"They're Either Going to Find Ways to Include You or They're Just Kind of Not": Experiences of Students With Orthopedic Impairments in Integrated Physical Education.

This study explored the experiences of students with orthopedic impairments in integrated physical education (PE) classes. An interpretative phenomenological analysis research approach was used, and six students with orthopedic impairments (age = 10-14 years) served as participants. Data sources were semistructured, audiotaped interviews and reflective interview notes. Based on data analysis, three themes were developed-"Without it, they probably would like, just treat me normal," visibility, disclosure, and expectations; "I sit out," limited participation and a lack of modifications/accommodations; and "PE doesn't feel great," social interactions and perception of self. The experiences portrayed throughout these themes highlight the marginalization and lack of access that the participants encountered in their integrated PE classes. The findings indicated that PE professionals working with students with orthopedic impairments may benefit from reflecting on personal biases and their instructional practices in an effort to improve the quality of PE experiences for these students.

Structured Instruction With Modified Storybooks to Teach Morphosyntax and Vocabulary to Preschoolers Who are Deaf/Hard of Hearing.

Children who are deaf/hard of hearing (D/HH) are at risk for diminished morphosyntactical and vocabulary development. The purpose of this study was to examine the effects of repeated reading combined with structured instruction. Targets were a morphosyntactical form and novel vocabulary words. Participants were 3 preschoolers who are D/HH who were receiving instruction with an oral approach. Data from a multiple baseline design indicated that all children acquired the targeted skills and demonstrated high levels of generalization of these skills to untrained context. Implications for teaching young children who are D/HH using repeated storybook reading are discussed.

"Everybody Wants to be Included": Experiences with 'Inclusive' Strategies in Physical Education.

This study examined how students with orthopedic impairments experienced strategies identified in the literature to support 'inclusion'. An interpretative phenomenological analysis research approach was used, and six students with orthopedic impairments (age 10-14 years) served as participants. Data sources were written prompts, semi-structured, audiotaped interviews, and reflective interview notes. Based on thematic data analysis, four themes were constructed: "It's kind of embarrassing": experiences with support; "I don't want to be different": equipment, activity, and rule modifications; "I like to be a part of the conversation": autonomy and choice in PE; and "I would rather be like the other students": discussing disability. The experiences portrayed through these themes highlighted the differential effects of these explicated strategies, where each strategy contributed to feelings of inclusion, as well as marginalization among participants. As such, the findings indicated that 'inclusive' strategies should not be considered as blanket recommendations; instead, attempts to promote 'inclusion' of students with disabilities should start with a reflexive look at the unique needs of each individual student.

Using Two Formats of a Social Story to Increase the Verbal Initiations and On-Topic Responses of Two Adolescents with Autism Spectrum Disorders.

This research used an alternating treatment design to investigate the relative effectiveness of participant specific social stories delivered using two distinct formats (i.e., technology-based, paper/book), on increasing the frequency of initiations and responses of two adolescents with ASD. Visual analysis of baseline, intervention, maintenance, and generalization data results indicated the intervention increased the frequency of initiations and on-topic responses regardless of delivery format; however, calculation of Percentage of Nonoverlapping Pairs and TAU-U for both formats indicated variable levels of effectiveness for each condition, with ranges of 43-86% and 0.02381-0.76190 respectively. Finally, despite varied results, both participants preferred the technology-based social story format and parents of both participants agreed the social story intervention increased communicative skills.

Are Gait Biomechanics Related to Physical Activity Engagement? An Examination of Adolescents with Autism Spectrum Disorder.

PURPOSE: Adolescents with autism spectrum disorder (ASD) rarely meet physical activity (PA) guidelines, thus not reaping associated health benefits. Although many barriers exist, abnormal or inefficient gait biomechanics could negatively impact engagement in PA. This study has two purposes: first, to compare total body mechanical work between adolescents with ASD and neurotypical age-, sex-, and body mass index-matched controls, and second to determine whether gait biomechanics are significantly related to engagement in PA. METHODS: Twenty-five adolescents (age, 13-18 yr) with ASD and 17 neurotypical controls (eight with ASD had no match) participated in the study. Three-dimensional motion capture and force platforms were used to record and analyze gait biomechanics at self-selected speeds and a standardized 1.3 m·s-1. Total body mechanical work (sum of joint works across lower extremity, low back, torso, and shoulders) was compared between groups (n = 17 for each) and speeds using a mixed model analysis of variance. Average daily light PA, moderate to vigorous PA, and total PA was recorded for the entire data set with ASD using triaxial accelerometers worn for 1 wk. Regression analyses were performed between work, stride time variability, speed, and stride length with each PA variable. RESULTS: Adolescents with ASD generated 9% more work compared with the controls (P = 0.016). Speed and stride length were significant regressors of light PA, moderate to vigorous PA, and total PA, explaining greater than 0.20 variance (P < 0.02 for all regressions). CONCLUSIONS: Although adolescents with ASD walked with significantly greater work, the complex full-body variable is not significantly related to engagement in PA. In agreement with research spanning multiple populations and ages, speed and stride length are indicative of PA engagement in adolescents with ASD.

