contributed by HEATHER HAMLIN and CHRIS STOPKA, DECEMBER 2004

INTRODUCTION
What is exercise induced asthma? It's an asthma attack that occurs at the start of exercising, and is a condition that is prevalent for many children.

"Exercise induced asthma (EIA) affects about 40-90% of children with asthma, and occurs when a child's asthma is triggered by exercise or physical activities" (1). However, this doesn't mean that children with this condition are not capable of exercise. To take away exercise, or play from a child, would severely limit their development and hinder their growth both mentally and physically.

Children with asthma have to be more cautious than others when it comes to physical activity and exercise, but in no way do they have to put a stop to it. It may seem contradictory, but the best thing for a child to do who has exercise induced asthma is to be active!

THE PRINCIPAL MESSAGE
In a nutshell, this is how it works.

Exercise induced asthma occurs when a person exercises at about 80% of their physiological capacity for at least 5-7 minutes. So, if the child is un-trained, most any physical activity, even for a brief amount of time, can cause an attack. However, if the child is physically fit the child has a far greater work capacity. The greater their work capacity the less chance they have of having an attack due to an exercise activity, as most exercise activities will be well under the physiological limits that cause an attack! So, the best way to prevent an attack is to be in the best physical shape possible.

To get in shape, the training program should be gradual. Some children even have to start with intermittent (start/stop) activities, to ensure enough rest between the movements, but as the child improves in training, continuous endurance activities are indicated.

Warm, humid air, is better than cold, dry air, thus swimming is a sport of choice for children with asthma. Indeed, in the 1996 Olympics, as many U.S. athletes with asthma won as many medals as their asthma-free counterparts! They got into swimming as children, due to their physicians' recommendations to participate in this activity to treat (minimize the effects of) their asthma.

BACKGROUND
Asthma is a disorder of the respiratory system, and can cause severely troubled breathing, or "dyspnea." "Asthma is a disease. More specifically, it is an inflammatory disorder of the lungs that causes obstruction due to narrowing of the bronchial tubes in the lung, and because that is not enough, there is an added bonus of mucus and fluid production. Wheezing, coughing, chest tightness, and sputum production are the classical symptoms of asthma” (5).

Asthma attacks can be fatal, and there is always a constant possibility of having an attack for those who do have it, especially for children who like to be active outside where there is pollen and dirt. Allergens, chemical irritants, and dust particles in the air, all which can get trapped in the lungs, can set the stage for an attack to occur. Asthma may be a limiting disorder, but in no way is it an excuse for a child to be excluded from activities and exercise. All that's needed is a slight modification.

TREATMENTS
Treatments for exercise induced asthma in children consists of several different options. Most children can be treated with a short acting inhaler prior to physical activities, which can help prevent asthma for several hours. There are also anti-inflammatory medications that can be taken prior to activity, as well, that can help prevent an attack. Other inhaled medications may be needed to treat/minimize the effects of an attack if one does occur.

However, the most optimal treatment for children with exercise induced asthma is simply physical activity. Treatments should be individualized for each child, with physician recommendations, including which types of physical activities are best. Some activities can cause an asthma attack easier than others (such as running in cold, dry air, without proper training), but if properly assessed, well controlled, and prevention is used consistently, the child should have fewer problems engaging in the activity of his or her choice.

Children with asthma don't have to be limited to activities that may not interest them. "Asthma doesn't have to keep your child out of the game. The right treatments can usually prevent asthma attacks in any sport" (4). Encouraging physical activity and exercise can greatly help a child cope with their asthma.

GETTING ACTIVE
There are numerous physical activities in which children with exercise induced asthma can participate, but it does require a huge responsibility on their part to be in control of their disorder. It is very important for children with asthma to continue to stay active and be healthy, along with taking the appropriate steps in protecting themselves.

Exercise and physical activity cannot be stressed enough in the prevention of asthma in children. Exercise doesn't have to be boring or routine. Just running around outside in the yard with a ball, riding a bike, or taking a hike on a dirt trail can prove to have huge rewards. "A few simple changes in your child's exercise routine can also help prevent attacks. Encourage them to warm up by walking, stretching, and briefly running in place before exercising" (4).

