C A S E R E P O R T

The Implementation of a Fitness

Program for Children with
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Disabilities: A Clinical Case Report

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Joe Schreiber, PT, MS, PCS, Greg Marchetti, PhD, PT, and Theresa Crytzer, PT, DPT
Department of Physical Therapy, Chatham College (J.S.), Department of Physical Therapy, Duquesne University (G.M.),
and Western Pennsylvania School for Blind Children (T.C.), Pittsburgh, Pennsylvania

Purpose: The purpose of this report is to describe a community-based fitness program developed and imple-
mented for children with disabilities. Several outcomes are reported for one of the participants, J, an 11-year-
old girl with hypotonia and mild mental retardation, to illustrate the strengths and limitations of this program
and to help guide clinicians and researchers in developing and critically assessing the effectiveness of similar
programs. Summary of Key Points: The fitness program, called “Off the Couch,” (OTC) was provided in
six-week sessions for one hour per week. Outcomes examined included the energy expenditure index (EEI),
rating of perceived exertion (RPE), maximum running velocity, and the overall daily activity level of the child
and the number of exercise sessions that the child participated in over a two-week time period. J demonstrated
a reduction in EEI and a slight improvement in maximum running velocity. Activity level remained at a
relatively high level. The program is discussed with respect to feasibility in a clinical setting, suggestions for
similar programs and areas for related research. J’s outcomes are discussed in terms of their functional
relevance. (Pediatr Phys Ther 2004;16:173–179) Key words: case report, child, mental retardation, physical
therapy/methods, physical fitness, energy metabolism, exertion, cardiovascular physiological processes

INTRODUCTION programs and facilities.2 Barriers to participation in com-

Children are at risk for inactivity and decreased fit-
ness. The amount of time that youths spend in physical
activity has decreased markedly over the past decades.1
Children with disabilities are at even greater risk for de-
creased activity and fitness levels. Community youth
sports programs, traditional physical education classes,
and community fitness centers may not accommodate in-
dividuals who cannot keep up well enough to participate.2
Adaptive physical education may be more focused on par-
ticipation and skill development than on lifelong fitness
education. Both children and adults with disabilities may
be limited in their ability to access community exercise
0898-5669/04/1603-0173
Pediatric Physical Therapy
Copyright © 2004 Lippincott Williams & Wilkins, Inc.
Address correspondence to: Joe Schreiber, Department of Physical Ther-
apy, Chatham College, Woodland Road, Pittsburgh, PA 15232. Email:
jschreiber@chatham.edu
Grant support: This work was supported by a grant from the Federation
of Independent School Alumni, Pittsburgh, Pennsylvania.
DOI: 10.1097/01.PEP.0000136007.39269.17
munity exercise programs include inadequate transporta-
tion, inaccessible exercise equipment, and poorly trained
fitness professionals and exercise instructors.2 Children
who have difficulty keeping up with their peers with no
disability or accessing and utilizing community sports and
recreation facilities are more likely to lead a sedentary life-
style.3,4 Children with physical disabilities tend to have
significantly lower levels of habitual physical activity, con-
sider themselves less fit relative to their peers, and report
more limitations for physical activity participation.3,4
Only 29% of children with physical disabilities report
themselves as being active.3 Activity levels are higher
among children with less severe physical disabilities
such as hearing impairment or chronic medical condi-
tions. However, even in these populations, the percentage of
active youths was reported to be only about 50%.3 This is well
below the desired health promotion targets established in
Healthy People 2010 guidelines that suggest that 90% of
youths should be regularly involved in physical activity.5
Given these low levels of activity, children with dis-
abilities are at increased risk of sedentary lifestyles that will
continue throughout their lives.3 Activity levels in adult-
hood are usually lower than during childhood.6,7 Previous

