Wednesday, March 14, 2007

How to Scuba Dive as a paraplegic

Scuba Diving For Paraplegics

By Neil McLennan


Copyright Neil R McLennan


INTRODUCTION

This manual is designed to assist paraplegics adapt themselves to standard SCUBA diving techniques. It is designed to be used in conjunction with a standard diving manual such as PADI’s Open Water Diving Manual. Using the techniques in this manual, the paraplegic should be able to dive at least as well as an able-bodied fin swimmer.
I have written it to apply to all paraplegics, whether or not they have good balance or not. As long as you have good hand and arm function, then this manual is for you.
My personal diving philosophy is to be adventurous. You may prefer to be more conservative and not dive off rocks or over 80 feet. I have included all the techniques I have used and you can pick those that suit you.
Remember that diving is a great social sport. It is a great way to make friends and through them, increase and improve your diving.



DOING A COURSE

Paraplegics should be able to complete a standard diving course such as PADI Openwater Diver. Paraplegia should not medically contraindicate diving. You can do the course with not really any more assistance on the course than able bodied students. When choosing a course you may prefer to pay little more to do a course that has boat dives rather than shore dives as access will be easier. You can also hire a personal instructor to cater the course specifically to you.



Disclaimer: Warning SCUBA DIVING and SNORKELLING are dangerous activities. Whilst I have tried to give safe advice it should not be used by someone who has not been trained by a recognised training agency.


SWIMMING

You will be required to swim 400m unassisted without stopping to be a SCUBA diver. In reality, modern SCUBA gear is so good many able-bodied students can't even do that but they still dive. However, you should practise to become a good swimmer so you can swim rings around able-bodied swimmers on the bottom.


Breaststroke
This is the stroke you will always use when under the water. On the surface it is fairly tiring because you have to lift your head out of the water to breathe. Underwater, if you are floating horizontally, it is a serene feeling breast stroking across the ocean floor. With fingers outstretched and almost touching about 8" in front of your chin and elbows at shoulder height, move your forearms out until your arms are straight. Hands should be slightly cupped with thumbs on the lower side. Then, pull your elbows in towards your hips relaxing your hands and bringing them back in front of your chin. This stroke gives a lot of power and good rotational control (when you don't use your legs there is nothing to stop your rolling over - -so you must control this with your arms). This stroke can be extended once the arms are straight by moving the whole arm down towards your hips and then drawing your hands up to your chest and back to your chin.If you don’t need the power of a full stroke then it can be reduced by bringing up only to shoulder height with the elbows, about 90 degrees. The arms are then straightened and brought down to the hips.


Freestyle
The fastest and most efficient stroke, it took me years to bee able to do it. It is not necessary to be able to freestyle as it is an impossible stroke in SCUBA gear. It is very useful, though, in the ocean where there is any surf or current to swim against. To freestyle your legs must float on the surface when you are face down. Most likely your knees will hang down like mine and you will need to wear some flotation. You can wear a wetsuit on your legs or use a float with straps attached. Once you have enough flotation to float your knees on the surface the swimming technique is the same as for an able-bodied swimmer without kicking.
This style will allow you to generate enough speed to swim out through the surf to boats and be able to catch waves bodysurfing. Remember to attach the flotation securely for surf conditions. Backward sculling through the surf when you lose your float results in a heavy duty wash and spin cycle.
I find a mm sleeveless triathlon suit works well in the ocean. The suit has the advantage of keeping you warm. In the pool, I normally wear just a float as it is easier to put on.

The stroke is the same as regular freestyling except that you don't kick. In the ocean, waves will cause you to roll. You can control this by modifying your stroke by straightening your arm. A straighter arm provides more lateral stability but less forward thrust.

Backward Scull
This is the easiest stroke, only useful for surface swimming. Because it is done on your back, breathing is very easy and you can stop anytime and rest without having to tread water. Start off by lying on your back and move your arms out about 45 degrees with elbows slightly bent and hands facing down; then, move your arms towards your hips keeping them fairly straight with your hands almost facing up. Be careful because it is easy to run into things with your head.

Forward Scull
This stroke is also useful while SCUBA diving where there is limited room to move your arms or for fine adjustments and hovering. This stroke is normally done while swimming face down. Hands are held just behind the buttocks and with fingers spread. The whole arm is rotated moving the hand through about 190 degrees. Start with the thumbs pointing at the tank and with your arms bent about 15 degrees; rotate your whole arm and hand to push against the water.

