Download Outcomes of Adaptive Sports and Recreation

Brittany Johnson
Research Methods
Final Literature Review
October 30,2014
Outcomes of Adaptive Sports and Recreation Participation among Veterans Returning from
Combat with Acquired Disability
Regarding the military men and women returning home from combat war, more than
31% of veterans from the Iraqi and Afghanistan war meet criteria for a mental illness. These
illnesses consist of traumatic brain injuries, depression, anxiety, and the most prevalent; PTSD.
As Friedman expressed in the 2013 article, Finalizing PTSD in DSM-5: Getting Here From
There and Where to Go Next, Post-Traumatic Stress Disorder is developed after one is exposed
to a traumatic event such as sexual assaults, warfare, serious injury, or threats of imminent death;
physically or psychologically. The diagnosis is given when the following symptoms occur for
more than a month after the event: re-experiencing flashbacks, having negative cognitions or
mood states, numbing of memories of the event, hyper arousal, and being reckless or having selfdestructive behavior (American Psychiatric Association, 2013).
There are various interventions to help prevent and treat the mental illnesses for those
returning home from war but many are unsuccessful due to misunderstanding PTSD. A recent
trend in interventions for military personnel is adaptive sports programs. In the first article,
Stebbins (2012) analyzed the effectiveness of a winter sports clinic used as medicine or
rehabilitation on a retired Army Veteran. His findings of the particular individual were
established to be constructive to the veteran. The adaptive sports the participant took part in was
skiing but the sports clinic offered rock climbing, scuba diving, trapshooting, snowmobiling,
curling, and sled hockey. The Army Veteran had previously been diagnosed with PTSD and was
a double amputee (Stebbins, 2012). The sports program was aimed to imply aspects of trust,
social interaction, community reintegration, and self-esteem boosting activities. The study
elaborated only on what measures the individual had to contest to participate but proves the
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benefits of adaptive sports on military personnel due to the increase of competence and quality of
life. Hawkins and Crowe (2011) also examined how participation in a sports clinic such as a
Paralympic Military sports camp would affect the quality of life for injured service members.
Hawkins and Crowe analyzed 50 service members participating in sports such as rowing,
cycling, archery, volleyball, swimming, and track and field. The object of the Paralympics is to
gain independence and confidence while promoting self-empowerment. The sports at hand alter
the perceptions of the disabled and increases social reintegration. Some limitations to this
particular study is that the service members are from the same general area and willingly
participate in the program yearly compared to having a complete randomized study. Stebbins
study along with Crowe and Hawkins illustrate the gain of self-autonomy for the service
members returning home with little data or set goals for the studies.
Building on the importance of adaptive sports programs for military veterans with PostTraumatic Stress Disorder; Lawrence, De Silva, and Henley (2008) actively observed the effect
of sports/games in alleviating or reducing the symptoms of PTSD compared to other care
interventions. They discovered when an individual has PTSD, their emotional reactions to things
become uncontrollable so the utilization of sports and recreation helps take the emphasis off of
the negative aspects of PTSD by focusing on the positive through recreation. Through recreation
the veterans could enhance their self-discipline, communication skills, teamwork and being more
aware of the body versus just living in the body. The research concluded the participants had
increased self-awareness, less distress of situations, and reduced the hypervigilance by 42%
(2008).
Weaning away from the impact of PTSD specifically, adaptive sports can benefit those
with combat injuries such as traumatic brain injuries, spinal cord injuries, amputees, etc. A prime
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example of being beneficial to combat related injuries is Surf Therapy. French (2011) conducted
an evidence based article on the health benefits surfing can have on those injuries. Surf Therapy
programs assist individuals cope with mental and physical illness by increasing self-efficacy
through the engagement of physical activities. It becomes therapeutic due to the experience the
ocean offers but also rehabilitative due to the extraneous impact it has on the body. French
(2011) illustrated surfing can help alleviate back pain in those who have spinal cord injuries
because the individuals are forced to use every muscle in the body. Besides the physical benefits
of surfing, it can also be emotionally and socially benefiting. It helps boost self-esteem and
improve quality of life which can enhance all aspects of one who has a physical or psychological
disability (French, 2011). For military members, it gives them a sense of adrenaline like the
previous studies. Adrenaline seeking activities are significant to Veterans because that is what
they are used to and they tend to miss in civilian life. One of the biggest theories in this article
was that military members can become easily hooked on medications to numb the pain inside
and out. But with surfing they do not take the medicine and have no side effects unlike
medications.
