)...with
severe and profound disabilities very
poor...because there is so much care involved...”
INDIVIDUAL CHARACTERISTICS
“I don’t think we give them enough credit...I think
sometimes...doing...an assessment on someone can
label them...”
 As the saying goes, “those who shout loudest get
the most” you know?
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THEME 4
Programme
Strengths
Frequency
One-to-one
Relationships
Consistency
Positive Feedback
FREQUENCY
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“Holding the bar and walking around – they
wouldn’t have done that before because their
sessions were limited and...they didn’t always
make their weekly session so two weeks, you’d
have forgotten, you know yourself... so I think
your consistency definitely helped yeah, I like
that.”
ONE-TO-ONE
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I think just...going on a one-to-one so often...every
day he seems to have something to look forward
to... He had something else as well you know he
knew that it was something for him.”
RELATIONSHIPS
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“Well I think they built up a rapport with you...I
think you were very kind, I think...you were
gentle, I liked the way you spoke to them, you were
very respectful to them...you knew what you were
about.”
“...you connected well with the lads.”
THEME 5
Service User
Needs
Poor quality of life
Social and family
contact
Extra-curricular activity
Complicated process of
understanding
Continuation needed
POOR QUALITY OF LIFE
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“Yes, their lives are mundane enough so no, I
don’t think they get enough (activity).”
“The severe profound range of disability is...one
area where people tend to just...you know if they’re
well and they’re fine and...they’ve good health and
looked after...some people seem to think that’s
enough.”
EXTRA-CURRICULAR ACTIVITY
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“So it was great that he actually...went off...went
out with you in the...wheelchair and...without
even going...into the pool at all like d’you know
just going from A to B...”
“So it was great that he was able to go out and
twas something he actually enjoyed.”
“Anything, in my opinion, that gets people out and
that they enjoy, is good – out of their houses.”
COMPLICATED PROCESS OF
UNDERSTANDING
 “You
have to teach the guys how to
play...It’s a shame that you have to teach it
but you do have to teach it, have a bit of
fun.”
 “...We
try to advocate on their behalf
because they find it really hard to advocate
on their own behalf...”
CONTINUATION NEEDED
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“The one fear...is that...how can we keep this
going...some of your swimmers loved those
sessions and definitely got something from them
and...if we go back to what it was before...these
guys are going to get possibly their just one weekly
session...so if there could be one way that we could
keep this going...that would be good...”
“So you would hope that this would
continue...because...unless something is like
continuous... it’d be great if something...similar
could...happen again sometime in the future...”
DISCUSSION
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Mean activity levels high compared to global
figures but majority of service users with severe
and profound ID not participating in the
recommended amount of physical activity.
Further promotion needed.
Aquatics is a good form of physical activity to
participate in for those who can.
The social aspect of the aquatics may have been
the most important part.
BUS DRIVES
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Bus drives take up the majority of activity time
for service users with severe and profound ID
Is this a good thing?
Some staff noted the value of bus drives as a time
and money cost effective method for getting
service users out of the house and active and that
they enjoy them.
Other staff, however, noted that bus drives do not
necessarily involve any form of interaction or
physical activity. May need to be evaluated in
terms of their worth.
WHAT’S REQUIRED FOR AQUATICS IN A
SERVICE FOR PEOPLE WITH SPID?
Manual Handling Training.
 Training for Working with Vulnerable Adults.
 Efficient Timetabling.
 Staff support.
 Getting into the pool with service user.
 Regular sessions.
 One-to-one support.
 Continuity and consistency.
 Building of strong relationships.
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FACILITATORS?
 Staff
attitude.
 Organisation’s position on activity.
 Individuals’ characteristics.
 Individuals’ enjoyment levels.
 Good facilities.
 Proximity.
 Regular pool session timetable.
BARRIERS?
Low staff numbers.
 Poor physical health and old age.
 Time constraints.
 Amount of care needed.
 Challenging population.
 Behavioural problems.
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Overcoming Barriers?
 Volunteer Programme.
 Not many volunteers are prepared to go through
the process of what it takes to be a volunteer
with a vulnerable population.
 Can this process be made easier?
ROTATIVE PROGRAMMES?
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Aquatics/Physical Activity Programmes need
regularity and individual support to be effective and
enjoyable.
Resources would be extremely stretched to offering
one-to-one support for physical activity several times
a week.
Possible to bring 2 service users to the pool at a time
and rotate between jacuzzi and pool?
Possible to have 4 week cycles between the individual
pool sessions and group gym sessions?
Rotative system so that regular activity in some
shape or form is had by all service users with severe
and profound ID may be feasible if structured well.
FUTURE RESEARCH POINTERS
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Took a significantly long time for researcher to
eventually get into the pool.
5 service users’ next of kin did not agree for their
participation.
3 participants could not participate because of
behavioural difficulties – is it possible to reach
the people who need it the most?
PERSONAL EXPERIENCE
 Greatly
positive experience.
 Strong relationships built.
 Strong attachments between researcher
and participants.
 Staff generally always available, helpful
and positive about the programme even
when their house was not involved.