Cornelia de Lange Syndrome / Maple Syrup Urine Disease / Rubinstean-Taybi Syndrome: teaching considerations Part two.

Individuals with Cornelia de Lange Syndrome (CdLS), Maple Syrup Urine Disease (MSUD), or Rubinstein-Taybi Syndrome (RTS) have many different medical considerations; therefore, an individualized physical education plan taught by an adapted physical education specialist is usually necessary. The adapted physical educator, and various other members of the motor development team (i.e., physical therapist, occupational therapist, recreational therapist), should begin working with these individuals as soon as possible. Early intervention programs established in the 1980s appeared to help (Purvis and Whelan, 1992).

Initially the adapted physical education specialist must collect thorough background information about medical and behavioral considerations regarding the individual from sources such as classroom teachers, aides, psychologists, parents, siblings, medical personnel, and others who know and have worked with the individual. Sharing pertinent information among professionals and parents needs to be done regularly to monitor behavior management. The adapted physical educator must become well acquainted with the individual for mutual trust and understanding to develop. This allows the adapted physical educator to know the individual and provide proper motivation necessary for the individual's participation in the program.

Individuals with CdLS, MSUD, and RTS have mental and motor delays that can affect participation and interest in participating in physical education (Cates, Bilimire, Bull, & Grosfeld, 1989; Filippi, 1989; Hawley, Jackson, & Kurnit, 1985; Kline, Stanley, Belevich, Brodsky, Barr, & Jackson, 1993; Kline Barr, & Jackson, 1993; Meinecke & Hayek, 1990; Mosher, Schuite, Kapian, Buehler, & Sanger, 1985; Opitz, 1985; Rubinstein, 1990). Because of apparent disinterest in physical activities to control weight and fully develop the cardio respiratory system, it is important these individuals have positive experiences in physical activities with friends, family members, and in various school programs.

The teacher should assess abilities of each individual on a regular basis and utilize teaching techniques encouraging the individual to improve weaknesses. At the same time, the individual needs to use learned strengths, with the teacher making appropriate modifications and manually assisting when needed. Accurate records of participation, skill acquisition, and behavior management techniques utilized for each individual are important for monitoring individual progress and programs.

Dealing With Mental Retardation 

Individuals with CdLS, MSUD, and RTS usually possess mental retardation, although degrees of retardation vary (CdLS Foundation, 1993; Naughten, Jenkins, Francis, & Leonard; Naylor, 1985; Potashnick, Carmi, Sofer, Bashan, & Abeliovich, 1987; Snyderman, 1988; Rubinstein, 1990; Subramanyam, Quadri, Dhalla, & Ozand, 1990: Uziel, Savoiardo, & Nardoccii, 1988). The adapted physical education specialist must be aware of the degree of retardation of each individual, since this affects instructional techniques. Some suggestions for teaching students with mental retardation, as presented by Seaman and De Pauw (1989) were found to be pertinent in trial and error experiences of the author with a student possessing RTS, including--

* Simplify and sequence instruction using short simple sentences.

* Praise attempts and reinforce performance with social praise (do not use food).

* Include structure and routine while stressing safety.

* Use tactile and kinesthetic cues and physical shaping if necessary.

* Provide opportunities for increased emotional adaptability by systematically and slowly changing structure.

* Use demonstrations by teachers, aides, and other individuals.

Due to limitations in attention span for some individuals with CdLS, MSUD, and RTS, when teaching new tasks consider using task variation with new tasks interspersed with maintenance tasks. This approach was highly successful for the boy with whom I worked in teaching the gross motor skills needed to walk, run, throw, kick, jump, and slide (Weber, 1995; Weber, 1996; Weber, 1997a-i; Weber & Hanna, 1998; Weber & Hisey, 1997; Weber, 1989; Weber, 2001; Weber, Hisey, & Harris, 2003).

Examples of how to utilize the task variation teaching method with special populations in physical education were presented by Weber (1989). In this method of teaching, the teacher intersperses new tasks with those previously learned, changing the activity every 3-5 minutes, or whatever the attention span of the individual might permit. The teacher moves from one activity to the next until four or more activities or skills have been covered, then beginning the skill rotation again.

