An indepth report backed with quantitative and qualitative data.

1. THE WILDERNESS AND
PERSONS WITH DISABILITY
Health and Therapy Benefits

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Contents
1 Introduction ..................................................................................................... 3
1.1 The Natural Environment............................................................................. 3
1.1.1 Outdoor Air Quality................................................................................... 4
1.1.2 How good air quality does affects health? ................................................ 4
1.1.3 Water Quality............................................................................................ 5
1.1.4 Ultra violet Radiation ................................................................................ 5
1.1.5 Food Safety ............................................................................................... 6
1.1.6 Green Space.............................................................................................. 6
2 The wilderness (natural environment) .............................................................. 7
2.1 The Concept of Disability.............................................................................. 8
2.1.1 The Disabled’s Environment...................................................................... 9
2.1.2 Disability and the Wilderness.................................................................. 10
3 Means End theory for Wilderness Experience................................................ 11
3.1 Medical Research on benefits of the wilderness on persons with emotional,
physical or mental disability by Wilderness Inc. (WI) ....................................... 12
3.1.1 Results and Discussion ............................................................................ 15
3.1.2 Consequences, Values, and Attributes .................................................... 15
3.1.3 Transference to everyday life................................................................. 20
4 Summary of wilderness benefits for disabled persons .................................... 22
4.1 Increased self-efficacy................................................................................ 22
4.1.1 Increased Social Adjustment. .................................................................. 23
4.1.2 Enhanced Relationships .......................................................................... 26
4.1.3 Increased Self-Concept and Reduced Anxiety Levels............................... 27
4.1.4 Increased leisure skills............................................................................. 28
5 Health Benefits of Outdoor activity on disabled persons (summary)............ 33
5.1 References ................................................................................................. 35

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“Disability need not be an obstacle to success. I have had motor neurone disease
for practically all my adult life. Yet it has not prevented me from having a
prominent career in astrophysics and a happy family life”.
- Professor Stephen W Hawking

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1 Introduction
The natural and built environment is a major determinant of the health of
people with disabilities and how they live. The surroundings can influence their
health through a variety of channels—through exposure to physical, chemical and
biological risk factors or by triggering behavioral changes. Likewise, there is a
growing awareness that human, through their intervention in the environment,
play a vital role in exacerbating or mitigating the general state of health.
This research presents a selection of evidence on the health and therapy
benefits of the ‘natural environment (wilderness)’ on the physical and mental
health of the “disabled” population i.e. individuals with either physical, mental or
emotional disabilities worldwide citing data or reports mostly from the United
States. Pertinent to note is how critical the environment affects the health of
people with disabilities not only them but also everyone non- disabled individual.
The environment influences the cellular function and metabolism of the body;
these can manifest emotionally, physically or mentally.
1.1 The Natural Environment
The natural environment encompasses all species, habitats and landscapes
found on earth—excluding aspects of the environment which originate from
human activities. It includes universal natural resources such as air, water and
climate, as well as complete ecological units such as vegetation, rocks, micro-
organisms and animals. For the purposes of this report, food safety and water
quality has been included as part of the natural environment, even though they
are subject to considerable human intervention.
The meaning of the word ‘environment’ is very broad. Essentially, our
environment is made up of all the external elements that surround, influence and
affect life. One way to view it is to see it as two interlinked domains: the ‘natural
environment’ and the ‘built environment’. The ‘natural environment’ can be

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classified as all the landscapes, habitats (on land, and in the air and water) and
species on earth, and the ‘built environment’ as everything made by people
(AIHW 2012). The natural environment can be positively and negatively affected
by human intervention and impact. It, in turn, can positively and negatively affect
people and their physical and mental health. However, we are only concerned
with its positive effect on people; mainly disabled people. Components of the
environment as it affects health are: air quality, food safety, water quality,
extreme weather events, ultra-violet radiation, and thunderstorm asthma to
mention a few.
1.1.1 Outdoor Air Quality
The air outside buildings, from ground level to several miles above the earth
surface- is a valuable resource for current and future generations because it
provides essential gases to sustain life and shields the earth from harmful
radiation. Outdoor air quality is the measure of the impact on the atmosphere of
outdoor air pollution. Outdoor air quality may be affected by car exhausts,
emissions from factory smoke stacks and road dust. Pollen in the atmosphere
contributes to reduction in outdoor air quality.
Good air quality is important to the wellbeing of everyone especially disabled
individuals. On average a person inhales about 14,000 liters of air every day, and
the presence of certain gases (nitrogen, oxygen, argon and carbon) in the right
proportion makes the state of the air healthy.
1.1.2 How good air quality does affects health?
 It breeds a relaxing ambience: Ever wonder why monks meditate in areas
where nature meets eye? Not only is a green environment soothing to the
mental and emotional aspects of the human body. It is also a healthy way
to breathe in fresh air
 Creates good working atmosphere: There is a reason why even at work,
good air quality needs to be sustained. The outdoor air quality of the

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outdoor environment can profoundly affect the health, comfort and
productivity of building occupants.
 Induces better socialization: Good air quality is an agent for good
communication and socialization either at home or elsewhere especially
when with large company (companions). An unhealthy air space can make
it hard for us to be comfortable and to be at ease with people around us.
1.1.3 Water Quality
Water quality relates to the physical, chemical and biological properties of
water, including color, clarity, salinity, acidity, chemical contaminants (such as
pesticide residues and heavy metals) and microbial contaminants (such as
bacteria, viruses and protozoa). Water quality sustains ecological processes that
support native fish populations, vegetation, wetlands and birdlife.
Why is water quality important? Water of adequate quality and quantity is a
fundamental requirement for personal and public health. Assessing water quality
requires the measurement of physical, chemical and biological characteristics,
although the exact standards may depend upon the purpose of the water supply
(such as drinking, bathing, washing, recreational purposes and agricultural
production). Indicators used to assess water quality include pH, salinity, color,
clarity. Our water resources is closely linked to the surrounding environment and
land use. Other than in its vapor form, water is never pure and is affected by
community uses such as agriculture, urban and industrial use and recreation. The
modification of natural stream flows by dams can also affect water quality. The
weather too, can have a major impact non water quality. Water has so many
health benefits that the US Centers for disease control and prevention
recommends drinking eight ounce glasses of water every day.
1.1.4 Ultra violet Radiation
What is ultraviolet radiation?
Ultraviolet radiation (UVR) consists of high-energy rays which are invisible to
the human eye. The most common source of UVR is sunlight, although some
people may be exposed to artificial sources such as in solariums and when using

