Running Head: Adaptive Equipment Problems

 

Equipment’s Role in the Problems of Adaptive Rowing

Maddie Jacks

Newton North High School CAPS

 

Abstract

 

      The purpose of this report is to reveal the current problems found in adaptive rowing, and investigate these issues’ equipment-related causes. Information was gathered both through secondary research and primary interviews. A survey was distributed to add further data to the study, but results could not be obtained. From this research, it was found that problems in adaptive rowing come in three main forms: injury, slow race times, and lack of independence. To amend these issues, several equipment adjustments and recommendations were made.

 

Introduction

 

       For those who live with disabilities, such as amputations, cerebral palsy, multiple sclerosis, and spinal injuries, finding a passion that can allow them to leave their disability behind is priceless. As the adaptive rowers at Community Rowing Inc. in Newton, MA have discovered, crew is a great way to accomplish this. The sport of rowing has been around for centuries, and since its beginning, it has provided an athletic experience like no other. Though it has assumed the nickname “the sport of masochists” for the physical rigor and endurance it requires, it also creates unique bonds, both among rowers and between rowers and nature. As Nancy Greene said, “Rowing provides a place to go, a community where people care about what I did and what I achieved.”

 

      The sport has been available to those with physical and mental disabilities since the 1980s. However, for many decades, it was simply a form of casual exercise for these athletes; no one thought of adaptive rowing as a competitive sport. However, by the early 1990s, athletes with disabilities began to wonder why they were not racing as non-disabled athletes were. Soon after the push for competitive adaptive rowing, athletes with handicaps were given a chance to compete in the 2002 World Rowing Championships. Their events were so popular, in fact, that rowing was included in the 2008 paralympics as well.

 

      Because adaptive rowing is still in its infancy compared to many other paralympic sports, it lends itself to a slew of problems with equipment that have yet to be resolved. Before coming up with any solutions, however, one must first investigate the problems that need to be solved. The aim of this study is to expose the shortcomings of this equipment by examining the injuries sustained by adaptive rowers and their ability to compete without interference or assistance, and suggest fair ways to amend the issues discussed.

Due to the multi-faceted nature of this paper, the thesis will be unfolded with responses to these three questions:

 

                      1. What injuries do adaptive rowers sustain?

     

                      2. Are these injuries preventable, and if so, how?

 

                      3. How else does equipment hinder positive experiences in adaptive rowing, and how can it be fixed?

 

Background

 

      In order to understand the full scope of what is being discussed in this paper, one must first understand some basic information about adaptive rowing. Firstly, what qualifies someone to be considered a “paralympic” or “adaptive” athlete? According to the World Rowing Federation, FISA, “anyone who lives with “a disability leading to a permanent and verifiable activity limitation,” including impaired muscle power, impaired passive range of movement, limb deficiency, leg length difference, short stature, hypertonia, ataxia,  athetosis, or vision impairment is eligible to qualify to compete (Regulations 2).

 

      This wide variety of disabilities creates an interesting dilemma. How can one make the playing field even for all athletes if they possess different ranges of motion and ability? The answer to this is differs depending on the sport, but in rowing, it is relatively simple. FISA delineates four categories of adaptive rower: LTA (for which there is a separate category for visually impaired athletes), TA, AS, and ID (Intellectually Disabled).

 

      LTA (Legs-Trunk-Arms) athletes are scullers who are able to operate a slide and both oars. Although their range of motion is similar to that of a non-adaptive rower, there are still a couple of equipment modifications that can be made. Firstly, for athletes with visual impairments, light occluding goggles are required in order to make sure those with slightly higher visual acuity do not have an advantage. Pontoons are sometimes used for novice LTA rowers to give them more stability on the water, but they are not recommended for competition, as they cause drag and hence slower times. Lastly, some opt for tractor seats, sliding seats with lower back support. These prevent athletes from sliding off the back of the seat, but can sometimes become a hinderance to more elite rowers due to their bulk.

