How to plan Adaptive Physical Activity 5. 1.

Author: Valentina Bolšec, Jasna Vešligaj Damiš

Keywords: physical activity, adaptation, persons with disability, sports, barriers

Active living means integrating physical activity into daily routines. Our body was meant to move and be physically active. Physical activity includes walking or cycling for transport, dancing, traditional games and pastimes, gardening and housework as well as sport or deliberate exercise (Edwards and Tsouros, 2008).

Any physical activity, movement and participation in sports can be beneficial as it has positive effects on our health which is particularly important for people with disabilities. When we are planning physical activity for people with disability, we refer to it as adapted physical activity (Reid, 2003).

When we are planning physical activity for people with disability particular attention must be paid to the adaptation of certain areas.

Figure 5: https://www.birmingham.ac.uk/Documents/college-les/sportex/Physical-Activity-Disability-Infographic.pdf

Figure 5: https://www.birmingham.ac.uk/Documents/college-les/sportex/Physical-Activity-Disability-Infographic.pdf

What do we adapt?

  • Environment
  • Equipment
  • Sport/play games
  • Rules
  • Exercises
  • Age adaptation – early childhood to elderly (Wittmannová, 2018).

Persons with a disability can participate in sports for able bodied persons but they may need additional equipment or adaptations. Not all sports are appropriate for everyone. Certain sports can be recommended and appropriate for certain disability. We can also find sports developed specially for people with certain disability, for example goalball for blind (Burger, 2010).

How to choose sports?

In the “Participation possibility chart” we can find some of the major physical disabilities and major sporting activities. It was developed by The American Academy of Orthopaedic Surgeons (Adams 1991, v Burger 2010). There are very few sports where adaptations are not possible and people with disabilities will not be able to participate.

PARTICIPATION
POSSIBILITY
CHART

Archery

Bicycling

Tricyclinh

Bowling

Canoeing/kayaking

Diving

Fencing

Field events*

Fishing

Golf

Horseback riding

Rifle shooting

Sailing

Scuba diving

Skating (roller & ice)

Skiing (downhill)

Skiing (cross-country)

Swimming

Table tennis

Tennis

Tennis (wheelchair)

Track

Track (wheelchair)

Weight lifting

Wheelchair poling

Baseball

Softball

Basketball

Basketball (wheelchair)

Football (tackle)

Football (touch)

Football (Whellchair)

Ice hockey

Sledge hockey

Soccer

Soccer (wheelchair)

Volleyball

AMPUTATIONS

Upper Extremity

RA

R

R

R

RA

R

R

R

R

RA

R

A

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

Lower Extremity (AK)

R

R

R

R

R

R

I

R

R

R

R

R

R

R

I

RA

RA

R

R

I

R

R

R

R

RA

RA

R

I

I

R

R

I

R

R

Lower Extremity (BK)

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

I

R

I

R

I

R

R

R

I

R

R

I

I

I

R

I

R

CEREBRAL PALSY

Ambulatory

R

R

R

R

R

R

I

R

R

R

R

R

R

I

R

RA

RA

R

R

R

R

R

R

R

I

I

I

I

R

R

Wheelchair

R

I

I

R

R

I

I

I

R

I

I

R

R

I

R

R

R

R

R

I

I

R

R

I

R

I

SPINAL CORD DISRUPTION

Cervical

RA

RA

RA

IA

I

R

X

RA

R

IA

IA

R

RA

IA

R

I

I

I

I

IA

High-thoracic (T1-T5)

R

R

R

R

RA

R

R

RA

I

R

R

R

IA

IA

R

R

R

R

R

R

RA

RA

R

R

R

R

RA

Low thoracolumbar (T6-L3)

R

R

R

R

RA

R

R

RA

R

R

R

R

RA

RA

R

R

R

R

R

R

RA

RA

R

R

R

R

RA

Lumbosacral (L4-sarcal)