Bodysurfing
This is a useful skill if you will be around water. You must be able to freestyle so I assume you are wearing a flotation device of same sort. This is important because it allows you to rest.
Go out through the small reformed wave as quickly as possible diving under them and grabbing the sand if they are big. Keep swimming until you are just outside the breakers. Here you are relatively safe. Watch the break of the wave and position yourself so that you are just out from where the wave starts to foam.
Start swimming for the beach, try to get in 3 strokes before you get on the wave. Keep swimming until you are up then get at least one arm out in front of you. You should be able to ride it for at least 10 metres.
The arm out in front will protect your head if you get dumped and acts as an aquaplane on the face of the wave. If you see a wave coming you want to avoid, swim at it. If you get caught in a rolling whitewater, relax and wait until you see some light. You won't get held down for more than a few seconds. Choose a safe beach. Beware of dumping waves and avoid rocky bottoms.




CLIMBING AND CRAWLING
Maximising your mobility will allow you to be virtually totally independent as a SCUBA diver. Two techniques often overlooked by paras are Crawling and Climbing. Both of these require a reasonable level of fitness, but most importantly it requires lightness. Your power-to-weight ratio is critical when you no longer have a wheelchair holding you up.

Skin protection
You must protect your coccyx and issual tuberosities as a priority because they will always get pressure on them. These can be safeguarded by wearing good protection (think of feet in a shoe) and using the sidearm crawl. This is preferable to the two-handed backwards crawl, as you can see where you are going, takes all of your weight on your hip away from the pressure areas and doesn't require good balance

Crawling
If you cannot get a lift across a beach then your only option is to crawl. Taking your time you can go quite a long way. Crawling is really useful on boats, allowing you to get to everything and be very independent.
The sidearm crawl is performed by assuming the position in fig xx. The arms lift and pull the body towards the straight arm. Then the other arm pulls the feet up to the hip. It does not matter if you cannot generate much lift on a beach because you can drag through the sand. This crawl gives good balance so you can be fairly controlled as you raise and lower your bottom off the ground.
The two handed backwards crawl requires a big lift with the arms every movement. That then leads to a big drop back to the ground. This is not good for the backside, is very tiring and you cannot see what you are about to sit on. It also requires more balance to do this crawl.
You must protect your coccyx and issual tuberosities as a priority because they will always get pressure on them. These can be safeguarded by wearing good protection ( think of feet in a shoe ) and using the sidearm crawl. This is preferable to the two handed backwards crawl, as you can see where you are going, takes all of your weight on your hip away from the pressure areas and doesn’t require good balance.


Climbing
Aim to be strong enough to be able to climb up a vertical rope or pole that you can get a good grip on. You should be able to hang by one hand easily for at least 30 seconds. If you can do this, combined with your crawling, you will be able to go virtually anywhere. This skill may sound difficult but I think that any paraplegic who is not over weight should be able to do at least about 12 mm in diameter to give adequate grip.

SNORKELLING

More physically demanding than SCUBA diving but often easier because heavy gear doesn't have to be lugged to the shore. It's a good idea to wear a wetsuit when snorkelling. It protects your skin from sunburn and rocks and of course keeps you warm but also allows you to float easily if you get tired.

The first problem is where to leave your wheelchair especially if you are solo.

Water access without boat--beaches
Generally, a wheelchair will roll through soft sand downhill if it is wheel stood. If the tide is out then the wheelchair will roll pretty well once you are onto the wet sand. Letting the pressure down makes a big difference. Leave the wheelchair above the height the water will reach before you get out. An unattended wheelchair on a beach always looks like a suicide. Once I swam out to my boat at night. When I swam back a policeman was waiting for me--two women I thought were watching my muscles as I got in thought I was going to drown and called the police--Fortunately, he was a big one and gave me a push up the beach.
Twice my chair has been stolen by kids--later recovered once by the cops and once by my girlfriend who tracked the runts down until they squealed where it was. Another time, I was surfing at Bond for about 1 ½ hour. An ambulance came down to the beach and the lifeguards were actively patrolling the beach. I figured one of the tourist had drowned. When I got out the ambulance came slowly down the promenade with I presumed--a dead one. They stopped next to me as I shepherded some Japanese tourists out of their way and said they had been looking for me--I was the dead guy!
So, when you leave your wheelchair, lock it up if possible and leave a note on your chair saying when you'll be back. If the beach is all flat soft sand, you may as well leave the chair on the harder soil and crawl the whole way.
Crawl to swimmable depth and away you go. When you return if your wheelchair is still there, push up to the soft sand until you get bogged. Get out an crawl, pulling your wheelchair after you. Take your time, it's hard work.
A 4WD is a great way to get onto the beach and other places. Be prepared to get it sandy as it is impossible to get the sand off you before you get off the beach. If there is an outside shower at the beach, roll right in the wheelchair and you to get the sand off.

