Understanding the Disabled Athlete Mary Donahue, MEd, ATC, PT

1. Understanding the Disabled AthleteMary Donahue, MEd, ATC, PT

2. Sports for the Disabled Athletes Participation in sports is based on the disability or diagnosis in these general categories: Amputations Blind or Visually Impaired Cerebral Palsy Deaf or Hearing impaired Intelligently Impaired Spinal Cord Injuries Others are grouped into a category called Les Autres

3. Competition • Athletes compete in the local, regional, national and international levels • Paralympics Games are the pinnacle of sports for disabled athlete with Amputations, Blindness, Cerebral Palsy, Les Autres and Spinal Cord Injuries and are recognized by the USOC • Deaf athletes compete in the Deaflympics • Intelligently Impaired athletes compete in the Special Olympics

4. Deaflympics The first organized disabled sport competition was held in 1924 in Paris for athletes with hearing impairment or deafness Longest reigning international games outside the Olympics 4000 athletes and officials from 77 countries competed in Taipei during the summer games and 600 athletes and officials were at the winter games in Salt Lake City, 2007

5. Special Olympics • Special Olympics were founded in 1968 by Eunice Shriver and were for athletes with Intellectual Disabilities • The first International games were held in 1977 in Colorado and are held every 2 years alternation summer and winter games • 2500 athletes from 100 countries competed in the 2009 winter games and 7500 from 165 countries complete in the 2007 summer games

6. Sport for the Physical Disabled Athlete Sir Ludwig Guttmann the “Father” of Disabled Sports Instituted sports as a component of rehab of spinal cord injured service men/women in 1944 Sir Guttmann felt sport participation was as important for the patients as learning proper skin/bladder care. First competition for disabled athletes was held in 1948

7. Athletes with Physical Disabilities • Archery was the first sport, followed by track • First team sport was wheelchair polo • Due to high injury rate with polo wheelchair basketball was developed

8. The first “Olympics for the Paralyzed” Held in 1960 in Rome with 400 athletes from 23 countries and were the precursor of the Paralympics games Paralympics are from the word Para in Greek meaning “attached to” the Olympic The first “Paralympic Games were held in Japan in 1964 The Beijing games hosted 3951 athletes from 146 countries

9. Paralympics were held in many of the same countries as the Olympics between 1960 – 1984 In Seoul, Korea the Olympic host city also became the host city for the Paralympics. Since 1988 a host city must submit a bid to host both the Olympic and Paralympic Games

10. The winter Paralympics were first held in 1976 in Sweden and have been in the same Olympic Host city since 1992 - Albertville

11. Paralympic Competitors Wheelchair Sport, USA (WSUSA) – an USOC recognized organization Founded as National Wheelchair Athletic Association (NWAA) in 1956, became WSUSA in 1994 Represents athletes who are physically disabled and use wheelchairs for locomotion and sports Mostly spinal cord injured athletes

12. Paralympic Competitors Disabled Sport, USA (DA/USA) - a member of the USOC Represents athletes with amputations, spinal cord injury, dwarfism, multiple sclerosis, head injury, cerebral palsy, and other neuromuscular and orthopedic conditions. Started as NASA in 1972, became NHSRA in 1976 and NHS in 1992 and DS/USA in 1996

13. Paralympic Competitors United States Association of Blind Athletes (USABA) founded in 1976 - A member of the USOC Represents blind athletes and ones with visual impairments

14. Paralympic Competitor BlazeSports, America (a member of the USOC) represents athletes with Cerebral Palsy as well as others with physical disabilities such as TBI and stroke impaired athletes The NASCP was the initial organization for the CP athletes and was reorganized to USCPAA

15. Category of Paralympic Disabilities • Amputations • Traumatic • Disease • Arthrogryposis • Blindness/Visual impairment • Cerebral Palsy • Dwarfism • Friedreich's ataxia • Les Autres (the others) • Muscular Dystrophy • Multiple Sclerosis • Ehler’s Danlos Syndrome • Osteogenesis Imperfecta • Spinal Cord Injuries • Traumatic • Disease • Spina Bifida

16. Classification SystemDesigned to equalize competition By Disability • Spinal Cord: based on motor innervations • Amputation: based on level of limb loss • Blind: based on level of vision loss or total blindness • Cerebral Palsy: most complicated, based on presentation , type of CP and involvement

17. Classification System • By Function based sport • Alpine Skiing • Basketball • Cycling • Power lifting • Quad Rugby • Swimming • Table Tennis • Track and Field • Volleyball

18. Classification System • By Function based sport • Alpine Skiing • Basketball • Cycling • Power lifting • Quad Rugby • Swimming • Table Tennis • Track and Field • Volleyball

19. Classification System • By Function based sport • Alpine Skiing • Basketball • Cycling • Power lifting • Quad Rugby • Swimming • Table Tennis • Track and Field • Volleyball

