Occupational Therapy and Wheelchair Fencing: Slashing into New Roles

The Olympic games have been an area of great public interest for centuries; however, the Paralympics has only started to receive recognition in the last decade. Documentaries such as Rising Phoenix and social media platforms such as Challenge Athlete Foundation and Move United have started to bring more public interest to adaptive sports and the Paralympic games. When thinking about the games usually people will mention track and field, swimming, and ball sports. Few respond with wheelchair fencing, exemplified by the event not even being televised during the Tokyo 2021 games. When thinking about the fastest things in the Olympics and Paralympics one starts to conjure up ideas of sprinters, bikers, or marksmen; however, the second fastest thing in the Olympic Games is the tip of a fencing weapon. Fencing is in a unique sport that works on improving reaction time, physical fitness, and mental acuity. Fencing can offer many accessible options for individuals, it can be done by the visually impaired, individuals with mobility deficits, and those with the inability to stand and move. In Olympic fencing the athletes utilize their legs to set the speed, distance, and build on their actions. In blind fencing, a new subset of accessible fencing, the athletes utilize a texture strip to determine where they are and set up actions based on feel. In wheelchair fencing the athletes utilize their core and arms to lean forward and backwards in the chair to set distance and set up actions. Wheelchair fencers utilize fast hand speed and body movements to build actions in a tight space, making it an almost completely different sport from able-bodied fencing.

Occupational therapy is a medical rehabilitation that focuses on improving quality of life, restoring ability to perform daily activities, and to promote participation. Occupational therapists work to help individuals thrive and regain their footing following disability, injury, and other life events. Occupational therapists work in adaptive sports to help modify the environment, provide adaptive workouts, and help build equipment. Now, what does wheelchair fencing have to do with occupational therapy? Let me start by telling you about myself and my journey in the sport and as an occupational therapist.

I was born with a rare genetic condition called Ehlers Danlos Syndrome. With this condition I experience dislocations, hyperextensions of joint complexes, and endure chronic pain. I spent most of my young adult life struggling to manage my chronic pain, maintain a social circle, and often found my quality of life slipping. Growing up I felt isolated, struggled with alcoholism, and often felt I lacked a community. I did not know any other disabled people in my early life, which made me struggle to find a life path forward. However, when I found wheelchair fencing I found a community, started making goals, and found a sense of self again. I have represented the United States at two world championships and am representing the US at the Paris games. Finding a community and a sport that pushed me to do more, changed my life and taught me how to thrive despite my disability. My experiences in adaptive sports pushed me towards occupational therapy. Through connection with other disabled individuals, I saw the importance of mentorship to help others cope with their own life challenges. I strive to be an occupational therapist who helps my clients learn to thrive again and fill the needed niche of disabled practitioners who clients can relate to. As an occupational therapist I wanted to give back to the community that has done so much for me. Therefore, I focused my research on the quality-of-life impact wheelchair fencing has on individuals with disabilities. I studied how it impacts the able-bodied community, and I developed clinical practice guidelines to help with advocacy of occupational therapy in wheelchair fencing and for program development. Occupational therapists should have a role in the interprofessional team that can build not only great athletes, but also thriving individuals.

The purpose of the research was to investigate the quality-of-life impacts wheelchair fencing has on both able-bodied and disabled athletes in the short-term and long-term. Quality of life was measured through physical health (reported functional outcomes, pain levels, stamina, and sleep quality), social participation, mental health (reported happiness, self-confidence, anxiety, and future mindset), and cognition (problem solving and attention). In addition, this capstone worked on establishing programs in New York and New England and established program development outlines.

The study is a mixed method design combining a quantitative survey with a qualitative phenomenological research design method. Semi-structured interviews were conducted and analyzed through in vivo coding to identify themes. Participants were individuals who were currently active in fencing or retired from fencing, who had experience with wheelchair fencing. Participants were recruited through snowball and convenience sampling via an email blast. Thirty-five individuals participated in the survey process and twenty-five individuals participated in the semi-structured interview portion of the study.

Quantitative data found no correlation between age, gender, and fencing experience. Most participants noted they are greatly affected by pain, have a positive mind-set about the future, have a lot of self-confidence, have access to multiple leisure activities, have disabled friends, and are satisfied with their social needs, physical health, quality-of-life, mental health, endurance, and access to sports. A majority of able-bodied participants noted that wheelchair fencing improved their technical skill, changed how they viewed disability, and benefited from wheelchair fencing while injured. Data showed that fencing was different from other sports and is desired due to the individuality of the sport, community, and mental aspects of the sport. Qualitative data supported the quantitative data. Three main themes with ten sub-themes were identified. 1. Why fencing: a. Mental Challenge, b. Provides both individual and team dynamics, and c. Longevity of participants. 2. Impact on able-bodied participants: a. Appreciation and awareness of adaptive sports, b. Skill improvement, and c. Improvement of mental health while injured. 3. Quality-of-life impacts on disabled participants: a. Improved physical health, b. Access to a supportive community, c. Improved cognitive processes, and d. Improved mental health. In terms of impacts it was found that wheelchair fencing significantly improved the physical health, mental health, socialization, and cognitive processes of disabled participants. In addition, this research found that the main draw to fencing are the mental game, community, and longevity of the sport for all populations of individuals. Wheelchair fencing was also shown to have positive impacts on able-bodied peers who trained with wheelchair fencers. These positive impacts were improved technical skill and changes in the view of disability and adaptive sports. Community was shown to be an important aspect of improving quality of life during the research process. Based on these results and occupational therapy theories, clinical practice guidelines were developed in order to act as a guide for building programming, producing strong athletes, and building a bigger community.

