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Focus on Capabilities Not Disabilities Sports and Recreation for the Blind and Visually Impaired

Because most activities of daily living are visually guided, effective visual rehabilitation strategies require the use of a variety of adaptive techniques and technologies that take full advantage of the individual’s capabilities. This is especially true of service members and veterans who, because of their injuries, would like to continue to participate in sports, recreational and athletic activities, and competitions.

Service members of the U.S. Armed Forces and veterans are affected by many visually disabling conditions, including combat eye injury, traumatic brain injury (TBI)-related visual dysfunction, and age-related eye diseases. Patients with significant losses of central vision, peripheral vision, or total blindness require rehabilitation to successfully function in their daily activities. Because most mobility and other activities of daily living (ADL) are visually guided, effective visual rehabilitation strategies require the use of a variety of adaptive techniques and technologies that take full advantage of the individual’s capabilities. 

Both the Department of Defense (DoD) and the Department of Veterans Affairs (VA) serve the visually impaired, although since WWII, it has been the primary responsibility of the VA’s Blind Rehabilitation Service to provide most of the rehabilitation services to active duty service members and veterans who are visually impaired. The current conflicts in Iraq and Afghanistan, coupled with the aging veteran population, have placed an increasing demand on both of these federal health care systems to deliver a sufficiently coordinated and robust set of services. This has led to the establishment by Congress of the DoD/VA Vision Center of Excellence (VCE) (See “DoD/VA VCE”), to better enable effective visual rehabilitation of all of our wounded service members and heroes with disabilities.

SPORTS AND RECREATION

Participation in sports and recreation events and activities are important to the health and fitness of all persons.

However, service members and veterans with disabilities have an even greater need to participate in order to maximize their physical health and to assist their reintegration in social groups. Because of this, both the VA and the DoD support the active involvement of veterans and service members in athletics. In fact, the VA recently renewed its grant of $7.5 million to the United States Olympic Committee (USOC) to support athletic competition and recreation for persons with disabilities and for the athlete who is blind or visually impaired.1 The VA also conducts Summer and Winter “Sports Clinics” for veterans with disabilities, while the DoD promotes para-sports via its relationships with the U.S. Paralympics Committee at its Military Treatment Facilities and Warrior Transition Units.

COMPETITIVE SPORTS

The benefits of athletics are especially important for service members and veterans who have lost vision in active service, because many of these individuals have been recently involved in sports and competition. Their understandable desire to participate and compete is not only physically beneficial but offers them a critical affirmation of their recovery, enabling them to experience greater, more active involvement with their environment, a purposeful interaction with others, the opportunity to compete, and a greater sense of well-being and quality of life.2-5 (See “Blinded Athlete.”) A wide variety of competitive sports are available to blind and visually impaired athletes, many of which are official USOC sports (Table 1). In addition, there are other popular sports for the blind athlete not yet classified as Paralympics sports, such as archery, baseball, bowling, golf, sailing, shooting, and water skiing. As the “Para” in “Paralympics” implies, sports participation for persons with a disability traditionally had a much larger footprint for persons with paralysis and amputation injuries. In contrast, sports for persons with visual disabilities are a more recent addition to the competition, possibly accounting for only about half the number of para-events compared with those for disabled persons with normal sight.6,7 However, there is a second reason that athletics for the visually impaired lags behind other para-sports. Compared with other physical disabilities, visual disabilities are unique in their impact on the athlete, because they impair visually guided bodily movement, causing a physical limitation even when there is no physical impairment.8,9 Because of this, “blind” sports have a significant need for alternative rules, adaptive technology, and the engagement of trainers, mentors, and sighted guides. One important issue in competitive sports for a person with vision impairment is the requirement for a classification system of prospective athletes. At present, visual classification is strictly by central visual acuity and peripheral visual field of view and much like the current clinical grading of visual disabilities, there is unevenness in how this translates to functional ability. This is partly due to the variable impact of visual acuity reductions vs field of vision losses; with each affecting visual function differently. Performance differences are also due to unevenness in residual functional visual capabilities compared with the measured depth of visual deficit.8 Table 2 lists the current classification system of blindness, legal blindness, and low vision used by the United States Association.

