Physical and Recreational Activities Considerations for Individuals

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					                          VCU Medical Center
                  Physical Medicine and Rehabilitation
                      Spinal Cord Injury Program

                         Compliance Alliance

                        Old Dominion Chapter,
                 National Spinal Cord Injury Association

                 Sheltering Arms Rehabilitation Centers
                    Recreation and Fitness Services

               Richmond Adaptive Sports & Recreation                       Physical and
         Serving those with physical disabilities (age 5 and up)
                            804-918-1977                                   Recreational Activities:
                                                                           Considerations for Individuals
Primary Author: Michelle A. Meade, Ph.D., Department of Physical
Medicine & Rehabilitation, Virginia Commonwealth University.
                                                                           with Spinal Cord Injury
The development of this booklet was made possible through grants
from the Christopher and Dana Reeve Paralysis Resource Center and
the National Institute of Disability and Rehabilitation Research (NIDRR)
in the Office of Special Education and Rehabilitative Services, U.S.
Department of Education (grant #H133N000015)
Page 2                                                                                                                  Page 11

Why Be Active??                                                   Resources
                                                                  Individuals with SCI may be able to get assistance in pay-
Recreational and physical                                         ing for equipment for sports and recreation or member-
activities are important                                          ships in clubs or facilities.
components of a healthy
lifestyle for all people —                                        Many states have programs designed to allow individuals
disabled or able-bodied.                                          with disabilities to secure a loan to purchase assistive
However, now that you                                             technology. Adaptive equipment and assistive technol-
have a Spinal Cord Injury                                         ogy for sports and recreation are usually covered under
(SCI), your margin of health is probably fairly narrow.           these programs. In Virginia, the Assistive Technology
Because of this, it is even more important that you do all        Loan Fund Authority (ATLFA) can be contacted. If you
you can to stay healthy. So, whatever your age,                   have internet access, check out
background or level of injury, keeping active needs to be         for more information.
part of your lifestyle.
                                                                  In addition, several programs exist that will provide grants
                                                                  to individuals to purchase adaptive recreational or sport-
Benefits of Participation                                         ing equipment. One of
Sports and recreation are important factors in quality of life.   these is the Challenged
In the general population, recreation is a chief determinant      Athlete Foundation. By
of life satisfaction above job, health and financial resources.   phone, contact (858)
Furthermore, physical activity decreases mortality and            866-0959; or go to www.
reduces risk of heart disease, stroke, obesity, and several
cancers. Despite these documented benefits, only 22% of           for more information..
Americans participate in sustained and regular physical
activity. People with disabilities are even more likely to be     Finally, many recreational programs and facilities are inter-
sedentary, as are people in certain ethnic minority groups        ested in serving individuals with SCI and other disabilities.
and those with lower income levels.                               If there is a program or facility that you are interested in
                                                                  joining, ask about it. Activities can often be adapted and
                                                                  fees may be variable depending on your income level.
Page 10                                                                                                                        Page 3

Assistive Technology                                                   Physical Health Benefits

Opportunities for individuals with SCI to participate in               Participating in physical activity can:
physical and recreational activities continue to grow. Many            •   Increase length and quality of life
activities can be adapted given special equipment and                  •   Decrease health problems, including number of
                                                                           pressure ulcers, urinary tract and respiratory infections,
someone willing to try. From                                               and severity of spasticity
worldwide travel to art, music and                                     •   Decrease the number and cost of hospitalizations
extreme sport, former spectators                                       •   Decrease time in bed
with SCI are now becoming                                              •   Help prevent diseases such as hypertension, diabetes
participants. Below are some                                               and obesity
examples of devices that can
facilitate participation.                                              Psychological Benefits

