This is an excerpt from Physical Activities In the Wheelchair and Out by E. Ann Davis.
Personalizing participation involves using the tools of space, equipment, and skill in unique ways that meet the abilities of each person. Each of these tools plays a vital role in success, and none are an end in themselves. They are all a means to an end and provide the key to successful participation.
Space requirements in an activity depend on range of motion, ability to impart force, speed of movement, and ability to understand boundaries. Here are some general guidelines for using space to adapt activities:
- Clearly mark activity areas to define boundaries and participation requirements within the space.
- Evaluate the spatial needs of each person. Some participants may need to be closer to activity components. Some may need to travel shorter distances. Some may need items to be higher or placed closer to the ground.
- Decrease the overall activity space when necessary to facilitate successful participation. Use a smaller court, a lower net, a smaller circle, or closer bases.
- During initial trials of an activity, err on the side of less space rather than more. Distances can be modified for the group and per individual as needed.
- Placement of the chair in relation to the activity affects the ability to perform.
- Adjust the angle of the chair and its proximity to equipment and supports for each person.
- Some activities may work better with the wheelchair in an upright position, others with the chair tilted back.
- Chairs may need to be turned sideways to facilitate use of a dominant side of the body.
- In some types of activities, chairs may need to be touching to encourage successful participation.
- Position chairs nearer to or farther from light sources, sounds, other participants, and equipment to accommodate individual needs.
It's important to select the right equipment for each person. Like clothing, equipment can be too big, too small, too heavy, or too light for the conditions. Whether participants will be able to use equipment that is of standard size and weight will depend on the disability. Equipment is a means to an end. Adapt and substitute in order to reach those ends.
Within the range of standard equipment items, there are many potential adjustments that can be made:
- An activity that uses a ball can use a basketball, volleyball, playground ball, semi-inflated ball, slow-moving ball, oversized ball, heavy ball, light ball, or even a balloon.
- Hanging a ball eliminates the need to chase and retrieve. Hang balls from the ceiling, basketball hoops, or chin-up bars.
- For two-hand throws, use a ball that can be slightly compressed to help with grip.
- Punchballs (purchased in the party supply area of stores) or balloons are slower moving, lighter, and easier to track, and they move easily with minimal force applied. They are a good option when range of motion is an issue.
- Less air in a ball makes for better grip, less bounce, and a shorter distance traveled.
- In activities that use an implement for striking, any of the following will work: a paddle, a bat, a dowel rod, a paper towel tube, a rhythm stick, one's own hand, one's hand with a puppet on it, or a plastic bowling pin.
- A thin bat or dowel rod can be easier to grasp.
- A fat bat and a large ball give the greatest potential contact area.
- A paddle or short bat is easier to move in the desired direction.
- A racket provides a large surface area for striking.
- Support equipment for striking, such as batting tees and balls suspended by rope or string, should be placed in the way that best works for each person. Distance, height, and placement in relation to the chair need to be considered. Some participants will be more successful with supports placed in front of them and some with the supports placed to the side. Experiment to see what works best.
Equipment choices are a part of the process of individualizing participation. The same equipment does not have to be used for each player even though the activity or game is the same for all.
The importance of developing methods that increase independent participation in physical activities cannot be stressed enough. In instances where there is limited mobility, it becomes imperative to structure techniques to meet the immediate capabilities of the participant. To learn by doing is to experience and organize firsthand single or sequential movements. Skill is acquired in many ways. Find these ways, often through trial and error, and assist the participant in building a repertoire of activities that can be done individually or with others. As competence is established, technique can become more focused and refined. Additional time, many repetitions, and assistance, provided as needed, lead to greater participation ability. Begin with what is and work toward what could be. Performance skill is another tool, a means to an end. And the end is always to cultivate the most independent participation possible for each person.
Consider the following general guidelines for modifying skill execution:
- Assess what movement is possible, right down to eye blinks, head nods, and smiles.
- Demonstrate first, and then offer physical assistance.
- Physical assistance is a means to an end, a learning tool. It is not a participation method. Every time there is physical assistance, there should be give and take between the participant and the person providing the assistance. In cases of severe disability, having the opportunity to indicate readiness for play by facial expression, eye contact, or sound may be the only independent participation possible.
- Break the action into simple steps and verbalize what body parts are moving as well as how they are moving.
- Simplify skills by providing cue words for each major step in the action. For example, for the overhand throw, say, “Up. Throw.” Use the fewest words that make sense to cue the action.
- Position the wheelchair to facilitate performance of the skill.
- In body awareness activities, looking at, pointing to, or moving a part are all acceptable ways of indicating awareness.
- Performance of a skill after a period of practice compared to the initial performance of the skill may show only small, if any, variation. Over time the ability to perform an action will improve, but the performance of a skill will always be individual.
- Gradations in movement components such as speed, force, and direction before and after practice may be minimal. Investigate these components individually, finding the best way for a participant to impart force, increase speed, or control direction (overhand, underhand, sidearm, and so on).
- When demonstrating an action, use a lot of space. Exaggerated movements are more visible and show smaller components more easily. Move slowly when demonstrating.
Use combinations of space, equipment, and skill execution that work for the individual participant. Finding ways for each person to experience success requires patience. It also entails letting go of standard rules for skill execution and, instead, being creative. Look at the function of the skill first. How can a person meet the function of the skill when the execution of the standard form is not within current abilities? To paraphrase William James, “If it works, it's true.”
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