Making exercise and physical activity fun for children with asthma will make it easier for them to want to stay active and take the necessary precautions to keep their asthma under control. Not only that, but it can help show children that they can participate in what they want to do, and not feel as though they are limited by their disorder.

SWIMMING
Swimming is an activity that can be extremely beneficial to a person with asthma. It doesn't require much effort, but is an active and fun way to work out. Swimming can be for competition, or for just recreational fun.

There are many different settings for swimming, whether it is the beach, a lake, or a pool in the backyard. It is a wonderful form of exercise, and a great way to also enjoy the outdoors. It is one of the best exercises that children with asthma can participate in because "Swimming works more muscle groups at once than any other sport. An aerobic exercise, swimming is great for cardiovascular and pulmonary systems" (3).

Swimming is a wonderful exercise for anyone, not just for children with asthma, and if done on a consistent basis it can improve one's health greatly. Swimming is the optimal exercise for children with asthma because it is an environment least likely to bring on an attack. "Swimming, which is done in a humid environment, rarely bring on attacks" (4).

Its non-weight bearing characteristic reduces the stress to heart and lungs. The water is a great place to play because it offers so much variety of fun. Snorkeling, scuba diving, and even surfing, are great activities that can be done in the water, and offer a change of pace from the normal laps or recreational splashing around. Swimming can help improve self-esteem in children with asthma because it's an activity that a child of any age, or size, can participate in and enjoy.

BIKING
Another great outdoor activity for children who have asthma is bike riding. Bicycling, a non-weight bearing activity is also less likely to stir up an attack.

Today there are so many different type of bikes that almost anyone of any age, size, shape and handicap can find one to fit their needs. Bicycling is great exercise, and can be a lot of fun for children of any age because there isn't anywhere you can't go on a bike.

"Many cities have bike paths that pass through their most scenic areas. A day trip of site-seeing is easier on a bike since more distance can be covered with less energy expenditure than walking, and a bike can be equipped to carry almost anything you need from medications to cell phone, to a picnic lunch" (2).

Riding a bike can turn into a great family even, where the child is not only getting exercise, but also having one-on-one time with his/ her parents, helping to form a stronger bond.

Bicycling doesn't have to be a strenuous activity either. Even just a ride around the neighborhood after dinner with parents each night can have an enormous impact on children's health, both physically and mentally. You can take them through dirt - go slow, go fast - the possibilities are limitless, which can help keep a child interested in staying active. There is a variety of places and things you can do on a bike, which can lead to a new adventure each day for a child, and at the same time keep him or her healthy.

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OTHER ACTIVITIES OF CHOICE
The key to helping children stay active, especially children with exercise induced asthma, is to have the exercise be FUN! Children want to have fun and do activities they enjoy. That's their main concern. Swimming and bicycling may be fun and provide health benefits, but not all children may find those activities enjoyable.

Some children love to play sports, even watch them. However, if a child has exercise induced asthma, isn't participating in a sport too dangerous? Of course not. There are sports that children with asthma play, and might even be better at it then some of their non-asthmatic teammates.

For example, soccer is a great sport that children with asthma can play, with just minor restrictions. There are some positions in soccer that require less continuous running, giving the child a break for their breathing to become normal again. Goalie is a great position for a child with asthma because there isn't much running; it requires more thinking and reflexes then anything else.

Another "asthma friendly" position is that of defense, because it doesn't require the child to run up and down the field in comparison to the position of a forward.

Participating in a sport can have an enormous affect on a child, because it enables him/her to be an important asset to the team, gives him/her the opportunity to participate with his/her peers, and increase his/her strength and endurance. Soccer involves running, paying attention to the ball and fellow teammates, coordination for kicking the ball, and an understanding of the sports rules and strategies, all of which a child with asthma can do. Soccer is a sport that a child with asthma can easily play, given that the necessary precautions are taken into account, and at the same time gives the child a sense of self worth!

SUMMARY
To summarize, exercise induced asthma doesn't have to be a limiting disorder if its properly controlled, and all the necessary preventive measures, including physician clearances, are observed. It's extremely important for children with asthma to continually be active. The disorder should not be used as an excuse for a child to not exercise or take part in physical activities.

