Running Head: INTELLECTUAL DIASBILITY TREATMENT PLAN Hartsoe 1

Intellectual Disability Treatment Plan

Kirsten Hartsoe

RTH 352

Western Carolina University

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ABSTRACT: This resident (Awesome) is a 38 year-old male who is currently diagnosed with moderate Mental Retardation, Pervasive Developmental Disorder, Autism, a history of Chronic Undifferentiated Schizophrenia, Irritable Bowel Syndrome, GERD, Allergic Rhinitis, acute Tinea Pedis, left Nephrolithiasis- non-destructing stone lower pole left kidney, mild Bilateral hip DJD, and s/p Laparoscopic Cholecystecomy- 2/14/2011.

KEYWORDS: Mental Retardation (MR), Pervasive Developmental Disorder, Autism, Undifferentiated Schizophrenia, Irritable Bowel Syndrome (IBS), Gastroesophageal Reflux Disease (GERD), Allergic Rhinitis, and Tinea Pedis.

PURPOSE STATEMENT: The purpose of this case study is to further understand the diagnoses of this 38 year-old male who was placed in J. Iverson Riddle Developmental Center (JIRDC) on March 30, 2011 and to accommodate Awesome’s Recreation Therapy needs.

DIAGNOSIS and LITERATURE REVIEW: ACCORDING to MERCK MANUAL of MEDICAL INFORMATION 2nd HOME EDITION

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*Mental Retardation (MR) - Mental retardation is significantly subaverage intellectual functioning present from birth or early infancy, causing limitations in the ability to conduct normal activities of daily living. (Beers, 2003, p. 1626)

Levels of Mental Retardation/Intellectual DisabilityLevel Intelligen

ce Quotient (IQ) Range

Ability at Preschool Age (Birth to 6 Years)

Ability at School Age (6 to 20 Years)

Ability at Adult Age (21 Years and Older)

Mild 52-69 Slightly impaired motor coordinationOften not diagnosed until later ageCan develop social and communication skills

Can be expected to learn appropriate social skillsCan learn up to about the 6th-grade level by late teens

May need guidance and assistance during times of unusual social or economic stressCan usually achieve enough social and vocational skills for self-support

Moderate 36-51 Poor social awarenessFair motor coordinationCan profit from training in self-helpCan talk or learn to communicate

Can progress to elementary school level in schoolworkMay learn to travel alone in familiar placesCan learn some social and occupational skills

Needs supervision and guidance when under mild social or economic stressMay achieve self-support by doing unskilled or semiskilled work under sheltered conditions

Severe 20-35 Able to learn some self-help skillsHas limited speech skillsPoor motor coordinationCan say a few words

Can learn simple health habitsBenefits from habit trainingCan talk or learn to communicate

Can develop some useful self-protection skills in controlled environmentMay contribute partially to self-care under complete supervision

Profound 19 or below

Little motor coordinationMay need nursing careExtreme

Limited communication skillsSome motor coordination

Usually needs nursing careMay achieve very limited self-care

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cognitive limitation

(Merck Sharp &Dohme Corp., 2010-2011)*Pervasive Developmental Disorder (PDD) - Children who have significantly impaired social interactions or stereotyped behaviors without all of the features of autism or Asperger’s disorder are considered to have pervasive developmental disorder not otherwise specified. (Beers, 2003, p. 1631)

*Autism - Autism is a disorder in which young children cannot develop normal social relationships, uses language abnormally or not at all, behaves in compulsive and ritualistic ways, and may fail to develop normal intelligence. (Beers, 2003, p. 1630)

*Schizophrenia (Undifferentiated)- Schizophrenia is a mental disorder characterized by loss of contact with reality (psychosis), hallucinations (usually hearing voices), delusions (false beliefs), abnormal thinking, flattened affect (restricted range of emotions), diminished motivation, and disturbed work and social functioning. Undifferentiated schizophrenia is characterized by a mixture of symptoms from the other subtypes: delusions and hallucinations, thought disorder and bizarre behavior, and negative symptoms. (Beers, 2003, p. 640 & 642)

