Recreation for the Disabled Child

Donna Bernhardt Bainbridge

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136549472
• Edition: 1
• Topic: Business
• Subtopic: Business General
• Index: Business

This valuable book deals with the recreation activities for the disabled, including skiing, horseback riding, running, camping, water sports, and team sports. Experts examine competitive spirit, training, and the psychological benefits of recreational activities for the disabled child. Program development, evaluation, and instruction are discussed.

Running for Therapy

Elizabeth Stevenson, EdD, RPT, ACT, CCT

Running is an ancient sport that has had phenomenal growth during the past fifteen years. Current estimates indicate that millions of Americans regularly jog or run. According to Williams et al.,¹ a sizable fraction of this number participate in competitive road racing events that draw in excess of 10,000 participants. Brody classifies levels of performance by the miles run per week.² Level one is the fitness jogger or “novice” who runs 3 to 20 miles per week at nine to twelve minutes per mile. Level two is the “sports runner” who runs 20 to 40 miles per week at an eight to ten minute per mile pace and participates in “fun runs” of three to six miles distance. Level three is the “long distance runner” who runs 40 to 70 miles per week at a 7 to 8 minute per mile pace and competes in races of 6.2 to 26.2 miles. Level four is the “elite marathoneer” who runs 70 to 200 miles per week at a pace of 5 to 7 minutes per mile.

The first level or “jogging” has been defined by an osteopathic physician, Perry, as a slow rhythmic step in which the hands and arms are held high and close to the body; the foot strike is short and flat, landing on the heel without any spring.³ He says that this pattern traumatizes the cervical and lumbar spines. To remedy this, Perry states that in running the arms should be projected anteriorly with the body slanted ten to fifteen degrees forward, eliminating much of the jarring action as the foot then lands in front of the heel near mid-arch and rolls onto the ball of the foot and onto the toes. Bush, another osteopath, also cautions against jogging which he says is too vertical.⁴ Bush suggests people should pick up the pace and make sure that the center of gravity is a little ahead of the body to reduce the jarring to the spine. He further states that most people can benefit more by running shorter distances with slanted body than by jogging longer ones. The forward center of gravity in running forces the legs to act as pullers not pushers. Pushing causes one to tire more quickly; hence, Bush concludes that running is less fatiguing and more efficient.

According to Ryan,⁵ the National Jogging Association has recognized the major shift of emphasis from the relatively slow-moving, short-stepping activity of jogging to the more physical, long-striding activity of running by changing its name to the American Running and Fitness Association. They have acknowledged that the pace is the substantial difference between jogging and running. Through the name change they hope to reflect more exactly the interest in development and maintenance of physical fitness.

The purpose of this paper is to review the physiological effects of running in adolescent populations, to present some essentials of conditioning for running in normals, to review briefly the use of running in some disabled populations and to present some alternatives to running.

PHYSIOLOGICAL EFFECTS OF RUNNING

Running has certain obvious advantages. One does not have to have expensive equipment such as skis or rackets; one only needs a good pair of shoes. One does not need a partner with whom to run. One does not have to drive a car to a mountain or a gym. Running has become a family activity with children making up a significant percentage of the entrants in many races. Distances previously thought impossible for the subteens have become routine. From the age of seven there are marathon records.

Any exercise program of an aerobic type, such as running, produces a training effect which, according to Cooper,⁶ influences most of the major systems of the body. What are some of the physiologic advantages and disadvantages of this sport for the systems of the body? If the human body is likened to a machine in which every body part contributes to or is affected by the “run” then the three major human networks might be the locomotor, which is composed of the muscular and the skeletal systems, the support network composed of the circulatory, respiratory, digestive and urinary systems, and the regulatory, composed of the nervous and endocrine systems.

Locomotor Network

Musculoskeletal system: To see the benefits of “use” of the human machine, let us look at some of the negative effects of disuse. Stevenson,⁷ after reviewing NASA bedrest and water suspension studies, concluded that deconditioning manifests itself in loss of calcium and phosphorous from the bones and nitrogen from the muscles in a matter of seven days in healthy servicemen. Bed exercises including bicycling did not stop this wasting. This excretion stopped only when weight-bearing and ambulation were resumed. Donatelli⁸ described the effects of immobilization on the periarticular connective tissue. He concluded that movement maintains lubrication and critical fiber distance within the matrix to assure an orderly deposition of new collagen fibrils and prevent abnormal crosslink formation.

