Module State of the Art Research of Psycho-Social Aspects of APA (part 2)
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Module State of the Art Research of Psycho-Social Aspects of APA (part 2)
general introductionProf. H. Van Coppenolle, co-ordinator
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Psycho-Social Aspects are maybe the most important ones in APA
and maybe as well the most forgotten
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Physical handicap what are the benefits of participation in sports on
the psychological and social domain when I am physically handicapped ? (blind, deaf, amputee, heartdisease, etc.)
excellent visual tool: “the awarded film ( Medal of Peace of the United Nations):” “I am not Disabled”
“The Winners”: “Everybody wins”
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Psychological problems What are the benefits of
participation in APA and sports (psychomotor therapy) when I have psychological problems (depression, anorexia nervosa, schizophrenia) ?
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Intellectual deficiencyWhat are the positive aspects
in sports and APA for persons with an intellectual handicap?
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These three groups of persons with a handicap
will be the subjects of research in this psycho-social area
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Research data are mostly based on questionnaires
if I want to know what the meaning of a handicapped person about sportsparticipation is , then I have to ask him
so all data are based on meanings of the persons themselves because there is no other way
but these impressions are the only meaningful ones because nobody else can speak for them
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on the other hand questionnaires have weak points
do the persons tell the truth? do they understand the
questions? are they motivated to fill out the
questionnaire in a serious way?
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Personality, Behaviour and Social adjustment of persons with a handicap
R. Shephard (“Fitness in Special Populations”) Human Kinetics, 1990, pp.201-221)
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Social Problems of the Disabled
The disabled individual faces many discouragement's during daily life. Schooling is hampered, employment prospects are poor, and the person faces much stigmatisation and stereotyping
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Stigmatisation a physical handicap creates a visible stigma that
tends to be socially discrediting, encouraging others to avoid the affected person (Aufesser, 1982, Hunt, 1966)
often the handicapped are regarded as unproductive or socially deviant, and civilisations have considered them to be punished by the deity or a witch, or possessed by the devil (Adedoja,1987, Goffman, 1963)
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unfortunately able bodied children seem to develop negative stereotypes of the disabled
in general sensory disabilities are the least stigmatised
physical handicaps rank next, and those with mental disorders are the most subject to ostracism
the cause of disability also influences perceptions surprisingly the process can also occur among the
disabled themselves
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Stereotyping the most stereotypes are a perceived lack of
physical attractiveness, intelligence and ability in many instances the entire stereotype is
inaccurate and inappropriate: the disabled are thus placed in special schools,
and sheltered workshops, when in fact they are well able to cope with normal education and employment opportunities
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negative stereotypes have contributed to conflicts over ownership of athletic contests
some able-bodied runners have wished to exclude wheelchairathletes from events such as the marathon
such exclusion immediately has an adverse impact on the majority of the handicapped participants who wish to be judged on their overall competitive performance rather than as blind or paraplegic patients
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Lifestyle and Disability
the social problems faced by the disabled often cause a reactive depression and this can lead to an adverse lifestyle (abuse of tobacco, alcohol and drugs) (Nelipovich, 1983; Nelipovich §Parker, 1981)
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Employment despite negative stereotypes many
employers, many supposed “cripples” are better motivated and more productive than their able-bodied peers
nevertheless employment prospects for the average disabled person remain relatively poor
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Habitual Activity following spinal trauma the leisure
satisfaction of the injured individual in general decreases (Price, 1987)
participation in sports was likely to decrease relative to the individual’s pre-trauma situation
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influence of the sportsorganisations for the disabled
among the various clinical types of disability the least active group where those affected by multiple sclerosis (maybe because for this group no special sportsorganisations exist)
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smoking habits the proportion of smokers among the
wheelchair disabled substantially exceeded provincial norms
the heavy smokers were predominantly those with a type B personality on the Rosemann scale: they intended to have an external locus of control, there were also trusting, shy and of below average intelligence
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alcohol consumption it is very difficult to obtain accurate
information on alcohol consumption from self-reports
Kofsky a,d Shephard found that 68% of their sample of paraplegics described themselves as no more than occasional drinkers
only 12 % admitted taking more than six alcohol drinks per week
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Personality of the Disabled inevitably the social problems tend to have
an adverse influence not only on the lifestyle but also on the manifest personality of the disabled person
although some disabled athletes have as high a level of selfactualisation as the able-bodied
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disturbed personality many disabled people show evidence of
maladjustment, retarded emotional development, social alienation, feelings of depression, etc.
