Golf: the game big enough for everyone.

According to the philosophical position statement of the National Therapeutic Recreation Society, everyone has the need for and the right to leisure involvement. Unfortunately, that right has not been fully realized by various segments of society, especially, individuals with disabilities. The disabled population is becoming a larger and more influential segment in American society. Today there are more than 43 million individuals with a disability, and this amounts to approximately one in every six Americans.

According to Bob Wilson, director of the National Amputee Golf Association (NAGA), approximately seven million of these are concerned with physical disabilities. This would include visual impairment, and mobility impaired by such things as strokes, heart disease, arthritis, joint replacements, paralysis, neuromuscular diseases and amputation. While the majority of these individuals do not actively play now, they may as they learn the benefits they can receive by playing the "royal and ancient game."

The recent implementation of the Americans With Disabilities Act (ADA) underlines the premise that fully integrating people with disabilities into the mainstream of society requires that all activities be made accessible. This recent legislation provides that "No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges and advantages of any place of public accommodation." Golf courses are specifically mentioned as one of the areas of public accommodation which must be made accessible to all people.

Recreational activities can be beneficial by contributing to the physical, social, cognitive and psychological development of those who participate in them. Enjoyable and successful experiences in leisure activities may change the self-concept by increasing self-confidence and motivation. Corbin Cherry, an amputee golfer, states that one of the benefits he receives from playing golf is the increased level of self-confidence brought about by knowing he can complete a task of his own choosing. Another benefit is that he is able to compete in an activity he-participated in before his injury.

Golf is a sport which can be adapted to those with disabilities very easily, for two reasons. One is that it is a game which pits the golfer against the course with a handicapping system which enables golfers to compete equally. Two is that the game is played at a pace that does not place undue physical stress on most disabled persons. Another benefit noted by Peter Longo, a PGA professional committed to introducing golf to people with disabilities, is that the golf swing is executed from a stand, thereby eliminating the running, jumping and other motor skills that severely prohibit most people with disabilities from participating in certain sports. In golf, a disabled person can hit a satisfying shot, experiencing all the thrill and sense of accomplishment that any other individual experiences.

Physical fitness is one of the primary benefits gained by playing golf. People with handicapping conditions need to be fit to achieve maximum mobility and independence. Through physical fitness people with disabilities can efficiently perform daily activities and enjoy recreation to the fullest. Other benefits of fitness are: improvements in physical strength, increased stamina, reduction of risk factors associated with health-related disorders, and an effective means of controlling resting blood pressure and weight gain.

Aside from physical and social benefits, golf can also contribute psychological advantages such as the opportunity for stimulation and adventure seeking. Therapists and others working with people with disabilities report significant progress in exposing their clients to golf and imparting to them an increased sense of their abilities by getting them back into the community and restoring their confidence and pride.

The Professional Golfers Association of America (PGA), National Amputee Golf Association (NAGA), and the Disabled American Veterans Association (DAV) have combined forces in a program which has enabled many to realize first-hand that they can play golf. To assist physical and recreational therapists who have realized the adaptability of golf as a recreational therapy, they have taken the principles found in the PGA's First Swing program and added additional material to create First Swing, Golf for the Physically Handicapped. This program is offered to hospitals and rehabilitation centers throughout the country.

One of the primary considerations when teaching golf to people with disabilities is to develop as efficient a swing as possible considering the disability, so the individual can get the most from their swing. For lower-body amputees, stability and balance are of primary concern, while for upper-body amputees the restriction may be control or arm strength. And for the visually impaired, while the full swing is not a problem, other issues arise such as alignment and touch, which sighted golfers take for granted.

Upper-body amputees may play with one arm or may have varying degrees of use from the other arm depending upon the place of amputation. Below-the-elbow amputees may be able to use a prosthesis and take advantage of golf aids which allow for the use of that arm in stabilizing the golf swing. Other adaptive equipment modifications center on making the grip more secure. For people who have difficulty gripping and holding onto the club, a hole can be drilled through the top of the club and a cord loop inserted which goes around the wrist (as in racquetball), For the club can be secured to the hand by wrapping with a stretch bandage, a velcro strap, or by having velcro on both grip and glove.

For the upper-body amputee who has never played golf before, some experimentation may be needed to decide which side to play from. One method is to learn to play so that their remaining arm is closest to the target at address so that it can be more dominant in the pulling motion toward the target; this is suggested for control reasons. Another method, however, states that pulling the club is a much weaker action and may actually contribute to control problems and that the pushing motion will add vital power to the shot. Another factor to consider is the person's natural side, since a person tends to make a better swing from that position. Hence, a right-handed golfer usually swings the club better from the right-handed side, even if he or she only has use of his or her left arm.

Lower-body amputees probably represent the greatest range of playing abilities in golf. With a prosthesis, a below-the-knee amputee would experience few constraints, while a paraplegic or a person with no legs would have far greater restrictions. The primary concern for lower-body amputees is maintaining stability because of weight distribution and the lack of a proper base of support during the golf swing. Some golfers choose to swing with one arm while using a crutch in the other arm to overcome the lack of support because of the missing leg, while others prefer the power achieved by using both arms and maintaining balance by moving around on one leg after the swing.