 

 

 

 

 

 

 

 

 

 

 

 

 

A Paralympic LTA quad without pontoons (left), a beginner LTA rower with pontoons (right), and an LTA tractor seat (below).

 

 

 

 

 

 

 

 

 

 

 

 

      TA (Trunk-Arms) rowers, unlike LTA rowers, can not use a sliding seat, and instead use a fixed seat to which their legs are strapped down. Though their legs are not used, TA athletes have a relatively large range of motion from hips to arms. Because their strokes involve the back moving from stern to bow, TA rowers do not often use seats with back support. However, AS (Arms-Shoulders) rowers do use such seats in order to provide support and prevent those with slightly more range of motion from using this to their advantage. Furthermore, AS competitors are strapped into these seats with a chest strap to prevent trunk movement. Both TA and AS rowers can use pontoons in competition, but they are only mandatory in AS competition.

 

 

 

 

 

 

 

 

 

 

 

 

A TA pair using backless fixed seats and leg straps (right), and an AS single with an AS fixed seat and a chest strap (left).

 

 

Discussion

 

      What injuries do adaptive rowers sustain?

      

      This question is not an easy one to answer. As of 2015, there is only one study specifically about the injuries sustained by adaptive rowers, the case study “Rib stress fracture in a male adaptive rower from the arms and shoulders sport class: case report” (Smoljanovic et al.). This study, though thorough, is not nearly enough to form any conclusions about the most significant injuries facing adaptive rowers. However, there have been quite a few studies in the last forty years about different adaptive sports, such as wheelchair marathon and paralympic track and field. Using the similarities between adaptive rowing and other adaptive sports, conclusions can be made about the injuries sustained by adaptive rowers.

 

      Before analyzing this data, it is important that a distinction is made between “wheelchair events,” those that require the athlete compete while sitting a chair, “amputee events,” those in which participants typically use prostheses, and rowing, which practically has a category of its own. In the context of epidemiology and injury frequency, taking the vastly different biomechanical functions of each group into consideration is critical. For instance, the relationship between a wheelchair marathon racer and his or her chair, and a paralympic rower and his or her seat is relatively similar. However, the common strains associated with amputee sprinting events are practically irrelevant when one is trying to identify injuries in rowers.

 

      Taking these differences and similarities into account, there are some trends that are applicable to adaptive rowers in the data of many studies on the injuries of adaptive athletes, including Madorsky (1984), Asayama (1985), Curtis (1985), Nilsen (1985), Bloomquist (1986), Shephard (1988), Martinez (1989), Ferrara (1990), Reynolds (1994), Ferrara (1996), Ferrara (2000), Klenck (2007), Patatoukas (2011), and Webborn (2012). Firstly, twelve of these eighteen authors expressed concern about pressure sores, or decubitus ulcers, in wheelchair athletes. These results are very relevant to rowers, because a boat seat is equally, if not more, rigid than a wheelchair. And, like wheelchair events, repeated and prolonged pressure is applied to the seat, which causes a significant force on the skin covering the tailbone.

 

      This especially true for TA, AS, and novice LTA athletes who can not to lift themselves off of the seat. For more elite LTA rowers, this may not be a problem because proper rowing form allows the rower to almost hover above the seat using the pull of the stroke (Whitwell). However, when the legs are not integrated into the stroke, as is true for the TA and AS classes, the seat acts as a support throughout the entire motion.

Other skin-related injuries were of interest to researchers as well. In eight of the eighteen studies, blisters, skin abrasions, and lacerations were reported as some of the “most common” injuries among adaptive athletes. While rowers may not be affected by such injuries in the same areas as other adaptive athletes, there is still increased friction in AS and TA rowers due to the straps required for competition.