Bicycle riding: Hand-cycles are bicycles that are propelled by         Physical, recreational and leisure activities can also provide
                   pedaling with the hands and arms rather             many psychological benefits. The idea is to do something
                   than with the legs and feet; additional adap-       that you enjoy, interact with others and have fun! These
                   tations can allow individuals with tetraplegia      activities can:
                   to use this equipment                               • Increase social interaction—a great way to connect
                                                                           with friends and family members or to meet new
Mountain and Rock Climbing: Adaptive climbing techniques and               people!
gear are available; among these are a “snowpod” - an arm pow-
                                                                       • Improve mental health, including decreasing feelings
ered, 49-gear contraption that has allowed individuals with SCI
                                                                           of anxiety, depression, sadness, and listlessness
to climb mountains independently
                                                                       • Assist with adjustment to disability
Skiing: Mono-skis and bi-skis are types of adaptive equipment that                        • Provide a sense of accomplishment
allow those with complete tetraplegia to turn, or assist in turning,                      • Serve as a coping mechanism and
by isolated head rotation                                                                     provide a way of managing stress
Sailing: Pulley systems can often allow an individual with SCI to                         • Increase confidence in your ability to
maneuver a boat independently                                                                 perform both sport-specific and
                                                                                              general activities of daily living
Hunting and Fishing: Devices to hold and stabilize a rifle as well
as cast a fishing pole are available. Also, specialized advances in
all terrain vehicles and wheelchairs allow access to more remote
areas for sporting opportunities.
Page 4                                                                                                                    Page 9

Participation: Myths and Realities                              Fitness and Exercise
Myths                                                           •   If your goal is fitness, weight loss, or improving your
•    There is an “ideal” participant                                physical health, you may want to consider adding
•    Adaptive sports are only for the                               exercise to your lifestyle.
     young                                                      •   Exercise can usually be classified as aerobic, strength,
•    Adaptive sports demonstrates a                                 and flexibility training.
     “battle” to overcome disability
                                                                •   Aerobic or cardiovascular workouts consist of exercises
•    Adaptive sports are only for serious
     athletes                                                       designed to raise your heart rate and breathing rate.
                                                                    These will improve heart and lung functioning if done
Realities                                                       •   Strength training works to build up or maintain your
•    Anyone can participate                                         muscles. This may consist of resistance exercises, lifting
•    There is a recreational activity or sport to fit almost        weights, or lifting or propelling yourself.
     any temperament                                            •   Flexibility training consists of stretching exercises and
•    Recreation can help you learn new skills and feel              may improve your range of motion.
     good about yourself
•    Sports and recreation can allow you to connect with        •   Adding all three types of exercise to your lifestyle has
     other people and be part of a team                             been found to produce the most improvements.
•    Level of injury has not been found to be related to        •   However, remember to talk with your physician before
     intensity of participation—individuals with tetraplegia        starting any new exercise program.
     have been found to engage in as many hours of              •   When possible, consult with a physical therapist or
     physical and recreational activities as individuals with
                                                                    qualified trainer to learn proper techniques, form and
•    Very few individuals with SCI will reach the elite level
     of athleticism displayed in international competition;
     most engage in physical and recreational activities for
     other reasons and benefits
•    For individuals who were active prior to injury, get-
     ting involved in a recreational activity or sport may
     help you sustain your identity as an athlete / active
Page 8                                                                                                              Page 5

Getting Started                                               Potential Barriers
So, you know you want to do more, or do SOMETHING,            •   Problems identifying what types of recreation, sport
but how do you start?                                             or fitness activity that you can do given your level /
                                                                  severity of injury
•   First, think of what you like to do.
                                                              •   Lack of accessibility in the physical and / or built
•   Consider your goals: Having                                   environment
    fun? Meeting people? Losing                               •   Lack of support and companionship
    weight? Relaxation? Gaining                               •   Problems with transportation
    or mastering a skill?                                     •   Problems finding knowledgeable or qualified trainers,
•   Think about what resources                                    instructors or coaches
    you have. This may include                                Each of these barriers can be overcome! If you need
    money for fees, registration, or                          help, talk with your physician, a recreational therapist, or
    transportation, and people to assist or join you in       another individual with a physical disability.
•   Also, think about your environment. Does it offer safe    Issues associated with SCI
    places to recreate? What facilities are in the areas?     SCI brings with it specific issues that you need to be
    How is the accessibility?                                 aware of. The chart on the next two pages provides in-
                                                              formation on types of injury that you may be at particular
•   Consider how easy it would be to incorporate this         risk for. Please remember that this is general information
    activity into your schedule. Is this something you can    and should not be used to make a diagnosis or to sug-
    do daily? Monthly? Only on special occasions? Is the      gest treatment. See a doctor if you experience any of
    activity something you can do independently or would      these issues or before starting any new sport or exercise
    you require assistance.                                   program.
•   You might want to consider talking with a therapeutic
    recreation specialist about options or to find out what
    resources may be available in your area.
•   Once you have chosen an activity, start slowly. Don’t
    overexert yourself. Take time to learn proper tech-
•   Most of all, have fun!
Page 6                                                                                                                                                                  Page 7

