Week 4: Climbing guide, presentation and overall thoughts

Welcome to Part 2 of my weekly Sport for Confidence blog. If you haven't read Part 1 yet, click here to read it.

Climbing guide and presentation

Throughout the week, I have been working on the climbing guide with Gab and Alana. I feel that we have worked well together. We had a meeting early in the week and came up with a plan and a list of tasks for each of us. I have been researching and thinking about the physical demands of climbing, the physical benefits of climbing, and exercises that will help a person to start climbing and make progress as a climber. Of course, there’s a difference between indoor climbing (bouldering) and outdoor climbing as well as free climbing versus harnessed climbing, so there isn't a 'one size fits all' approach. There are some general strengthening exercises that will benefit all climbers though. 

We also recorded a group presentation which we shared with Liz and our tutors. In the presentation, we shared our experiences on this placement so far, as well as our opinions on the possible role for a physio in SfC. You can watch the presentation here.

I think it has become clear that there is an emerging role for physios in SfC. They could work alongside OT's and coaches to assess new participants, screen for red flags and set collaborative goals. Physios can do risk assessments and give advice for managing injuries or pain. Working with individuals in the gym and devising an exercise programme would help to take some of the load off the OT's and coaches. Also, a physio in SfC could work with the local outpatient physio team to make sure the exercises are relevant to what the participant wants to do. 

"Ok, very funny! Who's hidden all the dumbbells?"
Source: Pixabay

These are my personal reflections for future practice as a MSK physio: 

1) Always think about different types of communication, including body language, tone of voice and expressions. Is the person truly understanding what I’m telling them? If not, can I say the same thing in a different way? Communication goes both ways. Am I truly understanding what my patient is telling me?

2) Be adaptable to changing circumstances. Think on the spot and don't be afraid to change plans if needed. For example, what if there isn't enough equipment? What if there are more participants than we were expecting? What if one or more of the participants cannot yet do the exercises that we’d planned? 

3) Make sure the goals and treatment plan are relevant to the person. If someone hasn’t done the exercises I’ve given them, think about why that might be. I shouldn't assume that they're being lazy.

4) Teamwork. Know my own scope of practice and don't be afraid to refer a patient on or ask another member of the team for advice. When doing a group project, make sure everyone in the team knows our common objectives, and then devise a plan before attempting to ‘just crack on with it.’

Looking forward

There has been a lot to think about in this blog entry. Certain aspects of this placement have been challenging, such as managing my own workload, dividing tasks with other students, and investigating how physios could fit into the SfC model. But I have learnt a great deal about people’s individual experiences with inclusive sports, and how physical activities have benefitted them mentally and socially as well as physically. It’s hard to measure and quantify how much confidence sport and exercise gives people in their lives, but the case studies show that physical activity in a group can be the gateway towards meeting other like-minded people and finding a new purpose in life.

When I start working as a physio, I want to make sure I am mindful that I am talking to a person with real thoughts, feelings, experiences and ambitions. I don’t want to be someone who just asks yes/no questions, comes up with a diagnosis and treatment plan, gives my patient a list of exercises and sends them on their merry way. The physiotherapy profession is always evolving and changing, and I hope that I will continue to change with the times and grow as a person. This SfC placement has given me so many experiences that I will remember for life - and it's not over yet! I've got three more days left, and I will make the most of those three days.

Week 4: Case studies, inclusive climbing and leisure centres

It’s come to the end of week 4, which means that I only have three days left on my placement with Sport for Confidence. I think this week has been productive, and I’ve enjoyed working with Gab and Alana. I can see a clearer role for physiotherapists in SfC than I did even a week ago, and in some ways it’s a shame that the placement has to end so soon.

Online meetings with disability and inclusive climbers

This week, we had online meetings with an inclusive climbing group and a disability climber. First, we spoke with Max from Not So Trad, an LGBTQ+ climbing group. After introducing ourselves, Max shared his personal experiences with the climbing community, and how Not So Trad has become more inclusive and diverse since it was founded. It was very useful to get an insight into the need for inclusive climbing groups and what they can offer. I’ve been thinking about how I can encourage people from marginalised groups to join a club in which they feel included and safe, to help them become active and reduce the risk of physical inactivity. When I become a fully-fledged physio, I intend to keep making connections with inclusive and diverse sports in the area (e.g. Colchester Kings RFC, an inclusive rugby club), so that I can signpost people to these groups when needed.

