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 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.

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).

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 well-being of service users?

What are the experiences of frontline staff members of implementing aquatics prog.?

PERCENTAGE TIME IN DIFF. ACTIVITIES

21,050 Mins, 30%

8,697 Mins, 13%

15,165 Mins, 22%

24,630 Mins, 35%

Physical ActivitySensory ActivitySocial ActivityBus Drives

MEAN VS RECOMMENDED TIME

Recommended Mean PA (Lin et

al., 2010)

Actual Mean PA0

20

40

60

80

100

120

90 90.73

Tim

e (m

inut

es)

Recommended Mean PA Sessions

(Lin et al., 2010)

Actual Mean PA Sessions

0

0.5

1

1.5

2

2.5

3

3.5

3

2.66

No. S

essio

ns

THOSE ABOVE & BELOW RECOMMENDED

36; 62%

22; 38%Below Recommended Phys-ical ActivityAbove Recommended Phys-ical Activity

28; 48%30; 52%

Below Recommended SessionsEqual to or Above Rec-ommended 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.

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.

PARTICIPANTSName Sessions

CompletedReasons for Missing Sessions

P1 12 Diarrhoea (1)P2 12 N/AP3 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.

P1 P2 P3 P4 P5 P6 P70

20

40

60

80

100

120

140

160

Tim

e (m

inut

es)

MOOD, INTEREST & PLEASURE

QUALITY OF LIFE

Activities Phys. WB Soc. WB Comm. & Inf Mat. WB Dev.0

2

4

6

8

10

12

14

16

Before InterventionAfter Intervention

Mean

QOL

-PMD

Sco

res

ENJOYMENT

ALERTNESS

P1 P2 P3 P40

0.5

1

1.5

2

2.5

3

3.5

4

4.5

Mean

Ale

rtnes

s Sco

res

REFLECTIVE PIECE: P1 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.

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.

REFLECTIVE PIECE: P4

Seemed to enjoy sessions from first day in programme.

Actively interacted and verbalised. Kicked legs for the majority of session.

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 INTERVIEWS6 staff members interviewed4 key workers/service managers1 member of management team1 member of gym team

Thematic Analysis of interviews

THEME 1Effects

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.”

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 3Barriers

Time constraints

Support and resources

Health

Challenging population

Individual Characteristics

TIME CONSTRAINTS “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.”

HEALTH “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.”

SUPPORT AND RESOURCES “I suppose our biggest barrier really...is

staffing and not having people...to take them to places.”

CHALLENGING POPULATION “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?

THEME 4Programme Strengths

Frequency

One-to-one

Relationships

Consistency

Positive Feedback

ONE-TO-ONE

“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.”

FREQUENCY

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 “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 5Service User Needs

Poor quality of life

Social and family contact

Extra-curricular activity

Complicated process of understanding

Continuation needed

POOR QUALITY OF LIFE “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 “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

“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 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 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.

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.

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? 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

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.