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incandescent lamps, arc discharges and lasers. UVR is divided into three types
according to wavelength (UVA, UVB and UVC). UVA, and to a lesser extent UVB,
are not wholly absorbed by atmospheric ozone and therefore are of interest for
human health.
A person’s degree of exposure to UVR can be influenced by behavioral
factors (for example, use of sunscreen and protective clothing and outdoor
activities) and non-behavioral factors (for example, latitude, atmospheric
conditions and time of year and day). In turn, these factors influence the extent of
health risk. There is also increasing awareness that due to global migration
patterns, people’s skin pigmentation may not be suited to the environment in
which they live (Lucas et al. 2006; Mackie 2006). UVR exposure can have both
beneficial and detrimental effects on health. Unlike many other environmental
exposures (which tend to exhibit a more linear relationship).
1.1.5 Food Safety
Food is said to be unsafe when it is likely to cause physical harm to a person
who may later consume it. This primarily relates to foodborne illness such as
gastroenteritis (‘food poisoning’), although other forms of illness and injury can
be triggered by short- or long-term exposure to particular contaminants. Food
safety can be compromised anywhere in the food chain—from production and
transport to storage and meal preparation. While risks associated with food
businesses have drawn substantial attention, food safety can also be affected
through incorrect food handling practices in the home or workplace.
1.1.6 Green Space
A green space is an area of vegetated land within or adjoining an urban area
(Health Scotland et al. 2008). It includes natural green spaces such as bush land,

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amenity parks and grasslands, outdoor sports facilities, school playgrounds,
vacant land and countryside immediately adjoining an urban area. Green spaces
are usually open to the public although some definitions will include private green
space such as home gardens or backyards (for example, CSIRO 2004).
Self-assessed health status
After controlling for socioeconomic status and demographic variables, several
studies have found that green space is associated with better self-assessed health
status (for example, de Vries et al. 2003; Maas et al. 2006). Maas and colleagues
(2006) used self-reported health data from 250,782 people registered with 104
Dutch general practices. They calculated the amount of green space within a one
or three kilometer radius of each household using green space data from the
Dutch National Land Cover Classification database. There was a significant
relationship between the percentage of green space within a one or three
kilometer radius and self-assessed health. In areas where 90% of the
environmental surrounds were green, only 10.2% of residents felt unhealthy,
compared with areas where only 10% was green where 15.5% of residents felt
unhealthy. Elderly and young people in large cities were found to benefit more
from green space than other population groups.
De Vries et al. (2003) found a similar effect for self-assessed health status,
also among a Dutch sample. The positive relationship between green space and
health was stronger for housewives and the elderly—groups hypothesized to
spend more time in the local area. This research included additional measures—
the number of symptoms experienced in the last 14 days and score on the Dutch
General Health Questionnaire indicating propensity towards morbidity. People
living in a greener environment were found to be significantly healthier than
others and displayed fewer symptoms in the last 14 days. Overall 10% more green
space was associated with a reduction in the number of symptoms which was
comparable to a decrease in age of five years.
2 The wilderness (natural environment)

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Wilderness or wild land is a natural environment on earth that has not been
significantly modified y human activity. It may also therefore be defined as the
most intact, undisturbed wild natural areas left on our planet- those last wild truly
wild places that humans do not control and have not developed with roads and
pipelines or other industrial infrastructure.
The value of wilderness participation for persons with disabilities is best
expressed by those for whom wilderness is a very important part of their lives.
Janet Zeller (1992), a person with quadriplegia who uses a wheelchair,
commented on her experience on a wilderness canoe trip in Maine
“I was back to feeling the quiet of the lake, listening to the loons at night as
the sun goes down, the sounds of the night, living with the land—it was something
that I had sadly missed. It was that place in my soul that needed to be refilled. And
it was. At the end of that week I could say that I felt less disabled than I usually do.
And it certainly was not because there were fewer barriers. It was the wilderness,
that peace you can’t get anywhere else.”
Anderson et al. (1997), studying persons with disabilities who go to wilderness
areas, found that the wilderness environment itself was a major contributing
factor to persons with disabilities realizing some of the major benefits of
wilderness. Study participants indicated that the wilderness environment
intensified their individual efforts, producing a dramatic positive impact on group
development.
2.1 The Concept of Disability
Disability is a part of the human condition. Almost everyone will be
temporarily or permanently impaired at some point in life, and those who survive
to old age will experience increasing difficulties in functioning. Most extended
families have a disabled member, and many non-disabled people take

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responsibility for supporting and caring for their relatives and friends with
disabilities.
Disability is complex, dynamic, multidimensional and contested. Over
recent decades, the disabled people’s movement –together with numerous
researchers from the social and health sciences have identified the role of social
and physical barriers in disability. The transition from an individual, medical
perspective to a structural, social perspective has been described as the shift from
the medical model to the social model in which people are viewed as being
disabled by society rather than by their bodies. The medical model and social
model are often presented as dichotomous, but disability should be viewed
neither as purely medical nor as purely social: persons with disabilities can often
experience problems arising from their health condition. A balanced approach is
needed, giving appropriate weight to the different aspects of disability-
emotional, mental or physical disability.
Disability results from the interaction between persons with impairments
and environmental barriers that hinder their full and effective participation in
society on an equal basis with others. Defining disability as an interaction means
that “disability” is not an attribute of the person.
2.1.1 The Disabled’s Environment
The environment has a huge impact on the experience and extent of
disability. Inaccessible environments create disability by creating barriers to
participation and inclusion. The disability experience resulting from the inter-
action of health conditions, personal factors, and environmental factors varies
greatly. While disability correlates with disadvantage, not all people with
disabilities are equally disadvantaged. Women with disabilities experience gender
discrimination as well as disabling barriers. School enrolment rates also differ
among impairments, with children with physical impairment generally faring
better than those with intellectual or sensory impairments. Those most excluded
from the labor market are often those with mental health difficulties or
intellectual impairments. People with more severe impairments often experience
greater disadvantage.

