R: Physical Disabilities

MODULE R: UNDERSTANDING PHYSICAL DISABILITIES[1]

IN THIS MODULE:

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INTRODUCTION

Physical disabilities are conditions where people cannot move or control their bodies well.  They encompass a broad variety of limitations and underlying causes. Some conditions that cause physical disabilities also impact intellectual ability, vision, hearing, or speech.  Those topics are addressed in other modules of the Inclusion Toolbox and you may need to review that information to help a specific individual.

The first goal of this module is to help you relate to what it is like to live with a physical disability, so you will take action to help.  The second goal is to give you specific methods and strategies for solving the more common challenges.

Typical humans are among the best adapted creatures on earth in terms of going where we want to.  We can’t fly, but we can crawl, walk, run, climb, swim, jump, vault, reach, pull up, tumble, wriggle, and roll on the ground.  We can even move sideways when it suits us. With all these abilities, we have a hard time noticing all the little obstacles we encounter as we move.  Most of us don’t realize how losing a little bit of this capability makes it much harder to do something.  Honestly, the best way to “get real” is to try making it through a day without an ability.  Try one of these challenges for a whole day:

  • Wear a pair of mittens (loss of pinching ability)
  • Keep your dominant arm in a sling and don’t use that hand for anything
  • Keep one foot off the ground and use crutches
  • Take a loaded baby stroller everywhere you go, without ever stepping away from it (routefinding with a wheelchair)
  • Wear a cervical collar and do not turn your head
  • Stop for two minutes for every 100 steps you take (loss of speed with crutches or wheelchair)
  • Limit yourself to 1000 steps for the day (endurance/stamina limitations)
  • Go grocery shopping, but you can’t buy anything more than 4 feet above the floor (height & reach limits)

For some people, like those that are missing limbs or are paralyzed, it is easy to understand what accommodations they might need.  However, there are many other people where the challenges are less obvious, like people with weak grip, nerve damage, or malformed joints. Physical disabilities can be caused by injury or damage to brain, nerve, muscle, bone, joint, or connective tissues. Some physical disabilities are present from birth but many others are from illness, injury, chronic pain, or progressive disease.  Almost everyone will experience a short-term physical disability during their lifetime due to an injury, like breaking a bone or spraining an ankle.

People with physical disabilities use assistive devices to access their environment, and some people use several devices.  This could be anything from a simple knee brace up to a customized van with hand controls and built-in chair lift.  To communicate and control devices they may use anything from a simple joystick up to eye-tracking devices and voice synthesizers.

To address the diversity of needs within the general category of physical disabilities, we will focus the discussion on three major themes: lower body disabilities and mobility, upper body limitations and doing fine work with hands, and accommodating daily living tasks, like grooming, dressing, and toileting. An individual can have disabilities from any or all of these aspects.

A great deal could be said about how to make spaces and buildings accessible.  This module discusses how to cope with situations that you must work with as they are, where you are not in a position to change the terrain or building features.  Module AA provides information about practical ways to improve accessibility at BSA camps and facilities.

BEING PREPARED

Advance preparation is especially important for physical disabilities.  While Scouts are resourceful, you cannot count on being able to improvise on short notice.  Every kind of mobility equipment has limitations and even with mobility equipment, there are places a Scout cannot go unless some access provisions are made in advance.  There are many activities that a Scout with a physical disability can participate in, but only if special equipment is already available and in place.

Preparation is important for regular meetings at the unit’s usual meeting place.  This is easier than at other locations because you get “do overs”.  That is, you can take advantage of the learning curve and you can put permanent access solutions into place.  You can also focus on the specific needs of your Scout to make adaptations.  One-time outings at other locations are a greater challenge, but since “outing” is essential to “Sc-outing”, preparing for outdoor activities and new locations is important as well.

Communication with the Scout is a key part of the preparation.  The Scout and family need to know as much as possible about an upcoming event.  This includes details about both the activities and the venue where the event is being held.  While you may be confident as a leader and organizer, it is very hard to spot all the potential trouble spots when you don’t live with that disability.  Think of the family members of the Scout as your teammates in spotting the needed adaptations and keeping you from wasting time and energy on unnecessary ones.

The staff of an event need to hear from the Scout and family as well.  Unlike the regular leaders of the Scout’s unit, camp staff members have no history or experience with the Scout and are responsible for many more Scouts than just the one with a disability.  Someone needs to reach out to the camp director long before the camp season opens to explain what the Scout’s needs are likely to be and what activities and merit badges the Scout wants to attempt. This allows a chance to be inventive and create solutions that are easy and effective.

Advance previews are a great tool.  Five minutes of looking at something is better than five hours of talking about it.  See if there is any way for the Scout and family to go out to the location ahead of an event to spot the problem areas.  In some instances, a simple item brought from home will address a lot of challenges.  For summer camp or day camp, see if you can go out during the staff training/set-up days for the camp.  Not only can you address the physical obstacles of the camp, the Scout can get acquainted with some staff members and you can talk to staff about how to include the Scout in the camp’s activities.  These conversations go so much better when the staff is not in the mad swirl of holding camp with large numbers of Scouts.

