Thriving Through Adaptation





This article focuses on identifying how health care providers can support a person with spinal cord injury to pursue and maintain involvement in adaptive sports. Benefits and barriers of sport participation, equipment considerations, and recommendations on how to determine sport appropriateness for a person with spinal cord injury will be provided. The authors emphasize through appropriate medical management and consideration of level of disability, functional performance, psychological readiness, and individual preference, a health care provider can play a valuable role in connecting individuals with spinal cord injury to adaptive sports and recreation.


Key points








  • Adaptive sports for individuals with spinal cord injury can improve physical health and functioning, psychological well-being, peer connections, overall quality of life, and even lead to employment opportunities.



  • Common barriers individuals with spinal cord injury who wish to participate in adaptive sports face include limited access to adaptive sports options and overall accessibility issues, lack of financial resources, and problems with transportation.



  • Health care professionals referring an individual with spinal cord injury to adaptive sports should consider the level of disability, functional performance, psychological readiness, and an individual’s personal preferences when assessing eligibility for participation.



  • Comprehensive health care, such as obtaining baseline medical status, conducting consistent monitoring of cardiovascular and autonomic function before and throughout sport engagement, and completing diagnostic tests to determine any needed activity parameters, supports successful integration and continued participation in adaptive sports and recreation.




Introduction


There are multiple factors that contribute to the ability of individuals with spinal cord injury (SCI) to thrive after sustaining a life-changing injury. After discharge from rehabilitation, individuals with SCI face many challenges upon returning to the home and community, such as learning to live with loss in function and identity, adjusting to changes in mobility, experiencing decreased self-efficacy, and feeling restricted by accessibility limitations that did not exist preinjury. Life skills training required for successful reintegration in the home and community that were once taught over 90 day rehabilitation stays in the 1970s now occur over a 30 day period in 2021. Due to this shorter duration in rehabilitation postinjury, the focus of training is likely limited to performance in activities of daily living and basic mobility as well as the psychosocial adjustment to injury. As a result, motivating patients with SCI to consider participating in health-promoting activities such as sports and recreation is deferred.


However, evidence suggests introducing people with SCI to sports and recreation earlier in the recovery process, coupled with health care provider support, is key. Adaptive sports offer opportunities for improvement in physical health and functioning, quality of life (QOL), psychological well-being, peer connections, and even employment opportunities. This correlates with the shift seen in the International Classification of Functioning (ICF), Disability and Health, which focuses in health care on bio-psycho-social functioning, disability, and health, to include participation. As defined in the ICF, participation refers to engagement in one’s life, including community involvement such as sports and recreation.


The concept of adaptive sports being incorporated into the SCI rehabilitation process began in 1948, thanks to the pioneering efforts of Sir Ludwig Guttman, the creator of the Stoke Mandeville Games, which later became the Paralympic Games. He not only pioneered sports activity for patients with SCI but also was responsible for sports becoming an integrated part of the rehabilitation course regardless of injury level or type. In 1960, the first Paralympic Games took place in Rome, Italy, with 400 athletes from 23 countries. Today, the Paralympic Games, both summer and winter, continue to be held in the same city as the Olympic Games 2 weeks after the closing ceremonies for the Olympic Games. The Paralympic Games are a major worldwide sporting event and the second largest global sporting event promoting the benefits of adaptive sports and recreation for individuals with physical limitations across the world.


Currently, the development of sports and recreation for people with SCI continues to reach new landmarks with changes in public and university policies promoting inclusion and equality in sports. This involves providing access at all levels of competition, with competitive scholarship teams, club sports, and intramural leagues. The promotion of the Paralympic Games and policy changes emphasizing inclusion and equality within university and collegiate programs have prompted increased interest in local, community-based opportunities for adaptive sports and recreation.


This article focuses on identifying how health care providers can support a person with SCI to pursue and maintain involvement in adaptive sports. First, insight will be given by reviewing the benefits and barriers of sport participation, followed by an overview of equipment considerations. Next, recommendations will be offered on how to determine sport appropriateness for a person with SCI. Resources will be provided, including specific details on the different adaptive sports available to people with SCI.


Adaptive sports participation: considerations, benefits, and barriers


People with SCI can have difficulty adopting a physically active lifestyle due to the psychological adjustment following injury, unawareness of how to engage in physical activity postinjury, and being limited in community exercise options. As a result, it is unsurprising that approximately 50% of people with SCI do not participate in regular exercise and are 1.5 times more likely to be sedentary than the general population. This leads to secondary conditions such as deconditioning and loss of muscle mass, obesity, cardiovascular and metabolic diseases, musculoskeletal conditions, wounds, depression, substance abuse, and social isolation. Participation in physical activity can be a preventive strategy in reducing the risk associated with these secondary conditions. As a result, QOL and overall life satisfaction for individuals with a chronic disability can improve through the positive impact of physical activity on health and well-being.