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2.1.2 Disability and the Wilderness
The personal benefits that people in general gain from the wilderness and
wilderness activities have been documented in a number of studies. Extensive
reviews of this kind are available in papers published by Easley, Passineau and
Driver (1990), Ewert and McAvoy (2000). The goal of this research is to present
the health and therapy benefits of wilderness experience on persons with
disabilities.
Person with disabilities go to wilderness for a variety of reasons. Lais et al.
(1992) questioned a sample of 80 persons with disabilities from across the United
States who had visited units of the National Wilderness Preservation System
about their motivations for going to wilderness. Their responses were very similar
to responses obtained from persons without disabilities in a number of larger
studies (Roggenbuck and Driver 2000). Those motivations were
(1) To experience scenery/natural beauty,
(2) To experience nature on its own terms,
(3) To experience a personal challenge
The value of wilderness participation for persons with disabilities is best
expressed by those for whom wilderness is a very important part of their lives.
Janet Zeller (1992), a person with quadriplegia who uses a wheelchair,
commented on her experience on a wilderness canoe trip in Maine:
“I was back to feeling the quiet of the lake, listening to the loons at night as the
sun goes down, the sounds of the night, living with the land—it was something
that I had sadly missed. It was that place in my soul that needed to be refilled. And
it was. At the end of that week I could say that I felt less disabled than I usually do.
And it certainly was not because there were fewer barriers. It was the wilderness,
that peace you can’t get anywhere else.”
Anderson et al. (1997), studying persons with disabilities who go to wilderness
areas, found that the wilderness environment itself was a major contributing

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factor to persons with disabilities realizing some of the major benefits of
wilderness. Study participants indicated that the wilderness environment
intensified their individual efforts, producing a dramatic positive impact on group
development. Research by Brown, Kaplan, and Quaderer (1999) studied the
preferences for natural settings for person with and without disabilities. They
found that persons with disabilities had the same preference for undeveloped
natural settings as did those without disabilities. Persons with disabilities valued
the undeveloped, wild elements of wilderness, as did persons without disabilities.
Indeed, research by Cordell, Tarrant, and Green (2003) indicated that a large
majority of Americans value the wild aspects of wilderness, and favor protecting
the lands within the wilderness system from development and exploitation.
Mike Passo, wilderness user and advocate, injured his spinal cord and now uses a
wheelchair. He expressed his view of the need to keep wilderness wild:
“Wilderness is the great equalizer, it takes everyone down a notch because
everyone is leaving their comfort zone. That leaves everyone on a wilderness trip
at about the same level. It lets everyone see people for what they really are rather
than how they get around. (Personal communication, October 23, 2002)”
Persons with disabilities also realize a full range of benefits from
wilderness and from participating in wilderness activities. A number of studies
have documented that persons with disabilities who participate in wilderness
trips experience positive changes as a result of their wilderness experience,
changes such as increased self-confidence, increased likelihood of pursuing new
challenges, and increased appreciation of diversity. Studies by Anderson et al.
(1997), McAvoy et al. (1989), Scholl, McAvoy, Rynders, and Smith (2003), and
Stringer and McAvoy (1992) show these benefits to include: increased self-
efficacy, increased leisure skills, increased social adjustment, enhanced
relationships, increased self-understanding and awareness of capabilities,
increased self-directed activity, increased family satisfaction, increased
appreciation for nature and the wilderness, and spiritual benefits.
3 Means End theory for Wilderness Experience

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Means-end theory posits that people think about the products and services they
purchase, consume, and experience in terms of three key types of product
meanings: (1) attributes, (2) consequences, and (3) personal values (Gutman
1982; Reynolds and Gutman 1988).
Means-end theory links these three different meanings together in a single
conceptual framework, known as a means-end chain (Gutman 1982). The
attributes of a product/service are viewed as the “means” by which
consumers/resource users obtain desired consequences/benefits (as well as avoid
undesired consequences/ costs), and achieve or reinforce important personal
values or “ends” (Gutman 1982). An example of a means-end chain for a
wilderness trip might link the attribute “wilderness environment” to the
consequence of “appreciate nature,” and this is linked to the value of feeling a
“personal or spiritual connection to nature.”
Attributes Consequences Personal
Attributes refer to the
characteristics or
features of the product
or service in question. In
the context of a
wilderness trip, relevant
attributes would include
a wilderness setting, the
type of activities
experienced while on the
trip, and the other
people on a group
wilderness trip
Consequences refer to outcomes
or benefits that are desired from
the product or service experience,
as well as undesirable outcomes or
costs/risks to be avoided. Examples
of consequences for a wilderness
trip would include the benefits of
experiencing nature, developing skills
and abilities, and reflecting on
one’s life or situation, as well as
potential costs/ risks such as
wasting time and money, feeling
embarrassed, or risking physical
injury.
Personal values refer to
enduring beliefs about desired
or undesired modes of conduct
or end states of being, in short,
what a person wants in life or
in living their life (Klenosky,
Gengler, and Mulvey 1993).
Values relevant to a wilderness
experience might include a
sense of accomplishment, self-
awareness, and warm
relationships with others.

