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lIBRARY
Michigan State
University

This is to certify that the

dissertation entitled

FACTORS THAT INFLUENCE THE PHYSICAL FITNESS
LEVELS OF DEAF CHILDREN

presented by

Marjorie Kathleen Ellis

has been accepted towards fulﬁllment
of the requirements for

 

 

Ph.D. degree in Kinesiology

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6/01 cJCIRC/DateDuepGS-p. 15

 

FACTORS THAT INFLUENCE THE PHYSICAL FITNESS OF DEAF CHILDREN
By

Marjorie Kathleen Ellis

A DISSERTATION

Submitted to
Michigan State University
in partial ﬁrlﬁllment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY
Department of Kinesiology

2001

ABSTRACT
FACTORS THAT INFLUENCE THE PHYSICAL FITNESS OF DEAF CHILDREN
By

Marjorie Kathleen Ellis

Maintaining appropriate ﬁtness levels and participating in regular physical
activities are associated with many positive health beneﬁts, including improved stamina,
ability to complete daily physical tasks, and reduction of risk factors related to various
diseases and disabilities (Rowland, 1999). These particular healthy lifestyle behaviors
are important to deaf children, given the general consensus that this group has
demonstrated lower physical ﬁtness levels than their hearing peers (Goodman & Hopper,
1992). However, the reasons why deaf children, as a group, have performed lower on
physical ﬁtness tests have not been researched or identiﬁed.

The purpose of this study was to investigate factors that inﬂuence the physical
ﬁtness of deaf children. A group of 51 deaf children in grades ﬁrst through fourth from
regular and special schools participated in this study. Participants had a minimum
hearing loss of 55 dB in the better ear and did not possess any multiple disabilities. A
modiﬁed version of the Fitnessgram test was used to measure physical ﬁtness. Parents/
guardians and school personnel completed surveys related to the child’s school
placement, participation in physical activity, and physical education participation, as well
as hearing loss/status information for both the parent and the child. Analysis of variance

(ANOVA) and multiple regression procedures were used to identify relationships

between independent and physical ﬁtness variables, and to determine which factors most
strongly predicted the physical ﬁtness performance of deaf children.

The results indicated that participation in regular physical activities and parents’
hearing status inﬂuenced the overall physical ﬁtness of deaf children. Children who
participated in at least three regular physical activities per week performed signiﬁcantly
better on all physical ﬁtness measures with the exception of the trunk lift, than did
children who participated in fewer activities per week. Parents’ hearing status was
determined to be an inﬂuential factor in that 80% of the children with two deaf parents
participated in three or more regular activities per week, compared to 37% of those with
at least one hearing parent.

The primary implication of this study is that parents of deaf children should be
educated about their inﬂuence as role models for healthy lifestyle behaviors. Education
should be targeted to those parents who are sedentary and those who may have
apprehensions about the child’s participation in physical activities, with the focus being

on getting the deaf children involved in regular physical activity participation.

ACKNOWLEDGEMENTS

The author would like to acknowledge the invaluable contributions to this
manuscript by the dissertation committee members of Dr. Gail Dummer, Dr. David
Stewart, Dr. Jim Pivarnik, Dr. Crystal Branta, and Dr. Steve Butterﬁeld. Feedback and
constructive criticism from all committee members led this project to be an experience of
great learning, coupled with a lifelong supply of perseverance. A special thanks to Dr.

Gail Dummer for her infallible guidance through all aspects of my doctoral program.

Table of Contents

Page
List of Tables .................................................................................................................... x
List of Figures .................................................................................................................. xi
CHAPTER 1: Introduction .............................................................................................. 1
Statement of the Problem ...................................................................................... 4
Need for the Study ................................................................................................ 4
Research Questions ............................................................................................... 5
Assumptions .......................................................................................................... 6
Limitations ............................................................................................................ 6
Deﬁnitions ............................................................................................................. 7
CHAPTER 2: Review of Literature ................................................................................. 9
What is Physical Fitness? ...................................................................................... 9
Why is Physical Fitness Important to Deaf Children? ........................................ 12
Reasons Important to Hearing Children ................................................. 12
Immediate beneﬁts ...................................................................... 12
Long-term beneﬁts ...................................................................... 14
Reasons that are Speciﬁc to Deaﬁress .................................................... 16
Readiness for Deaf Sport ............................................................ 16
Social status among hearing peers .............................................. 17
What are the Fitness Levels of Deaf Children? .................................................. 18
Factors Affecting the Fitness Levels of Deaf Children ...................................... 26
Same Factors as for Hearing Children .................................................... 26

Parental inﬂuence ........................................................................ 27

School physical education ........................................................... 28

Physical activity participation ..................................................... 32

Factors Speciﬁc to Deafness ................................................................... 33

Age at onset of hearing loss ........................................................ 33

Levels of hearing loss ................................................................. 34

Parents’ hearing status ................................................................ 36

School placement ........................................................................ 37

Summary ............................................................................................................. 39
CHAPTER 3: Methods .................................................................................................. 41
Research Design .................................................................................................. 41
Minimizing Threats to Internal Validity ................................................. 42
Minimizing Threats to External Validity ................................................ 44
Participants .......................................................................................................... 45
Selection Criteria .................................................................................... 45
Recruitment of Participants ..................................................................... 45
Sample Size ............................................................................................. 46
Informed Consent Procedures ................................................................. 47
Instrumentation ................................................................................................... 47
F itnessgram ............................................................................................. 48
Cardiorespiratory endurance ....................................................... 48

Body composition ....................................................................... 53

Muscular strength, endurance, and ﬂexibility ............................. 55

vi

Overall physical ﬁtness ............................................................... 63

Surveys .................................................................................................... 65

Data Collection Procedures ................................................................................. 65
Testing Schedule ..................................................................................... 65
Communication Modality ....................................................................... 67
Personnel ................................................................................................. 67
Timeline .................................................................................................. 68

Data Analyses ..................................................................................................... 70
Research Question #1: Level of Hearing Loss ...................................... 70
Research Question #2: Etiology and Age at Onset ................................ 71
Research Question #3: Parents’ Hearing Status ..................................... 71
Research Question #4: School Placement .............................................. 72
Research Question #5: Physical Education ............................................ 72
Research Question #6: Physical Activity Participation ......................... 72
CHAPTER 4: Results .................................................................................................... 73
Descriptive Statistics ........................................................................................... 73
Sample Characteristics ............................................................................ 73
Fitnessgram Test Results ........................................................................ 76
Overall results ............................................................................. 76

Analyses of Research Questions ......................................................................... 76
Research Question #1: Level of Hearing Loss ...................................... 76
Research Question #2: Age at Onset of Hearing Loss ........................... 78
Research Question #3: Parents’ Hearing Status ..................................... 79

vii

Research Question #4: School Placement .............................................. 82

Research Question #5: School Physical Education Participation .......... 84
Research Question #6: Physical Activity Participation ......................... 86
Factors Which Inﬂuence the Physical Fitness of Deaf Children ........................ 88
Percent Body Fat ..................................................................................... 91
PACER Performance .............................................................................. 91
Curl-Up Performance .............................................................................. 92
Push-Up Performance ............................................................................. 92
Flexibility ................................................................................................ 92
Healthy Fitness Zone Scores ................................................................... 93
Overall Outcome of Multiple Regression ............................................... 93
CHAPTER 5: Discussion ............................................................................................... 94
Fitnessgram Test Protocol ....................................................................... 94
Physical Fitness Levels of Deaf Children ............................................... 95
Cardiorespiratory endurance ....................................................... 95

Percent body fat .......................................................................... 97

Muscular strength and endurance ............................................... 99

Flexibility .................................................................................... 99

Conclusions and implications ................................................... 100

Inﬂuence of Physical Activity and Physical Education Participation .. 102

Inﬂuence of Parents’ Hearing Status .................................................... 104
Inﬂuence of Other Variables ................................................................. 107
Conclusions and Recommendations ..................................................... 107

viii

References ..................................................................................................................... 1 10

Appendices .................................................................................................................... 1 17
A. UCRIHS Approval ...................................................................................... 119
B. Pilot Test Results ......................................................................................... 121
C. Surveys ................................................................................................... 125

ix

List of Tables

Page

Table 1: Research and Descriptive Statistics from Studies Evaluating

Health-Related Physical Fitness of Deaf Children ....................................... 20
Table 2: Levels of Hearing Loss ................................................................................. 35
Table 3: Testing Time ................................................................................................. 69
Table 4: Sample Characteristics in Frequencies by Age Group ................................. 74
Table 5: Means and Standard Deviations of F itnessgram Test Results ...................... 75
Table 6: Fitnessgram Performances by Age at Onset of Hearing Loss ...................... 80
Table 8: Fitnessgram Performances by School Placement ......................................... 83
Table 9: Fitnessgram Performances by School Physical Education ........................... 85
Table 10: Fitnessgram Performances by Physical Activity Participation ..................... 87
Table 11: R2 Values for Independent Variables on Fitness Measures .......................... 89
Table 12: Reliability and Validity of Fitnessgram Measures of Deaf Children

aged 6-11 years (Pilot Study #2) ................................................................. 124

Figure 1:
Figure 2:
Figure 3:
Figure 4:
Figure 5:
Figure 6:
Figure 7:

Figure 8:

List of Figures

Page
The PACER Test ........................................................................................... 51
The PACER Test ........................................................................................... 52
The Curl-Up Test .......................................................................................... 57
The Curl-Up Test .......................................................................................... 58
The Push-Up Test ......................................................................................... 60
The Back-Saver Sit-and-Reach Test ............................................................. 62
The Trunk Lift Test ....................................................................................... 64
Tests Below, Within, and Above Healthy Fitness Zone ............................... 77

xi

CHAPTER 1
Introduction

Deaﬂ children, like their hearing counterparts, beneﬁt from participation in
regular physical activity and concomitant physical ﬁtness in several ways. Compared to
an unﬁt individual, a person who is physically ﬁt is more likely to be able to complete
daily and leisure activities such as dressing, walking, and shopping without undue
fatigue, as well as effectively handling mental challenges, such as stress (Harris, 1996;
McArdle, Katch, & Katch, 2001). Children who are physically ﬁt and active are more
likely than less active and unﬁt children to experience situations involving socialization;
whereas, poor ﬁtness may discourage involvement in socialization and physical activities
(Rowland & Freedson, 1994). Additionally, appropriate ﬁtness and activity levels may
reduce the onset of risk factors leading to many hypokinetic diseases (Rowland, 1999).
Risk factors associated with hypokinetic diseases include those leading to heart disease
(narrowing of the arteries); bone, joint, and muscle problems (decreased bone mineral
density); diabetes (inactivity and diet); and obesity (inactivity and diet). These risk
factors have been identiﬁed in children as young as six years of age, making physical
ﬁtness and activity participation an important strategy in the reduction of hypokinetic
diseases (Payne & Isaacs, 1999; Rowland, 1999).

Children and adults need to maintain at least minimal levels of physical ﬁtness in
order to experience the many beneﬁts associated with adequate ﬁtness. Minimal

acceptable ﬁtness for school-aged children is defined as having levels of

 

' For the purpose of this study, deaf with a lowercase “(1” refers to an individual with a hearing loss
exceeding 55dB in the better ear. Deaf with an uppercase “D” refers to individuals who identify
themselves as being a member of the Deaf community. As many individuals do not perceive deafness as a
disability, but rather an identity (Moores, 1996; Stewart, 1991), person-ﬁrst terminology was not used
within this study.

cardiorespiratory endurance, upper body and abdominal strength/endurance, and percent
body fat which rank at or above the 20th percentile for each measure (Cooper Institute of
Aerobic Research, 1999). Exercise physiologists recommend participation in vigorous
physical activities either vigorous activity 20 minutes per session for three days per week
or moderate activity 30 minutes per session for 5 days per week (Public Health Service,
1990; 2000).

Even with the importance placed on healthy ﬁtness levels, deaf children have
demonstrated lower ﬁtness levels than their hearing peers. Goodman and Hopper (1992)
completed a review of ﬁve studies (Bresett, 1971; Campbell, 1983; Pender & Patterson,
1982; Wiegersma & Van Der Velde, 1983; Winnick & Short, 1986) evaluating the
physical ﬁtness of deaf and hearing children, and noted that the results were generally
favorable to hearing children. Given that almost 70% of all hearing school-aged children
have not reached one or more of the national healthy ﬁtness and activity goals, the lower
physical ﬁtness levels of deaf children are especially alarming (Public Health Service,
1980; 1990; 2000).

The reasons why deaf children, as a group, demonstrate lower ﬁtness levels are
unknown. Deafness is not a physical disability, but rather a sensory disability deﬁned as
a hearing loss so severe, generally greater than 55 dB in the better ear, that difﬁculties in
communication exist even with the use of ampliﬁcation devices. In some cases, deaf
children may have multiple disabilities, including various physical disorders, such as
ataxia, which could affect ﬁtness and activity levels. However, for most deaf children
there are no physical reasons which would explain the occurrence of these lower ﬁtness

levels.

Deaf children may exhibit low levels of physical ﬁtness for the same reasons as
do hearing children. The ﬁtness levels of school—aged children, especially upper
elementary and older, are inﬂuenced by the amount of physical activity participation
within the community and school physical education settings (Lehnhard, Lehnhard,
Butterﬁeld, Beckwith, & Marion, 1992; Ross & Pate, 1987; Sallis, McKenzie, & Alcaraz,
1993). A child with many opportunities to be physically active and ﬁt at a young age and
remain active during his/her school years, is more likely to become a ﬁt and active adult
than is a child with fewer opportunities. Children with physically ﬁt and active parents
who model these behaviors are six times more likely to demonstrate similar healthy
lifestyle patterns than children with more sedentary and less ﬁt parents (Bona, Schwartz,
Spain, & Natchipolsky, 1995; Stucky-Ropp, & DiLorenzo, 1993). The child’s motor
skill level may also inﬂuence physical activity participation, with inadequate skill levels
potentially leading to lower activity participation and ﬁtness levels (Payne & Isaacs,
1999). Regardless of the child’s hearing status, the extent to which each factor inﬂuences
physical ﬁtness and activity levels vary from individual to individual (Hastad & Lacy,
1998; Moores, 1996).

There may also be some unique factors speciﬁcally related to deafness that
inﬂuence the physical ﬁtness of deaf children. Etiology and level of hearing loss are
potential inﬂuential factors, as both relate to the outcome of communication.
Communication problems are more prevalent among children with profound and acquired
deafness, especially when deafness is due to meningitis or involve sensorineural hearing
losses (Moores, 1996). This may inﬂuence the child’s understanding and participation in

activities leading to the attaimnent of ﬁtness. Parents may behave differently regarding

their deaf child’s involvement in ﬁtness and other activities depending on their own
hearing status. Hearing parents may be apprehensive of their deaf child’s participation in
physical activity settings and may limit his/her involvement in some activities; whereas,
deaf parents may not be overprotective due to a greater understanding of the disability
(Moores, 1996). School placement may also inﬂuence the physical ﬁtness and activity
levels of deaf children. Deaf children are placed in either regular or special school
settings. Deaf students in special schools typically have opportunities to participate in
activities, interact, and socialize with other deaf students; whereas, deaf students in
regular schools may or may not have similar opportunities. However, the factors that
inﬂuence the physical ﬁtness and activity levels of deaf children will likely remain
unknown until an investigation that focuses on these factors is completed.
Statement of the Problem
The purpose of this study is to identify factors that may inﬂuence the physical
ﬁtness levels of deaf children. Factors being investigated include: (a) school physical
education; (b) physical activity participation; (c) etiology of hearing loss; ((1) level of
hearing loss; (e) parents’ hearing status; and (i) type of school placement.
Need for the Study
Many deaf children have demonstrated lower ﬁtness levels than their hearing
peers (Goodman & Hopper, 1992). The reasons for lower ﬁtness levels are unknown, as
the literature provides very little information about the factors that inﬂuence the physical
ﬁtness levels of this group (Goodman & Hopper, 1992). Information about factors that
inﬂuence the physical ﬁtness levels of deaf children would beneﬁt approximately

200,000 school-aged deaf children in the United States, their parents, teachers, and other

individuals who are most likely to inﬂuence the attainment of ﬁtness by deaf children
(United States Department of Education, 1996). The importance of this information lies
in knowing if factors that affect the physical ﬁtness of deaf children are similar to those
that affect hearing children, more disability-speciﬁc, or a combination of both. This
study will provide baseline data regarding demographic, school, and/or deafness related
factors which should be evaluated more closely with respect to deaf children’s ﬁtness.
Presently, there is no research on the factors that affect the physical ﬁtness of deaf
children (Goodman & Hopper, 1992), leaving the profession to guess why deaf children
have demonstrated lower ﬁtness levels than their hearing peers.
Research Questions
1. Does level of hearing loss, in decibels, inﬂuence the physical ﬁtness levels of deaf
children?
2. Does etiology of hearing loss inﬂuence the physical ﬁtness of deaf children?
3. Is parents’ hearing status related to the physical ﬁtness levels of deaf children?
4. Does placement in regular or special school settings inﬂuence the physical ﬁtness of
deaf children?
5. Does the amount of weekly physical education inﬂuence the physical ﬁtness of deaf
children?
6. Does the amount of physical activity participation inﬂuence the physical ﬁtness levels

of deaf children?

Assumptions
Fitness test instructions were presented in the student’s desired mode of
communication, mainly contact signing and spoken/oral communication; therefore,
each participant understood these instructions.
Each participant had the necessary prerequisite skills (i.e., running) to perform
individual ﬁtness tests.
There were no differences in the physical capabilities of the deaf students within
special and regular schools to perform the ﬁtness tests.
Each participant gave his/her best effort on all ﬁtness measures.
Each participant’s parents/ guardians understood and were able to completely answer
the questionnaire items relating to themselves and their child.

Limitations
The sample size in this study was relatively small, limiting generalization of the
ﬁndings to the general population of deaf children.
Students in this study participated in physical education programs which ranged
from 20 minutes to 90 minutes per week. This wide class time range limits
generalization to other school systems across the country in that some classes met
once a week for 40 minutes, other classes met twice a week for 20 minutes each time,
and still others met daily for 45 minutes. This type of information may be difﬁcult to
generalize unless schools have similar physical education class meeting times.

Schools were selected from one state, limiting geographical representation.

Definitions

Acquired deafness. A hearing loss which occurred after birth that may be due to
illness, infection, or various other causes (Batshaw, 1997).

Congenital deafness. A hearing loss that was present at birth and may be caused
by prenatal illnesses, genetics, or unknown reasons (Sherrill, 1998).

