Special Populations

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 secPower lifters with cerebral palsy have lifted 400

lbsSingle leg amputees have high jumped 6’8”Blind swimmers have come within 1/100 of a sec

of qualifying for the US Olympic Team

Rudy Garcia- Tolson

6:48 mile

20:08 – 5K

2:24 – Half Marathon

Tri-athlete

Bi AKA

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% Musculoskeletal20% General Medical

Use appropriate terminologyKnow level of spinal cord damage &

related dysfunctions

Sport Options

SkiingTrack and FieldMountain bikingSwimmingArcheryRoad RacingBasketballCyclingTennisFencingRugby

PPE for the Disabled Patient

Establish baseline norms“Diagnostic Overshadowing”Avoid mass station based PPEEye level with wheelchair patients

----

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

Pathological Conditions

I. Traumatic tetraplegia & paraplegiaAutonomic dysreflexiaBoostingThermoregulation concernsSkin Breakdown & Pressure soresSpasmsBladder dysfunction

II. Spina BifidaCerebral shuntsLatex Allergy

Pathological Conditions, cont.

III. PoliomyelitisIV. Cerebral Palsy

SpasticityAthetoid Cerebral PalsyAtaxis Cerebral PalsySeizuresPathological Reflexes

V. AmputationsSkin breakdownPhantom Pain Syndrome

Pathological Conditions, cont.

VI. Sensory DisabilitiesVisual impairments/blindnessAlbinismGlaucomaDeafness

VII. Intellectual DisabilitiesDown Syndrome

Related medical concerns Atlantoaxial Instability

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

Autonomic Dysreflexia

Life threatening complication with lesions above T6 Sudden onset HBP & decreased HR leads to stroke/death

Strong stimulus discharges autonomic reflexCauses:

S/S:

Tx:

Prevention:

Boosting

Attempt to gain advantage over opponent by intentionally inducing AD

Methods:

Banned by International paralympic Committee

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:

Skin Breakdown & Pressure Sores

Decubitus Ulcers – pressure sores ↑ risk of infection & slower healing Unable to feel sensation Causes:

S/S: Stages

Tx:

Spasms

Can occur with lesions above L1Caused by excessive REFLEX activity below the lesionSudden, involuntary jerking of paralyzed limb3 main stimuli:

1. 2. 3.

Tx:

Bladder Dysfunction

Neurogenic bladdersKnow normal management plan – PPEIndwelling catheter vs. intermittent catheterS/S:

Tx:

Prevention:

II. Spina Bifida

Definition:

Types:• 1.

• 2.

• 3.

Spina Bifida, Cont.

Common Problems:SB & Cerebral Shunts – relieves hydrocephalus

SB & Latex Allergy

Poliomyelitis

Polio – rare in US, common in 3rd world countriesDefinition:

Salk Vaccination – 1950sPost-Polio Syndrome – 23% chance of recurrence of s/s

35-40 years post initial illness

Cerebral Palsy (CP)

Definition:

Occurs before, at or shortly after birthNot hereditary or progressiveMay also have deafness, visual disturbances, ↓ hand-

eye coordination, mental retardationCommunication critical

Cerebral Palsy, Cont.

Types: 1. Spasticity: most common

2. Athetosis: 2nd most common

3. Ataxia – least common (1-%)• Only Dx in CP patients that can walk

CP & Seizures

Amputations

Congenital or acquired Causes:

Regulated use in sports Categorized by location & # for identification in sports classification

i.e. AK = Above knee BK = Below knee

AE = Above elbowBE = Below elbow

Medical Concerns: Skin Breakdown

Phantom Pain Syndrome

Visual Impairments & Blindness

Communication concernsLegally blind vs. partial sight vs. total blind

Technology available

“blindisms” – Albinism –

Visual Impairments

Glaucoma:

S/S:

Tx:

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

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

Deafness, Cont.

Types: Cochlear ImplantsIf hearing aids don’t workSurgically placed in ear c external speech processor worn on

beltMicrophone worn externally behind earRemove during exercise to ↓ electrostatic chargeAlso avoid plastic mats, balls, etc to avoid electrostatic

charges

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%) – 3rd to 6th grade level

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

Down Syndrome

Most common intellectual disability Chromosomal condition Medical Concerns

Atloaxial Instability:

Balance, hand-eye coordination Obesity Vision Cardiac Postural concerns Hypothyroidism

Unique Considerations

Understand requirements and nature of physically challenged ahtlete’s sport

Understand the adaptive equipmentUnderstand environmental effects, risk of

thermal injury – no thermal regulationBe careful with modalities on insensative

skin