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APPENDICES
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General Screening Form For CWDs/PWDs
Appendix 1 : General Screening Form for CWDs / PWDs
Date of screening:
Information of person doing screening
Name: Occupation:
Children and young adults' personal information
Name: Age: yrs. Sex: M ( ); F ( )
Mother's/Father's Name:
Eating/Drinking
Able to take care of his/her daily needs?
Dressing
Yes No With Assistance
Washing
Using toilet
Difficulty communicating?
Understanding instructions
Speaking
Hearing
Seeing
Expressing needs
Spouse's Name:
Address:
Grade:Goes to School: Yes ( ) No ( ) Completed ( )
Special or mainstream school?
Vocational Training/Employment:
Socio-economic situation of family:
Form ID:
Type of Disability
Disability Inventory / Level of Independence
Physical Impairment Intellectual Disability Mental Illness
Visual Impairment (Low vision ; No vision ) Hearing Impairment Speech Impairment
Disability since birth or acquired?
If acquired, how ?
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Sitting
Difficulty moving or moves differently than others?
Standing
Walking
Running
Jumping
Catching
Throwing
Is already doing sport or physical activities? Yes ( ) ; No ( )If yes, specify:
Summary of capacities/skills for sports and physical activities, including if s/he can go alone to playground (e.g. "can throw"; "can run"; "has some vision on left eye"; "understands simple instructions"):
Does the person have any pain (for a long time)? Yes ( ) ; No ( )Describe where:
Contact Sport Non-contact Sport Running Throwing Leisure
Assistive Devices
Has/uses any assistive device? Yes ( ) ; No ( )If yes, specify:
Recommendations for assistive device (in discussion with the CWD/family):
Are there any deformities (e.g. amputated/missing arm; foot bent the wrong way)? Yes ( ) ; No ( )If yes, describe:
Risks and precautions (e.g. "has low vision, so certain ball games can be dangerous"):
Absolute contra indications (e.g. "has no vision: no cricket as field player with hard balls"; "no running"; "no contact sports"):
Disability Inventory / Level of IndependenceYes No With Assistance
Recommended Activities: fill 0-3 crosses in each box (0: not recommended; 3: highly recommended)
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SL No.
1.
2.
Type of Device Adaptation (if needed) Status of training on use of device
Follow up of Assistive Devices
Other Services
Type of Device Date Remarks
Follow up of services
Recommended services:
Receives any other services (corrective surgery; physiotherapy; occupational therapy; speech therapy; special education etc.)? Yes ( ) ; No ( )If yes, list/specify:
Has an Individual Rehabilitation Plan? Yes ( ) ; No ( )
Any other comments:
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Appendix 2 : Different Sports Materials
List of sports materials Adaptation
Cricket bat
Tennis ball
Football
Football goal post
Badminton Racket
Badminton Shuttle
Badminton net
Dart game
Different surface size , grip, length of the handle, velcro scratch to hold the bat
Different color, sound ball, soft ball, different weight (bean bag, sand bag)
Musical Chair Different colored chair, ring on floor
Different size, color, sound ball, light/soft/plastic ball
Markers, best if adjustable in size. Put some bells on the net for players with low or no vision
Different surface size, grip, length of the handle, velcro scratch band to hold the racket
Different color, ball made of news paper to make it slower
Different color, size, lower net
Different target size
Markers Different size and color (cones…)
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Appendix 3 : Warm Up / Stretching Exercises
Warm Up and Stretching Exercises
The following outline suggests a basic warm up and stretches, with a warm up first, then moving the main joints and finally stretching the muscles.
Possible adaptations focus on physically disabled players (i.e. mainly players with difficulties to move specific parts of their bodies), but might also serve the purpose for other types of disabilities. They are based on peer support which should first be instructed upon to the players by physical rehabilitation professionals and be carried out under their supervision. Supervision can then gradually decrease.
Only give as much support as needed to ensure the exercise is carried out properly.
A. Warm Up
Start with 10 to 15 minutes warm up which can include slow jogging (for wheelchair users: propelling the wheelchair), recreational games, etc. to heat the body up.
Carry out the exercises at a normal speed, unless stated differently
10-20 repetitions for each exercise
Adaptations: Need for support is often linked to muscle dysfunction. Hence, under adaptation, an exercise should be carried out more slowly to prevent injuries. Stay in the end position 10-20 seconds rather than perform10-20 repetitions, if high muscle tension hinders the movement.
