1. Special Populations

2. Disabled???? Wheelchair Boston Marathon participants have completed the course in under 90 minutes Paraplegic weight lifters have bench pressed over 600 lbs Double leg amputees have run 100m in 11.0 sec Power lifters with cerebral palsy have lifted 400 lbs Single leg amputees have high jumped 6’8” Blind swimmers have come within 1/100 of a sec of qualifying for the US Olympic Team

3. Rudy Garcia- Tolson 6:48 mile 20:08 – 5K 2:24 – Half Marathon Tri-athlete Bi AKA

4. Need to know! ↑ participation past decade; 3 million + in USA alone (43 million disabled in US) Injury rates have been similar in quantity as non-disabled patients 80% Musculoskeletal 20% General Medical Use appropriate terminology Know level of spinal cord damage & related dysfunctions

5. Sport Options Skiing Track and Field Mountain biking Swimming Archery Road Racing Basketball Cycling Tennis Fencing Rugby

6. PPE for the Disabled Patient Establish baseline norms “Diagnostic Overshadowing” Avoid mass station based PPE Eye level with wheelchair patients  -

7. PPE cont. Proper fit & adequacy of prostheses, wheelchair & orthoses Resting BP in 2 positions – supine, sitting, standing Bladder/Bowel habits Hx of heat related illnesses

8. Pathological Conditions I. Traumatic tetraplegia & paraplegia Autonomic dysreflexia Boosting Thermoregulation concerns Skin Breakdown & Pressure sores Spasms Bladder dysfunction II. Spina Bifida Cerebral shunts Latex Allergy

9. Pathological Conditions, cont. III. Poliomyelitis IV. Cerebral Palsy Spasticity Athetoid Cerebral Palsy Ataxis Cerebral Palsy Seizures Pathological Reflexes V. Amputations Skin breakdown Phantom Pain Syndrome

10. Pathological Conditions, cont. VI. Sensory Disabilities Visual impairments/blindness Albinism Glaucoma Deafness VII. Intellectual Disabilities Down Syndrome  Related medical concerns  Atlantoaxial Instability

11. I. Tetraplegia & Paraplegia All SCI patients have higher resting HR & lower BP Tetraplegia – renamed quadraplegia Lesion above T1 Paraplegia – complete vs. incomplete Lesion below T1

12. Autonomic Dysreflexia Life threatening complication with lesions above T6 Sudden onset HBP & decreased HR leads to stroke/death Strong stimulus discharges autonomic reflex Causes: S/S: Tx: Prevention:

13. Boosting Attempt to gain advantage over opponent by intentionally inducing AD Methods: Banned by International paralympic Committee

14. Thermoregulation Concerns SCI patients cannot rely on autonomic nervous system to regulate blood flow and thus core body temperature Sweating is impaired below lesion, thus less surface area for evaporation May lack normal warming mechanism – piloerection, shivering, circulatory shunting, d/t lack of working muscle below lesion ↑ risk of heat illnesses & cold illnesses S/S: Tx: Prevention:

15. Skin Breakdown & Pressure Sores Decubitus Ulcers – pressure sores ↑ risk of infection & slower healing Unable to feel sensation Causes: S/S: Stages Tx:

16. Spasms Can occur with lesions above L1 Caused by excessive REFLEX activity below the lesion Sudden, involuntary jerking of paralyzed limb 3 main stimuli: 1. 2. 3. Tx:

17. Bladder Dysfunction Neurogenic bladders Know normal management plan – PPE Indwelling catheter vs. intermittent catheter S/S: Tx: Prevention:

18. II. Spina Bifida Definition: Types: 1. 2. 3.

19. Spina Bifida, Cont. Common Problems: SB & Cerebral Shunts – relieves hydrocephalus SB & Latex Allergy

20. Poliomyelitis Polio – rare in US, common in 3 rd world countries Definition: Salk Vaccination – 1950s Post-Polio Syndrome – 23% chance of recurrence of s/s 35-40 years post initial illness

21. Cerebral Palsy (CP) Definition: Occurs before, at or shortly after birth Not hereditary or progressive May also have deafness, visual disturbances, ↓ hand- eye coordination, mental retardation Communication critical

22. Cerebral Palsy, Cont. Types:  1. Spasticity: most common  2. Athetosis: 2 nd most common  3. Ataxia – least common (1-%) Only Dx in CP patients that can walk CP & Seizures

23. Amputations Congenital or acquired Causes: Regulated use in sports Categorized by location & # for identification in sports classification  i.e. AK = Above kneeBK = Below knee AE = Above elbowBE = Below elbow Medical Concerns:  Skin Breakdown  Phantom Pain Syndrome

24. Visual Impairments & Blindness Communication concerns Legally blind vs. partial sight vs. total blind Technology available “blindisms” – Albinism –

25. Visual Impairments Glaucoma:  S/S:  Tx:

26. Deafness Hard of Hearing: condition that makes understanding speech difficult through use of a ear alone, c or s hearing aids Deaf: condition in which is unable to understand speech through the use of the ear alone, c or s hearing aids TYPES:  Conductive -  Sensorineural – if born deaf, usually this type  Mixed

27. Deafness, Cont. Communication concerns: Hearing Aids/Implants: Don’t make things sound clearer, just amplify sounds TYPES: worn where  On the chest/body  Behind the ear  In the ear  On the eyeglasses

28. Deafness, Cont. Types: Cochlear Implants If hearing aids don’t work Surgically placed in ear c external speech processor worn on belt Microphone worn externally behind ear Remove during exercise to ↓ electrostatic charge Also avoid plastic mats, balls, etc to avoid electrostatic charges

29. Intellectual Disabilities Formerly mental retardation Compete in 15 different sports Special Olympics started in 1968 by Eunice Kennedy Shriver Definition: A disability characterized by significant limitations both intellectual functioning and in adaptive behavior as expressed in conceptual, social, & practical skills – originating before the age of 18 Severity based on IQ (mild, moderate, severe, profound)  Normal average 100  Mild – 52-70 (90%) – 3 rd to 6 th grade level

30. Intellectual Disabilities, Cont. Medical Concerns:  Communication Demonstrate task, clear, concise directions One-step instructions Have them repeat back to you  Lower HR by 8-20% @ rest (10-15 beats less)  Lower fitness level  Seizures  Pain insensitivity – don’t rely on patient’s interpretation; make decisions off of MOI  Medications: anticonvulsive, antidepressant + more

31. Down Syndrome Most common intellectual disability Chromosomal condition Medical Concerns  Atloaxial Instability:  Balance, hand-eye coordination  Obesity  Vision  Cardiac  Postural concerns  Hypothyroidism

32. Unique Considerations Understand requirements and nature of physically challenged ahtlete’s sport Understand the adaptive equipment Understand environmental effects, risk of thermal injury – no thermal regulation Be careful with modalities on insensative skin