All-terrain vehicles

All-terrain vehicles (ATVs) are used for recreational enjoyment as well as a means to help access terrain that otherwise might be inaccessible. For individuals with decreased upper and/or lower extremity functioning who use a wheelchair for mobility, transferring onto an ATV can be somewhat of a challenge. A sliding board can help ease the transfer by bridging the gap between the wheelchair and ATV. Using a ramped platform for the wheelchair that is at the same height as the ATV is another technique that decreases the difficulty of the transfer.

The two main categories of ATVs that people with physical disabilities use are four-wheelers and utility vehicles. A four-wheeler should be driven only by someone who has the upper extremity functioning and trunk balance necessary to safely operate the vehicle. Under no circumstance should drivers ever strap themselves onto a four-wheeler. Individuals with decreased lower extremity functioning and sensation may need to select a four-wheeler that is automatic, and they may need to pad off the engine or the sides of the vehicle to protect their skin from the vehicle’s heat.

For utility vehicle users, seat belts are a standard feature and should be used by anyone with decreased balance and stability. A harness system similar to that used in racing cars can be added as extra support for individuals with little to no trunk balance. Foam padding can be placed between the individual, the vehicle, and the harness system to provide even greater stability. The foot accelerator and braking systems can be converted to a hand control system for individuals with decreased lower extremity functioning. For an individual with decreased grip, a grasping cuff can be used with the hand control system, and the steering wheel can be modified by adding a ball grip or a tripod wrist grip (Fig. 48-1).

Fig. 48-1 All-terrain vehicle. Utility vehicle has a harness system, accelerator and brake hand control, tripod wrist grip, and added padding for trunk stability.

Archery

A large selection of adaptive equipment is available that makes archery accessible to almost everyone. A tripod mounting system can be used to help stabilize and hold the bow. To assist with gripping the bow or the arrow and releasing the bowstring, archers who have decreased upper extremity functioning can use wrist and elbow supports, archery cuffs, quick-release cuffs, and mechanical trigger releases. Archers can use a self-retaining, draw-locking mechanism to draw the bowstring back and lock it in a fully drawn, ready-to-shoot position. For someone with an upper extremity amputation or little to no upper extremity functioning, a bite tab that is controlled with the archer’s mouth can be used to draw the bowstring. A crossbow can be adapted for someone with limited upper extremity functioning. A trigger activator and shooting rest are the two main pieces of equipment necessary to adapt a crossbow. The specifics of this equipment are discussed in greater detail in the section on shooting.

Basketball

Basketball requires few adaptations to the equipment and rules. It is played by individuals who have a lower extremity physical disability that prevents them from running, jumping, and pivoting. Players use wheelchairs designed specifically for basketball. The wheelchairs are lightweight, have cambered wheels, and use pressured tires that allow for quick turns and easy maneuvering. Players also can use a body bracer that goes around their chair and waist to maintain balance, as well as leg straps above the knees to sustain proper leg positioning. Spoke guards can be used to protect both the spokes of the wheels and the players’ hands.

Billiards

Several pieces of adaptive billiards equipment are available for individuals with decreased upper extremity functioning. Pool cuffs and grasping cuffs, which are secured to both the hand and the pool cue, can assist with gripping the pool cue (Fig. 48-2A). Prostheses can be used to hold a pool cue. Pool bridges can be used to help support and stabilize the tip of the pool cue. Generally, three types of bridges can be used: a standard pool bridge, a stationary bridge rest that sits on the pool table, and a mobile bridge that attaches to the tip of the pool cue (Fig. 48-2B).

Fig. 48-2 Billiards. A, Pool cuff and grasping cuff. B, Stationary bridge rest and mobile bridge.

