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Psychological aspects of wheelchair sport

This is an excerpt from Wheelchair Sport by Vicky Goosey-Tolfrey.

by David Shearer and Elizabeth Bressan

I was travelling with a wheelchair basketball team from the UK to the USA for an international tournament. Upon arriving at the airport, I went to check in with one of the athletes who was in his wheelchair. The check-in assistant proceeded to direct a torrent of questions at me. “Can he move through the airport without assistance? Will he need assistance to get onto the aircraft? Has anyone interfered with his bags since he packed them?” The athlete and I looked at each other in disbelief! Did she think he could not answer these questions himself? In my head I began to compose a response, but I was too slow. The athlete provided her with an energetic response aimed at her re-education about his functional capacity. Her red face showed that the desired effect was achieved. Her assumption that people who use wheelchairs are generally incapable was shattered. I doubt that she ever made the same mistake again.

David Shearer

Many people find it difficult to relate to someone who has a physical disability, often because they have not had any personal interaction with anyone with a disability. For example, they might be unsure what to expect from a person who has a mobility impairment and uses a wheelchair because they have never spent any time with wheelchair users. This lack of understanding can create additional challenges for people with disabilities. If society responded more adequately to people who have impairments, they would not experience nearly as many challenges and limitations (LoBianco & Shephard-Jones, 2007). Consider office workers who happen to use wheelchairs. Provided that there is only one level or there are ramps or elevators between levels, they may need no assistance whatsoever in the workplace. In other words, in an adapted work environment, they do not have a disability.

In wheelchair sport, the rules have been designed to ensure that people who have a variety of mobility impairments can play physically demanding and competitive sports in their wheelchairs. They provide adapted sport environments that encourage wheelchair users to become wheelchair athletes. The aim of this chapter is not to convince practitioners that wheelchair athletes deserve equal opportunities to participate in sport. Instead, our goal is to provide practitioners (e.g., coaches, sport science, and sport medicine support staff) with both general and specific psychological considerations for interacting and working with athletes with disabilities.

Getting Involved in Wheelchair Sport

Previous reviews that have compared working with athletes with physical disabilities to working with nondisabled athletes have highlighted more similarities than differences (Hanrahan, 1998, 2005; Martin, 1999). Whether working with a team sport or an individual sport, all practitioners must be prepared to adapt training methods, practice schedules, and communication styles in order to arrive at an optimal approach. This is true when working with any athlete, not just wheelchair athletes. By adopting this professional approach, practitioners will look at all wheelchair athletes as individuals. Although one athlete may have an amputation, another SCI, and another a mobility impairment, these physical disabilities will not be the point of departure when working with them. If practitioners' initial interactions with wheelchair athletes follow the same protocols as their interactions with all other athletes, they are likely to build strong rapport that will enhance the support that they can provide.

Who Participates in Wheelchair Sport?

From a clinical perspective, people who are eligible to participate in wheelchair sport at the Paralympic level have a variety of physical disabilities, all of which present serious disadvantages in the mobility aspects of sport participation. For example, a person with a below-knee amputation will be at a substantial disadvantage when playing basketball while wearing a prosthetic leg but will be able to participate without any disadvantage in wheelchair basketball.

It can be important to know whether a disability is congenital (present since birth) or acquired (caused by an accident or medical incident). Someone with a congenital disability has never experienced the sudden loss of physical mobility that has changed the life of a person who now uses a wheelchair as a result of paraplegia caused by an accident. On the other hand, the person with a congenital disability may have experienced a lifetime of discrimination. From a practical perspective, the practitioner's commitment to getting to know each athlete as an individual will help the practitioner develop an understanding of how the athlete feels. The realization that each athlete may feel differently about his impairment and the notion of disability will help the practitioner establish effective channels of communication.

Wheelchair athletes strive for victory and take pride in their achievements just as any other athletes do.

Photo courtesy of ES Bressan.

When working with wheelchair athletes, remember that in addition to the normal competitive pressures experienced by all athletes, those who use wheelchairs face a number of unique challenges. A wheelchair athlete will encounter disadvantages in nonadapted environments. For example, a gymnasium without an adapted entrance (e.g., a ramp) creates a barrier for fitness training for athletes who use wheelchairs for all their mobility needs, such as someone whose impairment is tetraplegia.

