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Activity ideas for students with severe/profound/multiple disabilities.

Effectively teaching students who have severe, profound, and multiple disabilities can be quite challenging. Imagination and creativity are essential. Sometimes one educator's idea will spark several new adaptations or new activity ideas. A few people sharing a few good ideas can cascade into a food of great new ideas.

Therefore, the purpose of this article is to suggest some realistic ideas for teaching students with severe disabilities. Hopefully, many of these activities will prove to be useful. Furthermore, it is hoped that with a little imagination, many more new ideas will be born.

The Program

Our program consists of six separate units of instruction for the school year--(a) Cause and Effect, (b) Balls, (c) Group Activities, (d) Music, (e) Movement Activities, and (f) Recreational Activities. Often there is overlap with some activities, as they may fit within more than one unit. If they are exciting activities this is welcomed, as learning is made easier through repetition and fun as effective reinforcers.

Finally, although these ideas are ideal for self-contained classes, most should work well in inclusive settings, as well. Strategies to incorporate these successfully in such settings are presented within the following discussions.

Unit One: Cause and Effect

The following activities are helpful to use when teaching the concept of cause and effect.

* Hanging Noise. Suspend a rope or net between two volleyball standards. Hang pots, pans, tambourines, bells, anything that will make some noise when students pass under/through them with their wheelchairs. Students seem to love this activity. Often, the more noise they can make, the prouder they are. Another variation is to suspend cans, bells, pots, from a pole suspended across a high jump standard (or even across the backs of two chairs) and have students toss bean bags at this hanging wall of noise. Manual assistance ensures everyone participates Get as close as needed. This facilitates range of motion, as well as grasping and releasing skills, however minimal these skills may be. Older children may wish to form mock teams for cooperative fun--teams which make the most noise win. Rotate team members often to ensure that all are winners; let fun and controlled chaos reign!

* Knock It Off. Set balls of different sizes and colors on T-ball stands or traffic cones of different heights. A toilet bowl plunger can be placed upside down in a cone to accommodate larger balls which may roll off a cone or tee. While explaining this activity to students, push them in their wheelchairs by this set-up and ask them to try to knock off the balls. A string or leash may be attached to the balls to minimize fetch time required to set back up and re-load this fun activity. Tactile balls, bell balls, anything which makes noise is helpful for students who are blind and much more fun for all involved.

* Blowing Games. Blowing games with soap bubbles, ping pony balls on a table top or in the water, and pin wheels are usually a hit with students with quadriplegia. Medically, it is important that activities like these be done to maintain and improve respiratory function as much as possible.

* Scooter Boards. Scooter boards come in many different sizes and shapes. Select (buy or build) one large enough to support even recumbent students. Strap them on securely. Most of these students are not too fragile to be spun around by teachers, aides, or classmates. We take this one step further and have the teacher on skates, pulling and skating with the scooters. All of our students, even those who are blind, love it. They can take part in relay races this way. Often, the faster and more furious the spinning, the more they like it. Frequently, we use an inner tube around the student as a sort of combination spotting belt, protective wear, and grabber handle.

Obviously, great care is necessary for more fragile students; those with shunts should not be spinning wildly. But the point is that many students can safely participate in this (organized chaos), want to do so, and love it. It is necessary to understand each child's medical situation and adhere to activity contraindications; however, it is not necessary to be over protective. Too many students are never taken out of their wheelchairs when they can and should be.

* Mats. Students can lie or sit on mats and be dragged around, even for relay races. A gentler variation of the preceding scooter activities is to take a small gym mat, approximately three feet by two feet in diameter, and put two holes in one end and string a rope through to make a handle (like a sled). Gently lay the child upon the mat and pull it around (again, like a sled). This works wonderfully for students who have severe physical disabilities that preclude them from being placed on a hard surface. Students can be placed in doughnut type mats and creep forward causing the mat to revolve around them (like treads on a tank). They creep forward, and the result is an advancement of their tank tread mat.

* Stretch Bands. Therabands or bicycle inner tubes make great sling shots. The ammo can be a soft bean bag, nerf ball, or even students themselves as they sit in their wheelchairs!

* Playground Swings. Often a student's feeding chair can be safely and securely fastened to playground swings to allow the most severely involved student to swing alongside peers.

* Parachute Play. The common group activities with parachutes are possible with most students. If everyone sits around the parachute, even students with the most severe disabilities can interact on the same level. Some of these students enjoy just lying in the middle of the parachute and then being spun around. Others enjoy lying on a mat and having the parachute moved up and down above them.

Unit Two: Balls

The following activities are examples of popular activities with balls.