MOBILITY CHALLENGES

There is a wide range of mobility devices that a Scout or adult may need.  These include:

  • Braces for legs, knees, ankles, wrists
  • Prosthetic limbs[2]
  • Cane
  • Underarm crutches
  • Forearm crutches
  • Walkers
  • Manual Wheelchairs
  • Powered Chairs/Scooters
  • Golf Carts
  • Utility Off-road Vehicles (UTV)
  • Wheelchair Accessible Conversion Vans/SUVs

Even if you use a mobility device, every movement is still harder and slower than for other people.  Even customized accessible road vehicles take more time and effort to load and unload than other vehicles.

The ideal surface for moving around is like a basketball court, which is hard, smooth, flat[3], level[4], and open.  Any deviation from this ideal surface makes movement harder. Stairs defeat everything except prosthetic legs, canes, and crutches, but even with those devices you can have a hard time managing stairs.  Less than ideal terrain impacts manual (self-propelled) wheelchair users more than anyone else, so for the rest of this section we will use that example to explain the problems that terrain creates.

Bumps, Steps, and Thresholds – The diameter of the wheels limits how tall a vertical step a wheelchair can cross.  The front wheels, called caster wheels, are smaller.  Unless the user is able to “pop a wheelie” it is hard to force the front wheels over any step taller than one inch.  A little taller step can be jumped while going backward, using the drive wheels.  A user with good upper body strength might be able to climb a 3-inch step, but the effort is like weightlifting and the chair tilts face down during the maneuver. Anything more will require help from another person.

Uphill and Downhill Slope – A downhill slope is an obstacle because a manual wheelchair only has “parking brakes”, not running (friction) brakes.  The user has to drag his hands along the drive wheels to control the speed going downhill.  A long downhill run exhausts your grip pretty quickly, not to mention tolerating the heat from the friction.   Very few outdoor rolling surfaces are dead level.  Even those lovely sidewalks across college campuses run up and down to line up with the natural slope that the buildings were placed on.  Building codes in the United States set limits on how steep a ramp can be (1 inch of vertical rise for each foot of horizontal run, or 5 degrees on a protractor), and how high it can go between landings (30 inches of vertical height).  Pushing yourself up a slope that steep feels like running a short sprint. Even with shallower slopes, it helps to have a level spot to rest for every foot of vertical change in elevation.

Left-Right Cross-Slope – Most outdoor paved surfaces have a slight slope to drain off rainwater.  On sidewalks a cross-slope of one inch in four feet is common and is treated as “flat enough” in building codes.  For a wheelchair user, cross-slope makes pushing much harder because the chair wants to turn downhill.  To compensate, the user has to push harder with the downhill arm.  One arm can end up doing the work of two. Don’t be surprised if a person with a wheelchair takes over the middle of the road, where the crown is, just to reduce the effort.

Surface Texture – Like any other wheel, wheelchair wheels roll easiest on a hard smooth surface.  Scout camps have a lot of unpaved walkways, so you need to be aware of the effects of other types of surfaces.  There are air-filled tires available for wheelchairs, similar to bicycle tires.  These help with rough surfaces but do nothing to help with slopes.  The size of the gravel on a path makes a difference (smaller is better), and so does how hard the surface is packed.  Trying to roll through loose dirt, sand, or gravel feels more like plowing than rolling.  Imagine walking through a swimming pool, across sand dunes, or through deep powder snow.  A muddy path is not only a mess because the mud gets all over your hands and clothes, but it is hard pushing and you can get stuck.  Hard packed dirt and packed small gravel are not too bad unless there are other obstacles like roots and rocks in the pathway. A wheelchair user may want to be in the part of a roadway where vehicles have already packed down the surface rather than off to the side.

Doorways – A person using a wheelchair, walker, crutches, or other mobility devices needs more space to navigate a doorway than a standing person does.  Unless there is enough space for the wheelchair to move around when doors are being opened, an otherwise accessible doorway may be impassable.  Aside from this, any door that has a spring-loaded closer is going to be hard for someone in a wheelchair because you need both hands to drive the wheelchair and don’t have an extra one to pull on the door and hold it open.

Route Finding – Even when a building has an accessible entrance, the location may not be obvious.  A person with a wheelchair may have to try several different paths to find the door that is accessible.  With Murphy’s Law, it seems like it is always on the farthest side of the building and is at the farthest point from the place inside the building where you are going.  This often means that wheelchair users have to exert more effort than others to get where they are going.