With the necessary knowledge, and determination, children with asthma can live to do anything a child without asthma can do, possibly even more. There are famous athletes who have asthma, but that didn't prevent them from accomplishing their goals and working hard to achieve their dreams. "Joanna Zeiger is a world class triathlete and former Olympian who has exercise-induced asthma. She is living proof that asthma doesn't have to stop you from achieving your goals" (5).

There are scores of people with asthma who have won Olympic medals competing against others who didn't have asthma. Jackie Joyner-Kersee, spokes-person for the Asthma Society of America, has asthma, and, she has won multiple Olympic track and field gold medals, and holds a world record in the long jump.

"Above all, encourage your child to stay active. Regular exercise is good for any child, asthma or no asthma. And, once your child controls his asthma on the basketball court or the soccer field, he'll have the confidence to control it the rest of his life" (4).

Participating in physical activity and sports not only improves a child's physical activities of strength, flexibility, and coordination skills, but also their social skills which can help give them a feeling of self worth. It's vital for children with exercise induced asthma to learn how to exercise for the main purpose of staying healthy. However, exercise may also increase their self confidence, and give them an overall balance between mind, body, and soul, which will help them succeed as they grow!

WORKS CITED
Exercise Induced Asthma
Rhoades, John. Asthma Friendly Sports-Bicycling
      (link no longer current)
Rhoades, John. Asthma Friendly Sports-Swimming
     (link no longer current)
Woolston, Chris. Asthma, sports, and Kids
Zieger, Joanna. Just For Kids: Dispelling the Myths of Exercise Induced Asthma

contributed by BRENT HARDIN, FEBRUARY 2004

Once you have a clear understanding of each student's individual abilities, look at modifying your present dance unit. While some specific examples will be provided in this section, it is important that you focus on the particular needs of your individual students when making modifications. The goal is to allow all students, including students with ambulatory disabilities, the opportunity to participate in a dance unit that is enjoyable, safe, and physically challenging.

DANCE PROGRESSIONS

A simple, yet effective way of introducing the concept of dance in an integrated manner is to start with hand dances, move to creative dance, and finish with partner dancing. This progression allows students to transition from simple dances that may be recognizable to them, to more complex dances that they are likely less familiar with.

Many students will have engaged in hand games such as Peas, Porridge, Pot, Macarena, or simple clapping and snapping. Hand dancing is merely a natural extension to these hand movement games. Once the students are comfortable working together and moving in time to the music, they are ready for more complex dances like creative dance and partner dancing. These dances build upon the initial teaching that involves movement, teamwork, expression, camaraderie, and fun.

HAND DANCING

Hand dancing is a matter of taking the "hand jive" we all know and love from "Grease" and using it in the classroom (if you have no idea what I'm talking about, run out and rent Grease!). Have students sit in a circle and give them a few basic hand movements. For example, you can start with a clap, clap, slap, slap; students clap twice in front of their chest, and then slap their thighs twice with both hands and repeat. Then you can add more elements, building upon what is already known. Thus you can have a whole series of movements that just involve upper body movement. You can either call out changes in movement, or call out a student's name and that person will initiate a new movement.

There are a myriad of other dances emphasizing upper body movements that will facilitate integration. For example, the "Macarena," a popular dance during the mid-1990s, is a good choice. Other choices that rely heavily on hand movements, and may be conducive for children with ambulatory disabilities are the "hand jive" and the "clap rhythm" (Harris, Pittman & Waller, 1999).

When the class finishes a hand dance, have them take their heart rate. Challenge the students to create and participate in other hand dances that allow them to increase their heart rate to enhance cardiovascular fitness.

CREATIVE DANCE

Creative dance can be used to express mood and emotion (Joyce, 1994). Using music that captures some type of feeling is the first part of creative dance. Once you have found music that suits the mood you want students to create, give students instructions on what components you would like to see incorporated in their dance. After your instructions, students can move around the room making different body shapes while expressing with their arms, legs, faces, and heads the emotions they are attempting to capture.

Since creative dance can be somewhat awkward feeling, it is a good idea to start students doing this individually before moving them into small groups. In addition, because students can get caught up in doing one movement, it is helpful to be clear about exactly what types of movement you expect.

Just as you did in hand dancing, ask the students to take their heart rate following creative dancing, and challenge the student to create creative dances that enhance cardiovascular fitness.