Gab, Alana and I also had an online chat with Clare Hands, a teenager who took up climbing after she experienced a life-changing stroke at the age of 13. We spoke to Clare and her mum about their experiences with climbing and how it has positively changed both of their lives. They told us about their local climbing wall, and the types of climbing equipment that can be used to help people with different disabilities. Clare's story is incredible. I am in awe of her persistence and her positive outlook towards life. Clare showed a remarkable level of bravery and determination to take up climbing, and her mum has been amazingly supportive all the way. Their story has inspired me to think about how important it is to know about local disability sports and to break down barriers that might be stopping people from being active.

Indoor bouldering is just one type of rock climbing, but it's easily accessible to most people.
Source: Pixabay

Basildon

Gab and I visited Basildon Sporting Village, which is where Sport for Confidence started. We spoke with Lyndsey, the director of SfC. Not only has she grown SfC from just one participant to where it is today, but she told us a moving story of her own experiences and struggles with the healthcare system. She emphasised how important it is for Allied Health Professionals (e.g. PT's, OT’s, speech & language therapists and dieticians) to keep persisting with so-called ‘difficult’ or ‘awkward’ patients. Lyndsey very nearly lost her ability to play netball as a result of a rare disease, but it was the OT’s and physios who got to know her personally who made the most difference to her recovery.

At Basildon, we spoke to some of the regular participants who attend both an MSK physio clinic and SfC. They benefited from the MSK appointments because the exercises they have been given are relevant to the activities they enjoy at SfC. I can see how important it is for physios to give people exercises that are relevant to the activities and tasks that they want to do. A generic, bland sheet of exercises will soon find its way underneath a mound of paperwork, but a personalised exercise plan incorporated into a sport is much more likely to be successful.

As a side note, I have to say that Basildon Sporting Village has an amazing athletics track!
Source: Pixabay

Colchester & Chelmsford leisure centres

Gab and I visited the sports centres in Colchester and Chelmsford again. In Colchester, we helped a participant in the gym with her individual exercise programme. We were able to talk through her exercises and adjust them as appropriate. I can see a clear role for a physio here, as it would take the load off the OT’s and coaches.

Multisports was good but we had to make changes to the basketball activities. Two people in my team were wheelchair users who had limited use of their legs, and two other participants had limited verbal communication and required a lot of facilitation from their carers. We adapted the games by using a big soft ball instead of a hard basketball, so that the participants could propel the ball with their feet. This made the whole session so much more enjoyable and rewarding. In future, I will always think about ways to adapt exercises and activities, e.g. using different equipment or changing the objectives of the game to make sure that everyone in the team benefits from the activity.

Part 2 of this week's blog entry will be up very soon!

Week 3: Halfway review, reflections and tennis

 Thursday: Halfway review and working from home

Thursday was another virtual day. In the morning, I had my halfway review with Liz. I thought that we had a good discussion about the placement so far, and I was happy with Liz's feedback. I have a clear idea of what is expected from me and the other students for the next two weeks, although I think we need to be honest with our educators and make sure we don’t take on too many projects, given that the placement is so short. Going forward, I will include a deeper level of self-reflection in my blog articles, as this is something which I have avoided so far! 

Over the next two weeks, I will also try different forms of adaptive communication such as Makaton when needed. A recent BBC article on Makaton being used in the special Olympics football team caught my eye. I plan to pick up some Makaton over the next couple of weeks. Even if I don't use it on this placement, there's a fair chance that Makaton will come in helpful at some point in my physio career.

Another learning point for me is how to approach and build up a rapport with people online. When asking people about their experiences with adaptive sports, we should remember to get to know them as people first. After all, we're designing projects for real people with life stories, hopes and ambitions. Liz reminded me of the #hellomynameis campaign. As healthcare workers, it's easy to dive straight into an assessment, but we shouldn't forget the human element behind communication. We're finding out why people have chosen a particular exercise, and how it gives them confidence in other areas of life. I know I wouldn’t appreciate being sent a long list of questions from someone who hasn't tried to get to know me. This is something I'll bear in mind going forwards.