 

      Both pressure sores and abrasions are specifically problematic for participants with paraplegia. Due to the nature of paralysis, paraplegic athletes have varying levels of feeling in their lower body. While some individuals may be able to feel pain, others are almost totally unfeeling in their entire lower half. Therefore, injuries that may be seen as relatively minor in non-disabled athletes can be detrimental in an adaptive athlete. For example, developing an abrasion during a training session may seem easily treatable and therefore relatively insignificant to a person with unimpaired nerve connection. However, if a rower with paraplegia were to sustain this injury, they may continue practicing without the knowledge that they have been wounded and turn what was a minor abrasion into a serious laceration.

The aforementioned studies also pointed to strains of the shoulder, upper trunk, and hamstring, as well as finger, hand, and wrist overuse injuries as recurring problems. However, due to the biomechanical differences between the events surveyed in these studies and rowing, these results can not be accurately used to make conclusions about rowing.

 

      Are these injuries attributable to unsuitable equipment?

 

      After identifying the most common and egregious injuries, it is important to investigate their causes. Furthermore, if new or adapted solutions are necessary, it is then critical to assess the preventability of these injuries through the means of equipment adjustment.

 

Pressure sores

 

      Pressure ulcers are most commonly found in people who are wheelchair bound, are in acute care facilities, have neurological disease, or are elderly. This is because the wounds form from prolonged pressure to a certain area without any shift in weight to allow for proper circulation and tissue reformation (Kirman et al.) Therefore, anyone unable to shift their weight by themselves, either due to a lack of feeling, motor control, or mental capacity, is susceptible.

 

      Because these sores are a relatively common and well understood phenomenon, coming up with preventative measures specifically for rowers is rather simple. First, we will examine the existing treatments as to whether they apply to an elite adaptive rower’s condition.

There are several simple preventative measures that any athlete should have no problem doing, including eating nutritiously, drinking ample amounts of water, exercising regularly, and keeping any sore-prone areas clean and dry (Berman). However, even with these precautions, pressure sores are sometimes unavoidable due to the unforgiving material that is currently being used in seats. Therefore, the seats must be redesigned to combat this issue. Because LTA rowers are, by definition, able to use their legs and thus are not paraplegic, I will focus on evaluating fixed seats, which are used by both AS and TA rowers.

 

      FISA’s Materials Committee amalgamated the equipment data from the 2012 Summer Paralympic Games in London into a chart including pictures of every individual seat used by adaptive rowers. From this chart, it is clear that there is some variety in the seats used by AS and TA athletes. Their seats seem to fall into two categories: carbon bottom and sling bottom (see images below, respectively). From these data, it was found that 13 athletes used just carbon seats, 3 used just sling seats, and 25 used foam to cover one of these.

           

 

 

 

 

 

 

 

 

 

Carbon-bottom seat (left) and sling-bottom seat (right)

 

      In order to assess whether each of these types of seats are safe and do not cause pressure sores, one must understand the methods with which support surfaces are tested. The National Pressure Ulcer Advisory Panel (NPUAP) has drafted four standards for surface testing in order to provide “objective means for evaluating and comparing support surface characteristics”, but until it is finalized it will not be available to the public (NPUAP). Until it is viewable, however, we must rely on the information already known about the qualities of support surfaces to analyze the adequacy of these seats.

 

      Though the standards themselves are not accessible, the resources used to support the drafted standards are. In NPUAP’s “Terms and Conditions Related to Support Surfaces,” related physical concepts, components, and features of support surfaces are defined, giving us a sense of what is important to consider when creating an adequate adaptive seat. Because these documents refer to support surfaces in a hospital setting, some considerations may not apply, such as the models of pressure redistribution for mattress, which require bulky, heavy technology that is not suitable for use on a boat. However, the physical concepts of friction, envelopment, immersion, mechanical load, pressure, pressure redistribution, and shear will all be important to consider in evaluating seat materials. Furthermore, the materials used in support surfaces that are listed, including viscoelastic foam, elastic foam, closed cell foam, open cell foam, gel, viscous fluids, and air can be used as a comparison tool for the seats already in use.

