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Special Populations

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 sec Power lifters with cerebral palsy have lifted 400 lbs

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Special Populations

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  1. Special Populations

  2. 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 6’8” • Blind swimmers have come within 1/100 of a sec of qualifying for the US Olympic Team

  3. Rudy Garcia- Tolson • 6:48 mile • 20:08 – 5K • 2:24 – Half Marathon • Tri-athlete • Bi AKA

  4. 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

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

  6. PPE for the Disabled Patient • Establish baseline norms • “Diagnostic Overshadowing” • Avoid mass station based PPE • Eye level with wheelchair patients • - • - • - • -

  7. 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

  8. 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

  9. 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

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

  11. 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

  12. 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:

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

  14. 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:

  15. Skin Breakdown & Pressure Sores • Decubitus Ulcers – pressure sores • ↑ risk of infection & slower healing • Unable to feel sensation • Causes: • S/S: Stages • Tx:

  16. 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:

  17. Bladder Dysfunction • Neurogenic bladders • Know normal management plan – PPE • Indwelling catheter vs. intermittent catheter • S/S: • Tx: • Prevention:

  18. II. Spina Bifida • Definition: • Types: • 1. • 2. • 3.

  19. Spina Bifida, Cont. • Common Problems: • SB & Cerebral Shunts – relieves hydrocephalus • SB & Latex Allergy

  20. 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

  21. 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

  22. 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

  23. 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

  24. Visual Impairments & Blindness • Communication concerns • Legally blind vs. partial sight vs. total blind • Technology available • “blindisms” – • Albinism –

  25. Visual Impairments • Glaucoma: • S/S: • Tx:

  26. 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

  27. 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

  28. Deafness, Cont. • Types: Cochlear Implants • If hearing aids don’t 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

  29. 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

  30. 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

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

  32. Unique Considerations • Understand requirements and nature of physically challenged ahtlete’s 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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