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Disability, participation and exercise
1 May 2016
Professor Nora Shields
will be sharing her extensive knowledge on physical activity among people with a disability at the annual VIC Winter Breakfast this July.
‘I’ve always been an active person and a strong believer in the importance and the effectiveness of exercise as a treatment approach. When I started to work in Australia with people with disability and families that included a person with a disability, it got me hooked’ Nora Shields says enthusiastically.
Her CV includes a PhD from Trinity College in Dublin, followed by over 12 years of research on disability and exercise culminating in her current role as Professor in Clinical and Community Practice (Allied Health, Northern Health) at La Trobe University.
A great deal of Nora’s early work involved qualitative research, an experience that she says has been invaluable to her development as a researcher.
‘Quite often in physio we don’t use qualitative research or consumer input enough to inform our research, but I think that’s changing, especially with the NHMRC [National Health and Medical Research Council]
guidelines about consumer participation
One particularly insightful finding of her earlier research was that many young people with an intellectual disability exercise for social reasons, as well as for health, meaning that a support person is a critical part of their exercise routine.
‘This really helps us to create behaviour change for some of those populations,’ Nora reflects.
Nora and her team conducted studies that matched student physiotherapy mentors with young people with a disability to encourage participation in exercise. Four trials conducted since 2008 showed the scheme created a ‘win-win’: the young people with a disability participated in more physical activity and the student physiotherapists gained experience working with diverse populations.
Many young people with an intellectual disability exercise for social reasons, as well as for health, meaning that a support person is a critical part of their exercise routine.
‘We may forget that physiotherapy students may not necessarily have met a person with disability in their life. In some respects, they’re probably more like the general population than we anticipate,’ Nora says.
The program, called Fit Skills, is now run at La Trobe University in Melbourne with the hope of scaling this up in the future.
Fortunately, the NDIS offers potential for participants to incorporate physical activity programs into their plans, with positive repercussions on ideas around intervention and benefits of physical activity. However, Nora reminds physiotherapists that they need to be claiming this space early given the profession’s expertise in this area.
‘We really are the physical activity champions, but we need to make sure that we step up to the plate.’
The last four to five years of Nora’s work have involved research translation projects in four Australian states. The projects aim to increase clinicians’ uptake of evidence-based practice through multifaceted knowledge translation strategies. Strategies have included ‘knowledge brokers’ who are experts respected by others in their field, e-evidence libraries and an outcomes database.
Nora hopes that her presentation at the VIC Winter Breakfast raises new considerations for physiotherapists, including how their current perceptions of participation fit with notions of impairment.
‘We’re really good at looking at physical function and activity, but it’d be great to see this brought into the realm of participation.
‘The other thing that’s really important to challenge is the notion that we now have young people with disability who are growing up and becoming adults with disability and they’ve got very different needs to other adults in rehabilitation. Their condition may be lifelong, but it’s not static.’
She thinks physiotherapists can challenge current models of care to account for this experience of living with a disability.
‘As physios we need to challenge the model of care that we have in rehab, because right now our health system is not set up to look after the needs of young people who grow into adults with a disability. I’d like to see more physiotherapists challenge the health model and think about it from a prevention point-of-view.’
Nora is also hopeful that after hearing her presentation, more physiotherapists will consider a career in the disability arena.
‘I do work in an area that’s challenging but that’s the thing that I enjoy. If nobody takes up the challenge, then you’ve got a group of people who don’t have the research evidence base that helps professionals—and everybody has the right to evidence-based care.’
'The feasibility of a physical activity program for young adults with Down syndrome: A phase II randomised controlled trial',
Journal of Intellectual and Developmental Disability
'A student-led progressive resistance training program increases lower limb muscle strength in adolescents with Down syndrome: a randomised controlled trial',
Journal of Physiotherapy
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