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Wheelchair Sports and Recreation:

Health and Wellness After Disability

Paul MortensenArizona Spinal Cord Injury Association

Chrystal SnyderRidgewood: Ingenious Communication StrategiesArizona Governor’s Council on Spinal and Head Injuries

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Arizona Statewide

SymposiumIn Support of

Military Families

July 15, 2010

In collaboration with

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█ Introductions█ Class objectives & expectations█ Secondary Conditions Model

(using spinal cord injury example)█ Conditions and Interventions█ Adaptive Sports and Recreation█ Resources█ Q/A█ Evaluation

Agenda

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ObjectivesBy the end of the session, the participant will be able to:

█ identify physiological systems at risk for secondary disabling conditions after paralysis

█ discuss the value of fitness and health promotion as a method for reducing risk factors of secondary disabling conditions

█ identify Arizona civilian, military, and government resources for information and health promotion support programs

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Secondary Conditions Model

Disability in America: Toward a National Agenda for Prevention

Andrew M. Pope & Alvin R. Tarlov, Editors Institute of Medicine, 1991.

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Secondary Conditions Model

Primary Disabling Condition

Environment (Social and Physical)

Lifestyle and Behavior

Biology

RIS

K F

AC

TOR

S

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Secondary Conditions Model

EVENTSe.g., infections, skin breakdown, ill-fitting equipment, poor diet,

depression, isolation, inadequate rehabilitation

PREC

IPIT

ATIN

G E

VEN

TS

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Secondary Conditions Model

Secondary Pathology

Secondary Impairment

Secondary Functional Limitation

Secondary Disability

DIS

AB

LIN

G P

RO

CES

S

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Secondary Conditions Model

QUALITY OF

LIFEINDICATORSPhysical Health

Emotional Well-being

Functional Level of Independence

Level of Mobility

Social Integration

Interpersonal Relationships

Personal Productivity

INDICATORSEconomic Status

Intellectual Functioning

Housing/Neighborhood

Subjective Perception of Health

Life Satisfaction

Job Satisfaction

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Secondary Conditions Model█ Disability is a dynamic process█ Disability is not predictable: two persons

with similar impairments may experience disability very differently.

█ Individuals with disabilities are susceptible to: ▐ chronic conditions found in the general

population

▐ conditions secondary to their primary disability.

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Common Medical Conditions After SCISE

CO

ND

ARY

CO

ND

ITIO

NS

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Common Medical Conditions After SCI█ Urinary tract problems█ Bowel management difficulties█ Pressure sores█ Deep vein thrombosis and pulmonary embolism█ Autonomic dysreflexia█ Pneumonia or other lung problems█ Spasticity█ Weight control issues█ Sexual dysfunction█ Pain█ New injuries█ Osteoporosis

SEC

ON

DA

RY C

ON

DIT

ION

S

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Chronic Health Conditions and SCI

█ Individuals with SCI are surviving longer

█ Chronic diseases are now being seen in individuals with SCI, for example:

▐Cardiovascular disease

▐Diabetes

▐Cancer

SEC

ON

DA

RY C

ON

DIT

ION

S

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Chronic Health Conditions and SCI

█ Some diseases occur earlier than expected when compared with able-bodied individuals

█ In some cases, the disease occurs more rapidly, is more aggressive, or is more advanced when diagnosed.

SEC

ON

DA

RY C

ON

DIT

ION

S

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Accelerated Aging

█ The combination of: ▐ secondary conditions and risk

factors▐ the long term effects of the

primary spinal cord injury contribute to the phenomenon of accelerated aging.

SEC

ON

DA

RY C

ON

DIT

ION

S

Health Promotion

“The purpose of health promotion is not simply to

extend life but also to improve the quality of life and to extend

active life free of disability.”Fries, 1988; Katz et al., 1983

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Source: Disability in America: Toward a National Agenda for PreventionAndrew M. Pope & Alvin R. Tarlov, Editors, Institute of Medicine, 1991.