Deaf Deaf, both with an uppercase and lowercase “(1,” refers to any hearing loss
greater than 55 dB in the better ear. The term Deaf using the uppercase “D” refers to an
individual or group of individuals who identify with the Deaf culture (Moores, 1996;
Stewart, 1991).

Decibel (dB). A measurement of intensity of sound that is commonly used to
categorize severity of hearing loss (Moores, 1996).

Physical ﬁtness. With respect to the Healthy People Goals for a Nation (Public
Health Service, 2000) and various ﬁeld test batteries (Cooper Institute of Aerobic Fitness,
1999; Payne & Isaacs, 1999), children’s physical ﬁtness levels are categorized by
components of health-related physical ﬁtness. Health-related physical ﬁtness includes
body composition, cardiovascular endurance, ﬂexibility, muscular strength, and muscular
endurance (Hastad & Lacy, 1998; US. Department of Health and Human Services,
1996)

Regular school. A public school where both deaf and hearing children are
educated, with deaf children being placed in self-contained classrooms, regular classes, or
a combination of the two.

Sign language. A visual-spatial communication mode that uses manual symbols

representing concepts and ideas through use of ﬁngerspelling and manual signs (Schein

& Stewart, 1995). The primary mode of communication used within the Deaf
community, in special schools, and self-contained classrooms.

Special school. A school where the majority of students are deaf and the primary
mode of communication is sign language. Students either return home at the end of the

day or reside at the school and return home on the weekends.

CHAPTER 2
Review of Literature

The purpose of this study was to identify factors that inﬂuence the physical ﬁtness
levels of deaf children. The following topics are discussed in this review of literature: (a)
background information on physical ﬁtness; (b) the immediate and long—term beneﬁts of
physical ﬁtness; and (c) factors that may inﬂuence the attainment of ﬁtness of deaf
children.

What is Physical Fitness?

Physical ﬁtness includes several components related to the ability of the body to
function effectively physiologically, and is categorized as being either skill-related or
health-related (Hastad & Lacy, 1998). Skill-related physical ﬁtness involves components
more closely related to sports and athletic performance, such as balance, agility,
coordination, and power. Health-related physical ﬁtness refers to components of
everyday functional ﬁtness, such as cardiorespiratory endurance, muscular strength/
endurance, body composition, and ﬂexibility. While both types of ﬁtness are important,
it is health-related physical ﬁtness that has generated the most emphasis from medical
professionals due to its connection with various diseases and disabilities (Public Health
Service, 1990). In general terms, health-related physical ﬁtness is deﬁned as the
physiological ﬁmctions which offer protection from diseases and disabilities associated
with inactive, sedentary habits (Wilmore & Costill, 1994). In order to experience such
protection from disease and disability, minimally appropriate ﬁtness levels are required,
which are deﬁned as performing at or above the 20th percentile on individual measures of

health-related physical ﬁtness (Cooper Institute of Aerobic Fitness, 1999).

Each category of health-related physical ﬁtness plays a role in the overall health
and well-being of an individual. Cardiorespiratory endurance is the component of ﬁtness
concerned with the ability of the heart and lung systems to provide the body with oxygen
during continuous movement (Wilmore & Costill, 1994). Individuals who possess
appropriate levels of cardiorespiratory endurance are able to exercise the entire body over
a period of time without undue stress or fatigue. Poor levels of cardio-respiratory
endurance have been found to be one of the main precursors for heart disease (Hastad &
Lacy, 1998; Francis, 1999). Individuals who demonstrate poor cardiorespiratory
endurance experience difﬁculties when moving their bodies from one point to another,
requiring periods of rest before‘able to continue movements. A healthy cardiorespiratory
system allows the heart to have strong cardiac output, decreased build-up of plaque and
deposits along the arteries, and efﬁcient pumping action (Wilmore & Costill, 1994).

Body composition refers to the relative amounts of bone, fat, muscle, and other
vital tissues and parts within the body (Wilmore & Costill, 1994). Body composition is
generally evaluated in terms of percentage body fat, and is the only health-related
physical ﬁtness component that is not a performance measure. The ratio between lean
body mass and fat mass is important in an individual’s ability to perform functional
movements, as body fat has been connected with performance on many weight-bearing
activities (Rowland, 1999). Many of the problems with percent body fat come from
overfatness, rather than overweight (Hastad & Lacy, 1998). An individual could have
larger muscle mass leading to a classiﬁcation of overweight on general height/weight
scales, but could still be within normal limits when body fat is evaluated. High body

fatness may cause an individual to have difﬁculty in moving their body efﬁciently. This

is one of the reasons why many children and adults drop out of physical activity, as it
becomes difﬁcult and cumbersome to move the additional fat. High body fat is
associated with sedentary lifestyles, a precursor for many hypokinetic diseases and
disabilities (Rowland & Freedson, 1994).

An individual could also either be underweight or underfat(Wi1more & Costill,
1994). An individual who has been classiﬁed as being underweight demonstrates a body
weight that is lower than the mean for his/her height, age, and gender. This individual
may have a percentage body fat within normal limits accompanied by a lean body build.
An individual who has been classiﬁed as underfat may demonstrate body weight within
acceptable limits for age, height, and gender, but possess lower than recommended
amounts of body fat. This individual could have higher muscle mass or a leaner than
normal body build. Low body fatness does not necessarily mean that the individual is
physically ﬁt; it can sometimes be an indication of malnutrition and below normal ranges
of fat storage which protect the body from injury; and can sometimes negatively affect
the growth and maturation of the child (Malina & Bouchard, 1991).

Muscular strength and endurance refer to the abilities of the upper and lower body
to exert muscular force initially and continually over a prolonged period (Cooper Institute
of Aerobic Research, 1999). In many tests, these two factors are evaluated concurrently
and are reported as either upper body or abdominal strength and endurance (Hastad &
Lacy, 1998). Muscular strength and endurance allow an individual to exert enough force
to perform functional everyday activities with ease. An individual who has low muscular
strength and endurance may have difﬁculties performing activities of daily living such as

carrying books, climbing stairs, doing laundry, or completing tasks around the house or

11

yard. As with body fatness, low muscular strength and endurance lead to many
movements being arduous, possibly leading to sedentary habits and an increased risk of
hypokinetic diseases and disabilities compared to individuals who demonstrate adequate
levels of muscular strength and endurance (Rowland & F reedson, 1994).

Flexibility is concerned with the movement of body joints through their functional
range of motion, and relates to the elasticity of muscles, ligaments, and tendons
(Rowland, 1999). Individuals who possess an adequate level of ﬂexibility are more
likely to demonstrate appropriate posture and are less susceptible to injury during
physical activities, including injuries associated with the lower back and body joints. An
individual with poor ﬂexibility may be prevented from participating in physical activities
where agility is necessary, due to an increased potential for injury (Hastad & Lacy,
1998)

Why is Physical Fitness Important to Deaf Children?

Fitness is important to deaf children, just as it is to children who do not have
hearing losses. There are several reasons why ﬁtness is important to deaf children,
including reasons directly related to their hearing loss (speciﬁc to deaﬁress) and those
which are important to hearing children as well.

Reasons Important to Hearing Children

Health-related physical ﬁtness plays an important role in the daily life of an
individual, regardless of hearing status. There are several reasons why physical ﬁtness is
important to all children, including both immediate and long-term beneﬁts.

Immediate beneﬁts. Appropriate ﬁtness levels can lead to many immediate

beneﬁts. One such beneﬁt is in the performance of everyday activities, easily and

without undue stress and fatigue, thus, promoting overall quality and enjoyment of life
(Kohl & Hobbs, 1998; Pate, Baranowski, Dowda, & Trost, 1996; Wilmore & Costill,
1994). Participation in leisure activities within the exercise and recreational arena, such
as walking, bicycling, and swimming, can be very enjoyable for individuals who have
attained appropriate ﬁtness levels (Heyward, 1990).

Interaction and socialization with others in physical activity and recreational
settings is another immediate beneﬁt of physical ﬁtness. Individuals who have
appropriate ﬁtness levels and are involved in sport and recreational activities participate
in a setting where interaction with others is a foremost objective (Stucky-Ropp &
DiLorenzo, 1993). Participation in physical activity promotes socialization and
cooperation among participants, an experience that is very important for children
(Ramsey & Rank, 1997). Successful interaction and socialization with others encourages
participation in physical activity, increases self-worth, promotes learning of socialization
and teamwork skills, and generates friendships among participants (Stucky-Ropp &
DiLorenzo, 1993).

Maintaining appropriate ﬁtness levels increases one’s overall quality of life, both
physically and psychologically (Ford, Puckett, Blessing, & Tucker, 1989; Leith & Taylor,
1991). Children feel better about themselves and their abilities when they are more
capable of performing even the most basic tasks without great effort (Fox, 1992;
Martinsen, & Stephens, 1994). Increases in overall physical activity performance and
ﬁtness measures lead to enhanced self-concept in children (Faigenbaum, Zaichkowsky,
Westcott, & Long, 1997; Salokum, 1994). This enhancement of self-concept is

especially strong when connected with positive changes in body fat (Marsh & Redmayne,

1994). Psychological well-being is critical in a world with increasing daily stressors.
Coping with situations that tend to promote stress and anxiety is a positive outcome from
physical ﬁtness and activity participation (Harris, 1996).

Long-term benefits. One of the most important long—terrn beneﬁts of ﬁtness and
physical activity participation is the potential to decrease the risk of hypokinetic diseases
and disabilities. Hypokinetic diseases are those associated with poor ﬁtness and inactive
lifestyles (Rowland, 1999). Some of the risk factors associated with hypokinetic diseases
have surfaced in children as early as six years of age, including narrowing of the arteries
and increased blood pressure. The risk factors associated with hypokinetic diseases can
be reduced through participation in physical activities and maintaining appropriate ﬁtness
levels (Rowland & Freedson, 1994). In addition, the same healthy lifestyle behaviors
promote an increase in overall bone mineral density leading to stronger bones (Heyward,
1990) reduce the prevalence of diabetes, and increase an individual’s psychological
capability to handle stress, depression, and anxiety (Rowland & Freedson, 1994; Stucky-
Ropp & DiLorenzo, 1993).

Compared to other life-altering diseases, cardiovascular disease has one of the
highest correlations with low ﬁtness levels, resulting in more than one million deaths per
year (Wilmore & Costill, 1994). According to present Public Health Service reports
(2000), more than 13.5 million individuals in the United States have coronary heart
disease, and 1.5 million individuals experience a heart attack each year. Not only does
poor ﬁtness place an individual at risk for cardiovascular disease, but also for dying
prematurely from disease complications (Public Health Service, 1990; 2000). Children

and adults who demonstrate low cardiorespiratory endurance on ﬁtness tests, such as

14

through endurance runs or the PACER protocol (Cooper Institute of Aerobic Research,
1999), are at increased risk for heart disease (Cooper Institute of Aerobic Research, 1999;
Ross & Pate, 1987).

Diabetes is another life-altering disease which is triggered by poor ﬁtness,
inactivity, and obesity (Albright, Franz, & Homsby, 2000). Diabetes is the inability of
the body to produce or use insulin, a necessary agent in glucose metabolism (Wilmore &
Costill, 1994). Type II diabetes usually surfaces in young and middle aged adults and
affects more than 8 million individuals in the United States (Public Health Service,
2000). Diabetes drastically increases an individual’s risk of heart disease, with affected
individuals having an 80% mortality rate from cardiovascular disease (Albright, Franz, &
Homsby, 2000). The alarming fact is that many cases of type II diabetes could have been
prevented through maintenance of healthy ﬁtness levels and daily physical activity
participation (Public Health Service, 2000). The main prescriptions for controlling
diabetes include maintaining appropriate ﬁtness levels, participating in regular physical
activity, adherence to a specialized diet, and, in some cases, medication.

Appropriate ﬁtness and activity levels promote strong bones and joints, thus
reducing the chance of fractures and debilitating injury caused by decreased bone and
joint stability (Heyward, 1990). Physical ﬁtness allows for greater participation in
weight-bearing activities, which in turn leads to increased bone mineral density and
ﬂexibility of joints (Harris, 1996; Heyward, 1990). Increased bone mineral density
allows the skeletal system to withstand greater weights and more pressure during weight-
bearing activities without the occurrence of injuries (Heyward, 1990). Flexibility allows

for uninhibited movement of body parts through joint range of motion, decreasing

chances of injury during physical activities and normal everyday movements (Harris,
1996). Additionally, physical ﬁtness and participation in physical activities promotes not
only increased muscular strength and endurance, but also improved muscle tone
(Rowland & Freedson, 1994). Improved muscle tone promotes smooth contraction of
muscles and decreased chance of injury and muscle soreness due to improper or
imbalanced movements. Thus, poor ﬁtness and sedentary activity levels can lead to
reduced bone mineral density, ﬂaccid muscle tone, and rigid joints, increasing the risk of
injury and limitations during movement (Harris, 1996; Heyward, 1990; Rowland &
Freedson, 1994).

Physical ﬁtness and activity participation provide several long-term beneﬁts,
namely reducing the risk factors associated with various hypokinetic diseases and
disabilities. Maintaining appropriate ﬁtness levels and participating in regular physical
activities reduces the risk and onset of such diseases as cardiovascular disease, diabetes,
and bone and joint problems. This in itself is an important reason for all children to be
introduced to participation in regular physical activities leading to attainment and
maintenance of appropriate physical ﬁtness levels from a young age.

Reasons that are Specific to Deafness

Physical ﬁtness is important to deaf children for the same reasons as for hearing
children. However, there are some additional deafness-speciﬁc reasons that must be
considered for children who are deaf.

Readiness for Deaf sport. One of the most important mainstays of Deaf culture is
Deaf sport (Stewart, 1991). Readiness for Deaf sport not only entails participation in

sports and physical activities, but also being physically capable of participation by

16

demonstrating appropriate physical ﬁtness levels. An individual who is not physically ﬁt
may be less likely to become involved in any form of physical activity (Francis, 1999).
Not being involved in any form of physical activity reduces the chance of the deaf
individual participating in Deaf sporting events. It is within the Deaf sport arena that
great pride and self-concept can be gained by participating with individuals who share
similar communication abilities and cultural experiences (Stewart, 1991). Through Deaf
sport, deaf children can learn about opportunities for participation as athletes, coaches,
ofﬁcials, volunteers, and spectators. Therefore, the deaf individual not only fails to
beneﬁt from physical activity participation, but also the socialization and interaction
opportunities with other deaf individuals that are associated with Deaf sport.

Social status among hearing peers. Social status among peers is a great source of
pride and self-worth (Williams & White, 1983). Increased pride and self-worth lead to
positive feelings toward oneself and in one’s belief that he/she can successfully attempt
and accomplish things that would otherwise have been avoided (Coakley, 1990; Williams
& White, 1983). Participation in sporting events and attainment of physical ﬁtness can
lead to popularity among peers and improved personal appearance, both which are
important to school-aged children (Chase & Dummer, 1992). This importance of social
status increases with age, with social status through sports participation more important
to males and personal appearance more important to females. For many individuals,
acceptance and social status among peers rolls over into other settings such as academics
and other school-related activities and involvement in physical ﬁtness and activity

participation tend to increase this acceptance among peers, both active and inactive

(Coakley, 1990).

Socialization and social status among peers are critical factors for deaf children,
especially with the barriers to communication that are present for deaf children in many
settings (Moores, 1996). Barriers to communication can and do prevent deaf children
from complete participation in many activities, mainly in the school settings, and affect
success in both learning and socialization (Moores, 1996; Stewart, 1991). Physical
activity is a setting that typically offers a level playing ﬁeld for deaf and hearing
individuals, where deaf children should not be at a disadvantage (Stewart, 1991). Deaf
children who are physically ﬁt and active are likely to experience the same beneﬁts as
hearing children including increased social status among their peers, feelings of pride,
and self-worth (Coakley, 1990). Individuals with poor ﬁtness, regardless of hearing
status, are more susceptible to isolation from their peers, leading to decreased
socialization opportunities (Coakley, 1990; Greenberg & Kusche, 1989). From a
sociological standpoint, it is important for deaf children to demonstrate physically ﬁt and
active habits in order to promote the beneﬁts of socialization and the attainment of social
status among their peers.

What are the Fitness Levels of Deaf Children?

The focus of this study was on the health-related physical ﬁtness of deaf children,
therefore, this review of literature will be limited to health-related physical ﬁtness rather
than skill-related physical ﬁtness. Goodman and Hopper (1992) completed a review of
studies evaluating the physical ﬁtness of deaf children. Of all the studies reviewed, only
ﬁve met the criteria for evaluating health-related physical ﬁtness (Table 1). According to
Goodman and Hopper (1992), the results of these studies generally indicated that deaf

children demonstrate lower physical ﬁtness levels than their hearing peers.

Bresett (1971) measured cardiorespiratory endurance using several methods of
evaluation. A total of 100 subjects, 50 males and 50 females, between the ages of 12 to
14 years participated in this study. The deaf participants (n = 50) were students at a
residential school for the deaf and the hearing participants (n = 50) were students at local
public schools. No information was provided regarding distribution of genders across
hearing groups. The author deﬁned deafness as “that condition in which the sense of
hearing is non-functional for the ordinary purpose of life with or without ampliﬁcation of
sound” (p. 3). Age at onset was categorized as either congenital or acquired before the
age of two; however, participants were not grouped based on differences in age at onset.
In addition, level of hearing loss and communicative preferences were not reported.

In the Bresett (1971) study, physical ﬁtness was evaluated using breathing
capacity, expiratory volume, leg strength, and arm strength. Breathing capacity and
forced expiratory volume were measured through use of manual spirometers. Arm
strength was evaluated based on push-up performance adjusted by the weight of the
subject. Leg strength was evaluated using one rep—max performance on a leg
dynanometer. Hearing participants performed signiﬁcantly higher than deaf participants
on both forced expiratory volume and breathing capacity. Female hearing participants
demonstrated signiﬁcantly higher leg strength than female deaf participants. Hearing
participants performed better on measures of arm strength; however, results were not
statistically signiﬁcant. From these results, the author postulated that the differences in
ﬁtness between hearing and deaf participants may have been due to differences in

opportunities to participate in physical activities outside the school setting.

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Fender and Patterson (1982) evaluated three aspects of ﬁtness, namely
cardiorespiratory endurance, abdominal strength/endurance, and upper body strength/
endurance. A total of 120 subjects between the ages of 6-11 years participated and were
classiﬁed as either hearing (n = 60) or deaf (n = 60). Deaﬁress was deﬁned as having a
congenital hearing loss of 60 to 110 dB in the better ear. Hearing participants were
students at a local public school, and deaf participants were students at the state
residential school for the deaf. Fitness was measured via a timed step test in which heart
rate was monitored (HR > 180 beats per minute led to cessation of the test), as well as the
total number of push-ups and sit-ups completed. Information on gender and speciﬁc test
administration used to measure upper body and abdominal strength/endurance were not
disclosed.

