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Adaptive Sports for People with DisABILITIES

PTs can prevent impairments related to long-term disability and encourage independence.

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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."

References
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.


 

hello how are you am happy for what ever you are doing, can you please include other interested persons in sports like me in your programmes to work with you, study with you and please expand to other developing countries like uganda or africa

ssenkungu jameson,  sports scientist,  scienceMarch 30, 2011
kampala, UT




A senior paper helpful to paraplegics and amputees. I'm looking for sponsorship to start such a program.
_____________________________________________________


Gretchen Laraine Thiel
Student # J00135051
Date of expected graduation: August 2009
Concentration: Water Safety
Disciplines: Education, Health and Safety, Physical Education
Senior Project Advisor: Alexandra Barter / Department of Health and Physical Education
Senior Project Title: “Benefits of Swimming and for Physically Disabled Individuals and Opportunities to Develop Programs”

Semester hours: three (3)

Biographical Sketch
I have taught swimming to people who for various reasons were apprehensive about submerging themselves under water. I have enjoyed helping people learn to swim and move with ease in the water. I have acquired aquatic skills and learned how to teach swimming skills from three supportive mentors, Alexandra Barter, Avery Fick, and Cheryl Schaffer.
I will continue to help people learn to swim or relearn to swim because they are now faced with physical disabilities. The perfection of their swimming form matters less to the health of people involved in swim programs than the process of moving all functioning limbs in the water. I look forward tom my future, helping people through aquatics to improve their quality of life, in turn improving the quality of my life.

Abstract
Helping people who do not have the ability to walk to the kitchen to make themselves a cup of coffee, or take a shower by themselves, would be a blessing, both to the disabled person, and the aquatic therapist. They might have various levels of abilities to accomplish these tasks, but to be an individual who feels no boundaries three hours per week while in a swimming pool is a gift a lifeguard or certified swim instructor can offer. Knowing the time spent in aquatic therapy by physically disabled individuals will have health benefits beyond temporary enjoyment and relaxation is very exciting.
Although the program needed for clientele described in this paper will necessitate multiple lifeguards and swim instructors to be successful and grow, I hope I will be able to participate as a valuable member of this type of team. I think this type of therapeutic swim program is beneficial, both physically and psychologically for persons with disabilities.

Rationale: I decided to focus on the ways, as a swimming instructor, I could make a difference in the health of paraplegic and amputee individuals. I found a wealth of information about physically disabled individuals, where prosthesis that can be used to propel them through the water. The choice of whether to use a prosthesis is not as important as the health benefits they will receive by participating in such a program.

Works Cited
Baechle, Thomas R., and Rogrer W. Earle, eds. Essentials of Strength Training and Conditioning. 2nd ed. Republic of China: Human Kinetics, 2000.
Bently, David J., Gary Phillips, Lars R. McNaughton, and Alan M. Batterham. "Blood Lactate and Stroke Parmeters During Front Crawl in Elite Swimmers With Disability." Journal of Strength and Conditioning Research 16 (2002): 97-102.
Bidgoli, Arash, James Wells, Thurman Whitted, and Clinton Faulk. "Prosthetics, Orthotics, Assistive Devices." Arch Phys Med Rehabil 88 (2007): E87.
Bressan, PhD, Elizabeth. "Striving for Fairness in Parlympic Sport: Support from Applied Sport Science." Fairness in Paralympic Sport 26 (July 2008): 335-38.
Chatard, Jean-Claude, Jean-Marc Lavoie, Helene Ottoz, Pierre Randaxhe, Georges Cazorla, and Jean-Rene Lacour. "Physiological Aspects of Swimming Performance for Persons with Disabilities." Medicine and Science in Sports and Exercise (1992).
"Children's Hemiplegia and Stroke Association." Children's Hemiplegia and Stroke Association. 2003. Chasa.org. 28 June 2009 .
Flowers, Jimi. "U. S. Paralympics Swimming 2009 Performance Plan." 07 Jan. 2009. US Paralympics. Www.usparalympics.org. 23 Jan. 2009 http://usparalympics.org.
"Including Swimmers With a Disability: A Guide for Coaches." Mhtml:http://webmail.
att.net. ASCA Online Articles. USA Swimming Headquarters, Colorado Springs, Colorado. 10 Nov. 2008 .
Mickleborough, Timothy D., Joel M. Stager, Ken Chatham, Martin R. Lindley, and Alina A. Ionesca. "Pulmonary adaptations to swim and Inspiratory Muscle Training." 14 May 2008. Springer-Verlag, Bloomington, IN. Keyword: Pulmonary, Swim.
Pelayo, Patrick, Michel Sidney, and Pierre Moretto. "Stroking parameters in top level swimmers with a disability." Official Journal of the American College of Sports Medicine December 31 (1991).
Prins, PhD, Jan H., and Nathan M. Murata. "Stroke Mechanics of Swimmers with Permanent Physical Disabilities." Palestra 24 (2008): 19-25.
Prins, PhD, Jan. "Swimming Stroke Mechanics: A Biomechanical Viewpoint on the Role of the Hips and Trunk in Swimming." Journal of Swimming Research 17 (2007): 39-44.
Real da Silva, Mauricio Corte. "Effects of Swimming on the Functional Independence of Patients with Spinal Cord Injury." Revista Brasiliera de Medicina do Esporte July/August 2005 11 (2008).
Resnik, Linda J. "Using International Classification of Functionubg, Disability and Health to understand challenges in community reintegration of injured veterans." Journal of Rehabilitation Research and Development 44 (2007): 991-1006.
"RRDS Clinical Guide. Physical."
17 Swimming. A Guide for Individuals with Lower Limb Loss. Vol. 17. RRDS. 210-16.
Scraba, Paula, and Lorraine Bloomquist. University of Rhode Island Adapted Aquatics Manual. Ts. ED 279 623. University of Rhode Island, Kingston, Rhode Island.

