Scuba Diving: The Tide Is In - scuba diving
and people with disabilities
© Parks & Recreation written by Kristen A. Johnson & Sara J. Klaas
An Innovative Approach to Treatment for Adolescents with Physical
Disabilities
The Project TIDE (Teenagers In Deep Environments) adventure program goes
outside the traditional hospital environment and uses scuba diving to
enhance self-esteem, communication skills, problem solving abilities, and
leisure education for teenagers with physical disabilities.
Involvement in recreation plays a significant role in fostering positive "I
can" attitudes in people with disabilities. With changes in healthcare,
staff are looking for new and innovative ways to continue to foster this
attitude. One area gaining particular attention is in adventure programming,
representing a paradigm shift from traditional treatment modalities.
Adventure Programming for Adolescents with Disabilities
Adolescence, particularly for persons with physical disabilities, is a
critical stage of human development. It's a period when the need for group
identification and social interaction is at its peak (Erikson, 1963). During
this complex stage of development, the single defining element for
self-concept is the need for a sense of personal identity (Goldhaber, 1986),
which is often formed through peer interactions, and having or sustaining a
disability during adolescence can have devastating consequences. Adolescents
with disabilities often experience a devaluation of their identities through
negative social interactions or through the absence of social interaction
altogether (Cogswell, 1986). These negative experiences may result in a
lower sense of self-esteem than their able-bodied peers have (Hayden,
Davenport, & Cambell, 1979; Kumar, Powers, & Allen, 1976; McAndrew, 1979).
Changes in social patterns parallel alterations in recreational involvement.
Of those whose disabilities occurred during their teenage years (such as
those with spinal cord injuries), many were risk takers who enjoyed some
degree of uncertainty in recreation activities prior to injury. Post injury,
these activities are often replaced with "plug in drugs," such as TV and
computer/video games, and, worse yet, many adolescents with physical
disabilities cease recreation participation altogether (Dew, Lynch, Ernst, &
Rosenthal, 1983).
Parents are often contributing factors to social isolation. Issues of
over-protection make it difficult for parents to allow teenagers the freedom
to access social and recreational opportunities that develop knowledge,
skills, and self-esteem. The proliferation of sedentary recreation activity
(Harrison & Kuric, 1987; Coyle & Kinney, 1990) exemplifies how adolescents
with physical activities may begin to withdraw from life.
Adventure programming offers both rehabilitation professionals and
individuals with disabilities an alternative to traditional treatment. In
fact, tremendous growth is being documented in this area, and rehabilitation
facilities are finding it a popular modality of care (Smith, 1996). Persons
with disabilities are eager to participate in adventure programming, such as
white-water rafting and rock climbing, for enjoyment, love of the natural
environment, a feeling of accomplishment, and an opportunity to improve
skills and test their own limits (Richardson, 1986). Adventure programming
is particularly well suited to adolescents because of their youthful energy
and propensity for risk taking (Godfrey, 1980). Studies with able-bodied
adolescents have shown that those who participate in adventure programming
have better self-esteem than their peers who do not (Carson & Gillis, 1994).
Why Scuba Diving?
Aquatic programs have psychosocial and physical benefits for persons with
disabilities (Beaudouin & Keller, 1994), and scuba diving is an adventure
activity that is rapidly gaining popularity. Scuba diving participation has
the potential to improve self-esteem, oxygen uptake, muscle strength, range
of motion, and aerobic endurance while allowing persons with disabilities
the freedom to explore the natural world. While scuba diving, people of all
ability levels have to adapt to a new environment, making it a great
equalizer (Buckley, 1994). In fact, persons with disabilities often find
scuba diving easier than people who are able-bodied--possibly because
persons with disabilities continuously adapt to barriers on land, making the
adaptations needed in an aquatic world a normal everyday experience.
Several professional dive organizations offer certification for persons with
disabilities. The Professional Association of Diving Instructors (PADI) and
the Handicapped Scuba Association (HSA) are two such organizations. HSA, in
particular, offers multilevel certification, which enables persons of
various levels of injury and ability to be certified for different dive
specifications. For example, a person who is certified at level 1, the
highest level, is required to dive with one buddy who, at minimum, has an
open water dive certification. This person has met all standards and can
take care of him/herself and another diver in distress. Level 3
certification, however, indicates the individual has the lowest level of
physical functioning and must dive with two buddies, one of which must be
certified as a rescue diver.