Pediatric Physical Therapy Fitness Program for Children with Disabilities 173
 exercise experience is a significant determinant of adult
exercise behavior.7,8 Poor fitness, inactivity, and subse-
quent obesity can potentially predispose children to a
number of future health problems such as hypertension,
type II diabetes, cardiovascular disease, and coronary heart
disease. Individuals with disabilities may be at even greater
risk of these health problems. For instance, compared with
their peers with no disability, children and adolescents
with mental retardation typically have lower levels of mus-
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cular endurance, lower levels of cardiorespiratory fitness,
and a higher incidence of obesity.9 –11 Children with a diag-
nosis of cerebral palsy present with decreased muscle
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strength and cardiovascular endurance when compared
with age-matched peers.12–15 Additionally, research indi-
cates that the incidence of cardiovascular disease and cor-
onary heart disease is significantly higher in adults with
physical disabilities.16 –21
In addition to being at risk of cardiovascular compli-
cations, children and adults with disabilities are suscepti-
ble to long-term secondary problems. These include osteo-
porosis, osteoarthritis, decreased balance, strength,
endurance, and flexibility, increased spasticity, depression,
skin problems, and other conditions.22–24 This increased
susceptibility is often exacerbated by inactivity and de-
creased physical fitness. These secondary conditions can
potentially have a devastating impact on independence and
function. Osteoporosis, fracture, osteoarthritis, and spas-
ticity can lead to pain and impaired motion and func-
tion.22–24 Decreased strength, balance, and endurance can
lead to increased risk of falls and injury along with in-
creased energy costs and fatigue during activities of daily
living.22–24 All these factors may lead to an inability to live
independently, poor educational and vocational attain-
ment, difficulty with developing and maintaining social
relationships, difficulty with motivation and persistence,
and depression and low self-esteem.22,23
The adverse effects of inactivity and decreased fitness
may be reduced with involvement in fitness programs
aimed at establishing lifelong health promotion.2 For chil-
dren with disabilities, the direct benefits of a community-
based, preventive fitness program include improved partic-
ipation in daily living activities, increased strength and
cardiovascular fitness, improved self-esteem, and im-
proved social competence.22,25 The indirect benefits may
include decreased pharmacological and surgical interven-
tions, improved independence with activities of daily liv-
ing, and decreased likelihood of secondary conditions.22,25
In Healthy People 2010, the definition of health promotion
for people with disabilities consists of four parts: the pro-
motion of healthy lifestyles and a healthy environment, the
prevention of health complications and further disabling
conditions, the education of the person with a disability to
understand and monitor his or her own health and health-
care needs, and the promotion of opportunities for partic-
ipation in common life activities.5 Goals of a fitness pro-
gram for people with disabilities should therefore include
eliminating barriers to participation, educating caregivers
regarding the benefits of exercise, increasing the activity
174 Schreiber et al
level, reducing the impact of a sedentary lifestyle on med-
ical and secondary conditions, providing an opportunity
for leisure and enjoyment, and enhancing the quality of
life.2,26,27
Physical therapists can play an important role in the
integration of fitness programs into the lives of children
with disabilities.28 Physical therapists provide direct ser-
vices in both school- and community-based programs.
Cardiovascular fitness and endurance activities are fre-
quently goals for children in these programs and are there-
fore important components of intervention programs. Be-
cause other fitness professionals may be inexperienced in
working with children with disabilities, physical therapists
might also function to develop community fitness pro-
grams aimed at this population.2 In fact, adolescents with
cerebral palsy participating in a community fitness pro-
gram developed and implemented in part by physical ther-
apists demonstrated significant improvement between pre-
and post-measures of strength and perception of physical
appearance. Positive psychological effects were identified,
indicating that many of the program participants “began to
take responsibility for their own physical fitness.”25
The purpose of this case report is to describe a com-
munity-based fitness program developed and implemented
by physical therapists for children, ages eight to 13 years
and open to all children, regardless of level of disability.
Several outcomes are reported for one of the participants, J,
an 11-year-old girl with hypotonia and mild mental retar-
dation. This outcome information is presented in an effort
to illustrate the strengths and limitations of this program
and to help guide clinicians and researchers in developing
and critically examining the effectiveness of similar pro-
grams in the future.
Program Description
The “Off the Couch” (OTC) program is a community
fitness program designed for children aged eight to 13
years, with a special emphasis on children with disabilities.
This six-week program is provided in one-hour sessions
once per week. The program is supervised by a physical