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3.1 Medical Research on benefits of the wilderness on persons with
emotional, physical or mental disability by Wilderness Inc. (WI)
The means-end theoretical and analysis perspective has been used to
explore the outcomes and related meanings associated with participating in a
wilderness experience program for people with disabilities as well as those
without disabilities. Data were collected through a questionnaire completed by
193 trip participants (74 with disabilities and 119 without disabilities) immediately
after their wilderness experience, and a telephone interview with 29 of those
same participants conducted six months later. The wilderness visitors with
disabilities are able to transfer the outcomes gained on the wilderness trip into
parts of their lives when they return home—parts of their lives such as family,
work, and their general perspective on life. The results show that participation in
these inclusive wilderness trips results in a higher appreciation of nature and the
wilderness for persons with disabilities. In fact, the wilderness environment is an
integral component that generates these benefits.
This research focused on persons who had participated in trips to wilderness
areas or wilderness like areas in Minnesota, Wisconsin, Montana, Maine, Florida,
Alaska, British Columbia, and Ontario. The trips were taken with Wilderness
Inquiry, Inc. (WI), a not-for-profit wilderness outfitter that provides wilderness
trip experiences for persons with and without disabilities. Since water travel is
more accessible for those with mobility impairments, most WI trips are water
related (i.e., involve the use of canoes, kayaks). WI’s integrated trips combine
participants with disabilities together with those without disabilities.
WI trips of at least four days in length during the summer season of 2002 were
selected for this study. All participants (272) on these trips over the age of 18
were asked to participate in the study. Post-trip questionnaires were distributed
to study participants on-site directly following the completion of their wilderness
trip. In the open-ended questionnaire, respondents were instructed to think
about the three most important outcomes resulting from their wilderness trip
experience (“think about the things you learned and the outcomes you received
from participating in this trip”), and to write these outcomes in spaces provided

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on the questionnaire. Then they were asked to indicate in an adjacent space, for
each outcome listed, why that outcome was important to them.
They were then instructed to explain in another adjacent space on the
questionnaire why that response was important (“and this is important to you
because…”). Finally, they were asked to list the attribute or part of the trip that
led them to each identified outcome. The process of having participants link a
particular trip component (attribute) to one or more outcomes (consequences),
and these outcomes to one or more personal values, formed a means-end chain
or “ladder” of related meanings. The concepts generated on the post-trip
questionnaires indicating participants’ attributes, consequences, and values, and
how they are linked together, were entered into a computer data analysis
program called Ladder Map (Gengler and Reynolds 1995). This analysis procedure
groups concepts from the data into categories within each of the three means-
end components (attributes, consequences, and values). The researchers then
created codes corresponding to the concepts grouped in each category. The data
were then analyzed again by the Ladder Map program to further sort all concepts
into the coded areas. An independent coder analyzed a portion of the data to
verify the accuracy and appropriateness of the codes created. The Ladder Map
program summarizes the number of times each concept was associated with the
other concepts included in respondents’ ladders. These links were then used as
the basis for constructing a Hierarchical Value Map, which graphically summarizes
the important concepts and associations reported by the respondents.
An HVM (Hierarchical Value Map) depicts the attributes,
consequences/outcomes, and values. Each concept in the HVM is represented as
a circle. Attributes are represented using white circles (and all lowercase letters),
consequences/outcomes using gray circles (and a mix of lower- and uppercase
letters), and values using black circles (and all uppercase letters). The larger the
circle the more frequently that concept was mentioned in participants’ ladders,
and the thicker the lines connecting concepts, the more frequently those
concepts were linked together in the ladders. The HVM allows the researcher to
see which concepts (i.e., attributes, outcomes, and values) were mentioned most
frequently; and also see the chain of meanings that help explain how and why
those concepts were important to the study respondents.

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The questionnaire also asked participants if they were willing to be contacted
by phone to further discuss their trip experience. Of the 111 participants who
indicated they were willing to be interviewed, 30 subjects were selected in a
stratified random sample to be contacted by phone for an interview six months
after their wilderness trip. The phone interview consisted of questions related to
the possible transference of outcomes into a person’s life after the trip
experience. Twenty-nine interviews were completed (14 with persons with
disabilities and 15 with persons without disabilities), audiotaped, and then
transcribed. The interview data were analyzed through qualitative techniques
(Glaser and Strauss 1967), including reading all responses, establishing themes,
coding narrative data to develop patterns, summarizing theme areas, and using
respondent statements to illustrate themes. Coding reliability was achieved by
having a second coder analyze 25% of the interview data, and agreement was
reached on coding themes and categories.
3.1.1 Results and Discussion
A total of 193 questionnaires were returned (71% response rate). Of the 193
respondents, 74 had at least one of a number of different disabilities, including
cerebral palsy, spinal cord injury, multiple sclerosis, head injury, blindness,
deafness, amputation, developmental disabilities, diabetes, and stroke.
3.1.2 Consequences, Values, and Attributes
Thirty-one content categories were generated from the questionnaire data: nine
referred to attributes, 14 to consequences, and eight to values (see table below)

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Two Hierarchical Value Maps were generated from the content codes: one for
people with disabilities (n=74), and one for people without disabilities (n=119).
There were few differences between those with and those without disabilities,
and these differences will be explained. The HVM generated from the responses

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of those with disabilities appears in figure 7. The consequences mentioned most
frequently by persons with disabilities included:
1) Awareness (increased awareness of things in their lives and understanding of
themselves)
2) Relationships with Others (developing personal relationships with others)
3) Personal Growth/Challenge (growing as a person and succeeding at a personal
challenge)
4) Nature Appreciation (increased awareness and appreciation for nature and
wilderness),
5) New Opportunities (experiencing something new or different).
The primary values associated with these outcomes included: Transference
(a sense that the outcomes of the trip would transform or enhance aspects of
daily life or life back home), Self-Awareness/Improvement/Fulfillment (feelings of
being more aware, improved, or fulfilled in one’s life), Value Personal/Spiritual
(feeling or valuing a personal and spiritual connection to people and nature),
Warm Relationships with Others (developing warm relationships with others on
the trip), and Personal Goal (achieving one or more personal goals). The attributes
or wilderness trip components that contributed most to the outcomes were
Interactions (interactions with other participants during the trip), Trip Overall (the
overall experience of taking the trip), and Wilderness Experience (being in a
wilderness environment/setting).
There were several links worth noting among the attributes, outcomes, and
values on the HVM for persons with disabilities. The attributes Wilderness
Experience and Canoeing linked to the outcomes Nature Appreciation and
Awareness (suggesting that being in the wilderness and appreciating nature
allowed participants to become more aware of and reflect on their lives), which
linked to Personal Growth/Challenge, which then linked to thoughts about
Transference (i.e., transferring the outcomes of the wilderness trip back home
into their everyday lives). The attribute Interactions (interactions with others on
the trip) linked to outcomes associated with better relationships with others and
with family members (Relationships with Others and Family Relationships
Strengthened), and to the value Warm Relationships with Others. The trip

