Camp-Workshop for Adolescent Amputees
MARY WILLIAMS CLARK, M.D. SANDRA MCCLOSKEY, R.P.T. LESLEY ANDERSON, M.D.
In June 1976 the Children's Hospital of Pittsburgh Amputee Clinic held a three-day camp-workshop for adolescent amputees. Inspired by a camp conceived by Dr. Ned Sharples and sponsored by the Michigan Department of Public Health, Area Child Amputee Program" 2 , the goal for our camp was to provide a relaxed, nonclinical setting in which adolescent amputees could discuss particular problems of being amputees and adolescents and could meet others with similar problems and strengths. Campers, counselors, and planners all came away from our camp with warm, positive feelings of an important shared experience. We also gained experience from the mechanical organization of the camp. Combining the positive responses of participants and the knowledge that we can organize it better for its second year, we are describing our approach to the weekend workshop.
The key ingredients for success in our camp-workshop were a genuine interest by planners and counselors for giving their time, and an ability in each person for a lot of spontaneous trouble-shooting. These factors do not show up on our timetable (Appendix I), but they provided the spark of success.
The initial planning and the timetable were provided by a fourth-year medical student as a special project. The bulk of organizational and mechanical work was done by persons related to the Physical Medicine Department at Children's Hospital. They included the medical director, the previously mentioned medical student, two physical therapists, an occupational therapist, and two secretaries. These people were the steering committee and workhorses for the camp-workshop. Suggestions for goals and the camp schedule came from Dr. Sharples and Ms. Shirley Furgerson, veterans of the original Grand Rapids Camp.
In general we used a broad base of support for ideas, direction, and planning the camp. Numerous resources were tapped to get funding, to give direction to discussion leaders, to secure a list of prospective campers, and to collect supplies. The general planning started 10 months before the camp was held; and a firm plan for the location, date, schedule, and counselors was set four months before the camp.
Information about possible campsites was secured from the National Directory of Accredited Camps 3 . We chose our particular camp from several in the area because of its proximity to Pittsburgh (70 miles away), because it supplied food, a cook, recreational facilities, and because the price was less than some other camps. The recreational facilities included a softball field, pool, basketball court, volleyball court, small lake with rowboats, and several indoor and outdoor meeting areas. We rented two large buildings for sleeping quarters, and they each had space for meetings and facilities for preparing snacks.
The funding for the camp came from a local Rotary chapter and the hospital's annual newspaper/radio campaign fund. Expenses included room and board for the camp ($18/day/person), rental fee for the charter bus ($180), and rental fee for two movies ($50). Snacks were donated by local companies, and equipment was loaned by the hospital. The weekend was free to the campers. Counselors volunteered their time. Lists of prospective campers between 13 and 17 years old were made from the patient lists of the Children's Hospital Amputee Clinic and other amputee clinics in town. Additionally we asked local prosthetists, local orthopedists, state Crippled Children's Clinic and state nurses for referrals of appropriate persons as campers or counselors. An explanatory letter was sent to parents, and a day later an invitation was sent to the teenagers. Each letter was signed by a person on our staff who knew the prospective camper. One week before the camp, letters were sent out with specific information about meeting place, parking facilities, clothes and toilet articles to bring, the time for return, and emergency telephone numbers.
Thirteen campers participated in the camp: one was 13 years old, two were 14, five were 15, and five were 16 years of age. Of the 13 campers, four were girls. Six campers had upper-limb amputations, and seven lower; all were unilateral. The counselors were interested members of our clinic staff, occupational therapists, a nurse, a prosthetist, a medical director, a medical student, physical therapists from other city agencies who had particular experience with children, and six young-adult amputees. Two of these had amputations necessitated by trauma, two by tumor, and two had congenital limb deficiencies. There were 15 counselors in all.
The counselors played an integral part in the organization as well as the execution of the camp. We had four counselor meetings before the camp. The first two were basically organizational meetings to give out ideas from the planning committee, to get feedback from the counselors, and to tap the variety of resources of the counselors. One meeting was a workshop run by the Social Service Department, with activities geared toward sharpening listening skills and basic suggestions for developing discussions. The fourth meeting was a rap session to smooth out last-minute details.
Postcamp organizational activities consisted of a slide show for the camp participants and their families, and sending out thank-you's to counselors and planners. We also included a group photo and an article about the camp from a hospital newsletter.
We met in a hospital parking lot and traveled together to the camp by the charter bus. We felt that beginning as a group was important, since many did not know each other before. By the time we arrived, there was some relaxation and a cohesive feeling, solidified by lunch and the Introductions-and-Meeting-People discussion which followed.
The campsite was ideally suited to our needs. It had many recreational facilities as well as good indoor and outdoor meeting areas. Good weather for the whole weekend allowed us to have discussion groups outside informally on the grass.