therapist and a physical therapist assistant and is staffed by
a number of volunteers from high schools and universities.
The goal of this program is to provide an opportunity for all
children to exercise and develop good health habits in an
enjoyable, noncompetitive, supportive atmosphere. Edu-
cational materials are provided to both the children and
their families on the importance of regular exercise, proper
nutrition, and lifelong fitness. Although this is a group
program, each child follows an individualized program
during a segment of each session. Individualized programs
are designed by the program supervisors and based on a
brief screening process at the start of each session. (See
Appendix A for a more detailed description of the OTC
program and activities.) The children and their families are
provided with a copy of the child’s individualized program
and are encouraged to continue to exercise at home, both
during and after the six-week session. A nutritionist is
Pediatric Physical Therapy
 available for group and individual counseling for the chil-
dren and families as a component of this program.
CASE REPORT
At the time of program participation, J was an 11-year-
old girl with a diagnosis of mild mental retardation and
hypotonia. J was 60 in. tall and weighed 127 lb. She was
generally healthy with an unremarkable medical or birth
history. J was independently ambulatory in the community
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and able to complete most activities of daily living indepen-
dently. She participated in top soccer and an adaptive
swimming program. J received twice-weekly physical ther-
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apy during this time period and attended a community
elementary school in a life skills program. Physical therapy
goals focused on abdominal, trunk, and lower extremity
strengthening, balance, and coordination. Parental consent
and child assent were obtained to use the data for this case
report. The Institutional Review Board of the Washington
Hospital approved this case report project.
Outcome Measures
Program effectiveness was evaluated using a number
of different outcome measures. These included the energy
expenditure index (EEI), rating of perceived exertion
(RPE), and maximum running velocity. These measures
were chosen for a number of reasons. Each measure was
relatively easy to obtain during the program sessions. In
addition, these measures also aided the program supervi-
sors in developing the individualized program for each
child. The outcome measures chosen seemed likely to re-
flect possible changes that may occur as a result of an im-
proved fitness level. The energy expenditure required for
various daily activities may decrease over time, along with
the child’s perception of level of exertion.
The RPE was obtained after each activity using the
Perceived Exertion Scale for Children. This scale has been
shown to be a valid and reliable means of monitoring ex-
ercise intensity for children without disabilities.29 The re-
liability and validity of the RPE in children with mental
retardation have not been established. It is a 10-point scale
with colors and facial expressions that correspond to level
of exertion. This scale was explained to J during each ses-
sion as she sat quietly on a mat while her resting heart rate
was recorded. She appeared to have a good understanding
of these instructions.
Energy expenditure was measured via the EEI.30 The
EEI assesses the extent to which walking speed affects the
heart rate at self-selected walking speeds. The calculation
TABLE 1
Outcomes at Baseline and Six Weeks, and 10 Months Post-baseline
Running
Date of Entry EEI Velocity (m/sec)
6/26/00 0.874 2.3
7/31/00 0.960 2.1
3/16/01 0.41 2.4
EEI ⫽ energy expenditure index; RPE ⫽ rating of perceived exertion.
Pediatric Physical Therapy
for the EEI is as follows: EEI ⫽ (walking heart rate ⫺
resting heart rate)/walking velocity.
EEI is measured in beats per meter, with a higher
number indicating greater energy expenditure. The lower
the EEI is, the more energy efficient the gait pattern.30 The
EEI reflects the strong linear relationship observed be-
tween heart rate and oxygen uptake in typical children over
a wide range of walking velocities.31 This is a clinically
feasible test with published baseline data that can be used
comparatively.32–34 In this program, the EEI was used as an
evaluative measure to determine individual change. Rest-
ing and exercise heart rates used to calculate EEI were
obtained using the Cardio Sport Excel PC Heart Rate Mon-
itor (Sark Products, Waltham, MA).
For the running velocity measure, J was instructed to
run as quickly as possible for a distance of approximately
40 m. Heart rate, RPE, and maximal velocity were recorded
during each running trial.
In addition to the above outcomes, parents were asked
via questionnaire (Appendix B) to identify the child’s level
of activity at home during a two-week time period. This
included tallying the number of exercise episodes and, us-
ing a visual analog scale, rating the child’s general activity
level. Because an important component of the program was
education for the child and family, monitoring the activity
level and number of exercise sessions during and after the
programs provided an indirect measure of the success of
this educational component.
Participation in the OTC Program
In J’s case, data were collected at the beginning and
end of an OTC six-week session. J also participated in two
subsequent six-week OTC sessions. A final data collection
session occurred approximately 10 months after the start