immediately following spinal injury , ego strength is low and depression scores are very high
in subsequent months they have big problems adjusting to their handicaps
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physical activity may be of considerable therapeutic and psychological benefit
during the early phase of rehabilitation helping the patient develop a sense of self-efficacy
and an awareness that is it not necessary to accept a life of total inactivity and dependency
subsequent participation in sports competition is also important to many disabled people not only for the physical gains
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but because of the social respect, approval and prestige that is gained
involvement in sports holds the prospect of desinstitutionalization and reintegration into able-bodied society
Tucker found that the Cattell personality test of physically handicapped persons reflected greater intelligence, more introversion,and less practical attitude than able-bodied subjects
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Harper used the Minnesota Multiphasic Personality Inventory (MMPI)
and found that the disabled were particularly prone to problems of social adjustment
other studies involved standard psychological tests, body image scales, locus of control tests, the status of blind athletes with reference to anxiety levels and mood states
of course the results on these paper -and pencil-tests depend on the truthfulness of the subjects
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because most of the studies were cross-sectional in type
there is no proof as to whether an increase of physical activity is responsible for the favourable psychological characteristics of groups such as wheelchairathletes
or whether initially favourable psychological characteristics have allowed such subgroups to undertake more vigorous activity subsequent to the onset of their disability
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Cattell Test Scores on this personality test Goldberg and
Shephard didn’t find significant differences of test scores relative to the general population
wheelchairathletes however were distinguished from more sedentary paraplegics on the factors intelligence, venturesomeness and tough-mindedness
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wheelchairathletes differed from the general wheelchairpopulation on factor H (shy versus venturesome)
this could imply that much of the achievements that mark the disabled athlete is due not to some peculiarity of physiological endowment but rather to a strength of personality
and an achievement orientation that has assured a willingness to undertake vigorous training
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Body Image Tests of body image provide a numerical
expression of how the self is perceived both physically and socially
if the image is poor a substantial gap develops between the ideal and the perceived image
early research suggested devaluation of self in various types of disability
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Harper (1978) found that paraplegics often had problems of selfperception and poor body image
although no difference was found between those with congenital and those with traumatic lesions
Brinkmann and Hoskins noted a poor self-concept of hemiplegic patients
after a period of training the researchers reported significant gains on several subscales on the Tennessee self-concept scale
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This subscales were: identity, physical self, personal self and social self
Patrick applied acceptance- of- disability scale and the Thennessee self concept scale
5 months after their first competition novice wheelchairathletes showed a significant improvement on this scale
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The Kenyon/Mc Pherson instrument is one measure of body image
It develops scores for items such as “My body is as I would like to be” and “ The real me “ from a series of Likert scales, spanning contrasting adjectives such as beautiful and ugly
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Goldberg and Shepard (1982) found that
the gap between the perceived and desired body image was larger in moderately actively spinally injured than in those who had achieved the status of wheelchair athletes
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Locus of Control the locus of control scale examines the extent
to which an individual perceives an ability to control her or his environment
external locus of control is assumed when a person perceives an event as unpredictable or the result of luck, chance or fate
internal locus of control is deduced if events are seen as contingent upon personal behaviour
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The locus of control of wheelchair-disabled individuals is usually external
the average score is almost twice than that described for young able-bodied people
the locus of control of the spinally injured person was uninfluenced by the level of the lesion or by habitual physical activity
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Self-Actualisation formal measurements of self-actualisation
in elite ISOD competitors, using the personal orientation inventory of Shostrom demonstrated fairly high levels of selfactualisation
relative to non-elite competitors the subjects scored higher
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Anxiety many disabled groups such as the blind become
acutely anxious following the onset of disability they fear that they will be unable to support
themselves several reports suggest that the blind
competitors particularly prone to anxiety during competition because of lack of normal visual cues
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Profile of Mood States (POMS) The POMS test is a simple one page
questionnaire examining immediate mood state
disabled athletes demonstrated the “iceberg profile”which is typical for an able-bodied competitor
a high score for vigour and low scores for tension, depression, fatigue and confusion
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Effects of training It is logic that a favourable personality increases
the ability to undertake training and that an increased ability to perform daily
activities and live an independent life would have a positive influence on the body image and psychological profile