Hearing participants demonstrated signiﬁcantly higher performance for measures
of upper body and abdominal strength/endurance; whereas, for the step test, deaf
participants showed superior performance (Pender & Patterson, 1982). The authors did
mention, however, that the deaf participants, while their performances were higher the
hearing participants, had greater difﬁculties maintaining pace on the step test. No
information was provided as to how directions or step-test cadence were presented to the
deaf participants. Additional in-depth information pertaining to deafness (level, other
etiologies, communication preferences) was not reported.

Campbell (1983) evaluated three ﬁtness variables for 47 hearing, 23 hard of
hearing, and 24 deaf children between the ages of 6-13 years. Gender information was
not provided. Hard of hearing was deﬁned as a hearing loss of less than 90 dB, and deaf

was deﬁned as any hearing loss at or greater than 90 dB. All participants attended the

22

same public school and were integrated within classes. Fitness was evaluated by the 9-
minute walk/run as a measure of cardiorespiratory endurance, 60-second ﬂexed knee sit-
ups for abdominal strength/endurance, and a timed ﬂexed arm hang for upper body
strength/endurance. This study did not identify the methods used for presenting test
directions to hard of hearing and deaf participants. Additional information pertaining to
deafness (age at onset, level of hearing loss, communication) was not reported.

Hearing and hard of hearing participants performed signiﬁcantly better than deaf
participants on the cardiorespiratory endurance test (Campbell, 1983). No signiﬁcant
differences were evident between the groups on the measure of upper body
strength/endurance. Deaf and hard of hearing participants performed signiﬁcantly lower
than hearing participants on the measure of abdominal strength/endurance, with hearing
females performing signiﬁcantly higher than deaf females, and hard of hearing males
performing signiﬁcantly higher than deaf males. Overall, deaf and hard of hearing
participants performed signiﬁcantly lower than did hearing participants on all measures,
with the exception of the performances of males on abdominal strength/endurance which
was not signiﬁcantly different and upper body strength/endurance which was similar
across groups. The results of this study were generally in favor of the hearing
participants.

Wiegersman and Van Der Velde (1983) evaluated the physical ﬁtness levels of 25
hearing and 32 deaf children aged 6-8 years. No information was provided pertaining to
gender, the classiﬁcation method used for deafness, school placement, age at onset of
hearing loss, or of the communication modality used during testing procedures. The

ﬁtness measures included ﬂexibility (sit-and-reach), abdominal strength/endurance (60-

23

second ﬂexed knee sit-ups), and agility (squat thrust). The conclusions of this study
indicated deﬁciencies in ﬁtness by deaf children across all ages, except for ﬂexibility
where negligible differences were found for the 8-year-old group. The authors postulated
that the smaller gap in ﬁtness seen with the 8-year-old group may have been due to the
greater number of activities offered through the residential school setting as compared to
the non—residential or public school settings. Other than the preceding statement, no
further information on school placement was provided, but from this, it was presumed
that the deaf participants were students at a school for the deaf.

Winnick and Short (1986) completed a large scale study evaluating the physical
ﬁtness of deaf and hearing children, with a sample size of 686 hearing, 153 hard of
hearing, and 892 deaf children aged 10-17 years. This sample size was ﬁrrther consisted
of 873 females and 858 males. Individuals with hearing losses in the 27 dB to 90 dB
range were classiﬁed as hard of hearing, and those with hearing losses exceeding 90 dB
were classiﬁed as deaf. All of the hearing students attended public schools and the hard
of hearing and deaf students attended either public schools or residential schools for the
deaf. No information was provided regarding age at onset of hearing loss. The test
administration procedures for presenting test directions to the deaf students were not
discussed.

Winnick and Short’s (1986) study evaluated the physical ﬁtness variables of
cardiorespiratory endurance (timed 1.0 mile for children aged 10 to 12 years and timed
1.5 mile for children aged 13 to 17 years), percent body fat (tricep and subscapular
skinfolds), abdominal strength/endurance (60-second sit-ups), and ﬂexibility (sit-and-

reach). Only the exclusion of upper body strength/endurance prevented this study from

24

being a complete ﬁtness assessment. Hearing children performed at higher levels on all
ﬁtness measures than both the hard of hearing and deaf children. Statistical signiﬁcance
was indicated between the hearing and non-hearing children on abdominal
strength/endurance and ﬂexibility. The deaf participants demonstrated signiﬁcantly
higher percentage body fat than both the hard of hearing and hearing participants. In
addition, the deaf participants performed slightly higher than the hard of hearing
participants on cardiorespiratory endurance, ﬂexibility, and abdominal
strength/endurance tests; however, none of these performances were statistically
signiﬁcant.

Ellis (2001) evaluated the health-related physical ﬁtness performance of 73 deaf
children aged 6-16 years and compared these results to the AAHPERD national standard
norms (AAHPERD, 1984; Hastad & Lacy, 1998). All participants had at least a 55 dB
hearing loss in their better ear. Directions were presented using a combination of sign
language and verbal communication. Physical ﬁtness components measured included
cardiorespiratory endurance (timed one-mile run), percentage body fat (calf and tricep
skinfolds), ﬂexibility (sit-and-reach), abdominal strength/endurance (60-second sit-ups),
and upper body strength/endurance (pull-ups).

The results of this study indicated that this group of deaf children demonstrated
physical ﬁtness performances below the 40th percentile on national standard norms for
all tests with the exception of ﬂexibility (Ellis, 2001). A number of the results fell below
the 20th percentile, mainly with cardiorespiratory endurance (M = 19th percentile) and
percent body fat (M = 20th percentile). Performances on the sit-up (M = 33rd percentile)

and pull-ups (M = 23rd percentile) were well below the 40th percentile. The results of

25

this study would indicate that deaf children performed below the median on standard
national norms for health-related physical ﬁtness measures, with the exception of
ﬂexibility (M = 58th percentile). This information suggests agreements with the
literature that deaf children demonstrate below average ﬁtness levels when compared to
norms formulated for hearing children.

Taking into account those studies that evaluated health-related physical ﬁtness
variables, the general consensus remains that deaf children, as a group, demonstrate
lower ﬁtness levels than their hearing peers. However, when evaluating the research
completed in this area, only one component of physical ﬁtness was evaluated using the
same ﬁtness measure (the 60-second sit-up test) in all six studies (Table 1). Even with
the variability in ﬁtness measures used between studies, the outcome of each remained
consistent in that deaf children were found to perform lower on many of the physical
ﬁtness tests than their hearing peers.

Factors Aﬂecting the Fitness Levels of Deaf Children

While deaf children as a group have demonstrated lower ﬁtness levels than their
hearing peers, the factors that contribute to the lower ﬁtness levels by deaf children are
generally unknown. It is logical to consider that some of the factors that inﬂuence the
physical ﬁtness of deaf children may be those that affect the ﬁtness levels of hearing
children. However, in addition to factors that are similar for hearing children, there may
be factors that are deafness-speciﬁc and unique to children with hearing losses.

Same Factors as for Hearing Children
Some of the factors that affect the physical ﬁtness levels of deaf children may be

those that are inﬂuential for hearing children. The main factors that have been found to

26

inﬂuence the physical ﬁtness of hearing children are those related to parental inﬂuence,
school physical education, and physical activity participation.

Parental inﬂuence. Several investigations have reported that parents’
involvement in physical activity and their encouragement of similar behaviors for their
children may increase the chances that the child will become physically active as well
(Biddle & Armstrong, 1992; Pate, et al., 1997). Pate et al., (1997) evaluated the inﬂuence
of activity patterns of family members on their children’s ﬁtness levels. A total of 739
sixth grade children, 387 males and 352 females, and their families participated in this
study. A questionnaire was used to determine the child’s perception of the family’s
physical activity habits. The questionnaire required the participant to indicate activity
levels for each family member using a 5-point Likert scale (l=not active to 5=most
active). In addition, each child indicated whether both parents are equally active, the
mother is most active, the father is most active, sibling(s) is most active, or no one in the
family is active. There was no mention of the directions given to the participants in how
to determine which family member(s) was the most active. Each participant completed
the health-related physical ﬁtness measures of cardiorespiratory endurance (1.0 mile
run/walk), abdominal strength/endurance (number of sit-ups), upper body
strength/endurance (number of pull-ups), ﬂexibility (sit-and-reach), and body
composition (skinfolds). Locations for the skinfolds and the sit-up protocol used were
not described.

The results of the Pate, et al., (1997) study indicated that children demonstrated
signiﬁcantly higher ﬁtness scores when the mother or both parents were perceived by the

child to be active. No signiﬁcant gender interaction was found for family activity habits

27

and children’s physical ﬁtness levels. Further analysis indicated that ﬂexibility scores
were the greatest for the group of children who reported that the mother was most active.
When the father was identiﬁed as the most active family member cardiorespiratory
endurance performance was the highest, but ﬂexibility scores were the lowest. The
authors suggested that mothers encourage more stretching and moderate activity
participation; whereas, fathers encourage more vigorous activity habits. Among all of the
participants, the lowest performances on all ﬁtness measures were demonstrated by the
children who identiﬁed no family members as being physically active. The results
indicated that when parents were not active and inﬂuencing their children to be active as
well, other inﬂuential factors must play greater roles in getting children active. For
example, where family members are not active themselves, factors such as school
physical education may become especially important in getting children to become
involved in physical activity.

School physical education. Schools offer many opportunities for children to
become involved in various school and extracurricular activities, including physical
activity. The frequency, duration, and quality of physical education programs have
signiﬁcant effects on the physical ﬁtness of school-aged children (McKenzie, et al., 1996;
Sallis, et al., 1997). A program that meets for more minutes during the week and focuses
on continuous activity will likely have more positive outcomes than a program that meets
on fewer occassions and does not provide opportunities for the children to be
continuously active during class (Sallis, et al., 1997). However, there is the question of
whether children are participating in sufﬁcient moderate to vigorous physical activity

during physical education classes. Pate, et al., (1996) reported that approximately 92% of

28

elementary and middle schools require physical education classes; however, only 27% of
these same school children participated in physical activity of a sufﬁcient intensity to
produce ﬁtness beneﬁts. Similar results were reported by Ross and Pate (1987). In their
study, 97% of elementary level children were enrolled in physical education classes;
however, less than 30% of their physical education class time was spent on actual
vigorous physical activity.

Sallis, et al., (1997) implemented a two-year physical education program
speciﬁcally designed to increase physical activity and ﬁtness levels. Seven elementary
schools and 955 fourth grade physical education students in those schools participated in
this study. Schools were assigned one of three groups: (a) physical education taught by a
specialist; (b) physical education led by a trained classroom teacher; (c) and physical
education led by an untrained classroom teacher (control group); however, no discussion
was provided on whether the assignment of schools to treatment groups was random.
Health-related physical ﬁtness included measures of cardiorespiratory endurance (1.0
mile run), abdominal strength/endurance (60—second bent knee sit-ups), upper body
strength/endurance (pull—ups), ﬂexibility (sit-and-reach), and body fatness (calf and tricep
skinfolds). Trained observers used the System for Observing Fitness Instruction Time
(SOFIT) protocol to evaluate the physical education program at each school (McKenzie,
Sallis, & Nader, 1991).

Physical education classes led by specialists met for an average 79.7 minutes per
week, while those with trained classroom teachers met 64.6 minutes per week, and the
control classes 38.0 minutes per week. Through observation, it was indicated that during

these classes, the control group students were moderately to vigorously active 17.8

29

minutes/week, trained teacher-led classes 32.7 minutes/week, and specialist-led 40.2
minutes/week. Signiﬁcant positive contrasts were indicated for both the amount of
physical education per week and the activity level of the students. The outcome of the
observations indicated that not only was the duration of physical education classes
important in participating in sufﬁcient levels of physical activities, but also that the
leadership within these classes played a role in the type and duration of activity
participation.

All participants, regardless of group, demonstrated similar performance on each
of the ﬁtness measures during the pretest at the beginning of the two-year program, with
the exception of the mile run, where the trained teacher-led group performed signiﬁcantly
higher than the specialist-led and control groups (Sallis, et al., 1997). At the conclusion
of the two-year period, the specialist-led group performed signiﬁcantly better on all
ﬁtness measures, with the exception of upper body strength/endurance and ﬂexibility for
males only. For the male participants, body composition remained relatively stable;
whereas, for females there was a non-signiﬁcant increase in percent body fat for the
specialist-led group and decrease for the teacher-led and control groups. The authors
suggested that the combination of the duration of physical education classes and
leadership within these classes most likely led to the improvements in health-related
physical ﬁtness of children. Several investigations have reported similar results
regarding the inﬂuence of frequency of physical education participation on the physical
ﬁtness of children (Centers for Disease Control and Prevention, 1997; McKenzie, et al.,

1996)

30

For some children, physical education classes provide the only opportunity during
the day to be physically active, making the duration of each session important to the
attainment of physical ﬁtness (McKenzie & Sallis, 1997; Strand, Scantling, & Johnson,
1997). This was evident in Ignico’s study (1994) which followed a group of 434 students
through grades 1-5 in two physical education programs, one meeting twice per week for
30 minutes (60 minutes total per week) and the other ﬁve times per week for 30 minutes
(150 minutes total per week) per session. The hypothesis was that children in the twice
per week program would not participate in sufﬁcient moderate to vigorous physical
activity in order to achieve health beneﬁts.

Each participant was evaluated thrice yearly on four measures of ﬁtness, namely
cardiorespiratory endurance (1.0 mile run), percent body fat (skinfolds), ﬂexibility (sit-
and-reach), and abdominal strength/endurance (sit-ups)(1gnico, 1994). The results
indicated that participants in the daily physical education programs demonstrated superior
performance across grades on all measures of ﬁtness. Additionally, all of the participants
in the daily physical education group performed at or above the 50th percentile, and in
many cases above the 75th percentile, on all measures. In comparison, all participants in
the twice weekly program performed at or below the 50th percentile, with many below
the 25th percentile, on all ﬁtness measures, with minimal improvement seen over the
course of the study. Follow-up testing revealed that when the students in the daily
physical education program entered middle school and began a two times per week
program, cardiorespiratory measures decreased slightly.

In summary, physical education programs provide children with opportunities to

improve important health-related beneﬁts. However, the literature indicates that this is

31

only true where the programs are characterized by sufﬁcient ﬁtness related activities and
are taught by qualiﬁed professionals.

Physical activity participation. Participation in regular physical activity has been
found to inﬂuence the physical ﬁtness of children (Colchico, Zybert, & Basch, 2000).
There has been a decline in the support generated for and frequency in which physical
education is being offered within schools, and this has led to an increase in the emphasis
placed on participation in physical activities within the community (Ross, Dotson,
Gilbert, & Katz, 1985). Dale, Corbin, and Dale (2000) reported that when children are
not physically active in the school setting through physical education or recess, they
typically do not compensate for this inactivity outside of the school setting.

Colchico, Zybert, and Basch (2000) completed a study using a small sample of 30
female students between the ages of 11 and 14 years. Each student participated in a
physical activity program designed speciﬁcally to increase activity and ﬁtness levels
three times a week for a period of 12 weeks. Fitness was evaluated using
cardiorespiratory endurance (1.0 mile run/walk), upper body strength/ endurance (60-
second push-ups), abdominal strength/endurance (60-second curl-ups), ﬂexibility (sit-
and-reach), body mass index, and percentage body fat (tricep and calf skinfolds).
Additionally, self-perceptions were evaluated by the Self-Perception Proﬁle for Children
using a modiﬁed 5-point Likert scale (Harter, 1985). The results indicated signiﬁcant
improvements on all ﬁtness measures, as well as self-perception scores. The
improvements in ﬁtness measures of cardiorespiratory endurance, abdominal
strength/endurance, upper body strength/endurance, and ﬂexibility were signiﬁcant at the

p < .00 level. Body mass index improved signiﬁcantly at the p < .01 level, and

percentage body fat at the p < .05 level. The greatest changes in self-perception (p < .01
and p < .00) were for social acceptance, athletic competence, behavioral conduct, and
global self-worth. This conclusion lends support to the importance and value of
participation in structured after school sports and recreational activities for enhancing
children’s physical ﬁtness levels and psychological well-being.

Factors Specific to Deafness

Some factors that inﬂuence physical ﬁtness may be speciﬁcally related to
deafness. These factors include the age at onset and level of hearing loss, parents’
hearing status, and school placement.

Age at onset of hearing loss. Age at onset of hearing loss is classiﬁed as being
congenital or acquired (Batshaw, 1997). The most common cause of congenital deafness
is an inherited autosomal recessive genetic disorder, accounting for approximately 70%
of cases of deafness present at birth. Spinal meningitis is the most common cause of
acquired deafness, accounting for approximately 20% of all cases of acquired hearing
loss. None of the reported studies that have evaluated health-related physical ﬁtness has
indicated type and cause of hearing loss of the participants (Goodman & Hopper, 1992).

Age at onset of hearing loss has not been evaluated relative to health-related
physical ﬁtness measures. Generally, the studies that have evaluated age at onset have
focused on skill-related ﬁtness (Boyd, 1965; Brace, 1936; Long, 1932; Myklebust, 1964).
The results of these studies indicated that, as a group, participants with congenital
deafness performed better than the acquired deaﬁress group on skill-related ﬁtness
variables of balance, speed, coordination, power, and coordination. However, within

each study, hearing participants performed higher on all measures than all deaf

33

participants. There is the possibility that age at onset may affect health-related physical
ﬁtness due to the affects found between age at onset and motor skill performances. For
example, many physical activities require adequate levels of balance in order to perform
movements efﬁciently (Payne & Isaacs, 1999). The majority of investigations that
evaluated balance of deaf children have indicated this to be a common problem for
children with acquired deaﬁiess, especially that caused by meningitis (Goodman &
Hopper, 1992). This could indicate a potential indirect relationship between age at onset
of hearing loss and physical ﬁtness performance of deaf children.

Levels of hearing loss. The degree of hearing loss basically refers to the decibel
(dB) loss in the better ear, with higher severity losses having some communication
implications (Sherrill, 1998). Levels of hearing loss are described in Table 2. Still, many
children with severe to profound hearing losses are educated in residential school
settings. The moderate to severe level is of importance because it is the minimal baseline
(>55 dB) for eligibility to participate in Deaf sport (Stewart, 1991).

