reSpOrT GUiDELinES U d E I P S r - European Commission

re SpOrT GUiDE Li nES

European ReSport Guidelines

For implementation

Of ReSport Activities

European sports network

for rehabilitation of persons

with disabilities

reSpOrT GUiDELinESU d EI

PS r


PS r

Maribor 2019

European ReSport Guidelines

For implementation

Of ReSport Activities



with disabilities


PS r

EUROPEAN RESPORT GUIDELINES FOR IMPLEMENTATION OF RESPORT ACTIVITIES

ReSport Guidelines

European ReSport Guidelines for implementation of ReSport Activities

Jasna Vešligaj Damiš, Yoana Filipic, Vladimir Jaćević, Ladislav Mesarič, Zvonka Novak, Valentina

Bolšec, Danijela Majcenovič Cipot, Zsuzsanna Kovács, Zsuzsana Antal, Dr Mohammed Mammad, Mireille

Boucher, Nihat Yıldız, Mehmet Afşin Güven, Gökhan Bahçecik, Melik Bingöl, Eduardo Borges Pereira,

Raúl Candido, Carlota Cunha, Michele Lepori, Alessandro Munarini, Silvia Noci, Paolo Zarzana, Ilona

Koval Grubišić, Michael Lamont, Fiona Mc Cabe, Treasa Rice.

Editor and foreword: Jasna Vešligaj Damiš

Proof reading: Brain Injury Matters

Technical editor, design and illustrations: Marko Damiš

Dtp: Marko Damiš & Kostja Bras

Publisher: Center Naprej, Maribor

centre for persons with acquired brain injury

Maribor 2019 www.resport.si

1st edition - 125 copies

Guidelines were published with the support of the Erasmus+ programme of the European Union.

The authors take sole responsibility for the content. The copyright is owned by partners and authors

in the project. Copying and reproduction without written permission is prohibited and is punishable

under the Copyright Act.

CIP - Kataložni zapis o publikaciji

Narodna in univerzitetna knjižnica, Ljubljana

796.034-056

RESPORT guidelines : European Resport guidelines

for implementation of Resport activities / [Jasna

Vešligaj Damiš ... [et al.] ; editor and foreword

Jasna Vešligaj Damiš ; illustrations Marko Damiš]. -

1st ed. - Maribor : Center Naprej, 2019

ISBN 978-961-290-436-4

1. Vešligaj Damiš, Jasna

COBISS.SI-ID 301584896



with disabilities

1. INTRODUCTION 9

FOREWORD 11

PARTNERS IN THE EU PROJECT ERASMUS + SPORT “EUROPEAN SPORTS

NETWORK FOR REHABILITATION OF PERSONS WITH DISABILITIES – RESPORT” 17

AUTHORS OF RESPORT GUIDELINES 18

1.1. TERMINOLOGY IN THE GUIDELINES 22

1.2. ADAPTED PHYSICAL ACTIVITY 24

1.3. DECLARATION ON THE SPECIFIC CHARACTERISTICS OF 26

SPORT AND ITS SOCIAL FUNCTION IN EUROPE (NICE 2000)

2. THE ROLE OF ORGANIZATIONS IN THE PROCESS OF INCLUSION 29

2.1. EXCLUSION, SEGREGATION, INTEGRATION AND INCLUSION 30

2.2. EFFECTIVE IMPLEMENTATION OF INCLUSION FOR VOLUNTEERS 32

2.3. RAISING AWARENESS OF INCLUSION 35

2.4. THE ROLE OF RESPORT PROJECT PARTNERS ORGANIZATIONS IN THE PROCESS OF INCLUSION 37

2.4.1. THE ROLE OF CENTER NAPREJ IN THE PROCESS OF COMMUNITY INCLUSION OF 37

PERSONS WITH ACQUIRED BRAIN INJURY

2.4.2. CENTRO SPORTIVO ITALIANO 41

2.4.3. RIJEKA DISABILITY SPORTS ASSOCIATION - THE ROLE OF ORGANIZATION 42

IN THE PROCESS OF INCLUSION

2.4.4. THE ROLE OF FPDD IN THE PROCESS OF INCLUSION 44

2.4.5. THE ROLE OF BRAIN INJURY MATTERS IN THE PROCESS OF COMMUNITY 44

INCLUSION OF PERSONS WITH ACQUIRED BRAIN INJURY

2.4.6. KEÇIÖREN MUNICIPALITY AND ITS ROLE IN THE PROCESS OF INCLUSION 45

2.4.7. THE ROLE OF HUMAN PROFESS NON-PROFIT LTD. IN THE 46

PROCESS OF INCLUSION OF PEOPLE WITH DISABILITIES

2.4.8. THE ROLE OF CIF FRANCE IN THE PROCESS OF INCLUSION 47

3. DISABILITY AND HEALTH 49

3.1. DEFINITIONS OF DISABILITY 50

3.2. CLASSIFICATION OF DISABILITY 52

3.3. HEALTH CONCERNS 55

3.3.1. THE HEALTH OF PEOPLE WITH DISABILITIES 55

3.3.2. MENTAL HEALTH 56

3.3.3. DISABILITY AND OBESITY 58

3.3.4. HARMFUL HABITS 59

3.3.5. 21ST CENTURY - VIDEO GAMES OR TRADITIONAL SPORT DISCIPLINES 62

3.3.6. DOPING IN THE SPORT FOR PERSONS WITH DISABILITY 65

4. BENEFITS OF PHYSICAL ACTIVITY 69

4.1. BENEFITS FOR THE PSYCHOLOGICAL AND SOCIAL FUNCTIONING 70

4.2. SPORTS AND PHYSICAL ACTIVITY AS REHABILITATION 76

ConTEnTS

EUROPEAN RESPORT GUIDELINES FOR IMPLEMENTATION OF RESPORT ACTIVITIES

5. PLANNING AN ADAPTIVE PHYSICAL ACTIVITY 87

5.1. HOW TO PLAN ADAPTIVE PHYSICAL ACTIVITY 88

5.2. COMPETITION IN SPORTS 93

5.3. RISKS IN ADAPTED PHYSICAL ACTIVITY 98

5.4. THE ROLE OF ADAPTED PHYSICAL ACTIVITY EDUCATION 104

5.4.1. CHANGING TRADITIONAL ATTITUDES, BELIEFS AND ASSUMPTIONS 104

5.4.2. BUILDING SAFE RELATIONSHIPS 106

5.4.3. PSYCHOLOGICAL PREPARATION OF ATHLETES WITH DISABILITIES AND CHALLENGES WE FACE 108

5.4.4. PHYSICAL ACTIVITY RECOMMENDATIONS 116

5.4.5. CHALLENGES FOR FACILITATORS AND SERVICE USERS 118

5.4.6. EQUIPMENT AND TECHNOLOGY 120

6. APPLICATION OF ADAPTED PHYSICAL ACTIVITY PROGRAMMES 125

6.1. SWIMMING 126

6.2. NORDIC WALKING AND GYMSTICK - GNW PROGRAM 129

6.3. STAND UP PADDLE BOARDING (SUP) AS A NEW FORM 134

OF REHABILITATION OF INDIVIDUALS WITH ACQUIRED BRAIN INJURY (ABI)

6.4. SLACKLINING OR WALKING ON FLAT WEBBING 141

6.5. CROSSBOCCIA 146

6.6. SKIING 150

6.7. FOOTGOLF 155

6.8. SNOWSHOEING 158

6.9. NETBALL 162

6.10. SPORT ORIENTATION 165

6.11. TABLE TENNIS 169

6.12. CHEERLEADING 172

7. EVALUATION OF SPORT PROGRAMMES 177

7.1. THE PURPOSE OF MONITORING AND EVALUATING SPORTS PROGRAMMES 179

7.2. THE SPORT FOR DEVELOPMENT COLLATION OUTCOMES MODEL 182

7.3. SPECIFIC OUTCOME MEASURES 186

8. LONGEVITY AND QUALITY OF LIFE 191

8.1. REGULAR PHYSICAL ACTIVITY 195

8.2. COMMUNITY ACTIVE LIVING PROGRAMMES 199

inTRo DUc tIon

EUROPEAN RESPORT GUIDELINES FOR IMPLEMENTATION OF RESPORT ACTIVITIES 11

ForewOrD

Sport represents a great part of human interest and life. His-

torically sport activities and other similar activities have

attracted huge interest since ancient times. Current evidence

can be traced back to 30,000 years as examples of paintings in

caves originating from prehistoric periods.

Sport activities in the form of rehabilitation originate from

the Greek, Roman, and Chinese empires. Then they already knew

that physical activity was an excellent media for rehabilita-

tion, since they also dealt with the physical, mental, emotion-

al, social and spiritual elements of a person.

The basic goal of physical activity is to optimize the psycho-

somatic condition of the individual, make effective use of the

leisure time, preventive health care procedures and improve

health, well-being and recovery.

Sport is an area of human activity, which is important for all

citizens of the European Union with an exceptional potential

for unifying people. It concerns everyone, regardless of age,

social status, disability, race or gender. However, we face the

fact that people with disabilities are physically less active

than their peers, and consequently 38% are overweight (53% more

than people without disability). Physical inactivity is the

fourth most common risk factor for premature mortality. At the

same time, we must be aware that every sixth person in the Eu-

ropean Union suffers from a mild or severe form of disability,

which means approximately 80 million individuals. Many European

countries are aware of this problem and act accordingly.

Sports activities represent an effective method for rehabil-

itation of persons with disabilities. Taking part in sporting

activities helps people with disabilities to achieve greater

quality of life and greater social inclusion. For this pur-

pose, they need to be able to participate in sports events and

appropriate sports programs, where they can engage equally and

access sports and recreational areas. Sports activities must

also become an integral part of the rehabilitation of people

with disabilities, regardless of the type or level of their

disability, age and level of physical fitness.

These facts are the reason that 8 partners from 8 European

countries gathered within the framework of the Erasmus + Sport

with a project entitled “European sports network for rehabili-

tation of persons with disabilities “ReSport”, connecting many

organizations, professionals, people with disabilities and

their relatives, volunteers and all who have a common goal of

11

EUROPEAN RESPORT GUIDELINES FOR IMPLEMENTATION OF RESPORT ACTIVITIES EUROPEAN RESPORT GUIDELINES FOR IMPLEMENTATION OF RESPORT ACTIVITIES 1312

equal opportunities. We decided to follow this goal and join in

the preparation of comprehensive sports solutions in the field

of physical activities with rehabilitation effects for persons

with disabilities. Therefore, after a long planning process and

discussion, we created and published European ReSport Guide-

lines for the implementation of “ReSport Activities”.

As project partners we are aware of the importance of ensur-

ing equal access and equal opportunities for all and promoting

healthy physical activity for all, especially for people with

disabilities. It is believed that patterns of physical activi-

ty are fundamental to lifelong physical activity and health in

the future and that they represent an important part of every

individual’s life.

The Guidelines is a result of the team work of the interdis-

ciplinary team of all partners in the project. The members of

the working group have made an enormous contribution in terms

of time, effort, knowledge and experience in shaping the guide-

lines, and this is why we are extremely grateful to the whole

team.

The Guidelines contain a number of directions and examples of

good practice that will help all readers - employees, thera-

pists, trainers, people with disabilities, their relatives and

interested members of society - in deciding and preparing pro-

grams of adaptive and integrated sports activities for people

with disabilities. Following the guidelines allow us to take

appropriate actions and monitor users in various adapted sports

activities, timely identification and prevent possible compli-

cations, and thus carry out sports and recreational programs

smoothly.

According to the data of international and national health

and sports organizations, physical activity is very important

factor in maintaining health. Indeed, persons with disabili-

ties, representing almost 15% of the world’s population, rarely

participate in sport and physical activity.

At the same time, we understand that, like everyone else, they

have to fight more and more for their rights, and always look

for optimal solutions for rightful development. Based on the

Convention on the Rights of Persons with Disabilities adopted

in 2006, the signatory countries of the Convention committed to

ensure appropriate conditions for the development of sports for

persons with disabilities, especially with regards to sports

facilities, financing, school system and education, both at

state level and in the local community, and introduce appro-

priate actions to enable persons with disabilities, as well as

others, to participate in recreational, leisure and sporting

activities.

Nevertheless, we still notice that there are too few existing

programs and organizations that allow them to exercise prop-

erly. It is of utmost importance that we encourage and raise

awareness both among state and experts at all levels about the

need to increase the chances of including people with disabil-

ities in various sports and recreational programs. “Re Sport”

Guidelines are designed to promote awareness of the importance

of the physical activity of people with disabilities, to trans-

fer knowledge at European level and to inspire as many of them

as possible to be active in their life.

Sport and recreation have many other positive outcomes, and

one of these is certainly connecting people with and without

disabilities. It is an excellent opportunity for integration,

overcoming prejudices and creating a tolerant society. And the

authors of the ReSport Guidelines hope that it will serve this

purpose!

JASNA VEŠLIGAJ DAMIŠ

PROJECT MANAGER


Photo: Center Naprej, Expert meeting, March 2017, Planica Slovenija


UK

FR

IT

SI

HR

HU

TRPT

SI - PARTNER 1 – coordinator and lead partner

CENTER NAPREJ Maribor

Slovenia

IT - PARTNER 2

CSI - Centro sportivo Italiano

Italy

HR - PARTNER 3

Rijeka Disability Sport Center Association

Croatia

PT - PARTNER 4

Federação Portuguesa de Desporto para pessoas

com Deficiência

Portugal

UK - PARTNER 5

Brain Injury Matters

United Kingdom

TR - PARTNER 6

Keçiören Municipality

Turkey

HU - PARTNER 7

Human Profess Közhasznú Nonprofit Kft

Hungary

FR - PARTNER 8

CIF France

France

Figure 1: Partners in the EU project Erasmus + Sport “European sports network for rehabilitation

of persons with disabilities – ReSport”.

Partners in the EU project Erasmus + Sport “European sports network

for rehabilitation of persons with disabilities – ReSport”.


Jasna Vešligaj Damiš, MA Psychology and licensed psychodrama

psychotherapist with extensive experience as Director of

Center Naprej providing long-term rehabilitation of persons

with acquired brain injury (ABI). She has completed the

course of dr. Sarah McKay in neuroscience and brain health:

The Neuroscience Academy Certificate of Completion in Applied

Neuroscience and Brain Health. She is also the project

manager of ReSport project. Leader of several rehabilitation

sports summer and winter events for people with ABI. She

offers psychological preparation for professional athletes

at international and world competitions in athletics - Ath-

letics Club Slovenska Bistrica, Jitai Maribor. She developed

a number of training programs for long-term ABI caregivers.

She is also an expert in management and co-ordination of EU

projects, national projects, realization of good practices,

networking with schools, companies and institutions and

dissemination of the project products and outcomes.

Yoana Filipic, MA Psychology and DBT skills coach currently

works at Center Naprej providing long-term psychological

rehabilitation of persons with acquired brain injury (ABI).

She has facilitated and provided support in the process of

crisis intervention of persons with disabilities and persons

with psychiatric disorders. Her professional interests are

focused in the area of counseling, goal setting and motiva-

tion of persons with disabilities and exploring challenges

facilitators of adapted physical activity programs face.

Vladimir Jaćević, BA Physiotherapy is certified for Bobath

problem-solving neuro-developmental approach and Cyriax

method. He currently works at Center Naprej providing long-

term rehabilitation of persons with acquired brain injury

(ABI). He facilitates a number of adapted sports programs.

His professional interests include assessment and treatment

of individuals with cerebral palsy, stroke and brain injury

and other allied neurological conditions, and incorporating

various techniques in the process of treatment.

Ladislav Mesarič, MSc Physical education, Sport and Kinesio-

therapy, Olympic coach in athletics, strength and condition-

ing coach of Taekwondo federation of Slovenia. He has more

than thirty years of experience coaching and training numer-

ous successful sportsmen, representatives of various sports.

With his primary sport - athletics he has been coaching

three Olympic athletes. He is an external collaborator of

Center Naprej in the preparation and evaluation of adapted

sports programs for persons with acquired brain injury.

Zvonka Novak, MA Social Work, licensed mediator and paedi-

atric nurse. She is currently employed as Head of unit at

Center Naprej in Maribor providing long-term rehabilitation

of persons with acquired brain injury (ABI). She has worked

as a paediatric nurse at Intensive therapy in Paediatrics

Unit of University Medical Centre Maribor. She has got vast

experience in the field of social welfare, managing dislo-

cated units, leadership in numerous camps and other group

activities for people with intellectual disabilities. Zvonka

has incorporated MATP (motor activity training program) in

different activities for people with severe disorders and

she has participated in Special Olympics with them. She has

participated in the project Happy Farm (Leonardo da Vinci)

and Grundtvig (Socrates).

Valentina Bolšec, MA Psychology currently works at Center

Naprej providing long-term psychological rehabilitation of

persons with acquired brain injury (ABI). Her work is based

on providing emotional and psychological support for people

with disability. She also focuses on providing cognitive re-

habilitation and encouragement of motivation and achievement

of goals for individuals with ABI.

Danijela Majcenovič Cipot, B.A. Sociology, as sociolo-

gist passed professional examinations on a field of public

administration and welfare. She worked on various fields (Law

enforcement, Military, Social Welfare, Long-term unemploye-

ment). She is currently working as group facilitator provid-

ing long-term rehabilitation of persons with acquired brain

injury (ABI). She is also Head of unit in Murska Sobota. She

participated in many international and national conferences

as attendee and also author of papers and gave preventive

workshops to various target groups. She has experience with

various projects on national and international level.

Zsuzsanna Kovács, she is 32 years old. She graduated at

the Faculty of Economics of West Hungarian University. Her

thesis focuses on equal chances and disadvantaged social

groups. She lives with a locomotory disability; she has been

swimming and cycling since childhood. She has always been

striving to help her fellow sufferes as much as she can.

She is aware of the opportunities provided by local sport

associations. She knows the system of national para sport

organizations, she is informed about the regularly orga-

nized programs and events, and she continuously follows the

changes. Along with her job, she completed a course entitled

„Enforcement of equal treatment and development of social

awareness”, organized by Equal Treatment Authority. Cur-

rently she has been working for Human Profess Public Benefit

Nonprofit Ltd. Her task is, among others, to organize sport

activity of disabled people.

Zsuzsana Antal, she is a certified adult training manager -

teacher. She has 20 years experience in the field of social

and labour market rehabilitation of disadvantaged groups and

people living with a brain injury. In her job, she primarily

deals with the development of international training mate-

rials. She used to work in the framework of a Slovenian-Hun-

garian project on the development of sport opportunities for

disabled people. Working together with a medical and dive

master team, she took part in the adaptation of the method

of diving, so that it can become a sport that is available

for disabled people. She took part in the development of the

ABI training manual, as well as the preparation of the Study

entitled Long-term rehabilitation of people living with an

acquired brain injury.

Dr Mohammed Mammad, Born on 11/07/1965 in Oran –Algeria,

Dentist surgeon since 1988, French License 200, Magister of

French, option: Sciences of the Literary Texts 2008, Doc-

torate of French, option: Sciences of Literary Texts, Jury

in 2019, Training in Mediation and Conflict Management from

2012 to 2014 in Algeria, France and Germany, Head of the IEC

(Information - Education - Communication) unit at the Hai

El Ghoualem Public Health Establishment in Oran, Training

in Montpellier for one month in 2001 on “Teaching French

as a Foreign Language”, 4 internships (2 in Lyon and 2 in

Oran) for the development of the university manual on oral

methodology in 2010, 2017 Social Action Program CIF France

in Bourges Saint Florent sur Cher, 2018 Training ANPAA (ad-

dictology) Bourges. Dr. Mammad takes part in a weekly radio

show “Tips on Health”, Trainer, communicator and trainer

of trainers. He joined the CIF France team as an expert for

actions around people with disabilities.

Mireille BOUCHER, Born April 11, 1951 Bourges, Retired

social worker director. Training: specialized educator.

President CIF France, CIF International Association inter-

national of social workers. Deputy Mayor school affairs and

early childhood in Saint Florent sur Cher Vice President of

the Local Mission (Insertion 16-25 years people) Competence

in the field of social action and integration. Trainer for

fosters families. Expert on insertion, animation of collec-

tive actions for people with disabilities.

AUThors oF Re-SPOrt guIDelINes


Nihat Yıldız, Deputy Mayor of Keçiören Municipality. He is

responsible for Sports and Youth Department of Municipality

and Sports Centres. He temporarily serves as rapporteur in

various commissions established by the Ministry of Interior

in the budget and accounting systems of the municipalities,

State Tender and Public Procurement Legislation, Personnel

Legislation, Public Financial Management System and Public

Audit. He is lecturer in seminars and training programmes

organized by the Ministry of Interior, Turkish Municipal-

ities Union, Konya Municipal Union, Aegean Municipalities

Union, Marmara and Boğazlar Municipalities Union, Black

Sea and Mediterranean Municipalities Associations, TODAİE,

Governorships, municipalities, foundations and universities.

He is member, founder or manager in various non-governmental

organizations.

Mehmet Afşin Güven, computer engineer and biologist. He

has got experience in EU Projects, preparation of Technical

Handbook, testing reports and evaluation. He is an expert

in EU Projects for disabled people, developing skills of

young disabled people, development of vocational suitabil-

ity for disabled adults and parental training in families

of children with disabilities. He has got experience in

web site design and management, software design, testing,

data analysis and management. He is a professional computer

programmer.

Gökhan Bahçecik, manager and head of Department of Youth

and Sports. He worked on several European Union Leonardo Da

Vinci Action Programmes related to local municipalities. He

participated in various seminars, meetings, symposiums and

training programmes regarding Turkish politics and local

government.

Melik Bingöl, manager and head of IT Department. He is a

computer engineer. He has many experience with various

projects (project partner and manager of EMPATHY Project,

Parental Training in Families of Children with Disabilities

and of DEVOMDA project - Development Of Vocational Suitabil-

ity for Disabled Adults, project coordinator of Developing

Skills of Young Disabled People DESYODIP, LLP –Leonardo

– TOI. He has got experience in preparation of Training

Modules for Disabled, Preparing Technical Handbook, Country

Analysis Reports, Expert Platforms, Dissemination of Proj-

ects and Mobility Tools.

Eduardo Borges Pereira, Sports Manager.

• National Technical Director of FPDD since 2017.

• Board of Directors Chairman and Sports Director at the

municipal town hall company “Palmela Desporto, EM” (Sport

Palmela) for five years – 2011 to 2016.

• Portuguese Sports Institute Vice-President of the Board

between 2003 and 2005.

• Sports Coordinator at the municipal town hall of Palmela,

from 1996 to 2011 (except from 2003 to 2005).

Raúl Candido, Sports Technician at FPDD Portugal since 1999.

• Adapted Sport Coach.

• Work in the technical area of Disability Sports since

1991.

• Technical support to several Paralympic Missions at

Portugal team.

CUNHA, Carlota, Sports Technician at FPDD Portugal since 2015

• 2 years work experience as physical teacher for disabled

people at Ginásio Clube Português.

• Technical Officials Coordinator in Paralympic Games Rio 2016.

• Boccia International Referee.

• 2 years work experience as Personal Trainer at Health

Club Solinca Vasco da Gama.

• Goalball National Referee.

• Coach of Boccia in the Cerebral Palsy Association of

Lisbon.

• Participation as National Technical Official at the Boccia

World Cup 2011 organized by the Cerebral Palsy Interna-

tional Sports & Recreation Association (CRISRA).

Michele Lepori, CSI ReSport project handler. He has twen-

ty years of experience in the field of sports associations

and in organizing events in the field of sport for disabled

people. For 10 years he has been a provincial councilor and

a member of the Paralympic commission of the Lombardy re-

gion of CSI, where he obtained the qualification of Paralym-

pic coach. Thanks to the experience he has acquired, he has

also obtained a CONI high-level diploma.

Alessandro Munarini, CSI referente nazionale attività

disabili. He obtained his magistral diploma, and for 15

years worked as a social worker in a cooperative, providing

assistance and support to disabled people. In the 90’s he

obtained the requalification on the job, acquiring the qual-

ification of professional educator. After a break in which he

carried out various jobs (building trade and agriculture) he

returned, from 2015, to work as a professional educator in

a cooperative, always in relationship with disabled people,

both minors and adults. In terms of volunteering, it has

given rise to and developed a sports club in the municipali-

ty of Reggio Emilia; he was president of this sports company

for 30 years. Also at the level of the Sports Center, he

performed, always free of charge, various tasks: provincial

councilor, head of training, regional councilor and gener-

al manager of the committee. He is currently President and

general manager of the Reggio Emilia committee, national

representative of the Sports Center for disabled persons and

professional educators (part-time) in a cooperative with

disabled people.

Silvia Noci, CSI National Technical Commission for disabled

people. She is a federal swimming technician. He is the

director of the CO.G.IS swimming facility and coordinator

of the swimming school. Swimming instructor, water fitness,

water pilates, bike and treadmill. Specializing in water

sports for infants and disabled people, she has worked in

this sector since 1992. She collaborates with local health

authorities and schools for inclusion and self-development

projects for disabled people, through physical activity in

the water. He currently manages the AcquaInsieme project

with the Centro Toscana Toscana which involves around 25

children from 20 months to 15 years.

Paolo Zarzana, CSI national trainer, CT of Italian Nation-

al amputee soccer team. He works at the CSI of Modena with

the role of Vice President, responsible for school projects

and activities for disabled athletes. In addition, he is a

councilor of the Municipality of Formigine (Mo). Graduated

in Educational Sciences, he is the Vice CT of the Italian

Soccer Amputation Team, which he has been following since

2012. With this team he participated in a European and 2

world championship. He currently works with the CSI in the

Technical School.

Ilona Koval Grubišić, Ph.D., associate professor, master of

physiotherapy

Michael Lamont, BSc Psychology has recently moved on from

his role as Associate Psychologist with Brain Injury Matters

(NI). Michael coordinated the Youth Matters Programme pro-

viding 1:1 and group based support services to young people

(13-25 years) across Northern Ireland, who have experience

of an acquired brain injury. Michael provided psychologic

input based on the individuals needs of the young people

involved in the programme.

Fiona Mc Cabe, Brain Injury Matters Ireland.

Treasa Rice, Community Engagement Officer, Brain Injury

Matters. Treasa Rice, BSc Environmental Health, MSc Health

Promotion currently works at Brain Injuri Matters (NI) coor-

dinating youth and adult services for persons with acquired

brain injury within their local community. She has facil-

itated support groups, sports interventions and one to one

sessions within her role as community engagement officer.


1.1.TerMinoLOGY in the gUIDeLiNES

AUTHOR: JASNA VEŠLIGAJ DAMIŠ

Key words: handicapped, disability, disabled person

For the purpose of these guidelines we used the

terms person with disability and athlete with

disability. Athletes with disability are peo-

ple with a disability who engage in sports and

are able to compete in sports at elite levels.

They can also practice almost any sports and

sometimes need adapted equipment (Ferrara &

Peterson, 2000). As we realize that the language

used is very important in terms of attitudes and

beliefs we chose to emphasise the person rath-

er than the disability placing the word person

first.

We also present a table differentiating the

terms disabled and handicapped person. We did

not decide to use the term handicapped for the

reasons stated in the table on the right page.

A disability is an impairment that may be cogni-

tive, developmental, intellectual, mental, phys-

ical, sensory, or some combination of these. It

substantially affects a person’s life activities

and may be present from birth or occur during a

person’s lifetime (Tanaka & Seals, 2003).

We refer to disability as normal part of human

life and experience that can occur. However

there are many definitions and different ways of

describing the term. We have chosen the World

Health Organization (2018) definition: “Disabil-

ity is an umbrella term, covering impairments,

activity limitations, and participation restric-

tions. Impairment is a problem in body function

or structure; an activity limitation is a diffi-

culty encountered by an individual in executing

a task or action; while a participation restric-

tion is a problem experienced by an individual

in involvement in life situations. Disability is

thus not just a health problem. It is a complex

phenomenon, reflecting the interaction between

features of a person’s body and features of the

society in which he or she lives.” — World Health

Organization, Disabilities. Writing these Guide-

lines we have followed the description of WHO

as this is the definition we support and think is

the most appropriate and politically correct. It

gives a vast and correct perception of the topic

and issues explored.

Reference

Ferrara M.S. & Peterson C.L. (2000). Injuries to athletes

with disabilities: identifying injury patterns. Sports Medi-

cine; 30(2):137-43.

Tanaka, H. & Seals, D. (2003). Invited Review: Dynamic

exercise performance in Masters athletes: insight into the

effects of primary human aging on physiological functional

capacity. J Appl Physiol.; 95(5): 2152–2162. pmid: 14555676

https://en.wikipedia.org/wiki/Disability “Disabilities”.

World Health Organization. Retrieved 6.5.2018

http://www.differencebetween.info/difference-between-disabil-

ity-and-handicap. Retrieved 18.9.2018

Disability Handicap

Meaning Disability means the inabil-ity of a person to perform his/her routine actions.

Handicap means the difficulty experienced by a person in performing his/her tasks.

Core difference

Disability is being completely unable to perform a function.

Handicap is a partial disability.

Applicability Disability is mostly as-sociated with the medi-cal condition of not being able to perform a task.

Handicap could also mean a disadvan-tage imposed in a professional sport.

Variants Disabilities of various kinds such as physical, sen-sory, intellectual, men-tal, emotional, etc.

Handicap related to medical condi-tions such as being physically, mental-ly handicapped et al., and handicap in terms of sports such as golf handicap, chess handicap, tennis handicap, etc.

Diplomatic accuracy

More acceptable as com-pared to ‘handicap’.

Regarded as being offensive to peo-ple suffering from conditions of im-pairment or disability.

Table 1: Difference between Disability and Handicap (http://www.differencebetween.info/difference-between-disabili-

ty-and-handicap, 18.9.2018)


1.2.ADApted PhySIcAL AcTIvity

AUTHORS: YOANA FILIPIC, JASNA VEŠLIGAJ DAMIŠ

Key words: adapted physical activity, EUSAPA, EUFAPA

Adapted physical activity (APA) is an extremely

broad concept. Therefore, we cannot give a sin-

gle exclusive definition. Opinions and views in

this area are quite different. Greg Reid (2003)

believes that the main problem lies in the word

“adapted”. Most of us have some ideas about what

physical activity means, however the word adapt-

ed is sometimes problematic. So, an immediate

response is often: “It’s physical activity for

people with special needs.” The APA description

in terms of activity for people with disabili-

ties gives us a perspective, but this is by no

means a complete definition or more precisely a

limited view of this concept (Reid, 2003). The

development of APA for people with disabilities

has gone through various stages of implementa-

tion and overcoming difficulties, due to dif-

ferences in understanding in various paradigms

- philosophical, kinesiological, psychological,

and social. EUFAPA (European Federation of

Adapted Physical Activity) defines APA as a cross

disciplinary field of knowledge and research

directed towards identification and solution of

individual differences in physical activity. It

is a service delivery profession and an academ-

ic field of study that supports an approach that

promotes acceptance of differences among indi-

viduals, advocates improving access to an active

lifestyle and sport activities and encourages

innovation and cooperative service delivery and

empowering systems (EUFAPA, 2018). The purpose

of adapted physical activity is to promote human

health, independence, quality of life and social

inclusion. APA is an area of interdisciplinary

expertise, which includes: rehabilitation and

therapy; physical education and sport; recre-

ation, competition and recreational activities;

sport in all its dimensions (Ninor & Partyka,

2007, Mälkiä, 2002).

EUSAPA - European Standards in Adapted Physical

Activities is a project that strives to devel-

op and research adapted physical activity at a

European level. It defines three areas of adapted

physical activity - 1 - adapted physical edu-

cation, 2 - adapted sports and recreation, and

3 - adapted physical activities in rehabilita-

tion. The Finnish expert Mälkiä shares a similar

opinion and states that apart from the implemen-

tation of adapted physical activity in sport,

recreation and education, it is also important

in rehabilitation of persons with disabili-

ties or people with chronic diseases. Physical

activity is crucial part of all areas of life

- health, knowledge, social inclusion, educa-

tion and rehabilitation. Adaptation of physical

activity may also involve technical adjustments,

such as using technical adaptation, adapting

sports equipment and structural changes. For

example in adapting rules and instructions of

the game or in developing training, which means

adapting professional approaches and methods and

methods of exercise and teaching (Mälkiä, 1991).

References

EUFAPA - European Federation of Adapted Physical Activity,

http://www.eufapa.eu/index.php/apa.pdf, Retrieved 2.2.2018

EUSAPA -European Standards in Adapted Physical Activities.

http://eacea.ec.europa.eu/LLp/project_reports/documents/

erasmus/multilateral_actions_2008/eras_emhe_142271_eusapa.pdf

Retrieved on 12.3.2018

Mälkiä, E. Puolanne, M. & Palosuo, M. (1991). Special Ex-

ercise 1: Appropriate Exercise basics. Jyväskylä. Gummerus

Kirjapaino Oy.

Mälkiä, E. & Rintala, P. (2002). New Special Movement. Exer-

cise facilitation for special groups Tampere. Tammer-paino

Oy.

Ninot, G. & Partyka, M. (2007). 50 good practices for teaching

APAs, REVUE EPS n°73, p.65

Reid, G. (2003). Defining Adapted Physical Activity. In R.D.

Steadward, G.D. Wheeler, & E.J. Watkinson (Eds.), Adapted

Physical Activity (pp. 11-25).


1.3.DeclaratIOn on the spECIfic Char-acteriStics of sP•Ort aNd its s•O-Cial FUnCTion in EurOPe (NICE 2000)

AUTHORS : ZSUZSANNA KOVÁCS, ZSUZSANNA ANTAL

Key words: declaration, sport for all, protection of young sportsmen and – women, solidarity

Introduction

The European Council has noted the report on

sport submitted to it by the European Commis-

sion in Helsinki in December 1999 with a view

to safeguarding current sports structures and

maintaining the social function of sport within

the European Union.

The European Council hopes in particular that

the cohesion and ties of solidarity binding the

practice of sports at every level, fair competi-

tion and both the moral and material interests

and the physical integrity of those involved in

the practice of sport, especially minors, may be

preserved.

Sport for all - ANNEX IV (Declaration, 2018)

- DECLARATION ON THE SPECIFIC CHARACTERISTICS

OF SPORT AND ITS SOCIAL FUNCTION IN EUROPE, OF

WHICH ACCOUNT SHOULD BE TAKEN IN IMPLEMENTING

COMMON POLICIES

Sport is a human activity resting on fundamental

social, educational and cultural values. It is

a factor making for integration, involvement in

social life, tolerance, acceptance of differenc-

es and playing by the rules.

Sporting activity should be accessible to every

man and woman, with due regard for individual

aspirations and abilities, throughout the whole

gamut of organized or individual competitive or

recreational sports.

For the physically or mentally disabled, the

practice of physical and sporting activities

provides a particularly favourable opening for

the development of individual talent, rehabili-

tation, social integration and solidarity and,

as such, should be encouraged.

The Member States encourage voluntary services

in sport, by means of measures providing ap-

propriate protection for and acknowledging the

economic and social role of volunteers, with the

support, where necessary, of the Community in

the framework of its powers in this area.

1.3.1. Role of sports federations

The European Council stresses its support for

the independence of sports organizations and

their right to organize themselves through ap-

propriate associative structures. It recognizes

that, with due regard for national and Community

legislation and on the basis of a democratic

and transparent method of operation, it is the

task of sporting organizations to organize and

promote their particular sports, particularly

as regards the specific sporting rules applica-

ble and the make-up of national teams, in a way

which they think best reflects their objectives.

It notes that sports federations have a central

role in ensuring the essential solidarity be-

tween the various levels of sporting practice,

from recreational to top-level sport, which

co-exist there; they provide the possibility of

access to sports for the public at large, human

and financial support for amateur sports, promo-

tion of equal access to every level of sporting

activity for men and women alike, youth train-

ing, health protection and measures to combat

doping, acts of violence and racist or xenopho-

bic occurrences.

These social functions entail special responsi-

bilities for federations and provide the basis

for the recognition of their competence in orga-

nizing competitions.

While taking account of developments in the

world of sport, federations must continue to be

a key feature of a form of organization provid-

ing a guarantee of sporting cohesion and partic-

ipatory democracy.

1.3.2. Protection of young

sportsmen and women

The European Council underlines the benefits

of sport for young people and urges the need

for special heed to be taken, in particular by

sporting organizations, to the education and

vocational training of top young sportsmen and

women, in order that their vocational integra-

tion is not jeopardized because of their sport-

ing careers, to their psychological balance and

family ties and to their health, in particular

the prevention of doping. It appreciates the

contribution of associations and organizations

which minister to these requirements in their

training work and thus make a valuable contribu-

tion socially.

1.3.3. Economic context of

sport and solidarity

The sale of television broadcasting rights is

one of the greatest sources of income today for

certain sports. The European Council thinks that

moves to encourage the mutualisation of part of

the revenue from such sales, at the appropriate

levels, are beneficial to the principle of soli-

darity between all levels and areas of sport.

Reference

European Council – Nice, 7-10 DECEMBER 2000, Declaration on

the specific characteristics of sport and its social function

in Europe, of which account should be taken in implementing

common policies. Retrieved from:

http://www.europarl.europa.eu/summits/nice2_en.htm?textMod-

e=on, 2018.02.08

Draft declaration on the specific characteristics of sport

and its social function in Europe, of which account should be

taken in implementing common policies. Retrieved from:

http://data.consilium.europa.eu/doc/document/ST-13948-2000-

INIT/en/pdf, 2018.02.08)

Incorporating the specific characteristics of sport and its

social functions into the implementation of common policies.

Retrieved from:

http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=LEGIS-

SUM:l35007, 2018.02.08

Learning outcomes:

• Familiarise readers with the differ-

ence between exclusion, segregation,

integration and inclusion and the devel-

opment of the concepts in the society.

• Effective implementation of in-

clusion for volunteers.

• An understanding of how organizations can

raise awareness to promote inclusion.

• The benefits of volunteering for generat-

ing equal opportunities for participation.

• Familiarise readers with the role of each

partner country in the process of inclusion.

• Familiarise reader with the differ-

ent approaches and ways of imple-

menting inclusive programmes.

2. The Role of Or gani zati•Ons in the ProcESs of InCl UsiOn


2.1.ExCLusI•ON, seGre-gatIon, INtegRati•On anD inclUSIOnAUTHORS: JASNA VEŠLIGAJ DAMIŠ, YOANA FILIPIC

Key words: inclusion, integration, segregation, exclusion, disability, education, employment

The Committee of United Nations highlights the

importance of recognizing the differences be-

tween exclusion, segregation, integration and

inclusion.

Exclusion happens when people with disability

are directly or indirectly prevented from access

to education, work, and community activities.

Social exclusion is defined as the inability to

participate in the economic, cultural and so-

cial life of society. It is the denial of civil,

political rights of citizens.

Segregation is a type of organization where

people with disabilities live in separate envi-

ronments designed or used to respond to a par-

ticular or various impairment. They are divided

from others and people without disabilities.

Integration is a form of placing persons with

disabilities in already existing educational and

employment institutions, considering that people

with disabilities can adjust to the standardized

requirements of such institutions.

Inclusion is an organization of systemic re-

forming and applying changes and adaptations

in content, teaching and employment methods,

approaches, structures and strategies in edu-

cation, work-force, community living in order

to overcome barriers with a vision serving to

provide all people with disability with an equi-

table and participatory living and environment

that best corresponds to their requirements and

preferences (Convention on the Rights of Persons

with Disabilities, 2016).

Some authors also see the process of inclusion

as combining different important concepts:

1. “Presence - participating in differ-

ent settings where people without dis-

abilities can engage. These could be

classrooms, work related meetings, neigh-

bourhoods, and community events.

2. Choice – gaining different experiences they

can learn and make conclusions from, choosing

and taking part in activities they prefer.

3. Competence - being recognized for

strengths, contributing, having op-

portunities to learn more.

4. Respect and Valued Roles - being seen as a

person - as well as a person with a disabil-

ity, being valued by others, not being seen

as out of the norm or as a “curiosity.”

5. Participation - engaging with others, hav-

ing a wide variety of relationships be-

ing known and knowing others, being part

of the event--not just an observer.

6. Belonging - a very strong feeling that a

person feels when they are valued by oth-

ers, when others call just to talk or invite

him or her to go to a party or “hang out”

at the mall.” (Community Inclusion, 2011)

Reference:

Convention on the Rights of Persons with Disabilities (2016),

United Nations. Committee on the Rights of Persons with Dis-

abilities. General comment No.4.

Illinois Department of Human Services. (2011). Community

Inclusion.

EXCLUSION

INTEGRATION

SEGREGATION

INCLUSION

Figure 2: differences between exclusion, segregation, integration and inclusion (Source: http://www.sanmarcoargentano-polis.

it/ARCHIVIO/02.COMMENTI/2017/L’inclusione.htm


2.2.Effective im-plemeNTAtion Of inclusIOn fOR VOLunteers

AUTHOR: TREASA RICE

Key words: inclusion, volunteers, Raising Awareness, Barriers

Introduction

There are around 11 million disabled people in

the UK. Only two in ten disabled people in En-

gland are currently active. A lack of knowledge

and awareness of opportunities that are avail-

able to disabled people is a major factor in the

lack of disabled people participating in sports

(The Association of Paediatric Chartered Physio-

therapists, 2014).

Sport Scotland (2001) outlined that some people

were simply unaware of the existence of facil-

ities or activities that could cater for the

needs of an individuals with a disability. They

had no knowledge of sports (at any level) that

was available and that they felt they would be

able to take part in. As such, they were pre-

vented from even considering taking in sport.

Sport, as an option, had no profile in the con-

text of their life (Sport Scotland, 2001).

Women are generally less inclined than men to do

sport, and ethnic minorities, people with dis-

abilities and other socially vulnerable groups

are also under represented (EU,2014).

For people with a disability sport can play a

key role; both as regards its value for social

inclusion and for activating health-enhancing

physical activity (European Paralympic Commit-

tee, 2015).

2.2.1. Impact of volunteering

The Department for Social Development (2012)

highlighted that volunteering is at the heart of

a vibrant society where people can contribute to

social change giving their time. Volunteers are

central in delivering the many things we take for

granted such as youth activities, sports clubs,

faith based activities, arts festivals, etc.

In 2002 research for Sport England identified 5.7

million sport volunteers and the National Survey

of Volunteering estimated a similar number in

1997 (Taylor et al., 2003; Davis Smith, 1998).

The Active People Survey conducted by Sport En-

gland in 2005-06 suggested a lower figure – more

than 2.7 million (Sport England, 2006).

Sport England’s 2002 National Population Survey

estimated that volunteers contribute 1.2 billion

hours each year to sport, with a value of over

£14 billion and equivalent to 720,000 additional

full-time paid workers (Taylor et al., 2003).

Volunteering in sport has an impact on clubs,

members and players, the community, and volun-

teers themselves. Sport England notes that the

community sport sector “can make increasingly

vital contributions to the health of the nation,

community regeneration and cohesion, community

safety and educational attainment” (Taylor et

al., 2003).

2.2.2. Characteristics

of volunteering

Ibsen (1992) defined volunteering by five central

characteristics:

• Voluntary activities

The activities are undertaken free-

ly without physical force, legal coer-

cion or financial pressure, and “retiring”

from voluntary work does not threat-

en the livelihood of volunteers.

• Which are unpaid or paid with a symbolic

amount

Volunteers may only receive reimburse-

ment of costs connected to the voluntary

work and symbolic fees for their work.

• The voluntary activities must be carried out

for other people than the family

This distinguishes voluntary work from

ordinary domestic activities and the in-

formal care for family members.

• For the benefit of other people

The value that the work done by the vol-

unteers has for other people is a con-

stitutive element of volunteering.

• And have a formal character (organized or

agreed)

Volunteering can take place in a voluntary

organization, but it can also be performed

outside of the voluntary organizations as

long as it is “agreed’ upon between the

person(s) doing the voluntary work and the

person(s) benefiting from it. Ordinary helpful-

ness of a spontaneous and informal character

is, however not considered volunteering.

2.2.3. Benefits of Volunteering

Gaskin (2008) highlighted that volunteers are

the lifeblood of sport in local communities;

the presence of volunteers in clubs and groups

enables them to function successfully and to

exist at all. Volunteers keep clubs and groups

going, and provide good quality services for

members and users. The opportunities that they

provide enable people to have fun, make friends,

improve fitness and health, and develop confidence

and skills. Volunteers themselves benefit from a

sense of satisfaction and the social aspects of

their volunteering.

2.2.4. Implementing

inclusion as a volunteer

Youth Sport Trust – Lead your gen-eration – An Inclusive Future

The Youth Sport Trust (2013) developed train-

ing courses for volunteers who work with people

with disabilities or additional support needs in

their local communities.

They use the STEP Model, developed by Black and

Stevenson (2011). This can be used to change the

way an activity is delivered so it can be made

in one or more STEP areas (Space, Task, Equip-

ment, People).

STEP Model (Black & Stevenson, 2011)

Space examples:

• Increase or decrease the size

of the playing area.

• Use zoning. e.g. where children are

matched by ability and therefore have

more opportunity to participate.

Task examples:

• Break down complex skills into small-

er component parts if this helps

to develop skills more easily.

• Ensure there is adequate opportunity for

players to practice skills or components

individually or with a partner before in-

cluding in a small-sided team game.


Equipment examples:

• In ball games, increase or decrease

the size of the ball to suit the abil-

ity of the participants, or on the

kind of skill being practised.

• The use of bell or rattle balls can as-

sist the inclusion of some players.

People examples:

Match players of similar ability in small-sided

or close marking activities.

• Balance team numbers to the over-

all ability of the group.

Youth Sport Trust (2013) provides some top tips

for volunteers to ensure they are implementing

inclusive practice:

• Focus on the participant is able to do – don’t

worry about the detail of their impairment.

Take the time to get to know what the partic-

ipant can do and plan activities around this.

• Ask – don’t be afraid to ask the individual

what works best for them and involve them in

the planning stage of the activity/session.

• Sometimes things don’t work – don’t be wor-

ried if something doesn’t work – not ev-

erything you have planned will work. Keep

communication open with participants during

the session and adapt when necessary.

• Use appropriate language – aim to always

give short, clear instructions and pro-

vide a demonstration where possible.

2.3.rAIsiNg AwAre-NEsS of IncLUsioN

AUTHOR: TREASA RICE

Key words: inclusion, volunteers, Raising Awareness, Barriers

2.3.1. Inclusion in sport

The European Paralympic Committee (2015) refers

to inclusion as a sense of belonging, which in-

cludes respecting feelings, being valued for who

you are, and a level of supportive energy and

commitment from others.

The concept of inclusion is particularly im-

portant in the sport realm, because in adapting

sport it is important to gain as much knowledge

from those that are directly playing it as they

are able to comment on their own capabilities as

well as providing great insight into any adapta-

tions or limitations etc. (Conroy, 2007).

Within a sport atmosphere persons with disabil-

ities are presented with a space that they can

develop skills such as teamwork, respect, commu-

nication and confidence which are all skills that

are important in everyday living (U.N Task Force

Report, 2003). Sport can also represent a form

of low-cost physiotherapy in that it allows in-

dividuals to work on mobility, balance, strength

etc. (Roy, 2006).

2.3.2. Barriers to inclusion

Conroy (2007) highlighted that there are major

difficulties in getting those with disabilities

to take part in sport, due to several reasons

including discriminatory attitudes of family

members who view those with disabilities as an

embarrassment, thus depriving them of access to

their local communities and facilities.

Conroy (2007) goes on the say that sport is an

excellent arena to raise awareness. Sport also

provides spectators the opportunity to break

their stereotypical beliefs about those with

disabilities because the spectators frequently

are surprised by those with disabilities exceed-

ing their expectations (Conroy, 2007).

2.3.3. Raising Awareness

There is still a great lack of awareness and

knowledge around the abilities of individuals

with disabilities. By raising awareness you can

provide people with information about the per-

sonal backgrounds of those with disabilities,

subsequently helping to overcome attitudinal

barriers (The European Paralympic Committee,

2015). By creating a barrier-free environment

for everybody you can ensure that persons with

any type of disability are able to have access

to all activities (The European Paralympic Com-

mittee, 2015).

England Athletics raise awareness by ensuring

that all their employees receive up to date

training on Equality, Diversity and Inclusion,

as well as providing information for clubs,

coaches, officials and members to help them tack-

le inequality and discrimination in athletics

(England Athletics, 2018).


Major events, such as the International Day of

Disabled Persons and European Week of Sport,

can provide great opportunities for raising

awareness, from national to local level, about

the need for inclusive recreation and sporting

activities. These events often attract posi-

tive media attention, which can raise awareness

across a wide audience (Khasnabis et al., 2010).

Case Studies

Alana, 25 Wellbeing Programme Volunteer

In 2012, Alana experienced a neurotoxic reaction

to medication and had to leave university. She

made a good recovery but through her experience

she learnt how isolating an illness can be, es-

pecially as brain injury has many symptoms that

are not visible to others and therefore wanted

to volunteer with brain injury survivors to help

others.

Through her volunteer role, Alana has developed

skills such as being flexible, creative, and pa-

tient, having an encouraging attitude and being

a good communicator. Alana assists the project

officer with setting up arts workshops, having

conversations with services users, helping them

to complete the arts activities, helping them

with their lunch and cleaning and tidying up

after the workshop. Alana also helps service

users with physical activity programs in the

gym; making sure they are completing the cor-

rect movements; helping them with their balance;

encouraging them to take part and assisting them

when they need help with specific exercises.

“Brain Injury Matters is a great place where

people with different brain injuries and from

different backgrounds can meet together to have

fun, learn new skills, and make friends. I love

getting to know the service users and see them

enjoy themselves and grow in confidence.”

“I hope to become an Occupational Therapist.

Through volunteering I gained experience of

working with people with brain injuries and have

observed how the well-being program can improve

their quality of life.”

“Volunteering is a great way to help improve the

quality of life of people with brain injuries,

to meet new people and learn new skills. Brain

Injury Matters is a great cause and I would en-

courage anyone who wants to help those affected

by a brain injury to get involved.”

Reference:

Association of Paediatric Chartered Physiotherapists. (2014).

Disability Sport. Retrieved from: http://apcp.csp.org.uk/

publications/disability-sport-0

Black, K., & Stevenson, P. (2011). The inclusion club.

Conroy, E. C. (2007). Aiming for Inclusive Sport: the Legal

and Practical Implications of the United Nation’s Disability

Convention for Sport, Recreation and Leisure for People with

Disabilities. The Entertainment and Sports Law Journal, 5(1),

4.

England Athletics. (2018). Equality, Diversity and Inclusion.

Retrieved from: https://www.englandathletics.org/about-en-

gland-athletics/equality--inclusion, Retrieved 3.9.2018.

EU. (2014). Special Eurobarameter 412. Sport and Physical

activity. Brussels: TNS Opinion and Social.

European Paralympic Committee. (2015). A Toolkit for Disabil-

ity – and Para – Sports. Retrieved from: http://be-inclusive.

eu/wp-content/uploads/2016/06/BeInclusive_Handbook.pdf,

3.9.2018.

Gaskin, K. (2008). A Winning Team? The Impact of Volunteers

in Sport. London: The Institute for Volunteering Research and

Volunteering England.

Isben, B. (1992). Frivilligt arbejde I idraetsforeninger

[Voluntary work in sports clubs]. Copenhegan: DHL.

Khasnabis, C., Heinicke Motsch, K., & Achu K. (2010). Com-

munity-Based Rehabilitation: CBR Guidelines. Geneva: World

Health Organization; 2010.

Roy, E. (2006). The Development of the Human Rights of Indi-

viduals with Disabilities in Sport at the United Nations and

Beyond. International Council of Sport Science and Physical

Education 48.

Sport Scotland. (2001). Sport and People with a Disability:

Aiming at Social Inclusion. Research Report No.77. Sport

Scotland.

The Department for Social Development. (2011). Join In, Get

Involved: Build a Better Future. The Volunteering Strategy

for Northern Ireland. The Department of Social Development.

Taylor, P., Nichols, G., Holmes, K., James, M., Gratton, C.,

Garrett, R., Kokolakakis, T., Mulder, C., & King, L. (2003).

Sports Volunteering in England. London: Sports England.

United Nations Inter-Agency Task Force for Sport Development

and Peace. (2003). Sport for Development and Peace: Towards

Achieving the Millennium Goals’ United Nations.

Youth Sport Trust. (2013). Lead your generation. An Inclusive

Future. Inclusive Futures. Volunteer Toolkit. Retrieved from:

https://www.youthsporttrust.org/sites/yst/files/resources/doc-

uments/IF%20Toolkit%20-%20volunteers%20FINAL.pdf, Retrieved

3.9.2018.

2.4.The ROle of Re-Sp•Ort Project ParTNers •OrgAni-zaTi•ONS in the ProcesS of In-cluSIOn

2.4.1. The Role of Center Naprej in the Process of Community Inclusion of Persons with Acquired Brain Injury


Key words: Center Naprej, inclusion in sports, acquired brain injury, rehabilitation

NAPREJ, Centre for Persons with Acquired Brain

Injury is a non-profit organization from Slove-

nia. Our field of expertise is long-term psycho-

social and health rehabilitation after acquired

brain injury. All the services and programmes

that we deliver (occupational therapy, physio-

therapy, psychological, social and health care,

employment under special conditions) are de-

signed to increase active participation of users

in society and to raise the quality of their

lives as well as the lives of their families. An

important field of our work are various preven-

tive, counselling, and educational programmes

taegeted at special groups and the general pub-

lic. Besides our users we devote special care to

their families – we include them in all phases

of the rehabilitation process, providing them

with counselling and support. The rehabilitation

programmes take place at two different units in

Maribor and Murska Sobota.