I spent some time arranging online meetings with members and participants of various snooker and climbing groups. We were very kindly invited to meet a climbing group in Cumbria for a pint and a climbing session. It's a shame that we're so far away from the rugged cliffs of Cumbria! I would always be up for a climbing session and a pint, but I think a Zoom chat is more realistic!

I'm not sure if this is Cumbria but it looks mountainous!
Image sourced from Pixabay

Friday: Chelmsford

Gab and I went to Chelmsford on Friday. This is our third visit to Chelmsford, and we feel, like in Colchester, that we are building up a good rapport with some of the regular participants. Friday’s classes included an introduction to group exercise (a small class with seated resistance exercises), a big boccia session and multisports. Tennis and ping pong were on the menu for multisports, and I think it worked well. I’m far from being the best tennis player myself, but I gave one of the participants some individual practice. He also tends to lose concentration and gets distracted very easily, so I encouraged him to stay focused. He did much better when he was focused on the task at hand.

Game, set and match!
Image sourced from Pixabay

Also, at the end of the group exercise session, one of the participants asked Gab and I for advice on managing pain. She is a wheelchair user and finds that she experiences elbow pain when using her wheelchair. We gave her some general advice on simple pain relief (e.g. heat and cold packs) and remembering to stretch and do regular arm exercises to avoid prolonged static positions. I think our physio education on pain relief and activity modification came in useful here.

Next week

Next week will be my last full week with SfC! It's become a bit clichéd to say 'time has gone by so fast' but it's true. 4½ weeks for a physio placement isn't long at all. I'll make sure I continue to get the most out of my time with SfC. Gab & I will visit another leisure centre (Basildon) next week and the three of us will crack on with our project work.

Week 3: Visits, chats and projects

It’s come to the end of week 3 of my physio placement with Sport for Confidence (SfC). Like the first two weeks, my days have been a mixture of virtual work and visiting local leisure centres. 

Monday: team meeting and getting on track with projects

Monday was a virtual day where I did some research for the project that I’m doing with Gab and Alana. Looking back at the beginning of the week, I think we were still a bit confused as to what the finished product should look like. We had a chat with Jo (our supervisor at Essex Uni) who suggested that we speak to Liz to clarify what we need to do by the end of the placement. She recommended that we draw up a GANTT chart or something similar, to make sure that the three of us know what we’re doing and when. I'm not exaggerating when I say that GANTT charts strike fear into my very soul, but the idea of coming up with a weekly plan and dividing tasks between us is a good one. I think if I was to tackle a group project again, I would make sure that we’re crystal clear in knowing what we need to do early on, so that we can plan our time, divide tasks out each week and meet at the end of the week to check that we’re all managing okay with our tasks.

Tuesday: social chat and Zoom chat with Lucy

Tuesday was another virtual day. I was a bit worried that I would lose focus, but it turned out to be a useful day. We joined a social Zoom chat with Sophie (OT), Charlie (OT assistant) and one of the regular SfC participants. The chat was quite structured, which I thought worked well, because it gave everyone a chance to contribute. We also had a chat with Lucy, one of the OT's who works in Canvey. It was interesting to hear about the differences in demographics in each area. Lucy was open to the idea of physios working for SfC, which is one of the things we're investigating on the placement.

Wednesday: Colchester

We spent Wednesday at Colchester leisure world. We're getting to know the staff and some of the regular participants. I was happy to see some of the regulars approaching us and initiating conversations. This will be good for practising their social skills. In terms of physio intervention, Gab & I helped a participant in the gym. He's a wheelchair user who recently fractured two ribs. We came up with modified exercises to work his upper body muscles without putting pressure on his ribs. The last thing we wanted was for him to be in agony! I feel we put our physiotherapy skills to good use here.

Source: Pixabay

We also designed and led the warm-ups for boccia and football. Leading the warm-up gave both of us confidence, and it was also a great opportunity for us to put our physio skills into practice. The coach, Toby, appreciated us doing the warm-ups and the participants seemed to enjoy the difference.

