RESNA Annual Conference - 2019

Occupational Therapy Perspectives And Analysis Of Adapted Nautical Activities For Long-Term Wheelchair Users

Karina Cristea1,2, Lise Poissant1,2, Johanne Filiatrault1, Dany H. Gagnon1,2

1Université de Montréal, 2Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR)


The benefits of physical activity have been largely reported in the scientific literature for several populations, including persons with physical impairments and functional disabilities. The offer of adaptive physical activities has increased over the past few years and several sports are now accessible for this clientele. Nonetheless, nautical sports remain to this day less available than other types of sports even though their benefits have been increasingly documented in the past few years. Moreover, technological adaptations allowing to increase accessibility to these sports, particularly for long-term wheelchair users, are now increasingly available.

This abstract aims to:

1) Present the results of a qualitative study carried out on surf therapy for children with special needs;

2) Introduce an alternative to surfing for long-term wheelchair users who do not live close to the ocean: adaptive stand-up paddling.


Design and methods

A qualitative research using an exploratory design was conducted among ten parents of children with special needs. Children were aged between 5 and 15. Most children (n = 7) were presenting with autism spectrum disorders. The main goal of this qualitative study was to explore the perceived benefits of periodical surf therapy events (organized by the California-based non-profit organization A Walk On Water) among parents of children with special needs who participated to these events. Individual semi-structured interviews were conducted with children’s parents after every surf therapy session. Parents were also asked to complete an observation grid related to their child during daily functioning throughout the 7 days preceding the first surf therapy event and after each subsequent surf therapy event.

Parents were asked to observe the following variables on a daily basis: bedtime and mealtime routines, level of engagement in school and leisure activities, physical abilities, communication and social interactions and children well-being. The interview guide prompted the participants to discuss about their child reactions during the surf therapy events (e.g., when meeting their surf instructor, after catching a wave). They also prompted parents to discuss about the elements they had recorded in their observation grid. [1] Data were analyzed using a deductive approach based on an occupational therapy model, the person-environment-occupation model. This model analyzes the interactions between the person, his/her environment and his/her occupations in order to understand how they affect a person’s occupational performance. In this study, the model was used to analyze the impact of surf therapy on children, on their environment and their occupations.


Perceived impact on the child

According to parents, surf therapy had a positive impact on children’s affective state. Themes like excitement, happiness and feeling good about oneself were highlighted by a majority of participants. Parents also reported that their child was more calm or relaxed than usual after surf therapy. These effects were reported mostly during the activity, but some parents reported that they were also noticeable prior (excitement) and after (calmness) the activity. Moreover, a majority of parents also mentioned that surf therapy had a positive impact on children’s social skills. The parents felt that this activity provided their children a sense of pride or accomplishment and a sense of belonging.

Perceived impact on the environment

Benefits of surf therapy on the child’s social environment were also highlighted by parents, mostly on themselves as they enjoyed the reaction that surf therapy had on their child. In fact, parents stated that they enjoyed seeing reactions of happiness, enjoyment and excitement that surf therapy seem to bring to their child. Parents also reported benefits of the activity on the child’s siblings as they could also surf during the event. However, some parents mentioned that the first event was very demanding for them, as their child needed to learn a new routine involving an entire day.

Perceived impact on occupations

Parents perceived that surf therapy contributed to a sense of autonomy in their child. Indeed, they reported that their child was more inclined to do things by themselves (e.g. during their bedtime routine).

Factors moderating the impact of surf therapy

Figure 1. Analysis of surf therapy from an occupational therapy perspective
Parents highlighted that volunteers’ attitudes, the natural conditions and the inclusive culture of the non-profit organization responsible for the events had an influence on the impact of surf therapy. In fact, volunteers were described as caring and demonstrating kindness and warmth. A majority of parents also mentioned the natural environmental conditions (e.g., number and size of waves) as important factors that influenced the impact of the activity. They mentioned that their child was disappointed when the wave conditions were not great and impeded them from surfing as much as they would have wanted to. Parents also described the non-profit organization was a safe place for their child, where they can be themselves without being judged. Their specific approach to therapy was also described as empowering for the children. Indeed, the non-profit organization assumed that each child can surf and provided them with the support necessary to do so.

