**3. Individualized education program and physical activity coaching intervention**

Since fitness is a main goal of physical activity, Physical Education (PE) teachers or coaches should take in to account that individuals with disabilities generally display the same physiological responses to exercise found in non-disabled people. "Although specific disabilities may affect the intensity, duration, and frequency of exercise, individuals with disabilities can benefit from training improving their performances. Wheelchairs can be adjusted or modified (by those qualified to do so) to improve physical activity performance. Those practicing physical activities or athletes in wheelchairs play basketball, tennis, and many other sports" [45].

The Individual Education Program (IEP) is the basic tool of PE teachers who firstly evaluate the cognitive-motor profile of those practicing physical activities. Subsequently the instructor designs the IEP which focuses on short- and longterm goals and objectives for training of the patient. Individuals with disabilities (children and adolescents) are entitled to receive special services based on their

### **Figure 4.**

*Exergame-based training (e.g., Kinect games: a. 20.000 leaks trains whole-body coordination and engagement with a dynamic environment; b. table tennis trains goal-directed upper limb movements, dynamic balance, and movement timing; c. light racing trains goal-directed lower limb motions, quick movements, and dynamic balance) [44].*

individual needs, which are determined by their assessment and evaluation. In a corresponding context Physical Activity Coaching Intervention is an Individualized Intervention Program (IIP) that take in to account the fitness profile and the individual characteristics of the patients to implement, for instance, a strength training program.

The PE instructor or coach should put the individual, not the disability, at the center of their planning when deciding how to instruct or train a student with a handicap. For instance, the instructor encourages the patient to continue attempting to build physical activity and health-related fitness with the goal of inclusion, challenges his intellect, and helps the patient stay on task longer. When working on basketball shooting techniques, for instance, the PE teacher or coach may also utilize modifications as a fundamental technique to make sure the patient feels competent and actively participates in the task. Given that he has trouble moving, you may try to make the basketball hoop smaller, use a lighter ball, or construct a basket that is worth more points.

Planned adaptations for physical activities include a modified setting, adjustments to the rules, the goal and content of the activities, and the rate of learning. For example, because field sports like baseball and soccer require adaptations, the surroundings will need to be changed when walkers and wheelchairs are used. Wheelchairs and walkers can also benefit from adaptive equipment, such as smaller or lower targets, areas on the playing field marked with cones, scoops for catching, and different balls (size, weight, color, and texture). "A person with cerebral palsy can stand up straight with the help of walkers or standing frames. The tool is helpful in maintaining range of motion, boosting endurance, and strengthening trunk muscles for cerebral palsy patients [45].

The term "least restrictive environment" refers to the practice of including people with disabilities as much as is practical in circumstances where their counterparts without impairments are present. "Empowerment is generally defined as a process through which individuals gain control over their lives, a sense of power equitable with others, and a feeling of responsibility for self, other, and environment" [46] (**Figure 5**).

**Figure 5.** *Balance & Gait Disorders [47].*

These two ideas are crucial for modification or adaptation in a learning environment when a PE instructor or coach wants to provide patients with ataxia with the least restrictive environment possible.

Maintaining one's health, wellbeing, and quality of life requires regular physical activity. The World Health Organization WHO, [48] suggests engaging in low to moderate intensity physical or recreational activities at least three times per week for a total of roughly 30 minutes per day. This can involve resistance training, aerobic exercise, or a combination of the two [48]. Regular aerobic training, manual wheelchair propulsion, arm cranking, swimming, and circuit training have all been shown to increase the cardiorespiratory fitness, upper extremity muscle strength, and endurance of wheelchair users. The patient's cardiometabolic profile is improved by aerobic exercise because it increases maximal oxygen consumption, improves cardiorespiratory status, and lowers blood glucose, body fat, and BMI levels. Patients also tend to engage in daily activities like wheelchair use, personal grooming, and cleaning their surroundings frequently [49].

For those who have neurodegenerative disorders, physical activity (PA) might be a potent neuroprotective intervention; unfortunately, rehabilitation programs frequently overlook methods to boost PA engagement. It has been demonstrated that the *Engage intervention* increases exercise self-efficacy and PA uptake in adults with ataxia, Parkinson's disease, and Huntington's disease. An ongoing single-cohort study called *Engage-Ataxia* is being conducted at Columbia University.

Over the course of 12 weeks, a physical therapist offered a 5-session coaching program (PA) via telemedicine. Based on the self-determination theory, the intervention featured a disease-specific workbook to direct the sessions and take into account balance and gait issues, deficiencies in motor learning, and weariness. Individualized workout advice, goal-setting, and strategies for overcoming movement challenges were all covered in the sessions. Only 19 of the 25 participants (mean age 55.8 years; SD: 13.7) completed the intervention (8 men; 11 women). To keep an eye on PA and heart rate, they used a Fitbit. The authors concluded that *Engage-Ataxia* offered a workable framework to increase PA in ataxia patients. This intervention was supported by preliminary results, which showed improvements in behavior change and disease-specific motor and cognitive function tests [50].

### *Adapted Physical Activity and Ataxia DOI: http://dx.doi.org/10.5772/intechopen.111792*

The practical benefit of evaluating ataxia patients for a variety of challenges and intensity, regardless of a specific medical diagnosis, is that a PE teacher can get a personalized appraisal of the patient's strengths and weaknesses. Future studies in program evaluation and design may be required to concentrate on patient profiles across a variety of domains (motor, cognitive, social, and emotional), examining each individual's strengths and limitations. Therefore, regardless of the diagnosis a patient receives, PE teachers and coaches will be able to modify their support in accordance and implement an effective IEP and IIP.
