Strength Training and Conditioning
Athletes with disabilities benefit from the same strength training and conditioning protocols as athletes without disabilities. In general, the same program used for athletes without disabilities can be used for their peers with a disability. There are a few considerations when developing a program for an athlete in a wheelchair sport.
Disability Specific Concerns
What is it? Athletes who participate in wheelchair sports and particularly those athletes who use a wheelchair for everyday mobility are susceptible to shoulder imbalance issues. Just as a nondisabled athlete may experience knee imbalance by overdeveloped quadriceps and underdeveloped hamstrings, a wheelchair basketball player is susceptible to overdeveloped anterior upper body muscles and underdeveloped posterior upper body muscles. This is a result of utilizing the arms and shoulders for all movement within the sport and the vast majority of that movement resulting from a pushing motion.
How do you address it? Training program should emphasize more pulling movements (3:1 ratio) than pushing movements in order to promote a well balance shoulder joint as well as balanced trunk and core muscles where appropriate.
Athletes who use a wheelchair for everyday mobility are more susceptible to pressure ulcers (sores). A pressure ulcer is an injury to the skin and underlying tissues that results from prolonged pressure on the skin. Pressure ulcers most often develop on skin that covers bony areas of the body, such as the heel, ankles, hips or buttocks. To help prevent the formation of pressure ulcers on athletes and in order to promote good health behaviors, the practice plan for a wheelchair basketball practice should include depressions/weight shifts every 30 minutes. The weight shift should last 30 seconds to one minute and involve the athlete raising their buttocks completely off of the seat cushion by pushing down on the top of the rear wheels of the chair and raising their upper body off of the chair.
Autonomic Dysrelfexia (AD)
Autonomic dysreflexia, also known as hyperreflexia, means an over-activity of the Autonomic Nervous System causing an abrupt onset of excessively high blood pressure. Persons at risk for this problem generally have injury levels above T-5 spinal cord level. Autonomic dysreflexia can develop suddenly and is potentially life threatening and is considered a medical emergency. If not treated promptly and correctly, it may lead to seizures, stroke, and even death.
AD occurs when an irritating stimulus is introduced to the body below the level of spinal cord injury, such as an overfull bladder. The stimulus sends nerve impulses to the spinal cord, where they travel upward until they are blocked by the lesion at the level of injury. Since the impulses cannot reach the brain, a reflex is activated that increases activity of the sympathetic portion of autonomic nervous system. This results in spasms and a narrowing of the blood vessels, which causes a rise in the blood pressure.
Signs & Symptoms
- Pounding headache (caused by the elevation in blood pressure)
- Goose Pimples
- Sweating above the level of injury
- Nasal Congestion
- Slow Pulse
- Blotching of the Skin
- Hypertension (blood pressure greater than 200/100)
- Flushed (reddened) face
- Red blotches on the skin above level of spinal injury
- Sweating above level of spinal injury
- Slow pulse (< 60 beats per minute)
- Cold, clammy skin below level of spinal injury
Proper treatment of autonomic dysreflexia involves administration of anti-hypertensives along with immediate determination and removal of the triggering stimuli. Often, sitting the patient up and dangling legs can reduce blood pressures below dangerous levels and provide partial symptom relief. Tight clothing, sock and shoes should be removed. Catheterization of the bladder every 4 to 6 hours, or relief of a blocked urinary catheter tube may resolve the problem. The rectum should be cleared of stool impaction. If the noxious precipitating trigger cannot be identified, drug treatment is needed to decrease elevating intracranial pressure until further studies can identify the cause.
Prior to attempting any of these treatment options, if you suspect an athlete is experiencing AD, you should first call 911 and then proceed to eliminate the precipitating stimuli.
Court Chair Basics
Sizing and Fitting a Sports Chair
- Seat Depth: Measure from the most posterior point of the body to the inside of the knee, minus at least two inches.
- Seat Width: Determined by the widest point of the body from knee to hip. Should be measured with clothing similar to what will be worn during activity.
- Back Height: Measured from the seat base to the top of the chair back. Depends on how much upper back support is needed, and also affects freedom for the upper body to rotate. This is often very different for a sports chair compared to an everyday chair. Athletes with less trunk function may also want the backrest angled and/or the upholstery sagged.
- Rear Seat to Floor: Measurement from the ground to the rear seat edge. Relative to the front seat-to-floor dimension., this determines the rearward slope (“dump” or “squeeze”) of the seat.
- Front Seat to Floor: Measure the leg from the back of the knee to the sole of the foot. Then subtract the thickness of the cushion when it is compressed. Next, add a minimum of two inches for footrest clearance. This will set the maximum chair height, not to exceed 21” or 53 cm.
- Wheel Camber: Angle of the wheel relative to the vertical. More camber improves stability and agility, but also limits ability to pass through narrow spaces. A typical daily chair uses three degress of camber. Chairs with large degrees of camber will be difficult to maneuver through passages that meet accessibility standards.
Program chairs should have an adjustable height and angle backrest
- Height should be set to allow for support while maximizing functional ability
- More function equals lower backrest
- Angle should be set for player comfort
- Less function equals Angle > 90 Degrees
Upholstery should be adjustable to allow for tension adjustments.
- The sport cushion gives wheelchair users pressure relief, reduces shearing, and increases ventilation that allows for true heat and moisture control
- Program chairs need to have cushions cleaned and maintained on a regular basis
- There are cushion height limitations in wheelchair basketball
- The height of the seat rail must be no more than 21 inches. Measurement must be made from ground or court to the top of the seat rail bar (highest point) with player in the chair