* Ball Bins. Even the most severely involved students can enjoy the tactile stimulation, safety, and fun of sitting, lounging, or rolling around in a bin of plastic balls. If buying such a bin is out of the question, make one with mat borders lined with a parachute. A plastic wading pool or a new or clean sandbox can be used for starters. Foam balls, nerf balls, even sponges as balls can be used if plastic bin balls are too expensive. Even old tennis balls or homemade newspaper balls can be used if necessary. Children love receiving a shower of soft balls falling upon them and around them as they gather to fill up their dry wading pool of ball water. Creativity abounds.

* Big Ball. Have students gather in a small circle. They can stand or sit, with or without a wheelchair or stander. Take a huge beach ball, cage ball, or therapy ball (whatever is available) and start to roll it around within the circle. Make sure the ball is large enough to obligate it being touched by all students it comes near. Each student's touch can be the throw to the next student. If possible, many students enjoy being able to shed their shoes and push the ball with their bare feet. Sensory stimulation, aiming skills, confidence, group work, and fun are products of this game.

* Hanging Balls. Suspend balls of all sizes, textures, colors, and softness from a basketball goal (or whatever). Students can now play many games. You, or they, can roll their chairs (selves) into them. They can use a whiffle ball bat to strike them (if they cannot hold the bat, the bat can be fastened to their hands, arm, or wheelchair). They can try tether ball with a friend. Activities are only limited by the imagination.

* Ball Trays. Balls and other objects such as bowling pins can be placed on table tops or trays. They can be knocked down by a swinging tethered ball (like table top tether ball), or they can be knocked down by whiffle bat armed students, or by students' bare hands (or other body parts). Ball trays can be made from firm cardboard three feet long by two feet wide; add an edge to the length to cover with contact paper. This will allow two students to face each other with the ball tray between them, resting on their trays or laps. Now students can roll a ball to each other affording independent peer play with little or no help from the teacher.

* Soccer Throw In. In inclusive situations, as during a soccer game on the grass (students in wheelchairs can participate equally in soccer on hard top surfaces), the student with disabilities, perhaps in a wheelchair, can be the person who throws the soccer ball back into the field of play. The student is not the fetcher or the score keeper, but has an integral, physical, strategy-requiring role in the game. Obviously, this also works for basketball (and many other games, as well). When a goal is made, the ball can be thrown in bounds by the student in a wheelchair. Certainly, students in wheelchairs can take more active roles than even this in most hard surface games; wheelchair basketball athletes are among the most elite athletes of any sport.

Unit Three: Group Activities

* Parachute Activities. So versatile and enticing, these activities can fit in multiple categories (cause and effect, balls, and even in the music unit). Group cooperation, sensory stimulation, and just plain fun can all be achieved through participation in parachute games. The parachute can be fastened to the child (or even the wheelchair) if the child cannot grasp it independently.

* Relays. Make these fun! Usually, the more zany, the less stressful and competitive they are. To maximize participation, emphasize fun. More severely involved students can zoom their wheelchairs (with or without help from the teacher) up and back between cone targets, simply having to knock something off the cone to prove they made their designated distance. They can also nudge something off their laptrays into an awaiting bucket or other container (i.e., net, target).

* Mr. Rubberband. This is a wonderful activity involving a large stretchy band (isotonic band, bungee cord) with which groups can encircle themselves, play tug of war (both end-to-end to form a straight line, but also with three equi-distant teams to form a triangle, or four teams to make a square). The group can also encircle itself with it, form a line and march, play choo-choo, and more. The group can also form a circle with the rubber band in the middle with everyone grasping it, and do seated or standing exercises. In all these examples, the band can easily be fastened to a student, wheelchair, or gurney, if it can not be grasped independently by the student. A series of old (but washed) bicycle inner tubes can be substituted for the stretchy band when commercial stretch bands are not affordable.

* Pass the Rubber Ring. Have students enjoy sitting in a very tight circle, shoulder-to-shoulder, while trying to pass an object around, such as a rubber ring, a spongy ball, or some other object. By sitting closely, chance of dropping and losing the object in the process is diminished, thus maximizing playing time and minimizing fetching time.

* Tag An oldie but goodie with infinite variations. Freezing and unfreezing people allow more easily tagged students to get multiple other chances of escaping the tagger. This works very well on gym floors or other hard surfaces when wheelchairs are present.

* Duck, Duck, Goose There are many variations of this; we suggest leaving out the head patting part. We have renamed the game Drop the Handkerchief, which reflects another modification; the handkerchief drops more slowly and softly which keeps the game inviting to more children.

* Crash the Cans. Often an activity as zany as building a can pyramid and then running the student in the wheelchair into it just to see, feel, and hear the cans crash down motivates and thrills even the most reticent students. Obviously this would also fit nicely in the cause and effect category.