Existing research regarding the physical ﬁtness of deaf children with respect to
degree of hearing loss share several commonalities including how hearing status is
reported within the literature. First, most of those studies have not evaluated degree of
hearing loss and age at onset separately, rather combining the two as groups (i.e.,
acquired, hard of hearing = 27 dB to 90 dB and congenital, deaf = exceeding 90 dB).
Secondly, the studies that have evaluated degree of hearing loss as an independent
variable have focused on skill-related physical ﬁtness and ﬁrndamental motor skills rather
than health-related physical ﬁtness (Butterﬁeld, 1983; Campbell, 1983; Goodman &

Hopper, 1992; Morsh, 1936). Other more recent studies that investigated the health-

34

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related physical ﬁtness of deaf children have not reported age at onset and level of
hearing loss information. Because of this, the amount of information regarding the
effects of age at onset and degree of hearing loss on health-related physical ﬁtness of deaf
children is limited.

Since age at onset and degree of hearing loss have not been evaluated in any study
focusing on the health-related physical ﬁtness of deaf children, these variables cannot be
eliminated as potential inﬂuential factors. There are several hypotheses that can be
speculated regarding the effect, if any, that age at onset and degree of hearing loss have
on a deaf child’s physical ﬁtness levels. One such hypothesis could be that a child with
an acquired hearing loss due to meningitis may demonstrate lower ﬁtness levels due to
potential underlying balance deﬁciencies related to meningitis. Another possible
hypothesis may be that an individual with a hearing loss of more than 90 dB may have
greater communication barriers which affect physical ﬁtness levels through reduction in
the opportunities to participate fully in physical activities. However, these hypotheses are
highly speculative until evidence is available regarding the effect of age at onset and
degree of hearing loss on the physical ﬁtness of deaf children.

Parents ' hearing status. Stewart (1991) indicated that deaf parents are more
likely than hearing parents to be aware and knowledgeable of sports opportunities for
their deaf children. This evidence was generated from years of experience within the
Deaf community rather than an empirical study. However, Stewart’s (1991) postulation
was supported by a study completed by Ellis (2001). Using a sample of 73 deaf students
between the ages of 6-16 years, physical ﬁtness was evaluated using a combination of the

Fitnessgram and AAHPERD ﬁtness tests. A short questionnaire was used to evaluate

36

parents’ hearing status and physical activity levels in order to determine the probability
that the child would be introduced into Deaf sport by family members. Parents’ hearing
status was divided into three groups: (a) both deaf; (b) both hearing; and (c) one deaf/one
hearing. Data analysis indicated that not only did deaf students with two deaf parents
demonstrate better performances on all ﬁtness measures than children with one or both
hearing parents, but also greater participation in physical activity as well. Deaf students
with two hearing parents demonstrated the lowest frequency of community sports
participation, lowest overall ﬁtness scores, and highest percentage body fat. These
results support the notion that hearing parents may not only have less awareness of
physical activity opportunities for their deaf children, but also may be apprehensive in
allowing their children to be involved in physical activities (Moores, 1996; Stewart,
1991, Vernon & Andrews, 1990).

School placement. Prior to the implementation of the Individuals with Disabilities
Education Act (IDEA) (Federal Register, 1977), the majority of deaf children attended
schools for the deaf, an educational placement which was explicitly designed to meet the
educational, communicative, and social needs of deaf children (Moores, 1996; Stewart,
1991). Now more than 75% of school-aged deaf children attend public schools, with
educational placements ranging from total integration in regular classes to total
segregation in deaf education, or self-contained, classes (Moores, 1996). There may be
differences in educational, communication, and social opportunities in different
educational placements, including physical education classes and extracurricular

activities.

37

Winnick and Short (1988) evaluated the ﬁtness levels of deaf children attending
various school placements using the deaf and hard of hearing sample from their 1986
study. The participants were divided based on their educational placement which
consisted of 599 residents of deaf schools, 318 non-residents of deaf schools, and 128
public school students. No information was provided about the class placement of deaf
students within the public schools, communication modality used, or of any additional
demographic characteristics pertaining to parents, activity, schools, or deafness.

The results indicated that deaf residential students performed signiﬁcantly better
on measures of cardiorespiratory endurance and abdominal strength! endurance than non-
residents and public school students. The residential students also demonstrated higher
ﬂexibility scores and lower percentage body fat; however, these results were not
statistically signiﬁcant (Winnick & Short, 1988). The overall conclusion from this study
indicated that deaf children educated in residential schools demonstrated higher ﬁtness
levels than deaf and hard of hearing students who were placed in other educational
settings. No comparisons were made to the hearing children from the Winnick and Short
(1986) sample to determine how the residential students measured up, neglecting a
valuable piece of information.

Ellis (2001) measured the health-related physical ﬁtness of 73 deaf children aged
6-16 years who were categorized as either residents or non-residents of the school for the
deaf in which they were students. Fitness measures included cardiorespiratory endurance
(timed 1.0 mile run), ﬂexibility (back saver sit-and-reach), abdominal strength/endurance
(60-second bent knee sit-ups), upper body strength/endurance (modiﬁed pull-ups), and

percentage body fat (tricep and calf skinfolds). Directions to all ﬁtness tests were

38

presented via spoken communication and contact sign language, and were supplemented
by demonstrations. The residential group performed signiﬁcantly better on all measures
of ﬁtness. There were no gender differences among ﬁtness variables up through 10 years
of age; however, aﬁer the age of 10, males performed signiﬁcantly higher on all measures
than did females. When compared to age- and gender-speciﬁc national norms developed
for hearing children, as indicated by AAHPERD standard norm scales (AAHPERD,
1994; Hastad & Lacy, 1998), the deaf children demonstrated performances which fell
below the 40th percentile on all measures, with the exception of ﬂexibility. There were
also a number of cases where performances fell below the 20th percentile, mainly on
cardiorespiratory endurance and percent body fat. This indicated that the deaf
participants as a group performed below median norms on nationally recognized ﬁtness
protocols.

From the few studies that evaluated school placement and physical ﬁtness levels
of deaf children, the general consensus is that residential students have demonstrated
higher ﬁtness levels than non-residential and public school students. Residential schools
have historically promoted social and cultural education as part of their overall
curriculum and also tend to have smaller student populations leading to increased
opportunities for participation in school-wide activities, an opportunity which could
positively inﬂuence the physical ﬁtness levels of deaf children (Moores, 1996; Schirmer,
2001)

Summary
Studies which have investigated the physical ﬁtness level of deaf and hard of

hearing children have reported this group to demonstrate lower ﬁtness levels than their

39

hearing peers. There are no obvious reasons why deaf children should demonstrate lower
physical ﬁtness than hearing children. In fact, there is no information within the
literature which evaluates the factors which may affect the physical ﬁtness of deaf
children. Potential factors may be those which have been found to inﬂuence the physical
ﬁtness of hearing children, namely physical activity participation, parents, and school
physical education. In addition, other factors may be more speciﬁc to deafness and

include school placement, age at onset of hearing loss, and level of hearing loss.

40

CHAPTER 3
Methods

The purpose of this study was to investigate factors that inﬂuence the physical
ﬁtness levels of deaf children. Physical ﬁtness was evaluated using the Fitnessgram test
battery, and information regarding demographic and school variables was obtained from
questionnaires completed by school personnel and parents/ guardians.

Research Design

The study design can be characterized as ex post facto in that participants had
already been categorized or placed within a certain group through natural selection prior
to this study. Independent variables consisted of level of hearing loss, etiology of hearing
loss, parents’ hearing status, school placement, school physical education, and physical
activity participation. Dependent variables included the health-related physical ﬁtness
measures of cardiorespiratory endurance, body fatness, ﬂexibility, abdominal
strength/endurance, upper body strength/endurance, and overall Healthy Fitness Zone
scores.

The independent variables such as etiology and level of hearing loss were stable
and not changed by this study. The investigator had no control over the outcome of the
independent variables, i.e., could not decide school placement for a student or hearing
status for a parent. Therefore, using the causal-comparative method, the inﬂuence that
each ex post facto independent variable had on the dependent variable (ﬁtness measures)
was determined. Cause and effect was not be determined using this method, but rather
the potential of each factor to inﬂuence, along with other factors, the outcome of each

ﬁtness variable. The inﬂuence of independent variables on the dependent variables was

41

determined through group comparisons. As an example, students were grouped based on
their school placement in regular or special schools and then compared on ﬁtness
variables.

Minimizing Threats to Internal Validity

Threats to internal validity included time, selection, and mortality threats. Group
threats (e. g., control versus experimental) did not apply to this study because there is only
one experimental group. The methods undertaken for minimizing the remaining threats
to internal validity are discussed in the following paragraphs.

Threats to internal validity due to time included those related to history,
maturation, test reactivity, and instrumentation. History may be a threat when an
unintended event occurs during the testing period or during the individual’s life that
affects only speciﬁc individuals and not other participants. This threat was difﬁcult to
minimize as incidents or events may vary from day to day. For example, students may
become ill or experience an injury. Threats to internal validity due to history were
minimized by completing all ﬁtness tests on one testing date. Using this short testing
period also reduced the chance of threats to internal validity caused by maturation, or the
occurrence of growth and development during the testing procedure that could lead to
changes in performance. Fatigue is a maturation threat that was more likely within this
study, and was reduced by having the exhausting tests (PACER, curl-ups) interspersed
within the less demanding tests (ﬂexibility, skinfolds). The ﬁtness tests included the
PACER which was a measure of cardiorespiratory endurance, the curl-ups and push-ups
were measures of muscular strength/endurance, the trunk lift and back-saver sit-and-

reach were measures ﬂexibility, and skinfolds were a measure of percent body fat. This

42

scheduling allowed students to rest both between tests and during the less exhausting
tests.

Some students may have already participated in the ﬁtness tests through their
physical education classes and were more familiar with them than students who had no
prior experience with the testing protocol. This posed a threat to internal validity due to
testing effects. Practice trials were allowed for the ﬁtness tests to ensure that participants
were familiar with the expectations of each test. This also increased the chance that the
participant demonstrated his/her best performance when tested, thereby minimizing
testing effects.

Instrumentation refers to unintended changes to testing procedures or equipment
that could have affected test results. However, problems associated with instrumentation
were reduced by using a standardized ﬁtness test battery, calibrating and checking
equipment (e. g., stopwatch, weight scale, calipers) before each testing session, and
following the same test administration procedures during each evaluation period.

Another threat to internal validity was subject mortality. Students may have
indicated that they wanted to participate only to later change their minds, have an injury,
or absence that might prevent participation. This threat was minimized by the
organization and administration of the study. First, all tests were performed on the same
day, reducing any chance that a student would drop out due to the short time interval.
Additionally, experienced investigators administered all test procedures and provided
close supervision of each student’s participation, decreasing the chances of injury.
Although subject mortality was a possibility, in fact, no participants were injured or

withdrew during the testing procedures.

43

Minimizing Threats to External Validity

External validity referred to the potential for the results of the study to be
generalized to other settings. A representative sample of deaf children in ﬁrst through
fourth grades participated in this study. Limitations were not placed on school settings;
therefore, this study can be generalized to deaf children in the ﬁrst through fourth grades
in both special and regular schools. This study employed the F itnessgrarn (Cooper
Institute of Aerobic Research, 1999) a common school-based ﬁeld test for measuring
physical ﬁtness of school-aged children, increasing the generalizability to school systems
using this protocol.

Another threat to external validity was that the students’ behavior in the
experimental setting may have been different than their behavior in their regular physical
education class or classroom setting This study involved having other individuals (the
investigator, teacher, classmates) observe each participant’s performances, with the
exception of individual measures of skinfolds, height, and weight. This may have caused
the students to perform better or worse than they would have in their regular physical
education class due to placing them on a “grandstand” when performing in front of other
individuals. These results may not generalize to deaf children in real-life situations.
Most tests were completed during their regular physical education classes, which made
this threat to external validity difﬁcult to minimize. Consistent adherence to the
standardized Fitnessgram administration procedures assisted in reducing this threat to
external validity by administering ﬁtness tests exactly the way they would be by others

using the same test protocol.

44

Participants

The sample included students from regular and special schools in a midwestem
state. Regular schools consisted of public schools from various sized school districts and
within rural, suburban, and urban locations. The special school setting was represented
by the state school for the deaf. Deaf students in grades ﬁrst through fourth from these
schools participated in this study.

Selection Criteria
Students satisﬁed the following criteria in order to participate in this study:
1. Participants were deaf with no multiple disabilities.
2. Participants were students within the ﬁrst through fourth grades.
3. Participants had at least a 55 dB hearing loss in the better ear.
Recruitment of Participants

Information letters were sent to school administrators at public schools across the
midwestem state, as well as the state school for the deaf. School administrators
completed a survey pertaining to demographic information about their school and
students, and a consent form granting permission to contact students’ parents/ guardians
and allow use of the school facilities. A self-addressed stamped envelope was provided
for the return of completed materials to the investigator.

Information packets were sent to parents/ guardians of all deaf children in the ﬁrst
through fourth grades at each participating school. Information packets were sent home
to parents/ guardians by the child’s classroom teacher or Hearing Impaired Coordinator
for the school district. The packets consisted of a letter describing the study, request for

the child’s participation, demographic survey, and a consent form. As with school

45

administrators, self-addressed stamped envelopes were provided for the return of
completed materials to the investigator.

Follow-up letters were sent to school administrators and parents/ guardians if
information was not received within three weeks after mailing the information packets.
In several cases, follow-up emails were conducted to ask the teacher to encourage parents
to submit the consent form, allowing the investigator to know if the child would
participate.

Sample Size

F ifty-one deaf children (n=30 males; n=21 females) in grades ﬁrst through fourth
participated in this study. The potential eligible sample size given the criterion and grade
level was identiﬁed to be in excess of 208 students from the schools who were asked to
participate. This was a small sample size in terms of statistical power (Cohen, 1982), but
nevertheless, large for a group of deaf children from one state. After completion of this
study the investigator contacted all of the Hearing Impaired Coordinators to discuss
potential reasons why there was a low number of students participating. Several
coordinators indicated that it was not unusual to have low parent approval within their
home school district, while others were unsure why more parents did not give permission.
However, all agreed that the short timeline allocated by this study may have hindered
getting some consent forms back from the parents and if given a second round of consent
forms may have had more participants. While the exact reasons are unknown why more
students did not participate in this study, possible reasons for low participation include
parents forgetting to return consent forms, disinterest in information that testing would

provide both to the parent and school, not wanting their children to be considered

46

“subjects” of a study, and/or lack of time to return consent information to parents and
schools.
Informed Consent Procedures

The informed consent process was initiated by obtaining approval from the
Michigan State University Committee on Research Involving Human Subjects
(U CRII-IS). School administrators and parents/ guardians of students in the ﬁrst through
fourth grades at each participating school were asked to give written informed consent.
After being presented with signed/spoken directions and demonstrations of each test and
expectations, each student gave spoken and/or signed assent to participate. UCRIHS
approval is documented in Appendix A.

Instrumentation

Physical ﬁtness was evaluated using the Fitnessgram test battery. Fitness
measures included cardiorespiratory endurance, percent body fat, ﬂexibility, abdominal
strength/endurance, and upper body strength/endurance. The results of pilot studies
evaluating the reliability and validity of a modiﬁed F itnessgrarn test battery for
evaluating ﬁtness of deaf children are shown in Appendix B. Two surveys were used to
obtain information relating to school, child, and parent factors (Appendix C). A school
administrator completed the survey relating to school physical education, location, and
number of deaf students enrolled. The parents/ guardians completed a survey regarding
their child’s hearing loss and physical activity participation, as well as their own hearing

status.

47

F itnessgram

The Fitnessgram test battery was used to determine the health-related physical
ﬁtness of deaf children in grades ﬁrst through fourth (Cooper Institute of Aerobic
Research, 1999). The Fitnessgram focuses on the components of ﬁtness that are most
important to overall health and well-being. In contrast to many older ﬁtness tests, such as
the AAHPERD physical ﬁtness tests (AAHPERD, 1984), Fit Youth Today (American
Health and Fitness Foundation, Inc., 1986) and the President’s Challenge Physical Fitness
Test (President’s Council on Physical Fitness and Sports, 1993), the Fitnessgram does not
employ guidelines of reaching above a certain normative baseline level (i.e., above the
85th percentile) or performance criterion (i.e., complete at least 30 sit-ups in one-minute).
The F itrressgrarn uses a Healthy Fitness Zone that represents “lower” and “upper”
performance levels associated with sufﬁcient physical ﬁtness to help prevent hypokinetic
disease. The lower and upper performance levels are criterion referenced standards;
however, research has shown that they correspond approximately to the 20th and 60th
percentile levels for most age and gender groups (Cooper Institute of Aerobic Research,
1999). Blair, Kohl, Gordon, and Paffenbarger, (1989) reported that the greatest increases
in optimal health occur when an individual moves above the 20th percentile level, with
performances anywhere above this point considered sufﬁcient. The purpose of the
Healthy Fitness Zone was to establish a range of “good” ﬁtness associated with
protection against hypokinetic diseases. The area above the “upper” limit was termed
“better” ﬁtness and was suggested as a motivation factor for improving ﬁtness levels

(Cooper Institute of Aerobic Fitness, 1999). The Fitnessgram consists of valid and

48

reliable tests that have been recommended to measure physical ﬁtness of children aged 5
years and older.

C ardiorespiratory endurance. The authors of the F itnessgram provide three
choices for the measure of cardiorespiratory endurance, namely the PACER, one-mile
run, and the walk test. The PACER was chosen because it was more appropriate than the
longer endurance runs for testing younger children (Cooper Institute of Aerobic
Research, 1999). The PACER consists of a 20 m shuttle run in which the pace becomes

progressively quicker. Additionally, the PACER is an indoor test that can be performed

mm!

in any location that is ﬂat and at least 30min length.

Directions for administering the PACER were followed according to the
Fitnessgram test administration manual (Cooper Institute of Aerobic Fitness, 1999). The
PACER uses an auditory compact disc (CD) that beeps to inform students when to start
running. Two parallel lines 20m apart are marked by cones, chalk, or marking tape.
Students line up at the ﬁrst line, wait for the beep, and then run the 20m distance to the
second line, turn and wait for the next beep before running back to the ﬁrst line. Students
continue this running pattern until they are unable to reach the line before the beep
occurs. However, students are allowed one “miss” if they are not able to reach the line
before the beep the ﬁrst time. When this happens, students are instructed to immediately
turn and run to the next line in an attempt to catch up with the pace. The PACER is
ofﬁcially over when the student, for the second time, is unable to reach the end of the
20m distance before the beep occurs. This test is scored based on the total number of
20m laps that the student is able to complete before being unable to continue performing

at the increasing pace.

