Equipment and Technology 5. 4. 6

Author: Vladimir Jaćević

Keywords: support technology, prostheses, orthoses

For persons with disabilities it is common to be poorly included in physical activities than for the general population and consequently first have more health problems. At the same time, there are fewer programs for recreation and sports education available for adults with disabilities. (Rimmer et al., 2014). Technological development of sports activities for persons with disabilities enables more and more people to be involved in sports activities using various devices and tools. The development of technology, especially in the field of materials for the manufacture of devices, allows people with disabilities with specially designed prostheses or other adapted equipment to participate in a variety of sports, individual and collective (Steadward, Wheeler and Watkinson, 2003)

Definition of technology in relation to the physical activities for persons with disabilities

According to one of the definitions, the technology is “the application of science for industrial and commercial purposes” (American Heritage Dictionary). This very broad definition nevertheless points to the connection between technology and functionality. In the field of adapted physical activity for persons with disabilities, the primary goal is to improve the functionality of individuals. So, in this case, the term technology refers to the use of science for manufacturing devices - orthoses and prostheses in order to achieve greater functionality for the users. All devices, equipment, tools, and product systems used to maintain and improve the ability of people with disabilities are referred to as the common term supportive technology. Similarly, term adaptive technology is also in use, and relates primarily to the use of electronic devices and information technology and devices that are intended and designed exclusively for people with disabilities (“Assistive and Adaptive Technologies for HIE”, 2018)

Definitions of basic concepts in the field of equipment and devices for adapted physical activities for persons with disabilities

In this chapter, we will focus primarily on equipment designed to establish, improve and maintain the functionality of the loco motor system of persons with disabilities or devices, common for general use - prostheses, orthoses and wheelchairs.

Prostheses are devices that replace missing parts of the body due to trauma, illness or congenital conditions. The purpose of using prostheses is to restore the function of the missing parts. (“How artificial limb is made,”, 2018).

Orthoses are defined as external mechanical devices that modify the structural and functional characteristics of the neuromuscular system. These are external devices that help individual parts of the body to overcome motor deficits and problems. The orthoses are used for various parts of the body such as belts and bandages. (Redford et al., 1995)

A special area dedicated to prescribing, making, adjusting and maintaining orthoses and prostheses is called orthotics and prosthetics. It is a science that links knowledge in the field of anatomy, physiology, pathophysiology, biomechanics and engineering, and professionals in this field need special education.

A wheelchair is a commonly used device that is used when walking is difficult or impossible due to illness, injury, or disability.

The impact of the development of technology on the use of orthoses, prostheses and wheelchairs

Due to technological development, in the area of the manufacturing of prostheses, orthoses and wheelchair, three fundamental changes occurred that influenced the use and functionality. The devices have become significantly lighter, more complex and with the possibility of external regulation. One of the most important technological changes in the sports activities of people with disabilities is the use of more modern materials such as polymers, ceramics, carbon fibres, for making devices. These materials have mechanical and physical characteristics substantially better than conventional materials such as steel and aluminium. Another essential change is the use of computers in the manufacture of prostheses and wheelchairs. Computer chips built into devices can help control the walking (Steadward, Wheeler and Watkinson, 2003).

The first records of iron prostheses were written between 3500 and 1800 BC. Knights who used heavy iron prostheses were unable to carry out daily activities. The first aluminium prosthesis was made in 1912. When the materials became lighter, the functionality of the user’s prosthesis was extensively improved. Similar changes have occurred throughout history in the field of wheelchair manufacturing. Progress in biomechanics and kinematics influenced the development of articulated and more complex devices. In 1980, the first sports wheelchair was manufactured. With the development of specialized sports activities for wheelchair users, arouse the need for specialized sports wheelchairs (e.g. basketball, races, etc.) (Steadward, Wheeler and Watkinson, 2003).

For walking or running, we do not usually need to focus attention on physical activity, as it is automated patterns. In old times, the use of prostheses and wheelchairs for movement involved cognitive activity, attention and regulation by the user. The use of modern gadgets still requires a degree of regulation by the user, but so-called “intelligent devices” allow more effective walking for people after amputation using a built-in computer chip. Similarly, the use of electric wheelchairs with the possibility of external regulation and control (e.g. use in adapted sports activities for children with cerebral palsy) (Steadward, Wheeler and Watkinson, 2003).

Use of technological achievements and involvement of people in adapted sports activities

In contemporary world, people with disabilities have a full range of specific sports activities they can engage in. Therefore, they can join recreational activities, participate in various organized programs and groups or actively compete at international level.