*Irritable Bowel Syndrome (IBS) - Irritable bowel syndrome is a disorder of mobility of the entire digestive tract that causes abdominal pain, constipation, or diarrhea. (Beers, 2003, p. 756)

* Gastroesophageal Reflux Disease (GERD)- In gastroesophageal reflux (gastroesophageal reflux disease), stomach acid and enzymes flow backward form the stomach into the esophagus, causing inflammation and pain in the esophagus. (Beers, 2003, p. 717)

*Allergic Rhinitis- Allergic rhinitis is caused by a reaction of the body’s immune system to an environmental trigger. The most common environmental triggers include dust, molds, pollens, grasses, trees, and animals.

*Tinea Pedis- Athlete’s foot (tinea pedis) is a common fungal infection that usually appears during warm weather. (Beers, 2003, p. 1225)

*Nephrolithiasis- The process of stone formation. (Beers, 2003, p. 864)

ADMISSION HISTORY:

Date of Birth: xx-xx-1973

Date of Admission: 3-30-2011

Length of Stay: Regular transition meetings are held to determine whether or not Awesome is ready to go into the community. This is determined by his progress and appropriate placement in the community.

IDENTIFYING INFORMATION:

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Awesome is a 38-year-old male who is single and likes to be dressed nice throughout the day. He was brought to this residential developmental center from a group home in central NC on March 30, 2011. He has lived in group homes since 2001. When Awesome first came to this facility he reportedly, according to staff, looked like a mountain man with a full head of long hair and full beard. Since he moved to J. Iverson Riddle Developmental Center, Awesome has really opened up to the staff and helps out in any way he can. He is very close to his mother and sister who are very involved in his treatment and visit him often.

Awesome is currently working in the in a resource center onsite. He assists with doing loopers and crushing cans and bottles for recycling. He also sweeps the floor and helps make the dog biscuits. He pours the already measured ingredients, helps mix the dough, helps roll the dough out for the dog biscuits, cuts out the dough with a cookie cutter, counts the dog biscuits using a stencil, and holds the bag the dog biscuits go in while someone ties it closed. He can sew and will fold wash cloths as well.

BIRTH AND DEVELOPMENTAL HISTORY:

Awesome was the product of a normal pregnancy weighing 8.5 pounds when he was born. He was born vaginally with forceps 1 week early. APGAR scores were good and there were no postnatal problems. During the prenatal period, 3 weeks before birth, his mother became very ill with severe flu like symptoms and didn’t take any medications. Awesome was a good eater, was not picky, and gained weight quickly. At 6 months of age, Awesome became constipated and he had to be manually disimpacted. He reportedly walked and talked at the high end of the normal range of the developmental milestones. At 1 year old, Awesome began saying single words but did not build on the words. His hearing tests were within normal limits. At age 2, his mother began to wonder if something was wrong because he did not progress as his older sister had. It was reported that at well baby visits, where he would receive immunizations, he would become sick several days to a week afterwards with fever. His arms would get red at the injection sites as well.

PAST MEDICAL HISTORY:

Awesome has no history of seizures. Since an early age, he has a long history of digestive problems varying from constipation to diarrhea. He has a history of allergies to tree pollen, dust, and dander confirmed by skin test results. He has never received immunotherapy. He also has an allergy to eggs, which “cause his eyes to glaze over”, and reportedly has not had any eggs since the ages of 5 or 6. Awesome has an allergy to milk and milk products, which “causes increased secretions and rhinorrhea”. In the past, he has been treated with multiple antihistamines but Benadryl has historically been the most effective antihistamine.