B. Joints
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Move slowly forwards and back (don't go to the end of range when you move forward)
Adaptation: Colleague gently helps to move the head forwards and back.
Move slowly and keep your head and neck straight
Adaptation: Colleague gently helps to turn the head left and right. Colleague can optionally fix the shoulders so they don't turn with the head and neck.
Move your head slowly, but don't move your shoulders (only head and neck move)
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NeckNumber 1: Bend neck forwards and back
Number 2: Look sideways
Number 3: Bend neck side to side
Adaptation: Colleague gently helps to bend the head to left and right side and fixes the opposite shoulder.
Make circles with your shoulder forwards, then backwards
Adaptation: Colleague gently helps to roll the shoulders backwards.
Make circles with your wrist
Adaptation: Colleague gently helps to open the hand and to stretch it back (keep in the end position 10-20 seconds rather than doing 10-20 repetitions).
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ShoulderNumber 4: Roll your shoulders
WristNumber 5: Rotate your wrist
Lift one leg and make circles with your lifted leg to move the hip joint
Close the hand (make a fist) and open it again
Adaptation: Adaptation of exercise 5 serves as a substitute for players with difficulties in performing independently.
Adaptation: For wheelchair users with difficulties in separating legs (i.e. to "open" knees), colleague holds knees in front and gently helps to increase the distance between the knees and to stretch the inner side of the thighs. Keep in the end position for 10-20 seconds.
Go into squat position and come up again.
Adaptation: For players with difficulties in controlling their legs, colleague stands behind and can prevent knees from "falling" inwards. Colleague can then also give support to the trunk if necessary.
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Hand-FingersNumber 6: Make a fist
Hip-KneeNumber 7: Bend your knee and make circles (at hip joint)
Number 8: Squats
Lift up one leg and make circles with your ankle
Adaptation: Colleague supports to simply bend toes and foot backwards (keep the end position 10-20 seconds rather than performing 10-20 repetitions).
C. Muscles
Stretch slowly and maintain posture 20-30 seconds
Red lines indicate where the stretch should be felt
Adaptation: Colleague supports in lifting up the arm and fixes it.
Lift up one arm, bend it behind the head and fix it with the opposite hand.
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Ankle-FootNumber 9: Rotate your ankle
Number 10: Stretch your arm
Bend sideways (without bending forwards) and pull further sideways with lifted arm
Adaptation: Colleague supports in lifting up the arm, fixes it around the elbow and guides the bending of the trunk sideward. He can additionally push the opposite shoulder downwards gently.
Bend one knee and hold the ankle with one hand. Keep a straight posture (don't move the back)
Adaptation 1: Player is in prone position on the ground, and a colleague can help bend the knee and bring the foot towards the buttock.
Spread your legs until you feel the stretch. Feet should be kept parallel and not be turned inwards or outwards
Adaptation: Player sits on the ground and colleague supports in spreading the legs and maintaining the posture.
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Number 12: Stretch the front of your thigh
Number 13: Stretch the inside of your thigh
Number 11: Stretch your abdomen (side)
Make a step, put one knee on the ground and push the hip of this knee forwards. Keep the back straight
Adaptation: Same posture, but colleague helps to keep balance. Alternatively, player can simply stay on the ground in prone position with straight legs which will slightly stretch front hip muscles.
Make a step, lean against a wall or a tree and push your buttocks towards the wall/tree. Keep the heel of the back foot on the ground and keep the knee straight. Keep both feet aligned (don't turn them inwards or outwards)
Adaptation: Colleague helps to keep the knee straight. He then gently pulls the foot backwards (his second hand helps by pushing the heel further away from the body).
Sit on the ground with legs spread apart and bend your trunk forwards. Try to touch your feet. Only move with the hip joint and keep the back straight
Adaptation: Same posture, but colleague can sit opposite in the same position, so that both players' feet touch each other. S/he then tries to take the disabled player's hands or wrist and leans slowly backwards. This will make the disabled player bend forward.
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Number 14: Stretch the hamstrings
Number 12: Stretch the front of your thigh
Number 16: Stretch your calf muscles
Session Preparation Card
Name Time Rules Materials Adaption Criteriafor Success
Level of Difficulty (+/-)
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Appendix 4 : Session Preparation Card
1. The Knot 2 players hold each other with one hand. After passing their second hand below their leg, they hold each others second hand. Then they try to open the knot without releasing the hands.
