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Essay: Rehabilitation through sport—pilot project with amputees in Angola
Essay Rehabilitation through sport—pilot project with amputees in Angola Jorge Carvalho, Amy Farkas “While sport has value in everyone’s life, it is even more important in the life of a person with a disability. This is because of sport’s rehabilitative influence, and the fact that it is a means to integrate the person into society . . . sport teaches independence”.
Lancet 2005; 366: S5–S6
Panel: Benefits of sport for individuals with disability ● ●
International Working Group on Sport and Development
Within the global agenda of sport for development lies a specific population—people with a disability. The World Bank estimates that 600 million people, or 10% of the world’s population, have a disability, of whom at least 500 million live in the developing world. These numbers continue to increase as a result of political conflict, accidents, and a high incidence of untreated disease for example. Sport has an important role in the lives and communities of all individuals, but has benefits beyond those applicable to all for individuals
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Assists a person to come to terms with their disability Reduces the focus on the impairment or disability and focuses more on a person’s abilities, leading to empowerment and greater self-confidence that can be applied to other areas of life—eg, education and employment Strengthens participants both mentally and physically, increasing their capacity for self-help Increases peer interaction and socialisation, since people with a disability often remain in the home environment, protected and guarded by their families Promotes inclusion of girls and women who are often stigmatised by their sex as well as their disability Provides opportunities for teaching empathy; by involving participants with and without a disability in sport programmes, there is increased understanding and sensitivity about individual differences that can also assist in preventing social exclusion
with a disability (panel). The importance of sport for re-education and rehabilitation is undisputed. After World War II, traditional methods of rehabilitation could not meet the medical and psychological needs of the large numbers of soldiers and civilians with a disability. As a consequence, and at the request of the British Government, Ludwig Guttmann founded the National Spinal Injuries Centre at the Stoke Mandeville Hospital in UK in 1944. Guttmann introduced sport as a form of recreation and as an aid for remedial treatment and rehabilitation. His work was the basis for the Paralympic Movement. When Pope John XXIII received Sir Ludwig Guttmann at the opening in Rome of what are now considered the first Paralympic Games he called him the “Coubertin of people with a disability”. Guttmann himself never tired of repeating that the best thing he did in his medical career was to introduce sport into the rehabilitation process, giving three reasons for its importance. The first was the therapeutic value of sport in improving the functional capacities of patients and surpassing the constraints imposed by traditional medicine. Second, was the psychological effect of sport to overcome problems of identity caused by disability, especially in people who saw themselves as different, torn between rejection and acceptance of their own body. The practice of sport, Guttmann noted, leads to motivation, pleasure, courage, and strength. Finally, Guttmann described sport as a means of social inclusion because of the visibility of the positive aspects www.thelancet.com Medicine and Sport Vol 366 December 2005
Jorge Carvalho is a Professor in the Faculty of Human Kinetics at the University of Lisabon, Portugal, and has been the national technical director for the Portuguese Sports Federation for the Disabled (FPDD) since 1993. Amy Farkas has a Masters degree in Disability Studies from the University of Illinois, USA, works with numerous organisations on international development projects that use sport as a tool for sustainable development, focusing on the needs of people with a disability, and is development manager for the International Paralympic Committee. International Paralympic Committee, Adenauerallee 212–214, 53113 Bonn, Germany (Prof J Carvalho, A Farkas MSc) Correspondence to: International Paralympic Committee [email protected]
S5
The International Paralympic Committee is the international governing body of sport for athletes with a disability. It supervises and coordinates the organisation of the Paralympic Summer and Winter Games and other multidisability competitions on an elite sport level. The Committee is made up of 161 National Paralympic Committees, five Regional Paralympic Committees, and four International Organisations of Sports for the Disabled. With the mission to organise successful Paralympic Games and its expansive membership the International Paralympic Committee is also responsible for developing sporting opportunities worldwide for athletes of all standards—from grassroots to the elite. See http://www.paralympic.org
See http://vvaf.org
S6
that sport brings in relation to people with a disability, making them the subject of the action and empowering them with capacity and potential to be active members of society. Here, we describe the rehabilitation through sport project in Angola, which was created and implemented by the International Olympic Committee, the International Paralympic Committee, the National Paralympic Committee, the National Olympic Committee, local government, and local rehabilitation centres. The aim of the initiative is to increase the quality of life of people with a disability in postconflict or developing nations, through the mobilisation of expertise in the import and application of sport in rehabilitation, through a human-rights based approach. Sport is a perfect foundation for such a project because it is a universal activity, popular with mainstream society, can be accessible to all, and can be implemented at low cost. In theory, for every project set up, rehabilitation professionals, focusing on physiotherapists, will receive three 2-week training sessions spread over 12 months. During these sessions, they will learn about the benefits of sport in the rehabilitation process, how to teach and lead sport-activity sessions, and appropriate techniques for coaching athletes through their rehabilitation and on the field of play. They will also be told about the opportunities that are available in their country for people with a disability. The professionals will then organise regular sporting activities both in the rehabilitation centre and in the community. Those trained will, in