Summerford, Christine F. "Apparatus used in teaching swimming to quadriplegic amputees." Palestra 9 (1993): 54-58.
Webster, Joseph B. "Sports and Recreation for Persons With Limb Deficiency." Arch/Phys Med Rehabil' 82 (2001): S38-43.
Whiteside, Kelly. "A Deep Reservoir of Inspiration." USA Today 19 Aug. 2008. 05 Feb. 2009 .



Timeline
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
May 10 /2 hr
Made 3 piles of papers May 11 / 3 hrs
Read swim tech journal articles May 12 / 2 hr
Decided to write health, technique and program papers May 13 / 2hrs Made outline for swim tech paper
May 14 / 1 hr
Met with Ms Barter
May 15 / 2hr
Free wrote for swim tech paper and began paper, May 16


12 hours
May 17 / 1hr
Added to technique paper May 18 May 19 May 20 / 2hrs
A friend read paper.
I corrected it. May 21 May 22 May 23

+ 3 hours
15 hours
May 24 /2 hr
Outlined health paper May 25 May 26 / 2 hr
free wrote for health paper May 27 May 28 May 29 May 30
+ 4 hours
19 hours
May 31 / 3 hr
Began writing health article June 1 June 2 June 3 / 3 hr
Wrote health article June 4 June 5 June 6
+ 6 hours
25 hours
June 7 / 2 hr
Researched health articles June 8 / 3 hr researched more health (cardio) articles June 9 / 1hr
Met with Ms. Barter June 10 / 2 hours
Read parts of Esntl Strngth Trng Txt
June 11 / 2 hr
June 12 / 3 hrs
Wrote health paper June 13 / 2 hr
Wrt hlth +17 hours
paper 42 hours

June 14 / 3 hr
Wrote more on technical swim paper June 15 / 4hr
Brought papers to work. Ppl rd thm.
I came home and corrected June 16 / 2 hr
Wrote more about swim technique paper June 17 / 3 hr
Wrote more on health paper June 18 / 1 hr
Met with Ms. Barter June 19 / 2 hr
Wrote more on health paper. June 20
+15 hours
57 hours
June 21 / 2 hrs worked on bibliography
June 22 / 2 hr
Wrote outline for swim program paper June 23 / 3 hr
Free wrote and started swim program paper June 24 / 2 hr
Wrote swim program paper June 25 / 3 hours
Wrote swim program paper June 26 / 2 hr
Wrote swim program paper June 27
+14 hours
71 hours
June 28 / 3 hr
Added to swim technical paper June 29 / 4 hr
Added to technical paper June 30 / 2hr
Added to health paper July 1 / 5 hrs
Added to health paper July 2 / 2 hrs
Finished health paper July 3 / 2 hours
Read Road Island swim program July 4
+18 hours
89 hours
July 5 / 3 hr
Read Surgeon Genrl’s Report July 6 / 3 hr
Added to swim program paper & had friend read papers July 7 / 5 hr
Met with Ms. Barter
& read my paper, corrected errors.
July 8 / 4 hr
Added to swim technique and swim program papers July 9 / 4 hr
met with Ms. Barter and added to health paper July 10 / 4 hr
Added to technique and health papers July 11
+23 hours
112 hours
July 12 / 4 hr Worked on bibliography and wrote technical swim paper July 13 / 9 hr
Researched prostheses and pool lifts. Brt paper to Ms. Barter
Worked on papers July 14 / 4 hr
Worked on front pages of papers, appendix, punched holes, met with Ms. Barter worked on technical swim paper July 15 / 3 hr
Worked on swim program paper and bibliography July 16 / 9 hr
Read papers, checked, rechecked, put copy of project on a CD, and brought a copy to Ms. Barter July 17 July 18

