482 various formats to meet the requirements of the various regulatory systems. Resources Since the challenge of providing services to this population is an emerging area of service delivery, it may be helpful to consult current journals in geriatrics and developmental dis- abilities, Periodicals such as Mental Retardation, American Tournal of Mental Retardation, and Journal of the Association for Persons with Severe Handicaps may be helpful. Also, the Administration on Developmental Disabilities has funded selected University Afiiated Programs to develop training and service programs specifically for older persons with de- velopmental disabilities. These programs offer multimedia information and are available to train service providers in providing appropriate care to elders with developmental dis- abilities (Box 31-4) Box tt University Aretiiatep Prookams — WITH SPECIEIC PROGRAMS FOR OLpeR PuRSONS wire f DEVELOPMENTAL Disaniirrizs: + Unversity Aft Progra for Developmental Dib, Ua versity of Arkansas, James I Denais Development Center, 1612 ‘Maryland; Lite Rock, AR 72202, (91) 569-3164 + Mostar Cate for Child Deelaones, invest of Mian, Schoal of Medicine, PO. Bex 01620, D-820, Miami FL 3310), (20s) 547-5655, + Itt jor Saud of Developmental Disabilities, Indiana Univer: sy. 2859 E1005 St Bloomington, IN 7408-2601, (812) 855 + Bunce Sbriver Center, 200 Trapelo Road, Walther, MA 02125, (617) 734-7508, + Inte for Human Development, Univers of Misous-Kaases ity, 22200 Files St, Third Floor, Kansas City, MO 64108, (6) 235-177 + Strang Comer for Developmental Disables, University of Rochester Medial Contes, 601 Ehnwood Ave, Rechestr, NY 14642, 716) 275-2966 + Nout Dakoes Cee for Developrrntal Disabites Minot State Universi. 500 University Ave, W Minot, ND 5K071, (701) #57 Case Studies Case 1 Zachary is a 67-year-old man with mild-moderate mental retardation and cerebral palsy of the spastic diplegic type. He is able to communicate verbally. He lives in an interme- iate-care facility and attends a day treatment program, As «child, he walked with crutches and long leg braces. He had, +hamstring lengthenings and heeleord lengthenings at age 10, years and again when he was 14 years old, As he got olde, Part Five PROGRAMS FOR PARTICULAR POPULATIONS he continued to walk with crutches but without the braces, By the time Zachary reached 60 years old, his gait had slowed considerably and he was encouraged to use a wheel- chair by the staff at his day treatment program. A manual wheelchair was purchased for Zachary when he was 62 years old. By 67, Zachary had gained 17 pounds and his wheel- chair needed to be replaced. The range of motion in Zachary’s legs had become more limited, making even stand-pivot transfers difficult. Planning and implementing a program appropriate for Zachary involved a comprehensive examination as previ- ‘ously described. Through an interview with Zachary and his ‘care-givers, it was found that Zachary was somewhat de- pressed regarding his inability to walk. He also was found to hhave an interest in improving his ability to manage transfers to and from the toilet independently, The care-givers stated that Zachary enjoyed swimming and was independent in the shallow water at the pool ‘The information gained from the informal interview was enhanced by the structured interview of the PEDI, This data coupled with the information gained from the neuromuscu- lar assessment allowed the therapist to create appropriate goals and a tealistic plan that involved the desires of Zachary and his care-givers. Independence in stand-pivot transfers was one goal. To achieve that goal, the therapist instructed Zachary's care- givers on performing tcansfers with the client and encourag- ing greater assistance from Zachary. The plan involved hav- ing Zachary practice this transfer each time he needed to use the bathroom. To create a program that was more likely to help Zachary reach his goals, the staff at the day treatment program also received training and agreed to follow the plan as designed. The therapist monitored progress weekly for 1 ‘month and then monthly for another 2 months to ensure progression toward the goal. Additionally, building on Zachary’s interest in swimming, the team designed a swim ‘ming program that would (1) promote cardiovascular fit- ness and weight loss and (2) improve lower extremity strength. Both of these goals would assist him in reaching his stand-pivot goal as well. Activities included swimming l and practicing standing and walking in the water, The recre- ational therapist monitored the program monthly with an agreement to contact the physical therapist with any ques- tions or concerns. In collaboration with the social worker and physician, a now, appropriate wheelchair was prescribed and obtained for Zachary. Zachary and his care-givers were consulted to ensure that the chair was functional for him and would be easily transportable. The therapist assessed