VCU Medical Center
Physical Medicine and Rehabilitation
Spinal Cord Injury Program
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 www.usatechguide.org
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 challengedathletes.org
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.
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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
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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-
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