Invited Perspective


Supporting Patients in the Pursuit of Adaptive Sports

Blaise A. Nemeth, MD

Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI

Correspondence: Blaise A. Nemeth, MD, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 750 Highland Ave., Madison, WI 53705. E-mail: nemeth@ortho.wisc.edu

Received: July 3, 2022; Accepted: July 4, 2022; Published: August 1, 2022

DOI: 10.55275/JPOSNA-2022-0073

Volume 4, Number 3, August 2022

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Introduction

Physical activity and sport participation are integral to all children’s health, benefitting mental health, behavior and cognitive performance, in addition to physical health.1 Making sure children with disabilities have access to physical activity opportunities is important to make sure they experience the same benefits.2 In this issue of JPOSNA®, Dr. Sean Tabaie and colleagues wonderfully present an overview of some of the important concepts for children with disability participating in sports, including benefits, risks, barriers, and resources for participation.

The preparticipation physical exam (PPE) is of particular note. The most recent edition of the multi-organizational PPE Monograph contains a section on athletes with disabilities, including an athlete history form supplement;3,4 it should be noted that Special Olympics has their own form.5 One critical consideration is input from subspecialists on restrictions regarding, but more importantly adaptations to allow, participation in sport. This not only helps the child and family understand the child’s health but also enlightens coaches and event organizers about the child’s abilities and needs. This approach allows the child to participate in a way that is safe and invites success while still feeling a sense of challenge and accomplishment.

While there are numerous adaptive sport organizations nationally and locally, many opportunities may develop de novo through local organizations that have no experience working with children with special healthcare needs. Having families or providers reach out to instructors, teachers, trainers, coaches, and organizers inquiring about opportunities to work with a child often opens the door. Meeting as a group and working together, whether virtually or at the venue of the activity, allows for an individualized approach to identify modifications and adaptations that increase the likelihood of a positive experience for all involved. Parents bring the greatest understanding of their child, medical providers (physicians and therapists) contribute experience on the medical conditions specific to the child, and coaches/instructors/organizers bring the knowledge of their sport. It’s important to understand that with every experience, more knowledge is gained and modifications might occur.

Developing Adaptive Opportunities

Over the last 10 years, I have worked with numerous local, regional, and national organizations to develop adaptive opportunities for my patients, ranging from powerlifting to dance and triathlons to Nordic skiing. Some have developed as a result of interest on the part of the child—I have one patient who is well-known for calling organizers to ask if they have a wheelchair division. If the answer is “no,” the response is “Well, why not? I’d like to compete.” Others have come from the organization wanting to increase opportunities or through a personal connection. Apprehension on the part of parents and organizers commonly occurs during the planning phase, as both are worried about the risk of injury and failure. Communicating with both parties about the child’s abilities, and limitations in joint range of motion and neuromuscular function, helps set reasonable expectations. Physical therapists provide valuable insights, and most are willing to advocate for their clients and participate as well. The physical therapy students from the University of Wisconsin have been critical to the success of many events in our area with some continuing their careers and volunteer involvement in the arena of sports and children with special healthcare needs. A “walk- (or wheel-) through” of the activity and venue with everyone involved a week or two prior to the event has proved invaluable to trial various course and equipment adjustments.

My experience is that after one or two times through this process, an adaptive division or class takes on a permanent presence. Most experts in their discipline are excited to take on an area of new development, having to think about their passion in a new light and putting their skills to work. Seeing the joy on a child’s face when participating validates the effort and investment. I still get emotional remembering one mother’s comment after her daughter’s first event—“She has spent her entire life sitting in the stands watching her brothers compete. This is the first time they have been able to come and watch her.” All it takes is overcoming the initial hesitancy around something new and unfamiliar on everyone’s part. I challenge the readers of this article who have not been involved in adaptive sport to consider how they might use the information presented in your practice and how to encourage, support, or create an opportunity for one of your patients, whether it be recreationally or competitively.

Disclaimer

The author has no conflicts of interest to disclose.

References

  1. Lobelo F, Muth ND, Hanson S, et al. Council on Sports Medicine and Fitness; Section on Obesity. Physical activity assessment and counseling in pediatric clinical settings. Pediatrics. 2020;145(3):e20193992.
  2. Coleman N, Nemeth BA, LeBlanc CMA. Increasing wellness through physical activity in children with chronic disease and disability. Curr Sports Med Rep. 2018;17(12):425–432.
  3. American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine. PPE: Preparticipation Physical Examination, 5th ed. Bernhardt DT, Roberts WO, Eds. American Academy of Pediatrics, Itasca, IL. 2019.
  4. Preparticipation physical examination – Athletes with disabilities form: supplement to the athlete history. Available at: https://downloads.aap.org/AAP/PDF/PPE-Athletes-with-Disabilities-Form%20rev.pdf?_ga=2.108748939.848979081.1656036166-1970446665.1656036166. Accessed June 23, 2022.
  5. Special Olympics athlete medical form. Available at: https://media.specialolympics.org/resources/leading-a-program/registration-forms/SOI-Medical-Form-US-Programs-April-2021-English.pdf?_ga=2.47324519.1715932892.1633998542-545588886.1624743622. Accessed June 23, 2022.