Awesome was diagnosed with PDD at the age of 3 years old. He learned to read and write and do simple math by attending special education classes in public school. The first medication he ever received was an antibiotic for a sinus infection at the age of 5. By the age of 14, he developed longer periods of psychomotor retardation and aggressive behavior. At the age of 14, Awesome was diagnosed with autism and prescribe Mellaril as his first psychotropic medication. He

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showed some improvement for several years but developed sexual aggressiveness in the form of hugging and grabbing in a nonspecific manner and the Mellaril was discontinued. Reportedly, by the end of high school, Awesome had declined to a point where he could no longer read, write, or do simple math. He attended some work placements with a one on one worker but he was no longer able to participate in the work program. In his mid twenties, he was restarted on Mellaril and this caused him to not be able to urinate. He also redeveloped sexual aggressiveness and was described as annoying to women. The Mellaril was discontinued and both of these symptoms stopped within a few days. He was later treated with Lithium for bipolar depression but the medication was not effective so it was discontinued.

He moved from the Midwest to the Southeastern US in 1993 and was off all of his medications until about 1996. He lived at home and was on a regular diet during this time period. In 1997, he began to develop aggressive behaviors such as hitting, pushing, throwing things, and grabbing people’s shirts. He was prescribed Risperidone for several months but it made him angry and worsened his aggression. He was taken off of Risperidone. At one point, he was given a sublingual dose of Haldol at 1/10th the usual minimum dose and it worked very well. During this time he was able to work at restaurant with a job coach. In 2001, he moved into a group home in a neighboring state due to the deteriorating health of his parents. He reportedly did well in this group home for several years and was receiving 10 milligrams of Abilify and varying doses of Ativan due to his agitation. He had been on Abilify and Ativan for most of the last 10 years, which his mother felt were the more effective medications he had been tried on. He complained of headaches when his dose of Ativan was wearing off and would sometimes hit his head. His father died from non-Hodgkin’s lymphoma in approximately 2006.

In 2007, Awesome moved to North Carolina where he first lived with his mother while she arranged his residential placement. He was retried on Haldol with a range of 1 to 5 milligrams daily. His mother reported that this trial was disastrous because his agitation and aggression increased. His mother reported an incident in a group home where a resident physically abused Awesome. Due to this abuse, Awesome learned negative behaviors to defend himself. On February 28, 2008, a psychological evaluation was done on Awesome. It was reported that on a Wechsler Adult Intelligent Scale his verbal IQ was 55, performance IQ was 50, and a full scale IQ was 52. He moved into a DDA group home with cap services. Due to deteriorating behavior such as aggression and refusal to bathe it was recommended on March 10, 2008 that he start on 5 milligrams of Zyprexa and to increase it to 10 milligrams after three days. It was not clear whether the medication was ever started or due to the mothers request that Awesome not receive it.

From March 17, 2010 to May 4, 2010, Awesome had his first psychiatric hospitalization for escalating aggression, refusal to bathe, eat, or use the bathroom. He had supposedly been unresponsive to his medication adjustments. When Awesome was discharged, he was receiving 100 milligrams of Zoloft, 300 milligrams of Lamictal, and 20 milligrams of Abilify. Also, he was receiving 120 milligrams of Inderal LA along with Flonase, Claritin, Prilosec, Metamucil, Mirilax, Colace, and Lactulose. He continued to have problems in the group home and had numerous medication adjustments. On a physical exam done in September 2010, he weighed 214 pounds and was on an 1800 to 2000 calorie diet per day. Around October or November 2010, Awesome would stay in bed until 2 p.m. or later and refused breakfast and lunch. Some days he

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would stay in bed all day long and be incontinent of urine and feces. He was also refusing to take baths for up to weeks at a time and developed some skin breakdown. Due to his refusal to get out of bed, to participate in activities of daily living, SIB (Self Injurious Behaviors), property destruction, and aggressiveness towards staff it was recommended that Awesome be tapered off of Zoloft and to start 25 milligrams of Clozaril three times a day for one week (then to increase it to 100milligrams hs (at bedtime)) along with starting 37.5 milligrams of Effexor titrated up to three times a day dosing, and continuing 20 milligrams of Abilify per day, 300 milligrams of Lamictal per day, as well as Ativan and Zyprexa as needed. On November 11, 2010, his Effexor was dose was increased to 75 milligrams three times a day and 15 milligrams of Remeron was added to his medication regimen. He had reportedly not received any Zyprexa since October 10, 2010. His Clozaril was increased from 100 to 200 milligrams daily due to worsening aggression and meal refusals. He would go 2 to 3 days without eating at times and would lie in bed and soil his self. By January 11, 2011, Awesome had developed skin breakdown of his buttocks and shoulders. He had lost 20 pounds in a month. He continued to be aggressive to staff, refuse meals, and refuse hygiene measures.