 

      Although the sling seats are relatively safe for use, carbon seats have proven much more problematic. Wintech’s fixed seats are made of carbon fiber-reinforced plastic, which has a rigidity of roughly 3.8 pounds per square foot. To put this figure in perspective, the rigidity of a typical wood, such as pine or oak, is around 10 pounds per square foot, and that of high-strength concrete is about 30. Clearly, carbon fibre is highly rigid, and this property allows for little to no envelopment, or the ability of a material to conform to irregularities of the body, and little to no immersion, or depth of penetration of a mass into the material. The higher the weight threshold for envelopment and immersion, the higher the pressure becomes, and therefore the higher the likelihood of pressure sores becomes. For these reasons, I conclude that rowers with paraplegia should not use a carbon fiber seat with no extra padding.

 

      Although the carbon seats themselves are extremely rigid, there are additional pads one can use in conjunction with the seats to lessen and redistribute pressure. As seen in the equipment chart, many athletes opt to cover the plastic with foam pads. However, despite their low rigidity, these pads are too thin to allow proper envelopment and immersion. It is doubtful that athletes prone to pressure ulcers would lessen the risk of sustaining one using these pads. However, FISA’s official “Adaptive Rowing Equipment List,” which outlines the approved equipment for competition, already has two pressure sore prevention technologies listed: the Vicair Allrounder and the Atkon Gel Pad. The Allrounder (pictured on the left below) is typically used in wheelchairs, and is characterized by its sectioned air pockets. Air, being one of the approved support surface materials, allows for envelopment, immersion, and pressure redistribution, all of which greatly lessen the probability of pressure ulcers. Though the standards are not available yet, it is likely that this technology would pass with ease.

 

      Like the Allrounder, the approved gel pads are used for pressure relief. Akton pads actually come in a variety of thicknesses and designs, ranging from ¼”  to ½” and having either a smooth or cubed surface. While gel is one of the materials used in certified support surfaces, such a thin product may not contain enough gel to truly act as a preventative measure. Even on Akton’s website, the description warns that the pads are “intended for comfort only, not medical intervention.” Therefore, one should use caution when using gel pads to prevent pressure sores in paraplegic athletes, or use them in tandem with other prevention technology.

 

      One may ask at this point, if there is pressure sore prevention equipment available and allowed in competition, then why are these injuries still problematic? In truth, this is likely because of a lack of awareness. Coaches, trainers, and athletes alike should become educated on the risk of pressure sores and compensate for this risk. The Materials Committee’s equipment data shows that only 4 of the 41 TA and AS competitors used Allrounders, and not a single rower used Akton gel pads. This rate is simply not enough to prevent sores, and once one is sustained, the likelihood of recurrence is 23-40% (Berman). I believe that Allrounders or other equally as supportive, pressure-redistributive equipment should be mandatory for rowers with paraplegia.

 

Abrasions

 

      Abrasions are a cause of chronic aggravation for all rowers. From “track bites” to blisters, dealing with frictional forces between one’s skin and one’s equipment can be challenging and painful. Although it may seem counterintuitive, these painful dermatological injuries are even worse for those who cannot feel them. Like pressure ulcers, abrasions are dangerous for athletes with paraplegia because if they are left unattended to, they can turn into severe lacerations, and possibly become infected.

 

The possible source of problems in AS and TA rowers is the straps required by FISA in their “Adaptive Rowing Regulations.” These regulations are as follows:

 

TAMix2x Strapping Requirements – rowers shall be secured with a strap to prevent flexion and

extension of the knee(s) during rowing. The strap must be secured under the seat or rails and

over the thighs, as close to the knees as possible.

 

AS1x Strapping Requirements – rowers shall use a strap that must be secured to the seat back

and around the torso just below the nipple line or the breasts and be tight enough to restrict

trunk movement whilst not restricting breathing. The point at which the strap is attached to the

seat should be no lower than the top edge of the supportive portion of the strap at the front

of the torso. Straps will be assessed with the spine straightened by bearing the weight of the

upper body through the arms while the buttocks and back remain in contact with the seat.