+29 hours
141 hours









Health Benefits of Swimming for Populations with Physical Impairments
Swimming, though a beneficial health option for anyone, holds particular advantages for people with physical disabilities. No matter how a participant chooses to move the water, swimming helps to circulate their blood with or without the use of a prosthesis. Although a prosthesis can aid a swimmer to move more effectively in the water and allow him to move easily improving swimming pace and distance; the true reward will be the health benefits he achieves.
The following information is intended to present a better understanding of the health benefits physically disabled individuals can achieve through swimming. Taking advantage of therapeutic aquatic environments promotes a more efficient recovery timeline allowing for earlier discharge from inpatient care. If swimming is continued in an outpatient situation, the health advances can continue to improve the quality of life. This would be both because of positive physical changes, and the sense of community an amputee, for example, would get from swimming with another amputee or quadriplegic. This sense of community would give him a natural emotional support system.
The cardiovascular organism includes functioning of the heart, arterial valves, the conduction system (mechanically contracts the heart to pump blood), and blood vessels.
These team members of the human body bring nourishment and oxygen to muscles and other body tissue. Pushing oxygen though the vascular system, feeding muscles, organs and skin becomes easier as a body adapts to aerobic endurance activity. (Baechle)
Since swimming is a highly aerobic exercise, it benefits the body by increasing the amount of blood the heart can pump in one contraction, the amount of air contained in that blood, by slowing the heart rate when not exercising and when participating in light exercise. (Baechle)
The overall physical payback for aerobic endurance training in swimming for the respiratory system is better oxygen replacement during inhalation, better blood circulation within the lungs, slower breathing at rest. The musculoskeletal system enlarged and more dense mitochondria, better myoglobin absorption, and healthier capillaries in muscles. Physical changes during aerobic endurance training are more aerobic power, higher lactate threshold, better energy use of the body, and better use of nutrients consumed. (Baechle)
Generalized premature physical breakdown and Diabetes Mellitus specifically related to inactivity contributes to the difficulty in helping the physically disabled. The characteristic inactivity of people with SCI (Spinal Cord Injury) increases the amount of glucose intolerance associated with high insulin levels. In plain English, inactivity resulting from the motion loss of paralysis contributes to the onset of Type II Diabetes. This means that basil insulin secretion will react to high carbohydrate intake coupled with no exercise to produce the rise in glucose levels. Swimming and its inherent increase in activity reduces problems associated with glucose intolerance. (Real de Silva)
Swimming also aids disabled participants by increasing their independence. This phenomena is distinguished as “the capacity to dominate the water element, dislocating in a safe and independent way under and on the water by using their functional capacity, and respecting their limitations.” (Real de Silva)
The International Classification of Functioning, Disability and Health (ICF) states categories of functioning which can be improved by the swimming skills which teach survival. These categories include, but are not limited to, the following: education coupled with the utilization of such wisdom, a broad array of independent undertakings, communications, movement, personal independence, housekeeping, public relations, community relations, and other life survival necessities comprising a more self-sufficient living. (Resnik)
Extrapolating these categories provides one with valuable insight needed to view the world as a person who has at one time functioned at a normal range only to endure the tribulations associated with learning how to accomplish these basic activities once again. If an aquatic instructor is able to involve a physically disabled individual or group of individuals in a swim program, their lives will likely be longer and with better quality.
While learning to swim, a physically disabled person learns to solve problems, make decisions, move their body independently, and maneuver things. He will have more independence in bathing, maintaining personal cleanliness, and in general a greater sense of self-sufficiency. Being physically challenged presents its own set of physical trials which spill over into serious psychological hurdles involving self-confidence, self-worth, and overall self-acceptance.
Accomplishing even small feats on one’s own helps a disabled person feel better about himself. The determination to work hard resulting in a positive self image is incredibly helpful during the process of recovery. As someone who has taken life guarding classes, I know the support a person receives while meeting the challenge of learning a difficult skill by sharing that challenge with all who participate. (Resnik)
When dealing with individuals who have experienced amputations or paralysis, a distal limb disability is much preferred, for therapeutic reasons, to a proximal amputation or paralysis. More complete joints supply more complete muscle attachments and vice versa, as virtually all muscles cross at least one joint, controlling the operation of that joint. (Real de Silva)
Even if a disabled participant has no control of active muscles at a specific point in a limb, he will still have to produce movement to force propulsion beyond the end of the natural functional limb. Whether the nonfunctioning part is a prosthesis or a limb without feeling, the participant will need to pull himself through the water. Movement can be more difficult depending on the proportionate amount of muscle needed to produce power. Many of these obstacles can be overcome when joining a swim group. Swimming induces muscles, bringing on positive adaptation of the respiratory and cardiovascular systems, hence placing more oxygen in the bloodstream and muscles.
Swimming, as does most any movement places more strain on the heart of a disabled swimmer than it does on an able bodied swimmer because all the muscles an able bodied person is born with complement each other by working as a team. A heart monitor while exercising produces guarded improvement of heart function. The monitor can help a swim coach or therapist know when to ask a disabled swim participant to slow down. This adaptation lends itself to guarded improvement of all these physical conditions if the swimmer is strong enough to acclimatize himself to meet the physical demands placed by the process of water propulsion. (Real de Silva)
When working with individuals with an amputation, the choice of whether or not to use a prosthetic is an important one. Moving a shorter limb can be difficult as there is less muscle to produce power. It is important to choose the correct size prosthesis using a prosthesis which is too short or too long can cause uneven power made by the limbs. This uneven power will prevent the swimmer from achieving stroke efficiency. The swimmer must adjust the thrust of each limb to help him swim in a straight line. If he chooses to use a prosthetic device he needs to keep in mind the force to power that extension needs to be provided by existing muscles. (Summerford)
One wonderful example of the rehabilitation that is possible through a swimming program involves a particular thirty-nine (39) year old man who had both legs amputated below his knee, and both arms amputated distally to his elbows (Note: These are known as trans-radial and trans-tibial amputations). He began his new life as an amputee in a motorized wheelchair. After the injury, he fully depended on others to get him where he needed to be. Although he had to depend on others; his attitude of perseverance enabled him to participate in a swimming program. Instead of giving up, he found camaraderie, cheerleaders, and a better defined sense of self in this sporting program. (Bidgoli)

