Slide 1

Cate Stephens Chartered physiotherapist

Slide 2

Lecture overview Defining disability Current levels of sports participation Factors affecting a persons reaction to be disabled Perceived benefits of sports Barriers to sport Congenital versus acquired Psychology of injury

Slide 3

History Pioneered by Sir Ludwig Gutmann Originally designed to assist in rehabilitation Motto of the Paralympic movement Empower, inspire and achieve

Slide 4

Definition of disability Largest minority group in the world The impact of impairments upon the performance of activities commonly accepted as the basic elements of everyday living If individuals are hindered in their mobility, domestic routine or occupation they are considered to have a disability.

Slide 5

I will be talking only about permanent disabilities Even relatively mild impairments can compete

Slide 6

Labelling Sticking to everyday living definition does not completely overcome what is and what is not a disability Many individuals are able to function very well in everyday living

Slide 7

Able athletes with disabilities From a psychological point of view, in a sporting environment athletes are more alike than different regardless of their intellectual, sensory or physical capabilities Factors that influence the development of mental skills will vary depending on disability e.g. visualisation, relaxation techniques

Slide 8

Reduced opportunities to the sports participation Health complications Low employment rates Reduced social contact These injustices make sports critical for the psychological, physiological and social well-being of people with disabilities

Slide 9

Current levels of sports participation: Adults with a disability and sport (National survey 2001) Limiting long-standing illness, wide variety of disabilities including emotional, cognitive, pain, neuromuscular Excluding walking, participation rates 38% in disabled compared to 59% for able-bodied Those with ambulation difficulties were least likely to partake in sport. Only 19% of ambulation difficulties partook in sport

Slide 10

Survey results continued 65% would like to play more sport with swimming the most popular Nine out of 10 of top 10 sports were played as individuals rather than team sports Disabled men are more likely to do sport than women

Slide 11

How people react or adjust to their disability Depends on the nature of disability Age at onset of disability Type of onset ie sudden, prolonged or self induced Specific functions impaired Severity of impairment Levels and persistence of pain How visible disability is Previous life experiences Personality Social support

Slide 12

Slide 13

Progressives or nonprogressive Amputations, cerebral palsy, spinal cord injuries not going to change appreciably Multiple sclerosis or neuromuscular conditions require people to confront an active disease process as well as the impairments Not always obvious if they are progressive

Slide 14

Static or dynamic disability Static disabilities-no changes occurred during sport Dynamic disabilities- physical state or condition can be altered during physical activity. Important when considering psychological techniques

Slide 15

Able-bodied versus disabled More similarities than differences reported when comparing disabled and able-bodied athletes psychological parameters. Below the average tension, depression, anger, fatigue and confusion found in both able-bodied and disabled athletes. Both groups demonstrate responses to success/failure in a similar way

Slide 16

Perceived psychological parameters affected by sport Self-esteem Body image Perceived competence Social interaction More autonomous

Slide 17

Self-esteem Based on Success experiences Favourable judgements from significant others Athletes with disabilities have higher self-esteem than non- athletic individuals with disabilities Is participation in sport trivialised? Positive and negative appraisals are made about disabled athletes performances Limited research looking at self esteem in disabled athletes compared to self-esteem in able-bodied athletes

Slide 18

Body image No strong evidence to suggest disabled suffer from adverse body image dissatisfaction than able- bodied populations people with disabilities tend to be more focused on body image-may reflect on the awareness of their differences

Slide 19

A visible difference in appearance result in altered body image because they often receive cues from the environment ie people staring Poor you look Increased satisfaction with body image in those that participate in sport

Slide 20

Perceived competence Sport increases participants efficacy in physical capabilities Most Studies report a sense of empowerment as a result of sport 24 college athletes described sport as a vehicle to display competence and refute stereotypes of their incompetence (Taub, 1999) Maintaining function (this is considered more important by parents)

Slide 21

Confidence gained in sport generalises to other life activities Few studies have looked at sport as an intervention. Martin- Ginis (2003) increase in self concept at 3, 6, 9 months in SCI compared to control

Slide 22

Social interaction May serve as a vehicle to allow increased social interaction and promote social support among individuals who share similar life experiences

Slide 23

Strategies for autonomy Self-determination Setting personal goals Focusing on positive aspects of life

Slide 24

Perceived psychological parameters affected by sport Self-esteem Body image Perceived competence Social interaction More autonomous

Slide 25

Congenital versus acquired Disabilities can be sensory, physical or intellectual. All of these can be congenital or acquired Approximately 85% of athletes with physical or sensory impairment have an acquired disability Congenital conditions gradually realise they are different to the community. Acquired conditions may already have positive or negative views of disability Sudden/slow onset

Slide 26

Acquired injuries Do experience initially loss of confidence, mental inactivity, reduced perception of physical competence, resulting in reduced social integration Massive change in a persons position Tasiemski et al (2005) demonstrated a higher satisfaction with life in general in sci individuals involved in sports compared to those not in sport

Slide 27

Congenital versus acquired Lower levels of athletic identity (Tasiemski2004) in SCI individuals than able-bodied adults and adolescents with physical disabilities Number of hours participating in sport significantly reduced after injury Number of individuals who continue to be involved in sport is reduced after injury

Slide 28

Emotional Response to acquired injury Fear of unknown Tension, anger, depression Frustration, boredom Grief Emotional coping 28

Slide 29

Those with acquired disabilities report more benefits e.g. mastering a new skill, reduced sense of dependence, increase confidence in physical abilities beyond the sporting environment than those with congenital disabilities

Slide 30

Active verses in active pre- disability If active pre-injury less problems with training Both groups reported varying times back to activity Examples of some people throwing themselves into sport and others avoiding it at all costs Strong athletic identity has been linked to post injury depression Therapists not considered an important source of information! Higher levels of activity associated with smaller discrepancy between pre-and post-injury self concept Wu and Williams, 2000

Slide 31

Motivational reasons for sport Fun Fitness Health Competition Social Rehabilitation Differs depending if male or female and level of activity

Slide 32

Level playing field?