Reduced student-teacher ratios, such as one-to-one or one-to two or three, are required due to combinations of physical, mental, and behavioral problems, so as to meet individual and unique needs.

The I CAN program (Wessel, 1976), developed for individuals with mild and moderate mental retardation, has been successfully utilized with individuals with CdLS, MSUD, and RTS to improve gross motor skills (Weber, 1995; Weber, 1996; Weber, 1997a-i; Weber & Hanna, 1998; Weber & Hisey, 1997; Weber, 1989; Weber, 2001; Weber, Hisey, & Harris, 2003). Materials from this program can easily be copied and sent home as homework for parents or siblings to work with the individual. Specific focal points are given for a parent to observe, with suggestions given as to how to communicate and teach each skill step by step.

Dealing With Motor Delays

Individuals with CdLS were reported by several writers to have psychomotor retardation or motor delays (Cameron & Kelly, 1988; Halal & Silver, 1992; Hawley et al., 1985; Meinecke & Hayek, 1990; Mosher et al., 1985). However, Purvis and Whelan (1992) reported early intervention programs decreased prevalence of motor delays in individuals with CdLS.

Children with MSUD at birth appear to be normal. The single most important factor is early detection through screening, so protein levels do not begin to escalate. Screening for MSUD is not standard procedure in most locations, so children with MSUD may continue to have various neurological problems affecting tendon reflexes and muscle tone--these problems usually cause motor delays. In reviewing the literature, consistent abnormality in muscle tone was not apparent. Several authors reported hypertonicity up to day 4-7, and then hypotonicity (Brismar, Aqeel, Brismar, Coates, Gascon, & Ozand, 1990; Feng, Chow, & Chan, 1986; Nord, van Doorninck, & Greene, 1991). Since early intervention is important for both hypertonic and hypotonic children to prevent motor delays, a program encouraging physical activity and motor patterning of various muscle groups is extremely important. Since RTS individuals were considered hypotonic at early ages (Rubinstein, 1990; Mazzone, Milan, Pratico, & Reitano, 1989) and had early signs of motor delay (Moran, Calthorpe, McGoldrick, Fogarty, & Dowling, 1993; Robinson, Stewart, & Hersh, 1993; Marcus-Harel, Silverstone, Seelenfreund, Schurr, & Berson, 1991; Hennekam, Van Den Boogaard, Sibbles, & Van Spijker, 1990; Rubinstein, 1990; Ramakrishnan, Sharma, Ramakrishnan, Parihar, Sharma, & Kanther, 1990), a program encouraging physical activity and motor patterning of various muscle groups was essential.

Problems of hypotonisity and motor delay appeared to have a number of possible causes in individuals with RTS. Partington (1990) reported major neurological problems that could be the answer. However, Rubinstein (1990) cited lax ligaments, hyperextensible joints in 70% of cases reported, and hyperactive deep tendon reflexes in 53% of cases. Moran, Calthorpe, McGoldrick, Fogarty, and Dowling (1993) reported joint laxity, and strongly suggested all individuals with RTS be evaluated for congenital dislocations of the patella.

Examples of early intervention techniques successful with both individuals with CdLS and MSUD included sensory stimulation, positioning and placement strategies, rhythmic stereotypes, utilizing objects to motivate actions, and good therapy hands (manual assistance) recommended for hypotonic children by Cratty (1989). Many of these same intervention techniques, with the addition of straddle activities and pool therapy, were also recommended for hypertonic children (Cratty, 1989).

Activities in the swimming pool are excellent for muscular strengthening when brisk deep tendon reflexes are involved. However, the adapted physical educator needs to have excellent control of pool and room temperatures to control bacterial levels in and around the pool. This is important because colds and other childhood diseases can cause metabolic imbalances in individuals with MSUD (Subramanyam, Qadri, Dhalla, & Ozand, 1990). Weber & Weber (1995) developed a pool exercise program entitled Aquacise: Fish Do It which has been successfully utilized for individuals with various disabilities involving tight tendons and brisk tendon reflexes.