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component of Wilderness linked to the outcome of Rest and Relaxation and then
to the value of Transference, indicating that the rest and relaxation found on a
wilderness trip can be transferred back home.
Hierarchical Value Map for Wilderness Inquiry participants with a disability (n=74)
The HVM for the persons without disabilities (see figure below) appears to be
very similar to the HVM for those with disabilities, but there are some differences.
Some persons with disabilities identified the outcome of Awareness of Abilities,

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and this did not appear on the HVM of persons without disabilities. This is not
unexpected. Some persons with disabilities had little history of outdoor
recreation or wilderness experience before their trip and may have thought that
wilderness experiences were beyond their capabilities.
Hierarchical Value Map for Wilderness Inquiry Participants without a disability (n=119)

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In the values category, persons with disabilities named the value of Warm
Relations with Others and the value of Sense of Accomplishment, and these did
not show up in the HVM for persons without disabilities. Persons with disabilities
saw the wilderness trip as giving them incentive to move forward in developing
warm relations with others during and after the trip. They also saw the wilderness
trip as an experience that brought them feelings of personal growth and facing
challenges successfully, which linked to their overall sense of accomplishment in
life.
3.1.3 Transference to everyday life
When asked on the questionnaires at the end of their wilderness trips the
values of the outcomes gained on those trips, persons with disabilities and those
without disabilities named Transference most often as a value. The code
Transference represented responses where participants indicated they believed
they could integrate or incorporate the outcomes gained in the wilderness back
into their everyday lives at home. In an effort to develop a better understanding
of this value, and to see if transference actually occurred once participants were
back in their everyday lives, we selected a group of participants to interview six
months after the wilderness trip experience. Fourteen of those interviewed were
persons with disabilities. Caution is needed in generalizing from 14 interviews, but
the in-depth responses (each interview was over an hour in length) help us to
better understand how people with disabilities can transfer outcomes from a
wilderness experience back into their everyday lives
All of the 14 persons with disabilities who were interviewed were able to
transfer outcomes from the wilderness trip back into their everyday lives. Results
of the interviews suggest that participants with disabilities were able to transfer
wilderness trip outcomes to their work, to outdoor skills, to their family lives, and
to everyday stressful and challenging situations. Many participants also indicated
overall higher levels of motivation and increased self-confidence in their regular
life abilities as a result of their wilderness experience. The outcomes transferred
to work included using communication skills, group interactions, teamwork, and
trust at work. The transference to outdoor skills meant that participants acquired
skills in lifetime outdoor recreation activities as a result of their wilderness trip

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experience. They learned how to camp, to canoe, to kayak, and they have
continued those activities after the wilderness trip. These activities are now
contributing to feelings of relaxation, peacefulness, connection to nature, and
connections to other people.
Some study participants went on their wilderness trip with family
members. They have been able to transfer outcomes including increased
awareness of important aspects of their life and developing relationships with
others into a deeper understanding of family members. They also have
transferred better communication among family members and a confidence that
the family can now go on outdoor trips as a group. The latter outcome is very
important for families that include a person with a disability. Often these families
are hesitant to go on an outdoor or wilderness-oriented outing because of the
logistical concerns with access, safety, and comfort. One of the results of the
wilderness experience in this medical research was the increased confidence that
a disabled person felt towards attempting tough life decisions.
The participants with disabilities in this study came away with higher levels
of self-confidence and motivation, and these outcomes were still present six
months after the experience. Interview participants often referred to having a
new outlook on what they could accomplish after their wilderness trip. An often-
heard comment in the interviews was that having successfully accomplished
difficult tasks on their wilderness trip, participants are now better able to
accomplish other difficult tasks in their everyday life. The wilderness experience
provided them with a fresh perspective on the issues of their lives. They
expressed having more motivation to do more activities in daily life, including
more challenging daily tasks. During an interview, one participant who was blind
spoke of the wilderness trip as follows:
“It was probably one of the best things I’ve ever done in regards to building
my confidence and really stepping out on a personal ledge for me. … And I think it
has given me a lot more confidence to take on some of those really out on-the-
edge things; and just kind of say I did this so it makes me think that I can probably
do anything I put my mind to. ”

23. 22
Having been immersed in a wilderness environment during their trip, participants
came away with a new or renewed appreciation for wilderness environments and
wildlife. Some of those interviewed expressed having discovered a new
wilderness area and valuing that discovery. Others noted seeing wildlife that the
participant had never seen before and having an increased understanding of
wildlife. These outcomes transferred into the participants having a deeper
appreciation for the beauty and diversity of wilderness and a deeper commitment
to preserve these wilderness areas and wildlife resources.
4 Summary of wilderness benefits for disabled persons
4.1 Increased self-efficacy
Self-efficacy is an individual’s belief in his or her innate ability to achieve
goals. Albert Bandura defines as a personal judgment of “how well one executes
courses of action required to deal with prospective situations”.
Expectations of self-efficacy determine whether an individual or for the
purpose of this research a disabled individual (be it mental, physical or emotional
disability) will be able to exhibit coping behavior and how long effort will be
sustained in the face of obstacles. Psychologists have studied self-efficacy from
several perspectives, noting various paths in the development of self-efficacy; the
dynamics of self-efficacy, and lack thereof, in many different settings; interactions
between self-efficacy and self-concept; and habits of attribution that contribute
to or retract from, self-efficacy. Kathy Kolbe adds, “Belief in innate abilities means
valuing one’s particular set of conative strengths. It also involves determination
and perseverance to overcome obstacles that would interfere with utilizing those
innate abilities to achieve goals.
Self-efficacy affects every area of human endeavor. By determining the
beliefs a person holds regarding his or her power to affect situations, it strongly
influences both the power a disabled person actually has to face challenges
competently and the choices a person is most likely to make.