R

R

R

R

R

R

R

R

R

R

R

R

R

I

R

R

R

R

R

R

R

R

R

R

R

I

I

R

I

I

R

R

NEUROMUSCULAR DISORDERS

Muscular dystrophy

RA

I

R

R

I

I

R

R

R

I

RA

R

I

I

I

I

R

R

I

I

I

I

R

I

I

I

I

I

I

I

I

I

I

Spinal muscular atrophy

RA

I

R

R

I

I

R

R

R

I

RA

R

I

I

I

I

R

R

I

I

I

I

R

I

I

I

I

I

I

I

I

I

I

Charcot-Marie-Tooth

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

I

R

R

Ataxias

R

I

I

R

I

I

R

R

I

I

R

R

I

I

I

R

R

R

R

R

I

R

I

R

I

I

I

R

I

I

I

I

I

R

I

OTHERS

Osteogenesis imperfecta

R

I

R

R

R

I

R

R

R

I

I

R

R

I

I

I

R

R

R

R

R

R

R

I

R

I

I

I

R

X

I

I

X

X

X

R

I

Arthrogryposis

R

I

I

R

R

I

I

R

R

I

R

R

R

I

I

I

R

R

R

R

R

I

R

R

R

X

R

I

I

I

R

Juvenile rheumatoid arthritis

RA

I

I

RA

R

I

I

I

R

I

I

R

R

I

I

I

I

R

R

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

Hemophilia

RA

R

R

R

R

R

R

R

R

R

R

R

R

R

I

I

R

R

R

I

R

I

I

R

R

X

I

X

I

R

Skeletal dysplasias

R

R

R

R

R

R

R

R

R

R

R

R

R

R

R

RA

R

R

R

R

R

I

R

R

R

I

R

R

R

R

* Clubthrow, discus, javel, shotput
R = Recomemended
I = Individualized
A = Adapted
X = Not Recommended

Table 4: Participation possibility chart. Adams, 1991

Barriers

When planning sports activities for persons with disabilities, we also have to refer to different barriers. Bragaru et al, 2013, exposed some factors that are negatively associated with participation in sports:

  • Technical barriers can include factors related to transportation, prosthesis, information etc.
  • Social barriers include lack of support in interactions with social groups or sports partners
  • Personal barriers include factors related to physical health or psychological attributes and even time management
  • There are also many other barriers that influence participation in sports: older age, poor weather, high cost and others.

A more detailed description and distribution of barriers can be found in the chapter 5.3.5. Challenges for Facilitators and Service Users.

How to Plan an Adaptive Physical Activity?

Planning an Adaptive Physical Activity can be demonstrated using a cyclic model:

Figure 6: PAIE model for planning an Adaptive Physical Activity (Vešligaj Damiš, 2018)

Figure 6: PAIE model for planning an Adaptive Physical Activity (Vešligaj Damiš, 2018)

The first component of the PAIE model is planning of a sports program or sports activities. It involves making decisions about the choice of sport - according to the wishes of the athlete with disabilities and according to his/her abilities and consideration of the personal characteristics of an athlete with disabilities, decisions about necessary adaptations, management of obstacles and risk analysis.

When planning a sports program or sports activities we must take into account the specifics of the individual disability as well as the recommendations for prescribing exercise (frequency, intensity, duration). In addition to general knowledge in the field of sports, trainers must also be equipped with knowledge of the specificities of people with disabilities and know the importance and possibilities of physical exercise for persons with disabilities.

If sport activities for people with disabilities are well planned, they are safe and appropriate for them and what is important, athletes show personal satisfaction in achieving personal goals in sports. For athletes with disabilities, sport activity is planned according to their functional abilities, physical capacity, interest and accessibility. It can take place in the gym or outdoors, individually or in groups.

When planning a sports program, we are looking for answers to a number of important questions, such as:

  • What are the current competencies of an individual - an athlete with a disability?
  • What kind of activity is appropriate for this individual?
  • What skills and abilities need to be evaluated for this individual?
  • What kind of interests does an athlete with disabilities now have and what will he have in the future?
  • How effective is the program in satisfying the needs of this individual?
  • Will the individual achieve any benefits from participating in this program?
  • What new skills will an individual learn in this program?
  • Is it possible and needed to improve the instructions for an individual in this program?
  • How will his/her quality of life be improved after joining the program?

It is necessary to take into account that we can achieve a better motivation of athletes with disabilities by including new activities, working with athletes without disabilities or practicing with music. Greater persistence in training can be promoted by the fact that the participant receives admiration and award when he reaches the goal or we can help ourselves with modern technology, for example, interactive computer games involving physical activity (Saunders, 2016).