Boating

With regard to boating, the main issues for individuals with a physical disability are access onto the boat and seating. Pontoon boats typically are the easiest boats to board because most can pull up evenly with a dock and have gates that provide access onto the boat. Boaters who use a wheelchair for mobility will be able to wheel onto the boat, as long as the gate is wide enough to accommodate the wheelchair. A ramp can be used to bridge any gap between the dock and the boat. With most other motorboats, boaters will need to transfer out of the wheelchair and into the boat, which can be difficult because the boat typically will not be positioned evenly with the dock. In such instances, boaters can transfer independently, use the assistance of other individuals, or modify the boat to include a hydraulic lift system that will lift them out of their wheelchairs and into the boat. Some boats can be modified to include a ramp that unfolds and allows easy roll-on and roll-off wheelchair access.

Once on a boat, if boaters choose to remain in their wheelchair, lock-down systems can be added to the floor of the boat to secure the wheelchair. If boaters choose to transfer into one of the boat’s seats, seats with a high back and armrests can provide stability to boaters who have decreased balance. Boaters with decreased sensation from the waist down can benefit from sitting either on the cushion from their wheelchairs or on a boat seat that is well padded. For boaters who have decreased grip and want to drive a boat, a grasping cuff or T-bar mount can be used to work the throttle, and the steering wheel can be modified by adding a ball grip or a tripod wrist grip.

Bowling

Bowling can be adapted to meet the physical abilities of any bowler. A bowler who lacks the finger strength and/or dexterity to completely grip a standard bowling ball can use a bowling ball with a spring-loaded handle or a bowling ball pusher. A bowler who is unable to bowl free-arm or use a ball pusher can use a bowling ramp. A standard bowling ramp can be placed in front of the lane, and the bowler releases the ball from the top of the ramp with a very light push (Fig. 48-3A). The spring-loaded handle bowling ball, the bowling ball pusher, and the standard bowling ramp all can be used from a seated or a standing position. A bowler who uses a wheelchair for mobility and has little to no upper extremity functioning can use a bowling ramp that attaches to his or her power wheelchair. The bowler controls the speed, direction, position, and timing of the release of the ball down the ramp by driving and stopping the wheelchair (Fig. 48-3B).

Fig. 48-3 Bowling. A, Standard bowling ramp. B, Bowling ramp that attaches to the wheelchair and allows the bowler to control the ball by driving and stopping the wheelchair.

Cycling

Advances in technology have helped introduce adaptive cycling to individuals with various physical disabilities. Cyclists with visual impairments can use tandem bicycles with a sighted pilot; cyclists with amputations can use a standard bicycle customized to accommodate a prosthesis; and cyclists with balance difficulties can use a triwheeled bicycle. Cyclists who have a physical disability that limits lower extremity functioning can use a three-wheeled handcycle.

Handcycles are arm-operated bicycles with a wide, backed seat that accommodates and provides support for the cyclist’s frame. Lateral supports can be added to the backrest to provide greater stability for a cyclist with decreased trunk control. Handcycles are equipped with multiple gears and hand brakes, and they are propelled by a crank system that is connected to the front fork. Tripod wrist cuffs, universal cuff style handles, grasping cuffs with hooks, and prostheses can be used to assist cyclists with grasping the crank handles. All of these grasping devices allow for cyclists to move between the handles, gears, and brakes as needed.

The two main styles of handcycles are upright and recumbent. In an upright model, the cyclist is in a position similar to that created when sitting in a chair. In a recumbent model, the torso is more reclined, and the legs are extended out in front of the cyclist. Upright handcycles use a pivot steer system, whereas recumbent handcycles can have either a pivot steer or lean-to-steer system.

Equestrian sports

Horseback riding can be enjoyed as a therapeutic modality, a leisure activity, and a competitive sport by individuals with physical disabilities. Riders who cannot mount a horse by climbing up on it often use a ramped platform that positions them at the height of the horse’s back. Many riders customize their saddles to meet their needs. Extra padding can be added to the saddle to guard against skin sores from pressure and shearing. Riders who need assistance with balance can attach a backrest to the saddle, and a bellyband can be used to secure their trunk to the backrest (Fig. 48-4). Stirrups can be customized and are important for maintaining balance and protecting a rider’s legs from injury. For riders with decreased trunk control who cannot sit on a horse, carriage driving is another option. In carriage driving, a horse pulls a carriage that is designed to accommodate a wheelchair or an adaptive seat. Access to the carriage typically is gained through a ramp or a hydraulic lift on the back of the carriage, and the carriage has a built-in safety system that secures the wheelchair to the carriage. The reins and how the reins are held can be adapted to allow drivers with decreased grip to control the horse.