Power Chairs and Scooters Are Not Always the Answer – The common types of power wheelchairs and scooters can drive up and downhill with little effort on the part of the user.  This extends the distance you can go and how fast you can move, but at the expense of overall fitness and cardiovascular health.  Power chairs have lower ground clearance and smaller drive wheels than manual wheelchairs, and are heavier.  This makes them more vulnerable to bogging down on soft surfaces and getting stuck going over humps.  Power scooters are narrower than manual wheelchairs, which makes them more prone to tip over on cross-slopes.  Another thing to recognize is that being able to propel yourself is empowering and has benefits for your mental state and self-image.

USING HELPERS

The preceding section makes it clear that most terrain outdoors is hard for those with physical disabilities to cross and they need others to extend their capabilities.  Ideally, everyone in the Scout unit works together to provide the extra help the Scout needs.  At its most basic, this is just an extension of the Buddy System we use with all Scouts.  In a Scout unit, the leaders may have to coach the Scouts on the kinds of help that are needed.  Here are some common needs:

  • Opening and holding doors
  • Carrying things from place to place
  • Lending a hand or an arm to steady someone
  • Helping a wheelchair get over a small obstacle
  • Carrying a food tray in a dining hall or restaurant
  • Reaching for things that are too high or too low for the Scout to reach
  • Stowing and getting out mobility aids when using vehicles
  • Doing small tasks for people whose hands don’t work well, like packing and unpacking
  • Exploring ahead to locate an accessible entrance for the Scout

It is good for everyone in the unit to be ready to offer this level of help to the Scout with a physical disability.  Ask “Is there anything you would like me to help with?” and “What would you like me to do?” and let the Scout have the power to decide how much help is wanted.  Helpful companions will need to learn not have their feelings hurt if help is refused. As everyone gets to know one another and relationships grow between the youth, the process of offering, asking, receiving, and refusing help gets easier and more intuitive.

Allowing a helper to push you in a wheelchair or unpack for you requires trust.  With a wheelchair, the Scout must trust you to not crash into something or mishandle an obstacle.  You need to pay attention to your own footing because if you fall while you are pushing a chair, you can pull it down with you.  In the case of unpacking, the Scout has to trust you to see and handle his or her personal things without making fun of anything, like the color or style of underwear, and without talking about this with others.

Some Scouts with physical disabilities need help with more personal needs like getting dressed, bathing, or using the bathroom.  Some may also need help with special medical equipment.  This kind of help is the realm of family members and professional caregivers.  Generally, professional caregivers have the legal permission of the Scout’s parents and guardians to provide care to their child and to make certain decisions as if they were the parent or guardian. They also generally have a close relationship with the Scout and can be a great resource in making the program a success for that Scout. We should recognize that these paid caregivers have been legally given these permissions and responsibilities.

The current (2020) BSA youth protection training (YPT) does not directly address professional caregivers, presumably because it is not a common situation. Not knowing better, unit leaders sometimes stop a Scout from going on an outing, or require a parent to attend an outing even though the parents or guardians have a professional caregiver who can stand in their place. Though acting in good faith as they understand the youth protection rules, this can create unnecessary hardship and conflict.

If we treat a professional caregiver like a parent, there are still things a caregiver must do:

  1. The caregiver needs to complete BSA YPT training like any other adult on an outing.
  2. The caregiver needs to be registered as an adult with BSA, primarily to obtain BSA background checks.
  3. The caregiver must complete the appropriate BSA annual health and medical record (medical form) for the outing, long-term or short-term. 
  4. The caregiver should have appropriate power-of-attorney documents for decision making.
  5. For long-term camps and schools, the camp/course director should be given advance notice that a non-parent caregiver is coming to camp, to make sure that any special documentation the camp needs is brought to camp.  This is important because laws and regulations vary from state to state and the camp needs to be in compliance with local law.

USING TRANSPORTATION

Even with personal helpers, a Scout with a physical disability needs to budget energy and time to be able to participate in the activities that are most meaningful. To get the most out of a large-venue outing like summer camp, a camporee, or jamboree, the most practical solution is to use some kind of vehicle transportation to get around the venue.  The first question is who is going to provide the vehicle and driver.  The second question is how to honor the other safety concerns of the venue where a vehicle is moving in and amongst pedestrians.

For a major event, it is worth asking in advance whether any on-site transportation will be available.  It is not uncommon to have power scooters available for rent at public venues.  Scout camps are notorious for having rough roads and that will dictate what kinds of vehicles might work.  The Scout will need to be able to get back and forth to every activity area at the camp from his campsite.  Hardcore off-road power chairs that use “tank tracks” do exist, but they are still too expensive for most families.  More practical vehicles are golf carts and utility work vehicles called UTVs.  They have limited top speeds that fit a camp environment better than a road vehicle.  They are also available for short-term rentals from farm and construction equipment rental companies.  Using a regular road vehicle is always an option as long as it has sufficient ground clearance for camp roads.

