Following a spinal cord injury (SCI), at the start of rehabilitation a reduced physical and psychological condition is the norm.12 Physical capacity has been defined as the “combined ability of the cardiovascular, respiratory and musculoskeletal systems to attain certain levels of activity.”2 Such capacity of an SCI patient is closely related to the performance of the activities of daily living. The often extreme reductions in performance of daily activities combined with a sedentary lifestyle results in inadequate maintenance of a patient’s physical capacity.3 The physical deconditioning and premature aging that can occur in SCI patients can be extreme. This includes increased rates of secondary conditions such as cardiovascular and respiratory diseases, bone and joint diseases, pain and obesity.45 The end result is more complications as well as reduced levels of functioning and quality of life.6

Therefore, one critical goal of rehabilitation includes breaking the cycle that results in reduced physical capacity leading to limitations in functioning.6 In addition to a reduced physical capacity, persons suffering from SCI can have a range of psychological problems, sometimes continuing or even arising after returning to their communities. Higher incidences of depression, anxiety and lower quality of life have all been reported.7

Undertaking sports has repeatedly been shown to contribute to physical capacity and health maintenance as well as psychosocial well being among persons both with and without SCI (see Box 1). Additionally, among athletically active patients, indirect health status benefits have been demonstrated, including decreases in hospitalizations and morbidity with regard to urinary tract and respiratory infections, spasticity and ulcers.7

Sporting activites may also contribute to the improvement in SCI patients’ psychosocial status (although the published studies in this area are not entirely conclusive, with some showing an effect while others show a negligible impact).7 One study demonstrated that those patients not practicing sports had higher rates of anxiety and depression compared to those who did.8 Both tetra- and paraplegics who practice sports more often obtain greater psychological benefits.7

On a broader level, sports can do much to facilitate aspects of community reintegration. Various sports have been shown to contribute to social interaction, adjusting to a disability, a sense of fun and as a coping mechanism for stress management — increasing self-efficacy overall in both the sport itself and activities of daily living.5

SCI patients involved in sports demonstrate a higher quality of life. One survey that compared 985 persons with SCI found reasons for sports participation included (in order of the most frequent) “fun,” “fitness,” “health,” “competition,” and “social.”9 Furthermore, there are increasingly greater options for the expansion of athletic activities, as demonstrated by publications such as Sports-n-Spokes and organizations such as Wheelchair Sports in the USA.101112 However, access to recreational resources can be a limiting factor in a patient’s participation in sports.10

Box 1 | Effects of Sports and Athletics on Physical Capacity

The physiological effects of sports in SCI patients have been well studied and have been shown to lead to overall increases in the quality of life of patients. Some of the specific body functions that are affected include:1

  • Cardiac function
  • Respiratory function increases in ventilatory reserve and VO2 peak, translating into better overall fitness
  • Improved physical work capacity through better cardio-respiratory functioning
  • Improved muscle strength: in complete SCIs above the level of injury; in incomplete SCIs through neural plasticity also below the level of injury
  • Vascular function — studies have shown mixed results in improving blood flow to the legs; reductions in the incidence of platelet aggregation have also been documented
  • Metabolically, highly trained SCI patients have higher levels of high density lipoprotein cholesterol (HDL-C), potentially reducing the risk of congestive heart disease
  • Training can increase muscular capacities, improve muscular aerobic metabolism and increase resistance to fatigue. Although aerobic power decreases in individuals following an SCI, endurance gains can be made with proper training. Anaerobic power, which focuses on short-term exertion tasks, can likewise be improved in SCI patients through the appropriate training.
  • Sports have been shown to be a factor in improving functional capacities based on the Functional Independence Measure over the first 10 years after SCI.

Given the range of positive effects that sports can have in persons with spinal cord injuries, integrating athletic activities into the rehabilitative process stands to do much to encourage regular exercise. In the long term, a person with SCI involved in sports stands to benefit in terms of functioning, health maintenance, reintegration and overall well-being.

This case study aims to illustrate how sporting activities can contribute both to physical health maintenance and psychosocial well-being. The study will describe intervention strategies that focus on physical functioning and the identification of suitable athletic activities for the rehabilitation of a person with traumatic SCI.

Table 1: Sport Therapy Progression in Paraplegics and Tetraplegics

Table 1: Sport Therapy Progression in Paraplegics and Tetraplegics