Fig. 48-4 Equestrian sports. Horseback riding saddle with backrest and bellyband.

Extreme sports

Extreme sports is a fast-growing recreation field due to the advancements of adaptive technology and the “can do” attitude of individuals with physical disabilities. Nature enthusiasts and thrill seekers are able to continue to enjoy the thrills of adventure-based activities such as camping, hiking, backpacking, mountain biking, rock climbing, high ropes courses, skydiving, paragliding, hang gliding, flying, whitewater rafting, and more. Organizations that provide these recreational and educational opportunities exist all over the world.

Outdoor areas such as campgrounds, beaches, and trails are becoming more accessible with the progression of the Americans with Disabilities Act (ADA). Wheelchair accessible tents are available. Trails are being designed and built with width, grade, cross-slope, and surface texture in mind to meet the needs of all trail users. Rig-shaw poles, all-terrain wheelchair tires, and the assistance of other individuals can enable hikers to access the roughest of terrains.

Off-road mountain biking can be enjoyed by cyclists with good trunk stability and upper extremity functioning. Downhill mountain biking, with the use of a harness system and/or adaptations for grip, can be enjoyed by individuals with decreased upper extremity functioning. Mountain bikes can be either three-wheeled (two wheels in the front and one in the back) or four-wheeled, and the rider can be positioned in a low profile or forward lean position. Mountain bikes can be equipped with a hand crank system for propulsion, a steering column, a brake system, a suspension system, all-terrain tires, a wide, backed seat that accommodates and provides support for the cyclist’s frame, and lateral supports. The style and makeup of the bike depend on the type of mountain biking as well as the cyclist’s physical abilities and personal preferences.

Rock climbing and high ropes courses can be enjoyed with minimal adaptive equipment or techniques. Climbers with upper or lower amputations can use or adapt their day-to-day prostheses, and climbers with visual impairments rely on the guidance from a sighted climber or instructor. A sling seat and pulley system enables a climber with little to no upper and lower extremity functioning to access a high ropes course. Climbers with decreased upper extremity strength and little-to-no lower extremity functioning can utilize a climbing ascender. Instead of using the rock face or climbing holds, climbers use an ascender to pull themselves up the rope. Grasping cuffs can be used with the ascender by someone with decreased hand function. A chest harness can assist someone with decreased trunk control, and climbing harnesses with wider straps can be used to prevent shearing. It is important for climbers with decreased circulation and sensation to protect their bodies with appropriate equipment and padding.

Paragliding, hang gliding, and skydiving can be done in tandem by someone with decreased lower extremity functioning, trunk control, and/or upper extremity functioning. Gliders and divers with visual impairments can communicate with a buddy through the use of headphones. Hand controls can be adapted and landing techniques modified to meet the needs of the individual taking to the air. Protective padding can be used to prevent injuries upon landing.

Flying, which includes planes, helicopters, and sailplanes, can be both recreational and vocational. Anyone can enjoy taking to the air as a passenger. Adaptations to flying controls and instruments can be made for those who want to pilot an aircraft. Foot controls can be converted to hand controls, and anyone has the option of learning to fly as long as they can manage the controls.

Whitewater rafting can be enjoyed safely with minimal adaptations. For water safety, rafters who require assistance rolling from a prone to supine position can use a type I personal flotation device. Rafters with decreased lower extremity functioning can attach flotation devices to their legs in order to prevent their lower extremities from hanging in the water should they be thrown from the raft. Rafters with decreased trunk balance can sit in the middle or the inside of the raft with adaptive seating. Rafters with an upper extremity amputation can use a prosthesis to hold a paddle, and paddles can be adapted with handholds to assist rafters with decreased grip in grasping the paddle. The specifics of this equipment are discussed in greater detail in the section on paddling sports.