20. Classification System • By Function based sport • Alpine Skiing • Basketball • Cycling • Power lifting • Quad Rugby • Swimming • Table Tennis • Track and Field • Volleyball

21. Classification System • By Function based sport • Alpine Skiing • Basketball • Cycling • Power lifting • Quad Rugby • Swimming • Table Tennis • Track and Field • Volleyball

22. Classification System • By Function based sport • Alpine Skiing • Basketball • Cycling • Power lifting • Quad Rugby • Swimming • Table Tennis • Track and Field • Volleyball

23. Classification System • By Function based sport • Alpine Skiing • Basketball • Cycling • Power lifting • Quad Rugby • Swimming • Table Tennis • Track and Field • Volleyball

24. Classification System • By Function based sport • Alpine Skiing • Basketball • Cycling • Power lifting • Quad Rugby • Swimming • Table Tennis • Track and Field • Volleyball

25. Classification System • By Function based sport • Alpine Skiing • Basketball • Cycling • Power lifting • Quad Rugby • Swimming • Table Tennis • Track and Field • Volleyball

26. Common injuries by Disability Spinal Cord Injured/Wheelchair athletes Overuse injuries Biceps Tendonitis Rotator cuff tendonitis Elbow epicondylitis Radial and/or Ulnar nerve entrapment Carpal Tunnel syndrome

27. Common injuries by Disability Spinal Cord Injured - Other conditions • Autonomic Dysreflexia • Impaired thermoregulatory system • Skin problems • Osteopenia/Osteoporosis

28. Common injuries by Disability Amputee athletes Skin breakdown of residual limb Lower limb strains and sprains Low back pain Contusions Injuries to the intact limb Injures to the amputated limb due to osteopenia or osteoporosis

29. Common injuries by Disability Cerebral Palsy Athletes Strains and sprains of all joints Overuse injuries of all joints Fall risk Osteopenia/osteoporosis Seizure disorders

30. Common injuries by Disability Blind athletes Injuries similar to able bodies athletes except increase lower extremity injuries secondary to trauma. Injuries due to reduced proprioception

31. Special Olympic Athletes • Athletes with Down Syndrome are the most common intellectual disabled athlete participating in the Special Olympic • Common medical problems: • Atlanto-Axial instability • Cardiac problems • Visual problems • Seizure disorder

32. Special Olympic Athletes • Athletes undergo a radiologic exam to determine the stability of Atlanto-Axial joint • If the instability is found, contact sports should be avoided • Cardiac malformation occur in 40-50% of Down syndrome individuals • Increased laxity of joints is also common

33. Care of the Disabled Athlete • Initial treatment and rehabilitation for the disabled athletes is very similar to the able-bodies athlete. • Differences include monitoring the athlete and being aware of the unique disability related medical conditions • Special attention should be given to the following situations:

34. Care of the Spinal Cord Injured Athlete • Hypertension due to Autonomic Dysreflexia • Hypothermia or Hyperthermia • Skin checks • Fracture awareness secondary to increased rate of osteopenia and osteoporosis • Injuries related to impaired sensation

35. Care of the Amputee Athlete • Check for skin problems in stumps and over boney prominences • Evaluate for stains or sprains of the intact limb • Maintain lower extremity muscle flexibility and strength to avoid and care for lumbar spine injuries • Core strengthening • Be award of the increased incidence of osteopenia or osteoporosis in the amputated limb

36. Care of the Cerebral Palsy Athlete • Evaluate for soft tissue injuries • Be aware that manual muscle testing my not be a good measurement of strength secondary to abnormal tone of muscles • Be cognizant of potential for fractures due to osteopenia and osteoporosis • Contusions, abrasions and lacerations occur due to the increased fall potential • If a seizures occurs, minimize injury by protecting the athlete

37. Care of the Blind Athlete • The care if these athletes is the same as the able bodied athlete • Injuries occur due to trauma from contact with items in their environment • Care of contusions, abrasions and lacerations due to reduced proprioception secondary to lack of visual input

38. Care of Special Olympic Athlete • Athletes with AA instability should already have cervical x-rays so they should not be in contact sports • Have this awareness if a cervical spine injury has occurred • Have the athlete evaluated for cardiac problems • Be aware of the increased laxity of the joints • If a seizures occurs, minimize injury by protecting the athlete

39. Summary • The athlete with a disability are more similar to the able bodies athlete. • Evaluation, treatment and rehabilitation utilize the same techniques with a extra considerations • In most circumstanced it is wise to ask the athlete of any special care that might be needed, after all they have lived with the disability for a good part of their lives

40. It is important to see the person, not the disability

41. Bibliography • Scruton L. Sir Ludwig Guttmann: creator of a world sports movement for the paralysed and other disabled Paraplegia. 1979 May;17(1):52-5. • Klenck C, Gebke K. Practical management: common medical problems in disabled athletes Clin J Sport Med. 2007 Jan;17(1):55-60. • Schaefer RS, Proffer DS, Sports medicine for wheelchair athletes Am Fam Physician. 1989 May;39(5):239-45. • Reynolds J, Stirk A, Thomas A, Geary F, Paralympics--Barcelona 1992 J Sports Med. 1994 Mar;28(1):14-7. • Ferrara MS, Peterson CL Injuries to athletes with disabilities: identifying injury patterns. Sports Med.2000 Aug;30(2):137-43.