The supportive portion of the back rest of the seat must not be lower than the level of attachment

point for the front strap. The back of the seat may be covered with a soft material to prevent

injuries, but the covering material must not be thicker than 2 cm. If a bracket is attached to the

strap it must not rotate at the attachment point.

 

      These rules are understandable; the range of motion of athletes in the same class should be restricted to the rower in that class with the least mobility. In other words, if an athlete has some ability for motion in their trunk, but not enough that they qualify for TA races, they should not be allowed to use this extra motion to their advantage when racing against athletes with no trunk-movement capabilities.

 

      Though these straps may create fairer competitions, they also create abrasions. When pushed against repeatedly, the inflexible nylon chafes the skin, just as a runner’s shoes chafe the feet. In a 2000 meter row, the extent of this chafing may be minimal. However, the longer and harder these athletes train with straps on, the more severe these skin problems will be. If an athlete continues to compete week after week with an unattended abrasion, the wound could have more serious ramifications, including infection.

 

      Though the equipment could technically be amended by creating a more flexible strap, and therefore lessening the frictional force on the bound area, the rules of competition prohibit such a change. Thus, prevention becomes reliant on the attentiveness of coaches. Just as in the case of pressure sores, the athletes’ trainers must check athletes for abrasions frequently to avoid escalation of the injury. If an abrasion is found, then typical treatment methods, including bandages and anti-infection ointment, should be applied, and the wound should be monitored carefully as the athlete continues to row.

 

How else does equipment hinder positive experiences in adaptive rowing, and how can it be fixed?

 

      From the experiences of several rowers and coaches at Community Rowing Inc. (CRI), it has been seen that injuries are not the only problem that insufficient equipment causes. Inaptly-designed equipment also contributes to slower race times and forces adaptive athletes to depend on others to set up their equipment. Taking the opinions of CRI’s members, I have considered redesigning equipment in three different areas: pontoons, boat-carrying, and on-dock stabilization.

 

Pontoons

 

      One story of pontoon malfunction came from a Masters rower and adaptive volunteer, Laura Davis, who rows in an LTA double with a youth adaptive athlete. One day, not far into their first piece, one pontoon began to loosen and rotate from its original position. This caused so much splashing and drag that they had to stop and take the pontoon off. Had such a mishap occurred during race, their boat would have been disqualified. Furthermore, because these floatation devices are not well-designed to limit hydrodynamic drag, their use can potentially slow down race times.

 

      For these reasons, I propose a redesigned pontoon with a more rigid attachment mechanism to counter rotational forces and a sleeker body, mimicking that of a skull’s hull, to minimize drag. Due to time constraints, I have not yet created a model of such.

 

Boat Carrying

 

      As Jenny Sichel, an adaptive coach at CRI, said, “something that would make rowing more enjoyable for my rowers is the ability to get all their equipment down the docks independently.” For anyone, feeling dependent on someone else is encumbering, and for someone with a disability, this is often an accepted nuisance. However, allowing adaptive rowers to be completely self-sufficient would make a sport that is already capable of separating an athlete from their wheelchair even more freeing.

 

      The first way I propose to do this is to create a device that allows adaptive rowers to self-carry their boats. Because different adaptive athletes use different apparati to get around, coming up with a universal boat carrying solution has been quite challenging. The first step in thinking about solutions was to find out all of the different ways that athletes do get around. One of the most common ways is by wheelchair, which are almost always manually operated. The other popular mode of transportation is using one or two crutches. Also, some adaptive athletes are able to walk with ease, but have a single arm amputation, which prohibits them from self-carrying their boats.

 

      With these variations of transportation in mind, I knew that the device I had to make must be modifiable to the needs of many. Luckily, however, there was a baseline for a boat carrying design that I discovered when volunteering at CRI: the boat dolly (pictured below). With this seesaw-like device, two volunteers can do the work of four by placing the boat on the two cradles, and wheeling it down to the dock. From there, the boat is pushed into the water directly from the slings.

