David Braddock

Overweight Prevalence in Persons With Down Syndrome

Prevalence of overweight among the general population has been reported to be 33% for males and 36% for females. We undertook this study to establish overweight prevalence data in a cohort with Down syndrome and to stratify the incidence of overweight by living arrangement. We measured Body Mass Index (BMI) in 283 persons with Down syndrome and found a higher prevalence of overweight in this group compared to the general population. Individuals with Down syndrome living in a family setting had a higher incidence of overweight than did those living in a group home setting. Overweight prevalence among persons with Down syndrome should be considered a major public health concern that warrants further attention from researchers, practitioners, family members, and individuals with Down syndrome.

Health characteristics and behaviors of adults with mental retardation residing in three living arrangements

Three hundred and twenty-nine subjects (aged 17-70 years) residing in an institution (N = 184), group home (N = 39), or with one or more family members (N = 106) were evaluated on body composition, blood lipids, and health behaviors. Subjects in the institutional group had lower body weights than those in the group home and natural family settings (p < .001) and also had lower BMIs and percent body fat levels compared to those in the natural family (p < .001). The institutional group also had lower total cholesterol and LDL-C levels than the group home and natural family groups (p < .001) and lower TG and ratio of total cholesterol to HDL-C than the natural family group (p < .01). Although overall use was quite limited, residents in the group home setting smoked more cigarettes, drank more alcohol and coffee, and exercised less than those in the institution and natural family (p < .001). Group home residents also exercised less. Health promotion and disease prevention initiatives for persons with mental retardation living in group homes, in supported living placements, and with their natural families should be undertaken and carefully evaluated.

Research on physical activity and disability: an emerging national priority.

Despite the voluminous amount of research that has been published in the field of exercise science over the past three decades, there remains a paucity of information on the activity patterns and physiological responses to exercise in persons with disabilities. In an era when physical activity has grown to new heights in terms of its importance in promoting health and preventing disease, many questions pertaining to how it affects the lives of individuals with physical disabilities remain unanswered. The purpose of this paper is to review the prevalence of disability in the United States and to present recommendations for future research on physical activity and disability. A related objective of this paper is to encourage exercise scientists to undertake research on this increasingly significant group of American citizens.

Health Promotion for People with Physical, Cognitive, and Sensory Disabilities: An Emerging National Priority.

Despite the growth in health promotion programs for able-bodied people, very little effort has been devoted to developing programs for people with physical and cognitive disabilities. Programs for people with disabilities must be developed with full recognition of limitations caused by both the primary and secondary disability.

Emerging Technologies and Cognitive Disability

Despite the potential of emerging technologies to assist persons with cognitive disabilities, significant practical impediments remain to be overcome in commercialization, consumer abandonment, and in the design and development of useful products. Barriers also exist in terms of the financial and organizational feasibility of specific envisioned products, and their limited potential to reach the consumer market. Innovative engineering approaches, effective needs analysis, user-centered design, and rapid evolutionary development are essential to ensure that technically feasible products meet the real needs of persons with cognitive disabilities. Efforts must be made by advocates, designers and manufacturers to promote better integration of future software and hardware systems so that forthcoming iterations of personal support technologies and assisted care systems technologies do not quickly become obsolete. They will need to operate seamlessly across multiple real-world environments in the home, school, community, and workplace.

Adult Day Programs versus Supported Employment (1988–2002): Spending and Service Practices of Mental Retardation and Developmental Disabilities State Agencies:

While supported employment has made significant gains since its formal introduction in 1984 (P.L. 98–527), segregated services continue to outpace the growth of supported employment. We discuss these and other important trends in this article, and conclude with recommendations that include (1) ensuring that all young adults leave high school competitively used or admitted to postsecondary education by age 18 and (2) that high schools coordinate post-placement follow-up for 3 years following employment or enrollment in postsecondary education. These recommendations are made because although current research suggests practices exist to employ persons with severe disabilities outside sheltered workshops and adult day care centers, these programs continue to grow at an alarming rate. In fact, the growth of supported employment has all but stalled since 2000. Diverting people and resources at the juncture between high school preparation and assuming adult roles such as employment appears to be a more realistic plan to promote integrated services over the foreseeable future.

Physical activity patterns of African-American women with physical disabilities

UNLABELLED There is a dearth of research on the exercise and activity patterns of persons with disabilities, particularly minority women with disabilities. This lack of information makes it difficult for public health officials to set policy guidelines for this segment of the population. PURPOSE The purpose of this study was to survey the exercise and activity patterns of African-American women with severe physical disabilities (N = 50). METHODS The Physical Activity and Disability Survey (PADS) was created for subjects who have a severe limitation in movement and function (e.g., limited ability to stand or walk, needs an assistive aid to ambulate, needs assistance with activities of daily living). Reliability data were obtained on the PADS for interrater, test-retest, and internal consistency on the two subscales (Exercise and Activity). The Exercise subscale had an interrater reliability of 0.83 and test/retest reliability of 0.85. The Activity subscale had an interrater reliability of 0.68 and test/retest reliability of 0.66. Cronbachs alpha for internal consistency was 0.78 for the Exercise subscale and 0.68 for the Activity subscale. RESULTS Results showed very low levels of exercise and general activity patterns in African-American women with physical disabilities. Only 8.2% of the sample participated in leisure-time physical activity, and only 10% engaged in aerobic exercise three or more days per week for at least 15 min. Unstructured physical activity (e.g., work-related activity, housework, gardening, shopping) was nearly absent. CONCLUSION Our data suggest that the extremely low levels of self-reported physical activity in African-American women with severe physical disabilities expose them to a higher risk of secondary health conditions.

Home and Community Based Services (HCBS) Waivers: A Nationwide Study of the States

In fiscal year (FY) 2009, the Medicaid program funded over 75% of all publicly funded long-term supports and services (LTSS) for individuals with intellectual and developmental disabilities (IDD) in the United States ( Braddock et al., 2011 ). The majority of spending was attributed to the Home and Community Based Services (HCBS) Waiver program. In FY 2009, federal-state spending for the HCBS Waiver program reached over

Family Support in the United States: Financing Trends and Emerging Initiatives

25.1 billion and constituted almost half of total funding across the nation that year ( Braddock et al., 2011 ). Considerable effort has been spent investigating Medicaid program expenditures, however, due in part to the unique and state-specific nature of HCBS programs, national-level analysis on the types of services offered to individuals with IDD has not been available. A full understanding of the supports available through the Medicaid program is critical as the United States considers strategies for economic recovery among competing state and federal budget priorities. This article presents the results of an analysis of 88 Medicaid HCBS Section 1915(c) waiver applications for individuals with intellectual and developmental disabilities in 41 states and the District of Columbia. It analyzes IDD data and trends close to the real time intent of states and empowers advocates in presenting timely solutions to real-time issues.

State of the States in developmental disabilities: 2004.

Trends in family support spending and new programmatic initiatives across the country during the 1990s are summarized. Nationally, total spending for family support exceeded