Sport and physical activity for people with physical disabilities

Although research focusing on sports and physical activity in the general population is plentiful, research addressing these areas for people with physical disabilities is a recent phenomenon. Some studies were completed prior to the mid-1970s, but most research addressing sports and physical activity for people with physical disabilities has been done in the last 15 years. Not coincidentally, increased interest in these areas of research paralleled two developments in society. First, political action by disability-related groups increased societal awareness of the needs and interests of people with disabilities. Secondly, technological advances in equipment and mobility aids have greatly expanded sports and physical activity opportunities for people with physical limitations.

Despite increased interest in recent years, research on sport and physical activity for people with physical disabilities remains in a development stage. Only a few researchers having developed a coherent focus in these areas, and interdisciplinary attempts to address research questions are almost non-existent. Theory-based research studies are rare, and methodological shortcomings are frequent. In addition, results of most studies are inappropriate to generalize due to small sample sizes and diversity of disabilities or physical characteristics among subjects. Nevertheless, research is beginning to shed some light upon the phenomenan of sport and physical activity for people with physical disabilities. Findings of particular interest to practitioners relate to (a) psychosocial characteristics of participants, (b) physiological impacts of participation, and (c) performance enhancement.

Psychosocial Characteristics of Participants

The psychosocial characteristics of athletes with physical disabilities are often provided in comparison to people without disabilities. Most studies using psychosocial variables have found few significant differences between athletes with disabilities and those without disabilities. Sherrill and Rainbolt (1988) found that elite athletes with cerebral palsy and intercollegiate athletes without disabilities had similar self-actualization profiles. Lathen, Stoll, and Hyder's (1988) survey results demonstrated that the desire to participate in risk sports among people with physical disabilities was similar to society in general. Brasile (1989) also found that the presence of a physical disability was of little significance in determining an individual's reasons for participating in sport and physical activity. Ogilvie(1990) summarized his review of studies on athletes with cerebral palsy by stating, "The most valuable general findings have been remarkable similarities of psychological, social, and motivational characteristics of disabled athletes when compared to the able-bodied athlete" (p. 44).

Brasile and Hedrick (1991) demonstrated that adult wheelchair athletes and youth with disabilities also have more similarities than differences regarding motivation for participation in sport and physical activity. Their study found youth were more motivated than adults by ego and social-integrative factors; however, intrinsic motivation and task-related reasons for participation were paramount among participants, irrespective of age. Their results appear to support earlier work by Dummer, Ewing, Habeck, and Overton (1987) who found that satisfaction with performance is an important motivational force for athletes with cerebral palsy.

Other recent studies have also contributed to our understanding of selected characteristics of participants with physical disabilities in sport and physical activity. Zoerink (1992) examined socialization factors that influence an athlete with a disability's participation in sport. In contrast to earlier studies, he found that family members, as well as therapists and other athletes with disabilities, were important socializing agents for athletes with congenital disabilities. Moreover, his results indicated that many respondents with acquired disabilities viewed themselves as socializers to sport; thus, demonstrating positive feelings of personal control. Two studies (Greenwood, Dzewaltowski, & French, 1990; Jacobs, 1989) found that psychological profiles of athletes with disabilities demonstrated more vigor and less psychological depression than profiles of nonathletes with disabilities. Studies of training habits of athletes with disabilities have demonstrated that health practices (e.g., diet, use of alcohol, smoking) are generally good, but that training practices are heterogeneous and often self-directed without specific goals (Hedrick, Morse, & Figoni, 1988; Watanabe, Cooper, Vosse, Baldini, & Robertson, 1992).

Physiological Impacts of Participation

Physiological impacts of participation was the focus of more early empirical examinations in sport and physical activity among people with disabilities. Generally, these investigations, plus recent studies, have demonstrated that athletes with disabilities respond favorably to training and exceed nonathletes with disabilities on most measures of physical fitness (Wells & Hooker, 1990). There is evidence, however, that not all sport and physical activities contribute to enhanced fitness levels. Coutts (1988) examined four wheelchair sports and concluded that aerobic effects are possible during regular participation in game conditions for basketball, racquetball and tennis. Volleyball game participation, however, was not sufficiently vigorous to produce training efforts, nor were practice sessions for all four sports.