Our service users are people who have experi-

enced severe brain injury, have a disability

status, and need different type of assistance

for daily living.

2.4.1.1. Center Naprej as an inclusive institution

Center Naprej holds an important role through

its work and implementation of services, the

role of integrating people with acquired brain

injury (hereinafter referred to as ABI) in the


local and wider social environment. Definite-

ly, this is a very sensitive area, since we

are talking about the people who are the most

vulnerable and threatened part of humanity in

the provision of declared rights, because they

themselves most often cannot defend and demand

their own rights.

Since most of our users need help of another

person, it is important who and what are the

organizations who provide this assistance. It is

important to support employees with appropriate

counselling, professional help, education and

training, supervision and intervision. Appro-

priate learning and technical tools are also

essential.

Center Naprej as an inclusive institution:

• emphasises/encourages partici-

pation, not competition,

• searches for solutions that are beneficial

to all, considering their impairments,

• prepares for relationships and

life in the community,

• establishes new relationships, con-

nects an individual with others,

• enhances respect and under-

standing of one another,

• it is directed towards the needs of the

individual – satisfying what is possi-

ble within or outside the institution.

2.4.1.2. The regulation of inte-gration of persons with disabil-ities as a mirror of society

The regulation of the integration of persons

with disabilities in the community is undoubt-

edly a mirror of the society as a whole (Šte-

fančič, 2002) and a society that wants to enable

people with disabilities to have better oppor-

tunities for development and that wish to accept

them as equal members of the community must, to

the greatest possible extent create suitable

environment for their social integration and

inclusion.

Joining the European Union, Slovenia has commit-

ted to following democratic values on equal op-

portunities and independent life of persons with

special needs. The country is responsible for

ensuring equal opportunities. It is especially

important to think about professional and ethi-

cal responsibilities, responsibility for ensur-

ing equal opportunities for all, which we have

signed as a country with numerous conventions

and wrote in the Constitution of the Republic of

Slovenia. To achieve this, a proper professional

and legal basis that allows it must be adopted.

There are many arguments in the professional

literature that confirm this hypothesis, but un-

fortunately in practice it often turns out to be

different (Bužan, 2011).

Persons with disabilities are an important

social subsystem, representing a significant

proportion of the total population: about 10%

worldwide, about 15% in the EU, in Slovenia

numbers are similar (Kresal Šoltes, 2006). The

Convention on the Rights of Persons with Dis-

abilities, which was ratified by the Republic of

Slovenia in 2008, has contributed significantly

to the recognition of their rights. This has

supported the greater realization of the objec-

tives of the Action Programme for Persons with

Disabilities 2014–2021 and the European Disabil-

ity Strategy 2010-2020: A Renewed Commitment to

a Barrier-Free Europe at the national and local

level in the everyday life of people with dis-

abilities in the Republic of Slovenia.

People with disabilities have the same needs as

all other people. In order to meet these, it is

necessary to support them, help them recognize

their needs, and even demand them. Every indi-

vidual needs to be paid attention to his special

features (Bužan, 2011). The Convention on the

Rights of Persons with Disabilities (http://

www.mddsz.gov.si) in its Article 30 regulates

this area of rights - the right to participate

in cultural life, recreation, leisure activities

and sports.

Individuals with disabilities can experience a

number of challenges in the process of inclusion

in the community. They also often face isolation

due to a narrowed social network, despite the

fact that nowadays the whole developed world

accepts the idea and the paradigm of inclusion.

2.4.1.3. What does “inclu-sion in sports” mean?

Often, in our work enabling our users (ABI sur-

vivors) to participate in sports, we encounter

various obstacles, such as:

1. lack of awareness of inclusion amongst people

without disabilities and how to properly

engage people with disabilities in groups;

2. lack of opportunities and sports programs;

3. lack of training programs for profession-

als and providers of assistance in the field

of sports for persons with disabilities;

4. limited access to some facili-

ties due to physical obstacles;

5. limited information, access to pro-

grams, facilities, assistants,

etc. (DePauw and Gavron, 2005)

Sport and recreation can be a great medium that

supports an active lifestyle and the development

of healthy relationships between people with

disabilities and people without disabilities,

as they offer many opportunities for communica-

tion and rich social experience. Adapted sports

activities carried out in the community promote

and facilitate the full participation of people

with disabilities in the real life.

Although sport activities can vary greatly (e.g.

skiing, stand-up paddle boarding, horseback

riding, biking, climbing, etc.), success depends

not only on the characteristics of an individ-

ual with disabilities, but also on the skills

and knowledge of professionals, assistants and

volunteers who collaborate with them. These

individuals spontaneously become partners in

communication as a result of a shared activity.

Thus, through active sports and recreational ex-

periences we encourage communication and social

relationships. Groups cooperate to be success-

ful and make the most of the experience of all

interested parties. Sports should not be the ex-

clusive right of a particular social group, but

an opportunity for everyone to develop oneself

through movement and mental activity according

to their abilities. (Mihorko, 2014)

Sport can be perceived as concept defined by the

President of UNESCO as “all forms of physical

activity that contribute to physical fitness,

mental well-being and social interaction, such

as playing, recreation, organized or competi-

tive sports and indigenous sports and games” (UN

Inter -Agency Task Force, 2003).

Over the past few decades, UNESCO has devoted

many efforts to implementing the principle of

inclusion at all levels in education systems

around the world. The idea that they must “pro-

vide a system of inclusive education at all

levels” is also a central objective of the UN

Convention on the Rights of Persons with Dis-

abilities. These questions about the principles

of inclusion are especially important in our

work, when we support our service users in their

return back to community.

2.4.1.4. Sports programs in Cen-ter Naprej - inclusive and adapt-ed physical activities

When integrating people with ABI into sports

programs, we are focused on two important as-

pects: the aspect of integration in general and

the real value of sports activities. Sports must

represent a way of social inclusion. Sports

activities are introduced as a training content

where, unlike educational activities, individ-

ual choice of sports activities can be made on

a large scale, ranging from separate activities

intended for people with disabilities to modi-

fied or adapted activities that are intended for

everyone. However, it should be emphasized that

each approach is equally important and valid,

and there is no need to discredit the separate

structures and to praise the role of the persons

with disabilities involved.

We focus our attention on the importance of the

processes and mechanisms of integration that

happen in the area of sports, and on the ques-

tions what happens or could happen to ABI survi-

vors when they enter sports settings. Involving

disabled athletes in sports in the community

helps overcoming prejudice, stereotypes and

fears. The latters tends to occur most often

as a result of lack of information about the

life of people with disabilities, their needs

and abilities. This is why this often leads to

social isolation of children, adolescents and

adults with disabilities.

The mechanisms of integration through sports

allow them to socialize, meet and communicate

in social settings. Sports activities can be

adapted for each individual according to his

abilities and capabilities and to the greatest

possible extent; they are adapted for people

with disabilities. Appropriate sports activi-

ties can be found for each individual, whether

for recreational, rehabilitation or competitive

purposes.


We include people with ABI in sports activities.

Survivors may be:

1. physically impaired,

2. blind or visually impaired,

3. deaf, hard of hearing,

4. cognitively-impaired,

5. speech-impaired,

6. individuals with mental health and/

or neurological disorders,

7. individuals with emotional and/

or behavioural problems,

8. multiple impairments – combined impairments.

Examples of sports programs that we perform for

rehabilitation, recreational or / and competi-

tive purposes in the Center Naprej:

1. rehabilitation exercise with or with-

out accessories, fitness;

2. water sports: rehabilitation swim-

ming, swimming using Halliwick con-

cept, water games, stand up paddle

boarding, rowing, snorkelling;

3. ball games (small, big, sound): football,

basketball, netball, foot golf, tennis,

table tennis, volleyball, crossboccia,

bowling, boccia, badminton, speedminton;

4. walking, Nordic walking, hiking,

slack line, orienteering, running;

5. winter sports: alpine skiing, snow

shoeing, sledding, skiing;

6. sports with animals: rehabilitation horse-

back riding, rehabilitation fishing;

7. dancing, cheer leading.

If we are committed to work promoting the health

of our users, we need to think about ways to

increase their physical activity considering

their individual differences. Consequently this

could be an important contribution to achieving

a healthier lifestyle. Participation in sport

can significantly improve their health, well-be-

ing and quality of life.

When adding sports programs into rehabilitation,

we are aware that for people with ABI sports may

impact physical condition in different ways -

good blood circulation, stronger muscles, im-

proved balance and coordination, etc. But sports

can offer much more. People who engage in sports

also benefit from a number of psychological

benefits, such as improved self-esteem, self-dis-

cipline and self-confidence, and confidence in

their abilities and capabilities. We also notice

an improved anger management and the ability to

deal with stressful situations more effectively

than those ABI survivors who are less active.

They are more cooperative and interactive with

others. They have more opportunities to gain a

sense of responsibility towards themselves and

others. Sport provides them with something to

looking forward to.

After suffering a brain injury, individuals may

find it difficult to cope in ordinary situations

and activities of daily living, so they experi-

ence many losses in their new lives. Therefore

it is very important that we help them find some-

thing they cannot only cope with but also enjoy.

Sport can give them a reason to live.

Therefore, we can state that sport is a platform

for acquiring knowledge and life skills as well

as an opportunity for social inclusion.

Reference

Bužan V. (2011). Uvod, Usposabljanje strokovnih delavcev za

uspešno vključevanje otrok in mladostnikov s posebnimi po-

trebami v vzgojo in izobraževanje v letih 2008, 2009, 2010 in

2011, Skupnost organizacij za usposabljanje oseb s posebnimi

potrebami v Republiki Sloveniji, Ljubljana

DePauw, K. P., and S. J. Gavron (2005). Disability and Sport.

Champaign, IL: Human Kinetics.

Konvencija o pravicah invalidov, Retrieved from http://www.

mddsz.gov.si/fileadmin/mddsz.gov.si/pageuploads/dokumenti__

pdf/konvencija_o_pravicah_invalidov.pdf, 8.6.2018

Kresal Šoltes,K., Novak, M., Kresal,B., Kalčič, M., Zaviršek,

D., Invalidi med socialnim varstvom in trgom dela (ekspertiza

– pravni in mednarodni vidik), Ministrstvo za delo, družino

in socialne zadeve, Ljubljana, 2006, Retrieved from http://

www.mddsz.gov.si/fileadmin/mddsz.gov.si/pageuploads/dokumen-

ti__pdf/invalidi_soc_varstvo_trg_dela.pdf, 10.6.2018

Mihorko, B., Štrumbej, B., Čander, J., Cimerman Sitar, M.

(2014). Smernice za šport in rekreacijo invalidov Operativni

program Slovenija-Avstrija 2007-2013, Maribor

Stevenson, P. (2009). “The Pedagogy of Inclusive Youth Sport:

Working towards Real Solutions.” In Disability and Youth

Sport, edited by H. Fitzgerald, 119–131. London: Routledge.

Štefančič, Z. (2002). Vizija preobrazbe specializiranih in-

stitucij – zavodov za vzgojo in izobraževanje oseb z zmerno,

težjo in težko in najtežjo motnjo v duševnem razvoju. V:

Destovnik (ur). Osebe s posebnimi potrebami v procesu inklu-

zije ter vloge defektologov in specializiranih institucij.

Društvo defektologov Slovenije.

UN Inter-Agency Task Force on Sport for Development and Peace.

(2003), Why Sport? Paris: UNESCO. Retrieved from http://www.

un.org/wcm/content/site/sport/home/sport on 20.6.2018

2.4.2. Centro Sportivo Italiano

AUTHORS : CENTRO SPORTIVO ITALIANO-WELFARE AND SOCIAL PROMOTION OFFICE

Key words: Centro Sportivo Italiano, non-profit association, voluntary work, promot-ing sport, educating through sports

Introduction

CSI - Centro Sportivo Italiano is a non-profit

association, based on voluntary work, promot-

ing sport as a moment of education, growth,

social engagement and aggregation, prompted by

the Christian vision of man and history at the

service of the people and the territory. Among

the most ancient sports promoting associations

in our country, CSI meets the demand of a sport

that is not only numerical, but also qualified on

the professional, human and social level. Young

people always make up our main reference point,

even if the promoted sports activities are de-

voted to any age bracket.

2.4.2.1. CSI mission and vision

Educating through sports is the mission of CSI.

This is consolidated in the procedure and con-

science of the association on all levels. Sport

facilitated by CSI can also be a preventative

instrument for particular social pathologies

such as loneliness, fears, dreads, doubts, devi-

ance of young people.

CSI is a sports promoting institution spread all

over the national territory acknowledged by the

Italian Olympic Committee (CONI). It is recog-

nized by the Italian Episcopal Conference as a

Christian inspired association. It is recognized

by the Interior Department as a national insti-

tution with charitable aims. It is registered in

the national register of Social Promotion Asso-

ciations, recognized by the Ministry of Work and

Social Policies.

CSI is recognized by the Department of Educa-

tion, University and Scientific Research as an

accredited institution for the formation of

school staff. It has stipulated an understanding

protocol for the organization and promotion of

sensitization and information actions devoted to

students, teachers and parents on the value of

sports practice as well as formation, updating

pathways and meeting occasions for teachers and

parents. It has an understanding protocol with

the Ministry of Justice to promote reinsertion

and social inclusion activities devoted to young

people moving around in the external penal area.

It is an institution accredited by the Nation-

al Office for Civil Service to manage projects

of voluntary civil service. It is a member of

the National Court of Laical Aggregation (Cnal)

it represents Italy internationally within the

Fédération Internationale Catholique d’Educa-

tion Physique et Sportive (Ficep), gathering

the catholic sports associations from Austria,

Belgium, Czech Republic, France, Germany, Italy,

Holland, Poland, Slovak Republic, Switzerland at

present, besides some sports groups from Mada-

gascar and the former Yugoslavia.

It is a member of the Permanent Forum in the

Third Sector and has signed cooperation conven-

tions with the Italian Parents Association, with

the Childline, etc.

THE NUMBERS OF CSI

• 1.152.000 Athletes

• 13.000 Sports clubs

• 42.000 Teams

• 100 sports disciplines

• 8.000 Tournaments per year


• 300.000 Competitions per year

• 139 Territorial gatherings

• 21 Regional gatherings

• 135.000 Trainers, animators, ref-

erees, judges and executives

• 12.000.000 Yearly hours of free en-

gagement and voluntary work

2.4.3. Rijeka Disability Sports Association - the role of organization in the process of inclusion

AUTHOR: ILONA KOVAL GRUBIŠIĆ,

Key words: sports association, sports clubs for persons with disabilities, inclu-sion, adaptive physical culture, adaptive sports, Paralympics sport.

The growth of disability is a world trend. In

total there are about 650 million officially reg-

istered disabled people in the world. According

to the World Health Organization, people with

disabilities make up about 10% of the world’s

population. Despite the success of medicine,

their number is slowly but steadily growing,

especially among children and adolescents. For

comparison: in the US - 54 million disabled, or

19%, in China - 60 million, or 5%. Until recent-

ly, the problems of this fairly large group of

people were ignored, and yet, as a result of the

gradual humanization of society, the Universal

Declaration of Human Rights, the World Program

of Action concerning Disabled Persons and the

United Nations Standard Rules on the Implemen-

tation of Equal Opportunities for Persons with

Disabilities were adopted. In many countries,

legislative acts have been adopted that reflect

the problems of disabled people. From year to

year, the number of children with developmen-

tal disorders increases. The number of children

with developmental disabilities and poor health

reaches 85% of the total number of new-borns.

Only some of these children will later become

the object of correctional work, but the number

of children who need such work is quite large.

According to foreign statistics, it is 9-11% of

the total child population (Sunagatova, 2012,

Dyachenko, Rzyankina, Solokhina, 2010)

Working with children with developmental disabilities in sports clubs (guidelines)

The Rijeka Sports Association for Persons with

Disabilities provides equal opportunities for

sports and recreation for all persons with

disabilities in the Rijeka area, regardless of

age, gender, socio-economic status or type of

disability.

The aim of the Association is to create a net-

work of sports clubs for persons with disabil-

ities in the Rijeka area, which will provide a

wide range of sports for people with disabil-

ities, as well as engagement and training of

skilled professionals to work with people with

disabilities. Such a bid will encourage and at-

tract many people with disabilities, and espe-

cially youth with disabilities to sports.

2.4.3.1. Basic programs of the association

Promotion of sports for per-sons with disabilities

The level of knowledge regarding the sport of

people with disabilities is very low in our

society. Reasons for this are numerous, but the

main cause is poor media coverage (below 2% of

total media coverage). In 2011 and 2012, the

Association made the project “Paralympics School

Day”, in cooperation with the HPO, which proved

to be extremely successful. The Association is

actively participating in the media promotion

of all sports and sports competitions for per-

sons with disabilities in the area of Rijeka, in

cooperation with all relevant media. The Associ-

ation communicates with the public through the

website.

Sports games for children with difficulties

The Rijeka sports games for children with dis-

abilities – launched in 2009, have transcended

their initial form and expanded so that now they

include a new Educational-Sport program for

children and young people. GAMES are held for

the 8th time in a row, and the Rijeka Sports As-

sociation for Persons with Disabilities took an

active part in the project. This year’s program

consisted of a series of games involving chil-

dren with developmental difficulties as well as

their friends without any difficulties in devel-

opment, and in this way, through the program “My

Friend and Me”, inclusion through sports was

presented.

The goal of Rijeka’s sports games is to enable

children with developmental difficulties to have

the best effect of physical activity, improving

self-confidence, positive perception, improving

sensory abilities, developing self-reliance and

helping in the group, socializing and joys, and

acceptance in the community.

Inclusion of new people with dis-abilities and new coaches in sport of people with disabilities

The success of any sports club in the long run

is based on the ability of the club to keep

current members and to attract new ones. At-

tracting new members to clubs has proved to be

the biggest problem of some member clubs of the

Association.

The key to recruiting new members - the op-

tion to include new people with disabilities

in sporting activities is to “reach” the right

people, especially the parents of young people

with disabilities. Therefore, the Association

regularly carries out workshops on the sport of

people with disabilities and actively promotes

sports for persons with disabilities in schools

health organizations, hospitals and healthcare

institutions.

As is common knowledge in our society, very

few people with disabilities are involved in

active sports and recreation, which is very

important in rehabilitation as well as social-

ization in society. In order to include people

with disabilities in sports and recreation, it

is necessary to organize effectively: clubs,

trainers, adapted facilities where people with

disabilities can have easy access, organize

seminars, promotion of available sports activ-

ities, organize promotional tournaments, and

tour of various institutions. The inclusion in

sports and recreation depends primarily on the

active participation of people with disabilities

and their primary environment (family, friends)

where they cease to be passive observers and be-

gin to actively participate in the creation and

upgrading of the system of their service.

By conducting sports and recreational activities

of people with disabilities, as well as accompa-

nying media coverage, the perception in society

of people with disabilities as passive social

entities will also change.

By actively engaging in sports, people with

disabilities will also gain new skills and in

doing so, will challenge community to respond

with new, different expectations, which will

in turn start the unstoppable process of social

evolution.

The employment program of city sports instruc-

tors for the sport of people with disabilities

will enable the creation of a special data bank

of one portion of the population with disabil-

ities, which will bring about new public in-

terest, and in particular the inclusion of a

greater number of young people with disabilities

in sport.

The program also includes ongoing openness to

the health system, its members and their ideas,

and cooperation with the families of people with

disabilities that, due to the many experiences

they have had, need to be actively involved in

the system. Since sport has a particular place

in the social hierarchy, it is logical to choose

this activity as the primary means of sensitiz-

ing our public, because of its social, public,

medical and emotional reasons.

References

Sunagatova LV, Marchenkova UA Influence of adaptive sports on

social adaptation of invalids // Young scientist. - 2012. - №

12. - P. 603-607. - URL https://moluch.ru/archive/47/5856/.

Retrieved 15.10.2018.

Dyachenko, VG, Rzyankina MF, Solokhina LV A guide to social

paediatrics. Under. Ed. V.G. Dyachenko / V.G. Dyachenko, M.F.

Rzyankina, L.V. Solokhin - Khabarovsk: Publishing house of

the Far-Eastern State Medical University, 2010, - 124 p.


2.4.4. The Role of FPDD in the Process of Inclusion

AUTHOR: EDUARDO BORGES PEREIRA

Key words: sport development; inclusion of people with disabilities through sport; disability areas.

FPDD – Portuguese Federation for Disability

Sports has 30 years of contribution for develop-

ment of sport in Portugal, especially for people

with disabilities.

FPDD and his four associates (there were five un-

til 2017) – the National Associations for sports

are specialized for disability area: blind,

cerebral palsy, deaf, intellectual and motor

impairment. They have had a major contribution

to bring more people with disabilities to sport,

having “sport for all” as the main mission and

competition sports, national teams and high per-

formance as second goal.

Our mission is to provide to all persons, in-

dependently of their functional capacity,

opportunities of sport practice and physical

activity through life, according with the level

of involvement required by each one, in their

community.

Our organization develops many projects in

partnership with other organizations, focusing

on disabled people, especially children and

youngsters, and on training of professionals

and teachers. We support the organization and

participation in international competitions by

some national teams, such as Boccia and Goal-

ball. This is a continuous process of inclusion

through sport and physical activities with very

good results in Portugal.

References:

http://fpdd.org/

2.4.5. The Role of Brain Injury Matters in the Process of Community Inclusion of Persons with Acquired Brain Injury

AUTHOR: FIONA MC CABE

Key words: Brain Injury Matters NI, inclusion, acquired brain injury, rehabilitation

2.4.5.1. Brain Injury Matters NI; organisational overview

Brain Injury Matters (NI) is a non-profit or-

ganisation aiming to help rebuild the lives of

children and adults living with Acquired brain

injury (ABI) to enable them to reach their full

potential in family and community life in North-

ern Ireland. Our purpose is to support people

living with brain injury, help develop the

skills and confidence to optimise their function-

ing and access a positive quality of life.

A considerable number of people with ABI will

have executive functioning impairments and ex-

perience a greatly reduced capacity to problem

solve, plan, organise and make decisions etc.

This can have a major impact on their ability to

manage everyday living, educational, employment

and inter-personal situations which many people

take for granted.

Brain Injury Matters (NI) delivers age-appro-

priate, needs-led support services designed to

minimize the impact of acquired brain injury on

the person and their wider network and reduce

the onset of secondary problems as a result of

the initial injury or illness. Our programmes

aim to help individuals achieve self-identified

goals, promote age appropriate independence,

maximise social and educational engagement,

promote psychological adjustment post-ABI and

improve overall well-being.

Services offering social, sports, exercise and

recreational activity, skills development,

counselling, information and support are now

recognised as an essential element in the range

of services required to support people with ABI

and their carers. They can influence recovery

and outcomes, in that they support and promote

the long-term adjustment and seek to help the

family unit manage stress, establish meaningful

activities, positive relationships and a valued

lifestyle.

2.4.5.2. Brain Injury Matters NI as an inclusive organisation

Inclusion of people with disabilities in society

means involving them in every aspect of social

participation and maximising a person’s quality

of life. This is a key principle underlying the

work of Brain Injury Matters. The principle of

inclusion is reflected in our organisational vi-

sion of a society where those with brain injury

can live a full and meaningful life. It also is

central to our three core organizational values:

Rights & Responsibilities Where everyone is

actively involved in creating solutions, encour-

aged & supported to take responsibility

Innovation Where we will not be satisfied with

the status quo and continually strive to deliver

the best evidence-based services

Respect for All Where we will treat everyone,

people affected by ABI, their families, staff

and stakeholders with equal respect and honesty,

listening and paying attention to feedback about

our services

References:

www.braininjurymatters.org.uk

2.4.6. Keçiören Municipality and its role in the process of inclusion

AUTHOR: KEÇIÖREN MUNICIPALITY

Key words: Keçiören, Keçiören Municipality

Keçiören Municipality is the biggest district in

Turkey by area and population density. Keçiören

Municipality is a local government unit which

uses its authorities to improve the economic,

social and cultural status of its residents in a

way that encourages them to participate in the

management of the district.

The services provided by Keçiören Belediyesi to

the residents are:

• Development and construction of pub-

lic facilities and infrastructures

• Develop geographical and city man-

agement information systems

• Provide recycling and environmental cleaning

• Provide municipal police, fire depart-

ment, ambulance, emergency assistance

• Forestation, parks and recreation areas

• Cultural activities, education, tour-

ism and publicity, sports activities

• Social services and care for dis-

abled and other disadvantaged people

• Protective services for children and women

Keçiören dates back to 1983 when it became a

separate municipal constituency. It comprises 51

Precincts and covers the area of 190 square km.

It is situated about 13 km from the city centre

with altitude of 1075 m above sea level. It is

the largest Municipality in Ankara with over

900,000 residents.


Our Values:

• Transparency

• Accessibility

• Productivity

• Participation

• Ecological Awareness

• Honesty

• Innovative Approach

2.4.7. The role of Human Profess Non-profit Ltd. in the process of inclusion of people with disabilities

AUTHOR: ZSUZSANNA KOVÁCS

Keywords: Human Profess, inclusion, disabled people

Human Profess Non-profit Ltd. is offering – among

other things – project management and labour

market services, training for NGOs, governments

and for-profit companies in Hungary. Activities

of the company also include services that pre-

serve, improve and assist the living and health

conditions of workers with disabilities.

Human Profess is an accredited employer where

they provide work for 24 workers with disabil-

ities: from simple, easily acquirable, semi-

skilled work through project administrators to

trainer tasks.

Their experts have many years of experience

in the fields of rehabilitation, labour market

services, adult education, and international

practices. Professional experience and knowledge

provides a safe base for the organisation to be

able to offer long-term assistance for people

with disabilities regarding their rehabilita-

tion employment. Methods and practices employed

in international projects are also incorporated

into the improvement process of employees. They

provide a complex service to their employees

with disabilities (job opportunity, training

opportunity, mentor support) in the interest of

their successful rehabilitation.

The long-term goal of Human Proffes is to assist

in the employment of workers with disabilities

and to provide them with an occupation suitable

to their education, existing skills and health

conditions. The company’s further goals involve

contributing to the improvement of their adap-

tion skills, to ensure their permanent employ-

ment, and to motivate and support their entry

into the open labour market. They also provide

regular sport activities for colleagues with

disabilities. Posts are regularly available on

their Facebook-site. They continuously share

articles and videos that are related to people

living with various diseases and impairments.

2.4.8. The role of CIF France in the process of inclusion

AUTHOR: DR MOHAMMED MAMMAD, MIREILLE BOUCHER

Key words: people with disabilities

CIF France contributes to the integration of

people with disabilities, which are excluded

from social interactions, with its continuously

organized programs in France for profession-

als and volunteers from different countries,

who work on the social field and socio-cultural

animation.

CIF France organizes multicultural international

programs in coordination with other branches in

25 countries around the world.

CIF France continues its integration actions

with its local, regional, national and inter-

national partners. Through its expertise, CIF

France has participated in several European

programs.

As part of the ReSport project, they contribute

to the integration by mobilizing local partners

with or without disabilities. They have devel-

oped partnerships by integrating people with

disabilities with people without disabilities.

The vision and fundamental goal of CIF France is

inclusion and in pursuit of this goal they have

made several visits to specialized centres for

the disabled. In order to carry out this project

well, they thought it would be better to include

young people and people with disabilities, they

also had the idea of giving them training in

communication and speaking to convey a message.

Inclusion was not just a theory but the action

of a whole group who saw this project as a step

to continuous working together and developing

new actions.

Learning Outcomes:

• to outline different definitions of disability

• to highlight the importance of focusing on

functional abilities and not on disability

• familiarising readers with general in-

formation about what disability is and

certain types of disabilities

• information on the specialties in the men-

tal health of people with disabilities

• familiarising readers with the risk

of obesity and preventing obesity

• to highlight the impact of harm-

ful habits for people with disabil-

ity and how to deal with them

• to get to know advantages and disadvantag-

es of video games, the usefulness of vid-

eo games for people with disabilities

• to highlight the problem of dop-

ing of people with disability

3. Dis aBil iTy and hEaLTh


3.1.DefinItions •Of DisabILiTy

AUTHOR: DANIJELA MAJCENOVIČ CIPOT

Keywords: Disability, models, interpretation

Disability is a concept that has during the

years and different cultures been described from

various perspectives. Although the authors of

these perspectives use the same term, the mean-

ing differs. This caused various interpretations

of the term, what is not good from the person

attached point of view – if these different

interpretations cause deprivation of rights in

one field, a person with disability is quickly

in a subordinate position. “The lack of consis-

tency is most dramatic when a person is defined

as disabled in one context and not another, such

that she or he receives therapies for serious

impairments but does not qualify for certain

disability-related benefits provided by his or

her employer or by the government” (Altman,

2011:98). In her research of different models

and concepts Altman produced a table, in which

she summarized the differences in understanding

of the term disability, that are most commonly

used.

Model Disability (A) Disability (B) Disability (C) Disability (D) Disability (E)

Social model ICIDH-1 model Nagi model Verbrugge and

Jette model

IOM-1 and IOM-

2 models

Definition Limit or loss of

opportunities

to take part

in community

life because of

physical and

social barriers

In the context of

health experience,

any restriction

or lack (re-

sulting from an

impairment) of

ability to perform

an activity in

the manner or

within the range

considered normal

for a human being

Pattern of

behaviour that

evolves in situa-

tions of long-term

or continued

impairments that

are associated

with functional

limitations

Disability is

experiencing

difficulty doing

activities in any

domain of life

due to a health or

physical problem

The expression

of a physical or

mental limita-

tion in a social

context-the gap

between a person’s

capabilities and

the demands of

the environment

Table 2: Variety of Meanings Given the Term Disability in Five Theoretical Models (Altman, B. M.: Disability Definitions,

Models, Classification Schemes, and Applications. 2001).

Use of these contexts differs from one public

sphere to another. Where rights and benefits of

special groups is in sight, legal and adminis-

trative spheres tend to categorise disabled in

groups granting them special rights, what can

cause differences and unequal treatment and

therefore inequalities between them. Social

definitions are usually not considered a medi-

cal point of view and vice versa. In a medical

context a person is seen in the light of his/her

boundaries deriving from their disability and

does not consider individuality. And there is

always personal view of the usage of the right

term – some people prefer the term handicapped

for this relates to their ability to work, other

prefer term person with disability or person

with special needs. This always differs from how

a person sees and defines him/herself.

All classification and categorisation of dis-

ability have special aspects on the person they

refer to. Thus they are all imperfect and incom-

plete, because they do not emphasize a person

as an individual, but tend to point out only

certain aspects. In the light of adapted physi-

cal activities the most useful classification is

based on functional level – what a person can do

without or with different levels of assistance.

Nowadays it is customary to describe the person

first and then state the disability – ex. child

with learning disability, person with multiple

sclerosis…. what gives emphasis on the indi-

vidual and doesn’t point out their disability.

But still we must recognize that categorizing

gives us fundamental knowledge about general

characteristics of disability types and there-

fore it is useful in planning adaptive activi-

ties. It can provide a wider framework because

it is essential to be aware of the fundamental

characteristics of conditions as described in

traditional disability classification and then

take into account the unique characteristics

(physiological and psychological) and functional

abilities of a person with disability.

Reference

Altman, B. M. (2001). Disability Definitions,

Models, Classification Schemes, and Applications.

Published in: Albrecht, G.L., Seelman K., Bury

M. (ed.), Handbook of Disability Studies (97-

122). Thousand Oaks – London – New Delhi: Sage

Publications Inc.

Squair, L., Groeneveld, H.J. (2003): Disability

Definitions. Published in: R. D. Steadward, G.

D. Wheeler and E. J. Watkinson (ed.), Adapted

Physical Activity (45-64). Canada: The Univerity

of Alberta Press


3.2.CLaSsiFIcaTIon oF DisabILIty

AUTHOR: VALENTINA BOLŠEC

Keywords: disability, mental illness, physical disabilities, sensory disabilities, learning disabilities, developmental disabilities, recommendations

People differ from each other according to their

physical, sensory, and other abilities. Also,

the types of disability are different, covering

all long-term physical, mental and sensory im-

pairments and mental disorders that disable the

person in order to function fully and partici-

pate in society. Persons with disabilities are

classified in categories of disability according

to impairments and other indicators. Since peo-

ple differ from each other, we must never equate

two people with the same disability category;

each person functions in his/her own way and at

his/her best (Squair and Groeneveld, 2003). From

the perspective of its etiology and basic under-

standing, we can place disability in the follow-

ing classification:

Mental disorders

Mental disorder is a medical condition that

includes changes in thinking, emotions and

behaviour or a combination of all and is asso-

ciated with distress or difficulties in the field

of social life, work, and family. It can occur

anytime and anywhere, regardless of age, gender,

financial and social status, race, ethnicity, re-

ligion, sexual orientation or cultural identity.

It can occur in different intensities and can

even cause a person to require hospital treat-

ment (Parekh, 2018). Mental disorders are often

the cause of stigma due to a lack of knowledge

and awareness amongst the public. Patients are

afraid to seek help due to shame, which can, of

course, cause the situation to worsen. Mental

disorders that cause impairment are: mood dis-

orders (depression, bipolar disorder), anxiety,

phobia, panic disorder, obsessive compulsive

disorder, schizophrenia, eating disorders, per-

sonality disorders, multiple personality disor-

ders, etc. (Squair and Groeneveld, 2003).

Recommendations: persons with mental disorders

may often have difficulty participating in phys-

ical activity due to feelings of worthlessness,

helplessness and/or hopelessness. Individuals

may need prompting or motivational tips to

attend a program or activity. It is also recom-

mended that they are accompanied by a friend/

carer/support worker and transported to the

activity location. They need to feel comfort-

able and safe in the environment (Squair and

Groeneveld, 2003).

Physical Disabilities

Physical disability can cause problems in vari-

ous areas such as neuromuscular, cardiovascular,

orthopaedic and pulmonary areas, and limit a

person’s movement, swallowing, breathing and/or

speech (Nkabinde, Obiakor, Offor & Smith, 2010).

People with physical disabilities tend to rely

on devices such as wheelchairs, crutches, walk-

ing frames, rods or artificial limbs. Disability

can be congenital or acquired, which is devel-

oped after birth and is not hereditary, degen-

erative, or induced by birth trauma (O’Reilly

et al., 2015). In the category of physical

disability, we include conditions such as ar-

thritis, asthma, amputation, amyotrophic lateral

sclerosis (ALS), arthrogryposis, brain injury,

cerebral palsy (spastic CP, athetoid CP, ataxic

CP), congenital hip dislocation, cystic fibrosis,

diabetes mellitus, epilepsy, Friedreich’s atax-

ia, Guillain-Barre syndrome, hemophilia, multi-

ple sclerosis, muscular dystrophy, osteogenesis

imperfecta, osteomyelitis, osteoporosis, paral-

ysis, Parkinson’s diesase, polyomyelitis, spina

bifida, spinal cord injury, Tourette syndrome and

tuberculosis (Squair and Groeneveld, 2003).

Recommendations: it is important that we adapt

activities to individual abilities and needs

of the person and to take into account all the

barriers which may occur. We need to ensure the

safety and protection for persons, especially

when they have problems maintaining balance.

Sensory Disabilities

We get to know the world around us through our

senses, which enable us to collect and under-

stand information and connect with people and

our surroundings. As much as 95% of all envi-

ronmental information is obtained through hear-

ing and sight, therefore, the failure of these

senses greatly affects the way a person collects

information about the environment (Types of

sensory disabilities, 2019). It is not necessary

for a person to completely lose hearing or sight

to be regarded as a disabled person with sensory

deficits. Sensory deficits include a partial or

complete loss of hearing, vision, or a combina-

tion of both. Squair and Groeneveld (2003) claim

that hearing loss can be divided into three

categories: conductive, sensory-neural and mixed

hearing loss. Visual impairments can be caused

by albinism, cataracts, glaucoma, retinal blas-

toma and rubella.

Recommendations: individuals, who have a vi-

sual disability, may need orientation of the

area where the activity is taking place. For

partially sighted, colour contrasts might be

appropriate. We can provide auditory cues, where

descriptive language is used. Individual can

be also guided or moved by another person. For

persons with hearing disability it is important

that instructions are given face to face. Also

visible signals and demonstrations should be

used (Squair and Groeneveld, 2003).

Learning Disabilities

We talk about learning disabilities when one or

more of the basic psychological processes in-

volving understanding or using spoken or writ-

ten language exist. Individuals with a learning

disability may have difficulty with input of

information to the brain, organizing and under-

standing information, storing information in

memory, communicating through language or motor

output. Learning disabilities can be broken down

into attention deficiency-hyperactivity disorder

(ADHD) and developmental coordination disorder

(DCD) (Squair and Groeneveld, 2003).

Recommendations: when planning physical activity

for people with learning disabilities, we must

take into account the difficulties of learning

cognitive information and some motor coordina-

tion difficulties. For individuals with ADHD, who

have very little patience, it is very important,

that we set an environment with few distrac-

tions. The activity should be consistent and

structured (Squair and Groeneveld, 2003).

Developmental Disabilities

Developmental disability is defined as severe,

chronic disability attributable to mental and/or

physical impairments that are likely to continue

indefinitely; resulting in substantial functional

limitations in three or more major life activity

areas: self-care, receptive or expressive lan-

guage, learning, self-direction, capacity for

independent living and economic self-sufficiency

and requiring care, treatment or other services

of lifelong or extended duration. (Larson et

al., 2001, p. 231-232). Squair and Groeneveld

(2003) divide developmental disabilities into:

Asperger’s disorder, autism, Alzheimer’s dis-

ease/dementia/senility, Down’s syndrome, fetal

alcohol syndrome (FS), fetal alcohol effects

(FAE) and intellectual disability.

Recommendations: for persons with developmen-

tal disabilities directions and instructions

should be clear, brief, concise, with appropri-

ate vocabulary and simple language that suits

the level of understanding. It is recommended

that in order to ascertain participant’s lev-

el of understanding the facilitator should get

the participants to repeat the instructions

or demonstrate them. Also the use of pictures,

videos, other visual aids, games and repetitions


are very effective. Instructions can be broken

into sequential steps for successful learning.

The use of a buddy system is also recommended

(Squair and Groeneveld, 2003).

References:

Larson, S. A., Lakin, K. C., Anderson, L., Kwak Lee, N.,

Lee, J. H., & Anderson, D. (2001). Prevalence of mental

retardation and developmental disabilities: estimates from

the 1994/1995 National Health Interview Survey Disability

Supplements. American Journal on Mental Retardation, 106(3),

231-252

Nkabinde, Z. P., Obiakor, F. E., Offor, M. T., & Smith, D. J.

(2010). Educating Children with Physical Disabilities

O’Reilly, M. F., Sammarco, N., Kuhn, M., Gevarter, C.,

Watkins, L., Gonzales, H. K.,... & Lang, R. (2015). Inborn

and Acquired Brain and Physical Disabilities. In Clinical and

Organizational Applications of Applied Behavior Analysis (pp.

179-193). Academic Press

Parekh, R. (2018). What Is Mental Illness? Retrieved

20.5.2019 from https://www.psychiatry.org/patients-families/

what-is-mental-illness

Squair, L., Groeneveld, H. J. (2003). Disability Definitions.

In R. D. Steadward, G. D. Wheeler and E. J. Watkinson (ed.),

Adapted Physical Activity (11-25). Canada: The Univerity of

Alberta Press

Types of sensory disabilities, 2019. Retrieved 21.5.2019

from https://www.hwns.com.au/about-us/about-disability/

types-of-disabilities/types-of-sensory-disabilities/

3.3.hEaLth COnCerns

3.3.1. The health of people with disabilities

AUTHOR: JASNA VEŠLIGAJ-DAMIŠ

Key words: health condition, disability

An individual’s health status is crucial for

experiencing a better quality of life, indepen-

dence and full participation in society. The

central mission of public health is to improve

the health of all inhabitants. It can be ob-

served that, compared to the general population,

individuals with disabilities often have worse

health and higher levels of chronic illnesses,

such as diabetes, obesity and depression. At the

same time, we can see that persons with disabil-

ities are less involved in organized preven-

tive health activities and often develop a less

healthy lifestyle. (Kasser, Lytle, 2013)

Over a billion people are estimated to live

with some form of disability. This corresponds

to about 15% of the world’s population. Between

110 million (2.2%) and 190 million (3.8%) people

15 years and older have significant difficulties

in functioning. Furthermore, the rates of dis-

ability are increasing in part due to ageing

populations and an increase in chronic health

conditions (“WHO: Disability and health”, 2019).

Disability is extremely diverse. While some

health conditions associated with disability

result in poor health and extensive health care

needs, others do not. However all people with

disabilities have the same general health care

needs as everyone else, and therefore need ac-

cess to mainstream health care services. Article

25 of the UN Convention on the Rights of Persons

with Disabilities (CRPD) reinforces the right of

persons with disabilities to attain the highest

standard of health care, without discrimination

(“WHO: Disability and health”, 2019).

In the case of persons with disabilities, a

number of health problems can be detected due to

secondary health conditions that overlap with

their primary disability as they are very sus-

ceptible to them. For example, in people with a

spinal cord injury or cerebral palsy, a number

of secondary health conditions such as osteo-

porosis, osteoarthritis, increased spasticity,

depression, etc. can be detected, and at the

same time lower balance, muscular strength, en-

durance, mobility and general fitness are common.

All this can significantly affect their daily

activities and the quality of life.

With a good health plan, people with disabili-

ties can improve their health and functionality.

A person, who has suffered a spinal cord injury

and takes good care of his health, eats well,

exercises physically and mentally, goes on reg-

ular medical examinations, prevents ulcers and

maintains appropriate body weight, will certain-

ly maintain good health. In cases were he/she

does not adopt a healthy lifestyle, health will

more than likely deteriorate and “unhealthy”

habits will be adopted, like smoking, alcohol

and drug consumption, which may have additional

unwanted consequences.

Because of all that, people with disabilities

often have more needs for health services,

but are also limited in access to them due to

disability (architectural barriers, necessary

escorts, communication barriers etc).


In some groups of people with disabilities we

can observe that ageing process begins earlier

than in the rest of the population. For example

some people with developmental disabilities show

signs of premature ageing in their 40s and 50s

(“WHO: Disability and health”, 2019).

In addition to early ageing, some people with

disabilities also notice a higher rate of pre-

mature death or lower life expectancy, what is

also connected to their general health condi-

tion. Overall, the life expectancy of people

with mental disorders is increasing (Coppus,

2013), but their health is still worse than in

the general population (Emerson et al, 2012),

and their life expectancy is still lower than

the life expectancy of their peers without

disability (Heslop et al., 2013; Hosking et al.,

2016).

In the case of individuals with disabilities

that belong to specific racial, ethnic and other

groups, who have a higher degree of disability

and a lower level of participation in the health

care system, we see even more health problems.

In these groups risky behaviour, such as physi-

cal inactivity and obesity are even greater.

It is important that we are aware that the

health of people with disabilities is equal-

ly important and has equal decisive influence

on their quality of life compared with others.

It is therefore necessary to provide them with

equal opportunities, conditions and access to

health services.

References

Coppus, A.M.W. (2013) People with intellectual disability:

what do we know about adulthood and life expectancy? Develop-

mental Disabilities Reviews, 18, 6 – 16

Emerson, E., Baines, S., Allerton, L., Welch, V. (2012)

Health Inequalities and People with Learning Disabilities in

the UK: 2012, Lancaster: Improving Health and Lives

Heslop, P. Blair, P. Fleming, P., Hoghton, M., Marriott, A.,

Russ, L. (2013) Confidential Inquiry into Premature Deaths

of People with Learning Disabilities, Bristol: Norah Fry

Research Centre, University of Bristol

Hosking, F.J., Carey, I.M., Shah, S., Harris, T., DeWilde,

S., Beighton, C., Cook, D.G. (2016) Mortality among adults

with intellectual disability in England: comparisons with the

general population, American Journal of Public Health, d.o.i.

10.2105/AJPH.2016.303240

Kasser, S.L., Lytle R.K., 2013, Inclusive physical activity:

Promoting Health for Lifetime, 2nd ed., Human Kinetics (8-9).

Konvencija o pravicah invalidov (2003). Uradni list RS, št.

37 (10. 4. 2008) Pridobljeno s http://www.mddsz.gov.si/

fileadmin/mddsz.gov.si/pageuploads/dokumenti__pdf/konvenci-

ja_o_pravicah_invalidov.pdf, 2018.02.08.

WHO: Disability and health, 2019: Retrieved from: https://

www.who.int/news-room/fact-sheets/detail/disabili-

ty-and-health, 2019.01.21.

3.3.2. Mental Health

AUTHORS: ILONA KOVAL GRUBIŠIĆ, VALENTINA BOLŠEC

Key words: mental health, mental disorders, mental disabilities, mental health and disability

Mental health is more than the absence of mental

disorders. Mental health is an integral part

of health; indeed, there is no health without

mental health. Mental health is determined by a

range of socio-economic, biological and envi-

ronmental factors. Cost-effective public health

and inter sectoral strategies and interventions

exist to promote, protect and restore mental

health (“WHO: Mental health: strengthening our

response”, 2018).

Mental health is an integral and essential com-

ponent of health. The WHO constitution states:

“Health is a state of complete physical, mental

and social well-being and not merely the absence

of disease or infirmity.” An important implica-

tion of this definition is that mental health is

more than just the absence of mental disorders

or disabilities (“WHO: Mental health: strength-

ening our response”, 2018).

Mental health is a state of well-being in which

an individual realizes his or her own abilities,

can cope with the normal stresses of life, can

work productively and is able to make a contri-

bution to his or her community. Mental health

and well-being are fundamental to our collec-

tive and individual ability as humans to think,

emote, interact with each other, earn a living

and enjoy life. On this basis, the promotion,

protection and restoration of mental health can

be regarded as a vital concern of individuals,

communities and societies throughout the world

(“WHO: Mental health: strengthening our re-

sponse”, 2018).

3.3.2.1. Determinants of mental health

Multiple social, psychological, and biological

factors determine the level of mental health

of a person at any point of time. For example,

persistent socio-economic pressures are recog-

nized risks to mental health for individuals and

communities. The clearest evidence is associated

with indicators of poverty, including low levels

of education.

Poor mental health is also associated with rapid

social change, stressful work conditions, gen-

der discrimination, social exclusion, unhealthy

lifestyle, risks of violence, physical ill-

health and human rights violations (“WHO: Mental

health: strengthening our response”, 2018).

There are also specific psychological and per-

sonality factors that make people vulnerable

to mental disorders. Lastly, there are some

biological causes of mental disorders including

genetic factors which contribute to imbalances

in chemicals in the brain (“WHO: Mental health:

strengthening our response”, 2018).

3.3.2.2. Disability and Mental Health

Disability undoubtedly presents a dimension that

increases risk for negative outcomes in mental

health and stress. Results of studies provide

evidence of a linkage between disability and

risk for impairments in mental health. Nearly

4 of 10 individuals with disability have faced

problems in mental health, which is almost dou-

ble the rate observed for non-disabled. There is

also higher risk for men than for women and for

the young than for the old (Turner, Lloyd and

Taylor, 2006).

Significant research has highlited that depres-

sion is commonly associated with impairment

or disability. Increased rates of depression

amongst people with disability are often a

consequence of experience of impairment and

functional limitations in the coexistence of

social and economic factors that may accompany

disability (Morris 2004). Causal link between

impairment and depression also often rests on

the assumption that acquisition of impairment

is an experience of traumatic loss. Person with

disability has to go through various stages of

grieving before becoming psychologically whole

again (Siller, 1969, p. 292 in Morris, 2004).

Sometimes disability can also be benefit-finding

and post-traumatic growth. Many individuals

believe that their disabilities have helped them

to find meaning or take a more adaptive perspec-

tive to life. These individuals reported they

appreciate personal worth regardless of appear-

ance or ability, they value time spent in family

activities and they became more thoughtful and

understanding. Persons who have developed great-

er acceptance of disability will value their

selfhood and maintain positive beliefs about

themselves (Wright 1983, Taylor 1983 in Elliot,

Kurylo and Rivera, 2002).

Individuals with a disability who have effec-

tive social-problem-solving skills and who have

positive orientations toward solving problems

are more assertive, more psychosocially mo-

bile, more accepting of their disability, and

less depressed than their counterparts who lack

these skills (Elliott, Godshall, Herrick, Witty,

& Spruell, 1991 in Elliot, Kurylo and Rivera,

2002). It is also very important for persons

with disabilities that they are goal-oriented.

Higher goal orientation is definitely associated

with lower levels of depression, greater accep-

tance of disability and increased life satisfac-

tion. We must also not forget the importance of

social support which is crucial for people with

disability.

References

WHO: Mental health: strengthening our response, 2018:

https://www.who.int/news-room/fact-sheets/detail/men-

tal-health-strengthening-our-response

retrieved 12.2.2019 11:48

Elliott, T. R., Kurylo, M., & Rivera, P. (2002). Positive

growth following acquired physical disability. Handbook of

positive psychology, 687-699.

Morris, J. (2004). People with physical impairments and men-

tal health support needs: A critical review of the litera-

ture. Joseph Rowntree Foundation.

Turner, R. J., Lloyd, D. A., and Taylor, J. (2006). Physical

disability and mental health: An epidemiology of psychiatric and

substance disorders. Rehabilitation Psychology, 51(3), 214.


3.3.3. Disability and Obesity

AUTHORS: LADISLAV MESARIČ, ILONA KOVAL GRUBIŠIĆ

Keywords: obesity, sports activities, healthy food, body mass index (BMI).

Obesity is one of the world’s greatest health

problems. Since 1975, the number of obese peo-

ple in the world has almost tripled. In 2016,

there were more than 1.9 billion adults with

overweight. Of these, more than 650 million were

obese (WHO, 2018). Research shows that obesity

among people with disabilities is significant-

ly higher than for the rest of the population

(Liou, 2005). For people with physical disabil-

ities, obesity is twice as distracting. It is

associated with potential chronic diseases and,

in linkage with existing limits, prevents or

aggravates active participation in sports and

social activities (Liou, 2005).

Obesity is a medical condition in which an

excess of body fat has accumulated to such an

extent that it could have a negative effect on

health (Sackett et al., 1996).

According to the WHO definitions, adults are

considered as obese if their body mass index

(BMI - is defined as the body mass divided by

the square of the body height, and is universal-

ly expressed in units of kg/m2) exceeds 30 kg /

m2. For weight gain, it is considered if the in-

dex is greater than 25 (Swinburn et al., 2005).

BMI is the most useful measure of overweight and

obesity at the population level, since it is the

same for both sexes and for all ages of adults.

However, it should be treated with caution be-

cause it may not correspond to the same degree

of obesity in different individuals.

In children, age should be taken into account

when determining overweight and obesity (Lob-

steinin sod, 2004). Research has shown that BMI

also may not be the best method for some people

with disabilities. BMI can underestimate the

amount of fat in people with spinal cord in-

juries that have less muscle mass. Different

measurement methods should be used for these

individuals, or the BMI value that determines

obesity should be lower (Liou et al., 2005).

The cause of obesity and overweight is most

often the energy imbalance between consumed and

spent calories. At the global level, there has

been an increase in the intake of energy (rich

foods that are high in fat and sugar); reducing

physical activity due to the increasingly sed-

entary nature of many forms of work, changing

modes of transport and increasing urbanization.

The genesis of obesity in people with physical

disability is unclear. There are several risk

factors as they are: type of injury, severity

and duration of injury or illness and sex and

age. More than 50% of youngsters with muscular

dystrophy are obese. As with a healthy popula-

tion, obesity is more susceptible to women than

men. Physical inactivity and consequently mus-

cular atrophy are very characteristic for people

with disabilities (Liou et al., 2005).

Obesity (elevated BMI) is one of the major risk

factors for diseases such as:

• Cardiovascular diseases (especially car-

diovascular disease and stroke)

• Diabetes

• Musculoskeletal disorders (especially os-

teoarthritis - degenerative joint disease)

• Some types of cancer (including endo-

metrium, breast, ovary, prostate, liv-

er, gall bladder, kidneys and colon).

One of the leading causes of disability is the

weakening of the muscular skeletal system caused

by overweight. In this case, this is a vicious

circle. The sedentary lifestyle causes obesi-

ty and obesity aggravates disability. The role

of physical inactivity in the development of

obesity is significantly higher in persons with

disabilities. There is plenty of evidence to

show that obesity can aggravate the state of

disability and that many disorders accompanying

disability cause a risk of obesity. (Ells et

al., 2006)

Illness associated with excessive weight and

obesity can be avoided. The choice of healthy

food and regular physical activity is essential.

This can be achieved by creating an appropriate

support environment and informing people.

Each individual can take care for himself by:

• limit the intake of foods contain-

ing high saturated fat and sugar,

• limit the intake of alcoholic beverages,

• increases the consumption of vege-

tables, legumes, nuts and fruit

• is regularly physical active (60 minutes per

day for children and 150 minutes for adults).