Involvement in adaptive sports for people with SCI has additional benefits on QOL measures, such as improving self-esteem and self-efficacy, providing a sense of belonging to a group, and maintaining an athlete’s identity. , Ali and Rider conducted semistructured interviews of SCI quad rugby athletes in the United States and found important benefits to sport participation included being introduced to the sport early on by health care providers while in rehabilitation, having peer mentoring during rehabilitation, and having a supportive family. Common barriers to the ability of people with SCI to participate in adaptive sports include the financial burden of sports involvement, limited resources (ie, facilities and training/staff), and accessibility issues. Benefits and barriers to participation in adaptive sports for people with SCI are outlined in Table 1 .



Table 1

Benefits and barriers to adaptive sports participation , , , ,










Benefits Barriers



  • Prevention of secondary conditions



  • Reduction of health risks



  • Promotion of healthy behaviors



  • Increased physical activity



  • Improved overall attitude and outlook



  • Improved performance in activities of daily living



  • Gains in strength and mobility leading to increased participation in other leisure activities



  • Experiencing a sense of camaraderie from socializing with other SCI athletes and their families



  • Increased social participation; reintegration into the community



  • Decreased depression and anxiety



  • Increased life satisfaction



  • Increased opportunity for gainful employment



  • Having fun



  • Being involved in a competitive sport reigniting preinjury identity as an athlete



  • Regulation of mood and stress



  • Increased sense of belonging and purpose



  • Valuing one’s contribution to the education and training of future athletes



  • Broadened view of life while encouraging a sense of hope




  • Limited access to facilities, adaptive sports teams, and local training staff



  • Lack of financial resources to support costs for participation, transportation, and equipment needs




    • Sports participation for adults is more expensive than for children




  • Stress/pressure to perform in a competitive sport



  • Medical issues associated with




    • Baseline health



    • Pain/injury from sport




  • Accessibility problems



  • Time constraints



  • Transportation concerns



  • Caregiver/family burden



  • Lack of awareness of sports opportunities



  • Poor health care support/assistance



Essential to the successful integration into adaptive sports is the need for health care providers to acknowledge the positive impact of adaptive sports on people with SCI and be able to provide appropriate medical management. Rayes and colleagues suggested health care providers who refer people with SCI to adaptive sports may benefit from having combined expertise in both disability medicine and sports medicine. Being able to take into consideration an athlete’s baseline medical status, patterns of injury associated with specific adaptive sports, and sport-specific requirements to include equipment needs are important for successful introduction and participation in adaptive sports.


It is important for medical providers to appreciate how physical activity dosage guidelines for able-bodied individuals contain activity intensity and duration recommendations that are difficult for people with disabilities to achieve safely, particularly in cases when a person with SCI is attempting to transition from a sedentary lifestyle to sports participation. Martin and colleagues noted greater health benefits occurred when sedentary people with chronic disability initiated participation in physical activity in small increments with light intensity. Box 1 contains suggestions for health care providers in the management of people with SCI who are interested in participating in adaptive sports.



Box 1

Medical considerations ,





  • Prior to Sports Referral




    • Screen client for conditions that require further evaluation and/or treatment



    • Determine any precautions or monitoring needs



    • Identify modifications to avoid injury




  • Recommended diagnostic tests




    • Exercise stress test to determine peak heart rate and oxygen consumption



    • Bone mineral density testing to determine fracture risk and threshold



    • Pulmonary function test to identify ventilatory parameters



    • Routine blood tests




  • Additional points




    • Conduct cardiovascular and autonomic function assessments prior to and throughout sports engagement



    • Modify concussion assessment to reflect baseline cognitive/neurologic function associated with a client’s specific disability



    • Note nutritional requirements for adaptive sports athletes with SCI are different that those of able-bodied counterparts



    • Appreciate that knowledge on the impact of longitudinal training and/or the ability to track sports performance in adaptive sports athletes with SCI is lacking





Equipment


Adaptive and wheelchair sports equipment can be highly specialized and technical. This equipment has a unique function, unlike the typical “day chair” used by people with SCI. For example, a wheelchair rugby sports chair contains bumpers and reinforced frames to accommodate the high impact associated with this sport. Adding to the uniqueness in design and function of adaptive sports wheelchairs, much of this equipment’s innovation and advancement has been driven by its users. For example, Marilyn Hamilton, cofounder of Motion Designs and a wheelchair tennis athlete, sought to design a wheelchair that would be both lightweight and responsive for individuals with disabilities who desired to participate in sports. Marilyn, a former hang-glider, understood the benefits of aluminum on performance and efficiency and introduced aluminum as a new, lightweight material to wheelchair design. The invention of sports-specific wheelchair models soon followed, incorporating materials such as titanium and carbon fiber to optimize performance while removing unnecessary design aspects to minimize weight. , In addition to the evolution of materials, athlete-driven innovations such as the ergo seat, integral antitip, custom side guards, ratchet straps, and high-pressure tires contributed to the improvement in the modern day sports chair both in safety and performance. ,


Sports Wheelchair Design


Wheelchair sports equipment is highly specialized to meet the needs of the individual athlete based on the athlete’s chosen sport and sport-specific classification, when applicable. However, there are principles of design that are considered to be universal across sports. These principles include optimizing the fit of the athlete–wheelchair interface along with the sport-specific wheelchair design, minimizing weight while maintaining stiffness, and minimizing rolling resistance. , ,


