Special Populations

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Special Populations
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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 68
• Blind swimmers have come within 1/100 of a sec of
  qualifying for the US Olympic Team

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Rudy Garcia- Tolson

• 648 mile
• 2008 5K
• 224 Half Marathon
• Tri-athlete
• Bi AKA

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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

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Sport Options

• Skiing
• Track and Field
• Mountain biking
• Swimming
• Archery
• Road Racing
• Basketball
• Cycling
• Tennis
• Fencing
• Rugby

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PPE for the Disabled Patient

• Establish baseline norms
• Diagnostic Overshadowing
• Avoid mass station based PPE
• Eye level with wheelchair patients
• -
• -
• -
• -

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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

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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

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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

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Pathological Conditions, cont.

• VI. Sensory Disabilities
• Visual impairments/blindness
• Albinism
• Glaucoma
• Deafness
• VII. Intellectual Disabilities
• Down Syndrome
• Related medical concerns
• Atlantoaxial Instability

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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

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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

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Boosting

• Attempt to gain advantage over opponent by
  intentionally inducing AD
• Methods
• Banned by International paralympic Committee

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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

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Skin Breakdown Pressure Sores

• Decubitus Ulcers pressure sores
• ? risk of infection slower healing
• Unable to feel sensation
• Causes
• S/S Stages
• Tx

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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

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Bladder Dysfunction

• Neurogenic bladders
• Know normal management plan PPE
• Indwelling catheter vs. intermittent catheter
• S/S
• Tx
• Prevention

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II. Spina Bifida

• Definition
• Types
• 1.
• 2.
• 3.

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Spina Bifida, Cont.

• Common Problems
• SB Cerebral Shunts relieves hydrocephalus
• SB Latex Allergy

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Poliomyelitis

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

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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

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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

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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 elbow BE Below elbow
• Medical Concerns
• Skin Breakdown
• Phantom Pain Syndrome

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Visual Impairments Blindness

• Communication concerns
• Legally blind vs. partial sight vs. total blind
• Technology available
• blindisms
• Albinism

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Visual Impairments

• Glaucoma
• S/S
• Tx

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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

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Deafness, Cont.

• Communication concerns
• Hearing Aids/Implants Dont make things sound
  clearer, just amplify sounds
• TYPES worn where
• On the chest/body
• Behind the ear
• In the ear
• On the eyeglasses

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Deafness, Cont.

• Types Cochlear Implants
• If hearing aids dont 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

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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

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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 _at_ rest (10-15 beats less)
• Lower fitness level
• Seizures
• Pain insensitivity dont rely on patients
  interpretation make decisions off of MOI
• Medications anticonvulsive, antidepressant more

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Down Syndrome

• Most common intellectual disability
• Chromosomal condition
• Medical Concerns
• Atloaxial Instability
• Balance, hand-eye coordination
• Obesity
• Vision
• Cardiac
• Postural concerns
• Hypothyroidism

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Unique Considerations

• Understand requirements and nature of physically
  challenged ahtletes sport
• Understand the adaptive equipment
• Understand environmental effects, risk of thermal
  injury no thermal regulation
• Be careful with modalities on insensative skin

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