24. 23
These effects are particularly apparent, and compelling, with regard to
behaviors affecting health. How does the wilderness increase self-efficacy of
disabled persons? Through 1) physical tasks mountain climbing, hiking. 2) Team
collaboration where everyone contributes actionable ideas. 3) Vicarious
experience- experience as “if they can do it, I can do it as well”.
4.1.1 Increased Social Adjustment.
People who experience disability for the first time undergo stress; cope with
life transitions, value changes, and experience disability issues across their life
spans. From a sociological perspective, people who experience disability for the
first time also have to deal with the role of family, cross-cultural issues and
adjustments, the consequences of negative demeanor's towards people with
disabilities as a whole, and the roles of professionals who work to assist them
with adjusting. Their system of life and living has changed in many different ways,
meaning they must endure a process of adjustment and self-evaluation.
The experience of an injury that leads to a psychological or physical disability is
similar to enduring a mourning process and might be equated to the loss of a
loved one; for example. The mourning process can involve adjustment to the
disability the person experiences and may be divided into a series of four stages
or tasks - shock, denial, anger/depression, and adjustment/acceptance.
The stages are expected, yet are not orderly or neat. People with new forms of
disabilities go through these stages at their own paces and might skip whole
stages entirely. A difficulty exists when the person has trouble with resolving one
of the stages or becomes, 'stuck.' When this happens, further progress towards
adjustment and acceptance is hindered.
The stages of adjusting to a new form of disability include four basic ones.
These stages include shock, denial, anger/depression, and
adjustment/acceptance. People progress through these stages at their own pace.
 Shock:
Shock involves a state of both emotional and physical numbness that can last
from a few hours to several days.

25. 24
 Denial:
Denial may last anywhere from three weeks to two months and is a defense
mechanism that allows the implications of the new disability the person has
experienced to be gradually introduced. Denial only becomes an issue when it
interferes with the person's life, forms of treatment, or rehabilitation efforts.
 Anger/Depression:
Anger and depression are reactions to loss and the person's change in social
treatment and status. The person may experience a number of different emotions
during this stage and grieve for the changes in their body image, function, loss of
future expectations, or former satisfaction based upon any function that has been
lost.
 Adjustment/Acceptance:
The stage of adjustment and acceptance does not necessarily mean the person is
happy about the disability they now experience, although it does allow for the
relinquishment of any false hopes, as well as the successful adaptation of new
roles based upon realistic potentials and limitations. The person might benefit
from interactions with others who experience forms of disabilities, and becomes
comfortable with who they are.
Emotional aspects associated with a new form of disability are many times a
major factor in determining the person's outcome and the benefits related to
rehabilitative efforts. Effective psychological intervention is beneficial where
ensuring recovery from an injury that has caused a form of disability is concerned.
Many people experience more than four stages of adjustment to a physical
disability; in fact - people might experience as many as twelve stages that include:
 Shock
 Anxiety
 Bargaining
 Denial
 Mourning
 Depression

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 Withdrawal
 Internalized anger
 Externalized aggression
 Acknowledgment
 Acceptance
 Adjustment
The experience of a form of disability forces the issue of, 'finding one's self.' Some
people take pride in the things they learn about themselves through the
experience of a form of disability. The wilderness here helps to boost social
adjustment mainly through interdependent team work
Using items from the SSRS (Social Skills Rating System -SSRS; Gresham
&Elliot, 1990. is a widely accepted tool for measuring general social skills)
parents of youth with disabilities were asked to report how often their sons or
daughters demonstrate each of the following nine aspects of social competence:
•Makes friends easily.
•Starts conversations rather than waiting for others to start.
•Seems confident in social situations, such as parties or group outings.
•Joins group activities, such as a group having lunch together, without being told
to do so.
•Speaks in an appropriate tone at home.
•Avoids situations that are likely to result in trouble.
•Controls his or her temper when arguing with peers other than siblings.
•Ends disagreements with parent calmly.
•Receives criticism well.
Possible responses were “never,” “sometimes,” or “very often.”
The wilderness therapy tackles such incapibilities through group tasks.

27. 26
The majority of people who experience a new form of disability adjust in ways
they never believed possible. With positive social support from family members,
friends, and society at large the vast majority of people who experience a new
form of disability do adjust.
4.1.2 Enhanced Relationships
“In a real sense all life is inter-related. All men are caught in an inescapable network of
mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all
indirectly. I can never be what I ought to be until you are what you ought to be, and you can
never be what you ought to be until I am what I ought to be...This is the inter-related structure
of reality.”- Martin Luther King, Jr. (1929–1968), American clergyman,
Activist, humanitarian, and civil rights leader
Research has shown over and over again that the percentage of ordinary
community members in the social network of a person with disabilities is usually
very small. The majority of relationships are family members, staff, and other
people with disabilities. One study found that 60% of individuals in group homes
had no friends who were community members. There is a great deal of medical
research that if you’re socially isolated and alone, you are going to get sick and die
sooner than if you are not. Social isolation is as great a mortality risk as smoking.
With all the attention in our field on people’s health, do you ever see a health
care plan that says “help the person have more friends”? Yet it’s something that is
likely to affect a person’s overall health in the long run, more than many other
things we do.
How does wilderness therapy enhance relationship? Through one to one
connection and relationships: this identifies who a disabled person already knows
and where the relationship can be strengthened