This successful amputee eventually was able to swim a distance of 1000 yards! At the end of training, he depended on others for two thirds (2/3) of his existence. This is vastly different for a person who was once completely physically dependent for even his most basic needs. By achieving a stronger sense of self worth and self confidence, this man’s focus on his life greatly improved. Paraplegic and tetraplegic individuals are often able to acquire aquatic skills aiding in floatation which then helps in relaxation. These skills also produce calorie consumption, communal experiences, which collectively bring optimism and independence promoting a healthier life. (Bidgoli)
Patients with spinal cord injury (SCI) could possibly attain the greatest physical health benefits from swimming. If therapy is begun in less than four years post-injury, benefits are often greater and more successful, especially if activity includes a swimming program. If a swimming activity is incorporated into a defined rehabilitation program better physical results can be realized for all abilities. The types and tensions of movements can actually reattach neuromuscular connections, possibly reconnecting in a program with minimal fear of injury from impact, thereby improving his functional independence measure (FIM). (Real de Silva).
Swimming improves gait, improves locomotion, and improves muscular ability. At the same time swimming teaches muscles to relax. Thus, swimming can provide patients with spinal cord injuries the ability to be more able to take care of their own hygiene and produce more efficient motor control. The ability to dress oneself with less assistance is a dramatic result for many such people. (Real de Silva)
Cardiovascular benefits can be achieved through the implementation of a swimming program into as part of a regular exercise routine for patients who experience differing degrees of paralysis. Some of these benefits include the following: the expansion of total lung capacity, pulmonary expansion (improving the levels of oxygenated blood circulating throughout the entire system), lessening of the condition of blood lactate, and reduction of problems associated with spasticity (the painful result from tightly clenched muscles). (Baechle)
Total lung capacity (TLC) is the amount of air lungs can hold at one time. The more regularly a person exercises, whether or not he is paralyzed, the more consistently he will breathe deeply. This level of breathing will increase his intake of oxygen proportionately, thereby expanding the volume of his lungs. If this exercise occurs over a period of time, more permanent benefits will be realized. One readily noticeable result is the better maintaining of the internal organs because of the additional inflow of oxygen to exchange with carbon dioxide. One can understand that an increase of total lung capacity leads to an increase in greater pulmonary diffusion, which is the amount of oxygen that enters the bloodstream. Lung growth is considered to be caused by alveolar expansion in the pulmonary respiratory system. The alveoli are where gasses are actually exchanged from oxygen to carbon dioxide. (Mickleborough, Baechle)
Pulmonary expansion enables muscles to have greater strength because the hydrostatic change in air pressure is thought to force inspiratory muscle growth. This happens because inhalation places pressure on the thorax, thereby inducing respiratory muscles to push back, strengthening them. Inspiratory muscle training (IMT) can produce not only a better exercise experience with the availability of better endurance as training continues, but also a better quality of life. (Mickleborough)
By being able to participate in more strenuous physical activity in a virtually uninhibited exercise environment, these properties combine to aid the athlete in a more efficient swim practice and healthier physical experience. (Mickelbourough)
Blood lactate lessens as a swimmer trains in an aquatic environment, which raises the lactic threshold. Therefore, the length of time a person can exercise without stopping is greatly lengthened. (Bentley)
By swimming, spasticity is abridged for many disabled people with muscle tension usually endured by cerebral palsy patients. While a person swims, his muscles naturally relax; they relax even more so when exercises are done before swimming. These exercises are performed on dry land and will be written about in the technique section of this paper. (Chatard)
Positive emotional and physical health changes occur in the relaxing environment which water therapy provides. Activity in the water can help a person to feel better in general, and specifically functionally independent. It gives a person who spends most of his waking hours in a wheelchair the opportunity to participate in a physical activity.