Young school age children with CdLS, MSUD, and RTS often demonstrate motor delays and lack coordination, as a result of possible reduced stimuli and over protection by parents. Both of these groups need a good physical education program emphasizing basic gross motor skills and eye hand/eye foot coordination. Results of studies by Weber,1995; Weber, 1996; Weber, 1997a-i; Weber & Hanna, 1998; Weber & Hisey, 1997; Weber,1989; Weber, 2001; Weber, Hisey, & Harris, 2003) involving gross motor skills of run, walk, throw, jump, kick, and slide suggested individuals with CdLS, MSUD, and RTS could benefit from early intervention and gross motor programs. Previously developed physical education programs, currently on the market, can be utilized for youngsters with CdLS, MSUD, and RTS, including 1 CAN (Wessel & Kelly, 1985), Data-Based Gymnasium System (Dunn, Morehouse, & Fredericks, 1986), Ohio State Motor Development Program (Loovis & Ersing, 1979), AlMS Program (Strauss & De Oreo, 1979), and Body, Skills (Werder & Bruininks, 1988).

Dealing with Hearing and Communications Difficulties for Cornelia de Lang Syndrome

Several authors identified the commonality of hearing and speech difficulties in individuals with CdLS (Cameron & Kelly, 1988; Halal & Silver, 1992; Sataloff et al., 1990; Goodban, 1992; Goodban, 1993; Kline et al., 1993). These individuals tended to vocalize with low-pitched cries and, if capable of speech, generally spoke in monotones (Fraser & Campbell, 1978: Johnson, Ekman, & Friesen, 1976); so, in large gymnasia with others actively playing, it may be difficult to hear an individual trying to communicate. Since the adapted physical education specialist and/ or physical therapist should be part of the early intervention team required by PL 99457, it is important for team members to be aware of the hearing status of the individual. Goodban (1993) reported almost all individuals with CdLS were diagnosed with mild to moderate, and sometimes severe, hearing losses. She suggested speech therapy start as young as 8 months of age. Initial procedures included continued stimulation and reinforcement for any imitations, both nonverbal and verbal.

Goodban (1993) recommended use of noise-making objects, and the teacher provide maximum visual and auditory stimulation, while encouraging attending behavior. Adapted physical educators could provide visual and auditory stimulation through use of beeper balls, objects that make noise or by using bright colors, shapes, numbers, and other such valuable material. For some individuals with CdLS, non-vocal or non-verbal strategies need to be considered.

Since it may not be possible to know the extent of hearing an individual may have until 6 or 7 years of age, the physical educator and others working with the individual should utilize a total communications approach, combining verbal words with sign language or pictures. In these cases the adapted physical educator may want to communicate using pictures similar to using a communications board or American Sign Language (ASL). Kalakian and Eichstaedt (1982) included several pages of commonly used words signed in physical education. When working with very young individuals, it is also very important bilingual families and teachers only utilize one language, preferably the one used at school to promote learning of language (Goodban, 1993). With technical advancements occurring, a lap top computer and various computer games may be a means of the future to communicate and teach game concepts to individuals with CdLS.

Certain activities may be contraindicated because middle ear difficulties seem to be common in individuals with CdLS (Sataloff et al., 1990), so the adapted physical educator needs to watch for possible balance problems. Dunn and Fait (1989) recommended activities of: standing on one foot, standing on the balance beam, walking the line, balancing objects on the head, and walking on a resilient surface, to improve balance for elementary school-aged children.

Dealing with Visual Problems for Cornelia de Lang Syndrome

Levin, Seidman, Nelson, and Jackson (1990) stated 46 oculofacial abnormalities had been reported in children with CdLS. Levi n, a member of the CdLS Foundation's Scientific Advisory Committee, recommended, "All children with CdLS be evaluated by a pediatric eye doctor at a young age" (CdLS Foundation, 1993). Most common eye difficulties associated with CdLS are nearsightedness, recurrent redeye, discharge, or tearing, and droopy eyelids (ptosis) (CdLS Foundation, 1993). Levin et al. (1990) additionally reported 36% of individuals with CdLS had nystagmus, 86% ocular alignment difficulties, and 86% some type of refraction and visual activity difficulties. Each of these conditions could adversely affect throwing, catching, and any other eye-hand or eye-foot coordination skills, and use of glasses, contact lens, and/or eye exercises to correct these difficulties is essential. Combination of small hand size, motor delays, and visual difficulties has had major impacts in developing catching skills utilized in so many sports and games. These difficulties combined with the natural reaction of many youngsters to close their eyes as a ball approaches the face region, adversely impact catching. To address difficulties in catching, utilization of a very structured teaching progression is necessary. Starting these individuals catching a rolled and then bounced ball before a fly ball is recommended.