42. Bibliography, cont • 6.Ramirez M, Yang J, Bourque L, Javien J, Kashani S, Limbos MA, Peek-Asa C. Sports injuries to high school athletes with disabilities Pediatrics. 2009 Feb;123(2):690-6. • 7.Webborn N, Willick S, Reeser JC Injuries among disabled athletes during the 2002 Winter Paralympic Games Med Sci Sports Exerc. 2006 May;38(5):811-5. • 8.Nyland J, Snouse SL, Anderson M, Kelly T, Sterling JC Soft tissue injuries to USA paralympians at the 1996 summer games Arch Phys Med Rehabil. 2000 Mar;81(3):368-73. • 9.Ferrara MS, Buckley WE, McCann BC, Limbird TJ, Powell JW, Robl R The injury experience of the competitive athlete with a disability: prevention implications Med Sci Sports Exerc. 1992 Feb;24(2):184-8.

43. Bibliography, cont • 10.Ferrara MS, Buckley WE, Messner DG, Benedict J. The injury experience and training history of the competitive skier with a disability Am J Sports Med. 1992 Jan-Feb;20(1):55-60. • 11.Ferrara MS, Palutsis GR, Snouse S, Davis RW A longitudinal study of injuries to athletes with disabilities Int J Sports Med. 2000 Apr;21(3):221-4. • 12.Taylor D, Williams T Sports injuries in athletes with disabilities: wheelchair racing Paraplegia. 1995 May;33(5):296-9. • 13.Curtis KA, Dillon DA Survey of wheelchair athletic injuries: common patterns and prevention Paraplegia. 1985 Jun;23(3):170-5. • 14.Madorsky JG, Curtis KA Wheelchair sports medicine Am J Sports Med. 1984 Mar-Apr;12(2):128-32. • 15.Patel DR, Greydanus DE The pediatric athlete with disabilities Pediatr Clin North Am. 2002 Aug;49(4):803-27. • 16.Bergeron JW.Carl D Athletes with disabilities.Phys Med Rehabil Clin N Am. 1999 Feb;10(1):213-28,

44. Bibliography, cont • 17.Dec KL, Sparrow KJ, McKeag DB The physically-challenged athlete: medical issues and assessment Sports Med. 2000 Apr;29(4):245-58. • 18.Black SA Triathlon participation for the physically challenged athlete: medical considerations Curr Sports Med Rep. 2007 Jun;6(3):195-9. • 19.Birrer RB The Special Olympics athlete: evaluation and clearance for participation Clin Pediatr 2004 Nov-Dec;43(9):777-82. • 20.Sanyer ON Down syndrome and sport participation Curr Sports Med Rep. 2006 Dec;5(6):315-8. • 21.Carroll KL, Leiser J, Paisley TS Cerebral palsy: physical activity and sport Curr Sports Med Rep. 2006 Dec;5(6):319-22...

45. Bibliography, cont • 22.Palmer T, Weber KM The deaf athlete Curr Sports Med Rep 2006 Dec;5(6):323-6. • 23.Schroeder EL, Lavallee ME Ehlers-Danlos Syndrome in athletes Curr Sports Med Rep. 2006 Dec;5(6):327-34. • 24.Groah SL, Lanig IS Neuromusculoskeletal syndromes in wheelchair athletes Semin Neurol. 2000;20(2):201-8. • 25.Nilsen R, Nygaard P, Bjørholt PG Complications that may occur in those with spinal cord injuries who participate in sport Paraplegia. 1985 Jun;23(3):152-8. • 26.Stotts KM Health maintenance: Athletes and Nonathletes Arch Phys Med Rehabil. 1986 Feb;67(2):109-14.

46. Bibliography, cont • 27.Wilson S Influence of the International Classification of Functioning, Disability and Health on Paralympic sports classification Rehabil Med. 2009 Nov;41(13):1104. • 28.Gold JR, Gold MM Access for all: the rise of the Paralympic Games J R Soc Promot Health. 2007 May;127(3):133-41... • 29.Leggat PA, Shaw MT From Sydney to Athens: preparing for the Olympic and Paralympic Games Travel Med Infect Dis. 2003 Nov;1(4):201-3. • 30.Jacob T, Hutzler Y Sports-medical assessment for athletes with a disability.Disabil Rehabil. 1998 Mar;20(3):116-9. • 31.Vanlandewijck YJ Sport science in the Paralympic movement. Rehabil Res Dev. 2006 Nov-Dec;43(7):xvii-xxiv.