Sports activities can greatly improve motor

skills, improve quality of life and represent

prevention against obesity. In order to reduce

weight, it is necessary to take into account

nutrition laws (Mesarič, 2017).

References

Ells, L. J., Lang, R., Shield, J. P., Wilkinson, J. R.,

Lidstone, J. S., Coulton, S. and Summerbell, C. D. (2006),

Obesity and disability – a short review. Obesity Reviews, 7:

341-345.

Liou, T., Pi-Sunyer, F. X. and Laferrere, B. (2005), Physical

Disability and Obesity. Nutrition Reviews, 63: 321-331.

Lobstein, T., Baur, L., Uauy, R. (2004): Obesity in children

and young people: a crisis in public health. Obes Rev.,5 Suppl

1:4-104.

Mesarič, L. (2017): Adaptirano fizičko vežbanje za osobe sa

traumatskom povredom mozga (master rad). Fakultet za sport i

turizam, Novi Sad

Sackett, D., Rosenberg W.M., Gray, J.A., Haynes, R.B., Rich-

ardson, W.S. (1996) Evidence based medicine: What it is and

what it isn’t. BMJ. 13; 312(7023): 71-2.

Swinburn, B., Gill, T., Kumanyika, S. (2005): Obesity pre-

vention: a proposed framework for translating evidence into

action. Obes Rev., 6 (1): 23-33.

WHO Helth Topics, Obesity. Prevzeto 21. decembra 2018 s stra-

ni: http://www.who.int/topics/obesity/en

3.3.4. Harmful habits

AUTHORS: DANIJELA MAJCENOVIČ CIPOT, ILONA KOVAL GRUBIŠIĆ

Keywords: harmful habits and disability, drugs, nicotine, alcohol, prevention

Harmful habits of a person are actions that

automatically repeat a large number of times

and can harm the health of a person or those

around him/her. If he/she cannot force them-

selves to stop doing certain actions that may

harm the health in the future, then gradually

it becomes a habit, which is quite difficult to

get rid of. What are bad habits? The influence

of bad habits on the life and health of a person

can be different. Some of them (alcoholism, drug

addiction) are considered by modern medicine

as a disease. Others are classified as unneces-

sary actions caused by imbalance of the nervous

system. Below the main bad habits of modern man

are listed:

• smoking;

• drug addiction;

• alcoholism;

• game dependence;

• shopaholism;

• internet and television dependency;

• binge eating;

• the habit of picking your skin or gnaw-

ing your nails; flicking the joints.

The main causes of bad habits

Most often, the causes of development of bad

habits in humans are:

• social coherence: if in the social group to

which a person belongs is considered a norm,

this or that behaviour pattern, for example,

smoking, then most likely he will also fol-

low it to prove his belonging to this group,

hence the fashion for bad habits arises;

• disorder in life and alienation;

• pleasure is one of the main reasons why

the influence of bad habits is so great, it

is constant enjoyment that leads to peo-

ple becoming alcoholics or drug addicts;

• idleness, inability to correct-

ly dispose of free time;


• curiosity;

• avoiding stress.

Harmful habits and their im-pact on human health

All bad habits can have a direct or indirect

effect on human health. The most severe conse-

quences are the habits of using drugs, nicotine

and alcohol, which quickly develop into addic-

tion and can lead to the development of a number

of complications, even to death.

As we stated in previous articles, people with

disabilities experience poorer health than those

in the general population with delays in access

to diagnosis, investigations and treatment.

Consequently they are particularly vulnerable

to the harmful impact of bad habits on their

health, and also on their financial and social

well-being. Despite this, indulging in bad hab-

its among people with disabilities has received

little research attention therefore there is

little known facts about this behaviour.

Next, we will examine in more detail some of

these harmful habits and their effect on human

health.

Tobacco smoking. Risks from smoking include:

• The risk of developing cancer and re-

spiratory system pathologie;

• Calcium is washed out from the body, the

skin of the face grows old, fingers be-

come yellow, the teeth become damaged, the

structure of hair and nails is destroyed;

• The work of the gastrointesti-

nal tract worsens, the develop-

ment of peptic ulcer is possible;

• Vessels become brittle and

weak, lose elasticity;

• Supply of the brain with oxygen dete-

riorates, hypertension develops.

The percentage of adults who smoke cigarettes is

higher among people with disabilities than peo-

ple without disabilities. For example, in 2014,

cigarette smoking was significantly higher among

those who reported having any disability (more

than 1 in 5 were smokers) compared to those who

reported having no disability (about 1 in 6 were

smokers) (CDC, 2017).

Smoking is especially common in people with

mental health difficulties. Around 33% of people

with mental health difficulties, such as schizo-

phrenia, and approximately 70% of patients in

psychiatric inpatient units, smoke. People with

a mental health difficulty die 10-20 years ear-

lier, on average, than people in the general

population, and smoking is the single biggest

factor contributing to this difference. Further-

more, smoking exacerbates poverty and social

stigma of people with a mental health difficulty

(UH, 2016).

Alcoholism is nothing more than a drug depen-

dence of the body, in which a person feels a

painful craving for alcohol. With this disease

develops not only the mental dependence, but

also the physical dependence of a person on al-

cohol (WHO, 2010, 2014). With alcoholism, severe

damage to the internal organs (especially the

liver) and degradation of personality occurs.

The systematic use of alcohol leads to the fol-

lowing consequences:

• The immune defence of the body decreas-

es thus the person is often unwell;

• Gradual destruction of the liver occurs;

• Increases the glucose level in the blood

thus leading to increased risk of Diabetes;

• Among alcoholics, the mortality rate is

higher due to accidents, suicides, poi-

soning with low-quality alcohol;

• Loss of memory (ASSIST, 2010).

Drug addiction is perhaps the most powerful and

dangerous bad habit that has long been rec-

ognised as a disease. Addiction is the depen-

dence of a person on the use of narcotic drugs.

The disease has several phases of the course and

staged syndromes. The harm that drugs do to the

human body is great. The following are the most

serious consequences of drug addiction:

• a significant reduction in life expectancy;

• an increased risk of contracting dangerous and

often incurable diseases (HIV, hepatitis);

• high mortality among drug addicts from acci-

dents, suicides, overdoses and drug poisoning;

• rapid ageing of the body;

• development of mental and so-

matic abnormalities;

• the strongest degradation of the in-

dividual (ASSIST, 2010).

Substance abuse (drugs, alcohol) is also a

problem for people with physical, cognitive, or

psychological disabilities. There is very little

research data to indicate frequency, however, in

2011 the United States Department of Health and

Human Services Office on Disability reported that

nearly 75 million people in the United States

have some form of disability. In addition,

nearly 5 million adults have both a disability

and a co-occurring substance use disorder. Based

on these figures, about 7 percent of people with

disabilities struggles with substance abuse

(Alcohol.org, 2018).

Other research showed that people with disabil-

ities use drugs and alcohol at least as often

as the general population and perhaps even more

often; however, they have less access to treat-

ment, even though treatment outcomes are similar

to those in the general population (Alcohol.org,

2018). Alcohol is one of the most common sub-

stances of abuse among people with disabilities

because of its availability, social acceptance,

and central nervous system depressant effects.

Use of other types of substances depends on type

of disability.

The risk factors associated with the development

of a substance use disorder among people with

disabilities include:

• Unemployment and low income

• Chronic pain and other chronic physical issues

• Mental illness, which is always a risk fac-

tor for developing a substance use disorder

• Easier access to prescription medications

• Less access to education

• Social isolation

• Physical abuse and sexual abuse

• Enabling behaviours by caregiv-

ers (Alcohol.org, 2018).

How to deal with bad habits of people with disabilities

What are the methods and ways to combat bad

habits, and which one is the most effective?

There is no unambiguous answer to this question.

Everything depends on many factors - the degree

of dependence, the willpower of a person and

individual characteristics of the organism. But

the most important is the person’s desire to

start a new life without bad habits, being with

or without disability. As we mentioned so many

times before, people with disabilities are even

more vulnerable when it comes to fighting a bad

habit or addiction.

They face:

1. Attitudinal barriers;

2. Communication barriers;

3. Discriminatory practices and procedures;

4. Architectural barriers.

Therefore it is of the utmost importance that we

have competent trained professionals that will

understand functional limitations and help over-

come these barriers regarding the specific types

of disabilities require specific adjustments to

the treatment program (deaf, blind, with cog-

nitive deficits, etc.). All treatment should

be inclusive, not only for people from diverse

racial and ethnic groups, but also for people

with disabilities. Inclusive programs need to

be accessible to those who want to participate

and in some cases adapted to address the needs

and expectations of the target population and

adjusted to suit the needs of the individual

included in the treatment.

Prevention of bad habits

Unfortunately, till now the prevention of bad

habits amongst people with disabilities has

not been given adequate attention. Due to the

architectural barriers they face, prevention

campaigns don’t reach them or they are excluded

because they are dependent on the help of an-

other person or cannot get to the program. In

some cases they don’t understand the topics or

they don’t have adequate support or understand-

ing environment to exercise changes in life.

They face financial deficit and therefore cannot

afford to live healthier. But most of all they

already face stress by struggling with disabil-

ity and therefore have additional psychological

problems, which make harder for them to face and

fight bad habits.


References

Alcohol.org, 2018. Treating an Alcoholic Who Is Differently

Abled. Retrieved from: https://www.alcohol.org/disabled/,

accessed 2019 02 16, 23:37.

ASSIST: The Alcohol, Smoking and Substance Involvement

Screening Test. Manual for use in primary care. Geneva, 2010.

Retrieved from: (http://www.who.int/substance_abuse/publica-

tions/assist/en/, accessed 31 March 2017.

CDC, 2017. How to Help People with Disabilities Quit Smoking.

Centers for Disease Control and Prevention. Retrieved from:

https://www.cdc.gov/features/disability-quit-smoking/index.

html, accessed 2019 02 16, 23:05.

UH, 2016. Smoking and People with an Intellectual Disabili-

ty. University of Hertfordshire. Retrieved from: http://www.

intellectualdisability.info/physical-health/articles/smok-

ing-and-people-with-an-intellectual-disability, accessed 2019

02 16, 23:16.

WHO. Set of recommendations on the marketing of foods and

non-alcoholic beverages to children. Geneva, 2010. Retrieved

from: https://www.who.int/dietphysicalactivity/publications/

recsmarketing/en/, accessed 31 March 2017.

WHO. Global status report on alcohol and health 2014.

Retrieved from: https://apps.who.int/iris/bitstream/

handle/10665/112736/9789240692763_eng.pdf;jsession-

id=B1AD972DD48280A38DD796C57AB86FF7?sequence=1, accessed 31

March 2017.

WHO. European Food and Nutrition Action Plan 2015-2020.

Regional Committee for Europe, 64th session; Copenhagen,

Denmark, 15-18 September 2014. Retrived from: http://www.

euro.who.int/__data/assets/pdf_file/0008/253727/64wd14e_Food-

NutAP_140426.pdf, accessed 31 March 2017.

WHO. HEARTS Technical package for cardiovascular disease

management in primary health care: healthy-lifestyle counsel-

ling; Geneva. Retrieved from: https://www.who.int/cardiovas-

cular_diseases/hearts/Hearts_package.pdf, accessed 31 March

2017.

WHO. Global strategy on diet, physical activity and health,

the 57th World Health Assembly, 2004. Retrieved from:

https://www.who.int/dietphysicalactivity/strategy/eb11344/

strategy_english_web.pdf, accessed 31 March 2017.

3.3.5. 21st Century - Video Games or Traditional Sport Disciplines

AUTHORS: LADISLAV MESARIČ

Keywords: video games, benefits, bad sides, health, physical activity

Introduction

Nowadays, video gaming is a highly popular and

prevalent entertainment option; its use is no

longer limited to children and adolescents.

Demographic data on video gaming shows that the

mean age of video game players is 31 years old

and has been on the rise in recent decades. It

is a common activity among young adults (Palaus

et al., 2016).

New research from innovation charity Nesta re-

veals that those who play video games are better

educated, no less wealthy and more likely than

non-games players to participate actively in

culture. The findings also turn the gamer stereo-

type on its head, with women more likely to play

than men do and the average gamer being aged 43.

However, among those that play, females do so

less often than men do. (Nesta, 2017) Gaming is

broad and complex. A ‘typical’ gamer may not ex-

ist. Based on the written, we can conclude that

video games are not just for young people.

In our perception, video games still have some-

thing bad. Against this backdrop of nearly ubiq-

uitous play, the popular press regularly pulses

out urgent warnings against the perils of addic-

tion to these games and their inevitable link to

violence and aggression, especially in children

and adolescents (Granic et al., 2016).

Video games are changing and the approach has

changed. The more balanced perspective, consid-

ers not only the possible negative effects but

also the benefits of playing these games.

3.3.5.1. The Benefits of Play-ing Video Games

According to meta study (Granic et al., 2016)

video games provide people with compelling so-

cial, cognitive, and emotional experiences and

can potentially boost mental health and well-be-

ing. Authors find the following benefits:

Cognitive development

Research into action games shows enhanced mental

rotation abilities, faster and more accurate

attention allocation, higher spatial resolution

in visual processing. Meta-analysis studies

showed that spatial skills can be learned in a

relatively brief time by playing video games and

that the results are often comparable to train-

ing in formal courses designed to enhance those

same skills. Cognitive advantages from video

games also appear to produce greater neural

processing and efficiency, improve attention

functioning and help with pattern recognition.

Interactive games also appear to improve cre-

ativity as well. Although it is still not clear

how well the skills learned from video games

generalize to real-world situations, early

research results seem promising (Granic et al.,

2016).

Emotion

Most gamers play video games for enjoyment and

to help improve their mood. Along with distract-

ing them from real-world problems (a special

concern for young people looking for escape from

bullying or other negative life situations),

succeeding in video games can lead to positive

feelings, reduced anxiety, and becoming more

relaxed.

Motivation

By setting specific tasks and allowing people to

work through obstacles to achieve those tasks,

video games can help boost self-esteem and

help people to learn the value of persistence.

By providing immediate feedback as video game

players solve problems and achieve greater

expertise, players can learn to see themselves

as having skills and intelligence they might not

otherwise realize they possess. Gaming helps

people realize that intelligence can increase

with time and effort rather than being fixed.

Social activity

Perhaps more than ever before, video games have

become an intensely social activity. Instead

of the stereotypical gaming nerd who uses video

games to shun social contact, over 70 percent of

gamers play with friends, whether as part of a

team or in direct competition. Social and pro-

social activities are an intrinsic part of the

gaming experience with gamers rapidly learning

social skills that could generalize to social

relationships in the real world.

The vast majority of reviewed studies revealed

positive health outcomes for older adults asso-

ciated with digital video game play, especially

related to mental and physical health benefits.

Significant mental health positive outcomes,

such as cognitive improvement, were reported in

multiple digital video game interventions, which

used measures such as working memory, focused

attention, fluid intelligence, scales for demen-

tia, scales for depression, information process-

ing, enjoyment of physical exercise, and balance

confidence to assess cognitive improvement. The

most frequently reported significant health out-

come among digital game interventions for older

adults were mental health outcome factors (Hall

et al., 2016).

Video games have been used as a form of physio-

therapy or occupational therapy in many differ-

ent groups of people. Such games focus attention

away from potential discomfort and, unlike more

traditional therapeutic activities; they do not

rely on passive movements and sometimes painful

manipulation of the limbs. Therapeutic benefits

have also been reported for a variety of adult

populations including wheelchair users with spi-

nal cord injuries, people with severe burns, and

people with muscular dystrophy (Griffiths, 2005).

Video games have many positive effects and are

appropriate for people with disabilities. Howev-

er, consideration should be given to suitability

of some games for special groups of people. In

addition to the above mentioned positive sides,

video games also have many negative sides.

3.3.5.2. The bad sides of video game

Muscle pain, Obesity, Sleep Deprivation

Though the activity level needed to play Wii or

Xbox Kinect are a step in the right direction,

a majority of video games still involve sitting

in front of a screen, often with poor posture.

Excessive screen game playing leads to increased

levels of muscle stiffness, especially in the

shoulders, which can be caused by poor posture.

Sedentary lifestyles and bad diets are directly

linked to obesity. Playing too many video games


has been associated with changes in physical

appearance. Increased gaming can cause sleep

deprivation and gamers can develop black rings

in the skin under the eyes (Tazawa & Okada,

2001).

According to a report in Paediatrics, seven out

of 10 children are vitamin D deficient. Vitamin

D, of course, is commonly absorbed from expo-

sure to sunlight. Unfortunately, being holed up

in front of video games console does not afford

the same exposure to sunlight as being outside

(Misra et.all 2008).

Negative aspects include the risk of video game

addiction (although the prevalence of true ad-

diction, rather than excessive use, is very low)

and increased aggressiveness. There have been

numerous reports of other adverse medical and

psycho-social effects. For instance, the risk of

epileptic seizures whilst playing video games in

photosensitive individuals with epilepsy is well

established (Griffiths 2005).

3.3.5.3. Answer to the main question

In accordance with the text above, video games

have a lot of space in our field of operation.

However, we have to answer the main question:

21st Century - Video Games or Traditional Sport

Disciplines?

The answer is both. While video games show their

advantages having regard to all the weaknesses

traditional games are another story.

People have many different reasons for exercis-

ing. Sport activities provide the health related

benefits. The main goals are to lower the risk

of developing health problems and preventable

disease. A person can be well even if he or she

has differences in movement capabilities, wheth-

er these are caused by a particular experience

or factors such as cerebral palsy, injury to

the spinal cord and paralysis, or advanced age.

Disabilities are not considered illnesses or

deficiencies. Regardless of ability level, age or

level of experience, exercise benefits can lead

to wellness. (Kasser & Lytle, 2013).

For adapted physical activity, it is considered

that it is one of the most sustainable support

systems for promoting physical activity for peo-

ple with different forms of disability and for

the continuous development of scientific knowl-

edge, based on the support of applied practice

and human rights (Aleksandrović et al., 2016).

Video games can be used for special purposes,

taking into account advantages and disadvantag-

es, but they cannot replace traditional sports

activities. We need to adapt physical activities

so people with disabilities can participate and

gain benefits.

Man was made to move. This is a biological fact

that no video game can substitute. But even from

video games we will have more if we play them in

good physical condition.

References

Bakhshi, H. (2017). New research proves cultural val-

ue of video gaming. (https://www.nesta.org.uk/news/

new-research-proves-cultural-value-of-video-gaming/)

Brown, A. (2017) Younger men play video games, but so do a

diverse group of other Americans. (http://www.pewresearch.

org/fact-tank/2017/09/11/younger-men-play-video-games-but-so-

do-a-diverse-group-of-other-americans/)

Granic, I., Lobel, A., & Engels, R. C. M. E. (2014). The

benefits of playing video games. American Psychologist, 69(1),

66-78.

Griffiths, M. (2005). Video games and health: Video gaming is

safe for most players and can be useful in health care. BMJ :

British Medical Journal, 331(7509), 122–123.

Hall, A.K., Chavarria,E., Maneeratana, V., Chaney, B.H., M.

Bernhardt J.M. (2012). Health Benefits of Digital Videogames

for Older Adults: A Systematic Review of the Literature.

Games for Health Journal 1:6, 402-410

Kaminsky, L. A. (2010) ACSM Priručnik za procenu fizičke forme

povezane sa zdravjem, Data Staus, Beograd

Kasser, S.L., Lytle R.K., (2013), Inclusive Physical Activ-

ity-2nd Edition, Human Kinetics, Human Kinetics Europe Ltd,

United Kingdom

Misra, M., Pacaud, D., Petryk A., Collett-Solberg P.F.,

Kappy, M. (2008) Vitamin D Deficiency in Children and Its

Management: Review of Current Knowledge and Recommendations.

Pediatrics, Volume 122 / Issue 2

Palaus, M., Marron, E. M., Viejo-Sobera, R., & Redolar-Rip-

oll, D. (2017). Neural Basis of Video Gaming: A Systematic

Review. Frontiers in Human Neuroscience, 11, 248. http://doi.

org/10.3389/fnhum.2017.00248

Tazawa, Y. and Okada, K. (2001), Physical signs associ-

ated with excessive television-game playing and sleep

deprivation. Paediatrics International, 43: 647-650.

doi:10.1046/j.1442-200X.2001.01466.x

3.3.6. Doping in the sport for persons with disability

AUTHOR: LADISLAV MESARIČ

Key words: doping, technodoping, bosting, self-harm

Most athletes who take part in adapted sports

activities compete ethically and use the ap-

proved methods to improve sports performance.

Improving the results is achieved through train-

ing that takes into account scientific knowledge

in the field of sports training. People, like in

all areas of life, as well as in adapted sports,

are looking for shortcuts to succeed. The rea-

sons for this are recognition and publicity (in

particular, the Olympic Games), financial benefits

from sponsors and state grants, and the human

desire to be better than others, albeit in an

illegal way.

There are many known cases of doping. In par-

allel with the development of methods for the

detection of doping in sport, even in the ear-

ly 1980s, doping controls were also conducted

in competitions for persons with disabilities

(Hale, 2016).

The use of doping in the Olympic and Paralym-

pic athletes does not differ significantly. As a

rule, there is an increase in power and endur-

ance. There are also similar sanctions, which

include disqualification, repossession of awards

and all the benefits that they have been given

after winning the medal (Collier, 2008)

However, in adapted sports activities, there are

certain characteristics that are specific for

athletes with physical and mental disabilities.

3.3.6.1. Different technology

Athletes from countries with advanced technology

and better economic standards have access to a

better technology that allows them greater com-

petitiveness. This can lead to an unequal posi-

tion among competitors (Guerrero et al., 2018).

Some people call it techno doping (Bolta, 2016).

3.3.6.2. Increasing of blood pressure (Bosting)

Another form of “cheating” is encountered in

some athletes with spinal cord injuries who want

to increase their blood pressure and thereby

improve their performance. Due to the nature

of the spinal cord injury, some athletes do

not feel the parts of their body. If the body

is damaged in areas where there is no sense,

a physiological response, known as autonomic

dyslexia, is triggered. In order to speed up

this response, some athletes deliberately harm

themselves. Self-harm is, for example, fracture,

causing pressure due to very tight clothing,

overload of the bladder or in male sport - too

tight clothing in the area of pelvis. These are

very extreme behaviours, but they point to what

all para athletes are willing to do to reach the

desired result or success (Bolta 2016, Guerrero

et al., 2018).

Different qualification systems are available

in the sport of persons with disabilities. That

enables equal and fair competitions for persons

with different types and degrees of disabili-

ty (Aleksandrović et al., 2016). Although the

system is constantly improving, it may be con-

troversial, because in some cases individuals

simulate a lower level of ability. A well-known

example is the Spanish basketball team where

people without disabilities appeared and entered

the competition due to inconsistent classifica-

tion procedures (Bolta, 2016).

References

Aleksandrović, M., Jorgić, B., Mirić, F. (2016). Holistički

pristup adaptivnom fizičkom vežbanju, učbenik za studente

master akademskih studija. Fakultet sporta i fizičkog vaspi-

tanja Niš

Bolta T.(2016) Paraolimpijske igre in Slovenci. Diplomsko

delo, Fakulteta za šport, Ljubljana


Collier, R. (2008). Most Paralympians inspire, but others

cheat. CMAJ : Canadian Medical Association Journal, 179(6),

524. http://doi.org/10.1503/cmaj.081279

Guerrero L.A., Drakes S., De Luigi A.J. (2018) Controversies

in Adaptive Sports. In: De Luigi A. (eds) Adaptive Sports

Medicine. Springer, Cham

Hale L. (2016) A brief history of doping in disability sport.

Retrieved from http://www.parasport-news.com/a-brief-history-

of-doping-in-disability-sport/10515/ on 15.5.2018

4.

Learning outcomes:

• to outline Physiological and So-

cial benefit of Physical activity

• recommendation for physical activi-

ty in different stages of life

• an understanding of Adapted Phys-

ical Activities (APA).

• familiarizing reader with the benefits

of sport and APA in rehabilitation.

BeNe fITs of PhySI cAL AcTIv ITy


4.1.BENefiTS fOr thE PSYcholOGIcal aND SoCial FUNctIONingAUTHORS : MICHELE LEPORI, ALESSANDRO MUNARINI, SILVIA NOCI, PAOLO ZARZANA

Key Words: Well being; physical activity; muscular fitness; self-esteem; self-confi-dence; social relationship;

Introduction

There are many publications in the field of mo-

tor sciences and the promotion of health; many

studies have been carried out to state both the

value and the importance of motor activity,

physical activity and sports on the psychophysi-

cal well-being of any individual.

WHO guidelines (2010) provide recommendations

on Physical Activity specific for each age

group (following) and concepts and technical

terminologies.

5–17 years

For children and young people physical activity

includes play, games, sports, transportation,

recreation, physical education or planned ex-

ercise, in the context of family, school, and

community activities. Physical activity benefits

include cardiorespiratory and muscular fitness,

bone health, cardiovascular and metabolic health

biomarkers and reduced symptoms of anxiety and

depression.

18–64 years old

For adults of this age group, physical activity

includes recreational or leisure-time physi-

cal activity, transportation (e.g. walking or

cycling), occupational (i.e. work), household

chores, play, games, sports or planned exercise,

in the context of daily, family, and community

activities in order to improve cardiorespiratory

and muscular fitness, bone health and to reduce

the risk of Non-Communicable diseases NCD’s

(e.g. Parkinson’s disease, stroke, and cancer)

and depression.

Adults aged 18–64 years should aim to do at

least 150 minutes of moderate-intensity aerobic

physical activity throughout the week, or at

least 75 minutes of vigorous-intensity aerobic

physical activity throughout the week, or an

equivalent combination of moderate- and vigor-

ous-intensity activity.

65 years old and above

For adults of this age group, physical activity

includes recreational or leisure-time physi-

cal activity, transportation (e.g. walking or

cycling), occupational (if the person is still

engaged in work), household chores, play, games,

sports or planned exercise, in the context of

daily, family, and community activities in order

to improve cardiorespiratory and muscular fit-

ness, bone and functional health, and reduce the

risk of NCD’s, depression and cognitive decline.

In 2008 the U.S. Department Health and Hu-

man Services published the Physical Activity

Guidelines for Americans - Be Active, Healthy,

and Happy! (www.health.gov/paguidelines) that

provide achievable steps for youth, adults and

seniors, as well as people with special condi-

tions to live healthier and longer lives.

Key Guidelines for Adults with Disabilities

• Adults with disabilities, who are able to,

should get at least 150 minutes a week of

moderate-intensity, or 75 minutes a week

of vigorous-intensity aerobic activity, or

an equivalent combination of moderate- and

vigorous-intensity aerobic activity. Aero-

bic activity should be performed in episodes

of at least 10 minutes, and preferably, it

should be spread throughout the week.

• Adults with disabilities, who are able

to, should also do muscle-strengthening

activities of moderate or high intensi-

ty that involve all major muscle groups

on 2 or more days a week, as these activi-

ties provide additional health benefits.

• When adults with disabilities are not able

to meet the Guidelines, they should engage

in regular physical activity according to

their abilities and should avoid inactivity.

• Adults with disabilities should consult their

health-care provider about the amounts and

types of physical activity that are appro-

priate for their abilities (ODPHP, 2008).

In addition, it is important to note that sport

has an important social role, not only does it

help to improve the physical and psychological

recovery, but it also helps to develop social

relationships regardless of the age, the social

origin or the physical difficulties. It is a

source of important values such as team spirit,

solidarity, tolerance and fair play, contribut-

ing to personal development and fulfilment.

Sport is an important means of social integra-

tion by which the person increases social inter-

actions which subedequently improve self-esteem.

Benefits for the Psychologi-cal and Social Functioning

Sports activity, in general, assumes, of course,

a role of “privileged context” within which to

foster relationships and to counter the risk of

isolation, which weighs heavily on certain cate-

gories of citizens, such as, for example, people

with disabilities.

The UN Convention on the Rights of Persons

with Disabilities suggests a set of rights,

including:

a. to encourage and promote the widest possible

participation of persons with disabilities in

mainstream sports activities at all levels;

b. ensure that they have access to plac-

es that host sports activities

c. to ensure that minors with disabilities can

participate, on an equal basis with oth-

er minors, in recreational activities,

leisure and sport, including the activi-

ties provided for by the school system.

As the Ministry of Health confirms, sporting

activity produces, a beneficial effect on the

physical and mental health.

It is well known that the benefits of sport are

undeniable. Those who play sports live longer

because they protect their health better example

prevents muscle and bone decline. The calming

action of sports activity should not be forgot-

ten. Doing sports allows you to disconnect from

everyday problems and recharge yourself. Sport

makes it possible to become not only stronger

physically but also mentally, giving greater

motivation to achieve increased self-esteem,

confidence and optimism.

All these considerations can thus safely be

transported to the world of sports for persons

with a disability; we always tend to think of

disabled people as sick, steady, immobile peo-

ple, but if we look at them engaged in sports we

find them to be tenacious, determined and con-

centrated people. This is because practising a

sport and trying to reach a goal creates import-

ant motivations. Through the sporting activi-

ty the disabled person has the possibility to

improve in different aspects, in particular on

the psychological, social and educational level

increasing their autonomy, encouraging commit-

ment during training and respect for opponents,


teaching courage, promoting loyalty; encourag-

ing socialization, integration, thus overcoming

fears, prejudices and isolation. We must there-

fore always put the person at the centre of our

project. Sport has some peculiarities that we

must always be able to exploit: managing emo-

tions, collaborating with others, feeling part

of a team, respecting the rules and learning to

accept their limits, not without trying to go

further. All these benefits affect all people,

disabled or not (Munarini A., CSI referente

nazionale attività disabili CSI).

4.1.1. Motivation

One of the most influential internal barriers

addressed in the literature is the attitudes and

motivations of people with a disability, par-

ticularly self-consciousness and low levels of

confidence. This lack of confidence and self-es-

teem has been reported to manifest itself in the

following ways:

• Feeling different from the ma-

jority of the population.

• Feeling unable to fit in at

a sporting facility.

• Self-consciousness or lack of confi-

dence in asking for help and assis-

tance in a sporting environment.

• A fear of failure on the part of the per-

son with the disability can present another

type of internal barrier, particularly in

the case of people who have newly acquired

their disability and with low self-esteem.

Motivation is essential for physical activity

in the general population and among individuals

with disabilities. Self-determination theory

(SDT) divides motivation into 2 components.

Controlled motivation is derived from exter-

nal sources, such as physicians, trainers or

media, while autonomous motivation is derived

from oneself across 3 basic psychological needs:

autonomy, relatedness and competence. Recent

research has shown the importance of autonomous

motivation for adherence to physical activi-

ty, and that it is associated with increased

activity in people with physical disabilities

(Saebu M. et al.; 2013). It is also noteworthy

that maintenance of behaviours over time re-

quires autonomous motivation for that behaviour.

Conversely, controlled motivation is unrelated

to long-term adherences and is less malleable

(Bean J. Et al., 2007). Autonomous motivation

is closely associated with motivation for a

change in behaviour, and is a person’s confidence

in the ability to perform new activities. This

notion is often termed “self-efficacy” and is

defined by Bandura (Bean J. Et al., 2007) as the

perceived capability of a person to perform a

specific action required to achieve a concrete

goal. Self-efficacy has been shown to be a strong

predictor of physical activity in individuals

with disabilities (Hutzler Y. Et al.; 2007). In

addition, the degree of impairment is close-

ly related to physical activity in individuals

with disabilities. However, it is challenging to

reach a common assessment of impairment across

different diseases and disabilities. Pain and

fatigue are associated with disability, but may

play a unique role for motivation in physical

activity. Adapted Physical Activity (APA)-based

rehabilitation includes physical activities

adapted to the specific needs of each individual

with a disability. The goal is to enhance the

subject’s autonomy, motivation and ability to

engage in physical activities, and ultimately

increase physical activity over time. Although

this type of rehabilitation is beneficial with

respect to pain and functioning, we have less

knowledge about its influence on motivation and

physical activity levels over time (van Mid-

delkoop M. et al. ; 2011).

4.1.2. Self-Esteem

Practising sport helps to develop and enhance

the potential and autonomy of the disabled

person in respect of the evolutionary process:

through motor sports activities aimed at the

well-being of the disabled person, it contrib-

utes to the increase of specific skills to be

carried out by increasing the opportunities

for social integration, using it as a tool for

growth and enhancement of personal skills (Noci

S., CSI National technical commission for dis-

abled people).

Individuals with disabilities who participate

in sports have higher self-esteem, better body

images and higher rates of academic success;

are more confident and more likely to gradu-

ate from high school and enrolling in college.

Furthermore, sport is where skills like team-

work, goal-setting, the pursuit of excellence in

performance and other achievement-oriented be-

haviours necessary for success in the workplace

are developed (Richman, E. L.; 2000).

An adapted physical activity helps to achieve a

good autonomy in the game and changing room en-

vironment, to develop a gradual transition from

not knowing one’s body to the elaboration of the

body schema; to find a balance between mind and

body; to reach a personal balance, to improve

co-ordinative and conditional skills, to develop

laterality, to better perceive one’s own body

through the elaboration of motor and perceptual

experiences (Noci S., CSI commissione tecnica

Nazionale disabili)

4.1.3. Emotional Well-Being

Sports Reduce Stress and Depression

Those who practice sport prevent bone and mus-

cle decline, protect their health, recharge by

detaching their mind from everyday problems and

focusing on movement. The sporting motion pro-

duces endorphins, substances that stimulate the

body to react positively to situations of anxi-

ety and stress. The movement not only enhances

the physical, but also strengthens the mind,

increasing self-esteem, optimism and self-con-

fidence. On the sporting level, the technical

knowledge of the sports disciplines is acquired,

the respect of the rules and the collaboration

are encouraged, communication is encouraged. On

the psychological level we work on the contain-

ment of emotions and on increasing the capacity

for self-control. (Noci S., CSI National techni-

cal commission for disabled people).

When you are physically active, your mind is

distracted from daily stressors. This can help

avoid getting bogged down by negative thoughts.

Exercise reduces the levels of stress hormones

in your body. At the same time, it stimulates

production of endorphins. These are natural mood

lifters that can help keep stress and depression

at bay. Endorphins may even leave you feeling

more relaxed and optimistic after a hard workout

on the field. Experts agree that more quality

research is needed to determine the relationship

between sports and depression.

4.1.4. Attention

Regular physical activity helps keep your key

mental skills sharp as you age. This includes

sharp thinking, learning, and using good judge-

ment. Research has shown that doing a mix of

aerobic and muscle strengthening activities

is especially helpful. Thanks to the sporting

performance a return is achieved in terms of

improving the strength of determination, vital

energy and passion in everyone.

4.1.5. Social encounters

and Social Skills

The relationship with the sports opponent or

with the teammate, stimulates interaction with

the other, promotes socialization and social

integration, offering valuable help to the

prevention of isolation and overcoming fears and

false judgements (Noci S., CSI National tech-

nical commission for disabled people). If the

physical benefits are evident and known, perhaps

the psychological benefits of sport, are less

experienced, and are a secondary and not very

visible aspect.

Sport, on the other hand, produces decidedly

positive and important effects on a psychologi-

cal level. Physical activity allows the athlete

with a disability to gain greater confidence in

the things they do, helping to restore confidence

in their potential.

In addition, the athlete is able to test their

skills and abilities, their possibilities and

limits, thus acquiring a greater awareness of

them.

Sports practice is very important, because it

allows individuals to be inserted or reinserted

in a healthy and suitable social context. By

coming into contact with the outside world, an

athlete with a disability discovers a healthy

collaboration, one that goes beyond personal

benefits, and savours the joy of human relation-

ships. Within the sports world the interactions

that are established are, in fact, multiple

and of different types; for example, you get in

touch with the coach, with the teammates, in the

case of team sports, and with opponents.


These connections allow individuals to experi-

ence a wide range of feelings and emotions, to

manage any relationship conflicts and to learn

how to adapt relationships dependent on who they

are interacting with. In the interpersonal re-

lationships to the subject, goals and a specific

role are recognized, thus enhancing the process

of building his personal identity (Zarzana P.,

CSI National trainer and CSI formatori nazi-

onali, Italian National amputee football team

coach).

The power of sport as a transformative tool is

of particular importance for women as women

with disabilities often experience double dis-

crimination on the basis of their gender and

disability. It is reported that 93% of women

with disabilities are not involved in sport and

women comprise only one-third of athletes with

disabilities in international competitions. By

providing women with disabilities the opportu-

nity to compete and demonstrate their physical

ability, sport can help to reduce gender stereo-

types and negative perceptions associated with

women with disabilities.

Moreover, by improving the inclusion and

well-being of persons with disabilities, sport

can also help to advance the Millennium Devel-

opment Goals (MDGs). For example, sports-based

opportunities can help achieve the goal of

universal primary education (MDG2) by reducing

stigma preventing children with disabilities

from attending school; promote gender equality

(MDG3) by empowering women and girls with dis-

abilities to acquire health information, skills,

social networks, and leadership experience; and

lead to increased employment and lower levels of

poverty and hunger (MDG1) by helping to reduce

stigma and increase self-confidence.

The UN Convention on the Rights of Persons with

Disabilities is the first legally binding inter-

national instrument to address the rights of

persons with disabilities and sport. Article 30

of the Convention addresses both mainstream and

disability-specific sport and stipulates that

“States Parties shall take appropriate measures

to encourage and promote the participation, to

the fullest extent possible, of persons with

disabilities in mainstream sporting activities

at all levels”. It also calls upon Governments,

States party to the Convention, to ensure that

persons with disabilities have access to sport

and recreational venues — as spectators and as

active participants. This also requires that

children with disabilities be included in phys-

ical education within the school system “to the

fullest extent possible” and enjoy equal access

to “play, recreation and leisure and sporting

activities” (Convention on the Rights of Persons

with Disabilities Article 30); (General Assembly

Resolution: Sport as a means to promote educa-

tion, health, development and peace A/RES/69/6);

(International Disability in Sport Working

2018).

Case studies

Background Although the promotion of social

inclusion through sports has received increased

attention with other disadvantaged groups, this

is not the case for children and adults with

intellectual disability who experience marked

social isolation. The study evaluated the out-

comes from one sports programme with particular

reference to the processes that were perceived

to enhance social inclusion.

Method The Youth Unified Sports programme of Spe-

cial Olympics combines players with intellectual

disabilities (called athletes) and those without

intellectual disabilities (called partners) of

similar skill level in the same sports teams for

training and competition. Alongside the devel-

opment of sporting skills, the programme offers

athletes a platform to socialise with peers and

to take part in the life of their community.

Unified football and basketball teams from five

countries – Germany, Hungary, Poland, Serbia and

Ukraine – participated. Individual and group

interviews were held with athletes, partners,

coaches, parents and community leaders: total-

ling around 40 participants per country.

Results Qualitative data analysis identified

four thematic processes that were perceived

by participants across all countries and the

two sports to facilitate social inclusion of

athletes. These were: (World Health Organiza-

tion 2010 “Global Recommendations on Physical

Activity for Health”) the personal development

of athletes and partners; (Richman, E. L., &

Shaffer, D. R.; 2000) the creation of inclusive

and equal bonds; (Saebu M.; 2013) the promo-

tion of positive perceptions of athletes; and

(Bean JF, 2007) building alliances within local

communities.

Conclusions Unified Sports does provide a vehicle

for promoting the social inclusion of people

with intellectual disabilities that is theoreti-

cally credible in terms of social capital schol-

arship and which contains lessons for advancing

social inclusion in other contexts. Nonetheless,

certain limitations are identified that require

further consideration to enhance athletes’ so-

cial inclusion in the wider community

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4.2.Sports and Phys-ical Activity as RehabilitationAUTHOR: MICHAEL LAMONT

Key Words: sport, rehabilitation, persons with disabilities, Adapted Physical Activities

Introduction

Sport is a cultural phenomenon and an integral

part of society. It is highly visible and touch-

es almost everyone as participants, spectators

and consumers - DePauw & Gavron (2005).

Sport represents an efficient rehabilitation

method for persons with disabilities. Through

regular sporting activity persons with dis-

abilities can achieve greater quality of life

and improved social inclusion. For this purpose

persons with disabilities need to be provided

with the possibility of participating in appro-

priate sport programme, where they can equally

participate. Sporting activities need to become

a component of rehabilitation of persons with

disabilities regardless of the nature or degree

of their disability, age and level of physical

competence.

4.2.1. Definition of

Rehabilitation

The World Health Organisation

The WHO (2011) defined rehabilitation as “a set

of measures that assist individuals who expe-

rience, or are likely to experience disability,

to achieve and maintain optimal functioning

in interaction with their environments. Reha-

bilitation provides disabled people with the

tools they need to attain independence and

self-determination.”

The European Standards in Adapt-ed Physical Activities

The EUSAPA (2010) stated that “Rehabilitation

is concerned with identifying and maximising

quality of life and movement potential within

the spheres of promotion, prevention, treatment/

intervention, habilitation and rehabilitation,

encompassing physical, psychological, emotional,

and social well-being.”

The United Nations Convention on the Rights of Persons with Disabilities

The UNCRPD (2007) outlined the responsibility of

states to provide “appropriate measures, includ-

ing through peer support, to enable persons with

disabilities to attain and maintain their maxi-

mum independence, full physical, mental, social

and vocational ability, and full inclusion and

participation in all aspects of life.”

4.2.2. Definition of

Adapted Physical Activity

– Play, Game Sport

Sport

Sport is defined as “all forms of physical activ-

ity which, through casual or organised partici-

pation, aim at expressing or improving physical

fitness and mental well-being, forming social

relationships or obtaining results in competi-

tion at all levels.” (European Sports Charter

1992; revised 2001).

Adapted Physical Activity (APA)

APA can be defined as the provision of physical

activity services and programmes to persons of

all ages with special needs (Hutzler & Sherrill,

2007). APA includes, but is not limited to,

physical education, sport, recreation, and reha-

bilitation of people with disabilities (EUFAPA,

2006, article 5).

According to the International Federation of

Adapted Physical Activity (IFAPA), APA means:

• A service-oriented profession

• An academic specialisation or field of study

• A cross disciplinary body of knowledge

• An emerging discipline or subdiscipline

• A philosophy or set of be-

liefs that guides practices

• An attitude of acceptance that pre-

disposes behaviours

• A dynamic system of interwo-

ven theories and practices

• A process and a product (i.e. pro-

grammes in which adaptation occurs)

• An advocacy network for disabili-

ty rights to physical activity of par-

ticipants with disability

4.2.3. The benefits of Sports in

the Process of Rehabilitation

The history of Sport in Rehabilitation

Although the use of physical activity in re-

habilitation can be traced as far back as 3000

B.C. in ancient China (EUSAPA, 2010), the modern

evolution of physical activity and sports as a

means of rehabilitation is attributed, among

others, to the Swedish scholar Per Henrik Ling

(1776-1839). Ling established a system of medi-

cal gymnastics in the University of Stockholm,

Sweden after curing himself from rheumatism and

paralysis through practising fencing and gymnas-

tics (Hutzler, 2010).

The inclusion of sport and organised competi-

tion in rehabilitation is associated with Sir

Ludwig Guttmann, founder of the International

Stoke Mandeville Games in 1948, followed by the

first Paralympics in 1960 and the Special Olym-

pics in 1968. Since the 1970s there has been a

dramatic increase in the number of international

organisations/associations serving athletes with

disabilities (De Pauw & Gavron, 2005).

EUSAPA

The European Standards in Adapted Physical

Activities (EUSAPA, 2010) identifies three main

areas of benefit of APA for rehabilitation:

1. Adapted physical activities during, but

also after the rehabilitation phase have a

beneficial effect on an individual’s general

physical fitness level, their functional-

ity, and performance of activities of daily

living. Research suggests that physiotherapy

programmes often pay insufficient attention to

these domains, therefore implementing adapted

physical activities within the rehabilitation

programme may result in an enhanced qual-

ity and successfulness of rehabilitation,

while also reducing the risk of relapse.

2. Adapted physical activities have a beneficial

effect on the patient’s/client’s psycho-

social well-being, reducing isolation and

sedentary lifestyle. Adapted physical ac-

tivities offer opportunities to share expe-

riences and to learn how to accept or come

to terms with an impairment, disorder, etc.


3. In addition, individuals experience the

benefits of physical activity and sports

with respect to their physical and men-

tal and psychosocial well-being, enhanced

quality of life and the improved execu-

tion of activities of daily living.

APA vs Physical Therapy (PT)

Hutzler (2010) highlighted that the differences

between physical therapy (PT) and APA suggested

by Lorenzen (1961) are still evident today:

• A medical orientation in PT, compared

to a pedagogical orientation in APA;

• Intervention goals mostly refer to the

impairment in PT compared to the whole

person and participation in APA;

• Activity is typically prescribed in PT,

compared to self-motivation in APA;

• The participant is passive and ac-

tive in PT but only active, most-

ly in group settings, in APA;

• The goal in PT is mostly restricted to specif-

ic biological changes, while in APA the goal

is promoting activity across the lifespan;

• The intervention is mostly identi-

fied as treatment in PT, compared to

self-determined action in APA.

The Benefits of Sport and APA in Rehabilitation

As with the general population, physical activ-

ity reduces the risk for chronic illnesses and

secondary conditions for persons with disabil-

ities (Durstine et al., 2000; Heath & Fentem,

1997). However the benefits of participation in

sports and APA reach beyond physical rehabil-

itation (Parnes and Hashemi, 2007), improving

independence and empowerment, increasing social

integration and inclusion, and helping to change

attitudes among members of the society in gen-

eral (Burchell, 2006; Capella-McDonnall, 2007;

Sherrill, 2004).

APA and sport promotes rehabilitation through

social networks between those who share simi-

lar life experiences and through teaching how

to function with relative autonomy (Lindemann

& Cherney, 2008), this happens in both causal

recreational activity as well as elite disabil-

ity sport (Cherney, Lindemann & Hardin, 2015).

Social networks can help people negotiate con-

straints to participation, including lack of

knowledge about an activity or lack of motiva-

tion to participate (Jackson, Crawford, & God-

bey, 1993; Jackson & Scott, 1999). Both children

(Seymour, Reid, & Bloom, 2009), and adults with

disabilities report developing friendships as

one of the benefits of participation in sport and

APA (Ashton-Shaeffer, Gibson, Autry, & Hanson,

2001; Lindemann & Cherney, 2008).

4.2.4. Opportunities

for Participation

UNCRPD, Article 30

Article 30 addresses equal participation of per-

sons with disabilities in recreational, leisure

and sporting activities and states that State

Parties shall take appropriate measures:

• To encourage and promote the participa-

tion, to the fullest extent possible, of

persons with disabilities in mainstream

sporting activities at all levels;

• To ensure that persons with disabilities

have an opportunity to organize, devel-

op and participate in disability-specific

sporting and recreational activities and,

to this end, encourage the provision, on

an equal basis with others, of appropri-

ate instruction, training and resources;

• To ensure that persons with disabil-

ities have access to sporting, rec-

reational and tourism venues;

• To ensure that children with disabilities

have equal access with other children to

participation in play, recreation and lei-

sure and sporting activities, including

those activities in the school system;

• To ensure that persons with disabilities have

access to services from those involved in

the organization of recreational, tourism,

leisure and sporting activities (UN, 2006).

APA and the International Classification of Functioning, Disability and Health

APA is strongly associated with an understanding

of the interrelationship between the person, the

environment and the task (Kiphard 1983; Newell

1986; Reed 1988). In 2007, Hutzler and Sherrill

proposed the WHO’s International Classification

of Functioning, Disability and Health (ICF: WHO

2001) as a conceptual framework for the planning

and implementation of APA.

ICF is a comprehensive classification system

designed to capture aspects of human functioning

in the context of a health condition. The sys-

tem consists of a hierarchy of classifications

for each of its domains: Body Functions and

Structures, Activities and Participation, and

Environmental Factors (See figure 3. below) and

has been widely accepted among rehabilitation

services worldwide (Hutzler, 2010). Codes can be

recorded for each classified item within a domain

to indicate the extent of ‘problem’ with any

of these aspects of functioning. Environmental

Factors can be recorded as being either barriers

to or facilitators of a person’s functioning

(Bufka, 2009).

Helpful resources explaining how to use the ICF

are available from the website:

http://www.who.int/classifications/icf/en/

PARTICIPATION

(Restriction) (work, social,

athletic, etc roles)

PERSONAL FACTORS

(age, comorbidities, person-

ality, etc)

HEALTH CONDITION

ACTIVITY

(Limitation) (speaking, walk-

ing, jumping, etc)

ENVIROMENT FACTORS

(living conditions, occu-

pational situation, social

circumstances, climate, etc)

BODY FUNCTIONS & STRUCTURES

(Impairments) (bones, liga-

ments, muscles, sensation,

circulation, etc.)

Figure 3: ICF example adopted from ‘WHO, How to use the ICF: A practical manual for using the ICF’ (2013).


EUSAPA Functional MAP - Rehabilitation

The EUSAPA (2010) developed functional guidance

for the design and implementation of APA in re-

habilitation, consisting of four key areas:

Key Area Key Role Key Functions

A. Planning A.1. Assess the role and

added value of an Adapted

Physical Activity programme

within the multidisci-

plinary character of the

rehabilitation programme.

A.1.1. Identify the responsibilities of the APA programme

as a complementary part of the rehabilitation programme.

A.1.2. Identify the strengths and weaknesses of the cur-

rently used rehabilitation and APA programme.

A.1.3. Identify the available and required resources (fa-

cilities, equipment) to implement the APA programme.

A.1.4. Develop a structured Adapted Physical Activity pro-

gramme in collaboration with rehabilitation team.

A.1.5. Identify the short and long term aims of

the Adapted Physical Activity programme.

A.2. Assess the (dis)

abilities, risk factors,

needs and potential of

the patient / client.

A.2.1. Understand the condition of the patients / cli-

ents and its consequences in terms of function-

al (dis)abilities, health conditions, etc...

A.2.2. Understand clinical investigation data (e.g. X-rays,

gait analyses, cardiorespiratory tests) and the conclu-

sions and recommendations of rehabilitation specialists.

A.2.3. Assess the patient’s / client’s cur-

rent and potential level of functioning.

A.2.4. Understand the patient’s / client’s response to

physical activity; identify and remediate potential con-

traindications, health risks and risk factors.

B. Education &

Information

B.1. Educate patients /

clients about their (dis)

abilities and potential

through physical activity.

B.1.1. Educate the patient / client about his/her functional (dis)

abilities, response to exercise, potential health risks, risk

factors and contraindications with regards to physical activity.

B.1.2. Educate the patient / client about the recog-

nition and remediation of symptoms that potential-

ly lead to health risks, injuries, etc...

B.1.3. Educate patients / clients about the APA pro-

gramme and its benefits during rehabilitation.

B.2. Provide the appro-

priate information to

guarantee a continuation

of an active lifestyle

post rehabilitation.

B.2.1. Inform the patient / client about communi-

ty based physical activity programmes, and the short

and long term benefits of physical activity.

B.2.2. Provide a database with information regarding com-

panies and community based organisations to ensure a con-

tinuation of an active life style post rehabilitation.

B.2.3. Provide information regarding legislation about possible

benefits from national, regional and local governing bodies with

respect to physical activity and sports post rehabilitation.

C. Implementation C.1. Implement an individual-

ised Adapted Physical Activi-

ty programme complementary to

the other disciplines within

the rehabilitation programme.

C.1.1. Develop a structured and individualised APA pro-

gramme in collaboration with the multidisciplinary team.

C.1.2. Facilitate and optimise participation

through adaptation of the instructions, encourage-

ments, rules and settings when appropriate.

C.1.3. Initiate community based physical activity.

Key Area Key Role Key Functions

D. Assessment

& Evaluation

D.1. Evaluate the effects

of the Adapted Physical

Activity programme as a part

of the rehabilitation and

post-rehabilitation process.

D.1.1. Monitor the long term health related out-

comes of the Adapted Physical Activity programme.

D.1.2. Determine the effects of the Adapted Physical Ac-

tivity programme on functional ability of the patients/

clients in collaboration with rehabilitation team.

D.2. Evaluate the pa-

tient’s/client’s response

to physical activity, his/

her progress, and compare

with the preset goals.

D.2.1. Assess and evaluate the patient’s / client’s physical and psy-

chological well being and its progress, and remediate if necessary.

D.2.2. Assess the motivation of the patient/client toward the

Adapted Physical Activity programme, and remediate if necessary.

D.2.3. Monitor and assess the responses to physical ac-

tivity to ensure safe and successful participation.

D.2.4. Document individual development and progress accord-

ing to the aims of the rehabilitation and the APA programme.

D.2.5. Identify tools, methods, etc… to optimise the patient’s / cli-

ent’s functional abilities in daily life and in physical activity.

Table 3: EUSAPA Functional Map – Rehabilitation, adapted from EUSAPA (2010) Appendix 3.