Unit Four: Music

* Songs with Themes. Music facilitates learning and alleviates monotony. Have students act out themes as they listen to them. Give physical assistance to those who need it. Students with hearing impairments can often pick up on the beat and can hear some of the lower, more vibrating notes and tones. Play songs about trains and have children line up and choo-choo around a town. Play songs about dinosaurs and have children imitate some dinosaur movements. The list is endless.

* Songs with Holiday Themes. Play songs about the Easter Bunny or other catchy spring tunes and have an Easter Egg hunt; anything can be used as eggs (bright balloons, balls, pogs, etc.). Even severely involved children can run their chairs into a homemade pinata, specially designed to spill out its candy or toys with the slightest nudge. Valentines Day may be a good time to introduce various types of dancing.

* Dancing with Students in Wheelchairs. Dancing is a highly versatile activity. Line dances, square dance, rap dancing, dancing from the 60s and 70s (the jerk, the monkey, the swim, the Freddie, and so many more can all be done fantastically in a wheelchair).

* ROMaerobics. This is a name given to an activity using the multiple discipline of music, physical education, speech, physical or occupational therapy, and even art together, interactively. For example, a physical therapist may help a child work on sitting and balancing postures while the child catches and rolls a ball to music, perhaps toward a target he/she painted, while trying to pronounce the words correctly for the number of times the ball is thrown/caught or whatever. Another example is to select songs about body parts; the therapist, teacher, or aide can manipulate the body part being sung about. Even just touching the body part being sung about helps the student feel more a part of a lesson. The touch can be a gentle rub, pat, shake, or even a brief tickle to get a laugh or show some warmth. This is truly transdisciplinary and integrative. Communication among various professionals is optimized at the child's benefit.

* Workout Videotapes. Sitting workout tapes are becoming easier to find. Richard Simmons has a tape entitled Reach for Fitness which is specifically designed for users of wheelchairs. Mousercise (Walt Disney) can be adapted for children with disabilities. Our school board (Alachua County) has an excellent videotape, Arms Alive, available for the cost of the tape (about five dollars) which is geared toward late elementary-aged students through adults. Very motivating, current songs are used with a multitude of interesting, helpful, and safe exercises. This can be ordered by contacting Ann Goodman, c/o Sidney Lanier Carter, 312 N.W. 16th Ave., Gainesville, FL 32601.

Feel free to adapt movements (e.g., from the videotapes), or even physically assist students as needed. If students cannot do it at first, do it for them! Yes, passive exercising, especially in a group setting with music, is a wonderful, motivating activity. It is surprising how much students learn and take on themselves in time.

Unit Five: Locomotor Movements

* Scooter Boards. If students can propel their own scooter boards, wonderful! Often they may only need some assistance to get going. Some of the more severely involved students may need full assistance (pushing, pulling, and spotting) for the entire ride. It does not matter how much assistance is needed; what matters is the experience of traveling from one point in space to another in the most fun-filled, exciting way possible. Even our more fragile students love to use a larger, softer, adapted scooter, and have the feeling of zooming and spinning around with peers. Obviously, care must be taken as needed (students with shunts due to hydrocephalus do not need to be spun around). Still, many more students than one might think can safely participate in this activity and would be thrilled to do so; just give them the chance'

* Obstacle Course. This is the gold standard which allows for exploration, problem solving, and individualized teaching due to its informal station format. Be creative! Students in electric wheelchairs or gurneys can negotiate interesting and safe courses. For example, just having them move through a series of multi-colored plastic flags hung from a clothesline is safe, stimulating, and fun. Many other similarly interesting and adaptable ideas for the course can be gleaned from some of the other instructional units described here. Slalom courses for students in electric wheelchairs are common events in some sport contests involving athletes with disablities. The obstacle course format allows for virtually any skill or activity to be taught within its framework. With the use of seasonal themes, plus a little creativity, this activity can be everyone's favorite.

* Body Bowling. This is another popular event in which with care even more severely involved students can participate safely. In this activity, the student rolls his/her body into bowling pins, or plastic pins, trying to knock down as many as possible within a specified time frame. Students who cannot roll independently can have help to do so. Feel free to use a mat for comfort. For the most severe disabilities, a student can lie supine and turn his/her head toward the pins. This often facilitates extension of the limbs on this side (due to the asymmetric tonic neck reflex which is often present in children with neurologic deficits), which can then reach the pins to knock over.

* Barrel Rolling. Students love crawling into a barrel (often a hollow round or hexagonal mat). The teacher and/or classmates can carefully, slowly, push (roll) each other around. This is a vigorous and stimulating experience for all.