For those who are unable to stand or maintain any balance while swinging, there are still options, mainly chair golf. There are at least three popular ways to play from the seated or leaning position. For those who can move with crutches, a portable stool or tripod can be adapted for greater balance while retaining the greatest degree of freedom in the arms and shoulders. This position should be used if at all possible because this stance most closely resembles the proper golf swing position.

For some disabilities, the only remaining option is to play from the fully seated position. However, even double-leg amputees and individuals with spinal injuries, polio and various other lower-extremity disabilities can play golf with the right instruction and adapted equipment. The two most popular methods are to play from a sport wheelchair with the arms and leg supports removed and from a specifically designed motorized cart with a swivel seat that turns 90 degrees.

If playing from a wheelchair, the arm and leg supports should be removed, and the back should be as low as possible. The chair should be made as tall as possible, or padding or cushions should be added to elevate the golfer to as upright a stance as possible. This position is preferred because when playing from the fully seated position the player's knees and feet restrict the swing. An electric golf cart can be modified by replacing the standard passenger seat with a swivel seat, from which the player can swing using his or her upper body. In both examples, the golfer must find a way to anchor him or herself into position (such as a seat belt or shoulder harness) during the swing for support and safety.

The distinction between blind individuals, blind from birth and those who were originally sighted and later lost their sight, becomes important when choosing teaching methods. Those blind from birth lack visual imagery and will rely heavily on some type of physical model to understand the layout of golf courses. They will also require the use of a sighted guide. During the teaching period, the instructor will have to physically move the individual through the swing process to acquaint them with how the proper swing feels. Constant feedback during these early stages of kinesthetic movement is necessary to establish a correct, repetitive swing. The instructor will have to pay close attention to his or her instructions and improve his or her verbal skills as this will be the primary teaching technique.

One tip which can help the visually impaired student understand the concept of contacting the ball with a square face is to have students hold the club extended out in front of them in the palm of the hand closest to the target to begin the grip position. They should then take the other hand and move it down the shaft until they feel the face of the club. They then rotate the club face until it is square; this provides the beginning grip position. The other hand is then placed next to the first hand to complete the grip.

There has been very little written on the nature of course design necessary to accommodate people with disabilities, because in reality most present courses could be adapted very easily. The majority of changes would occur on tees and around greens. Patrick O'Brien, director of the Southeastern Region of the USGA, wrote an article detailing the effectiveness of synthetic turf on tees. He was dealing with tee areas that did not receive enough sunlight to support grass growth, but this could easily be adapted for tees which would support any type of vehicle or support aid. This would also be suitable material for practice tee areas. Maintenance on this surface would be minimal if properly installed.

Synthetic turf probably would not be suitable for greens, but the vast majority of disabled golfers would be able to use already existing greens with few modifications. The only exception would be those without the use of their lower body who are playing in a motorized cart as described earlier or in a wheelchair. And, even here there is some disagreement among disabled golfers as to the damage that wheelchairs would do to greens. The majority of articles that deal with people with disabilities playing golf state that wheelchairs are not suitable for use on greens because of the damage the pivoting front wheels can do.

However, Jim Listerud, executive director of the Physically Limited Golfers Association, states that their association members have proven that when done properly, the golfer in a wheelchair can wheel onto the green and make the putt and then exit successfully without damaging the green in any way. He maintains that if the more common hard rubber or plastic front casters are replaced with pneumatic front casters the damage done to greens is minimal. This is possible because the larger turf surface puts less pressure per square inch than the smaller type. He adds, "When you think about it, driving a golf cart onto a tee or green isn't going to do anymore damage than the very machine they use to mow them."

Another innovation their association has developed is a prototype "golf tire" which is about three inches wide and is on a bicycle rim which is then adapted to the wheelchair. He remarks that they have yet to be denied access to greens on any of the golf courses they play and that by educating the golfer in the proper method of wheelchair use, using the proper equipment, and applying common sense, there should be no reason to deny a golfer access to every aspect of the game. However, the prevailing opinion over the years has been that carts must be kept a certain distance from tees and greens. Research could be conducted which measures damage, if any, that wheelchairs and other adapted equipment do to greens and if the effects are long lasting. This would provide information as to the nature of equipment which could be allowed on the golf course.

One option in the design process would be to include an alternative green adjacent to the primary one where the wheelchair or cart player would have access. This green could be covered with astroturf or constructed as a hard-packed sand green. If there is only one green for all participants, there could be a scoring system for those who are not able to putt based on how close the ball comes to rest from the hole. A circle could be drawn on the green, such as ten feet, and anything in that circle would be considered holed out on the next stroke. Anything outside the circle, but still on the green, would be considered holed out in two putts.

However, Bob Wilson, executive director of the NAGA, notes that through his discussions with those in wheelchairs that such an alternative scoring system is usually not used. He states, "... it is the combined opinion that circles on greens or other means introduces artificiality to the game." Unless the golfer is participating in a tournament format, he suggests that since the wheelchair golfer will, on the average, take more shots to reach the green, once the ball is on the putting surface they should stop counting.

So what impact will this new emphasis on legislation and mainstreaming people with disabilities into society have on the game of golf? I'm sure it will be a positive one, especially if everyone involved views this new group of potential players optimistically. Golf is an activity that can be adapted easily with few exceptions, and except in the area of equipment modification, should be played as closely as possible to able-bodied individuals. We should no longer relegate those with disabilities to the role of spectators. Let's encourage them to be active participants. Golf is a great game, and with these new participants it will become even greater.