Off Rocks
Not easy but can be done. It depends on the terrain whether you can get your wheelchair across it--otherwise, you will have to crawl. Remember the tide can make it a lot harder to get out. If you went in at high tide then the water level may have fallen one metre or more when you go to get out. If you went in one hour before high tide then you could get out at the highest water. You can calculate the tide times easily by looking in the local paper, Time your entry to go in just after a swell has come by. When getting out, swim close to the rocks avoiding breaking waves. Make a quick pull for the rocks on the top of a wave not the bottom, grab as high up as you can on the rocks and lie prone as the wave recedes and you are left high and dry. When the next wave comes in, pull yourself up higher--good luck. Do not try to do this in an area exposed to the wind or swell. I have done this numerous times, you will need to wear a full 5 mm wetsuit and gloves for this. Use the protection of jutting rocks and lee shores for rock hops.

In the water
With just a mask and snorkel and no wetsuit, you will be slightly buoyant with your head in the water. When you put your mask on, make sure there is no hair hanging into it and that it sits smoothly on your face; spit in it and rub around the inside lenses to stop fogging; then rinse in salt water. I find the easiest way to put it on with poor balance is to sit upright and lean forward on my elbows for balance and then using both hands pull the mask onto my face. Then, I run my fingers around the edges to make sure no hair is in the way. Choose a snorkel that is wide enough to allow you to expel the air rapidly enough to clear water from the snorkel. If you have reduced trunk muscles (T12 and above) then a narrow snorkel will overcome your reduced breathing strength.
Before going in the water you must be able to hold your nose and pop both your ears by trying to blow into your nose. This is called the Val Salva manoeuvre and although a strange name and manoeuvre, it is essential that this be done when you go underwater. It increases the air pressure inside your ears to compensate for the increasing water pressure. Don't dive underwater unless you can do this comfortably.
Lying face down in the water and breathing comfortably, take a big breath, reach forward and pull your head under the water. Pointing your head straight down, pull strongly towards the bottom. The key to getting to the bottom is to dive vertically creating as little drag as possible, putting most of your effort into the first two metres.. Perform the Valsalva manoeuvre, ideally your mask will be snug enough on your nostril to allow you to Valsalva without holding your nose.
Start off snorkelling in the pool Get good at this sport before you SCUBA dive and then the rest will be easy. When you snorkel in the ocean pay attention to the current and then swim AGAINST it. For a paraplegic, this is the most important rule. If you get down current, getting back may not happen.
When surfacing, give some good pulls for the surface. Pushing off the bottom gives you a good boost. Tilt your head back slowly and breathe out just before you break the surface. This will clear your snorkel easily. If water remains a sharp blow should clear it. Otherwise, get a narrower snorkel. You an achieve 10 metres with practice. When you snorkel, be as quiet as possible i.e. don't break the surface with your hands as this will scare the fish.
A fast way to the bottom is to pull yourself down the anchor line or a fish trap or a wharf pier etc. If you are wearing a wetsuit , leave your weightbelt behind when pulling yourself down a line. When you let go, a slight stroke with your arms will rocket you upwards. Additionally, a good push off the bottom will speed you upwards.
The really quick way down is to grasp a weight and let it go to the bottom. The hard point is getting the weight back up. You can tie the weight to a pulley attached to a boat or a float or pull it straight in from a boat.
When I am snorkelling without a wetsuit I prefer to wear a couple of pounds of weight to overcome my buoyancy. Weight belts are standard items at dive shops--just make sure it has a quick release buckle.
WETSUITS