European Opportunities for Participation

A detailed list of European organisations,

campaigns and initiatives providing people with

disabilities opportunities to participate in

sport can be found in the Council of Europe’s

‘Good Practice Handbook, No. 3 – Disability

Sport in Europe, Learning from experience’:

http://unescoittralee.com/wp-content/

uploads/2015/04/Disability-Sport-in-Eu-

rope-Good-practice-handbook.pdf

4.2.5. Challenges that

Organisations Face

Some common barriers to inclusion in sporting

activities for people with disabilities have

been identified as (DePauw & Gavron, 2005; Hut-

zler & Sherrill, 2007):

• Lack of early experiences in sport (this var-

ies between individuals and whether a disabil-

ity is from birth or acquired later in life)

• Lack of understanding and awareness of how to

include people with a disability in sport

• Limited opportunities and programmes for

participation, training and competition

• Lack of accessible facilities, such

as gymnasiums and buildings

• Limited accessible transportation

• Limiting psychological and sociological

factors including attitudes towards dis-

ability of parents, coaches, teachers and

even people with disabilities themselves

• Limited access to information and resources

Different. Just like you. A psychosocial ap-

proach promoting the inclusion of persons with

disabilities.

This Danish Red Cross handbook (2015) provides

practical guidance for organisations and profes-

sionals on how to facilitate safe and inclusive

sport and APA:

https://www.icsspe.org/sites/default/files/Dif-

ferent.%20Just%20like%20you.pdf

Safety

• Wherever possible, select locations that

are screened off from the general public.

• Before activities begin, all facilita-

tors, helpers and participants should do

a safety check on the playing field. Dan-

gers might include glass, garbage, plas-

tic bags and wrappings, animal excrement,

sharp rocks, wood or any other debris that

could cause injury to participants.

• Use locations that are safe for all us-

ers (e.g. stay away from rivers, em-

bankments, cliffs, roads, etc).


• Make sure there is enough space for all

of the participants to do the activity.

• Make sure there is enough equipment for

everyone and that it is the correct equip-

ment for the activity wherever possible.

• Make sure it is safe to get to and from the

playing field, if a sports activity is held

outside (e.g. no travelling in the dark).

• Changing rooms and bathrooms should

be available, wherever possible.

• First aid kits should be available and

all facilitators trained in using them.

• Be aware of participant’s pre-existing

health conditions (e.g. asthma, diabe-

tes), psychological/emotional problems or

current illnesses or risk conditions.

• Always plan each session and ensure that the

activities are suitable for the participants.

• Rival groups should not be involved in

competitive games. If competitive games

are played, rival group members could

play in mixed teams. Choose activi-

ties carefully to promote cooperation.

• Make sure that participants choose team

members in a fair way and in a manner that

does not demean anyone. For example, if

two team captains choose team members in

turn, someone will be left at the end, feel-

ing they are not wanted in any team.

• Be sure that there are enough facilita-

tors and helpers for each session so that

the participants are supervised well and

are not at risk of harm. Facilitators

should be trained in risk management.

Inclusion

Organisers promote inclusion by building on in-

dividuals’ strengths and interests, rather than

focusing on their impairments.

The key elements in this approach are:

• Do not underestimate the person’s abilities.

• Have a plan for positive experiences by

setting challenging but achievable goals.

• Have a flexible approach to coach-

ing and communication that recog-

nizes individual differences.

• Be creative and explore new and unconven-

tional methods to ensure that every ses-

sion is fun and rewarding for all.

• Be aware that there are different impair-

ment groups (blind, deaf, learning disabled

and physically disabled) that need dif-

ferent adaptations and that safety, (both

physical and mental), is very important.

The Inclusion Spectrum

Developed by Black and Stevenson (2011), this

model (figure 2.) is now widely used for the de-

sign and implementation of inclusion for all in

physical education and sport.

The model classifies activities into 5 differ-

ent groups based on the level of adaptation

required:

1. Open – minimal or no adaptations to the

environment or equipment; open activi-

ties are by their nature inclusive so that

the activity suits every participant.

2. Modified - everyone plays the same game or

performs the same activity but the rules,

equipment or area of activity are adapt-

ed to promote the inclusion of all indi-

viduals regardless of their abilities.

3. Parallel - although participants fol-

low a common activity theme, they do so

at their own pace and level by working

in groups based on their abilities.

4. Separate/Alternate - emphasises that,

on occasions, it may be better for a

person to practice sports individual-

ly or with their disabled peers.

5. Disability/APA - ‘reverse integration’ where

non disabled people are included in disabil-

ity sports together with disabled peers.

STEP tool - enables organisers to adapt the

activity across the key areas of Space, Task,

Equipment and People.

Figure 4: The Inclusion Spectrum incorporating STEP

(Black & Stevenson, 2012) adapted from England Athlet-

ics: https://www.englandathletics.org/shared/get-file.

ashx?itemtype=document&id=10176

4.2.6. Development of

preventative and health

conscious habits

Persons with disabilities have lower levels of

physical activity than their peers, consequently

38% of the population is obese (53% more than

people without disabilities), and engage in low-

er levels of physical activity. High costs for

health services caused by overweight (increased

blood pressure, diabetes Type 2, Hypercholes-

terolemia, stroke, osteoarthritis, sleep apnea,

etc.) are a huge problem for the European tax

payers.

A review of the literature (Zakus, Njelesani &

Darnell, 2007) on sport, physical activity and

health demonstrated:

• Cardiovascular health benefits occur at

moderate levels of physical activity and

increase at higher levels of physical ac-

tivity and fitness (General, 1996).

• Exercise is effective in the manage-

ment of diabetes, as it has been shown

to improve glucose homeostasis (War-

burton, Nichol & Bredin, 2006).

• Both obesity and physical inactivi-

ty have similar patterns of associa-

tion with clinical risk factors, such as

blood pressure (Blair & Church, 2004).

• Obese individuals with at least moderate

cardio respiratory fitness have lower rates of

cardiovascular disease (Blair & Church, 2004).

• 40% of all cancers may be prevent-

ed by a healthy diet, physical ac-

tivity and not using tobacco.

• Regular physical activity is an effective sec-

ondary prevention strategy for osteoporosis,

as well as the maintenance of bone health.

• Exercise can be effective in improving men-

tal well-being largely through improved mood

and physical self-perception (Fox, 1999).

Parnes & Hashemi (2007) highlighted the health

benefits of physical activity specifically for

persons with disabilities:

• Persons with Disabilities share many traits

with the general population, suggesting that

the positive effects of physical activity on

cardiovascular diseases are also attributable.

• Individuals disabled by osteoarthritis

of the knee may benefit from aerobic and/

or resistance exercise programs in the

areas of physical performance and pain

management (Ettinger et al., 1999).

• Physical activity and sport participation re-

sult in improved functional status and quality

of life among persons with selected impair-

ments and disabilities (Heath & Fentem, 1997).

• Children and adolescents with cerebral

palsy may benefit from physical activity

through improvements in strength and abil-

ity to walk, run, jump and climb stairs

after participating in a strength-training

program (Dodd, Taylor & Graham, 2003).

• Aerobic dance may affect cardiovascular

endurance of adults with intellectual dis-

abilities (Cluphf, O’Connor & Vanin, 2001).

• Physical activity may lead to improvements

in physical health and well-being. Spe-

cifically, improvements have been noted in

coordination, postural alignment and nor-

malization of muscle tone, improved sitting

balance and strength and rhythmical move-

ments of the upper body (DePauw, 1986).

• Aerobic (endurance training) exercise is

effective in improving general mood and

depressive and anxiety disorders in se-

lect psychiatric patients. There is no

harm associated with participation in

STEPAdaptation tool

DI

SABIL

ITY SPORTAdapted physical a

ctiv

ity

everyone can play

OPEN

ability groupsPARALLEL

MODIFIED

change to includeS

EPARATE/

ALTERNATE


physical activity and exercise in these

populations (Meyer & Broocks, 2000).

• Participation in sports and physical fitness

activities has been associated with three em-

powerment outcomes: perceived competence as a

social actor; facilitation of goal attainment

(including setting and pursuing goals, deter-

mination, and competitiveness); and social

integration (including bonding, broadening

social skills and experiences, and increased

social inclusiveness) (Blinde & Taub, 1999).

Romano-Spica et al., (2015) highlighted that

advances in APA technologies and the scientific

evidence to date indicates physical activity is

a priority tool in the prevention of multifacto-

rial diseases and sedentary lifestyle.

Incorporating sport and APA into rehabilitation

services as well as post-rehabilitation com-

munity services, as outlined in this chapter,

provides an effective means of improving the

physical activity levels of persons with dis-

abilities, ultimately improving the health and

well-being of this population.

Case studies

Tom, 64

In 2016, Tom suffered a brain injury and un-

derwent two brain surgeries. As a result he

initially lost all mobility and suffered facial

paralysis, affecting his ability to swallow. Tom

spent 5 months as an inpatient in hospital. When

being discharged from hospital Tom was able to

walk with support for very short periods of time

in the home, but required the use of a wheel-

chair when travelling outside.

As a result of his injury Tom experienced left-

side weakness and had difficulties with memory,

concentration and fatigue. He now needed support

in performing everyday tasks such as getting

dressed, cutting food and tying his shoe laces.

“I was motivated to improve my mobility as I

have two sons who live abroad that I would like

to be able to visit… but I lacked the confidence

to engage in physical activity.”

The Community Brain Injury Team Physiotherapist

informed Tom of Brain Injury Matters’ Sports 4

U programme. Sports 4 U involves a Physiothera-

pist-led exercise programme specifically designed

for people with acquired brain injury, followed

by workshops aimed at improving overall health

and well-being.

Tom’s wife describe the timing of the programme

as “a god send, both physically and mentally for

Tom.” Since starting the programme Tom has made

tremendous progress and reports enjoying “being

part of a group that share similar experiences.”

Having just been signed off to walk up and down

the stairs independently before commencing the

programme, Tom is now jogging for the first time

since his injury and reports using the ‘SMART’

goals discussed in the Sports 4 U workshops to

increase the distance he walks outside of the

programme.

“I now have the confidence to go places we hav-

en’t been since my injury, like the cinema… and

to sign up for another physical activity pro-

gramme with the GP.”

“We were able to visit our son in Scotland,

our next goal is to visit our son who lives in

America.”

Tom’s wife said “we couldn’t speak highly enough

of Brain Injury Matters and the work they have

been doing; we would thoroughly recommend the

Sports 4 U programme to anyone in a similar

situation.”

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5.

Learning outcomes:

• Familiarise readers with what needs

to be focused on when planning APA

• Familiarise readers with common principles

of preparation for competitive sports

• Gain knowledge of recommendations for

managing risks in adapted sports

• Highlight and understand risk factors when

planning APA for people with disability

• Recognise professionals assump-

tions, attitudes and beliefs, ana-

lysing them and challenging them

• Practical examples and strategies in the

process of maintaining boundaries

• Familiarise readers with the importance of

psychological preparation and strategies

to prepare athletes with disabilities

• Define the importance of motivation and goal

setting in the process of mental preparation

• Familiarise readers with the importance of fa-

cilitating physical activities for people with

disabilities and identify obstacles they face

• Getting familiar with devices and equip-

ment used by persons with disabilities

when performing physical activity

• Defining the impact of technological de-

velopment and the use of modern devic-

es and equipment on the integration

of people with disabilities into var-

ious adapted sports activities

Pla nniNg aN adaptiVE PhySIcal ACTiviTy


5.1.hOW tO plan ADAptIVe Phys-ICal ActivITy

AUTHORS: VALENTINA BOLŠEC, JASNA VEŠLIGAJ DAMIŠ

Key words: physical activity, adaptation, persons with disability, sports, barriers

Active living means integrating physical activ-

ity into daily routines. Our body was meant to

move and be physically active. Physical activ-

ity includes walking or cycling for transport,

dancing, traditional games and pastimes, garden-

ing and housework as well as sport or deliberate

exercise (Edwards and Tsouros, 2008).

Any physical activity, movement and participa-

tion in sports can be beneficial as it has posi-

tive effects on our health which is particularly

important for people with disabilities. When we

are planning physical activity for people with

disability, we refer to it as adapted physical

activity (Reid, 2003).

When we are planning physical activity for peo-

ple with disability particular attention must be

paid to the adaptation of certain areas.

Persons with a disability can participate in sports for able bodied persons but they may need addi-

tional equipment or adaptations. Not all sports are appropriate for everyone. Certain sports can be

recommended and appropriate for certain disability. We can also find sports developed specially for

people with certain disability, for example goalball for blind (Burger, 2010).

5.1.1. How to choose sports?

In the “Participation possibility chart” we can find some of the major physical disabilities and

major sporting activities. It was developed by The American Academy of Orthopaedic Surgeons (Adams

1991, v Burger 2010). There are very few sports where adaptations are not possible and people with

disabilities will not be able to participate.

PARTICIPATION

POSSIBILITY

CHART

Archery

Bicycling

Tricyclinh

Bowling

Canoeing/kayaking

Diving

Fencing

Field events*

Fishing

Golf

Horseback riding

Rifle shooting

Sailing

Scuba diving

Skating (roller & ice)

Skiing (downhill)

Skiing (cross-country)

Swimming

Table tennis

Tennis

Tennis (wheelchair)

Track

Track (wheelchair)

Weight lifting

Wheelchair poling

Baseball

Softball

Basketball

Basketball (wheelchair)

Football (tackle)

Football (touch)

Football (Whellchair)

Ice hockey

Sledge hockey

Soccer

Soccer (wheelchair)

Volleyball

AMPUTATIONS

Upper Extremity RA R R R RA R R R R RA R A R R R R R R R R R R R R R R R R R R

Lower Extremity (AK) R R R R R R I R R R R R R R I RA RA R R I R R R R RA RA R I I R R I R R

Lower Extremity (BK) R R R R R R R R R R R R R R R R R R R R I R I R I R R R I R R I I I R I R

CEREBRAL PALSY

Ambulatory R R R R R R I R R R R R R I R RA RA R R R R R R R I I I I R R

Wheelchair R I I R R I I I R I I R R I R R R R R I I R R I R I

SPINAL CORD DISRUPTION

Cervical RA RA RA IA I R X RA R IA IA R RA IA R I I I I IA

High-thoracic (T1-T5) R R R R RA R R RA I R R R IA IA R R R R R R RA RA R R R R RA

Low thoracolumbar (T6-L3) R R R R RA R R RA R R R R RA RA R R R R R R RA RA R R R R RA

Lumbosacral (L4-sarcal) R R R R R R R R R R R R R I R R R R R R R R R R R I I R I I R R

NEUROMUSCULAR DISORDERS

Muscular dystrophy RA I R R I I R R R I RA R I I I I R R I I I I R I I I I I I I I I I

Spinal muscular atrophy RA I R R I I R R R I RA R I I I I R R I I I I R I I I I I I I I I I

Charcot-Marie-Tooth R R R R R R R R R R R R R R R R R R R R R R R R R R R I R R

Ataxias R I I R I I R R I I R R I I I R R R R R I R I R I I I R I I I I I R I

OTHERS

Osteogenesis imperfecta R I R R R I R R R I I R R I I I R R R R R R R I R I I I R X I I X X X R I

Arthrogryposis R I I R R I I R R I R R R I I I R R R R R I R R R X R I I I R

Juvenile rheumatoid arthritis RA I I RA R I I I R I I R R I I I I R R I I I I I I I I I I I I I I I I I I

Hemophilia RA R R R R R R R R R R R R R I I R R R I R I I R R X I X I R

Skeletal dysplasias R R R R R R R R R R R R R R R RA R R R R R I R R R I R R R R

* Clubthrow, discus, javel, shotput

R = Recomemended

I = Individualized

A = Adapted

X = Not Recommended

Table 4: Participation possibility chart. Adams, 1991

Figure 5: https://www.birmingham.ac.uk/Documents/college-les/

sportex/Physical-Activity-Disability-Infographic.pdf

5.4.7. What do we adapt?

• Environment

• Equipment

• Sport/play games

• Rules

• Exercises

• Age adaptation – early childhood to

elderly (Wittmannová, 2018).


5.1.2. Barriers

When planning sports activities for persons with

disabilities, we also have to refer to different

barriers. Bragaru et al, 2013, exposed some fac-

tors that are negatively associated with partic-

ipation in sports:

• Technical barriers can include fac-

tors related to transportation, pros-

thesis, information etc.

• Social barriers include lack of sup-

port in interactions with so-

cial groups or sports partners

• Personal barriers include factors re-

lated to physical health or psychologi-

cal attributes and even time management

• There are also many other barriers that

influence participation in sports: older

age, poor weather, high cost and others.

A more detailed description and distribution

of barriers can be found in the chapter 5.3.5.

Challenges for Facilitators and Service Users.

5.1.3. How to Plan an Adaptive

Physical Activity?

Planning an Adaptive Physical Activity can be

demonstrated using a cyclic model:

Figure 6: PAIE model for planning an Adaptive Physical Ac-

tivity (Vešligaj Damiš, 2018)

The first component of the PAIE model is plan-

ning of a sports program or sports activities.

It involves making decisions about the choice

of sport - according to the wishes of the ath-

lete with disabilities and according to his/

her abilities and consideration of the personal

characteristics of an athlete with disabilities,

decisions about necessary adaptations, manage-

ment of obstacles and risk analysis.

When planning a sports program or sports activ-

ities we must take into account the specifics of

the individual disability as well as the recom-

mendations for prescribing exercise (frequency,

intensity, duration). In addition to general

knowledge in the field of sports, trainers must

also be equipped with knowledge of the specific-

ities of people with disabilities and know the

importance and possibilities of physical exer-

cise for persons with disabilities.

If sport activities for people with disabilities

are well planned, they are safe and appropriate

for them and what is important, athletes show

personal satisfaction in achieving personal

goals in sports. For athletes with disabilities,

sport activity is planned according to their

functional abilities, physical capacity, inter-

est and accessibility. It can take place in the

gym or outdoors, individually or in groups.

When planning a sports program, we are looking for answers to a num-ber of important questions, such as:

• What are the current competencies of an

individual - an athlete with a disability?

• What kind of activity is appro-

priate for this individual?

• What skills and abilities need to be

evaluated for this individual?

• What kind of interests does an ath-

lete with disabilities now have and

what will he have in the future?

• How effective is the program in satis-

fying the needs of this individual?

• Will the individual achieve any bene-

fits from participating in this program?

PROGRAM

PLANNING

ASSESSINGPERSON WITH

DISABILITY

IMPLEMENTA-

TION PLANING

AND TEACHING

EVALUATION -

PERSON, PROGRAM

• What new skills will an individ-

ual learn in this program?

• Is it possible and needed to improve the in-

structions for an individual in this program?

• How will his/her quality of life be im-

proved after joining the program?

It is necessary to take into account that we

can achieve a better motivation of athletes

with disabilities by including new activities,

working with athletes without disabilities or

practicing with music. Greater persistence in

training can be promoted by the fact that the

participant receives admiration and award when

he reaches the goal or we can help ourselves

with modern technology, for example, interac-

tive computer games involving physical activity

(Saunders, 2016).

Regular physical exercise of the appropriate

intensity and frequency in people with disabil-

ities may be hampered by a number of factors.

Personal factors include depression, fatigue,

lack of interest, poor perception, inadequate

self-assessment of one’s own abilities, negative

values related to physical exercise, fear (from

falling, to defeat, etc.). Among environmental

factors it is very important that the individual

has family and social support. It is also im-

portant that training centers are available and

that transport and exercise costs are low.

Sports training also bring a certain risk for

people with disabilities. Therefore, it is

important to make a risk analysis in prepara-

tion of the sports program, which covers all

the possible dangers of the sporting, physical

exercise for people with disabilities. We base

our assumption on the fact that the benefits of

sports activities outweigh the risk.

The second component of the PAIE model is the

assessment, which includes the systematic pro-

cess of observing the athlete with disabilities,

on the basis of which his needs and progress are

determined. It is a multi-faceted approach of

gathering information on the success and ability

of an individual. It is an integral part of the

effective implementation of physical activity.

This is a continuous process that takes place

before, during and after the implementation of

the program (Kasser & Lytle, 2013).

The assessment covers several areas: screening,

decision about support, planning and develop-

ment, assessment of progress and testing for

classification in sport (Kasser & Lytle, 2013).

Evaluation can be performed by standardized

tests (tests, questionnaires or scales) or by

non-formal testing (recording, task analysis,

behavioral observation, communication, use of

support technology, etc.).

The third component of the PAIE model is the

implementation of sports programs and learning.

Athletes with disabilities actively carry out

the chosen sports activity and gain experi-

ence based on their assessed needs. In the case

of involvement in sport, we are talking about

choosing: today, participants should have the

option of choosing, and the disabled person has

the opportunity to participate in sports activ-

ities and sports together with peers without

disabilities and competitors or in separate

environments. Accessible activities cover a

range of opportunities ranging from “involvement

in conventional circumstances” to “inclusion

in opportunities for specific disabled people”

(Kiuppis, 2018).

The last component is an evaluation that is done

for both athletes with disabilities as well

as for sports programs and activities. It is

important to check if the program is appropri-

ate, satisfies the athlete with disabilities and

allows him/her to achieve their set goals. On

the basis of the evaluation, proposals for the

necessary changes will be made.

Reference

Bragaru, M., Van Wilgen, C. P., Geertzen, J. H., Ruijs, S. G.,

Dijkstra, P. U., & Dekker, R. (2013). Barriers and facili-

tators of participation in sports: a qualitative study on

Dutch individuals with lower limb amputation. PLoS One, 8(3),

e59881.

Burger, H. (2010). Sport for disabled. In M. Kovač, G. Jurak

and G. Starc (ed.), Proceedings of the 5th International Con-

gress Youth Sport 2010 (29-30). Ljubljana: Faculty of Sport,

University of Ljubljana

Edwards P, Tsouros AG. (2008). A healthy city is an active

city: a physical activity planning guide. World Health Orga-

nization Europe.

Kasser, S.L., Lytle R.K., (2013), Inclusive Physical Activ-

ity-2nd Edition, Human Kinetics, Human Kinetics Europe Ltd,

United Kingdom)

Kiuppis, F., & Kurzke - Maasmeier, S. (2012). Sport Im

Spiegel Der UN-Behindertenrechtskonvention [Sports Reflected

in the UN-Convention on the Rights of Persons with Disabili-

ties: Interdisciplinary Approaches and Political Positions].

Stuttgart: Kohlhammer.


Reid, G. (2003). Defining Adapted Physical Activity. In R. D.

Steadward, G. D. Wheeler and E. J. Watkinson (ed.), Adapted

Physical Activity (11-25). Canada: The Univerity of Alberta

Press

Saunders, D.H., Sanderson, H., Hayes, S., Kilrane, M., Greig,

C.A., Brazelli, M., Mead, Ge. Physical fitness training for

stroke patients. Cochrane Database of Systematic Reviews

2016: CD003316. DOI: 10.1002/14651858.CD003316.pub6.

Wittmannová, J. (2018). Šport za vse: opolnomočenje

strokovnih kompetenc z izobraževanjem o prilagojenih športnih

aktivnostih. In M. Pajek (ed.), 13. kongres športa za vse,

športna rekreacija invalidov (17-22). Ljubljana: Olimpijski

komite Slovenije–Združenje športnih zvez

Figure 5: https://www.birmingham.ac.uk/Documents/college-les/

sportex/Physical-Activity-Disability-Infographic.pdf Re-

trieved 12.2.2019 at 9:25

Table 4: Adams R.C., Mc Cubbin J.A. (1991). Games sport, and

exercise for the physically disabled. London: Lea & Febiger

5.2.CompetITiON iN SpoRTs

AUTHOR: LADISLAV MESARIČ

Key words: competition, weather conditions, overload, principle of specifici-ty, principle of progressive development, continuity principle, principle of individuality

Experts acknowledge the importance of sports

and recreation in the successful rehabilitation

of people with different types of disabilities.

Adapted sports and recreational activities offer

an opportunity for success in a very short time.

Success has a positive impact on self-esteem

and focus on opportunities, rather than dealing

with what is no longer possible. The ability

to participate in sport offers the opportunity

to reunite with family and friends in a joint

venture (Sherrill, 2003).

People get engaged in various sports activities

in order to improve their health, well-being and

working abilities. Many of them are not satisfied

with just being active. They want to compare

their abilities with others at sports compe-

titions. Increased interest in sports has led

to the development of competitive systems for

people with disabilities. Different regulations

and classifications have been developed for indi-

vidual sports, enabling people with disabilities

to compete under the same conditions. The clas-

sification of disability is numerous and diverse,

some are based on the cause of disability,

others on the affected body parts such as arms,

legs, heart etc. (Aleksandrović, 2016).

Dealing with competitive sports irrespective of

gender and age requires proper preparation for

competition. In the case of persons with dis-

abilities, specific limitations arising from the

nature of their disability should be taken into

account. These limitations must be taken into

account both in the choice of sport and in the

choice of training assets. Every chosen sport

has its own laws and necessary adjustments.

In any case, the general principles of sports

training apply to all athletes, with or without

disability.

Many authors have defined different principles

that basically overlap. As a rule, they refer to

the frequency, intensity, duration and type of

sports activity. Frequency describes how often

a person deals with a certain sport activity.

The intensity of the exercise is the strength

with which the individual perform a sport. It

represents a key point in training planning.

It depends on the maturity of the individuals

involved, the current form, the personal goals

of athletes and many other factors. The duration

describes how long the training should last to

get the proper results. The duration is inverse-

ly proportional to the intensity of training. We

cannot train for a long time at a high level of

intensity. However, the development of aerobic

abilities requires a longer duration with an

appropriate lower intensity. The type of exer-

cise relates to the way or form of how a sports

exercise is performed. Aerobic abilities can be

practised by walking, cycling and other contin-

uous activities. We can gain power with weights,

exercises with our own weight, and other exer-

cises where we overcome external resistance.

Different types of exercise are crucial for

involving different people into sports activi-

ties, each meeting their own needs and goals. Of


course, different sports disciplines have their

own specific features. However, this principle

is well established (Ayers & Sariscsany, 2013;

Bompa & Haff, 2009).

The most common are the following principles

(Ayers & Sariscsany, 2013):

The overload principle

The principle of overload refers to the fact

that the individual needs to be burdened more

than usual for it to make changes or positive

adaptation to the training. Progress is achieved

by the gradual burden of physical systems with

specific exercises and training schedule. Over-

load is a positive stress, which is achieved by

increasing the intensity of training, increasing

the number of training sessions, increasing the

duration of each training.

The principle of

progressive development

Good sports condition cannot be achieved in a

short time. Body systems have their own lim-

itations in terms of the speed of adapting to

the training load. Loads must be gradual. If

a load increases in a short time, it can lead

to fatigue and damage. By contrast, insisting

on a certain degree of burden without a gradu-

al increase leads to stagnation as a result of

reduced adaptation to training.

Principle of specificity

The sports training program must be adapted to

the desired result. Training improves only those

skills that we train and have a slight influence

on other abilities. We need to choose the ap-

propriate exercises. It does matter, however,

which exercises we perform. If we want to im-

prove the strength of the hands, we will choose

strengthening hand exercises, we will increase

the mobility by stretching the part of the body,

where the mobility is reduced, and the aerobic

abilities will be trained with long-term contin-

uous activities.

Continuity principle

Sports training should be carried out regularly

so that we can get proper results. As the organ-

ism gradually adjusts to the load and reaches

the appropriate fitness level, at reduced activi-

ty body is adapted to it and the fitness reduces.

This training principle helps to understand why

lifelong sport activities are so important.

Principle of individuality

People who are involved in sports have different

physical characteristics and biological poten-

tials for change. Coaching takes into account a

variety of factors and has different objectives.

Opportunity for individually selecting a sports

program is crucial for creating lifelong habits

of engaging in sports.

Recommendations for

physical activity

Regardless of the above recommendations, it is

necessary to know how many physical activities

we need in order to achieve our goals and conse-

quently adjust our training plan accordingly.

Physical activity that provides a variety of

health benefits consists of dynamic and rhythmic

contractions of large muscle groups that trans-

mit the body at a distance or act against gravi-

ty with moderate intensity over a long period of

time in which the body consumes 200 to 400 kilo

calories (or 4 kilo calories per kilogram of

body weight). For optimal health benefits, such

(aerobic) activity should be carried out every

day or at least every other day, and should be

supplemented by strength and mobility exercises

(Haskell et al., 1985).

Competitors with higher ambitions need to find

appropriate professional help.

Recommendations for exercising

individual motor skills

in an adaptive sports

exercise programme

The following tables describe the application of

training principles for flexibility, strength and

aerobic endurance.

The mobility and extent of movement depend on

various factors. These may be anatomical (joint

shape, tendon characteristics) or are condi-

tioned by neuromuscular factors. The latter

are common in adapted sports practice (e.g.,

spasticity). The usual exercises for flexibility

are performed in the form of static stretching

(Kasser, 2013)

Training

variables

General recommendation

Frequency Before and after activi-

ty, minimum 3x per week

Intensity Individually depending on the abil-

ities, should not cause pain

Duration 10-30 seconds, 2-3 repeti-

tion of each exercise

Type Static stretching, dimanic stretching

as preparation for sports training

Overload Careful movement of the stretching

points, increasing of the number of

repetition and duration of stretching

Progress Slow and easy progress, first big-

ger muscle groups, then extreme

and small muscle groups.

Application of training principles for flexibility (Kasser,

2013)

Training

variables


Frequency 3-4 x per week with one day break

during the exercise days

Intensity Easy or medium 40-0% of the maximum effort

Duration 3-5 series, 3-7 repetition for strength

and 12-20 repetition for endurance

Type Exercises with own weight, ex-

ercises with resistance

Overload For strength we gradually increase

the resistance, for endurance in-

crease the number of repetition or

duration of repetition or decrease the

duration of break between series

Progress Gradually as trying to avoid injuries

Application of training principles for muscular strength and

endurance in strength (Kasser, 2013)

Training

variables


Frequency 3-5 per week

Intensity 55-90% of maximum heart rate (de-

pending on the abilities)

Duration 15-60 minutes (in time it

could be increased)

Type Walking, running, swimming …

continuous activities

Overload Increased speed, time or temp

Progress We predict gradual prog-

ress in the individual plan.

Application of training principles for training aerobic

abilities (Kasser, 2013)

Less is more

Successful training is not just the final goal.

The aim is to achieve optimal results with opti-

mum amount of training. We do not need to train

until pain and injuries occur. Training is usu-

ally strenuous and often unpleasant, but pain is

not a regular companion. If it occurs regular-

ly, it should be treated seriously. Unpleasant

feelings in particular parts of the training may

occur due to the release of lactic acid, which

monitors anaerobic activity, weight lifting and

interval training. Fatigue and pain may also oc-

cur due to micro-lesions in the muscles. Delayed

muscular fatigue and pain that occur 24 hours or

more after activity are not a result of lactic

acid. Lactic acid is removed rapidly by the

blood circulation quickly after the activity.

Activity-related pain usually occurs after new

activities and in when some activities have not

been performed for a long time and are probably

related to the micro traumas of the muscles and

connective tissue.

Organization of training hours

Each training session must be systematically or-

ganized and consist of a warm-up, main training

activity and cool down. This approach helps the

athlete to gradually prepare for the main loads

and gradually reduce the load before the end of

the training so that there are no fast transi-

tions from one part to another.


Warm-up

Warm-up is a low-intensity sports activity

that takes place before an intense main part of

the training and serves for preparation of the

body and mind to what follows in the main part.

Regular and thorough implementation of warm-up

can significantly reduce the likelihood of sport

related injuries.

The main part of the training

The main part of the training is the key part

in which we acquire new knowledge and improve

one or more components of the sports shape. By

following the basic principles of training we

develop motor skills and elements of sports

games. The main part can have one or two main

contents.

Final part of the

training (cooling)

The final part of the training consists of

low-intensity activities and rests. It usually

consists of continuous low-intensity aerobic

activity. Sometimes stretching is also included.

It is also recommended to do a short analysis of

the work done and to help further training.

Exaggeration and

exercise dependence

Although inactivity is a far greater problem,

overloading during training can lead to over-

training in active people. This is the state

of the reduced ability of the immune system to

resist infection. Symptoms of overtraining are

low motivation, fatigue, insomnia, poor results,

loss of appetite and poor health. Symptoms come

gradually, so overtraining is difficult to de-

tect. The reasons may be the following: boring

and overloaded training, rapid weight loss,

inadequate nutrition and inadequate hydration.

Overtraining is treated by reducing the volume

and intensity of training, and in many cases

with complete rest.

The influence of the environment

on the training process

Environmental effects, such as heat, cold, hu-

midity, altitude and poor air, can have a strong

impact on health and sports achievement. If we

do not pay attention to the environment, serious

problems can arise, which may end up with death.

On the other hand, we can adapt to the circum-

stances, which makes it easier for us to work,

improves the effect, and helps us to survive

comfortably in different circumstances (Sharkey

et al., 2008).

Sport activity in high-er outdoor temperature

During sports activity at high temperatures, we

can only regulate the temperature balance with

circular adaptation and sweating mechanisms for

a short time. The body absorbs heat when the

outside temperature exceeds the temperature of

the skin. When the air humidity is low, the heat

balance is controlled by sweating, and when the

humidity is high, the sweat does not evaporate

quickly enough, the heat is not released quickly

enough, the temperature of the body grows and

endangers the working abilities and in extreme

cases the life of the athlete. Therefore, it

follows from this that there is a logical advice

to avoid great efforts at high outdoor tempera-

tures. If we cannot avoid high temperatures

and moisture, we must adapt to such situation.

People who live in such environment are usually

adapted to these conditions. People from dif-

ferent backgrounds usually adapt within five to

ten days. The key principal is hydration and the

input of minerals. Liquids need to be introduced

several times during the activity. Minerals can-

not be compensated by the introduction of clean

water. Water rinses the minerals from the body.

We can help with sports drinks rich in carbohy-

drates and electrolytes.

Activities in the cold

Since the metabolic processes of the human body

produce heat during sport activities, low tem-

peratures are not as dangerous as high. If ath-

letes are exposed to low temperatures for a long

time, frostbite can occur, and extreme exposures

may lead to hyperthermia and death. The intense

muscular activity in cold weather consumes

significantly more energy than in the normal

environment. Individuals who train in the cold

weather should have enough energy when they are

at risk. The feeling of fatigue is the first step

to hypothermia. Cold wind increases the rate of

heat loss. Athletes can themselves cause the ef-

fect of cold wind, when on skies, skates as they

are rapidly moving towards the wind. In cases

where you are dealing with sports in a cool

environment, you should be adequately protected,

especially the distal parts of the body, eyes

and nose. People who regularly engage in sports

activities in the cold are psychologically and

physiologically adapted to low temperatures and

enjoy winter activities despite the cold. It is

especially important that during winter activ-

ities, due to sweating and breathing fluids lost

are always replaced. For longer activities, it

is also necessary to have an appropriate amount

of calories from snacks and energy drinks.

Activities at a higher altitude

Although a healthy person may not notice this;

saturation of arterial oxygen decreases already

at an altitude of 1500 m. But as we climb more,

the pressure of oxygen in the lungs decreases as

air pressure decreases. Under such conditions,

oxygen cannot be properly attached to the blood,

only a small amount of oxygen is transferred to

the tissues, and these are forced to adapt to

the new conditions. As a result, aerobic abili-

ties associated with endurance are always re-

duced at higher altitudes.

Athletes who train and live at normal altitudes

must prepare properly for performance at higher

altitudes. They can do this by spending time in

“climatic chambers”. These are rooms or chambers

that simulate high-altitude conditions. Athletes

should be at the competition location at least

three weeks prior to the competition in order to

adapt to the conditions properly.

Avoiding bad air

Sport activity increases the amount of air we

breathe. Injuries due to bad air are propor-

tional to the amount of exposure time to the

polluted air; therefore, they need to reduce the

time of activity in a polluted environment or to

avoid such activities completely and find another

option. Air pollution is different in many areas

and depends heavily on traffic, industry and

season. In large cities with constant pollution,

an adequate alternative is indoor exercise with

an appropriate air purification system. Although

polluted air is a serious problem in some plac-

es, cigarette smoke contains the highest amount

of harmful substances. This irritates bronchial

pathways, reduces resistance to bronchial in-

fections, causes bronchitis and hinder oxygen

transportation, causes lung disease, cardiovas-

cular problems, and many other problems. Smok-

ing unlike industrial pollution, is a matter of

personal choice.

Reference

Aleksandrović, M., Jorgić, B., Mirić, F. (2016). Holistički

pristup adaptivnom fizičkom vežbanju, učbenik za studente mas-

ter akademskih studija. Fakultet sporta i fizičkog vaspitanja,

Niš.

Ayres, S.F. & Sariscsany, M.J. (2013) Fizičko vaspitanje za

celoživotnu formu. Data Staus, Beograd

Cox, H.R. (2005). Psihologija sporta, konceoti i prmjene,

Naklada Slap, Jastrebarsko

Haskell, W.L., Montoye, H.J., Orenstein, D. (1985). Activity

and Exercise o Achieve Health-Related Physical Fitness Com-

ponents. Published in: Public Health Reports 100(2):202-12.

March 1985.

Kasser, S.L. & Lytle R. K. (2013). Inclusive Physical Activi-

ty: Promoting Helth for Lifestyle, Human Kinetics, Montgomery

Sharkey, J.B. & Gaskill, S. E. (2008). Vežbanje i zdravlje,

Data Staus, Beograd

Sherrill, C.(2003). Adapted Physical Activity, Recreation,

and Sport: Crossdisciplinary and Lifespan, Mc Graw Hill, New

York


5.3.risKS iN ADAptED PhYsICal ACTivITy

AUTHOR: LADISLAV MESARIČ, JASNA VEŠLIGAJ DAMIŠ, ZVONKA NOVAK

Key words: risk factors, prevention of injuries, regulation of temperature, risk assessment, risk management plan

Fifteen percent of the world’s population lives

with disabilities, many of whom decide to en-

gage in sports. There are numerous obstacles to

the participation of athletes with disabilities

in sports activities, and sports injuries can

have a major impact on everyday life. Therefore,

prevention of their sports injuries is extremely

important (Weiler, Van Mechelen, Fuller & Verha-

gen, 2016). The number of athletes with disabil-

ities who participate in organized sports and

the popularity of the Paralympic Games are con-

stantly increasing all over the world. Despite

the growing interest and the fact that partic-

ipation in sports exposes athletes to certain

risks of injury, there is little research about

the types of injuries, risk factors and injury

prevention strategies for athletes with disabil-

ities (Fagher & Lexell, 2014)

5.3.1. Risk factors and injuries

Traditionally, risk factors are divided into

two main categories: internal risk factors and

external environmental risk factors. It is im-

portant that we can divide the risk factors into

dependent and independent variables or factors.

Although independent factors such as gender

and age can be interesting, it is important to

consider factors that can change with exercise,

such as power, balance or mobility. However,

this is not enough to determine internal and

external risk factors for sports injuries. For a

complete understanding of the causes, the mech-

anisms of occurring must be identified. Sports

injuries are due to the complex interaction of

several risk factors and events, of which only

some are known (Bahr, Holme, 2003).

Therefore, studies on sports injuries require

a dynamic model that takes into account several

factors of sports injuries, and considers the

sequence of events that eventually lead to an

injury. One of these dynamic models, describing

how injuries occur as a result of several fac-

tors, is the one adapted according to Meeuwisse

1994 (Bahr & Holme, 2003). The model is tested

on population without disability, but without

special adaptations can be used for the popula-

tion of athletes with disabilities. Only specific

definitions of individual expressions are needed.

The internal risk factors for persons with

disabilities are mainly the type and degree of

disability. This defines the choice of sports

activities and risk prevention measures during

sports activity. Among the external risk factors

is sports equipment. For persons with disabili-

ties, the risk factor is the adequacy of equip-

ment adjustments. During the activity, it is

necessary to pay due attention to the adapted

program of sports training and competitions.

5.3.2. Prevention of injuries

Many factors influence the prevention of injury

or reduce the risk of injury. Some are general

and do not depend on the type and degree of dis-

ability. The instructions for Special Olympics

contain the following actions:

• An appropriate assessment of the fitness

of athletes - the coaching staff must de-

termine the baseline for each athlete es-

tablished on his/her fitness and skill. The

type and complexity of the sport activities

that are taking place depends on this.

• The sports performance must be the backbone of

the appropriate long-term preparation of ath-

letes. The coach cooperates with the athlete,

healthcare staff, the family and other factors

that influence the long-term development of

the athlete. Individual must develop specif-

ic skills and fitness for the chosen sport.

• Special healthcare guidelines and co-

ordinated activities must be avail-

able for each individual.

• A first aid kit should always be avail-

able at all trainings and competitions.

• It is recommended for the athlete to adapt

to the environment. Athletes must gradually

adapt to exercise at an elevated temperature.

At the beginning, they should practice in

light clothing in the cooler parts of the day.

They gradually expose themselves to heat for

a short time and carry out activities even

in the hotter part of the day, at the time

when the competition takes place. If sport

involves the use of heavier clothing and

equipment, they must first adapt to wearing

clothing under normal conditions only then

in hot conditions. For all games and compe-

titions proper hydration must be maintained.

• They should also get gradually adapt-

ed to low temperatures. They must learn

to layer their clothes so that they can

adjust their outfit to the temperature.

If necessary, wear caps and gloves.

• Competitions at higher altitudes require grad-

ual adjustment that lasts 10 to 14 days. Exer-

cise should be gradually increased in duration

and intensity. Without gradual adaptation

they may experience altitude sickness, such

as nausea, dizziness and shortness of breath.

• In order to prevent sun and snow blind-

ness due to strong sun athletes need

PREDISPOSED

ATHLETE

SUSCEPTIBLE

ATHLETE INJURY

Internal risk factors:

• Age (maturation, aging)

• Gender

• Body composition (eg

body weight, fat mass,

BMD, anthropometry)

• Health (eg history of previous

injury, joint instability)

• Physical fitness (eg mus-

cle strength/power, maxi-

mal O2 uptake, joint ROM)

• Anatomy (eg alignment in-

tercondylar notch width)

• Skill level (eg sport, specific

technique, postural stability)

RISK FACTORS FOR INJURY

(DISTANT FROM OUTCOME)

INJURY MECHANISMS

(PROXIMAL TO OUTCOME)

Exposure to external risk factors:

• Human factors (eg team

mates, opponents, referee)

• Protective equipment (eg

helmet, shin guards)

• Sports equipment (eg skis)

• Enviroment (eg weather, snow

and ice conditions, floor and

turf type, maintenance)

Inciting event:

• Joint motion (eg kinematics,

joint forces and moments)

• Playing situation (eg

skill performed)

• Training programme

• Match schedule

Figure 7 : Risk factors for injury (Meeuwisse, 1994)


to wear dark glasses with side shields

during outdoor activities. Glass-

es must have an ultraviolet blockade.

• If during sports activity athletes are exposed

to the sun, they must wear shades and t-shirts

with long sleeves. On exposed parts of the

body, such as the nose, ears, face, bald-

ness, lips, sun protection must be applied.

Temperature Regulation

Dysfunction of the sympathetic nervous system,

especially important for athletes with spinal

cord injury above the eighth thoracic vertebra,

can cause significant problems in regulating

internal body temperature. These athletes cannot

sweat effectively or have difficulty in vasodila-

tion below the level of injury. This can lead to

difficult body thermoregulation, or the body is

more difficult to cool by sweating or warm up by

shaking and vasodilation.

Athletes with a significantly reduced body sur-

face, such as those with bilateral amputation,

should also be considered. Medicines commonly

used by individuals with disabilities, such as

anticholinergics, sympathomimetics, diuretics,

muscle relaxants, and medicines that improve

thyroid function, can cause greater sensitivity

to heat (Richter, Sherrill, McCann, Mushett and

Kaschalk, 1998).

5.3.3. Risks related to sports

activities by type of disability

Different types of disability are classified into

wider categories, such as motor impairment,

sensory impairment, and intellectual disability.

Disability can be congenital (present at birth)

or acquired (not present at birth resulting from

acquired injury or disease). Coaches should try

to understand the disability of athletes they

train.

A plan or risk assessment should be made for

each athlete, including one’s disability, ill-

ness, relevant characteristics and behavioural

disorders (e.g. epileptic seizures) and other

important information which may have a signif-

icant impact on the sport performance of the

persons involved.

Basic information about specific safety aspects

according to the type of disability (Coaching

Association of Canada, 2005)

Athletes with intellectual disabilities

Close co-operation between athletes, parents,

guardians, trainers and assisting staff regard-

ing the characteristics and needs of the athlete

is crucial. People with Down’s syndrome often

have orthopaedic problems due to too much loose

joint envelopes and reduced normal muscular ten-

sion (i.e., muscle tone). People with DS often

have foot problems. Hallux valgus is 2.5 times

more common than in the general population and

presents an increased risk of subsequent arthro-

sis of the underlying joint of the thumb. Due to

the flat feet of 2- 6% of children with DS, they

are more likely to get tired of walking, report-

ing pain in the tibia. Difficulties can occur on

all joints due to increased mobility for exam-

ple on knee joint, unstable kneecap, hip, spine

(Leshing, 2003). It is necessary to determine if

they have atlanto-axial instability. The insta-

bility in the joints between the nasal bone and

the first and second cervical vertebrae is due

to loss of bonds. It is present in 80% of people

with DS, but for the vast majority of them (90%)

it does not cause any problems. If they have not

performed this examination or if instability is

found, it is necessary to avoid activities such

as contact sport, diving, gymnastics, especially

sports activities with intense neck movements

(Büchler, 2003). Congenital heart defects, un-

derdeveloped vascular system and low respiratory

capacity are also possible.

Athletes with physical disabilities

These are athletes with impaired mobility

caused by a spinal cord injury that prevents

the transmission of nerve signals below the

level of injury. Spinal cord injury is usually

due to traumatic injury. The trainers must pay

attention to their feet and toes while pulling

on various surfaces because people with this

type of injury feel poorly or do not feel legs.

For the same reasons, we must be mindful of the

surface on which activities are taking place.

Particular care must be taken that the surface

is not too hot (in the summer) or too cold (in

the winter). Individuals with tetraplegia have

limited ability to control body temperature, so

they need to be protected against heat and cold.

Due to limited access to sanitary facilities

they have difficult access to water. Assisting

staff must ensure adequate hydration during

sports activity.

Athletes with mobility disad-vantages (amputated limbs)

This group includes athletes with amputated

limbs and athletes born without limbs. Caring

for the remaining part of the limb is the key

daily activity of athletes with amputated limbs.

Sport activity can cause additional wear on the

remaining limb and orthosis. In particular, it

is necessary to monitor the skin of the wound to

prevent possible infections. Suitable socks must

be used for remaining limb to keep it dry and to

prevent irritation, scabies and other injuries.

Athletes in wheelchairs should use helmets when

beginning with sport.

Athletes with cerebral palsy

Injuries to different parts of the brain during

pregnancy, at birth or in childhood are mani-

fested in muscle weakness, paralysis, poor coor-

dination and uncontrolled movement of the limbs.

Individuals may also have intellectual disabil-

ities. As there are usually balance problems,

falls are a common risk that we must consider.

It is necessary to remove all potential obsta-

cles from the environment in which they are

moving. We need to avoid situations requiring

demanding movement control, and avoid contact

with other people and objects or perform these

with the extreme attention of the trainer. We

approach slowly to activities, such as climbing,

bicycle riding and similar consistently using

protective equipment.

Athletes with sensory impairments

Athletes with vision or hearing impairment need

accurate and well-established instructions

in case of a danger. In particular, they must

clearly understand the signal for the immediate

cessation of the activity that will protect them

from continuing and reduce the possibility of

injury. Athletes with hearing impairment cannot

receive verbal instructions from the trainer

or co-athletes. Therefore it is necessary to

establish an appropriate alternative communica-

tion strategy. For activities starting with an

acoustic signal, it is necessary to replace the

acoustic signal with a visual one.

Athletes with acquired brain injury (ABI)

The consequences of traumatic or non-traumatic

brain injuries are manifested in different ways.

Because, as a rule, two people do not have the

same abilities, it is the task of the coach /

facilitator of the sports activities to deter-

mine what a person can or cannot do. Activities

are carried out slowly by gradually increasing

the intensity, duration and complexity of the

exercise. It is important to follow the needs,

abilities and wishes of individual athletes

with ABI, and that we can adapt the activities

accordingly during the activity. In the chronic

period after brain injury, the lack of aware-

ness and insight often impedes the involvement

in activities. However this should not be an

obstacle to one’s cooperation, as it can reason-

ably be expected that the state of awareness and

insight can be improved over time. Together with

an athlete with ABI, we shape realistic expec-

tations during setting goals that he/she can

actually achieve. We must also consider all the

clinical problems and disorders that are pres-

ent in people who suffer from brain damage. For

this purpose in Center Naprej, we have designed

recommendations for sports activities (with-

in the framework of the ReSport project) and a

risk assessment form, which we complete prior to

including an athlete with ABI in sports activity

(Vešligaj Damiš, 2017). It is important for all

facilitators to familiarize themselves with ABI

athletes and consider them during all sports

activities.

5.3.4. Risk assessment in

Adapted Physical Activity

An example of a risk assessment for people with brain injury in the Center Naprej

When we include users with ABI in sports ac-

tivities, we must be aware that the latter are

often accompanied by various risks of someone or

something get injured, of a physical or emotion-

al nature, etc. To this end, we complete a risk

assessment process.

When making a risk assessment, we identify all


the hazards and anything that could cause dam-

age. Based on this, we decide how serious the

risks are and how we will manage these risks. We

assess the risk for each sport activity for all

athletes with disabilities in order to prevent

possible complications or negative impacts of

the sport to the individual. The benefits of

sports activities must be greater than the risks

that sport presents to the person. The facilita-

tor of sports activities must know and respect

the limitations of each individual - athlete

with disabilities.

The risks that we know and are aware of can be

assumed as part of the real possibilities. It is

important that we understand the risk as some-

thing that is not negative. We are not at risk

because we expect negative outcomes and conse-

quences, as we expect positive results involving

people with disabilities in sports activities.

In order to complete a risk assessment, we

prepared a risk assessment form at the Center

Naprej. It assesses the risk areas with a risk

matrix, which helps us to evaluate the degree of

risk with regard to the impact of the threat in

relation to the likelihood of the risk.

If the risk or impact of the threat and the

likelihood of risk is high (the red field), we

should ask ourselves whether it is worth risk-

ing or whether such a high risk for the user

is still appropriate. Therefore, for such an

area / areas we prepare a RISK MANAGEMENT PLAN,

which reduces the risk and damage and protects

the athletes with disabilities. The plan must

include measures to reduce the risk. There are a

number of measures that we need to define clear-

ly: how, who and what we will do to reduce the

risk.

In the process of risk assessment and the prepa-

ration of a risk management plan, an individual

who is included in sports activity (athlete with

disabilities) must be actively involved. We help

him/her to understand the risks and take re-

sponsibility for his/her actions. If necessary,

relevant expert people are included in the Risk

Management Plan. If the risk of inclusion of a

disabled athlete is greater than his benefit of

sports activities, if it is harming the ath-

lete or others, and also with various measures

and adjustments, we do not achieve sufficient

safety for all, we do not include him in sports

activity.

The problem arises when an individual (athlete

with a disability) wants to make a decision

without consent of facilitator and latter thinks

that the individual who has made such a decision

does not fully understand the decisions and its

consequences. The task of the sports activities

facilitator and other participating experts is

to ensure that the athlete fully understands

the consequences of his/her decision and that

such decisions can lead him to a situation in

which he/she can be emotionally and physically

injured. It is important that we work together

with an athlete with disabilities in looking for

suitable solutions to the situation, consid-

ering different options, goals or find possible

adaptations.

Figure 8: Risk assessment form (Center Naprej)

Reference

Bahr, R., Holme, I. (2003). Risk factors for sports injuries

— a methodological approach. British Journal of Sports Medi-

cine, 37(5), 384–392. http://doi.org/10.1136/bjsm.37.5.384

Büchler, G. (2003),Atlanto-axiale Instabilität Leben mit

Down-Syndrom Nr. 43, September 2003 https://www.ds-infocen-

ter.de/downloads/lmds_44_sept2003.pdf

Coaching Association of Canada (2005). Coaching Athletes with

a Disabilityhttps://www.coach.ca/files/Coaching_Athletes_Dis-

ability_update2016.pdf

Fagher K1, Lexell J. (2014). Sports-related injuries

in athletes with disabilities. Scand J Med Sci Sports.

Oct;24(5):e320-31. https://onlinelibrary.wiley.com/doi/

abs/10.1111/sms.12175

Leshing, L. (2003) Orthopädische Probleme. Leben mit

Down-Syndrom Nr. 43, September 2003 https://www.ds-infocen-

ter.de/downloads/lmds_44_sept2003.pdf

Richter K.J., Sherrill C, McCann C.B., Mushett C.A. &

Kaschalk S. (1998). Recreation and sport for people with

disabilities. In JA DeLisa and B Gans (Eds.). Rehabilitation

Medicine: Principles and Practice. Third Edition (pp. 853-

871). Philadelphia, Lippincott-Raven

Special Olympics (2003) COACHING GUIDE Sport Safety and Risk

Management for Coaches http://media.specialolympics.org/soi/

files/resources/Sports-Rules-Competitions/Sport_Safety-Risk-

Management.pdf

Vešligaj Damiš, J., Čeh, M., Majcenovič Cipot, D. (2017),

Priporočila izvajalcem »ReSport« aktivnosti, interno gradivo

Center Naprej, Maribor

Weiler, R., Van Mechelen, W., Fuller, C., & Verhagen, E.