Project TIDE
Shriners Hospital's Recreation Therapy Department in Chicago regularly uses
a "try scuba" experience as part of the rehabilitation process and during
their annual Spinal Cord Injury Sports and Conditioning Camp. It focuses on
the development of self-esteem by successfully facing and meeting physical
and emotional challenges. Due to the positive feedback of these scuba
experiences, Project TIDE (Teenagers In Deep Environments) was formed.
Project TIDE is a scuba adventure program for adolescents with physical
disabilities organized and regulated by Underwater Safaris Scuba Center in
Chicago. The program's mission is to enhance self-esteem, problem solving
abilities, and communication skills that will enable them to lead more
active and productive lives by overcoming adversity.
Each year an interdisciplinary team comprised of hospital staff and the
scuba center select five to six participants based on preset criteria. For
those who are able, this includes independence in all aspects of self-care.
Persons with higher level tetraplegia can participate and use medical
assistance from Shriners Hospital, which provides personal care attendants
on the trip. Participants must be free of pressure ulcers, have a certain
degree of comfort in the water, and be identified as benefiting from the
program. Those adolescents who are accepted then undergo both classroom and
experiential pool training to become certified divers. Emphasis is not
placed on attaining certification, but on challenging individuals to step
out of their respective "comfort zones" to experience personal growth.
Metaphoring and processing the scuba experience is where the real benefits
can be seen. Being able to successfully challenge and master the adventure
experience often means a newfound knowledge of self.
After the classroom and pool experiences, the participants, staff, and
volunteers travel to a selected destination known for its excellent diving.
The Cayman Islands and Cozumel, Mexico, have ideal scuba diving conditions
because of their warm, crystal-clear waters and abundant marine life. Warm
water is a crucial element, as it decreases the likelihood of pokliothermia
and hypothermia for persons with temperature regulation problems.
There are also a number of safety precautions inherent in Project TIDE. For
instance, Radloff and Helmreich (1969) found that divers who experience high
levels of anxiety are the least successful divers; therefore, participants
and staff strictly adhere to a "challenge by choice" philosophy. This means
the participants control their level of involvement. Other safety features
include a minimal one-to-one, student-to-instructor ratio. Participants are
assigned to a professional dive instructor who remains with them in the
water at all times. Adolescents with a higher level of injury or less
physical functioning receive a higher ratio of two dive masters to one
student.
Adherence to dive tables (the guidelines for dive depth and time under
water) is another safety feature. However, when these tables were originally
formulated, only male able-bodied subjects were used. Therefore, female
divers and divers with disabilities are at a theoretically higher risk for
decompression sickness. For people with disabilities, decompression sickness
is considered more likely to hit sites of prior injury, such as those with
spinal cord injuries (Lin, 1987). Another possible risk to consider is that
unused tissues may release gasses at a different rate than that of regularly
used tissues (Lin, 1987). Therefore, female divers and divers with
disabilities should underdive the traditional dive table.
Evaluation and the Future
Outtake interviews are conducted with each participant. Evaluations have
been overwhelmingly positive with one participant stating, "If I can do
this, I can do anything!" Participants believed that they had not only
achieved their goal of learning how to scuba dive, but also had learned
other important lessons, such as increased ability to communicate their
needs, increased self-advocacy, and a feeling of overall success. These
became self-evident as the trip progressed. The participants were
transformed from tentative individuals to self-assured young people. For
most of the participants, these characteristics have carried over into other
areas of their lives. It seems that Project TIDE is meeting its goal.
Changing the Way We Think
A paradigm shift must occur in the way treatment is being delivered in
today's healthcare environment. Adventure programming is one way
professionals can meet the changing needs of patients and their families. It
is a proactive approach to therapy that uses an interdisciplinary team of
professionals. By participating in a goal-oriented, structured outdoor
adventure program, patients can increase self-esteem, problem solving
abilities, and social opportunities. The outcomes of these programs are
valuable lessons that will increase each participant's likelihood of success
in life.
© Parks & Recreation written by Kristen A. Johnson & Sara J. Klaas