Swimming Techniques in Adaptive Swimming
Accurate functioning of the body of a swimmer who is experienced in the sport, or who is beginning to learn is very important to maintain the desire to continue and improve. Swim technique can include range of motion, stroking and kicking propulsion, and the keeping body position as horizontal and streamline in the water as possible. (Prins & Murata)
Proper horizontal positioning while swimming creates lift, enabling a participant to move faster and with more ease, while drag slows momentum, expending more energy when a person swims at an angle. Drag happens when body parts are not parallel to the surface of the water For these reasons, changing the type of swim stroke a person is performing can be pertinent to the success of someone related to his time in the water. (Prins & Murata)
Core muscles in the trunk of the human body are very important to success in swimming for anyone. Shoulder adduction is needed to produce stroke force for each side. Shoulder adduction brings into play the latissimus dorsi, pectoralis major, and teres major. All these muscles help to create propulsion and maintain momentum by drawing the upper limbs, most importantly the humerus, toward the body’s trunk, which is also considered the core. (Prins)
Progression and regression are coaching techniques used for disabled athletes. Progression is when a skill is being acquired. Regression is used to inhibit unwanted and ill-fated techniques. When progression stops, the athlete and skill should be re-evaluated. The instructor should understand the reasons behind any major changes in attitude, as it will likely effect training time if it persists.
The front crawl is usually the quickest way to swim through water, bringing bodies often level more easily. Athletes who possess less muscle control in the lower half of their body are likely to select this stroke because, on average, kicking during the front crawl is only ten percent of the overall effort. This is particularly true with amputees, as there is very little weight in the lower half of the body to pull through the water. (Prins & Murata)
Backstroke is performed in the supine (on back) position, making it a good stroke for anyone who would have a difficult time breathing in the prone (face down) position. In a swimming competition tailored to allow disabled persons to compete, the elementary backstroke, which includes symmetrical arm and leg motions rather than alternating, is often allowed. In either backstroke event, the face remains out of the water and breathing can be constant. (Prins & Murata)
Breaststroke uses more coordination between the arms and legs to move both sides of the body symmetrically creating a direct forward movement. (Prins & Murata) Breaststroke is a preferred stroke for amputee athletes who wear paddles on their arms, pulling the water from over their heads to a shoulder width ten and two position, returning to overhead extension at the end of the stroke. (Summerford)
Swimming efficiency is moderated by the stroke rate (SR) and the stroke length. (SR) is the speed at which limbs are pulled through the water. Together with the stroke length (SL) which is the distance an athlete reaches before he starts to pull the water, they become the stroke velocity (SV). (SV) is the amount of power used to pull the water propelling an athlete through the water. (Pelayo)
Loss of limbs reduces an athlete’s ability to create a (SV), lessening the driving force, while paralysis not only reduces the ability to create speed, but gives a nonparallel drag. Drag is a swimming term which is as it sounds, causes the participant to pull a nonfunctioning limb through the water. Spastic muscle tension and lack of muscle coordination are complications brought on by diseases such as Cerebral Palsy. (Scraba & Bloomquist)
Over performing involuntary muscle actions lower the ability of the body to move through the water at a comfortable pace, and lessen buoyancy by becoming flexed while not having a purpose for function. Spastic muscle actions also reduce ease and enjoyment of the swimming activity. For these reasons, relaxation exercises have been developed by adaptive swimming programs.
Precautions need to be taken when coaching a person with Cerebral Palsy (CP). There should be ample lifeguards present. Range of motion and balance are skills should be goals for someone with spastic muscle complications such as CP. The swimming pool temperature should be at least 85 degrees Fahrenheit, particularly for participants with spastic muscle tightening conditions. (Scraba & Bloomquist)
One of the foremost programs for this method of teaching swimming to this group of disabled athletes is the University of Rhode Island’s (URI) Adaptive Aquatic Program, which teaches relaxation techniques to aid in floatation. The more a muscle is tranquil, the more oxygen it contains, hence relaxation exercises are advantageous to any swim program and very valuable. (Scraba & Bloomquist)
There are eleven such exercises included in the University of Rhode Island’s adaptive aquatic program which begin at the participant’s face, continuing down the body to the ankles and feet. They are performed in a dimly lit room resembling a yoga class environment. The exercises are intended for the general population of people with spastic and involuntarily flexed muscle action. Which exercises are performed, by which athlete should be chosen by the practitioner to suit each individual. (Potter)