In most situations you will want a vehicle with at least four seats and a place to load and secure the mobility equipment the Scout needs while at the activity area.  That provides room for a driver, the Scout with the disability, a buddy Scout, and a caregiver.  The Scout should be allowed to have a buddy come along in the vehicle for social reasons if nothing else.  It is no different than allowing two Scouts to talk while they walk together to a location.  The other reason for a buddy to come along is to comply with “no one-on-one” contact rules for youth protection.

If you have special transportation needs and need to use a vehicle at a Scout camp or other venue where most people are on foot, do not surprise the camp administration and staff with this need.  You need towork things out with the camp administration to set reasonable allowances and restrictions for the use of the vehicle.  You will likely need to be able to keep the vehicle at your campsite even if others are not allowed to do so.  You can expect to have some restrictions, like speed limits, not using certain roads with high foot traffic, or avoiding driving in the busiest areas.

UPPER BODY CHALLENGES

The type and effect of upper body limitations will vary widely from one person to another.  As a general philosophy when working with Scouts, we seek to empower and enable the Scout’s efforts.  That means taking some time to understand what the Scout can do physically and allowing the Scout to do as much as he or she can.  Sometimes an adaptive device can fill in the capability gap.  Sometimes a helper needs to amplify the force the Scout can exert.  Sometimes you need to help stabilize a shaking hand.  And yes, there are times when the helper needs to physically do a task while the Scout directs the helper through the task.

You do not have to have a mobility or lower body disability in order to have an upper body limitation.  Many Scouts with upper body limitations will try to hide this from others to avoid being embarrassed or ridiculed.  A Scout that has a lower body disability but no upper body limitation will still need some adaptations to allow tasks to be done from a sitting position or from a wheelchair.  A wheelchair will often obstruct upper body motion in some way that will need to be accounted for.

Pinching – Many detailed tasks require an ability to pinch something between the thumb and one or two fingers.  In terms of basic living, if you cannot pinch and hold a button, you cannot button your clothes.  If you can’t pinch a zipper pull you can’t zip up clothes, tents, backpacks, or anything else.  If you cannot pinch something for a long time, you can’t write with a pen or pencil, use a paintbrush, or work with small tools for crafts.  With clever adaptations, many pinching tasks can be eliminated, for example by replacing buttons with Velcro®[5] squares or magnets. Other tasks can be converted from a pinching task to a gripping task.  For example, knotted cords can be tied to zipper pulls to extend them.  A tool, like pliers, can be used to pinch with.  The handles of tools can be lengthened or thickened so they can be gripped with the whole hand.  Foam tape and epoxy putty work well for enlarging a handle.

Gripping – Gripping or squeezing an object uses different muscles from those used to pinch and do small controlled motion.  Grip is more important than you might think because you cannot lift or pull anything with force if you cannot grip it. Anyone who has moved furniture can understand that even if you have the strength to lift a heavy object in every other respect, you can’t lift something heavier than your grip can handle. If you’ve moved furniture you also understand that how long you can maintain a grip matters.  There are devices to enhance grip strength for specific tasks.  For example, in adapted archery, there are devices that attach to the hand, arm, or wheelchair to hold the bowstring while the bow is pushed away from the archer.  There are special gloves with a strap that wraps over the outside of the fingers and back to the glove to keep the hand in a curled position to hold a handle or lift a dumbbell. Other modified gloves have a hook-shaped metal shank that can be used to catch a handle while leaving the fingers free.

Arm Strength – No matter how strong we are, all of us have limits to how much force we can exert.  Short of a high-tech powered exoskeleton, there is little that one can do to enhance the basic strength that a person has.  Instead of adaptive devices, we turn our focus to accommodations to limit the amount of force a Scout has to generate to what he or she can physically do.

Feeling – Upper body limitations are not all about strength.  Anything we do that requires delicate handling or precision relies on our nerves and touch sensations too.  A good example is holding a drink in a paper cup.  You need to hold the cup firmly enough to not slip out of your hand, but not too tightly or you will crush the cup and it will fall out of your hand that way.

Positioning – The human body has a “sixth sense” that most people have never heard of.  Proprioception is the sense of where all of your body parts are positioned and how fast they are moving[6].  To demonstrate this to yourself, hold your arm out to your side, close your eyes and then touch the tip of your nose with your index finger.  Most people can do this without looking because there are nerves all over your body to tell your brain what position all of your joints are in and your brain remembers how long your bones are.  There are some people that have difficulty with coordinated movement. To adjust for this, they may move more slowly and carefully and use their eyes to closely follow their body motions.

Shaking – Some types of physical disabilities affect how nerve signals go to muscles, and result in shaking, tremors, or muscle spasms that make it hard to manipulate objects in a useful way.  For example, using utensils to feed yourself can be very frustrating with shaking hands.  There are some adaptive technologies that can help with this.  Sometimes a hand or wrist brace can resist the shaking physically and can allow a person to use a pen despite tremors.  Extra heavy eating utensils and cooking implements can reduce the shaking at the end of the tool.  More advanced technology uses a vibrator inside the tool that shakes to counteract a muscle tremor and keep the end of the tool from shaking.  For computers, there are accessibility settings that can be adjusted to reduce duplicated keystrokes.  A larger format keyboard may be helpful too.

