THE DISABLED ATHLETE

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THE DISABLED ATHLETE

• Kevin F. Fitzpatrick, MD
• Paul F. Pasquina, MD
• Physical Medicine Rehabilitation

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INTRODUCTION

• Terminology
• Legal aspects
• Unique medical issues
• Competitive categories
• Sports Recreational opportunities

Access Awareness
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TERMINOLOGY

• Pathology / Disease
• Impairment
• Disability
• Handicap
• The expression of the physical or mental
  limitations in a social context.

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THE LAW

• Disabled Persons Employment Act of 1944 (United
  Kingdom)
• The Federal Rehabilitation Act of 1973
• Americans with Disabilities Act of 1990

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Federal Rehabilitation Act
Prohibits the exclusion of otherwise qualified
individuals from participation in otherwise
federally funded programs
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AMERICANS WITH DISABILITES ACT
Extends the rights to include the private sector
Five Titles 1. Employment 2.
Transportation 3. Public service 4.
Telecommunications 5. Miscellaneous
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P.L. 101-476 Individuals with Disabilities
Education Act (IDEA)

• Affirms the rights of all children with
  disabilities to an appropriate public education
• Includes
• Adapted Physical Education
• Individualized Education Program (IEP)

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DEFINITIONS POLICY

• Disability
• ADA
• NCAA
• Rights of Impaired Individuals
• Reasonable Accommodations
• Informed Decisions
• Exculpatory Waivers/Court Order

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Disability (ADA)

• Impairment that limits a major life activity.
• Record of impairment.
• Perception by the public than an impairment
  limits a major life activity.

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Disability (NCAA)

• Those who are confined to a wheelchair, deaf,
  blind, or missing a limb, those who have only one
  of a paired set of organs, or those with
  behavioral, emotional and psychological disorders
  that substantially limit a major life activity.

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TYPES OF DISABILITIES

• CONGENITAL
• Amputees
• Spina Bifida
• Cerebral Palsy
• Erbs Palsy
• Muscular Dystrophy
• MS / ALS
• Visual / Hearing

• ACQUIRED
• Amputees
• SCI
• TBI
• Polio/ Post Polio
• Myopathies
• CVA
• Visual / Hearing

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CAUSES OF SPINAL CORD INJURY
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SCI IN SPORTS
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VALUE OF PHYSICAL ACTIVITY

• Physical
• Cognitive
• Affective

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PHYSICAL BENEFITS

• Bone Mineralization
• Fitness (Aerobic, Strength, Flexibility)
• Obesity / Lean Body Mass
• CNS Development
• Cardiac Development
• Motor Skill Development

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AEROBIC TRAINING BENEFITS

• Improve Cardiac Performance
• VO2 max, SV, CO, HR
• Number of Mitochondria Enzymes
• Usage of Free Fatty Acids
• Capillary Density
• of Type IIA Fibers
• Muscle Fatigue
• Decrease Mortality

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STRENGTH TRAINING BENEFITS

• Increase Bone Mineral Density
• Improve Glucose Metabolism
• Increase Gastro-Intestinal Transit Time
• Reduce Resting Blood Pressure

• Improve Blood Lipid Levels
• Avoid Muscle Loss
• Reduce Body Fat
• Reduce Arthritic Pain
• Reduce Low Back Pain

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STRENGTH TRAINING

• Prescription
• Population
• Goals
• Amount of weight
• Single v. multiple sets
• Frequency of training

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COGNITIVE BENEFITS

• Perceptual Abilities (high/low/up/down)
• Teaches Content (stop/go/colors/shapes)
• Promotes Language/ Communication
• Creative Decision Making
• Problem Solving

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AFFECTIVE BENEFITS

• Enhances Self Esteem, Confidence, Assertiveness,
  Independence
• Positive attitude towards physical activity and
  active lifestyle.
• Enhances Socialization
• Relieves Stress
• Emotional Stability

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ROLE OF SPORTS MEDICINE TEAM

• Medical Examinations
• Prevention of Injury
• Recognition and Diagnosis of Disease
• Treatment
• Awareness
• Medical Classifications

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MEDICAL CLASSIFICATION

• Visual / Hearing
• Amputees
• Cerebral Palsy
• Wheelchair
• NWAA
• NWBA

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WHEELCHAIR ATHLETIC INJURIES

• Limited research
• Increase injury rate with increased
  participation.
• No relationship between disability type,
  classification, or sex.
• Temperature regulation and
• pressure sores particular to SCI.

