Monday, September 27, 2010

Pursuit of Happiness

     Victim's of cancer, in this case breast cancer, often struggle to live their lives to their fullest potential and/or desire.  With any cancer patient, they are effected daily by the sickness, weakness, and medical treatments which alters their living and activity. Patients struggle to cope and their quality of life diminishes and is effected as well (Guyatt, Feeny, & Patrick, 1993). Emotional health and physical health both need to be addressed in help ensure a positive recovery for the patient. Many patients often think about the benefit that physical activity can bring them throughout their unfortunate sickness. For example, last year a linebacker at Boston College was diagnosed with cancer, and missed the 2009 season due to treatment. In an interview with ESPN, he stated that he believed that his ability to workout and lift throughout the treatment, assisted his fast recovery and emotional health, believing that he would soon return to the playing field for his senior season in 2010. So being able to increase quality of life for a cancer patient can be beneficial to an optimal recovery.

    Quality of life is so important for a cancer patient. They tend to develop negative emotions; such as depression, increased stress, fatigue, etc... which can contribute to emotional and physical downfall of the treatment process. For a patient to be physically healthy won't go very far if the patient is struggling with the mental/emotional health. For a patient to use physical activity to cope with these negative emotions, whether it's resistance training, group fitness classes, or a relaxation type class; yoga or tai chi. These are only a few ways of being active for a patient to help them cope and possible overcome the negative emotions that they may be dealing with.

     First off, I would sit down with the patient, talk with them, building a relationship to better understand what their thoughts and feelings are in an attempt to construct a plan for physical activity. I realized this is a sensitive subject, so wouldn't make them feel as though they have to give me great detail if they are uncomfortable talking about it. However, I would inform them that I would like at least a general understanding, so I could make the best possible plan to fit them.
     Next, I would like to know their physical feedback, whether they're fatigued, for example, because this will help me determine what type of physical activity may best suit them. If they are experiencing high levels of fatigue, stress, anxiety, etc... some physical activity may add to it (Gill & Williams, 2008).
     Ideally, I would have them start off by attending our yoga and/or tai chi classes a couple times, 2-3 days, per week to build up confidence of being able to participate in physical activity, with hopes of building off that confidence and further pursuing higher levels of activity. Also, with regards to this, I would meet them at least once a week and discuss their thoughts and feelings about the activity they are participating in, collecting feedback from them in order to alter the plan of attack.
    The reasoning for having them start off with yoga or tai chi, is the mental aspects that are needed for them to partake in the activity. Being able to build a solid mentally healthy start when beginning physical activity is a great foundation to build off of. Once a solid mental base is constructed, we can then work gradually into the physical aspect (Holmes et al., 2005). Starting with some light resistance training or fitness class and work up to a more demanding level of activity, remembering to follow their progress and collect feedback. Also, most importantly, making sure they are enjoying what they are doing. Our main goal here is to increase quality of life for these patients and if they are not enjoying what they are doing, then action needs to be taken on my part to construct a plan that they can enjoy to develop a healthy and happy outlook of life through their unfortunate illness.

     In conclusion, developing a high quality of life through physical activity for these patients is important. Collecting feedback, physically and emotionally, will help construct a satisfying plan for them to achieve a positive, quality outlook on life throughout their fight. Different levels of activity should be considered, however, I believe a more quality summation of the activity will occur for the patient to truly reap the benefits that they will and want to experience. 

Gill, D. L., & Williams, L. (2008). Psychological Dynamics of Sport and Exercise (3rd Ed.). Champaign, IL: Human Kinetics.

Guyatt, G. H., Feeny, D. H., & Patrick, D. L. (1993). Measuring health-related quality of life. Annals of Internal Medicine, 118(8), 622-629.

Holmes, M. D., Chen, W. Y., Feskanich, D., Kroenke, C. H., & Colditz, G. A. (2005). Physical activity and survival after breast cancer diagnosis. Journal of American Medical Association, 293(20), 2479-2486.

Monday, September 20, 2010

Sport Injury Rehab: More then just physical

     Some of the biggest challenges that this athlete will face with an injury of this magnitude are; motivation, to rehab or return to play; retraining the body to not favor the injured leg; also, arousal and anxiety placed on the athlete throughout the rehab process.  Also, injury is often accompanied by depression, tension, anger, and low self-esteem, particularly in competitive athletes. Mood disturbance relates to the athlete's perceived progress in rehab and has been shown to negatively relate to attendance at rehab sessions (Smith, 1996).  Any/all of these issues can and may contribute to stalling of the rehabilitation process.  When rehabbing an injury, the athlete not only needs to regain physical strength, but mental strength is just as important to regain a fully recovery.  Ideally, to have a successful recovery, an athlete needs to be in touch with their mental and physical abilities.