Before progressing to a thrown fly ball a teacher would be wise to utilize a suspended ball that can be swung to the individual below shoulder height, and/or balloons slowing this action. In beginning attempts to catch a fly ball it is imperative the teacher always keeps the ball under shoulder height and begins conditioning the individual to force the eyes to be big and wide when attempting to catch a ball. A fun verbal prompt to utilize when conditioning a child to keep the eyes open wide is to say "bug eyes;" the teacher might even take an old set of sun glasses and tape a set of big eyes on them as a reminder. It is important with all individuals, including those with CdLS, to be conditioned to open the eyes as wide as possible. If a ball is lobed for the individual to catch, natural reaction is for the individual to track the ball to head height, then as it passes the eyes on its way to the outstretched hands, the eyes reflexively close, and the ball hits the hands before being dropped. Since individuals with CdLS usually display motor delays, this may not be accomplished as rapidly as hoped.

Dealing with Visual Problems for Rubinstein-Taybi Syndrome

Many different visual impairments have been associated with RTS, including strabismus, refractive errors, drooping eyelid, and nasal duct obstruction (Volcker & Haase, 1975). Forty-five percent of all of these individuals must wear glasses for correcting refraction errors (Hennekam, Van Den Boogaard, Sibble, & Van Spijker, 1990).

Lesions or defects of the eye, cataracts, intrauterine inflammation of cornea/corneal white or opaque/congenital corneal scar, and glaucoma are other visual problems reported (Ziring, Weiss, & Cooper, 1974). High percentage of refraction errors could adversely affect throwing, catching, and other eye-hand or eye-foot coordination skills, if not corrected with glasses. Since 74% of individuals with RTS have IQs below 50, getting a proper correction through glasses is quite difficult.

Dealing with Physical Fitness Factors for Rubinstein-Taybi Syndrome

When dealing with physical fitness factors in individuals with RTS, obesity (Partington, 1990), respiratory problems, congenital heart detects, problem with glucose metabolism, and seizures must all be considered. With the many components involved, it is imperative the adapted physical educator work closely with the physician of the individual. If the individual has a history of seizures, the teacher must know how to respond in case of a seizure and must understand side effects of any medications being utilized. In case an individual has hypoglycemia or diabetes, the adapted physical educator needs to communicate with parents and the physician to regulate the student's medications or diet, since diet, exercise, and insulin levels must be monitored.

Because both respiratory and heart abnormalities are factors, it is highly recommended a complete physical exam, including stress test, be performed by a physician. Program considerations and intensities of activities need to follow closely the program recommendations by the physician. A graded exercise program, similar to that used by heart patients may need to be followed. At the very least, an age-adjusted target range for heart rate should be monitored and exercise discontinued if respiratory problems develop. Because of other possible medical problems and obesity, maintaining a healthy weight for stature is important.

Based upon personal experience of this author with an individual having RTS, strict observation of caloric-intake, in conjunction with 30 to 60 minutes of daily physical activity are recommended. Aerobic activities, such as swimming, jogging, biking, rowing, canoeing, and cross-country skiing are excellent in moderation, once the skill is learned.

Selected References

Brismar, J., Aqeel, A., Brismar, G., Coates, R., Gascon, G., & Ozand, P. (1990). American Journal of Neuroradiology, 11, 1219-1228.

Cameron. T.J., & Kelly, D.R (1988). Normal language skills and normal intelligence in a child with de Lange Syndrome. Journal of Speech and Hearing Disorders, 53, 219-222.