49

The PACER starts slow and becomes progressively faster with each passing
minute. During the ﬁrst minute, cues are given every nine seconds, with a half-second
pace increase every minute (second minute: one lap/8.5 5; third minute: one lap/8 s, and
so forth). After the end of each minute, a rapid succession of three beeps occurs to warn
participants that the pace will be increasing. Using this pace, the range of performance
would be from zero laps to a maximum of 305 laps total. However, given the quick pace
and the young age of the participants, a realistic performance for an individual with very
high cardiorespiratory endurance would be the ability to complete one lap in 5 seconds
(consistent with the 9 minute level), or a maximum of 80 laps.

Because the auditory cue was inappropriate for deaf children, a 24-foot string of
cable lights were used to mark each starting line, substituting visual cues for the auditory
beeps (Figure 1). The two lines of cable lights separated the 20 m distance (Figure 2).
These lights were activated by a hearing assistant each time a beep was heard on the CD
recording. After each minute, the lights ﬂicked rapidly to warn students that the pace
was increasing. The deaf children completed the PACER using these visual cues as a
hearing child would the auditory cues.

The PACER has been determined to have acceptable validity for use with hearing
children. In fact, the PACER is the preferred method for evaluating cardiorespiratory
endurance in prepubescent children, as many forms of distance runs have demonstrated
low reliability and validity among this population (Cooper Institute of Aerobic Research,
1999). This could be due to the difﬁculty of motivating children for completion of the
distance run and lack of comparative information for shorter distances (i.e., half-mile

run). A pilot test was conducted to determine the feasibility of the PACER as a measure

50

 

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of cardiorespiratory endurance for deaf children using the visual light cues. Twenty-one
deaf children between the ages of 6-11 years completed a one-mile timed run and two
measures of the PACER, with tests being performed one week apart (Appendix B).
Pearson correlations were found to be r = -.70 between the mile and the ﬁrst PACER test
and r = -.74 between the mile run and the second PACER. These results indicated
moderately high concurrent validity for the PACER run using the cable lights. Validity
has been reported to be between r = .52 to r = .93 when compared to maximal oxygen
consumption measured via a treadmill stress test (Safrit, 1995; Vincent, Barker, Clarke,
& Harrison, 1999).

The Fitnessgram authors have reported the PACER to have strong reliability
(Cooper Institute of Aerobic Fitness, 1999). A pilot test was conducted by the
investigator to determine reliability between two measures of the PACER test using 21
deaf children between the ages of 6-11 years (Appendix B). A moderately high test-
retest correlation of r = .79 was reported between the ﬁrst PACER and the second
PACER. The results of this pilot study indicated that the visual cues were suitable for
this test, and that the PACER was an appropriate measure of cardiorespiratory endurance
for this sample of deaf children. Reliability has been reported between r = .89 to r = .98
for hearing children of both genders and between the ages of 6-12 years (Saﬁit, 1995;
Vincent, et al., 1999).

Body composition. The Fitnessgram authors offer two options for measuring
body composition, skinfold measures and body mass index (BMI). Percent body fat was
evaluated by the recommended tricep and calf skinfolds measured in millimeters using

Lange skinfold calipers. BMI could have been used as it only requires knowledge of an

53

individual’s height and weight. However, skinfold measures have higher validity when
compared to laboratory measures of percent body fat (Rowland, 1999), and were
therefore selected instead of BMI.

Tricep skinfolds were measured by a vertical fold on the back of the right upper
arm, halfway between the elbow and the acromion process. This location was identiﬁed
by the investigator using a piece of string or ruler to determine the midpoint (Cooper
Institute of Aerobic Research, 1999). The vertical fold was grasped just above the
marked location to ensure that the measurement was taken at the midpoint. Subjects
were instructed to relax their arms during this skinfold measurement.

Vertical calf skinfolds were taken on the inside right calf at the location of
maximum circumference. Each participant ﬂexed his/her leg to a 90° angle with the foot
on an elevated, ﬂat surface, such as a step or stool. The participant was instructed to keep
the foot ﬂat on the surface so not to ﬂex the leg muscles during measurement. Maximum
circumference was visually identiﬁed, marked, and the skinfold grasped just above this
location in order for measurement to occur at the speciﬁed site (Cooper Institute of
Aerobic Research, 1999).

Each skinfold was grasped and pulled slightly away from the body by the
investigator’s thumb and pointer ﬁnger (Cooper Institute of Aerobic Research, 1999).
Skinfolds were re-grasped for every successive measurement. At each location, three
consistent measures, with each skinfold rounded to the nearest 0.5 mm, were taken with
the median (middle score) value being recorded for investigative purposes. To ensure
consistency of measures, the triceps or calf skinfold readings did not vary by more than 3

mm among readings (Hastad & Lacy, 1998). If individual skinfold measures varied by

54

more than 3 mm among the three trials, the investigator ceased that round of
measurement and repeated all measures. Median skinfold measure values were entered
into the Fitnessgram computer program, and percent body fat was calculated
automatically for each participant using the Slaughter et al. (1988) equations.

Estimating percent body fat from tricep and calf skinfolds is recommended for
the ﬁeld-testing of children aged 6-11 years (Lohman, 1987). Use of these two
anatomical sites has been reported to have a good level of validity, with a 3% to 5% error
rate when compared to underwater weighing (Cooper Institute of Aerobic Research,
1999). Hastad & Lacy (1998) deﬁned good validity as being between r = .60 and r = .80.
Validity for hearing children has been reported between r = .70 and r = .90 when
compared to underwater weighing procedures (Safrit, 1995). Pilot testing indicated a
reliability coefﬁcient of r = .98 for measuring the percent body fat of 21 deaf children
aged 6-11 years on two occasions scheduled one week apart (Appendix B). For male and
female hearing children (age not reported), reliability has been reported to be r = .95
(Saﬁit, 1995).

Muscular strength, endurance, and ﬂexibility. The F itnessgram authors describe
several tests for measuring muscular strength, endurance, and ﬂexibility. For abdominal
strength and endurance, the curl-up was the only recommended choice. For the measure
of trunk extensor ﬂexibility and strength, the trunk liﬁ was the only recommended
choice. Four choices were suggested for upper body strength and endurance, namely
push-ups, modiﬁed pull-ups, pull-ups, and the ﬂexed arm hang. The push-up test was
recommended. For ﬂexibility, the choices of the back-saver sit-and-reach and shoulder

stretch were given, with the back-saver sit-and-reach being recommended.

55

Abdominal strength and endurance was measured using the recommended curl-up
test. This test has been found to be a more valid measure of abdominal strength]
endurance than the sit-up test where performance is assisted by the hip ﬂexors (Hastad &
Lacy, 1998). Participants lay in a supine position on a gym mat, with feet ﬂat on the
ﬂoor, knees ﬂexed at approximately 140°, and arms placed to the sides with palms face
down on the mat. A 3.0- or 4.5-inch measuring strip was placed under the participant’s
bent legs so that the tips of the ﬁngers touched the top of the strip when the participant
was lying on his/her back in a stationary position (see Figure 3). The 3-inch strip was
used for participants up through 9 years of age and the 4.5-inch strip for participants 10
years and older.

Each participant raised the upper body and shoulders in a “crunch” fashion so
that the hands moved passively over and touched the bottom of the measuring strip and
then returned to the starting position. This movement was performed in a slow,
deliberate manner of one curl-up every three seconds. Cadence is usually maintained by
having subjects listen to beeps recorded on a compact disc (CD). The auditory recording
of the cadence is inappropriate for deaf children. Modiﬁcations were provided by the
investigator in the form of visual hand cues. She raised her hand on the 1- and 2-second
count, and lowered it on the 3-second count (Figure 4). Participants were instructed to
begin movement when the hand was raised, and then lower the trunk to the starting
position when the arm was lowered. Participants continued this sequence until they
reached a maximum of 75 curl-ups or were unable to continue the pace. The number of

curl-ups performed ranged from zero to a maximum of 75.

56

 

Starting position for the curl-up test.

  

///II
1111!”
[/l/IlllllllII/llllll/

Position of student in the “up" position for the curt-up test.

Figure 3. The Curl-Up Test

57

 

 

 

Figure 4. The Curl-Up Test.

58

Content validity has been assumed for the curl-up test as a measure of abdominal strength
and endurance of hearing children (Cooper Institute of Aerobic Research, 1999). Pearson
correlation has indicated test-retest reliability values of r = .78 to r = .90 for hearing
children ages of 6-1 8 years on the curl-up test (AAHPERD, 1994; Massicote, 1990;
Safrit, 1995). Validity for use with deaf children was reported through pilot testing to be
r = .90 for children for ages 6-11 years when compared to the 60-second sit-up test and
test—retest reliability was reported to be r = .88 for the same group (Appendix B).

Upper body strength and endurance was evaluated using the push-up test as
recommended by the Fitnessgram authors (Cooper Institute of Aerobic Fitness, 1999).
Participants began in a prone position with the palms of the hands placed on the mat
directly under their shoulders, toes touching the mat, and legs slightly apart and straight.
The body was lowered as a unit until the arms reached a 90° angle, then returned to the
starting position for the completion of one push-up. According to the F itnessgrarn
manual, participants performed the push-ups to a auditory three—second cadence similar
to that used for the curl-ups. Because the auditory cues were inappropriate for use with
deaf children, the investigator substituted visual cues. She kneeled directly in front of the
participants, lowered her hand onto the ﬂoor during the l- and 2-second count, and raised
her hand on the 3-second count (Figure 5). Participants were instructed to reach the point
where their arms were bent at 90° angles when the hand reached the ﬂoor, and move their
bodies back to the starting position when the hand was raised. The total number of push-
ups completed before the subject was unable to continue or keep up with the pace was

recorded, with the range being zero to an unlimited maximum number.

59

 

 

-.. -..o=§ -:‘ "—

Figure 5. The Push-Up Test.

60

 

Reliability coefﬁcients for the push-up test have been reported to be r = .87, with the
assumption of face validity for hearing participants aged 6 years and older (Johnson &
Nelson, 1986; Massicote, 1990). Through the pilot test, validity was determined to be r =
.95 for hearing children aged 6-12 years comparing the 3-second cadence push-ups with
the regular, no cadence, push-ups test. The pilot studies indicated reliability and validity
data of the 3-second cadence push-ups for evaluating deaf children to be r = .92 for
children aged 6-11 years (Appendix B).

The back-saver sit-and—reach was used to measure ﬂexibility of the lower back
and thighs. This test was recommended by Fitnessgram authors instead of the regular sit-
and-reach because it prevents hyperextension of the knees and back by testing one side at
a time (see Figure 6). The back-saver sit-and-reach protocol consists of a box with a
measuring stick or ruler placed on the top. The zero measure on the ruler was at the end
facing the student and extending outward, with the nine-inch point marking the location
where the student places his/her foot. Each participant sat on the ﬂoor placing the right
foot (no shoe) at the base of the box and bending the left knee, keeping the sole of the left
foot ﬂat on the ground. The student then bent forward, moving the hands along the
measurement scale on the top of the sit-and-reach box.

Forward movement was performed four times with the fourth attempt held for one
to two seconds for measurement to be recorded to the nearest half inch. Each participant
completed the back-saver sit and reach with the left foot at the box and the right knee
bent. Scoring consisted of the maximum distance, in inches, that the student was able to
reach forward without bending the straight leg or bouncing. Distance ranged from a

minimum of zero to a maximum of 12 inches.

61

 

Figure 6. The Back-Saver Sit-and-Reach Test.

62

Content validity has been reported for hearing individuals for the back-saver sit-and-
reach as an appropriate measure of back and hamstring ﬂexibility; however, reliability
values have not been reported (Hastad & Lacy, 1998; Safrit, 1995). A pilot test on two
measures of ﬂexibility completed one week apart indicated a reliability coefﬁcient of r =
.88 for ages 6-11 years for right sit-and-reach performance and r = .89 for ages 6-11 years
for left sit—and-reach performance (Appendix B).

Trunk extensor ﬂexibility and strength was measured using the trunk liﬁ as
recommended by the authors of the F itnessgram (Cooper Institute of Aerobic Research,
1999). Participants lay face down on a gym mat with the chin resting on the mat, hands
placed under the hips, and toes pointed (Figure 7). Students focused on a quarter-sized
marker (poker chip) placed at the edge of the mat and directly within the line of vision.
Students began by raising the upper body as far as possible without bouncing or jerking.
The distance from the gym mat to the participant’s chin was measured with a ruler and
reported in inches. Two trials were allowed with the highest score being recorded. The
distance for the trunk liﬁ ranged from zero to a maximum of 12 inches. Content validity
has been assumed for the trunk liﬁ when evaluating hearing children; however, reliability
has not been reported (Cooper Institute of Aerobic Research, 1999; Hastad & Lacy,
1998). Test-retest reliability and validity for use with deaf children was reported to be
r = .96 for ages 6-11 years and r = .97 for ages 12-16 (Appendix B).

Overall physical ﬁtness. Overall physical ﬁtness was determined through the
number of Fitnessgram tests in which performance was in or above the Healthy Fitness
Zone (Cooper Institute of Aerobic Research, 1999). The lower end of the Healthy Fitness

Zone does not indicate a high level of ﬁtness, but rather the level at which signiﬁcant

63

 

Figure 4.17 Measurementof trunk lift.

Figure 7. The Trunk Lift Test.

64

improvements in health occur leading to lower susceptibility of hypokinetic diseases and
ease in everyday and leisure activities (Blair, et al., 1989). The F itnessgram authors
recommend that children demonstrate levels within or above the Healthy Fitness Zone in
at least four of the six areas, including cardiorespiratory endurance and percent body fat.
Individuals who demonstrate this requirement are deemed to have overall healthy ﬁtness
levels (Cooper Institute of Aerobic Research, 1999). No information has been reported
concerning the reliability and validity of the overall Fitnessgram test.
Surveys

Three surveys were used to collect information pertaining to each school, physical
education program, parent, and student (Appendix C). School administrators completed a
survey about numbers and placements of deaf students within their schools. Parents
completed a survey about the child’s deafness (level, age at onset, etiology), child’s
school placement (years at present school, disability accommodations), child’s physical
activity participation (out of school activities), parents’ hearing status (hearing or deaf),
and parents’ participation in Deaf community activities. The physical education teacher
completed a survey regarding the school’s physical education program, including days
and minutes per week that the classes meet and type of communication used with deaf
students.

Data Collection Procedures

Testing Schedule

Collection of ﬁtness data occurred during one regularly scheduled physical
education class period with additional time arranged as needed. At the beginning of their

physical education class, students were introduced to the investigator and data collection

65

 

team, and had each test explained through signed and spoken directions and
demonstrations. Aﬁer describing and demonstrating the tests, the investigator requested
assent from each child. Students who wished to participate signed and/or spoke their
intent to be a participant in the study. Written informed consent was obtained previously
from parents/ guardians. The testing set-up for this study turned out to be very unique.
Speciﬁc testing dates and times were arranged with the schools and on scheduled testing
periods school personnel brought only those children whose parents had given consent to
the gymnasium, at which time all children gave their assent to participate.

Aﬁer assent was obtained from the participants, students moved onto the
gymnasium ﬂoor allowing enough room for stretching and warm-ups. After warming up,
students lined up behind the cable lights at line #1 for the PACER test. All students
completed four 20m laps as a practice trial, running from line 1 to line 2, waiting for the
visual cue, and then running another lap. After completion of the practice trial, students
were given several minutes to rest and cool down. Students then completed the PACER
test in groups of no more than six. When performing the PACER test, participants lined
up behind line #1 and began at the ﬁrst visual cue, continuing as long as they are able to
keep up with the increasing pace. For this aspect of the data collection period, a hearing
individual, usually being the physical education or classroom teacher, activated the cable
lights.

During the remainder of the physical education class, the other F itnessgram test
items were administered. Students were divided into two groups for administration of the
remaining F itnessgram tests. Group #1 completed the back-saver sit-and-reach, push-

ups, and trunk lift in that speciﬁed order. Group #2 completed height and weight

66

measures, followed by curl-ups and skinfold evaluation. After completion of the tests
within their speciﬁed group, the students then rotated to the next group to complete the
remaining ﬁtness measures. Height, weight, and skinfolds were measured individually
and in a private area away from other participants. This order allowed the more fatiguing
endurance tests to be interspersed between one or more less tiring tests that offered rest
periods. Any test items not completed after the physical education classes were
conducted during a time mutually convenient to the students and teacher, usually
immediately following the physical education class.
Communication Modality

Stewart, Dummer, and Haubenstricker (1990) reported that using only spoken
communication was unsuitable when testing deaf students and may lead to
misunderstanding of directions, inappropriate performances, and increased error with
data collection procedures. Therefore, the communication modality used during group
presentations included both spoken and signed communication to ensure that students
were receiving the information in a way that they understood the directions. When
addressing a participant during testing procedures, the communication modality of the
student’s choice, as identiﬁed by the parent/child survey, was used. The child’s name or
sign name was implemented when addressed in order to personalize the instructions.
General positive feedback and encouragement was given for each test to enhance best
effort performance.
Personnel

All Fitnessgram tests were administered by the investigator and trained assistants.

The investigator had extensive experience and familiarity in using the Fitnessgram

67

protocol for evaluating ﬁtness of deaf children, most recently within grades K-12 at a
school for students who are deaf, as well as with hearing and deaf children aged 6-12
years during recently conducted pilot tests. Several assistants aided with the ﬁtness data
collection. The investigator met with each assistant individually, as well as assigned and
trained them on speciﬁc tests, e. g., curl-ups and the sit-and—reach to maintain consistency
in testing. Directions for each test were described and demonstrated and then the
assistant had to demonstrate testing competency on three consecutive measures prior to
testing any of the participants. In addition, when the physical education teacher and/or
classroom teacher was present, they were asked to assist with recording of data recording
and general control of the class.
T imeline

Using the previously described data collection procedures, approximately 45
minutes were necessary for each individual to complete the Fitnessgram test battery,
including assent, warm-up, and cool-down (Table 3). Most tests were completed within
the students’ regularly scheduled physical education classes. There were only three
instances where additional testing time was needed to complete the tests due to the large
number of students being tested during those particular sessions. Since several activities
(assent, warm-up, the PACER, and cool-down) could be completed as a group, only 15
minutes were required to test each person on individual measures (e. g., skinfolds, height,
weight, curl-ups). However, in the ﬁnal analysis, approximately 14 testing hours (7

schools X 2 hours) were needed to evaluate the 51 study participants.