Therefore, to augment each athlete’s mobility and sport-specific performance, it is essential to evaluate the interface between the athlete and wheelchair. Success depends on physical ability and how much time and resources are put into adjusting, adapting, and refining an athlete’s wheelchair positioning. To ensure an optimal fit, it is important to have a comprehensive understanding of the athlete, including anthropometric data, sport-specific classification, physical and functional impairments, level of physical fitness, and sport-specific ability. , Ultimately, the wheelchair should serve as an extension of the athlete to truly optimize performance and efficiency and maintain comfort and safety during sport performance. ,


Procuring Equipment


Acquiring adaptive sports equipment can be challenging, as not all adaptive sports programs have adequate equipment supplies, and many prospective athletes lack the financial means and awareness of available funding opportunities to support the cost of obtaining sport-specific equipment. Fortunately, the 21st Century Assistive Technology Act exists to increase the funding for and access to “assistive technology” for individuals with disabilities through comprehensive statewide programs. “Assistive technology” includes any piece of equipment intended to improve function or independence with school, work, recreation, or activities of daily living. To find additional resources for assistive technology and adaptive equipment within a local community, a prospective athlete can contact a local Assistance and Training (AT3) Center. In addition, adaptive sports athletes and organizations may find funding opportunities through local and national grant programs ( Table 2 ).



Table 2

Funding opportunities































Organizational Grant Programs Qualifications
Athletes Helping Athletes ( https://www.roadrunnersports.com/content/apply-for-grant )


  • Any person aged 18 y or younger with a permanent physical disability



  • Must be able to self-propel a bike without assistance

Challenged Athletes Foundation ( https://www.challengedathletes.org/grants/ )


  • Individuals with permanent physical disabilities, a disability that impairs mobility, affects the neuromuscular system, or impairs balance or motor control

High Fives Foundation ( https://highfivesfoundation.org/grant-application/ )


  • Individuals injured in outdoor adventure sports



  • Wounded veterans who wish to pursue outdoor adventure sports



  • Individuals injured in inertia-based accidents who wish to pursue outdoor adventure sports

IM ABLE Foundation ( https://imablefoundation.org/grant-application/ )


  • Individuals with physical, cognitive, and/or behavioral challenges



  • Must live in the mid-Atlantic region (Pennsylvania, New Jersey, Maryland, Delaware, District of Columbia, and New York)

Kelly Brush Foundation ( https://kellybrushfoundation.org/theactivefund/ )


  • Individuals with paralysis caused by SCI

Ryan Shazier Fund ( https://ryanshazierfund.org/golden-window/ )


  • Individuals with SCI



  • Must live in Western Pennsylvania, Eastern Ohio (including Columbus, Ohio), and Northern West Virginia

Score Fund ( https://scorefund.org/applying-for-a-grant/ )


  • Individuals with SCI whose injury was not while participating in nonmotorized sports or athletic recreation activity



  • Demonstrates financial need

Triumph Foundation ( https://triumph-foundation.org/outreach/grants-and-equipment/ )


  • Individuals with SCI



Determining sport selection


There are many important factors to consider when determining a prospective adaptive sport athlete’s sport selection. A hallmark element of adaptive sports and recreation, compared to standard, able-bodied sport options, is that each adaptive sport has been specifically modified to allow full, active participation for those with disabilities. However, not every disability is the same, so adaptive sports are often categorized by different types of disabilities or impairments. The International Paralympic Committee has established 10 eligible impairments categorized into 3 distinct groups (physical impairments, vision impairment, and intellectual impairment) to assist with determining sport eligibility and performance capacity. Determining adaptive sport appropriateness can be summarized into 4 areas: physical function, participant interest, participant readiness, and accessibility. It is important for practitioners recommending a prospective athlete to a sport or recreation program to understand these areas to identify appropriate sports options that will support successful outcomes.


Functional capacity is important when determining baseline eligibility and potential for successful performance in adaptive sport selection. In formal, competitive settings like the Paralympics, adaptive sports require a “minimum impairment criteria” per sport and subsequent classification of impairments to create an equitable playing field of competition. A person with SCI’s individual level of disability and functional performance are considered not only for initial sport eligibility but also as a part of a classification process that reflects sport-specific physical ability. It is important to ensure that the adaptive sports athlete has the potential to develop the sport-associated skills required for successful participation. Health care providers who refer a client for adaptive sports may consider recreational adaptive sport options instead of competitive sports, depending on the needs and choices of the client.


A factor that may be even greater than physical readineses is the psychological readiness of a person with SCI. Practitioners should be cognizant of how well an individual with SCI is coping with the adjustment and grief following injury prior to recommending adaptive sports and recreation options. Appreciating the readiness of a person with SCIs may provide insight into when it is appropriate to introduce the topic of adaptive sports to a potential participant. One avenue that may help with openness to adaptive sports participation is through lived-experience recommendations from a peer mentor with a similar disability. The value in adjustment to disability by utilizing firsthand experience to educate on the benefits of participation in sports can be very effective in promoting successful sport integration. Overall, determination of participant emotional readiness may be best evaluated by a psychologist within the treatment team, and practitioners should caution from overencouraging adaptive sports participation when a person with SCI is struggling with psychological readiness.