in children with mental retardation participation in competition (Special Olympics) had a very positive impact on self-image and social interactions
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For the physically disabled Much depends on the establishment of a
training program with realistic goals and expectations
trainers must take into account of inherent shifts in mood state and avoid making excessive physical or emotional demands that could damage an already fragile self-image
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Exercise Motivation and Compliance Initial recruitment to an activity class and
subsequent compliance are major problems even with able-bodied subjects
well-designed programs attract no more than 20 to 30% of eligible adults
and as many as half of those who are recruited drop out of the organised activity within 6 months
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Attitudes toward physical Activity the Kenyon instrument examines the
instrumental value to the individual of a global concept of exercise in seven specific domains
a series of contrasting adjectives (e.g. good/bad) rate the corresponding concepts (e.g.,( good/ bad ) rate the corresponding concepts (e.g. exercise as a means for fitness and health)
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Delforge ( 1973) found no differences between handicapped and nonhandicapped students
Goldberg and Shephard 1982) found that paraplegics perceive five of the seven scales as did able-bodied individuals
wheelchairathletes showed more interest than the general population in exercise “as a pursuit of vertigo” and “exercise as an ascetic experience”
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Perceived reasons for participation M. Cooper (1986) used a paired comparison
test to rank the main perceived reasons why the disabled individual participated in sport
the first seven reasons were in order: challenge of competition, fun and enjoyment, love of sport, fitness and health, knowledge and skills relating to sport , contribution to sport, and the team sport atmosphere
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These seven items were all ranked significantly higher than items such as:
liking for other team members travel liking for the coach and status
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Socialisation into and via Sport disabled individuals generally show poor
social relationships and a limited integration into their immediate society
potential expressions of maladjustment include shyness, timidity, fearful behaviour and other forms of withdrawal, concealment, refusal to recognise the reality, and actual delusions
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Involvement in sport can sometimes help the process of integration
but whether it is effective, particularly in the long term depends not only on the attitude of the disabled individual
but also on the reaction of physical education majors and society as a whole
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the primary perceived stimuli to sports involvement of a group of disabled athletes were
1. the initiative of the individual participant (29%)
2. encouragement of disabled friends (27%)
3. of Able-bodied friends (27%) 4. or the family (9%)
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Hopper (1986) suggested however that:
other factors such as career and domestic happiness may have had a larger impact upon self-esteem than did success in wheelchaircompetition
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Psychomotor Therapy for Psychiatric Patients
– is a form of treatment that has been systematically used in Belgium (Flanders) since 1965
– in that year a post-graduate course was started at the KU Leuven
– this form of treatment attempts to act systematically on the body perception and the behaviour in order to achieve therapeutic objectives
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Observation Scales in Psychomotor Therapy
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the Leuven Observation Scales for Objectives in Psychomotor Therapy
Adapted Physical Activity Quarterly, 1989, 6, 145-153
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originally
psychomotor therapy goals were imposed or set by general therapy theories such as:
psychoanalysis phenomenology behaviour therapy, etc.
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but this approach was not individualised
towards the patient and moreover was quite
speculative because most theories on which
this approach was based are quite speculative and unscientific as well
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therefore
the therapeutic objectives are no longer based on these general theories
but on a specific observation method during movement situations
because everyone moves according his personality
and this movement behaviour can offer useful indications for PMT
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development of the scales
an observation method should only give information about those aspects that are directly related to the goals
213 therapeutic goals for PMT were derived from literature
and named in 9 categories of goals who are important for psychiatric patients
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the 9 groups of therapeutic objectives
improving: 1. emotional relations 2. self-confidence 3. activity 4. relaxation 5. movement control 6. focusing on the situation
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other therapeutic objectives
7. movement expressivity 8. verbal communication 9. social regulation ability
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in a second phase these objectives were made operational as observation items
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by the following steps
a definition of each item for each item a 7 point scale was
established from -3 to + 3 the disturbed behaviour can present itself as
an excess or as a lack the zero score corresponds with non
disturbed behaviour
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to operationalize further
general descriptions of the -2 and the + 2 scores were developed on the basis of adjectives
for example: underemotional relations are revealed in contact that is apathic, inhibited, detached, refusing, inaccessible, too formal
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more specific descriptions more specific descriptions were developed
