Put Me In, Coach
When injuries bench kids with disabilities, a specialized team of physical therapists helps them get back in the game.
Equestrian eventing provides both an athletic and social outlet for Sage Moore, now 17. “The equestrian center is like her home away from home,” says her mom, Kelly Moore.
Sage Moore has always loved horses. “My grandparents put me on their horse when I was still in diapers,” she says. “I’ve been riding pretty much ever since.”
Sage’s passion grew when she discovered eventing, an equestrian competition that combines dressage, cross country and jumping. “What I like best is that you and your horse area team. I really, really love it,” she says.
Riding offers Sage, now 17, something almost no other sport can — the chance to compete on an even footing with others. Tangled blood vessels in Sage’s brain disrupt communication with the muscles on the left side of her body, leaving that half weak and rigid.
“I could never excel at soccer or tennis or softball, but I’ve become a good rider,” Sage says. “When I’m riding, I’m judged the same as everyone else. That means the world to me.”
“It feels so good to think of myself as an athlete as opposed to a person with special needs.”
The Adaptive Sports Physical Therapy Program fills the gap between rehabilitation and independent participation in community sports and activities, says Dr. Mimi Racicot, who leads physical therapy programs at Seattle Children’s.
Last year, Sage’s ankles began to ache when she pressed her heels into her stirrups. The pain became unbearable. It was an orthopedic sports injury caused by overuse. Yet to ensure she healed properly and could continue to compete, the biomechanics of her disability needed to be factored into her treatment plan.
Young athletes with disabilities face a Catch-22 when they need rehabilitation for even common sports injuries. Typical sports physical therapists who are trained to help athletes return to play after injuries like sprained ankles or twisted knees may not be knowledgeable about underlying neurologic problems like paralysis or tremors. Physical therapists who are trained to work with people with neurologic disabilities like spina bifida or hemiparesis (which is Sage’s disability) may not be knowledgeable about orthopedics and helping athletes resume their sport.
“Kids like Sage usually have to choose between one type of physical therapy or the other,” says Dr. Mimi Racicot, who leads physical therapy at Seattle Children’s. “They are in no man’s land because neither choicefully addresses their needs.”
Seattle Children’s Adaptive Sports Physical Therapy Program meets the unique rehab needs of this group of kids. Each physical therapist on the team is trained and experienced in both sides of the physical therapy equation —orthopedic and neurologic — so athletes with disabilities can keep playing the sport they love and enjoy the physical and emotional rewards athletic competition brings.
The program, open to school-age children and young adults of all skill levels, helps the hospital fill a gap in rehabilitation medicine between physical therapy that helps kids with disabilities function in daily life and conventional outpatient sports physical therapy.
“We’ve always known that athletes with disabilities are an underserved population,” says Laura Crooks, who leads rehabilitation medicine at Seattle Children’s, “but we needed to hire a team of physical therapists with the right orthopedic, neurologic and pediatric credentials before we could create this program. That’s not an easy combination of specialties to find.”
A different normal
Specialized knowledge — of orthopedic injuries, neurological underpinnings, and how to work with kids and teens — enables physical therapists like Steve McKenzie to get young athletes, like Sage Moore, back in the game.
Rehab for injured athletes with disabilities might seem no different than rehab for any other injured athlete. A pulled hamstring is a pulled hamstring, right?
Not so, says Steve McKenzie, a sports physical therapist who is also certified in hippotherapy, which utilizes the movement of a horse to help people with neurologic conditions and other disabilities improve strength, balance and motor skills to function better in daily life.
What’s normal for most young athletes in terms of biomechanics —like strength, range of motion and muscle tone — may not be normal for young athletes with disabilities, McKenzie explains, so the adaptive sports physical therapy team must adjust the nature, intensity and goals of physical therapy accordingly.
“Kids with cerebral palsy, for example, may have unusually tight muscles while kids with Down’s syndrome typically have unusually loose muscles,” McKenzie says. “Our team understands how things like muscle tone and muscle imbalances affect their movement, so we can develop a plan that achieves the best possible result for each child.”
The team also knows how to work with children whose disability includes cognitive delays. “A child might be 16, but if their comprehension is that of a 6-year-old, the therapist needs to recognize that and provide instructions the child can understand and follow,” Racicot says.
Every child an athlete
Sports are especially important for kids with disabilities because their daily lives can be more sedentary than those of other children. Running down a soccer field, wheeling up a basketball court or swimming across a pool helps prevent secondary health problems related to their disability (like obesity, diabetes and heart disease) while promoting lifelong participation in exercise.
Playing sports also gives children with disabilities a big emotional lift because it provides a chance to be like other kids — something that’s not always easy to find. Through sports they can gain confidence, make new friends and acquire a positive outlook that can last a lifetime.
“Sports are often a big part of their identity, but many parents of children with disabilities tell us their kids are playing with pain or not playing at all because they can’t find the specialized assistance they need,” says Crooks. “That’s not acceptable. These kids —like every kid — need to play.”
Playing sports also gives children with disabilities a big emotional lift because it provides a chance to be like other kids.
While children with disabilities can play many of the same sports as other children, they often can’t throw or kick or catch the same way because of their unique biomechanics. The adaptive sports physical therapy team helps them modify their stroke or stride or swing to compensate for the different way their bodies move.
The team also helps them strengthen specific joints and muscles to improve performance and prevent injury. “A swimmer who has lost the use of their legs, for instance, relies heavily on their shoulders,” Crooks says. “We can give them the right exercises to develop the right muscles so their shoulders can handle the extra load.”
“Many parents tell us their kids are playing with pain or not playing at all because they can’t find the specialized assistance they need. That’s not acceptable.”
When she has patients who want to ride, physical therapist Kristie Bombaro-McCollum of Seattle Children’s Adaptive Sports Physical Therapy Program often calls on Dan Retailliau of Outdoors for All to get them set up and custom fit with an adaptive cycle.
Many athletes with disabilities also need braces or adaptive equipment like a wheelchair for basketball, but can get injured if their form isn’t right or their equipment doesn’t fit. “We help them find the right gear, adjust it correctly and teach them the correct techniques to perform safely and successfully,”McKenzie says.
If a child with a disability wants to try sports for the first time, the adaptive sports physical therapy team will assess them, develop an exercise program and connect them with community programs, such as Special Olympics, Seattle Adaptive Sports, Little Bit Therapeutic Riding Center or Outdoors for All.
“Children with disabilities sometimes don’t see themselves as athletes, but I tell them ‘if you have a body, you’re an athlete,’” McKenzie says. “I get a lot of satisfaction from helping these kids play sports just like other children.”
To help Sage heal, McKenzie fit her with inserts for her stirrups and taught her exercises to help her stretch and strengthen her ankles — all while keeping in mind the imbalance created by her impaired left side. Now, “the pain is almost all gone,” Sage says.
The pain in Sage’s ankle would have been matched by the pain in her heart if she’d been unable to continue riding. “It feels so good to think of myself as an athlete as opposed to a person with special needs,” she says. “I don’t know what I’d do without it.”
Published in Connection magazine, Spring 2015