When a child has a stroke in later childhood or adolescence, they may have been involved in a sport that they loved before their stroke. The impact of stroke or social perceptions can create barriers for young people returning to sport or participating.
In this episode of the Childhood Stroke Podcast series, we speak to a survivor of childhood stroke and two professionals about returning to sport after a stroke and how to overcome some of the barriers young people and their families may face. The episode also covers the Para classification process.
Guests:
Simone: Stroke Foundation respectfully acknowledges the traditional owners and custodians of Country throughout Australia and acknowledge their continuing connection to land, water, sky and community. We extend our respect to the peoples, cultures and elders past, present and emerging, for they hold the memories, culture and hope of their peoples.
Welcome to the Childhood Stroke Podcast. The Childhood Stroke Podcast is for survivors of childhood stroke and their families. We aim to build knowledge, skills and confidence in navigating services and support. This podcast is also an opportunity for families to share their stories and messages of hope.
The advice given in this podcast is general in nature. Discuss your situation and needs with your health care professionals. This series is presented by Australia's Stroke Foundation and funded by the Barr Family Foundation. I'm your host, Simone.
Simone: Welcome to the Childhood Stroke Podcast series. In this episode we're talking about sports inclusion after childhood stroke, with a particular focus on older children and adolescents. Being part of an inclusive sport environment has important health and social benefits. When a child has a stroke in later childhood or adolescence, they may have been involved in a sport that they loved before the stroke. Sometimes disabilities caused by stroke or social perceptions can create barriers for young people returning to sport or participating. There can be medical restrictions after a stroke, so we encourage families to discuss their specific situation with their child's medical team before returning to sport.
In this episode we’ll be talking to a survivor of childhood stroke and two professionals about returning to sport after a stroke and how to overcome some of the barriers young people and their families may face.
So today I’m really excited to introduce you to Tommy Quick, a self-confessed sports fanatic and a passionate advocate for inclusion. He has a diploma of fitness, is a qualified nutritionist and an inclusion consultant. Tommy is also a member of the Stroke Foundation’s Childhood Stroke Lived Experience Advisory Group and you might know Tommy from his recent 4Points challenge or his Kokoda trek a few years ago.
We also have Scott Nicholas, who’s the Pathways Lead at Paralympics Australia. Scott works to support the Pathways Team to identify and progress para-athletes along the performance pathway, working with 28 sports as part of the Summer and Winter Paralympics Program. Scott previously worked with the AFL as Disability Programs Manager.
Nathan Zuzic is a physiotherapist working within the Victorian Paediatric Rehabilitation Service (VPRS). He coordinates the VPRS accessible sport and recreation program, collaborating with Paralympics Australia and Power Wheelchair Sports Victoria.
Welcome Tommy, Scott and Nathan, it's so fantastic to have you on this episode.
Scott: Thanks. It's great to be here.
Nathan: Thanks for having me.
Tommy: Thanks.
Simone: Tommy, you had a stroke when you were just 12 years old. Could you share a little bit about your story?
Tommy: Yes, so I suffered a stroke just on the 6th of April 2006. I woke up, thought I had a headache, went into my parents, I’m like “oh I think I’ve got a headache” and it just escalated and about 15 minutes later where I was unconscious and didn’t wake up till 5 weeks, 2 days later from an induced coma. Honestly, I thought I was in a video game, like where if I'd press that button everything would reset, everything reset, everything would go back to normal, but that wasn’t the case. So yeah, it was, it was scary.
Simone: And I know that you're a sports lover and you were involved in a lot of sport before your stroke. Can you tell us a little bit about, I guess your love of sport and I guess, pre-stroke what that was like? And then some of the challenges, or even just the journey of getting back to sport after your stroke. What was that like?
