According to an article written by Kenneth J. Ottenbacher, PhD, OTR, the length of stay for inpatient medical rehabilitation hospitals has decreased dramatically over the past decade and a half. The median length of stay decreased from an average of 20 to 12 days from 1994 to 2001.1 Although improvement in effectiveness and efficiency of rehabilitation was demonstrated by improved functional status, mortality at follow-up increased by almost four percent. Ottenbacher attributed the improvement in efficiency of rehabilitation to earlier access to treatment, advances made in clinical research and adoption of evidence-based practice; however there was little explanation for the increase in mortality rate post-rehabilitation.
As physical therapists, we understand the need to be committed to providing the best possible treatment to our patients. However, the importance of educating patients about post-rehabilitation issues is often overlooked. Physical therapists have a unique opportunity to provide community resources aimed at preventing impairments related to long-term disability and to encourage active participation and independence for optimal quality of life. Evidence supports that physical therapy is effective in improving functional status and independence. But what happens when an individual completes physical therapy? When a "patient" leaves an environment of constant support and enters the world as an "individual with a disability?"
Opportunities for adaptive sports are on the rise across the United States and the world. Getting involved with adaptive sports is one way to assist individuals with disabilities in the potentially abrupt transition from a rehabilitation center to the community. The Adaptive Sports Foundation (ASF) in Windham, NY, is a good example of what sports have to offer. "It takes a good year or so before it really hits you," said Tom Trevithick, a Level III alpine/Level III adaptive certified ski instructor (the highest level of professional ski instruction possible) for ASF. "It takes a few years to find out what's really going on - what you can't do anymore,"
Trevithick was reintroduced to the slopes a few years after losing his own limb (following a ten-year battle to try to save it) due to a motorcycle accident. After a short time watching people ski, he thought to himself, "I can do that." He soon learned how to "three-track," using a single ski and two outriggers - specially designed forearm crutches with a shortened or "mini" ski at the bottom to provide balance and steering for someone missing a leg or with one weakened leg.
Now, Trevithick works as the technical director and equipment manager for ASF at Windham Mountain, as well as an eastern division professional examiner. The volunteers for ASF come from many different backgrounds. Some have family members with disabilities or disabilities themselves, some work in health care, while others just love to ski and teach. They all come with a common goal - to help develop character and a sense of accomplishment in those individuals searching for independence rather than isolation.
ASF was founded a little more than 20 years ago. Starting with about 20 students and 10 volunteers, it has grown to become the largest adaptive sports program on the East Coast with about 1,300 student visits and more than 200 volunteers. ASF serves all disabilities ranging from mild cognitive impairment to severe physical impairments. It provides an opportunity for individuals with disabilities to become more independent. In a sense, it is rehabilitation beyond physical therapy.
Kirsty Digger, a Professional Ski Instructors Association (PSIA) examiner and ASF ski instructor, has been an active member of ASF for many years. She is familiar with the inner workings of the foundation as well as the commitment required from participants and has a unique perspective due to her own life experiences. Always an active person, Digger was paralyzed from the waist down by a kayaking accident at age 20.
"I thought life was over," recalled Digger. "That was it."
When she had the opportunity to return to skiing, the realization that there was so much more out there took over. "It's different from how it was, but I really have an incredibly full life. I do everything I want to."
Nothing could be closer to the truth. In addition to her skiing, Digger works full-time as a nursing professor, continues to work in the emergency room at a local hospital, participates in marathons using a hand cycle and has returned to kayaking. She is a great asset to ASF and an example for people coming to the foundation to find new opportunities for independence and recreation.
The Gwen Allard Adaptive Sports Center houses ASF and has an equipment room stocked with the basic equipment needed for adaptive skiing. Monoskis, bi-skis, outriggers, fixed outriggers, ski bars and sliders sit alongside racing skis and helmets awaiting students. To make sure all skiers are properly set up in their respective equipment, a full evaluation is performed prior to the first lesson and detailed settings are documented for future visits. The evaluation and set-up can take hours and requires the patience of all involved. Although physical therapists have been involved with many of the evaluations, and trained many of the current volunteers, ASF volunteers from all backgrounds are trained to conduct thorough, sport-specific assessments.
Beyond socialization, adaptive sports offer an opportunity for many people with life-long disabilities to engage in physical competition. Kevin Murray, a long-time monoskier and member of the ASF ski team, has been skiing at Windham for seven years. For Murray, competitive skiing is just a chance to take his love of skiing "to the next level." It is a place where he can show his physical strengths - something he rarely considered during his traditional therapy sessions. ASF ski team members race at different locations locally and have competed nationally with great success.
The adaptive sport experience can also be the rare family event for many individuals with disabilities. Meghan Mertens began skiing at Windham eight years ago after her brother, Joe, had gone on a school field trip and observed a monoskier on the mountain. He came home and shared his experience with his parents. "He said, 'I think this is something Meg can do,' the same night that we saw a TV special on Windham. We checked it out the next season," recalled Marianne Mertens, Meghan's mother.
Meghan was born with cerebral palsy, which primarily affects her lower extremities. A great amount of time and effort has always been put into her care and treatment. When her brother discovered adaptive skiing, it was great for everyone. Marianne shared, "It was the first major activity that all of us can do and enjoy together."
Joe begged his dad to ski. Marianne works in the office. After three years, Joe became an instructor and Meghan, although not an official instructor, began providing education and support for new skiers. Meghan feels that one of the best parts was being able to keep up with the other kids. "Working with ASF gave the family a bond and cohesiveness that we've never known," stated Marianne. "We now have a family of 200."
Many programs with similar goals exist around the globe, providing individuals with lifelong disabilities an opportunity to enjoy something they are passionate about. As Digger put it, "My take on life is that you have two choices - you can watch or play. I choose to play!"
Our goal as therapists should be for our patients to leave therapy with a renewed sense of ability and the information they need to "choose to play."
1. Ottenbacher, K.J., Smith, P.M., Illig, S.B., Linn, R.T., Ostir, G.V., & Granger, C.V. Trends in length of stay, living setting, functional outcome, and mortality following medical rehabilitation. Journal of the American Medical Association. 2004. 292(14): 1687-1695.
Crystal Garritano recently earned her DPT from Stony Brook University in Stony Brook, NY. Eric M. Lamberg and Lisa M. Muratori are clinical associate professors in the department of physical therapy at Stony Brook.