of the first six-week session. At each data collection ses-
sion, the parent completed the questionnaire regarding J’s
activity level and number of exercise episodes.
Outcomes
Table 1 presents the data gathered on J. Her EEI de-
creased from a high of 0.96 beats per meter to 0.41 beats
per meter at the end of the 36-week period. Running veloc-
ity increased slightly, and both maximum heart rate and
RPE during this activity decreased. Taken together, the
changes in EEI and heart rate and RPE during the maximal
running velocity test seem to suggest that J was able to com-
plete these tasks with increased efficiency and decreased en-
ergy requirements. The subjective comments from the parent
Maximum Heart Rate RPE Immediately after
During Running Test Running Velocity Test
192 8
182 8
147 4
Fitness Program for Children with Disabilities 175
 in the final questionnaire also support this conclusion. J’s
mother offered the following comments: “Off the Couch is a
wonderful program. . .I have noticed a big difference in J’s
activity level. . .she is much more confident. . .J can walk
longer and faster on family walks.” According to the visual
analog scale, J’s mother characterized her as being “very, very
active” for each of the data collection points. In addition, dur-
ing the two weeks before the second data collection point
(7/31/00), J’s mother reported that J had exercised each day.
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At the final data collection point (3/16/01), the number of
exercise sessions for the preceding two-week time period was
six (of 14 possible).
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J’s cognitive ability and limited expressive language
skills hindered her ability to provide feedback on her own
perceptions of the OTC program. However, she did appear
to enjoy the activities and interaction during each session.
Her mother indicated that J was always very eager to attend
OTC each week. J has subsequently continued with a reg-
ular exercise program at home, including daily walks and
membership in a community health and fitness club.
DISCUSSION
The results of this brief case report support the work of
previous investigations that indicates that children and adults
with cognitive and physical disabilities are willing and able to
participate in an exercise program and are likely to experience
some benefit from that program.11,12,14,15,21,25,35–37 In this case, J
was able to sustain a high level of activity and consistently
participate in regular weekly exercise episodes over a 10-
month period, per the report from mother. Although data
were not collected across the entire 10 months, before data
collection points two and three, J was participating in an ex-
ercise program at least three times per week. In addition, both
J and her mother participated in three six-week OTC sessions
over this period.
To help both J and her family, along with other OTC
participants, to sustain increased levels of activity and reg-
ular exercise, an effort was made to reduce barriers to par-
ticipation in both OTC and in fitness activities in general.
This included scheduling the sessions once per week at a
time and location that were convenient for as many partic-
ipants as possible. For example, during the school year, the
sessions were held on Saturday mornings. However, in the
summer, a weekday morning was chosen at the suggestion
of many of the parents. The program directors were capable
of designing, implementing, and modifying individually
designed exercise programs for children with disabilities.
Parents were provided with written and verbal recommen-
dations that encouraged sustaining the established exercise
program, both during and after the six-week OTC pro-
grams. Finally, any equipment utilized was adapted to
meet the needs of the participants. Although J did not re-
quire any equipment modification, the reduction in barri-
ers and support from her mother to continue to exercise at
home appear to have contributed to J’s ability to sustain a
fairly high level of activity, with regular weekly exercise
episodes over this 10-month period.
In addition to the increased level of activity, J also
176 Schreiber et al
demonstrated the ability to move with decreased energy
requirements. During the summer, the EEI was calculated
initially (days 1 and 2) on measures obtained outside. This
may partly explain the EEI and RPE scores for J during the
day 1 and 2 sessions as compared with day 3, when, due to
inclement weather, the measurements were taken inside,
over a more confined and shorter course. Nonetheless, the
EEI did decrease from 0.96 beats per meter to 0.41 beats
per meter. At fast walking speeds, children without a dis-
ability aged nine to 11 years typically present with an EEI
score of 0.61 (⫾0.18) beats per meter, while at comfortable
speeds, the EEI score is 0.47 (⫾0.11) beats per meter.31
Thus J’s scores would seem to indicate that initially she had
increased energy expenditure relative to her age-matched
peers and that her energy expenditure did improve over the
course of the 10 months. Future investigations would ben-
efit from a more regular data collection schedule. J’s im-
provements occurred at some point between the second
and third data collection session, a time period of approx-
imately nine months. Knowledge of how and when this
improvement occurred within this period would be
valuable.
It is unlikely that the change in maximal running ve-
locity is clinically significant. Although the same method-
ological considerations must be taken into account regard-
ing the differences in data collection during each session,