on the basis of very specific descriptions of behaviour for the - 2 and + 2 scores
for example: emotional underrelating can be revealed in the following descriptions
the patient does not react and shows no interest in contact if he is contacted by others
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reliability of the observation scales (inter and intra)
was for the general LOFOPT ranging from 0.74-1.00
for the specific LOFOPT: 0.70-0.98
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Body Experience and Body Composition in Anorexia Nervosa PatientsIssues in Special Education & Rehabilitation. Vol.8, No. 2, 1993, pp. 35-39
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Introduction: a disturbed body experience is a central element in the AN syndrome
it is one of the four diagnostic criteria in DSM III Revised
it has a perceptual and an affective component nevertheless studies indicate no significant
over or underestimation of body measures no significant difference from estimates by
controls
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these studies don’t refer to body composition
which is an important element because it can affect body satisfaction and perception
body experience has not been studied before and after a therapeutic program
this was the reason of this study we carried out with 43 AN patients
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mean and range of age, height, weight, percentage of fat mass and fat free mass on admission
age:(years): 22.8 12.8-37.6 height (cm): 162.6 140.0-178.0 weight:(kg) :39.7 23.4-52.1 fat mass (%): 12.2 1.2-4.3 FFM (kg): 34.922. 22.2- 43.3
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method
the subject group was re-evaluated after a therapeutic program: 21 patients
mean duration of hospitalisation: 159 days (range 117-184)
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procedure
body experience was evaluated by the distortion technique
and by a self report instrument: the Body Attitude Questionnaire which examine body image satisfaction
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the video distortion technique
a video camera is linked to a color monitor using a potentiometer in the monitor: a distortion
(widening or narrowing) of max. 33% can be achieved
the extent of the distortion is displayed by a voltmeter
a dummy was used as lifeless control the subject can turn a dial to widen or narrow her
image
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4 tasks
adjust the thin or fat body image in full frontal and profile positions until she thought it represented her real image
third task: estimate the dummy in order to know whether the subject showed a more general perceptual disturbance or poor estimation abilities
finally the subject was asked to adjust her own frontal image to her ideal image
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for each of these four tasks
the subjects were asked to perform six trials ad random
alternating between trials initially with a thin image and trials initiating with a fat image
the composite score was the sum of the six trials
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the Body Attitude Test
consists of 20 items which examine body dissatisfaction
the maximum score is 100 the higher the score the more
dissatisfied the subject is with her body the items are scored on a 5 point scale
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Body Composition
was measured with densitometry techniques which uses the underwater weighing technique
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the Psychomotor Program Tries to influence the disturbance of the body
image through confrontation with and awareness of the
body it attempts to alter the negative body experience in a more positive attitude
the movement situations consist of relation and confidence- improving techniques, non-verbal expression, body oriented sensory awareness and social skill exercises
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results: body experience perception
significant underestimation was found on the four estimation tasks
but also the control dummy object was as well significantly underestimated, suggesting that a general perceptual disturbance could be the basis of the underestimation
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body experience: ideal body measures
the ideal body measures correspond with the actual thin body appearance
this indicates that prior to a therapeutical program anorectic patients are satisfied with their emaciated bodies
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body experience: dissatisfaction
the mean score on the BAQ was high: 46
and differed significantly from the control group of 103 students
they are dissatisfied with their body
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relation between body experience and body composition
no significant relationship between body composition and scores on the body attitude questionnaire
some significant correlations with data from the videodistortion technique:
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significant relations
the higher the weight, fat and fat free mass, the more the ideal images measures were narrowed
the less fat mass anorexics have the more they underestimate their measures this increases the perceptual disturbance
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body experience after therapy
a decrease of the underestimation of body measures was noticed in frontal, profile and dummy estimations
patients ideal image adjustments continue to show significant underestimation
this means that after a considerable weight gain (39.3- 50.6) their basis wish to become thinner has not changed
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body satisfaction after therapy
the mean dissatisfaction score on the BAQ decreases from 47.1 to 33.7
this means that following the therapeutical program the patients were less dissatisfied with their body
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EXAMPLES OF GOOD PRACTICE
Different Films illustrating the theory concerning
psychosocial aspects of APA
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“I am not disabled” “Psychomotor observation and therapy
in a psychotherapeutic community” Psychomotor therapy with anorexia
nervosa patients” “Fitnesstraining as psychomotor
therapy in depressive patients “A real slice of the action”