Veterans not only face coping with mental illnesses as well as physical disabilities due to
combat in Iraqi and Afghanistan but have to cope with keeping or forming relationships,
especially family life. One of the first articles that tied in social support for Veterans as well as
adaptive sports was Addressing Posttraumatic Stress Among Iraq and Afghanistan Veterans and
Significant Others: An Intervention Utilizing Sport and Recreation by Bennet, Lundberg,
Zabriske, and Egget in 2014. This study was conducted to assess how effective an adaptive
sports program called Higher Ground can decrease symptoms of Post-Traumatic Stress Disorder,
personal growth after combat, and strengthen marital satisfaction in veterans who have served in
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Operation Iraqi Freedom and Operation Enduring Freedom: Iraq and Afghanistan. The study is
developed by the Sun Valley Adaptive Sports Program. This program consisted of skiing,
snowboarding, and evening activities. The study had two groups and one control group: one
experimental group had five participants and their significant other, another had six couples, and
the control consisted of six couples. Each participant was giving a pretest and a posttest to track
the findings of the study. The Sun Valley Program is geared to helping the veterans successfully
reintegrate into civilian life and reestablish healthy relationships. Those with PTSD have
decreased family functioning, poor communication skills, isolate themselves, and have conflict
in relationships so the program added in activities to enhance the problem areas (2014).
Families, particularly spouses were involved with the participation of majority of the
activities to not only support the veterans through the process but to get a better understanding of
one another. Research indicated that when veterans have been diagnosed with PTSD their
significant other would report less satisfaction with their life which leads to relationship distress,
intimacy difficulties, and psychiatric symptoms (2013). Considering the debilitating effects of
PTSD, it is not surprising that veterans and their significant others have elevated marital distress.
Having strong social support is one of the prime factors in being successful in any therapy
intervention those with combat related injuries undergo.
In further expansion of social support on the adaptive sports programs, the following two
articles elaborate on the significance of the program as well as participating in the programs with
loved ones. Bennet, Puymbroeck, Piat, Rydell (2014), analyzed how veterans’ perceptions of life
change during the participation in the fly-fishing program. The study’s intent was to reduce the
symptoms of PTSD, depression, anxiety, negative moods, and increase life satisfaction, leisure
satisfaction, and sleep quality. Six focus groups of four to seven individuals; 28 participants,
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were conducted and compared the perceived benefits and program components. Each participant
had a spouse or significant other along with them in the study. The groups lasted four days
fishing in Utah, Idaho, or Wyoming rivers. The men got to fish 8 hours out of the day and had no
evening activities planned. The object of the study was to learn a new activity while enhancing
problem areas through recreation (2014). While the Veterans participated in the recreational
activities such as fly-fishing, their spouse was participating in the activities as well. Half of the
couples would spend the whole day together, and then go to dinner together. At each dinner
session, the couples were asked series of questions pertaining to the day to enhance affection,
communication, intimacy, etc. amongst the couple. The comparing groups, half of the couples
participated in the activity together but went their separate ways for dinner and were asked
individually questions about the day and the relationship shared amongst the couples. The results
were higher with the couples who spent the day together but went their separate ways for the
night due to needing a healthy moderation of time for the Veteran to focus and become a civilian.
The researchers found that when the couples spent time apart, the aspects of their relationship
were increased (2014).