FUNCTIONAL PRIVATE SPACE

Many of the activities of ordinary life take longer when you have a physical disability.  This includes toileting, bathing, grooming, getting dressed, and changing in and out of swimwear.  A person with a disability needs patience from others and has to plan ahead to allow time to get things done.

The physical space you live in makes a difference when you have a physical disability.  You travel with a lot more stuff (equipment and supplies) to support your disability and have to bring enough supplies to carry you through the entire outing.  You can’t just run to the store if you run out.

Tents – To deal with time issues, you want to place tents housing those with physical disabilities as close as possible to latrines, cooking/eating areas, and group activity areas.  Some types of tents don’t work well with physical impairments.  Those with upper body limitations need to have cords or handles attached to the zipper pulls in order to work the zippers.  Metal tooth zippers are preferred because they tolerate rougher use than plastic ones and are less prone to jam.

For Scouts using wheelchairs, walkers, and crutches; the tent will usually need to be tall enough to get into while standing upright.  The doorway needs to be wide enough for a wheelchair.  Special attention needs to be paid to the threshold.  Some tents have “bathtub” floors, where the threshold is several inches high.  Unless a wheelchair can push down the fabric as the chair rolls over, this will not work.

Another factor is that you cannot put as many people into a tent together.  When you need to sleep on a cot rather than the ground and park a wheelchair or walker beside your bed, there isn’t as much room for other people in a tent.  Realistically a 6-person cabin style tent may only hold two people; the Scout with the disability and a buddy or caregiver.

Sometimes it makes sense to have an extra tent that serve as a “garage” for the Scout’s extra equipment and supplies.  The garage can also be used for some of the group gear.  This is a good use for an older tent that has too much age or wear to use for sleeping anymore.

Toilets and Latrines – Toilet and bathing facilities at Scout camps are rapidly improving, but it will take time to make things better for everyone everywhere.  This section does not talk about how facilities can be built or permanently modified to make them accessible.  That will be addressed in Module AA.  Instead we will focus on ways to make the most out of existing imperfect facilities and create workable temporary spaces at a campground.

At most Scout camps there are facilities tucked away in buildings that the campers and unit leaders are unaware of because they are reserved for staff or adults.  Dining halls usually have a restroom for the kitchen workers and may have a clothes washer and dryer for washing dish rags.  Staff quarters often have bathrooms with fixtures similar to home. The camp headquarters or business office usually has a restroom. The health lodge/medical facility usually has restroom and shower, and these may be wheelchair accessible. The important thing is to take the time to ask about these facilities when you get to camp because they are out of sight and out of mind even for the staff.  It should be possible to allow Scouts with physical disabilities to use these restricted facilities while they are in camp.  This will solve a lot of problems while the Scout is in the central core area of the camp.

At the campsite, the Scout may be too far from an accessible latrine to be workable.  There are ways to improve upon older style latrines.  If the latrine has a single-person stall, like an outhouse, you can enlarge the private space by screening it with a tarp to create a vestibule.  This allows the door to the stall to remain open while a wheelchair or walker sits in the doorway.  If the pathway inside the latrine is an impassable maze, or the latrine is on a raised platform, you may have to create a complete temporary facility.  This is easier than it sounds.  If your unit travels with a gear truck or trailer, bring a couple of sheets of exterior grade plywood to lay on the ground as the floor.  This gives you an 8 foot by 8 foot square area to work in that is out of the dirt and wheelable.  Sightscreen the temporary platform with tarps and four poles (lashings and knots anyone?), or pitch a pop-up shelter over it and attach tarps to the shelter legs.  A folding toilet chair and a 5-gallon bucket create a temporary toilet.  For washing, bring a garden hose to extend water from the faucet at the campsite to the temporary latrine.  Be sure to put a valve or spray handle at the end of the hose that the user can control.  A smaller bucket on a small folding table can serve as the sink.  While Scouts tend to avoid bathing, this kind of improvised facility is good enough for sponge bathing and cleaning up as well.

One last topic about bathroom facilities is signage.  It is worthwhile for a unit to have some premade signs to use with latrines and bathrooms to address privacy between youth and adults, males and females, and disabled and typical people.  Some flippable signs could say open/closed, occupied/open, female/male, or adult/youth. 

Clothes Changing – Some activities at camp, like swimming and boating, require special clothing to participate, but there may not be an adequate changing area at the venue.  A good example would be a Scout with upper body limitations that require him or her to have help getting into or out of clothes.  You can pitch a large tent or tarps at the venue to create a space where the Scout and caregiver can work, out of sight of others (see the Using Helpers section above regarding youth protection).  Even if the Scout can get dressed without assistance, you may still need a large tent to provide enough room to maneuver if the permanent changing space is cramped.

