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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 John Hanc

The Therapeutic Value of Adaptive Sports

Men playing wheelchair basketball
VM/iSTOCKPHOTO

On a hot day in July 2019, Norbert Holowat miscalculated the depth of a friend's pool—and his life changed forever. When he inadvertently dived into the shallow end, he shattered two bones in his neck. The catastrophic injury left his legs and much of his upper body paralyzed, and he spent the next four months in a rehabilitation hospital where his every need was met by pressing a call button. “I didn't have to worry about a lot,” he says.

Transitioning to his new circumstances at home was difficult. “The extent of my injuries really hit me,” says Holowat, now 24. He struggled to establish a new life, worried about everything, and became angry and depressed—until he met Tony Fitzgerald, a vocational counselor, as part of his reentry into society.

Like Holowat, Fitzgerald was in a wheelchair, the result of a car accident in 1987 that had killed his brother. “I kind of knew what Norbert was going through, because I'd been there,” says Fitzgerald. Holowat didn't need job training—he was an engineer, a graduate of the Rochester Institute of Technology, and would have little problem getting a job, even with his disability—but Fitzgerald suspected he might need help in other ways.

He invited Holowat to join him and a group of friends with disabilities at a local park for a game of wheelchair softball. “I thought, ‘A bunch of guys in wheelchairs trying to play softball? I don't want to do this; it's ridiculous,'” says Holowat, who lives in Williston Park, NY. “But Fitz said to give it a shot. So I gave it a shot.”

That was Holowat's introduction to the world of adaptive sports—a term used to describe competitive and recreational sports that have been modified (or adapted) with equipment for people with disabilities. Skiers use skis they can sit on and shorter poles with miniature skis attached, for example. Softball is played on blacktop so the wheelchairs can move faster, and in hockey, players sit on sleds with ice skates attached to the bottom. “Sometimes we modify the sport; other times we modify the equipment,” says Fitzgerald, who competed for the United States Paralympic team in sled hockey in 1998. “Normally it's a combination of both.”

Although Holowat wasn't very good at softball, it didn't matter. “It became more about hanging out with these guys,” he says. “Everybody there had been in a wheelchair for a pretty long time. Talking with them was really good.”

This, of course, is exactly what Fitzgerald had hoped would happen. “It's more than sport; it's therapy,” he says. “Being with others who are dealing with the same problems, day in and day out. Especially for someone newly injured, as Norb was at the time, the psychological benefits cannot be overstated.”

And it's why adaptive sports are recommended by medical professionals who work with people who have a spinal cord injury, traumatic brain injury (TBI), or degenerative neurologic disease such as multiple sclerosis.

“I think it has tremendous value,” says Michael Jaffee, MD, FAAN, director of the Brain Injury, Rehabilitation & Neuroresilience Center at the University of Florida in Gainesville. “It can enhance strength and fitness, help with better sleep and overall functioning—and boost self-esteem, self-confidence, and a sense of independence.”

Almost any activity can be adapted, from skiing and rugby to running and basketball, says A.M. Barrett, MD, FAAN, medical director of the cognitive neurology clinic for the Atlanta VA Health Care System. “There are so many things people can do, and we know that the benefits of participating in sports are potent.”

A 2017 study published in PM&R, the journal of the American Academy of Physical Medicine and Rehabilitation, said that participants experienced physical benefits from adaptive sports and considered them “transformative in terms of how they view themselves.” A 2019 study in the journal Current Sports Medicine Reports concluded that for people with acquired neurologic disabilities, adaptive sports are “a feasible, efficient, and cost-effective complement to conventional rehabilitation.”

“We very much encourage people with neurologic conditions to participate in these sports,” reiterates Dr. Jaffee. “For people with degenerative diseases, adaptive sports may help slow progression. When the disease inevitably worsens, people are less able to do things. So anything we can do to establish a habit of being active now will help.”

Getting involved has another, more intangible benefit, says Kenneth Lee, MD, chief of the spinal cord injury division at Zablocki VA Medical Center in Milwaukee. “Sports are driven by who we are as humans,” says Dr. Lee. “We're used to challenging each other. It's innate. And that's why adaptive sports can help us become something better.”

He should know. The physiatrist sustained a TBI and various orthopedic injuries in a car bombing in 2003 while commanding a medical battalion in Iraq, and adaptive sports helped him overcome postinjury malaise. “Adaptive sports get people out of the ruts they're in, whether they have a spinal cord injury or Parkinson's,” he says. “They open up doors for people who thought their lives were ruined. Once they get into adaptive sports, they realize they can do a lot more than they thought.”

Getting started can be a challenge. The PM&R study cited “difficult-to-find information about program offerings” as a barrier to participation. Some people may be turned off by what they perceive to be the competitive nature of the sports. The reality is that anyone can participate regardless of disability or fitness level. “We don't want people thinking they have to compete on an elite level,” says Dr. Jaffee. “They can just enjoy the fun of being part of a group and getting some healthy exercise.”

For Holowat, that first game of casual wheelchair softball has morphed into something bigger: endurance racing. Using a special lightweight chair, he completed his first marathon in March 2021. Last fall he qualified to participate in the 2022 Boston Marathon—based on his time of 2 hours, 41 minutes in New York's Suffolk County Marathon.

The Boston Marathon has long welcomed wheelchair racers, who start ahead of the runners. On average, 40 to 60 compete every year in Boston, and the world's best competitors wheel through the 26.2-mile course in under an hour and a half (nearly 40 minutes faster than the world's fastest runners). They compete for prize money and are a crowd favorite among the thousands of spectators who line the course from Hopkinton, MA, to Boston.

Holowat's physiatrist, Adam B. Stein, MD, is proud of his patient—and hopes Holowat's example inspires others. “Norbert is winning the battle,” says Dr. Stein, chair and professor of physical medicine and rehabilitation at Zucker School of Medicine at Hofstra/Northwell. “For every person like Norbert, there's someone struggling to come to terms with his or her situation. Those others need resources and support to choose something purposeful.”

Summing up the impact adaptive sports have had, Holowat says: “They've changed my entire outlook on life. I've learned that so much more is possible.”

Adaptive Sports Resources