68

Table 3

Testing Time

 

 

Test Time needed (min) Grouping

Assent Procedures 10 All students together
Warm-Up & Stretching 5 All students together
PACER Test 8 Groups of 6 or fewer
Curl-Up Test 5 Partnered, 2 at a time
Push-Up Test 3 Partnered, 2 at a time
Skinfolds 2 Individually

Trunk Lift Test 2 Individually
Back-Saver Sit-and-Reach Test 2 Individually
Height/W eight 1 Individually
Cool-Down _5 All students together
Total Time 43

 

69

Data Analyses

Data analyses consisted of descriptive statistics of each dependent (measure,
correlations of independent variables and analysis of variance procedures, followed by
appropriate planned contrasts via Scheffe’ and multiple regression procedures. The small
sample size prevented the use of the more appropriate statistical technique of MAN OVA,
even when two variables were highly correlated with one another. For example, parents’
hearing status and school placement were found to correlate signiﬁcantly; however, there
were only 6 subjects in the two deaf parents/regular school cell and 4 subjects in the two
deaf parents/special school cell, disallowing MANOVA computations. Therefore,
ANOVA procedures were used to answer all research questions. This is a major study
limitation since interactions between independent variables could not be evaluated. The
use of repeated ANOVA procedures led to concern about increased family error rate.
This is a limitation in that the signiﬁcance level for all data analysis procedures was set at
.05 and the repeated AN OVAs (a total of eight per independent variable) would reduce
the signiﬁcant alpha level to approximately .005. in addition to family error rate, the use
of multiple ANOVAs computed for each individual independent variable also caused
concern regarding the occurrence of type I error.
Research Question #1: Level of Hearing Loss

Level of hearing loss ranged from 55 dB to 100+ dB. Participants were classiﬁed
into three nominal scale groups, moderate (55 dB to 70 dB), severe (71 dB to 90 dB) and
profound (> 90 dB). AN OVA methods were used to determine differences between level
of hearing loss groups and each individual ﬁtness measure Where signiﬁcant differences

(p < .05) were found through ANOVA procedures, the Scheffe’ technique was used to

70

determine differences among speciﬁc groups. The Scheffe’ test was recommended
because of its conservative nature in identifying signiﬁcant differences and the ability to
use with unequal cell sizes.
Research Question #2: Etiology and Age at Onset

Etiology and age at onset of hearing loss was categorized in two ways: (a) based
upon age at onset of deafness, namely congenital, acquired, or unknown; and (b) based
upon the cause of deafness such as meningitis, other illness, drug administration, etc.
The nominal scale categories of congenital, acquired, or unknown were used to conform
to previous studies that evaluated etiology (Goodman & Hopper, 1992). Cause and onset
of hearing loss were evaluated because some of the existing literature reported these
variables to be potential inﬂuencers of skill-related physical ﬁtness; therefore, these
factors were evaluated to determine if the same was true for health-related physical
ﬁtness. AN OVA methods were used to determine relationships between etiology of
hearing loss and each individual ﬁtness measure. Where AN OVA procedures indicated
signiﬁcant differences (p < .05), the Scheffe’ technique was used to determine differences
between groups.
Research Question #3: Parents ' Hearing Status

Parent’s hearing status was categorized as either both deaf (D/D), both hearing
(H/H), or one deaf and one hearing (D/H). Thus, parents’ hearing status was measured
using a nominal measurement scale. In this case, ANOVA methods were used to
determine if relationships were present between parents’ hearing status and individual
ﬁtness variables. Where signiﬁcant differences (p < .05) were found, follow-up testing

was through use of the Scheffe’ technique.

71

 

Research Question #4: School Placement

School placement factors were evaluated based on the type of school that each
student attended. School placement was categorized as either in a regular or special
school. School factors were categorical measures. ANOVA procedures were followed to
determine relationships between school placement and individual ﬁtness variables,
followed by the Scheffe’ tests when signiﬁcant differences (p < .05) were found.
Research Question #5 .' Physical Education

Physical education classes were evaluated based on the duration in minutes per
week that the children participated in classes. AN OVA methods were used to determine
if a relationship existed between physical education and each ﬁtness variable. When
ANOVA procedures indicated signiﬁcant differences (p < .05), the Scheffe’ technique
was computed to identify the differences between groups.
Research Question #6: Physical Activity Participation

Physical activity participation was evaluated based on the number of regular
physical activities in which the student had participated during the two months prior to
the actual test date. Physical activity participation was grouped as either 0-2 activities
per week or 3+ activities per week, an ordinal scale measurement. AN OVA methods
were used to determine if a relationship existed between frequency of participation and
individual ﬁtness measures. Follow-up testing consisted of using the Scheffe’ technique

to identify the differences between groups.

72

CHAPTER 4
Results

The purpose of this study was to identify factors that inﬂuence the physical ﬁtness
levels of deaf children. Fitness levels were evaluated through administration of the
Fitnessgram, a ﬁeld-based test for measuring health-related physical ﬁtness of school-
aged children (Cooper Institute of Aerobic Research, 1999). Demographic and school
variables were evaluated through questionnaires completed by parents and school
administrators. The results of this study are presented in this chapter.

Descriptive Statistics

Descriptive statistics for participant characteristics and F itnessgram test results
are provided in Tables 4 and 5. The resulting information is discussed relative to age,
gender, and individual ﬁtness and demographic variables.
Sample Characteristics

A total of 51 subjects (30 male, 21 female) participated in this study. Of these
participants, almost half reported having a congenital hearing loss (n = 25), followed by
unknown (n = 18) and acquired hearing loss (it = 8). The majority of the participants
attended regular schools (n = 32) compared to special school settings (it = 19). Almost
three-fourths of the participants were from families with two hearing parents (n = 38),
followed by two deaf parents (n = 10), and one hearing/one deaf parents (n = 3).
Nineteen participants were categorized as participating in more than 90 minutes per week
of physical education class (n = 19), with the remaining subjects being evenly split
between less than 45 minutes/week (n = 16) and 45-90 minutes per week (n = 16) of

participation in physical education classes. The majority of participants engaged in 0-2

73

Table 4

Sample Characteristics in Frequencies by Age Group

 

 

 

 

Male (n = 30) Femile (n = 21) M
6-7 8-9 10-1 1 6-7 8-9 10-11 6—11
(n=8) (n=13) (n=9) (n=8) (n=9) (n=4) (n=51)
Age at Onset
Congenital 4 4 5 5 4 3 25
Acquired 2 3 1 1 1 O 8
Unlmown 2 6 3 2 4 1 18
School
Placement
Special 4 8 3 3 1 0 19
Regular 4 5 6 5 8 4 32
Parents Hearing
Status
Both Hearing 6 9 6 6 8 3 38
Both Deaf 1 4 3 1 1 O 10
One Hearing/
One Deaf 1 O O 1 O 1 3
Physical
Education
<45min/wk 3 2 3 3 5 0 16
45-90min/wk 1 3 3 2 3 4 16
90+min/wk 4 8 3 3 1 0 19
Physical Activity
Participation
0-2 times/wk 6 7 5 4 4 2 28
3+ times/wk 2 6 4 4 5 2 23

 

74

 

 

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75

activities per week (it = 28) compared to those who participated in 3+ activities per week
(it = 23). Table 4 provides a description of overall sample characteristics.
F itnessgram Test Results

The Fitnessgram test battery included measures of body composition (percent
body fat/skinfolds), cardiorespiratory endurance, ﬂexibility, and muscular
strength/endurance. Scores above the 20th percentile and below the 60th percentile on a
given test were associated with the Healthy Fitness Zone (HFZ). In addition, the total
number of tests within the Healthy Fitness Zone for each individual was tabulated.

Overall results. Across the entire sample of 51 deaf children, the number of tests
within the Healthy Fitness Zone was (M : SD) 5.25 i 1.00 out of six tests. This indicates
that the deaf children in this sample demonstrated healthy ﬁtness levels. However, an
extension of this observation is that the Fitnessgram indicates children must score within
the Healthy Fitness Zone on at least 4 of 6 tests, with percent body fat and
cardiorespiratory endurance being included. In this case, 82.4% of the deaf children
scored within the Healthy Fitness Zone for percent body fat and 88.2% on the scores on
the PACER were within this range. Percentages within the Healthy Fitness Zone were
high for all tests, ranging from 78.4% for the left sit-and-reach test, 80.4% for the right
sit-and-reach test, 88.2 % for push-ups, 90.2% for curl-ups, and 92.2% for the trunk liﬁ.
This information on overall results is provided in Table 5 and Figure 8.

Analyses of Research Questions

Research Question #1: Level of Hearing Loss.

The inﬂuence of level of hearing loss on the physical ﬁtness of deaf children

could not be determined because parents did not provide sufﬁcient information when

76

  

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77

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% Body Fat

PACER (# laps)

Fitnessgram Tests

Figure 8. Tests Below, Within, and Above Healthy Fitness Zone.

responding to the questionnaires. Of the 51 completed questionnaires returned, 48 did
not provide information about decibel hearing loss, with most parents leaving the
question blank or writing in “don’t know.” Of the three respondents who did provide this
information, all three (two were twins) indicated similar level hearing losses (90-100 dB),
nullifying any potential between-subj ect comparisons.

Research Question #2: Age at Onset of Hearing Loss

Age at onset of hearing loss was categorized as being congenital (n = 25),
acquired (n = 8), or unknown (n = 18). Of the eight cases of acquired hearing losses,
seven speciﬁed that the loss was due to an illness, with three cases caused by meningitis,
one caused by high fever, and three providing no indication of the type of illness.

AN OVA procedures indicated no signiﬁcant differences among the three age at
onset groups for overall scores in the Healthy Fitness Zone, F (2,48) = 1.09, p < .35.
Non-signiﬁcant differences were revealed for each of the physical ﬁtness variables of
percent body fat, F(2,48) = 2.14, p < .13, PACER performance, F(2,48) = 1.61, p < .21,
curl-ups, F(2,48) = .56, p < .58, trunk lift, F(2,48) = .35, p < .71, right sit-and-reach,

F (2,48) = .71, p < .50, and left sit-and-reach, F (2,48) = .25, p < .78. The closest any
group test performances came to being signiﬁcantly different were push-ups, F (2,48) =
3.17, p < .06.

The group with acquired deafness not only demonstrated fewer scores within the
Healthy Fitness Zone and lower performances on the strength and endurance tests, but
also higher percent body fat, when compared to the groups with congenital and unknown
age at onset. The congenital group demonstrated the best overall performance on all

tests, with the exception of a slightly lower performance on the push-up test compared to

78

the unknown age at onset group. However, no differences were statistically signiﬁcant.
Overall ﬁtness scores by age at onset group are presented in Table 6.
Research Question #3: Parents ' Hearing Status

Parents’ hearing status was classiﬁed as either hearing or deaf. Therefore, a child
could have two deaf parents (n = 10), two hearing parents (n = 38), or one deaf and one
hearing parent (n = 3). ANOVA procedures indicated signiﬁcant differences among the
parent hearing status groups for the physical ﬁtness variables of percent body fat, F (2,
48) = 3.89, p < .03, PACER performance, F(2, 48) = 5.57, p < .01, and scores within the
Healthy Fitness Zone, F (2, 48) = 4.02, p < .03. No signiﬁcant differences were found for
curl-ups, F (2,48) = 2.32, p < .11, push-ups, F (2,48) = 1.69, p < .20, trunk lift, F(2,48) =
1.23, p < .30, right sit-and-reach, F(2,48) = 1.69, p < .20, or left sit-and-reach, F(2,48) =
.95, p < .40. Descriptive information is presented in Table 7.

Scheffe’ post hoc procedures indicated that participants with two hearing parents
had signiﬁcantly higher, p<.03 = 7.41 , percent body fat than did those with two deaf
parents, with no signiﬁcant difference involving participants with one hearing/one deaf
parent. Participants with two deaf parents demonstrated signiﬁcantly higher, p<.01 =
9.84, PACER performances than did children with two hearing parents, with no
difference found involving children with one hearing/one deaf parent. All participants
with two deaf parents performed within the Healthy Fitness Zone on all six ﬁtness tests,
with the Healthy Fitness Zone scores being signiﬁcantly higher, p<.03 = 1.33, when
compared to children with two hearing parents only. No other signiﬁcant differences
were found for any of the other physical ﬁtness variables. These data must be interpreted

with caution. While responses from parent surveys revealed that each of the participants

79

 

 

 

 

 

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had two parents, information was not obtained about whether the children actually
resided in a two-parent or single-parent household.
Research Question #4: School Placement

Deaf children attended either special (n = 19) or regular (n = 32) schools. Six
schools participated in this study. School A was a state school for the deaf located in an
urban location with a total student body of 120 students. School B was located in a
suburban area and consisted of a total student body of 58 students, including 6 deaf
students. Schools C and D were both located in rural areas and had approximately 60
total students, including 14 deaf students at each school. Schools B and F were situated
in suburban locations with school B having 58 total students, including 38 deaf students,
and school F having 26 deaf students within a total student population of 50 children.

Students who attended special and regular schools demonstrated nearly identical
scores within the Healthy Fitness Zone, F (1, 49) = .00, p < .96. Students from special
schools performed signiﬁcantly better, F (1 , 49) = 6.95, p < .01, on the curl-up test than
did students from regular schools. However, this signiﬁcant difference could have been
inﬂuenced by the two high performance outliers (range = 10 to 75) demonstrated by
students at the special schools resulting in a high standard deviation compared to students
at regular schools (range = 5 to 45). There were no signiﬁcant differences for percent
body fat, F(1, 49) = 3.48, p < .07, PACER performance, F(1, 49) = .80, p < .38, push-
ups, F(1, 49) = .44,p < .51, trunk lift, F(1, 49) = .89,p < .36, right sit-and-reach, F(1, 49)
= .76, p < .39, and left sit-and-reach, F( 1, 49) = .55, p < .46, between the two school
placements. Overall physical fitness performance and descriptive statistics for school

placement are presented in Table 8.

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The results of this study indicate that school placement does not have an inﬂuence
on children’s overall physical ﬁtness performance within the Healthy Fitness Zone.
Given the similarity of scores across ﬁtness measures and the overall scores within the
Healthy Fitness Zone, the results suggest that placement in regular and special schools
do not inﬂuence the physical ﬁtness of deaf children.

Research Question #5 .' School Physical Education Participation

Physical education classes were categorized according to the number of minutes
that the children participated per week; namely <45 minutes/week (n=16) , 45-90
minutes/week (n=16) , and 90+ minutes/week (n=19). Scores within the Healthy Fitness
Zone were similar across physical education groups, F(2, 48) = .25, p < .78. Signiﬁcant
differences among groups were indicated for PACER, F (2, 48) = 4.59, p < .02, and curl-
ups, F (2, 48) = 4.01 , p < .03, performances, but not for the physical ﬁtness variables of
percent body fat, F (2, 48) = 1.91, p < .16, push-ups, F(2, 48) = .41, p < .67, trunk liﬂ,

F (2, 48) = 1.95, p < .15, right sit-and-reach, F(2, 48) = .61, p < .55, or leﬂ sit-and-reach,
F (2, 48) = 1.36, p < .27. Scheffe’ post hoc analysis revealed that the 45-90 minutes/week
physical education group performed higher on the PACER test than did the <45
minutes/week group, p<.02 = 7.08. The group that had physical education more than 90
minutes/week performed higher on the curl-up test than did the group that had physical
education less than 45 minutes/week, p<.03 = 15.62. Descriptive statistics and overall
ﬁtness performance are presented in Table 9.

The results suggest that physical education participation does not inﬂuence the
overall physical ﬁtness performance of deaf children. These results may also provide

some anecdotal evidence on the importance of having a trained specialist lead the classes.

84

 

 

 

 

 

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The physical education group that met for more than 90 minutes/week consisted only of
the students from a special school. Their physical education classes were led by a teacher
with no physical education background. Even with the greater frequency participation,
this group only performed signiﬁcantly higher than the other groups on one ﬁtness
measure. In all the regular schools, physical education classes met less frequently, but
were taught by certiﬁed physical education teachers.

Research Question #6: Physical Activity Participation

Physical activity participation was recorded as the number of activities that the
children participated in on a regular basis of three or more times per week for at least 30
minutes per session. For this study, physical activity participation was identiﬁed as the
number of activities in which the deaf children participated in on a regular basis during
the two months preceding the ﬁtness test date. Physical activity participation was divided
into two groups: 0-2 activities/week (n = 28) and 3+ activities/week (n = 23).

ANOVA computations indicated signiﬁcant differences between the groups in
percent body fat, F(1, 49) = 8.47, p<.01, PACER performance, F (1, 49) = 17.32, p< .00,
curl-up performance. F (1, 49) = 8.54; p<.01, push-up performance, F (1, 49) = 8.24,
p<.01, right sit-and-reach, F (1, 49) = 4.76, p<.03, left sit-and-reach, F(1, 49) = 4.48,
p<.04, and Healthy Fitness Zone scores, F (1, 49) = 18.59, p<.OO. The only ﬁtness
measure that was not associated with signiﬁcant statistical differences between the
groups was the trunk lift, F ( 1 , 49) = 1.01 , p<.32 The 3+ activities/week group
demonstrated better performance across all physical ﬁtness measures than did the 0-2

activities/week group. Information on group performances and differences are presented

in Table 10.

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The results indicated physical activity performance outside of the school setting
influenced the physical ﬁtness of deaf children. Those children who participated in three
or more activities per week demonstrated better overall physical ﬁtness performance,
with the exception of the trunk lift than did those children who participated in less than
the recommended three activities per week.

Factors Which Inﬂuence the Physical Fitness Levels of Deaf Children

Through statistical correlational methods, it was found that many of the
independent variables correlated with one another, an indication that MANOVA
procedures should have been used to evaluate interactions between variables on ﬁtness
measures. However, this study did not satisfy the assumptions of having at least seven
subjects per cell required to compute MANOVA statistics. Therefore, multiple
regression procedures were computed as a post hoc analyses to determine which
independent variables provided the most inﬂuence on the physical ﬁtness levels of deaf
children. The subject base from this study (n=51) satisﬁed the assumption of sample size
for multiple regression given that only one cell per independent variable is required for
computation rather than the different levels of each independent variable used in
MAN OVA procedures. Table 11 details the results of the multiple regression
computations for each ﬁtness measure. To interpret Table 11, R refers to the regression
coefﬁcient or the relationship between the weighted sum of the independent (predictor)
variables and the ﬁtness measure being evaluated, R2 refers to the amount of variance in
the evaluated ﬁtness scores accounted for by the independent variables, and RZA refers to

the increase in explained variance with the addition of other independent variables.

