Medical Officer For the GB Paralympic Swimming Team Dr Derek Martin Medical Officer For the GB Paralympic Swimming Team

Recent Past Athens 2004 16 Gold 20 Silver 16 Bronze Total 52

Durban World Championships 2006 24 Gold 14 Silver 16 Bronze Total 52

World Champions

Amputees Stump injuries/infection Prosthesis shorter for the swing through -hip, pelvic and back pain. Injuries to artificial limbs! Falls

Visually Impaired Classification Total Up to 2/60 /or a field of less than 5 degrees. 2/60 – 6/60 or field loss of 5-20 degrees Falls/cuts/collisions Missed tapping Poolside checks

Cerebral Palsy Complex condition Spastic – motor cortex Choreo-athetoid – Basal Ganglia or Cerebellum Mono-Quadriplegia Epilepsy Intellectual impairment Visual defects Speech impairment

Spinal Lesions/Injuries Sensory/motor loss Urinary retention Fractures due to osteopenia Bowel impaction Pressure sores Increase in shoulder injuries. Hand, median/ulnar nerve injuries Access Punctures

High Spinal Injuries Thermoregulation Autonomic dysreflexia Boosting Impaired cardiac response above T2-4 Loss of intercostal muscle function

Thermoregulation Loss of autonomic function Loss of sensory afferent impulses below level of lesion may limit hypothalamic response. Loss of sweating/vasodilatation. Loss of shivering Strategies needed for extreme conditions

Autonomic Dysreflexia Medical emergency Lesions above the splancnic sympathetic outflow (C2-T6) Irritant stimuli below this level

Causes Bladder distension Irritation of the urinary tract Skin ulcers Fractures Abdominal emergencies Uterine contractions

Mechanism Impulses ascend the spinal chord to the sympathetic cell bodies resulting in massive sympathetic discharge.

Symptoms Intense headache Profuse sweating Nasal stuffiness

Signs Goosebumps Facial erythema Pallor distal to lesion Blood pressure > 200 mm Hg

Sequelae Seizures Pulmonary oedema Increased force and rate of cardiac contractions Dysrythmia Cerebral haemorrhage Death

Treatment Treat the underlying cause Sit patient up Sublingual nifedipine

Boosting Increased output 7-10% Banned in 1994 Call up room checks if BP > 180 mm Hg systolic athlete withdrawn Previous records can be requested Policing difficult

Multiple Disability Athens opening ceremony Paraplegia Epilepsy Laryngomalacia Ulcerative colitis Ileostomy

Thank You!