(2016). Sport Injuries Sustained by Athletes with Disability:

A Systematic Review. Sports Medicine (Auckland, N.z.), 46,

1141–1153. http://doi.org/10.1007/s40279-016-0478-0

AREAS OF RISK

RISK RELATED TO: Risk level RISK RELATED TO: Risk level RISK RELATED TO: Risk level

Falling Breathing problems Alcohol abuse

Balance problems Cognitive problems Swallowing harmful substances

Movement control Special disorientation Depression, Anxiety

Illness and injury of locomotor system

Time disorientation Suicide

Sensory impairments Leave without informing Other mental health problems

Chronic illnesses and conditions Vanish and get lost Aggression towards self

Amputated/missing limbs Use of staircase/ liftAggression towards others verbal (threads)

Problems with cardio vascular system (high blood pressure, Cardiac rhythm disturbances…)

Use of equipment/ devices Aggression towards others – physical

Bladder and bowel dysfunction Eating disturbances (exaggerated eating)

Self – neglecting

AlergiesEating characteristics – diet, avoiding particular food

Socialy inappropriate behaviour

Epilepsy seizures Swallowing Sexually inappropriate behaviour – towards self

Problems with thermoregulation Smoking Sexually inappropriate behaviour – towards others

Other Other Other

Risk Assessment Form - Center Naprej Risk Assessment In The Rehabilita-tion Plan For Sports Activities

Date of assessment

Name and surname of the user

Facilitator of sports activities

Sports activity

Use of supporting accessories (wheelchair, walking stick, orthoses, prostheses etc.) during the sports activity

RISKS MATRIX

Omitted Small Medium High Catastrophic

Rare 1 2 3 4 5

Less probable 2 4 6 8 10

Probable 3 6 9 12 15

More probable 4 8 12 16 20

Almost certain 5 10 15 20 25

Risk level

Very small Small Medium High

Annex 1

AREA OF HIGHEST RISK (red areas)

Impact on the physical activity and impact of the sports with regards to the risk, warnings:

RISK MANAGEMENT PLAN:

NOTES, EXPLANATORY STATEMENTS (and other relevant characteristics regarding the individual):

RISK ASSESSMENT UPDATED WITH CHANGES

Updated by: Signature:

Date:

Changes:

RISK ASSESSMENT COMPLETED

Assessment

completed by:

Signature:

Date:

Impact of the risk

Proba-bility of the risk

Footnote:It is very important to prepare a risk management plan for each area with the highest level of risk (red areas) - Appendix 1.


5.4.The ROLe oF adaPt-Ed PhySICal AcTIvity EduCAtiOn

5.4.1. Changing traditional attitudes, beliefs and assumptions

AUTHOR: YOANA FILIPIC

Key words: assumptions, attitudes, beliefs

Attitudes, assumptions and beliefs are important

concepts in understanding facilitators’ thought

processes, classroom practices, change, and

learning to teach. In such adapted programs,

beliefs and attitudes of facilitators and ser-

vice users affect what they perform and how they

practice sports activities (Sikula, 1996).

Allport (1967) describes attitudes as “a mental

and neural state of readiness, organized through

experience, exerting directive or dynamic influ-

ence upon the individual’s response to all ob-

jects and situations with which it is related”.

Therefore attitudes could be predispositions

that consistently affect actions and consequent-

ly strongly influence facilitating activities.

Assumptions are something taken for granted;

a supposition. It is something that you accept

as true without question or proof (Cambridge

Dictionary, 2018). It represents preconceived

notions about what is good or bad, what is pos-

sible or impossible.

Goodenough (1963) defines beliefs as proposi-

tions that are held to be true and are “accepted

as guides for assessing the future, are cited

in support of decisions, or are referred to in

passing judgement on the behaviour of others”.

Multiple studies have examined those concepts

and how these beliefs affect facilitators’ con-

ceptions of their role. In a study of teachers’

theories of learning, Anning (1988) stated that

the theories about student’s learning in her

study were determined “by their own particular

previous experiences of teaching and learning

in their classrooms”. Debora Britzman (1991)

has wrote useful case studies of two student

educators that indicated that they held power-

ful conceptions of the role of educators --both

positive and negative--gained from observing

teaching models. Britzman prompted the consider-

ation that these conceptions profoundly affected

the student teachers’ classroom behaviours.

All facilitators hold beliefs, about their work,

their students, service users, their activity,

and their roles and responsibilities. For ex-

ample, Clark (1988) suggested that their use is

not at all consistent with what one might find in

textbooks or professors’ lecture notes, for they

“tend to be eclectic aggregations of cause-ef-

fect propositions from many sources, rules of

thumb, generalizations drawn from personal ex-

perience, beliefs, values, biases, and prejudic-

es”. These predispositions and beliefs include

questions about the purpose of implementing ac-

tivities, about facilitators responsibility for

achieving specific goals, and about beliefs that

users are capable of achieving these goals.

In another study Fitzgerald and Kirk (2009)

have prepared an analysis of the experience of

the persons with disability of physical educa-

tion and disability sport. They emphasised some

of the primary concerns when using disability

sports as a tool for change. Considering having

a disability is often associated with a deficit

perspective, by default then, disability sports

is thought to be a lesser form of sport. Con-

sequently disability sports could be viewed as

either accommodating basic principles inherent

to mainstream sport or as sports activities

suitable only for persons with disabilities.

Research that focused on experience of teachers

within a teacher education program that en-

courages reflective teaching, Korthagen (1988)

came to important conclusions in relation to

attitudes in the education process. He suggest-

ed that some teachers varied in terms of their

learning orientations from those who learn with-

in an internal orientation (reflection) to those

who have an external orientation (just tell me

what I should do). As a result of different ori-

entations, Korthagen found that they may relate

to their beliefs and theories about how students

learn. Many students, whose approaches were not

reflective and therefore not in tune with the

orientations represented in the program, dropped

out after one year, suggesting to Korthagen that

educators should understand both their students’

learning orientations and those of the program.

These findings definitely lead to useful impli-

cation for our programmes in terms of exploring

our attitudes and beliefs and those of our users

who join the programmes.

In their study of 2006 Smith and Thomas implied

that some educators support segregation by

engaging students with a disability in differ-

ent activities to mainstream students, which

“appears to be strongly associated with the

‘privileging’ of competitive teams sports over

more individualized physical activities”. Jer-

linder et al. (2009) declared that “disability

ought not to matter”, but also concluded that

“it paradoxically seems to matter very much …

particularly, in the specific context of sports

activities for individuals with physical impair-

ments” who were often judged against “normative

aspects of parity of participation.” Researchers

noted that students with physical disabilities

were often denied participation, not purely

because of a lack of resources, but also because

individuals’ abilities and desires were not

explored and recognised. Slee (2001) drew on the

notion of identity and stated that “inclusive

education has been framed as a field for special

educational research, training and bureaucratic

intervention”, in which such perceptions have

inhibited inclusion in mainstream schools. He

suggested that students with a disability were

often denied their individuality as it was be-

lieved that physical activity may be dangerous

and may cause more complications than benefits.

On the other hand authors like Sharma et al.

(2008) suggest that educators’ attitudes needed

to evolve. In their review of literature, Sharma

et al. (2008) outlined that ‘disability physi-

cal education’ was the single common variable

that influenced educators to be more positive

about physical education. Slee (2001) hoped that

pre-service teachers might be the innovators of

future solutions to inclusive education.

Nevertheless, there are a number of characteris-

tics that a successful facilitator should hold;

particularly those related to the exploration

of his/her own attitudes (who am I, what is my

goal as a facilitator, what am I able to do) and

the students’ own beliefs (of their identity and

abilities) as well as alternative beliefs and

practices. In addition, facilitators should have

the opportunity to engage extensively in the

active exploration of different living contexts

of persons with disabilities. This process may

promote the first stages in the acquisition of

practical knowledge.

Discussing and evaluating our work and approach-

es opens opportunities for new ideas and more

creative approaches to planning adapted physical

activity. Therefore we all would benefit from

on-going learning, searching new ways of imple-

menting programmes, differentiate facts from

opinions search for information that will enrich

our professional learning and discussions with

those we work with.

Reference

Allport, G. (1967). Attitudes. In M. Fishbein (Ed.), Readings

in attitude theory and measurement (pp. 1-13). New York: John

Wiley & Sons.


Anning, A. (1988). Teachers’ theories about children’s learn-

ing. In J. Calderhead (Ed.), Teachers’ professional learning

(pp. 128-145). London: Falmer.

Britzman, D. (1991). Practice makes practice: A critical

study of learning to teach. Albany: State University of New

York Press.

Clark, C. M. (1988). Asking the right questions about teacher

preparation: Contributions of research on teaching thinking.

Educational Researcher, 17(2), 5-12.

Goodenough, W. (1963). Cooperation in change. New York: Rus-

sell Sage Foundation.

Korthagen, F. A. J. (1988). The influence of learning ori-

entations on the development of reflective teaching. In J.

Calderhead (Ed.), Teachers’ professional learning (pp.35-50).

Philadelphia: Falmer.

Mauerberg-de Castro, E., de Souza Paiva, A.C., Figueredo,

G.A., Ayres de Costa, T.D., Rodrigues de Castro, M., Frances

Campbell, D. (2013). Attitudes about inclusion by educators

and physical educators: Effects of participation in an inclu-

sive adapted physical education program. Mortis, Rio Claro,

vol. 19 n. 3, p.649 – 661.

Porter, A. C, & Freeman, D. J. (1986). Professional orienta-

tions: An essential domain for teacher testing. Journal of

Negro Education, 55, 284-292.

Sharma U, Forlin C & Loreman T (2008). Impact of training on

pre-service teachers’ attitudes and concerns about inclusive

education and sentiments about persons with disabilities.

Disability & Society, 23 (7), pp. 773-785.

Slee R (2001). Social justice and the changing directions in

educational research: the case of inclusive education. Inter-

national Journal of Inclusive Education, 5 (2), pp. 167-177.

Smith A & Thomas N (2006). Including pupils with special

educational needs and disabilities in National Curriculum

Physical Education: a brief review. European Journal of Spe-

cial Needs Education, 21 (1), pp. 69-83.

Fitzgerald H (2005). Still feeling like a spare piece of

luggage? Embodied experiences of (dis) ability in physical

education and school sport. Physical Education & Sport Peda-

gogy, 10 (1), pp. 41-59.

Richardson, V. (1996). The role of attitudes and beliefs in

learning to teach. In J. Sikula (Ed.), Handbook of research

on teacher education (2nd ed., pp. 102–119). New York:

Macmillan.

5.4.2. Building Safe Relationships

AUTHOR: YOANA FILIPIC

Key words: safe relationships, boundaries, maintaining boundaries

Extending beyond education building safe re-

lationships has been a topic of intense theo-

retical and empirical interest within teaching

and counselling. The collaborative relationship

between facilitator and service user in the

teaching setting is definitely a predictor of

programme outcomes. This research area raises

the question of why sport psychology researchers

have not considered examining the “we” of the

relationship, in addition to the two separate

“I”s or the two separate individuals in the dyad

relationship.

The basis for the professional relationship is

the respect for the dignity, worth and rights

of the client. Facilitators demonstrate respect

when they maintain “appropriate boundaries and

ensure their relationships are always for the

benefit of the persons with disability. Another

important characteristic of the relationship

is trust. Therefore it is the belief that the

facilitators possess the knowledge and skills

required for particular programme, that they

will keep confidentiality if shared a personal

experience. Boundaries are a very important part

of the relationship as an appropriate emotional

and physical distance is required in order to

stay objective and professional while teach-

ing service users. This is also related to the

imbalance of power and facilitator must remain

mindful of the goal of the relationship in order

to prevent abuse. What is needed is the sense of

closeness and empathy that is needed to under-

stand and react adequately when a person with

disability is anxious and experiencing distress

(Papouli, 2014; Reamer, 2003).

A sample list of tips to create a safe

relationship:

1. Honour each member’s style of interaction

2. Invite users to share experience and

thoughts with regards to the program

3. Show gratefulness when lis-

tened to and respected

4. Invite families of other profession-

als to participate in special events

5. Create time when you see a user in

distress and speak to him/her

6. Respect individual cultur-

al and familial differences

Professional boundaries are a key component of

any professional ethics. Not all issues related

to these boundaries are necessarily unethical,

but many of them are (Reamer, 2003). Factors

such as emotional involvement with a service

user, a desire to religiously indoctrinate him

or her, potential financial gain, and a desire

to exploit the user in other ways can sometimes

lead to crossing these boundaries in an unethi-

cal manner (Papouli, 2014; Reamer, 2003).

This means that maintaining professional bound-

aries can sometimes mean balancing personal and

professional codes of ethics (Reamer, 2003).

Bowler and Nash’s (2014) training framework

includes discussions on the differences be-

tween two types of relationship – professional

and personal. In terms of behaviour they set

few important categories - remuneration, pur-

pose of the relationship, balance of power in

the relationship, and responsibility for the

relationship. These categories are very dif-

ferent considering their implication in profes-

sional and personal relationship. With regards

to behaviour, professional relationships are

regulated by professional standards and codes

of ethics, on the other hand personal relation-

ships are guided by personal beliefs and values.

In personal relationships, no remuneration is

required, whereas in professional relationships

the facilitator is paid for providing education

to the client. There is an employment contract

that states the terms for this payment.

We have provided you with a sample scenario so

that this could be useful for helping facilita-

tors understand how to differentiate between the

two types of relationships in real-world situ-

ations, and how they could benefit from doing so

in an effective manner.

Situation: You are a facilitator of sports ac-

tivities working in a centre for rehabilitation

of persons with acquired brain injury. A person

with a traumatic injury was admitted a month ago

and you have become particularly attached to him

while spending time on the playground. His fami-

ly is distant and not particularly interested in

his success in sports. On his win at a competi-

tion you buy him a present costing 30€ and make

a cake. He is excited. You feel satisfied.

Should you do this, if so why, if not why?

Answer: In your excitement to do something spe-

cial for the person with an injury, you inde-

pendently singled out an individual client. You

did not carefully consider the broader meaning

of giving a gift to this person. As a result,

another client in the physical activity group

may have felt excluded. Also the giving of a

gift can be seen as an attempt by you to cre-

ate a special, personal relationship beyond the

boundaries of the professional relationship. The

reaction of the person may create an element of

attachment and hope for friendship and socializ-

ing outside the centre.

Smith et al (1997) have provided us with a sam-

ple list of warning signs for facilitators that

their behaviour has crossed the boundaries of a

professional relationship (Smith et al 1997).

The list is not exhaustive but it gives a view

of some common situations when our relationship

with a user has become confused:

• Frequently thinking of the

user when away from work

• Frequently planning other users’ ac-

tivities around that user’s needs

• Seeking social contact with or spend-

ing free time with the client

• Sharing personal information or work concerns

with the client that can cause user see you

as friend, not as professional any more

• Feeling so strongly about the client’s goals

that colleagues’ comments or the client’s

or their family’s wishes are disregarded

• Hiding aspects of the relation-

ship with the client from others

• More physical touching than is appro-

priate or required for the situation

• Romantic or sexual thoughts about the client

Reference

Bowler, M. & Nash, P. (2014). Professional Boundaries in

Learning Disability Care. Nursing Times, 110, 12-15.

Papouli, E. (2014). The Development of Professional Social

Work Values and Ethics in the Workplace: A Critical Inci-

dent Analysis from the Students’ Perspective. Retrieved from

http://sro.sussex.ac.uk/48325/1/Papouli%2C_Eleni.pdf on

29.6.2018

Reamer, F. (2003). Boundary Issues in Social Work: Managing

Dual Relationships. Social Work, 48 (1). 121-133.

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5.4.3. Psychological Preparation of athletes with disabilities and challenges we face


Key words: psychological preparation, relaxation, motivation, goal setting, commu-nication, self-esteem

In modern sports, appropriate psychological

preparation has become more and more important

in order to achieve good, excellent results. The

purpose of this preparation is improvement of

results, which the individual is able to achieve

only if he/she is well psychologically prepared

for all the distress he faces in sports.

Good psychological preparation of the athlete

means strong motivation, high concentration,

high self-esteem and good emotion management.

An athlete who has received good psychological

preparation works better, reaches ones potential

and top results.

However, in order to become a successful ath-

lete, you do not need to be a professional

athlete or an Olympic champion. You do not need

to have many trophies or cups, you do not need

to win at the national championship or be on the

cover of a sports magazine.

It is essential for an athlete that the sport

he/she chooses is important to him/her and he/

she is dedicated to it, regardless of the fact

if he/she is a top athlete or a recreational

player, an athlete with disability or no dis-

ability, a Paralympic or an Olympic athlete who

uses sports as a means of rehabilitation.

It is important that an athlete develops desired

realistic goals that are sufficiently high and

realistic according to his/her own abilities. It

is important for the goals to be in accordance

with ones limitations such as, daily life obli-

gations, finances, time, disability, etc. Conse-

quently sport participation enriches the life

of an athlete, and if he/she values what he/she

receives, it is worth the resources he/she has

invested in sports.

At the same time, psychological work for an

athlete can be of much broader significance since

the same mental abilities that athletes use to

achieve success in sport can also be used to

achieve success in other areas of life.

Sports psychologists thus help athletes improve

their motivation, increase self-confidence, in-

crease team cohesion, and concentration (Kajtna

and Jeromen, 2013). If a sports psychologist

cooperates with a disabled athlete, it is im-

portant to focus on the individual’s abilities

rather than on his disabilities (Hanrahan,

2007).

The goal of professional psy-chological preparation

Through psychological characteristics for an

athlete with a disability, we encourage the

improvement of the performance of the activity,

the achieving of better results and significant

success in competition. Therefore, we discover

the causes of:

• fluctuations in implementation, motiva-

tion for sports activities, etc.,

• managing crisis, stress,

• setting limits (how much he/she is

able to perform, where is his/her lim-

it, or limits can be improved);

• differences in performance, when he/

she works better or worse,

• slow progress - the athlete progress-

es steadily, but much slower than he/

she wants or imagines he/she could.

5.4.3.1. Practical aspects of men-tal preparations for work with athletes with disabilities

In general, psychological skills programs for

athletes with disabilities are not very differ-

ent from those for athletes without disabili-

ties. Nevertheless, there are some adaptations

to be taken into account (Hanrahan, 2014).

The main adaptations that are normally required

in the work of people with disabilities are most

often related to communication issues and other

specific adjustments resulting from disabili-

ty. Working with individuals with disabilities

requires appropriate assistance, communication

adaptation and creativity. (Hanrahan, 2015).

The mental preparation of an athlete with dis-

abilities, like an athlete without disabilities,

helps him/her to focus, to be self-confident

and to have a positive mindset. General mental

preparation consists of:

• creating a positive philosophical, moral

and ethical attitude towards the world,

• creating a positive attitude towards sport,

• Creating a high level of motivation,

self-motivation (internal motivation),

• creating appropriate, realistic goals,

• managing effectively anxi-

ety, emotions and stress,

• maintaining good and focused concentration,

• creating a stimulating social envi-

ronment where appropriate atmosphere

and support must be established,

• learning effective patterns of behaviour

towards self, situations and others,

• learning and using different psy-

chological techniques.

Psychological preparation involves learning

psychological techniques that allow an athlete

to recognize his or her abilities. This process

requires of him/her many hours of training and

persistence. Among the most popular and most

frequently used techniques are (Tušak, Misja and

Vičič, 2003):

• Relaxation techniques,

• Visualization, sensory,

• Concentration techniques,

• Self-speech techniques,

• Breathing techniques,

• And techniques of positive think-

ing and hypnosis.

All these techniques can also be used for ath-

letes with disabilities, if necessary, modified

according to their abilities or skills and spe-

cific limitations.

Relaxation training

Progressive muscle relaxation (PMR) may be prob-

lematic for some individuals with physical dis-

orders. For example, clinical observation shows

that individuals with cerebral palsy who have

higher level of spasticity may skip the phase of

tension of PMR and focus only on relaxation, as

the tension phase may increase spasticity (Han-

rahan, 2015).

Alternatively, these athletes may want to con-

sider alternative ways of relaxation, such as

autogenic training.

Athletes with amputated limbs or those in

wheelchairs are given the option of selecting

the PMR script: the relaxation is performed on

individual parts of the body, where the muscles

are in place and leave the amputated limbs or

body parts that are affected by the spinal cord

lesion. Hanrahan (1995) found that the ath-

letes with physical difficulties decided about

50:50 with regards to the mentioned relaxation

scripts.

It should be noted that abdominal breathing as

a relaxing exercise can enhance relaxation and

concentration in athletes who do not use abdomi-

nal muscles (Hanrahan, 1995).

Visualization and sensory training

The technique of visualization, which is a

form of mental representation, is very often

used in sports. It helps to learn new motor-

ic functions and movement elements, eliminates

negative thoughts and feelings and improves

concentration.

Visualization technique or presentation of

motoric images can be an extremely useful

technique for athletes with physical disabili-

ties, and can be used as mental preparation for

training physical skills. Because athletes with

disabilities often have limited opportunities


and certain training problems that are difficult

to overcome compared to their healthy colleagues

(due to problems such as transport, accessibil-

ity, poor equipment etc.), mental exercise can

become extremely important. In addition, exer-

cise for visual motoric behaviour is helpful for

athletes with cerebral palsy, because the relax-

ation component can reduce spasticity (Martin,

2013).

It also assists with preparation for stressful

events and sports performance, as with mental

imaging the automation and optimization of the

performance is increased.

The visualization technique can be effective

for athletes with physical disabilities. It is

important that athletes see themselves as they

are and how they do sports (Hanrahan, 1995). For

example: swimmers with one foot do not swim with

prosthetic devices, so prosthesis is not part of

the image they represent.

It is important to ensure that images of visu-

alization are precise in terms of what is or

what is not included and physically match the

real situation (for example, if a sportsman uses

prosthesis in sport, this prosthesis should also

be part of the visualization image).

The clarity of the motoric images (visualiza-

tion) of affected limbs after complete damage to

the spinal cord is maintained, but is weaker af-

ter loss of the limb (Malouin & Richards, 2010).

Short-term physical disorders, such as broken

legs, can lead to reduced clarity of motoric

images, for example those that include the leg.

Immobilisation of the ankle in only 2-4 weeks

leads to a significant reduction in the clarity

of motoric images in movement of the foot (Mal-

ouin et al., 2009).

Of course in athletes who have acquired physical

disorders (as opposed to those who have genetic

disorders), the use of visualization techniques

can lead to frustrations that originates mainly

from the relationship between the image itself

and image before the injury. For example: a

swimmer who has an amputated hand, swims with

only one hand, and visualizing themselves in the

picture with both hands as before the injury.

This can lead to anger, frustration, split image

of oneself, etc. This is why we must be very

careful when we guide such an athlete through a

visualisation technique. It is important that

we build on the clarity of the imagined image of

himself, the image control (swim with one hand)

and in this way we form an effective strate-

gy for improving his technique, preparing for

competition and strengthening his own confidence

(Hanrahan, 2014).

Similar to visualization is sensory technique in

which athlete imagines ones sport performance

but it also contains kinesthesia, voices and

other sensory performances that occur during the

sport performance (Tušak & Tušak, 2003).

People with mild mental disorders have improved

their performances in cognitive and motoric

tasks through visualization (Screws & Surburg,

1997). The combination of physical training and

visualization in people with mental disorders

has shown to be more effective compared to only

physical exercise (Surburg, Porretta & Sutlive,

1995).

Positive thinking training

During mental preparation we also include the

technique control of positive thinking. It is

important that we guide an athlete with a dis-

ability to positive thoughts and self-managing

them. This can be achieved by training positive

thoughts and positive self-talking. The conse-

quences of negative thinking cause low self-es-

teem, increase anxiety and worsen performance.

The athlete uses different autosuggestion during

the training of positive thinking, which is also

the most important part of the positive think-

ing. Suggestions must be realistic and specific,

some are focused on correcting problems that

arise from negative thoughts, and some sugges-

tions prevent misconception. Important are also

the suggestions that improve self-confidence and

self-esteem of the athlete.

Routine

When developing preliminary routines for ath-

letes with physical problems, it is important

to pay attention to the problems associated

with accessories for example wheelchairs and

allow longer time for transportation and solving

problems with accessibility at the competition

location (De Bress, De Guast et al., 2013).

5.4.3.2. Communication as a chal-lenge for facilitators and per-sons with disabilities

When working with athletes with disabilities,

communication is extremely important. For ex-

ample, it is important that a psychologist, as

well as a coach or assistant talk with an ath-

lete in a wheelchair on the same level.

As cerebral palsy often affects muscle control,

which is necessary for a clear speech (Nordberg,

Miniscalco, Lohmander & Himmelmann, 2013), it is

sometimes difficult to understand athletes, who

are strongly affected by it. Some athletes have

assistants who can take part in sports events

and training with them. If assistants play

together with an athlete, make sure that you

continue to maintain eye contact and communicate

with athlete not with the assistant. When commu-

nicating with a disabled person, be patient when

they speak and avoid finishing their sentences.

When communicating with athletes with disabil-

ities, it is always important that we are aware

of the extent to which individuals can see or

hear, and what forms of communication are best

for them (for example, reading from lips, large

fonts…). It is also useful to establish methods

for gaining attention (eg. flashing lights, touch

on the shoulder, beeping).

When working with athletes who have vision or

hearing disorders, it is important to reduce

background noise. Individuals with visual im-

pairments rely on hearing aids and those with

hearing impairments (but they are not completely

deaf) will struggle if the voice overlies noise

from the background.

We must consider that the level of communication

and understanding is adapted to the abilities of

athlete with intellectual disabilities. If nec-

essary, give the athlete more time to understand

and respond, talk slowly using short sentences

and wait long enough before asking a new ques-

tion. Ensure our sentences are clear and we need

to speak to them gradually, it may be neces-

sary to clarify and explain multiple times the

purpose of the tasks and the instructions for

work. We combine verbal instructions with other

ways of providing information. The instructions

should be simple, short and accurate. Longer and

more complex instructions should be divided into

shorter sequences or steps.

When working with people with mental disorders

it is important to provide additional time for

mental training and gradually prepare them for

particular mental ability, each one according to

the situation and behaviour. Learning and train-

ing more than one mental skill at a time can be

too difficult for them (Gregg et al., 2004). This

is the most common mistake sports psychologists,

trainers and assistants are dealing with. For

example: to play tennis, they may explicitly

learn to avoid going on the other side of the

field during the game to get the ball.

If a person with intellectual disability is il-

literate, we should consider using audio records

or drawings instead of writing when setting

goals or performing other activities that usual-

ly involve writing (Hanrahan, 2004).

Often, creativity is needed to pass the messag-

es effectively to individuals with intellectual

disabilities. It is also important to make sure

that the messages are correctly understood.

As people with mental disorders often agree or

accept positive answers (Gregg, 2013), it is

better to avoid asking yes/no questions (because

the answer will likely be ‘’no’’, regardless of

the question). Instead, we ask questions that

require an individual to show understanding of

the answer, or ask the athlete to repeat infor-

mation or message.

In the case where a sport psychologist has

limited contact with a team or the athlete, it

is useful to explain to the coach or to other

relevant professionals what the team or indi-

vidual athlete has learned from psychological

preparation or intervention (Gregg, 2013), to

repeat, train and strengthen it during exercises

and competitions. Patience and numerous repe-

titions are important when working with people

with intellectual disabilities.

When working with people with acquired brain

injury (ABI), facilitators of the sports ac-

tivities should be aware of the numerous

consequences caused by ABI and abide by the rec-

ommendations of the professional body according-

ly. The consequences of the brain injury, which

may affect the sport activity of an athlete with

ABI, can influence the physical activity perfor-

mance as well as mental functioning. Thus, we

have to devote special attention to the problems

in executive functioning, motivation, confron-

tation, problems of setting goals and creating

realistic expectations etc…


Athletes with ABI often have difficulty in plan-

ning and organizing their activities. Problems

have been identified in determining the steps

required to achieve the goal and their order

(what happens sooner or later). They initiate an

activity with difficulty and often need detailed

or additional instructions before performing the

activity.

After brain injury, injured victims face a range

of memory problems. The most common and highly

unpleasant form of memory disorder is a problem

with short-term or ‘’working’’ memories. This

means that it is difficult to remember new facts,

new names, faces, agreements, forget where they

left belongings, obligations they have.

When working with athletes with ABI it is im-

portant (as with people with developmental

disorders etc.) to avoid excessive stimulation,

such as several people speaking at the same

time, and address him/her directly, slowly,

clearly and comprehensively. It is crucial to

eliminate as much as possible stimuli in terms

of sounds from the background or environment

(radio, noise in the room, etc.). We need to

carry out numerous repetitions and behavioural

trainings due to user’s memory problems and

diminished learning ability.

5.4.3.3. Motivation and set-ting goals techniques

Practical approaches to motivating athletes with

disabilities derive from different theoreti-

cal directions, similar to those for athletes

without disabilities (for example, productiv-

ity motivation theory, theoretical directions

explained by behaviour, theories based on incen-

tive motivation, goal setting theory, etc…).

The basic characteristics of motivation are

encouraging and guidance (Kajtna & Jeromen,

2013). One of the most important factors in the

process of motivation is setting goals. It is a

planned choice of specified goals, which must be

precisely defined, realistic and achievable. This

technique is used in sports most of the time.

An athlete sets goals and tries to achieve them

with appropriate behaviour. Goals should meet

athlete’s needs. Motives are goal focused rea-

sons for behaviour. Needs arise and maintain mo-

tives until satisfaction occurs (Tušak & Tušak,

2003).

Specific goals affect activity more accurately

than general goals. The coach sets them up with

the athlete, and they have to define strategies

for achieving the set goals. In this approach

the feedback given by the coach to the athlete

after the analysis play an important role. If it

shows positive progress, the technique will be

more successful.

Setting short-term and long-term goals has a

significant impact on maintaining motivation.

Sub- targets (sub-goals) lead to the main goal

and when one of them is not achieved, this is

a sign of the need to change the strategy to

achieve an ultimate goal.

The athlete must believe that he/she is able to

achieve set goals. Setting goals does not only

serve as a tool to increase motivation, but also

to improve concentration and effective time man-

aging (Tušak, Misja & Vičič, 2003).

This technique of setting goals in sport is

equally applicable in sports for people with

disabilities, regardless of whether it is a

competitive sport, recreational sport or reha-

bilitation. At the same time it is important to

understand why an athlete with disabilities is

attracted by sport. Disabled and healthy ath-

letes have similar incentive systems (incentive

are attractive goals). According to Tušak and

Tušak (2013), from existing research we can

recognize 7 incentive systems that explain the

motivation of the athlete to participate in

sports:

• Desires for achievement and success,

• Desire for socialising,

• Desires for sensual satisfaction,

excitement,

• Curiosity

• Aggression

• Power

• Independence.

The importance of certain incentives varies

from individual to individual. The first two are

extremely important for everyday life, social-

ization, entertainment and achievements. We

can connect them with the individual’s need for

experience and activation.

5.4.3.4. Self-concept and self-con-fidence of an athlete with disabili-ties as challenge for facilitators

Self-confidence is by definition an athlete’s

conviction or a sense of confidence about the

possibility of successful performance. It is a

subjective factor that arises from an athlete

and has a major impact on his sports engagement.

In some sports studies of people with disabil-

ities, the positive benefits of sports partic-

ipation have been identified to include better

self-image, feelings of belonging and many

benefits to health (DePauw & Gavon, 2005).

Sports psychologist can help both athletes with

disabilities or those without with psychologi-

cal preparation to develop psychological resis-

tance and build self-confidence and appropriate

motivation.

The process of achieving high self-confidence

in an athlete with disabilities can last for

many years and the psychologist has a role of

counsellor. An athlete must set an environment

around him/her that includes people who always

believe in him/her. Repeated positive sport

experiences can contribute greatly for achiev-

ing global and balanced self-confidence (Tušak,

2001).

By analysing the self-confidence of an athlete,

we can determine his/her personality. Indi-

viduals with low self-confidence are afraid of

defeats, have negative thoughts, doubt their

abilities and feel that they will not succeed.

Those with too high self-confidence do not see

their mistakes and do not want to fix them, they

think they are better than they really are, and

in case of failure always find excuses. Such

problems can often be faced by athletes with

ABI, as a result of the injury and inability to

create a real image of oneself and one’s abili-

ties (Žini, 2018).

Parents, relatives, coaches and personal as-

sistants have the strongest influence on the

individual’s self-confidence and self-esteem.

The right approach includes positive encourage-

ment, praise, positive experience and emotional

support.

Self-concept is a set of individual’s opinions

and attitudes towards oneself based on experi-

ence and beliefs, reflected in the individual’s

relationship with oneself. As a consequence one

forms values about oneself and the environment

he/she lives in. The one with good self-concept

has high self-confidence and vice versa, low

self-concept comes from low self-esteem.

Self-concept depends on the perception and

knowledge of one’s own strengths and weaknesses,

depends on the individual’s opinion of his/hers

abilities and the people the individual compares

with. We separate physical, social and academic

self-concept.

The physical self-concept of an athlete with a

disability can be largely influenced by sports

activities. Sport can be an important stimulus,

which increases the competence of their perfor-

mance and improves their physical abilities. Un-

fortunately, in practice, it often happens that

poorly coordinated individuals with disabilities

are less active in sports and recreation, spend

more time watching other better coordinated

individuals with disabilities, consequently

limiting their chances of improvement.

5.4.3.5. Coping with stress

A successful athlete must have the ability to

effectively cope with stress, and this also

applies to athletes with disabilities. Several

techniques are known to adequately solve prob-

lems caused by stressors.

In order to reduce stress we introduce training,

which include a program for reducing the harmful

effects of stress. It involves learning self-

talk, observing one’s thoughts, problem solving

skills and focusing attention.

It has three phases:

• Education about this principle of training,

• Multiple exercises that involve plan-

ning and problem solving, relaxation

and changing thinking patterns.

• Testing of acquired skills in a controlled

environment (Tušak, Misja and Vičič, 2003).

Sport as an environment where a person with

disabilities can develop connections and reduce

loneliness can be described as an extremely

positive activity and a tool for improving the

quality of life. However, in everyday life they

may be limited by their disability due to their


physical abilities and consequently experience

stress and low self-confidence.

5.4.3.6. Coping with stress in paralympic sports

The Paralympic Games, like the Olympic Games,

are considered to be the highest level of compe-

tition an athlete with a disability can aim for.

The increased attention paid to the Paralympic

Games and the importance that society, coaches

and support staff all attribute to the winners

of the Paralympic Games, therefore influence

the experience of the Paralympic Games as very

exciting and stressful. Athletes with disabil-

ities experience similar pressures as athletes

without disabilities to achieve victory. First

often experience increased stress as a result of

increased attention of media and family (Dis-

ability and Sport, 2018)

In addition to related sources of stress ex-

perienced by both athletes with disabilities

or without disabilities, we can identify some

are unique to disabled athletes, e.g. those in

wheelchairs or with prosthetics, such as: prob-

lems travelling to the competition, how to get

on the plane, transfers from seat to wheelchair

to toilets and back and personal care, how to

proceed from a long evening trip to competi-

tion, gastrointestinal problems, etc. Often, a

longer absence from home can also be stressful.

Athletes with disabilities miss their important

ones who help them and support them socially

(Disability and Sport, 2018).

Paralympic athletes spend considerable time in

the Paralympic village. Athletes, who compete

at the end of games, have to spend a critical

amount of time in an unknown environment. They

sleep in a bed they are not used to. A study on

Brazilian Paralympic athletes who participated

in the Paralympic Games in Beijing, shows that

most of them had poor quality of sleep. Anxiety

was associated with poor sleep, 72% of athletes

had a medium degree of anxiety, while only 28%

of athletes who were sleeping well were less

anxious. Members of the British team also re-

ported that they were dealing with issues about

room sharing and how well they would compete

after a poor sleep (Martin & Wheeler, 2011).

Athletes with disabilities often have less

access to sports psychologists and coaches

compared to athletes without disabilities. Sim-

ilarly, access to doctors, therapists, masseurs

and athletic trainers is also limited. They usu-

ally have only coaches and assistants available.

Athletes with disabilities are ranked by func-

tionality and competitors are also assigned in

this way. Ranking that occurs before the compe-

tition can be stressful as athletes may expect

classification at a different level. If athletes

reclassify, they will have to compete with bet-

ter athletes. It is clear that such a scenario

can reduce confidence and increase anxiety in key

times (Disability and Sport, 2018).

Drug testing has also become an essential part

of the Paralympic Games and can be a new and

therefore stressful experience. Testing in

Paralympic Games may be more complicated com-

pared to the testing of healthy athletes. For

example, many athletes urinate with catheters.

Some may need to ask for exceptions to the use

of illicit substances as part of their treatment

in relation to their disability.

Some suffer chronic pain and can be treated with

medical marijuana, which can be legally per-

mitted at home, but is prohibited in Paralympic

Games.

Most elite athletes are influenced by the events

and conditions of their sports world. However,

Paralympic athletes must deal with a number of

unique conditions and challenges that can hinder

their optimal functioning.

Well-developed psychological abilities help

disabled athletes cope with stress. Furthermore

sports psychologists play an important role in

the psychological preparation and training.

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5.4.4. Physical Activity Recommendations

AUTHOR: VLADIMIR JAĆEVIĆ

Key words: recommendations for facilitators, education of professionals, professionals

The importance of regular movement activities

for persons with disabilities and the factors

that impede their inclusion and implementation

Physical activities are defined as physical move-

ments that are produced by skeletal musculature

and require energy consumption. They include

activities that are carried out during work,

travel, play, housework and recreation. The

World Health Organization advises 150 minutes of

moderate physical activity per week (WHO, 2017).

In comparison with persons performing physical

activities in this range, inactive persons have

a 20-30% higher risk of mortality due to various

causes (WHO, 2017).

When talking about persons with disabilities, it

is essential to put the individual first. Dis-

ability does not define the person and is only

a medical diagnosis. According to the medical

model, disability is defined as a medical and

biological problem, the emphasis is on treatment

compared to prevention and promotion of health.

On the other hand, the social model presents

disability as a uniqueness, without condemna-

tion, and highlights deficiencies in the system

and discriminatory behavior as an obstacle to

the integration of people with disabilities into

motor activities (Martin, 2013).

For people with disabilities, physical activity

is extremely important due to the high degree of

influence on chronic diseases, due to the posi-

tive effect on cognitive, emotional and social

difficulties, psychological benefits in terms of

improving self-image in positive experiences

during exercise, stress reduction, reduction of

pain, improvement of depressive symptoms, due

to the social benefits - better social integra-

tion, improved communication skills, networking

through communication with professionals and

other participants (Jaarsma, 2014).

Despite these benefits, there are obstacles to

the integration of people with disabilities into

physical activities related to their age and

type of disability. Obstacles can be individual

- lack of knowledge about opportunities engaging

in physical activity, fears, nature of deficits

and pain, lack of energy. There are also social

barriers, such as the lack of properly trained

professionals (eg gym trainers, sports education

professors with special skills in activities

adapted for people with disabilities), lack of

necessary equipment for adapted sports practice,

underestimation of the ability of persons with

disabilities by health professionals and other

experts. Obstacles may also be environmental

when locations for physical activities are not

adapted for use by persons with disabilities.

(Martin, 2013).

5.4.4.1. Professional recommen-dation and guidelines for facil-itating physical activities

Physical activities are one of the most import-

ant factors for improving the health status of

people of all ages. Therefore, the recommenda-

tions and guidelines that the general population

receives from experts is very important. For

example, in the US, the US Physical Activity

Guidelines 2008 (2008 Physical Activity Guide-

lines for Americans) are applied. The guidelines

contain guidance based on scientific evidence

to help people aged over 6 years to improve

their health by appropriate physical activity.

This is even more important for people with

disabilities, as they tend to have less active

lifestyle. According to US data, almost half of

the people with disabilities who are capable of

physical activities do not even perform aerobic

exercise. On the other hand, disability should

not be equated with poor health, since most

people with disabilities are able to engage in

regular physical activities. Therefore, there

are special guidelines for persons with dis-

abilities in the USA that include the following

recommendations:

• Adults with disabilities should practice at

least 150 minutes of weekly moderate exercise

activity or 75 minutes of more intense aero-

bic activity or an equivalent combination of

moderate and intense motor activity. Aerobic

activity should be performed in episodes of at

least 10 minutes, best spread over the week.

• Adults with disabilities should also per-

form twice a week activities of moder-

ate or higher intensities, which involve

bigger muscle groups to increase muscu-

lar strength. These activities bring ad-

ditional positive health effects.

• In case persons with disabilities are

not able to adhere to these guidelines,

they should be involved in physical ac-

tivities according to their abilities

and avoid physically inactive life.

• They should consult an expert about

the quantity, type and intensi-

ty of physical activities.

• Also, children and adolescents with dis-

abilities should adhere to specific

guidelines for physical activity appro-

priate for their age and abilities.

It has been proven that physical activities play

an important role in the maintenance of health,

well-being and quality of life. They can help

maintain adequate body weight, improve mental

functioning, reduce the risk of premature death,

heart disease, type 2 diabetes, and certain

types of cancer. Physical activities are very

helpful for improving day-to-day functioning

and for increasing the autonomy of persons with

disabilities (CDC, 2014).

5.4.4.2. The role of healthcare and other professionals who treat peo-ple with disabilities in the pro-motion of physical activities

Healthcare workers significantly influence the

amount of physical activity persons with dis-

abilities engage in as they are more likely to

contact them than other experts. It is also more

likely for people with disabilities to be more

active if they are recommended by experts.

In order to appropriately encourage people with

disabilities to perform physical activities,

experts can follow these steps:

• Physical activities are recommend-

ed for all persons with disabilities.

• When performing physical activi-

ties, persons with disabilities fol-

low general recommendations.

• Persons with disabilities are led and

asked by experts on specific issues, such

as how often they are active in the week,

what is the duration of activities, what

is the intensity, what activities they

perform, how to incorporate more physi-

cal activities into their life, etc.

• Experts encourage persons with disabil-

ities to talk about their obstacles and

limitations when performing physical ac-

tivities. Thus obtain information about

the individual and his/her ability needed

to prepare an appropriate program, appro-

priate preparation of the venue, necessary

adjustments, necessary assistance from the

experts and the extent of social support.

• Experts need to know the particular opportu-

nities for physical activity of persons with

disabilities and provide them with appropri-

ate instructions and guidance for partici-

pation in various physical activities and

in various organized programs (CDC, 2014).

5.4.4.3. The importance of edu-cating professionals in the field of adapted physical activities for people with disabilities

Nowadays, the term is adapted physical activi-

ty. It refers to movement, physical activities

and sports activities, with special emphasis on

the interests and abilities of individuals with

different limitations such as disability, health

problems and age. This growing field requires

the integrated treatment of people with dis-

abilities, which includes a multidisciplinary

approach and professionals from various fields

(occupational therapists, physiotherapists,

social workers, psychologists, coaches, sports

instructors, sports education professors, etc.).

The technological development and accessibility

of modern equipment makes it easier to include

more and more people with disabilities not only

in recreational but also in competitive sports

activities. Therefore, continuous professional

training is necessary as well as developing and

learning new methods and approaches. Experts


with appropriate knowledge and approach can

encourage people with disabilities in performing

physical activities, monitoring them and pro-

viding necessary support resulting in positive

effects on their health and functioning.

Reference

CDC Centers for Disease Control and Prevention. Adults with

Disabilities - Physical activity is for everybody. 2014

[cited 01/08/2018]. Retrieved from: https://www.cdc.gov/vi-

talsigns/disabilities/ on 20.6.2018

Jaarsma EA, Dijkstra PU, Geertzen JHB, Dekker R. Barriers

to and facilitators of sports participation for people with

physical disabilities: A systematic review. (2014) Scandina-

vian Journal of Medicine & Science in Sports, 24 (6), 871-881

Martin JJ. (2013). Benefits and barriers to physical activ-

ity for individuals with disabilities: a social-relational

model of disability perspective Disability Rehabilita-

tion. ;35(24):2030-7. doi: 10.3109/09638288.2013.802377. Epub

2013 Jun 19.

US Department of Health and Human Services. 2008 Physical

Activity Guidelines for Americans, 2008. Retrieved from

https://health.gov/paguidelines/pdf/paguide.pdf on 20.6.2018

WHO. Physical Activity Fact sheet [Internet]. 2017 [cited

01/08/2018]. Retrieved from: http://www.who.int/mediacentre/

factsheets/fs385/en/ on 20.6.2018

WHOa. Prevalence of insufficient physical activity [Internet].

2017 [cited 01/08/2018]. Retrieved from: http://www.who.int/

gho/ncd/risk_factors/physical_activity_text/en/ on 20.6.2018

5.4.5. Challenges for Facilitators and Service Users

AUTHORS: JASNA VEŠLIGAJ DAMIŠ, YOANA FILIPIC

Key words: location, facilities, communication, perception

This chapter draws on the research and experi-

ence of facilitators in order to outline the

challenges that facilitators/coaches/ trainers

and persons with disabilities themselves face

when planning or participating in physical ac-

tivity. Many authors describe multiple specific

characteristics and challenges they face when

organizing adapted physical activity programmes

(Bodde and Dong-Chul, 2009; Frey et al., 2005)

What we first observe is the learning of mo-

tor skills, which should be taken into account

during the implementation of the activity. We

plan more time for consolidation of skills -

the more complex the skill, the harder it is to

acquire. The degree of flexibility is reduced,

and in the activities where coordination is

needed, the rigidity of the muscles is visible.

During the performing of the new skill, there

are excessive movements that are present for a

long time and are difficult to eliminate. People

with special needs often strain the wrong mus-

cles, hyperactivity or muscle hypoactivity also

occurs.

The challenges are organized according to B.

Horne´s criteria in “Making Sport and Physical

Activity Inclusive for Disabled People, 2016”

(in Clemete 2017) and Dowling’s criteria in

Sport, Coaching and Intellectual Disability. So

we divided bridges and challenges into two main

categories:

Environmental:

• Facility: No accessible build-

ings/facilities, waiting lists

• Equipment: Lack of accessible exercise

equipment, lack of suitable equipment

• Health and safety: Pain, lack of energy,

health conditions, lack of strength, fatigue,

longer to develop skills, obesity, decreased

ability to understand rules and interpret

instructions, poor motor skills, prosthesis

(which can cause corns or blisters during

walking or running so a number of athletes

chose to take part in wheelchair sports or

another type of sports in which the prosthe-

sis was not required) (Bragaru et al, 2013).

• Location: Lack of transportation, build-

ings or facilities located far away.

• Expense: Programme and equip-

ment costs, complicated family situa-

tion due to high extra costs for taking

care of person with disability

• Support from others: Unqualified staff that

cannot modify or adapt individual and group

exercise classes for people with disabilities,

not having necessary staff or support, not

having knowledgeable staff, lack of interest

from the administration to adapt activities

• Communication: Lack of specific knowledge

about the benefits of physical activity, lack

of knowledge about how to exercise, lack of

information about physical activity, no coun-

selling, limited partnerships between sectors

• Suitability: High level competition, em-

phasis on winning, no facilities adapt-

ed for a person with disability.

Psychological:

• Personal perceptions: Lack of motivation, lack

of self-confidence about exercising in public,

perception that exercise is too difficult,

negative mood, depression, anxieties, fears,

frustration and even time management (a busy

schedule or a busy daily life, taking care of

children, daily household activities or work

were can be a barrier) (Bragaru et al, 2013).

• Attitudes from others: Discriminatory prac-

tices at fitness centres and other recreational

venues, other people´s negative attitudes,

not having a role model, overprotecting

parents, parental exhaustion and there-

fore, the parents themselves discourage

5.4.5.1. Bridges to over-come those barriers

In the second part of this article we would like

to suggest possible encouraging factors and

changes that may enable involvement in sports

and physical activities (Heller et al., 2002;

Howie et al., 2012; Messent et al., 1999; Rob-

ertson & Emerson, 2010; Temple, 2007).

Environmental:

• Facility: Accessible facilities to physical

activity or sports in the community, good

surface for walking or running, parks and

playgrounds available in the community,

• Equipment: Direct exercise equip-

ment, adapted exercise equipment

• Health and safety: Maintenance of fitness/

muscle strength, maintenance of functional

independence, walking ability, wheelchair

skills, perceiving health benefits, physi-

cal appearance, weight loss, endurance.

• Location: Transportation, Good weather

• Expense: Better funding of pro-

grammes and play areas

• Support from others: Social support, having

a good trainer, friends are supportive or

physically active, family is supportive or

physically active, doing chores at home.

• Communication: Awareness of opportuni-

ties for sport and physical activity,

good communication between coaches, so-

cial contact, asking for help, collabo-

rative approach between organisations.

• Suitability: Training in small groups,

playing individual/dual sports, playing

team sport, involving favourite figures/

interests, programme emphasis on improve-

ment of social skills and self-confidence.

Psychological:

• Personal perceptions: Perception of relaxation

and fun, attitude that exercise has health

benefits, desire to be active, positive at-

titude towards being challenged, acceptance

of the disability, view of sports and phys-

ical activity as an opportunity for social

encounters, feeling accepted as part of a

group, feeling recognized, feeling rewarded.

• Attitudes from others: Important others

awareness of the benefits of physical activ-

ity, relatives’ perseverance, relatives’

assertiveness, being accepted by peers.

Aside from the practical strategies, and to

support people with disability access to sports

activities there is need to encourage government

for wider access to many other kinds of opportu-

nities within individuals’ communities. Limited

by dependency on the attitudes of carers people

with disability remain subject to significant

discrimination.

Reference

Bode, A.E. & Dong-Chul, S. (2009) A review of social and

environmental barriers to physical activity for adults with


intellectual disabilities. Disability and Health Journal, 2,

57–66

Bragaru, M., Van Wilgen, C. P., Geertzen, J. H., Ruijs, S. G.,

Dijkstra, P. U., & Dekker, R. (2013). Barriers and facili-

tators of participation in sports: a qualitative study on

Dutch individuals with lower limb amputation. PLoS One, 8(3),

e59881.

Clemente, I. (2017) Barriers and facilitators to participa-

tion in physical activity for children with disabilities A

systematic literature review. (Master Thesis) Retrieved from

http://www.diva-portal.org/smash/get/diva2:1107967/FULL-

TEXT01.pdf

Frey, G.C., Buchanan, A.M. & Rosser Sandt, D.D. (2005) ‘I’d

Rather Watch TV’: An examination of physical activity in

adults with mental retardation. Mental Retardation, 43,

241–254.

Hassan, D., Dowling, S., & McConkey, R. (2014). Sport, Coach-

ing and Intellectual Disability. London: Routledge.

Heller, T., Hsieh, K. & Rimmer, J. (2002) Barriers and

supports for exercise participation among adults with Down

syndrome. Journal of Gerentological Social Work, 38, 161–177.

Howie, E.K., Barnes, T.L., McDermott, S., Mann, J.R., Clark-

son, J. & Meriwether, R.A. (2012) Availability of physi-

cal activity resources in the environment for adults with

intellectual disabilities. Disability Health Journal, 5 (1),

41–48.

Mahy, J., Sheilds, N., Taylor, N.F. & Dodd, K.J. (2010) Iden-

tifying facilitators and barriers to physical activity for

adults with Down syndrome. Journal of Intellectual Disability

Research, 54 (9), 795–805.

Messent, P.R., Cooke, C.B. & Long, J. (1999) Primary and sec-

ondary barriers to physically active healthy lifestyles for

adults with learning disabilities. Disability and Rehabilita-

tion, 9, 409–419.

Robertson, J. & Emerson, E. (2010) Participation in sports

by people with intellectual disabilities in England: A brief

report. Journal of Applied Research in Intellectual Disabili-

ties, 23, 616–622.

Temple, V.A. (2007) Barriers, enjoyment and preference for

physical activity among adults with intellectual disabili-

ty. International Journal of Rehabilitation Research, 30,

281–287.

5.4.6. Equipment and Technology

AUTHOR: VLADIMIR JAĆEVIĆ

Key words: support technology, prostheses, orthoses

For persons with disabilities it is common to

be poorly included in physical activities than

for the general population and consequently

first have more health problems. At the same

time, there are fewer programs for recreation

and sports education available for adults with

disabilities. (Rimmer et al., 2014). Technologi-

cal development of sports activities for persons

with disabilities enables more and more people

to be involved in sports activities using vari-

ous devices and tools. The development of tech-

nology, especially in the field of materials for

the manufacture of devices, allows people with

disabilities with specially designed prostheses

or other adapted equipment to participate in a

variety of sports, individual and collective

(Steadward, Wheeler and Watkinson, 2003)

5.4.6.1. Definition of technology in relation to the physical activi-ties for persons with disabilities

According to one of the definitions, the technol-

ogy is “the application of science for industri-

al and commercial purposes” (American Heritage

Dictionary). This very broad definition neverthe-

less points to the connection between technology

and functionality. In the field of adapted physi-

cal activity for persons with disabilities, the

primary goal is to improve the functionality of

individuals. So, in this case, the term technol-

ogy refers to the use of science for manufactur-

ing devices - orthoses and prostheses in order

to achieve greater functionality for the users.