 

 

 

 

 

 

 

 

 

 

 

 

 

      In order to modify this device to fit the needs of adaptive rowers, two considerations must made. First of all, the athlete must be able to pull or push the boat without worrying about it slipping off of the slings. This requires that an two extra straps be added to go over the boat and under each sling for stability. Secondly, the mechanism with which the rowers push or pull the boat must be adaptable to different needs and must also mimic the abilities of a human arm. Because terrain is often sloped from boathouses to docks, I decided that pulling the dolly would be easier than pushing it. However, this means that the attachment mechanism from the boat to the rower must be rigid, so that the boat does not hit the rower as he or she descends ramps. In order to satisfy all of these requirements, I decided that the best attachment technique would be a metal rod welded to the the end of the beam of the dolly with a cushioned plate on the end of it. Attached to the cushioned plate would be carabiners to allow for different kinds of straps depending on the user’s needs. A single velcro strap would be provided to go around the torso of those who use crutches and two connected loop straps would be provided to go around wheelchair users’ chair handles. For rowers with a single-arm amputation, their functional arm can be used to pull the boat. Below is sketch of the proposed technology:

 

 

 

 

 

 

 

 

 

 

      This device would allow for an adaptive rower with mobility challenges to successfully transport their boat from the boathouse to the dock. However, the problem of getting the boat from the dock to the water still remains unsolved. Even so, this technology will greatly increase adaptive rowers’ independence, and hopefully therefore their happiness.

 

On-dock Stabilization

 

      Once the boat is in the water, a rowers next step is to enter the boat. USRowing’s “Guide to Adaptive Rowing” provides a catalog of the available adaptive rowing equipment, which includes “transfer equipment,” equipment designed to assist adaptive rowers from their chair and into the boat. In this section are three designs, all of a similar nature (pictured below).

 

 

 

 

 

 

 

 

 

 

 

      While this equipment is a usually essential part of the chair-to-boat process, it alone does not always allow athletes to be completely independent. Once down on the dock, the rowers almost always require a volunteer or coach to hold the boat steady for them as they get in. Therefore, I propose a piece of equipment designed to steady the boat upon entry. As the guide says, “adaptations do not have to be complicated or expensive,” and our device is not. I propose a design using the Bracket Conversion Set found on Revolution Rowing’s site (pictured below), and redrilling the holes to fit ⅜” hex bolts. Then, these devices could be bolted to the dock and affixed to any boat with pontoon brackets, allowing stable entry. Because all AS rowers use pontoons, and many TA rowers do as well, this solution would service almost everyone who need assistance getting into their boat.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The bracket on the left would be bolted directly under the boat’s pontoon bracket (on right) as shown by the red square.

 

Conclusion

 

      Creating reliably safe and effective equipment for any sport is challenging. But, for adaptive sports this task is even more difficult due to the variability in how each individual interacts with the equipment. Despite its difficulties, adapting equipment to the sport of rowing to allow rowers with disabilities the same safety, performance quality, and freedom as typical rowers is crucial in making adaptive rowing a positive experience.

 

      From my research, I have learned that abrasions and pressure sores are the two most common injuries among adaptive athletes. In rowing, both types of wounds can be avoided if coaches are vigilant and check to make sure that they are not forming in places that athletes with paraplegia cannot feel. Furthermore, the FISA-approved equipment should be better integrated into rower’s seats for further protection.

Through working at CRI, I have also discovered that equipment can be used to improve other problems as well, including the pace of races and rowers’ independence. Using technology that I have designed, I believe that adaptive rowers will make steps towards faster times and being completely autonomous.

 

      Although I hope that my research will improve the sport of adaptive rowing, there is still much work to be done in order to get it up to the standards of typical rowing. With further research into the prevalent injuries and discomforts experienced by adaptive rowers, we can design more solutions, make lives easier and more pain-free, and help one of the newest adaptive sport become the safest.

 

Bibliography

 

To view the bibliography, please visit the link given at the top of the page.