Whether the water temperature requires one or not, a wetsuit is great for protecting your skin. You can crawl and crash over objects that would otherwise leave you lacerated. It's a good idea to wear one always when you are in a boat to protect you. Whenever you are swimming, a wetsuit will let you stop and rest and swim faster.
There are two different types of suits, the overall style and the jacket and long johns For general swimming, I prefer a 7 mm sleeveless. Overall, it gives flotation, is streamlined and allows good arm movement.
For diving, I prefer long johns and jacket. The advantage is that the jacket can be removed easily while you are in the boat and the long johns will still provide protection to your bottom and legs. In the tropics you can dive in just long john. I like to have an attached hood on my jacket as it is much warmer and protects your head from rocks. Get flies put in your long johns. Women can get flies running left right inside the crotch. Wetsuits come in different thicknesses. In the seat, at least 5 mm is needed to protect your behind .
To put your wetsuit on it is best to stay in your wheelchair. Put one leg into the pants and pull it up over the knee (It makes it easier if your leg can spasm out straight when you pull it up.) Then pull the cuff over your heel and put the other leg in, pull it up over the knee, and then the cuff. Leave both feet off the foot plate and pull the pants up as high as you can. Lift up quickly and pull the top part of the pants up under your bottom. Now you should be able to pull them up all the way.
For climbing around on boats and anything else for that matter, I use a pair of wetsuit shorts with a zip down each thigh and closed cell padding in the seat. If I am going to be bouncing around a lot I put a low profile Roho in the seat. The two zips allow the pants to be easily removed and put on. The fly obviously is important. Putting a Roho in the shorts not only gives great protection but will also provide an environment for healing cuts on your coccyx. It is a real shame to be on an overnight or extended dive trip and have to curtail your activities due to a minor cut. I have found injuries to my coccyx are like skinned knees and elbows and can be managed while still being active.
An example of the protective nature of the neoprene wetsuit is when I was diving the Duckenfield near Sydney with my twin brother Alan. We were using a petrol powered compressor to pump air to the diver via an air line (called a Hookah) As we had just found this wreck we were diving it at night so no one would find its location. Alan was under the water and I was monitoring the compressor. I began to smell burning rubber. Concerned that my brother's air may become contaminated, I quickly searched for the cause. I looked around unable to find it and then noticed my foot was under the exhaust pipe and my neoprene bootie was burning. I pulled my foot away and put it in the ocean. Then I gently took the bootie off my foot and was amazed to see no injury. Only the outer casing had burnt and the water in the neoprene had stopped my skin from burning.
The long johns are also good protection for crawling activities. I have crawled through several caves which would have lacerated bare skin. Because the long johns are secured over the shoulder and are a tight fit they will not be pulled off by drag as one crawls along. Wearing the wet suit shorts is also a good lifesaving measure as it allows you to float in the water and to freestyle.

POSTURAL DIURESIS
This is a major problem for paraplegics. When you are under the water, the water pressure exerts equal pressure over your entire body. Therefore, fluid cannot pool in your legs as it will when you sit in your wheelchair. The body will excrete any pooled fluid through the bladder once you submerge. In a one-hour dive, my experience is that you may excrete half a litre. If you are unable to void your bladder under the water then you are very likely to distend your bladder as this pooled fluid is excreted. To avoid this you need to void your bladder before diving and immediately afterwards and restrict your fluids beforehand.
In short dives say 20 minutes, this is not a great problem. For long dives over one hour, it becomes hard to avoid. If you have a bladder which empties spontaneously, then this will not be a problem, the only drawback will be your wetsuit will smell when you take it off. If you use intermittent catheterisation, you will need to catheterise before and after diving, hence the importance of putting a fly in your suit.
I have found diuresis to be a problem on deep dives with long bottom times. When I was diving the Catterthun in 60 metres, our bottom times were 25 minutes. We would then be required to do 60 minutes of decompression: two minutes at 18 metres 3 minutes at 15 metres, 5 minutes at 12 metres, 9 minutes at 9 metres 15 minutes, at 6 metres and 25 minutes at 3 metres. This was about 1 ½ hours under the water and meant a lot f fluid was excreted As a result, I suffered bladder distention. I have tried to restrict my bottom times since then.
WEIGHT BELTS

When you wear a wetsuit you will need to wear extra weight to overcome the buoyancy of the suit. This is done by wearing a belt of lead weights around your waist. In the event of an emergency, it must have a quick release buckle so you can make a rapid ascent., it must have a quick release buckle so you can make a rapid ascent.
For optimum swimming potential, it is important not to wear too much weight. You should try to adopt a prone position in the water. Many paraplegics adopt a standing position underwater because they use gear designed for persons using fins swimmers who adopt a standing position by wearing extra weight to overcome the upward thrust of their fins. Once they start swimming, their fin thrust will put them in the prone position. However, a paraplegic if naturally floating in the standing position will stay in the standing position once he starts swimming. The standing position causes a lot of drag and the prone position carries the least.

Putting on the belt
For paraplegics, the worst part of weight belts is that they are easy to lose. Because our thighs are skinny, and our hips are very slim and don't give the belt much to rest upon. Therefore, they tend to slip off over the hips. It is difficult to get them tight while sitting up so I put the weight belt on by lying down and doing it up tight when I exhale.
Several different types of buckles are available. The clasp type requires threading the belt through the buckle which is difficult if your balance isn't good. I prefer the old fashioned wire buckle style as it can be done up easily.
As soon as you get into the water check that your weight belt is secure. The amount of weight to wear depends on the buoyancy of your suit and the buoyancy of your body. You may find like me that 2 or 3 pounds of weight helps me when I am snorkelling without a wetsuit. With a full 7mm suit, I would wear 18 pounds.
Also available are elasticized belts which are easier to keep on because they can be put on with more tension.

Losing your weight belt
If it falls off while diving let all the air out of your BC, exhale and swim down as hard as you can and grab the weight belt on the bottom. To put it on, put the buckle in your left hand and while lying on your back bring it u to the back of your waist. Then, grab the free end with your right hand. Maintain the position on your back as you do it up.
If it falls off while you are on the surface drop a weighted line as soon as possible where you lost it. Depending on the depth you or your buddy can snorkel or SCUBA for it by following the line.

