Outdoor Adaptive Athletes

1
Chapter 31

• Outdoor Adaptive Athletes

2
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.

3
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.

4
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)

5
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.

6
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

7
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.

8
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

9
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.

10
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.

11
Cerebral Palsy (CP) Patients

• CP is a result of a brain injury before, during,
  or shortly after birth.
• Three syndromes
• Spasticconstant muscle contraction
• Athetoidslow, writhing movements
• Dystonicextreme muscle rigidity
• Usual fracture treatments may not work.
• Again, let comfort guide treatment.

12
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.

13
Muscular Dystrophy (MD) Patients

• Progressive muscle atrophy
• Easily fatigued
• Joints are hypermobile.
• Usually sit skiers
• Gentle approach to prevent further injuries

14
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.

15
Spina Bifida (SB) Patients

• Mono- and bi-skiers mostly.
• Spinal compromise only below congenital anomaly
• SB patients may have a CSF shuntblockage may
  cause mental status change.
• They may also have an extreme latex allergy. Use
  non-latex gloves.

16
Spinal Cord Injury Patients (1 of 2)

• Quadriplegiainjury to cervical spine
• Paraplegiainjury 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

17
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.

18
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.

19
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.

20
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.

21
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.