88

Table 1 l

R2 Values for Independent Variables on Fitness Measures

 

 

R R2 R2 p
Healthy Fitness Zone
Physical Activity Participation .524 .275 .275 .000
Parents’ Hearing Status .553 .306 .031 .000
School Placement .560 .3 14 .008 .000
Age at Onset .567 .321 .007 .001
Physical Education .574 .328 .007 .002
Percent Body Fat
Physical Activity Participation .384 .147 .147 .005
School Placement .423 .179 .032 .009
Parents’ Hearing Status .446 .199 .020 .014
Age at Onset .449 .202 .003 .032
Physical Education .451 .203 .001 .061
PACER
Physical Activity Participation .51 1 .261 .261 .000
Parents’ Hearing Status .560 .314 .053 .000
School Placement .564 .3 18 .004 .000
Physical Education .604 .365 .047 .000
Age at Onset .608 .370 .015 .001
Curl-Ups
Physical Activity Participation .385 .148 .148 .005
Physical Education .556 .309 .1 61 .000
School Placement .587 .345 .037 .000
Parents’ Hearing Status .592 .350 ‘ .015 .000
Age at Onset .597 .357 .007 .001

89

Table 1 I (continued)

 

 

R R2 R2 p
Push-Ups
Physical Activity Participation .379 .144 . 144 .006
Parents’ Hearing Status .414 .171 .027 .011
School Placement .439 .193 .022 .017
Physical Education .442 .195 .002 .037
Age at Onset .452 .204 .009 .060
Trunk Lift
Physical Education .23 1 .053 .053 .103
Parents’ Hearing Status .368 .135 .082 .030
School Placement .417 . 174 .039 .028
Physical Activity Participation .438 .191 .017 .041
Age at Onset .449 .202 .011 .063
Right Sit-and-Reach
Physical Activity Participation .297 .088 .088 .034
Parents’ Hearing Status .319 .102 .014 .076
Age at Onset .344 .119 .018 .112
Physical Education .382 .146 .027 . 1 16
School Placement .421 .177 .03 1 .107
Left Sit-and-Reach
Physical Activity Participation .289 .084 .084 .039
Physical Education .337 .1 14 .030 .055
School Placement .409 .167 .053 .034
Parents’ Hearing Status .448 .200 .037 .033
Age at Onset .462 .214 .014 .048

 

90

Percent Body Fat

Table 11 identiﬁes the R2 values computed for all independent variables and their
inﬂuence on deaf children’s percent body fat. Multiple regression statistics indicated that
physical activity participation accounted for the most variance seen among the
participants for percent body fat (R2 = .15). These results indicated that 15% of the
variance seen in percent body fat between the subjects could be attributed to physical
activity participation. No other combination of independent variables contributed to a
meaningful increase in RZA with school placement contributing 3.2%, parents’ hearing
status 2.0%, age at onset of hearing loss .3%, and physical education participation .1%.
PACER Performances

Multiple regression procedures were computed for R2 values to determine which
variables had the greatest inﬂuence on deaf children’s PACER performance. This
information is presented in Table 11. The results showed an R2 value of .26 for physical
activity participation, indicating that this one independent variable accounted for 26.0%
of the variance in PACER performances across subjects. No other independent variables
provided a meaningful increase in R2 A for PACER performances. Parents’ hearing status
contributed only 5.3% of explained variance, followed by physical education
participation with 4.7%, age at onset of hearing loss with 1.5%, and school placement
with .4%. However, the variance explained by physical education participation was a
negligible R221 of .007 when inserted into the regression equation before or without
school placement. This statistical outcome can probably be attributed to the high

correlation (r = .88) between school placement and physical education participation.

91

C url- Up Performances

Regression procedures yielded a RZA value of .31 for the combination of physical
activity participation and physical education, indicating that 31% of the variance in curl-
up performances can be attributed to these two factors. No other combinations of
independent variables contributed to any reasonable increase in the R221 value, with
school placement contributing 3.7%, parents’ hearing status 1.5%, and age at onset of
hearing loss .7% of the variance in curl-up performances.
Push- Up Performances

Table 11 identiﬁes the RZA values for all independent variables with respect to
their inﬂuence on push-up performance. The highest R2 value was associated with
physical activity participation, with 14.0% of explained variance in push-up performance
accounted for by that one variable. No other combinations of independent variables
contributed to a meaningful increase in the percent variance accounted for by the
independent variables. Of the remaining variables, parents’ hearing status contributed to
a 2.7% change in the RZA value, school placement 2.2%, age at onset of hearing loss .9%
and physical education participation .2%.
Flexibility Performances

Multiple regression computations revealed no meaninng inﬂuence by any of the
independent variables on the three ﬂexibility measures of trunk lift, right sit-and-reach,
and left sit-and-reach (Table 11). Physical activity participation had the most impact, a
negligible inﬂuence of less than 8% on all three measures of ﬂexibility, indicating that

these ﬁtness measures were inﬂuenced by variables not evaluated within this study.

92

Healthy Fitness Zone Scores

The independent variable of physical activity participation contributed to the
greatest R2 value of .28 to differences seen in scores within the Healthy Fitness Zone.
The RZA progression for the Healthy Fitness Zone scores is in Table 11. These results
indicated that 28.0% of the variance seen among groups for overall physical ﬁtness
performances within the Healthy Fitness Zone was explained by physical activity
participation. The addition of parents’ hearing status contributed to a R221 of 3.1%,
school placement .8%, age at onset of hearing loss .7%, and physical education
participation .7%.
Overall Outcome of Multiple Regression

These results indicated that physical activity participation was the greatest
inﬂuential factors on physical ﬁtness performances with the exception of ﬂexibility.
Physical activity participation was the only consistent independent variable that
accounted for variance seen in physical ﬁtness scores among the deaf children. None of
the other variables, with one exception of physical education participation on curl-up
performances, had any meaningful inﬂuence on the outcome of physical ﬁtness

performances.

93

CHAPTER 5
Discussion

The purpose of this study was to determine factors that inﬂuence the physical
ﬁtness levels of deaf children. Physical activity participation was the lone factor found to
inﬂuence the physical ﬁtness levels of deaf children. Parents’ hearing status, school
physical education, school placement, and age at onset of hearing loss did not have a
statistically signiﬁcant inﬂuence. In this discussion section, information on inﬂuential
factors, usefulness of the Fitnessgram protocol, and implications of the results of the
present study will be discussed.
F itnessgram Test Protocol

The Fitnessgram test protocol has been widely used to evaluate the physical
ﬁtness of school-aged children (Cooper Institute of Aerobic Research, 1999) and was the
measure used within this study to evaluate the physical ﬁtness of deaf children. This test
battery was modiﬁed for deaf children using visual cues for the PACER, curl-up, and
push-up tests. These modiﬁcations were evaluated through two pilot studies with results
showing acceptable reliability and validity, indicating that the modiﬁed test was
appropriate for evaluating the physical ﬁtness of deaf children (Appendix B). This
ﬁnding was important because it indicates that with some simple modiﬁcations, the
popular F itnessgram test battery is not only a feasible, but also a valid and reliable
measure for evaluating the ﬁtness of deaf children. In addition, the use of the modiﬁed
Fitnessgram for evaluating the physical ﬁtness of deaf children increases the likelihood
that deaf children will understand the test directions and perform the tests correctly.

Therefore, the scores from the modiﬁed Fitnessgram are likely to be more representative

94

of the true abilities of deaf children than would scores obtained from the original,
unmodiﬁed F itnessgram.
Physical Fitness Levels of Deaf Children

In contrast to much of the research literature, the results of this study indicated
that deaf children have at least minimally acceptable levels of physical ﬁtness. One of
the major differences between the present and past studies is that in this investigation
deaf children were not compared to hearing children when evaluating their ﬁtness levels.
Rather, ﬁtness performances were evaluated with reference to the Healthy Fitness Zone
(Cooper Institute of Aerobic Research, 1999), an indication of adequate ﬁtness. The
Healthy Fitness Zone was designed for and evaluated through ﬁtness research on hearing
children. Within the current sample of deaf children, 73% of boys (n = 22 of 30) and
91% of girls (n = 19 of 21) between the ages of 6—11 years satisﬁed the recommended
criteria of at least four of six test performances within the Healthy Fitness Zone,
including percent body fat and cardiorespiratory endurance. Of the 10 participants who
did not meet the criteria, most were from the 10—11 year old group. The ﬁnding that 59%
of the participants from the 8-9 year old group achieved scores in the Healthy Fitness
Zone on all six measures, compared to 56% of the 6-7 year old group and 46% of the 10-
11 year old group was likely due to the lack of criterion standards on the PACER for the
younger groups and because most statistical outliers occurred within the older group.
These results are discussed further in the following paragraphs.

Cardiorespiratory endurance. While this study indicated that deaf children
generally demonstrated adequate ﬁtness levels, there is concern regarding the

interpretation of their PACER performances. The outcome that 73% of male and 91% of

95

female participants scored within the Healthy Fitness Zone for all ﬁtness measures can
easily be misinterpreted given that the Fitnessgram does not provide criterion-referenced
standards for the PACER for participants under the age of 10 years. Rather, the
administration manual indicated that if children under the age of 10 years participated
then they “passed” and were therefore considered to have scored within the Healthy
Fitness Zone. Due to this, 100% of the children under 10 years of age were considered to
fall within the zone due solely from the fact that they participated. For those participants
in the 10-11 year old group, only 54% performed within the Healthy Fitness Zone for the
PACER test. This results is an indication that almost half of the children in the 10-11
year old group had poor cardiorespiratory endurance.

The results of the PACER performance cause concern in the interpretation not
only of the deaf children’s ﬁtness levels, but also when making comparisons to the
literature. This or any similar study cannot conclusively indicate that children younger
than the age of 10 years have appropriate levels of cardiorespiratory endurance because
of the absence of criterion-referenced standards within the Healthy Fitness Zone for these
children. Other than to say that these children participated and therefore “passed” the
PACER test, no evidence of their true cardiorespiratory endurance can be reported. Thus,
this study does not provide evidence to the ﬁeld regarding the cardiorespiratory
endurance of deaf children under the age of 10 years.

In order to gain insight on potential PACER performance, the deaf children in the
younger age groups were compared to the Healthy Fitness Zone criterion values for 10
year olds. The purpose of this comparison was to determine if any of the younger

children reached the minimum criterion set for the 10 year old group, with the hypothesis

96

that if they did reach this level then they would actually have cardiorespiratory
performances within the Healthy Fitness Zone. These comparisons indicated that 38% of
the participants in the 6-7 year old group and 55% of those in the 8-9 year old group met
the minimum criterion for performance within the Healthy Fitness Zone set for 10 year
old children.

Cardiorespiratory endurance results from this study are difﬁcult to compare to
existing research because no previously published studies with deaf children used the
PACER test. While direct comparisons cannot be made between the present cardio-
respiratory endurance results and those form past studies, general conclusions can be
provided. Campbell (1983) and Winnick and Short (1986) both reported that hearing
children demonstrated higher cardiorespiratory endurance than did deaf children, and
Ellis (2001) reported that cardiorespiratory endurance performances by deaf children fell
below the 40th percentile of standardized norms designed for hearing children. The
present study is in agreement with these results with the demonstration that 46% of the
deaf children in the 10-11 year old group performed below the lower limit (corresponding
to approximately the 20th percentile) of the Healthy Fitness Zone on the PACER test.
This conclusion was also supported by the observation of the low number of laps
compared by many deaf children in the younger 6-9 years age groups where criterion-
referenced standards were not available.

Percent body fat. Within the present study, 82% of all participants scored within
the Healthy Fitness Zone for percent body fat. However, gender differences indicated
that while 100% of the females scored within the Healthy Fitness Zone, only 73% of the

males scored within this range for percent body fat. Most male participants demonstrated

97

appropriate levels of percent body fat, however, four of the seven statistical outliers for
percent fat (scores more than 3 SD from the mean) were for males in the 10-11 year old
group and corresponded to those who performed below the 20th percentile on the PACER
test. These outlier scores were compared to the Center of Disease Control and Prevention
grth charts for age and gender (CDC, 2001). The males in the 10-11 year old group
whose percent body fat levels were classiﬁed as statistical outliers demonstrated body
weights that were at least 25 percentile points higher when compared to their heights for
age and gender. For example, one 10 year old male had a height which was in the 50th
percentile for age and a body weight at the 85th percentile. The percentile difference
between height and weight for these four males in the 10-11 year old group ranged from
25 to 40 percentile points, with all four body weights being classiﬁed as above the 60th
percentile for age.

Percent body fat from the present study could not be directly compared to existing
research which evaluated deaf children due to differences in the anatomical sites used for
measurements or incomplete reports of data in the literature. The present study evaluated
percent body fat of children 6-11 years of age using the tricep and calf anatomical sites
for measurement. However, sum of skinfolds from the present study was compared to
results from the Winnick and Short (1986) investigation which used the same skinfold
sites for evaluation. Deaf females from the present study demonstrated similar but higher
sum of skinfolds (M = 27.95mm) than did deaf (M = 25.80mm) and hard of hearing (M =
27.70mm) females from the Winnick and Short study (1986). Males from the present
study demonstrated higher sum of skinfolds (M = 27.69mm) than both the deaf (M =

23.20mm) and hard of hearing (M = 22.50mm) males from the Winnick and Short study.

98

However, only the sum of skinfolds from the 10-11 year old group from the present study
could be compared because the Winnick and Short study focused on children between the
ages of 10-12 years. AAHPERD (1984) percentile norms were not comparable with the
results from the present study because of differences in site measurement (tricep and calf
versus tricep and subscapular).

Muscular strength and endurance. The results of this study indicated that 90.2%
of all participants performed within the Healthy F itrress Zone on the curl-up measure and
88.2% on the push-up test, indicating that the majority of deaf children demonstrated
appropriate levels of muscular strength and endurance. However, it is difﬁcult to make
direct comparisons with existing research because a 3-second cadence was required for
completion of both the curl-up and push-up test. For this reason, any comparisons must
be done with caution when interpreting the results of the present study to those in the
literature. Comparing the results of the curl-up test from the present study to normative
standards for the 60-second sit-up test (AAHPERD, 1984) indicated that all performances
were below the 50th percentile, with curl-up performances demonstrated by participants
from the 10-11 year old group falling below the 20th percentile. In the present study,
none of the mean curl-up performances by age group fell below the 20th percentile or
low end of the Healthy Fitness Zone, but several low (but adequate) performances by the
10-11 year old group caused some concern with their performances. Normative
standards for the regular no—cadence push-up test were not reported; therefore, the results
of this study could not be directly compared to existing performance norms.

Flexibility. The results of this study revealed that 92.2% of the participants within

the present study scored within the Healthy Fitness Zone for the trunk lift, 80.4% on the

99

right sit-and-reach, and 78.4% on the left sit-and-reach. This was an indication that the
majority of deaf children generally demonstrated adequate ﬂexibility scores, a ﬁnding
which is in accordance with past research that reported similar performances between
deaf and hearing children (Ellis, 2001; Wiegersma & Van Der Velde, 1983; Winnick &
Short, 1986). Comparing mean ﬂexibility performances to AAHPERD (1984) national
norms indicated that the deaf children from the present study demonstrated sit-and-reach
performances above the 50th percentile for age and gender. The lone exception was for
females in the 10-11 year old group with mean performances below the 20th percentile.
Generally, research has indicated that females demonstrate improvements in ﬂexibility
with increasing age (McKenzie & Sallis, 1997; Wihnore & Costill, 1994). The results of
this study were somewhat in contrast with this research ﬁnding with the demonstration of
average female sit-and-reach performances below the 20th percentile for the 10-11 year
old group. However, this may have been due to both the small sample size and the wide
variability of scores ranging from well above the 50th percentile to below the 10th
percentile for age and gender.

Conclusions and implications. The results of this study not only indicated that
deaf children generally demonstrate adequate ﬁtness levels, but also reinforced the belief
that deaf children are more similar than dissimilar to hearing children. The signiﬁcance
of this information is that the physical ﬁtness of deaf children ﬁtness can be evaluated
based on national criterion standards and norms designed for hearing children, including
the Healthy Fitness Zone used with the Fitnessgram. Information about deaf children’s
ﬁtness can be gained through simple modiﬁcations of the same test batteries used for

hearing children. The results of these ﬁtness tests can beneﬁt not only the deaf child, but

100

also their parents and teachers. Therefore, it is safe to assume that since deaf children are
similar to hearing children, they can also beneﬁt from the same activities designed to
enhance ﬁtness and that different activities are not necessary for deaf children to improve
on their ﬁtness levels.

In addition, the outcome of this study and that of past research emphasize the
importance of having performance levels for comparison and evaluation of ﬁtness
performances not only for muscular strength and endurance, but also for percent body fat
and cardiorespiratory endurance. Whether criterion or normative standards are used, this
information allows for evaluation or ranking of individual performances and tracking of
trends related to ﬁtness over a period of time. In addition, normative standards give a
more speciﬁc performance outcome (30th percentile, 35th percentile, and so forth) which
can be used for motivational purposes when working with children on improving ﬁtness
levels. With criterion-referenced standards, the performance is to a certain speciﬁed
criterion, and it is sometimes difﬁcult to determine how much improvement has been
accomplished. However, both standards are important in that they provide information
relative to an individual’s ﬁtness level. This is an important suggestion for a ﬁtness test
battery as popular as the Fitnessgram and especially one that is used within the school
system, a setting where accountability has increased in importance over the years. Not
only does this information permit easier identiﬁcation of children’s levels of ﬁtness, but
also helps children, teachers, and parents to assess improvements with respect to the

normative standards.

101

Inﬂuence of Physical Activity and Physical Education Participation

Physical activity participation was the lone factor that inﬂuenced the overall
physical ﬁtness performance of deaf children. Regular physical activity participation of
three or more activities per week for at least 30 minutes per session was associated with
signiﬁcantly better overall physical ﬁtness performances, especially on the tests of
cardiorespiratory endurance, percent body fat, and muscular strength/endurance. These
results are not surprising as they are in agreement with past research indicating that
regular physical activity participation positively inﬂuences physical ﬁtness levels
(Colchico, Zybert, & Basch, 2000). This outcome also reinforces the assumption that
deaf children are physiologically similar to hearing children and that the same principles
of exercise physiology and ﬁtness apply to this group of participants. While these results
are in agreement with existing research regarding physical activity participation, caution
must be exercised due to the small sample size and limitations associated with self-report
data. The surveys used within this study were investigator-developed because there were
no existing protocols within the literature that focused on evaluating children’s physical
activity participation and were appropriate for the age range evaluated within this study.
In addition, the investigator-formulated survey was not validated through pilot testing and
could therefore pose a lirrritation on reporting such information as children’s physical
activity participation. Another limitation in reporting ﬁtness results involves the overall
sample make-up. In this study, all children who provided consent to participate were
tested for physical ﬁtness. Out of the 208 potential subjects, only 51 or approximately
25% of all prospective participants actually participated. Because of this small number

and the results generated from this study indicating that this group was generally ﬁt and

102

active, it was possible that those students who did participate may have been a biased
sample and not truly representative of deaf children in grades ﬁrst through fourth.