Incontinence Needs – There are some physical disabilities that cause a loss of sensation or control of the bladder, the bowels, or both.  A person who cannot feel when the bladder is getting full may use a catheter to empty the bladder on a regular schedule.  Young people are usually trained how to do this for themselves, but if not, a family member or caregiver may need to help a Scout with this.  Others may use “adult diapers” to manage their needs.  Even when a Scout is used to taking care of waste needs on a schedule, things can be different at camp.  He or she may be eating and drinking on a different routine from home, with different foods than normal. In hot weather we try to increase fluid intake, which can also change the normal routine.

As a related matter, we need to think about discreet disposal of the waste diapers and catheters to spare Scouts from unwanted attention and embarrassment.  Catheter users prefer single-use disposable catheters, which can be up to 20 inches long.  While diapers and catheters can be disposed of with regular trash, you want to provide opaque trash bags and tall trash cans, so nothing is left in view.

Cleaning Up Accidents – There are some disabilities that result in occasional unexpected bowel or bladder control issues.  While the family of the Scout needs to make provisions for extra clothes and may need to send a caregiver, it is wise for the Scout unit to have a few supplies to handle an unexpected accident.  This includes a spare sleeping bag if one gets wet, disposable gloves, antiseptic hand wipes, and a few large zip-lock bags for containing soiled clothing until it can be cleaned.  This is a good idea whether you have Scouts with special needs or not because any youth could slip and fall into mud or water and then need a little help.

ADAPTATIONS FOR SCOUTING ACTIVITIES

Hiking – A mobility disability does not mean “no hiking”.  There have been Scouts who completed long distance treks on crutches, with the support of the other Scouts in their crew.  A Scout who uses a wheelchair can still go on hikes with a reasonable choice of location.  An internet search can usually find accessible trails in your area.  One site worth special mention is the Rails-to-Trails Conservancy[7] (railstotrails.org).  The experience of a hike is much more than just walking from one place to another.

Cycling – There are a variety of adaptive cycles available to suit different physical abilities.  This includes variations on tricycles that are powered by either feet (natural or prosthetic) or by hands.  The hand powered cycles can use either a cranking motion or a rowing motion.  Tandem bicycles are another way a person with a disability can participate in a bike trip.  Another relatively new option is the e-bike, which has a battery-powered motor to eliminate or reduce the effort of pedaling.

Like with hiking, the terrain needs to be taken into account when planning a bike trip for a Scout with a disability.  You want to have better paved and flatter terrain to make up for the extra effort it would take to propel yourself with your hands or to pedal with a prosthetic foot or leg.  Many of the accessible trails that are available for hiking will also permit cycling.

Orienteering – Orienteering instruction is no different for a Scout with a physical disability, unless the Scout lacks the dexterity to manipulate a compass.  Inexpensive oversized teaching compasses are on the market and can be easily modified to work like map compasses.  The next step is to find reasonable terrain for a compass course. Although traditional competitive orienteering includes cross-country running, competitive courses can be designed where each station can be accessed by a road or wheelable trail.  Arguably, requiring all the competitors to find and stay on accessible routes would make the orienteering more challenging.

Shooting – Shooting ranges need to be prepared to be accessible in advance of an activity.  You want to create a shooting station where the bench rest or railing height can be adjusted to match the height of a shooter sitting in a wheelchair or a regular chair.  This will accommodate Scouts with lower body disabilities for the most part.  You need to prepare for a shooter who lacks the strength to lift and hold the weight of the gun for a reasonable length of time.  Large beanbags can be used to create an arm/gun support that will conform to the shooter.  A third type of shooter to prepare for is one who cannot absorb the force of recoil, but can aim and pull the trigger.  A pivoting gun rest, where the gun is mounted to the rest and the rest is anchored to the bench or the ground is a workable solution.  The fourth type of shooter is one who has an uncontrollable shake or tremor.  In some cases, having a vertical pole to lean or rest the gun against will work.  A pivoting gun rest that has friction built into it could allow a shooter to get the gun into position without having to hold it throughout the shot.  Shooters may need a trigger extension or a pushbutton trigger release.  For time management reasons, many shooters with upper body limitations will need a helper to reload and do other things to speed up the range operation so the shooter can shoot in rounds with everyone else.

Archery – Seated archery is a simple adaption to allow on the range and will accommodate most lower body disabilities.  The other two challenges for archery are finding a way to draw the bow and finding a way to grip and release the bowstring.  A grip problem requires special equipment that will need to be obtained in advance.  A mechanical release allows the bowstring to be held by a “claw” that you release with a pushbutton or squeezing action.  There are versions for one-armed archers that can be operated with your teeth.  When a mechanical release is used, the bow is drawn by pushing the bow away from the body, which is the reverse of conventional archery.