Tommy: Oh, well like before I suffered a stroke I was playing footy, I was playing cricket. Because I was in year 7 at the time, the first term we were doing volleyball and stuff and I think at lunch time how I would play soccer on the basketball courts. And like, I would, like I was an ordinary kid and I didn’t have to adapt and when I suffered the stroke, essentially my life was destroyed because of the capacity which was I couldn't even walk, talk, like yeah. It was really frustrating I suppose. I believe in a lot of the influences shape who you are, well sort of believe, so there's things I can remember that helped me to get to where I am now, which is very hard to describe. But like, I remember my OT and probably the first thing I remember was going out to the, near the food court area at the old Royal Children’s – that shows how old I am, and yeah like we were just playing markers up and that kind of gave me a little bit of belief to have the motivation to continue. There was another experience where we just finished woodwork at school because that was the only class I did in year 7 after my stroke until year 8 where I went back full time. We were like waiting for my parents as my dad was going to be late or something and so we knew, there were Table Tennis courts and so we went and played that and I was absolutely terrible because my right hand had been affected by the stroke so I had to learn to do everything left handed. Yeah, it was messy but like from there. I found some love for sport and I’ve found other loves of different sports and different adaptations to what I could do, so like it progressed. So yeah, I think it's a little bit of a confidence thing as well. So, belief in your ability.
Simone: And I'm going to ask a question around school. How did that impact on your journey, kind of back into sports?
Tommy: My mates were great in class, but at lunchtime, pretty much all of year eight, half of year nine maybe, or a quarter of year 9, at lunchtime they would head off to Maccas. Until one of my mates come up to the aids room. He gave me that confidence, almost as if he had belief in me to come out and like be included, I suppose. And like it didn’t happen like that, there was a whole build up to that, where every Wednesday at lunchtime he’d come and he’d sit with me, read the paper, read the betting and yeah eventually more mates came up and like we transitioned over to going out to the basketball courts. But yeah, like going back, I did try walking up to Maccas but like because I was so slow and took too long, I just gave up on that. So, it was really the need of meeting halfway, the need of him coming up to the integration aids office and sit with me as opposed to me going out to get to him.
Simone: You talked about influences, I'm just keen to hear what was the biggest influence? Was it sport outside of school? Was it those individuals that you talked to? Like just that, you said it was a slow process of kind of transitioning and getting your confidence up in general, and then starting to kind of open your eyes to different sports that you might not have been that into before. Was there anything else that you wanted to add around the influences that really impacted your journey back to sport?
Tommy: I think it's various collective. Like not one influence – it builds up and builds up until you have, I want to say niche but that doesn’t sound right!
Simone: You find that thing, that activity or that sport? Yeah?
Tommy: Yeah, like now I found Kokoda to the 4 Points, to now wanting to do off road trike and aiming for the Paralympics. That’s the long-term goal – so I’ve got a long way to go. And yeah so, like it’s a transition – I still have a love of table tennis, I still go out, when possible on a Sunday.
Simone: it sounds like the journey kind of evolves over time and that you're still thinking of new goals and challenges in sport. You know even this far down the track since your stroke. Nathan, you help kids get back into sport and run an accessible sport group, can you tell us a little bit about that?
Nathan: Yeah, so I work for the Victorian Paediatric Rehab Service, and we've had an accessible sporting program for a very long time. But I think over the last couple of years the feedback from patients and families is they don't know how to kind of link into the community. They don't know what's possible and there's a real gap from the hospital-based setting out to the community. So really trying to change that and over the last two years, partnering with Paralympic Australia, Power Wheelchair Sports Victoria and Disability Sports and Recreation, and seeing what we can do in that space. We kind of ran our first pilot year last year, and we ran a successful athletics, racket sports, power wheelchair sports, and a wheelchair basketball event, and I think what we found, not only from a sporting perspective, but from a peer support perspective it was really powerful. For some of these children it was the first time they've been around someone else in a wheelchair, or with a similar disability. For some of these children it was the first time, they might have been 10, 11, or 12 that they've participated in organised sporting events. So, it was really rewarding to see, and I think from there we're able to build up their confidence in a safe space and try to link in to support that community integration. I think we're also trying to improve our education as well. I think even in the disability space some clinicians aren't well educated on how to link in with sports. So again, I think partnering with people like Scott from Paralympics Australia has been really helpful to see how we can build on that, educate out into the community and link more of these kids in. And I know we're just kind of continuing to grow the program - Monash Children's is adopting a similar model and that will be interesting to see through avenues like yourself, how we can promote the service and grow it to achieve our goals.