Amputees can be aided by the use of fins, plexiglas paddles, and prosthetic limbs manufactured to adapt to aquatic activity. These devices enable a swimming athlete to maintain bilateral symmetry, which is important to help a limb enforce more power. The choice of whether to use fins or Plexiglas paddles is often a personal or individual choice. There are thousands of variations of amputation and disability which can make a difference in the choice of using paddles or fins. The length of a limb or stump being a half of an inch longer could make a difference in the power produced by that limb.
Aquatic prostheses are different from many other artificial limbs because most limbs are only used on land. When air is the environment a prosthetic is used in, the intention is to make the prosthetic very light. In a swimming pool artificial limbs which weigh very little float, making movement through the water more challenging. Specially designed aquatic limbs provide weight, enabling the prosthesis to move in the water. This makes a more natural limb movement for the disabled swimmer.
The best prosthesis for a swimmer, economically, employs space for both air and water. With kicking and arm stroking motions needed for pulling the water, a prosthetic limb that doesn’t sink, keeps the body from being able to push the water to propelling itself through the water at a competitive pace.
When fins are being used, an athlete needs to remember he doesn’t have as much strength on the side of his body that has less muscle to use for power. There is also usually a dominant limb usually in paralysis which can lead the body toward the side with less total muscle control. This actually gives an amputee an advantage over a paraplegic regarding swimming. (Summerford)
Activeankle ™ is a product that can be locked in a pointed toe position for sports like swimming, or in a flexed position for walking. Trans-femoral amputees can use a special attachment which can accommodate a fin, making the prosthesis the accurate length: This helps to make the force the same, or close to having the same ability to produce force because an inequality of power draws an athlete toward the direction of the weaker or shorter limb, or side. (Webster)
A prosthetic hand or partial hand can be added to a partial or missing distal portion of an arm. The prosthetic phalanges are webbed and can be adapted to how much accessible lower upper extremity is present. On each side of each finger, there is a lever type flap. As the limb is pulled through the water the flaps close, aiding the athlete in propulsion through the water. They collapse, and then open as the hand returns in recovery to begin another stroke. This is extremely helpful when a participant doesn’t have the ability to bring his arms out of the water. (Gabourie) Also offered as an alternative to this is the freestyle swimming, a terminal device (TD), which means it is the distal choice of prosthesis, for swimming folds when it is pushed in front of the swimmer, then opens to give resistance during the pull phase of the stroke, thereby helping to propel the athlete through the water. (Webster)
Attaching fins to legs is done by strapping them to the end of the leg stump. It is important to use the appropriate size of fin to exert the same force as the other limb. This is very important for balance of physical strength. The attachment of Plexiglas paddles is often done by securing them with tube-like silicone or neoprene sleeves or socks often made of a special stretchy material. (Summerford)
Although many varieties of swimming prostheses are available, many amputees choose not to use an artificial limb because of the appreciation they feel with the freedom they feel in the water, but sometimes when a participant prefers not to use a prosthetic, does so because the limb is amputated proximally, and the stub is too short to easily attach a prosthesis and because the limb by itself has little drag placed on the body. The remaining limb can be trained to pull or kick in a manner as to not pull toward the shorter side. (Webster)
In the case of children afflicted with Spina-bifida who are moderately paralyzed by the disease, many improve vastly by watching recordings of themselves attempting to swim. They have an understanding of what the stroke is supposed to look like, and watching themselves aids their progress in resembling that image.
Complications more often exist for a disabled athlete entering or exiting a swimming pool than during the actual challenge of swimming. Although there are hydraulic lifts which lift disabled people into and out of swimming pools, many public and private swimming organizations don’t have funding for such equipment. Physically lowering himself into and lifting himself out of a swimming pool can be emotionally and physically exhausting.
Various styles of lifts which can help participants in a program such as this helps them not meet with such frustration, bringing only the positive challenge of fitness. (17 Swimming)