Second, for blind and visually impaired athletes, access to community athletic facilities and services is often limited. Locally, this is because there can be issues regarding consistent and reliable transportation, trained personnel to provide instruction, and the variability of accessible equipment. For athletes desiring to participate at a competitive level, access to the necessary services is often limited. There are simply not enough facilities, trained staff, and volunteers, and these are inadequately distributed nationally to serve this need. Organizations such as the USABA and the IBSA are working hard to expand their services for blind and visually impaired athletes, including the solicitation and training of volunteers to act as classifiers, trainers, and mentors to prospective athletes. USABA’ s Military Sports Program has been established, in collaboration with the DoD, to provide services to our service members with a vision impairment. However, access remains an issue due to limited classifiers, facilities, and service locations, especially in rural areas. Third, adults wishing to participate in competitive sports while attending college or secondary education are frequently faced with a lack of mainstream physical education instructors who are trained to mentor them as an athlete with a vision impairment. The “mainstreaming” of para-sports, for visual impairments will likely take time to improve. This problem may have to do with the apparent “exceptionalism” of para-sports, making it difficult for educators and trainers to consider para-athletes in the same venue with the nondisabled. It is possible, however, that as the current conflicts wind down, the new generation of motivated veterans with a vision impairment will provide the impetus for a “new look” at this longstanding problem within the physical education community. Finally, although blind athletes have competed in the Paralympics for a number of years, there are very few technologic advancements to modify sports equipment for blind or visually impaired athletes. The present modifications include auditory cues, sighted guide, enhanced visual markings, or alterations of the target. Because of the extreme variability of the visual capability of each individual, some events have been modified to accommodate the participants using blindfolds so all participants have the same visual acuity. Again, the work of the USABA and the IBSA to provide a more functional definition of visual impairment, in relationship to each sport, is an important step that will help in this area. Once the capabilities of each athlete for each sport are better understood, it will be much easier for the team of clinicians, therapists, and trainers to design and study the most appropriate visually adaptive approach to treatment and training. Perhaps, the most important point is that those professionals who have found themselves supporting visually impaired athletes were typically not trained for that role. Neither were they trained to come together interactively in a multidisciplinary team to support a person with a vision impairment ambition to participate or compete in a particular sport. Solving this conundrum will take a paradigm shift involving all team members. The current situation, in which returning service members and veterans with vision loss desire a rapid engagement in competitive sports, adds priority to the issue and may help in stimulating the necessary change.

*Members of the Vision Center of Excellence Technologies Assessment Working Group:
Jackie Britton, Anthony Candela, Richard Cardillo, Zaskia Diaz-Marrero, Donald Fletcher, Duane Geruschat, Belinda Hawkins, Udobi Ikeji, William Kallenberg, Natayla Merezhinskaya, Mia Lipner, Sue Martin, Matthew McMahon, Maria Nevarez, Lukus Patterson, Eli Peli, Theresa Prudencia, Mark Riccobono, Paul Schroeder, Ronald Schuchard, Wanda Smith, Karen Spruill, Joan Stelmack, Nancy Strohm, Richard Wacker, Wanda Washington, and James Weiland.

Author Disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Quadrant HealthCom Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.


1 VA Awards $7.5 Million to U.S. Olympic Committee. United States Department of Veterans Affairs website. http://www.va.gov/opa/pressrel/pressrelease.cfm?id=2186. Updated October 19, 2011. Accessed May 14, 2012.

2 Marini M, Sarchielli E, Portas MF, et al. Can baseball improve balance in blind subjects? J Sports Med Phys Fitness. 2011;51(2):227-232.

3 Shapiro DR, Martin JJ. Athletic identity, affect, and peer relations in youth athletes with physical disabilities. Disab Health J. 2010;3(2):79-85.

4 Goodwin DL, Lieberman LJ, Johnston K, Leo J. Connecting through summer camp: Youth with visual impairments find a sense of community. Adapt Phys Activ Q. 2011;28(1):40-55.

5 Nakashima S, Miki Y, Miki T, Wang H, Yamasaki M. How the number of years of sports experience and the frequency of sports activities can influence the quality of life of people with challenges. J Hum Ergol (Tokyo). 2009;38(1):19-26.

6 Wilson PE, Clayton GH. Sports and disability. PM R. 2010;2(13):S46-S54.

7 Paralympic Sports by Physical Disability Group. U.S. Paralympics website. http://www2.teamusa.org/US-Paralympics/Sports.aspx. Accessed May 16, 2012.

8 Patel DR, Greydanus DE. Sport participation by physically and cognitively challenged young athletes. Pediatr Clin N Am. 2010;57(3):795-817.

9 Makris VI, Yee RD, Langefeld CD, Chappell AS, Slemenda CW. Visual loss and performance in blind athletes. Med Sci Sports Exerc. 1993;25(2):265-269.

10 Ponchilla PE. AccesSports: A model for adapting mainstream sports activities for individuals with visual impairments. RE:view. 1995;27(1):5-14.

11 IBSA Visual Classifications/USABA Recognized Low Vision Classification. United States Association of Blind Athletes (USABA) website. http://usaba.org/index.php/membership/visual-classifications/visual%20classifications/. Accessed May 14, 2012.