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We provide you with articles on brain science, timely topics, and healthy living for those affected by neurologic challenges or seeking better brain health.  

Exercise
By Bob Barnett

Scuba Diving for People with Disabilities

The Cody Unser First Step Foundation offers scuba diving to people with disabilities. Courtesy Cody Unser First Step Foundation

Cody Unser was 12 when she collapsed at her sixth-grade basketball practice in 1999. She had trouble breathing and an excruciating headache. Within 20 minutes, she was paralyzed from the chest down. A week later, she was diagnosed with transverse myelitis, a neurologic disorder caused by inflammation of the spinal cord.

After three “grueling” months in a rehabilitation clinic “learning how to live with my paralyzed body,” Unser was deeply depressed. “I would stab my legs with pins, throw myself out of bed,” she recalls. “I couldn't see any reason for my existence.”

Searching for a larger purpose, Cody and her mother established the Cody Unser First Step Foundation, a nonprofit group that raises awareness of transverse myelitis, advocates for research, and supports people with disabilities. Her older brother helped her find another source of inspiration and solace: scuba diving. “I just fell in love with the peace, the tranquility. I felt like I could do anything. What was I doing, doubting life and my capabilities?” Cody says.

She and her mom tweaked their foundation to sponsor scuba diving trips for people with disabilities, including veterans with post-traumatic stress disorder (PTSD). “I was like, ‘Everybody with a disability needs to try this, to get back into life.' Because it definitely saved mine.”

When she dived, Unser could feel sensations in her legs and bladder. She asked her doctors at Johns Hopkins Medicine to figure out why. Her neurologist, Daniel Becker, MD, ran the university's spinal cord injury rehab center, and her neuropsychiatrist, Adam Kaplin, MD, PhD, was studying mood disorders and suicide among people with transverse myelitis. In 2011, with funding from the Paralyzed Veterans of America, the doctors took 20 people with spinal cord injury on a scuba trip to the Cayman Islands for research.

The participants dived 10 times over five days. For most of the divers, serotonin levels tripled. Some had less spasticity. Those who also had PTSD experienced a dramatic decline in symptoms such as hypervigilance, irritability, and hostility. And like Unser, all the divers experienced increased sensation in light-touch pinprick testing.

The pilot study was considered inconclusive. Based on animal studies, Drs. Becker and Kaplin hypothesized that nitrogen forced into cells during scuba diving spiked serotonin, which can stimulate nerve firings even in areas affected by spinal cord injury, leading to restoration of function. The effect faded after about a month. Funding has been hard to find for a “recreational” sport, but there are plans to repeat the study later this year or early next.

Even without scientific proof of its benefits, Dr. Becker encourages people with disabilities to try scuba diving, if they have access to it. “Absolutely do it, but do it with the right people,” he advises. “Look for organizations with divers who are certified to take care of people with physical disabilities. They can ensure that it is safe. You are going to have a great time, and maybe it will result in some positive changes.”

The Professional Association of Diving Instructors (PADI) created an adaptive techniques program for instructors in 2018.

People who have disabilities and want to dive must be medically screened. Some conditions, such as seizure disorders, may be disqualifying. Once cleared, the people should seek out scuba instructors trained in adaptive diving.

“A lot of people who are in wheelchairs think, ‘Hey, there's no way I can go 60 feet underwater, let alone get into a boat,'” says Jesseca Smith, an occupational therapist doing research with PADI. “Even some medical professionals don't understand that scuba diving is a safe activity.”

But a single experience could be enough to assuage fears. “Once you eliminate gravity,” Smith says, “you suddenly see how many possibilities there are.”

Cody Unser says she was terrified on her first dive. Just figuring out how to put on a wetsuit was challenging, she says. An instructor trained in adaptive diving can help divers overcome psychological or physical obstacles.

For anyone new to diving, the first lesson (and maybe additional early sessions) would take place in a pool. Some people with disabilities are content to stay with pool scuba, where they can experience the benefits of movement and buoyancy. Others go on to open-water diving, with one or more specially trained nondisabled “buddies” to help them dive safely.

“If you have no use of your legs, for example, you can use your arms to propel yourself,” says PADI's Eric Albinsson, who helped develop the adaptive diving program. “We can give you webbed gloves to put on—kind of like hand fins—to help you move along. It's liberating.”

Unser loves the autonomy and independence she feels when diving. “It's been an awesome journey for me. The second you submerge, all you hear is your breathing,” she says. “You don't have to explain your disability to a fish, right? It's a whole other experience. There's not the gravity we feel in our chairs. And there isn't the mental gravity of not being able to do what you want to do, because even if society isn't adaptable, the ocean is limitless.”

Resources for Divers with Disabilities