collaboration with the National Paralympic Committee, be responsible for creating or expanding a network of volunteers to ensure there is communication within the community. A comprehensive toolkit of training materials and sports equipment for successful implementation of these projects will be provided, and is being developed through a pilot project in Angola. Angola was chosen as the site for the pilot project because it is among the top three countries most affected by landmines. From 1975 to 2002, Angola endured a civil war during which many people lost limbs. Unfortunately, the risk from landmines remains. According to the Vietnam Veterans of America Foundation, there are more than 2200 known minefields in Angola, which killed or injured 660 people in 2004. The Angolan National Paralympic Committee, the Angolan National Olympic Committee, the Angolan Government, and the Bomba Alta Orthopaedic Centre (COBA) are all involved with the project. COBA is located in the Huambo Province and was selected as the site for the project because of its sophistication in providing rehabilitation services, facilities, human resources, and ongoing help to individuals newly injured by landmines. The centre is under the supervision of the Ministry of Health and is run at a provincial level by the Huambo Provincal Health Authority. In Angola, eight physiotherapists and sport trainers have, as of August, 2005, completed their training with one of us (JC), an international expert of Portuguese nationality to ensure effective communication. The sports equipment has been provided and activities are underway. This project has already achieved a great deal. It has brought together the International Olympic and Paralympic Committees in their first international development partnership, and nationally draws them together with support from local government. The project has also benefited the Huambo Province, torn apart by the civil war, in enriching the quality of services at COBA. And it has increased awareness of the abilities, inclusion, leadership potential, and rights of people with a disability in the province. The primary challenges now for the project in Angola are effective dissemination of the knowledge gained to other provinces and rehabilitation centres, and identification of ways to assist individuals with a disability and an interest in sport to advance to a higher level to train and compete. On the basis of the lessons learned during the setting up of the pilot project, the partners intend to revise the project plan and identify new nations in which to implement a similar project in the coming years. The drive to continue this project in other nations is primarily to provide an impulse to postconflict countries to improve opportunities for people with a disability and to expand the reach of sport for all.
www.thelancet.com Medicine and Sport Vol 366 December 2005
Lancet 2005; 366: S5–S6
Panel: Benefits of sport for individuals with disability ● ●
International Working Group on Sport and Development
Within the global agenda of sport for development lies a specific population—people with a disability. The World Bank estimates that 600 million people, or 10% of the world’s population, have a disability, of whom at least 500 million live in the developing world. These numbers continue to increase as a result of political conflict, accidents, and a high incidence of untreated disease for example. Sport has an important role in the lives and communities of all individuals, but has benefits beyond those applicable to all for individuals
●
●
●
●
Assists a person to come to terms with their disability Reduces the focus on the impairment or disability and focuses more on a person’s abilities, leading to empowerment and greater self-confidence that can be applied to other areas of life—eg, education and employment Strengthens participants both mentally and physically, increasing their capacity for self-help Increases peer interaction and socialisation, since people with a disability often remain in the home environment, protected and guarded by their families Promotes inclusion of girls and women who are often stigmatised by their sex as well as their disability Provides opportunities for teaching empathy; by involving participants with and without a disability in sport programmes, there is increased understanding and sensitivity about individual differences that can also assist in preventing social exclusion
with a disability (panel). The importance of sport for re-education and rehabilitation is undisputed. After World War II, traditional methods of rehabilitation could not meet the medical and psychological needs of the large numbers of soldiers and civilians with a disability. As a consequence, and at the request of the British Government, Ludwig Guttmann founded the National Spinal Injuries Centre at the Stoke Mandeville Hospital in UK in 1944. Guttmann introduced sport as a form of recreation and as an aid for remedial treatment and rehabilitation. His work was the basis for the Paralympic Movement. When Pope John XXIII received Sir Ludwig Guttmann at the opening in Rome of what are now considered the first Paralympic Games he called him the “Coubertin of people with a disability”. Guttmann himself never tired of repeating that the best thing he did in his medical career was to introduce sport into the rehabilitation process, giving three reasons for its importance. The first was the therapeutic value of sport in improving the functional capacities of patients and surpassing the constraints imposed by traditional medicine. Second, was the psychological effect of sport to overcome problems of identity caused by disability, especially in people who saw themselves as different, torn between rejection and acceptance of their own body. The practice of sport, Guttmann noted, leads to motivation, pleasure, courage, and strength. Finally, Guttmann described sport as a means of social inclusion because of the visibility of the positive aspects www.thelancet.com Medicine and Sport Vol 366 December 2005