Clinical Practice Guidelines for Program Development

1. 1 Fencing coaches and adaptive sports programmers may utilize adaptive sports to improve, 1) social participation, 2) physical health (functional mobility, cardiopulmonary health, pain levels, and muscle function), 3) mental health (PTSD, depression, and reported happiness improvements), and 4) cognition (global cognition, attention, and social behavioral skills) in their participants.
2. Fencing coaches and adaptive sports programmers may utilize goal writing, working with the athletes to establish program and individual goals, in individual training programs to improve athletic performance.
3. Fencing coaches and adaptive sports programmers should use sport specific conditioning in their training programs to decrease the risk of injury in their athletes, including stretching, muscle training, and neuromuscular training.
4. Fencing coaches and adaptive sports programmers may seek to improve reaction time, speed, flexibility, and strength in their participants to improve sports performance and decrease sports anxiety.
5. Fencing coaches and adaptive sports programmers may incorporate individualized routines into their programs, such as warm up routines, daily routines, and program structure, to decrease sports related anxiety.

Chart one outlines the critical CPGs of the program. To display the utilization of these guidelines in practice, we shall work through a case study from the research study.

The athlete: The athlete is a male in his early twenties. He sustained a high-level spinal cord injury when he was a child resulting in decreased abdominal, latissimus dorsi, and torso strength. Prior to building a plan for him he noted that he had difficulty with performing at the level of his opponents. He had difficulty with retreating in his new back brace and with being able to perform heavy blade actions and flicks without severe fatigue and shoulder pain. He approached our team because he wanted to build strength, endurance, accuracy, and start being able to keep up with the competition. Early on when discussing with the athlete we noted that he did not have any solid goals for the sport, which was impacting his motivation. Mental and emotional tools were included in the plan to help the athlete succeed.

Goals:

1. 1. In two weeks, he will be consistent with performing the workout and can do so independently.
2. He will be able to transfer independently from the floor to chair and chair to chair while utilizing his back brace, 50% of the time within six months.
3. He will be able to land 75% of his flicks by June. [This goal incorporated reaction time.]
4. He will identify what his STG and LTG in the sport are by the end of the week. a. He did go on to identify his goals and noted a spark in motivation following this.
   Long-Term Goals:
5. He will be able to increase ROM backwards to a functional level in the sport.
6. He will be able to accelerate forwards, utilizing the back arm for power, to a functional level in the sport.

The interventions: A strengthening plan was made for the athlete that included shoulder strengthening, speed training, reaction time training, and repetition of skills to build a motor plan. In addition, discussions surrounding routines were conducted. Working with the athlete we made him a schedule of when to do what exercises and drills. Due to the schedule, he was consistent with the program and saw improvements within a few weeks.

End results: 15 weeks following the program plan for this athlete the following improvements were seen: improved shoulder stability, strength, reflexes, ROM, and speed. Mentally he was able to process information faster and had reduced frustration. The athlete had achievable goals and motivation. One year following this program the athlete qualified for the Paralympic games. Through the use of the CPGs we were able to help the athlete reach peak performance and improve QOL through improving physical, mental, and emotional health.

My research surrounding the quality-of-life impacts of wheelchair fencing highlights its multifaceted benefits for athletes, regardless of their physical abilities. From the immediate gains in mobility and mental well-being to the enduring effects on physical fitness and empathy, wheelchair fencing emerges as a transformative endeavor with far-reaching implications. By recognizing and harnessing the power of this sport, we not only empower individuals to reach their full potential but also foster a more inclusive and compassionate world. Occupational therapists are well suited to help enable these improvements in individuals through their specialized training of working with many disabilities and conditions. Occupational therapists can improve patient quality of life through adding adaptive sports into their programs. Next steps for this project would be to use findings from the research and apply it to the 2028 LA Games program development guidelines for building the sport nationally.

Suggested Resources:

IWAS: https://wheelchair-fencing.org/

USA Fencing: https://www.usafencing.org/

Special thanks to my advisor Elizabeth Kloczko Wescott, OTD, OTR/L for guiding me through this process and my mother Dawn Isaacson for editing my work.