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Interventions█ Screening for early detection and

treatment of the secondary conditions

█ Reducing the risk factors for secondary conditions

█ Education

█ Promoting self-care

█ Counseling

█ Effective Rehabilitation

INTE

RVE

NTI

ON

S

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Personal Monitoring█ SCI-related health issues requiring regular

monitoring include:▐Respiratory system

▐Urinary system

▐Gastrointestinal system

▐ Integumentary system

▐Cardiovascular system

▐Neurologic changes

INTE

RVE

NTI

ON

S

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Health Promoting Factors█Proper nutrition█Stress management█Weight control█Physical fitness█Regular monitoring of health status█Strong social support system█Elimination of substance abuse█No smoking

INTE

RVE

NTI

ON

S

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ADAPTIVESPORTS & RECREATION

Sports / Recreation Programs

for Spinal Cord Injury, TBI and PTSD

in Vietnam versus Today’s Programs

Paul Mortensen602-507-4209

paul@azspinal.org

www.azspinal.org

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Video PresentationsAdvancing our Abilities:

Introduction to Adaptive SportsU.S. Military Warrior Games

BG Gary CheekAirman survives life-threatening burns,

now trains for Warrior GamesTSgt Israel Del Toro

Warrior GamesSgt Randi McCartney

Arizona Resources & Activities

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Wheelchair Sports and Recreation█ Promote broader participation in the

community

█ Build a sense of community and reduce the isolating impact of disability

█ Promote health and fitness and reduce the risk of secondary conditions

█ Foster mental renewal through involvement in athletic and leisure activities

█ Enhance the quality of life for persons with spinal cord injury and their families

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PUR

POSE

S

Social & Recreational Events█ Opportunities for shared activities in wheelchair

accessible settings█ Outdoor activities that promote fitness and

offer participants access to areas of the state they may not have had the opportunity to experience

█ Sports (as audience and/or participants)█ Social networking █ Sharing of information█ Modeling of effective mobility and coping

strategies█ Fun, interesting experiences, stimulation

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PRO

GR

AM

S &

AC

TIVI

TIES

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SCI Empowerment Course

The goal of this 12-week course is to promote

optimum quality of life after spinal cord injury.

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SCI Empowerment Course

Based upon the principles of:

█ independent living

█ informed choice and self-advocacy

█health promotion

█prevention of secondary conditions after spinal cord injury

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Key Concepts▐ Acceptance and adjustment to disability as a

process

▐ Prevention rather than crisis intervention

▐ Improved quality of life and all systems of health

▐ Full consumer engagement in his/her life choices and life decisions

▐ Personal advocacy skills

▐ Education of self and others through self-advocacy

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Key Concepts▐ Information and changed attitudes can lead to

wellness and health

▐ Accessing medical care and services that works for you

▐ Identification of issues that need to be addressed continuously

▐ Health promotion and prevention of secondary conditions become “routine” habits of living

▐ Understanding the laws impacting persons with disabilities

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Wheelchair Skills TrainingThis program grew out of the findings of the Arizona Spinal Cord Injury Association that

the early training in wheelchair use that is provided during rehabilitation

is not enough to support an individual’s long-term needs.

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Wheelchair Skills Training█ The rehabilitation period is an

emotional process, where the individual is attempting to come to terms with a substantial change in his expectations for how life is now as compared to how it was planned to be.

█ More education will be needed after this adjustment period is completed—long after access to rehabilitation staff is over.

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Wheelchair Skills Training█ In rehab, the primary focus is on basic skills

needed to ensure that she can function adequately to be discharged home.

█ Later, after some adjustment to the disability has occurred, that these individuals are ready for and interested in learning a greater array of skills.

█ The desire to begin or resume athletic activities can open a world of extended mobility and physical vitality through exercise.

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Wheelchair Skills Training█ Everyone’s body changes over time; the

changes in a body after spinal cord injury may be even greater.

█ New education about using a wheelchair is essential at an older age, after weight gain or loss, after arthritis has developed, or in response to any other type of body change that impacts upon mobility in a wheelchair.

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Arizona Connections: Information & Referral

█ Local Soc/Rec Programs

█ Municipal Recreation Resources

█ College/University Adaptive Gyms

█ Healthcare & Rehab Providers

█ Durable Medical Equipment

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Arizona Spinal Cord Injury

AssociationInformation & Referral

602-507-4209888-889-2185

(toll-free)

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Arizona Spinal Cord Injury Association

At theDisability Empowerment Center

(DEC)5025 East Washington Street

Suite 110Phoenix, AZ 85034

www.azspinal.org

Disability Empowerment Center

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Arizona Activities

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www.azspinal.org/calendar.aspx

Christopher & Dana REEVE FOUNDATION

paralysis.org

National Information & Activities

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Q & A

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