Lastly, practicing a client-centered approach is key in determining whether to recommend an individual with SCI to adaptive sports and recreation sources. It is important to consider the personal interests and preferences of an individual with SCI in order to promote successful integration and continued participation in adaptive sports and recreation. Prospective athletes with preinjury sport interest and a background in sports or athletics are known facilitators for successful participation in adaptive sports. Identifying a prospective athlete’s interest in sports and recreation and specific preferences in sport characteristics, such as competitive versus recreational, individual versus team-based, or sports versus athletics, are also important in promoting successful integration into adaptive sports and recreation.


Involvement in standard, able-bodied sports, recreation, and fitness programs can be limited for those with disabilities due to multiple barriers, as featured in Table 1 . Understanding these barriers may change a practitioner’s recommendations on the involvement of a person with SCI in adaptive sports. For example, suppose a person with SCI lives in a rural community lacking adaptive sports programs with team-based options. In that case, this person may benefit from participating in an individual-based sport. Educating people with SCI on overcoming barriers and utilizing adaptive sports and recreation resources can provide a basis for successful selection and integration into an adaptive sport. Determining a successful adaptive sports match can benefit from the support of an interdisciplinary team, including but not limited to physicians, psychologists, physical and occupational therapists, and recreational therapists.


Summary


Health care providers are a valuable link in connecting people with SCI to adaptive sports by providing appropriate medical screening and monitoring, understanding adaptive sport-specific physical ability requirements, referring people with SCI to sport-specific connections, appreciating the benefits and barriers to participating in adaptive sports, and being a member of an interdisciplinary team. Table 3 includes the most common sports and resources available for individuals with SCI. Each state or region may have additional resources. Table 4 contains nationally based organizations that provide additional sports resources.



Table 3

Adaptive sports for spinal cord injury












































































































































































































Sport What Is It? Who Can Participate? Online Resource
Archery


  • In adaptive archery, the target size and distance between the archer and target differ based on the competition category



  • Participants with physical or cognitive impairments, who may otherwise be dissuaded from participating in sports, can participate in archery alongside athletes without any disability




  • Individuals with impaired muscle power, athetosis, impaired passive range of movement, hypertonia, limb deficiency, and ataxia



  • Classification : 2 categories




    • Open class contains both standing athletes and those in a wheelchair. Archers position themselves at a 90° angle to the target and may use body support



    • W1 athletes may use either a bow limited to 45 lbs in draw weight and without magnifying sights


https://www.paralympic.org/archery
https://www.worldarchery.sport/
https://moveunitedsport.org/sport/archery/
Badminton


  • Para badminton is played on a 44 × 22 court with a net and follows the same rules as standard badminton




  • Amputee, spinal cord injury



  • Classification 6 divisions




    • Divisions differentiate wheelchair and standing divisions and severity of disability in each division




  • Only manual wheelchairs incorporated

https://moveunitedsport.org/sport/badminton/
https://www.paralympic.org/badminton
https://corporate.bwfbadminton.com/
Basketball


  • Wheelchair basketball is an adaptation of the able-bodied version where the court dimensions, basket height, scoring structure, number of players on court, and playing time are the same



  • Adaptations are for dribbling, travel violations, and fouls



  • Adult and youth leagues




  • Amputation/limb loss, leg length discrepancy, spinal cord injury, spina bifida, post-polio syndrome, cerebral palsy, brain injury, stroke, and other orthopedic and locomotor disabilities with permanent joint disorders that severely limit the ability to jump, run or pivot



  • Manual wheelchair sport

https://www.nwba.org/
https://www.paralympic.org/wheelchair-basketball
https://turnstone.org/sports
https://pva.org/adaptive-sports/
Billiards


  • Adapting billiards allows individuals to stay active recreationally or at a competitive level



  • Multiple levels of adaptive equipment available based on need




  • Spinal cord injury, amputees, cerebral palsy, low vision, multiple sclerosis, and neuromuscular disorder



  • Manual or power wheelchair

https://www.nchpad.org/Directories/Organizations/2085/
https://poolplayers.com/showdown-series/wheelchair/
https://pva.org/adaptive-sports/billiards/
https://www.cannonaid.com/
Boccia/bocce


  • Like able-bodied bocce, a set of balls is thrown or rolled onto a court by opposing players, getting as close as possible to a target ball



  • In adaptive bocce, there are 6 balls per side, and athletes may use an aide to assist with specific tasks during competition, such as a ramp to propel the ball




  • Persons with conditions of a noncerebral origin that affect all 4 limbs such as high spinal cord injury, muscular dystrophy, arthrogryposis, multiple sclerosis, stroke, or ALS



  • Competitive boccia is open to persons with tetraplegia, cerebral palsy, and traumatic brain injury

https://turnstone.org/sports
https://pva.org/adaptive-sports/
https://www.worldboccia.com/
Bowling


  • Adaptive bowling is played on standard lanes and can be modified for varying skill levels



  • Adaptive equipment includes ramps, guide rails, ball pushers, and varying types of bowling balls and wrist supports




  • Physical and cognitive impairments



  • American wheelchair bowling has 4 divisions: Scratch, A, B, Novice

https://awba.org/
Canoeing/kayaking


  • Adaptive canoeing and kayaking can occur at recreational level as well as competitive level using either kayak or Va’a