Cates, M., Billmire. D.F., Bull, MJ., & Grosfeld, J.L. (1989). Gastroesophageal CdLS Foundation (1993). Facing the challenges: A family's guide to Cornelia de Lange Syndrome. Collinsville, CT: CdLS Foundation, Inc.

Cornelia de Lange Syndrome Foundation. (1994). Album. (Available from Cornelia de Lange Syndrome Foundation, Inc., 60 Dyer Avenue, Collinsville, CT 06022-1273).

Cratty, B .J. (1989). Adapted physical education in the mainstream (2nd edition). Denver, CO: Love Publishing Company.

Dunn, J .. & Fait, H. (1989). Special Physical education: Adapted, individualized, developmental (6th edition). Dubuque, IA: Wm. C. Brown Publishers.

Dunn, J.M., Morehouse, J .W., & Fredericks, H. (1986). Physical education for the severely handicapped: A systematic approach to a data-based gymnasium. Austin, TX: Pro-Ed Publishers.

Feng, K., Chow, K., & Chan, Y. (1985). Maple Syrup Urine Disease in Chinese. Chinese Medical Journal, 99(2), 119 120.

Filippe, G. (1989). The de Lange Syndrome. Report of 15 cases. Clinical Genetics, 35,343-363.

Fraser, W.I., & Campbell, B.M. (1978). A study of six cases of de Lange Amsterdam dwarf syndrome, with special attention to voice, speech and language characteristics. Developmental Medicine and Child Neurology, 200-270.

Goodban, M. (1992). Developing speech and language skills in children and adolescents with Cornelia de Lange Syndrome. Workshop conducted at the Cornelia de Lange Foundation, Boston, MA.

Goodban, M. T. (1993). Survey of speech and language skills with prognostic indicators in 116 patients with Cornelia de Lange Syndrome. American Journal of Medical Genetics, 47, 1059-1063.

Halal, F., & Silver, K. (1992). Syndrome of microcephaly, Brachmann-de Lange like facial changes severe metatarsus adductus, and developmental delay: Mil Brachmann de Lange Syndrome. American Journal of Medical Genetics, 42, 381-386.

Hawley, S.P., Jackson, L.G., & Kurnit, D.M. (1985). Sixty-four patients with Brachmann-de Lange syndrome: A survey. American Journal of Medical Genetics, 20, 453-459.

Hennekam, R., Van Den Boogaard, M. J., Sibbles, B. J., & Van Spijker, H. G. (1990). Rubinstein-Taybi syndrome in the Netherlands. American Journal of Medical Genetics Supplement, 6, 17-29.

Hennekam, R., Stevens, C.A., & Van De Kamp, J.J.P. (1990). Etiology. Genetics Supplement. 6, 55-64.

Johnson, J.G., Ekman, P., & Friesen, W. (1976). A behavioral phenotype in the de Lange syndrome. Pediatric Research, 10, 843-850.

Kalakian, L.H., & Eichstaedt, C.B. (1982). Developmental/adapted physieal education: Making ability count. Minneapolis, MN: Burgess Publishing Company.

Kline, A.D., Barr, M., & Jackson, L. G. (1993). Growth manifestations in the de Lange Syndrome. American Journal of Medical Genetics Supplement, 47(7), 1042-1049.

Kline, A.D., Stanley, C., Belevich, J., Brodsky, K., Barr, M., & Jackson, L.G. (1993). Developmental data on individuals with the de Lange Syndrome. American Journal Medical Genetics, 47(7), 1053 1058.

Levine, A.V., Seidman, D.J., Nelson, L.B., & Jackson, L.G. (1990). Opthalmologic findings in the Cornelia de Lange Syndrome. Journal of Pediatric Ophthalmalogy and Strabismus, 22(2), 94-102.

Loovis, E.M., & Ersing, W.G. (1979). Assessing and programming gross motor development for children (2nd edition). Bloomington, IN: College Town Press.

Marcus-Hard, T., Silverstone, B.Z., Seelenfreund, M., Schurr, D., & Berson, D. (1991). Retinal detachment with high myopia in the Rubinstein-Taybi syndrome. MetabolicPediatric and Systemic Ophthalmology, 14, 31-34.