Awesome was evaluated at the Emergency Room on January 13, 2012. He had complaints of abdominal pain and constipation. A urinalysis was done and was normal. A BMP was wnl (within normal limits) except for a slightly decreased potassium of 3.4. An abdominal series demonstrated nonspecific gaseous distention of the small bowel and colon. Incidental mild degenerative changes of both hip joints with mild supraacetabular spurring were noted. He received an enema and his symptoms resolved. He was evaluated again in the ER on January 21, 2011 due to complaints of abdominal pain and discomfort. An ultrasound of the gallbladder showed cholelithiasis with a contracted gallbladder without evidence of acute cholecystitis. A CT scan of the abdomen and pelvis showed a contracted gallbladder containing small stones, a nonobstructing small calculus in the lower pole of the left kidney, trace bilateral pleural effusions and trace nonspecific free pelvic fluid. Awesome was evaluated by a gastroenterologist due to his gallstones and he was put on a mild muscle relaxer to help decrease the gallbladder spasms but he did not experience any relief in his intermittent abdominal pain. Awesome has had significant issues with constipation and had several ER visits where he required enemas because of severe constipation.

On January 27, 2011, Awesome was evaluated at ER for worsening skin breakdown and abdominal skin discomfort. There were also reports where he had been hitting his head during episodes of SIB. His laboratory evaluation was completely normal including a lipase, amylase, CMP, CBC, and urinalysis. A CT scan of the head showed partial opacification of the right sphenoid air cells. The mastoid air cells were clear and there was no evidence of acute intracranial abnormality. He was diagnosed with sphenoid sinusitis and treated with a 10-day course of Augmentin. Due to continued complaints of abdominal pain, which consists mostly of him verbally reporting abdominal discomfort and waving his hand over his sternum, he underwent a laparoscopic cholecystectomy on February 14, 2011 without complications. It was reported in the hospital that he would get up, sit at the table, and eat all of his meals. He had an EGD and colonoscopy scheduled due to his irritable bowel symptoms and history of GERD but it was cancelled prior to his admission. He reportedly had an EGD done about 10 years before which was normal. He had an episode about one week prior to admission where his group home staff was unable to arouse him and EMS was contacted. When EMS arrived, he rolled over on

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his own. He had low blood sugar in the 60’s and was given oral glucose, which improved his level of alertness.

When he first came to this facility, Awesome was staying in bed most days, all day long. He would refuse breakfast but may ask for snacks. Some days he would get up and go to the bathroom when prompted but about once a week he was still incontinent in the bed. He refused most lunches but would get up to eat supper. Once he was done with supper, he would immediately go back to bed. He used Duoderm on his lower back to avoid skin breakdown and has had to use it on his shoulders in the past. His CBC was monitored weekly because he was receiving Clozaril. Awesome reportedly had a low WBC several weeks before but it was repeatedly being monitored weekly and his WBC improved. He has a history of hyperlipidemia, which was treated in the past with Lopid and Zocor.

MEDICATIONS:

At Admission:Abilify, Clozaril, Effexor, Remeron, Ativan, Lamictal, Propranolol, Flonase, Zyrtec, Prilosec, Amitiza, Robinul, Bentyl, Colace, Lactulose, and Vitamin D daily.

Tylenol, MOM (Milk of Magnesia), and Metamucil as needed.

Currently:Colace, Flonase, MOM, Multiple Vitamin, Zyprexa, Omega-3 Purified Fish Oil, Prilosec, Propranolol, and Zocor daily.

Tylenol and MOM as needed.