All students should be able to enjoy the fitness enhancing aspects of dance, and integrating children with ambulatory disabilities in a dance unit can be achieved with relative simplicity. Reasonable modifications will often allow students of all ability levels the opportunity they deserve to participate in typical dance units. By adhering to basic integration principles (Block, 1994), and using the above progression as a guide, you can integrate students with ambulatory disabilities and make dance meaningful and challenging for your entire class.

References

Block, M.E. (1994). A teacher's guide to including students with disabilities in regular physical education. Baltimore: Brookes.

Enya. (2001). Wild Child. Hollywood: Warner Brothers Records.

Harris, J., Pittman, A., & Waller, M. (1999) Dance awhile: Handbook of folk, square, contra, & social dance. 8th edition. New York: Macmillan.

Holst, G. (1998). The Planets. New York: Polygram Music.

Joyce, M. (1994). First Steps in Teaching Creative Dance to Children. 3rd edition. Mountain View: Mayfield.

contributed by KELLIE ROSSLOW and CHRISTINE STOPKA, JULY 2004

On August 13, 2001 life changed drastically for Sarah Kane, a first year teacher on her way home from work. A driver had missed a red light and smashed into the driver's side of Sarah's car. The driver of the other car was saved from significant injury due to the protection of a front end airbag. But with no side airbags, Sarah was not as fortunate; indeed, she was lucky to be alive.

Sarah had suffered a fracture around her right eye, a broken collarbone, a broken pelvis, and a broken leg. She also suffered a collapsed lung. But, the worst part was the injury to her brain, which was severely injured on the left side and in the back. Sarah suffered what is termed Traumatic Brain Injury (TBI). Traumatic Brain Injury is defined as the rapid acceleration and deceleration of the brain, including shearing of nerve fibers, contusion of the brain tissue against the skull, brain stem injuries, and edema.

For Sarah, nothing worked like it was supposed to. She spent four months in the hospital and a rehabilitation center. Before the accident, Sarah was as runner, former cheerleader, and she loved to swing dance. Now she longed just to be able to walk! After being released from the hospital and rehabilitation center she began attending physical therapy three times a week. Two years later, by July 2003, the steady progress had seemed to plateau. She and her family were starting to believe that this was the way things were pretty much going to be.

Then, a month later, Sarah learned of something called "Hippotherapy." No, it was not physical therapy for hippopotami, as many may think upon first hearing the name. Actually, "hippo" means horse, and Hippotherapy is physical therapy using the horse (or ponies, for the convenience of reaching and spotting), as a "tool" or a "medium" for the physical therapy (like water is used for physical therapy in the water, called aqua-therapy, the horse is used to enhance the rider's physical therapy).

So, in the Fall of 2003, Sarah began Hippotherapy. This therapy uses the multi-dimensional movements of the horse, and works to improve neurological function and sensory processing. As just one example, when the horse walks, the movement of the horse's pelvis moves the rider's pelvis in exactly the same way the rider's pelvis should move if the person were walking independently on land. Muscles get worked and re-educated, flexibility and coordination are improved, and endurance and balance are enhanced.

Indeed, on Sarah's first day, she arrived very dependent upon her wheelchair. Her speech was extremely hard to understand, and she was incredibly depressed. While being fully supported by the physical therapist, Sarah stumbled toward the horse. The horse's movement was used to evaluate Sarah's balance. Sarah barely had any balance; she was swaying all over the place, and with her energies devoted to surviving this, she was certainly not able to communicate verbally while on the horse. Clearly, Sarah's session was not long. The work of trying to maintain her balance, activation of old muscles, and trying to talk all took a toll on her.

However, during the following weeks, Sarah began showing improvements at each of her sessions. As a matter of fact, for her second session, she arrived at the barn not in her wheelchair, but walking with her walker. Her balance was steadily improving, and slowly her ability to talk while on the horse improved. By Sarah's third week of therapy she had shed her walker and was walking only with a therapy belt.

Her riding balance had also improved; she was not requiring the support of her hands throughout her session. Her depression was disappearing, and she was beginning to smile and laugh again. Sarah was showing steady improvement, however, as can be expected she still had her good and her bad days.