Mazzone, D., Milana, A., Pratico, G., & Reitano, G. (1989). Rubinstein-Taybi syndrome associated with Dandy-Walker cyst: Case report in a newborn. Journal of Perinatal Medicine, 17, 381-384.

Meinecke, P., & Hayek, J. (1990). Brief historical note on the Brachmann-de Lange Syndrome: A Patient closely resembling the case described by Brachmann in 1916. American Journal of Medical Genetics, 35,449-450.

Moran, R., Calthorpe, D., McGoldrick, F., Fogarty, E., & Dowling, F. (1993). Congenital dislocation of the patella in Rubinstein-Taybi syndrome. Irish Medical Journal, 86(1), 34-35.

Mosher, G.A., Schulte, R.L., Kaplan, P.A., Buehler, B.A., & Sanger, W. G. (1985). Brief clinical report: Pregnancy in a woman with the Brachmann-de Lange Syndrome. American Journal of Medical Genetics, 22, 103-107.

Naughten, E.R., Jenkins, J., Francis, D.E.M., & Leonard, J.V. (1982). Outcome of Maple Syrup Urine Disease. Archives of Diseases of Childhood, 101, 553.

Nord, A., van Doorninck, W.J., & Greene, C. (1991). Developmental profile of patients with Maple Syrup Urine Disease. Journal of Inherited Metabolic Diseases, 14, 881-889.

Opitz, J.M. (1985). Editorial comment: The Brachmann-de Lange Syndrome. American Journal of Medical Genetics, 22, 89-102.

Partington, M.W. (1990). Rubinstein-Taybi syndrome: A follow-up study. American Journal of Medical Genetics Supplement, 6, 65-71.

Potashnik, R., Carmi, R., Sofer, S. Bashan, N., & Abeliovicb, D. (1987). Maple Syrup Urine Disease in a Bedouin tribe: Prenatal and postnatal diagnosis. Israel Journal of Medical Sciences, 23, 886-889.

Purvis, P., & Whelan, R.J. (1992). Collaborative planning between pediatricians and special educators. In Christopherson, E.R., & Levine, M.D. (Eds). Development and behavior: Older children and adolescents (Vol. 39, pp. 451-469). Philadelphia: W. B. Saunders Co., Pediatric Clinics of North America.

Ramakrishnan, S., Sharma, D.C., Ramakrishnan, V., Parihar, RS., Sharma, S., & Kanther, D.K. (1990). Rubinstein-Taybi syndrome. Indian Pediatrics, 27, 404-405.

Robinson, T., W., Stewart, D.L. & Hersh, J. H. (1993). Monozygotic twins Concordant for Rubinstein-Taybi syndrome and implications for genetic counseling. American Journal of Medical Genetics, 45, 671-673.

Rubinstein, J.H. (1990). Broad thumb-hallux (Rubinstein-Taybi) syndrome 1957-1988. American Journal of Medical Genetics Supplement, 6, 3-16.

Sataloff, R.T., Spiegal, J.R., Hawkshaw, M., Epstein, J.M., & Jackson, L. (1990). Cornelia de Lange Syndrome: Otolaryngolgic manifestations. Archives of Otolaryngology Head & Neck Surgery, 116, 1044-1046.

Seaman, J.A., & De Pauw, K.P. (1989). The new physical education: A Developmental approach (2nd edition). Mountain View, CA: Mayfield Publishing Company.

Snyderman, S.E. (1988). Treatment outcome of Maple Syrup Urine Disease. Aeta Pacdiatrie Japan, 30, 417-424.

Strauss, R., & DeOreo, K. (1979). AIMS, assessment manual and activities manual. Austin, TX: Education Service Center.

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Uziel, G., Savoiardo, M., & Nardocci, N. (1988). CT and MRI in Maple Syrup Urine Disease. Neurology, 486-488.

Volker, H.E., & Haase, W. (1975). Augensymptosmatik beim Rubinstein-Taybi syndrome. Klin Monatsbi Augenheilkd, 167, 478-483.

Weber, R.C. (1989). Utilizing task variation in adapted PE to motivate and teach disabled students. Journal of Physical Education, Recreation and Dance, 60(2), 85-87.