All devices, equipment, tools, and product

systems used to maintain and improve the ability

of people with disabilities are referred to as

the common term supportive technology. Simi-

larly, term adaptive technology is also in use,

and relates primarily to the use of electronic

devices and information technology and devices

that are intended and designed exclusively for

people with disabilities (“Assistive and Adap-

tive Technologies for HIE”, 2018)

5.4.6.2. Definitions of basic con-cepts in the field of equipment and devices for adapted physical activi-ties for persons with disabilities

In this chapter, we will focus primarily on

equipment designed to establish, improve and

maintain the functionality of the loco motor

system of persons with disabilities or devices,

common for general use - prostheses, orthoses

and wheelchairs.

Prostheses are devices that replace missing

parts of the body due to trauma, illness or con-

genital conditions. The purpose of using pros-

theses is to restore the function of the missing

parts. (“How artificial limb is made,”, 2018).

Orthoses are defined as external mechanical de-

vices that modify the structural and functional

characteristics of the neuromuscular system.

These are external devices that help individu-

al parts of the body to overcome motor deficits

and problems. The orthoses are used for various

parts of the body such as belts and bandages.

(Redford et al., 1995)

A special area dedicated to prescribing, making,

adjusting and maintaining orthoses and prosthe-

ses is called orthotics and prosthetics. It is

a science that links knowledge in the field of

anatomy, physiology, pathophysiology, biomechan-

ics and engineering, and professionals in this

field need special education.

A wheelchair is a commonly used device that is

used when walking is difficult or impossible due

to illness, injury, or disability.

5.4.6.3. The impact of the develop-ment of technology on the use of or-thoses, prostheses and wheelchairs

Due to technological development, in the area of

the manufacturing of prostheses, orthoses and

wheelchair, three fundamental changes occurred

that influenced the use and functionality. The

devices have become significantly lighter, more

complex and with the possibility of external

regulation. One of the most important technolog-

ical changes in the sports activities of people

with disabilities is the use of more modern

materials such as polymers, ceramics, carbon

fibres, for making devices. These materials have

mechanical and physical characteristics substan-

tially better than conventional materials such

as steel and aluminium. Another essential change

is the use of computers in the manufacture of

prostheses and wheelchairs. Computer chips

built into devices can help control the walking

(Steadward, Wheeler and Watkinson, 2003).

The first records of iron prostheses were written

between 3500 and 1800 BC. Knights who used heavy

iron prostheses were unable to carry out daily

activities. The first aluminium prosthesis was

made in 1912. When the materials became lighter,

the functionality of the user’s prosthesis was

extensively improved. Similar changes have oc-

curred throughout history in the field of wheel-

chair manufacturing. Progress in biomechanics

and kinematics influenced the development of ar-

ticulated and more complex devices. In 1980, the

first sports wheelchair was manufactured. With

the development of specialized sports activities

for wheelchair users, arouse the need for spe-

cialized sports wheelchairs (e.g. basketball,

races, etc.) (Steadward, Wheeler and Watkinson,

2003).

For walking or running, we do not usually need

to focus attention on physical activity, as it

is automated patterns. In old times, the use of

prostheses and wheelchairs for movement involved

cognitive activity, attention and regulation

by the user. The use of modern gadgets still

requires a degree of regulation by the user,

but so-called “intelligent devices” allow more

effective walking for people after amputation

using a built-in computer chip. Similarly, the

use of electric wheelchairs with the possibili-

ty of external regulation and control (e.g. use

in adapted sports activities for children with

cerebral palsy) (Steadward, Wheeler and Watkin-

son, 2003).

5.4.6.4. Use of technological achieve-ments and involvement of people in adapted sports activities

In contemporary world, people with disabilities

have a full range of specific sports activities

they can engage in. Therefore, they can join

recreational activities, participate in various

organized programs and groups or actively com-

pete at international level.

Organized sport for people with disabilities

has existed for more than 100 years, the first

sports clubs for people with hearing impairments

existed in Berlin in 1888. Nevertheless, adapted

sports activities became more widely available

after World War II. The purpose was to help

a large number of war veterans and civilians

who suffered injuries during the war. In 1944,

at the request of the British Government, Dr.

Ludwig Guttman opened a centre for spinal cord


injury at Stoke Mandewille Hospital in Great

Britain. Dr. Guttman promoted the idea of using

sports for rehabilitation purposes (“Paralympics

History - History of the Paralympic Movement”,

2018). After this, numerous studies have con-

firmed the positive impact of sports activi-

ties on the physical, psychological and social

functioning of persons with disabilities. In

addition to the improvements in the affected

functions, a positive impact on self-esteem,

mood, social inclusion and employability, is

essential. Long-term physiological adjustments,

as a result of long-term intensive training in

athletes with disabilities, among other positive

effects, lead to a better respiratory volume,

reaction time and improvement of executive func-

tions (Lastuka, Cottingham 2015).

Over time, sports activities part for rehabili-

tation developed first into recreational and then

into competitive sport. Increasing involvement

in a wide variety of sports activities is accom-

panied by the development of technology for the

production of various accessories or customized

equipment and equipment for individual sports.

With appropriate education people with disabil-

ities can also use recreational facilities that

are generally used, such as different poles

(e.g. Nordic walking, gymstick, balance boards,

balls of different sizes and different materi-

als). In addition, the use of modern materials

in production eases adaptation to the needs of

the individual.

In 1948, on the day of the opening ceremony of

the London Olympics, Sir Guttman organized the

first international wheelchair sports competi-

tion called Stoke Mandewill Games. These games

later became the Paralympic Games, which first

took place in Rome in 1960 and were attended by

athletes of 23 countries (“Paralympics History -

History of the Paralympic Movement”, 2018).

People with disability can compete in various

sports disciplines in modern times. Most sports

disciplines are existing sports, adapted to the

needs and abilities of people with disabilities.

One of the main disciplines is athletics. We

would also mention adapted swimming, wheelchair

basketball, sitting volleyball, shooting, and

table tennis. Contemporary sports as curling,

bowling, and netball are somewhat less preva-

lent. These activities include the use of specif-

ic equipment that can be specifically designed or

slightly adapted for persons with disabilities.

Some disciplines and sports are designed espe-

cially for people with disabilities. An example

is the discipline boccia (Italian word, bullet)

developed for people with cerebral palsy and

first presented at the Paralympics in New York in

1984. Discipline is now practised in more than

50 countries by people with cerebral palsy or

various neurological conditions involving the

use of a wheelchair. The rules and equipment are

adapted to the specific abilities of people with

different levels of disability (people can move

balls with a hand or foot, they can throw them

or roll them through specially designed ramp

(“fusion ramp”) (“Boccia - Disabled Sports USA”,

2018).

The development of sports disciplines and the

inclusion of more and more people with disabil-

ities are accompanied by the rapid development

of technology in the field of the production of

accessories and equipment. As an illustration,

athletes who competed on Stoke Mandewille games

used trolleys weighing approximately 22 kg. Con-

temporary adapted trolleys for competitions are

roughly 5 kg. Three-wheel wheelchairs are often

used for competitions, and five wheel wheelchairs

are used for ball games. Nowadays athletes in

wheelchairs can ski, bake, play hockey, cycle.

For persons after amputation of legs and arms,

there are special devices adapted to be used in

specific sports activities (for example, swing-

ing prostheses, climbing prostheses, basketball

prostheses). The use of modern technology in

competitive sports opens up new ethical ques-

tions about the impact of equipment on sporting

results. (Steadward, Wheeler and Watkinson,

2003).

5.4.6.5. The importance of the mul-tidisciplinary team and the impact of specialized education in work-ing with people with disabilities

The use of modern equipment undoubtedly results

in improving the quality of life of people with

disabilities, as well as in the field of daily

activities and implementation of adapted phys-

ical activities. On the other hand, users need

professional treatment and a complex approach

when choosing, using and maintaining various

technology and equipment.

Rapid technological development in the field

of prosthetics and orthotics and the use of

increasingly demanding devices requires addi-

tional assistance and involvement of profes-

sionals working with persons with disabilities.

The choice and prescription of the appropriate

device is definitely highly individualized ac-

cording to the characteristics and needs of each

user (it is about the motor, health, psychologi-

cal, social and other factors). All profession-

als of different profiles involved in disability

treatment programs (selected doctors, sports

education professors, trainers, physiothera-

pists, work therapists, nurses, psychologists,

social workers) need additional knowledge of

the equipment and devices used by the persons

concerned, where they can provide users with

help and support. It is a field in which there

is a trend of very rapid changes. Due to all of

this, cooperation and knowledge sharing within

multidisciplinary teams is essential. It is also

important to regularly train all team members in

terms of specific know-how in the field of orthot-

ics and prosthetics, and in general the use of

science and technology achievements to improve

the functionality of people with disabilities.

Reference

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6.

Learning outcomes:

• Familiarizing readers with the programmes

we implement in the ReSport Project

• Present useful information about

adapting rules, equipment and ter-

rain for persons with disabilities

Adapted Physical Activity Programmes

Based on the developed and performed activities

in the framework of the ReSport project, test-

ing results, evaluation and consultations with

experts from different sport and rehabilitation

fields we prepared a number of adapted physical

programmes. We facilitated those sports in dif-

ferent locations and settings in the three years

of the project and researched its implications

for persons with disabilities.

aPpliCa ti•On •Of ADaPTeD PhySicaL ACTivIty Pr•OgramMEs


6.1.SwimMING

AUTHOR: ILONA KOVAL GRUBIŠIĆ

Key words: swimming, adapted aquatics, aquatic activities, therapeutic water exer-cise, swimmers with disabilities, Halliwick

Swimming and aquatic activities for children

with disabilities can foster physical fitness and

motor skill development within a physical educa-

tion program and during recreational pursuits.

In the opening scenario, Jack’s parents are

within their legal rights to request swimming

as part of their son’s IEP because aquatics is

listed as a component of physical education un-

der the Individuals with Disabilities Education

Act (IDEA). Aquatics instruction for students

with disabilities is neither a luxury nor a

therapeutic (related) service. Adapted aquatics

means modifying the aquatic teaching environ-

ment, skills, facilities, equipment and instruc-

tional strategies for people with disabilities.

It can include aquatic activities of all types,

including instructional and competitive swim-

ming, small-craft boating, water aerobics, and

skin diving or scuba diving (AAHPERD-AAALF,

1996).

Physical educators, school administrators,

parents, related service personnel, and special

education teachers must be educated about the

benefits of aquatics and its role in a child’s

physical education. The physical and psycho-

social benefits of aquatics for students with

disabilities are more pronounced and significant

than for students without disabilities. Because

of the buoyancy afforded by water, many people

whose disabilities impair mobility on land can

function independently in an aquatic environ-

ment without the assistance of braces, crutch-

es, walkers, or wheelchairs. Although adapted

aquatics does not focus on therapeutic water

exercise, warm water facilitates muscle relax-

ation, joint range of motion (ROM), and improved

muscle strength and endurance (Koury, 1996).

Swimming strengthens muscles that enhance the

postural stability necessary for locomotor and

object-control skills. Water supports the body,

enabling a person to possibly walk for the first

time, thus increasing strength for ambulation

on land. Adapted aquatics also enhances breath

control and cardiorespiratory fitness. Blowing

bubbles, holding one’s breath, and inhalation

and exhalation during the rhythmic breathing of

swimming strokes improve respiratory function

and oral motor control, aiding in speech devel-

opment (Martin, 1983).

Benefits are not limited to the physical realm.

Water activities that are carefully planned and

implemented to meet individual needs provide an

environment that contributes to psychosocial

and cognitive development. As a student with

a physical disability learns to move through

the water without assistance, self-esteem and

self-awareness improve. Moreover, the freedom

of movement made possible by water boosts morale

and provides an incentive to maximize potential

in other aspects of rehabilitation.

The Swimming-Therapeutic Club Forca is the first

such club in our area and one of the few clubs

in Croatia whose members are children with

developmental disabilities and persons with

disabilities - persons with physical disabili-

ties, impaired sight and hearing and those with

learning disabilities. The club was founded with

the basic aim of promoting and developing the

sport of people with disabilities in Rijeka and

the region.

Club activities:

• planning of the work and development of

swimming sport of persons with disabilities

• organizing and conducting regular system-

atic training sessions for learning and

improving swimming skills of its members

and preparing them for competitions

• teaching and training of children and youth

• preparing its members for participation

in the city, county or state selection

• care for the health and health pro-

tection of club members

• the overall club activities aim to fos-

ter understanding and adoption of ethi-

cal values through sporting activities

• kinesiotherapy

In the SC Forca, we gather 120 members with whom

we regularly work at the Kantrida pools and in

summer on the disability beach in Kostabela.

In addition to regular activities in summer

schools, more than 200 children and young people

have been trained.

We are a sports club in the County with the

most highly educated staff that we have further

educated at the Halliwick courses. The club is

operated by kinesiologists, physiotherapists,

defectologists, educators all of whom are former

swimmers or athletes. The volunteers are the

students of the Physiotherapy Studies at the

Faculty of Medicine in Rijeka. The main goal is

to teach children to swim regardless of their

disability, ie, they are literally learning

about their motor abilities.

There are five sections in the club:

1. Therapeutic section

2. School for non-swimmers

3. Swimming School

4. Competitors

5. Recreation

With our program we want to improve the biopsy-

chosocial development of the child. The program

is implemented by a multidisciplinary team of

kinesiologists-kinesitherapists, physiothera-

pists, educators and trainers.

The Halliwick concept is widely used in the club

program. The Halliwick concept is the approach

to teaching of all people, especially those with

physical disabilities and / or learning disabil-

ities, to be able to take part in activities in

the water, to move independently and swim. (IHA

- Halliwick Concept 2000).

Photo, Center Naprej, rehabilitation in the water, summer camp in Moščenička Draga, 2018


At first, Halliwick was called the method. The

International Halliwick Organization (IHA) was

founded in 1994 with the goals of promoting and

developing Halliwick around the world. IHA has

chosen to use the term Halliwick concept as

the word ‘concept’ because it suggests a wider

framework within which different practitioners

can apply Halliwick in different contexts.

The concept influenced the traditional ways of

teaching swimming and hydrotherapy techniques.

At the same time it developed into a special

therapeutic activity in water.

The Halliwick concept recognizes the benefits

that can be derived from water activity, and

sets out the basics needed for teaching and

learning in this environment. These benefits are

holistic and include physical, personal, recre-

ational, social and therapeutic aspects.

Therefore, Halliwick can have a significant

impact on the quality of life of people. The

holistic Halliwick approach encourages people to

take part in water activities, to float and swim

independently, and it fits well within the ICF.

Therapists who want to solve certain limita-

tions can use Halliwick’s structure with special

emphasis on areas such as movement (including

range of movement, coordination and planning),

strength, endurance, respiratory capacity, oral

control, fitness etc. Water also promotes sensory

integration.

Halliwick helps develop social skills, commu-

nication, learning abilities, psychological

well-being and self-esteem. Working in a group

further promotes the development of these abili-

ties. (Lambeck, Stanat, 2001).

Swimming can be an important activity in pro-

moting quality of life. As mentioned earlier,

swimming as a therapeutic tool plays an import-

ant role in improving and maintaining health.

At the swimming school, by methodical approach

and the appropriate props, we approach the

teaching of all swimming techniques: the front

crawl (freestyle stroke), the breaststroke, the

backstroke, and the butterfly stroke. The aim is

for the participants to adopt basic swimming

techniques and to start participating in local

and regional competitions. Attendees of the

swimming school are children ranging 4-12 years

of age.

In the club, we gathered a special social

group, children with intellectual impairments,

who attend a swimming school 3 times a week on

recreational and rehabilitation levels, but at

the same time, for the interested and serious

participants, there are opportunities to compete

at local, regional and state level.

Photo, Center Naprej, rehabilitation in the water with aqua

gymstick, 2018

The program consists of a swimming school –

teaching and perfecting basic swimming tech-

niques – front crawl, backstroke, breaststroke

and butterfly stroke. With regular trainings, we

raise the level of fitness for the participants,

influence the morphological characteristics of

the body, teach new motor skills and raise the

overall level of motor skills.

Reference

Koury, Joanne M. (1996). Aquatic therapy programming: guide-

lines for orthopedic rehabilitation. Champaign, IL: Human

Kinetics, 280 p.

Martin, K. (1983). Therapeutic pool activities for young

children in a community facility. Physical and Okkupational

Therapy in Pediatrics, 3, 59-74.

Lambeck, J., Stanat, F.C. (2001). The Halliwick method. Part

1and Part 2. AKMA, 15, 39-41.

6.2.NoRDic Walk-iNG aND GyMSTick - GNW PROGRAMAUTHOR: JASNA VEŠLIGAJ DAMIŠ, LADISLAV MESARIČ

Key words: nordic walking, gymstick, bands, nordic walking poles, gymstick exercise bands

Introduction

With Nordic Walking Gym exercise bands we can

modify our walking, cross country or alpine

poles into a Gymstick exercise bar in just a few

seconds by attaching the NW Gym bands on them.

The combination of poles and bands will allow

you to perform a complete workout improving your

muscle strength, balance and mobility. You can

choose to exercise in between your walking pro-

gram in the open air or at home. This allows you

to do both walking cardio exercise and muscle

condition training anywhere, anytime!

6.2.1. GNW program -

who is it for?

The program is intended for those who are

attracted to this kind of physical activi-

ty, but especially adapted for persons with

disabilities.

Persons with disabilities are those who devi-

ate from the expected features and capabilities

defined in a particular environment, and require

extra attention and care, like:

• Persons with acquired brain injury (ABI),

• Persons with intellectual disabilities (ID),

• Visually impaired,

• Hearing impaired,

• Persons with speech and language disorders,

• Physically handicapped persons,

• Long-term sick persons,

• Persons with learning difficulties,

• Persons with emotional and be-

havioral disorders,

• Persons with autism spectrum disorders,

• Talented person.

The program was developed by the Centre Naprej

as part of rehabilitation programs to include

users who all experienced severe brain damage.

6.2.2. Why gnw program for

people with disabilities or

for persons with ABI?

Good physical condition allows welfare. The re-

sult of a systematic and continuous work is also


a consequence of mental attitude to live healthy

and active, which also increases confidence.

Being fit does not mean only physical ability,

but it touches all areas of our lives. It helps

to purify negative patterns, traumas from past,

frustrations and focus on what really counts in

life. Physical activities are critical to main-

taining an active and independent lifestyle. A

man aged between 30 and 70 years losses about a

quarter of his muscle strength, a man who ex-

periences 90 years more than half. Movement is

the key to maintaining the health, welfare and

working capabilities.

Physical/sport activity may be an important

factor in the social life of a person. It allows

him to have fun in the company of others, make

acquaintances and friendships, and feel part of

the group.

All individuals with special needs can have a

variety of problems in the field of physical dis-

abilities. Despite this, they must be physically

active within their capabilities, because the

lack of movement leads to new complications that

prevent a better quality of life. People with

traumatic head and brain injury, which usually

occurs as a result of a traffic accident, fall,

etc., the basic physical exercises affect the

improvement of motor functions, functions of the

locomotor system, relaxation of muscle tone and

stimulate the equilibrium reaction.

Walking is man’s elemental movement and efficient

movement workout. It is suitable for all people

who can walk and is a completely natural and

safe recreation that can be performed anywhere,

anytime. It does not require expensive equipment

or special facilities, but only the time and

the will. Regular walking improves both mental

as well as physical health as it strengthens

each and every muscle in the body, while not

overloading the joints. In addition, the body

after thirty minutes of walking begins with the

secretion of serotonin, the hormone of happi-

ness, and endorphin, thus largely contributing

to a good and a lot less stressful mood. Due to

release tension, walking has a beneficial effect

on sleep.

The first step towards improving the efficiency

of walking is walking with poles (more common-

ly known as Nordic walking). Poles have always

been a device for walking. The poles evenly

distribute loads which occur during walking.

They redistribute part of the weight that would

otherwise put pressure on the hips and knees,

on the hands. Thus, with each step, we are

strengthening the hands. The intensive work

period also strengthens the cardio-respiratory

function. Poles provide additional stability

when walking which is especially important for

people with impaired balance.

However, exercising only through walking is

not sufficient to prevent the loss of muscle

strength. Without strength training the muscles

still become weake and less functional. Ef-

fective training has duration of not more than

twenty minutes and requires little effort. The

key is to use the exercises in which muscles

work against an external resistance, and to in-

clude all parts of the body. Methods of strength

training include the use of free weights, fitness

equipment, rubber bands, balls and exercis-

es with its own weight. To avoid injury start

slowly and build up exercise strengths where

appropriate.

Poles also serve as requisite and support for

exercises for flexibility. The combination of

walking with poles, exercises for power with

elastics and exercises for flexibility with

poles, gives an ideal combination, which meets

all the basic requirements of natural (physical)

fitness related to health. The American College

of Sports Medicine has defined adequate physical

fitness related to health, as a set of five dif-

ferent measurable elements.

Cardio respiratory capacity is defined as the

ability of the heart, circulatory and respira-

tory system that efficiently supplies the active

muscles with oxygen at the time of continuous

muscle activity. The structure of the body

usually refers to the percentage of muscle, bone

and fat mass in the body. Normally we monitor

the percentage of fatty tissue. Physique is an

organism’s ability to perform activities re-

quiring a high level of generation of muscular

force.

Muscle endurance is the ability of a muscle or

muscle group to perform repeated muscular con-

traction for a long time, or to retain a high

level of development of muscular force for a

long time.

Especially important is to maintain muscle mass,

that is, if it is inactive, subjected to rapid

atrophy. Both parameters can be in dealing with

the physical form and health considered together

as muscle strength.

Mobility is the ability to perform large ampli-

tude movements in a certain order or a certain

plane.

All of the above mentioned areas effectively

improve due to appropriate exercise at all ages.

6.2.3. Gymstick nordic

walking – adaptations for

persons with disabilities

Adjustments to the program in terms of age

Implementation of the program is not limited

by age; it can be implemented in all stages of

life. Therefore it is wrong to think that this

kind of physical activity cannot be carried out

by elderly. Ageing is a gradual reduction of

biological functions, and the ability of the

organism. During this process an individual

is facing deterioration of his working, repro-

ductive and creative functions. During ageing

changes can be seen at the level of cells,

tissues and the organism itself. Many years of

research confirmed the fact that in the process

of ageing regular and balanced aerobic physical

activity has a significant impact on the preser-

vation and enhancement of physical and mental

abilities. So it is never too late to start with

exercising regularly.

Regular exercise can effectively reduce or

prevent a number of functional problems asso-

Photo: Jasna Vešligaj Damiš, users of Center Naprej, Piramida, Maribor, 2017

CARDIO-

RESPIRATORY

BODY

COMPOSITION

MUSCLE

STRENGTH

PHYSICAL FITNESS RELATED TO HEALTH

MUSCULAR

ENDURANCEFLEXIBILITY

Figure 9: Physical fitness related to health (Source: American College of Sport Medicine)


135

130

125

120

115

110

105

100

6’5” 200

6’3” 190

6’1” 185

5’11” 180

5’9” 175

5’7” 170

5’5” 165

5’3” 160

5’1” 155

4’11” 150

4’9” 145

ciated with ageing. Strength training helps to

delay the reduction of muscle mass and strength,

which is typical for ageing. This type of ex-

ercise improves the bone structure, and there-

by reduces the risk of osteoporosis, improves

the balance and thereby minimizes the risk of

falling, consequently associated with injuries

and fractures, and also improves flexibility and

range of motion. Physical activity has a favour-

able effect on the cardiovascular and respirato-

ry systems. Regular exercise is also connected

with the maintenance of cognitive function,

reducing depression and improving self-esteem.

In addition to these, regular physical activity

enriches the elderly with positive emotion and

welfare, reduces nervousness and mental stress,

maintains the mental and spiritual balance,

improves sleep, maintains and creates new

friendships.

Adjustments to the pro-gram in terms of gender

This program is suitable for both men and women

and there is no need for adjustments regarding

gender. There are also no restrictions in terms

of physical, cognitive and sensory deficits.

Quite the contrary - appropriately selected

physical activities that improve flexibility,

muscle strength, aerobic capacity and other

physical aspects, allow better rehabilitation of

people with various deficits.

For the implementation of the program for per-

sons with different limitations two conditions

must be provided: trainers must know the par-

ticularities of the population they are dealing

with and must be specially trained to adapt the

exercise to the remaining physical and cognitive

abilities of users. Therefore an

individual training can be ac-

complished, completely balanced

on the personal aims. An import-

ant part is also risk assessment

of the program because in ev-

ery training there must be full

safety measures provided for all

included.

6.2.4. Equipment for gnw programme

Nordic Walking Poles

Nordic Walking poles differ from regular trek-

king or alpine skiers poles in one main area:

the grips and straps. The Nordic Walking straps

stay wrapped snugly round the hands and are

clipped to the slimmer grip of the pole. This

allows the pole to be swung from the hand, with

the downward pressure from the arms quickly

applied to the pole when it reaches the desired

position. Carbon is best for pole composition

but it costs more and other compounds are en-

tirely suitable for the recreational Nordic

Walker.

Select the correct Length of Poles

To choose the right length poles, first determi-

nate the proper pole by multiplying your height

by 0,68 or by referring to the chart down. As a

rule of thumb, the elbow should be at 90 degree

angle to the surface when the poles in a relaxed

grip on the ground. For beginners it is recom-

mended to start with a shorter pole.

Use the following table to select the correct

length of the poles:

Photo: Zvonka Novak, users of Center Naprej, Kalvarija,

Maribor, 2017

Figure 10: Gymstick Nordic

Walking poles

Nordic Walking Gym Exercise Bands

The Nordic Walking Gym Exercise bands are avail-

able in any of the three resistance levels

below:

• Light/Green - for rehabilitation workouts and

exercise for the elderly. The resistance of

green exercise bands ranges from 1 to 10 kg.

• Medium/Blue - for junior athletes and women

who want to start exercising. The resistance

of blue exercise bands ranges from 1 to 15 kg.

• Strong/Black - for fit women, men who

want to start exercising, and ath-

letes. The resistance of black exer-

cise bands ranges from 1 to 20 kg.

Photo: Zvonka Novak, users of Center Naprej, Piramida,

Maribor, 2017

How to use the Exercise Bands

Transforming the poles to a Gymstick and adjust-

ing the resistance

• Take bands from handbag.

• Put the poles next to each other, han-

dles pointing to opposite directions,

with the paw-part extending further out

than the handle of the other pole.

• Tighten the poles to each oth-

er with the Velcro.

• Set the loops on both feet, in the middle of

the sole, roll the elastic band around the

bar (both poles) a couple of times and you are

ready to begin a Gymstick exercise routine.

• In the beginning of each movement the ex-

ercise band must be straight but not

stretched. You can increase the resis-

tance by rolling the bands around the

poles and decrease the resistance by re-

leasing the bands from around the poles.

• When you have adjusted a suitable resis-

tance, remember to grip the stick with a

relaxed but firm grip to avoid slipping.

• Do not stretch the bands over four times

their original length when exercising

Appropriate clothing and footwear

In order to feel good during the training and to

maintain obtain safety we have to pay special

attention on proper footwear and clothing. We

should never put on new shoes or hiking boots

for the first long hike. Footwear must be suited

to activities carried out in nature. We can use

running shoes, trekking shoes or light hiking

boots. Hiking boots shouldn’t be too high, as

this prevents proper technical implementation

of Nordic walking. It is important that the shoe

offers good support and has non-slip soles.

We can engage in GNW in all seasons, but we

must always dress according to the weather

conditions, because the cold contributes to

exhaustion. In the case of variable weather

conditions, we have to wear several layers of

clothing, which can be, if necessary, removed.

Clothing should be light, sporty. Too loose

clothing can hinder us in the activities. If we

are too hot and we face excessive sweating, we

need to make sure our body gets enough fluids. In

the backpack, which should not be too heavy, we

carry only the necessary things. We have to make

sure that our back and neck are protected from

the cold and wind. Therefore, we should have a

spare T-shirt to be able to change clothes.

Reference

Retrieved from manual for rehabilitation of persons with

disabilities: Vešligaj Damiš, J., Mesarič, L., Mesarič, P.

GNW- Gymstick – Nordic walking program

Table 5: Measure of Poles


6.3.stand UP paddle Boarding (SUP) as a NEw form of RE-haBILitaTIOn Of iNDivIDUals With ACqUiREd BRAin iNJurY (aBI)


Key words: swimming, adapted aquatics, aquatic activities, therapeutic water exer-cise, swimmers with disabilities

Introduction

Stand up paddle boarding, otherwise known as

SUP, once an ancient method of transportation

is now a sport that is easy and appropriate for

everyone who wants to explore the nature pad-

dling. Nevertheless, it is also a unique oppor-

tunity for developing a rehabilitation program,

practising interesting sports, rehabilitation

exercise for the whole body, exploring nature

and way of meeting new people and sharing expe-

rience (Hammer, 2011, Walker, Nichols, & Forman,

2010).

It is sports enjoyed by young kids, men, women,

older adults and people of all sizes, disabled

and everyone in between. Saying it is appropri-

ate for the whole family we should not forget

our four-legged companions as paddle boarding is

a fun way to spend time with our dogs.

Standing, paddling and taking the pleasure in

observing the nature we were honestly surprised

that our users got used to balancing and gained

control over the paddle boards very quickly.

Even though having fun is important, safety is

always our priority as any sport may lead to

injuries (Walker, Nichols, & Forman, 2010).

Boards should be appropriate length and width,

hull type and we should have accessories like a

paddle, PFDs (Personal flotation devices) and a

leash. Our service users were capable to learn

how to maintain control of the boards and confi-

dently floated around in just half an hour. With

a lower centre of gravity and a life vest on,

which adds buoyancy they did not fear much and

falling in off a board when they lost balance

was the best thing they could possibly do. As

they fell on the soft life vest they faced their

fear of water and slowly overcame it and en-

joyed, even more, when they got on the board the

next time.

And last but not least SUP stands out amongst

sports for being a very sociable, calming and

engaging with nature activity (Hammer, 2011,

Schram, Hing, Climstein, 2016). As we quietly

float together crossing lakes we have the unique

opportunity to explore and learn about the beau-

tiful nature of Slovenia.

6.3.1. Why is stand up paddle

boarding appropriate for persons

with acquired brain injury (ABI)?

1. Because SUP is a fun full body workout ac-

tivity (Green, 2016, Ruess et al., 2013).

2. It is a great sport for everyone.

3. We can stimulate brain activity ex-

ploring rivers, lakes, sea bays...

4. We have an opportunity to observe the lo-

cal scenery from a new angle. SUP gives us

a wider view than we would get on land so

we can see and experience the hidden side

of the rivers and lakes we already know.

5. Lying on the board with eyes closed,

listening to the sounds of the sea al-

lows us to escape the urban con-

fines and reconnect with nature.

6. Service users with severely impaired vi-

sion and those with other disabilities

that prevent them from standing, go on

the board with assistants who choose an

appropriate size of board for two.

7. It offers a very effective workout. The

constant wobbling of the board means that all

our muscles are working to keep the balance

of our body (Schram, Hing, Climstein, 2016).

It’s also good for rehabilitation of our

service users, to offset the loss of balance

which often comes with acquired brain injury.

8. It is a fantastic full-body workout. We

practice relaxation and at the same time we

facilitate injury rehabilitation. Almost

every muscle in the body is working during

paddle boarding. Because of the balance re-

quired, leg muscles are struggling attempting

to stabilize our centre of gravity, while the

arms, back, shoulders and higher abdominal

muscles are used to push the paddle in the

water. The core, back and abdominal mus-

cles are constantly at work to maintain our

balance. Therefore paddle boarding increases

our strength; improve our balance and endur-

ance (Schram, Hing, Climstein, 2016, Vojska,

2017). If we spend enough time in the water

paddling quickly we would get a good car-

dio workout. It is also a good way to burn

off excess weight and build lean muscles

that would help us in reducing strain on the

Photo: Jasna V.D., users of Center Naprej, Hoška gramoznica, 2017


lower back and the knees (Green, 2016).

9. SUP is an extremely fun and enjoy-

able activity that could replace in

some ways therapeutic work indoors

(Schram, Hing, Climstein, 2016).

10. We can go paddle boarding alone or with

friends. It’s very easy to chat to

friends paddling alongside.

11. We would never forget the unique expe-

rience while boarding as a group.

12. Stand up paddle boarding may reduce stress.

Floating on water naturally, soothes the

body, it is an exercise for mind and mus-

cles. That is why we would recommend

this powerful natural stress buster.

13. We gain a completely different and more

beautiful perspective of the nature

around us when we stand on the board.

14. It is quite a “green” activity as we need

just a board and a paddle. We do not need an

engine, fuel and we do not make noise or dis-

turb wild creatures in their natural habitat.

15. SUP offers us a lot of opportuni-

ties – to engage in conversation with

friends, to exercise outdoors or even

get an adrenaline adventure.

16. It is relatively easy to learn and practice,

and it is probably the only activity which

can be equally enjoyable for everyone.

6.3.2. General advice and

instructions for stand up paddle

boarding with individuals

with acquired brain injury

Preparation

• Start out in flat, calm water – the most

appropriate locations are lakes, sea sur-

face without waves or safe gravel pits.

• Safety check access to the water as it

should enable us to go in and out safely.

• Prepare the service users appropriately for

the activity (what is expected to happen,

safety instructions, accessories etc.) Pre-

pare a risk assessment for the activity.

• Prepare the equipment. We should be care-

ful when choosing a proper board (all round,

solid). We should adapt the volume in or-

der to fit our weight – we should add 110 to

our weight and we would get the appropri-

ate volume for us. We should not forget the

accessories such as paddle, PFD (personal

floatation device), leash and proper clothes

(t-shirt, baseball cap, sunscreen) and fluids.

Basic Paddle Board Equipment

• Stand up paddle board

• Leash

• Paddle

• Sunscreen

• Baseball cap

• UV protection t-shirt

• Water bottle

• Dry bag

• PFD (personal floatation device)

6.3.3. Educational approach

1. Teaching service users how to stand up on the paddle board their first time out

• First, we have to teach the service us-

ers how to step on the board, how to at-

tach their leash, to squat on the board

in order for them to be able to stand.

• Gradually we teach service users how to

stand up, how to gain balance and after

they have developed these skills we fo-

cus on teaching them how to paddle and

turn the board in the desired direction.

• We always teach our service users where

the water is deep enough (at least 80cm)

to prevent them from hitting the bot-

tom when they fall. They start out on

their knees and take a few strokes on each

side of the board until they reach deep-

er water, then they slowly stand up with

one foot at a time trying to balance.

2. Teaching service users to stand on the paddleboard

• The right combination for gaining balance

- being upright on the board, feet shoul-

der width apart, knees slightly bent plac-

ing our head in the centre of the board.

• We should balance with our hips, so head

and shoulders stay still, keeping eyes

on the horizon, not on our feet.

• We should be careful positioning our service

users on the board as they should not place

their body in the front of the board as the

nose will drop in the water and as soon as

they start paddling they will fall. If they

stand far back on the board, the tail will

drop into the water and the speed will de-

crease. They should stay in the middle of the

board with their feet parallel to the string-

er – about shoulder width apart with knees

slightly bent, and back completely upright.

3. Teaching service users to pad-dle (stroke techniques)

• As soon as service users feel com-

fortable on the board we start teach-

ing them how to use the paddle

• We use adjustable paddles, take the rid-

er’s height and add 15 - 20cm to de-

termine the correct paddle length.

• They paddle as they grip the top of the paddle

with one hand and place their other hand at

a comfortable distance about one - third

down the paddle. They should keep their arms

straight as they extend the paddle forward

for each stroke. When paddling on the right

side of the board right hand stays lower when

switching sides we reverse our hand position.

• They should start paddling keeping their lower

shoulder to the front and the top shoulder

back in order to reach far out to the front,

preferably – 30 – 50cm ahead as it is the most

important thing for making a good stroke. They

push the paddle down with their whole upper

body moving it from the nose to the tail and

then as it reaches the point of their an-

kles they take the paddle out, quickly put

their body upright again, throwing their hips

forward and shoulder backwards. They should

not use their arms but use the whole upper

body to push the blade deep into the water and

pull through. Using upper body and shoulder

rotation for power would make the board move

faster. They should keep the paddle upright

and closer to the sides of the board, moving

their core forward using hips and legs to

pull the paddle. As hips move forward board

slides faster. This technique is appropriate

for those who are physically and mentally

capable of completing it. Otherwise, we can

simplify it in order to ensure the safety of

the users and let them enjoy the paddling.

Photo: Jasna Vešligaj Damiš, users of Center Naprej, Drage, Croatia, 2017


• In order to paddle in a straight line, they

should take a few strokes (3-5) on one side

then switch to the same number of strokes

on the other. Usually, in the beginning we

are able to complete fewer strokes that

are also shorter. At this point in time,

the most important tasks are keeping bal-

ance and getting used to the board.

And a frequently asked question: How to hold a sup paddle properly?

We should hold the paddle so that its angle

should face away from us. As there are many

kinds of paddles with differently placed angles

we provide you with a simple way to show you the

correct way. When faced the right way the blade

will lift and allow us to move faster with less

effort (derived from https://www.justpaddle-

board.com/proper-paddle-form/). Please see the

photos below:

Figure 11 and 12: Paddle height and paddle position. Adappt-

ed from: https://www.justpaddleboard.com/proper-paddle-form/

Falling into the water

• Spend time to prepare the users for the

possibility of falling into the water.

Give them instructions when losing bal-

ance to try falling into the water rath-

er than on the boards as it is safer.

• Users have their boards attached to them

using a leash. In the event of fall, they

should release the paddle for safety rea-

sons, swim back to the board and then push

the board forward with hands to the paddle.

Turning the board

Once users are able to paddle forward and keep

the balance we move on to turning the board.

This is an important lesson as they need to know

how to go back to the shore. We start lessons

when the board is still, making a 180-degrees

turn as this is the easiest turn. They should

keep a low stance and pull, towards the tail or

backwards, while twisting and leaning to the de-

sired side with their torso. The important thing

is keeping the balance and the core still as the

board may become unstable.

Paddling faster

If the service users are successful in learning

the basic stroke techniques and safety measures

we continue the learning process with teaching

them how to paddle faster completing more and

longer strokes (3-5 on the left side and 3-5 on

the right side).

These are the basic lessons that we teach our

users. We could always upgrade our knowledge to

knee paddling, advanced turn techniques, one-

leg, squat paddling, squat paddling, exercising

on the board.

We focus on the learning techniques finding a

calm body of water, once we have learned to pad-

dle there we could explore seas where the waves

are slightly bigger.

Photo: Jasna Vešligaj Damiš, users of Center Naprej, Gams

Bad, Austria, 2017

Always remember: Start with providing a thorough

stand up paddle boarding and swimming training

for your assistants before teaching your users.

Photo: Jasna Vešligaj Damiš, users of Center Naprej, Velen-

jska plaža, 2018

6.3.4. The Benefits of Stand

up Paddle Boarding

• SUP is having fun outdoors: a little safe

sun exposure is great for our body’s need

of vitamin D. Our body needs vitamin D that

keeps our bones strong by helping our body

absorb calcium and phosphorus (Green, 2016).

• We can practice stand up paddle board-

ing almost everywhere: in the sea (near

the coast, in lagoons, bays, in the open

sea...), in lakes, gravel pits, rivers, wa-

tercourses, streams, ponds and even pools.

• It is an extraordinary activity that en-

ables paddlers to get the benefits of

a full-body workout (Schram, 2015).

• SUP improves our overall fitness, it is

great workout, which is one of the rea-

sons that top athletes involved in various

sports practice it as part of their routine

or as part of the rehabilitation process.

• When paddling we train our muscles,

“burn” calories, increase our heart rate.

Movement relaxes muscles, and releas-

es endorphins (pleasure hormone) in the

body, which alleviates the effects of

stress and makes us feel better (Schram,

Hing, Climstein, 2016, Green, 2016).

• SUP is a full-body workout. As paddlers

we use different muscle groups. We need to

learn to balance which trains core mus-

cles and fingers. SUP strokes require move-

ments of hips and shoulders similar to

those in golf, tennis or baseball.

• The back muscles are of crucial impor-

tance and constantly at work as they

maintain the posture and stabilize the up-

per part of the body (Schram, 2015).

• The abdominal muscles are at work when pad-

dling, they are used to propel the paddle-

board into the water and work together with

the back muscles attempting to maintain our

balance (Schram, Hing, Climstein, 2016).

• Paddling strengthens and trains the mus-

cles of the spine, as well as the triceps

and biceps. Our buttocks, thigh and calf

muscles are also working hard in order to

keep our body upright (Schram, 2015).

• SUP improves our motor skills,

strength, endurance, coordina-

tion and mobility (Schram, 2015).

• SUP activates both sides of the body. Thus,

the users (persons with acquired brain injury)

also activate their weaker (affected) side

of the body, as a result of that they extend

the shortened muscles of this side and rotate

the core, which is extremely important for

their rehabilitation (Ruess et al., 2013).

• SUP as mental training. Practicing SUP af-

fects our mental health and mental fitness

(Schram, Hing, Climstein, 2016). Stand up

paddle boarding can alleviate stress levels

and mental tension. On the boards we can get

closer to nature and its beauty as it is sci-

entifically proven to have a relaxing effect.

SUP enables our overwhelming mind to rest.

The released endorphins improve our mood.

• Stand up paddle boarding stands out as

a very sociable activity. This is a fun

and safe way to spend time with friends

(Schram, Hing, Climstein, 2016).

• SUP is a great opportunity to find adventures,

explore and discover wilderness and reconnect

with nature. It is a way of travelling and

conquering interesting places (Green, 2016).

• SUP is also a popular activity for compe-

titions (Schram, Hing, Climstein, 2016).


• Age is not a barrier for those who want to

stand up paddle board. It does not matter

whether we are young or old, it is suit-

able for everyone. It offers relaxed rec-

reation and everyone can learn to do it.

We can see children, teenagers, pregnant

women or our grandparents on the boards.

• SUP is also appropriate for practis-

ing by persons with disabilities, and

we do practice SUP at Center Naprej!

Reference

Green, D. (2016). “ACE-Sponsored Research: Can Stand-Up

Paddleboarding Stand Up To Scrutiny?” ProSource. American

Council On Exercise. August 2016.

Hammer, S. (2011). Catch the wave of stand-up paddling The

Providence Journal, Sep. 5, 3.

Maja Vojska (2017). Aktivnosti, ki ti učinkovito pomagajo

izboljšati ravnotežje. derived from https://www.bananaway.

si/7-aktivnosti-ki-ti-ucinkovito-pomagajo-izboljsevati-rav-

notezje/

Ruess C, Kristen KH, Eckelt M, Mally F, Litzenberger S, et al.

(2013) Stand up Paddle Surfing-An Aerobic Workout and Balance

Training. Procedia Engineering 60: 62-66.

Schram B. (2015). Stand up paddle boarding : an analysis of a

new sport and recreational activity. PhD Thesis. Gold Coast:

Bond University.

Schram B, Hing W, Climstein M. (2016) The physiological,

musculoskeletal and psychological effects of stand up paddle

boarding. BMC Sports Science, Medicine and Rehabilitation 8:

32.

Walker, C., Nichols, A., & Forman, T. (2010). A survey of

injuries and medical conditions affecting stand-up paddle

surfboarding participants. Clinical Journal of Sports Medi-

cine, 20(2), 144.

https://www.justpaddleboard.com/proper-paddle-form/

Photo: Zvonka Novak, users of Center Naprej, Velenjska plaža, 2018

Figure 13: SUP - complete workout Adapted: http://www.serenapaddlesports.com/blog/standup-paddleboardinga-complete-workout

6.4.SlACkliniNG OR walking On flAT webBINgAUTHOR: JASNA VEŠLIGAJ DAMIŠ

Key words: slackline, balance, basic positions and movement, outdoor sports activities

The introduction of a novelty, especially new

sports activities, such as slackline or walking

on flat webbing is always challenging but at the

same time exciting. When users perform something

new as part of their rehabilitation, they do not

know whether they will succeed or not, regard-

less of the experience - if they have already

tried it before the injury or not, it causes an

increased level of stress for them.

The introduction of novelties is also a partic-

ular challenge for employees. The employees of

Center Naprej tried first themselves walking on

flat webbing. They tested their balance, focus,

giving and receiving feedback, managing waves

on the webbing, managing fear of falling, per-

sistence, and so on. When they had familiarized

themselves with the various aspects, possibil-

ities and critical points of slacklining, and

gained the appropriate skills and knowledge, we

started introducing users to this interesting

but also challenging sports activity.

6.4.1. What is slackline?

Slackline is a suspended length of flat web-

bing that is tensioned between two anchors.

It is most often tensioned between two strong

trees about 30 - 50 cm above the ground. We can

tension it just above the ground or above water

surface, and we can stand on it, walk, jump,

perform tricks, do yoga, etc. It differs from

the ordinary rope because slackline is more

elastic therefore it can function similarly to a

narrow trampoline.

In the beginning, we try to keep the balance on

the tape, and from time to time, we try to take

a step across the whole length or even make a

more demanding exercise.

6.4.2. Why slacklining

with persons with acquired

brain injury (ABI)?

Walking along the nylon tape is a sports ac-

tivity with multiple aspects, where awareness

of one’s own body, balance and coordination is

extremely important, and at the same time it

influences a wide spectrum of other human psycho-

physical abilities. While slacklining, people

with ABI develop different abilities:

Sense of the position of one’s own parts of the body - proprioception

Proprioception is the perception of motion and

the positions of the body parts. While slacklin-

ing, we perceive the movement, the positions of

the limbs, the pressure on the feet, the speed

BODY EXERCISE CARDIO EXERCISE

SHOULDER MUSCLES

CHEST MUSCLES

ARM MUSCLES

ABDOMINALS

THIGH MUSCLES

LOWER LEG MUSCLES

TRAOEZIUS MUSCLES

LOWER BACK MUSCLES

GLUTEAL MUSCLES

LOWER LEG MUSCLES

• HEART

• LUNGS


of movement and the force of inertia that arise

during the activity. Thus they improve their

proprioception. It is important to focus the

sight to the horizon. For even more propriocep-

tive challenges, we close our eyes and try to

stand and walk on the mice tape.

Balance

Slacklining is a test of balance. Some users’

goal is to remain on the webbing, others’ to

take a few steps or to move from one end to the

other, others to stretch on the tape. While

slacklining, we are constantly trying to hold

our body in a stable position and are constantly

on the border between stable and unstable state.

When we step onto the webbing we leave the

ground (the comfort zone) which we are used to,

and enter the state of uncertainty (no comfort).

The line swings. The main problems are caused

by the body and the mind that like known situ-

ations. Let’s confront the unknown, which is a

good training for all and it is happening to us

in everyday life. In fact we are never sure how

the day will end. Therefore, slacklining can be

said to be an ‘’ out of comfort zone ‘’ activity

or opportunity to cross the threshold of our own

uncertainties.

Stabilization and strength-ening of the core

Slacklining requires a fairly tight central part

of the body (the core), the upper part of the

legs, while the arms are released. In this way,

we stabilize the transverse bandwidth of the

tape.

A social and healthy entertain-ment for everyone and psycho-phys-ical abilities training

Slacklining is a social and healthy entertain-

ment for anyone who is able to stand upright and

take a step on solid ground. It is a good phys-

ical as well as mental exercise that improves

the management and stabilization of the body and

helps to cope with feelings (fear, excitement).

In addition to the above mentioned positive

effects, it is observed to help improving body

posture, reaction time, concentration, focus and

perception. It can be a relaxation technique and

help with remaining calm in difficult situations

and in achieving greater determination. It is

a preventive activity and helps the treatment

of joint damage. It is a good workout for the

ankles, knees or hips and strengthen the whole

body.

6.4.3. Tips before starting your

employment with persons with ABI

First, let’s get familiar with the rules import-

ant for all aspects of slacklining. They are

especially useful for beginners (Nahtigal, 2012)

and of course when working with our users - ath-

letes with acquired brain injury.

Preparation of the surface

• We select and prepare the surface: the ground

should be flat, preferably grass, prefera-

bly we placed a thin protective pad under

the line, for safety in case of fall.

• Select the appropriate tension points - the

distance of the tensioning. We have to se-

cure enough space around the line (at

least 5 meters on each side of the line)

to prevent damage in the event of fall.

• Tension the tape to fixing points (e.g.

two trees). The best fit is with origi-

nal clips. We must not forget to pro-

tect the trees so they do not get damaged

(e.g. wrap them with a foam sponge).

• The distance from the ground should be big

so that the tape in the middle at the largest

part is just above the ground (10 to 20 cen-

timeters), and the distance between the fixing

points should be short, 5 to 10 steps, to be

as close as possible to the ground to jump.

• Stretch the webbing to the desired extend

(the shorter and more tense it is, smaller and

faster is the wavelength of the oscillation).

• On both sides of the tension point

(i.e. on both trees), we mark the

point of sight (the horizon).

Preparing the users

• Before commencing slacklining it is import-

ant to prepare the users appropriately psy-

chophysically: we perform various exercises

for balance training and coordination, teach

them relaxation with breathing, managing

emotions, awareness of body parts, etc.

• Users have to take off their shoes before

slacklining. They are barefoot on the tape.

Bare feet improve the feeling for the line

and help them to start balancing faster.

• Before users start the activity, we

calm them down and make them relax and

gain control of their breathing. If he/

she is appropriately prepared, his/her

legs on the tape will be less shaky.

• Before slacklining, they need to be lead

as to how to step on it, to focus eye-

sight on the indicated point on the tree.

Some general instructions

• The recommended width of the line

is 3.5 cm and the length for be-

ginners is between 4 and 8 m.

• We start with demonstration of each exercise.

• Often, the first attempts to tackle the

tape are unsuccessful and the user can-

not stand alone on the tape. That is why

we offer him support and encouragement

to persistently repeat the exercise.

• When stepping down from the tape, make

sure that the user does not jump quick-

ly from the line. The line is dynamic and

will respond to the jump with stretch, and

consequently the user will lose control

and fall uncontrollably from the tape.

• It is best to start in the centre of the

tape, especially for safety reasons. It is

more likely to hit and get injured in case

of a fall near the tension point. In the

middle, the tape is at the lowest point

and thus reduces the height of any fall.

• When slacklining, the user will initially be

most hindered by the fluctuation of the tape,

but continuous exercising may improve con-

trol or even eliminate the fluctuation over

time. The tension of the line depends on the

distance between the fixing points. The wave-

length of the oscillation in the middle is

the largest and slowest; when approaching the

fixing points, the wavelength of the vibration

is always short and quick. The fluctuation

also depends on the length of the tape and

the force with which the tape is tensed.

• The line is very tense, so care should

be taken to ensure that in case of fall-

ing line does not hit the user.

• Even if the line is only a few centime-

ters above the ground, the fall can cause

injury (strains, bumps). Injury depends

on the surface under the webbing and the

type of fall. Therefore, a protective lin-

ing is recommended under the tape.

Photo: Center Naprej, 2017

6.4.4. Basic exercises

Exercises with assis-tance while slacklining:

• Exercises with assistant (hold-

ing the user for the hips).

• The assistant sits on the tape.

• The user is holding the assistant’s shoulder.

Practical exercises

• Training with running poles (2 poles, one

pole, the length of the poles is approx-

imately to the shoulders of the user)


Examples of exercises for prepar-ing users for walking along the tape with various forms of assistance

Exercises on the ground:

• walking along the line with

open / closed eyes,

• walking on a low bench, low lath

• exercises on soft surfaces - soft pillows

• exercises on sticks, walking, squats, turns

• exercises on balance boards

• breathing exercises, relaxation exercises

Exercises for getting used to the webbing - we start all exercises in a way that the user is placed in front of the tape:

• with one foot on the line and push-

ing it in all directions;

• with one foot on the line, swings, so that

the tape pushes the foot back to the ground;

• with one foot jump on the line, so that

the line pushes foot back to the ground;

• with one foot on the line and

cross it with the other foot.

Exercises for balance position on the line - all exercises are performed while the assistant is sitting on the line.

We start with the exercises as we are about 2

meters away from the user. Later this distance

between the user and the assistant sitting on

the webbing is increasing. We can perform:

• walking with the help of poles,

• walking with the help of an assistant.

6.4.5. Movements - basic

instructions for implementation

1. Stepping on the line

Start position: Basic start position.

Implementation: We focus our weight directly on

the leg on the line, and then with a calm and

balanced motion we step on it. Keep the body

upright throughout the movement. Finish in the

basic position on the tape with one leg on.

Note: Do not press down on the foot on the tape,

as the tape is moving away and the pressure is

higher, feet are shaking quicker. In order to

get on the tape, you need some determination.


2. Walking forward - backwards

Start position: Basic start position.

Implementation: From a balanced basic position,

we begin to move the body’s center of gravity to

the foreleg. Gradually we begin raising the heel

of the leg behind. When the body’s center of

gravity is already completely on the front leg,

we make a steady step forward with the rear. The

foot leaves the tape with the fingers, we step on

the whole foot, and the center of gravity of the

body rests on both feet. The body is upright all

the time while the arms are in a slightly bent

position. The joints of the feet, the knee and

hip joint are slightly bent.

Exercises:

• Get on the line.

• Stand on the line on one leg.

• Stand on the line on the other leg.

• Stand on the strap on both legs,

one leg should be behind the oth-

er, then replace the legs.