The camp schedule is reproduced in Appendix II. The schedule was approximate and worked well. Most of the free time was used spontaneously by campers and counselors for softball, volleyball, or basketball ( Figure 1 ). These games provided an outlet to several of the campers who were reluctant to participate in the discussion groups. They also provided an opportunity for one of the above-knee amputees to learn to run, and several spontaneous helpful hints were shared during these highly competitive games. The pool was open for an hour or two each afternoon, and everyone went into the water (some reluctantly). A few of the campers used the free time for swapping jokes and playing records. In all cases these experiences were a lot of fun and helped to create a group feeling.
The discussions centered around Introductions, Participation in Sports, Social Situations, Careers, Care of Skin and Prosthesis, and Adaptive Equipment. Each topic had one or two counselors assigned to stimulate participation, and the number of counselors in each group was kept to a minimum (3). The other staff "floated" among groups, listening and taking pictures.
The Introductions sessions were begun at lunch on Friday, dividing into two large mixed groups of counselors and campers. People were paired off by group leaders (avoiding two counselors together). Sheets with suggested questions were given out, including such questions as,
- What school do you attend?
- What is your occupation?
- What is your favorite sport'?
- What are your goals in life?
- Why did you come to this camp?
- What do you want to get out of this camp?
The pairs scattered for about 10 minutes to become acquainted. Groups reformed and each person introduced his partner to the group. After this, the group leaders turned the discussion to other situations of meeting new people, including things that make it difficult or easy and whether being an amputee makes a difference.
The discussion of sports participation, on Friday evening, was combined with pizza, movies, and slides. The movies were of three-track skiing 4 and of a below-knee amputee skiing with a modified prosthesis 5 . Slides of regional and national amputee-wheelchair competitions were shown. Also a table of literature was set up with information about sports organizations for amputees, a scrapbook with pictures of amputees participating in skin diving, horseback riding, boxing, and other sports, and pictures of adaptive equipment available for sports. Little discussion was held at this time, but it served for exposure of opportunities available. We found during the next two days that campers returned to the table of literature and also asked advice from several of the amputee counselors who were active in sports such as wrestling, skiing, and kayaking.
For the Social Situations discussion campers were divided by age (13-14, 15-17) and by sex. For the first hour discussions were begun in these groupings and then combined. There was investigation of subjects such as body image, feelings about themselves, and reactions when people commented on their amputations. There was much sharing of feelings and individual ways of reacting to various situations. Discussions about dating were planned, but time and interest
kept the topics in the previously mentioned areas. The leaders of these sessions were amputees themselves, and this was a big reason for the spontaneity of the questions and comments. This was the most involved discussion held, and it seemed to stimulate the most participation from the older campers.
The Careers discussion was separated by age. It involved some role playing with situations of interviewing for a job, receiving unnecessary help from a well-meaning co-worker, and handling a situation of staring by a co-worker. Individual career choices were explored, along with the questions of whether being an amputee makes a difference.
At the Adaptive Equipment session we reviewed adaptions for such activities as sports and playing a musical instrument. The most popular information was about Pennsylvania state laws regarding hand controls, left-foot accelerator pedals, and driving tests for amputees.
The topic of the last session was unscheduled to allow time to discuss areas of special interest and prosthetic adjustments. Information was reviewed about skin care and cleanliness. Suggestions were given about home repairs for prostheses as well as equipment needed for these repairs. Also, one of the counselors demonstrated cleaning and adjusting of his above-knee prosthesis. This stimulated discussion about the nagging "squeaks" that are rarely repaired in a prosthetics shop.
All of these discussions and sporting activities were intermingled with a lot of fun, which included guitar songfests, card games, and middle-of-the-night raids. Reactions were invited from campers and counselors, using questionnaires. The overwhelming response was that this experience should be repeated next year ( Figure 2 ).
The biggest problem was the reluctance of campers and parents to accept the invitation. We realized this would be a psychological hurdle for many patients, and we expected a low return. Nineteen campers originally signed up to come; six campers changed their minds at the last minute with excuses ranging from plausible to vague. Recruitment seemed to be the weakest area in the organization. Some of the negative or undecided responses were followed up with a telephone call, and in three cases the person decided to attend the camp. In one case a mother replied negatively for her 16-year-old son; but when we spoke to the son, he said, "Yeah, I'd like to come." Anxiety was high beforehand. One camper actually locked herself in the car while waiting in the parking lot for the bus, and was "talked out" by her father. When her parents came to the camp to pick her up on Sunday, she sent them away for a few hours because camp was not over yet. For the next camp we plan to have "charter" campers telephone prospective campers. Also, we hope that informal discussions about the camp might reach new campers.
