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Jena Munson, a certified therapeutic and brain injury specialist, coordinates an adaptive golf program for individuals with disabilities called Back 2 Swing, part of the Sports and Leisure Program offered through the recreational therapy department at Alegent Health Immanuel Rehabilitation Center in Omaha, NE.

Since 1996, golfers who have sustained injuries such as stroke, amputation, spinal cord injury and brain injury have been able to attend weekly clinics to receive equipment and instruction on adaptive techniques from Munson and golf professionals. Activities range from practicing on the driving range to playing in local tournaments.

Therapeutic Golf
Golf can be used to improve fine-motor control, gross-motor control, balance, endurance, social participation and self-esteem. Clients may start at different levels and progress at different rates throughout therapy.

"Rehab can go from not being able to pick up the golf tee to actually playing a round of golf," Munson said. By using activity analysis, a therapist can determine what steps are necessary to get clients on the golf course. Table 1 provides a brief activity analysis of a typical golf game.


It is important to keep in mind that each individual is different, and the game may need to be adapted according to the individual's needs. For instance, "Bob" is being seen in a rehabilitation setting after a left CVA. He has right hemiparesis with decreased tone in his right arm, and some right-side neglect. Bob is right-hand dominant, and has been working on bilateral activities to strengthen his right arm. Occupational therapy has addressed dressing and feeding, but Bob's ultimate goal is to be able to golf with his grandchildren again.

The therapist feels that this is an achievable goal but realizes that the task must be broken down into smaller steps. Bob has difficulty placing the ball on the tee. He also has poor balance that will interfere with his stance and safety while hitting the ball. Bob's inability to participate in his favorite leisure activity since his stroke has negatively affected his self-esteem.

The therapist starts by having Bob sit at a table and practice placing tees into a peg-board while playing a game of tic-tac-toe. After Bob gains some fine-motor control, he begins to practice placing a golf ball onto the tee while sitting, then progresses to doing so while standing to work on static balance and standing endurance. Next he practices putting with a putt-putt game. The game is more realistic and Bob remembers what it feels like to hold a club and hit a golf ball. Bob is able to work on weight bearing/weight shifting to his affected side during this activity, and his standing endurance and dynamic balance also increase. He is able to gain awareness of the affected side and engage in bilateral upper-extremity use while swinging the putter. Eventually, Bob is able to go to the driving range with his grandchildren.  

Overall, doing simple tasks he enjoyed has increased his fine-motor control, static and dynamic balance, endurance, gross-motor control, eye-hand coordination, upper-extremity strength, range of motion, and self-esteem. Physical activity is important to recovery, as it "helps to prevent disease, promotes health and maintains functional independence" (Kennedy, Taylor, & Hindson, 2006).

Psychosocial factors are also important to recovery. O'Sullivan (2005) states, "the level of satisfaction gained from participation in leisure activities is directly related to a positive attitude and feelings of well-being." Participation in a golf program may help to decrease anxiety and depression, improve stress management, and provide a healthy coping mechanism.

Adaptive Golf Equipment
A variety of adaptive golf equipment is available to golfers with a wide range of disabilities. Munson notes that a significant part of the Back 2 Swing program is the Single-Rider Golf Cart.

This cart allows an individual with a disability complete access to the course, including greens and sand traps. He can play from a seated position, or the seat can swivel 360 degrees and be raised to a standing position. There are straps to hold the golfer in place, and special controls that allow him to move the cart and control desired positioning. This is a great device for people with standing, endurance and balance issues.

"Barry" was injured in a car accident in 1998. He sustained a spinal cord injury at the T6 level and is now paraplegic. At the time Barry was injured, there was not any adaptive golf equipment available in his area. Barry had enjoyed golf before his accident, and wanted to return to the course, despite the fact that he could not stand or walk. Determined to complete a round of golf, Barry would push his wheelchair the entire nine, and sometimes 18, holes.

Following course guidelines, Barry was not able to finish by putting at the end of each hole because his wheelchair was not allowed on the putting green. It was challenging and exhausting for Barry to push his chair throughout the course because there were many bumps and hills. Barry also had to have a friend join him to carry his bag and assist him with teeing up the ball.

After Munson and the Alegent Health Immanuel Rehabilitation Center received grants through the United States Golf Association to fund four single-rider golf carts for Omaha-area golf courses, Barry was able to putt and complete a round of golf without exerting a tremendous amount of energy. Instead of using most of his energy to push his wheelchair, Barry is now able to focus on improving his golf swing and becoming a more independent golfer. In fact, when Barry returned to his own community, he spoke with his local city council, and within a few weeks two of the courses near him had Single-Rider Golf Carts.

Many other adaptive golf aids are available to assist golfers with a variety of special needs. Adaptive gloves are available for individuals with arthritis or decreased grasp to ensure better control and grip of the club. Golf clubs adapted to a specific angle allow the golfer to hit more accurately from a seated position. There are also adaptive devices that help with teeing and picking up the golf ball for individuals with back issues or those with decreased range of motion. Upright Golf, located in Cedar Falls, IA, has a variety of adaptive golf equipment. Knowing what equipment is available and where to get it will help to increase involvement in adaptive golf.       

Getting Involved With Adaptive Golf
Adaptive golf is a leisure activity that a therapist can introduce to clients whether they are beginning golfers or self-proclaimed golf professionals. Occupational therapists are great professionals to promote the use of sports in rehabilitation because of "their knowledge and skills in activity analysis, equipment adaptation, and psychosocial issues" (Hanson, Nabavi, & Yuen, 2000, p. 337). Therapists can also become an advocate for their communities, inform clients of available resources and encourage clients to advocate for themselves, as Barry did.

The following are a few helpful tips to getting an adaptive golf program started:

·         Research local programs and other available resources (Table 2 contains a list of helpful adaptive golf resources).

·        Suggest golf as a leisure activity to clients.

·        Become familiar with golf rules, etiquette and equipment.

·        Find the most accessible local courses.

·        Find local golf and other professionals willing to collaborate.

·        Attend golf /adaptive sports workshops.

·        Explore fundraising and grant opportunities to acquire equipment.

 

Adaptive golf is one example of how using leisure as a therapeutic tool can improve quality of life. Collaborating with other professionals and researching different opportunities will help increase awareness of what programs are available, and provide new ideas to use during therapy. Using sports and leisure as a therapeutic tool can truly enhance quality of life, and provide an opportunity to live life to its fullest.

Shauna Fox is an occupational therapy student at the College of Saint Mary in Omaha, Nebraska. She will graduate with her MOT degree in May 2010.

References available at www.advanceweb.com/OT or upon request.


 

Wonderful article! I facilitate an adaptive golf program for wounded active duty troops and veterans out of the Tampa VA hospital weekly at a local course. We use Solo Riders, adaptive equipment for our participants for patients in and out of the hospital that are rehabbing at our facility. Of all our adaptive sports that our therapists provide (RT, OT, PT, KT) the adaptive golf clinic/program is offered the most consistently for which we are delighted! I was wondering, do you know of any research, data, statistics, articles that link vestibular therapy to golf? I was searching the internet and your article popped up. I am attempting to accumulate information, and I thank you for your great read and wonderful work....that parallels my passion! Good luck with the rest of your studies until May 2010! Thanks again, Kathryn Bryant, CTRS, CBIS

kathryn Bryant,  CTRS,  James A. Haley Veteran's HospitalJanuary 23, 2010
Tampa, FL



great article!!!! I am proud to see the involvement in Omaha as it is my home town!! Thanks for the details on this!!!

barb fleege,  otr/l,  mary greeley medical centerAugust 20, 2009
ames, IA




     

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