  • Adaptive equipment such as outriggers, double hull catamaran, seating or paddle adaptations can allow large variety of participants




  • Tetraplegia, paraplegia, cerebral palsy, amputees, multiple sclerosis, and neuromuscular disorders



  • Classification:




    • 3 classes exist in competition that addresses abilities to use arms, legs, and trunk


http://www.uscanoe.com/adaptive-paddling
https://moveunitedsport.org/sport/canoeing/
https://americancanoe.org/
https://www.canoeicf.com/disciplines/paracanoe
Curling


  • Wheelchair curling occurs on same field of play and with same stones as well as many of the same rules as abled body curling



  • The differences are as follows: no sweeping in wheelchair curling; teams must be composed of male and female participants




  • Significant impairments in lower leg/gait function, spinal cord injury, cerebral palsy, multiple sclerosis, amputees, others



  • Both power and manual wheelchairs are allowed; if manual, brakes are necessary on wheelchairs

https://moveunitedsport.org/sport/curling/
https://www.usacurling.org/
https://worldcurling.org/
Dance


  • Para dance is an elegant, graceful, and stylish sport. Participants can have an able-bodied partner or duo dance for 2 wheelchairs together



  • Dance floor is minimum of 250 m 2 (350 m 2 for championships), with no side of the floor <10 m in length




  • Impaired muscle power, impaired passive range of motion, limb deficiency, leg length difference, athetosis, hypertonia, and ataxia



  • Classification:




    • 6 sport classes in 4 competition classes




  • Utilizes power or manual wheelchair

https://www.paralympic.org/dance-sport/about



  • Equestrian:




    • Equine-assisted therapy



    • Hippotherapy



    • Therapeutic riding



    • Para-equestrian





  • Para-equestrian (competitive) has 3 divisions: para-dressage, para-driving, and para-reining



  • There is a wide variety of adaptive equipment for mounting and securing riders in saddle




  • Spinal cord injury, cerebral palsy, amputees/limb loss, blindness/visual impairments, brain injury, stroke, and neuromuscular disorders

https://uspea.org/
https://www.fei.org/
https://www.paralympic.org/equestrian
https://pathintl.org/
https://moveunitedsport.org/sport/equestrian-horseback-riding/
Fencing


  • Wheelchair fencing has the same objective as standard fencing by earning points through touches to your opponent



  • The difference is that the participant is sitting in a wheelchair and is stationary




  • Amputees, spinal-cord injuries, and cerebral palsy



  • Classification: 2 categories of athletes:



  • Category A: good trunk control



  • Category B: athletes have an impairment that impacts their trunk or their fencing arm



  • Manual sports wheelchair with specialized playing surface system to lock chair in place

https://www.iwfencing.com/
https://www.paralympic.org/wheelchair-fencing
https://moveunitedsport.org/sport/fencing/
https://worldabilitysport.org/sports/international-federation/wheelchair-fencing/
Fishing/boating


  • Adaptive fishing is an activity that people with various disabilities can enjoy



  • There is a host of adapted fishing equipment available that range from simple devices such as rod holders to more complex adaptive devices such as powered casting reels



  • Adaptations for boat controls and seating




  • All types of diagnosis, including physical and cognitive disabilities, can participate



  • Can participate from wheelchair level or standing

https://moveunitedsport.org/sport/fishing/
https://projecthealingwaters.org/
https://fhnbinc.org/
https://pva.org/adaptive-sports/bass-tournament-series/
Floorball


  • Floorball is played on an indoor court 26 m by 16 m with 5 players on court not to exceed 12 points



  • Of the 5 athletes: 3 have hand sticks, and 2 have T sticks



  • Goal is to shoot ball into goal



  • Original name was electric wheelchair hockey




  • Tetraplegia multiple sclerosis, muscular dystrophy, cerebral palsy, head trauma, or stroke



  • Floorball is a sport for those with very limited physical abilities

https://powerchairhockey.org/
Football


  • Wheelchair football can be played on an indoor basketball court or concrete/asphalt that is 60 × 25 yards divided into 15 yard segments with end zone 10 yards



  • There are two 20 min halves with 10 min half time. 7 players are on the field for each team




  • Permanent physical disability consistently reduces the function of the lower limbs to a degree where they cannot run, pivot, block, or tackle at the speed, control, safety, stability, and endurance required to play running football as an able-bodied player



  • Classification : Players are classified via a functional classification system comparable to wheelchair basketball



  • Manual sports chairs are used

https://moveunitedsport.org/usa-wheelchair-football-league/
Golf


  • Adaptive golf allows players the opportunity to enjoy golf independently or with friends and family by providing access to equipment and supplies



  • In adaptive golf, the golfer may adjust the ball’s position to allow the club to be swung and the ball to be hit




  • Participants with a physical disability who can move one or both arms and have at least minor trunk function



  • Many adaptive golf devices are available; however, it is important to ensure the course will allow adaptive golf devices such as a para golfer

http://www.adaptivegolf.org/
https://turnstone.org/sports
https://moveunitedsport.org/sport/golf/
https://www.usaga.org/
Handcycling
Off roading