     With this sort of injury, ACL surgery, the athlete needs to use cognitive skills to stay focused, motivated, and determined throughout this tough adversity that athletes, at times, go through.  It's all about how they bounce back mentally, more so than physically.  This type of injury tends to place a lot of doubt and second guessing within an athlete.  This can be either on the field, "I'm not the same athlete," or during rehab, "this isn't helping, what's the point of rehabbing?"
     Elite athletes often make skilled moves without thinking (Gill & Williams, 2008), this is known as control and automatic process.  By allowing the athlete to regain the proper motor pathways necessary, through rehab, to perform sport specific movements without thinking will help this athlete regain the ability to perform and react like they did prior to the injury.
     Developing imagery abilities can assist the athlete in motivational specific and general, mastery and arousal; cognitive specific and general skills (Gill & Williams, 2008).  These skills can help the athlete overcome adversity, whether it's physical or mental challenges they may encounter throughout the rehab process.  This also ties in with automatic process.  It allows the them to develop "muscle memory" to regain control and reaction of the injured leg in this situation (Gill & Williams, 2008).  Imagery isn't only helpful with rehab, but can also assist the athlete in training and competition.  Whether it's to deal with anxiety, arousal, or performance skills.  Imagery of the healing process may also contribute to a speedy recovery process (Smith, 1996).
     Goal setting is another important aspect that the athlete should use throughout the rehab process.  Similar to using goals to improve drive and performance during sport.  By setting goals it can give the athlete something to look forward to and be motivated to achieve while rehabbing.
    Self-talk throughout the rehab process can influence a positive attitude towards the effort, time and patients needed to have a successful recovery.  It's important to use positive self-talk skills to stay motivated and have a positive mind set (Hamson-Utley, Martin, & Walters, 2008).

     First off, I will sit down with the athletes and discuss her thoughts and feelings about the injury, recovery, and physical activity.  I want to do this to see how she feels and her mind set going into the rehab to get a feeling for her motivation.  This will allow me to determine what cognitive skills might work best for her, or which one needs to be more heavily focused on.
     I will have the athlete set short and long term goals directed towards rehab and physical activity.  She will set a couple different short term goals for week to week, and the long term goal to be accomplished between weeks 6 and 8.  As she meet each short term goal, I will have them make another and another leading up to their long term goal.  By setting goals, the athlete will have something to look forward to and be motivated to achieve to keep their mind at peace.  Also, this will help the rehab process run more smoothly, in hopes that the recovery process happens more quickly.  When the athlete encounters a hurdle along the way, goals will allow the athlete to bypass this hurdle and look at the positive to get back on track and staying positive.
     To develop the proper skills needed to allow this athlete to perform movements without thinking, automatic process, I will use imagery skills to assist the athlete in developing control and muscle memory.  After surgery, an athlete tends to favor their weaker leg and by using imagery skills, the athlete can think of using both legs equally, and imagining the muscles of the injured leg firing throughout the movement.  By being able to control this process, and imagining yourself going through the movements properly and correctly, proper muscle memory and motor units will develop and once this has occurred, less thought will be needed to perform the movements allowing automatic process to occur.
     Lastly, by using self-talk skills, positive, the athlete may be able to speed up the automatic process to occur.  While they are performing specific movement, they shouldn't only imagine them going through the movement, but also tell themselves what to focus on.  For example, if the athlete is performing single leg squats, they should focus on the movement by seeing themselves doing the movement as well as saying "squat deep," "knee out," or "drive using your leg, not your back." Self-talk isn't only good for performing movements, but also for keeping a positive mind set towards daily rehab activities.  There may be days where the athlete's knee is sore, but as long as she tells herself that she can perform the activities and that the soreness will work out, she'll be able to overcome the negative feedback.