Simone: Yeah, fantastic. It's so great to hear. I think you know, that you're working together and you're collaborating with people like Scott. So Scott, love to hear a little bit about your role at Paralympics Australia, and how you support children and adolescents engage in sport after stroke.
Scott: Yeah, absolutely. I think, I feel really fortunate that my role is one that intersects sport and the broader, I guess disability sector. So you know, I've worked really closely with Nathan over the years, and also get to work with all of our sports based in Australia really closely. So, I’m in the pathways team at Paralympics Australia, and basically what we do is work with that broader ecosystem to help identify and progress athletes on a pathway. So, that could be an entry point into sport for some people and people who are just starting out whether that's young people with congenital impairments, or if it's people who have acquired an impairment. Often that period can be really tricky to navigate what sport looks like maybe in new life circumstances. So we do a lot of work with individuals who reach out and make inquiries with us to just understand what sports they may be eligible for, maybe what sports exist, that they weren't familiar with previously and how they can go about getting in contact with those sports, or how we could play a role in connecting them in. So, although we don't run sport ourselves, we play a pretty critical role in helping making those connections. So people who may be unfamiliar with what sport looks like with a newly acquired impairment, they have the confidence to restart that journey in sport, or reconnect with sport, hopefully with the right support to make it a really enjoyable experience. So, Nathan mentioned the program that we've collaborated with the Royal Children's and hopefully Monash this year and VPRS. We've got lots of examples like that where we're connected with different organisations who have a cohort of clients or participants or members, and we help support those connections to sport. So yeah, I could talk more about what that looks like specifically, but I guess we feel really lucky that we're just bridging the gap between people who want to play sport and where the sport pathways begin.
Simone: Yeah, fantastic. Such important work. Can you tell us a little bit about Para classification? I know Tommy mentioned it as well. How can you get young people classified, and how can it be beneficial in their journeys?
Scott: Yeah, classification is really critical for Parasport, because it's really critical in unlocking what the opportunities might be for individuals. So within Para-sport there's three main eligible impairments being physical impairments, intellectual impairments and vision impairment. And each of those groups have a slightly different classification process. But to give you an example for athletes with a physical impairment - the classification is delivered by the sports. So often the entry point for classification is what's called a provisional classification. Which would just see someone go and visit their GP or their physiotherapist, or a number of other allied health professionals and complete some basic paperwork with them. That paperwork is then sent off to the sport, who will have one of their classifiers assess it and provide a provisional classification. And all that does is indicate whether someone is eligible for paralympic pathways. Because, although the Paralympic games offer competition for a broad range of athletes, not every type of impairment is currently included in the Paralympic games. So, there are other pathways to international competition out there, but not all disability or impairment types are included within the Paralympic games. So, classification is basically a way of determining whether someone is eligible for those pathways first and foremost and then providing a sport class, or their classification to determine which other group of athletes should they be competing with. So, the whole purpose of classification is to create a fair and equitable playing field. So, it's not someone's impairment that would dictate winning or losing, it goes back to those fundamentals of sport, how hard someone's trained, how hard they're willing to work and how they compete on the day. So, although we have some sports where it might be within one class a group of athletes with varying impairments, the idea would be that those impairments impact their performance in a similar way. So every sport is slightly different but again, that's one of the roles that we play in supporting individuals wanting to start a journey in Parasport - is navigating how to go and get classified, and how to connect in with each sport.