SPEARFISHING
I have successfully spearfished as a paraplegic. It can be very fun especially if you are hungry. It is a good activity when camping on dive trips or on sailing trips. I have found a pneumatic gear to be the easiest to use because they are shorter and easier to aim and to load. A rubber powered gun is hard to load as it requires two hands and the butt must be firmly held against the hip which is hard if you can't brace with trunk muscles.
A fin swimmer will swim with the gun extended in his hand ready to shoot any fish that comes in front of him. If you swim with your hands you cannot do this. My technique is to tie the gun to my weight belt with the safety catch on, then dive down to my desired depth, then point my gun in front of me with one hand and with the other, rotate myself 360 degrees and shoot any fish that comes to view.
It is important to make the gun easy to detach. Once I had it tied to my jacket and while I was under the water the gun became caught under a rock. I was unable to surface and was fortunate to break the string holding the gun. Of course, the same could happen if you speared a big fish and the gun was attached to the spear.
The spear is attached to the gun with a retractable cord. The gun is tied to a rope which runs through a loop attached to your weight belt and then onto a red buoy. This buoy acts to warn boats of your presence and by attacking a stainless steel spike on a lanyard to the buoy, you store your fish on the buoy. It's good to keep dead fish away from you in case of sharks.
When you spear a fish, you can let go of your gun if the fish is pulling hard and recover it when the fish tires by pulling on the buoy line.
SCUBA DIVING

This sport is totally dependent upon man-made equipment. Firstly, let's go through the equipment and I will discuss how paraplegia will affect how you will use it. The following are the standard SCUBA gear:
Tank
Regulator
Buoyancy Compensator
Gauges
Timer/Computer

Tanks
Air is compressed to about 200 times regular air pressure dried and pumped into an air tank. It give you a finite amount of air for breathing depending on how deep you are and how hard you are breathing.
Tanks come in different sizes. Different designs of tanks can hold greater pressures; therefore, the physical size of tanks does not indicate the amount of air that they hold. The tank is the hardest item to carry above and below the water, so it is best to use a tank that is no bigger than necessary
New high pressure steel (370 bar) tanks are the most compact but require special screw in regulator fittings (DIN fittings) and many dive stores cannot fill them. Aluminium 63 tanks are easy to carry and get filled but hold 30% less than a 90. It is up to you the tank you select. They should last for 100,000 fills and cost about $200 each (less, second hand) so it is a good idea to have two, say a 63 or 72 and a 90.If you are diving out of your own boat, you will find it much easier to lift a 63 in than a 90.
Carrying the tank in the wheelchair is not that hard. I grab the tank by the valve and pull it between my knees and sit it on the footplates or leg strap. If it is only a small tank, it can be laid on your lap. I prefer not to have protective shrouds or boots on the tanks as it makes dragging it up over the legs or wheelchair very hard on the skin.

Buoyancy Compensators (BC)
The BCs principal function is to increase and decrease your buoyancy so you can float at different depths. Additionally, it secures the tank to your back and has pockets for storing things.
The modern BC has breakaway clips on the chest and provides much greater stability than the old horse collar and non breakaway jacket designs. It is important to have as much of the buoyancy in the jacket located near the main weight area, ie the weight belt.
BC's come in different sizes. Make sure yours is a snug fit when all the straps are done up. Different jackets have different amounts of buoyancy I always look for one with minimum drag-no bulky pockets. It is important to achieve a snug fit. If the tank can slide around on your back it makes swimming much harder.
The KEY TO SWIMMING EASILY IS TANK PLACEMENT. For most paraplegics, I have dived with, they position their BC's high on their tanks. This emulates the fin swimmers who position their tanks there to weight their legs to overcome the upward thrust of their legs. When they do this, they end up swimming standing up. In the end, they really only do a vertical dive using their BC, as swimming horizontally becomes exhausting
If you are swimming without fins, then you are better adopting a slightly head-down position as you will receive a slight upward thrust from your arms. Additionally having a slightly head down attitude will lift your legs clear of obstructions when pulling yourself along the bottom.
This body attitude is simply attained by moving your BC up and down your tank. With a 90, I like to place the top of my BC in line with the start of the curve on the tank. With a 72 or 63, I put it halfway along the tank.
Your BC should have clips on the chest so it can breakaway easily This makes the BC very easy to get off and easy to put on. It was especially useful for me once when I was diving with Amghad. After a spectacular dive to 160 feet at the Cape Byron Pinnacle, we decompressed and then surfaced in a 4-knot (very strong) current. Hanging on to the side of the anchored inflatable, with water flowing around us like a river, Amghad removed his tank and we pushed it into the boat. he had become very tired decompressing and was washed away. Now I was on my own wondering how I would get in, when I inflated my brand new BC and with one hand, released the should clips and the BC tank and erg went racing away 3 miles out to sea. Without that weight I as able to jump in the boat and after half an hour hacking through the anchor line with some old pliers. Poor Amghad had grabbed the mermaid line and wrapped around his hand. Half an hour of that had worn the skin away where the rope had been. Following the current, I found my tank half a mile away.
Another advantage of having a low placement on your tank is that the regulator hoses and tank valve are very easy to reach over your head. I have never had any problem hitting my head on the tank valve although able body people say it happens to them. I think as paraplegics we don't stand up with our tanks on our backs, which is when this may happen.