Weber, R. (1995). Kinematic analysis of the gait of a female with Maple Syrup Urine disease. In (Ed.), Adapted Physical Activity: Proceeding from the 10th International Symposium on Adapted Physical Activity, Oslo & Beitostolen, Norway.

Weber, R. (1996). Kinematic analysis of the gait of a male with Rubinstein-Taybi syndrome. Research Quarterly, 67, 124.

Weber, R. (1997a). Kinematic analysis of running for a female with Cornelia de Lange syndrome. Paper presented at the 114 International Symposium for Adapted Physical Activity, Quebec, Canada.

Weber, R. C. (1997b). (Kinematic analysis of the jump for Cornelia de Lange Syndrome) Unpublished raw data.

Weber, R. C. (1997c). (Kinematic analysis of the kick for Cornelia de Lange Syndrome) Unpublished raw data.

Weber, R. C. (1997d). (Kinematic analysis of the slide for Cornelia de Lange Syndrome) Unpublished raw data.

Weber, R. C. (1997e). (Kinematic analysis of the throw for Cornelia de Lange Syndrome) Unpublished raw data.

Weber, R. C. (1997f). (Kinematic analysis of jumping pattern of a male with Rubinstein-Taybi syndrome) Unpublished raw data.

Weber, R. C. (1997g). (Kinematic analysis of kicking pattern of a male with Rubinstein-Taybi syndrome) Unpublished raw data.

Weber, R. C. (1997h). (Kinematic analysis of sliding pattern of a male with Rubinstein-Taybi syndrome) Unpublished raw data.

Weber, R. C. (1997i). (Kinematic analysis of the throwing pattern of a male with Rubinstein-Taybi syndrome) Unpublished raw data.

Weber, R. (2001). Kinematic analysis of the running pattern of a male with Rubinstein-Taybi syndrome. In D. Beaver (Ed.), Adapted Physical Activity Conference Proceedings for the Worm Congress & Exposition on Disabilities (208210). Macomb: Western Illinois University Press.

Weber, R., & Hanna, M. (1998). Kinematic analysis of the gait changes in a female with Maple Syrup Disease subsequent to participation in adapted physical education: A case study. Journal of The International Council for Health, Physical Education, Recreation, Sport and Dance, 34(3), 42-49.

Weber, R., Hisey, P., & Harris, H. (2003). Kinematic analysis of the changes in gait pattern of a female with Cornelia de Lange Syndrome. In 14th International Symposia on Adapted Physical Activity Abstracts. Seoul, South Korea: IFAPA.

Weber, R.C., & Hisey, P. (1997). Kinematic analysis of the running pattern of a female with Cornelia de Lange Syndrome subsequent to participation in adapted physical education: A case study. Manuscript submitted for publication.

Weber, R., & Weber, N. (1995). Aquacise: Fish do it. In (Ed.), Adapted Physical Activity: Proceeding from the 10th International Symposium on Adapted Physical Activity. Oslo & Beitostolen, Norwary.

Werder, J.K., & Bruininks, R.H. (1988). Body skills: A motor development curriculum for children. Circle Pines, MN: American Guidance Service.

Wessel, J. (1976). 1 CAN program. Northbrook, IL: Hubbard Scientific Company.

Wessel, J., & Kelly, L. (1985). Achievement-based curriculum development in physical education. Philadelphia: Lea & Febiger.

Ziring, ER., Weiss, D.I., & Cooper, L.Z. (1974). The association of congenital Glaucoma with the Rubinstein-Taybi syndrome. Journal of Pediatric Ophthalmology, 11, 203.

Robert C. Weber is Coordinator of Adapted Physical Education at the University of Wisconsin Oshkosh. The Adapted Physical Education Program at the University of Wisconsin Oshkosh is a full minor program based on APENS competencies and student engagement with individuals with disabilities in all of the courses. Dr. Weber has been conducting research involving individuals with genetic disorders for the past 25 years and encourages those in our field to visit the new UWO Adapted Physical Activity Web Site http ://www.uwosh.edu/adaptedpe