ALLERGIES:

Awesome has NKDA (no known drug allergies).He is allergic to tree pollen, dust, and dander.Awesome’s food allergies are eggs (eyes glaze over), and milk or milk products (causes increased secretions and rhinorrhea).

PHYSICAL EXAMINATION:

General Appearance: He is a disheveled 37-year-old white male who leans to the right and seems mildly intoxicated and sedated. He is unkempt with greasy hair and an untrimmed beard.

HEENT:Head: Dark brown hair. Scalp clear. Atraumatic normocephalic (AT/NC). Eyes: Gray. PERRL. EOMI. Positive red reflux OU. Fundus exam obscured by squinting and motion. Sclera is nonicteric and conjuctiva is clear.Ears: Both the tympanic membranes are obscured by wax.Nose: Both of the nares are patent without discharge. He has mild mucosal erythema.

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Throat: The oral pharynx was clear without exudates or lesions. The teeth appear in fair condition with multiple fillings.

Neck: Supple without JVD, lymphadenopathy or bruits. Carotid +2 and equal. No thyromegaly.

Breasts: No gynecomastia. No axillary lymphadenopathy.

Chest & Lungs: The chest wall is grossly symmetric. The lungs are clear to auscultation without rhonchi, rales or wheeze.

Cardiovascular: Regular tachycardia without murmur. Pulses are normal in all extremities. No peripheral cyanosis, clubbing edema or varicosities.

Abdomen: Mildly protuberant. Soft and non-tender with normal bowel sounds in all quadrants. No hepatosplenomegaly or masses.

Genitalia: Normal circumcised male with both testes present in the scrotal sac and benign to palpation. No hernia. No inguinal lymphadenopathy.

Rectal: No hemorrhoids mass or fissure. Stool is heme negative. Prostate is mild to moderately enlarged but smooth without nodularity.

Musculoskeletal: Spinal alignment is grossly normal. Full range of motion in all extremities.

Skin: A 10x4 mm horizontal scar is present in the mid forehead. Multiple small dark brown (<4 mm) nevi are present on the upper back and shoulders. Several are also located on the anterior torso. Two nevi with inch long hair are present on the anterior left shoulder. Four 1.5 cm well healed abdominal surgical incisions are present from recent laparoscopy cholecystectomy. Two are present in the right upper quadrant, one is located just below the umbilicus and one is located below the sternum at the midline. Moist white fungal changes are present between the fourth and fifth toes on both feet. Neurologic: Awake and alert and oriented to person.Cranial nerves II-XII are grossly physiologically intact.Vision: Appears to fixate and follow without difficulty.Hearing: Grossly normal to verbal request.Speech: Expressive skills- limited to one or two word phrases during the exam. Receptive skills- follow simple requests.Motor: Strength and tone normal in all areas.Sensory: Normal response to light touch and noxious stimuli in all areas.Coordination: Gross motor control is reduced. Fine motor testing not performed. No tremor.Gait: Leans to the right and veers to the right in an intoxicated manner.DTRs: +2 and equal in upper extremities. None elicited in the lower extremities but cooperation was limited. Babinski: Bilateral plantar flexion.Clonus: None.

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Intellectual disability

Definition

Intellectual disabilities “a disability characterized by significant limitations in both

intellectual functioning and in adaptive behavior. This involves everyday social and practical

skills.” (American Association on Intellectual and Developmental Disabilities [ADDIDD], 2013,

p. 1). Intellectual function refers to being able to learn, reason, and problem-solve. A way to

measure this would be IQ tests. Adaptive behavior has to do with conceptual, social, and

practical skills. Language, concepts, self-direction, interpersonal skills, responsibilities, activities

of daily living, and schedules and routines all fall along the lines of these four main skills. A way

to measure adaptive behaviors is by doing standardized tests. Mental retardation is another word

for ID but the term intellectual disabilities is more commonly used due it being more word

friendly (Society for Accessible travel & Hospitality [SATH], 2007). These terms are used

intertwined, but intellectual disabilities is slowly becoming used more.

