1. Sport for Athletes with Spinal Cord Injuries: Medical Issues and Sports Injuries

2. At BlazeSports America, our mission is… to advance the lives of youth and adults with physical disability through sport and healthy lifestyles

3. This presentation is meant as a summary review of the information presented in the BlazeSports manual: Sport for Athletes with Physical Disabilities: Injuries and Medical Issues

4. Athletes with Diabetes Concerns: Possibility of hypoglycemia or hyperglycemia occurring during exercise Vulnerability to excessive heat

5. Athletes with Diabetes Precautions: Always carry easily accessible glucose and medical alert info Increase consumption of carbohydrates based on intensity and duration of exercise

6. Thermoregulation Ability to control or regulate internal body temperature. The higher the level of the SCI and the more complete the lesion the more severe the inability of the body to cool itself.

7. Thermoregulation Prevention: Stay well hydrated before, during and after exercise Wear lightweight clothes Use fans, air conditioners, stay indoors in extreme heat and humidity Use spray bottle to cool exposed skin Use wet cloth, headbands or neck bands

8. Thermoregulation Heat stroke Early signs: mental confusion Be unable to drink fluids Sweating generally ceases, skin is hot and dry Athlete may feel faint May lose consciousness or be incoherent Body temperatures rises to dangerous levels If an athlete is experiencing any of the above begin cooling and seek Emergency Medical treatment.

9. Thermoregulation: Medications Certain medications can increase a persons vulnerability to heat: anticholinergics sympathomimetics diuretics certain muscle relaxers Athletes should consult their doctor if on any of these types of medications.

10. Thermoregulation Coaches and athletes should have concern for hypothermia when athletes are exposed to cold temperatures over a period of time.

11. Autonomic Dysreflexia (AD) Marked elevation in blood pressure Affects athletes with SCI at the T6 level or above Research suggests that between 48-90 % of individuals with SCI may experience AD.

12. Autonomic Dysreflexia (AD) Most Common Causes: Obstructed urinary catheter/distended bladder Pressure sores Rectal impaction

13. Autonomic Dysreflexia (AD) Other Causes: Ingrown toenails Fractures Body position Tight clothes Passage Range of Motion Deep Vein Thrombosis

14. Autonomic Dysreflexia (AD) Symptoms: Hypertension Sweating Headache Shivering Rapid heart rate

15. Autonomic Dysreflexia (AD) Treatment: Identify the cause and remove it If symptoms continue, medical attention may be necessary especially if high blood pressure continues

16. Pressure Sores (Decubitus Ulcers) Definition: An area of unrelieved pressure over a defined area, usually over a bony prominence, resulting in ischemia, cell death and tissue necrosis. National Pressure Ulcer Advisory Panel (OConnor and Kirshblum, 1998, p.1057)

17. Pressure Sores (Decubitus Ulcers) Causes: Prolong sitting in one position Worn wheelchair cushions Continued sitting on hard surfaces Skin moisture from sweating Use of improper fitting wheelchairs or other adapted equipment Falls

18. Pressure Sores (Decubitus Ulcers) Most common sites: Sacrum Buttocks Hip Heel

19. Pressure Sores (Decubitus Ulcers) #1 Treatment is Prevention Use well padded cushions Wear absorbent clothing to absorb sweat Good Nutrition Proper hygiene practices Check wheelchairs and adapted equipment for proper fit Perform pressure releases (arm push ups) every 20- 30 minutes

20. Spasticity Spasticity normally occurs in some athletes with disabilities. Temporary increases in muscle tone may occur due to intense sport, aggressive exercise or strength training.

21. Spasticity Experience and research has shown that sport training tends to lessen the impact of spasticity.

22. Spasticity Treatment/prevention: Regular participation in a stretching program No bouncing or ballistic stretching For the upper extremities, strength training should focus primarily on extension and reduces the number of flexion exercises when flexion dominates over extension.

23. Venous Pooling Cause Lack of sympathetic activity and loss of active muscle function in the legs and trunk muscles.

24. Venous Pooling Treatment/Prevention Wearing an abdominal binder during exercise.

25. Common Overuse Injuries Musculoskeletal Injuries Shoulder Strain or Injury Blisters, Abrasions & Lacerations Carpal Tunnel Syndrome

26. Treatment: Musculoskeletal Injuries Blisters, Abrasions & Lacerations Treat as standard athletic injury and attempt to identify and eliminate cause to prevent recurring injuries. Proper pre and post exercise warm and cool down can also be a helpful.

27. Carpal Tunnel Syndrome Caused by a number of contributing factors including years of transfers, propelling a wheelchair, performing pressure release exercises where the wrist is at maximum extension and the forearm is in supination.

28. Carpal Tunnel Syndrome Occurrence increases with the time a person has been using a wheelchair. 27% of users 1-10 years from onset 54% of users 11-20 years from onset 54% of users 21-30 years from onset 90% of users 31+ years from onset

29. Carpal Tunnel Syndrome TREATMENT Best treatment is prevention: Good body mechanics Wrist flexibility and strengthening exercises Use of padded gloves ICE: 20 minutes at the end of each day

30. Carpal Tunnel Syndrome TREATMENT Severe Cases: Rest Immobilization Anti-inflammatories Surgery

31. Shoulder Strain or Injury Contributing factors: Wheelchair use Number of years after SCI Age Overweight or obesity Not starting shoulder exercises within 2 weeks of injury Low levels of recreation and physical activity

32. Shoulder Strain or Injury TREATMENT: Standard therapeutic modalities Strengthening of shoulder internal and external rotators and adductors Arm and shoulder flexibility exercises

33. Shoulder Strain or Injury Suggested Exercises: Arm swings Shoulder rolls Arm circles Chest fly Bicep curl Tricep extension

34. References: BlazeSports America Sport for Athletes with Physical Disabilities: Injuries and Medical Issues Ben Johnson, Carol Mushett, Grant Peacock and Ken Richter National Center of Physical Activity and Disability Introduction to Common Overuse Injuries in Wheelchair Users Patricia M. McClintock

35. Additional Resources: National Center of Physical Activity and Disability NCPAD.org Exercise Program for Individuals with Spinal Cord Injuries: Paraplegia & Exercise Guide for Individuals with SCI Exercise Program for Individuals with Spinal Cord Injuries: Tetraplegia & Exercise Guide for Persons with Tetraplegia

36. QUESTIONS?

37. jjones@blazesports.org 770-850-9095 www.blazesports.org