the data indicate that J was able to complete the running
activity with a reduced RPE. Taken together, the reduced
EEI and RPE provide support for the notion that she was
able to complete gross motor activities with improved effi-
ciency and decreased energy requirements.
In determining the overall effectiveness of the OTC
program, there are a number of factors to consider in addi-
tion to the those that appear in the case of J. Enrollment in
the program was open to all children regardless of level of
cognitive or physical ability. The number of participants
ranged between 10 and 15 children and often included
children without disability (mainly siblings of children
with disabilities who were participating) as well as some
children with more severe cognitive and/or physical dis-
abilities. Structuring meaningful, effective, and enjoyable
activities for such a wide range of participants is very chal-
lenging. Nonetheless, subjectively, most of the children
appeared to thoroughly enjoy the program, indicated by a
consistently high number of return participants. In addi-
tion, preliminary data collected on some of the other par-
ticipants indicate that some children also experienced im-
provements in activity level, number of exercise sessions
tolerated, and in impairment level outcomes. For example,
one of the other OTC participants was a seven-year-old
child with Duchenne muscular dystrophy. Despite the pro-
gressive nature of this disorder, this child was able to main-
tain his maximum running velocity during the 10-month
period of this case report. His mother also reported that he
was able to sustain a high level of activity and number of
exercise sessions during this time frame. Interestingly, this
child also demonstrated a fairly substantial increase in his
EEI, indicating that although he was able to sustain the
Pediatric Physical Therapy
 functional running skill, his overall energy expenditure
was increased.
An additional factor supporting the effectiveness of
the OTC program is that parents were extremely support-
ive of the program. This was reflected in both their subjec-
tive comments and also the high number of return partic-
ipants. The OTC sessions were held on Saturday mornings
for six consecutive weeks during the school year. Most of
the children with disabilities also received weekly outpa-
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tient therapy. Thus, despite very busy schedules, the par-
ents were able to transport their children to and from these
sessions and to participate in the program itself via inter-
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action with the nutritionist and with the program direc-
tors. Several comments from the parent questionnaires are
listed below.
“My daughter has a lot of fun with the other children and it
seems that she performs better when there are other
children to push her. . .the teen volunteers are so
nice. . .”
“My son was very active and enjoyed interacting with the
other kids. . .he talked a lot about the program and I
feel that his energy level increased. . .”
“I think its great and I wish it were two or three times per
week instead of one.”
“My son enjoyed having his sister in class with him. The
program gives him a chance to increase his endurance
and to socialize with the other kids.”
“My daughter became aware of the need to exercise on a
regular basis.”
“It kept my child moving, she liked it and looked forward
to it. She also seems to have more stamina.”
An additional benefit of the OTC program was the
opportunity for the children to regularly interact with the
program volunteers, mainly high school and college stu-
dents. Children and volunteers were paired together over
the course of the six weeks. Each volunteer became familiar
with the child’s individualized program and was able to
serve as a “coach” and motivator for the child. The children
and their volunteer “coaches” often developed a strong
rapport.
SUMMARY
The preliminary data collected on J and the subjective
comments and information gathered from the other chil-
dren and their parents suggest that children with disabili-
ties can benefit from a center-based, weekly exercise pro-
gram. Future investigators should attempt to determine
the effectiveness of similar programs. For example, al-
though it is difficult in a clinical setting to limit an investi-
gation to a specific age group and/or a specific diagnosis,
gathering data on a specific patient population may en-
hance the ability of program directors to implement a more
effective program tailored to the needs of a specific popu-
lation. The OTC program included participants with a
wide range of cognitive and physical abilities and was lim-
ited to 10 to 15 children per session; thus, the program was
Pediatric Physical Therapy
not targeted toward children with a specific diagnosis or
disability.
Additionally, one of the important challenges for fu-
ture investigations includes the development and utiliza-
tion of sensitive, reliable, valid, and clinically feasible out-
come measures. The outcomes used in this case report
included EEI, RPE, maximum running velocity, and a brief
parent questionnaire. This represents a combination of
outcomes at the impairment and disability levels. The im-
pairment level measures have established reliability and
validity with some clinical populations.29,32 However,
much work remains to be done to establish reliable and
valid measures of disability that represent meaningful
change for the participants and their families. Additional
outcomes that may be affected by this type of program
include self-esteem or social competence and the level of