Demographic Information

“A number of factors are associated with increased risk of intellectual disability.

Prenatal causes are genetic and congenital malformations and exposure to toxins.

Perinatal factors are those related to infections and delivery-related causes. Postnatal

causes are those associated with childhood infections, and physical and psychological

growth of the child. However, most cases are of unknown etiology (30-50%)” (Maulik,

2010, p. 17).

There is a higher ratio that a male would be diagnosed with an intellectual disability over

a female. It is also more common in poor communities due to the fact that people are unable to

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pay for certain healthcare and so their health conditions are worse which could lead to

intellectual disabilities. Also, most people are diagnosed before the age of 18. Those that are

classified with mild mental retardation were mostly boys and this was less than 15 years of age

when diagnosed (Maulik, 2010).

Strengths

Awesome has good hygiene and presents himself well. He is open and friendly to staff.

He is also very helpful when there is something to be done such as cleaning or helping others do

certain tasks. He also has a job, which shows that he can finish task. He also has great family

support from his mother and sister. They come visit him every day at the developmental center

and throughout his life have been his caregivers. He has good motor skills and his muscles are

pretty tone and healthy. He is very alert and self-aware which is very important as you start to

get older, especially when taking so many different kinds of medications. He is also not allergic

to any medications he has previously been on, so his caregivers would be alert to any possible or

potential reactions to new medicines.

Needs

Participating in activities to stimulate Awesome’s brain to keep his brain and abilities

working is very important as he continues to age. “There is a higher prevalence of

sedentary behavior among adults with intellectual disability (ID) compared to the general

population” (Indiana University, 2009, p. 1)

Awesome has a history of mood swings. He can also be very stubborn at times and not

wanting to complete appropriate hygiene. “When people with intellectual disabilities

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experience major depression, they may try to stay in bed all day, become mute, eat too

little or too much, and refuse to wash or even use the toilet.” (Melrose 2015 p. 27)

Environmental Barriers

Employment opportunities for Awesome and discrimination against those with

intellectual disabilities is something that has to be in consideration for Awesome when

looking for a job.

The Americans with Disabilities Act in 1990, “It mandated that local, state, and

federal governments and programs be accessible, that employers make

“reasonable accommodations” for workers with disabilities and not discriminate

against otherwise qualified workers with disabilities, and that public

accommodations and commercial facilities make “reasonable modifications” to

ensure access for disabled members of the public, and not discriminate against

them” (University of Illinois, p. 20).

This Act was not active until the 1990 so less than 30 years ago there was still

discrimination to those with intellectual disabilities in the work place.

Transportation for Awesome to work and get out in the community is something that

could be considered. “The act also mandated access in public transportation and

communication” (University of Illinois, p. 20).

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Culture Information

The client is a male and males are more prone to have intellectual disabilities (Maulik,

2010)

Awesome may not fit the cultural norms of ethnicity from the info given. “Few studies

have analyzed data on ethnic differences in ID. One study on children in the U.S. found

that ID was proportionately higher among African-American children, after controlling

for socio-demographic variables” (Murphy et al., 1995).

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Efficacy Research

Wilhite, B., Biren, G., & Spencer, L. (2012). Fitness intervention for adults with developmental

disabilities and their caregivers. Therapeutic Recreation Journal, 46(4), 245-267.

A 12-week study was done on fitness and health with people with intellectual disabilities

and their caregivers. This was to promote healthy living styles and for everyone to be able to get

out and be active. This also was family-oriented, meaning many of the participants had their

caregivers and they also participated in fitness exercises and healthy eating. The study was to

improve the health and wellness for the whole family or with a health care provider if the family

is unable to participate. They originally started with 25 people, 15 with intellectual disabilities

and 10 caregivers. Some individuals were unable to participate due to their personal time

conflicts, which left the study with only 16 participating, 10 with intellectual disabilities and six

caregivers. This study consisted of protocols about nutrition and fitness which gave guidelines to

give participants the best practice. Strategies were used to help the participants stay motivated by

providing rewards such as food or music to help the participants stay motivated and help them

retain information. There were pre and post intervention assessments that tested the participants’

ability to do certain physical activities and check their health.

