Outdoor Adaptive Athletes Chapter 31 Outdoor Adaptive Athletes

Objectives Determine special needs of patients who are mentally challenged. Determine special needs of patients who are physically challenged. Demonstrate the special care needs required when treating adaptive patients.

Adaptive Populations In 1990, the ADA opened frontiers for participation. Different terms are used; the NSP has adopted “adaptive athlete.” Adaptive athletes have a long and rich history in sports. Adaptive skiing programs exist at many ski areas in Europe and the U.S.

Mental Challenges Learning disorders: ADD and/or dyslexia Mental retardation: Down syndrome Autism: developmental neurologic disorder Cognitive disability from a prior brain injury Psychological disorder: psychosis, manic-depressive (bipolar)

Mentally Challenged Patients Assessment can be challenging. Supervising adult or caregiver can help communicate. Use a gentle, calm, caring approach. Determine level of communication and level or interaction. Determine if an underlying condition is cause of behavior or if an injury is the cause.

Physical Challenges Amputations, ataxia, cerebral palsy Deafness, epilepsy, multiple sclerosis Muscular dystrophy, spina bifida Postpolio syndrome, stroke Spinal cord and/or brain injuries Blindness or other visual challenges

Amputee Patients Amputations can be traumatic, surgical, or a person can be born missing a limb. Amputation at a joint is a disarticulation. Prosthesis (artificial limb) may be worn. Specialized equipment such as outriggers and “buckets” are often used with regular skis.

Adaptive Snowsports Terms (1 of 2) Outrigger: forearm crutch with short ski built onto the bottom Three tracker: A skier with one ski and two outriggers Four tracker: A skier with two skis and two outriggers

Adaptive Snowsports Terms (2 of 2) Mono-skier: A skier in a seat or “bucket” mounted to a single ski Bi-skier: A skier in a seat or “bucket” mounted to a pair or skis. Both use outriggers.

Treating Amputee Athletes Gently remove prosthesis from an injured limb. Extricate patient from equipment. Traction for a femur fracture may not be possible due to distal amputation. Outriggers can cause upper extremity injuries. Let patient comfort guide treatment.

Cerebral Palsy (CP) Patients CP is a result of a brain injury before, during, or shortly after birth. Three syndromes: Spastic—constant muscle contraction Athetoid—slow, writhing movements Dystonic—extreme muscle rigidity Usual fracture treatments may not work. Again, let comfort guide treatment.

Multiple Sclerosis (MS) Patients Neurologic condition that effects stamina, balance, vision, and cranial nerves. Disease may have periods of remission and exacerbation. Individuals process information slower and may take longer to respond.

Muscular Dystrophy (MD) Patients Progressive muscle atrophy Easily fatigued Joints are hypermobile. Usually sit skiers Gentle approach to prevent further injuries

Postpolio Syndrome Patients Usually have a “wasted” or atrophied limb The limb can have some or no function. Be aware of pre-existing CMS dysfunction. Protect any affected limb.

Spina Bifida (SB) Patients Mono- and bi-skiers mostly. Spinal compromise only below congenital anomaly SB patients may have a CSF shunt—blockage may cause mental status change. They may also have an extreme latex allergy. Use non-latex gloves.

Spinal Cord Injury Patients (1 of 2) Quadriplegia—injury to cervical spine Paraplegia—injury to thoracic or lumbar spine Sit skiers (mono or bi) if injury was lower than T5 May exhibit autonomic dysreflexia (AD) Can be a life threatening due to hypertension Eliminating stimuli will usually correct

Spinal Cord Injury Patients (2 of 2) Lack normal sensation and movement below original injury site Unknown injuries can occur easily: Frostbite, fractures, and soft-tissue injuries such as lacerations, abrasions Assess insensate extremities carefully. Guard against further injury. Upper extremity injuries occur due to outrigger use.

Stroke and Brain Trauma Patients Disability is related to the amount and site of prior injury. Some may exhibit behavioral or psychological changes as well. Patients may exhibit aphasia. Watch for seizures, and treat them appropriately.

Visually and Hearing Impaired Patients Participation is increasing. Visually impaired patients have a guide. Remember to speak to patient while treating. Gain the attention of the hearing impaired patient and speak directly to him or her.

Other Treatment Concerns Ostomy bags collect feces and urine. Rescuers should avoid exerting pressure on these appliances. Watch for blood in collection bags; this could indicate trauma.

Lift Evacuation and Transport Sit-skiers should always have a three-point leash that can be used for evacuation. Visually impaired skiers should be lowered before their guide.