the wheelchair ona quarterly bass for safety fit, and function. The therapist taught the staff appropriate wheelchair care and nance. Zachary and his care-givers were pleased! with the pro- gram because it took into consideration everyone's needs and Zachary’s desired outcome, Zachary was pleased be painte- -Chapter 31 Otne Persons writ Deveronsten tas Disasiurris 483 cause he was ableto practice “walking” inthe water, which he enjoyed. He was motivated to practice the stand-pivot trans fer because he wanted to regain the ability to transfer inde- pendent. This intervention program proved to be quite successful. At the end of 3 months, Zachary had lost weights was able to complete standing. pivot transfer with only stand-by assistance; and his new wheelchair was modern and streamlined, allowing him to maneuver in his home more ef ficiently. The success ofthis program was due to the collab: oration among al team members including Zachary and the fact that it was based on Zachary's desired outcomes. Case 2 Lisa is 71 years old and has a diagnosis of mild mental rtar~ dation. She lives in a community residential facility and at- tends an integrated adult day care program ata local nursing home, Lisa ambulates independently on all surfaces includ= ing stairs. he is independent in activities of daily living, She is able to take a bus to a destination, after she has been shown three to four times. Lisa has always enjoyed riding a stationary bike, but her knees and hips have begun to bother her. She has been diagnosed as having osteoarthritis, and hee physician suggested that she find an alternate activity to re- place the stationary bike riding ‘Upon interviewing Lisa and the supervisors of her CRE, it ‘was discovered that Lisa once enjoyed swimming, but since she had moved to this particular facility 7 years ago, there had been no opportunity for this activity. The physical ther- apist realized that Lisa was not in need of his direct services, Dut he fele that she could benefit from a non-weight-bearing cxercise program. The physical therapist collaborated with the group home supervisor, recreational therapist, and social worker f0 involve Lisa ina regular swimming program. The social worker found a companion to accorapany Lisa on the bas to a local indoor pool. The recreational therapist arranged with the staff atthe pool to have Lisa participate in a water aerobics class. The adult day care staf were made aware that Lisa would be coming in late on Wednesdays and Fridays—the days she would participate in the aerobics pro- ‘gram, The physical therapist was available to consult with the home care providers, recreational therapist, and pool staf, if necessary. Lisa and the staff were pleased with the progress. Lisa ex- perienced a problem often seen in the aging population, but her developmental disability made it difficult for her to ac- «ess appropriate care and activities. The therapist in consul tation with other members of the interdisciplinary team found an activity that Lisa enjoyed and created an effective program for her. Through a collaborative effort, a program ‘was implemented that met the patient's needs Summary Information regarding aging individuals with developmen. tal disabilities has recently begun to receive attention in the literature, Older persons with developmental disabilities have begun to be recognized by service providers and policy rakers asa large heterogeneous group who require special- ized services integrated into the service system of the geneva population of elders. ‘This chapter reviewed the legal mandates and social pol- icy impetus guiding service to this group. The role of the physical therapist in examining individuals and assisting team members with designing appropriate, holistic habilita tion plans was presented. Although litte information is available on specific aspects of the aging process in develop- mental disabilities, aspects of aging in persons with Down syndrome and cerebral palsy were discussed. Physical therapists are in a unique position to assume leadership roles in the care of elders with developmental dis- abilities and develop integrated programs of habilitation. Additionally, a critical role for physical therapists will be to design and foster leisure skill programming for these per- ‘ons that will promote and maintain functional skill. Phys ical therapists also are in a position to effect system change, specifically recognizing the importance of leisure skill pro- gramming and creating reimbursement strategies that will take leisure skill programming into consideration. REFERENCES Bodh Wet le Alathisia in ads with mental retaedation: Develop ment ofthe Alathisa Reins of Movernent Seale (ARMS), am J Ment Retard 1997, 1013-433, Brock DB, Gusluk JM, Brody IA: Demogeaphy aad epidemiology of ‘ging in the United State in Schneider EL Rowe JW feds) Handbook ofthe Bolg of Aging 3. 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