Simone: And beyond that, I'm just curious to hear a bit more about the journey if someone is classified, what your role is from there?
Scott: Yeah so, as I said before, we don't necessarily run sport, but we hopefully work to support the broader system create the conditions where there's more parasport occurring. So a big part of that is classification and once someone becomes classified that then allows them to take part in Para-specific competition. As I said, provisional classification is the entry point, and it's the most accessible form of classification, because you can just go and visit your local GP or your current physio, or allied health professional and start that process. The next level of classification if you do want to compete at a state level or a national level that would require a face-to-face classification with the sport which is called the national classification. Obviously, if athletes are continuing on their pathway and performing really well and competing at an international level, there's then an international classification that would take place which often has a panel of classifiers internationally, so from different countries to make sure that that provisional national level classification aligns with the IPCs - the International Paralympic Committee's classification policy as well. So, although it can sound really complicated, basically, classification is to determine whether someone is eligible for those paralympic pathways and which group of athletes they should be competing with. So we really like to think it creates a lot of opportunities, because once someone knows what they're eligible for and who they'll be competing against it starts to give you a really clear picture of whether this is a sport I really want to pursue, or whether this is a sport I can be really competitive in.
Simone: Thank you. It was such a clear outline of the process, so I think that people listening will really appreciate you, yeah, unpacking the pathway and the process for classification. I want to ask, the three of you a couple of different questions, just to see what your thoughts are around, the changes that are needed to improve sports inclusion. Like, what do you see in each of your specific fields and perspectives around the challenges and the changes that are needed to really improve sports inclusion. I know, Nathan and Scott, you're working much closer together, which is, you know, something that you've identified is going to benefit children with disability and stroke survivors, survivors of childhood stroke, getting back into sports. But yes, anything that you see and, Tommy, I'm really keen to get your input on this as well of what changes need to happen still, and perhaps you know, challenges that you see in your day to day?
Tommy: When I had my stroke in 2006 like this hadn't even been thought about. So we've come a hell of a long way in regards to kind of fixing gaps. Yes, there’s still work to be done. But I think the opportunities for the kids these days are better, the opportunities for kids to thrive.
Scott: I'd probably agree with Tommy. I think that there has been some you know, really amazing things happening over the last, you know, 5 to 10 years. But I think the biggest thing for us is just the continued increase in awareness of what's out there and what's available, it's probably one of our consistent challenges is we've got some great sports offering some great programs, you know, really wanting more people and new people to come and get involved and join their pathways and progress to the Paralympic games. But there's still a lack of awareness out in the community about how to get involved and what is out there, what sports are on offer, and those kind of things. So we get a unique opportunity every couple of years with the summer and winter games, where there's a huge spike in interest across the Australian community. So we'll be really trying to capitalize on that interest come Paris this year but hopefully you know, expose new people to what Paralympic sport is, and how they can go about getting involved. And you know, a big role for us is trying to educate you know, the allied health system and the school system and teachers - people who are connected with young people to make sure that they've got the tools to point them in the right direction.
Nathan: I might jump in there as well, I think, from the healthcare perspective, I think in the past, often the education was around what the child kind of couldn't do, and what challenges they might present with and I think there's been a really nice shift to start to think about what's actually possible. Kind of building on role models and even peer support in the paediatric space and I think being able to educate kind of clinicians, GPs, NDIS providers on what's actually achievable has been really powerful to kind of get more children linked in and open people's minds to what these children can be doing in the longer term.
Tommy: Just wanna jump in. Scott, are the paralympics, being viewed at the same time as the Olympics, or are they right after?