Like the article above, Lundberg and Smith (2011), conducted a study on the outcomes of
adaptive sports and recreation programs among veterans with acquired disabilities. The intent of
conducting this study was to see if changes in quality of life, relationships, mood state, and
competence were increased in a therapeutic adaptive sports and recreation program. The thesis of
the study was participation in such programs would increase physical, social, psychological, and
environmental quality of life. 18 veterans and their significant other participated in a three week
long study in Sun Valley Idaho. In the study the veterans took a pretest and posttest to analyze
the results of the program at the end. Results of the study showed a significant increase in overall
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health and those high impact adaptive sports programs for veterans can help improve quality of
life. There was a drastic increase in relationships at the end of the study due to the participation
and support from loved ones. As stated by Carroll, Orthner, Behnke, Smith, Day, and, Raburn
(2013), “Military families face daunting challenges as they attempt to build and sustain
relationship strengths while experiencing ever increasing demands and pressures” (pp. 559).
In conclusion, Post-Traumatic Stress Disorder is a debilitating illness that affects every
aspect of an individual’s life including the families. Many interventions are utilized to help the
individual cope with civilian life however many are unsuccessful. What the therapists do not
understand is the Veterans are reluctant to discuss traumatic events during combat due to the
stereotype; therapists will not be able to understand. The adaptive sports programs are operated
to be individualized and allow the Veterans to participate in adrenaline induced activities, which
offer opportunities to challenge them, improve their quality of life, self-awareness, competence,
and feel like a person again, not someone who is just living in their body. The researchers touch
base on the prominence of the success rate for the veterans when they have social support,
especially from their loved ones. Having a joint participation makes the Veterans feel as if they
are not alone and they spouse is putting forth the effort to comprehend. The articles and research
I have found specifically on adaptive sports programs are not aimed around talking about the
problems; it is about feeling as if they can contribute to civilian life through partaking in
everyday activities. Through recreation, the individuals feel supported and comfortable which
ultimately allows them to open up about their illness or injury. Adaptive sports programs
concede on the importance of investigating how the physical self is tied into emotional or
psychological self, as well as state of mind. Adaptive sports can be a good alternative
intervention compared to treatments such as pharmacotherapy or cognitive behavioral therapy.
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Regardless of the lack of actual implementation in many of the articles, the final result of
adaptive sports is that there are no side effects to adaptive sports programs and recreation.
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References
Bennet, J., Lundberg, N., Zabriskie, R., & Egget, D. (2014). Addressing Posttraumatic Stress
Among Iraq and Afghanistan Veterans and Significant Others An Intervention Utilizing
Sport and Recreation. Therapeutic Recreation Journal, Vol. XLVIII,(No 1.), 74-93.
Retrieved October 22, 2014, from file:///C:/Users/Brittany/Downloads/3723-15677-1PB.pdf
Bennet, J., Puymbroeck, M., Piat, J., & J. Rydell, R. (2014). Veterans’ Perceptions of Benefits
and Important Program Components of a Therapeutic Fly-Fishing Program. Therapeutic
Recreation Journal, Vol. XLVIII(No. 2).
Carroll, E. B., Orthner, D. K., Behnke, A., Smith, C. M., Day, S., & Raburn, M. (2013).
Integrating Life Skills into Relationship and Marriage Education: The Essential Life
Skills for Military Families Program. Family Relations, 62(4), 559-570.
French, A. (2011). Surf therapy. Surfer, 52(4), 96-102.
Friedman, M. J. (2013). Finalizing PTSD in DSM-5: Getting Here From There and Where to Go
Next. Journal Of Traumatic Stress, 26(5), 548-556.
Hawkins, B., Cory, A., & Crowe, B. (2011). Effects of Participation in a Paralympic Military
Sports Camp on Injured Service Member. Therapeutic Recreation Journal, Vol. XLV(No.
4), 309-325.
Lawrence, S., De Silva, M., & Henley, R. (2008, June 15). Sports and Games for Post Traumatic
Stress Disorder (PTSD). Retrieved October 22, 2014.
Lester, P., & Flake, E. (2013). How Wartime Military Service Affects Children and Families.
Future Of Children, 23(2), 121-141
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Lundberg, N., & Smith, S. (2011). Outcomes of Adaptive Sports and Recreation Participation
Among Veterans Returning from Combat with Acquired Disability. Therapeutic
Recreation Journal, Vol. XLV, No. 2, 105-120.
Stebbins, J. (2012, June 1). Finding Their Footing. Retrieved October 23, 2014.