Sarah thoroughly enjoyed the intervention sessions and would attempt to initiate intervention sessions on days when there wasn‟t one. She began to use the “Mighty Muscles” equipment spontaneously and appropriately outside of the intervention. She enjoyed the physical stimulation of the sessions and would ask for various exercises outside of session, e.g., stretching.
During the project Sarah learnt or mastered various skills through the program that were not recorded by the test instruments, but were recorded by the journal and session target sheets.
Cardiovascular training: Skipping with a rope was not mastered but became more fluid and the concept was learnt. Stationery exercises like star jumps and hopping were mastered. The concept of catch was learnt.
Strength training: Sarah exhibited improvement in muscular strength and muscle tone in all muscle groups. She was able to manipulate heavier weights and complete more straining tasks at the end of the intervention.
Balance: Increased core strength helped with improved balance skills, both in static and dynamic balance exercises. When working on unstable environments, she was able to maintain her balance for much longer periods of time.
Ball Skills: Catching, bouncing, throwing and aiming skills were very weak at the beginning of the intervention. However Sarah improved and mastered working with a big and medium ball and was attempting the same skills with a tennis ball at the completion of the project. Kicking and batting also were poor but the 20 week intervention resulted in her being able to have control and projection in both skills. Sport‟s skill: Both tennis and soccer were introduced and the foundation skills were learnt. Swimming was also included and basic diving and doggy paddle were mastered.
Discussion
Although Sarah‟s post-test assessment scores in the M-ABC are still indicative of a borderline motor impairment problem, the improvement from the baseline and pre-test assessment scores show there was an overall development in manual dexterity, ball skills and balance. Weekly practice, the continuous assessment of these motor skills, a program designed for the individual‟s needs and the overall improvement in strength from resistance training has resulted in this development and enhanced performance in these tasks. This confirms one of the benefits of resistance training which is the improvement of basic motor skills and the efficiency in the performance of these skills in motor tasks (Roberts, 2002).
Gross motor testing has shown that children with autism have difficulty with coordination, timing of movements and grading of leg and arm movements (Murray-Slutsky & Paris, 2000). This could explain the Sarah‟s results received in the dynamic balance tasks. This test Sarah found particularly difficult and only a slight improvement was observed.
Post-test assessments of Sarah in the BPFT show improvements across all motor proficiency skills. Her performance in the aerobic capacity test show an improved level of fitness as she was able to complete the test and was observed to be physically fitter and less affected by the test. This result confirms previous research that participating in a physical activity program will increase the level of fitness (O‟Connor, French & Henderson, 2000, Yilmaz et al., 2004). The test activities and the endurance exercises included tasks that Sarah enjoyed and participated in until fatigued. Ensuring that Sarah enjoyed her cardiovascular tasks resulted in longer periods of participation and independent selection of these tasks outside of the sessions (Reid & O‟Connor, 2003). A definite improvement in Sarah‟s general muscular strength and flexibility could be seen in the results in the BPFT, more specifically the arm hang, isometric push up, curl up and sit and reach test. There is limited research about the effects of a resistance training activity program on children with ASD. However it is clear from the results achieved in these assessments that an APA program can provide children with ASD an opportunity to improve muscular strength and flexibility which results in enhanced motor control, agility, coordination and power. Improvement in more complex skills confirm that physical activity programs can aid in teaching and developing foundational skills (Byrne & Hills, 2007).
After completion of the intervention program, Sarah was observed initiating games played in the Mighty Muscles sessions and was socially more interactive with the researcher. Her limited communication skills may be the result of poor social interaction with others that are unable to use Makaton. However Sarah is more aware of her body and objects around her and is more receptive when guided to communicate or socialise with others. Her improved social interaction
with the researcher confirms research that physical activity aids in development of socio-cognitive skills (Jasmin et al., 2009; Reid & O‟Connor, 2003).
There has been a substantial decrease in self-stimulatory behaviours during activities as well as during free time. The research done on the effects of physical activities on children with ASD has been focused mainly on the reduction in these behaviours and confirms the results achieved (Elliot, Dobbin, Rose & Soper, 1994; Rosenthal-Malek & Mitchell, 1997). Sarah also has been documented being less aggressive and there are less self-injurious behaviours present. Similar results were observed by Allison, Basile and Mac Donald (1991).
Sarah thoroughly enjoyed the activities and the physical stimulation. The Mighty Muscles program for Sarah was targeted for her motor needs and functional goals (Baranek, 2002). With the correct use of prompts and reinforcement Sarah was able to feel confident in the activities and was able to access the reinforcers (Fox, 1991; Reid, O‟Connor & Lloyd, 2003; Zhang & Griffin, 2007). As a result of the stimulation Sarah received from the intervention the hours spent in voluntary physical activity increased significantly (O‟Connor, French & Henderson, 2000). Sarah„s sedentary lifestyle confirms reports on the physical activity level and fitness of children with ASD (Pan & Frey, 2006; Pitetti, Rendoff, Grover, & Beets, 2007; Yilmaz et al., 2004). However the increased independent hours spent in physically tiring activities verify research that physical activity encourages voluntary participation (Fox, 1991) and results in children making healthy lifestyle choices (Byrne & Hills, 2007).
The positive contribution that this APA program had on Sarah‟s motor proficiency and behaviours demonstrate the benefit and importance of providing quality physical activity programs designed for the individual‟s specific needs and personally traits (Reid & Collier, 2002).
Recommendations
Recommendations for Sarah include daily participation in a structured, physical activity program. Sarah is spontaneously choosing to perform various tasks that she was introduced to during the intervention. However, her final scores in the
motor proficiency assessments still indicates that she exhibits motor impairments.
It is recommended that supervised exercises are executed with Sarah in order to improve her motor abilities. Continual development is necessary in the following areas, ball skills, balance, flexibility, sports and strength training with particular focus on upper body. Since Sarah‟s self-stimulatory behaviours and aggressive tendencies have reduced after the intervention program it is recommended that there is continual participation in a physical activity program. This will help maintain these behaviours and provide Sarah the stimulation she requires to manage these behaviours.