  • Adaptive handcycling and off-road cycling allow individuals to enjoy the outdoors, improve cardiovascular fitness, and socialize with friends and family




  • Multiple sclerosis, stroke, spinal cord injuries, amputations, stroke, spina bifida, and cerebral palsy



  • The concept is to modify and adapt cycles to suit an individual rider. Many options are available to be inclusive to many

https://usadaptive.net/adaptive-cycling/
https://moveunitedsport.org/sport/cycling/
https://adaptivesportsnw.org/sports/cycling/
Lacrosse


  • Wheelchair lacrosse is played on a roller hockey rink or box lacrosse pad, using a no-bounce ball. Gameplay is 8 vs 8 (including goalie)



  • Players use lacrosse sticks to scoop, catch, carry, pass, and shoot the ball into the other team’s goal




  • Amputees, spina bifida, spinal cord injury, cerebral palsy, congenital limb issues, leg length discrepancy, muscular dystrophy, Parkinson’s, multiple sclerosis, motor dyspraxia, and stroke



  • Manual wheelchairs are used, often the same sport wheelchairs that are typically used for wheelchair basketball are used for lacrosse

https://www.wheelchairlacrosse.com/
www.usalacrosse.com



  • Marital arts




    • Judo



    • Karate



    • Kung Fu



    • Brazilian jiu-jitsu





  • Modifications to rules and techniques are made



  • Goal is to continue to offer physical strength, coordination, flexibility, mental focus, and discipline through martial arts




  • Physical and cognitive impairments of all levels



  • Incorporates manual and power wheelchairs

https://adaptivemartialarts.org/about-us
https://www.fightcoop.com/adaptive-martial-arts-techniques-for-people-with-disabilities/
https://usadaptive.net/adaptive-martial-arts/
www.adaptivemartialarts.org .
Pickleball


  • Wheelchair pickleball can have one or more players on the pickleball court who are in a wheelchair



  • The difference from able-bodied pickleball:




    • There is a larger court size



    • A wheelchair athlete can hit off double bounce



    • The wheelchair is considered part of player’s body, therefore:



    • Wheelchair player’s rear wheels must be in the correct serving area at the point of contact on the serve



    • On volley, zone faults are based on the back wheels of a wheelchair





  • Diagnoses not defined for this emerging sport. Participants must play using a wheelchair



  • Manual wheelchair sport: Players in a wheelchair must always be seated and cannot stand in the wheelchair

https://usapickleball.org/
Powerlifting


  • Para powerlifting focus is on the bench press—lower bar to chest, hold motionless, then press upward



  • In para powerlifting, athletes participate laying supine on para bench




  • Spinal cord injuries, spina bifida, congenital limb deficiencies, lower limb amputee, cerebral palsy, bone shortening, and multiple sclerosis



  • Classification: 10 different weight categories per gender exist in competitive para powerlifting

https://moveunitedsport.org/sport/powerlifting/
https://www.paralympic.org/powerlifting
Power soccer


  • Power soccer is played in power wheelchairs with a specialty attachment in a gymnasium on a regulation basketball court



  • Two teams of 4 players attack, defend, and spin-kick a 13 in soccer ball in a challenging game like able-bodied soccer




  • Tetraplegia, multiple sclerosis, muscular dystrophy, cerebral palsy, head trauma, or stroke



  • Power soccer is a sport for those with very limited physical abilities



  • Participants 5 y and up can participate

https://www.powersoccerusa.org/
https://turnstone.org/sports
https://moveunitedsport.org/sport/soccer-power-soccer/
Racing


  • Wheelchair racing includes the use of a racing wheelchair and occurs on a track or road



  • Racing wheelchairs are like a recumbent handcycle with 2 wheels in the back and one in the front, but no gear system exists



  • Athletes wear specialized gloves to help with pushing wheels and for use on the turning system of the racing wheelchair




  • Amputees, spinal cord injuries, and cerebral palsy



  • Divisions of racing are




    • those who have complete function from waist up only



    • those who have complete function in upper limbs but impaired in abdominals



    • those with upper limb restrictions



    • those with cerebral palsy qualify but have different division


https://livingspinal.com/active-mobility/wheelchair-sports/wheelchair-racing
https://www.wheelpower.org.uk/sports/wheelchair-racing/
https://kellybrushfoundation.org/activeproject/racing/
Rock climbing


  • Para climbing/adaptive climbing makes climbing accessible to people with any type of physical or cognitive disability



  • Specialized equipment is utilized during adaptive rock climbing that is customized to the individual




  • Physical and cognitive impairments; limb difference, amputees, spinal cord injury, those with visual impairments, autism, down syndrome, cerebral palsy, traumatic brain injury, multiple sclerosis; and epilepsy



  • Participants have the option to use a wheelchair depending on the activity

www.climbroca.com/adaptiveclimbing
https://www.commonclimber.com/adaptive-climbing.html
Rowing


  • Adaptive rowing is a sport for sweeping, rowing, or sculling



  • Para-rowing can be recreational or competitive



  • Adaptations to boat, seat, and oars can be made to allow successful participation