28. 27
4.1.3 Increased Self-Concept and Reduced Anxiety Levels.
Many scholars, researchers, and social service professionals view self-concept as
a central construct for understanding people and their behavior (Fitts, 1971).
Developed from the theoretical positions of Allport (1937), Combs & Snygg
(1949), James (1890), Maslow (1954), Rodgers (1951) and others, self-concept is
the frame of reference through which an individual interacts with the world. It is
the sum total of the view which an individual has of himself/herself. The better
the self-concept, the more able one is to cope with the demands of life and
realize self-fulfillment (Fitts, 1971). Enhancing levels of self-concept has long been
a major goal of social institutions (Ewert, 1983).
Several authors have reported the positive impacts of wilderness programs
on self-concept and its components of self-confidence, self-esteem, and attitude
toward self (Ewert, 1983; Fletcher, 1970; Mathias, 1977; Nye, 1976; Thorstenson
and Heaps, 1973; Wetmore, 1972). However, some research shows contradictory
and inconclusive results about the effects of wilderness programs on self-concept
and further study is suggested using more appropriate research designs and
instruments (Ewert, 1983; Gibson, 1979). Recent research studying the impacts of
wilderness program participation has turned toward the issue of anxiety
reduction to enhance self-concept (Ewert, 1987, 1988).
The critical role of anxiety in the personality was first proposed by Freud (1936).
Anxiety is an unpleasurable subjective state of tension indicating the presence of
some danger, the source of which is largely unknown or unrecognized (Branch,
1968). Anxiety as one of the factors in self-concept, is connected with the
mechanisms which maintain a negative or positive self-concept, and influences
the manner in which individuals will respond to situations (particularly those
involving achievement or evaluation). A substantial inverse relationship between
self-concept and anxiety has been found (Felker, 1972; Glass, Merluzzi, Biever &
Larson, 1982; Miller, 1971; Ornes, 1970; Thompson, 1972). If anxiety is lowered,
there is usually a corresponding increase in self-concept and self-esteem.

29. 28
The anxiety self-concept relationship has been explored by wilderness
adventure researchers using the State-Trait Anxiety Inventory developed by
Spielberger and his colleagues (1983). Studies such as those of Drebing, Willis, and
Genet (1987), and more specifically, Ewert (1988), have indicated that
participation in wilderness adventure programs can positively influence anxiety
levels. If anxiety levels could be lowered through participation in a wilderness
program, then the corresponding increase in self-esteem and self-concept could
help prepare a person to successfully cope with life situations. This seems
especially important for a person who is disabled.
4.1.4 Increased leisure skills
Physically active leisure has been found to be a major contributor to feelings of
health, wellness and a high quality of life (Hall, 2005). People with disabilities
stand to gain many benefits from their regular participation and inclusion in
physically active leisure options (Table 1). A leisure benefit is defined as a positive
and beneficial change to an individual as a result of leisure participation. A benefit
may also be seen as the maintenance of a level of functional independence that
could have otherwise declined without leisure intervention (Mannell & Kleiber,
1997).Some of these benefits include opportunities to foster the development of
friendships and social networks. Group exercise programs can help to overcome
the feelings of social isolation and disengagement that are often experienced by
people who have limited mobility and functional capacity (Shephard, 1992).
Improved self-image that often results encourages social activity and full
participation in community life (Basmajian & Wolf, 1990). The stimulus of being a
valued group member provides people with disabilities with an increased sense of
self-worth, positive self-esteem and reduced social isolation (Beaudouin & Keller,
1994; Blake, 1991).
Taylor and McGruder (1996) exposed a small group of people with spinal cord
injury to sea kayaking. Participants stated that kayaking provided ‘an overall
feeling of high’ and that going on the water was ‘a whole other exciting world’.
They also emphasised that they enjoyed the social interaction that the activity
provided. The activity also provided the means for the discovery of ‘I can do this’,

30. 29
challenging their previous perspectives of their abilities and enabling them to
construct a more positive identity.
Henderson, Bedini and Hecht (1994) and Henderson and Bedini (1995) were
interested in exploring the experiences of physically active women with sensory
and physical disabilities. In-depth qualitative interviews were conducted with 30
adult women who functioned independently in their communities. Henderson et
al. (1994) concluded that despite the limitations that were potentially imposed by
a disability, physical activity was seen to be important and had perceived benefits
for these women. The main benefits of physical activity were for leisure (freedom,
choice and control), therapy (not for fun but required for therapy), and for
maintenance of their physical and mental health. Ruddell and Shinnew (2006) in
their study of elite women basketballers, found that peers with disabilities were
considered to be important socialising agents in developing positive attitudes
towards leisure.
Friendships have enabled people with disabilities to take risks in life, share
deep confidences, feel important, and become more outgoing and social. Mahon,
Mactavish and Bockstael (2000) surveyed the personal viewpoints of people with
intellectual disabilities and discovered two interrelated themes consistently
emerged from their responses: the importance of friendships and the desire for
participation in structured recreation. ‘Social integration involved a sense of
belonging that comes from sharing time, activities and experiences with family
and friends’ (Mahon et al., 2000: 28). It is interesting to note that structured
programs in leisure settings were the most commonly cited as places that were
more likely to foster social connections.
In a study by the Australian government to find answers to these questions:
1.What are the main benefits of participation in physically active leisure for
people with disabilities? The benefits of physically active leisure For People with
Disabilities.
2. Are there any differences between the main benefits of participation in
physically active leisure for men and women with disabilities?
3. What strategies need to be implemented to encourage the development of
these leisure benefits through inclusive opportunities for people with
disabilities at the local level

31. 30
It was found that there were no major differences between the leisure benefits of
men and women with disabilities. However, several benefits of physically active
leisure were found to be important such as: wanting to be more involved in group
or structured activities; to escape from family or other people; the need to meet
others; and the need for relaxation. Many of these benefits can be fulfilled
through participation in inclusive leisure and sport opportunities in the natural
environment level.
This study identified seven major benefits in relation to leisure participation for
people with disabilities. These were categorized as: to be away from family and
other people; to be involved in structured group activities; to participate in casual
leisure; to be challenged and work towards a goal; to meet other people; to be
entertained and have fun; and to help them relax. Each of these factors will be
discussed in order of importance.
1. To be away from family and other people
This finding supports the important role that leisure plays as a natural form of
respite for people with disabilities to encourage independence and provide time
away from their families and other relations. Leisure has been shown to help
develop social competence, communication, and decision-making skills as well as
to encourage independence and appropriate behavior in community settings
(Penson, 1998). Leisure also enhances interpersonal relationships with peers and
encourages greater learning opportunities (Johnson, Bullock, & Ashton-Shaeffer,
1997).
2. To be involved in structured group activities
Group-oriented physical activity provides an opportunity to foster the
development of friendships and social networks. If exercise is performed in a
group setting, it can help to overcome the social isolation and disengagement
from society often experienced by people who have limited mobility and
functional capacities (Shephard, 1992). The stimulus of being a valued group
member can provide an increased sense of worth, positive self-esteem and
reduced social isolation (Beaudouin & Keller, 1994; Blake, 1991).

