Life on Wheels (30 page)

It increases endurance for physical activity by helping more blood and oxygen to reach muscles.

Only some manual chair riders are active enough that pushing the chair alone is adequate aerobic exercise to benefit the heart and general fitness. Most manual wheelers do not push enough in the course of an average day to provide for optimal health, nor do they work up a sweat or maintain an increased heart rate for long enough in the process, indicators of productive aerobic exercise.

Unfortunately, medical schools do not teach much about exercise physiology or the preventive values of exercise. Your doctor will encourage you to be active to the degree you are able and might refer you to physical therapy, but usually for practical purposes like activities of daily living. You should directly ask your doctor and therapists to develop an exercise program specific to your needs. Exercise needs to be a continuing program—not just short-term therapy.

Keeping to an exercise program might seem like an unwanted burden on top of everything else required of you by your disability. But even small amounts of regular exercise make a remarkable difference in a short period of time and more than compensate for whatever inconvenience the exercise entails.

After extensive exercise and training in rehab, this person noticed a decrease in physical abilities as he exercised less:

The type and duration of exercise appropriate for you is a matter of experimentation and building endurance. You will need to design a program for yourself working with the best qualified doctor and therapist you can find. Any professional who develops an exercise plan for you must clearly understand the physiology of your disability as well as your personal experience. For example, people with MS are sensitive to being overheated and must not let body temperature rise much. People with paraplegia need to take care not to overstrain their shoulders. For people with postpolio syndrome, certain types of exercise can be exactly the wrong thing to do.

Even if you have high quadriplegia or experience fatigue easily, you can be physically active in ways that benefit your general fitness. Aerobic exercise is very good for the heart, but just being outside enjoying even modest activity and getting some sun is worthwhile. It helps you maintain a more positive attitude and higher spirits.

An exercise program doesn’t have to mean lifting weights, pulling on rubber straps, or using some exercise machine. There is a tremendous array of athletic options available. Almost anyone can participate in some form of sport. Many can swim or exercise in water. Bowling, shooting, or archery can be performed even with high quadriplegia with the use of newly developed adaptive devices. Those with higher degrees of function can participate in sports like wheelchair basketball or quad rugby. Accessible sports are discussed in Chapter 8, Getting Out There.

Of the vast number of health facilities, few are well equipped for wheelchair access, and staff is rarely trained in issues that relate to disability. Most weight trainers come from a bodybuilding point of view. They are interested in building muscle mass to give your body a bulkier, sculpted look. Building to a “bulked up” degree of muscle mass—which can limit your range of motion—is generally not appropriate for a wheelchair user, although those wheelchair users involved in weight lifting or certain other wheelchair sports can benefit from this approach.

Ask whether your physical therapist can visit the health facility with you. She can review the various exercise machines, discuss whether swimming would be an option and how you would actually do it, and help you prepare a program. Asking for such consultation is not an unreasonable request on your part. Therapists are often given approval to make such visits. It is especially important that your program is balanced among the various muscle groups you are able to control.

As a wheelchair user going to a health club, you might find yourself uncomfortably conspicuous at first:

Health clubs are highly unlikely to have any of the equipment that has been designed for doing exercise from your wheelchair. Examples of such equipment include offerings from Apex Designs (www.apexeq.com), RTM Fitness (www.grouprmt.com), or the Quadriciser (www.quadriciser.com).

Brooks Rehabilitation Hospital in Jacksonville, Florida, has built a substantial health center that is available to any users with a disability, equipped with all the appropriate equipment as well as a full gym and pool, whirlpools, and sauna. It is open to the public, yet includes disability-specific services such as the postrehabilitation fitness program (www.brooks rehab.org/healthandfitness).

For those with little or no muscle tone in the abdominal area, development of a “quad belly” is very common, but not entirely inevitable. The muscles in your abdomen can no longer work to keep your internal organs in place. Your stomach, intestines, pancreas, and liver are all contained snugly in that space, held there as well by ligaments and the peritoneum—a membrane that encloses the area. As the muscles atrophy, the organs literally slide down and out causing the quad belly.

Some people regularly wear an abdominal binder, which wraps around the body and can be adjusted for a firm fit—somewhat like a girdle. Although this will not prevent the atrophy of abdominal muscles, it will limit the stretching of the peritoneum—the membrane that contains this abdominal region—simply by preventing gravity from pulling your organs down and out.

Abdominal muscle tone can be maintained using electrical stimulation, but you have to really keep it up.

The human organism is a biochemical machine. The body relies on water, vitamins, proteins, carbohydrates, fats, and minerals from a balanced diet of pure and healthy foods. The fact of being a chair user, or particular features of your disability, raises specific issues about diet.

Manual and power chair users have some different dietary considerations. A manual chair rider burns more calories in the act of pushing the chair, whereas a power chair user does not exert himself in the same way while using a joystick. Manual riders need more usable calories, whereas power chair riders should take extra care not to gain unnecessary weight.

People with high quadriplegia are particularly at risk of weight gain because their ability to perform aerobic activity is very limited and because any muscles that have atrophied require fewer calories. They are well advised to work closely with a dietitian to develop a dietary plan that includes foods they enjoy but defines appropriate amounts for the sake of weight management.

All chair users need to take extra care of their skin, already at risk from the pressure of sitting for long periods. Power chair users have a more difficult time shifting their position if they have limited arm strength, so added weight gain only increases the potential for more pressure where they sit. Healthy skin can be promoted by a balanced diet with a complete range of nutrients.

A variety of whole foods with minimal processing is the best source of nutrients needed by the body. A few examples are included here.

Vitamin A helps in the growth and repair of body tissues and maintenance of healthy skin. It is derived by the body from carotene, which is abundant in carrots, green leafy vegetables, and broccoli.

Vitamin B complex is a group of B vitamins that work together to produce energy by helping the body to convert carbohydrates to glucose, the source of your body’s energy. They are also crucial to the nervous system. They are found in whole grains, liver, and brewer’s yeast. Some antibiotics limit the ability of the body to produce B vitamins in the intestines.

Vitamin C, or ascorbic acid, plays a role in the healing of wounds by maintaining collagen, the protein that forms connective tissue in the body. It also helps fight bacterial infections. It is found in fresh fruits and vegetables.