Individuals living with a disability often face occupational challenges in their activities of daily living because of their reduced physical abilities and functional capacities. [2] These challenges can have important psychological consequences since the capacity to engage in meaningful activities and accomplish social roles is a health determinant.

Figure 2. Photo of an adapted stand-up paddleboard designed for manual wheelchair users (taken during an activity organized by O’sijja SUP Adapté)
Adaptive physical activity can be seen as a way to promote health, as well as social integration for persons with disabilities. Since many barriers (physical, administrative, cultural, etc.) can influence the participation of this clientele to physical activity, an analysis of the possible benefits of participation to these activities is relevant to promote the participation to adaptive physical activity.

The analysis presented above could serve as a basis not only to promote the practice of other types of adaptive physical activity, but also to develop innovative rehabilitation programs based on adaptive physical activity, such as a rehabilitation program for long-term wheelchair users.


Stand-up paddling is a sport that has expanded rapidly in the last 5 years. It is now considered as the aquatic sport that has known the most important expansion worldwide. This sport could provide an interesting alternative to surfing in areas that are far from the ocean coast and could be offered to persons with a variety of disabilities, including long-term wheelchair users. In fact, high volume stand-up paddleboards can be adapted in order to optimize their stability, especially in the frontal plane, therefore allowing the safe practice of this sport for manual wheelchair users (Figure 2).

Adapted stand-up paddling could be an interesting alternative to more conventional rehabilitation or health promotion interventions used by rehabilitation or physical activity professionals. In fact, the physical, postural, cardiorespiratory and cognitive demands of this sport and the natural environment in which it takes place make it a relevant option as part of the rehabilitation process of persons interested in nautical sports. On one hand, many muscle groups of the upper limb and trunk muscles are engaged in order to maintain the stability of the paddleboard and generate the movements required to propel the board. This continuous muscle work also promotes aerobic fitness (i.e. cardiorespiratory demand) during the practice of this sport. [3, 4] On the other hand, it is now documented that participating in outdoor activities, particularly in environments in which water is predominant, helps reduce stress and increase well-being.

Surprisingly, very little scientific research has been done to this day on the potential benefits of adaptive stand-up paddling. Considering the growing number of adepts of this sport in the last few years, the important documentation of its benefits in informal publications (websites, magazines, blogs, etc.) and the unique characteristics of the sport, more research is therefore warranted to assess its therapeutic potential. Our team is actually working on a research project aiming to develop and assess the outcomes a rehabilitation program based on this adapted sport, in collaboration with long-term wheelchair users and key stakeholders from adaptive sports organizations. Among those, O’sijja SUP Adapté is one of these organizations that strives to make stand up paddling accessible to persons with physical impairments and functional disabilities. A comprehensive research program articulated around adapted paddling will be presented.



[1] Law, M., & et al. (1996). The Person-Environment-Occupation Model: A Transactive Approach to Occupational Performance. Canadian Journal of Occupational Therapy, 63(1), 9-23.

[2] Moll, S. E., Gewurtz, R. E., Krupa, T. M., Law, M. C., Larivière, N., & Levasseur, M. (2014).  « Do-Live-Well »: A Canadian framework for promoting occupation, health, and well-being.  Canadian Journal of Occupational Therapy, 82(1), 9-23.

[3] Barucq, G. (2014). Surf thérapie - Se soigner au contact de l'océan (2 ed.). France Surf Prévention.

[4] Nichols, W. J. a. (2014). Blue mind : the surprising science that shows how being near, in, on, or under water can make you happier, healthier, more connected and better at what you do: First edition. New York : Little, Brown and Company, 2014.