2. Spinning TopPlayers hold each other's hands, lift them up and perform one circle rotation without releasing their hands.
3. Shake Hands Players stand face to face, arms stretched out with open palms. When Red player tries to clap into Yellow player's hands, Yellow player withdraws.
4. Who is the Wolf?Everybody runs in pairs, one is Red player, the other is Yellow player. When the teacher calls out a color, mentioned color has to catch the other in each pair.
5. Rooster Fight Without using arms and standing on one leg, players try to make each other lose balance.
EXERCISES WITHOUT MATERIAL
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Appendix 5 : 31 Exercises
6. Duck Fight In squat position, players hold each others hands (palms against palms) and try to push each other down.
7. Pair Catching 1Players are face to face in pairs (standing, sitting, kneeing…). When coach calls out 'red', yellow players try to catch red players in front of them. Red runs away and tries to get to the baseline before getting touched.
10. The Shadow Red player has to follow Yellow player like a shadow. Yellow player jumps, rolls, runs, etc.
9. The HookerPlayers balance body on arms, face to face and try to make each other fall by pulling/pushing the other's arms.
11. The Caterpillar Players move by holding each other to from a caterpillar. The first tries to catch the last.
8. Pair Catching 2Players stand face to face. When yellow player touches the line and runs away, red tries to catch yellow. Change roles and starting positions (sitting with crossed legs face to face ; lying in prone position face to face; etc.)
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12. Attacked Caterpillar Similar to "caterpillar" game, but the front player defends the last against an attacker.
13. Caterpillar HuntingSimilar to "attacked caterpillar" but with two or more caterpillars, where a front player tries to touch the last player of another caterpillar.
14. Caterpillar's RacesTwo or more caterpillars do a race on one circuit: use zig-zag, doors, obstacles…
15. The Crocodile's RiverRed players are crocodiles; s/he has to stay in "the river"(marked in clear green). Yellow players try to cross the river, when the crocodiles touches them, they become a crocodile too. Game continues until all players are crocodiles.
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16. Indian Ball is passed by players overhead from front to back. The last player passes (with the ball) between the legs of all players and takes the first place.Possible to do races with 2 or more teams.
17. Reverse Indian Similar to "Indian file" but ball is passed backwards between legs. The last player goes in front. Possible to do races with 2 or more teams.
18. Gymnastic Throw 1Throw the ball from between your legs. Try to catch it over your head.
19. Gymnastic Throw 2Drop the ball behind your back. Try to catch it between your legs.
20. Accuracy Throw A throws to B. B returns to A. Same with C and D. Afterwards D becomes A. Race is possible with 2 teams.
21. The Mini Golf Throw the ball in area number 1. When you achieve this, throw in 2, then 3.
EXERCISES WITH BALL
A B C D
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22. Target Ball Throw one ball and then throw another ball and try to be as close as possible to the first ball.
23. Around the WorldThrow the ball to target from 1, then 2, then 3 which are at different distances from the target.
24. Mirror PassingPass the balls to each other at the same time.
25. Roll-over PassingRed passes to Yellow with one roll.
26. Clock Race 4 players pass the ball by foo t to each other counter-clockwise without stopping the ball. Then do the same clockwise.
27. BowlingPlayers stand outside the circle and try to kick down the sticks in the middle by playing with the feet. Each player has 3 shots. Which one is able to hit most sticks?
1
2
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28. The Frog Jump or walk by keeping the ball fixed between the legs. Possibility to do races (in single or in teams).
29. The RainbowRope jumping in pairs (in place or while walking). Players are hand in hand beside each other or behind each other.
30. The Coach2 players are horses and pull along the third player who tries to resist.
31. Rainbow GatePass under the swinging rope without being touched.
EXERCISES WITH ROPE
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Handicap International is an international organization specialised in the field of disability. Non-governmental, non-religious, non-political and non-profit making, it works alongside people with disabilities, whatever the context, offering them assistance and supporting them in their efforts to become self-reliant.
Since its creation, the organization has set up programmes in approximately 60 countries and intervened in many emergency situations. It has a network of eight national associations (Belgium, Canada, France, Germany, Luxembourg, Switzerland, United Kingdom, USA) which provide human and financial resources, manage projects and raise awareness of Handicap International's actions and campaigns.