Slide 33

Barriers to sport National survey- Health limitations, lack of time, lack of money One in 10 had had negative experiences in sport due to their disability Most frequent help with advice on what they can do lack of information available

Slide 34

72% said they needed help or adapted equipment to take part in sport, association between level of care and reduced exercise

Slide 35

Barriers continue Attitudes of society at large Architectural and physical although national survey only 3% of respondents cited lack of facilities Wheelchair users described accessibility as one of the key barriers (Pluym et al 1997) Difficulty in getting sporting wheelchairs

Slide 36

Potential psychological barriers Overprotective parents Pushy parents-believe peers are more accepting his child is physically active Reduced self confidence Dislike of traditional sports for people with disabilities

Slide 37

Britain (2004) and page (2001) Disability is connected to incapability Disability becomes the dominant feature of social identity Athletes perceive themselves to be a burden on society

Slide 38

Competing against able-bodied Normalises disability reduces social stigmatization Oscar Pistorius However.. a swimmer with an arm amputation, disqualified for failing to touch the wall with both hands Benchpress amputee competitor disqualified for not having both feet on the floor, when he used his prosthesis disqualified for using unapproved equipment

Slide 39

Other peoples views of disability sport Often their abilities are not appreciated, there is no expectation of skill mere act of participating is seen as an accomplishment as if athletes should spend their time at home doing nothing Media coverage

Slide 40

1. Disability as an emblem of evil 2. Disabled as monsters 3. Disability as a loss of ones humanity 4. Disability as total dependency and lack of self- determination 5. The image of the disabled as the maladjusted person 6. Disability with compensation or substitute gift e.g. blind 7. A disability leading to courageousness or achievement 8. Disability and sexuality 9. Disability as an object of pity 10. The disabled as an object of charity Haralambos and Holborn, 2000

Slide 41

Media coverage 2004 sports personality of the year Tanni won third place

Slide 42

Media coverage Media coverage suggest the value placed on it by programmers and perceived interest Lack of exposure has numerous knock-on effects Lessens the possibility of non-participating athletes being aware of it or inspired to take part Limited role models with a disability

Slide 43

Athletes themselves can be discriminated to other athletes Disability groups can be prejudiced against other disability groups-supporting groups can represent those with specific disabilities, conditions fighting against each other for limited government funding all for integration with able-bodied organisations

Slide 44

Psychology of injury

Slide 45

Personality 1. Hardiness: curiosity, willingness to commit, seeing change as a challenge, control over ones life. 2. Locus of control: degree to which individuals view their lives & environment as under their personal control (internal vs external) -2 characteristics have a direct relation to stress. 3. Achievement motivation: the need to succeed and the need to avoid failure. 4. Competitive trait anxiety: High need to avoid failure (i.e. high trait anxiety) appraise more situations as stressful stress.

Slide 46

46 Psychosocial Issues & Injury Numerous challenges evident Coping with pain Discomfort of rehabilitation Feelings of distress Concerns about outcome Isolation Trust in the rehabilitation process

Slide 47

47Stressors Physical E.g. Pain, permanent physical changes Rehabilitation Environment E.g. Lack of personal attention, poor quality Emotional E.g. Trauma, loss & grief, setback Cognitive E.g. Threat to future performance, life, career, self-concept Financial E.g. loss of income Social Isolation, social role, pressure from others

Slide 48

48 Appraisal Perception about: cause of injury recovery status availability of social support Ability to cope Athlete self-perception (self worth, value, abilities/capabilities) Self esteem/self-confidence/self efficacy Importance for application within rehabilitation?

Slide 49

49 Emotional Response Fear of unknown Tension, anger, depression Frustration, boredom Grief Emotional coping Importance for application within rehabilitation?

Slide 50

50 Practical Implications? Response to loss results in the disruption of goal- directed behaviour. Goal setting Restore goal-directed behaviour Enhance motivation & adherence to rehabilitation Counteract feelings of apathy Positive effect on self-confidence.

Slide 51

51 Grief Shock and disbelief Despondency and depression ( despair, apathy, irritability, isolation, withdrawal, anger, denial, anxiety, guilt, feelings of loss of self, inability to concentrate) Highly under-minded by the loss of goal-directed behaviour Recovery and adaptation Kubla Ross-anger, denial, bargaining, depression, acceptance

Slide 52

52 Restlessness Feeling Cheated Devastation Dispirited Isolation Reorganisation How do injured athletes respond?

Slide 53

Take home message Psychological benefits of sport must not be underestimated more similarities than differences when working with able-bodied and disabled athletes Psychology of injury needs to be considered when treating athletes