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Summary

This study being conducted is to demonstrate people with intellectual disabilities are able

to promote their own health and enjoy being more physically active. People with intellectual

disabilities have many barriers that affect them. Researchers want this study to succeed in

encouraging the action and involvement of others. Based on some past research, individuals who

were not involved in exercise lacked incentive to participate. This study shows that individuals

with ID can have fun while exercising. Finding this incentive for increased exercise is the

common goal of many researchers.

Subjects and Methods

The number of participants in the study declined from the initial start. The numbers went

from 25 to 16 which was from individual participants not being able to attend on their personal

time. Over 70 percent of the ethnicity in the group was Caucasian but there were also Asians and

African Americans in the mix. The medium age was 40 years old. Of the participants, 9 of the 10

people had intellectual disabilities and one had autism. All subjects were in pretty good health

and the majority had family members paired with them during the study. Fitness and nutrition

protocols were taught and shown to them of exercise and healthy eating portions. These were the

beginning steps of the study to help participants learn the proper way to maintain being healthy.

Health and fitness assessments were completed by taking each participant’s height and weight.

The assessment also identified the participant’s physical ability, in terms of how many sit ups

and crunches the individual was able to complete and also walking endurance. There were

physical trainers to help participants with the physical aspect of the assessment to give them

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access to experts. These physical trainers had to have experience with people with ID and

interviewed after to get feedback on how they think the process went. By being interviewed and

giving evaluations, this was how information was obtained from the participants and helpers

expressing how they think the study went.

Findings and Implications

All participants said that the goals of the program were accurate and that they liked

making physical activity enjoyable and learning new nutritional guides. There were table charts

of data retrieved from information from the assessments which showed that most of the

participants fell under having stage one obesity and fell in the ranges of optimal to extreme

obesity. Cholesterol levels when tested were at the normal levels for everyone within the results

too. “Studies cited in this paper have reported that while persons with ID are one of the most

physically inactive groups in society, lack of knowledge and opportunity may be a greater barrier

to the achievement of health and fitness outcomes than lack of interest of ability”(Wilhite, 2012,

p.46). “In this study, people with ID demonstrated that not only were they capable of making

significant fitness gains, thus promoting their own health, they enjoyed doing so. The health and

fitness outcomes achieved by study participants should prove motivating for others considering

similar health promotion interventions” (Wilhite, 2012, p. 46). The data expressed that everyone

improved in different aspects such as endurance, cardio-respiratory, and strength. “Muscle

endurance for crunches were on average increased by seventeen percent, chest press grew by

thirty two percent, and bicep curls increased by nine percent” (Wilhite, 2012, p. 37). Cardio

respiratory was tested by participants walking on the treadmill which stated that they got fatigued

quickly which shows that their endurance for cardio is not on healthy scale.

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Applications for the Case

The average age of participants was forty and my client is 38 so he fits into this study age

range. Awesome’s needs are to help keep his moods swings to a minimum, have proper hygiene,

and eat well. Fitness can lead to a domino effect of improving happiness that leads to better

hygiene and healthier eating. With Awesome having a caregiver being his mom and sister this

study could also be helpful for them. Even health care providers that work at the developmental

center he stays at now could help in this process. This way more than just Awesome would

benefit from this fitness and nutrition challenge. This fitness intervention would also help with

improving his independence and taking care of his body and health by allowing him to take

charge of his own health. This would be by educating him on important health tips and doing

these activities for himself to better his physical endurance and strength.

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Top Three Strength/Needs

Strengths:

Cl. has good family support

Cl. is very open with staff

Cl. is very helpful

Needs:

Maintain healthy/steady weight

Increase self-care

Decrease mood swings

Goals:

Improve self-care by washing hands before and after playing sports and handling the

equipment within the six weeks.

Maintain a healthy lifestyle through physical activity within the six week program.

