Bowling for the Physically Handicapped Part II
Ronald C. Adams
Part I of this article appeared in the October 1970 issue.
Program Adjustments for Specific Disabilities
Asthma and/or Chronic Obstructive Lung Disease
Many individuals with chronic obstructive lung disease have a low-exercise tolerance level and cannot participate in uninterrupted exercise. Bowling is a physical conditioning sport that provides intermittent exercise while permitting the individual to take frequent rest periods. Other therapeutic values include improvement in lung ventilation through an increase in the rate and depth of respiration to meet the increased oxygen consumption.
Amputations-Unilateral Upper Extremity
Generally, this group of amputees can bowl with little or no difficulty. The bowler can use the terminal device to assist in holding the ball above the waist at the starting position. This position is recommended because it helps promote concentration and relaxation prior to starting the approach. It is suggested that the bowler wear the prosthesis while bowling, since the artificial limb can assist in the development of balance and coordination during the approach and delivery.
Case History. This 21-year-old student became a left, below-elbow amputee as the result of a hunting accident. He was evaluated at Woodrow Wilson Rehabilitation Center, Fishersville, Va., for training in drafting or accounting. When bowling, he would steady the ball with his prosthesis at the start of his approach and the artificial limb would swing close to his body to help promote balance during the delivery. He has a Muenster-type prosthesis with a single axillary loop; but a triceps pad, flexible elbow hinges, and the routine Figure-8 harness are recommended for bowling1(Fig. 7 ).
Amputations-Unilateral Lower Extremity
Some unilateral lower-extremity bowlers prefer to bowl from a stationary position at the foul line, while others prefer to use a two-step or four-step approach. However, in most instances, the steps will be shorter than those taken by the normal bowler. This group tends to turn the left slide foot at a right angle to the line of approach (right-handed bowler) when releasing the ball, thus causing an incorrect swing and follow-through to the right. Another common problem, particularly with above-knee amputees, is their inability to achieve rhythm during the approach. The first two steps are often too fast, causing an abrupt stop at the foul line and a jerky backswing.
Case History. This 16-year-old student is a left below-knee amputee as the result of a farm-machinery accident. She is presently being considered for training in cosmetology at Woodrow Wilson Rehabilitation Center. No difficulties were encountered in teaching the student to bowl on her temporary prosthesis. She used the standard four-step approach, but her steps were slightly shorter than the normal bowler would use. She would swing her right leg behind the prosthetic leg and maintain excellent balance as she followed through in the delivery. Her permanent prosthesis will be a patellar-tendon-supracondylar type with wedge suspension (Fig. 8 ).
Amputations-Bilateral Upper Extremity
A suction-type assistive device for bilateral arm amputees1, which enables this group of bowlers to compete on an equal basis with their normal contemporaries, was designed at Sunnybrook Hospital, Toronto, Canada. The suction device is attached to the prosthesis and movement of the terminal device is the mechanism which releases the ball.
Those with standard, bilateral above-elbow amputations could possibly use the bowling pusher with handlebar-extension accessory previously described. The bowler would naturally need to grasp the handlebar firmly in order to control the movement of the ball properly. The therapist or instructor would need to evaluate the bowler's shoulder strength to determine the possible benefits and problems that would be presented during flexion-extension movements when using the device.
The more severely involved, particularly those using shoulder-disarticulation prostheses, could bowl with the assistance of the bowling-frame unit.
Amputations-Bilateral Lower Extremity
As mentioned previously, the major problem with bowlers handicapped by lower-limb amputations is the inability to achieve rhythm during the approach. This difficulty is often caused by a tendency to pause or hesitate after, or on, one or more of the steps. Usually, bilateral lower-extremity amputees who are learning to bowl develop confidence from the stationary position and prefer to use this style. Some bowl from wheelchairs to compensate for their inability to coordinate footwork and arm swing.