knowledge regarding fitness and healthy lifestyles. In fu-
ture investigations, it will be valuable to continue to gather
this information in a more systematic fashion.
Physical therapists are uniquely positioned to influ-
ence community and education systems and to advocate
for the inclusion of fitness and recreation opportunities for
all children. Advocating for, developing, and implement-
ing fitness programs that benefit children with disabilities
and all children within a community or school setting and
reducing barriers to participating in those programs may
result in beneficial effects on the long-term health and
well-being of children and families in our communities.
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APPENDIX A
The program was designed for 10 to 15 children aged
eight to 13 years. The six-week program ran on Saturday
mornings for one hour during the school year, and for one
hour on Thursday mornings during the summer. All chil-
dren received clearance from their family physician before
participating. The cost of the six-week program was $55
per participant. Grant funds were used to cover the cost for
families who indicated a financial need.
The children demonstrated a wide range of physical
and cognitive abilities with most of the children exhibiting
some level of physical disability, including children who
were nonambulatory. Each child was paired with at least
one volunteer who helped to guide and assist the child
throughout the one-hour session. Volunteers were trained
by the program supervisors before each six-week program
and to the extent possible worked with the same child each
week. Program supervisors screened each child before the
initiation of the program and developed written programs
for each session. The screening included examination of
the child’s cognitive level, behavioral capabilities, and
gross motor skills. Each child’s heart rate was monitored
during the session via Cardio Sport Monitors, which could
be downloaded and displayed graphically, and used to de-
velop an individualized program for each child.
Features of the Program
All one-hour sessions began with a group warm up fol-
lowed by therapy ball activities. The warm up consisted of five
to seven minutes of wide arc upper and lower extremity
movements as well as standing and/or seated stretching activ-
ities. Some activities included in the warm up were arm cir-
cles, heel lifts, ankle circles, marching and jogging in place,
side bends with reaching, sitting with crossed legs, and long
sitting while reaching forward and to either side.
Seated therapy ball activities were done by each
participant. Volunteers were paired with children who
required spotting for safety or assistance with the move-
ments. Age-appropriate music with an upbeat tempo
was played to increase motivation and maintain the
rhythm during exercise. The instructor sat in front of the
class on a therapy ball while demonstrating and calling
out each movement. Activities on the therapy ball in-
cluded bouncing and marching with the lower extremi-
ties, various arm movements while bouncing, heel lifts,
toe lifts, knee extensions, hip rotation, and trunk
strengthening movements. This component generally
lasted about 10 to 15 minutes.
After the group therapy ball activity, some children
completed group step aerobics while other children per-
formed individualize exercise routines. The physical ther-
apist assistant led the children in step aerobics for seven to
10 minutes. After the step aerobic routine, this group pro-
ceeded to their individual programs. Volunteers were pro-
vided with note cards that listed the child’s individual ex-
ercise plan along with exercise parameters. The exercises
were not carried out in a specific order. Heart rates and RPE
Pediatric Physical Therapy
 were monitored during each exercise, and children were
encouraged to maintain a consistent activity level. The vol-
unteers noted the child’s response to each activity, and the
PT and PTA supervisors also monitored each child and
assisted as indicated with the children with more physical
impairments. The information gathered by the volunteers
was used to update and alter the individualized programs
as needed. The individual exercise plans included
strengthening and aerobic activities. The strengthening ac-
Downloaded from http://journals.lww.com/pedpt by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1A
tivities included exercises such as abdominal crunches,
push-ups, dumbbell and ankle weight activities, step-ups,
and squats and were adapted as necessary to ensure com-
pliance and success with the activities. The aerobic portion
of the program included activities such as walking, light
jogging, treadmill, and the stationary bike/adaptive tricycle.
During the last 10 to 15 minutes of the program, chil-
dren gathered together for a group activity such as kickball,
volleyball, basketball, or parachute golf.

APPENDIX B
WnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= on 08/25/2023

Off the Couch Parent Questionnaire

1. Please indicate on the line HOW ACTIVE your child has been in the last two weeks

_____________________________________________________________________________________________________

Completely Inactive Very, Very Active

2. Please circle the NUMBER OF TIMES YOUR CHILD EXERCISED in the past TWO WEEKS

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

3. Please list what you were satisfied with for “Off the Couch”

4. Please list any suggestions to help us improve the “Off the Couch” program

Pediatric Physical Therapy Fitness Program for Children with Disabilities 179