One of the participants, who I have developed a good rapport with over the last 2-3 weeks, came in complaining of pain on the inside of his foot. There was another participant last week who told us his arm hurt when he swam, but we found that group exercises appeared to distract him from the pain. I carried out a brief assessment with the participant who had foot pain - essentially to rule out red flags. I was satisfied that his pain didn't indicate anything serious so I encouraged him to take part in the sports, but to take breaks if he needed to. He said his pain was no worse at the end of the session. I will use that experience to think about how to assess people with pain in the future.

We finished the day with a football session, which involved a series of drills in small groups followed by short football matches. After the football session, one of the participants said that he felt excluded from the game because other people were not passing to him. My observations were that everyone was included, but in future I will make sure that I try to pass the ball to the less confident players to give them a chance.

Click here to read part 2 of my weekly blog entry

Week 2: Snooker, climbing and general thoughts

Snooker and climbing project:

On Thursday, Gab and I visited a bouldering wall. This is my local climbing wall in Colchester, so I already know some of the staff who work there. We spoke to one of the staff members about his experiences with inclusive or adaptive climbing. He said that he considers climbing to be an inclusive sport and that Paraclimbing is becoming popular. At the Colchester climbing gym, there is a regular climber with learning disabilities who climbs with his carer. Some of the walls would be difficult to access for wheelchair users due to the lack of ramps, and the staff member says that he doesn't see many climbers with physical disabilities, but not to say there aren't people with 'hidden' disabilities.

Whike we were there, we went for a climbing session! As we were climbing, we were thinking about the activity analysis for bouldering, and whether it would be suitable for SfC participants. It would be unfair to make a blanket statement along the lines of: 'SfC participants can't do bouldering.' There's no such word as can't! However, our thoughts are that bouldering without harnesses or equipment would be difficult due to the level of supervision that would be needed for most participants. Bouldering is demanding on the body and it requires a good level of strength, endurance, coordination, flexibility, balance and planning. 

I have watched a case study involving a teenage girl who had suffered a severe stroke, who was able to climb with harnesses and support post-stroke. Our thoughts at this time are that harnessed climbing would be a better option than unharnessed bouldering, depending on local facilities.

As a side note, my triceps still ache three days later!

This week, we have been contacting inclusive and adaptive climbing and snooker venues. I’ve contacted the CSP (Chartered Society of Physiotherapists) DisAbility and LGBTQ+ networks to see if anyone knows of any inclusive or adaptive climbing centres. Several members responded, and gave me the details of local inclusive climbing groups that they know about. So far, I’ve contacted a number of disability and LGBTQ+ friendly climbing companies and venues, so hopefully I’ll hear back from them soon! Snooker is proving to be more of a challenge, but Gab and I might visit some local snooker venues to see what provisions they have for people with disabilities. Of course, it would be a shame not to have a game of snooker while we're there!

General thoughts:

Week 2 has given me more insight into the range of sports and activities that SfC can offer. I’ve also thought more deeply about activity analyses for sports such as boccia and climbing. Based on the processes that are involved in carrying out these activities, I’ve thought about the safety aspect of climbing. Bouldering might not be feasible for many of the regular SfC participants, but there may be some participants who could attempt bouldering after a screening tool followed by an exercise programme to work on strength and balance. I think that physios could play a role in designing exercises for people, which use specific muscle groups to allow them to progress to a new activity.

Also, we felt that we helped the participant in the gym by giving him cues for good form and by progressing his exercises. There is a potential role for physios here.

Next week, we will be designing a boccia warm-up that focuses on balance, with modifications for wheelchair users. I’ll also be having two virtual days so that the three of us can work together on our projects. I can't believe the time is going so quickly!

Week 2: Leisure centres (re)visited

I’ve finished week 2 of my placement with Sport for Confidence. Gab and I split our time between visiting leisure centres and working at home for our group projects. We’ve been working online with Alana to find information for our projects on inclusive climbing and snooker. Alana has been able to visit and contact local places in Bristol, which adds some extra strings to our bow (not that we’ve practiced archery yet!)