In order to produce aerobic effects, the amount of effort expended by athletes with some disabilities may have to be greater than that required to athletes without disabilities. Hooker and Wells (1989), for example, found that producing training effects for persons with spinal cord injuries requires higher maximal heart rate levels (i.e., 70 percent) than the general population. Nevertheless, others have demonstrated that regular, vigorous exercise has produced positive cardiovascular outcomes for people with spinal cord injuries (Hoffman, 1986; Shenberger, Leaman, Neumyer, Musch, & Sinoway, 1990). Earlier studies have also demonstrated that regular exercise for persons with disabilities improves muscular strength and endurance, flexibility, weight control, and general well-being (c.f., Compton, Eisenman, & Henderson, 1989; Lasko-McCarthey & Aufsesser, 1990; Wells & Hooker, 1990). Bjorklund, Moody, Beal, & Burton (1988) found that these improvements are evident to the parents of participants with disabilities, as well.

Performance Enhancement

As noted earlier, satisfaction with performance appears to be of vital concern to athletes with physical disabilities. Therefore, research that leads to improved performance in sport and physical activity should be of interest to practitioners. To date, much of this research has been performed by biomechanists, particularly those interested in wheelchair design and propulsion. The relevance of this work to athletic performance is underscored by Higgs (1990) who found that proficiency in wheelchair racquetball corresponds with "greater distances covered per rally, greater wheelchair speed, and a higher degree of maneuverability" (p. 370). Advances in wheelchair technology have also improved the daily lives of most people who use manual wheelchairs for mobility.

Reviewing earlier studies on wheelchair propulsion reveals that peak velocity of a hand-pushed wheelchair is influenced by a variety of interrelated factors, including stroke frequency, range of contact on the handrim, and amount of percent of time in contact with the handrim. Although findings are often contradictory, it appears that the greater the stroke frequency, the greater the range of contact on the handrim, and the less time in contact with the handrim, the greater the peak velocity of the wheelchair. A recent study by Gehlsen, Davis, and Bahamonde (1990) also demonstrated that changes in trunk position (i.e., increasing forward lean) produced greater peak velocity among wheelchair athletes. Hedrick, Wang, Moeinzadeh, and Adrian (1990) found that body positions which reduce frontal area, thus decreasing wind resistance, increase wheelchair coasting velocity. This latter finding might be particularly important to wheelchair road racers when conditions dictate coasting downhill.

Characteristics of the wheelchair are also important to performance. For example, the introduction of lightweight wheelchairs resulted in dramatic improvements in performance for virtually all athletes in wheelchair-related sports and physical activity. Other aspects of the wheelchair, in relation to the user, have also been shown to influence performance. Early research demonstrated that many characteristics of wheelchair design may enhance performance, including smaller handrims, low and inclined seat position, and cambered wheels. Recently, studies by van der Woude et al. (1988) and Gayle, Pohlman, Glaser and Davis (1990) have confirmed that using a smaller handrim dimension reduces both metabolic costs of wheelchair propulsion and perceived exertion by wheelchair users. In a review article, however, van der Woude, Veeger and Rozendal (1989) cited conflicting evidence on the performance-enhancing efforts of other wheelchair design characteristics. Thus, considerably more work is needed in understanding the multiple factors that enhance performance by athletes who use wheelchairs for mobility.

Practical Implications

With the advent of the Americans with Disabilities Act of 1990 (ADA), research in sport and physical activity for people with physical disabilities has relevance for all recreation professionals. Providing appropriate access to programs requires an understanding of psychosocial and physiological factors that may influence or affect participation in recreational activities. The research cited above documents some of these factors and provides a basis for programming activities for people with physical disabilities.

