Sailing … On Land?

SCI patients learn to sail with robotic, ride-on simulator

Sailing is a sport that can be adapted for people with disabilities, but it can sometimes be intimidating for someone who hasn’t tried before.

But a research program at the Kennedy Krieger Institute in Baltimore, Md., is allowing patients with spinal-cord injuries to test the waters before setting sail.

Albert Recio, MD, medical director of the aqua therapeutic program at Kennedy Krieger Institute, discussed his recent rehabilitation work with spinal-cord injury (SCI) patients using the Vsail-Access sailing simulation system during Wednesday’s second day of the Paralyzed Veterans of America Healthcare Summit + Expo at the Renaissance Orlando at SeaWorld in Orlando, Fla.

Recio emphasized the importance of sports and recreation in the lives of people with disabilities, including positive effects on well-being, physical fitness and reintegration into the community.

“There is evidence that above and beyond the cardiometabolic benefits, sports participation has the ability to stimulate confidence, self-efficacy and self-perceived quality of life,” Recio says. “There is also evidence that community integration questionnaire and quality-of-life scores were higher among individuals with SCI who participate in sports compared to non-sport participants. There are also studies that show that adults with chronic SCI who participate in organized sports has been shown to be positively associated with employment and that those who are actively involved in sports have higher employment rates than their physically inactive individuals with SCI.”

Albert Recio, MD, medical director of the aqua therapeutic program at Kennedy Krieger Institute, discussed his recent rehabilitation work with SCI patients using the Vsail-Access sailing simulation system during the second day of the Paralyzed Veterans of America Healthcare Summit + Expo in Orlando, Fla. (Photo by Brittany Martin).


Despite those benefits, researchers have found that people with SCI often experience barriers to accessing and learning new sports.

“Now, virtual reality training provides safe, accessible method of rapid skill acquisition, and they promote activity and translation of skills through real world experience,” he says.

With that in mind, Kennedy Krieger Institute utilized the Vsail-Access system in a 12-week therapeutic sailing program. Recio and his team hypothesized that if participants learned to sail to a stage where they were competent to begin to sail on water in moderate conditions like wind strength up to 40 knots, they would show measurable physical quality of life and self-confidence improvements.

The trial consisted of outpatient adults with SCI who were at least six months post-injury. All neurologic levels from C1 to S1 and all-American Spinal Cord Injury Association (ASIA) impairment scale grades from A to D were included.

As for the sail simulator, it’s a generic sailboat cockpit powered by pneumatic piston and custom-designed software. The user sails the simulator around the virtual courses displayed on a computer screen or overhead display in the same way as a real sailboat on the water, but in a safe and non-threatening environment.

There is a tailor to control the rudder angle, a mainsheet to control the sail and body position to control the heeling (leaning). Electronic sensors provide real-time feedback to match the movement of the virtual sailboat displayed on the screen with those of the simulator. Sailors can select the wind strength and conditions to suit their ability, and the cockpit is fitted with a seat based on the Hansa Access dinghy, which is used in adaptive sailing programs across the country.

Trial subjects were first assessed using a sailing score, which is based on the ability to perform specific sailing maneuvers. Subjects were also asked to complete a quality of life questionnaire. Out of 18 participants enrolled, 13 (six females and seven males) completed the study. In addition, six participants had tetraplegia and seven had paraplegia, with an average age of 23 to 63 years old.

After the training, a majority of subjects rated their sailing abilities as “very good” and when asked if they were ready to sail on the water, a majority answered, “definitely.” Participants also reported decreased depressive feelings and improvements in other quality of life markers.

Following the trial, participants had the opportunity to sail on water at the Downtown Sailing Center in Baltimore. For researchers, the trial also helped determine certain adaptations needed for people based on their ASIA impairment scale levels, including sip-and-puff or head controls, handgrip assist gloves, joystick drive, various other supports and a pressure relief cushion.

“I’ve been working with the Johns Hopkins Biomedical Engineering Department to come up with a better sip-and-puff control and see if we can, you know, have even more sophisticated control using sip-and-puff. We’ll see,” Recio says.

He adds that the VSail-Access system is a great option during the winter, so patients can be ready to sail when the weather is right. And he says t can also be used to train specific skills, such as sail training, in a way that’s not possible on the water when there are a large number of interacting variables.

“Specific adaptations based on impairment level can be easily be implemented, with further individualized modifications made on a patient-by-patient basis, and additional research will be required to develop the relevant protocols,” Recio says.


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