By March, 2004, about six months later, Sarah did not look or sound like the same person. Not only is Sarah frequently walking now with only minimal assistance, her speech is much more clear. People other than family and close friends are able to understand her now. She is able to eat with utensils, which is something that she hadn't been able to do since her accident.

Sarah's biggest challenge in the beginning was balance, and Hippotherapy, with its effect on trunk stability, has resulted in balance function being her most improved domain. And with so many other functions, including fine motor tasks dependent upon balance, Sarah has seen considerable improvements in all aspects of her activities of daily living - that is, her life.

Sarah now has much more control over all of her motor functions. At Sarah's last session before the summer break, she was riding the horse with her hands out to the side, requiring no support from her hands for balance and strength. Indeed, her trunk was stable and strong. As for her mental health, it had drastically improved; her family will be the first to say that she is back to her normal "spunky self."

People with traumatic brain injury, like Sarah, are showing improvements in many areas of their life - physically, mentally, and emotionally - because of Hippotherapy. Though Sarah would have never chosen to have a disability, she would not trade her time with her horse for anything. And with a little help from a four footed friend, what a difference a year can make!

contributed by Phillip Conatser, DECEMBER 2005

Within each health related activity there are multiple ways and/or combinations on how the topic could be presented. Also, note that depending on class population (e.g., autism, mental retardation, students that use a wheelchair) the teacher should focus activities toward their specific health related needs and interests.

For example, when choosing a nurse or doctor to be a guest speaker for a class of students who have autism and cerebral palsy, choose a presenter that has a background in that population(s). Teachers should always develop a curriculum that supports students, parents, community, and the IEP objectives.

Health Services Information
Ask the school nurse, counselor, or police officer to be a guest speaker for the class, or utilize from the community a dentist, doctor, or firefighter to share their expertise. The teacher and students should develop and send a list of applicable questions prior to the presentation. This will help foster discussion as well as prepare the presenter.

Learning How to Avoid Negative Behaviors
When teaching resistance skills, the student should practice several times with more than one rationale for a given scenario. The teacher should describe several uncomfortable behaviors student(s) with disabilities might be pressured by (e.g., smoking, drinking, stealing, skipping school, etc.), and then have the student(s) talk out, or physically act out, several correct ways to avoid the situation.

Saying "no," "I don't want to," "not now," "I’m busy," "That makes me sick," "I need to go home," "Let’s go play football," "Let’s go to my house and play," or "not saying anything," just teach students to physically turn and walk away are all good alternatives from doing unwanted behaviors.

For example, students with autism may not have good verbal skills, so the teacher could show them pictures of knifes or cigarettes and teach them upon identification that they need to physically remove themselves away from that object.

Learning How to Make Decisions
Each class, let students make low level decisions such as: when to take a break, where to play, how many balls will be used, what the class will drink, and/or who will be in each group. After the activity, ask students how the activity went, what made the activity fun and/or what would make the activity better next time. The teacher could note changes, if any, and repeat the activity next class.

Fire Safety Activities
Have students practice the "Stop, Drop, and Roll" technique, and discuss when this skill should be used. The teacher could also set up an obstacle course that resembles a house floor plan, and have students crawl, role, slide, and push their wheelchair to safety (bedroom, livingroom, front door, outside). Further, students could dress up as a firefighter or Santa Claus while practicing exiting techniques.

Another activity, using class time wisely, is to have students identify exits, smoke detectors, and fire alarms while walking to the gym. Remember, students with disabilities may need many practices beyond that of the nondisabled students in order to acquire skills. The teacher should provide instruction that includes lots of physically participation, demonstration, pictures, and verbal clues.

Bicycle Safety Activities
Have students learn how to ride correctly through an obstacle course that has stop signs, yield signs, railroad crossing signs, and/or a traffic lights. They should also learn what side of the road to ride on, and to wear a bicycle helmet. The signs should be constructed, with the students, to foster awareness and promote "rules of the road" discussion.

This activity could first be conducted in the gym, and then moved to the school parking lot if safety permits. Note: Many students with disabilities enjoy riding, but do not like to, or know how to, "stop" their bike. Therefore, teaching students how to stop and/or avoid hitting each other, or objects while riding are good beginning skills.

Due to the length of the article versus the height of this column, please finish reading this article in the archives. It's all linked up, so just CLICK and enjoy!