Scott: We like to think that the Olympics are a great warm up event to the Paralympic games. So there's a 2 week break in between the games, and then the Paralympics follow pretty much immediately after the Olympic games. So you know come Paris this year, the end of August the Paralympic games will start and hopefully very similar to Tokyo a couple of years ago we'll see the Australian public really get behind our Paralympic athletes and you know, Australian media really supported the Tokyo games and we're really excited to work with our broadcast partners again to get more information in the broadcast to educate people about what is Paralympic sport and how to get involved. So yeah, the games will happen just after the Olympic games a couple of weeks after in Paris this year in August and then we'll have the winter games in a couple of years time in 2026 in Milano, Cortina in Italy. So it's an exciting couple of years ahead for summer and winter sport in the Paralympic games.
Simone: When sports inclusion is done well, what are the benefits? How does it help the people participating? The community?
Nathan: I might jump in. I think obviously, there's a physical benefit; so improves gross motor skills, strength, wheelchair skills and better long term outcomes as well. I think, on the peer support and kind of developmentally, socially, it can be really powerful. Building confidence and there's some evidence to say that kids that are linked in with accessible sporting opportunities actually do better in adults, not only socially, but linking with employment opportunities and have that increase self-efficacy to conquer challenges and I've actually got a really nice example. Last year we had a girl with a stroke in her spinal cord, who was really petrified to leave the hospital setting and kind of go back to school in the community in a wheelchair. And she was able to link in with one of our wheelchair basketball events through Scott and Paralympics Australia and that was really powerful for her in terms of, getting the confidence to do something that she used to really enjoy, and that led to linking in with the development program back home and getting back to school getting out and about with friends and also meeting some other people that were also in a wheelchair to try to normalise it, and build her confidence that she can do anything that she wants to do.
Scott: Let's say she's got a lot of future potential if she does choose to pursue wheelchair basketball as well. But, Simone, I think when inclusion and sport is done well, it impacts everyone in that community. Nathan's just talked about the individual benefits to you know the person at the centre of that. But, we see in coaching, that coaches with experience, coaching diverse groups, they would generally have great communication skills, have great understanding of the athletes they're working with, and they then apply those skills to coaching other people as well within their club settings. And we'd probably just see that, when inclusion is done well, there's a great diversity of thought and experience within those communities which only adds a lot of benefit. I think further to that, you know, at a different level, what we see is remarkable Paralympic performance being a driver for social change. So, we've got great paralympic champions like Dylan Alcott and Maddie De Rozario in recent years that through their performances, are able to create awareness and change perspectives about disability in the community. So that can only happen when we've got our broadcast partners promoting these great athletes on a national stage. So, I think, you know, we look at inclusion in a lot of different forms, but it not only benefits the individual, it can go a long way to educating others and creating great diverse environments.
Simone: Yeah, I couldn't agree more. I think you've touched on so many great points in addition to Nathan's as well. And I think you touched on it a little bit, Scott, but I'm curious how important is it to engage in sport as a kid or a teen, to set that foundation for adult participation? And you know, do you find that some people tend to explore sport more in adulthood than in younger years, due to the barriers? Or, yeah, are there any trends that you've experienced? And, Tommy, it sounds like you've done a bit of both; you've kind of felt confident and slowly started to explore in your teens but then you've kind of been finding your niche as you've gotten older. So I'm curious just to get your thoughts on that.
Scott: Yeah, I mean, I'd be really interested in Tommy's thoughts on this, but I think from our perspective you know, any new child should be participating and exploring a lot of different sporting options. And you know, young people with a disability or impairment are no different. I think there's a real kind of risk that children, or young families kind of pick a sport and put all their eggs in one basket for lack of a better term. But I think, even for those with aspirations of competing at the highest level, it’s still really important, that at a young age that they're exploring lots of different sports, there's huge benefits for skill development and I guess yeah, athletic development for those who are competing or learning or developing in a number of sports. So, it's definitely something we encourage at a young age and I think, even for adults who maybe acquire an impairment or a disability later in life there's still probably initially, a lot of social and physical benefits, of exploring lots of different sports. I think the opportunity to meet people who have maybe had similar life experiences is really critical, and that can be beneficial for their health and wellbeing broadly. But then just learning about their new life sport can be a great vehicle to do that. And there are opportunities and pathways for people to progress from, you know, never having competed in the sport before acquiring impairment and then you know, progressing to the point where they're representing Australia at the Paralympic games. So, we really encourage people to love sport, try lots of different sport, and there is one they really feel a connection to and want to commit themselves to, we've got pathways that can support that to high performance as well.