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PRESSURE SORES

• Unrelieved pressure
• Greater than capillary pressure (32 mm Hg)
• Ischemia / Hypoxia / Loss of Nutrients
• Friction Shear Forces
• Location
• Ischium/Sacrum/Troch/Heel
• Incidence
• SCI 25 - 66
• Contributing Factors

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CONTRIBUTING FACTORS

• Insensate areas
• Atrophy / Loss of padding
• Improper seating devices
• Aerodynamic body positions
• Containment straps
• Splash guards / Brakes
• Falls

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TREATMENT/PREVENTION

• Monitor skin closely
• Proper fitting
• Proper padding
• Friction reducing material on arms, chest wall,
  axilla
• Gloves

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NERVE ENTRAPMENTS AMONG WHEELCHAIR ATHLETES

• Clinical Criteria (19 to 23)
• EDX Criteria (50-64)
• Carpal Tunnel Syndrome
• Ulnar neuropathy at wrist
• Ulnar neuropathy at elbow
• Decreased incidence of CTS in marathon racers vs.
  non racers.

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HEAT INJURY

• Symptoms
• Cramps
• Syncope
• Headache
• Clumsiness
• Nausea
• Dizziness
• Erratic wheelchair propulsion

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ENVIRONMENT

• HOT - DRY
• 90 degrees / 20 humidity
• Evaporation
• HOT - WET
• 90 degrees / 70 humidity
• Radiation Convection
• Increase skin blood flow,
• decrease venous return.

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RISK FACTORS

• Clothing
• Lack of sleep
• Erythropoietin
• Sunburn
• Fever
• Infection
• Acclimatization

• Dehydration
• Diarrhea / Vomiting
• Lack of recent heat exposure
• Insufficient training
• Recent alcohol abuse
• Training Schedules

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AUTONOMIC DYSREFLEXIA

• SCI level at T6 or above
• Level of sympathetic splanchnic outflow
• Acute Massive Sympathetic Discharge
• resulting from noxious stimuli below level of
  lesion.
• Causes
• Symptoms
• Treatment

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COMMON CAUSES

• Bladder Bowel Distention
• Pressure sores
• Tight clothing, shoes, leg bag straps
• Bladder catherization
• Rectal stimulation
• Infections
• Ingrown toenails

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SYMPTOMS

• Acute Hypertension
• Sweating Piloerection
• Facial Flushing
• Nasal Congestion
• Brady or Tachycardia
• Atrial Fibrillation
• Seizure/Stroke/Death

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TREATMENT

• Raise head
• Identify and remove the cause
• bladder catherization
• manual disimpaction with local anesthetic
• Medications
• Nitrates
• Nifedipine

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WHEELCHAIR ATHLETICS

• Individual Sports
• Marathon
• Tennis
• Power Lifting
• Body Building
• Swimming
• Golf
• Skiing
• Boccia
• Cycling
• Fencing

• Team Sports
• Basketball
• Quad Rugby
• Track Field
• Volleyball
• Soccer
• Recreation
• Fishing
• Bowling
• Rock Climbing
• Sailing

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X PARALYMPIC GAMES

• Rome 1960
• 400 athletes, 23 delegations.
• Atlanta 1996
• 3,500 athletes, 124 countries.
• 2nd largest sporting event.
• USOC sponsored
• 17 medal / 2 demonstration
• Modifications
• 350 bathroom doors, 750 shower heads, 700
  transfer benches
• Door handles

Australia 2000
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BASKETBALL

• Court Size
• Basket Height
• Rules
• 3 sec 5 sec
• 24 sec 45 sec
• Dribbling / Traveling
• Three point line
• Classification (12pts)
• Wheelchair Features

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QUAD RUGBY

• 5 Payers total of 8 Points
• Rules
• NONE !!!
• Demonstration Sport at 1996 games, medal sport
  in Australia and Athens
• Murderball

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TRACK FIELD

• Sprints
• Distance
• Pentathlon
• Throwing
• Jumping

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MARATHON

• Ernst Van Dyk from South Africa
• 11827 Boston 2004
• Diane Roy from Canada
• 13639

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SPORTS RECREATION
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SKIING

• Amputees with or without a prosthesis
• 3 or 4 track technique
• Prosthetic modifications
• Wheelchair Athletes
• Sled or Monoski (2,000)
• Injury Rates
• Able-bodied vs. Disabled Skiers
• Upper Ext 1.4 times more often than lower
  extremities.
• Acute vs. Chronic
• More at end of day.

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