Regular physical exercise of the appropriate intensity and frequency in people with disabilities may be hampered by a number of factors. Personal factors include depression, fatigue, lack of interest, poor perception, inadequate self-assessment of one’s own abilities, negative values related to physical exercise, fear (from falling, to defeat, etc.). Among environmental factors it is very important that the individual has family and social support. It is also important that training centers are available and that transport and exercise costs are low.

Sports training also bring a certain risk for people with disabilities. Therefore, it is important to make a risk analysis in preparation of the sports program, which covers all the possible dangers of the sporting, physical exercise for people with disabilities. We base our assumption on the fact that the benefits of sports activities outweigh the risk.

The second component of the PAIE model is the assessment, which includes the systematic process of observing the athlete with disabilities, on the basis of which his needs and progress are determined. It is a multi-faceted approach of gathering information on the success and ability of an individual. It is an integral part of the effective implementation of physical activity. This is a continuous process that takes place before, during and after the implementation of the program (Kasser & Lytle, 2013).

The assessment covers several areas: screening, decision about support, planning and development, assessment of progress and testing for classification in sport (Kasser & Lytle, 2013). Evaluation can be performed by standardized tests (tests, questionnaires or scales) or by non-formal testing (recording, task analysis, behavioral observation, communication, use of support technology, etc.).

The third component of the PAIE model is the implementation of sports programs and learning. Athletes with disabilities actively carry out the chosen sports activity and gain experience based on their assessed needs. In the case of involvement in sport, we are talking about choosing: today, participants should have the option of choosing, and the disabled person has the opportunity to participate in sports activities and sports together with peers without disabilities and competitors or in separate environments. Accessible activities cover a range of opportunities ranging from “involvement in conventional circumstances” to “inclusion in opportunities for specific disabled people” (Kiuppis, 2018).

The last component is an evaluation that is done for both athletes with disabilities as well as for sports programs and activities. It is important to check if the program is appropriate, satisfies the athlete with disabilities and allows him/her to achieve their set goals. On the basis of the evaluation, proposals for the necessary changes will be made.

References

Bragaru, M., Van Wilgen, C. P., Geertzen, J. H., Ruijs, S. G., Dijkstra, P. U., & Dekker, R. (2013). Barriers and facilitators of participation in sports: a qualitative study on Dutch individuals with lower limb amputation. PLoS One, 8(3), e59881.

Burger, H. (2010). Sport for disabled. In M. Kovač, G. Jurak and G. Starc (ed.), Proceedings of the 5th International Congress Youth Sport 2010 (29-30). Ljubljana: Faculty of Sport, University of Ljubljana

Edwards P, Tsouros AG. (2008). A healthy city is an active city: a physical activity planning guide. World Health Organization Europe.

Kasser, S.L., Lytle R.K., (2013), Inclusive Physical Activity-2nd Edition, Human Kinetics, Human Kinetics Europe Ltd, United Kingdom)

Kiuppis, F., & Kurzke - Maasmeier, S. (2012). Sport Im Spiegel Der UN-Behindertenrechtskonvention [Sports Reflected in the UN-Convention on the Rights of Persons with Disabilities: Interdisciplinary Approaches and Political Positions]. Stuttgart: Kohlhammer.

Reid, G. (2003). Defining Adapted Physical Activity. In R. D. Steadward, G. D. Wheeler and E. J. Watkinson (ed.), Adapted Physical Activity (11-25). Canada: The Univerity of Alberta Press

Saunders, D.H., Sanderson, H., Hayes, S., Kilrane, M., Greig, C.A., Brazelli, M., Mead, Ge. Physical fitness training for stroke patients. Cochrane Database of Systematic Reviews 2016: CD003316. DOI: 10.1002/14651858.CD003316.pub6.

Wittmannová, J. (2018). Šport za vse: opolnomočenje strokovnih kompetenc z izobraževanjem o prilagojenih športnih aktivnostih. In M. Pajek (ed.), 13. kongres športa za vse, športna rekreacija invalidov (17-22). Ljubljana: Olimpijski komite Slovenije–Združenje športnih zvez

Figure 5: https://www.birmingham.ac.uk/D... Retrieved 12.2.2019 at 9:25

Table 4: Adams R.C., Mc Cubbin J.A. (1991). Games sport, and exercise for the physically disabled. London: Lea & Febiger