benefits and pitfalls of incorporating regular …neill, shannon.pdf · benefits and pitfalls of...
TRANSCRIPT
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BENEFITS AND PITFALLS OF INCORPORATING REGULAR SPORTS
INTO PARAPLEGIC REHABILITATION
INPATIENT REHAB IN GHENT, BELGIUM
Shannon O’Neill
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OBJECTIVES To evaluate the benefits and downfalls of recreation therapy in patients with paraplegia
Shannon and Meg outside the therapy building
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INPATIENT REHAB – PARAPLEGIC UNIT
Patients consent was obtained to use this photo
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Cages to perform gravity eliminated exercises and
resistance exercises Standing table with Hoyer lift
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SPORT DAY
Each Thursday was “sport day”
Each week was a different sport
Bowling, biking to a park, roller basketball, rugby, etc
The rehab facility had a separate basketball court, large outdoor yard, and several sport wheelchairs which allowed flexibility to play many sports
The patients were driven to a nearby bowling alley
with several reserved lanes
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BACKGROUND INFORMATION
Belgium is a small country located within central Europe and has generally mild weather, making it an ideal location for outdoor activities
The country is very active, and bikes dominate the roads
Sports, specially football (soccer) are very important to Belgians
Most Belgians ride bikes regularly, and many patients had goals to return to bike-riding
The rehab center was equipped with special tri-
wheel bikes and arm bikes for patients with
balance impairments
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BENEFITS OF PARAPLEGIC SPORTS
Community building
All patients were under the age of 65, and sport day gave them an opportunity to work as a team
Competitive outlet
Since sports are so culturally important, patients could use this day to still receive their competitive outlet
Stress relief
Diversifying therapy
Therapy that was “fun”
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PITFALLS OF RECREATION THERAPY
Loss of identity (1)
Frustration over loss of abilities
Not all patients are at the same level and can compete in team sports
Some patients were tetraplegia and most could not participate in the team sports such as roller basketball
Equipment limitation
Special wheelchairs for roller basketball/rugby
Time limitation
Many times we had to drive to a different location, or spend a lot of time setting up for the sport
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CONCLUSIONS
Recreation therapy is overall beneficial for patients with paraplegia
How to implement this in the states:
Perform sports that need limited equipment/space
Yard games, flag football in a parking lot, dodge ball
Bring in coaches who can help train in wheelchair sports and give compensations
If coaches aren’t accessible, research the wheelchair sport and think of compensations for patients in advance
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MOST PROFOUND CLINICAL EXPERIENCE
Patients with Guillain Barre were also admitted to the paraplegia wing. One of my favorite patients to work with was a 45 year old male recovering from Guillain Barre. The autoimmune disorder completely paralyzed him within 24 hours, and he was in a coma for 2 months. When he was first admitted to the rehab facility, he was completely dependent with all ADLs and transfers. He was very anxious during therapy to try new things, such as rolling, scooting, and transferring. I encouraged him and pushed him to be challenged each session. During my 6 week stay, I saw him progress from mod assist slide board transfers to independent transfers. He progressed from mod-max assist with bed mobility to independent, and he took his first few steps independently in the pool. This patient was very rewarding to work with, because he was making progress quickly, and had the potential for full recovery.
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THERAPY CULTURE IN BELGIUM
The therapy culture in Belgium was different for many reasons. The patients are very self-motivated, and most are in excellent physical shape due to the active lifestyle. Each patient receive 5-6 hours of combined therapy per day, and are responsible for scheduling and attending their own therapy sessions. If patients are frequently not participating in therapy, they are discharged from the rehab center. During my 6 weeks, there were no patients that were discharged for this reason. Patients are also allowed to stay at the facility for up to one year, which is much longer than most rehabilitation centers in the US. Belgium has social healthcare insurance, which makes this affordable. This insurance system seemed to be more “hands-off,” and required little-to-no documentation. Because there was no documentation, therapists could spend up to three hours with one patient, and could essentially provide unlimited services. This seemed to expedite patient’s progressions and allow for great flexibility for the therapist.
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REFERENCES
Levins, Stephen. “Individual and Societal Influences on Participation in Physical Activity Following Spinal Cord Injury: A Qualitative Study.” Physical Therapy. June 2004.