    In conclusion, being able to understand the mind set of the athlete when beginning a rehab program is important to determine which cognitive skills may work best to put the athlete in the most successful outcome possible.  Sitting down and discussing how the athlete feelings towards the rehab process and return to their sport will direct you down the correct path for program design, cognitive aspect none the less.  Once you have determined which cognitive skills will best suit this athlete, have them set long term and short term, week to week, goals.  Be sure that the short term goals are goals that can be accomplished, yet push the athlete to achieve them.  Too easy of goals can allow the athlete to become easily distracted from the goal.  Too difficult goals will also distract the athlete, as well as frustrate them and make the rehab process more difficult, to the point of wanting to give up possibly.  Developing the athlete's mental ability is as important as physically.  A strong focus should be devoted to the mental and physical connection while performing specific movements.  After an injury, motor pathways are disrupted or unclear.  Being able to perform movements during an event without thinking, known as automatic process, is key.  To develop this, the athlete needs to be able to perform the movements correctly, using imagery and self-talk to guide them through the movements to develop muscle memory.  Once they are able to perform the movements with proper technique, over time, the athlete will require less imagery and self-talk during the execution of the movement, and be able to use these skills prior to the movement, and react and move freely when performing in a live situation.  Imagery and self-talk can also be used to motivated the person.  This can be either specific or general motivation, as well as to control anxiety and arousal.  Each one of these aspects are important to a successful rehab of an athlete.  The ability to be mental strong after an injury is as important as being physically strong.  Rehab is more than the development of physical strength, but mental strength and skills are equally as important.

Gill, D. L., & Williams, L. (2008) Psychological Dynamics of Sport and Exercise. Champaign, IL: Human Kinetics.

Hamson-Utley, J. J., Martin, S., & Walters, J. (2008). Athletic Trainers' and Physical Therapists' perceptions of the effectiveness of psychological skills within sport injury rehabilitation programs. Journal of Athletic Training, 43(3), 258-264.

Smith, A. M. (1996). Psychological impact of injuries in athletes. Sports Med, 22(6), 391-405.

Monday, September 13, 2010

Stand up! Be Proud! More Importantly...Be Confident!!

     Chris is a 10 year old girl who plays soccer for a rec league.  She has trouble with self-confidence and esteem while playing the game, whether it's in a game or during practice.  Her parents are also convinced that she will be unable to boost her self-esteem now since she's been playing for 2 years and they haven't seen much to any improvement.

     According to Harter, children aged from 8-12 make more reliable judgments in the domain areas and are able to form overall judgment of self-worth. (five domains: cognitive competence, physical competence, physical appearance, social acceptance, and behavioral conduct) With this said, the domains are linked, but independent from, global self-esteem domains which are more related to older kids and teens, which may include college students.
     Self-efficacy is believed to have a greater impact on the performance of an athlete.  It's a situation-specific form of self-confidence.  If they believe they are talented, there's a good chance that they will perform better.  However, specific situations may affect self-confidence on the field.  If they determine that their opponent is better than them, or they see that the opponent has more energy/fight left in them at the beginning of a half, period, or quarter, their self-confidence may change affecting their performance. This is all in relations to Bandura's self-efficacy Theory.

     As a coach, I would attempt to help Chris realize that she is capable of performing well at soccer.  Help her realize that she is physically, mentally, and socially capable of performing well.  I would do this by choosing specific events or situations that provide strong evidence that she is well capable.  By giving her specific examples of each of the domains that Harter provided, should open her eyes to believing that she can perform well during games and practice.  The more examples of success that she see, hear, or be reminded of will boost her self-esteem while she's playing soccer.  Also, by giving her examples of success she's had off the field may carryover to her self-esteem off the field, vice versa for on the field performance for off the field self-esteem.  As long as she's given positive feedback, there should be a carry over of her self-esteem on and off the field.
     By giving Chris specific examples of her performance or events and the increase in self-esteem, there should be a carryover of her increased self-esteem to an increase of her self-efficacy.  If she's able to understand that when she does perform well and good things happen, the more she's able to realize this happening, she will go into games/situations with more confidence that she can take this event head on and still perform to her capabilities.  Even if she determines that her opponent isn't tired and still has life in them, she may be able to bypass that with her confidence and not let it affect her performance.  Bandura's Theory states that an athlete determines their choice of activity, level of effort, and degree of persistence.  Which means people with high-efficacious seek challenges, try harder, and persist; whereas, low-efficacious people tend to avoid challenges, easily give up, and become more anxious/depressed when facing adversity.  With Chris, by increasing her self-efficacy, she will be more willing to try harder when facing adversity and less willing to give up, especially if she knows she's been able to overcome similar adversity in the past.

     In conclusion, in order to boost or increase this young lady's, Chris, self-esteem and confidence, being able to point out positive events and/or situations that she's participated in and reminding her of specific times of when she has overcome adversity will assist her in feeling more confident while playing soccer.  Self-esteem and self-efficacy can go hand at hand, assisting one another in helping Chris feel happier about her performance and outlook at soccer as well as off the field events.  With a boost in self-confidence/efficacy during games, ideally it should carry over to increase Chris' self-esteem.  If she's able to perform with more confidence, there's a good chance that her performance will increase by trying harder and not giving up as easily during competition.