Regulators
For low drag, I think it is best to use a regulator with the yoke at 90 degree to the first stage. This setup leaves the hoses close to your shoulders rather than packing over your head like in an in line mode.
With that exception, I don't believe a paraplegic needs anything special in a regulator. As they are expensive and durable, you ought to buy a good quality balanced regulator as they give superior performance at all depths.

Gauges
Gauges are normally mounted in a console attached to the HP line. This works well for the pressure gauge. I normally have my depth gauge there as well. However, because it is difficult to look at the console without ceasing to swim, it can be hard to regularly monitor your depth gauge or compass. Therefore, sometimes, I will wear them on my right arm so that I can easily monitor them while controlling my ascent/descent with my left hand. I like to put my high pressure hose through my left BC sleeve and then under the BC waist strap. This makes the console easy to find and reduces drag.
It would be nice to have a compass mounted on your mask or chest so that you could monitor it as you swim. However, I have never done this. I take a bearing on an object and then swim at it and then take another bearing.

Computers
These are really useful but not specifically for paraplegics. Get one if you can afford it--preferably one which goes down further than 70 metres--why not!

Gloves
They are great as your hand are very prone to hitting sharp rocks as you pull through the water with your hands. You will often pull yourself along a shipwreck or wall in a current and gloves make it much less painful.
A close fitting neoprene glove is the best a they have the least drag but wear out fast and are expensive. As your gear depends on finger movements (BC buttons, grabbing hoses, purging regs), you need a glove that does afford some sensitivity.
I have tried webbed gloves for extra propulsion without success. Unlike the legs, arms do not have a lot of excess power to drive a pair of fins. I found that my arms couldn't handle the extra force generated by the webbed gloves. Additionally, I found that they reduced the sensitivity and movement of my fingers in manipulating my equipment, taking longer to adjust my gear and therefore slowing down my swimming.

Knives
Knives are always lost fairly rapidly so I have given up wearing them. When I do wear one, I normally put it on my arm or BC rather than ankle as the ankle is hard to reach readily.

Fins
Fins (Flippers) are superfluous for a paraplegic

GETTING IN
I will assume you will be diving out of a boat and that you already have your wetsuit on. Put your weightbelt on, you may have to lie down to do this. Sit at the doorway or on the side of the boat and put on your tank. If you loosen your shoulder straps on your BC first it will be easiest to put on. Put some air is in the BC (with your mouth, to conserve air) Hold a line attached to the boat and roll in. Holding the line means you can't get washed away especially if you have a gear problem. Ideally, you can run the mermaid line from the anchor line so you can pull yourself along it to the anchor line.
As soon as you get in check that your weight belt is tight and then tighten your BC straps.
If it is too rough to do your straps up easily on the surface go in with just your arms through the BC and the straps undone. Do them up when you get to the bottom. It can be difficult getting straps done up with poor balance as you try to hang on with one hand.
It is often easier, especially if you are on your own to throw your tank in and then put it on. Slide a rope attached to the boat, through the arm of the BC and put the tank in the water holding onto the end of the rope. Jump in yourself, then position the BC (with some air in it) so that the tank valve is pointing downwards at about 40 degrees and the BC is between you and the tank. The hoses should be hanging clear of the BC, then put the reg in your mouth. Put your arms through the holes, taking the rope back through the hole but holding it so you stay connected to the boat. Push your head down under the water until you have the BC on your back. Once you have done this, allow yourself to roll on your back and relax as you do up all your straps.
If there is no rope from the anchor line getting past the boat can be the hardest part of the dive if there is current or waves. You can either swim hard pull yourself along the boat and submerge and swim underwater. I don't recommend the latter as you don't know where you will end up. In a boat up to 25 feet long it is practical to place both hands on the gunwale and 'walk" hand over hand to the anchor line. Otherwise, you may be able to pull yourself along the rubbing strakes along the side of the boat. If all else fails, generally you can submerge and pull yourself along the vessel's keel.
When you get to the anchor line, clear your ears and let the air out of your BC and pull yourself down the anchor line. You should be weighted so that with your BC deflated, you will sink when you exhale.
You should be able to clear your ears by blowing into your mask (with practice). This will leave your hands free for swimming. The advantage of descending down the anchor line is that it is physically easy and fast, you can't get lost, you arrive at the dive site and you can check the anchor will not pull out. Another advantage is that if you have trouble clearing your ears, you can stop rapidly.
If it is impractical to go down the anchor line be careful because you cannot stop quickly to clear your ears, you must use your BC to stop if you have to use your arms for some problem.
When close to the bottom, hold onto the anchor line, clear of the bottom. Tighten all your straps and weight belt, check your air an depth and current direction. Inflate your BC until you feel yourself become slightly buoyant.
Plan your dive to take you up current so that you know you will make it back to the anchor (or at least to the boat).
If SCUBA diving off the shore, get your buddy to take your tank out to safe water and then snorkel out to it.