Does running affect the adolescent musculoskeletal system in negative ways in growth and development? Epiphyseal injuries have been identified by Pappas,⁹ Benton,¹⁰ Rovere et al.,¹¹ and Wilkins¹² as the weakest link in the musculoskeletal unit for adolescent athletes, but this is less frequent for runners. Some evidence exists that exercise affects growth of the prepuberal child if it is heavy and sustained, but according to Ryan,¹³ there is no good evidence that prepuberal children suffer more injuries; he contends that they probably have less than the adult.

Mersereau¹⁴ studied the photographic running patterns of sixty children 2½ to 5½ years of age and concluded that by five years the running pattern of the children resembled that of an adult. Smith¹⁵ did a five year longitudinal photographic study of the running performances of five children and found that as the children grew older they were taller, heavier, ran faster, had a greater stride length, less ground time, and could run further distances. Running was not found hazardous to their health. These were the same conclusions found in Brown's study of thirteen preschoolers, eighteen kindergarteners, 42 second graders and 33 fourth graders.¹⁶

According to Morehouse,¹⁷ exercise, including running, enables a greater number of muscle fibrils to be activated; causes muscles to become denser and heavier; increases the concentration of sarcoplasmic protein in the muscle; and causes ligaments, tendons and other connective tissues to increase in strength in the adolescent. In addition, chemical changes, such as increased muscle protein and muscle hemoglobin and storage of larger amounts of glycogen, phosphocreatine, and myoglobin, result in the more efficient action of the muscles. Morehouse concludes that exercise for children can increase the thickness of the cartilage at the joint and increase the manufacture of red and white blood cells in the bone marrow. An increase in the number of collaginous fibers produces a thicker and better cartilage to protect young joint surfaces. He maintained that the pressure of running stimulates bone growth up to the optimal length.

Apparently running does not affect the musculoskeletal system of children in negative ways unless the child is indifferent to the running surface, careless about the type or condition of the shoes used for running, has biomechanical faults in running which may stress ligaments and joints, or has unrecognized congenital problems. These are the same concerns of any runner, regardless of age.

Support Network

If we consider the support network: the circulatory, respiratory, digestive and urinary systems; we are studying the human machine's servicing mechanism for fuel processing and delivery, for oxygen intake and transportation and for waste removal. How does running affect this network in the adolescent runner?

Circulation: The heart becomes larger, slower and more efficient with running in adolescence but, according to Jokl,¹⁸ this is not to be confused with an enlarged heart from critical impairment of its functional capacity nor with a shorter life expectancy. Sady et al.¹⁹ noted that normal resting heart rates were higher in prepubescent boys than in adult men and that their HR increased less with exercise on bicycle ergometers than did that of the adults. This effect of age and exercise on heart rate was validated by Londeree et al.²⁰ in studying 25,000 subjects from 5–81 years of age on treadmill and bicycle ergometers. They also concluded that young girls have a higher rate than young males. Palgi²¹ studied 30 girls and 28 boys (10–14 years) and found that the girls had a significantly higher heart rate. He also found more vasodilitation with a greater peripheral blood flow on running.

Gilliam et al.²² studied the physical activity patterns of 59 children by recording heart rates before and during an exercise intervention program and concluded that children are not as active as they appear and do not voluntarily engage in high intensity activity. They recommended setting up an exercise trail on school grounds and setting up a large clock with a second hand on the playground to encourage children to run or walk around the school's playground before participating in recess.

Frederickson²³ studied the effects of training on the iron status in the blood of young women cross country runners and found five of the eight young girls had lower than normal hemoglobin. She concluded that iron costs were continually exceeding replacement. Sheehan²⁴ stated that intensive running can give all the laboratory findings usually associated with anemia (low hemoglobin, fall in hematocrit), but he called this a pseudoanemia. He stated that it is a sign of fitness because, in actuality, the blood volume has increased by about 25%. Sheehan suggested a temporary reduction in training during these periods to allow the body mechanism to regenerate iron. If iron was very low, he suggested taking it orally. Indices of red blood cell (RBC) status were assessed by Puhl et al.²⁵ on a high school girls’ cross country team versus controls. They assessed several times during the running season and found the running group had a higher RBC fragility, supporting the concept of increased RBC destruction rather than hemodilution as the cause.

Francis²⁶ found a high concentration of high density lipoprotein (HDL) cholesterol in blood of children who ran. He concluded that high levels of HDL cholesterol was a sign of fitness and that it lowered the risk of developing heart disease. The Bassler hypothesis stated that no cases of fatal atherosclerosis have been documented in marathon finishers of any age.²⁷ The idea that running elevates HDL cholesterol resulting in protection from coronary artery disease is a well publicized theory.

Increasing arterial blood pressure is...