One of the simplest adaptations for limited upper body strength is to have a bow available that has a light draw weight and then combine that bow with a target that is closer to the shooting line than the rest of the targets and therefore within the “throw distance” of the light bow. Both left-handed and right-handed bows will be needed.  A Scout can learn the form and technique of archery without shooting at a long distance.  This also serves the needs of smaller and younger Scouts.  A different adaptation is to allow the Scout to use a compound bow that is adjusted for a low draw weight at full draw.  An archery assistant helps the archer draw the bow to a full draw, and then hands control of the bow to the Scout to aim the shot and release the bowstring.

Swimming – Every willing Scout should have opportunity to get into the water and have fun.  The most difficult challenges don’t have anything to do with swimming itself.  They are creating accessibility so wheelchairs can navigate through the gates and dressing spaces to get to the water and providing private space where a caregiver can help the Scout out of street clothes and into a swimsuit.

Most safety concerns can be solved by using flotation aids for the Scout with a physical disability.  In addition to lifejackets/PFDs; pool floats, kickboards, small surfboards, and paddleboards are options to allow Scouts to move about in the water.  The other safety concerns can be resolved by having a responsible buddy stay with the Scout and help position and move him or her through the water.  An important thing about the buddy is that the Scout needs to be able to trust the buddy completely.  If another Scout is going to be a helper, the helper needs to be taught that he or she can never play a trick in the water on the Scout that needs help.

Special lifting equipment is available for pools that will allow a person in a wheelchair to transition onto a movable chair, swivel out over the pool, and then be lowered slowly and smoothly into the water.

For further information on aquatics and special needs, consult Module BB.

Boating – It is difficult to give specific guidance for boating with physical disabilities because of the wide variety of watercraft, water conditions, and limitations a Scout could have.  If a wheelchair is going onboard a larger craft, there need to be provisions to tie down the wheelchair so it does not move around on deck.  For smaller craft, you may need to build a seat back for the seat to support the Scout’s upper body. Tying a Scout down is not advised.

If the Scout is unable to maintain a safe, face-up floating position on his or her own, the buddy will need to be able to function as a lifeguard.  Safety Afloat requires the buddy to be an adult who has passed the BSA swimmer-level test.  However, that may not be enough skill level by itself to manage the risks.  The adult buddy needs to be familiar and comfortable enough with the watercraft that he or she can give due attention to the Scout, and also needs to have in-the-water rescue skills to assist the Scout in the event of an overturn.

Scouts with a physical disability, even moderate ones where they could be rated as a swimmer, should not be alone in a boat.  That does not mean that a capable Scout cannot do the solo boat handling required for merit badges (e.g. paddle a canoe or kayak, steer a sailboat, or drive a motorboat), but it does mean there should be a second person on board to assist in an emergency. A good example of this need would be a Scout that experiences seizures.

For further information on aquatics and special needs, consult Module BB.

Knife and Woods Tool Use – In a general sense, these tools are no different from the other tool modifications that were discussed in the upper body challenges sections above.  As a practical matter, the need to use a knife for anything other than cooking has always been limited.  Furthermore, as the Scouting movement embraces “leave no trace” conservation principles, we are building fewer fires.  Land managers are limiting the use of open fires and restricting the gathering of firewood in many locations.  Our focus then falls on teaching knife and wood tools safety.  These skills can be taught using hand-over-hand techniques so Scouts can have the experience of using a tool while limiting the risk of a tool getting out-of-control to the point it becomes a hazard.

With this said, since Scouts are generally allowed to keep personal knives if used responsibly, a Scout with a physical disability needs to be allowed to have a type of knife that he or she can use safely.  In some cases that means a Scout will not be able to open or close a folding knife and will need a fixed-blade sheath knife.  While a personal knife does not need to have a large blade, it may need to have a large grip.

Fishing – Like swimming, most of the challenges of fishing have little to do with fishing itself.  Often the biggest adaptation that is needed is to make a level place for a chair or wheelchair to sit near the water so you don’t have to sit tilted forward or be at risk of rolling off into the water.  Obviously, there needs to be an accessible path to the fishing spot.  Fishing from a dock is more straightforward, but the gangplank from the shore onto a floating dock may be too steep to manage without help from others.

The other challenges of fishing come from upper body limitations.  The first thing is to provide a tether for the fishing rod so it does not fall into the water if it is dropped.  (Frankly, this is a good idea for fishing with younger Scouts too, since they sometimes get excited when they hook a fish and drop the pole.)  Sometimes, the fishing pole handle will need to be longer or to be lengthened to allow it to be used two-handed or to be strapped to the forearm.  When the Scout has difficulty using her or his hands, a helper will be needed to bait hooks and get fish off the hook, for the safety of the fish and those fishing.