In contrast to results reported by existing research, physical education was not
found to be an inﬂuential factor on deaf children’s ﬁtness. The lone exception was that
physical education was found to inﬂuence curl-up performance when combined with
physical activity participation. This outcome could have been because students
participating in the daily physical education classes (all from the same school) were
taught by a classroom teacher with no physical education background. The children who
participated in 45-90 minutes of physical education per week demonstrated the highest
overall number of scores in the Healthy Fitness Zone when compared to the daily and
<45 minutes/week physical education groups. The results of this study were in contrast
to past research which indicated physical education to be inﬂuential on the physical
ﬁtness levels of hearing children (McKenzie, et al., 1996; Sallis, etal., 1997). However,
both the <45 minutes/week and 45-90 minutes/week physical education groups were
instructed by certiﬁed physical education teachers, lending support to the importance of
both the duration of physical education classes and leadership within these classes (Sallis,
et al., 1997).

The conclusion regarding physical education participation by the deaf children
was limited because only one school offered daily physical education, a small number of
schools/programs were evaluated, and there was no investigator control over the activities
offered within these programs. No information was collected pertaining to the types and

quality of instruction and activities provided within the physical education classes;

103

therefore, it was difﬁculty to conclusively state that physical education classes did not
have an inﬂuence on the physical ﬁtness of the subjects within this study.

The results of this study support the importance of regular physical activity
participation for enhancing physical ﬁtness. The results also indicate that the knowledge
gained from testing hearing children on ﬁtness-related measures probably generalizes to
deaf children as well. Thus, deaf children and their parents should be encouraged to
follow the same healthy lifestyle goals formulated for the hearing population with respect
to physical activity participation and ﬁtness.

Influence of Parents ’ Hearing Status

Parents’ hearing status was not found to inﬂuence the physical ﬁtness levels of
deaf children. However, the results indicated that all of the children with two deaf
parents (n = 10) demonstrated performances within the Healthy Fitness Zone on all six
measures of ﬁtness. In addition, 80% of these children participated in at least three
regular physical activities per week. In comparison, only 37% of the children with at
least one hearing parent participated in the recommended three regular physical activities
per week. This outcome suggests that even though the results were not signiﬁcant,
parents’ hearing status may play an importance in the children’s physical ﬁtness levels.
This possibility is supported by the ﬁnding that the children with two deaf parents were
older (M = 8.6 years) than both the children with two hearing parents (M = 8.0 years) and
one hearing/one deaf parent (M = 7.8 years). Younger children are more naturally active
and not as inﬂuenced by extraneous variables with respect to physical activity
participation (Rowland, 1999). Taking this information into account, as well as the fact

that the deaf children with two deaf parents were from the older age group, there is the

104

possibility that the deaf parents inﬂuenced both their physical activity and ﬁtness levels.
It is possible that the deaf parents in this study allowed their deaf children more
opportunities to participate in physical activities leading to positive changes in ﬁtness.
The hypothesis is that the changes in ﬁtness were due to physical activity participation
encouraged by the parents rather than the deaf children being more habitually active as is
common with younger children.

In the current study, parents’ hearing status did not inﬂuence the physical ﬁtness
of deaf children, an outcome that contrasts with existing research which shows that
parents of hearing children exert a strong inﬂuence on their children’s physical ﬁtness
levels (Biddle & Armstrong, 1992; Pate, et al., 1997). However, deaf children with two
deaf parents demonstrated more scores within the Healthy F itrress Zone, as well as higher
physical activity participation levels, than children with two hearing parents or with one
deaf and one hearing parent, suggesting that deaf parents of deaf children do inﬂuence
their children’s physical ﬁtness and activity levels. This conclusion must be tempered
with the recognition that there were a relatively small number of participants in each of
the parent status groups. There were 3 participants in the one hearing/one deaf parent
group and 10 participants in the two deaf parents group, compared to the larger sample of
38 participants in the two hearing parents group.

Multicollinearity is also an issue that affects interpretation of the results related to
parents’ hearing status. There was a signiﬁcant correlation (r = .62) between parents’
hearing status and physical activity participation. This ﬁnding, in combination with the

knowledge that physical activity participation was the only variable that had a signiﬁcant

105

inﬂuence on physical ﬁtness scores, suggests that the actual inﬂuence of parents’ hearing
status may have been overshadowed by the inﬂuence of physical activity participation.

However, these potential limitations do not nullify the indication that deaf parents
may indeed encourage greater physical activity participation for their deaf children as
speculated by both Ellis (2001) and Stewart (1991). Deaf parents may be more familiar
with not only the fact that their children have no restrictions to activity participation and
encourage this behavior, but also more knowledgeable regarding activity opportunities
for their children. Hearing parents may be more apprehensive of allowing their children
to participate in physical activities and may restrict participation which could enhance
physical ﬁtness. In fact, compared to deaf parents, hearing parents have been found to
be more overprotective of their deaf children and apprehensive about their involvement in
school-related activities, such as extracurricular activities, within the educational setting
(Vernon & Andrews, 1990), a behavior which may generalize into the physical activity
setting.

The ﬁndings that parents’ hearing status may inﬂuence the physical ﬁtness of deaf
children suggests that a parent education program may be needed for parents who are
sedentary, apprehensive, or even unaware of opportunities for allowing their deaf
children to participate in physical activities. A program focused on educating parents
may provide sedentary parents, regardless of hearing status, with information regarding
the importance of ﬁtness and activity participation and the incentive to get their children
involved. It could also provide the evidence of the similarities between hearing and deaf
children’s capabilities in order to demonstrate that deaf children can and should

participate in regular physical activities and can reap the same beneﬁts as any other child.

106

Influence of Other Variables
Neither school placement nor age at onset of hearing loss inﬂuenced the physical
ﬁtness of deaf children. This outcome indicated that when the child lost their hearing and
where the child attends school are not as important as other factors in the attainment of
appropriate ﬁtness levels. These results are potentially limited by the small sample size
and number of schools that participated within this study. Regarding school placement,
these results are in contrast to past research which indicated that deaf children in special
schools demonstrated higher ﬁtness levels than did deaf children in regular schools
(Winnick & Short, 1986). It is possible that these results were affected by school-related
factors such as physical education classes and self-contained classroom settings, which
were not identiﬁed in past research. School placement should be considered in future
studies, as all students within both school settings were in segregated classrooms and
taught by deaf education teachers, making it impossible to evaluate the effects of
inclusive settings on any of the ﬁtness measures. There was no evidence provided by this
study that age at onset affected the outcome of physical ﬁtness; therefore, along with the
results from past research that indicated similar outcomes, ﬁrture studies should focus on
other variables rather than solely age at onset of hearing loss.
Conclusions and Recommendations
Several conclusions can be drawn from the present study:

1. Deaf children, as a group, demonstrate adequate physical ﬁtness as deﬁned by the

Healthy Fitness Zone (Cooper Institute of Aerobic Research, 1999). The lone

exception was with the cardiorespiratory endurance performance of the 10-11 year

old group where 46% of the participants performed below the 20th percentile.

107

2. Physical activity participation has a greater inﬂuence on the physical ﬁtness of deaf
children than other variables tested in this study, namely physical education
participation, parents’ hearing status, school placement, and age at onset of hearing
loss.

3. Parents’ hearing status may also inﬂuence the physical ﬁtness of deaf children. Deaf
parents may be more aware of their deaf children’s physical capabilities and provide
greater encouragement for their children to become involved in a wide range of
physical activities. Hearing parents may be more overprotective or apprehensive of
their deaf children and may restrict their participation in activities which could
enhance ﬁtness. Even though this study did not ﬁnd that parents’ hearing status was
an inﬂuential factor on deaf children’s physical ﬁtness levels, information supporting
the inﬂuence of parents was provided. Deaf children with two deaf parents not only
performed within the Healthy Fitness Zone on all six ﬁtness tests, but also had the
highest average number of physical activities participated in per week.
Comparatively, the deaf children with two hearing parents had the lowest average
number of physical activities participated in per week.

4. The modiﬁed Fitnessgram is a valid and reliable method for evaluating the physical
ﬁtness of deaf children.

Several recommendations are suggested for ﬁrture research:

1. The present study consisted of a modest sample size for a group of deaf children from
one midwestem state. Future studies should consist of a larger sample size to protect
against a biased sample which is non-representative of a given group of deaf children

and to allow greater generalizability. In addition, having a larger sample size would

108

allow the use of appropriate statistical methods for analyzing interactions among
independent variables.

. The present study focused on elementary school children in grades ﬁrst through
fourth. Future research should evaluate children in middle school and high school to
determine whether there are differences in physical ﬁtness seen at these educational
levels.

. The present study only evaluated the number of minutes per week of physical
education instruction. Future research should involve a more in-depth evaluation of
the quality of instruction and the curriculum of physical education classes in order to
determine more conclusively whether physical education is an inﬂuential factor on
deaf children’s physical ﬁtness levels.

. This study identiﬁed a main inﬂuential factor of physical activity participation.
However, the information was collected by an investigator-formulated, self-report
questionnaire completed by the parents. A future study could use more reliable and

valid means for evaluating physical activity participation.

109

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116

APPENDICES

117

 

Appendix A: UCRIHS Approval

118

 

ornce or
RESEARCH

Michiom State University
246 Administrator: Building
East lamina, Michigan
48824-1046

51 7B55-21w

FAX' 517353-2976

Web: m.m.edu/userluuhs
E-Mall: ucrihsOl'nsuedu

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MICHIGAN STATE

 

UNIVERSITY

February 23, 2001

TO: Gail DUMMER
132 IM Sports Circle

RE: IRB# 01-036 CATEGORY: EXPEDITED 2-o
APPROVAL DATE: February 23, 2001

TITLE: FACTORS THAT INFLUENCE THE PHYSICAL FITNESS LEVELS OF DEAF
CHILDREN

The University Committee on Research involving Human Subjects' (UCRIHS) review of this
project is complete and i am pleased to advise that the rights and welfare of the human
subjects appear to be adequately protected and methods to obtain informed consent are
apprOpriate. Therefore, the UCRIHS approved this project.

RENEWALS: UCRIHS approval is valid for one calendar year, beginning with the approval
date shown above. Projects continuing beyond one year must be renewed with the green
renewal form. A maximum of four such expedited renewals possible. Investigators wishing to
continue a project beyond that time need to submit it again for a complete review.

REVISIONS: UCRIHS must review any changes in procedures involving human subjects, prior
to initiation of the change. If this is done at the time of renewal, please use the green renewal
form. To revise an approved protocol at any other time during the year, send your written
request to the UCRIHS Chair. requesting revised approval and referencing the project's lRB#
and title. Include in your request a description of the change and any revised instruments,
consent forms or advertisements that are applicable.

PROBLEMSICHANGES: Should either of the following arise during the course of the work-
notify UCRIHS promptly: 1) problems (unexpected side effects. complaints, etc.) involving
human subjects or 2) changes in the research environment or new information indicating
greater risk to the human subjects than existed when the protocol was previously reviewed and
approved.

if we can be of further assistance. please contact us at (517) 355-2180 or via email:
UCRIHS@msu.edu. Please note that all UCRIHS forms are located on the web:
httpﬂwwwmsueduluser/ucrihs

Sincerely.

sat/WW

Ashir Kumar, MD.
Interim Chair. UCRIHS

   

AK: bd

CC: Kathleen Ellis
1501 W. Stoll Rd. #D
DeWitt. Ml 48820

119

Appendix B: Pilot Test Results

120

Pilot Study Results

Pilot Study #1

Pilot study #1 was conducted to determine the validity of the PACER test using
visual cues (cable lights) rather than auditory cues (compact disc recording). In addition,
validity was evaluated for the curl-up and push-up tests using both the auditory cues via
CD recording and hand signals used by the investigator. A small sample of hearing
children (n=6) between the ages of 7-12 years completed two measures of the PACER,
curl-ups, and push-ups, once with auditory cues and once with visual cues. Each test was
administered one week apart in the same school gymnasium, with the auditory cued tests
completed during the ﬁrst test session. Validity was determined to be r=.90 for the
PACER, r=.88 for the curl-up test, and r=.83 for the push-up test using Pearson
correlations. These results indicated that valid modiﬁcations were used in the fonrr of
visual signals.
Pilot Study #2

Pilot study #2 was completed to determine the feasibility of using the Fitnessgram
tests for evaluating the physical ﬁtness performances of deaf children. A group of 21
deaf children (16 males, 5 females) aged 6-11 years participated in this study. In order to
validate the PACER, which has not been used to evaluate the cardiorespiratory endurance
of deaf children, participants’ performances on the timed one-mile run were compared to
their performances on the PACER using visual cues. Each participant completed the mile
run once and the F itrressgram tests twice. The F itnessgrarn tests included the PACER,
curl-ups, push-ups, trunk lift, right sit-and-reach and left sit-and-reach. Curl-up and

push-ups were evaluated using the hand signals in place of the auditory 3-second cadence

121

described by the F itnessgram test administrators manual and evaluated for validity by
comparison to the 60-second sit-up and regular push-up tests, respectively. In addition,
tricep and calf skinfolds were measured on both test dates. Each evaluated period
occurred one week apart. All reliability and validity coefﬁcients, computed through
Pearson correlational methods, were found to be signiﬁcant. This indicated that the
Fitnessgram tests, including the PACER and hand-signaled curl-up and push-up tests,
were appropriate measures of ﬁtness for deaf children. Reliability and validity results for

all Fitnessgram measures are summarized in Table 14.

122

Table 12

Reliability and Validity of F itnessgram Measures of Deaf Children aged 6-11 years
(Pilot Study #2)

 

 

Test l/T est 2 Reliability Validity
Mile/PACER 1 -.70
Mile/PACER 2 -.74
605 Sit-Ups/Hand Curl-Ups .90
Push-Ups/Hand Push-Ups .76
PACER l/PACER 2 .79

Tricep 1/Tricep 2 .98

Calf 1/Calf 2 .99

Curl-Up 1/Curl-Up 2 .88

Push-Up l/Push-Up 2 .92

Right S&R l/Right S&R 2 .89

Left S&R 1/Left S&R 2 .88

Trunk Lift l/Trunk Lift 2 .96

 

123

Appendix C: Surveys

124

 

Factors that Inﬂuence the Physical Fitness of Deaf Children
School Information Survey

You indicate your voluntary agreement to participate in this research by completing and returning this
questionnaire

Schook

 

Address:

 

Principal or Administrator:

 

Phone: Email:

 

Please answer the following regarding your students in 1st through 4th grades.

Number of deaf Number of deaf students
students in physical education

Regular class/Regular school

 

 

Special class/Regular school

 

 

Special class/Special school

 

 

Person to contact to set up testing dates:

 

Phone Number: Email:

 

How may I contact the parents/guardians of your students?
We will provide a list of mailing addresses.
We will add mailing labels and conduct the mailing of
information packets prepared and stamped by the

investigator.

Should you have any questions or concerns, please do not hesitate to contact my dissertation directors
or myself. Thank you.

M. Kathleen Ellis Dr. Gail Dummer Dr. David Stewart

Doctoral Candidate Dissertation Director Director, Deaf Education
Michigan State University Michigan State University Michigan State University
Department of Kinesiology Department of Kinesiology Department of Special Education
katellis@aol.com dummer@msu.edu dstewart@msu.edu
(517)485-5768 (home) (517) 355-4744 (work) (517) 355-1837 (work)

125

Physical Education Survey

Please complete the following information pertaining to the physical education program
that your 1"-4"' graders participate in.

Days per week that physical education classes meet:

 

Minutes per week that physical education classes meet:

 

Please complete the following information pertaining to the use of communication methods with
deaf students in your physical education class.

Do you use sign language during class to explain directions? YES NO
If yes, type of sign language used: (please circle all that apply)
ASL English Contact SEE
Does an interpreter come to your PE class to communicate
directions to the deaf student? YES NO
Please complete the following consent form to algow use of the above information in this research
stu y.

I have read the description pertaining to the research study “Factors which affect the ﬁtness levels
of deaf children.”

[ ] YES, I give permission to the investigator to use the information pertaining

 

 

to my PE program.

[ ] NO, I do not want the investigator to use the information pertaining to my
PE program.

Name:

School:

Signature: Date:

 

 

126

Factors that Inﬂuence the Physical Fitness of Deaf Children
Parent and Student Information Survey
You indicate your voluntary agreement to participate in this research by completing and returning

this questionnaire

Student Name:

 

Date of birth: Age: Grade:

School:

 

Mailing address (where personal ﬁtness analysis will be sent to):

 

 

Please supply the following information for the child listed above:

Is your child: (please circle) Hard of Hearing Deaf

 

Decibel hearing loss in the: Right ear: Left ear:
What is the cause of your child’s hearing loss? (please circle)
Congenital Acquired Unknown
If you do know the speciﬁc cause of your child's deafness, please answer the following:
Genetics/hereditary Meningitis CMV

Other:

 

How many years has your child attended his/her present school:

 

Which accommodations does your child receive at his/her present school?

 

Please provide the following information regarding the above child’s parents:

 

 

Is this child’s mother: (please circle) Hearing Deaf
Decibel hearing loss in this parent’s: Right ear: Left ear:

Is this child’s father: (please circle) Hearing Deaf
Decibel hearing loss in this parent’s: Right ear: Left ear:

 

 

127

Please provide information pertaining to the above child’s sports and recreation
participation.

On the chart below, please insert a:

‘1 under each month that your child participated in the activity at least three times Ler
week for more than 30 minutes each time

 

S Jan Feb Mar Ma June J A Oct Nov Dec
Basketball
Softball/Baseball
Football
Vol] 11
Running

Swimmin
Golf
Cheerleadin
Tennis

Bowlin

Soccer
Bicycling
Other — Specify

 

Do you regularly participate in Deaf community activities? YES NO

If yes, which activities?

 

If yes, in what capacity?

 

(participant, spectator, coach, etc.)

Please return completed questionnaire to Kathleen Ellis in the provided envelope.

Your time and participation in this study is greatly appreciated. Thank you!

128

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