The most compelling finding of psychosocial research in sports and physical activity for people with physical disabilities is the striking similarity between athletes with disabilities and their peers without disabilities. Similarities were documented in motivation to participate, perceptions of important aspects of athletic events, and psychological profiles. This implies that recreation programmers do not need to modify programs extensively in order to meet the needs of constituents with disabilities. Risk activities that are important to people without disabilities are also important to provide for people with physical disabilities (Lathen et al., 1988). Parents of young people with and without disabilities have found to be among the primary socializers to sport and physical activity-(Zoerink, 1992); therefore, improving parental awareness of activities may enhance participation for everyone. The psychological profiles of athletes with disabilities demonstrate that they have the requisite psychological skills for participation in rigorous, competitive activity (Cox & Davis, 1992). As noted by Brasile and Hedrick (1991), leaders should emphasize "pursuit of challenging but attainable personal behavioral goals [that allow for] participants to experience success regardless of their relative skills and abilities" (p. 46).

Since regular, vigorous exercise has been shown to improve fitness levels of people with physical disabilities, practitioners should provide opportunities for these activities. This requires offering a variety of activities that have been demonstrated to produce aerobic effects. General guidelines for participants without disabilities are applicable during aerobic activities (Hoffman, 1986), but activity leaders should strive to reach maximal heart rates of at least 70 percent for participants with spinal cord injuries (Hooker & Wells, 1989). Appropriate precautions must also be taken, however, to ensure the safety of participants (Battilo & Guadagnolo, 1988) and avoid exercise regimes that are potentially harmful to participants. In sports, game situations should be emphasized or practice sessions should be structured to ensure training effects are realized (Coutts, 1988).

The results of the above studies should also be of concern to commercial fitness facilities and other fitness providers. People with physical disabilities represent a largely untapped market; moreover, the ADA mandates that services be accessible to people with mobility limitations. As noted by Wells and Hooker (1990), "Programs need to be developed and facilities must be altered to accommodate the needs of wheelchair [users] in gymnasiums, health spas, and training centers" (p. 282). This is vital because improved fitness levels improve most other aspects of life with a disability.

Finally, research related to sport and physical activity offers important, practical information for leaders of sports programs for people with disabilities. People with physical disabilities should be able to choose to participate in separate or parallel sports participation (Thiboutot, Smith & Labanowich, in press), and leaders of these activities must keep abreast of scientific developments to maximize competitive performance. To date, most research on performance enhancement in sport and physical activity is directed toward wheelchair track and road racing, with an emphasis upon wheelchair design characteristics. Improved techniques in wheelchair mobility, however, benefits all users of wheelchairs.

With increased emphasis upon accessible recreation participation for all citizens, practitioners will be called upon to provide sport and physical activities that are appropriate for people with physical disabilities. Ultimately, two things will define "appropriate" sport and physical activities: (a) input from consumers with physical disabilities, and (b) practical application of scientific evidence, such as the research cited above.

REFERENCES

Bjorklund, R., Moody, N., Beal, E, & Burton, A. (1988). Benefits of sport participation for handicapped youth ... parents' perspectives. Palaestra, 5(1). 32-34, 60-62.

Brasile, F.M. (1989). Participation motivation among wheelchair athletes. Dissertation Abstracts International, (University Microfilms No. 8823084).

Brasile, F.M., & Hedrick, B.N. (1991). A comparison of participation incentives between adult and youth wheelchair basketball players. Palaestra, 7(4), 40-46.

Compton, D.M., Eisenman, P.A., & Henderson, H.L. (1989). Exercise and fitness for persons with disabilities. Sports Medicine, 7, 150-162.

Coutts, K.D. (1988). Heart rates of participants in wheelchair sports. Paraplegia, 26, 43-49.

Cox, R., & Davis, R. (1992). Psychological skills of elite wheelchair athletes. Palaestra, 8(3), 16-21.

Dattilo, J., & Guadagnolo, F.B. (1988). Perceptions of road races by participants in the Challenged Division. Adapted Physical Activity Quarterly, 5, 193-202.

Dummer, G.M., Ewing, M.E., Habeck, R.V., & Overton, S.R. (1987). Attributions of athletes with cerebral palsy. Adapted Physical Activity Quarterly, 4, 278-292.