• Stand on both legs to swing the tape

in the direction up - down.

• Stand on both feet to carry the center

of gravity from one leg to the other.

• Stand on the line on one leg; touch the

line with the other foot first in front

of the holding led then behind it.

• Take a short step forward.

• Take a short step backward.

• Stand on the line with your eyes closed.

• Stand on the line with your

hands on your body.

• Take a few steps forward.

• Take a few steps backwards.

• Step on the line side laterally (the shoul-

ders parallel to the tape) with both legs on.

• Try to make a turn on the tape.

Reference

Nahtigal, A. (2012), Učenje hoje po najlonskem traku,

Diplomska naloga, Univerza v Ljubljani, Fakulteta za šport,

Specialna športna vzgoja, Gorništvo z dejavnostmi v naravi,

Ljubljana


6.5.CrOssBOCCIa

AUTHOR: RAÚL CANDIDO

Keywords: Cross Boccia as a trendy sport; physical adapted activity; sport for all.

We are in an age where the participation of

communities is of the utmost importance for the

societies. Sport is a factor that ensures equi-

table conditions and has been one of the stron-

gest tools for people with disabilities to take

an active role by creating close links in their

communities.

The sports phenomenon, when valued by a signif-

icant number of people, allows minorities, in

this case people with disabilities, a kind of

affirmation that will pose new challenges, which

will tend to find new answers in search of an

increasingly inclusive participation. Cross Boc-

cia, as a group game, can be a friendly instru-

ment for socialization, establishing group and

family ties, which can help draw attention to

physical, psychological or group culture bar-

riers, which at first sight are not visible, or

when they exist seem insurmountable.

Some dilemmas put on people with disabilities,

such as those that follow, may seem outdated,

but in unfortunately, they are not.

Because I use a wheelchair I can´t play, or

cannot throw the balls with enough strength for

more distance I can never play Cross Boccia.

Because I have visual difficulties I do not

know my street, my neighborhood, I cannot have

friends to play Cross Boccia.

Because I do not understand all the Cross Boc-

cia rules, or I find it difficult to learn some

things on a daily basis, or do not have much

concentration, I will therefore be condemned to

being trapped in a life, like a force jacket,

that will not let me make friends and relate to

others, and enter the game.

As I do not hear, I cannot even speak, I am only

isolated in my corner, because sports are not

for me, because most people do not understand

me.

In a time of such sophisticated conquests these

questions are still of the daily life of those

who have some kind of disability. It is true

that adapted sport has grown in implementation

in several countries and the number of informal

or federated practitioners has increased, but it

is not enough and we must continue to affirm the

need for regular sports to maintain the neces-

sary stabilization and progression of physical

adapted activity and sport for all.

The Cross Boccia is a trend sport that takes ad-

vantage of the basics of traditional boccia and

boules, but adds some aspects to it. The Cross

Boccia, also called soft boccia, is therefore

an additional development of boccia sport and

therefore equates to sports formats like BMX,

snowboard, parkour or headis, known as radical

sports, which also expanded the game principles

to create a new sport.

The fact is that Cross Boccia can be played ev-

erywhere, especially in the aspects of freedom,

spontaneity and creativity. In February 2010,

the sport was for the first time in the largest

global start-up competition, “Brand New Award”,

in the international recognition of the brand.

Cross Boccia is the new freedom. With the

free-style variant of the well-known boccia or

boules, you make the world the playing field.

With the flexible balls, you can now, for exam-

ple, play on the stairs, in the teams or on the

10th floor of the yard. Your creativity knows no

bounds!

The idea of playing Cross Boccia also “crossed”,

that is, in three-dimensional space, is much

longer than the term boccia in street itself.

For example, the use of plastic balls has been

used to bring more movement into the game. The

problem, however, was that the balls jumped and

the control needed to play the game was no lon-

ger guaranteed.

The Cross Boccia as another sport that can be

practiced outdoors by everyone, so the inclusive

aspect of the game is very important. People

with any type of disability can play it, and it

is advisable that this participation has the

greatest possible autonomy for the practitioner,

attending naturally to the minimum safety mea-

sures for their practice, in the chosen space.

Just like a game that is fashionable, we set out

to further develop this opportunity for inclu-

sive sports practice. It provides group inter-

vention strategies, space and time structuring,

strategic reasoning, movement skills develop-

ment, body notion, abstract thinking and group

notions. GET THE FUNSPORT!

6.5.1. Rules of CROSS BOCCIA

Overall characterization:

The game consists of sets of three (3) balls of

the same color / designs / patterns and a main

ball, the target ball, which is smaller and

different from all the others. It can be prac-

ticed by players individually or in teams with

three (3) players. In this variant there must be

two sets of three (3) equal balls per team and

each player has two balls at his disposal. It

is played on any terrain, indoors or outdoors,

without space limitations.

Goal:

The objective of the game is to reach / stay in

contact with the target ball or place the balls

as close as possible to to target closer to the

opponent’s balls and thus score points.

Development of the game:

Each player, in the individual variant, has

three (3) equal balls (colors / drawings /

patterns) to play; in games between teams,

each player only has two (2) balls. A player /

team is drawn or selected to start the game by

throwing the target ball from a starting point

he chooses. All other players also have to play

from this same location. The target ball can be

played anywhere; there is no special or delim-

ited play area. The player who threw the target

ball must start the game by throwing his first

ball. All other players then play their first

ball as well. The player having the ball far-

thest from the target ball must play the second

ball and, if not closer to the target ball, the

third ball. All other players also have to play

their second and third game balls, according to

the distance to the target ball. When all the

balls are played, the points must be counted.

The player who won the game begins the next game

by throwing the target ball to a place he choos-

es. If in a game set two or more players are

tied in number of points, the player who won the

previous game starts to throw in the next game.

Points:

Each game ball that is closer to the target than

any opponent’s ball counts a point. If in any of

the two or more opponents’ throws, the balls are

the same distance to the target ball, then each

game ball scores with one point each. If a ball

falls on an opponent’s ball and overlaps it,

this is called “KO / kill” and the opponent’s

ball is not counted. The game ends as soon as a

player or team reaches 13 points, but there has

to be a two-point advantage, for example, 13-11,

12-14, 15-13, etc.

Note: in these rules, the player who throws the

target ball first and then the first ball of the

game did not take it into account, that the op-

posing player had to reproduce the same type of

gesture, and other conditions determined.

Examples: the ball must be thrown between the

legs, the ball has to make two tables on the

walls, before going to the target ball, we have

to throw on our back, we have to throw with the

left hand, etc…


6.5.2. Annex

1. Situation of KO and its consequences:

The red (A) ball is KO, it does not count

Example 1: When one ball overlaps another, this

ball, cancels the ball underneath (green - B

ball covering the red - A) cancels the red ball.

Take the ball off a KO ball

Example 2: In the case of a play in which a red

ball removes the green ball covering the red,

the red ball, which has removed the green ball,

will be available to the player to be played

again. The red ball that was covered by green is

no longer KO, and can even score if that is the

case, being closer to the target ball, than the

opponents’ balls.

2. Ball combinations and punctuation reinforcement:

Ball attach to target ball

Example 1: Whenever your ball (A) is in contact

with the target ball (B), it gives a score of 2

points.

Worm

Example 2: The green ball is in contact with

another green ball, which is in contact with the

smaller (black) target ball, gives a score of 3

points.

Snake

Example 3: Two green balls touching another

green ball, which is in contact with the smaller

(black) target ball, gives a score of 5 points.

A

TARGET BALL

A

TARGET BALL

B

A

TARGET BALL

BC

A

B

Pyramid

Example 4: Two yellow balls leaning against

another yellow ball, next to the top making a

triangle, touching the yellow ball that is in

contact with the smaller (red) target ball,

gives a score of 5 points.

Flower

Example 5: All yellow balls in contact with

the smaller (red) target ball give a score of 5

points.

Ball on the target ball or the top mountain

Example 6: The yellow ball is on top of the

smaller (red) target ball, gives a score of 5

points.

Reference

CALIMAN, Mark C. - https://www.zoch-verlag.com/en/games/

crossboule/

SCHMIDT, Alexander, OBERMANN, Anika GbR - Der urbane Trend-

sport für Abenteurer | Anleitung Crossboccia® get FREE! -

http://www.crossboccia.com

Author of photos: All the photos in the Annex are from the

catalog of Mark Calin Caliman https://www.yumpu.com/de/doc-

ument/read/50993297/crossboule-regeln-als-pdf-zum-download-

jugglux. Retrieved on 20-07-2017.

A

TARGET BALLB

C

A

TARGET BALL

A

B

CC

B

A

C A B

1 2


6.6.SkIINg


Key words: skiing, balance, safety measures, outdoor sports activities

Alpine skiing is one of the most popular winter

sports. It is accessible to a wider audience of

people who poses the appropriate mobility skills

and ski equipment. Alpine skiing is sliding on

the snow, with ski on your feet. Usually, the

skier also has sticks in his/her hands. Anyone

who likes winter sports and is not afraid of

cold can do skiing. Alpine skiing means white

slopes, low temperatures and great pleasure.

6.6.1. Who is the program

appropriate for and why we are

skiing in Center Naprej?

Alpine skiing is one of the important programs

we have included in our sports rehabilitation

programs, which we use for training and testing

the balance of users. It is a comprehensive and

very demanding activity with a high level of

risk for our users. As part of the risk assess-

ment, we identified weak balance as a major risk

factor in the rehabilitation skiing program

that causes a high level of risk of a fall and,

consequently, a risk of a new brain injury or

a bone fracture. Activity, focusing on bal-

ance training presents great importance for all

day-to-day activities, including self-care and

walking.

The Alpine skiing program is intended for skiers

with disabilities with acquired brain injury,

who have at least basic ski knowledge that they

had acquired before the brain injury. Skiing

belongs to a very complex physical activity,

and it would be very difficult and risky to learn

after such heavy injuries suffered by our us-

ers. Learning is one of the most complex higher

mental processes that the brain performs, and

any disturbance or damage to the brain causes a

change in this process.

In Center Naprej, we started skiing with us-

ers who had already skied before the injury

and wanted to reacquire and improve their ski

skills. Skiing is a great challenge for us,

because besides pleasure it also has a certain

risk.

Photo: Center Naprej, Weinebenne 2017

6.6.2. Some tips and instructions

for alpine skiing with our users

or persons with disability

In order to be able to perform alpine skiing,

the skier must have:

• good preparation and physical fitness (aer-

obically sufficient muscular strength

and an aerobic ability, especially mus-

cles of the legs, abdomen and back),

• ability to maintain balance.

The ski training consists of two parts:

1. physical preparation for ski-

ing and fitness training,

2. ski training, skiing and racing.

At the same time, all the above conditions are

necessary to be integrated for a harmonised

programme. Only then a specific movement, such as

skiing, would be harmonized - thus recognized as

good or successful. This can be achieved through

a well-planned ski preparation program and care-

ful implementation of this. Only in this way,

we can expect a successful snow movement, which

will be pleasant and safe for the user. Without

good preparation, skiing will not be successful.

It includes fitness training, skiing “gymnastics”

and maintenance of the motor fitness throughout

the year. We also help with the ProSki simulator

training.

Each disabled skier has his companion. For bet-

ter orientation and improved visibility on the

track, we use visual support and signs. Proper

preparation and adequate knowledge of skiing of

the companion and good competence for working

with people with disability are important. In

order to work with our users, knowledge of the

field of work and rehabilitation of persons with

acquired brain injury (limitations, specifici-

ties, rules) is required.

Skiing with users is usually individual or

maximum in pairs - up to 2 users per trainer.

Particular emphasis is placed on the safety of

users, so it is extremely important that we pre-

pare a risk assessment for the location and all

skiers before the skiing starts.

6.6.3. Special features for

skiing with persons with

acquired brain injury

In the case of skiers - persons with acquired

brain injury - we must pay attention to the

following:

1. choose appropriate ski slopes and ski trails

according to the individual’s capabilities

(physical and cognitive) and knowledge;

2. the load during exercise should not ex-

ceed the individual’s ability,

3. users must be appropriately dressed,



so that they can move properly, that

they are not cold or hot and that this

does not hinder their activity;

4. due to cold, we must pay atten-

tion to the skin care and the prob-

lem of thermoregulation;

5. brain injury can damage the centre of bal-

ance, which affects the balance of the

individual. In case of weak balance, the

risk of a fall and new brain damage or

bone fracture is very high. Therefore it

is important to make an appropriate risk

assessment and prepare actions to cope

with these problems before skiing.

6. We need to be alert to the visibility an-

gle of persons with neglect (where part of

the visual field fail) and to take appro-

priate safety measures at the ski track.

7. We must take into account and anticipate

users’ needs and physical comfort. Users

can become agitated and restless when they

are tired, hungry or feel pain, often fail-

ing to recognize latter. We must determine

the breaks during the activity and the

length of skiing individually, depending on

fatigue, attention deficit and other abil-

ities. Fatigue consequently affects both

physical and cognitive ability, and in-

creases the risk of injury and accidents.

8. When preparing for skiing with users, it is

important that we form realistic expecta-

tions setting goals that users can achieve.

9. Avoid excessive stimulation in the ski

track. We give short, clear instructions.

10. We use learning by model: we teach our

users giving example and thus provide

them with adequate patterns of behaviour

and consistency in various (burdensome)

situations. Demonstration: Sometimes

it takes several demonstrations to un-

derstand; let the person do the exer-

cise; repeat the necessary steps, etc.

11. Users need a lot of directions, di-

rectives and guidance. The least em-

phasis should be on errors. We focus

on encouraging achieving success.

12. The skiing needs to be planned well, because

ABI users can have problems with the sim-

plest tasks due to problems with executive

functions and motivation, rather than as-

suming that he/she does not want to do this.

The fact is that the affected part of the

brain may disable initiating, motivation and

planning capability. It is sometimes very

difficult to distinguish between these dis-

turbances and non-cooperation on purpose.

13. Skiing should be a fun and pleasant activity.

Photo: Jasna Vešligaj Damiš, 2018, Weinebene

6.6.4. Advantages, positive

effects and goals of the program

Exercise has many positive effects on the human

organism including a number of disease preven-

tion effects. The most important thing is that

activities are carried out in nature in the

winter, in the fresh air.

The main goals of the program are to improve or

maintain physical fitness, to improve and promote

a healthy lifestyle, to develop an appropriate

attitude towards nature, to use its properties

for a healthy lifestyle, to promote positive

self-image and personal satisfaction in life, to

increase the self-confidence in performing tasks,

acquire knowledge and skills.

Some of the health and psychosocial benefits that

skiing brings to our users:

• improves general fitness be-

cause the whole body works,

• improves flexibility of joints, mobility,

• has a positive impact on raising gen-

eral motivation due to activation and

achievement of success in sports,

• strengthens the abdominal muscles,

• improves functioning of the car-

diovascular system,

• positively affects cardiorespiratory

health and increase aerobic capacity,

• increases anaerobic abilities - muscle

strength of the legs, back and abdomen,

• improves balance and coordination - coordi-

nates the movement of all large muscle groups,

• outdoor skiing in nature im-

proves stress management,

• enables learning, renewal and main-

tenance of ski skills,

• allows you to compete and entertain,

• provides training in social skills

and group activities,

• provides training for receiving and performing

instructions and executing functions training,

• provides memory and communication training.

For our users, it is a unique effort to try to

stay upright while skiing. They must work with

the abdominal muscles to remain balance, with

those abdominal muscles located deeper and begin

on each side of the spine, swirl around the body

and end up in the pelvis. These are the key ab-

dominal muscles that shortened act as a “corset”

and squeezing the lower abdomen. Other abdomi-

nal muscles also strengthen and stabilize the

spine, so it does not bend when leaning forward

or falling. Improving the strength of the abdom-

inal muscles helps them to improve balance and

coordination.

Half an hour of skiing without breaks is a

good exercise for the cardiovascular system,

no matter how you ski, that means an increased

heartbeat, increased blood circulation, and more

intense nutrients and oxygen flow through the

body, extra substances discharged. At the same

time, more calories are burnt when skiing, mus-

cles are prepared for more oxygen and blood, the

capillaries are more loaded and the muscles are

able to stretch. Skiing strengthens the entire

body and is good for all the main muscle groups.

The inner and outer muscles of the thigh, mus-

cles bending knees, the muscles of the buttocks

are most affected.

Skiing is also good for managing body weight.

The steeper the terrain is, the more calories

you burn. Greater inclination of the ski slope

requires investing more efforts to balance and

using more energy. The reason for losing weight

is also the low temperature in the environment,

if it is below zero body causes body tempera-

ture to rise and you spend more calories. All

this also applies to our users, although we do

not ski with them on very steep and demanding

ski slopes, but carefully choose the difficul-

ty of the route according to their skills and

knowledge.

6.6.5. Skiing equipment

Technical equipment

• alpine skis, which must be properly pre-

pared and ready for snow with bindings,

• ski poles.

For seated skiing, we use: “biski, monoski,

kartski, tandemski” and stabilizers with skis

(instead of sticks) - which we have not prac-

ticed so far in our centre, because there have

not been similar needs or opportunities.

Personal equipment

• personal clothing: jacket and ski pants

Jacket should be warm, waterproof. The ski pants

must be extremely warm so people do not get cold

in the legs.

• mandatory helmet

The helmet must allow the user comfort from the

inside, especially in the area of the ears, and

at the same time strength from the outside to

protect the head from possible hits. Also im-

portant is the locking system of the helmet,

which keeps the helmet stable in case of fall.

• ski gloves

Ski gloves must be warm and at the same time


provide good grip on the stabilizer. For people

with impaired motoric hand functions, they use

gloves for one finger, due to the difficulty in

using gloves.

• ski shoes

Ski boots, like other equipment, must keep feet

warm but at the same time they must have appro-

priate hardness and not be too demanding.

• a reflective jacket

The reflective jacket is highly recommended,

especially in ski resorts where there are more

people, as the skier and skier’s reactions are

longer than in individual skiing. With this, we

remind other skiers to pay more attention to us

at the ski resort.

• ski goggles or sunglasses

They are recommended mainly due to the reflec-

tion of light from the snow cover. They are also

important in case of bad weather and fog.

Personal equipment of the trainer / assistant

• alpine skis

Usually we recommend shorter skis (slalom), for

easier handling and medium hardness. Assistants

must have skis light enough to make them swiv-

el, and at the same time must be able to manage

themselves and the skier.

• ski shoes

They are usually softer, because preparation and

heating require a lot of work without skis for

the trainer, walking in ski shoes, opening and

closing the skis, track assistance, etc.

• personal clothing and helmet

The gloves should be thin but warm, with good

grip, so that they are not a hinder.

Accessories for making ski-ing more appealing

• cones,

• flags,

• flex poles, etc.

Reference

Alpsko smučanje za osebe s pridobljeno možgansko poškodbo

v Centru Naprej. Interno gradivo Centra Naprej. Maribor,

oktober 2014.

6.7.F•O•OTgoLF


Key words: footgolf, footgolf rules, outdoor sports activities

6.7.1. What is footgolf and

for whom is it appropriate?

Footgolf is a sport where we replace the golf

ball with a soccer ball. It is played by golf

rules. This represents a unique and fun sport

that combines the passion of football and the

precision of golf and is a unique opportunity

to socialize in a slightly different way. It’s

an easy and fun sport for everyone who is able

to kick the ball. According to the tactics, the

footgolf is similar to playing golf, but the

players kick the ball with their leg. It can be

played as a group activity or individually. The

advantage of this fairly new sport is in its

simplicity. After acquiring basic knowledge of

the rules and the good manners on the footgolf

course, we can very quickly start enjoying the

game. It is suitable for individuals from all

generations.

Footgolf offers us:

• a pleasant environment and the possibili-

ty of socializing over fun activities,

• a competitive spirit in a green environment,

and in the winter time on a snowy slope,

• interesting recreation and intense play,

• a football spirit on the golf course

for an unforgettable entertainment,

• relaxation from everyday worries.

The classic footgolf course has 18 holes, which

can also be scribbled. There is a flag on each

hole. The size of the holes must be adapted to

the size of the ball. Each player has his own

ball. Footgolf can be played individually or in

small groups. The group consists of a maximum

of 4 players who count the number of theirs and

others hits. During the entire game, the player

can use 72 shots. If a player moves his own ball

while searching or preparing for a shot, he gets

a penalty spot. During the game, it is necessary

to wait until the ball stops completely be-

fore the player kicks it. The footgolf match is

shorter than the match of golf, and it usually

lasts for more than two hours.

6.7.2. Why are we playing

footgolf with the users

of Center Naprej?

People with acquired brain injury (ABI) suf-

fer from serious consequences that permanently

affect their daily functioning and their sur-

roundings. Although the person with ABI can ex-

perience various chronic physical disabilities,

it is generally the cognitive, emotional and be-

havioural disorders that restrict the individual

the most resulting in many problems in interper-

sonal relationships, creating and maintaining a

social network, integrating into daily leisure

activities, sports activities and employment.

These disorders most often change lives of indi-

viduals completely, affect their family life and

their integration into the community.

In Center Naprej, therefore, we are constantly

looking for new ways to encourage users to join


activities that would be fun on the one hand,

and on the other hand have rehabilitation ef-

fects in order to manage more effectively their

limitation. At the same time, we want to encour-

age them to improve their strong areas.

That’s exactly why we started with this com-

pletely new for us sport, footgolf, that com-

bines fun and recreation. It is an activity

where users can relax, have fun, and at the same

time have to follow certain rules, improve their

physical as well as mental abilities, and learn

to improve their tolerance levels. Users have

learned how to play footgolf very quickly, they

enjoyed playing and had fun.

6.7.3. Some tips and instructions

for playing footgolf with our

users or people with disabilities

When we started playing footgolf with our users,

we did not have the right course available. We

made the course on a grass surface, and in the

winter on a snowy terrain, where we marked the

course and made large enough holes in the snow

for the balls to fit in. The holes were marked

with flags or cones, in order to be well visible

to users with vision disturbances.

We took care of appropriate clothing and foot-

wear depending on the weather. In the winter,

we were dressed in comfortable warm clothes and

suitable hiking boots, and in warmer months more

loose clothing (T-shirt, shorts). Appropriate

footwear is important.

In case you play footgolf outside of the official

course (if you do not have a footgolf course

nearby), be careful where making holes and ar-

ranging the terrain so that it is properly pre-

pared (remove branches, obstacles, litter etc.).

The rules of footgolf have to be well presented

to the users (counting shots, penalty points,

when the ball can be hit) so that there will be

no complications.

6.7.4. Advantages and positive

effects of playing footgolf

1. improving fitness

2. improving balance,

3. learn to transfer and take weight to

the weaker (affected) side and ac-

tivate that part of the body


4. improvement of visual - motor coordination

5. improving the functional body position

6. activation of proprioception

7. activation of several muscle groups

8. socializing while having fun in the nature

9. encouraging a competitive spirit

10. relaxation in the nature and

in pleasant company

11. training precision, patience, memory, pos-

itive behavioural patterns and clothing

12. training acceptance and implementa-

tion of precise instructions.

6.7.5. Necessary equipment

for footgolf

The mandatory equipment of the player includes:

• appropriate clothing and footwear (rec-

ommendations: shirt with a collar or

polo shirt, short trousers to the knees,

suitable footwear as indoor soccer

shoes or shoes for artificial grass)

• ball.

If you do not play footgolf on a footgolf

course, you can prepare it on your own because

there is no footgolf without a course!

Reference

http://www.footgolf.si/footgolf-pravila/, retrieved on

18.10.2018

https://en.wikipedia.org/wiki/Footgolf, retrieved on

18.10.2018

https://www.golftrnovo.si/kaj-ponujamo/footgolf, retrieved on

18.10.2018


6.8.SnowShOEiNg


Key words: showshoeing, safety measures, outdoor sports activities

6.8.1. Snowshoeing – lost in the

beauty of the white wilderness

There is nothing more beautiful than spending

an active sunny winter day in nature. Take the

snowshoes and go on a hike. Snowshoeing can be a

particularly magical experience: walking through

the white winter landscape, spending the day in

the nature, filling your lungs with fresh win-

ter air, and at the same time doing some good

exercise.

Considering this, it is necessary also to pro-

vide good protection for the face against sun

rays, since the sun is reflected from the snow

cover and therefore is even more intense. It is

also advisable to wear a hat and gloves, because

regardless of how sunny and warm the day is in

the snow your body begin to cool down.

6.8.2. What is snowshoeing?

Snowshoeing is walking on snow-covered surface

with snowshoes, attached to winter hiking boots.

Snowshoes, due to their shape and surface, pre-

vent you from sinking in the snow, thus enabling

walking safely on it. Snowshoeing is an ancient

way of walking in the snowy landscape, as snow-

shoes were used by our ancestors when hunting.

Snowshoeing is very similar to walking or run-

ning, but doing it in the snow - where you can

enjoy the wonderful winter day. In this form of

recreation, everyone can experience something

nice, because it is an undemanding, interesting

form of movement that can be learned by everyone

with a little exercise. Above all, it is import-

ant that, when walking with snowshoes, you move

as naturally as possible, and enjoy it.

6.8.3. How it looks?

Snowshoeing is, in fact, walking in the snow,

with specially adapted footwear, which has a

large surface area, so during the walk, the foot

does not sink into the snow. It is also possible

to walk across very deep and soft snow cover-

ings with snowshoes - in the snowy provinces of

Canada and Alaska, this was once the main way to

go from place to place. Snowshoes were also used

in Scandinavian and some Asian countries. Today,

snowshoeing is especially popular as a form of

recreation. We activate the whole body during

the activity, so this excellent winter exercise

ensures higher heart rate and intense muscle

strengthening. And the most beautiful thing is

that at the same time, you can enjoy the view of

snow-covered nature around you.

6.8.4. What are snowshoes?

Snowshoes are a kind of footwear that we attach

to hiking shoes in order to make it easier to

walk on the snow. They work on the principle

of allocating an individual’s weight over the

entire surface of the snowshoes, which prevents

sinking in the snow. Therefore walking on the

snow is much easier and more energy saving and

it is also supported by functional ties and free

heel, which can be fixed if necessary. When snow-

shoeing, it is advisable to use walking poles

to improve the balance, while at the same time

doing exercise for the entire body.

6.8.5. Who is the program

intended for and why are we

snowshoeing in Center Naprej?

The program of snowshoeing is intended for users

of the Center Naprej - people with acquired

brain injury who can walk or move with the sup-

port of others or a crutch.

It is an easy and safe way of walking and run-

ning across the snowy surface. The technique of

walking or running is not demanding, which is

why users learn it very quickly. It is one of

the most popular winter activities, which pro-

vides excellent exercise for the cardiovascular

system; it is suitable for people with little

physical fitness, for the elderly and people

after injuries.

You can snowshoe by yourself or accompanied by

friends, you can discover the unknown landscape;

you can take part in guided hikes. In the Cen-

ter, we do it in small groups, organize a compe-

tition and have fun in the nature.

Snowshoeing is fun for people of all ages, even

for the youngest. Older users can also join

the hike, because they can learn the skills

relatively quickly, and at the same time, walk-

ing will not pose a dangerous burden on their

joints. We can snowshoe during the daytime, but

we can also go on night walks.

6.8.6. Some advice and

instructions or preparation

for safe snowshoeing

Although exercise at first glance may seem com-

pletely simple and undemanding, snowshoeing

can replace intense cardiovascular training by

activating most of the body’s muscles. However,

when snowshoeing with users (people with ABI),

you need to be particularly careful about the

following:

• Select a safe location and select the

difficulty of the route according to

the individual’s capabilities or lim-

itations (physical and cognitive).

• Choose a location and terrain that match-

es the competence of people with dis-

ability. The load during exercise should

not exceed the individual’s ability.

• Remove larger objects from the sur-

face for walking.

• Practice on trodden trails, such as cycling

trails or trail routes closed for traffic.

• Check the route before starting the activ-

ity. Avoid narrow paths dense with trees

and ice paths that allow high speeds.

• Check all equipment before ex-

ercise or competition.

• Check the first-aid kit and com-

plete it if needed.

• Assume emergency procedures (haz-

ards). Teach all participants how

to act in case of emergency.

• If necessary use helmets.



• Have mobile phones and drinks with you.

• Train and compete on windless terrain.

• Attach the snowshoes properly to the

feet and check the fasteners.

• The user must be adequately dressed so

that he7she does not overheat while walk-

ing and his/her clothes do not pre-

vent him/her performing the activity.

• Pay attention to skin care and the problem

of thermoregulation due to cold and freez-

ing in the snow or due to the strong sun.

• Because of the brain injury, the centre of

balance can be damaged, which affects the

balance of the individual. In case of a

poor balance, the risk of a fall, another

brain injury or bone fracture is high, so

it is important that we do an appropriate

risk assessment and prepare actions to cope

with these problems before snowshoeing.

6.8.7. Trainers / assistants

safety checks

The safety and well-being of people with ac-

quired brain injury are the most important.

Snowshoeing is not a dangerous sport, but it

includes speed and variety of conditions that

require caution. Accidents can happen. The main

task and responsibility of the trainer/coach

assistant is to reduce the chance of accidents

to a minimum.

What is necessary for suc-cessful snowshoeing:

• During exercise and competition, introduce

clear behavioural rules from the beginning.

• No one should hike alone.

• Encourage disabled athletes to wear ap-

propriate clothing and shoes.

• Pay attention to changes in weather.

• Ensure that disabled athletes per-

form appropriate stretching exercis-

es before and after the activity.

6.8.8. Dry training -

preparation of disabled

athletes for snowshoeing

In order to successfully carry out the activity,

it is necessary to:

• have good physical fitness (suffi-

cient aerobic muscular strength, an-

aerobic ability in particular muscles

of the legs, abdomen and back),

• be able to maintain balance.

Athletes should be prepared for snowshoeing

appropriately and in time – enable them to try

activities for improving their psychophysical

fitness. This can be achieved through a well-

planned fitness training program and its cautious

implementation. Only in this way can we expect

and provide a successful movement on the snow,

which will be pleasant and safe for the user

(person with disability).

Type of training:

1. exercise for training specific mus-

cle groups (lower limb muscles, ten-

dons in the knee, hip flexor and

quadriceps - four-head thigh muscles),

2. walking and / or running according to

the length of the snowshoe trail,

3. specific exercises in the phys-

iotherapy cabinet,

4. aerobic exercises and stretching.

Every person with disability, who does the

activity, has an assistant. In order for users

to orientate better and to increase visibility

on the track we use visual support and signs. We

provide users with individual guidance and help.

6.8.9. Positive effects

of snowshoeing and goals

of the program

Snowshoeing has many positive effects on the hu-

man body and at the same time health prevention

and effects. It is important that the activity

is carried out in nature breathing fresh air.

Although it is known that anyone who can walk

can snowshoe, this activity nevertheless re-

quires some skills, such as the basic elements

of this sport: hiking uphill, hiking downhill,

walking in an arc, so that no unnecessary prob-

lems and falls occur during a serious hike.

Snowshoeing is very similar to cross-country

skiing or Nordic walking, as it is highly in-

tense, but less burdensome to your joints than

many other winter activities.

Some of the benefits that snowshoeing brings to

our users (ABI people):

1. Improving fitness.

2. Improving balance and coordination.

3. Improving joint flexibility.

4. Social skills training and group activities.

5. Acceptance training and implementing in-

structions and executing functions.

6. Communication and memory training.

7. Competition and fun.

8. Physical activity in nature.

6.8.10. Necessary equipment

for snowshoeing

For this unique sport you need:

• a pair of snowshoes,

• waterproof hiking shoes,

• walk bars,

• appropriate suit for movement in win-

ter conditions, gloves and hat,

• a headlamp (in the case of night hiking),

• helmet (in the case of a user with

a weaker mobility or balance).

And of course, snowshoeing is not possible with-

out a large amount of snow.

Reference

Priročnik Krpljanje: Krpljanje, hoja in tek s krpljami, Spe-

cialna olimpiada Slovenije -SOS, http://www.specialna-olimpi-

ada.si/si/za-clanice/knjiznica/, Pridobljeno 17.9.2017


6.9.NeTBaLL

AUTHORS: RAÚL CÂNDIDO, CARLOTA CUNHA

6.9.1. Rules of the game

Netball, mainly practised in England and the

United States of America, initially began to be

played by men and women. However this sport has

always been more popular among female players.

Today it is practised in some European countries

such as England, Holland and Germany, but mainly

in the United States of America and Australia,

but only in the female variant.

We do not know an inclusive version with the

adaptations for people with disabilities, a

solution that we will propose later after a sum-

mary characterization of the game in its formal

aspect.

Netball is a collective sport, consisting of

teams of seven elements, played in a sport pa-

vilion. The goal is to score in a basket; this

is achieved through passes between the players,

who occupy specific and pre-defined zones in the

field. It is in these areas that the players have

their action in the game. The objective of the

game is to score more points than the opposing

team, and the players who occupy the attack

zone, the semicircle or the launch area that is

closest to the basket, positions occupied by

the pivot and the attacker, can only score the

points.

In order for the positions of

each player to be perceptible

in the field, the shirts they

wear have the initials of the

positions they occupy on the

playing field.

WA - Wing Attack - Can move within the attacking

third and center third, with the exception of

the shooting circle – lateral forward;

GK - Goal Keeper - Can move anywhere within the

defensive third of the court, but cannot leave

it – goalkeeper;

GA - Goal Attack - Can move anywhere within the

attacking third and the center third of the

court – forward;

WD - Wing Defense - Can move within the center

third and the defensive third, with the excep-

tion of the shooting circle – lateral defense;

GS - Goal Shooter - Can move anywhere within the

attacking third of the court, but cannot leave

it – pivot;

C - Centre - Can move anywhere across the court,

apart from either of the shooting circles – mid-

dle field;

GD - Goal Defense - Can move anywhere within

the attacking third and the center third of the

court – defense. Only the ‘Goal Shooter’ and

‘Goal Attack’ of a team are allowed to score di-

rectly, and can only do so when they are in the

position’s goal circle.

The basket is similar to that of korfball, has

no table and is on a pole 3 meters from the

ground.

The ball used is specific to Netball.

The dimensions of the field are 35 meters length

by 20 meters wide, being divided by 3 zones,

defense, central and attack.

The players cannot dribble or run with the ball.

As already said, this is a positional game above

all, in which the passes are decisive, since

it is from these that the teams try to progress

WA

in the field, attack and score through basket,

avoiding the interception of the players of

the opposing team. The player who receives and

passes the ball shall, at least, always have one

foot in contact with the ground.

Each player must have the ball in his / her pos-

session for a maximum of 3 seconds, after which

he / she must have executed a pass or throw

into play zone. The player of the team that is

defending, that is that does not have the pos-

session of the ball, must maintain the distance

of about one meter of its opponent that has the

ball. Contact is not allowed in the game.

The infractions / fouls occurring when there is

contact between players, offside (player who

invades another position in the field, other than

their zone), or dribbling, give place to the

loss of ball, or placement of the missing player

in a position, behind the player who can receive

the ball.

The players of the two teams are distributed

in the field by doubles, in situation of oppo-

sition 1 to 1, according to the pre-determined

positions.

The winning team will be the one that scores the

most points. The game is played in four parts

of 15 minutes each, without stopping the game’s

timer.

6.9.2. Inclusive / adapted

netball proposal

Netball’s adaptation proposal for players with locomotor disabili-ties and other disabilities

We have tried to adapt this sport to an inclu-

sive version for athletes with locomotor and

other disabilities. The game is intended for

players who have locomotor disability, wheel-

chairs users or not, intellectual disabilities

and able-bodied, playing on the same team. We

used identical approach to the original game,

with some adaptations according to the athletes

and their functional capacity, mainly for loco-

motor disabilities.

Physical Rehabilitation Centers and other dis-

ability support institutions are target groups

which allows both disabled and non-disabled

players to interact, so that the physical ther-

apists, physicians, other staff at the Center

and the players’ families and friends can be

involved. Our formula that consists of the use

of this sport as rehabilitation, and can later

explored more formally, as a regular practice

variant, and that they can play it in full in-

clusion with other potential players. The game

is mixed can be played by athletes with and

without disabilities. They are eligible for the

game, players with locomotor disabilities, upper

and lower limbs, intellectually handicapped and

able-bodied players, making it an all-inclusive

sport.

DEFENSE/ATTACK ZONE CENTRAL ZONE ATTACK/DEFENSE ZONE

WD

WD

C

GK

GKWA

WA

C

GS

GSGA

GA

GD

GD


In each team there must have, at least, two

players who use a wheelchair. In terms of ad-

aptation of the game, players who play in a

wheelchair can only be marked / striking by

opposing players who also has this device of

compensation. Wheelchair players will be allowed

to dribble (hit the ball on the ground) at least

once and move with the ball in the lap. The

type of wheelchairs can be sporty, like basket-

ball-style, or simple daily wheelchairs, while

not ideal, but make the practice possible and

more accessible with more rudimentary materials

and then less high equipment costs.

Adapted game

As players distributed by zones according to

rules of the regular Netball, this is a game

that privilege the ball pass, strategic place-

ment and field positions, marking the zone of the

opponent, for the conquest of the ball through

movements of defence and attack, with which it

is possible to get to score. The movements in

the wheelchair in the zone of action and the

accurate and speed in the pass, are fundamental

for the success in the game.

1. Game of 40 minutes with four

parts of 10 minutes.

2. The game starts in the center with

player C (center) passing the ball.

When you score a point the game re-

turns to the center of the field.

3. Wheelchair players can move with

the ball within their zone.

4. Wheelchair players can propel the chair with

the ball on your legs; you can only rotate

the chair with the ball on your legs.

5. There is no contact with oth-

er players or chair.

6. The chair of a defending play-

er must be away one meter from the

other player with the ball.

7. Player only being allowed 5 seconds with the

ball in the hands; if it exceeds 5 sec-

onds the ball is passed to the opponent.

8. Only GS and GA can score goals while

still within the throwing circle.

9. Penalties are scored when there is contact

with the player or wheelchair, or obstruc-

tion of the player who has the ball.

10. Remaining fouls, the ball passed

to the opposing team.

11. Only GS and GA can score every time

they are inside the throwing circle.

12. Each goal is worth one point

for the team that scores.

13. The height of the basket may be

3 or 2 meters off the floor.

Reference

Netball, http://www.educacaofisica.seed.pr.gov.br/modules/con-

teudo/conteudo.php?conteudo=212. Retrieved 12.2.2019.

6.10.SpORT OriENTATioN

AUTHOR: RAÚL CANDIDO

Keywords: A Sport for Intellectual Disability; Sport for all; Alternative communication.

6.10.1. Adapted Orienteering

– A sport for all

Adapted Orienteering (a variation of Sport

Orienteering) is a sport that, above all, pro-

motes a fruition of outdoor spaces, removing

people with intellectual disabilities, but also

children, young and old participants of a cer-

tain passivity, bringing them into contact with

nature, in an active and interplay with others

and with the environment in a playful way.

When we are sharing the activity with people

with intellectual disabilities, we must take

into account some strategies so that activity

can proceed without precariousness and keep the

participants interested and involved.

Is important:

• If possible, a previous approach

with educators or monitors to mea-

sure the types of needs of the group.

• If possible, request previously for

global group characterization.

• Participants with total need of sup-

port to do the activity;

• Partial need for support to do the activity;

• Almost independent to do the activity.

• Make prior recognition of the space when-

ever possible, while marking the course.

This may help to predict some less “friendly”

situations and create strategies for greater

and better involvement, but also the safety of

participants. Thus, aspects like the signaliza-

tion and the marking of the route can bring many

advantages.

6.10.2. Building the

circuit for the game:

Nature walks adapted for more participants

that are elderly, young children or people with

disabilities. It is a type of “vulnerable”

participants, with losses of balance, or high-

er levels of fatigue, intolerance to heat and

cold. It is necessary to avoid sharp gradients

in the terrain of the course; to prevent fatigue

that can compromise the success of the game,

with negative consequences for the rest of the

participants, as well as for the most vulnera-

ble participants. Concern about travel course

time and hydration should be quite compensated

factors.

In case of need, delimit the route / trail

for orientation reasons and safety of the

participants.


Simple elements and reference points should be

considered so that participants with more lim-

itations can be able to identify them. One of

the characteristics that present a significant

part of the participants with moderate or even

severe intellectual disability is related to the

decoding of the symbols. Thus, the greater the

possibility of association with known elements,

symbols and codes, the greater will be the ten-

dency towards a more autonomous exploration.

Seek to use simple messages in communication.

The instruction must be detailed, and must

tell what the activity consists of, such as the

course and the necessary safety measures.

You should be patient and make sure that the

participant understands and memorizes the in-

structions, as the attention and interest in the

instructions, is usually low. It is necessary

to use simple and pragmatic messages during

communication. There may need to receive re-

inforcement in the repetition of messages and

instructions.

Before the orienteering trail, a body warming

should be done, using music or dancing in a

combination of fitness. Through augmentative lan-

guage, schematics or three-dimensional models,

you can help to structure the adventure of what

will be found in the trail route, bringing to

the choreography elements of increased communi-

cation, with the symbols of the cards, maps and

the colours that will appear on the course.

The spots on the map of course must be easy to

relate to elements that the participants can

make simple association: ex. doghouse, water

well, flower beds, mill, lake, etc.

For this purpose, several strategies can be

used, such as:

• Words with rhyme; Sounds; Graphics; Move-

ments, facial and body expressions.

Endow the educators / monitors of groups with

extended versions of the elements of the game.

Such elements would be provided separately in

order that different puzzle sets can be made.

For example: color plates, symbols, and numbers,

like the Bliss symbols, which are shown on the

game cards.

A map in A3 format allows a short story to be

devised making use of the symbols and creating

associations for example the food chain. An area

with games that can help you relate to elements

and objects that you find along the trail will be

available.

Use exercises / games like: Stone, scissors,

paper; Boxes of different sizes for a color

puzzle.

Identification of groups: With t-shirts, vests,

badges, bracelets, etc. to ensure that the par-

ticipant does not get lost and is not endangered

by rough terrain which gives security to educa-

tors and monitors.

Adapted Orienteering is mainly a game that

should help to achieve situations of autonomy,

in terms of space and time for people with in-

tellectual disabilities. For example, for those

participants who do not know the letters and

numbers and even some colors, we can use tex-

tures so that they can make associations to the

images / pictograms in the cards and the plates

in order to achieve the combinations for the

answers.

6.10.3. Brief history and

basic rules of the sport

Orienteering is a competitive sport, practised

in many countries, particularly popular in

Northern Europe.

In Portugal, Mr. Joaquim Margarido, blogger,

photographer, a nurse practitioner, in the

Prelada Hospital, in the Oporto region, and pas-

sionate about nature and orienteering, has been

linked to this sport for several years, decided,

to make a variant in which all people with and

without disabilities of all ages could partici-

pate, he created Adapted Orienteering in 2014.

He created a simple scheme with the use of maps

of basic routes, with cards where basic colors,

red, green and blue are used, together with

effective language pictures or symbols invented

by Charles Bliss, so that people with more deep

disabilities, can use for a basic communication.

Based on his work, we create these guidelines,

which can help all to perceive this variant of

this sport and enjoy it as an activity practised

outdoors, in contact with nature.

Let us get started!

6.10.4. Activity development

and materials:

Adapted Orienteering is a game which runs along

a route drawn on a map. In the map are marked

spots / points, that we call beacons, that must

be found and visited in a sequential way; It

must start at the first point on the map and

finish at the last one that is proposed. When we

draw the map we can choose the number of points

that we will have on route and that are marked

on the map.

1. At the place of departure, which will also be

that of the arrival, the judges give each player

or team, a map and control card, with the number

of points that we must visit in our route, (fig-

ure 1). Each player or team will have a map with

different routes. Near the map, we have a card

drawn that has three colors and numbers that are

the various points / beacons, through which we

will have to go through, to do the course. Next

to the colors, there is an empty square, where

there should be a symbol / picture.

2. On the control card with symbols (figure 2),

that is given with the map to each player or

team, can also place your name/team name and

the hour and minutes of your departure. The

card will serve to mark the passage through the


points indicated on the map, attesting that

you have found the various points noted on your

route map.

3. Each point on the map signalled with a bea-

con, which we see in the next image, will have a

check punch attached that will be used to per-

forate our control card in the square to confirm

completion of the points.

4. Each point on the course will be allocated

with one number, 4 stakes, 4 plates with the

colors, red, green or blue, which may be in

another order, and one of the symbols we have

already talked about.

5. Then we look at the plates, to choose the one

that has the right answer following the correct

sequence of colors plus the corresponding pic-

ture. Next we mark the picture on the control

card with check punch marking what we think is

right and move on to another point. If none of

the color matches the desired sequence, mark

square with X.

6. When we finish our course after visiting all

the points, we return to the starting point and

deliver our card with all answers perforated.

Judges of the game, who have a card with all the

correct answers, color sequence and pictures

will compare with yours and provide a score for

all correct answers.

7. If players or teams tie, in the number of

correct answers, the team who take the least

time to complete the entire course will win

overall.

Reference

Margarido, Joaquim in http://orientovar.blogspot.com/2012/10/

orientacao-adaptada-um-desporto-para.html Retrieved on

02-10-2018

Figures and photos from: Joaquim Margarido’s Blog

6.11.TABle TenNIs

AUTHOR: MICHELE LEPORI

Key words: Tennis table, Adapted sport activity, Equipments and rules

Introduction

Table tennis training can be very flexible and

can satisfy a wide range of needs. Adding a

warm-up and improvement of resistance skills,

in addition to training specific skills, can

give life to a complete routine that improves

balance, coordination, mobility and muscle

strength. Speaking of activities for rehabili-

tation purposes they do not necessarily require

expensive materials and, with simple precau-

tions, you can adapt the workouts to your needs.

Orienteering is a very common sport in Europe

and is increasingly gaining ground.

6.11.1. Table tennis

- Who is it for?

Table tennis is a sport that lends itself to

many types of disability, both physical and

intellectual relational. For physical disability

there are specific measures and regulations, de-

veloped by the high level activity, which cover

practically the whole range of possibilities.

Even for the most serious cases it is possible

to find ad hoc solutions.

The most difficult case is for people with visual

impairments. These limit the ability to see the

ball, already small in itself, to make it impos-

sible in the event of complete blindness. For

this type of disability we advise against table

tennis.

6.11.2. Why Table Tennis?

Table tennis can be interesting for a number of

factors. Like all sports, it brings benefits to

the physical condition that has already been

stated in these guidelines. Specifically, it is

very challenging in the eye-hand coordination

skills and in the ability to perceive one’s own

spatiality, that is, to manage one’s movements

coherently with the environment around us.

However, the greatest benefits are in terms of

integration. In many institutions, especially

for youth, you can find a table tennis table,

bats and balls. This gives the opportunity to

have the tools available to play, without having

to purchase expensive materials. In addition

you can play in the same places and schedules

of able-bodied boys, by reacquiring the dis-

abled boys their qualification of athletes in all

respects. Joint training and integrated activi-

ties between able-bodied and disabled people are

to be encouraged and can also be used to create

real tournaments (for example in double).

Accessibility of table tennis tables in common

areas will help to integrate the boys socially.

They will be able to practice table tennis even

outside of training facilities, public gathering

centres, parks...

6.11.3. How to adapt the activity

The table tennis practice does not discrimi-

nate against age and gender. Indeed, it is easy


even in high-level federal tournaments, to find

athletes of very different ages in the same

category.

For wheelchair athletes (category 1-5 according

to the criteria of the international federa-

tion - ITTF site citation) or with other types

of motor disabilities (6-10) there are minor

regulatory adaptations, which do not specifically

affect our rehabilitation activities.

Obviously athletes with amputations, paralysis

or similar to the upper limbs, have the possi-

bility to use special bats. They may use velcro

bands to secure the racket to the hand or to the

prosthesis.

For athletes with intellectual-relational

disabilities (class 11 according to ITTF clas-

sification) there are no particular general adap-

tations, we will proceed to train progressively,

reacting to the specific needs of children.

For all three groups, preparation is necessary

before moving on to the actual practice.

In the case where athletes have difficulty co-

ordinating and hitting the ball in flight, you

can proceed as follows. Mount the side barriers

to the table, lift the net, and use soft rub-

ber balls (of decreasing size depending on the

skills) with special bats (or even the hands).

In this case the ball will be slid on the sur-

face of the table, rather than bounced.

It is an exercise that can be quite challenging

for some types of disability (those with the

greatest impact on the abilities of the boys),

but also a good exercise of introduction to more

advanced training levels.

6.11.4. Equipment

To proceed with the activity of table tennis we

need: a table, a net, bats and balls.

TABLES: Approved tables can be costly and

heavy, but offer the possibility to train at

the highest level and to be able to organize

competitions approved in the future. From that

point of view all the intermediate solutions are

possible, with non-approved tables (lighter and

cheaper), up to adapt to alternative solutions

(see chapter nets).

NETS: There are different types and prices. Al-

most all of them consist of two clamps that hook

to the table and support the net. Those approved

by the international federation are of very

resistant material, they allow to control many

variables (height of the net, tension, length),

obviously they are more expensive and do not

always adapt to any type of table. Other cheaper

solutions are based on the same principle, vary-

ing only the reliability of the materials. They

are specifically created to adapt to any type of

table, even kitchen tables, desks etc.

BATS: the costs vary a lot. In this case, how-

ever, we suggest the economic solution. The

benefits of high-cost bats are not understood

by the athlete until he/she has developed some

experience. In addition to each frame and each

rubber correspond some specific characteris-

tics. These are used by coaches to support

the athlete’s type of game at a higher level.

Therefore, for the bats, you can easily use the

cheaper solution. Different specifications for

the various disabilities that affect the upper

limbs. Those who have difficulty in shaking a bat

can use special accessories (extended handles,

velcro strips...). These are solutions that must

be evaluated on a case-by-case basis, almost

tailor-made for each athlete. The general rule

is that adaptations do not interfere with the

part of the bat covered by rubber or increase

the surface.

BALLS: There are also different types and pric-

es. It makes no sense to start with the expen-

sive balls of competition grade (which could

become useful only after a certain technical

level acquired by the boys). The most economi-

cal solution is valid, especially taking into

account the fact that many will be broken during

training.

To decrease the breakage of many balls it is

useful to give only one / two to the table, or

have a supervisor to help you collect them.

Photos: Center Naprej, 2018


6.12.CheeRLeadINg

AUTHORS: MICHELE LEPORI, ZVONKA NOVAK

Keywords: cheerleading, fun, balance, cooperation, support, affiliation.

Introduction

Cheerleading is a very common sport especially

in the United States. In Europe it is catching

on, thanks to a movement that is gaining more

and more competence and professionalism, coming

out of an initial phase of improvisation. The

goal of cheerleading is to combine choreography

composed of elements of gymnastics, dance and

acrobatics, to create routines. Cheerleading is

designed to encourage teams on the playing field

during matches. For this reason, an element of

excitment and encouragement to the public is

never missing in the choreography, to increase

its involvement during the performance.

6.12.1. Cheerleading - What is it?

Cheerleading is a routine of dance. This is a

group dance that includes cheering, aerobics,

gymnastics and more. It began to develop in the

19th century in the United States as a support-

ive activity in other sports (»rtv slo: otroški

portal - Navijanje«, 2019).

There are 2 types of cheerleading: the first is

competitive cheerleading, and the other is the

pom pom groups (Cheerleading, 2018).

It is common for both of them that their main

purpose is to enhance the sporting atmosphere

at competitions and to represent the society,

school or institution. Choreographies are made

up of dance steps performed with rhythmic music,

and is very cheerful, where the vocal power of

performers, their energetic and originality ap-

pear. Groups can make use of boards with signs,

coffees (pom poms), megaphones, flags and other.

Cheerleaders include choreographers with rather

difficult acrobatic elements (jumping, pyramid),

but choreographies of pom pom groups should not

contain acrobatic elements. Important part of

the choreography is the clothes that need to be

matched in color. In the pom pom dance groups,

the pom poms need to be matched in color also

(Zveza znps: Navijaške in plesne skupine, 2019).

6.12.2. Cheerleading

- Who is it for?

Cheerleading is very versatile and, working on

the complexity of the choreography, it is possi-

ble to adapt it to almost all types of disabili-

ty. For example, there are integrated teams with

physical and intellectual relational disabili-

ties, which perform with great ease.

Obviously the basic level will be composed

mainly by elements of dance, leaving the parts

of artistic gymnastics (flip, wheels...) or

acrobatic (jumps, stunt...) only to athletes

whose disabilities allow it. The element of

spectacularisation that cheerleading brings

with it should not be underestimated. It is not

by chance that the term “exhibition” is used.

The choreography is made to bring attention to

the guys who are doing it, to engage the public

on an extrovert and energizing way. That is an

aspect that could help young people to relate to

a more or less extensive public.

6.12.3. Why do it?

Energy, excitment, involvement. These are three

key words in cheerleading. This allows the wall

of pietism and sadness to be more effective-

ly eliminated, which too often accompanies the

activities of disabled children. Even public

accustomed to contact with the Paralympic ac-

tivity will be infected by the choreography, the

invitation to action and rhythmic music.

Furthermore, cheerleading is not just a compe-

tition sport. Born as a “sideline” activity,

that is to say the field of a sporting event, to

entertain the public and encourage it to cheer.

