The definition of disability and disabled people depends on the model used. The most widely used model in the health system is the “medical model”. It assumes disability as an individual mental or physical impairment that is independent of environmental conditions. In contrast, the “social model” defines disability as a social response to a person’s deviant mental or physical characteristics. According to this definition, disability arises in interaction with other persons or the environment. In addition, people with disabilities often get stuck in their patient role and do not perceive themselves as capable of acting or are perceived as such by others.
As part of my PhD dissertation, I have developed an innovative concept that combines nature, sport and physiotherapy to help people with (mainly) physical disabilities to be perceived by their environment and themselves as a capable, self-determined person rather than as a disabled person. This new therapeutic approach of playful-sport-exercise therapy is based on physiotherapeutic theories and concepts on the one hand, and sports pedagogics on the other hand, and was practically tested and evaluated using sailing as an example. Sailing was chosen because physical disabilities can be balanced by boat adaptions and tactical moves whereby even severely disabled people gain the ability to act and can experience nature, as well as handle it.
The intervention consists of three elements, the examination, the additional content and the activity itself. The examination is similar to a classical physiotherapeutic examination with the difference that the focus is on the abilities and not on the limitations. Additional contents are, for example, getting in and out of the boat or tying knots when rigging the boat. In the preparation, just as in the sailing itself, care is taken to ensure that participants make the best possible use of all available features and practice them. For example, a participant with hemiplegia is assisted in using the more affected hand, if only to fix the knotted rope. When sailing, participants are instructed by radio and, of course, always wear life jackets; in addition, a safety boat is always ready for use. The Physiosail therapists are specially trained physiotherapists or occupational therapists who also have good sailing skills.
Prof. Dr. Christina Groll
HS Gesundheit Bochum, University of Applied Sciences
Christina Groll is a professor of physiotherapy at the Hochschule für Gesundheit, Bochum, Germany, and founder of physiosail. For more than ten years she also supported the Paralympic sailing team. In addition to sailing, she is interested in a critical view of current physiotherapy and a more person-centred development of the profession.
The experiences and also the results of the mostly qualitative research show complex changes, for example, in terms of self-perception and perception of others, as well as self-esteem and empowerment. Through their sailing activities, the participants were able to leave the patient role caused by the disability and change into the identity of a sporty active sailor. In addition, participants rated and reported an increased use of the affected limb or trunk functions, presumably because they had to use all available resources when sailing.
An important aspect was the influence of nature, as wind and weather act as co-therapists. For example, the physiosail therapists can influence how strong the physical strain is through the size of the sail. But nature always provides variety in the training load. Besides, nature and the boat always give the sailor feedback about his activity first – not the therapist.
Physiotherapy does not have to take place in the treatment room; nature, sports and leisure activities offer the same – or even better – opportunities to support patients in their development into self-determined people. However, this only works if they do not experience barriers, but have a sense of achievement – and we can make this possible through professional therapeutic support. A quote from a participant sums up the potential of nature well:
“When you were in the boat and learned to steer it, you felt you could handle nature. It’s often a patient problem that you think you can’t handle everything anymore. You didn’t have that at all when you were sailing.”
You can find more information about physiosail here.
References
Groll, C. (2010). physiosail: Segelnbasierte Physiotherapie zur Verbesserung der Lebensqualität von Patientinnen und Patienten nach Schlaganfall. Der Andere Verlag.
Groll, C. (2018a). Kompetenzbildung bei Menschen mit Behinderung: Probleme und Perspektiven spielerisch-sportlicher Bewegungstherapie im Schnittfeld von Physiotherapie und Sportpädagogik (1.). Schneider Verlag Gmbh.
Groll, C. (2018b). Spielerisch-sportliche Bewegungstherapie—Eine Ergänzung zur Bobath-Therapie?! Bewegung Und Entwicklung, 41, 40–43.
Dunn, D. S., & Burcaw, S. (2013). Disability identity: Exploring narrative accounts of disability. Rehabilitation Psychology, 58(2), 148–157.
Groll, C. (2010). physiosail: Segelnbasierte Physiotherapie zur Verbesserung der Lebensqualität von Patientinnen und Patienten nach Schlaganfall. Der Andere Verlag.
Groll, C. (2018a). Kompetenzbildung bei Menschen mit Behinderung: Probleme und Perspektiven spielerisch-sportlicher Bewegungstherapie im Schnittfeld von Physiotherapie und Sportpädagogik (1.). Schneider Verlag Gmbh.
Groll, C. (2018b). Spielerisch-sportliche Bewegungstherapie—Eine Ergänzung zur Bobath-Therapie?! Bewegung Und Entwicklung, 41, 40–43.
Kastl, J. M. (2010). Einführung in die Soziologie der Behinderung. VS, Verl. für Sozialwiss.
Pack, S., Kelly, S., & Arvinen-Barrow, M. (2016). ‘I think I became a swimmer rather than just someone with a disability swimming up and down:’ paralympic athletes perceptions of self and identity development. Disability and Rehabilitation, 1–8.
Perrier, M.-J., Shirazipour, C. H., & Latimer-Cheung, A. E. (2015). Sport participation among individuals with acquired physical disabilities: Group differences on demographic, disability, and Health Action Process Approach constructs. Disability and Health Journal, 8(2), 216–222. Beaudry, J-S. (2016). Beyond (models of) disability? Journal of Medicine and Philosophy, 41:210–28.