Blind bowlers are classified in two categories:
- Totally blind bowlers; those who cannot see the pins and therefore cannot use their sight as an advantage.
- Partially blind bowlers; those with no more than 20/200 vision with the best correction; or 10 per cent of vision.
ABBA tournaments with singles, doubles, and team competition are sanctioned by the American Bowling Congress. Division A consists of bowlers with an average of 100 or below, and Division B is for those with an average of 101 or above. Two important bowling rules for the blind are: 1) each five-man team must have two totally blind bowlers, and 2) bowlers do not change lanes after each frame.
Like ambulatory and wheelchair-bound bowlers, the beginning blind bowler should first learn the pendulum swing from a stationary position at the foul line. A guide rail (Fig. 9 -Further information may be obtained from the American Foundation for the Blind, 15 W. 16th St., New York, N.Y. 10011) is often used to help the bowler locate the proper starting point before he attempts the approach. The center-ball or strike-ball starting point is located by crooking the elbow of the guiding arm over the rail. The guide rail is positioned so that as the ball hangs at the side of the bowler in his delivery hand it is in direct line with the center of the lane. The guide rail is positioned at that point for the remainder of the game. The approach is a matter of individual choice but blind bowlers usually use a two-step or three-step approach followed by a straight-ball delivery.
The totally blind bowler is dependent upon an assistant to relay information regarding the number of pins remaining when bowling for spares. Once the bowler knows what pins are left, he can adjust his starting point by appropriate positioning of his guide arm in relation to the guide rail. The distance of the lateral (sidestep) movement which determines the proper starting position is again a matter of individual choice which is learned through practice, with the aid of an assistant.
Permission should be obtained from their physicians before cardiac patients participate in the sport of bowling. If the sport is to be used as part of a graded exercise regimen, as in the case of rheumatic fever patients, then the major objectives would be: 1) to increase general physical and heart-muscle strength, and 2) to obtain the psychological benefits of participation in active motor movements. Individuals whose physical activity is markedly restricted may require the use of the adapter-pusher device to participate in the sport. Careful watch should be kept for signs of fatigue and dyspnea, and all activity should be stopped at the onset of any symptoms of circulatory embarrassment.
Most persons with cerebral palsy have numerous limitations, therefore the instructor or therapist should evaluate the total intellectual and motor capacities of each person before introducing him to the sport of bowling. Patients in the spastic group will have exaggerated stretch-reflex movements which cause problems when they attempt to learn the basic maneuvers associated with the sport. Repetitive bowling fundamentals should be introduced. However, if the individual is severely afflicted and is unable to develop the initial pendulum-swing skill, then it may be necessary to provide an assistive device. The athetoid group will naturally be limited in their participation, due to extraneous movements; however, the bowling-frame unit can be used to compensate for their involuntary jerky movements. An assistant will need to lift the ball from the ball-return rack and adjust the bowling frame according to the verbal instructions of the bowler.
Program adjustments for those patients with involvement on one side of their body will depend upon the degree of affliction. The obvious problem with members of this group is their inability to coordinate footwork and arm swing. The handlebar-extension bowling accessory is often recommended as a means of providing the bowler with body-awareness exercise. He can develop bimanual skills by using the affected extremity as an assist on one side of the handlebar, while using the unaffected extremity on the opposite side as the main guiding force to push the device.
Legg-Perthes Disease and Other Orthopaedic Disorders Involving Hip-Joint Limitations
Treatment procedures for this group will vary. However, restriction of weight-bearing is recommended during a portion of the treatment period. Under some circumstances, the patient is confined to a litter. It is possible for this group to bowl by placing the litter on the approach to the lane, head toward the pins. If the litter can be raised to a position where the bowler can develop the pendulum-swing motion, it is possible to bowl from this position. If the litter can be collapsed to a point close to floor level, then the bowler could possibly use the adapter-pusher device. Those with medical permission to bowl from a wheelchair will experience fewer problems. However, before they begin bowling from this position, the instructor or therapist should evaluate their sitting tolerance, realize their anatomical limitations, and then keep within the bounds of safety.
