BENEFITS AND PITFALLS OF INCORPORATING REGULAR SPORTS

INTO PARAPLEGIC REHABILITATION

INPATIENT REHAB IN GHENT, BELGIUM

Shannon O’Neill

OBJECTIVES To evaluate the benefits and downfalls of recreation therapy in patients with paraplegia

Shannon and Meg outside the therapy building

INPATIENT REHAB – PARAPLEGIC UNIT

Patients consent was obtained to use this photo

Cages to perform gravity eliminated exercises and

resistance exercises Standing table with Hoyer lift

SPORT DAY

Each Thursday was “sport day”

Each week was a different sport

Bowling, biking to a park, roller basketball, rugby, etc

The rehab facility had a separate basketball court, large outdoor yard, and several sport wheelchairs which allowed flexibility to play many sports

The patients were driven to a nearby bowling alley

with several reserved lanes

BACKGROUND INFORMATION

Belgium is a small country located within central Europe and has generally mild weather, making it an ideal location for outdoor activities

The country is very active, and bikes dominate the roads

Sports, specially football (soccer) are very important to Belgians

Most Belgians ride bikes regularly, and many patients had goals to return to bike-riding

The rehab center was equipped with special tri-

wheel bikes and arm bikes for patients with

balance impairments

BENEFITS OF PARAPLEGIC SPORTS

Community building

All patients were under the age of 65, and sport day gave them an opportunity to work as a team

Competitive outlet

Since sports are so culturally important, patients could use this day to still receive their competitive outlet

Stress relief

Diversifying therapy

Therapy that was “fun”

PITFALLS OF RECREATION THERAPY

Loss of identity (1)

Frustration over loss of abilities

Not all patients are at the same level and can compete in team sports

Some patients were tetraplegia and most could not participate in the team sports such as roller basketball

Equipment limitation

Special wheelchairs for roller basketball/rugby

Time limitation

Many times we had to drive to a different location, or spend a lot of time setting up for the sport

CONCLUSIONS

Recreation therapy is overall beneficial for patients with paraplegia

How to implement this in the states:

Perform sports that need limited equipment/space

Yard games, flag football in a parking lot, dodge ball

Bring in coaches who can help train in wheelchair sports and give compensations

If coaches aren’t accessible, research the wheelchair sport and think of compensations for patients in advance

MOST PROFOUND CLINICAL EXPERIENCE

Patients with Guillain Barre were also admitted to the paraplegia wing. One of my favorite patients to work with was a 45 year old male recovering from Guillain Barre. The autoimmune disorder completely paralyzed him within 24 hours, and he was in a coma for 2 months. When he was first admitted to the rehab facility, he was completely dependent with all ADLs and transfers. He was very anxious during therapy to try new things, such as rolling, scooting, and transferring. I encouraged him and pushed him to be challenged each session. During my 6 week stay, I saw him progress from mod assist slide board transfers to independent transfers. He progressed from mod-max assist with bed mobility to independent, and he took his first few steps independently in the pool. This patient was very rewarding to work with, because he was making progress quickly, and had the potential for full recovery.

THERAPY CULTURE IN BELGIUM

The therapy culture in Belgium was different for many reasons. The patients are very self-motivated, and most are in excellent physical shape due to the active lifestyle. Each patient receive 5-6 hours of combined therapy per day, and are responsible for scheduling and attending their own therapy sessions. If patients are frequently not participating in therapy, they are discharged from the rehab center. During my 6 weeks, there were no patients that were discharged for this reason. Patients are also allowed to stay at the facility for up to one year, which is much longer than most rehabilitation centers in the US. Belgium has social healthcare insurance, which makes this affordable. This insurance system seemed to be more “hands-off,” and required little-to-no documentation. Because there was no documentation, therapists could spend up to three hours with one patient, and could essentially provide unlimited services. This seemed to expedite patient’s progressions and allow for great flexibility for the therapist.

REFERENCES

Levins, Stephen. “Individual and Societal Influences on Participation in Physical Activity Following Spinal Cord Injury: A Qualitative Study.” Physical Therapy. June 2004.