Q&A with Robert Gailey

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June 2003

By Sarah Schmelling

Chad Colley is a triple amputee and world champion monoskier.

Robert Gailey, PhD, PT, has specialized in the rehabilitation of people with lower-extremity amputations for more than 20 years. An active speaker and writer, he has become deeply involved in the effort to motivate amputees to participate in all kinds of athletics. Following his presentation on sports equipment for people with amputations at the American Physical Therapy Association Combined Sections Meeting in February, Rehab Management caught up with him to find out more about this intriguing specialty.

RM: On your Web site, it says that a great deal of what you have learned has come from listening closely to your clients, and passing along that knowledge to others. What are some examples of this?

GAILEY: When I first started in the early 1980s, there wasn’t a lot of information in the [physical therapy] literature concerning the rehabilitation of amputees. So along the way I learned a lot from listening to the amputees describe what they are feeling and what works for them. For instance, many amputees can actually feel their prosthetic foot and they know when they are on the toe or the heel. From listening to amputees talking about this sixth sense, we have developed techniques in which we can actually assist prosthetic wearers feel more connected to the ground, achieving greater proprioceptive input. By utilizing this sensation, they tend to develop better control of their prosthetic knee and foot, resulting in better overall prosthetic control. From techniques like this, many amputees tend to walk a little better.

Another example is learning to teach amputees how to run. There have been a number of methods that folks have shown me through the years, but it is the little things that amputees have told me that helped us develop a system to teach amputees how to run in five fairly easy steps. In short, the greatest contribution we have received in developing gait training techniques, or returning people back to recreational sports, comes from really listening to what the amputees are saying regarding the sensations they experience with their prostheses, and then trying to develop exercises or treatment techniques that can build on what they are reporting and make it all work together.

RM: You often speak on this topic to other therapists. What major points do you try to get across to the rehabilitation community?

Robert Gailey, PhD, PT

GAILEY: The keys are this: most healthy amputees can get back to recreational sports if they are afforded the opportunity to maximize the use of their prosthesis. Some suggestions are to seek training from other amputees, therapists, or coaches who are familiar with how the prosthesis can assist them and what will allow them to be able to participate at their appropriate functional level. People with disabilities often say that the difficult adjustment is getting used to their new body when they have lost a limb or the function of the limb. Then, once you learn to accommodate the new body, you have to determine what adaptations you require, whether it is a wheelchair, a prosthesis, or some type of assistive device such as crutches.

Then it is just a matter of how to put it all together. I have found in my experience that one of the most beneficial ways for folks to do this is to participate in events that are specifically geared for people with disabilities, such as skiing or golf programs. By getting involved, they have the chance to meet other people who have gone through the same things they have; they also get to see the latest technology that allows them to improve their performance.

Most important, they feel more confident because they are with a large group of people just like themselves, they don’t feel different, and throughout the event they have the opportunity to talk with other people who have had similar experiences. From the sports clinics and other experiences, they develop, first, an inner strength to help them do what they enjoy, and second, they become educated on critical information and technology that allow them to perform to their capabilities. As a result, I have witnessed many people do some amazing things. And they continue to amaze everybody—including themselves.

RM: Are there a lot of programs like this for people with disabilities?

GAILEY: There are a limited number of programs. One of the best programs is through the Disabled American Veterans, which has had ski clinics for veterans and their families for many years. Disabled Sports USA also has a learn-to-ski program. Both programs get folks out there with spinal cord injuries, amputations, and visual impairments who can all participate. There are also summer programs for people with almost every type of disability that include sports like track and field, wheelchair basketball, and a host of outdoors sports such as sailing.

Are there a lot of programs? Yes. Are there enough programs? No. The most difficult challenge for all of the existing programs is funding. Today it is very expensive, when you look at the technology of wheelchairs and prosthetics, not to mention the training and getting access to facilities. Then there is the matter of getting people out there to participate. Many of these programs are begging people to come out, and many people with disabilities don’t participate, either because they don’t have the confidence, they don’t know enough about the programs, or they don’t have the access or transportation. The number of participants in organized programs seems to be falling, and yet the number of people with disabilities in this country is increasing.

The major benefit of these programs we need to get across is that, as with the able-bodied population, the more fit or active a person is, the fewer health care issues they generally have. In the disabled population, those who are fit and active will have fewer encounters with the health care system than the unfit population, so there is a real benefit to getting folks active and into a healthier lifestyle.

RM: Are there sports that are particularly popular with people with amputations?

GAILEY: We have found that the top sports amputees tend to enjoy are swimming, golfing, walking, cycling, fishing, dancing, boating, and bowling. However, the strongest programs are in golf and skiing. The National Amputee Golfers Association (NAGA) is one of the largest and most active of all of the disabled sports groups. NAGA offers a program called First Swing, where they will come at no charge to clinics in different areas around the country and teach amputees using prostheses or wheelchairs how to get back to playing golf. This program is funded by the Disabled American Veterans and Professional Golfers Association. Now, skiing is a sport that people with disabilities say gives them a real sense of freedom and of speed. Some of the competitive monoskiers and three tracker skiers will go at speeds upwards of 60 miles per hour or better. Recreational skiers can get out to the slopes and ski as a family.

Other sports such as swimming and cycling are also very popular, but they are individual sports, so there are not very many programs specifically for the disabled since most athletes just join the community swim or cycling clubs and train or go on weekend rides with the club. What we usually suggest is that folks join a support group such as the Amputee Coalition of America, which can put them in contact with other amputees or support groups in their communities. So we are trying to educate therapists on programming that is available, so they can introduce their clients to recreational activities as soon as possible.

Unfortunately, today the amount of time for rehabilitation is decreasing, and we as therapists really have to educate our patients on what they need to do to take an active role in their rehabilitation and motivate them to participate in their program. We are typically teaching them activities of daily living that will allow them to become healthier in the short amount of time we have in rehab. And if they do make exercise a part of their activities of daily living, then they generally are motivated to go on to try recreational pursuits that interest them.

RM: What are the best ways for PTs to motivate their clients to try these activities?

GAILEY: I’m in the same situation as everyone else—I have only a couple of weeks at best to work with somebody. It is a short amount of time. But I have a list of Web sites and disabled sports organizations I pass on to my clients. Now, many people are not ready to hear that they can get back to cycling, skiing, or golf when they are in the acute phase, but I give them that list of programs anyway and I tell them to give me a call when they are ready. And I’ve had many clients come back over the years. Frequently, the conversation comes around to: I’d really like to get back on the golf course, or do you think I could try skiing again. That’s when we make a phone call together and find out when the next golf or ski clinic is going to be held.

I had a [client] who had lost his leg above the knee some years ago. He was from Cuba and had never seen snow in his life. His wife, who was from ski country, wanted to take their two children skiing. So I hooked them up with the Disabled Sports USA ski clinic. After the week was over, he came up to me with tears in his eyes and said, “My wife and kids saw me ski, and I feel like we’re a family again.” That’s the greatest gift he could have received, participating without limitation in the very same activity as the rest of the family. As a therapist, it is just a matter of passing on the right information and helping people through the process. Because physical therapists tend to spend more time with our patients than other health care professionals do, I think we are probably the one profession best suited to seeing our clients back into the community and helping them live life to the fullest.

Sarah Schmelling is senior editor of Rehab Management.

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June 2003