To decrease mood swings through group participation in the six week program.

Facility:

The healthy program at the University of Arizona is a program whose goals are to help

people Dx. c ID improve their fitness and health.

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Intervention:

The intervention for the Cl. will be to attend the healthy program at the developmental

training center at the University of Arizona for a six week period. During the six weeks, the Cl.

will improve his physical fitness of maintaining a healthy lifestyle by participating in exercise

class such as aerobics, cycling, dancing, and sports such as basketball and racket ball. Cl. will

also improve knowledge of healthier foods of maintaining a healthy lifestyle which will include

cooking lessons and informative interactive classes. He will then work to improve self-care,

maintain a healthy weight, and decrease mood swings. This program will give the Cl.

opportunities to help keep a steady weight and also lift his spirits by keeping him active and

engaged with others. The physical aspect of the intervention should last no longer than an hour

and a half with breaks every 30 minutes to provide rest and water for the Cl. The nutrition aspect

of the intervention should last no longer than an hour with two breaks every 20 minutes to allow

question e.m.p and get hands on experience with making certain foods being discussed that day.

The Cl. should participate for at least for 45 minutes for whatever fitness intervention is chosen

for the day and 30 minutes interacting with the informative nutrition intervention for the six

weeks there while being assisted by a CTRS.

Objectives

1. **Cl. will participate in aerobics class for the day, the CTRS and Cl. will participate

for an hour and a half with 30 minute breaks to help improve self-care.**

2. Cl. and CTRS will also be interactive and hands on in the nutrition class for an hour

with 20 minute breaks to show improvement in self-care.

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3. Cl. will demonstrate 15 minutes of an activity class or sport and giving a couple

informative nutrition facts that have stuck with the Cl. through the informative nutrition

classes to know how to have a healthy lifestyle.

Progress Note

S- Cl. states that he “doesn’t have self-care issues and that physical activity wouldn’t help

that anyway.” prior to go to the healthy program in Arizona. Cl. says he thinks “attending

these activity classes and sports are going to be too tiring for his age”. Later after a

couple weeks into the Healthy Program CTRS states, “saw an improvement in

Awesome’s endurance in aerobics.” Cl. states after being in program for three weeks that

he “feels more energetic.”

O- Cl. is participating in the fitness intervention of the day and improving self-care and

healthy eating by taking a shower after playing a sport. Cl. is showing an improvement in

self-care by washing hands before and after handling equipment and walking to the

corner if he has to sneeze or cough.

A- After the cl. learns or already knows how to play a certain sport or fitness class he

enjoys demonstrating with the instructor’s techniques and tips.

P- Cl. will keep working on the fitness intervention e.m.p to help met his goals by

participating in the healthy program in Arizona. He not only is gaining knowledge about

a healthy lifestyle but is also improving his health by exercise which improves self-care.

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D/C Plan:

Cl. is a 38 y/o SM who was Dx. c Intellectual Disability. The Cl. has problems with maintaining

a healthy weight, hygiene issues, and mood swings. Cl.’s goals in Arizona at the Healthy

program is to improve self-care which will also help other needs to be met. Cl. attended a six

week healthy program in Arizona where he participated in different fitness interventions for an

hour and a half with a break every 45 minutes and a nutrition intervention that lasted an hour

with breaks every 20 minutes c a CTRS. Cl. was about to show functional use of a particular

fitness class or sport for the day and gave /d demonstrations of techniques to others. Cl. was also

able to take notes and stayed collected for 45 of the hour long nutrition class. Cl. still needs help

with hygiene by being reminded to put deodorant on and to occasionally wash hands before and

after cooking. Cl. still needs supervision when being on certain equipment for safety reasons. Cl.

still needs motivation here and there when playing a sport. Cl. should still participate in at least

45 minutes of physical activity 4x a week. Cl. will continue showing improvements on his self-

care and healthy eating. Client will continue RT services at the Developmental Center he usually

stays at back home and will stay active there in their workout facilities.

Kirsten Hartsoe 4/24/17

Signature Date

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