ON THE BOTTOM
Before you get in, tell your buddy not to swim right next to you or you will hit him in the head as you swim.
When SCUBA diving, you should be weighted so that you can easily swim in any orientation. You should never have to swim really hard. When you feel tired stop and have a rest. You will waste air working flat out.
If the bottom is flat look for a crack in the rock to follow. It will most likely lead you to a wall you can then follow. Wherever you go, look back regularly and try to remember what it looks like. Underwater navigation is the key to speed. Everything tends to look the same. If you can navigate well you will beat everyone back to the boat.
If the bottom is featureless sand or kelp, swim straight up current and count the number of strokes you make. When you come back if you take an equal number of strokes, you will gone too far as you have the current behind you. If you reduce the stroke number by 30%, you should be near the anchor.
Swimming along a slope is fairly easy, keep the slope on one side when you swim out and then on the other as you swim back.
Walls, of course, are easy to navigate on.
Shipwrecks can be very easy if they are intact. If they are broken up then you may be faced with swimming across sand to another part of the wreck. I often drag my knees through the sand to leave a trail
Keep an eye on your air and turn around before you get to 50%. Keep an eye on your buddy if he is behind you by tilting your head right down and looking back under our waist. Also, you can roll on your back to look at your buddy. In this way, you don't have to stop swimming just to keep an eye on them
When current is present on the bottom you may not be able to swim against it. Swim as hard as you can and grab the bottom. Pull yourself along it taking advantage of any rises, boulders or walls that will block the current. it is also easier if you traverse back and forth against the current. This traversing can be done up and down against a wall as well.
Where there is no current but surge from passing swells, you can use its force to give you a big lift. When you feel a contrary motion, hang on to the bottom. Before the surge comes behind you, start pushing off the rock and swim hard. You will be surprised how far you will go with little effort. It is a great activity around swim throughs where you can hold the rocks wen the surge is against you and then give a big push through the swim through. You can gauge when the surge will change direction by watching the kelp swaying.

SURFACING
If you make it, back to the anchor surfacing is easy. If you can't find it you will have to do a blue water ascent. With enough air in your BC, use your arms to swim up. Remember to look at your watch before you leave. Come up at the speed of your smallest bubbles, venting your BC regularly. Use your hands to spin around so you can watch your buddies. As you get near the surface listen and look for boats to avoid. If your ascent becomes to great with all your BC air dumped use your hands palm up to push against the water.
On surfacing inflate your BC and look for the boat. Use your snorkel and swim towards the front of the boat. If it is rough , you can swim on SCUBA under the water when you have taken a bearing on the boat.


NIGHT DIVING
A beautiful experience, the only special equipment needed is a torch. As you can't hold it still and swim you need to attach it to your head. It is best to get a caving helmet and attach 2 or 3 torches with wire ties. If you are lazy, you can just push the torch under your hood as or even tape it to your mask strap. There are also several proprietary products available now for putting a lighting source on your head.
My craziest night dive was on a wreck in 50 metres. My two mates, Mike and Mal, went in first. I would mind the boat while they wen in and then go down 18 minutes later when they should be coming up. I never saw them as I went down and pondered in my narcotic state where they were. After leaving the bottom, I was sitting decompressing when Michael appeared out of the black void. On the surface, he explained that having lost the anchor line, he surfaced and swam for the boat, skipping his deco. Mal stayed under doing his deco drifting with the current. We searched for Mal for 3 hours when fearing the worst, headed back home. And that was where he was. In only 40 minutes, he had swum 1 ½ miles ashore, run 400 metres to my house, and was having a cup of tea.

BUDDY BREATHING
This skill is becoming much less important now that octopus regulators are so common. For the paraplegic, it is impossible to swim while your hands are busy using the second stage. I have found the best procedure is for the paraplegic to grasp the buddy's BC firmly and control the second stage, moving it between the buddy and himself. Then, the buddy is free to swim the couple to safety.