A Swim Program for Physically Impaired Individuals
A Paralympics Sport Club facility (PSC), is an affiliate of the U.S. Olympic Committee’s Paralympics organization to promote competition swimming for disabled populations. A facility occupied by such a swim program can be an organization which variably functions at a competent level: It must have a genuine interest in the well-being of the participants, and the functional wherewithal to implement the training plan. Although competition is not for everyone, and can cause added frustration for some, being competitive is sometimes useful for motivation. (US Paralympic)
A researcher for a paper of this size would be careless for not mentioning Sir Ludwig Guttmann, who lived in England, in 1948 where, he developed, a competitive sports program for heroes of World War II. The stipulation was that they had to be stricken with Spinal Cord Injuries. These competitions now incorporate deaf and blind individuals, giving them not only a non-contact sport in which to feel competitively athletic, but also a social connection to their physical fitness. (Bressan)
“Para,” when referring to a Paralympics swim program comes from the root word parallel, because it is an attempt to level the playing field. It is not named for the paraplegic condition itself. If everyone performs at their personal best in a disabled competition, a person with three paralyzed limbs could win competing against an athlete who has a paralyzed arm, although with one paralyzed arm, the swimmer would probably win in a race judged purely on time. (Bressan)
Disability of a swimmer in a Paralympics swim competition hinges on the disability that swimmer has in relation to the stroke he is competing in. Backstroke, butterfly, and freestyle swimmers have the initial “S” with ten levels of disability. The breaststroke qualifications are categorized as “SB.” There are nine physical disability levels in swimming competition. Medley competitors are abbreviated as “SM.” There are ten levels of disability in medley competitions.
Physical ability levels are calculated for competition because they give more value points to disabled people leveling the playing field, giving the understanding of their swimming competence. It takes into consideration the most elite disabled athlete with that exact impairment performing that particular swim stroke. (Bressan)
Natalie du Toit, who is from South Africa, is now twenty five (25), but when she was sixteen (16), she swam in the Olympic trials, almost competing in the 2000 Summer Olympics. As she prepared for the 2004 games, she was hit by a car while riding a motorcycle. She only stayed out of the pool for a few months, and swam a six-point-two (6.2) mile race at the 2008 World Games in Beiging, taking fourth place in an able bodied race. (Whiteside)
Miss du Toit did not come in first, although she competes at her personal best as she did that day. She doesn’t have any feeling in her left leg which is amputated below her knee, but she competes against others from all skill levels, including able-bodied athletes. She competes in able-bodied races partly to swim long distance. There are no long distance races tailored to disabled participants. Du Toit once said, “Once your dream is fulfilled, you face another one.” (Whiteside)
Many participants in adaptive swim programs will never wish to compete against able bodied athletes, but it is important to have options for a swimmer with a competitive nature and a less profound disability. An athlete, no matter what his disability, needs to be challenged by his physical activities, without crossing the threshold of being overwhelmed. Too much of a challenge can put a hopeful swimming participant back into his wheelchair, and the trainer may never be able to reach that participant again.
Swim instructors should to be sensitive to the emotional needs of people with disabilities, although a facilitator can give sympathy, paraplegics, amputees, and those born with abridged limbs are the only people who can give needed empathy. Even if participants don’t speak of their disabilities, seeing others they identify with is more likely to help them be more comfortable in a swimsuit, being seen climbing, or being pulled in and out of the pool. Body image is very important for most anyone, but can be even more traumatic for physically disabled individuals. A group of disabled swimmers meeting for an activity provides not only physical group supported activity, but emotional support for fellow disabled comrades who look and move as they do.