32. 31
3. To participate in casual leisure
The study found that people who are blind or have vision impairments
wanted to participate more frequently in casual leisure experiences than people
who had intellectual disabilities. This finding may be reflective of the need to
move away from more structured experiences that often characterize long-term
care arrangements.
4. To be challenged and work towards a goal
Being physically active was found to be significantly more important for
people with high support needs (to challenge their abilities and to work towards a
goal) than for people with low support needs. Taylor and McGruder (1996) found
that the outdoor recreation activity of kayaking provided people with disabilities
with the challenge of working together (paddling in unison) to achieve a common
goal (not tipping the kayak over and getting wet). As a result, they reported an
overall feeling of ‘being high’ and that kayaking opened up a whole other exciting
world.
5. To meet other people
For people with high support needs who had a sensory or intellectual
disability, meeting other people was seen to be a major benefit of participation in
physically active leisure. However, for people with physical disabilities with high
support needs this was only seen as a minor benefit. An older woman with a
sensory disability stated: ‘I have become very isolated over the years. I find it
difficult to talk to people, as my eyesight is not so good anymore and I find that I
have to listen more.’ Of the people with low support needs, the benefit of
meeting others through physically active leisure was a major benefit for people
with physical and neurological disabilities, but only a minor benefit for people
with sensory and intellectual disabilities. Shephard (1992) concluded that social
interaction was an important benefit of participation in community based physical
activities
6. To be entertained and have fun

33. 32
Weiss and Jamieson (1988) found that two thirds of people with disabilities
felt that membership in a community-based water-exercise program provided
support, camaraderie and positive and enjoyable experiences which were the
Prime motivators for continuing in an exercise program. Community-based water-
exercise programs and adapted aquatics have also been found to help to improve
psychological functioning through a reduction of stress, improved morale, self-
concept and locus of control (Beaudouin & Keller, 1994).
7. To help them relax
Henderson et al. (1994) found that women with disabilities valued doing
relaxation activities. The physical tiredness resulting from physical exercise
improves a person’s sleeping patterns, which in turn improves their energy levels
and vigor, helping people with disabilities to fight anxiety and depression.
Bouchard, Shepherd, Stephens, Sutton and McPherson (1990) reported that
regular participation in physical activity that involved continuous, rhythmic
(aerobic) exercise resulted in a reduction in the state and trait anxiety and stress
levels. Regular participation in exercise and sport by people with disabilities is
becoming increasingly popular for relaxation, enjoyment, fitness, and general
health purposes (Arthritis Foundation, 1994).
Women with disabilities reported similar levels of importance for each of the
benefits experienced by the overall sample of men and women. However,
challenging abilities and casual participation were perceived to be as important by
women with disabilities, but in the reverse order to the overall sample. Bramely
et al. (1990) concluded from their study of young women with disabilities that, in
the past, opportunities for involvement in structured group activities in sport and
recreation have been neglected. They found that very few young women with
disabilities participated in any sporting group outside the school setting, and were
mainly dependent upon the school to provide a wide repertoire of recreation
experiences.
To be challenged and work towards a goal was perceived to be more
important for women with disabilities than being involved in casual participation
compared to the total sample. This may reflect the need for stimulation outside
the traditional role of participating in home-based, passive activities and
subscribing to the traditional roles of women as nurturing and supporting

34. 33
(Henderson et al. 1994). Henderson found that women with disabilities valued the
sociability that leisure offers, while Freysinger and Flannery (1992) identified the
importance of maintaining friendships as one of the major reasons for women’s
participation in physically active leisure.
5 Health Benefits of Outdoor activity on disabled persons (summary)
For someone with a physical, mental or emotional disability, getting out and
enjoying nature is more of a challenge. To do the kinds of things that non-disabled
people do without even thinking about it requires many more steps, as well as
accessibility accommodations, and even adaptive equipment. To set up a tent or
to hike an easy trail may seem ordinary to someone else, but to a child or adult
who is disabled may feel daunting or even impossible. Spending time outdoors,
enjoying parks and trails should be something that everyone can do, and it is
possible. You just need to know where to find accommodations and how to ask
about accessibility.
First, it’s important to understand why being disabled should not prevent
anyone from getting outside to enjoy fresh air and activity. Researchers have
found that there are important mental and physical health benefits to spending
time outside, not just being active, but also just the act of being in and observing
and experiencing nature. Anyone, but particularly someone living with the
limitations of cerebral palsy, can benefit from the mood boost and other health
effects of being outside.
One study, for instance, found that just five minutes spent being active
outside, causes significant improvements in self-esteem, mood, and depression.
Another study found that even an easy walk in a park or any natural area
outdoors can reduce signs of depression in the brain. Sunlight is also proven to
boost mood and reduce depression and anxiety. While being active adds to the
mood boost and physical health benefits, simply being outside in a natural area is
enough to help us feel better. That means that someone with a physical disability
doesn’t need much, just access to nature, parks, and natural areas.
National parks are great for anyone with a disability because they provide
accessibility at every location. It is a requirement of the Americans with

35. 34
Disabilities Act and other laws that these federally-funded parks are accessible.
The goal of the National Park Service is to make their activities, programs, and
parks as accessible to those with disabilities as anyone else and to ensure as much
integration as possible. The Park Service is currently in the middle of a five-year
strategic plan to make the parks even more accessible. The parks are also free to
any American with a permanent disability.
Camping is also a great experience for anyone, especially for disabled persons.
Instead of just an hour or a day in nature, camping provides a more immersive
experience. The United States Access Board outlines guidelines and provisions for
making outdoor recreation, including camping, accessible. These include things
like providing plenty of space for mobility, integrating accessible campsites with
standard campsites, non-sloping tent platforms, adequate parking space, and
more.

36. 35
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