DEEP DIVING
The problems of diving over 30 metres are:

· Nitrogen Narcosis

· Decompression stops

· Air consumption

Nitrogen narcosis doesn't present any unique problems for the paraplegic. It can be very dangerous or very enjoyable. The best way to avoid it is to get a lot of experience at depth and to visit a deep dive site several times before straying far from the anchor.
Finding the anchor is essential as decompression stops must be performed near the surface. If you aren't hanging on to the anchor line, you will be washed away by the current and it will be hard to maintain the correct depth.
The only real problem for the paraplegic in deep diving is carrying the twin tanks, which are often essential to supply enough air at depth. I have never been able to move twin tanks out of the water. I always rely on my buddy to shift them around and then I put them on in the water. Swimming with them is not hard. The tanks must be moved forward as with a single tank to provide a prone swimming position.
I have never suffered from decompression sickness in over 500 dives, many of which were over 50 metres. As well most were done to US Navy tables which have greater bottom times than the sport diving tables now in use. From my observation paraplegia does not cause any noticeable increase in decompression sickness. It is possible that a paraplegic could suffer a bend in the legs which he could not feel, but the consequences of that in someone who cannot walk anyway would not be very severe. I think that it is unlikely that a paraplegic would get bent in the legs without bent in his arms, because the relatively slow flow of blood in paralysed legs would have a much slower exchange of dissolved nitrogen to the leg tissues than in the arms.

LIFTS
Very often, it is easier for everyone if a mate gives you a lift. There is the piggy back, the come to me and the fireman's chair. The latter is the best--less strain on the lifters and less strain on you. Come to me is comfortable for you but requires a strong lifter. Piggy back is a powerful life but it is difficult to achieve from the squatting position and can be hard to spread your legs apart. Quite uncomfortable for the passenger, too.
If somebody offers you a hand, I will generally accept it except if it is something I do all the time and my doing it keeps me fit, like pushing up a ill. I will also ask if I need a hand. Normally, that hand is offered well before I ask for it.
BOATS

By far, the easiest boat to use for a paraplegic is an inflatable on a trailer. They have no sharp edges, are extremely seaworthy and are very easy to get in and out of. At a suitable ramp, they can be driven on and off the trailer. When travelling in an inflatable, sit up on the middle of the pontoon. You will not bounce out of the boat but up and down. As long as you can hold onto the lifelines along the side you should be able to hang on even with a rough ride. Many people stand up to absorb the shock of a speed boat bouncing across the chop. As you have to sit, sit at the back of the boat because it tends to remain steady while the front of the boat bounces around a lot.
Aluminium and fibreglass boats need to be much bigger to carry the load and be as seaworthy as an inflatable. They have lots of hard edges that can injure a paraplegic when it gets choppy. The most likely injury is to the coccyx from the edge of a seat. This can't happen in an inflatable because the seats curve away from the coccyx. I would recommend a 14 foot inflatable, with a 25 hp motor.
To get into the boat, at the ramp it is often easiest to board the boat while it is still on the trailer. Then the wheelchair can be put in the car. If you are needed to back the trailer, then after you've parked the car you may get your buddy to lock it in the car or take it with you in the boat.
At most wharves there are steps you can '"roll" down or you can get out and climb down. Sometimes, the boat is sitting at a wall with a big drop. I like to go hand over hand down the mooring line. Or you can jump in somewhere else and swim around.

Getting out
These diagrams show a couple of ways to get into the boat. This is a very important skill if you want to be independent. Take your weight belt off first and put it in the boat. Take it off with one hand while you hold on with the other. Then take your tank off and attach it to a lanyard hanging from the boat. Many able bodied divers have difficulty getting back in so a paraplegic will also. Look at the boat and see where it is easiest to get in. One tip is to get some of the people in the boat to go to the side you want to get in on so that the boat lists in that direction.


Driving the boat
Most boat are set up to be driven by hands only. So long as your can sit at the wheel or tiller driving it shouldn't be a problem. An advantage of inflatables is that you can rapidly slide along the pontoon to the front of the vessel. In an aluminium or fibreglass boat, seats normally run across the boat requiring lots of climbing.
I can easily pull start a 1993 Mariner 40 twin but a 1987 Mariner 15 is too hard. Before you buy a motor make sure it is geared to be easy to pull start.

2 comments:

jamie said...

I'm T2 complete para, diving the south coast of the north island in New Zealand. I'm about to complete my advanced ticket and your write up was very insightful, expecialy the details regarding deep diving. Thanks for taking the time to post this.

michael, claudia and sierra said...

c5-6 incomplete. american diving in se asia. just got certified in thailand. going to be diving more soon but need to work on certain issues - and yes, this was very helpful and nice to find...