An Upward Slope: Therapeutic Recreation and Downhill Skiing

Article excerpt

When it comes to meeting the needs and goals of pediatric rehabilitation, Shriners Hospital for Children in Chicago has transformed downhill skiing into a team sport. In recent years, a group of interdisciplinary team members have joined forces to create a downhill ski trip for adolescents with orthopedic and neurological impairments. The results? Patients receive creative and innovative treatment, while rehabilitation professionals transcend ordinary approaches to therapy, stretch boundaries and help to recreate the health care paradigm.

This interdisciplinary program--which includes physical therapy, occupational therapy, recreation therapy, social work and volunteers--annually takes a group of adolescents, all with various physical disabilities, to Chestnut Mountain Resort in Galena, Ill. During the weekend, they spend the majority of time learning adaptive skiing techniques. The participants return home with a sense of accomplishment, new friends and a newfound belief in their abilities.

Pediatric Rehabilitation Goals

The overall goal of pediatric rehabilitation is to help maximize children's abilities to interact with and manipulate their environment. In adolescent development, the most important element is forming a group identity. Therefore, therapies with this population are maximized when they focus on integrating the client into peer situations. In combination, outdoor adventure programs are not only gaining tremendous popularity among the general population, but are also becoming a recognized treatment modality in hospitals. A team-driven and peer-oriented recreation opportunity, such as downhill skiing, has great potential for improving quality of life.

The specific goals of the downhill ski program are comprehensive and diverse, and thus best met by an interdisciplinary team. For example, physically oriented goals include working on strength, fitness, balance and coordination. Social-emotional goals include becoming involved with group activities, enhancing feelings that accompany success in a challenging activity and getting a chance to experience independence away from parents and caregivers. The ability to comprehensively work on multiple goals with a number of clients in one program is not only holistic, but potentially a cost-effective approach to treatment.

Selection of Participants

The selection of participants is the key to the success of any program. For downhill skiing, a small group is recommended for increased cohesion and the ability to control participant outcomes. Participants are required to be independent in all self-care and activities of daily living (ADLs). Equipment options need to be assessed, as availability may also dictate participant selection. If participants will be attempting upright skiing, they will need to be at least therapeutic or household ambulators and have fair standing balance.

For this program, participants needed to be between the ages of 1 and 19 and willing to attempt skiing both days. The program has had adolescents with the following diagnoses: upper extremity amputations, below-knee amputations, myelomeningocele, spinal cord injury and residual brain injury. The participants were selected through means such as chart reviews and recommendations from a variety of team members.

Staffing

Downhill skiing programs for individuals with disabilities are staff-intensive. For patients who are ambulatory, either a one-to-one or one-to-two staff-to-client ratio is suggested, depending on ability level. For the participants who use any type of sit-ski, a two-to-one staff-to-client ratio is recommended. With six participants, the program at Shriners Hospital for Children used five staff members from the various disciplines and two volunteers, thus ensuring an adequate staff-to-participant ratio.

Using an interdisciplinary team brought diverse specialties to an assorted client population, thus enhancing each participant's likelihood of success. …