Adaptive sports program gives rehab patients mind and body confidence

Waterfront facility makes good use of river

A Boston rehab hospital long has benefited from having a waterfront view, but now the picturesque scenery serves a dual purpose for spinal cord injury (SCI) and other rehab patients, as it’s the site of a new adaptive aquatics program.

The program begin in 1999 as a way to ease the transition from rehab inpatient care to the community for severely injured patients, says Joseph A. Martini, vice president of Network Integration and Communication at Spaulding Rehabilitation Hospital Network in Boston.

"We wanted to motivate our patients to continue with not only their form and more traditional rehab programs, but also with the nontraditional rehab program that comes about through exercise and activity," Martini says.

When the aquatics program began on a trial basis, it was first run from Community Boating, a public-access community boating club for the city of Boston, located less than half a mile away from the hospital. The hospital contracted with AccesSport America of Boston to provide equipment and staff for the water sports.

Hospital moved successful program to its own pier

It was quickly apparent that the program, located on the Charles River, was a success, so key staff at Spaulding began planning to move the program to the hospital’s backyard. There had been a pier abutting the property until it burned down in 1984 and, while insurance money was available to rebuild it, approvals weren’t in place for this to happen until 1999. The pier was ready and the program was moved to the hospital’s site this year, Martini says.

"With our experience with adaptive water sports, we built into this replacement pier an adaptable high-performance floating dock that had many features available to facilitate our patients getting involved," Martini explains.

For example, the dock has a gradual slope into the water so watercraft can be brought very close. It also has a patient lift so a wheelchair patient can be put on the lift and transferred into one of the vessels, Martini says.

The cost was $1.5 million, which was paid entirely by the insurance money plus interest over the years since the original pier had burned, Martini says.

The contract with AccesSport America is paid for with money raised from a large annual fundraiser.

So far the rehab hospital has not pursued obtaining insurance reimbursement for the therapy involved in the aquatics sports program, but that could be a goal down the road, Martini says.

"It truly is therapy with inpatients, current outpatients, and former patients," Martini says.

Although the aquatic sports program is run only in the summertime, it has provided many advantages to rehab patients, Martini says.

"We have noticed increased balance, increased strength, increased endurance, and there have been psychological benefits," Martini says. "It has motivated patients and their families to work harder and longer because they can see that there are fewer limits to what they can do with a severe disability."

Kayaking helped build strength, concentration

For example, one young man who had anoxic brain injury from surfing in Puerto Rico was enrolled in the aquatic sports program after his rehab inpatient discharge. He and his mother were involved in kayaking using a two-person kayak, Martini recalls.

"They’d go out about every day while they were here, and the young man was able to increase his upper body strength, range of motion, and balance," Martini says.

Due to the man’s brain injury, he had difficulty with initiating behavior, but he was capable of following cues. "If you said to him, You need to paddle now,’ he would paddle, but after a few minutes he would forget what he was doing and needed constant cueing," Martini says.

"After working with his mom in the kayak, where she was able to provide constant cueing, he could continue paddling for longer periods
of time, building up his strength and concentration," Martini adds. "He went from needing cueing every few minutes to a where he could paddle for up to half an hour without cueing."

For other patients, the adaptive sports program is their first opportunity to be engaged in an athletic pursuit, and it’s a big boost for their confidence, Martini says.

"There have been no patients who have not been able to get on either a windsurfing board, adapted kayak, or outrigger canoe," Martini says. "So they see that anything is possible, and that truly motivates them."

Here are some of the features of the adaptive sports program:

Matching patients to activities: Since water sports — including sailing, windsurfing, and kayaking — are very popular in Boston because of the river, rehab patients naturally are attracted to the idea of being able to engage in some of these activities.

Patients have included those with SCIs, amputees, brain-injured patients, and patients in pain management, substance abuse, and geriatric programs, Martini says.

While some of the patients have come directly from the hospital, other participants come from the community, he adds.

"We are able to demonstrate that it’s a benefit to a variety of different patient populations, including patients in their 80s," Martini says.

Therapists help select appropriate activity

When a patient expresses a desire to be involved, a therapist determines what the patient will be able to do at the start and comes up with a plan, says Patti Mechan, PT, MPH, CCS, manager of professional development for physical therapy.

Therapists will coax patients away from the most difficult activities when they begin the program, telling them that it’s better to start off with a safer activity and build up to a more challenging one, Mechan says.

"Depending on the activity they are choosing to do, they need a certain amount of balance to maintain their upward posture either sitting or standing," Mechan says. "And sometimes they don’t have enough sitting balance to row or shift their weight, or they don’t have enough coordination or balance in their trunk or head to shift their weight and hold onto objects at the same time."

For example, there was one patient who wanted to windsurf, although he had never done it before. The man could walk with forearm crutches, but it was challenging for him to walk, Mechan says.

"He wanted to go windsurfing, but he wasn’t keen on sitting down," Mechan says. The man’s therapists were concerned about his attempting to windsurf standing up when they had no idea how good his balance would be, so they convinced him to try windsurfing first in a sitting position and then moving to a standing position as he became more experienced with the sport, Mechan says.

Staffing the aquatics program: This past summer, the program was held from 10 a.m. to 4 p.m. three days a week for 13 weeks. Next year, it will be held five days a week. During the program, there is a registered therapist on site at all times, and other therapists are assigned as needed, Martini says.

Participating staff include physical therapists, an occupational therapist, and therapeutic recreational therapists. The therapists work with AccesSport’s staff in assisting patients with the sports activities, and a therapist typically is involved in the organizing and scheduling of patients and sports activities, Mechan says.

Since the program so far is not reimbursed by insurers, the staff time has been an additional cost for the hospital, Martini says.

"The hospital was generous enough to free up these therapists from their patient time to engage in this," Martini says.

Providing therapy during activities: Therapists will work with sports participants to give them individual cues about how they’re performing the activities, Mechan says.

"If a person is kayaking, there may be a certain way they’re kayaking, how they’re holding the oar, that causes them to complain they are tired," Mechan says.

So the therapist will show the patient ways to hold the oar, row, and rest that will decrease the patient’s fatigue.

"Likewise, if the patient is sitting in a certain way, their sitting posture may need to be adjusted, such as having them straighten up their shoulders and look up," Mechan says.

Also, patients standing on a windsurfing board might be given instructions on holding their feet in a different position, Mechan says.

Producing positive outcomes: Besides the physical benefits from exercise and doing activities that increase range of motion and other improvements, the adaptive aquatics program has given patients greater self-confidence and has improved their quality of life, according to anecdotal evidence, Martini and Mechan say.

"We’ve had one participant who had not done any water sports activities before, and her experience with the program was so positive that she’s been involved in doing volunteer work and advocacy work for disabled persons," Mechan says.

Another participant, a college student, went out with the program every day that he could and told his therapists that this was the first time he had been able to engage in sports activities, Martini says.

"He said when he goes back to school he’ll start an exercise and training program, and that’s one of the goals we want with the program," Martini adds. "We want people to know that exercise is going to help their overall health and reduce infection and complications and the need for hospitalization."

Need More Information?
  • Joseph A. Martini, Vice President of Network Integration and Communication, Spaulding Rehabilitation Hospital Network, 125 Nashua St., Boston, MA 02114. Telephone: (617) 573-7103.
  • Patti Mechan, PT, MPH, CCS, Manager of Professional Development for Physical Therapy, Spaulding Rehabilitation Hospital Network, 125 Nashua St., Boston, MA 02114. Telephone: (617) 573-2111.