Gayle, G.W., Pohlman, R.L., Glaser, R.M., & Davis, G.M. (1990). Cardiorespiratory and perceptual responses to arm crank and wheelchair exercise using various handrims in male paraplegics. Research Quarterly for Exercise and Sport, 61, 224-232.

Gehlsen, G.M., Davis, R.W., & Bahamonde, R. (1990). Intermittent velocity and wheelchair performance characteristics. Adapted Physical Activity Quarterly, 7, 219-230.

Greenwood, C.M., Dzewaltowski, D.A., & French, R. (1990). Self-efficacy and psychological well-being of wheelchair tennis and wheelchair nontennis participants. Adapted Physical Activity Quarterly, 7, 12-21.

Hedrick, B.H., Morse, M.I., & Figoni, S.F. (1988). Training practices of elite wheelchair roadracers. Adapted Physical Activity Quarterly, 5, 140-153.

Hedrick, B.H., Wang, Y.T., Moeinzadeh, M., & Adrian, M. (1990). Adapted Physical Activity Quarterly, 7, 41-51.

Higgs, C. (1990). Wheelchair racquetball: A preliminary time motion analysis. Adapted Physical Activity Quarterly, 7, 370-384.

Hoffman, M.D. (1986). Cardiorespiratory fitness and training in quadriplegics and paraplegics. Sports Medicine, 3, 312-330.

Hooker, S.P., & Wells, C.L. (1989). Effects of low- and moderate-intensity training in spinal cord-injured persons. Medicine and Science in Sports and Exercise, 21, 18-22.

Jacobs, D. (1989). A comparison between the psychological profiles of wheelchair athletes, wheelchair nonathletes, and able-bodied athletes. Palaestra, 5(3), 12.

Lasko-McCarthey, P., & Aufsesser, P.M. (1990). Guidelines for a communitybased physical fitness program for adults with physical disabilities. Palaestra, 6(4), 18-29.

Lathen, C.W., Stoll, S.K., & Hyder, M. (1988). Do physically disabled individuals desire participation in risk sports? Palaestra, 4(2), 19-23.

Ogilvie, B.C. (1990). Applications of sport psychology for the athlete with cerebral palsy. Palaestra, 6(5), 42-48.

Shenberger, J.S., Leaman, G.J., Neumyer, M.M., Musch, T.I., & Sinoway, L.I. (1990). Physiologic and structural indices of vascular function in paraplegics. Medicine and Science in Sports and Exercise, 22, 96-101.

Sherrill, C., & Rainbolt, W. (1988). Self-actualization profiles of male ablebodied and elite cerebral palsied athletes. Adapted Physical Activity Quarterly, 5, 108-119.

Thiboutot, A., Smith, R.W., & Labanowich, S. (in press). Examining the concept of reverse integration: A response to Brasile's "new perceptive" on integration. Adapted Physical Activity Quarterly.

van der Woude, L.H.V., Veeger, D.E.J., & Rozendal, R.H. (1989). Ergonomics of wheelchair design: A prerequisite for optimum wheeling conditions. Adapted Physical Activity Quarterly, 6, 109-132.

van der Woude, L.H.V., Veeger, H.E.J., Rozendal, R.H., van Ingen Schenau, G.J., Rooth, F., & van Nierop, P. (1988). Wheelchair racing: Effects of rim diameter and speed on physiology and technique. Medicine and Science in Sports and Exercise, 20, 492-500.

Watanabe, K.T., Cooper, R.A. Vosse, A.J., Baldini, F.D., & Robertson, R.N. (1992). Training practices of athletes who participated in the National Wheelchair Athletic Association training camps. Adapted Physical Activity Quarterly, 9, 249-260.

Wells, C.L., & Hooker, S.P. (1990). The spinal injured athlete. Adapted Physical Activity Quarterly, 7, 265-285.

Zoerink, D.A. (1992). Exploring sport socialization environments of persons with orthopedic disabilities. Palaestra, 8(3), 1992.

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