Exercise, in addition to dietary regulation, is an important factor in developing a realistic weight-control program for overweight individuals. Bowling is a sport that can be enjoyed regularly by all members of the family. Energy expenditure in bowling is approximately 350 calories per hour, consequently it is a recommended physical activity for obese persons. Bowlers who are overweight often lack rhythm in their approach due to a lack of joint flexibility. Most beginners prefer to use a six-step or eight-step approach to compensate for their inability to take long strides. This approach usually complicates matters and increases the jerkiness of the delivery motion.
It is recommended that the paraplegic engage in a medically prescribed physical therapy program of upper-extremity strengthening exercises prior to engaging in bowling. Sitting balance must be carefully evaluated, since learning the pendulum-swing skill is dependent upon the bowler's ability to obtain a comfortable arm-swing motion while leaning over the side of the wheelchair. Some paraplegics have a tendency to use a high backswing which causes the ball to hit the hand rim of the wheelchair during the forward swing. If the ball is swung too high the momentum of the forward swing can throw the bowler off balance and cause an improper follow-through. In some situations, assistive devices may be needed to compensate for weakness of the arm and shoulder musculature.
Progressive Muscular Dystrophy and Other Conditions Associated With Hypotonia and Muscular Weakness
Program management for this group of patients will naturally depend upon the extent of involvement. In most instances, the bowler will be unable to throw an 8- to 10-lb. bowling ball due to lack of arm and shoulder strength. The adapter-pusher device is not usually recommended because those patients confined to a wheelchair with progressive muscular weakness cannot generate enough force from the forward thrust movement to push the ball down the lane with any degree of speed or accuracy. This problem is also prevalent among those who ambulate with a waddling gait and lordosis. In the majority of these cases, the bowling-frame unit will be the most suitable device to use. An assistant will need to retrieve the ball from the return rack.
Each case of rheumatoid arthritis is different, therefore the ability of the individual to participate in bowling will depend upon the severity of the disease and the joints affected. Although special bowling balls with five finger holes can be used by those bowlers handicapped by upper-limb joint involvement, this procedure is not recommended unless approved by the physician. The handlebar-extension pusher is usually safe for the ambulatory bowler and helps to increase the range of joint motion and strengthen the muscles of the arm and shoulder. Persons with more serious forms of the disease may need to use the bowling-frame unit.
In order to participate, persons with high cervical lesions may need to use the bowling-frame unit. Many patients with lesions at the C6-C7 level have used various types of assistive appliances and bowling-pusher devices. Different kinds of straps have also been used to attach the bowler's hand firmly to the handle of the adapter-pusher. The instructor or therapist should evaluate the sitting balance of each participant and prescribe the use of a seat belt for those persons with nonfunctioning trunk muscles.
Treatment for structural scoliosis varies, but, because of the change in bone structure, the deviation cannot be corrected except by surgery or by placing the involved area in a cast or special brace. Due to the lack of a flexible back, bowlers wearing Milwaukee braces have two major problems: 1) Inability to coordinate footwork, particularly at the point of release; and 2) inability to comfortably bend the body forward from the waist to achieve the full swing motion of the arm and shoulder. Nevertheless, bowling is an excellent sport for Milwaukee-brace patients since it requires poise and balance, both of which are important body-awareness skills.
Undernutrition Associated with Low Physical Fitness
Since the underlying causes for this condition may range from chronic infection to cultural deprivation, it is important to review the therapeutic values that can be derived for each case before enrolling the individual in the sport of bowling. If the cause is of a psychogenic origin, then participation in group activities may be a contraindication. In general, the major problem will be the inability of the bowler to throw an 8- to 10-lb. ball due to lack of strength. The handlebar-extension adapter-pusher device is recommended for ambulatory participants in this category.
