Breaking Barriers with Adaptive Snowsports
December 2009 Issue
That first day on the mountain, it awoke me again. I had been in a pretty depressed state, but just going down the bunny hill was so exhilarating that I didn't know what to do with myself.
-Staff Sgt. Orlando Gill (ret.)
|Staff Sgt. Orlando Gill (ret.) can still burn up the slopes while wearing an artificial knee. Photographs courtesy of Disabled Sports USA.|
Staff Sgt. Orlando Gill (ret.) is like a lot of American veterans who have survived a battle injury. He was in excellent physical shape-a competitive snowboarder-until an Iraqi explosive torched his old life and transformed his body forever. Lying in Walter Reed Army Medical Center (WRAMC), Washington DC, with a transfemoral amputation, he existed in a fog of pain and depression for weeks, believing he could never return to the intensity and freedom of his previous life. Then, Kirk Bauer, a fellow amputee veteran and the executive director of Disabled Sports USA (DS/USA), walked into his hospital room and told Gill that he would not only snowboard again, he would do it just three months after his amputation.
DS/USA is just one of many local and national organizations that introduce people with physical disabilities to adaptive skiing and snowboarding. Most of these organizations provide or facilitate access to adaptive equipment and offer training from certified adaptive instructors. Perhaps just as importantly, they may also help participants navigate the subtler benefits and challenges of adaptive winter athletics.
Promise and Pain
Snowsports comprise far more than just physical movement, asserts Dan Savone, MEd, a prosthetics-program manager who works out of the Hanger Prosthetics & Orthotics office in Golden, Colorado. He is a specialist in adult learning and amputee psychology who trained for three years with what was then the U.S. Handicap Olympic Ski Team after he sustained a transhumeral amputation. "As we move through learning to ski, the better we get at it, the more musical it becomes, and the more enjoyable and the freer the flow," he says. "Lifelong learning can be an effortful venture, but skiing is so much fun that it makes learning fun, and then we can use that experience to invigorate learning in other aspects of our lives. The joy of learning just one perfect parallel turn can help retrain our self-gratification system so that we maintain the perseverance and frustration-resistance amputees need to become great at other things."
Bauer says that DS/USA pours its resources into snowsports programs in large part because "you can use a chairlift to get to the top of the mountain, which brings in gravity as an equalizing factor that almost completely eliminates the debilitating effects of the disability. So, right away, whether a person is in a wheelchair or has multiple artificial limbs, they can come down the mountain with their family and friends and do it as an equal."
Savone cautions, however, that learning adaptive snow-sports is a multifaceted process. To succeed, both students and instructors of the icy arts need to tailor what they do on the slopes to match the particulars of the athlete's injury or physical disorder.
What the Pros Say
According to Adaptive Snowsports Instruction, the official adaptive teaching manual of the Professional Ski Instructors of America (PSIA) and the American Association of Snowboard Instructors (AASI), an instructor teaching adaptive skiing should thoroughly evaluate students' physical, cognitive, and psychological state before any lesson.
For example, it queries, "To what degree does the student feel pain, heat, or cold in any residual limb and/or all limbs?... Does the student wear foot or leg braces? The student may need a larger boot to accommodate a brace. You may need to insert padding to eliminate extra space and prevent pressure points where a brace rubs against the leg. In some cases, ski boots may provide as much support as a foot brace. For students with a long leg brace, consider how they might be able to ride the chairlift."
The student can help by communicating frankly and thoroughly about his physical and mental condition, any medications he takes, and his desires and goals for the lesson. This allows the instructor to tailor her instruction and all equipment, watch for any troublesome physical symptoms, and intervene quickly should problems arise.
Many people with a physical disability have more than one condition, which can increase the amount of communication needed. For instance, a person with a leg amputation may also have a traumatic brain injury (TBI) and use medications for pain and blood clotting. Adaptive Snowsports Instruction emphasizes that in such cases, taking simple steps can help make the lesson successful. The instructor and student can work to prevent the student's residual limb from becoming too chilled, its delicate skin from being abraded by equipment, or recent wounds from being bruised during falls. They also can protect an expensive prosthesis (and other people) on the mountain by making sure the limb is secured and covered. To manage cognitive symptoms, they can minimize the student's exposure to stress, crowds, and snow glare, and the instructor can modify her directions to circumvent any difficulty with short-term memory or attention span. If the student takes blood thinners, the instructor can plan to keep a first-aid kit on hand for immediate treatment of scrapes and be especially aware of symptoms of internal bleeding in the unlikely event that the student takes a hard fall. If a student's painkillers affect his balance, the instructor can add outriggers or a bamboo balance pole to the equipment list, or the student can switch from a monoski to a bi-ski.
