James H. Rimmer, Ph.D., Director

A few weeks ago, I was visiting my daughter at Augustana College in Rock Island, Illinois. It was homecoming weekend, and we were attending a football game against archrival Illinois Wesleyan. Several minutes into the first quarter, a group of young adults with intellectual disabilities, accommodated by one staff person, walked by my wife and me on their way to finding their seats. The aide prompted the group to descend a flight of stairs in transit to their seats, but the five adults paused at the top of the stairs because there was no railing to hold onto as they began their descent. As with most bleachers, there were no handrails to hold onto and with only one aide and five sets of hands, it was impossible to accommodate all the adults at the same time.

The first adult to attempt the stairs gave the appearance of trying to walk down a steep cliff, slowly testing each stair with as much hesitancy as a rock climber trying to find the best foot placement on the side of Mt. Everest. The staff member made an attempt to try and coax the residents to their seats, but decided rather wisely that it would be better to find an easier place to sit than to deal with a serious fall. There were too many hands to hold and not enough staff to hold them. You could feel the tension begin to mount as the residents blocked the view of several fans in the stands, for what seemed like hours but in fact was only a few seconds. The staff person finally gave up and headed back toward the other side of the stadium. As she and the five adults passed my seat, I tapped her on the shoulder and invited her to sit in an open row below me. She herded the group into the seats, which had the luxury of a handrail and only required two ascending steps.

The tension on that staff person's face that day along with the apprehension displayed by the five young adults was a reminder of how important it is to maintain good motor skills throughout the lifespan. A few lessons on how to walk down a flight of stairs without a railing probably would have alleviated the problem and allowed everyone to get to their seats safely. The unfortunate woman responsible for providing recreation for her group home residents never realized that walking down a few steps was going to be such a challenging and daunting task. It was apparent that she was a new employee and never expected that taking residents to a local football game would have been this much trouble. Perhaps this would be their last football game for a long while.

Often what you find among many adults with intellectual disability is that their ability to accurately shift their center of gravity with good balance, strength, and coordination is severely lacking. Walking down a flight of stairs is not an easy task for many people, particularly older adults who lose depth perception and visual acuity in their later years. But four of the five adults were most likely in their late 20s and early 30s and shouldn't have displayed that much difficulty walking down a few steps. The motor skill pattern they displayed was similar to a young child learning to navigate stairs for the first time -- small, shuffling steps, improper weight transfer, and a sense of hesitancy associated with the fear of falling. It was especially troubling, but not surprising, that 25 years after I began teaching motor skills to children and adults with intellectual disability, those same elementary motor patterns can still be seen today among many adults with intellectual disability - slouched posture; head too far forward; shuffling gait; short, choppy steps; and wide base of support.

During my first semester at Ohio State University in 1977, we were trained to use a motor skills test called the Ohio State University Scale of Intra-Gross Motor Assessment (OSU-SIGMA). The test included a qualitative analysis of ascending and descending stairs. I used the OSU-SIGMA with many children with intellectual disability and spent class time in adapted physical education teaching my students the proper mechanics of ascending and descending a flight of stairs - head up, eyes straight ahead, heel-toe touchdown, good posture and weight transfer, and so on. Twenty-five years later in a small rural town along the Mississippi, five adults exhibit the identical motor patterns of the students I worked with 25 years earlier. Not much has changed.

In 1991, Dr. Ken Pitetti from Wichita State University wrote a classic paper on the fitness levels of adults with intellectual disability. After conducting several exercise physiology studies and finding extremely low fitness levels, Dr. Pitetti concluded that as a group, adults with intellectual disability were a "population at risk." Dr. Greg Reid and another colleague from McGill University conducted a 13-year retrospective study evaluating the fitness levels of a group of Canadian adults with intellectual disability. Their conclusion was that 13 years of physical inactivity resulted in a faster decline in fitness and overall health than in the general population, and that rate of decline predisposed them to higher health risks in their later years. Once again, nothing has changed.

Last year, the Surgeon General sponsored a conference on health disparities in adults with intellectual disability. The conference proceedings emphasized that there were serious health deficiencies in this population. Those of us who have been working in the field for the past quarter-century were not surprised. In January 2003, there will be another national conference in Washington, D.C. to discuss the health status of adults with developmental disabilities and to determine ways to improve health. My hope is that this time around we get it right. We cannot afford to go another 25 years with a lack of attention devoted to improving motor skills and physical fitness in this neglected and often-ignored population.

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