It’s a component that can still be exploited

today, leading the team to perform at large or

small events in the area and help promote and

raise awareness of the sport.

6.12.4. How to adapt the activity

The activity is adapted, as already underlined,

depends on the difficulty of the choreography.

The simplest elements are those of the dance

that should be well exploited with intelli-

gence. The routine must be simple enough for the

kids to perform but interesting enough for the

audience.

If for the users with relational intellectual

disability coordination, memory and spatiality

should be taken into account, for the Paralym-

pics users others factors must be taken into

account.

Artificial arts may not be a problem in the sim-

plest choreography, but they could become a risk

in the more complex ones, becoming blunt ob-

jects. Always pay close attention. Wheelchairs,

on the other hand, are not an insurmountable

obstacle. There are also many examples in the

dance world, from which it is possible to take a

cue.

When athletes have more physical possibilities,

they can include elements of artistic gymnastics

or even acrobatics. Recall that these elements

should be well considered and evaluated on a

case-by-case basis. In addition, you should

devote much effort and introduce them gradual-

ly, so as to make them as perfect as possible

(during the performance the emotion could play

tricks).

6.12.5. Equipment

Cheerleading, in its less demanding form, does

not require special equipment:

Clothing

The impact of a uniform is fundamental, at least

during performances. Various solutions are

possible. An equal suit for everyone is a good

starting point, up to the professional uniforms

(which require an important budget).

Pom poms

Old-fashioned in the collective imagination, they

are not absolutely necessary elements in sports

cheerleading. Also in this case there are cheaper

“training” versions up to the professional ones.

Audio system

The choreography is designed based on a musi-

cal composition. This must be played during the

tests. It will therefore be necessary to equip

oneself with a system to reproduce the chosen

track. This is what is needed to carry out a

very basic choreography, composed of elements of

pure dance. As training difficulties increase,

other equipment will also be needed. Mattress-

es and artistic stripes are essential to train

stunt and artistic gymnastics safely.

6.12.6. Example - cheerleading

in Center Naprej

In Center Naprej, we offered users the oppor-

tunity to join the pom pom dance group. We made

two groups of users who expressed their desire

to participate in the group. Different mov-

able structures, jumps, dance steps and spatial

changes affect the balance, coordination, flexi-

bility and memory of the involved users. Because

the activity is group-based and requires cooper-

ation and consistency, we also actively work on

social skills like cooperation, customization,

acceptance...

We adapt choreographies to the abilities and

limitations of the users involved (problems with


balance, motor interference, memory disturbanc-

es, poor coordination...). Although the ultimate

goal is the composition and implementation of

the choreography, which the group performs as

synchronously as possible, it is very import-

ant in the rehabilitation sense that we include

users in the planning of choreography, costume

design, music selection, preparation of cheer-

leading equipment and pom poms.

6.12.7. Recommendations for work:

1. Involvement of users in the plan-

ning of choreography and the prepara-

tion of equipment, clothing and music;

2. Adapting choreography to the abilities

and limitations of the users involved;

3. Suitable footwear (comfort-

able, soft, non-slippery);

4. Heating before the start of the exer-

cise (walking, jogging, leg lift) and

stretching (neck, shoulders, arms,

back, abdomen, chest, legs, ankles)

5. Dance part (progressive learning of

steps, change of positions) without mu-

sic by counting, later with music;

6. Adapting the choreography to the ca-

pabilities of the involved;

7. Talk and relaxation af-

ter the training session.

Basic movements

Basic palm positions:

• fist,

• “blade” (straight palm, fingers together),

• jazz position of the hands.

Basic foot positions:

• extension (“spikes”),

• flexion,

• normal position.

Typical foot positions:

• stands apart (wide range),

• a step forward and to the side,

Basic movements with hands:

• high and low “V”,

• an archery position,

• position “L”,

• diagonal,

• position “T” (half),

• punch,

• position “K” (Zagorc, Korošec, Če-

bela and Fajmut, 2009).


Reference

Navijanje, retrieved from https://otroski.rtvslo.si/bansi/

prispevek/1694 13.2.2019

Cheerleading (2018), retrieved from https://sl.wikipedia.org/

wiki/Cheerleading 13.2.2019

Zveza znps: Navijaške in plesne skupine, retrieved from

http://www.zveza-znps.si/predstavitev.html 13.2.2019

Zagorc, M., Korošec, N., Čebela, D., Fajmut, N. (2009).

Priročnik za navijaške skupine. Ljubljana: Fakulteta za

šport, Inštitut za šport

7.

Learning outcomes:

• An understanding of monitoring and evaluation.

• An understanding of why it is import-

ant to evaluate sports programmes.

• How to plan effective evalua-

tion of sports programmes.

• Examples of physical, psychological and so-

cial outcome measures used in evaluation.

EvalUa ti•On of Sp•Ort Pr•O GramMEs


7.1.ThE PUrpOse Of mOnitORIng anD evalUating sPOrTs ProgrammEs

AUTHOR: MICHAEL LAMONT

Key Words: monitoring, evaluation, outcome measures and tools

Introduction

What is monitoring and evaluation?

The online platform Sportanddev.org (2013)

defines monitoring as the systematic and routine

collection of information from projects and pro-

grammes for four main purposes:

• To learn from experiences to improve prac-

tices and activities in the future;

• To have internal and external ac-

countability of the resources used

and the results obtained;

• To take informed decisions on the fu-

ture of the programme;

• To promote empowerment of bene-

ficiaries of the programme.

Monitoring is defined as a periodically recurring

task which begins in the planning stage of a

programme. Monitoring allows results, processes

and experiences to be documented and used as a

basis to steer decision-making and learning pro-

cesses. Monitoring is checking progress against

plans. The data acquired through monitoring is

used for evaluation.

Evaluation is systematically assessing a

completed or phase of an ongoing programme.

Evaluations appraise the collected data and

information, informing strategic decisions and

thus improving the programme and outcomes in

the future. Evaluation is made up of a number of

progressive steps, the most important of which

is the collection of appropriate data that is

subsequently used to make a judgment about the

value of a programme (Dugdill & Stratton, 2007).

Sportanddev.org (2013) states an evaluation

should help to draw conclusions about five main

aspects of the programme:

• Relevance of the programme to pre-

determined goals.

• Effectiveness of the programme.

• Efficiency of the implementa-

tion of the programme.

• Impact of the programme.

• Sustainability of running the programme.

Information gathered during the monitoring

process provides the basis for the evaluation.

The evaluation process is an analysis of the

collected information which looks at the rela-


tionships between the results, the effects and

overall impact of the programme (“Sportanddev.

org”, 2013).

The World Health Organisation recommends that

between 10-20% of the total intervention costs

should be spent on evaluation (Dugdill & Strat-

ton, 2007). However, evaluation can be seen as

problematic, time consuming and can take lower

priority compared to delivery of the programme

(Stratton et al., 2005).

A recent review (Sport England, 2017) assessed

the evidence to date supporting the impact of

sports programmes on 5 key areas:

• Physical Wellbeing

• Mental Wellbeing

• Individual development

• Social and community development

• Economic development

The review outlined the evidence supporting the

positive benefits of sports and physical activity

programmes in each of these areas, including:

7.1.1. Physical wellbeing

Good evidence for the prevention of illness,

increased therapeutic and management effects

in rehabilitation, improvements in strength,

balance, gait and motor skills, and maintaining

a healthy weight. Other outcomes include im-

proved sleep, increased energy, healthy early

year’s development, reduced engagement in risk

behaviours such as smoking, reduced mortality,

effective pain management and improved quality

of life in ageing.

7.1.2. Mental Well-being

There is a strong association between taking

part in sport and physical activity and posi-

tive mental wellbeing outcomes, but the causal

mechanisms are less well understood. There are

challenges around the varied definitions used in

the field, and the subjective nature of measures.

There is much evidence that sport and physical

activity contributes to enjoyment, happiness,

and life satisfaction. Social interaction ap-

pears to be central to this. Self-esteem and

confidence can increase through the opportunity

to develop new skills and relationships. There

is potential for sports and physical activity

programmes to reduce the symptoms of anxiety

and depression in participants. Other outcomes

include improved cognitive functioning, benefits

for people with dementia, and impacts around

emotion regulation.

7.1.3. Individual development

To date substantial evidence indicates the po-

tential for positive outcomes from taking part

or volunteering, particularly for young peo-

ple, but the wider set of circumstances around

an individual will determine effectiveness in

relation to these outcomes. Evidence was identi-

fied for improved educational attainment, either

directly (improved grades and behaviour) or

indirectly (enhanced skills like concentration

and teamwork).

There are positive impacts on employability

(employment opportunities, earnings, job per-

formance and satisfaction), including (limited)

evidence for younger people ‘not in education,

employment or training’ (NEETS). Sport can

promote self-efficacy (motivation and commit-

ment), for groups including elderly people and

disaffected young people. Other outcomes are

an increased willingness to volunteer and the

development of soft skills (such as integrity,

responsibility and leadership).

7.1.4. Social and

Community Development

Outcomes can be defined in relation to a range of

concepts that are often challenging to evidence

(such as social capital, trust and networks).

Many of which are positively associated with

participation or volunteering, but the effec-

tiveness of any intervention is dependent on

a broader set of conditions. Sport acts as a

conduit for people of different backgrounds to

interact, can bridge divides between groups such

as men and women and people with different em-

ployment backgrounds, and play a key role in the

integration of migrants. A small body of lit-

erature on bonding capital suggests that sport

helps to build relationships within communities.

For volunteers, motivations and outcomes over-

lap at the personal and the community level (for

example, bonding with others increases a sense

of community and citizenship).

7.1.5. Economic development

The sources reviewed use a wide variety of tech-

niques to calculate economic value and it was

not possible to accurately assess the strength

of the evidence base without a critically ap-

praising the full range of these methods.

There was some evidence on the direct impact

of the sport sector on the economy, largely in

terms of gross value added and job creation.

There was more evidence on the indirect impacts,

including reduced healthcare costs due to a

healthier population, reduced crime and improved

employability.

This review concluded that:

The evidence base is strongest for the physical

and mental well-being outcomes, then the indi-

vidual development outcome. It is weaker for

the social and community development and econom-

ic development outcomes.

More longitudinal studies could help strengthen

the evidence base by identifying the longer-term

effects on mental well-being, individual devel-

opment and social and community development.

The main focus of this review was examining

the evidence of the impact of sports programmes,

rather than how to design programmes to ef-

fectively achieve outcomes. A number of other

working groups have focused on developing a

framework for identifying, monitoring and eval-

uating outcomes of sports programmes, including

The Sport for Development Collation (2013).


7.2.ThE SPort fOR DeveLOpmENt CoLLaTIon Out-cOMes MoDEl

The focus of the Sport for Development Colla-

tion is to define a collective and sector-led

understanding of how to improve the outcomes

of sports programmes, provide advice on how to

design programmes and promote the use of shared

and consistent measurements of impact in an

attempt to further strengthen the evidence base

in this area (Sport for Development Collation,

2015).

The Sport for Development Collation Outcomes

Model (2015) defines outcomes across two contin-

uous sequences - from intrinsic to extrinsic,

and from individual to social. The two sequences

reflect the strong evidence that links emotional

skills and behaviours to positive outcomes in

other areas of life.

Sport programme outcomes can either be in-

trinsic or extrinsic, for example a programme

can support a person to increase essential and

intrinsic elements of their nature (self-esteem,

managing emotions, motivation), and also support

them to develop certain extrinsic behaviours

(play sport, be active and healthy, learn and

have a job).

Sports programmes deliver outcomes for the in-

dividual person or for social groups and commu-

nities. For example, a programme can change an

individual’s emotional skills and behaviours,

and as a result influence their family lives,

communities and wider society.

The model identifies four distinct groups of

outcomes:

• Social, emotional and cognitive capabilities

• Individual achievements and behaviours

• Inter-personal relationships

• Benefits to society

Definitions of the outcomes identified in each section can be found below:

Social, emotional and cognitive skills

Self-efficacy* Perceived self-confidence in their current abilities and future tasks.

It is task specific; a person can view themselves as good at one task but not another.

A person’s sense of self-efficacy can play a major role in how they approach goals, tasks

and challenges. It involves recognition that they can make a difference to their own life

Self- esteem An individual’s overall sense of self-worth (personal value), self-re-

spect, selfperception and self-awareness. It involves beliefs about the

self, such as appearance (body image), emotions and behaviours

Motivation The process that initiates, guides and maintains an individual’s goal oriented behaviour.

Motivation is what causes a person to act and achieve something:

a person’s ambitions and aspirations. Sometimes individuals are motivated by per-

sonal gratification and other times for external rewards (such as money, recog-

nition or praise). Motivation involves initiating action (active initiative)

and continued effort even though obstacles may exist (determination)

Managing emotions An individual’s ability to recognise their emotions and their effects (self-

awareness) by examining and regulating emotions, thoughts and resulting ac-

tions (self-reflection, self-management) and keeping disruptive emotions and

impulses in check (self-control, self-regulation, self-discipline)

Resilience An individual’s perseverance and persistence when faced with obsta-

cles (grit) and their flexibility in handling change (adapting, coping)

Social skills How an individual interacts and relates to others. It can apply to simple social contexts

and work environments. It relates to confidence in social interactions (social competence),

forming relationships, working effectively in teams and interpreting others. It includes

the ability to lead peers and be a role model, and to empathise and motivate others.

It also includes communication skills such as expressing, presenting and listening

Cognitive functioning The mental processes (such as perception, attention, memory and deci-

sionmaking) involved in an individual’s problem-solving, time manage-

ment, critical thinking, creativity and intellectual flexibility

Benefits to society

• Less need for health services

• Contribution to economy through par-

ticipation to the labour market

• Less dependence on welfare

• Not subject to the criminal justice system

• Strengthened community through leader-

ship and democratic participation

• Increased fairness and equality

Individual achievements and behaviours

• Increased physical wellbeing*

• Improved mental wellbeing*

• Sustained participation in sport

and physical activities*

• Positive health behaviour

• Reduced anti-social behaviour

• Improved attitudes to learning and attendance to school

• Improved educational attain-

ment and achieving qualifications

• Enhanced career prospects

• More securely housed

Social, emotional and cognitive capabilities

• Self-efficacy*

• Self- esteem

• Motivation

• Managing emotions

• Resilience

• Social skills

• Cognitive functioning

Inter-personal relationships

• Increased social capital and trust*

• Increased volunteering

• Increased community cohesion and spirit

• Positive parenting

Figure 15: The Sport for Development Collation Outcomes Model (2015, adapted from: https://londonfunders.org.uk/sites/de-

fault/files/images/SfD%20Framework_0.pdf)

EXTRINSIC

INTRINSIC


Individual achievements and behaviours

Increased physical

wellbeing

Improved functional fitness, cardio respiratory fitness, muscular strength, adiposity/ body

composition; cholesterol levels, bone health, joint health and immune system function

Improved mental wellbeing Improved mood, feelings of happiness and life satisfac-

tion, and reduced levels of stress and anxiety

Sustained participation in

sport/physical activity

Increased intrinsic motivation for physical activity; cre-

ation of sporting habits; and belief that ‘sport is for them’

Positive health behaviour Improved diet (healthy eating), safe sex, reduced substance misuse, and smoking cessation

Reduced anti-

social behaviour

Improved pro-social values and reduction of behaviour likely to cause harass-

ment, alarm or distress to others. Increased positive social interactions

Improved attitudes

to learning and

attendance to school

Improved engagement with school; improved behaviour in school; reduced abenteeism

Improved educational

attainment and achieving

qualifications

Improved learning, academic performance, attain-

ment at school and achievement of qualifications

Enhanced career prospects In a secure job or accessing training opportunity; improved skills and experience

More securely housed Adequate and sustained accommodation

Inter-personal relationships

Increased social cap-

ital and trust*

Social capital describes the pattern and intensity of formal and informal networks among

people and the shared values which arise from those networks. Aspects of social capital

include increased levels of trust, increased membership of various groups and improved

access to networks and amount of social contact individuals have in their lives. Differ-

ent types of social capital can be described in terms of different types of networks:

• Bonding social capital describes closer connections be-

tween people and is characterised by strong bond

• Bridging social capital describes more distant connections between peo-

ple and is characterised by weaker, but more cross-cutting ties

• Linking social capital describes connections with people in posi-

tions of power and is characterised by relations between those with-

in a hierarchy where there are differing levels of power

Increased volunteering Frequent activity that involves spending time, unpaid, doing something that aims to

benefit the environment or someone (individuals or groups) other than, or in addition

to, close relatives. Volunteering must be a choice freely made by each individual

Increased community

cohesion and spirit

A cohesive community is one where there is a common vision and a sense of be-

longing for all communities; the diversity of people’s different back-

grounds and circumstances is appreciated and positively valued; and those

from different backgrounds have similar life opportunities

Positive parenting Improved parenting skills and styles, improved parent men-

tal well-being, reduced behaviour difficulties in children

Benefits to society

Less need for

health services

Improvement in physical health by increasing fitness and reducing obesity; pre-

venting a number of chronic diseases (cardiovascular disease, coronary heart dis-

ease, diabetes, some cancers, strokes, osteoporosis, hypertension); and providing

therapeutic benefits for the management of existing diseases and illnesses. Im-

provement in mental health by lowering the risk of depression; managing anxiety

and stress; increasing an overall sense of wellbeing; and helping with some sys-

tems of clinically diagnosed personality disorders (such as schizophrenia)

Contribution to econo-

my through participation

in the labour market

Healthy employment market; increased productivity for goods and services; increased

innovation and new businesses; and increased revenue gerenated through taxable income

Less dependance on welfare More people better able to meet the expenses of daily living for a prolonged pe-

riod of time and not be reliant on government welfare benefits (such as heat-

ing and housing benefits, Jobseeker’s Allowance and low-income benefits)

Benefits to society

Not subject to the crim-

inal justice system

Improvement in pro-social behaviour, reduction in crime and reduction in anti-social

behaviour particularly through lower levels of recidivism, drunk driving, use of illegal

drugs, crime and suspension from school, property crime, shoplifting and juvenile crime

Strengthened community

through leadership and

democratic participation

Increased civic engagement (citizens participate in the life of a com-

munity in order to improve conditions for others or to help shape

the community’s future); and greater social cohesion

Increased fair-

ness and equality

Improved equality of opportunity and reduced stigma and discrimination for all,

at work, in public, social and political life, and in people’s life chances

Figure 16:. (i-iv) Definitions of the Sport for Development Collation Outcomes (2015, retrieved from: https://londonfunders.

org.uk/sites/default/files/images/SfD%20Framework_0.pdf)

Dugdill & Stratton (2007) highlighted the RE-

AIM framework planning tool as a useful way for

practitioners to think about structuring their

evaluation:

• Reach - Who did the intervention reach?

– e.g. monitoring of participant num-

bers through registers, post codes,

questionnaires, facility usage.

• Effectiveness - How effective was the inter-

vention at meeting its aims and objectives?

– e.g. physical activity increase, decrease

in body mass index or increasing the con-

templation to become physically active.

• Adoption – Have significant parts of

the intervention been adopted else-

where? -e.g. programme has been ad-

opted by other organisations.

• Implementation - How was the intervention

implemented and managed? How was the interven-

tion funded? What skills did the staff have?

• Monitoring: What were the monitoring

and evaluation strategies used to as-

sess the quality of the intervention?

Is the intervention sustainable?


7.3.SPEcific OUt-cOme MEaSUresAs the resources and skills available for eval-

uations are often limited, it is important to

decide at the planning stage of a programme what

will be measure and why (Dugdill & Stratton,

2007). For the purpose of these guidelines we

have categorised outcome measures into three

categories:

• Physical outcome measures

• Psychological outcome measures

• Social functioning outcome measures

7.3.1. Physical outcome measures

There are a variety of methods available for

measuring sport/physical activity levels but

there is no gold standard (Welk, 2002).

Key parameters for physical activity measurement

include:

• Frequency (when/how often does it occur)

• Intensity (how hard is the activity)

• Time (the duration)

• Type of activity (walking, run-

ning, swimming etc.).

Dugdill & Stratton (2007) stated the challenge

is selecting a measure that is valid, accurate

and reliable, defining a valid instrument as one

that measures what it purports to measure and

a reliable measure as one that produces stable

and repeatable results when used under the same

conditions.

Self-report tools

Self-report tools are one of the most commonly

used outcome measure as they are less time con-

suming than other measures and are easily ad-

ministered. Self-report tools can take the form

of diaries, questionnaires or interviews. They

can be completed both by the participant and by

another person significant in the participant’s

life e.g. parent, carer, sibling or child.

A person’s ability to understand a survey ques-

tion and their ability to accurately recall and

communicate their activity pattern will affect

the reliability and validity of their self-re-

port, therefore the most reliable tools tend to

be 3 day or 7 day recall tools (e.g. a partic-

ipant recalling and communicating their level

of physical activity participation over past

3 or 7 days) (Dugdill & Stratton, 2007). These

self-report tools are recommended as they have

shown adequate reliability and validity in large

populations (Welk, 2002).

International Physical Activity Questionnaire

Revised (IPAQ): The IPAQ (Booth, 2002) comprises

a set of 4 questionnaires. The purpose of the

questionnaires is to provide common instru-

ments that can be used to obtain international-

ly comparable data on health–related physical

activity.

Global Physical Activity Questionnaire (GPAQ)

(“WHO: GPAQ Questionnaire): The GPAQ covers sev-

eral components of physical activity including

intensity, duration, and frequency.

The Active Lives Questionnaire (“Sport England”,

2015): The Active Lives Questionnaire collects

data on demongraphics, geography and engagement

in sport/physical activity and takes roughly

15 minutes to complete.

The Physical Activity Questionnaire for Old-

er Children (PAQ-C) and Adolescents (PAQ-A)

(Crocker et al., 1997): The PAQ-C and PAQ-A are

Self-administered 7 day recall questionnaires,

assessing general levels of physical activity

in 9 to 15 year old children using 10 questions.

There are no valid questionnaires for children

under the age of 9.

The Borg Scale of Perceived Exertion (Borg,

1982): The Borg RPE scale is a self-report rat-

ing scale assessing a participant’s level

of perceived exertion during physical activity.

Heart rate Monitors

Heart rate monitoring usually come in the form

of a belt that fits around the chest and detects

electrical impulses from the heart and converts

these to beats per minute. These data are either

stored in the belt or transmitted to a receiver

in the form of a wristwatch. Heart rate monitors

can be programmed to record heart rate second to

second or minute to minute (recording interval

is called an epoch) continuously for weeks. The

main advantage of heart rate monitoring is the

relatively low participant burden and ease with

which data is collected and analysed. The in-

struments require a PC for collected data to be

downloaded. Although these tools provide objec-

tive measures of physical activity, the cost and

technical expertise required for use and data

analysis may restrict the feasibility of use

for evaluation purposes.

Accelerometers

These small devices are usually placed on the

waistband or the wrist in wheelchair users and

record the vertical (uni-axial) or vertical,

horizontal and diagonal (tri-axial) accelera-

tion of the body. These accelerations are then

converted to gravitational counts per epoch

duration. These instruments can record in second

by second or minute-by-minute epochs (Dugdill

& Stratton 2007). As with heart rate monitors,

the cost and technical expertise required for

the use and data analysis of accelerometers may

restrict the feasibility of their use for evalu-

ation purposes.

Pedometers

Pedometers provide information on walking.

A person’s individual data such as stride

length, body weight and age can be input into

some pedometers. The in correct input of stride

length is arguably the largest cause of error in

estimating physical activity energy expenditure

and distances covered during walking. The best

use of pedometers is for recording steps and

pedometers should always be manually checked for

counts by using a calibrated shaker table or by

hand (by counting each shake 1, 2, 3 etc. and

checking against the device) (Dugdill & Stratton

2007). For representative data to be obtained

participants it is advised participants wear a

pedometer for 3 days (Tudor-Locke et al., 2005).

Pedometers are a low cost method of generating

accurate and reliable data (depending on the

quality of the pedometer; Schneider et al.,

2004). The daily target for physical activity

is 10,000 steps per day (Tudor-Locke and Bas-

sett, 2004) for persons without physical dis-

abilities. However 15,000 and 12,000 steps have

been recommended for male and female adoles-

cents, respectively (Tudor Locke et al., 2004).

The key aspect for activity intervention is not

necessarily the debate over number of steps but

whether total steps increase as a result

of engaging in an activity intervention. Recent

pedometer evaluations in schools have suggest-

ed that pedometers work as motivational tools

(Butcher et al., 2007) and stimulate increases

in physical activity (Dugdill & Stratton 2007).

Berg balance scale (BBS) (Berg, Wood-Dauphinée,

Williams & Maki, 1992)

The BBS is a qualitative measure that assess-

es balance via performing functional activi-

ties such as reaching, bending, transferring,

and standing that incorporates most components

of postural control: sitting and transferring

safely between chairs; standing with feet apart,

feet together, in single-leg stance, and feet

in the tandem Romberg position with eyes open

or closed; reaching and stooping down to pick

something off the floor. Each item is scored

along a 5-point scale, ranging from 0 to 4,

each grade with well-established criteria. Zero

indicates the lowest level of function and 4

the highest level of function. The total score

ranges from 0 to 56. The BBS is reliable (both

inter- and intratester) and has concurrent and

construct validity.


Systemic Observation

Systematic observation involves a trained per-

son observing and coding predetermined physical

activity behaviours of participants over a set

period of time, e.g. sitting, walking, running

etc. The SPACES system (Systematic Pedestrian

and Cycling Environmental Scan, Pikora et al.,

2002) is an example of a comprehensive observa-

tion tool used to assess walking and cycling.

Systematic observation requires observers to

have undertaken specific training and can be used

to assess participants in real time or video

recordings. Although providing vaild data, the

time and specific training required for this

technique may reduce its feasibility for evalua-

tion purposes.

7.3.2. Psychological

outcome measures

The Warwick-Edinburgh Mental Well-being Scale

(WEMWBS) (Tennant et al., 2007): The WEMWBS was

developed to enable the monitoring of mental

wellbeing in the general population and the

evaluation of projects, programmes and pol-

icies which aim to improve mental wellbeing.

SWEMWBS is a shortened version of WEMWBS. This

is a 7 item scale for which item scores need

transforming.

Rosenberg Self-esteem Scale (RSES) (Rosenberg,

1965): The RSES is a 10-item scale that measures

global self-worth by measuring both positive

and negative feelings about the self. The scale

is believed to be uni-dimensional. All items

are answered using a 4-point Likert scale for-

mat ranging from strongly agree to strongly

disagree.

General Self-Efficacy Scale (GSE) (Schwarzer

& Jerusalem, 2010): This scale was created to

assess a general sense of perceived self-effica-

cy with the aim in mind to predict coping with

daily hassles as well as adaptation after ex-

periencing all kinds of stressful life events.

The scale is designed for the general adult

population, including adolescents. Persons below

the age of 12 should not be tested. The measure

has been used internationally with success for

two decades. It is suitable for a broad range of

applications. It can be taken to predict adapta-

tion after life changes, but it is also suitable

as an indicator of quality of life at any point

in time

The Life Satisfaction Questionnaire (LISAT)

(Fugl-Maeyer et al. 1991): The LISAT is a self

or interviewer-administered rating scale,

taking approximately 5 minutes to administer.

The LISAT-9 has 9 items; one is a global item

for ‘life as a whole’ and 8 are domain-spe-

cific items for ‘vocational situation’, ‘finan-

cial situation’, ‘leisure’, ‘contact friends’,

‘sexual life’, ‘activities of daily living’,

‘family life’, and ‘partnership relationship’.

The LISAT-11 has 11 items, which includes the

same items as the LISAT-9 but with two additions

evaluating ‘physical health’ and ‘psychological

health’.

World Health Organization Quality of Life In-

strument (WHOQOL-BREF) (WHO, 1998): The WHO-

QOL-BREF instrument comprises 26 items, which

measure the following broad domains: physical

health, psychological health, social relation-

ships, and environment. The WHOQOL-BREF is a

shorter version of the original instrument that

may be more convenient for use in large research

studies or clinical trials. The questionnaire

captures many subjective aspects of quality of

life (QOL) and is one of the best known instru-

ments for cross-cultural comparisons of QOL and

is available in many languages.

The Beck Depression Inventory (BDI) (Steer,

Beck, Brown, 1996): BDI is a 21-item self-re-

porting questionnaire for evaluating the se-

verity of depression in normal and psychiatric

populations. A shorter version of the question-

naire, the BDI Fast Screen for Medical Patients

(BDI-FS), is available for primary care use.

That version contains seven self-reported items

each corresponding to a major depressive symptom

in the preceding 2 weeks.

7.3.3. Evaluation of

Social Functioning

The New Philanthropy Capital’s Outcomes Map:

Personal and Social Well-being (Copps and Plim-

mer, 2013).

In this NPC publication, Copps & Plimmer (2013)

defined personal and social well-being as a per-

son’s state of mind, relationship with the world

around them, and the fulfilment they get from

life. It can be understood as how people feel

and how they function, both on a personal and a

social level, and how they evaluate their lives

as a whole. It is linked to a range of other

outcomes, including mental health.

Copps & Plimmer (2013) divided the measurement

of personal and social well-being into on 3

categories:

1. Feelings about self.

2. Relationships with family and friends.

3. Perception and connected-

ness to the community.

1. Improved feelings of self

Examples of valid outcome measures discussed in

Psychological Outcome Measures section. Other

examples include:

• The Self-concept Scale

(10-items) (Marsh, 1992).

• The Resilience Scale (14-item) (Wag-

nild and Young, 1987).

• The Children’s Society’s Wellbeing In-

dex (Rees, Goswami & Bradshaw, 2010).

2. Improved relationships with family and friends

Examples of valid outcome measures included:

The Multidimensional Students’ Life Satisfaction

Scale (MSLSS) (Huebner, 2001)

The MSLSS is designed to provide a profile of

children’s life satisfaction across key domains.

The 40-item scale is completed by children and

young people and captures information on five

domains:

• Family (7 items)

• Friends (9 items)

• School (8 items)

• Living Environment (9 items)

• Self (7 items)

• There is also a 6-item Brief Multidimen-

sional Students’ Life Satisfaction Scale.

The Friendship Scale (Hawthorne 2006)

This short, user-friendly 6 item scale measures

6 of the 7 important dimensions that contribute

to social isolation and its opposite, social

connection.

Lubben Social Network Scale–Revised (LSNS-R)

(Lubben et al., 2002)

The LSNS-R is designed to gauge social isolation

in older adults by measuring perceived social

support received by family, friends and mutual

supports (eg. neighbours), including confidant

relationships. The tool has an abbreviated

version (LSNS-6) and an expanded version (LSNS-

18) and takes approximately 5-10 minutes to

administer.

UCLA Loneliness Scale – Revised (Russell, Pep-

lau, & Cutrona, 1980)

This 20-item scale is designed to measure a

person’s subjective feelings of loneliness and

social isolation.

3. Improved perceptions of and con-nectedness to the community

Copps & Plimmer (2013) defined this as a per-

son feeling part of a meaningful community or

communities, feeling connected to the envi-

ronment around them, and feeling included and

involved. Approaches to measuring these aspects

of well-being tend to be survey-based and depend

on the responses of individuals to questions

about their feelings and perceptions. Many of

the tools tend to be very similar and are often

derived from the same research base but differ

slightly in length and emphasis. Overall, there

is no firm consensus on what the best tools are.

In practice, where they are in use, well-being

approaches tend to be combined with measures

specific measures tailored to the intervention.

As in many areas of measurement, there remains a

skills gap in analysing and interpreting data.

There is a clear need to create tools that are

practical and can be applied by non-experts

(Copps & Plimmer, 2013).


Reference

Berg K, Wood-Dauphinee S, Williams JI, Maki, B: Measuring

balance in the elderly: Validation of an instrument. Can. J.

Pub. Health, supplement 2:S7-11, 1992.

Borg, G. A. (1982). Psychophysical bases of perceived exer-

tion. Med sci sports exerc, 14(5), 377-381.

Butcher, Z. Fairclough, S. Stratton, G. & Richardson, D.

(2007) The Effect of Feedback and Information on Children’s

Pedometer Step Counts at School. Pediatric Exercise Science,

19(1).

Copps, J. & Plimmer, D. (2013). Outcomes Map: Personal and

Social Well-being. NPC, retrieved from: https://www.thinknpc.

org/?s=OUTCOMES+MAP%3A+PERSONAL+AND+SOCIAL+WELL-BEING.

Dugdill, L. & Stratton, G. (2007). Evaluating sport and

physical activity interventions: a guide for practitioners.

University of Salford.

Fugl-Meyer, A. R. Eklund, M. & Fugl-Meyer, K. S. (1991).

Vocational rehabilitation in northern Sweden. III. Aspects

of life satisfaction. Scandinavian journal of rehabilitation

medicine, 23(2), 83-87.

Hawthorne, G. (2006). Measuring social isolation in older

adults: development and initial validation of the friendship

scale. Social Indicators Research, 77(3), 521-548.

Huebner, E. S. (2001). Manual for the multidimensional

students’ life satisfaction scale. SC: University of South

Carolina (unpublished paper provided by the author).

Lubben, J. (2002). Lubben Social Network Scale–Revised.

Retrieved from: https://instruct.uwo.ca/kinesiology/9641/

Assessments/Social/LSNS-R.html

Sportanddev.org, (2013). Retrieved from: https://www.

sportanddev.org/en/toolkit/monitoring-and-evaluation/

what-monitoring-and-evaluation-me.

Sport England: The Active Lives Questionnaire, 2015, re-

trieved from: http://www.activelivessurvey.org/main/)

Sport England, (2017). Review of Evidence on the Outcomes

of Sport and Physical Activity – A Rapid Evidence Review.

Retrieved from: https://www.sportengland.org/media/11719/

sport-outomes-evidence-review-report.pdf.

Pikora, T. J. Bull, F. C. L. Jamrozik, K. Knuiman, M. Giles-

Cortie, B. & Donovan, R. J. (2002). Developing a reliable

audit instrument to measure the physical activity environment

for physical activity. American Journal of Preventive Medi-

cine, 23 (3), 187-194.

Sport for Development Coalition, (2015). Sport for Devel-

opment outcomes and measurement framework. Retrieved from:

https://londonfunders.org.uk/sites/default/files/images/SfD%20

Framework_0.pdf

Steer R.A., Beck A.T. & Garrison B (1986). Applications of

the Beck Depression Inventory. In: Sartorius N, Ban TA, eds.

Assessment of Depression. Geneva, Switzerland: World Health

Organization, 121–142.

Stratton, G. Ridgers, N.D. Gobbii, R. & Tocque, K. (2005)

Physical Activity Exercise, Sport and Health: Regional Map-

ping for the North-West. Retrieved from: www.nwph.net/pad/

accessed.

Schwarzer, R. & Jerusalem, M. (2010). The general self-effica-

cy scale (GSE). Anxiety, Stress, and Coping, 12, 329-345.

RE-AIM, (2014). RE-AIM as a planning tool. Retrieved from:

http://www.re-aim.org/re-aim-as-a-planning-tool/.

Rosenberg, M. (1965). Rosenberg self-esteem scale (RSE).

Acceptance and commitment therapy. Measures package, 61, 52.

Russell, D. Peplau, L. A. & Cutrona, C. E. (1980). The revised

UCLA Loneliness Scale: Concurrent and discriminant validi-

ty evidence. Journal of personality and social psychology,

39(3), 472-480.

Tennant, R. Hiller, L. Fishwick, R. Platt, S. Joseph, S.

Weich, S. & Stewart-Brown, S. (2007). The Warwick-Edinburgh

mental well-being scale (WEMWBS): development and UK valida-

tion. Health and Quality of life Outcomes, 5(1), 63.

World Health Organization: GPAQ Questionnaire http://www.who.

int/ncds/surveillance/steps/GPAQ/en/) Retrieved 12.11.2018

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health-related research. Human Kinetics.

World Health Organization, (1998). World Health Organization

Quality of Life Instrument (WHOQOL-BREF). Retrieved from:

http://www.who.int/substance_abuse/research_tools/whoqolbref/

en/.

8. LonGEV itY aND QUal ItY of LiFELearning outcomes:

• what regular physical activi-

ty means and how important it is

• how and in what ways people with phys-

ical disability can be motivat-

ed to do exercises regularly

• what the expert can do according to the lev-

els of physical condition and motivation

• Factors influencing the participation of

people with disabilities in community sport

• What can the trainer do?

• What is team sport and community sport?


InTroDUctioN

AUTHORS: ZSUZSANNA KOVÁCS, ZSUZSANNA ANTAL

Suppositions, studies and questions about qual-

ity of life and longevity are not new at all.

Perhaps it is one of the most ancient questions

of mankind: the question of what makes a human

satisfied, what makes life meaningful and happy,

and what is the secret to have a full and good

life. The basic aim of human existence is to

practise human functions as fully as possible.

The living conditions of mankind have changed

to a great extent, but the final aim remained the

same - reaching happiness and integrity.

There are many conditions influencing one’s qual-

ity of life. Including, but not limited to: cul-

ture and leisure activities, economic situation,

environmental conditions, infrastructure, secure

and health state. These factors are of course

all related to each other, and they cannot be

examined on their own. Just a simple example:

financial wealth influences the consumption rate

of healthy food as well as the total spent on

health insurance. The quality of our nutrition

and the money spent on relaxation and recreation

influences our health state, etc.

Life length and life quality cannot be separated

from each other, either. The higher our quality

of life is, the more likely that we will live to

a higher age. If we spend the last 5-10 years of

our life ill, then we speak about a lower life

quality.

8.1.rEGuLar PhYSi-CaL ACTIvity

AUTHOR: ZSUZSANNA KOVÁCS, ZSUZSANNA ANTAL

Keywords: disability/impairment, physical condition, motivation, guiding

It is useful to consider factors affecting life

quality in terms of those ones we can influence.

Our health state is such a factor. If you think

that we are merely passive sufferers of the na-

ture of our genetic map that is not necessarily

true. We can do against the encumbered gene pool

for example by attending regular screenings or

by doing regular physical activity and sport.

8.1.1. Conceptual definition

Advantages of regular physical activity are

well-known, “regardless of sex and age”. Beyond

the general, favourable impacts of physical

training and sport, it can be applied in the

prevention, treatment and rehabilitation of some

illnesses. Based on the stand of several Hun-

garian and international statements it can be

stated that:

• Regular physical activity reduces the

number of illnesses and early deaths

due to hypertonia, diabetes, coro-

nary-artery disease and obesity.

• Its advantageous impact at-

tunes the motoric system.

• The regulation of central ner-

vous system improves.

• The capacity of the endocrine system grows.

• The metabolism will become more economical.

• It affects the function of the im-

mune system advantageously.

• It prevents obesity and ill-

nesses connected to it.

• The oxygen supply of the organism improves.

As a bonus, regular physical activity also has a

good impact on our psychological well-being:

• It reduces anxiety and depression.

• It maintains memory.

• It increases self-esteem and self-confidence.

• It stimulates endorphin production that brings

about the growth of long-term happiness.

• It increases libido.

Even a moderately intensive and a moderate time

of physical activity has a positive impact (e.g.

30 minutes of walk done 4-5 times a week) as it

is able to improve one’s state of health and

quality of life.

Regular physical activity and recreation-

al sport activity are an important element of

health behaviour as it has an important role

in the prevention and intervention of several

chronic illnesses. Regular physical activity

has a significant life quality-raising impact

both among healthy people, those suffering from

chronic illnesses and those with disabilities.

It improves corporal and mental health, as well

as psychosocial well-being and the ability of

coping with stress.


In places where there is lower economic depri-

vation, the frequency of doing regular sport

activity decreases, thereby contributing to

lower health indicators of these groups. How-

ever, there are unexploited health development

opportunities that could be addressed by move-

ment intervention programmes that could target

these groups. With the use of adequate tools

and measures this could provide a cost-efficient

solution to increase the physical and mental

health of this population.

The question of social responsibility has been

brought into the foreground, according to which

sport has a positive impact on the individual

and on wider society. Higher economically and

socially developed countries have already rec-

ognized that quality of life in society contrib-

utes to the economic success of the individual,

his/her broader surroundings as well as to that

of the country. On the contrary, where people

are struggling with illnesses and psychological

disorders this can place a large burden on the

social security of the given country.

8.1.2. What can regular

physical activity mean to

people with disability?

Photo: Zsuzsanna Antal, Boccia, Human Profess, Szombathely,

2017

Irrespective of having physical, intellectual,

mental, psychosocial or sensory disabilities,

regular physical activity can create stability

in the individual’s life. Not only because this

can contribute to the development of a routine,

but also because certain exercises contribute to

the production of endorphins, thus promoting the

feeling of happiness.

8.1.3. Models and methods

Here, the physically injured have to be empha-

sized since for them, regular physical activity

means life itself. Therefore, this is the only

means by which self-care may be promoted or

facilitated.

There are several models (ICF, IMAPA) and

methods (Dévény Anna, Pető András) which aim

to improve the state of people with physical

injuries.

However, it is well-known that models only serve

as a theoretical basis as they often simplify

reality. On the other hand, methods only provide

solutions for certain types of diseases. Conse-

quently, the combination of different methods or

modified versions may be the solution.

8.1.4. Individualised physical

training/physiotherapy for

physically injured people

Before creating a training plan, the charac-

teristic features and the symptoms of a disease

have to be studied, in addition to its develop-

ment. This information is important as it can

influence and explain how unmotivated or motivat-

ed the individual is and influences the end re-

sult to be achieved. In addition to this, family

background is also of great importance. The key

to regular physical training/physiotherapy is to

continuously set achievable goals and promote a

sense of achievement.

8.1.5. Relationships and guiding in the interest of the

successful training of people with disabilities

Table 1: The relation between the type of physical impairment and the main goal of physical train-ing/adapted physical education

The type of impairment Goal

Physical impairment

acquired by stroke

Restoring former phys-

ical condition

Cerebral palsy acquired

during/after childbirth

Achieving the possible

highest level of self-care

Person suffering from

muscular atrophy

Delaying the impair-

ment of condition at the

possible highest level

Injury or limb loss

acquired by accident

Restoring former phys-

ical condition

Person with multi-

ple impairments

At least maximising

physical condition

Source: Data colection of Zsuzsanna Kovács made among her

disabled sport mates, 2018

Table 2: Different life stag-es and motivational strength

Life stage Motivation

Child Acquiring reward

Teenager Reducing dependen-

cy on parents

Unmarried Starting an inde-

pendent life

Married Commitment in a rela-

tionship and family

Divorced/ Widowed/ El-

derly single people

Preserving the abil-

ity of self-care as

long as possible.

Source: Data colection of Zsuzsanna Kovács made among her

disabled sport mates, 2018

Table 3: What the expert can do according to the lev-el of physical condition and motivation

Physical condition Intrinsic motivational level What can the sport expert do?

The development of

physical condition has

just started (child)

Very motivated (from instinct) Diversified exercise series, maintenance

of interest/curiosity is essential,

Rehabilitation fol-

lowing an accident

Very motivated (from instinct) Diversified exercise series, maintenance

of interest/curiosity is essential

Rehabilitation following

a reconstructive sur-

gery correcting former

injury/impairment

Motivated, (the hope of a physical con-

dition being better than the previous),

however, this can diminish quickly if

there are no small senses of achieve-

ment since it may happen that the physi-

cal condition has to be improved from the

lowest level as a result of the surgery.

Not only a diversified exercise series, but

also a diversified environment (background

music, exercises done outdoors, diversified

training program (floor exercises – swim-

ming – horse-riding) is necessary.

Physical condition

that has been stagnat-

ing for a long time

Unmotivated (It may have been triggered

by the same exercises that had to be done

too many times and also by little sense of

achievement or by too great goals or the lack

of goals together. Respectively, the individ-

ual is satisfied with their state and thinks

that it is enough to take actions if the next

stage of the impairment of condition begins.)

In the first case, diversified training

program, exercise series, environment, and

surmountable challenges are essential. In

the second case, motivating conversations

supported by powerful arguments are necessary

(With physical training the next stage of the

impairment of condition can be delayed and/

or its degree can be decreased. The de-

crease/termination of possible pains or the

control or termination of the assuaging of

pain with medicine can also be achieved.)

Continuously deteriorat-

ing physical condition

Unmotivated (embittered, tired of, re-

signed themselves to their condition)

Combination of various methods, devel-

oping new methods in close collaboration

with the individual in order to stop or

reverse physical deterioration or showing

a tiny ray of hope regularly in any way.

Source: Data colection of Zsuzsanna Kovács made among her disabled sport mates, 2018


To achieve and maintain the demand for regu-

lar physical activity, we have to continuous-

ly affect the individual’s emotions either by

encouraging, praising, warning, or sanctioning

which depends on the individual’s personality to

a large extent.

Reference

DSGM Retrieved from: http://www.dsgm.eu/index.php?option=com_

content&view=article&id=20&Itemid=2&lang=en (2018. 07.26)

Meet the needs of all individuals with IMAPA Retrieved from:

https://uk.humankinetics.com/blogs/excerpts/meet-the-needs-

of-all-individuals-with-imapa (2018. 07.26)

Method by Pető András Retrieved from:http://semmelweis.hu/

pak/en/ (2018. 07.26)

The International Classification of Functioning, Disability

and Health (ICF) Retrieved from: http://www.rehab-scales.

org/international-classification-of-functioning-disabili-

ty-and-health.html (2018. 07.26)

8.2.COmmuNItY acTIVE liVINg pROgraMmEs

AUTHOR: ZSUZSANNA KOVÁCS

KEYWORDS: INDIVIDUALIZED CONDITIONS, TYPES AND ADVICE OF TEAM/COMMUNITY SPORT

8.2.1. It’s better to

sport in a community!

Community sport goes beyond what exercising

means in order to preserve one’s health. Exer-

cising in a team, or even together at the same

space creates a community: it helps you to make

new relationships, it strongly motivates you,

it inspires you and it fills you up emotional-

ly. It strengthens the social network around

the people, it motivates for playing, it in-

spires, and participants thereby can reach a

“flow”-experience.

If we do sports in a team, then the good partic-

ipation of the team depends on the cooperation

of the individuals. It is a common interest of

every team member; let it be either an occasion-

al leisure community, or a permanent one, not

to speak about athletes involved in top-level

sport, to be part of the game and of a poten-

tially winning match. For this, it is necessary

to have the skill of cooperative behaviour,

the altruistic cooperation built on realistic

self-knowledge, the humility and the effort

towards the common aim. The feeling of group

identity and belonging together, which provides

security, can be established based on these val-

ues. (Rétsági, 2015)

In the publication entitled White Paper on sport

(2007:7), made by the Committee of European

Communities, we can read that belonging to a

team, the fair competition, keeping the rules,

respecting others, solidarity, principles of

discipline all foster active citizenship, social

integration, and they discourage from crime.

Photo: Zsuzsanna Antal, Gymstick-Nordic walking, Human Pro-

fess, Szombathely, 2017

8.2.2. Factors influencing the

participation of people with

disabilities in community sport

• Personality (how motivated a person is, at-

titude, determination – impressionability)


• The character and degree of impairment

(physical and intellectual condition, ac-

cess to the establishment and to the scene)

• Living conditions, financial situation

(travel expenses, purchase of equip-

ment’s, activity that can be performed

in parallel with learning or work)

• Access to the establishment, its facilities

and degree of accessibility with wheel-

chair, (Zsuzsanna Kovács, own experience)

8.2.3. The trainer has to be

aware of the following things:

For what reason does the indi-vidual choose the sport?

a. external pressure: it was recommended

by a doctor or the person was persuad-

ed by family, friends and acquaintances

b. own decision

What is the primary goal of doing sports?

a. to gain community experiences

b. preserving or developing health/

physical condition/appearance

c. proof, self-realisation, competing

What kind of ideas does the individu-al have on their own sport facilities?

a. has no idea

b. has an idea at large, but it is not realistic

c. has a realistic idea at large

d. has a concrete idea, but is not realizable

e. has a concrete, realistic idea

To what extent can the individual be influenced or guided? What is their at-titude? What is their habitus like?

a. does not accept help either from

helpers or volunteers

b. accepts help from helpers and volunteers

c. does not accept either instructions or advice

d. carries out instructions, but

does not accept advice

e. is a pessimistic or optimistic person

f. is an introvert or extrovert person

g. is an unmotivated or persuad-

able or suitably motivated person

h. is a person who easily runs away from

problems or is a persistent one

What are the individual’s liv-ing conditions like? What about their financial situation?

a. is it or is it not a problem for the in-

dividual and for their relatives to en-

sure the conditions of doing sports?

What are the most important cri-teria, symptoms and consequenc-es of the individual’s disease?

Zsuzsanna Kovács, own experience

8.2.4. As a trainer what can

I do with knowledge of the

above mentioned things?

Based on the cause, the aim, the personality,

on the individual’s idea and disease, it has to

be decided whether I am able to choose the right

type of sport, the suitable training method and

the appropriate motivational tools thus, the

strategy either individually or with assistance.

8.2.5. Educational methods:

Typical methodical procedures

• Verbal methodical procedure: explanation,

instruction, word of command, exhortation,

stimulation, encouragement Take the indi-

vidual’s age, preliminary training and dis-

ease into consideration. There is a great

emphasis on employing explanation, exhor-

tation, stimulation and encouragement.

• Visual methodical procedure: direct and

indirect demonstration. The basic criteri-

on of direct demonstration is exemplariness

and faultlessness. Therefore, demonstration

performed by the trainer seems to be more

effective. However, it is possible that a

greater stimulating effect can be achieved

if demonstration is done by an experienced

fellow sufferer. The tools of direct demon-

stration are: drawings on board, magnetic

board, pictures, videos, common match, vis-

iting competitions.The greatest motivating

power is embodied by the two latter tools.

• Practical methodical procedure: providing

and ensuring assistance, and exercising. In

case of assistance, if it is not provided

by the trainer, but it is given by a vol-

unteer, it is important that expertise of

a certain degree is necessary in this case

too, and they also have to know the train-

er’s and the individual’s all vibration.

Assistance shall only be provided if the indi-

vidual needs it. However, assistance should be

continuously guaranteed.

Exercising: Depending on the aim of doing sports

and on the individual’s disease, either the

quality or the quantity is a priority.

8.2.6. If necessary, I have to

decide, to whom I turn for help.

For example: The individual’s family, friends,

or a doctor, a physiotherapist, a masseur,

(sport) psychologist, a social expert.

If it is required by the living conditions and

the financial situation, we have to try to create

an optimal condition more carefully than usual,

either by ensuring accessibility with wheelchair

or providing ideal training time and occasion or

simply by providing the available information.

(Zsuzsanna Kovács, own experience)

8.2.7. Team sport and

community sport

The good participation of a team depends on the

cooperation of the individuals constituting

the team. It is a common interest of every team

member regarding either occasional or permanent

leisure communities, not to mention partici-

pants of high-performance sports and first-class

sports, that they should be participants of

games involving experience and possibly of a

winning match. For this, the skill of cooper-

ative behaviour, the altruistic cooperation

based on realistic self-knowledge, humility, and

effort toward a common aim are essential. Team

identity and belonging together which gives the

feeling of security may develop based on these

values. (Rétsági, 2015)

In the publication entitled White Paper on Sport

(2007:7) made by the Commission of the Europe-

an Communities, we can read that belonging to

a team, fair competition, following the rules,

respecting others, solidarity, principles of

discipline all promote active citizenship, so-

cial integration and discourage from crimes.

Proposals of the White Paper (2007:7) aim at the

improvement of the situation:

‘The Commission furthermore encourages Member

States and sport organisations to adapt sport

infrastructure to take into account the needs

of people with disabilities. Member States and

local authorities should ensure that sport ven-

ues and accommodations are accessible for people

with disabilities. Specific criteria should be

adopted for ensuring equal access to sport for

all pupils, and specifically for children with

disabilities. Training of monitors, volunteers

and host staff of clubs and organisations for

Photo: Zsuzsanna Antal, Nordic walking training, Human Pro-

fess, Szombathely, 2017


the purpose of welcoming people with disabili-

ties will be promoted. In its consultations with

sport stakeholders, the Commission takes special

care to maintain a dialogue with representatives

of sportspeople with disabilities.’

Photo: Zsuzsanna Antal, Netball training, Human Profess,

Szombathely, 2018

Reference

Bíróné Nagy, E. (2011): Sportpedagógia. Dialóg Campus Kiadó.

Commission of the European Communities: White Paper on Sport

Retrieved from: https://eur-lex.europa.eu/legal-content/EN/

TXT/?uri=celex:52007DC0391 (2018. 07 23.)

Kristonné dr. Bakos, M.: Testneveléstanítás és módszertan.

Retrieved from: http://uni-eszterhazy.hu/public/uploads/

testneveles-tanitas-es-modszertan_544f3a032bdb9.pptx (2018.

07 23.)

Rétsági, E. (2015): Sport szerepe a szocializációban és a

pedagógiában. In Laczkó, T. – Rétsági, E. (Eds.), A sport

társadalmi aspektusai. (pp.51-61).

Pécs: Pécsi Tudományegyetem Egészségtudományi Kar.

Vincze, T.: A testnevelés tanítása. Retrieved from: https://

uni-eszterhazy.hu/public/uploads/a-testneveles-tanita-

sa-2-_5538f30805117.pptx (2018. 07 23.)

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