Children and adults can both participate in Paralympics programs. Visually disabled participants are as welcome as those who are physically disabled. Their levels of visual disability are evaluated as are physically disabled. After rating the intensity of a disability of a participant, a scaled rating as to which athlete he should be competitive against is provided.
Swimming activities for a disabled person should be divided with breaks or games no matter how old the participant is. These breaks could include submerging to get things from the bottom of the pool, the distance a person can glide, bobbing in the water, and kickboard activities for those with propulsion ability in the lower half of their body, etcetera. (Scraba & Bloomquist)
Personal floatation devices (PFD) should be used for many disabled individuals initially, to build strength and swimming stamina, while helping the participant enjoy the experience of being in the water. Whether an individual has the ability to float should not determine the option of considering swimming as an athletic and recreational experience. Water resistance improves endurance of both children and adults. (Scraba & Bloomquist)
Prosthetic devices are expensive, particularly when produced specifically for swimming, because insurance will often only pay for one prosthetic appliance. This leaves the participant to bear the expense of buying professionally-made appliances to efficiently participate. There are some prosthetic limbs people would not only use to walk on or hold a fork with, but will fill partially with water for swimming. Insurance is more likely to pay for prosthetic limbs for swimming if they are functional on land and in the water, but dual purpose limbs may not be the proper solution for all amputees to use for all athletic needs. For those who are able to use dual-use prosthetics such as the active-ankle for swimming, such devices may become damaged by water, and often need replacement.
Having prosthetic appliances for amputees specifically to be used in a swim program can possibly be funded by a grant program identified as The Orthotic and Prosthetic Assistance Fund (OPAF) Program. The OPAF organization offers help to nonprofit organizations who participate in therapy programs, particularly organizations in need of prosthetic appliances. If an adaptive swim program had possession of precise swimming prosthetics, athletes would more likely be able to use their personal prostheses only for land. This would save the prosthetic from deterioration from pool chemicals.
Paralyzed individuals and those with amputations or limbs which are shorter from birth defects can all benefit from swimming. A special and growing population of hopeful participants are military service people who have been injured in battle. These war veterans can benefit from swimming not only physically, but mentally because swimming is a survival sport, one in which a person can save his own life just by knowing how to relax in the water.
Including disabled people in swimming programs is a fair and welcoming goal of a swim instructor, the camaraderie wounded veterans can attain from learning or relearning to swim together is also important. This sense of community can give an otherwise maimed and lonely feeling soldier something to do away from his daily routines which he can often no longer perform with ease. In a swim program, soldiers will be with people who not only understand each other’s current difficulties, but also the experiences they had before being injured. Wounded soldiers, while enjoying the spatial freedom of water, can be helped to reach a higher level of survivorship which is good for the self esteem of anyone.
For all individuals who face physical boundaries such as the disabilities discussed in this paper, learning how to reach past that symbolic wall can be not only inspiring for that person’s life, but can be influential to other physically disabled people. Their effort to overcome their disability can also be a positive influence on able-bodied athletes who take their physical abilities for granted.
The Central Gulf Coast, ranging from Pensacola to Biloxi, has little to offer disabled populations in aquatics. This is surprising, considering the military presence in our immediate area. I feel this is a need, not only for military personnel, but for all disabled in our community. The opportunity to help the disabled through aquatics is something I feel strongly about, and aspire to accomplish in the Mobile area.



Gretchen Thiel,  looking for workSeptember 16, 2009
Mobile, AL




     

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