There are other kinds of barriers that present wheelchair athletes with challenges not usually experienced by nondisabled athletes. Researchers have found that elite wheelchair basketball players suffer unique stressors not experienced by nondisabled players (Campbell & Jones, 2002a, 2002b), including worries associated with travelling (e.g., going to the toilet on planes, handling luggage) and a lack of understanding from the general public (e.g., airline staff, support staff). In addition to these general concerns, there may also be sport-specific stressors. For example, research has shown that wheelchair racers experience greater stress about the condition of road surfaces compared with nondisabled racers (Martin, 2005). In our experience, knowledge of the challenges that athletes face is best gained through open and honest communication with them. This knowledge can be enhanced by observing athletes in and out of sporting contexts and noting the challenges faced and the manner in which the person copes with those challenges.

Not all wheelchair athletes use wheelchairs for their day-to-day mobility. Athletes with leg amputations and some athletes with SCI or with cerebral palsy are able to walk. They are wheelchair athletes because they play competitive sport in wheelchairs. There are also people who play wheelchair sport who do not have any mobility impairment at all. They choose to play wheelchair sport based on an inclusive model for recreation or competition. They also may be motivated by a shortage of athletes with mobility impairments needed to form a team. However, athletes without mobility impairments do not meet minimum eligibility requirements for participation in Paralympic wheelchair sport and are not included in our presentation.

Familiarization With Wheelchair Sport

Beginner and elite wheelchair athletes want support from people who understand their sport. This requires familiarity with their sport. Sport familiarization is a continuous process, and the longer practitioners remain involved in wheelchair sport, the more sophisticated their understanding of how they can contribute.

The simplest way to become familiar with any wheelchair sport is to become immersed in the sport and actively observe the athletes in training and competition. Actively observing is more than just watching; it entails observing with specific objectives. For example, before attending a competition, practitioners could identify specific aspects of the sport on which they intend to focus, such as team tactics in wheelchair basketball or the biomechanics of serving technique and ground strokes in wheelchair tennis.

Often, observation alone is not enough. Using the previous examples, a coach may notice that one basketball team frequently uses the fast break after winning a defensive rebound whereas the other team tends to slow the game down when they get possession in a similar situation. Similarly, one wheelchair tennis player may hit the forehand from a more full-on position than another. Asking questions of people who have specialist knowledge is invaluable in understanding any wheelchair sport. This might include having conversations with existing coaching staff but more importantly speaking with the athletes themselves. Athletes generally enjoy talking about their sport. These conversations will also provide an opportunity to become familiar with the athletes as well as their sport.

You may also consider attempting the sport yourself. For example, a physiotherapist and a sport psychologist for a wheelchair basketball team tried playing one-on-one after the team had finished practice. The physiotherapist thought that this gave him a better understanding of the forces that the athletes' muscles were subjected to and the potential injuries that might occur, and the sport psychologist believed he had a better grasp of the attentional demands of the game. In contrast, the coach of this same team, who was an accomplished basketball coach but was new to wheelchair basketball, decided not to try playing the game. His reasoning was that because his wheelchair skills were poor, he would not have a realistic experience and might unconsciously lower his expectations for the players. For him, sport familiarization did not include actual participation.

In some instances it may be useful to experiment firsthand how athletes' lives are affected by their disability. Hanrahan (1998) suggested trying to complete simple tasks such as getting off and on a chair without the use of leg muscles, a daily ritual for an athlete with paraplegia. It might be helpful to take a trip using a wheelchair to increase awareness of the barriers that wheelchair athletes face on a daily basis. However, the knowledge gained by such exercises should be used for personal insight only. Some athletes may consider such efforts patronizing, so practitioners should not try to use their experiences as a basis for understanding what their lives are like. If you would like to know what any athlete is thinking or feeling, the best advice is to ask her.

Sport-specific knowledge is critical. Learning the rules of the sport as well as the system of athlete classification is central to understanding how the sport is played and how competitions are managed. However, given the various support roles when working with wheelchair athletes, there is some variation in the knowledge required. In some roles, such as coach, sport-specific knowledge must become more and more sophisticated. For the physiotherapist or sport psychologist, developing a good understanding of the sport may be sufficient. Both the coach and the sport psychologist will use an understanding of the areas presented in the next two sections in order to help wheelchair athletes develop their sport commitment and the psychological aspects of their sport.

This is an excerpt from Wheelchair Sport.

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