SCI Forum Reports
Fitness Month: Skiing and Cycling
March 14, 2006
Snow and Water Skiing
Participating in a sport is a wonderful way to get the exercise we all need to stay healthy, said Randee Young, program director for SKIFORALL Foundation, an organization that provides outdoor recreational opportunities to people with disabilities in the Puget Sound region. And it has other benefits as well: enhanced mood and sense of well-being; social interaction; improved strength and endurance; excitement and thrills; increased self-esteem; enhanced body image; reduced anxiety and depression. "Outdoor sports provide an escape from urban life," Young said. "And you can claim a sport. You can say, 'I'm a skier' or 'I'm a cyclist.'"
SKIFORALL began as an adaptive downhill ski program in 1978, but has since expanded to include a wide variety of recreational programs year-round, including waterskiing, cycling, river rafting, rock-climbing, kayaking and canoeing. In addition to overnight excursions and day camps for kids, SKIFORALL offers "demo days," which give people an opportunity to try out a new sport for a day, at no cost.
Ski equipment.
Adaptive ski equipment is versatile enough so that "basically anybody can ski," Young said. There are many different ski designs, but the basic setup consists of a contoured seat attached to specially designed skis. Short ski poles sometimes have little skis on the bottom to help with turning and stopping.
- Mono-ski-for the experienced skier who has good use of the arms. This is the type of ski used by Paralympic competitors.
- Bi-ski-for people who need extra balance, support and stability. The bi-ski can be used by people with tetraplegia (quadriplegia). Skiers are tethered to an able-bodied skier to help control turns.
- Sit-ski-for somebody who doesn't have a lot of upper body mobility, strength or movement. As with the bi-ski, users are tethered to an able-bodied skier.
- Water ski-similar to a mono-ski setup. The skier can start from the beach or in the water, depending on experience and physical limitations. In the water start, a spotter is positioned alongside, holding the skier up in the water until the boat pulls out. "People with cervical injuries can water ski." Young said.
Safety & Clothing
- Helmets are required and provided by SKIFORALL
- Avoid cotton as it does not insulate when wet. Use polypropylene and dress in layers. Use sunscreen and lip balm, and wear goggles or sunglasses to protect eyes from sun, wind or snow.
- For snow-waterproof boots, gloves, hats, jackets, ski suits. In summer, wear wet or dry suits, depending on how cold the water is. In heat, use spray bottles if you are out on a boat, and drink lots of water.
- Avoid pressure sores by doing regular pressure releases. Keep skin clean and dry. Avoid movements that will cut or rub skin. Avoid clothes that are too tight or have thick seams, buttons or zippers.
Rentals and lessons
- SKIFORALL offers rentals and lessons for any level of skier.
- SKIFORALL has a financial aid program to ensure that all activities and equipment rentals are financially accessible.
- Equipment costs $1,200 to $2,500 to buy. Adaptive ski sites may have some used equipment for sale.
Locations
- SKIFORALL runs adaptive snow skiing programs at Stevens Pass, Snoqualmie and Crystal Mountain.
- Water-skiing takes place in Lake Sammamish; multi-day excursions in Eastern Washington.
- Transportation is available for some of the programs.
Contact SKIFORALL
- http://skiforall.org/
- 1621 114th Ave SE, Suite 132 Bellevue, WA 98004-6905
- Telephone: 425/462-0978 TTY: 425/462-0979 Fax: 425/462-0980
- Hotline: 206/835-7706
- Email: info@skiforall.org
Resources
- Sitski Adaptive Sports Programs and Equipment: www.sitski.com/index.htm
- Whistler Adaptive Ski Program, Whistler, BC, Canada www.whistlerblackcomb.com/rentals/adaptive/index.htm
Cycling
Carrie Booker is a recreation therapist in the VA Puget Sound Health Care System who has accompanied cyclists with SCI on the annual STP bike ride from Seattle to Portland (200 miles in two days) and is an expert in choosing, fitting and using handcycle equipment for persons with SCI.