Barriers Fall Away
|DS/USA trainers help a young athlete learn to ski.|
No matter what their disabilities, beginning students of the slopes may be surprised to learn how few limits they actually have on the snow. Factors such as equipment availability, level of amputation, and age present fewer barriers to participation now than they did just a few years ago.
Neal Eckrich, Veterans Association (VA) Acting Chief Operating Officer for Prosthetics, told The O&P EDGE that the VA is now aggressively seeking out opportunities to keep injured vets fit through adaptive sports opportunities and by providing appropriate equipment. For civilians, non-profit organizations across the nation-including the Challenged Athletes Foundation (CAF) and National Sports Center for the Disabled (NSCD)-help provide equipment and training to those who would use it but can't afford it.
In terms of devices, Bauer asserts that because energy-storing prosthetic feet and extremely strong, lightweight sockets now exist, many amputees with even a five-inch residual limb can ski standing, and that new ultra-light sit-skis and outriggers bring skiing into reach even for those with bilateral amputations and limited arm strength.
Pam Eberly, a transtibial amputee who served as a DS/USA snowboard instructor for many seasons, is an example of someone who sees through a variety of perceived limitations in snowsports to the power they can offer. Now age 58, she medaled in all-ages competition at the USA Snowboard Nationals just three years ago. She says that people with a disability "can feel like their whole world is ending, but learning to snowboard can not only show them that they can snowboard, it also opens their eyes to the fact that they can pretty much do anything that they want. Sometimes it takes more effort and a few more tools, but they can do it.... It shows that their life isn't really over-this is just a new chapter."
Morgan Stanfield can be reached at
Clinicians: How to Get Your Patients on the Slopes
Carrie Melton, CPO, LPO, is clinical director of prosthetics for OrPro Prosthetics & Orthotics' Ohio area, and is also a Professional Ski Instructors of America (PSIA)-certified adaptive ski instructor. She offers responses to practitioners' most common questions about preparing their patients for adaptive snowsports.
Why introduce my patients to snowsports?
Patients who ski [or snowboard] can experience a significant change in their life and health and begin taking risks again. When they succeed-and they almost certainly will-they can realize that they can actually accomplish whatever they put their mind to.
When and how should I present the idea of snowsports?
Start at the initial visit. With new patients, as we go through the fitting process and the conversation turns to the kinds of things they'll be able to do with their device, I'll just ask if they've thought about skiing this winter. I'll show them brochures and websites for the programs in our area and tell them about how it works. Of course, I recommend that they have a release from a physician and, with newer amputees who are in physical therapy, I'll discuss the activity with their therapist or have the patient talk about it with their therapist. Many PTs in our area actively participate as volunteers in our programs.
What are the clinical issues?
Suspension: A lot of patients won't have to wear a prosthesis to ski-they can three-track or sit ski. But if they'll wear a prosthesis, I'll recommend an auxiliary suspension. For instance, if they're in a lock-and-pin system, it may not release because of the weight of the ski, but if they were to inadvertently bump the release pin with their ski pole or someone else bumped it, there's the chance that their prosthesis could come off. In cases like that, we would typically add a suspension sleeve, or some patients will utilize a belt-style suspension system.
Balance: For unilateral upper-limb patients, it can help to weight the side with the amputation for balance. I've seen a fellow instructor tuck a small sandbag inside the patient's tucked-in sleeve.
Alignment: Most ski boots are dorsiflexed, and you stand with your knees flexed while skiing. If you go out on the snow with your patients and have proper tools, it's pretty easy to adjust alignment there. But most ski boots have removable foot beds, and the easy thing to do is to just add forefoot or hindfoot lifts to assist with establishing proper alignment of the prosthesis. Freedom Innovations also makes the Slalom Ski Foot, which is designed to clip right into bindings without a boot attached.
Can clicinicians get involved even if we don't ski?
Absolutely! Most [snowsports] programs are volunteer-driven. They need people to help maintain equipment, perform clinical histories, and prepare equipment for the participant. It is typical for three or four people to assist a participant with all their equipment out onto the hill. We need all the help we can get.