  • Amputees, cerebral palsy, cognitive impairments, traumatic brain injury, autism, epilepsy, spinal cord injury, and hearing and visual impairments

https://worldrowing.com/
https://usrowing.org/sports/2019/9/19/us-adaptive-programs.aspx?id=961
Rugby


  • Wheelchair rugby is a full contact sport that is played on a basketball court



  • There are 2 cones at baseline 24 ft apart at goal line



  • Teams are composed of 4 players who are permitted to be on the court at one time



  • The game’s objective is to take a volleyball and advance it from one end of the court to the other



  • Extensive gloves and taping system are used for skin protection; other equipment is specialized per impairments and athlete needs




  • Diagnoses include tetraplegia, cerebral palsy, muscular dystrophy, multiple sclerosis, lateral sclerosis, amputates, post-polio



  • Classification: players classed from 0.5 to 3.5 in increments of .05 (7 classes). 0.5 is lowest function, and 3.5 is highest function



  • Customized manual sport wheelchairs are required

https://www.uswra.org/
https://moveunitedsport.org/sports/wheelchairrugby
https://turnstone.org/sports
https://pva.org/adaptive-sports/
Sailing


  • Parasailing can occur with able-bodied and disabled sailors together



  • Sailing includes cruise, race, or potter in a variety of boats on sea or inland water



  • Adaptations can include but are not limited to special seating, electric power winches, electric starter motors, talking GPS, roller furling, davit Transfer system (like Hoyer lift), and joystick controls, like sip-and-puff systems




  • Both physical and cognitive impairments can participate. The sport is focused on variety, types, and degrees of disability



  • Classification focuses on 3 factors: stability, hand function, and mobility. Classification rating is from 1 to 7. Visual impairments have a separate process

https://www.sailing.org/our-sport/para/
https://www.ussailing.org/education/adult/adaptive-sailing/
https://www.ussailing.org/
Scuba


  • Adaptive scuba diving is a method of training persons with various disabilities to participate in scuba diving as independently as their abilities allow them to do




  • Amputations, spinal cord injuries, those with hearing loss or vision impairment



  • Individuals must be able to meet the basic medical criteria for scuba diving.

www.adaptivesportsfund.org/adaptive-scuba-diving
https://hsascuba.com/
https://www.iahd.org/en/
Sled hockey


  • Sled hockey is played with 6 team players (including a goalie). Sled hockey follows most of the typical ice hockey rules except for variability in equipment



  • Specially designed sleds that sit on top of 2 hockey skate blades



  • Two shorter sticks with metal picks on the bottom for players to propel themselves, similar to cross-country skiing



  • Goalies wear the same equipment but have metal picks sewn into the backsides of the gloves to allow the goalie to maneuver




  • Amputation/limb loss, spinal cord injury/wheelchair users, cerebral palsy, brain injury, and stroke

https://www.usahockey.com/disabledhockey
https://turnstone.org/sports
https://moveunitedsport.org/sport/sled-hockey/



  • Snow skiing




    • Nordic skiing



    • Cross-country skiing



    • Snowboarding





  • Adaptive skiing enables skiers with disabilities to participate by using special equipment. Athletes combine speed and agility while racing down slopes



  • Types of skiing: downhill, slalom, giant slalom, super-G, super combined, and team events



  • There are many levels of equipment to allow for various participants. This includes monoskis, biskis, and outriggers




  • Spinal cord injury, cerebral palsy, amputation, limb deficiency, leg length difference, hypertonia, ataxia, athetosis, impaired passive range of movement, and blindness/vision impairment

https://moveunitedsport.org/sport/alpine-downhill-skiing/
https://www.paralympic.org/alpine-skiing
https://www.disabled-world.com/sports/snow/
https://www.paralympic.org/snowboard
Softball


  • Wheelchair softball is played with 10 players on field for one team not exceeding 24 classification points. The field is on hard surfaces, which include cement/blacktop fields



  • Players must tag the bases with their wheels. No running, hopping, or using the lower limbs to reach the bases is allowed




  • Tetraplegia, muscular dystrophy, multiple sclerosis, post-polio, amputation/limb loss, leg length discrepancy spinal cord injury, spina bifida, post-polio syndrome, cerebral palsy, brain injury, stroke, and other orthopedic and locomotor disabilities with permanent joint disorders



  • Classification: players must use wheelchair basketball or wheelchair rugby classification. One of 10 players must be tetraplegic



  • Participants play in manual sports chairs

www.wheelchairsoftball.org
Surfing


  • Like standard surfing, adaptive surfing involves the surfer paddling away from shore and riding a wave toward the shore



  • Adaptive surfing can occur wherever there are suitable waves, this is mainly in the ocean; however, this can occur in lakes, rivers, and through artificial wave pools. Surfing requires the use of a surfboard




  • Amputations (upper and lower), visual impairments, and spinal cord injury



  • Adaptive surfing can occur in multiple positions, including upright and prone. There is also an option for assisted adaptive surfing

https://www.sports.org.au/adaptive-surfing
https://adaptivesurfproject.com/
https://moveunitedsport.org/sport/surfing/
Swimming


  • Adaptive swimming can utilize specialized devices and offers many benefits, including strengthening the cardiovascular system and major muscle groups of both the upper and lower body