Use of a Simulated-Virtual Training Module to Improve Dental Hygiene Students' Self-Reported Knowledge, Attitudes, and Confidence in Providing Care to Children with Autism Spectrum Disorder: A pilot study.

Purpose: Autism spectrum disorder (ASD) is a developmental disorder affecting an individual's ability to communicate, interact, behave, and learn. The purpose of this study was to determine knowledge, attitudes, and confidence of dental hygiene students in providing care to children with ASD as a mechanism for evaluating dental hygiene curricula for patients with special needs.Methods: A simulated-virtual training (SVT) intervention was developed as an interactive approach for educating dental hygiene students on providing care to a child patient with ASD. The SVT intervention consisted of a scenario in which the clinician "interacted" with a child with ASD who was having difficulty in the dental environment. Pre- and post-test surveys measured students' knowledge, attitudes, and perceived confidence related to providing dental hygiene services to children with ASD prior to and following the intervention. The Wilcoxon Signed Rank was used to determine statistical significance at the p=.05 level.Results: Thirty-three second year dental hygiene students completed the pre- and post-test surveys for a response rate of 97%. Statistically significant differences were observed for self-reported confidence to provide care to patients with ASD upon graduation, assessment of the unique needs of children with ASD, and an understanding of the dental needs for children with ASD (p<0.05). Participants' confidence with performing dental hygiene services on children with ASD greatly increased, with statistically significant difference found for almost all services (i.e., oral exam, oral hygiene instruction, oral photos, radiographs, scaling, fluoride treatment; p<0.05) except selective polishing. Most (90%) agreed that there is a need for additional/elective resources to help increase comfort in providing care to children with ASD.Conclusion: Results indicate the SVT intervention increased students' knowledge, attitudes, self-perceived confidence, and comfort. Dental and dental hygiene curricula could include technologies and intervention methods to advance access to dental care by children with ASD.

Walking lower extremity biomechanics of adolescents with autism spectrum disorder.

Although the literature indicates children with autism spectrum disorder (ASD) walk at slower speeds and altered kinematics compared to neurotypical controls, no research has examined walking at matched speeds. This study examined biomechanical differences between adolescents with ASD and matched (age, sex, and body mass index) neurotypical controls. Lower extremity biomechanics of seventeen adolescents with ASD and seventeen controls were compared at matched speeds: self-selected and a standardized 1.3 m/s. Controls exhibited greater eversion angles and hip abduction moments compared to those with ASD. This study found adolescents, which may have a more mature gait than young children, walk with a similar pattern in the propulsive plane (i.e. sagittal) as neurotypical controls, but with alterations in the supportive plane (i.e. frontal).

A Feasibility Study of Autism Behavioral Markers in Spontaneous Facial, Visual, and Hand Movement Response Data.

Autism spectrum disorder (ASD) is a neurodevelopmental disability with atypical traits in behavioral and physiological responses. These atypical traits in individuals with ASD may be too subtle and subjective to measure visually using tedious methods of scoring. Alternatively, the use of intrusive sensors in the measurement of psychophysical responses in individuals with ASD may likely cause inhibition and bias. This paper proposes a novel experimental protocol for non-intrusive sensing and analysis of facial expression, visual scanning, and eye-hand coordination to investigate behavioral markers for ASD. An institutional review board approved pilot study is conducted to collect the response data from two groups of subjects (ASD and control) while they engage in the tasks of visualization, recognition, and manipulation. For the first time in the ASD literature, the facial action coding system is used to classify spontaneous facial responses. Statistical analyses reveal significantly (p <0.01) higher prevalence of smile expression for the group with ASD with the eye-gaze significantly averted (p<0.05) from viewing the face in the visual stimuli. This uncontrolled manifestation of smile without proper visual engagement suggests impairment in reciprocal social communication, e.g., social smile. The group with ASD also reveals poor correlation in eye-gaze and hand movement data suggesting deficits in motor coordination while performing a dynamic manipulation task. The simultaneous sensing and analysis of multimodal response data may provide useful quantitative insights into ASD to facilitate early detection of symptoms for effective intervention planning.

Interventions for the Reduction of Dental Anxiety and Corresponding Behavioral Deficits in Children with Autism Spectrum Disorder.

PURPOSE: Autism Spectrum Disorder (ASD) can greatly inhibit a child's communication and social interaction skills, impacting their comfort during dental hygiene treatment and services. Children with ASD may exhibit sensory sensitivities, fear of the unfamiliar and lack of socio-cognitive understanding, leading to anxiety and corresponding behavioral deficits. Since the prevalence rates for ASD have risen significantly in the past decade, increased emphasis has been placed on educational and behavior guidance techniques, which can be helpful for children with ASD because of their increased capabilities in visual-processing. The purpose of this literature review is to summarize the interventions available to reduce dental anxiety in children with ASD, and to determine which strategies are best suited for implementation by the dental hygienist. Advancements in technology and socio-behavioral interventions were assessed for appropriate use, efficacy and engagement in the target population. Interventions were categorized into the following groups: picture cards, video technologies and mobile applications.