"There is a lot of great equipment out there to choose from," Booker began. "It's so individualized, you really need to take the time to look at what kind of riding you want to do." Choice of cycle is not necessarily determined by level of injury. "Part of the decision is-What are your goals now? What is your strength now? How much are you going to use the bike? And are you going to 'grow out of' what your first bike has to offer?"
There are three basic types of handcycle: recreational, for cruising through the park with the kids or riding around the neighborhood; touring, for long distance rides; and racing, for competitive events. Many bikes are versatile and can be used for several different kinds of activities.
"When helping someone make a bike selection, we try to choose equipment that you will be able to use independently as much as possible," Booker said, referring to the recreation therapy program at the VA. "One of the first things we look at is the ability to transfer off the floor or to do under- or over-height transfers. You need to look at all your postural and range-of-motion challenges, what's unique to your body, and what bike can best accommodate your seating needs."
Equipment
(To view pictures of different handcycles, check the Web sites listed under Retail , in the "Resources" section, below.)
- Upright handcycles. Mainly for recreational use, the rider sits in an upright position, with the knee angle close to 90 °. It looks similar to a manual wheelchair, with a front wheel and crank assembly. It is easy to steer and, compared to the recumbent style cycle, has a tighter turning radius but a higher center of gravity. The upright might be the best choice for someone who cannot transfer off the floor, who has difficulty transferring to levels higher or lower than the level of the wheelchair, or has limited lower extremity extension.
- Recumbent handcycle (fork steer) . This is the most popular type of handcycle, and there are many different manufacturers and component options (handlebars, tires, seats, gears, brakes) that allow for a wide range of customizing. It sits lower to the ground than the upright, and legs extend out in front, with foot rests alongside the front wheel. Because of the leg position, the turning radius is wider and the user should always use leg guards. It is far more stable than uprights. This cycle is very versatile and can be used for all types of cycling-recreational, touring and racing. It is appropriate for people who can do over- and under-height transfers and can transfer off the floor.
- Recumbent (lean to steer). Similar to the fork steer, except the user needs to have good trunk control since steering comes strictly from leaning the body. "The is exclusively a road and racing bike," Booker noted. "There are no different tire options; you have to ride on pavement." It is the lightest weight bike and is meant for advanced cyclists. The steering takes some getting used to, Booker said. "I know T3s who sail on these things with no problem. It's totally personal preference." Seating is trickier on this bike because the cushion needs to be attached (leaning can cause the cushion to slide), so normal cushions may not always work well.
- Trunk powered . This is another type of recumbent cycle, but "I'm not really sold that they are ideal for the SCI population," Booker said. "The rider sits with lower extremities fully extended, leans over the top of the cranks and uses abdominal muscles for power. Seating requires either extreme hamstring stretch or a kneeling position. These are primarily used for racing. I recommend the cycle be selected only after significant trial."
Clothing
"I believe that if you're going to take on a sport, you should look the part," Booker said. Cycling clothing is designed to be light-weight and wick sweat from the body. There are many different styles of pants and shorts, and Booker recommends buying pants that are form-fitting so fabrics don't get caught in spokes, but not skin tight or constricting. Bike pants and shorts are seamless, which is important for people with no sensation, but she suggests avoiding the styles with saddle padding in the crotch.
The typical bike jersey has pockets in the back, which Booker noted were "totally useless for all of you." But there are many other styles also. Again, choose a fabric that is moisture-wicking and breathable.
Safety and health
- Water . As with any recreational activity, it is important to carry water with you. Standard water bottle holders can be purchased in a bike shop and placed in different locations on the bike. A hands-free camel-back style hydration pack can be attached to the back of the bike, with the hose coming over the shoulder.