 Risk/Injury              Signs/Symptoms                                        on
                                                                        Preventio                                Treatment                       Special Concerns

 Hyperthermia      Feeling “overheated” with progres-       Drink plenty of water beffore, during,     Seek cool environment and             People with SCI are at risk for
                   sion to extreme fatigue, dizziness,      and after event. Avoid traaining and       drink plenty of water. In more        hyperthermia because
 (elevated body    nausea, mental confusion, and finally                             res
                                                            competing in temperatur above 70           severe cases with mental              “normal” defense mechanisms
 temperature)      loss of consciousness with risk of       degrees Fahrenheit and 50% humidity.       confusion, persistent                 such as perspiration and blood
                   death. Additional signs include ;        Wear loose fitting and lig weight
                                                                                     ght               temperature elevation despite         flow to extremities for cooling
                   ethargy and heavy perspiration early     clothing. Do not train or compete          cooling efforts, or temperature       are altered.
                   on with progression to dry and           when feeling ill.                          >103, seek medical attention.
                   flushed skin later..

 Dehydration       Fatigue, dizziness, nausea progress-     Drink plenty of water bef fore, during     Re-hydration with at least 1 liter    After SCI, mechanisms to
                   ing to feeling faint and confusion       and after event. Ensure t that weight      of water per kg of weight loss.       maintain blood pressure are
                                                            loss after strenuous activit does not      Seek medical attention for            not as effective thus enhancing
                                                            exceed 4% of body weight.                  confusion or persistent fainting      vulnerability to dehydration.

 Shoulder          Commonly pain with movement,                                       tretching as
                                                            Pay special attention to st                Rest or relative rest until pain is   Shoulder injuries are very
 Injuries          especially when performing over-                                   s
                                                            well as strengthening less used            absent. Apply ice / cold com-         common and can threaten
                   head activities. Loss of range of mo-    muscles of the shoulder. DO NOT            press to decrease inflammation        independence and ability to
                   tion, crepitus, or grinding sounds       EXERCISE WITH PERSISTE PAIN.
                                                                                     ENT                                                     work for individuals with SCI.
                   can also be present.                                                                Gradual re-entry into sport with      Take them seriously.
                                                            Specific exercises to stretc and
                                                                                       ch              emphasis on warm-up, stretch-
                                                            strengthen the “rotator cu muscles”        ing and gradual strengthening.
                                                            are beneficial in preventin injury,
                                                            especially for wheelchair users who        Seek medical attention if pain is
                                                            place high physical dema   ands on their   severe, recurrent, or does not
                                                            shoulder joints.                           subside after 1 week of rest.

 Other joint,      Pain -localized or diffuse and, most     Adequate warm-up with attention to         Similar to shoulder injuries          Exacerbation and recurrence
 muscle and        often, exacerbated with certain          stretching and sport-spec strength-
                                                                                    cific                                                    of muscle injuries is common in
 tendon injuries   movement. Bursitis can result in                                  SE
                                                            ening.. DO NOT EXERCIS WITH                                                      people with SCI due to
                   swelling, especially involving the el-   PERSISTENT PAIN.                                                                 dependence on arm muscula-
                   bow.                                                                                                                      ture for daily living. The best
                                                                                                                                             “medicine” is prevention.

 Nerve             Pain that can be diffuse in hands        Carpal Tunnel and other nerve entrap-      Early in the progression, splint-     Again, because people with
 Entrapment        and at night with numbness, tin-                                 cult
                                                            ment syndromes are diffic to pre-          ing and steroid injection may be      SCI rely so heavily on their
                   gling, and weakness often occurring      vent. However, when dia agnosed early      helpful. Later, minor surgery         hands and arms, nerve entrap-
                   later.                                                          orable.
                                                            the outcome is more favo                   may be necessary and quite            ments are more common. If
                                                                                                       effective early in disease course.    you have the described symp-
                                                                                                                                             toms, don’t wait to consult a