Tommy: Scott nailed it on the head. The thing I wanted to point out was, back in 2006 we didn't really have the resources or the awareness that these sports were available. I probably didn't hear about the Paralympics until 2009 and like had no idea how to get into it. Probably the first thing that really stood out was a Disability Sports Recreation Winter Camp that I went on. From there, that kind of led to doing like working with the board summers as a participant, as a staff member and from there a long way down, few years down the track doing Kokoda. So yeah, like yeah like influences again.
Nathan: And to jump in on both Scott and Tommy's points, I think the literature supports kind of trying a range of sports because children that link in with accessible sport are more likely to continue that into adulthood. And we know, particularly with acquired brain injury or stroke in children, kind of as they grow, their gross motor skills tend to plateau, and we see a difference in their skills compared to their age match peers and that's when sports participation tends to drop off. So if we can catch them before that with accessible opportunities, it really helps promote increased participation as they continue to grow and I think, with Scott's point, if they can try a range of sports that's hopefully going to capture their interest and keep them involved for longer.
Simone: You've covered it off so brilliantly, the three of you that particular question, so thank you. You've covered lots of advice actually throughout the episode, any final practical advice for parents or survivors of childhood stroke who might be listening on how to get back into sports, or perhaps exploring some of these new sporting activities? Any final tips that we've missed, or that you'd like to share?
Scott: I think the best advice we can give is just get out there and give it a go and that followed up by a little shameless plug that anyone can visit our website which is just www.paralympic.org.au and there's information about all the sports that are part of the Paralympic program, and there's also the ability to leave an inquiry with us through our “get involved” section and then we can help you on the beginnings of your journey in Parasport from there. So, get out there, give it a go and if you need some support, visit our website.
Nathan: And I think building on that taking a bit of a team approach; I think a lot of these kids after stroke get disheartened if they try one accessible sporting program, and it's not for them or is not as accessible as what they'd like. But there are resources, whether it's through rehab clinicians, through people like Scott, Power Wheelchair Sports, Disability Sports and Rec. Even acknowledging the school-based system, the parents as experts in their field, or looking at Stroke kind of things like the Heads Together, which is a peer support program and learning from people with lived experience. I think, don't get disheartened if your first try, doesn't go well and reach out to the people that can support you a little bit further.
Simone: Tommy?
Tommy: If I were to sum it up in my sports inclusion in one word it'd probably be belief. It's a belief, the inner belief that they can do it, but also the belief from others to like help you out and cradle and nurture you in the direction you want to go.
Simone: Fantastic. It's been a wonderful episode, so thank you so much Tommy, Scott and Nathan, for being on this important episode around sports inclusion. I'm going to share all of the resources that we've talked about. So, Scott, you've mentioned the website for Paralympics Australia but we'll also share other resources that we've discussed today, and we'll keep the community up to date with any of your programs or events. We'd love to share those opportunities with the broader childhood stroke community. But just a really big thank you for coming on and for your expertise today.
Nathan: Thanks for having us.
Tommy: Yeah, thank you. Thank you it’s been fun.
Simone: That's all for today's Childhood Stroke Podcast. Find out more about Stroke Foundation's Childhood Stroke Project by visiting Stroke Foundation dot org dot au forward slash childhood stroke. Stroke Line’s Health professionals provide practical, free and confidential advice. Connect with them on EnableMe or call 1800 stroke. That's 1800 787 653. The advice given here is general in nature. Discuss your situation and needs with your health care professionals. This series is presented by Australia's Stroke Foundation and funded by the Barr Family Foundation.