Organized sport for people with disabilities has existed for more than 100 years, the first sports clubs for people with hearing impairments existed in Berlin in 1888. Nevertheless, adapted sports activities became more widely available after World War II. The purpose was to help a large number of war veterans and civilians who suffered injuries during the war. In 1944, at the request of the British Government, Dr. Ludwig Guttman opened a centre for spinal cord injury at Stoke Mandewille Hospital in Great Britain. Dr. Guttman promoted the idea of using sports for rehabilitation purposes (“Paralympics History - History of the Paralympic Movement”, 2018). After this, numerous studies have confirmed the positive impact of sports activities on the physical, psychological and social functioning of persons with disabilities. In addition to the improvements in the affected functions, a positive impact on self-esteem, mood, social inclusion and employability, is essential. Long-term physiological adjustments, as a result of long-term intensive training in athletes with disabilities, among other positive effects, lead to a better respiratory volume, reaction time and improvement of executive functions (Lastuka, Cottingham 2015).

Over time, sports activities part for rehabilitation developed first into recreational and then into competitive sport. Increasing involvement in a wide variety of sports activities is accompanied by the development of technology for the production of various accessories or customized equipment and equipment for individual sports. With appropriate education people with disabilities can also use recreational facilities that are generally used, such as different poles (e.g. Nordic walking, gymstick, balance boards, balls of different sizes and different materials). In addition, the use of modern materials in production eases adaptation to the needs of the individual.

In 1948, on the day of the opening ceremony of the London Olympics, Sir Guttman organized the first international wheelchair sports competition called Stoke Mandewill Games. These games later became the Paralympic Games, which first took place in Rome in 1960 and were attended by athletes of 23 countries (“Paralympics History - History of the Paralympic Movement”, 2018).

People with disability can compete in various sports disciplines in modern times. Most sports disciplines are existing sports, adapted to the needs and abilities of people with disabilities. One of the main disciplines is athletics. We would also mention adapted swimming, wheelchair basketball, sitting volleyball, shooting, and table tennis. Contemporary sports as curling, bowling, and netball are somewhat less prevalent. These activities include the use of specific equipment that can be specifically designed or slightly adapted for persons with disabilities. Some disciplines and sports are designed especially for people with disabilities. An example is the discipline boccia (Italian word, bullet) developed for people with cerebral palsy and first presented at the Paralympics in New York in 1984. Discipline is now practised in more than 50 countries by people with cerebral palsy or various neurological conditions involving the use of a wheelchair. The rules and equipment are adapted to the specific abilities of people with different levels of disability (people can move balls with a hand or foot, they can throw them or roll them through specially designed ramp (“fusion ramp”) (“Boccia - Disabled Sports USA”, 2018).

The development of sports disciplines and the inclusion of more and more people with disabilities are accompanied by the rapid development of technology in the field of the production of accessories and equipment. As an illustration, athletes who competed on Stoke Mandewille games used trolleys weighing approximately 22 kg. Contemporary adapted trolleys for competitions are roughly 5 kg. Three-wheel wheelchairs are often used for competitions, and five wheel wheelchairs are used for ball games. Nowadays athletes in wheelchairs can ski, bake, play hockey, cycle. For persons after amputation of legs and arms, there are special devices adapted to be used in specific sports activities (for example, swinging prostheses, climbing prostheses, basketball prostheses). The use of modern technology in competitive sports opens up new ethical questions about the impact of equipment on sporting results. (Steadward, Wheeler and Watkinson, 2003).

The importance of the multidisciplinary team and the impact of specialized education in working with people with disabilities

The use of modern equipment undoubtedly results in improving the quality of life of people with disabilities, as well as in the field of daily activities and implementation of adapted physical activities. On the other hand, users need professional treatment and a complex approach when choosing, using and maintaining various technology and equipment.

Rapid technological development in the field of prosthetics and orthotics and the use of increasingly demanding devices requires additional assistance and involvement of professionals working with persons with disabilities. The choice and prescription of the appropriate device is definitely highly individualized according to the characteristics and needs of each user (it is about the motor, health, psychological, social and other factors). All professionals of different profiles involved in disability treatment programs (selected doctors, sports education professors, trainers, physiotherapists, work therapists, nurses, psychologists, social workers) need additional knowledge of the equipment and devices used by the persons concerned, where they can provide users with help and support. It is a field in which there is a trend of very rapid changes. Due to all of this, cooperation and knowledge sharing within multidisciplinary teams is essential. It is also important to regularly train all team members in terms of specific know-how in the field of orthotics and prosthetics, and in general the use of science and technology achievements to improve the functionality of people with disabilities.


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