- Equipment. "Know your equipment and keep it in good repair," Booker advised. "If you're going to spend money on a handcycle, it's a good idea to spend another $60 and take a bike maintenance class (offered through bike shops, bike clubs, and community colleges.) Know how to change a tire and fix a flat. All handcycling components are the same standard cycling equipment found all over the world, just mounted on a different frame."
- Helmet. "Always wear a helmet; it's smart and it's the law. Get one that fits well and is easy to put on."
- Hand signals. "You need to know and use them. If hand function is a problem and you can't do the signals well, you probably shouldn't ride on the street; use a bike trail instead."
- Mirrors. "Don't buy them from the handcycle manufacturer-go to a bike shop instead. You can attach them to the foot rest, helmet, whatever works best for you."
- Lights & flags. "Always order your cycle with a safety flag holder. You're lower (on the roadway), so you need that. Buy lights at a bike shop. The white light goes in front, red in back. Although only a red reflector is required in back, you should get a good strobe light."
- Skin. First, get the seating evaluated by a knowledgeable health professional (see "Seating" section, below). Next, remember that "when you're in a new skin position situation, you need to build up your activity tolerance," Booker warned. Start by using it only 15 minutes, increasing by 15-minute intervals each time you ride. After each session, "check your skin all over, in places you don't usually worry about." Don't forget to stop regularly and perform pressure releases!
"I would encourage you to go to someone who has done the seating for your wheelchair, or whoever your seating expert is," Booker said. "I'm a recreation therapist with lots of experience with handcycle seating, but most recreation therapists don't have this specialized training. So go to your PT (physical therapist). If your PT is unfamiliar with handcycles, explain that all they need to do is transfer all the wheelchair seating principles onto this piece of equipment. Pressure mapping can be done on cycles, too. With your feet out in front, it has changed your whole skin picture, so pressure mapping is really important." (See article on " Pressure Mapping.")
The right cushion is critical, even though it may be expensive, Booker said. "It won't necessarily be the same cushion you use for your wheelchair because your position will most likely be different." She has found that Roho cushions are often excellent choices for handcycles, even if a person doesn't usually like them for their wheelchair.
Resources
- Retail
- Spin Life ( www.spinlife.com ). Visit their handcycle page at www.spinlife.com/critpath/match.cfm?categoryID=10 or call 800-850-0335.
- Sport Aid ( www.sportaid.com , 800-743-7203) carries sport and everyday wheelchairs.
- Bike-on ( www.bike-on.com ; 888-424-5366) specializes in handcycles.
- Cycling clubs
- Tacoma Wheelmen Bicycle Club- www.twbc.org/ ; Rideline: 253-759-2800.
- Cascade Bicycle Club- www.cascade.org ; 206-522-3222.
- Seattle Bicycle Club- www.seattlebicycleclub.org/
- Manufacturers
- Freedom Ryder: Based out of Oregon. Manufacturer is a good contact if you want to go down and trial equipment ( www.freedomryder.com/ ; 800-800-5828).
- Sunrise Medical (Quickie): find local distributors at www.sunrisemedical.com .
- Invacare Top End: www.invacare.com , click on "sports and rec."
- Bicycle guides and maps
- Cascade Bicycle Club has links to several regional maps and routes: www.cascade.org/Community/maps_routes.cfm
- King County Regional Trail System: www.metrokc.gov/parks/trails/trails1.htm
- Washington State Bicycle Map: order from the Washington State Department of Transportation, 360-705-7277. Learn about state bike paths and trails at www.wsdot.wa.gov/bike/Paths_Trails.htm .
- Seattle Cycling Guide Map www.seattle.gov/transportation/bikemaps.htm or call 206-684-7583.
- Getting Around Bellevue on a Bike: maps and information, call 425-452-2894.
- Other
- United States Handcycle Federation- www.ushf.org/
- Washington State Department of Transportation-Bicycling (safety, laws, maps, organizations, etc.): www.wsdot.wa.gov/bike/
- Challenged Athletes Foundation- www.challengedathletes.org/