The upper-limb amputees were also concerned about wearing their prostheses. Several called or wrote before accepting to ask, "Do I have to wear my arm?" Our answer was, "Whatever you'd rather do." Some did not bring a prosthesis to camp. One wore a prosthesis on the bus, going and coming, but not at all the rest of the weekend. Others wore theirs only for certain activities (one boy only for playing softball and another for everything but softball).
Counselor anxiety was high about discussion sessions. This year we plan to have fewer counselor meetings relating to organizing the camp, as anxiety seemed to rise with each meeting.* The burden of organization should rest with a committee and not be transferred to the counselor group as a whole. Counselor meetings will revolve around training sessions or mock discussions.
A few mechanical mistakes included forgetting to make a final checklist for collecting last-minute items, not bringing a movie camera, and not taking black-and-white photographs for publicity.
There was much mixing of campers and counselors informally, one-to-one and in small groups, and many of the good things that people remembered and commented on happened spontaneously, to show and reassure the campers that others were coping with similar problems and how they could, too.
*After the final draft of this paper was written, we had the 1977 Camp. We had only one counselor meeting, held on a Saturday five weeks before the camp. The meeting was an all-day one, using the morning for such activities as planning schedules and leaders for discussion groups, and the afternoon for practice of small-group techniques and vocabulary awareness, led by our social worker and a colleague. Our counselors, including 10 new ones, agreed after camp that this worked well and they felt well prepared.
Appendix I TIMETABLE
4-6 months ahead: general planning meeting to assess
needs, goals, and set up organizational timetable secure lists of prospective camps
M. W. Clark, S. McCloskey, and L. Anderson
4-6 months ahead: January-February 1976
3-4 months ahead: mid-February
2 months ahead: early April
1 month ahead: mid-May
2 weeks ahead: mid-May
Week of camp: 1St week in June get information about possible camps secure funding for camp secure films invite counselors to organizational meeting, discuss goals, discussion groups, and get their ideas select and book camp select and book bus transportation set up form letters to prospective campers, their parents, and design brochure about camp hold second counselor planning meeting get commitments from them as discussion leaders for particular sessions. send letters to parents send letters and brochures to campers secure commitments from local food establishments for donations of snack food hold third counselor planning meeting workshop in developing good listening skills and leading discossions visit camp follow up negative responses from campers with phone call from counselor who knows camper personally fourth and final counselor meeting. Give final itinerary and delegation and responsibilities send out list of articles to bring to camp for campers and counselors with final reminder of where and when to meet pick up snack food, and other materials (movie projector, camera, stereo, slide projector, pencils, paper) Camp---Final "Product" June 4-6, 1976 Week after: mid-June send camper and counselor reaction form send letters cards of thanks to those who contributed time, supplies, and energy
M. W. Clark, S. McCloskey, and L. Anderson- 12 months after: August send group picture hold slide show for participants and families
11:00- Arrive at Camp
11:00 12:00 Bunkcheck
12:00- 1:00 Lunch and Announcements
1:00-- 2:30 Session I Introductions (2 large aroups)
2:30-4:30 Organized sports (ball, swimming)
4:30- 5:30 Free
5:30- 6:30 Dinner
7:00 - 9:00 Session 2--- Movies (sports)
9:00- Pizza-Making Party
7:30- 8:30 Breakfast
9:00-10:00 Session 3-- Group A Social Situations (separate male and female)
Group B Careers
10:00-- 11:00 Group A -Continuation of discussion with combined male and female group
Group B--Adaptive Equipment
12:00- 1:30 Lunch
1:30- 2:30 Session 4- Group A Careers
Group B Social Situations
2:30-3:30 Group A Adaptive Equipment
Group B Continuation of discussion with combined male and female group
3:30-5:30 Free (sports, etc.)
5:30-- 6:30 Dinner
6:30-- 7:30 Organized sports
7:30- Chapel (voluntary)
8:00 Records, snack, campfire
7:00 8:30 Wake up Breakfast
9:00 10:00 Session 5 - Special Interest
10:00-12:00 Free Time
12:00- Leave to return to Children's Hospital
Sharples, G. F., and R. L. Crawford, Child Amputees: Disability Outcomes and Antecedents. December 1972. University of Michigan, p. 105.
Sharples, G. E., and Lyla Spelbring, Long term outcomes of amputee management. Report given at Annual Amputee Clinic Chiefs Meeting, Atlanta, Georgia, 1973.
National Directory of Accredited Camps for Boys & Girls. American Camping Assoc., Bradford Woods, Martinsville, IN 46151.
2,3, Fasten Your Ski. Denver Children's Hospital, 1056 East Nineteenth Ave., Denver, CO 80218.
Graves, Jack M., and Ernest M. Burgess, The extra-ambulatory limb concept as it applies to the below-knee amputee skier. Bull Prosth Res, Fall 1973:126 131. Film available from Prosthetics Research Study, Eklind Hall, Room 409, 1102 Columbia St., Seattle, WA 98104.