Jorge Carvalho is a Professor in the Faculty of Human Kinetics at the University of Lisabon, Portugal, and has been the national technical director for the Portuguese Sports Federation for the Disabled (FPDD) since 1993. Amy Farkas has a Masters degree in Disability Studies from the University of Illinois, USA, works with numerous organisations on international development projects that use sport as a tool for sustainable development, focusing on the needs of people with a disability, and is development manager for the International Paralympic Committee. International Paralympic Committee, Adenauerallee 212–214, 53113 Bonn, Germany (Prof J Carvalho, A Farkas MSc) Correspondence to: International Paralympic Committee [email protected]
S5
The International Paralympic Committee is the international governing body of sport for athletes with a disability. It supervises and coordinates the organisation of the Paralympic Summer and Winter Games and other multidisability competitions on an elite sport level. The Committee is made up of 161 National Paralympic Committees, five Regional Paralympic Committees, and four International Organisations of Sports for the Disabled. With the mission to organise successful Paralympic Games and its expansive membership the International Paralympic Committee is also responsible for developing sporting opportunities worldwide for athletes of all standards—from grassroots to the elite. See http://www.paralympic.org
See http://vvaf.org
S6
that sport brings in relation to people with a disability, making them the subject of the action and empowering them with capacity and potential to be active members of society. Here, we describe the rehabilitation through sport project in Angola, which was created and implemented by the International Olympic Committee, the International Paralympic Committee, the National Paralympic Committee, the National Olympic Committee, local government, and local rehabilitation centres. The aim of the initiative is to increase the quality of life of people with a disability in postconflict or developing nations, through the mobilisation of expertise in the import and application of sport in rehabilitation, through a human-rights based approach. Sport is a perfect foundation for such a project because it is a universal activity, popular with mainstream society, can be accessible to all, and can be implemented at low cost. In theory, for every project set up, rehabilitation professionals, focusing on physiotherapists, will receive three 2-week training sessions spread over 12 months. During these sessions, they will learn about the benefits of sport in the rehabilitation process, how to teach and lead sport-activity sessions, and appropriate techniques for coaching athletes through their rehabilitation and on the field of play. They will also be told about the opportunities that are available in their country for people with a disability. The professionals will then organise regular sporting activities both in the rehabilitation centre and in the community. Those trained will, in
collaboration with the National Paralympic Committee, be responsible for creating or expanding a network of volunteers to ensure there is communication within the community. A comprehensive toolkit of training materials and sports equipment for successful implementation of these projects will be provided, and is being developed through a pilot project in Angola. Angola was chosen as the site for the pilot project because it is among the top three countries most affected by landmines. From 1975 to 2002, Angola endured a civil war during which many people lost limbs. Unfortunately, the risk from landmines remains. According to the Vietnam Veterans of America Foundation, there are more than 2200 known minefields in Angola, which killed or injured 660 people in 2004. The Angolan National Paralympic Committee, the Angolan National Olympic Committee, the Angolan Government, and the Bomba Alta Orthopaedic Centre (COBA) are all involved with the project. COBA is located in the Huambo Province and was selected as the site for the project because of its sophistication in providing rehabilitation services, facilities, human resources, and ongoing help to individuals newly injured by landmines. The centre is under the supervision of the Ministry of Health and is run at a provincial level by the Huambo Provincal Health Authority. In Angola, eight physiotherapists and sport trainers have, as of August, 2005, completed their training with one of us (JC), an international expert of Portuguese nationality to ensure effective communication. The sports equipment has been provided and activities are underway. This project has already achieved a great deal. It has brought together the International Olympic and Paralympic Committees in their first international development partnership, and nationally draws them together with support from local government. The project has also benefited the Huambo Province, torn apart by the civil war, in enriching the quality of services at COBA. And it has increased awareness of the abilities, inclusion, leadership potential, and rights of people with a disability in the province. The primary challenges now for the project in Angola are effective dissemination of the knowledge gained to other provinces and rehabilitation centres, and identification of ways to assist individuals with a disability and an interest in sport to advance to a higher level to train and compete. On the basis of the lessons learned during the setting up of the pilot project, the partners intend to revise the project plan and identify new nations in which to implement a similar project in the coming years. The drive to continue this project in other nations is primarily to provide an impulse to postconflict countries to improve opportunities for people with a disability and to expand the reach of sport for all.
www.thelancet.com Medicine and Sport Vol 366 December 2005