* Haunted House (play fort, club house or whatever). Children love to crawl, roll, or scooter board under a table with sheets hanging down to hide or briefly gather with their peers to plot their next activity. Simply put, hang some sheets from a table, call the game what you wish, and the children will be attracted to it like a magnet. They may problem solve their own ways of being able to locomote themselves to it--variations are endless.

Unit Six: Recreational Activities

These are specifically geared toward helping children learn activities and games they may encounter at home so they can better participate with others.

* Water Play. Warmer months invite use of sprinklers, hoses, water tables, small plastic pools, water balloons, squeeze/squirt bottles, squirt guns, water slides, and more. Even students with several disabilities can usually find a way to pull a trigger on that squirt gun to soak their favorite teacher or peer. These activities also provide excellent opportunities to teach safety, fair play, and respect for others. Learning where to draw the line with this controlled chaos is important. It may be required that all water balloons be thrown at inanimate objects, not people. Relay races with water balloons can work to keep excitement, but channel away the desire to drench others.

* Instruction in Aquatics. Swimming skills, aquatics safety, and hydrotherapy are invaluable activities for students with even the most severe disabilities. Water is a great equalizer--gravity is no longer the enemy. A student with minimal strength can move freely in water. Good teaching, buoyancy aides, swim masks, pool toys, and the like can all help to ensure that the aquatics experience will be optimal for all. Strength, endurance, flexibility, balance, coordination, self-esteem, social skills, and games skills are all easily attainable goals when using the magic of water.

* Sandbox Play. Young children just love the feel of sand. Older children can create sand structures and roadways all day long, if allowed. Often the chore of child cleanup is well worth the enjoyment experienced. Elevated sand tables for students in wheelchairs make this medium more accessible and less difficult to clean-up afterward.

* Chalk. A colorful bucket of sidewalk chalk can delight children for hours. They love to make hopscotch designs, pictures of people, and often beautiful rainbow scenery. They can paint up the town, yet the next rainfall will clean it all away and offer a new slate for more creativity.

* Painting. Students love to paint. Whether it is with fingers, sponges, potatoes, or real paint brushes, they love to paint. Water colors and smocks help clean-up time tremendously. Painting with shaving cream is exciting and even easier to clean up.

* Croquet, Horseshoes, Shuffleboard. These classic games are fun, and all can be played from a sitting position. Thus, little or no modifications are needed with these activities, which should help motivate students to try these activities at home as well.

* Bowling This activity can be taught at school, but the end of the semester field trip to a bowling center can serve as a great motivator. Balls can be lighter weight and can be purchased with retractable handles. Bowling ramps can be purchased or easily made. Bowling guide rails can be used for students with visual impairments. With a few modifications, virtually everyone can enjoy this sport.

Final Thoughts

Remember, keep the activities and the equipment age appropriate. Adaptations can be major, minor, or absent entirely based on need; but when they are used, think about what is appropriate for students' ages. Even secondary students with elementary level intellectual functioning deserve the dignity of age-appropriate adaptations.

Do not underestimate the effectiveness of letting students decide on games to play and/or modifications to make. Within the bounds of safety and reason...let them explore; allow them to benefit from their experiences--this is learning.

Finally, keep activities geared for fun and success. Yes, fun is not a bad thing; it is a wonderful motivator for all. Fun is an important goal to achieve every day. Students have a lot more fun if they are successful with their efforts. Successful programs are motivating because they are fun. Also, when teachers appear to be having a great time, students usually have the best of times. Keep it safe, keep it interesting, and keep it fun!

Selected Reference

Stopka, C.B., & Sullivan, P. (1992). Mainstreaming disabled children into physical education: Adapted equipment ideas to make it happen. Dubuque: Kendall-Hunt.

Christine Stopka is an associate professor in the Department of Exercise & Sport Sciences at the University of Florida where she directs the Exercise Therapy Program, as well as the graduate program in Special Physical Education. She is a NATA certified trainer, a licensed athletic trainer in the State of Florida, and an NSCA certified strength and conditioning specialist. Ann Goodman is an adapted physical education teacher with the Sidney Lanier Center which serves state-referred students with mental and multiple disabilities in Gainesvlle, Florida. Claudia Siders is a special education teacher in the nine-county referral unit for physically impaired students at the Howard Bishop Middle School in Gainesvlle, Florida.
COPYRIGHT 1997 Challenge Publications Limited
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Copyright 1997 Gale, Cengage Learning. All rights reserved.

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Author:Stopka, Christine; Goodman, Ann; Siders, Claudia
Article Type:Cover Story
Date:Sep 22, 1997
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