  • Impaired muscle power, limb deficiency, leg length difference, short stature, hypertonia, ataxia, athetosis, impaired passive range of motion, vision impairments, and cognitive impairment



  • Classification: Competitive swimming has divisions based on diagnosis/impairments to create fair competition

https://usadaptive.net/adaptive-swimming
https://www.paralympic.org/swimming
https://www.usaswimming.org/
Table tennis


  • Para table tennis can be played as singles or doubles



  • Table tennis can be played recreationally or competitively



  • Rules are the same as standard table tennis except in the severely limited division, where accommodations are made if the ball goes off-table or if the ball does not go over the net




  • Impaired muscle power, athetosis, impaired passive range of movement, limb deficiency, ataxia, leg length difference, short stature, and intellectual impairment



  • Classification for sport: 11 different classifications over 3 divisions: wheelchair level, standing, and intellectual impairment



  • Can compete in sitting or standing

https://www.paralympic.org/table-tennis
https://moveunitedsport.org/sport/table-tennis/
Target shooting
Para shooting



  • Para shooting includes air rifles and air pistols. Participants shoot from distances of 10, 25, and 50 m.



  • There is a wide range of shooting equipment to improve a shooter’s stability and accuracy while reducing fatigue




  • Impaired muscle power, limb deficiency, hypertonia, ataxia, athetosis, and impaired passive range of movement



  • Can occur in wheelchair or standing

https://www.paralympic.org/shooting
https://moveunitedsport.org/sport/shooting/
https://shootata.com/
Tennis


  • Wheelchair tennis is played on a standard tennis court and follows many of the same rules as standard tennis



  • In wheelchair tennis, a player is allowed to let the ball bounce twice, not once, before hitting a return shot



  • The athlete’s wheelchair is considered a part of the body, so rules applying to the player’s body apply to the chair




  • Participants can fit into 2 levels of play



  • Open: have permanent physical disability that results in a substantial loss of function in one or both upper extremities. Diagnosis: paraplegia or leg amputations



  • Quad: Impairment in arms as well as legs, which limits the ability to hold a racquet or move in a wheelchair



  • Diagnosis: tetraplegia, athetosis, impaired passive, hypertonia, limb deficiency, ataxia, and leg length discrepancy



  • Wheelchair tennis is played in a manual sports wheelchair

https://turnstone.org/sports ; https://pva.org/adaptive-sports/
https://moveunitedsport.org/sport/tennis-wheelchair-tennis/
https://www.paralympic.org/wheelchair-tennis
Track and field


  • Adaptive track and field sports have multiple areas for participation:




    • Throwing disciplines in field competition: javelin, shot put, and discus. Each of these events aims to throw, hurl, or put an object over a distance as far as possible. All 3 sports can be done from an ambulatory or seated position



    • Races take place on the track



    • Throwing and jumping competitions take place on the field inside the track





  • Dwarfism, amputation/limb loss, blindness/visual impairment, spinal cord injury, cerebral palsy, brain injury, and stroke



  • Athletes can have physical disabilities and visual impairments that affect their ability to learn the running, pushing, and throwing techniques



  • Athletes can participate in stand-up events and racing chairs or field chairs

https://dasasports.org/sports-and-fitness/competitive-teams/track-and-field ;
https://adaptivesportsnw.org/sports/track-field
https://moveunitedsport.org/sport/track-and-field/
Triathlon


  • Para triathlons consist of 750 m swimming, 20 km cycling, and 5 km running




  • Spinal cord injury, amputees, cerebral palsy, low vision, multiple sclerosis, and neuromuscular disorder



  • Classification: 9 divisions with eligible impairment types including impaired muscle power, athetosis, impaired passive range of movement, hypertonia, limb deficiency, ataxia, and vision impairments



  • Handcycles or tandem bikes are allowed for cycling and wheelchairs for running

https://www.paralympic.org/triathlon
https://triathlon.org/paratriathlon
Water skiing


  • Adaptive water skiing is a subgenre of water skiing in which the equipment is modified—water ski known as a sit ski, special rope, or special handle, are incorporated to allow a person to enjoy the sport regardless of their level of mobility



  • The sport allows a skier to participate in a range of water sports, from skimming the surface in an inner tube to competitive skiing, including slalom, tricks, and jumping




  • Spinal cord injuries, amputee/limb loss, stroke, blind/low vision, muscular dystrophy, multiple sclerosis, and cerebral palsy



  • Sport is open, widely available for almost anyone regardless of mental or physical condition



  • Exclusionary diagnoses: brittle bones syndromes, uncontrolled seizures, hemophilia, and open tracheotomy

https://www.usaadaptivewaterski.org/
https://learnwatersports.com/adaptive-waterskiing/
https://moveunitedsport.org/sport/water-skiing/
Yoga


  • Adaptive yoga’s goal is to allow for increased flexibility, strength, focus, and clarity




  • Can include individuals with physical and/or cognitive impairment



  • Can use power or manual wheelchair

https://www.nchpad.org/295/1834/Yoga
https://wecapable.com/wheelchair-exercises-chair-yoga-poses/

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May 22, 2025 | Posted by in PHYSICAL MEDICINE & REHABILITATION | Comments Off on Thriving Through Adaptation

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