Case History. This 13-year-old patient was diagnosed as having generalized peritonitis, apparently secondary to a perforated peptic ulcer. During three months of hospitalization she was treated for numerous abdominal abscesses. She was then transferred to the Children's Rehabilitation Center for convalescence and continuation of a high-protein and high-caloric diet., During this period she was enrolled in a recreational therapy program of adaptive physical education activities to increase exercise tolerance and to improve her strength generally. Her participation in the bowling program served as a postural exercise and improved her endurance for activities in the upright position. Due to lack of upper-extremity strength and a low endurance level, she used the handlebar-extension pusher as a bowling aid (Fig. 10 ).
In addition to the many positive qualities already mentioned in this report, the sport of bowling provides the physically handicapped person with a lifelong hobby and an opportunity to use public facilities through which he can achieve a sense of communality with his normal contemporaries. The physically disabled person does not want an activity modified to make allowances for his disability; he wants activities to which his remaining abilities may be successfully applied. Bowling is an activity which lends itself to many adaptations to meet this need.
My sincere thanks and appreciation are extended to Mr. Wendell Coleman, Recreational Therapist, and Mr. Joe Little, Recreation Supervisor, at the Woodrow Wilson Rehabilitation Center, for their assistance in the preparation of this article. Also, my appreciation is extended to the American Bowling Congress for their contributions and cooperation.
THE NATIONAL WHEELCHAIR ATHLETIC ASSOCIATION OFFICIAL RULES
Wheelchair bowling is conducted in accordance with the American Bowling Congress Rules. In case of a point seemingly not covered, the judgment of the officials and the principles of "normal" bowling competition will apply.
Devices of any kind which will tend to provide additional support for the wheelchair or to aid the delivery of the ball are not allowed. Wheelchair brakes are permitted if they are conventionally designed to secure the rear wheels and to lock and release quickly. If a wheelchair does not have brakes, it is permissible for an attendant to hold the two large wheels.
No part or portion of the body shall make contact with the floor during the delivery of the ball.
The following classifications are recommended for wheelchair bowling competition:
Stick bowlers: Class 1A and 1B
- Class 1A-Incomplete quadriplegic, who has involvement of bilateral hands, weakness of triceps, a generalized weakness throughout the trunk and lower extremities, and loss of voluntary control.
- Class 1B-Incomplete quadriplegic, who has some upper extremity, but less than 1A, but with nonfunctioning trunk muscles, similar to that of a 1.
- Class I- Complete spinal paraplegia at T-9 or above, or comparable disability where there is a total loss of muscular function originating at T-9 or above.
- Class II and III combined
Class II-Complete spinal paraplegia at T-10 or below or comparable disability where there is a significant loss of muscular function of hips and thighs.
Class III-All other disabilities.
Ball striking to the left of the headpin.
Two strikes in a row.
The line that determines the beginning of the lane.
Touching or going beyond the foul line as the ball is delivered.
The tenth part of a game. The squares indicating the tenth of a game are called frames or boxes.
A ball which goes into the gutter.
The Number 1 pin.
A ball that breaks sharply to the left.
Throwing the ball out beyond the foul line.
The 1-3 "hole" for the right-hander; the 1-2 for the left-hander.
A hidden pin.
The 7-10 split.
All ten pins are knocked down on two balls.
Combinations of pins left standing after the first delivery in a frame with a pin down immediately ahead of or between them.
A place on the lane at which the bowler is aiming.
All pins knocked down on the first ball.
Three strikes in a row.
Director of Recreational Therapy and Adapted Physical Education Children's Rehabilitation Center, University of Virginia Hospital Charlottesville, Virginia
1. Kay, Hector W., Shaela L. Lewis, and W. A. Stewart, A bowling device for bilateral arm amputees, Inter-Clin. Information Bull.,9:7:13 16, Apr. 1970.