Colchester:

On Monday and Wednesday, Gab and I visited Colchester Leisure World, where we met Sam and Sophie, two of the OT's who work for SfC. We helped out with the sports and activities, which included boccia, dance, football and multi-sports. When it comes to boccia, some of the participants are incredibly accurate with their throws! Don't underestimate anyone.

Sam recommended that we read the ‘activity analysis’ page of the SfC boccia booklet and make a note of the different aspects and processes that are involved in playing boccia.

A performance analysis involves determining the demands of an activity, the range of skills involved and the meanings associated with the activity. I paid attention to the activity analysis for boccia while we were playing the game, and I thought about the ways in which the game can be modified. People with limited use of their upper limbs can, with the help of their carer, use a ‘slide’ to move the ball. Alternatively, people can kick the ball. Some participants need prompting to remind them to take their turn. The space between the participants and the hoops / jacks can be decreased if needed.

We will use the boccia performance analysis as a guide for our climbing and snooker projects. Also, a possible role for physiotherapists is to suggest modifications or even certain exercises for individuals who are finding it difficult to throw the ball due to a neurological or musculoskeletal condition. We can also suggest balance exercises as a warm-up as suggested by Sophie, because boccia does require sitting balance.

While we were in Colchester, Gab and I worked with a participant in an individual gym session. He already has a set gym programme which he manages himself. We watched him carry out his exercises, paying attention to his form and technique, and we thought about how to progress his exercises. We suggested a couple of small modifications to his technique, to protect his spine, and we progressed some of his exercises. I think this is an area which physiotherapists can help with SfC. Movement analysis and exercise progression is a key component of physio, and I felt that Gab and I were able to contribute in a meaningful way.

Return to Chelmsford:

On Friday, we returned to Chelmsford. The first session was an introduction to group exercise class, which is a seated class that is geared towards people with physical disabilities or limited mobility. Last week, we practiced boxing which the participants liked – although my boxing partner said she felt sore the next day! This week, we practiced ball skills and boccia. I think this class works well because it’s a small group, and the fact that the exercises are different each week adds variety to the class.

We also did basketball, which involved a series of drills in small teams followed by two matches. I have been really pleased to see that the team sports are very inclusive. The staff at SfC are excellent at making sure that everyone is included in a match, and the participants enjoy the challenge of playing a match. It is true that there will always be a wide range of abilities in each game, and some players will naturally tend to dominate. However, we made sure that the other players had a chance to dribble and shoot so that they weren’t left behind.

First week: Part 2

Overall thoughts from week 1

I think week 1 was a success. I'm glad to have had the opportunity to visit local leisure centres and to take part in group activities with SfC. The team has been very welcoming and I can see how the OT’s and coaches make sure that everybody is included.

As a physio student, I know how important exercise is for physical health (1), and I like the fact that the range of SfC sessions offers something for everyone. The exercise classes range from seated activities such as boxing practice and boccia, to more dynamic activities such as basketball and volleyball. There is no expectation that the participants have to be at a certain standard, but they are all encouraged to take part. As well as the obvious benefits of physical activity, I can see how the classes give the participants confidence in terms of social skills, taking turns, following instructions and leading others.

Physios and SfC

I’ve been thinking about how physios could contribute to SfC. When we had the 1-on-1 gym session with the lady who has muscular dystrophy, I think we did offer a different perspective to her treatment plan, as we were able to identify specific movement patterns. From there, we suggested some exercises that would be helpful to her.  

If SfC was to employ physios, it would have to offer something different to standard outpatient physio. If a SfC participant has a specific MSK problem as well as an underlying condition (e.g. communication difficulties or MS, for example), then they could be assessed by a physio at an SfC session, and then be referred to MSK physio. Another potential benefit of physios is that we can observe gait and movement patterns of individual participants, and we could recommend specific adjustments or exercises that might help (of course, just because somebody has an ‘unusual’ gait pattern, it doesn’t mean that it needs to be corrected.)

I'm sure I'll come up with more thoughts over the next few weeks!

Looking ahead to week 2

Next week, Gab and I are planning to visit local leisure centres again. We’re going back to Chelmsford for a day next week. This will be good because we can continue to build up a rapport with the participants, carers and staff. Some people were already beginning to open up with us last week, so it will be good to see them again.