Fire Building/Stove Use/Cooking – The most obvious accommodation needed for these activities is to get the height of the “working surface” at the right level for a Scout who uses a wheelchair.  A Scout with a physical disability can usually build and tend a campfire.  It may mean that the campfire is in an elevated fire pit rather than on the ground.  You can also use a fire pit bowl on top of a stone platform built in the field by other Scouts.  Many units will also have round metal “oil change” pans for their Dutch ovens and one of these pans can be used as a fire platform for a smaller campfire.  A couple of adjustable height plastic folding tables may be needed for the Scout to be able to have the stove at a lower or higher level than usual.  If a Scout has grip limitations, you may need to create a set of cooking tools with extra thick or long handles.  You may also want to have a rocker knife in the cook kit.

Rope Work – All Scouts who are learning how to tie knots and make lashings can benefit from the adaptations for a Scout with a gripping or pinching limitation.  The secret is to use large diameter, solid color, braided (boating-style) rope.  The braided rope bends easily and the large diameter makes it easier to see what you are doing.  Thicknesses up to 5/8 inch are readily available[8]. Another good adaptation is to use ropes of two different colors to teach joining knots.  This makes the shape of the knot easier to see and the paths of the different ropes through the knot clear. While good lashings require natural fiber three-strand rope to be secure, you can teach lashing with the softer thicker rope.

Rock Climbing/Rappelling/Challenge (COPE) Courses/Zipline – High element challenges are more about the mental challenge of working a puzzle or controlling fear than the physical challenge. These activities are not beyond the capabilities of a Scout with a physical disability, though the process and equipment setup will be very individualized.  The details of what to do are too complex to do justice to in this module. In most set-ups, the climber needs to be equipped with both a chest harness and a waist harness.  This allows the climber to remain upright after a slip and eliminates the risk of slipping out of a waist harness because the shape of your hips or legs is different from most people.  Those climbers who cannot use leg force to lift themselves will need some kind of counterbalance device to support part of their weight so they can enjoy the challenge without it being impossible for them.

ADVANCEMENT CONSIDERATIONS

As explained in Module E, in most cases disabilities can be accommodated by an open-minded reading of the requirement, keeping in mind the intent and learning objective of the requirement. 

Demonstrate/Show – There are many requirements that use the word “demonstrate” or “show”.  While for many Scouts that will mean “do the task by yourself, while I watch you”, this is not a viable option for some physical disabilities.  What we need to point out is that it is reasonable to allow an able person to amplify the force a Scout can exert or to steady a shaking hand[9], while the Scout does the advancement task.  For a Scout who cannot use hands, it is reasonable for another person to “be the hands” of the Scout while the Scout directs the task. The person serving as the “robot” needs to carefully follow the instructions of the Scout and not think on behalf of the Scout.

Write/Draw/Sketch/Diagram – Here we address a Scout who is unable to wield a writing implement at all.  Otherwise, we should be willing to accept a document that communicates what it needs to even if it is not elegant. In a low-tech environment, the practical solution for writing requirements is to allow a scribe to take down the information the Scout gives verbally and write it on the page.  However, if you look closely, many requirements that we assume require a written product don’t actually say that.  Report, describe, discuss, and explain can all be done verbally.  In a high-tech environment, it may be possible for the Scout to type directly or to use voice recognition software to create a document.

There are a variety of ways to adapt to produce a graphical product without the traditional pen and paper.  First decide if a verbal “word picture” would suffice, or if it is OK for a scribe to draw what the Scout tells them to.  The next alternative is for the Scout to work with pen on paper with someone to help move the hand to a starting position and steady the hand while the Scout draws. Fingerpaint can be used to draw on a larger scale. 

Physical Fitness Requirements – In some cases, a Scout with a physical disability will not be able to perform certain kinds of exercises that are identified in advancement requirements.  You will need to get alternative requirements approved, but we still prefer to have them be a physical activity.  If the Scout works with an occupational or physical therapist, ask questions and try to use exercises that the Scout already needs to do for therapeutic purposes.  Even with a disability, a Scout benefits from the discipline and activity of exercise, and the Scout can certainly show improvement as the physical fitness requirements ask.

[1] The Boy Scouts of America would like to thank United Cerebral Palsy (UCP.org) for reviewing the contents of this module for accuracy and usefulness.

[2] Prosthetic limbs can be configured for general purpose movement or specially configured for a particular sport or work task.

[3] Flat is all in one plane.

[4] Level is perpendicular to gravity.

[5] Velcro® is a registered trademark Velcro BVBA.

[6] This sense also extends to memorizing where fixed objects are in a familiar space like your home.  If someone moves a piece of furniture you find yourself running into it until your mind map compensates.

[7] The Rails-to-Trails Conservancy (railstotrails.org) focuses on converting abandoned railroad right-of-ways into recreational trails.  Since railroads have tight restrictions on slope and flatness, these trails are especially well-suited to wheelchair and bicycle traffic.  They are also longer routes than you can easily find with most accessible trails.

[8] Another good source for rope is used climbing rope.  Camps regularly have to decommission rope by cutting it into short lengths.  The short lengths are still good for knot-tying instruction.

[9] On a practical basis, this is no different than allowing a deaf scout to be assisted by a sign language interpreter.