We’re looking forward to working with Alana, who’s starting her physio placement with us this week. She will be doing her placement virtually, so this will be a challenge and an opportunity for all of us. I’ll need to make sure we stay in regular contact with Alana and keep her fully in the loop. We’re arranging online chats with OT’s, including Tom who analyses the data. The data tells SfC about the demographic make-up of the participants – it will be interesting to find out if any population groups are over- or under-represented compared to the general population. Gab and I are also planning to visit the local climbing gyms so we can make a start on our project.

References

(1) Nystoriak MA, Bhatnagar A. Cardiovascular Effects and Benefits of Exercise. Front Cardiovasc Med. 2018 Sep 28;5:135. doi: 10.3389/fcvm.2018.00135

First week: Part 1

 

Introduction

Hi, thanks for reading my blog! My name is Jon West, and I’m a 3rd year undergraduate physiotherapy student at the University of Essex. I am currently on my final placement, where I will be spending five weeks with Sport for Confidence, before I finish my degree in June. I am doing this placement with two other physio students, Gab and Alana. Gab is also studying at Essex, while Alana (starting next week) is at UWE in Bristol. We will be the first physio students in the Sport for Confidence team, which is exciting, but we will need to get used to - and embrace - the uncertainty!

I had already heard of Sport for Confidence from a previous placement that I did last year. On that placement, I took part in a ‘buddy day’ where I spoke to an adult with a physical disability, to gain a deeper understanding of her lived experience. She told me that she attended Sport for Confidence and particularly enjoyed boccia.

Before starting my Sport for Confidence placement, I met Liz (my educator) and my fellow students, Gab and Alana. Liz gave us an overview of Sport for Confidence (SfC). In a nutshell, SfC is a social enterprise that deploys OT’s and coaches to utilise sport and physical activity to enhance a person’s health and wellbeing. This is very much in my area of interest. I believe that adopting the biopsychosocial model of health is the right way to help people. We need to take social and psychological factors into account. After all, people are more than just a collection of bones, muscles and nerves!

Liz sent us some videos to give us an idea of what SfC is about, and what kind of activities they do. Liz suggested that we develop a resource for inclusive climbing and snooker as part of our placement. As a keen climber, I can see the benefits of inclusive climbing, so this is something I’m really looking forward to doing.

First week: Visiting leisure centres

On Wednesday, Gab and I visited the leisure centre in Chelmsford. This is one of the centres in Essex where SfC is based. The team at Chelmsford gave us a warm welcome, and we helped out with a one-on-one gym session with a lady who has muscular dystrophy (MD). She told us that she has a type of MD called Facioscapulohumeral dystrophy (FSHD). I wasn’t familiar with this type of muscular dystrophy so it was a great learning experience for me. The lady was very happy to talk to us and she was grateful for our input.

We spent some time by the swimming pool where we spoke to some of the participants, and then we took part in a basketball session. The team sport sessions are organised and run by SfC staff, but they designate some of the participants as assistant coaches. It seems to be a great confidence booster for the participants who are given the responsibility of setting up a session and organising others.

On Thursday, Gab and I visited the leisure centre in Witham. The leisure centre is smaller than the one in Chelmsford, but it is well-equipped and, like Chelmsford, boasts a swimming pool. Interestingly, the demographics are different in Witham; most of the participants are people with learning disabilities, whereas in Chelmsford it is more varied.

We took part in two dance classes which were fun but exhausting! I need to up my dancing game! At the end of the dance class, each participant took it in turns to choose their own song and dance to it. I thought this was really good, as it gave everyone a chance to shine.

We took part in the swimming pool session in Witham. The session was well attended, with about 20 participants plus carers. Many of the participants were wheelchair users, but water-based activities gave them a chance to use their whole body. One participant in the swimming session was a young man who attended with his mum, his sister and a carer. We learnt that he will only go into the pool when his mum is with him, as he is too anxious to go into the water without her. However, it is a delicate balancing act; mum has expectations that he will make a significant recovery, and she seems to put a lot of pressure on herself.

In the next part of this blog entry, I will talk about my learning points, overall thoughts and my general musings on how physios can contribute to SfC.

Stay tuned for part 2!